Roberta Calcaterra - Academia.edu (original) (raw)

Papers by Roberta Calcaterra

Journal of Investigative Dermatology, 2000

Mycoses, Jan 22, 2010

A 9-year-old girl, presented with a 4-week history of an inflammatory suppurative plaque, 8 cm in... more A 9-year-old girl, presented with a 4-week history of an inflammatory suppurative plaque, 8 cm in diameter, localised in the occipital area of the scalp. Mycological direct examination showed ectoendothrix invasion of the hair and Trichophyton mentagrophytes was isolated. Oral therapy with griseofulvin 25 mg kg)1 day)1 was prescribed, but after 2 weeks of treatment appeared multiple erythematous subcutaneous nodules localised in the legs. Erythema nodosum (EN) was confirmed by histological examination of a nodule and then we combined therapy with 1 mg Kg)1 day)1 of prednisone. At the remission of the panniculitis, which occurred in about 10 days, the steroid therapy was suspended, while the orally administered griseofulvin continued for 6 weeks until full recovery. EN is the most frequent clinical form of acute nodular panniculitis and it is considered an epiphenomenon relative to various infectious and non-infectious stimuli. The association of EN with dermatophytosis of the scalp is infrequent, with only 15 cases reported in the Literature.

Lupus, Jul 1, 2008

Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythema... more Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythematosus (SLE), especially as an initial sign of the disease. Moreover, it has never been reported as an initial manifestation of subacute cutaneous lupus erythematosus (SCLE).1,2 We report two cases of acute pancreatitis, as the initial presentation of SLE in one patient and SCLE in the other one. Patient 1 is a 24-year-old womanwith a 2-week history of fatigue, malaise, arthralgia of knee, fever, generalized abdominal pain and recent onset of alimentary vomiting. There was no history of alcohol, drugs or any other medications. Physical examination revealed a diffuse erythema with purpuric elements on the dorsum of her hands and forearms and erythematous, scaly, maculo-papular lesions on the trunk (Figure 1); generalized abdominal tenderness with no guarding or hepato-splenomegaly was detected. Laboratory tests showed: WBC 1600/mm3 (normal 4000–10,000), RBC 3,400,000/mm3 (normal 3,800,000–5,100,000), HGB 9.7 g/dL (normal 12.0–16.0), PLT 84,000/mm3 (normal 130,000– 400,000); AST 70 U/L (normal 5–32), ALT 45 U/L (normal 6–31), γGT 66 U/L (normal 5–36), LDH 921 U/L (normal 220–480), amylase 456 U/L (normal 28–100) and lipase 443 U/L (normal 13–60). Triglycerides and calcium serum level were normal. Serology for HIV, CMV, EBVwas negative; ANA positive at titre of 1:5120, positive dsDNA antibody at titre of 1:40, anti-histone antibody 3.8 (normal range 0.0–1.1 index). ESR was 65 mm/h (normal 1–18), complement 3 (C3) 41.1 mg/dL (normal 83.0–177.0), complement 4 (C4) 9.3 mg/dL (normal 15.0–45.0), anticardiolipin, anti-SSA/Ro and lupus anticoagulant antibodies were negative. A biopsy and direct immunofluorescence (DIF) of a trunk lesion were suggestive for lupus. Abdominal Computed Tomographic (CT) and ultrasonic scan showed a swollen pancreas, but no gallbladder stones (grade B according to Balthazar scale). A diagnosis of acute pancreatitis and SLE was made according to the clinical signs and laboratory results and the patient started therapy with methylprednisolone at initial dose of 1 mg/kg daily i.v. and somatostatin 3.5 μg/kg/h i.v. After 7 days, in consideration of the clinical improvement, azathioprine 1.5 mg/kg daily was associated and somatostatin stopped. After 6 weeks, no cutaneous lesions were detectable and the pancreatic enzymes returned normal. After a further period of 6 weeks, the treatment was progressively reduced to methylprednisolone 0.1 mg/kg/day and azathioprine 0.3 mg/kg/day. Patient 2 is a 39-year-old woman with a 4-week history of a few papules of the face and erythematous, oedematous papules, some of themwith ring forms, of the upper trunk and arms (Figure 2). She had a 5week history of persistent abdominal pain, loss of appetite associated, in the last week, with nausea and intermitting vomiting. The patient had no history of alcohol or drug use. Laboratory tests were normal except: AST 70 U/L, ALT 62 U/L, γGT 61 U/L, amylase 388 U/L, lipase 419 U/L, LDH 879 U/L, ESR 18 mm/h, ANA titre of 1:160, anti-SSA/Ro antibody 1.5 index (normal 0.0–1.1). Abdominal CT and ultrasound scan showed fullness of the pancreatic head and absence of stones (grade A according to Balthazar scale). A biopsy of a trunk lesion and DIF were evocative of lupus. A diagnosis of SCLE with acute pancreatitis was made and the patient was started on treatment with somatostatin 3.5 μg/kg/h i.v. and methylprednisolone 1 mg/kg daily i.v. with Lupus (2008) 17, 695–697

