Sclerodermoid chronic graft-versus-host disease (scGVHD) is a severe complication of allogeneic haematopoietic stem cell transplantation. The aim of this study was to investigate the usefulness of high-frequency ultrasound of the skin in assessing the inflammatory patterns and prognosis of patients with scGVHD. A prospective study was carried out with patients who developed scGVHD in the period June 2016 to April 2018. Clinical and ultrasound examinations were performed on the first visit and at 6-month follow-up. A total of 24 patients were included in the study. A 6-month follow-up high-frequency ultrasound of the skin was performed on 20 of the 24 patients. Abnormal B-mode findings in high-frequency ultrasound of the skin consisted of hypoechogenic dermis, hypoechogenicity of septa and hyperechogenicity of lobules in hypodermis. No differences were observed in these basal parameters between treatment progressive/non-responding and inactive/responding scGVHD groups of patients. Basal Doppler showing increased vascular flow with a systolic peak ≥10 cm/s and a vascular resistance index ≥ 0.70 was observed only in those patients who developed progressive/non-responding scGVHD (62.5% vs 0% p = 0.006). In conclusion, Doppler ultrasound is a useful tool to assess the inflammatory activity and outcome of scGVHD. These findings could enhance patient management and help to guide treatment decisions.

Objectives This study aimed to validate dermatologic ultrasound as a complementary teledermatologic imaging modality in primary and tertiary care centers. Methods Six primary care centers and 1 tertiary care dermatology department collaborated in the program. Images were sent through the institutional teledermatologic platform to the tertiary care dermatology department. At the reference hospital, ultrasound images and clinical data were received and registered by a physician trained in dermatologic ultrasound. An in‐person consultation was scheduled to confirm the teleultrasound diagnosis. The time of response by the tertiary center, quality and size of the teledermatologic image, and concordance with the in‐person diagnosis were assessed for each dermatologic lesion. Results A total of 147 teleultrasound consultations with 143 patients (93 women and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and January 2019. Nine teleultrasound consultations (6.1%) were not valid. Discordance between teleultrasound and the in‐person diagnosis was evident in 6 of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 100%), although 2 cases of benign lesions were telediagnosed as malignant (specificity, 97.8%). The positive and negative predictive values of a teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, respectively. Conclusions Asynchronous primary care teleultrasound combined with dermatologic ultrasound training at tertiary centers is an effective teledermatologic modality.

Background: Deep-learning algorithms (DLAs) have been used in artificial intelligence aided ultrasonography diagnosis of thyroid and breast lesions. However, its use has not been described in the case of dermatologic ultrasound lesions. Our purpose was to train a DLA to discriminate benign form malignant lesions in dermatologic ultrasound images. Materials and methods: We trained a prebuilt neural network architecture (Efficient-Net B4) in a commercial artificial intelligence platform (Peltarion, Stockholm, Sweden) with 235 color Doppler images of both benign and malignant ultrasound images of 235 excised and histologically confirmed skin lesions (84.3% training, 15.7% validation). An additional 35 test images were used for testing the algorithm discrimination for correct benign/malignant diagnosis. One dermatologist with more than 5 years of experience in dermatologic ultrasound blindly evaluated the same 35 test images for malignancy or benignity.Results: EfficientNet B4 trained dermatologic ultrasound algorithm sensitivity; specificity; predictive positive values, and predicted negative values for validation algorithm were 0.8, 0.86, 0.86, and 0.8, respectively for malignancy diagnosis. When tested with 35 previously unevaluated images sets, the algorithmt's accuracy for correct benign/malignant diagnosis was 77.1%, not statistically significantly different from the dermatologist's evaluation (74.1%). Conclusion:An adequately trained algorithm, even with a limited number of images, is at least as accurate as a dermatologic-ultrasound experienced dermatologist in the evaluation of benignity/malignancy of ultrasound skin tumor images devoid of clinical data.

BackgroundThe growing use of expensive drugs has brought about the introduction of new strategies to optimise financial resources in hospital pharmacy. Some sterile preparations of expensive drugs are reconstituted in medical wards. Frequently, available preparations don’t match with patient doses, therefore part of the reconstituted drug is lost.PurposeTo assess the financial impact of pharmacy reconstitution of preparations for individual patients, in order to improve the drug reconstitution process.Material and methodsA prospective study was carried out in a university hospital between June 2013 and June 2014. We studied drugs reconstituted in a laminar fluid cabinet (LFC) excluding cytotoxics, biological drugs and parenteral nutrition solutions. Additionally, we reviewed the most expensive drugs reconstituted in out-patients, chosen after a pilot financial study. These drugs were reconstituted by pharmacy staff by a volumetric method of preparation instead following the manufacturer’s instructions, using the entire volume of the vial, including overfill and without discarding drug leftovers. Data collected: number of treatments, type of drugs, time of preparation and savings.ResultsThe most expensive drug reconstituted in outpatient wards was levosimendan. In LFCs ganciclovir and foscarnet were chosen. Total of treatments: 44, levosimendan 12 (27.27%), ganciclovir 26 (59.09%), foscarnet 6 (13.64%). Savings: €9,100.68; levosimendan: €3,629.4 (39.88%), ganciclovir €2,249 (59.09%), foscarnet: €3,221.84. Pharmacy compounding time: 5 (3–8) minutes. In terms of the technician’s annual salary, average cost per preparation was €0.75 (0.45–1.35). Total cost of technician per year: 33€. Total savings: € 9,067.68.ConclusionPreparation by the Pharmacy staff represents an efficient strategy. The estimated annual savings were up to €9000, with only €40 of investments. The implementation of strategic cost management in the process of drug reconstitution is key to improve efficiency and profitability.References and/or AcknowledgementsNo conflict of interest.