Zinc is a key element for growth and development. In this narrative review, we focus on the role of dietary zinc in early life (including embryo, fetus and preterm neonate), analyzing consequences of zinc deficiency and adequacy of current recommendations on dietary zinc. We performed a systematic search of articles on the role of zinc in early life. We selected and analyzed 81 studies. Results of this analysis showed that preservation of zinc balance is of critical importance for the avoidance of possible consequences of low zinc levels on pre- and post-natal life. Insufficient quantities of zinc during embryogenesis may influence the final phenotype of all organs. Maternal zinc restriction during pregnancy influences fetal growth, while adequate zinc supplementation during pregnancy may result in a reduction of the risk of preterm birth. Preterm neonates are at particular risk to develop zinc deficiency due to a combination of different factors: (i) low body stores due to reduced time for placental transfer of zinc; (ii) increased endogenous losses; and (iii) marginal intake. Early diagnosis of zinc deficiency, through the measurement of serum zinc concentrations, may be essential to avoid severe prenatal and postnatal consequences in these patients. Typical clinical manifestations of zinc deficiency are growth impairment and dermatitis. Increasing data suggest that moderate zinc deficiency may have significant subclinical effects, increasing the risk of several complications typical of preterm neonates (i.e., necrotizing enterocolitis, chronic lung disease, and retinopathy), and that current recommended intakes should be revised to meet zinc requirements of extremely preterm neonates. Future studies evaluating the adequacy of current recommendations are advocated.

https://www.mdpi.com/2072-6643/7/12/5542/pdf

Zinc in Early Life: A Key Element in the Fetus and Preterm Neonate

Merkel cell carcinoma (MCC) is an uncommon primary cutaneous neuroendocrine cancer. It most commonly presents as an indurated plaque or nodule on sun-damaged skin in elderly patients and is characterized by high rates of local recurrence and nodal metastasis. Survival at 5 years is 51% for local disease and as low as 14% for distant disease, which underscores the aggressive nature of this tumor and challenges in management. Advances in immunology and molecular genetics have broadened our understanding of the pathophysiology of MCC and expanded our therapeutic arsenal. With this comprehensive review, we provide an update of MCC epidemiology, pathogenesis, clinical presentation, diagnostic evaluation and prognostic markers. The second article in this continuing medical education series explores the evolving landscape in MCC management.

Merkel cell carcinoma: An update and review: Pathogenesis, diagnosis, and staging.

Lichen planus pemphigoides (LPP) is a very rare autoimmune sub-epidermal blistering disease associated with lichenoid skin changes. Initially thought to be a mere variant of more common inflammatory dermatoses, particularly Bullous Pemphigoid (BP) or Lichen Planus (LP), a growing body of evidence suggests that it is a disease entity in its own right. In common with a range of autoimmune blistering diseases, including BP, pemphigoid gestationis (PG), mucous membrane pemphigoid (MMP) and linear IgA dermatosis (LAD), a key feature of the disease is the development of autoantibodies against type XVII collagen (COL17). However, accurately establishing the diagnosis is dependent on a careful correlation between the clinical, histological and immunological features of the disease. Therefore, we present an up to date summary of the epidemiology and etiopathogenesis of LPP, before illustrating the predisposing and precipitating factors implicated in the development of the disease. In addition to a selective literature search, we compare reports of potential drug-induced cases of LPP with pharmacovigilance data available via OpenVigil. We subsequently outline the cardinal clinical features, important differential diagnoses and current treatment options. We conclude by demonstrating that an improved understanding of LPP may not only lead to the development of novel treatment strategies for the disease itself, but may also shed new light on the pathophysiology of more common and treatment-refractory autoimmune blistering diseases.

/pdf/lichen-planus-pemphigoides-from-lichenoid-inflammation-to-2kyykztwdh.pdf

Lichen Planus Pemphigoides: From Lichenoid Inflammation to Autoantibody-Mediated Blistering.

Unusual microorganisms and antimicrobial resistances in a group of Syrian migrants: Sentinel surveillance data from an asylum seekers centre in Italy.

Alpha-1-antitrypsin (AAT) is an acute phase secretory glycoprotein that inhibits neutrophil proteases like elastase and is considered as the archetype of a family of structurally related serine-protease inhibitors termed serpins. Serum AAT predominantly originates from liver and increases three to five fold during host response to tissue injury and inflammation. The AAT deficiency is unique among the protein-misfolding diseases in that it causes target organ injury by both loss-of-function and gain-of-toxic function mechanisms. Lack of its antiprotease activity is associated with premature development of pulmonary emphysema and loss-of-function due to accumulation of resultant aggregates in chronic obstructive pulmonary disease (COPD). This' in turn' markedly reduces the amount of AAT that is available to protect lungs against proteolytic attack by the enzyme neutrophil elastase. The coalescence of AAT deficiency, its reduced efficacy, and cigarette smoking or poor ventilation conditions have devastating effect on lung function. On the other hand, the accumulation of retained mutant proteins in the endoplasmic reticulum of hepatocytes in a polymerized form rather than secreted into the blood in its monomeric form is associated with chronic liver disease and predisposition to hepatocellular carcinoma (HCC) by gain- of- toxic function. Liver injury resulting from this gain-of-toxic function mechanism in which mutant AAT retained in the ER initiates a series of pathologic events, eventually culminating at liver cirrhosis and HCC. Here in this review, we underline the structural, genetic, polymorphic, biochemical and pathological advances made in the field of AAT deficiency and further comprehensively emphasize on the therapeutic interventions available for the patient.

