Comparison and Analysis of Antibiotic Consumption in Two Italian Hospital Settings in Relation to the Fight of Antimicrobial Resistance

Introduction: The emergence and spread of drug-resistant pathogens due to the improper use of antibiotics have become increasingly apparent in recent years. Objective: This retrospective comparative analysis aimed to assess and compare antibiotic prescription trends in Italy across two different regions based on geographic area and healthcare structure. One region represents a large hospital institution, while the other represents a populous local Italian health agency. The study also examined the impact of documented antibiotic stewardship programs and efforts to promote responsible antibiotic use at all levels, in alignment with international goals. Antibiotic consumption data were collected from the Umberto I Polyclinic Hospital and the ASL Napoli 3 South Local Health Agency. Methods: To compare consumption between regions, a standardized comparison using the Defined Daily Dose (DDD) was employed. The internal management system of each healthcare facility records all prescriptions and drug dispensations, and these data were extrapolated for this retrospective study. Results: A comparative assessment between the first half of 2022 and 2023 (January-June) highlighted a significant increase in beta-lactam antibiotic consumption, showing a twofold rise compared to the previous year's term. Regarding prescription averages, there was a noticeable increase of +29.00% in hospitalizations and +28.00% in hospital discharges within the ASL Napoli 3 South. Conversely, at Policlinico Umberto I, there was a marginal increase of +1.60% in hospitalizations and a decrease of -7.40% in hospital discharges. Conclusions: The study offers valuable insights into expenditure patterns and antibiotic consumption, underscoring the need for enhanced prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings stress the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.

Kyrle disease: a case report and literature review

BACKGROUND

Perforating dermatoses are heterogeneous skin disorders characterized by transepidermal elimination of dermal tissue components. Acquired perforating dermatoses can be divided into four types, according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. They characterize adult patients with coexisting systemic diseases, regardless of the dermal materials eliminated. The association between Kyrle disease and renal failure or diabetes mellitus is common.

CASE REPORT

We reported the case of Kyrle disease in a patient with chronic kidney disease. A literature review was performed with the aim to highlight the associated comorbidities and point out the role of early and specific treatment of the cutaneous symptoms and manifestations.

CONCLUSIONS

Being Kyrle disease a pruritic condition which adversely affects the patient's quality of life, it would be desirable to place greater therapeutic attention on the alleviation of itching and on the correct management of the underlying comorbidity.

Treatment of erosive pustular dermatosis of the scalp: our experience and review of unconventional topical drugs

BACKGROUND

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disorder of elderly individuals, characterized by relapsing pustular and eroded lesions of the scalp, which may lead to scarring alopecia. Treatment is challenging and classically based on topical and/or oral corticosteroids.

CASE REPORT

From 2008 to 2022, we treated fifteen cases of EPDS. We used mainly topical and systemic steroids with good results. Nevertheless, several non-steroidal topical drugs have been described in literature for the treatment of EPDS. We have carried out a brief review of these treatments.

CONCLUSIONS

Topical calcineurin inhibitors represent a valuable alternative to steroids to avoid skin atrophy. Emerging evidence about other topical treatments, such as calcipotriol, dapsone, zinc oxide, together with photodynamic therapy, are evaluated in our review.

An impressive case of alopecia universalis after COVID-19 vaccination: a coincidental finding or a consequence?

BACKGROUND

Several cutaneous manifestations in patients undergoing COVID-19 vaccination have been described in literature.

CASE REPORT

Herein, we present a case of alopecia universalis that occurred after the first and second dose of Comirnaty vaccine. A bibliographic search was conducted and a total of 14 studies concerning the association were reviewed.

CONCLUSIONS

Given the autoimmune pathogenesis of the disease, we discussed the potential role of SARS-CoV-2 infection and vaccination as a trigger for the development of hair loss. Physicians should be aware of SARS-CoV-2 vaccine-related hair loss and properly treat this undesirable effect.

