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Association of enthesitis with severity of psoriasis in psoriatic arthritis: an observational study
No full textThe relationship between dermatological and articular manifestations of psoriatic disease remains incompletely elucidated. There is no strong correlation between the severity of cutaneous psoriasis and the clinical phenotypes of psoriatic arthritis (PsA). This study aims to examine the correlation between the severity of psoriasis and various clinical features, including measures of severity and activity of PsA, in a real-world clinical setting. Seventy-six consecutive adult patients of both genders with confirmed diagnoses of psoriatic arthritis (PsA) and psoriasis were included in the study. The Psoriasis Area and Severity Index (PASI) was assessed alongside various PsA variables: tender joint count (TJC), swollen joint count (SJC), duration of morning stiffness, presence of dactylitis and number of affected digits, presence of enthesitis and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), patient’s global assessment (PGA), and examiner’s global assessment (EGA). Associations were analyzed using the Spearman correlation test and the Kruskal-Wallis test. Statistical significance was established at p = 0.05. Forty-two men and thirty-four women, median age of 56 (range 33–85) years, participated in the study. The median duration of psoriasis was 216 (range 0–600) months and median duration of PsA was 120 (range 7–456) months. There was no significant correlation between PASI and any PsA variables, except for the correlation between PASI and the presence of enthesitis (ρ = 0.285; p = 0.013). Moreover, older patients and patients with a long history of psoriasis manifested more often with enthesis as a sign of PsA. Our findings emphasize the correlation between the severity of psoriasis and presence of enthesitis in patients with PsA
One Incremental Stride for Doxycycline, One Substantial Advancement for Thyroid Eye Disease
No full textThe aim of this study is to assess the effectiveness of a 12-week doxycycline treatment for thyroid eye disease (TED), an autoimmune condition associated with thyroid dysfunction. In this randomized controlled clinical trial, 82 patients were randomly assigned at a 1:1 ratio to receive doxycycline (50 mg) or to undergo no treatment. Various metrics, including margin reflex distance (MRD1 and MRD2), eyelid aperture, levator muscle function, lagophthalmos, proptosis, ocular motility, diplopia, and Graves’ ophthalmopathy-specific quality-of-life (GO-QOL) scale scoring were assessed. Exclusion criteria were uncontrolled systemic diseases, tetracycline allergies, pregnancy, lactation, or age below 18. The mean age was 51.6 years (SD), 87.8% of participants were female, and all were Caucasians. By week 12, the doxycycline group exhibited a significant improvement rate based on MRD2 (from 4 to 15 participants with physiological findings), clinical activity score (from 7 to 35 participants with non-active disease), and GO-QOL (from 51.22% to 70.73% of participants with a good life quality). Doxycycline showcased anti-inflammatory and immunomodulatory effects in treating TED, suggesting its potential efficacy for TED and other orbit inflammatory conditions. However, these results warrant further validation through future research involving extended follow-up periods and larger cohorts
Transient clitoromegaly in an extremely preterm twin infant with popliteal pterygium
No full textClitoromegaly can be congenital or acquired, and it is usually associated with exposure to androgen excess. Pathophysiological mechanisms responsible for transient clitoromegaly in premature female infants have not been fully elucidated. Herein, we present the case of an extremely premature female twin infant, with an extensive web of skin on the back of the left leg, hypoplastic left labia majora, and normal clitoris appearance at birth. At the age of 48 days, clitoral enlargement was observed. Significantly elevated levels of gonadotropins, testosterone, and dehydroepiandrosterone sulphate (DHEAS) were recorded. 17-hydroxyprogesterone (17OHP) was unremarkable, and anti-Müllerian hormone (AMH) was low, in accordance with normal female karyotype. Ovaries were not visualised ultrasonographically. During the following weeks, gradual normalisation of gonadotropin, testosterone, and DHEAS levels was accompanied by regression of clitoromegaly. As described in this case, transient clitoral enlargement may appear in extremely premature female infants due to transitory elevated androgens of ovarian and adrenal origin
Pulmonary presentation and coil marcation of dirofilaria lung coin nodes – case report
No full textClinicians face significant diagnostic challenges when dealing with nodal lesions of the lung. The majority of lung nodules are benign; however, a significant number can be cancerous. Dirofilaria infestation should also be considered in the differential diagnosis of nodal lung lesions. Most patients with Dirofilaria infestation are asymptomatic. To determine the etiology of nodal lung infiltrations, procedures like radiological imaging, bronchoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), transthoracic biopsy (TTB), tumor markers, nonspecific serological tests, or surgical removal of the lung coin lesions can be performed. Coil marking of the smaller lung lesions under computed tomography (CT) guidance is a helpful tool in determining the position and localization of the nodal lung lesions. Video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracoscopic surgery (RATS) wedge resection is a diagnostic and therapeutic method of choice. No additional treatment of Dirofilaria other than wedge resection of the lung is necessary.Kliniken stehen vor großen diagnostischen Herausforderungen, wenn sie mit Knotenläsionen in der Lunge zu tun haben. Die Mehrheit der Lungenknötchen ist gutartig; jedoch können eine erhebliche Anzahl von ihnen bösartig sein. Bei der Differenzialdiagnose von