Alpha-1-antitrypsin deficiency: Genetic variations, clinical manifestations and therapeutic interventions.

A cicatrizacao de feridas constitui um processo complexo e coordenado, envolvendo a interaccao entre celulas e varios sistemas mensageiros. Este processo pode dividir-se em 3 fases: inflamatoria, proliferativa e de remo- delacao. O mecanismo exacto das feridas cronicas permanece ainda por esclarecer. Os avancos recentes da biologia molecular permitiram identificar moleculas que evidenciaram novos mecanismos fisiopatologicos das feridas cronicas, assim como possiveis alvos terapeuticos. Este artigo tem como objectivo uma revisao dos mecanismos envolvidos na cicatrizacao, pilar fundamental para a compreensao e abordagem de doentes com feridas cronicas, pratica corrente em Dermatologia.PALAVRAS-CHAVE – Cicatrizacao; Factores de Crescimento; Matriz Extra-celular; Integrinas; Feridas Cronicas.

/pdf/cicatrizacao-de-feridas-4n8j27e6qq.pdf

Cicatrização de Feridas

Background: Pancreatic panniculitis is a rare complication of pancreatic disease occurring in 2% to 3% of all patients, most commonly those with acute or chronic pancreatitis. Main observations: We report the case of a pancreatic panniculitis associated with acute pancreatitis in a 63-year-old man. He presented with a 2-day history of multiple tender subcutaneous nodules, followed by nausea, vomiting, severe epigastric pain and loss of appetite, hours before admission. Laboratory and radiologic findings revealed acute pancreatitis. Histopathological examination from a skin biopsy specimen taken from a nodule showed a mostly lobular panniculitis with "ghost cells", without vasculitis. Nodules disappeared with the resolution of acute pancreatic inflammation, as amylase and lipase levels returned to normal. Conclusions: Panniculitis may be the first manifestation of pancreatic disease. Therefore clinicians must have a high index of suspicion for the diagnosis of pancreatic panniculitis. ( J Dermatol Case Rep . 2014; 8(1): 35-37)

https://repositorio.hff.min-saude.pt/bitstream/10400.10/1601/1/J%20Dermatol%20Case%20Rep.%202014%20Mar%2031%2c%208%281%29%2035-7.pdf

Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis.

Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria. To our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in Portugal but also worldwide. The patient was treated with surgical excision of the lesions and oral itraconazol without relapse.

https://repositorio.insa.pt/bitstream/10400.18/2938/1/alternaria%20publicado%20Med%20Mycol%20Case%20Rep.pdf

Cutaneous infection by different Alternaria species in a liver transplant recipient.

Background: Dermatofibromas are common benign skin neoplasms. Main observations: The authors report the clinical, dermoscopic and histopathological features of a hemosiderotic dermatofibroma mimicking melanoma in an 85-year-old woman. Conclusions: Atypical dermoscopic patterns may prove difficult to differentiate from melanocytic lesions, and because of its polymorphic, melanoma-like presentation, definite diagnosis of hemosiderotic dermatofibroma can be reached by histopathological examination. ( J Dermatol Case Rep. 2015; 9(2): 39-41)

Hemosiderotic dermatofibroma: clinical and dermoscopic presentation mimicking melanoma

Panniculitis is a recognized, but rare complication of α1-antitrypsin (A1AT) deficiency Less than 60 cases have been reported, mostly in the homozygous PiZZ variant We report the case of a 55-year old woman with A1AT panniculitis associated with the heterozygous phenotype PiMS and discrete reduction of A1AT serum levels In addition, the pathophysiology of the disease, clinical and histopathological features, and current treatment possibilities are briefly reviewed

/pdf/alpha-1-antitrypsin-deficiency-associated-panniculitis-a-364hrqusdr.pdf

André Laureano

Papers

Cicatrização de Feridas

Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis.

Cutaneous infection by different Alternaria species in a liver transplant recipient.

Hemosiderotic dermatofibroma: clinical and dermoscopic presentation mimicking melanoma

Alpha-1-antitrypsin deficiency-associated panniculitis: a case report.