Hard to face: cutaneous malignant melanoma

An 88-year-old Caucasian man recently sought medical attention due to recrudescence of skin disease in the area of previously excised nodule (in 2002) on the nose dorsum. The original lesion was clinically considered as a pigmented basal cell carcinoma, after which histological examination revealed a superficial spreading melanoma in vertical growth face (Clark level IV; Breslow thickness 2.1 mm) arising from a pre-existing nevus. The adjacent skin also showed significant actinic damage both in the epidermis and in the dermis. A sentinel node was positive (micrometastases of melanoma) and radical lymph node dissection of the neck was performed. Other lymph nodes did not contain metastasis. Computed tomography scans of brain, chest, abdomen and pelvis performed at that time showed no evidence of systemic disease.

Unexpected parasitosis

Neotrombicula autumnalis is an arthropod living in the soil and parasitizes animals only in its larval stage. Depending on climatic conditions, one to five life cycles can take place in a single year. Human infestation is probably underestimated and can be easily missed due to non-pathognomonic cutaneous manifestations in absence of systemic signs. We describe a case of human trombiculiasis and discuss the diagnostic and therapeutic management of this ‘synanthropic’ dermatosis.

Laser treatment of post-thyroidectomy scar

A good aesthetic result in thyroid surgery is one of the main goals, as this procedure usually involves young women affected in clearly visible anatomical areas. To minimize the detrimental effects of scarring outcome, several therapeutic options have been employed. Lasers may be an alternative choice for prevention and treatment of post-surgical thyroidectomy scar. This paper reviews literature and the current knowledge on this topic. A comprehensive search in the Cochrane Library, MEDLINE and PUBMED databases was performed to identify relevant literature investigating the role of laser therapy in both prevention and treatment of unappealing scarring after thyroid surgery. Laser treatment of post-thyroidectomy scar is emerging with promising clinical outcomes. The greatest efficacy has been seen with vascular-selective and ablative sources. Laser therapy should be taken into account as it represents a valid and safe treatment option.

Removal of benzoylecgonine from water matrices through UV254/H2O2 process: Reaction kinetic modeling, ecotoxicity and genotoxicity assessment

Benzoylecgonine (BE), the main cocaine metabolite, has been detected in numerous surface water and treatment plants effluents in Europe and there is urgent need for effective treatment methods. In this study, the removal of BE by the UV254/H2O2 process from different water matrices was investigated. By means of competition kinetics method, the kinetic constant of reaction between BE and the photogenerated hydroxyl radicals (OH) was estimated resulting in kOH/BE=5.13×10(9)M(-1)s(-1). By-products and water matrices scavengers effects were estimated by numerical modeling of the reaction kinetics for the UV254/H2O2 process and validated in an innovative microcapillary film (MCF) array photoreactor and in a conventional batch photoreactor. The ecotoxicity of the water before and after treatment was evaluated with four organisms Raphidocelis subcapitata, Daphnia magna, Caenorhabditis elegans, and Vicia faba. The results provided evidence that BE and its transformation by-products do not have significant adverse effects on R. subcapitata, while D. magna underwent an increase of lipid droplets. C. elegans was the most sensitive to BE and its by-products. Furthermore, a genotoxicity assay, using V. faba, showed cytogenic damages during the cell mitosis of primary roots.

Platelet Glutamate Uptake and Release in Migraine With and Without Aura

Glutamate may play an important role in the pathogenesis of migraine: glutamate release in the brain may be involved in the development of spreading depression and increased concentrations of this amino acid have been reported in plasma and platelets from migraine patients. Here we assessed platelet glutamate uptake and release in 25 patients affected by migraine with aura (MA) and 25 patients affected by migraine without aura (MoA), comparing the results with a group of 20 healthy matched controls. Both glutamate release from stimulated platelets and plasma concentrations of the amino acid were assessed by high-performance liquid chromatography, and were increased in both types of migraine, although more markedly in MA. Platelet glutamate uptake, assessed as 3H-glutamate intake, was increased in MA, while it was reduced in MoA with respect to the control group. These results support the view that MA might involve different pathophysiological mechanisms from MoA and, specifically, up-regulation of the glutamatergic metabolism. Understanding these dysfunctional pathways could lead to new, possibly more successful therapeutic approaches to the management of migraine.

Lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy

We reported a case of an 11-year-old girl admitted to our hospital for goiter, tachycardia, sweating, and visible and palpable thyroid. Thyroid function tests revealed a low thyrotropin level (<0.004 mIU/L) and elevated free thyroxine level (3.4 ng/ dL) diagnosed with Graves' disease and treated with methimazole. This anti-thyroid drug is recommended as first-line treatment in children with Graves' disease because it produces minor adverse effects with respect to propylthiouracil. She developed a lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy. The symptoms resolved after discontinuation of methimazole and treatment with an antihistamine and a corticosteroid. Furthermore, the treatment was changed to propylthiouracil without any adverse effects. According to current literature this is the first case of cutaneous figurate erythema related to methimazole, different from other well-known reactions such as skin eruption or urticaria.

JPEG vs. JPEG2000: benchmarking with dermatological images

BACKGROUND

Despite the importance of images in the discipline and the diffusion of digital imaging devices, the issue of image compression in dermatology was discussed only in few studies, which yielded results often not comparable, and left some unanswered questions.

OBJECTIVE

To evaluate and compare the performance of the JPEG and JPEG2000 algorithms for compression of dermatological images.

METHODS

Nineteen macroscopic and fifteen videomicroscopic images of skin lesions were compressed with JPEG and JPEG2000 at 18 different compression rates, from 90% to 99.5%. Compressed images were shown, next to uncompressed versions, to three dermatologists with different experience, who judged quality and suitability for educational/scientific and diagnostic purposes. Moreover, alterations and quality were evaluated by calculation of mean 'distance' of pixel colors between compressed and original images and by peak signal-to-noise ratio, respectively.

RESULTS

JPEG2000 was qualitatively better than JPEG at all compression rates, particularly highest ones, as shown by dermatologists' ratings and objective parameters. Agreement between raters was high, but with some differences in specific cases, showing that different professional experience can influence judgement on images.

CONCLUSION

In consideration of its high qualitative performance and wide diffusion, JPEG2000 represents an optimal solution for the compression of digital dermatological images.

Genistein aglycone improves skin repair in an incisional model of wound healing: a comparison with raloxifene and oestradiol in ovariectomized rats

BACKGROUND AND PURPOSE

Oestrogen loss at menopause is frequently related to poor wound healing. Genistein has been tested in anti-ageing cosmetic preparations with interesting results on skin health. Here, we investigated the effects of the genistein aglycones, given systemically, in an incisional model of wound healing, compared to systemic oestradiol and raloxifene.

EXPERIMENTAL APPROACH

Six months after ovariectomy (OVX), rats were randomly assigned to groups of 12 animals each and treated daily with genistein aglycone (1 and 10 mg kg(-1) s.c.), raloxifene hydrochloride (0.05 and 0.5 mg kg(-1) s.c.) or 17-alpha-ethinyl oestradiol (0.003 and 0.03 mg kg(-1) s.c.) for 12 weeks. Untreated OVX and sham OVX rats were used as controls. Then, 14 or 7 days before the end of the experiment, an incisional wound healing procedure was performed and skin specimens were collected to evaluate molecular, histological and functional measurements.

KEY RESULTS

Seven and fourteen days after wounding, samples from OVX rats showed a decrease in transforming growth factor-beta1, tissue transglutaminase 2 and vascular endothelial growth factor compared to samples from sham OVX rats. Oestradiol, raloxifene and genistein all significantly modified this decrease, but the lowest genistein dose exerted a greater effect than the other treatments. Moreover, the lowest dose of genistein was the most effective in improving skin healing and wound tensile strength.

CONCLUSIONS AND IMPLICATIONS

Genistein aglycone might be an alternative therapy for the management of skin wound healing.