The American Journal of Clinical Nutrition, Feb 1, 2008

Background: Celiac disease (CD) is a Th1-driven autoimmune permanent enteropathy that is triggere... more Background: Celiac disease (CD) is a Th1-driven autoimmune permanent enteropathy that is triggered by dietary gluten. Molecules able to shift the immune response from a Th1-to a Th2-type response have been suggested as therapeutic agents for Th1 autoimmune diseases. Objective: We sought to investigate the possibility that a decapeptide from durum wheat (p10mer, QQPQDAVQPF), which was previously shown to prevent the activation of celiac peripheral lymphocytes, may promote a shift from a Th1-to a Th2-type immune response in gluten-specific intestinal T cells of CD patients. Design: Intestinal T lymphocyte lines derived from 8 children with CD were incubated with gliadin peptides both alone and simultaneously with p10mer. Cell proliferation and the production of interferon-␥ and interleukin-10 by these T cells were measured. Results: The incubation of celiac intestinal T cells with deamidated gliadin peptides resulted in a significant (P 0.008) increase in cell proliferation and interferon-␥ release, whereas the simultaneous exposure to p10mer totally abolished the cell proliferation and cytokine release. Moreover, incubation with p10mer maintained an elevated release of interleukin-10, whereas exposure of the cells to culture medium only did not. The replacement of the residues of aspartic acid in position 5 or those of alanine in position 6 in the sequence of p10mer resulted in peptides with no activity in the activation experiments. Conclusion: In vitro, p10mer showed the ability to shift the pathogenic immune response of a CD patient from a Th1-to a Th2-type response.

Scandinavian Journal of Gastroenterology, 2009

Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeli... more Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination. All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy. Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) >25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn's disease, TI mucosal aftoid lesions were seen in two only in magnified view. Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn's disease.

Mycoses, Dec 1, 2002

Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had c... more Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had contact with Africans, and two due to Trichophyton schoenleinii in an African and an Italian child, respectively, are reported. Infections caused by anthropophilic dermatophytes are rare in Italy and are related to immigration. The most frequent agents of tinea capitis in Italy are zoophilic dermatophytes. Zusammenfassung. Wir beschreiben 4 Fälle von Tinea capitis bei Kindern, zwei davon mit Trichophyton soudanense als Erregern, die bei Italienern beobachtet wurden, die in Kontakt mit Afrikanern waren. Die anderen zwei Fälle, verursacht durch Trichophyton schoenleinii, waren jeweils bei einem italienischen und einem afrikanischen Kind beobachtet worden. Infektionen durch anthropophile Dermatophyten sind selten in Italien, wo die häufigste Ursache von Tinea capitis zoophile Dermatophyten sind. Sie sind eng mit dem Phänomen der Einwanderung verbunden.

Scandinavian Journal of Gastroenterology, 2007

The avoidance of oats in coeliac patients is still controversial. If oats is confirmed to be safe... more The avoidance of oats in coeliac patients is still controversial. If oats is confirmed to be safe, it would be a valuable component and offer more variation in a gluten-free diet. The aim of this work was to evaluate whether avenins from different varieties of oats show different abilities in the activation of coeliac peripheral lymphocytes. In order to assess whether the immunogenic effect of oats varies according to the cultivar, peripheral lymphocytes from 10 coeliac children were exposed to avenins from four different oats varieties: Lampton, Astra, Ava and Nave. Lymphocyte proliferation and interferon-gamma (IFN-gamma) release in the culture medium were measured as indexes of immune activation. All the varieties of oats tested were immunogenic, with Lampton and Ava avenins inducing lymphocyte activation similar to that activated by wheat gliadin, while Astra and Nave avenins showed less immunogenicity, but still with a measurable effect. There are still concerns about the suitability of including oats in a gluten-free diet. Coeliac patients consuming oats-containing food should be carefully monitored, until there is more evidence to show the safety of oats and varieties of low-toxicity oats.

Mycoses, Dec 1, 2002

Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had c... more Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had contact with Africans, and two due to Trichophyton schoenleinii in an African and an Italian child, respectively, are reported. Infections caused by anthropophilic dermatophytes are rare in Italy and are related to immigration. The most frequent agents of tinea capitis in Italy are zoophilic dermatophytes. Zusammenfassung. Wir beschreiben 4 Fälle von Tinea capitis bei Kindern, zwei davon mit Trichophyton soudanense als Erregern, die bei Italienern beobachtet wurden, die in Kontakt mit Afrikanern waren. Die anderen zwei Fälle, verursacht durch Trichophyton schoenleinii, waren jeweils bei einem italienischen und einem afrikanischen Kind beobachtet worden. Infektionen durch anthropophile Dermatophyten sind selten in Italien, wo die häufigste Ursache von Tinea capitis zoophile Dermatophyten sind. Sie sind eng mit dem Phänomen der Einwanderung verbunden.

