Publications by authors named "Tommasino N"

The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities. While HS typically affects the anogenital and intertriginous regions, elderly patients may exhibit atypical features such as the involvement of the neck, mammary area and gluteal region. The prevalence of HS in the elderly population is lower and the average age of disease onset is higher than in patients under 65.

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Article Synopsis
  • Pityriasis rubra pilaris (PRP) is a rare skin disease that causes red and scaly patches, making it hard to treat.
  • Because PRP is uncommon and can sometimes get better on its own, studying how to treat it is tricky.
  • New medicines that target specific parts of the immune system, like IL-17 and IL-23, have shown some promise for treating PRP, but more research is needed to understand how well they work.
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Several studies have described increased risk ratios of certain types of malignancies in patients with severe psoriasis. Among these, the lymphoproliferative disorders, including non-Hodgkin's lymphoma, cutaneous T-cell lymphoma and non-melanoma skin cancer, have been described most frequently. In addition to traditional cancer risk factors, some psoriasis treatments may also be implicated as potential carcinogens.

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Introduction: Psoriatic arthritis (PsA) is an immune-inflammatory disease that affects both joints and entheses, and with diverse extra-articular manifestations (psoriasis, inflammatory bowel disease (IBD), and uveitis). A wide range of comorbid conditions, including cardiovascular diseases, obesity, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), mental health disorders (depression/anxiety), and osteoporosis are highly prevalent in course of PsA.Biological DMARDs (bDMARD), including TNF-inhibitors (TNFi), Interleukin (IL-17i) and IL-23i represent the cornerstone of the management of active disease.

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Article Synopsis
  • Current psoriasis therapies face challenges like patient compliance, safety concerns, effectiveness issues, and side effects, leading to ongoing clinical trials for new treatments.
  • This review aims to summarize existing research and explore trends in psoriasis management, utilizing resources like PubMed and clinicaltrials.gov.
  • Despite available treatments, there is a need for more effective options for moderate to severe psoriasis, emphasizing the importance of developing innovative therapies to tailor patient care and improve outcomes.
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Psoriasis is a chronic inflammatory cutaneous disease with multifactorial pathogenesis involving both genetic and environmental factors as well as the innate and acquired immune response. Several triggering factors may exacerbate or worsen the disease. In this context, we performed a review manuscript with the aim of investigating current literature on psoriasis risk factors, also showing possible mechanisms by which they act on psoriasis.

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  • Tildrakizumab is an IgG1/k monoclonal antibody that targets the p19 protein of IL23, and while it is known to be effective and safe, there is limited data on its use in patients who have previously failed anti-IL17 treatments.
  • A study involving 23 patients who had not succeeded with anti-IL17 therapies showed significant improvement in psoriasis symptoms after 28 weeks of treatment with tildrakizumab, with many achieving substantial PASI scores.
  • The study concluded that tildrakizumab could be a promising treatment option for psoriasis patients unresponsive to anti-IL17 therapies, with no severe side effects reported.
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The management of patients affected by moderate-to-severe psoriasis may be challenging, in particular in patients with serious infectious diseases [tuberculosis (TB), hepatitis B and C, HIV, COVID-19]. Indeed, these infections should be ruled out before starting and during systemic treatment for psoriasis. Currently, four conventional systemic drugs (methotrexate, dimethyl fumarate, acitretin, cyclosporine), four classes of biologics (anti-tumour necrosis factor alpha, anti-interleukin (IL)12/23, anti-IL-17s, and anti-IL-23], and two oral small molecules (apremilast, deucravacitinib) have been licensed for the treatment of moderate-to-severe psoriasis.

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Atopic dermatitis (AD) is a common inflammatory skin disease with multiple clinical manifestations. Among AD phenotypes, psoriasiform AD shows the coexistence of eczematous itching lesions in flexural areas with psoriasiform plaques. The use of anti-interleukin (IL)-4 and anti-IL-13 in psoriasiform AD may lead to therapeutic failure or worsening of manifestations.

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Introduction: Nowadays, despite the wide availability of biological drugs and apremilast for psoriasis management, there is always a need for new therapies to customize the therapeutic approach on the basis of the patient's clinical features and comorbidities, especially in order to achieve a prolonged therapeutic response. Thus, new treatment strategies are required to offer patients a personalized approach. In this scenario, major knowledge on psoriasis pathogenesis led to the development of deucravacitinib, an orally administered selective TYK2 inhibitor.

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Psoriasis is now considered a systemic disease, and several comorbidities have been described such as cardiovascular diseases, neurologic and psychiatric disorders, chronic inflammatory bowel disease, psoriatic arthritis, etc. Regarding cardiovascular comorbidities, major adverse cardiovascular events have been reported in psoriasis patients by multiple epidemiologic studies. Moreover, smoking, obesity, metabolic syndrome, hypertension, dyslipidemia, diabetes and reduced physical activity are associated with psoriasis, increasing cardiovascular risk.

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Teledermatology may be defined as the application of telemedicine to dermatology. According to published data, teledermatology is more widespread in Europe and North America, probably where resources for health care are greater than in other areas of the world. Indeed, teledermatology requires advanced technology to be efficient, as high image quality is necessary to allow the dermatologist to make correct diagnoses.

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Article Synopsis
  • Managing hidradenitis suppurativa (HS) has been tough for dermatologists, with adalimumab being the only biologic approved since 2015, showing mixed effectiveness around 70%.
  • The chronic nature of HS and variability in treatments highlight the need for new therapeutic options.
  • Recently, the FDA approved secukinumab for moderate to severe HS, and a case study reported successful treatment of a 17-year-old with Guselkumab, confirmed effective after 52 weeks.
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Lichen sclerosus (LS) is a chronic inflammatory dermatosis typical of the genital region, with rare involvement of extragenital areas and particularly the face. LS therapeutic management is challenging, and common therapies including topical and systemic corticosteroids, topical calcineurin inhibitors, surgery are often ineffective. Herein, we present a case of LS occurred in a 36-year-old girl with facial involvement resistant to therapy with systemic corticosteroids and topical tacrolimus.

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Background: The main obstacle to obtaining lungs for transplantation is the shortage of donors. Once potential donors have been offered to transplant programs, the acceptance rate is highly variable, ranging from 5% to 20%. Minimizing donor leakage by converting potential lung donors into real donors is one of the key elements to improve results, and it is essential to have tools that facilitate decision-making in this scenario.

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Background: Guselkumab, tildrakizumab, and risankizumab, acting on interleukin(IL)23 axis, have been recently approved for psoriasis management. However, real-life data regarding their comparison are scant.

Objectives: The aim of our real life study was to perform an indirect efficacy and safety comparison among anti-IL23s, particularly focusing on difficult-to-treat areas.

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The detection of brain death (BD) plays a fundamental role in the management of hospital donation. Delayed diagnosis of BD is the main cause of donor loss. A tool for monitoring and prognosis in the neurocritical patient is essential to meet these objectives.

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Introduction: The improvement in understanding the process that determines the death of an individual and his or her evolution toward brain death allows organization and planning of health policies, optimization of clinical activity and management of organ and tissue procurement processes for transplantation.

Objective: This study sought to analyze the epidemiological and evolutionary profile of patients with spontaneous subarachnoid hemorrhage (SAH) with a Glasgow Coma Scale score (GCS) ≤8 who entered follow-up in the Neurocritical Patient Monitoring Program (SPN) of Instituto Nacional de Donación y Trasplante (INDT), Uruguay.

Materials And Methods: SPN, a monitoring and follow-up program for neurocritical patients with GCS ≤ 8, prospectively collected data from 5 public and private intensive care units.

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Objective: To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy.

Methods: Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit.

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Introduction: The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD.

Materials And Methods: This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447).

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Introduction: The increase in the number of donors is the main objective of all transplantation organizations around the world. Further understanding of the factors involved in increasing donation rates is very important for planning future strategies to improve outcomes in each country.

Objective And Method: With this purpose we analyzed the relationship between social and economic factors of the countries and organizational aspects of health systems and institutions dedicated to transplantation in relation to the number of actual donors per million population.

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