Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. Results of a pilot study

BACKGROUND

Hidradenitis suppurativa (HS), an inflammatory-based dermatological condition often associated with obesity, poses significant challenges in management. The very low-calorie ketogenic diet (VLCKD) has shown efficacy in addressing obesity, related metabolic disorders, and reducing chronic inflammation. However, its effects on HS remain underexplored. In this prospective pilot study, we aimed to investigate the impact of a 28-day active phase of VLCKD on HS in a sample of treatment-naive women with HS and excess weight.

METHODS

Twelve women with HS and overweight or obesity (BMI 27.03 to 50.14 kg/m2), aged 21 to 54 years, meeting inclusion/exclusion criteria and agreeing to adhere to VLCKD, were included. Baseline lifestyle habits were assessed. The Sartorius score was used to evaluate the clinical severity of HS. Anthropometric parameters (waist circumference, weight, height, and body mass index), body composition via bioelectrical impedance analysis, levels of trimethylamine N-oxide (TMAO), oxidized low-density lipoprotein (oxLDL), and derivatives of reactive oxygen metabolites (dROMs) were assessed at baseline and after 28 days of the active phase of VLCKD.

RESULTS

VLCKD led to general improvements in anthropometric parameters and body composition. Notably, a significant reduction in the Sartorius score was observed after the intervention (Δ%: - 24.37 ± 16.64, p < 0.001). This reduction coincided with significant decreases in TMAO (p < 0.001), dROMs (p = 0.001), and oxLDL (p < 0.001) levels. Changes in the Sartorius score exhibited positive correlations with changes in TMAO (p < 0.001), dROMs (p < 0.001), and oxLDL (p = 0.002).

CONCLUSION

The 28-day active phase of VLCKD demonstrated notable improvements in HS severity and associated metabolic markers, highlighting the potential utility of VLCKD in managing HS and its association with metabolic derangements in women with overweight or obesity.

The Burden of Pruritus Associated With CKD: A Mixed Methods Analysis Among Patients Undergoing Dialysis

Rationale & Objective

Despite its prevalence and distress to patients, chronic kidney disease-associated pruritus (CKD-aP) is poorly characterized, which may contribute to the condition's underdiagnosis and inadequate management. This study aimed to understand the symptom experience of patients with CKD-aP and the extent to which pruritus impacts their lives.

Study Design

Mixed methods study including one-on-one qualitative interviews and completion of the Skindex-10 Questionnaire (measuring itch-related quality of life).

Setting & Participants

A total of 23 patients undergoing hemodialysis and reporting pruritus at 4 dialysis centers in the United States.

Analytical Approach

Interviews followed a semistructured guide that included targeted and follow-up questions to elicit discussion of patients' symptoms of pruritus, including frequency and variability, impact on activities of daily living, and emotional and social functioning. Interviews were digitally audio-recorded. A coding dictionary was developed from transcripts to analyze themes and concepts.

Results

Participants described their itch with various terms, including "numbness," "pain," and "tingling" on their skin. Itch affected multiple areas but especially the back, usually occurred daily, and was often worse at night. For some, itching was a constant experience. Patients relieved their itch through scratching and various off-label treatments; some reported skin damage from excessive scratching and most indicated treatments provided limited relief. Pruritus considerably disrupted physical function, including sleep, daily activities, social functioning and relationships, and emotional and psychological wellbeing. All participants reported being bothered by their itching during the past week on the Skindex-10 Questionnaire.

Limitations

All participants were from the United States, so the findings may not be generalizable to other countries.

Conclusions

Although symptom experience varies considerably, CKD-aP causes severe distress for many patients undergoing hemodialysis and can profoundly impair their quality of life. The results of this study show the impact of itch from patients' perspectives and highlight the need for greater awareness and better management of this condition.

Plain-Language Summary

Patients with chronic kidney disease often experience itching, or pruritus, but its importance to patients is regularly overlooked. This study used one-on-one interviews to investigate patients' experiences of chronic kidney disease-associated pruritus and how it impacts their lives. We found that participants experienced itch on various body areas and used different words to describe their itch (eg, "numbness" and "pain"). Some reported skin damage from excessive scratching, and many used off-label treatments and other interventions (eg, rubbing alcohol and multiple showers daily), which provided limited relief. For many, itching was experienced daily and severely disrupted sleep, daily activities, interactions with others, and mental wellbeing. These findings reveal chronic kidney disease-associated pruritus severely impacts patients and highlights the need for improved management of this condition.