Background. Onchocerciasis, commonly known as river blindness, is a parasitic infection afflictin... more Background. Onchocerciasis, commonly known as river blindness, is a parasitic infection afflicting 18 million people worldwide. The causative organism, Onchocerca volvulus, is a filarial nematode transmitted by infested black flies of the genus Simulium, which are found near freely flowing waterways. Simulium kaffaense has been identified as the vector in Ethiopia and East Africa. Methods. We analyzed the cases of onchocerciasis observed at the Italian Dermatological Centre (IDC) in Mekele, capital of Tigray, the northern region of Ethiopia, between January and December 2007. Results. Fifhteen patients (six females and nine males) with onchocerciasis were seen at IDC. All patients were from the Tigray region. In all cases, there was a long history of diffuse itching and chronic dermatitis, particularly involving the buttocks and lower limbs. Conclusions. Onchocerciasis represents a major public health problem in the tropical and subtropical regions of 37 endemic countries. Onchocerc...

Redia-Giornale Di Zoologia, 2006

Aim. Desloratadine (DL) is an effective treatment for chronic idiopathic urticaria (CIU) symptoms... more Aim. Desloratadine (DL) is an effective treatment for chronic idiopathic urticaria (CIU) symptoms, but there is little information about its impact on patients' perceived general wellbeing. The primary objective was to measure the effect of DL on the quality of life (QoL) of CIU patients, using the Dermatology Life Quality Index (DLQI). Secondary objectives were: evaluation of the effects of DL on pruritus and number of hives, sleep and daily activities, overall CIU condition, and assessment of therapeutic response. Safety and tolerability of DL were also evaluated. Methods. Two-hundred and fifty-five patients, aged 18-79 years and with moderate to severe CIU, were treated with DL 5 mg once daily for 28 days. Patients recorded signs and symptoms scores daily, and completed the DLQI questionnaire at baseline and on treatment days 7, 14, 21 and 28. Patients and investigators jointly evaluated overall CIU condition and therapeutic response at days 14 and 28. Results. After 28 days of treatment, DL significantly reduced mean overall DLQI score from 9.4 (\ub15.4) at baseline to 3 (\ub14.1) (-66.1%; P<0.001), with no significant differences between moderate and severe patients. Improvement in QoL was significant (P<0.001) at all time points and for all DLQI domains. All signs and symptoms scores were significantly correlated with DLQI score. Conclusion. Treatment with DL 5 mg for 4 weeks significantly improves symptoms and QoL in patients with CIU, irrespective of disease severity, and with a rapid onset of action

Journal of Investigative Dermatology, 2000

The International journal of periodontics & restorative dentistry

Screw loosening can damage the interfaces of implant components, resulting in susceptibility to c... more Screw loosening can damage the interfaces of implant components, resulting in susceptibility to contamination of the internal parts by microorganisms. The aim of this study was to investigate the impact of abutment screw retightening on the leakage of two different types of bacteria, Streptococcus sanguinis and Fusobacterium nucleatum, and of the yeast Candida albicans. Two types of implant-abutment systems with tube-in-tube interfaces were tested. Groups A and B each used a different type of system that consisted of 20 different pieces that were assembled according to the manufacturer's torque recommendations; four samples in each group were closed just one time, four samples three times, four samples five times, four samples seven times, and four samples nine times. The implants of groups A and B were contaminated with 0.1 μL of microbial solution just before being assembled for the last time to minimize the possibility of contamination. Results showed a direct correlation bet...

European Archives of Oto-Rhino-Laryngology, 2013

Although many immunologic mechanisms have been investigated in studies of the pathogenesis of cho... more Although many immunologic mechanisms have been investigated in studies of the pathogenesis of cholesteatoma, the role of pattern recognition receptors (PRRs) has not been fully determined. Therefore, we assessed innate immune responses in patients with cholesteatoma. We prospectively evaluated 21 patients with acquired cholesteatoma between August 2010 and July 2012. Cholesteatoma specimens were obtained during surgery, and skin from the external meatus of each patient was used as a control. RNA was extracted from these tissue samples, followed by real-time PCR to quantitatively assess the relative expression of toll-like receptors (TLRs), NOD-like receptors (NLRs), retinoic acid-inducible gene (RIG)-I, NO synthase (NOS) and cytokines. The levels of TLR-2,-3,-4,-6,-7, and-10, NOD-2, and IL-1 and-8 mRNAs were significantly higher in the cholesteatoma than in the skin specimens (p \ .05). The expression levels of TLR-2 and-3, RIG-I, IL-6, and TNF-a mRNAs were significantly higher in cholesteatomas from women than from men. The levels of TLR-8, NOD-2, IL-12, and TNF-a mRNAs were significantly higher in recurrent than in initial cholesteatoma specimens (p \ .05). Hearing level did not correlate with the levels of expression of mRNAs encoding TLRs, NLRs, NOS, RIG-I and related cytokines (p [ .05). In conclusion, alterations in innate immunity triggered by PRRs are important in the pathophysiology of cholesteatoma. Gender differences and frequency of surgery may affect the expression of PRRs in cholesteatomas.

Dermatology, 2001

Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis c... more Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. Objective: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. Patients and Methods: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. Results: Dire...

