Proliferative verrucous leukoplakia (PVL) was first described by Hansen, Olson, and Silverman in 1985 as a form of hyperkeratosis, remained resistant to treatment and was further distinguished by the aggressive nature of the lesions and a high rate of malignant transformation (MT). The OPMDs classification developed in 2020 recognized PVL as a distinct form of multifocal oral leukoplakia, characterized by a progressive clinical course and with changing clinical and histopathological features. According to WHO, the risk of malignant transformation of PVL among OPMDs is approximately 50%. This frequent MT of PVL involves transformation into VC or OSCC, which, according to various sources in the literature, occurs in between 43.87% and 65.8% of cases, and according to some in up to 70% of cases. Some reports even suggest a possible malignant transformation rate of around 100%. PVL usually occurs in multiple areas of the oral cavity simultaneously and is characterized by slow but continuous progression. The aetiology of PVL and the factors influencing its progression to cancer are unknown. Close monitoring of patients is recommended and, if necessary, biopsies should be performed to assess changes in the appearance, colour, and size of observed lesions, as well as the appearance of subsequent lesions. Early diagnosis, surgical removal, and patient observation are crucial in the treatment of PVL.
Despite effective antiretroviral therapy (ART), no clear guidelines exist on microbiome-targetednadjuncts for people living with HIV (PLWH). Human immunodeficiency virus (HIV-1) infection damages the gastrointestinal tract by altering the mucosal surface and prompting dysbiosis. Gut microbial imbalance, characterized by the predominance of opportunistic bacteria, leads to increased microbial translocation, which, in turn, results in chronic inflammation, digestive tract symptoms, and reduced quality of life. PLWH have substantial dysbiosis compared to healthy controls. In addition, gastrointestinal complications occur as a side effect of ART treatment. Gut-associated lymphoid tissue (GALT) harbors the majority of CD4+ lymphocytes, and this population is significantly depleted during HIV-1 infection. Antiretroviral therapy does not facilitate CD4+ lymphocyte restoration in GALT tissue. Even if the general CD4+ lymphocyte count increases, the GALT CD4+ count, despite therapy, remains stable and low due to unknown causes. Research assessing probiotics in PLWH on ART has yielded mixed results. Some studies report that probiotics may increase CD4+ T cell counts, improve gut barrier integrity, and reduce the incidence of diarrhea in HIV-positive patients. These benefits may be linked to specific probiotic strains that possibly enhance immune function by promoting regulatory T cell populations, thus decreasing microbial translocation. On the other hand, multiple studies did not show any consistent or significant benefits from probiotic supplementation for PLWH. This article assesses critical clinical trials and systematic reviews on this topic, based on limited existing research data. More data from large clinical trials on this topic is needed to assess whether this is or is not a justified new clinical approach for HIV-1-positive patients.
INTRODUCTION:Patients with psoriasis treated with biologic therapy are considered to have increased risk of developing skin neoplasms. The impact of novel therapies on the development and biology of melanocytic lesions is not completely known. The aim of the study was assess if the treatment with biologics exerts effects on the melanocytic nevi. MATERIAL AND METHODS:Dermoscopy and videodermoscopic imaging of 276 melanocytic lesions were performed at the initial visit and after one year in 13 patients with psoriasis treated with IL-12/23 inhibitors, IL-23 inhibitors or IL-17 inhibitors. RESULTS:The nevi size significantly increased at the one-year follow-up in the whole study group and in patients treated either with IL-23 inhibitors or IL-12/23 inhibitor. 2% of melanocytic nevi showed an increase in any of the scores (ABCD score, 7-Point Checklist score, CASH score) or at least 1-mm change in the diameter at the one-year follow-up; however, these changes were not statistically significant between the different therapy groups. CONCLUSIONS:Although treatment with novel groups of biologics leads to an increase in nevi size, it does not contribute to significant structural or color changes in melanocytic nevi or to the development of dysplastic nevi or melanoma at the one-year follow-up.
Pregnancy and the postpartum period are associated with physiological, hormonal, and hemodynamic changes that may increase susceptibility to cervical artery dissection. Structural alterations of the arterial wall can result from a variety of factors, predisposing vessels to injury and subsequent neurovascular events. In the present study, we analysed the contribution of multiple factors to the development of cervical artery dissection in pregnant women, including advanced maternal age, hormonal status, hypertension, hyperlipidaemia, connective tissue disorders, arterial malformations, migraine, adverse or rapidly changing head and neck positions, neck trauma, chiropractic manipulation, the presence of an elongated styloid process, pressure-inducing activities, and physical exercise.
Congenital central hypoventilation syndrome (CCHS) and Hirschsprung's disease (HD) belong to neurocristopathies - autonomic nervous system defects caused by abnormal neural crest cells migration. Their co-occurrence defines Haddad Syndrome (HS) associated also with increased risk of neural crest origin tumors, mainly neuroblastoma (NBL), and PHOX2B gene mutation. This case concerns a male newborn presenting respiratory failure minutes after birth. Due to sleep apnea and increasing hypercapnia, he required intubation. Genetic testing revealed an anomaly in PHOX2B gene. In subsequent days, the patient did not pass the meconium, which, based on the imaging tests and biopsy, raised a suspicion of HD. The boy was diagnosed with HS and additional diagnostic measures, including cancer screening, were ordered, owing to the syndrome's characteristics. Awareness of such conditions enables clinicians to implement targeted management that may significantly improve long-term outcomes and quality of life for affected children.
