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Highlights • An enanthem is a mucosal eruption that precede, follow or occur simultaneously with an exanthem. • Enanthems may be triggered by an underlying infection or a drug received by the patient or both. • Patterns are: vesicular, macular, maculo-papular, maculo-papular-petechial, and petechial. • Erythemato-vesicular and petechial patterns are the most frequent in adults. • Some enanthems are pathognomonic for a disease as Koplik's spots for measles., Globalization entails several medical problems, along with economic and social complications. Migrations from the other continents, increasing numbers of tourists world-wide, importation of foreign parasites, Aedes albopictus for example, have made diseases so far unknown in Europe a reality. The rapid spread of the COVID-19 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as a rash. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.

In response to the Covid-19 outbreak, among other previous "non-pharmaceutical interventions'', on March 22, 2020 the Italian Government imposed an economic lockdown and ordered the closing of all non-essential economic activities. This paper estimates the causal effect of this measure on mortality by Covid-19 and on mobility patterns. The identification of the causal effect exploits the variation in the number of active workers across municipalities induced by the economic lockdown. The difference-in-difference empirical design compares outcomes in municipalities above and below the median variation in the share of active population before and after the lockdown within a province, also controlling for municipality-specific dynamics, daily-shocks at the provincial level and municipal unobserved characteristics. Our results show that the intensity of the economic lockdown is associated to a statistically significant reduction in mortality by Covid-19 and, in particular, for age groups between 30-64 and older. Back of the envelope calculations indicate that 4,793 deaths were avoided, in the 26 days between April 5 to April 30, in the 3,518 municipalities which experienced a more intense lockdown. Assuming linearity, a 1 percentage point reduction in the share of active population caused a 1.32 percentage points reduction in mortality by Covid-19. We also find that the economic lockdown, as expected, led to a reduction in human mobility. Several robustness checks corroborate our empirical findings.

We provide evidence about voters' response to crime policies. Our research design exploits a natural experiment arising from the Italian 2006 collective pardon bill suddenly releasing more than one third of the prison population. The design of the bill created idiosyncratic incentives to recidivate across pardoned individuals and municipalities. We show that municipalities where the incentive to recidivate of resident pardoned individuals was higher, experienced higher recidivism. At the same time, in these municipalities: i) newspapers were more likely to report crime news involving pardoned individuals; ii) voters held worse beliefs on the incumbent government's ability to control crime. Moreover, with respect to the previous elections, the incumbent government experienced a significantly worse electoral performance in the April 2008 elections relative to the opposition coalition. In terms of political cost, our estimates suggest that a one standard deviation increase in the incentive to recidivate (i.e., the random component in the effects of the policy) reduced the margin of victory of the incumbent government by 3.3%. Overall, our findings indicates that voters keep the incumbent government accountable by conditioning their vote on the observed effects of its policies.

We discuss measurement issues in crime rates in a cross-country comparative perspective. We show that while homicide and general crime rates follow quite similar patterns in the US this is not always the case in Europe. We provide an explanation of the observed patterns based on the use of fire harms.

Background & Aims: To better understand the role of small intestinal bacterial overgrowth (SIBO) in rosacea, we aimed to assess the presence of SIBO in patients with rosacea and the clinical effectiveness of its eradication. Methods: We enrolled 113 consecutive rosacea ambulatory patients (31 M/82 F; mean age, 52 15 years) and 60 healthy controls who were sex- and age-matched. Patients and controls underwent lactulose and glucose breath tests (BTs) to assess the presence of SIBO. Patients positive for SIBO were randomized to receive rifaximin therapy (1200 mg/day for 10 days) or placebo. A group of patients with negative BTs were also treated with rifaximin. Eradication was assessed 1 month after the end of therapy. Two dermatologists, unblinded on therapy, evaluated rosacea patients before and after treatment on the basis of an objective scale. Results: The prevalence of SIBO was higher in patients than controls (52/113 vs 3/60, P < .001). After eradication, cutaneous lesions cleared in 20 of 28 and greatly improved in 6 of 28 patients, whereas patients treated with placebo remained unchanged (18/20) or worsened (2/20) (P < .001). Placebo patients were subsequently switched to rifaximin therapy, and SIBO was eradicated in 17 of 20 cases. Fifteen had a complete resolution of rosacea. After antibiotic therapy, 13 of 16 patients with negative BTs for SIBO remained unchanged, and this result differed from SIBO-positive cases (P < .001). Conclusions: This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls. Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

This article presents a unique historical experiment to explore the dynamics of institutional change in the Middle Ages. We have assembled a novel data set, where information on political institutions for northern central Italian cities between 1000 and 1300 is matched with detailed information on the earthquakes that occurred in the area and period of interest. Exploiting the panel structure of the data, we document that the occurrence of an earthquake retarded institutional transition from autocratic regimes to self-government (the commune) in cities where the political and the religious leaders were the same person (episcopal see cities), but not in cities where political and religious powers were distinct (non–episcopal see cities). Such differential effect holds for destructive seismic episodes and for events that were felt by the population but did not cause any material damage to persons or objects. Ancillary results show that seismic events provoked a positive and statistically significant differential effect on the construction and further ornamentation of religious buildings between episcopal and non–episcopal see cities. Our findings are consistent with the idea that earthquakes, interpreted in the Middle Ages as manifestation of the will and outrage of God, represented a shock to people’s religious beliefs and, as a consequence, enhanced the ability of political-religious leaders to restore social order after a crisis relative to the emerging communal institutions. This interpretation is supported by historical evidence.

Background The association of human herpesvirus 6 (HHV-6) and HHV-7 with pityriasis rosea suggests that systemic drugs directed against HHV may hasten recovery of patients with pityriasis rosea. Objective The purpose of this study was to verify the efficacy of oral acyclovir in the treatment of pityriasis rosea. Methods Eighty-seven consecutive patients were treated for 1 week with either oral acyclovir (800 mg 5 times daily) or placebo. In all patients, the time of lesion clearing and the number of new lesions appearing during treatment were recorded. Results On the 14th day of treatment, 79% of treated patients fully regressed compared with 4% of the placebo group. The lesions cleared in 18.5 days in treated patients and in 37.9 days in the placebo group. Clearance was achieved in 17.2 days in patients treated in the first week from onset and in 19.7 days in the patients treated later. On the 7th day, there were significantly fewer new lesions in patients treated in the first week than in those treated later. Limitations This trial was neither randomized nor double blind. Objectivity was achieved by counting the lesions. Conclusion Acyclovir may be effective in the treatment of pityriasis rosea, especially in patients treated in the first week from onset, when replicative viral activity of HHV is probably very high.

This paper uses an original dataset covering the presence of local news in medium-large Italian cities in the period 1993-2010 to evaluate the effects of newspaper entry and exit on electoral participation, political selection, and government efficiency. Exploiting discrete changes in the number of newspapers, we show that newspaper entry increases turnout in municipal elections, the probability of the incumbent mayor being reelected, and the efficiency of the municipal government. We do not find any effect on the selection of politicians. Competition plays a relevant role, as the effects are not limited to the first newspaper entry.