Biomedical Materials, 2010

The association of Morse taper implant-abutment design with the use of a smaller abutment diamete... more The association of Morse taper implant-abutment design with the use of a smaller abutment diameter (platform switching) may improve dental implant success rate and prevent peri-implant bone loss. The aim of the present study was to histologically and histomorphometrically evaluate the behavior of peri-implant tissues around an implant with a conical connection associated with platform switching. A platform-switched Morse-cone connection implant was inserted in the left posterior mandible of a 61-year-old patient. The implant was inserted at the level of the alveolar crest. After 11 months from placement and 6 months of loading, the implant was retrieved for psychological reasons and processed for histological evaluation. The retrieved implant was wholly surrounded by bone tissue, except for a small area in the apical portion. At higher magnification, in the coronal portion of the implant, it was possible to observe bone directly at the implant platform level. No resorption of the coronal bone was present, except for 0.2 mm on the vestibular aspect. Crestally, bone remodeling with areas of newly formed bone was detected; the bone-implant contact was 73.9%. Apposition of bone was detected even upon the platform. Peri-implant crestal bone preservation can be achieved with the combination of Morse taper conical internal implant-abutment connection with the use of a smaller abutment diameter (platform-switching).

Pacini Edtore Medicina, 2014

Acta dermatovenerologica Croatica : ADC, 2013

ABSTRACT Tinea incognito is a dermatophytosis with atypical clinical manifestation in the absence... more ABSTRACT Tinea incognito is a dermatophytosis with atypical clinical manifestation in the absence of the typical &quot;ringworm&quot; (1). The term tinea incognito was originally used in 1968 by Ive and Marks in 14 patients with atypical dermatophytic infection caused by a previous steroid treatment (2) . Since then, several cases of tinea incognito have been described after topical application of pimecrolimus and tacrolimus, although the use of corticosteroids continues to be the most common trigger of the disease (3). A 47-year-old woman presented at our Institute with a 3-month history of erythematous papules with rare pustules on the face. The patient reported a three-month application of topical corticosteroids and metronidazole cream with progressive exacerbation of the eruption. Physical examination revealed numerous papules and some pustules forming an erythematous plaque localized on the face (Fig.1). No pathologic signs were observed on the rest of the body and nails. The patient&#39;s history was otherwise unremarkable. Scrapings from the facial lesion, examined directly in 10% potassium hydroxide solution, showed the presence of dermatophyte hyphae. Culture on Mycosel Agar (agar-dextrose + cycloeximide + chloramphenicol) at 27 °C for three weeks yielded colonies with a powdery and granular surface and yellowish reverses (Fig. 2). Microscopically, we observed round and pyriform microconidia, spiral hyphae and rare smooth-walled macroconidia. These findings confirmed the diagnosis of dermatophyte infection caused by Trichophyton mentagrophytes vr. mentagrophytes. A diagnosis of rosacea-like tinea incognito was made and the patient started therapy with oral terbinafine 250 mg/die for 4 weeks, with progressive and total resolution of the facial lesions. Tinea faciei, a relatively uncommon dermatophyte infection, usually shows up as an erythematous, scaly patch with an annular edge, the size of which gradually increases. Clinical presentation of the condition is often atypical. The absence of classical features of ringworm, likely because of the complex anatomy of the face, makes the initial diagnosis difficult and often leads to misdiagnosis of tinea faciei (1). A broad range of skin diseases, like seborrheic dermatitis, cutaneous candidiasis, atopic dermatitis, contact dermatitis, granuloma annulare, systemic and discoid lupus erythematosus, rosacea, drug-induced lupus, perioral dermatitis, pityriasis alba, pityriasis rosea, sarcoidosis, tuberculosis, psoriasis vulgaris, and polymorphic light eruption can mimic tinea facei (1-3). This can lead to misdiagnosis of the disease, consequential use of steroids, and finally to worsening of the disease and onset of tinea incognito. The pathogenesis of tinea incognito is presumably linked to a steroid-modified response of the host to fungal infection rather than to a direct pharmacological effect on the mycete (3). Topical steroids suppress the local immune response and allow the fungus to grow easily. As a result, the fungal infection may take on a bizarre appearance. The prevalence of dermatophytes responsible for the condition shows marked geographical variation (4,5). In Italy, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum, and Trichophyton erinacei have been reported as the main etiologic agents (5). Tinea faciei responds to treatment with topical or⁄and oral antifungals. Patients with highly inflamed lesions, resistant, extensive and complicated disease, or those with multiple plaques may require oral antifungal therapy, as in our case. Terbinafine, itraconazole, and fluconazole have been shown to be superior to griseofulvin because they concentrate at the level of the skin (4). The presented case highlights the importance of considering tinea on the differential diagnosis of all facial eruptions and the essential role of mycological examination to make a correct diagnosis and treatment.

International journal of immunopathology and pharmacology

Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. ... more Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. albicans is the most common pathogen; however, other emerging Candida species are also responsible for this condition. Few data are available about the occurrence of Candida species in the oral cavities of denture-wearing immigrants to Italy. In this study, we compare the Candida species found in the oral mucosa and on dentures from a population of denture wearing immigrants to Italy to a matched Italian group. Oral swabs were collected from dentures and the underlying mucosa of patients enrolled in the study and were then cultured to test for the presence of Candida species in each sample. Out of 168 patients enrolled (73 Italians and 95 immigrants), 51 Italians (69.8 percent) and 75 immigrants (78.9 percent) tested positive for the presence of Candida. Candida albicans was the most frequently observed species overall; however, we found a higher occurrence of C. glabrata among immigrant...

