Stefano Gentileschi MD, Antonio Vitale MD, Donato Rigante MD PhD, Giuseppe Lopalco MD, Giacomo Emmi MD PhD, Ida Orlando MD, Gerardo Di Scala MD, Jurgen Sota MD, Claudia Fabiani MD PhD, Bruno Frediani MD, Mauro Galeazzi MD, Giovanni Lapadula MD, Florenzo Iannone MD and Luca Cantarini MD PhD
Background: Clinical research is needed to identify patients with axial spondyloarthritis (axSpA) who are more likely to be responsive to interleukin (IL)-17 inhibition.
Objectives: To evaluate short-term efficacy of secukinumab in the management of axSpA.
Method: Twenty-one patients (7 males, 14 females) with axSpA were consecutively treated with secukinumab. Laboratory and clinical assessments were based on erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Data were recorded at baseline and at a 3 month follow-up visit.
Results: The study was comprised of 21 patients. Both BASDAI and ASDAS-CRP showed a statistically significant reduction between the baseline and the 3 month visit (P < 0.0001 and P = 0.0005, respectively). During the laboratory assessment, ESR showed a significant decrease (P = 0.008) while CRP improvement did not reach statistical significance (P = 0.213). No statistical significance was observed between patients treated with secukinumab 150 mg vs. 300 mg in BASDAI (P=0.99), ASDAS-CRP (P = 0.69), ESR (P = 0.54), and CRP (P = 0.56). No significant differences emerged between the BASDAI (P = 0.15), ASDAS-CRP (P = 0.09), and CRP (P = 0.15) rates in biologic-naïve patients and those previously failing tumor necrosis factor-α inhibition. Conversely, ESR decrease was significantly higher in the biologic-naïve subgroup (P = 0.01). No adverse events were reported.
Conclusions: Secukinumab has proven remarkable short-term effectiveness, regardless of the biologic treatment line. A dosage of 150 mg proved to be appropriate in the clinical and laboratory management of axSpA.
Hagay Orbach MD, Nimrod Rozen MD PhD, Guy Rubin MD, Eytan Dujovny MD and Noam Bor MD
Background: Supracondylar humerus fractures are the most common elbow fractures in the pediatric population.
Objectives: To evaluate the outcomes of French's corrective osteotomy for correction of post-traumatic cubitus varus deformity in children.
Method: We conducted a retrospective review of medical charts of all patients who had undergone French's corrective osteotomy in our institution from 1998 to 2012. We recorded range of motion, cosmetic deformity, carrying angle, lateral cortex prominence index, hyperextension, and lateral cortex step before and after the surgery.
Results: Seven patients were enrolled the study. Average follow-up time was 4.6 years (range 2–9 years). An average of 18.3º of limited flexion (range 5º–35º) compared to the healthy elbow was recorded in three patients. Lateral condylar prominence was recorded in one patient. The average preoperative carrying angle was -20.5º (range -15º–30º) and postoperative angle was 9.6º (range 7º–13º). In comparison, the average carrying angle in the healthy elbow was 8.5º (range 4º–13º). No lateral cortex prominence was recorded. An average of 27.5º (range 15º–35º) of hyperextension of the distal fragment was recorded immediately postoperatively in four patients; however, during postoperative follow-up, the hyperextension was corrected spontaneously in all patients.
Conclusions: As described by French, osteotomy has the ability to correct the varus deformity only in the coronal plane. However, our research supports the assumption that hyperextension in the sagittal plane might be corrected spontaneously.
Alexander Korytny MD, Adi Kibari MD, Itzhak Rosner MD and Devy Zisman MD
Hymie H. Chera MD, Max Cohen BS, Robert Ishakis BS, Yitzhak Rosen MD, and David J. Ozeri MD FACR
Yuval Cavari MD, Victor Ginzburg MD, Gabriel Szendro MD, Anatoly Leytzin MD, Evelin Novik Farkash MD and Isaac Lazar MD
Dallit Mannheim MD and Ron Karmeli MD
Kosta Y. Mumcuoglu PhD, Vera Leibovici MD, Inbal Reuveni MD and Omer Bonne MD
Delusional parasitosis (DP) is a somatic type of delusional disorder, usually mono-symptomatic, in which the patients are convinced they are being infested with animal parasites while no objective evidence exists to support this belief. The complaints are usually about skin infestation, but involvement of the gastrointestinal tract has also been described. Numerous samples are brought for examination from skin, clothes, and environmental sources, while a detailed description of the “parasite” is given. In primary DP, the delusion arises spontaneously as a mono-delusional disorder, while in secondary DP, the delusional disorder arises secondary to another major medical, neurological, or psychiatric disorder. Practically all patients refuse psychiatric help. Shared psychotic disorder – folie à deux – is a known mode of presentation in delusional parasitosis. More than one member within a family may experience the same delusional state. For diagnosis and treatment of DP, a close collaboration among dermatologists, psychiatrists, and parasitologists is essential. Patients whose delusion of parasitosis is not severe can sometimes be relieved of their symptoms by establishing a reliable and meaningful therapeutic relationship. Symptomatic medication may be prescribed for the relief of pruritus, pain, and other symptoms. In more severe cases, such patients should be treated with psychopharmacological agents.
Asaf Shemer B.Med.Sc, Liron Talmi MD, Dror S. Shouval MD, Gil Har-Zahav MD and Raz Somech MD PhD