Digital image compression in dermatology: format comparison

Digital image compression (reduction of the amount of numeric data needed to represent a picture) is widely used in electronic storage and transmission devices. Few studies have compared the suitability of the different compression algorithms for dermatologic images. We aimed at comparing the performance of four popular compression formats, Tagged Image File (TIF), Portable Network Graphics (PNG), Joint Photographic Expert Group (JPEG), and JPEG2000 on clinical and videomicroscopic dermatologic images. Nineteen (19) clinical and 15 videomicroscopic digital images were compressed using JPEG and JPEG2000 at various compression factors and TIF and PNG. TIF and PNG are "lossless" formats (i.e., without alteration of the image), JPEG is "lossy" (the compressed image has a lower quality than the original), JPEG2000 has a lossless and a lossy mode. The quality of the compressed images was assessed subjectively (by three expert reviewers) and quantitatively (by measuring, point by point, the color differences from the original). Lossless JPEG2000 (49% compression) outperformed the other lossless algorithms, PNG and TIF (42% and 31% compression, respectively). Lossy JPEG2000 compression was slightly less efficient than JPEG, but preserved image quality much better, particularly at higher compression factors. For its good quality and compression ratio, JPEG2000 appears to be a good choice for clinical/videomicroscopic dermatologic image compression. Additionally, its diffusion and other features, such as the possibility of embedding metadata in the image file and to encode various parts of an image at different compression levels, make it perfectly suitable for the current needs of dermatology and teledermatology.

MIDAS questionnaire in the emergency setting

Migraine is a common disorder and is a major cause of disability and loss of working performance in western countries. Therefore, many tools have been developed to assess migraine related disability. Among these, the Migraine Disability Assessment (MIDAS) questionnaire has been shown to be of particular interest, as it is valid, reliable and useful for therapeutic decisions. In this pilot study, we address the validity of the MIDAS questionnaire in an unselected population of migraine patients in the emergency setting. We found that the MIDAS scores in the emergency room were similar to those collected in a specialised headache centre. This result suggests that the MIDAS questionnaire could be reliably used in the emergency setting, hence avoiding unnecessary delays in the treatment of migraine patients.

Treatment of psoriatic nails with topical cyclosporin: a prospective, randomized placebo-controlled study

BACKGROUND

Nail involvement is a frequent event in the course of psoriasis causing severe distress. While systemic cyclosporin (CsA) represents a well-established therapy of psoriasis, its topical use is limited by the difficult penetration of the molecule through the skin and the nail because of its highly lipophilic nature.

OBJECTIVES

We carried out a prospective randomized placebo-controlled study in order to analyze the effectiveness and tolerability of topical oil-dissolved 70% CsA solution in nail psoriasis.

METHODS

Sixteen adult patients with nail psoriasis, divided randomly into two groups of 8 patients (group A and group B), were treated respectively with a 70% maize-oil-dissolved oral CsA solution and maize oil alone. To compare the therapeutic effectiveness, all patients were evaluated, before starting the treatment and after 12 weeks of therapy, by the same dermatologists. The patients were also asked to assess the severity of their nail involvement at baseline and at the end of the treatment.

RESULTS

In group A, 3 patients came to a complete resolution of nail lesions and 5 showed a substantial improvement of the overall severity score. In group B, a slight improvement was noted in only 1 patient. All the patients of group A judged positively the results of the therapy, while in group B only 1 patient reported a moderate improvement.

CONCLUSION

Our results show that topical therapy with oral CsA solution is a safe, effective and cosmetically highly acceptable treatment modality for nail psoriasis. The ability of CsA to influence keratinocyte proliferation and T-cell lymphokine release, reducing the cornification of the upper layers of the epidermis, may prevent the typical alterations observed in nail psoriasis.