Skinmed

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) ... more In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling...

Journal of Investigative Dermatology, 2000

Mycoses, Jan 22, 2010

A 9-year-old girl, presented with a 4-week history of an inflammatory suppurative plaque, 8 cm in... more A 9-year-old girl, presented with a 4-week history of an inflammatory suppurative plaque, 8 cm in diameter, localised in the occipital area of the scalp. Mycological direct examination showed ectoendothrix invasion of the hair and Trichophyton mentagrophytes was isolated. Oral therapy with griseofulvin 25 mg kg)1 day)1 was prescribed, but after 2 weeks of treatment appeared multiple erythematous subcutaneous nodules localised in the legs. Erythema nodosum (EN) was confirmed by histological examination of a nodule and then we combined therapy with 1 mg Kg)1 day)1 of prednisone. At the remission of the panniculitis, which occurred in about 10 days, the steroid therapy was suspended, while the orally administered griseofulvin continued for 6 weeks until full recovery. EN is the most frequent clinical form of acute nodular panniculitis and it is considered an epiphenomenon relative to various infectious and non-infectious stimuli. The association of EN with dermatophytosis of the scalp is infrequent, with only 15 cases reported in the Literature.

Lupus, Jul 1, 2008

Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythema... more Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythematosus (SLE), especially as an initial sign of the disease. Moreover, it has never been reported as an initial manifestation of subacute cutaneous lupus erythematosus (SCLE).1,2 We report two cases of acute pancreatitis, as the initial presentation of SLE in one patient and SCLE in the other one. Patient 1 is a 24-year-old womanwith a 2-week history of fatigue, malaise, arthralgia of knee, fever, generalized abdominal pain and recent onset of alimentary vomiting. There was no history of alcohol, drugs or any other medications. Physical examination revealed a diffuse erythema with purpuric elements on the dorsum of her hands and forearms and erythematous, scaly, maculo-papular lesions on the trunk (Figure 1); generalized abdominal tenderness with no guarding or hepato-splenomegaly was detected. Laboratory tests showed: WBC 1600/mm3 (normal 4000–10,000), RBC 3,400,000/mm3 (normal 3,800,000–5,100,000), HGB 9.7 g/dL (normal 12.0–16.0), PLT 84,000/mm3 (normal 130,000– 400,000); AST 70 U/L (normal 5–32), ALT 45 U/L (normal 6–31), γGT 66 U/L (normal 5–36), LDH 921 U/L (normal 220–480), amylase 456 U/L (normal 28–100) and lipase 443 U/L (normal 13–60). Triglycerides and calcium serum level were normal. Serology for HIV, CMV, EBVwas negative; ANA positive at titre of 1:5120, positive dsDNA antibody at titre of 1:40, anti-histone antibody 3.8 (normal range 0.0–1.1 index). ESR was 65 mm/h (normal 1–18), complement 3 (C3) 41.1 mg/dL (normal 83.0–177.0), complement 4 (C4) 9.3 mg/dL (normal 15.0–45.0), anticardiolipin, anti-SSA/Ro and lupus anticoagulant antibodies were negative. A biopsy and direct immunofluorescence (DIF) of a trunk lesion were suggestive for lupus. Abdominal Computed Tomographic (CT) and ultrasonic scan showed a swollen pancreas, but no gallbladder stones (grade B according to Balthazar scale). A diagnosis of acute pancreatitis and SLE was made according to the clinical signs and laboratory results and the patient started therapy with methylprednisolone at initial dose of 1 mg/kg daily i.v. and somatostatin 3.5 μg/kg/h i.v. After 7 days, in consideration of the clinical improvement, azathioprine 1.5 mg/kg daily was associated and somatostatin stopped. After 6 weeks, no cutaneous lesions were detectable and the pancreatic enzymes returned normal. After a further period of 6 weeks, the treatment was progressively reduced to methylprednisolone 0.1 mg/kg/day and azathioprine 0.3 mg/kg/day. Patient 2 is a 39-year-old woman with a 4-week history of a few papules of the face and erythematous, oedematous papules, some of themwith ring forms, of the upper trunk and arms (Figure 2). She had a 5week history of persistent abdominal pain, loss of appetite associated, in the last week, with nausea and intermitting vomiting. The patient had no history of alcohol or drug use. Laboratory tests were normal except: AST 70 U/L, ALT 62 U/L, γGT 61 U/L, amylase 388 U/L, lipase 419 U/L, LDH 879 U/L, ESR 18 mm/h, ANA titre of 1:160, anti-SSA/Ro antibody 1.5 index (normal 0.0–1.1). Abdominal CT and ultrasound scan showed fullness of the pancreatic head and absence of stones (grade A according to Balthazar scale). A biopsy of a trunk lesion and DIF were evocative of lupus. A diagnosis of SCLE with acute pancreatitis was made and the patient was started on treatment with somatostatin 3.5 μg/kg/h i.v. and methylprednisolone 1 mg/kg daily i.v. with Lupus (2008) 17, 695–697