Evaluating minimal important differences and responder definitions for the asthma symptom diary in patients with moderate to severe asthma

Background

The Asthma Symptom Diary was developed to assess severity of symptoms in patients with moderate to severe asthma, and has evidence supporting reliability and validity. Only limited information is available on sensitivity to change and responder definitions for the Asthma Symptom Diary.

Objectives

Main study objectives were to evaluate sensitivity to change and provide responder definitions for clinically meaningful effects for the Asthma Symptom Diary.

Methods

This is a secondary analysis of Phase II clinical trial data in patients with moderate to severe asthma, Asthma Symptom Diary (ASD) was collected daily during the 24-week study. The Asthma Control Questionnaire and the Patient Global Assessment were collected at baseline, and week 12 and 24. Analysis of covariance (ANCOVA) models were used to evaluate sensitivity to change in Asthma Symptom Diary scores after 12 and 24 weeks of treatment. Anchor-based methods, using Asthma Control Questionnaire and Patient Global Assessment defined anchors, were used to identify minimal important differences and various responder criteria for changes in mean 7-day ASD score, symptomatic days, and minimal symptom days.

Results

Sample was 59% female, 81% White, with a mean age of 47.3 (SD = 13.6) years. ANCOVAs demonstrated significant differences in baseline to week 12 and week 24 changes in mean 7-day Asthma Symptom Diary scores and symptomatic days by Asthma Control Questionnaire (all p < 0.001) and Patient Global Assessment anchors (all p < 0.001). Meaningful responders, from the patient’s perspective, were defined as improvements of 0.5–0.6 points (SD = 0.6; scale range 0 to 4) in mean 7-day Asthma Symptom Diary scores, and as a reduction of 2 to 3 Asthma Symptom Diary-based symptomatic days.

Conclusion

The Asthma Symptom Diary was responsive to changes in clinical status in patients with moderate to severe asthma. Responder definitions were identified, including symptomatic days, for evaluating individual level treatment effects in clinical trials.

The importance of drug safety and tolerability in the development of new immunosuppressive therapy for transplant recipients: The Transplant Therapeutics Consortium's position statement

The Transplant Therapeutics Consortium (TTC) is a public-private partnership between the US Food and Drug Administration and the transplantation community including the transplantation societies and members of the biopharmaceutical industry. The TTC was formed to accelerate the process of developing new medical products for transplant patients. The initial goals of this collaboration are the following: (a) To define which aspects of the kidney transplant drug-development process have clear needs for improvement from an industry and regulatory perspective; (b) to define which of the unmet needs in the process could be positively impacted through the development of specific drug-development tools based on available data; and (c) to determine the most appropriate pathway to achieve regulatory acceptance of the proposed process-accelerating tools. The TTC has identified 2 major areas of emphasis: new biomarkers or endpoints for determining the efficacy of new therapies and new tools to assess the safety or tolerability of new therapies. This article presents the rationale and planned approach to develop new tools to assess safety and tolerability of therapies for transplant patients. We also discuss how similar efforts might support the continued development of patient-reported outcome measures in the future.

Validation of the shortened Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS)

Background

The rare disease, Hunter Syndrome (mucopolysaccharidosis type II; MPS II), characterized by iduronate-2-sulfatase deficiency, has heterogeneous symptoms often including cognitive impairment (CI). To evaluate physical functioning and daily activity limitations of patients with MPS II, the multidomain shortened Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) questionnaire was previously developed and preliminarily validated. Here we gather data in a dedicated prospective longitudinal observational study using direct responses to the shortened instrument and assess its psychometric properties further.

Methods

Interview data were collected from eligible self-reporting patients (≥ 12 years of age) or caregivers of patients using respective versions of the instrument at baseline and 2–4 weeks later. Internal consistency, test–retest reliability, convergent and discriminant validity, and validity of known groups were assessed. Participants also completed Child Health Questionnaire (CHQ), Health Utilities Index Mark 3, and Global Impression of Severity (GIS) questionnaires.