Dermatomyositis in 132 patients with different clinical subtypes: cutaneous signs, constitutional symptoms and circulating antibodies

We retrospectively studied 132 patients with dermatomyositis; 84 had idiopathic, 30 paraneoplastic, 5 juvenile and 13 amyopathic forms of the disease. The commonest features were macular erythema, heliotropic erythema and Gottron's papules. Flagellate erythema occurred in 5% of patients with idiopathic dermatomyositis and correlated with the disease activity. Necrotic lesions were also found in this group of patients but did not always signal malignancy. The prevalence of malignancy was high (23%). Raynaud's phenomenon occurred in 10.6% of patients, also in those with malignancy. Dysphagia, interstitial lung disease and arthralgias affected 20%, 8% and 40% of patients, respectively. Anti-Jo-1 antibodies were found in 5% of patients with idiopathic dermatomyositis and low titre ANA in 1/3 of patients. ANA did not correlate with the disease activity. We confirmed the data from the literature, but no cutaneous sign, constitutional symptom or circulating antibody was found marking a particular subtype of the disease.

Pretibial myxoedema associated with Hashimoto's thyroiditis

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves' disease, although it may also develop in subjects with non-thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58-year-old woman with biopsy-proven Hashimoto's thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.

Changes in the distribution of laminin alpha1 chain in psoriatic skin: immunohistochemical study using confocal laser scanning microscopy

BACKGROUND

Recent studies have demonstrated the presence in psoriatic skin of ultrastructural and molecular alterations in the basement membrane and an altered polarized distribution of the integrins. Previous studies have demonstrated the existence of some epithelial cell lines synthesizing only laminin beta and gamma chains that, in the absence of the laminin alpha chain, do not form a distinct basal lamina.

OBJECTIVES

To investigate a possible reduction/absence of the laminin alpha 1 chain in keratinocytes in psoriatic skin and to correlate this with fibronectin distribution.

METHODS

Using monoclonal antibodies against the laminin alpha1 chain or human plasma fibronectin and using confocal laser scanning microscopy, we evaluated the immunohistochemical expression of these two proteins in cutaneous biopsies from involved and uninvolved skin of the sacral region of 12 men with extensive chronic plaque psoriasis. Site-matched biopsies of normal skin from four men without psoriasis were used as controls.

RESULTS

In normal skin antilaminin alpha 1 chain antibodies stained the dermal-epidermal junction in a regular and continuous manner. In involved and uninvolved psoriatic skin large regions of discontinuous immunostaining were observed, mainly at the apex of the dermal papillae; in the same regions, clusters of keratinocytes appeared markedly reactive and fibronectin was overexpressed in the papillary dermis under the interruptions of the basement membrane.

CONCLUSIONS

The present study defines the location of the laminin alpha1 chain in involved and uninvolved psoriatic skin and suggests a possible role of the alteration of this chain, together with T-cell lymphokines and fibronectin, in the dysregulation of cell morphological processes.

Phototrichogram using videomicroscopy: a useful technique in the evaluation of scalp hair

The purpose of our work is to contribute to the definitive standardization of the phototrichogram in view of the new possibilities offered by information technology. We placed under investigation a 1 cm2 scalp area on the vertex of 28 healthy volunteers (20 women and 8 men) between the ages of 18 and 30 (average age was 23.32 +/- 3.48 years). We performed the examination using a computerised videomicroscope equipped with lenses x 20 and x 50. The results obtained can be summarized as follows: total hair density was 260 +/- 30/cm2 in men and 300 +/- 20/cm2 in women; telogen percentage was higher in men (16.5 +/- 1.5% vs 11 +/- 1% of women); thin hairs (< 0.040 mm) were 9.4 +/- 1.8% in men and 9 +/- 2% in women; growth rate was 0.35 +/- 0.03 mm/day in men and 0.38 +/- 0.03mm/day in women. Thanks to its integration with digital imaging, the phototrichogram has undoubtedly become an examination of primary importance in trichology because of its simplicity and sensitivity even if it cannot yet be considered the ideal technique to replace all the others.

Successful treatment of pustulotic arthro-osteitis (Sonozaki syndrome) with systemic cyclosporin

Pustulotic arthro-osteitis, first described by Sonozaki, is a relatively rare disorder, the prevalence of which is probably underestimated in dermatological literature; its early recognition can prevent misdiagnosis, unnecessary surgery, and the use of prolonged and ineffective antibiotic treatment.