The American Journal of Clinical Nutrition, Feb 1, 2008

Background: Celiac disease (CD) is a Th1-driven autoimmune permanent enteropathy that is triggere... more Background: Celiac disease (CD) is a Th1-driven autoimmune permanent enteropathy that is triggered by dietary gluten. Molecules able to shift the immune response from a Th1-to a Th2-type response have been suggested as therapeutic agents for Th1 autoimmune diseases. Objective: We sought to investigate the possibility that a decapeptide from durum wheat (p10mer, QQPQDAVQPF), which was previously shown to prevent the activation of celiac peripheral lymphocytes, may promote a shift from a Th1-to a Th2-type immune response in gluten-specific intestinal T cells of CD patients. Design: Intestinal T lymphocyte lines derived from 8 children with CD were incubated with gliadin peptides both alone and simultaneously with p10mer. Cell proliferation and the production of interferon-␥ and interleukin-10 by these T cells were measured. Results: The incubation of celiac intestinal T cells with deamidated gliadin peptides resulted in a significant (P 0.008) increase in cell proliferation and interferon-␥ release, whereas the simultaneous exposure to p10mer totally abolished the cell proliferation and cytokine release. Moreover, incubation with p10mer maintained an elevated release of interleukin-10, whereas exposure of the cells to culture medium only did not. The replacement of the residues of aspartic acid in position 5 or those of alanine in position 6 in the sequence of p10mer resulted in peptides with no activity in the activation experiments. Conclusion: In vitro, p10mer showed the ability to shift the pathogenic immune response of a CD patient from a Th1-to a Th2-type response.

Scandinavian Journal of Gastroenterology, 2009

Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeli... more Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination. All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy. Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease, TI mucosal aftoid lesions were seen in two only in magnified view. Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease.

Mycoses, Dec 1, 2002

Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had c... more Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had contact with Africans, and two due to Trichophyton schoenleinii in an African and an Italian child, respectively, are reported. Infections caused by anthropophilic dermatophytes are rare in Italy and are related to immigration. The most frequent agents of tinea capitis in Italy are zoophilic dermatophytes. Zusammenfassung. Wir beschreiben 4 Fälle von Tinea capitis bei Kindern, zwei davon mit Trichophyton soudanense als Erregern, die bei Italienern beobachtet wurden, die in Kontakt mit Afrikanern waren. Die anderen zwei Fälle, verursacht durch Trichophyton schoenleinii, waren jeweils bei einem italienischen und einem afrikanischen Kind beobachtet worden. Infektionen durch anthropophile Dermatophyten sind selten in Italien, wo die häufigste Ursache von Tinea capitis zoophile Dermatophyten sind. Sie sind eng mit dem Phänomen der Einwanderung verbunden.

Scandinavian Journal of Gastroenterology, 2007

The avoidance of oats in coeliac patients is still controversial. If oats is confirmed to be safe... more The avoidance of oats in coeliac patients is still controversial. If oats is confirmed to be safe, it would be a valuable component and offer more variation in a gluten-free diet. The aim of this work was to evaluate whether avenins from different varieties of oats show different abilities in the activation of coeliac peripheral lymphocytes. In order to assess whether the immunogenic effect of oats varies according to the cultivar, peripheral lymphocytes from 10 coeliac children were exposed to avenins from four different oats varieties: Lampton, Astra, Ava and Nave. Lymphocyte proliferation and interferon-gamma (IFN-gamma) release in the culture medium were measured as indexes of immune activation. All the varieties of oats tested were immunogenic, with Lampton and Ava avenins inducing lymphocyte activation similar to that activated by wheat gliadin, while Astra and Nave avenins showed less immunogenicity, but still with a measurable effect. There are still concerns about the suitability of including oats in a gluten-free diet. Coeliac patients consuming oats-containing food should be carefully monitored, until there is more evidence to show the safety of oats and varieties of low-toxicity oats.

Mycoses, Dec 1, 2002

Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had c... more Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had contact with Africans, and two due to Trichophyton schoenleinii in an African and an Italian child, respectively, are reported. Infections caused by anthropophilic dermatophytes are rare in Italy and are related to immigration. The most frequent agents of tinea capitis in Italy are zoophilic dermatophytes. Zusammenfassung. Wir beschreiben 4 Fälle von Tinea capitis bei Kindern, zwei davon mit Trichophyton soudanense als Erregern, die bei Italienern beobachtet wurden, die in Kontakt mit Afrikanern waren. Die anderen zwei Fälle, verursacht durch Trichophyton schoenleinii, waren jeweils bei einem italienischen und einem afrikanischen Kind beobachtet worden. Infektionen durch anthropophile Dermatophyten sind selten in Italien, wo die häufigste Ursache von Tinea capitis zoophile Dermatophyten sind. Sie sind eng mit dem Phänomen der Einwanderung verbunden.

Background. Onchocerciasis, commonly known as river blindness, is a parasitic infection afflictin... more Background. Onchocerciasis, commonly known as river blindness, is a parasitic infection afflicting 18 million people worldwide. The causative organism, Onchocerca volvulus, is a filarial nematode transmitted by infested black flies of the genus Simulium, which are found near freely flowing waterways. Simulium kaffaense has been identified as the vector in Ethiopia and East Africa. Methods. We analyzed the cases of onchocerciasis observed at the Italian Dermatological Centre (IDC) in Mekele, capital of Tigray, the northern region of Ethiopia, between January and December 2007. Results. Fifhteen patients (six females and nine males) with onchocerciasis were seen at IDC. All patients were from the Tigray region. In all cases, there was a long history of diffuse itching and chronic dermatitis, particularly involving the buttocks and lower limbs. Conclusions. Onchocerciasis represents a major public health problem in the tropical and subtropical regions of 37 endemic countries. Onchocerc...