Results

All patients were male, consisting of 31 caregiver-reported patients (aged 3–26 years) and 20 self-reported patients (aged 12–58 years). Most (77.4%) caregiver-reported patients had CI. Both questionnaire versions demonstrated good internal consistency and test–retest reliability; Cronbach’s alpha and intra-class correlation coefficients were > 0.70. Spearman’s correlations demonstrated good convergent validity with moderate (> 0.3) to high (> 0.6) correlations of the HS-FOCUS total score with physical functioning, role/social–physical, and bodily pain domains of CHQ. The tool also differentiated between MPS II severity levels based on GIS scores.

Conclusions

The shortened HS-FOCUS questionnaire was found to be a valid and reliable tool to assess the physical functioning impact of MPS II.

Vitamin D Intake and Magnetic Resonance Parameters for Knee Osteoarthritis: Data from the Osteoarthritis Initiative

PURPOSE

There is evidence that vitamin D may play a role in the osteoarthritis (OA) pathogenesis, but the few data available are limited to X-rays and clinical findings. The aim of this study was to investigate whether a higher intake of vitamin D was associated with a better architecture of the cartilage of the knee, assessed with magnetic resonance (MRI), in a large cohort from North America.

METHODS

783 participants (59.8% females; mean age: 62.3 years) with an MRI assessment from the Osteoarthritis Initiative were included. Vitamin D dietary intake was calculated as the sum of food and oral supplementation. A coronal 3D FLASH with Water Excitation MR sequence of the right knees was used. The strength of the association between dietary vitamin D intake and knee MRI parameters was investigated through an adjusted linear regression analysis, reported as standardized betas with 95% confidence intervals (CIs).

RESULTS

Using a linear regression analysis, adjusted for ten potential confounders, higher vitamin D intake (reported as an increase in one standard deviation, = 250 IU) corresponded to significantly higher values of mean cartilage thickness and volume of cartilage at medial tibia, volume of cartilage and mean cartilage thickness at central lateral femur, volume of cartilage and mean cartilage thickness at central medial femur, and volume of cartilage and mean cartilage thickness at central medial tibial-femoral compartment.

CONCLUSIONS

Higher vitamin D intake is associated with a significantly better architecture of the cartilage of the knee, also independently taking in account from several potential confounders.

Diagnostic imaging of two related chronic diseases: Sarcopenia and Osteoporosis

Sarcopenia and osteoporosis are two major health problems worldwide, responsible for a serious clinical and financial burden due to the increasing life expectancy. Both when presented as a single entity and, in particular, in the form of “osteosarcopenia”, they lead to an important increased risk of falls, fractures, hospitalization and mortality. In dealing with these two pathological conditions, it is important to understand that between bone and muscle there is not only a functional correlation but also a close relationship in the development and in maintenance, which is well expressed by the concept of “bone-muscle unit”. This close relationship agrees with the existence of a linear association between sarcopenia and osteoporosis, in particular in elderly population. It is mandatory, in the clinical assessment of both diseases, to do an early diagnosis or to delay as far as possible the appearance of an established form in order to prevent the onset of complications. The aim of this review is to present the different imaging modalities available for a non-invasive investigation of bone and muscle mass and quality in osteoporosis and sarcopenia, with their application and limitations.

Osteoporosis: what the clinician needs to know?

Osteoporosis is a common condition and an important cause of disability. For this reason, early detection of the disease and patients at higher risk of bone fractures is compulsory. In the recent years, conventional quantitative methods have been spreading for the diagnosis of osteoporosis; moreover, new improvements in computed tomography (CT) and magnetic resonance imaging (MRI) have been made in this field and imaging findings may correlate to the morphological and structural changes within the bone.

Imaging of metabolic bone disease

Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures. (www.actabiomedica.it)

New Trends for the Evaluation of Heat Treatments of Milk

Milk is generally very rich in nutrients and this may lead it to be an ideal growth environment for many microorganisms, including pathogens, so effective measurements aiming to ensure total microbiological safety of milk and minimize the risk to human health are needed. Milk heat treatments are the most common practices carried out to inhibit the microbial growth; therefore it is necessary to have analytical procedures that are more and more up-to-date and capable of detecting the effectiveness of the heat treatments. Most of the reference and official methods to assess heat treatment in milk are based on the evaluation of the modifications of some milk components following the thermal process, such as the determination of enzyme activities (alkaline phosphatase and lactoperoxidase), whey proteins, Maillard reaction compounds (generally furosine), and lactulose. Besides the most common techniques (liquid and gas chromatography, capillary electrophoresis, or spectroscopy) used for the detection of single thermal indicators, new approaches, such as chemometric studies or more recent techniques, including size-exclusion chromatography with online electrospray mass spectrometry or stable isotope ratio mass spectrometry, are discussed in this review in order to evaluate heat treatment in milk.