Multiple familial basal cell carcinomas including a case of segmental manifestation

BACKGROUND

A tendency to develop multiple basal cell carcinomas at an early age is a characteristic feature of some rare hereditary disorders; moreover, multiple basal cell carcinomas are sometimes observed as a corollary of familial basaloid follicular hamartomas or familial multiple trichoepitheliomas.

OBSERVATION

We report 3 cases of multiple basal cell carcinomas involving 3 successive generations of a family, with a segmental manifestation of lesions in one of these patients. No additional cutaneous or extracutaneous anomalies were found.

CONCLUSIONS

We hypothesize that a gene mutation may have caused the tumors observed in this family as an autosomal dominant trait. The segmental arrangement of tumors may reflect loss of heterozygosity: at an early stage of embryogenesis, a postzygotic mutation would give rise to a population of cells either homozygous or hemizygous for the underlying gene. The segmental arrangement following the lines of Blaschko would visualize the dorsoventral proliferation of a cell clone characterized by loss of the corresponding normal allele.

"Sporadic" dystrophic epidermolysis bullosa: a new dominant or mitis recessive mutation?

We describe a case of dystrophic epidermolysis bullosa which occurred in a young boy who presented thickened and dystrophic nails both in hands and feet, atrophic scars on the elbows and knees, some large bullae and milia on the hands and ankles. The parents were clinically unaffected and the family medical history was negative for blistering disease. The immunofluorescence for type VII collagen was positive, yet low in intensity and the number of anchoring fibrils was reduced, as revealed by transmission electron microscopy. The diagnosis of a "sporadic" case of dominant dystrophic epidermolysis bullosa was suggested, although a mitis case of recessive dystrophic epidermolysis bullosa cannot be excluded on the basis of clinical, immunofluorescent and ultrastructural examination. However recent studies, carried out in a series of seemingly sporadic cases, have pointed out the possibility of inheritance of two mutant alleles from unaffected parents. This implies that 'mild' recessive dystrophic epidermolysis bullosa is commoner than once thought. This information is important for genetic counselling and determination of recurrence risk in the present and future generations.

Clinical, histological and immunopathological features of 58 patients with subacute cutaneous lupus erythematosus. A review by the Italian group of immunodermatology

BACKGROUND

Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of cutaneous lupus erythematosus clinically characterized by psoriasiform and/or annular lesions and by a mild or absent systemic involvement.

OBJECTIVE

The Italian Group of Immunodermatology of the Italian Society of Dermatology and Venereology reviewed the cases of SCLE seen in 10 years (1987-1996).

PATIENTS

Forty-six women and 12 men have been retrospectively studied, 42% had annular lesions, 39% psoriasiform ones and 16% both.

RESULTS

Lesions were mainly localized on the neck and face and relapsed in spring and autumn. Seventeen patients had 4 or more American College of Rheumatology criteria and could be classified as having systemic lupus erythematosus. The most frequent histopathological alterations were epidermal atrophy, hydropic degeneration of the basal layer and perivascular lymphocytic infiltrate. Deposits of immunoglobulins and C3 at the dermo-epidermal junction on the clinically involved skin were present in 86% of the patients. Dust-like particles in the epidermis were only found in 3% of cases. Anti-Ro/SSA antibodies were found in 71% of the cases and anti-dsDNA only in 5% of cases.

CONCLUSIONS

SCLE is a particular subset of cutaneous lupus erythematosus with peculiar clinical and immunopathological features.

Subcorneal pustular dermatosis and IgA lambda myeloma: a uncommon association but probably not coincidental

The present report deals with a case of subcorneal pustular dermatosis (SCPD) associated with IgAlambda myeloma and reviews the literature for similar cases. Three relevant points arise from this case: the association of the dermatosis with an IgAlambda myeloma that, as far as we know, has been described only three times previously; the longest period of time between the onset of the dermatosis and that of the myelopathy observed up to now; the good therapeutic response to etretinate, useful in the management of severe recalcitrant forms of SCPD.