Redia-Giornale Di Zoologia, 2006

Aim. Desloratadine (DL) is an effective treatment for chronic idiopathic urticaria (CIU) symptoms... more Aim. Desloratadine (DL) is an effective treatment for chronic idiopathic urticaria (CIU) symptoms, but there is little information about its impact on patients' perceived general wellbeing. The primary objective was to measure the effect of DL on the quality of life (QoL) of CIU patients, using the Dermatology Life Quality Index (DLQI). Secondary objectives were: evaluation of the effects of DL on pruritus and number of hives, sleep and daily activities, overall CIU condition, and assessment of therapeutic response. Safety and tolerability of DL were also evaluated. Methods. Two-hundred and fifty-five patients, aged 18-79 years and with moderate to severe CIU, were treated with DL 5 mg once daily for 28 days. Patients recorded signs and symptoms scores daily, and completed the DLQI questionnaire at baseline and on treatment days 7, 14, 21 and 28. Patients and investigators jointly evaluated overall CIU condition and therapeutic response at days 14 and 28. Results. After 28 days of treatment, DL significantly reduced mean overall DLQI score from 9.4 (\ub15.4) at baseline to 3 (\ub14.1) (-66.1%; P<0.001), with no significant differences between moderate and severe patients. Improvement in QoL was significant (P<0.001) at all time points and for all DLQI domains. All signs and symptoms scores were significantly correlated with DLQI score. Conclusion. Treatment with DL 5 mg for 4 weeks significantly improves symptoms and QoL in patients with CIU, irrespective of disease severity, and with a rapid onset of action

Journal of Investigative Dermatology, 2000

The International journal of periodontics & restorative dentistry

Screw loosening can damage the interfaces of implant components, resulting in susceptibility to c... more Screw loosening can damage the interfaces of implant components, resulting in susceptibility to contamination of the internal parts by microorganisms. The aim of this study was to investigate the impact of abutment screw retightening on the leakage of two different types of bacteria, Streptococcus sanguinis and Fusobacterium nucleatum, and of the yeast Candida albicans. Two types of implant-abutment systems with tube-in-tube interfaces were tested. Groups A and B each used a different type of system that consisted of 20 different pieces that were assembled according to the manufacturer's torque recommendations; four samples in each group were closed just one time, four samples three times, four samples five times, four samples seven times, and four samples nine times. The implants of groups A and B were contaminated with 0.1 μL of microbial solution just before being assembled for the last time to minimize the possibility of contamination. Results showed a direct correlation bet...

European Archives of Oto-Rhino-Laryngology, 2013

Although many immunologic mechanisms have been investigated in studies of the pathogenesis of cho... more Although many immunologic mechanisms have been investigated in studies of the pathogenesis of cholesteatoma, the role of pattern recognition receptors (PRRs) has not been fully determined. Therefore, we assessed innate immune responses in patients with cholesteatoma. We prospectively evaluated 21 patients with acquired cholesteatoma between August 2010 and July 2012. Cholesteatoma specimens were obtained during surgery, and skin from the external meatus of each patient was used as a control. RNA was extracted from these tissue samples, followed by real-time PCR to quantitatively assess the relative expression of toll-like receptors (TLRs), NOD-like receptors (NLRs), retinoic acid-inducible gene (RIG)-I, NO synthase (NOS) and cytokines. The levels of TLR-2,-3,-4,-6,-7, and-10, NOD-2, and IL-1 and-8 mRNAs were significantly higher in the cholesteatoma than in the skin specimens (p \ .05). The expression levels of TLR-2 and-3, RIG-I, IL-6, and TNF-a mRNAs were significantly higher in cholesteatomas from women than from men. The levels of TLR-8, NOD-2, IL-12, and TNF-a mRNAs were significantly higher in recurrent than in initial cholesteatoma specimens (p \ .05). Hearing level did not correlate with the levels of expression of mRNAs encoding TLRs, NLRs, NOS, RIG-I and related cytokines (p [ .05). In conclusion, alterations in innate immunity triggered by PRRs are important in the pathophysiology of cholesteatoma. Gender differences and frequency of surgery may affect the expression of PRRs in cholesteatomas.

Dermatology, 2001

Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis c... more Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. Objective: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. Patients and Methods: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. Results: Dire...