Updating Nutritional Data and Evaluation of Technological Parameters of Italian Milk

Different technologically treated Italian milks (whole and semi-skimmed ultra-high temperature (UHT), pasteurized and microfiltered milk), collected from 2009 to 2012, were evaluated for nutritional and technological properties. No significant differences in calcium and sodium were detected (p > 0.05), while significant differences were observed concerning phosphorus content, between whole and semi-skimmed milk, and lactose content, between pasteurized and UHT milk (p < 0.05). In UHT milk, lactose isomerization occurred, and lactulose (from 8.6 to 104.0 mg/100 g) was detected. No significant differences (p > 0.05) were detected for choline, a functional molecule, between whole (11.3–14.6 mg/100 g) and semi-skimmed milk (11.1–14.7 mg/100 g), but there were significant differences (p < 0.05) in processing milk (UHT vs. pasteurized milk and UHT vs. microfiltered milk). Among the unsaponifiable compounds, only 13 cis retinol and trans retinol showed differences in technologically treated milk (pasteurized vs. UHT milk and microfiltered vs. UHT milk; p < 0.05). In this research, the greater was the “severity” of milk treatment, the higher was the percent ratio 13 cis/trans retinol (DRI, degree of retinol isomerization). The degree of antioxidant protection parameter (DAP), useful to estimate the potential oxidative stability of fat in foods, was significantly different between whole and semi-skimmed milk (p < 0.05). Finally, the evaluation of color measurement of whole milk showed a good correlation between beta carotene and b* (r = 0.854) and between lactulose and a* (r = 0.862).

Modulation of antioxidant compounds in organic vs conventional fruit (peach, Prunus persica L., and pear, Pyrus communis L.)

Despite the increasing interest in organic products, knowledge about how different levels of fertilization affect nutritionally relevant components is still limited. The concentration of polyphenols and the activity of polyphenoloxidase (PPO), together with the content in ascorbic acid, citric acid, and alpha- and gamma-tocopherol, were assayed in conventional and organic peach (Prunus persica L., cv. Regina bianca) and pear (Pyrus communis L., cv. Williams). 2-Thiobarbituric acid reactive substances and the tocopherolquinone/alpha-tocopherol ratio were used as markers of oxidative damage in fruits. A parallel increase in polyphenol content and PPO activity of organic peach and pear as compared with the corresponding conventional samples was found. Ascorbic and citric acids were higher in organic than conventional peaches, whereas alpha-tocopherol was increased in organic pear. The concentration of oxidation products in organic samples of both fruits was comparable to that of the corresponding conventional ones. These data provide evidence that an improvement in the antioxidant defense system of the plant occurred as a consequence of the organic cultivation practice. This is likely to exert protection against damage of fruit when grown in the absence of pesticides.

Investigation of the mechanisms affecting Cu and Fe bioavailability from legumes: role of seed protein and antinutritional (nonprotein) factors

Chemical composition and content in polyphenols, phytic acid, and dietary fiber of whole cooked common bean (Phaseolus vulgaris L.) and faba bean (Vicia faba L.) and of soluble and insoluble fractions separated from them were determined. Simultaneous determination of Cu, Fe, and protein bioavailability in the small intestine of rat was carried out in single-dose, short-term (1 h) experiments. After cooking, about 80% of seed components (on a weight basis) of either legume was recovered in the precipitate (insoluble fraction) after extraction with water. Protein, lipid, starch, dietary fiber, and polyphenols underwent the most severe insolubilization, together with more than 70% of total Cu and Fe. Cu, Fe, and protein bioavailability showed a similar trend (i.e., the lower the protein, the lower the Cu and Fe availability). Availability of proteins, Cu, and Fe in the insoluble fractions were the lowest, but Cu bioavailability was higher than that of Fe in all fractions. The results provide evidence that the heat-induced insolubilization process adversely affects not only protein but also Cu and Fe bioavailability from legumes and that polyphenols are likely to be a major inhibitor on absorption.