A case of human <em>Dirofilaria repens</em> in Rome, Italy: A clinical and radiological challenge

Human subcutaneous dirofilariasis caused by Dirofilaria repens is a vectorborne zoonotic disease mostly transmitted from dogs to humans through a mosquito’s blood meal. Heartworms replication is amplified by the climate change, the increase of the range of suitable vectors, the facilitation of pet travel and the high rate of undiagnosed dirofilariasis in dogs. We describe a case of a young Romanian woman, resident in Rome for 18 years, that came to our attention for the appearance for five months of a subcutaneous nodule in the left arm. The patient reported that she first felt an insect bite, after which she noticed the onset of an erythematous and itchy wheal in the same skin area, turned into a subcutaneous nodule within a few weeks. The ultrasound examination showed a hypoechoic subcutaneous formation of 1,2 cm in diameter, containing a ribbon-like structure made up of hyperechoic parallel double lines, reminiscent of a warm. Based on this suspicion, we opted for the surgical radicalization of the lesion. The histological examination confirmed the radiological hypothesis of a warm-like foreign body morphologically compatible with Dirofilaria repens. Our experience shows how a clinical nonspecific skin nodular lesion may conceal an unexpected and unsettling diagnosis of subcutaneous Dirofilaria repens.

Pain as Defining Feature of Health Status and Prominent Therapeutic Target in Patients with Hidradenitis Suppurativa

BACKGROUND

Pain is one of the main aspects of hidradenitis suppurativa that strongly affects the quality of life of patients. We explored the relationship between pain and clinical severity as well as its role in defining the health status in patients with HS.

METHODS

Pain was defined by three measures: (a) question 1 ("my skin hurts") of the Skindex-17; (b) Bodily Pain (BP) scale of the SF-36; and (c) Visual Analog Scale (VAS). Clinical severity of HS was assessed by the Hurley staging, the Sartorius HS Score, and the International HS Severity Score System.

RESULTS

The study population included 341 HS patients with complete data for the VAS pain, 316 for question 1 of the Skindex-17, and 294 for BP. Clinical severity was positively associated with pain. This result was observed for all three severity scores and all three pain evaluation methods. In addition, the number of fistulae, abscesses, and nodules were significantly associated with the three severity measures of pain, while the association with scars was not observed for question 1 of the Skindex-17 and BP.

CONCLUSIONS

Pain may be a good proxy of clinical severity and efficacy of a treatment in HS and therefore a crucial hallmark of patients' health status.

Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

Basal cell carcinoma (BCC) is the most common human cancer worldwide, and is a subtype of nonmelanoma skin cancer, characterized by a constantly increasing incidence due to an aging population and widespread sun exposure. Although the mortality from BCC is negligible, this tumor can be associated with significant morbidity and cost. This review presents a literature overview of BCC from pathophysiology to novel therapeutic approaches. Several histopathological BCC subtypes with different prognostic values have been described. Dermoscopy and, more recently, reflectance confocal microscopy have largely improved BCC diagnosis. Although surgery is the first-line treatment for localized BCC, other nonsurgical local treatment options are available. BCC pathogenesis depends on the interaction between environmental and genetic characteristics of the patient. Specifically, an aberrant activation of Hedgehog signaling pathway is implicated in its pathogenesis. Notably, Hedgehog signaling inhibitors, such as vismodegib and sonidegib, are successfully used as targeted treatment for advanced or metastatic BCC. Furthermore, the implementation of prevention measures has demonstrated to be useful in the patient management.

Seasonal characterisation of maritime traffic and the relationship with cetacean presence in the Western Mediterranean Sea

Seasonal maritime traffic was investigated in relation to cetaceans, through direct observations (July 2013-June 2015) along three fixed transects in Western Mediterranean. Visually obtained vessel abundance was compared with Automatic Identification System data to explore if the two methods provided different results. Traffic intensity and composition were characterised by seasons and vessel categories. Finally, cetacean presence was investigated in relation to traffic by measuring the difference of vessel abundance in the presence and absence of animal sightings. Results showed that visual sampling was consistent with AIS data, providing more information on small-medium vessels. Traffic was more intense and diverse in Spring/Summer, and the highest vessel abundance and seasonal variations in composition emerged for inshore subareas. The difference of traffic in the presence and absence of cetaceans was higher in most offshore subareas in Spring/Summer, verified for B. physalus and S. coeruleoalba; in inshore waters, mostly occupied by T. truncatus, no significant differences emerged.

Cetacean response to summer maritime traffic in the Western Mediterranean Sea

Maritime traffic is one of many anthropogenic pressures threatening the marine environment. This study was specifically designed to investigate the relationship between vessels presence and cetacean sightings in the high sea areas of the Western Mediterranean Sea region. We recorded and compared the total number of vessels in the presence and absence of cetacean sightings using data gathered during the summer season (2009-2013) along six fixed transects repeatedly surveyed. In locations with cetacean sightings (N = 2667), nautical traffic was significantly lower, by 20%, compared to random locations where no sightings occurred (N = 1226): all cetacean species, except bottlenose dolphin, were generally observed in locations with lower vessel abundance. In different areas the species showed variable results likely influenced by a combination of biological and local environmental factors. The approach of this research helped create, for the first time, a wide vision of the different responses of animals towards a common pressure.