Biomedical Materials, 2010

The association of Morse taper implant-abutment design with the use of a smaller abutment diamete... more The association of Morse taper implant-abutment design with the use of a smaller abutment diameter (platform switching) may improve dental implant success rate and prevent peri-implant bone loss. The aim of the present study was to histologically and histomorphometrically evaluate the behavior of peri-implant tissues around an implant with a conical connection associated with platform switching. A platform-switched Morse-cone connection implant was inserted in the left posterior mandible of a 61-year-old patient. The implant was inserted at the level of the alveolar crest. After 11 months from placement and 6 months of loading, the implant was retrieved for psychological reasons and processed for histological evaluation. The retrieved implant was wholly surrounded by bone tissue, except for a small area in the apical portion. At higher magnification, in the coronal portion of the implant, it was possible to observe bone directly at the implant platform level. No resorption of the coronal bone was present, except for 0.2 mm on the vestibular aspect. Crestally, bone remodeling with areas of newly formed bone was detected; the bone-implant contact was 73.9%. Apposition of bone was detected even upon the platform. Peri-implant crestal bone preservation can be achieved with the combination of Morse taper conical internal implant-abutment connection with the use of a smaller abutment diameter (platform-switching).

Pacini Edtore Medicina, 2014

Acta dermatovenerologica Croatica : ADC, 2013

ABSTRACT Tinea incognito is a dermatophytosis with atypical clinical manifestation in the absence... more ABSTRACT Tinea incognito is a dermatophytosis with atypical clinical manifestation in the absence of the typical &quot;ringworm&quot; (1). The term tinea incognito was originally used in 1968 by Ive and Marks in 14 patients with atypical dermatophytic infection caused by a previous steroid treatment (2) . Since then, several cases of tinea incognito have been described after topical application of pimecrolimus and tacrolimus, although the use of corticosteroids continues to be the most common trigger of the disease (3). A 47-year-old woman presented at our Institute with a 3-month history of erythematous papules with rare pustules on the face. The patient reported a three-month application of topical corticosteroids and metronidazole cream with progressive exacerbation of the eruption. Physical examination revealed numerous papules and some pustules forming an erythematous plaque localized on the face (Fig.1). No pathologic signs were observed on the rest of the body and nails. The patient&#39;s history was otherwise unremarkable. Scrapings from the facial lesion, examined directly in 10% potassium hydroxide solution, showed the presence of dermatophyte hyphae. Culture on Mycosel Agar (agar-dextrose + cycloeximide + chloramphenicol) at 27 °C for three weeks yielded colonies with a powdery and granular surface and yellowish reverses (Fig. 2). Microscopically, we observed round and pyriform microconidia, spiral hyphae and rare smooth-walled macroconidia. These findings confirmed the diagnosis of dermatophyte infection caused by Trichophyton mentagrophytes vr. mentagrophytes. A diagnosis of rosacea-like tinea incognito was made and the patient started therapy with oral terbinafine 250 mg/die for 4 weeks, with progressive and total resolution of the facial lesions. Tinea faciei, a relatively uncommon dermatophyte infection, usually shows up as an erythematous, scaly patch with an annular edge, the size of which gradually increases. Clinical presentation of the condition is often atypical. The absence of classical features of ringworm, likely because of the complex anatomy of the face, makes the initial diagnosis difficult and often leads to misdiagnosis of tinea faciei (1). A broad range of skin diseases, like seborrheic dermatitis, cutaneous candidiasis, atopic dermatitis, contact dermatitis, granuloma annulare, systemic and discoid lupus erythematosus, rosacea, drug-induced lupus, perioral dermatitis, pityriasis alba, pityriasis rosea, sarcoidosis, tuberculosis, psoriasis vulgaris, and polymorphic light eruption can mimic tinea facei (1-3). This can lead to misdiagnosis of the disease, consequential use of steroids, and finally to worsening of the disease and onset of tinea incognito. The pathogenesis of tinea incognito is presumably linked to a steroid-modified response of the host to fungal infection rather than to a direct pharmacological effect on the mycete (3). Topical steroids suppress the local immune response and allow the fungus to grow easily. As a result, the fungal infection may take on a bizarre appearance. The prevalence of dermatophytes responsible for the condition shows marked geographical variation (4,5). In Italy, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum, and Trichophyton erinacei have been reported as the main etiologic agents (5). Tinea faciei responds to treatment with topical or⁄and oral antifungals. Patients with highly inflamed lesions, resistant, extensive and complicated disease, or those with multiple plaques may require oral antifungal therapy, as in our case. Terbinafine, itraconazole, and fluconazole have been shown to be superior to griseofulvin because they concentrate at the level of the skin (4). The presented case highlights the importance of considering tinea on the differential diagnosis of all facial eruptions and the essential role of mycological examination to make a correct diagnosis and treatment.

International journal of immunopathology and pharmacology

Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. ... more Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. albicans is the most common pathogen; however, other emerging Candida species are also responsible for this condition. Few data are available about the occurrence of Candida species in the oral cavities of denture-wearing immigrants to Italy. In this study, we compare the Candida species found in the oral mucosa and on dentures from a population of denture wearing immigrants to Italy to a matched Italian group. Oral swabs were collected from dentures and the underlying mucosa of patients enrolled in the study and were then cultured to test for the presence of Candida species in each sample. Out of 168 patients enrolled (73 Italians and 95 immigrants), 51 Italians (69.8 percent) and 75 immigrants (78.9 percent) tested positive for the presence of Candida. Candida albicans was the most frequently observed species overall; however, we found a higher occurrence of C. glabrata among immigrant...

Skinmed

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) ... more In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling...