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Medical News in a Nutshell 8/2020

PRIME Time in Rheumatoid Arthritis

Identification of preinflammatory mesenchymal, or PRIME, cells — that appeared in blood just before disease flares, by sequential RNA analysis before and during flares of RA

Roflumilast Cream for Chronic Plaque Psoriasis

Roflumilast cream contains a PDE-4 inhibitor

The mean baseline PASI scores were 7.7 in the roflumilast 0.3% group, 8.0 in the roflumilast 0.15% group, and 7.6 in the vehicle group; the mean change from baseline at week 6 was −50.0%, −49.0%, and −17.8%

Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus

Nemolizumab is a subcutaneously administered humanized monoclonal antibody against interleukin-31 receptor A

The median VAS score (0-to-100 scale when the baseline score is 100)

 for pruritus at baseline was 75. At week 16, the mean percent change in the VAS score was −42.8% in the nemolizumab group and −21.4% in the placebo group 

The mean percent change in the EASI (0-72) score was −45.9% with nemolizumab and −33.2% with placebo.

DLQI score of 4 or less was 40% in the nemolizumab group and 22% in the placebo group

DLQI; (range, 0 to 30, with higher scores indicating a greater effect on daily life)

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COVID-19 in kids

Kawasaki like Syndrome – „pediatric inflammatory multisystem syndrome“ or PIMS or „multisystem inflammatory syndrome in children“ or MIS-C. Skin or mucous membranes were involved in up to 87% of the children

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An image to remember

Es handelt sich um ein Symptom des Cowden Syndroms:

Genetic testing was performed and showed an inactivating mutation in the tumor-suppressor gene encoding phosphatase and tensin homologue (PTEN). The Cowden syndrome, an autosomal dominant PTEN hamartoma syndrome, is associated with an increased risk of breast, thyroid, endometrial, and other cancers. Oral mucosal papillomas are commonly associated skin lesions. Adapted from N Engl J Med 2020; 382:e29

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Artificial Intelligence (AI) plus the doctor out performs AI or doctor alone

In Nature Medicine für Sie nachgelesen: AI-based support of clinical decision-making improves diagnostic accuracy over that of either AI or physicians alone 

We further find that AI-based multiclass probabilities outperformed content-based image retrieval (CBIR) representations 
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Wenn die Zielscheibe fehlt…

Die durch Zecken übertragene Borreliose Erkrankung an der Haut verursacht eine typische „schiessscheibenartige“ ringförmige Hautveränderung. Auf dunkler Haut fehlt diese Veränderung oft, ein Umstand, welches die Erkennung auf dunkler Haut erheblich erschwert. Hier hilft das „heuristische“ Prinzip der Einseitigkeit weiter: jede solitäre, einseitige, einzelstehende oder assymmetrische Hautveränderung ist eine Infektion oder Tumor bis zum Beweis des Gegenteils.

Panel A shows an erythematous nodule; Panel B shows erythema migrans. The image in Panel A is reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol 2011;64:619-36, with permission from Elsevier. The image in Panel B is from the Centers for Disease Control and Prevention/James Gathany.

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Down Syndrom (Trisomie 21) an der Haut

Nachgelesen im New England Jounral of Medicine (June 11, 2020 N Engl J Med 2020; 382:2344-2352)

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Off-Label Einsatz von Dupilumab

Dupixent ist ein Biologikum (Biological) mit Zulassung bei schwerer Neurodermitis. Eine schwere Infektion mit Coccidioidomycosis wurde erfolgreich mit Interferon-γ und Dupilumab (im New England Journal of Medicine publiziert) behandelt:

„Risk factors for disseminated coccidioidomycosis include pregnancy, immunosuppression, HIV and acquired immunodeficiency syndrome, and monogenic defects of the interleukin-12–interferon-γ axis2— all states in which type 2 immunity dominates over type 1 immunity. In this report, we showed that treatment with interferon-γ (augmenting type 1 immunity) in combination with dupilumab (suppressing type 2 immunity) resulted in complete resolution of disease in a patient with life-threatening disseminated coccidioidomycosis who had no known monogenic immunodeficiency. These observations imply that a relative insufficiency of type 1 immunity combined with strong type 2 responses confers susceptibility to disseminated coccidioidomycosis. We propose that restoring the balance between type 1 and type 2 immunity enables clinical improvement and that the relative differentiation state of helper T cells may serve as a useful biomarker in this disease.“