Lungenknotenläsionen sollte auch ein Dirofilaria-Befall in Betracht gezogen werden. Die meisten Patienten mit Dirofilaria-Befall sind in der Regel asymptomatisch. Zur Bestimmung der Ätiologie der nodalen Lungeninfiltrationen können Verfahren wie radiologische Bildgebung, Bronchoskopie, Transbronchialnadelaspiration mit endobronchialem Ultraschall (EBUS-TBNA), transthorakale Biopsie (TTB), Tumormarker, unspezifische serologische Tests oder die chirurgische Entfernung der Münzläsionen der Lunge durchgeführt werden. Die Coilmarkierung der kleineren Lungenläsionen unter CT-Führung ist ein hilfreiches Instrument zur Bestimmung der Position und Lokalisierung der Lungenknotenläsionen. Die videogestützte thorakoskopische Chirurgie (VATS) oder die robotergestützte thorakoskopische Chirurgie (RATS) mit Keilresektion sind die diagnostische und therapeutische Methode der Wahl. Außer der Keilresektion der Lunge ist keine weitere Behandlung von Dirofilaria erforderlich
Diagnostic and Therapeutic Aspect of Toe Walking in Children-Perspective of Physiatrist and Kinesiologist
No full textHod na prstima obuhvaća manje od 1 % dijagnoza prilikom posjete fizijatru. Kod ovakve inadekvatne kinematike hoda dijete ostvaruje inicijalni kontakt prednjim dijelom stopala na podlogu umjesto inicijalnog kontakta petom o podlogu. Kada ostvari kontakt petom o podlogu, takav je hod često praćen biomehaničkim kompenzacijama, nepravilnom posturom i lošijom koordinacijom pokreta. Često je prisutan unutar prve razvojne faze bipedalnog hoda. Kod većine djece urednog opsega pokreta gležnja koja hodaju na prstima, dolazi do spontane normalizacije hoda. No kod nekih perzistira te je potrebna klinička evaluacija i liječenje. Ovaj klinički entitet obuhvaća široku diferencijalnu dijagnozu i postoji mogućnost genetskog nasljeđivanja. Dijagnoza idiopatskog hoda na prstima postavlja se isključenjem. Ponekad jasna diferencijacija između idiopatskog oblika i drugih bolesti povezanih s hodom na prstima u okviru mišićno-koštanih i neuroloških bolesti ili poremećaja senzorne obrade informacija može biti klinički izazovna. Sofisticirana procjena biomehanike gležnja može se učiniti u laboratorijima za kvantitativnu analizu hoda primjenjujući sustave temeljene na inverznom dinamičkom pristupu, ali i na novijim nosivim mjernim sustavima. Brojni modaliteti liječenja ograničene su snage dokaza. Potreba za liječenjem i odabirom individualnog optimalnog modaliteta trebala bi se temeljiti na kliničkoj procjeni i eventualno kvantitativnoj analizi hoda u opremljenom laboratoriju. U kliničkoj praksi zastupljeni su konzervativni modaliteti liječenja kao što je fizikalna terapija u obliku kineziterapije, opskrba ortozama, serijsko gipsanje te kirurške intervencije. Kod djece s urednim opsegom pokreta gležnja, ali perzistentnim hodom na prstima, liječenje je primarno konzervativno uključujući fizikalnu terapiju i ortoze.Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose. Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose
Understanding the Impact of Obesity and Parental Blood Pressure in Identifying Optimal Hypertension Screening Group in Youth
No full textBackground: The rising incidence of hypertension (HTN) in pediatric patients imposes the need for its timely recognition by finding the optimal screening population. The goal of our study was to explore the ambulatory blood pressure (BP) parameters in selected groups of obese children and adolescents with different obesity levels and quantify the impact of parental hypertension (PH) on their blood pressure (BP) values. Methods: This retrospective study included 176 obese Caucasian patients, 94 (53.4%) males, aged 6-18 years, who were divided based on their office blood pressure (OBP), body mass index (BMI) Z-score, and history of PH. Results: Patients with PH had a significantly higher prevalence of masked hypertension (MH) and higher BMI
(p=0.007 and p<0.001, respectively) compared to those with normotensive parents. There was no difference in whether HTN was of maternal or paternal origin, although the subjects with both hypertensive parents had higher diastolic blood pressure (DBP) parameters: office DBP (p=0.013), 24-hour DBP (p=0.017), and nighttime DBP (p=0.002). The multivariate regression analysis identified office systolic blood pressure (SBP) as a significant overall predictor of HTN (p<0.001), including the group with normotensive parents. In contrast, resting heart rate (HR) was an important predictor of HTN in subjects with PH (p=0.002). Additionally, a non-dipping BP pattern was predominantly observed in obese subjects, regardless of the degree of obesity (p=0.587). Conclusion: Our results emphasize the importance of performing ambulatory blood pressure monitoring (ABPM) in obese children and adolescents, especially those with a history of PH. This group represents the target screening population for MH, which increases cardiovascular risk in this population when combined with obesity
Knowledge, perceptions, and practices of axial spondyloarthritis diagnosis and management among healthcare professionals: an online cross-sectional survey
No full textSpondyloarthritis (SpA) is a group of inflammatory disorders, including axial SpA (axSpA), characterized by inflammation in the spine and sacroiliac joints. Healthcare professionals have a crucial role in diagnosing and managing axSpA. Assessing their knowledge, perceptions, and practices is essential to enhance patient care. The objective of this study is to evaluate these factors by conducting an online survey. This online survey was performed using SurveyMonkey.com to assess healthcare professionals’ knowledge, perceptions, and practices related to axSpA diagnosis, management, and monitoring. The questionnaire included questions about definitions, management strategies, monitoring approaches, treatment options, and barriers to care. Convenience sampling was used, and the data were analyzed descriptively by Microsoft Excel. One hundred sixty-four healthcare professionals participated; most respondents were rheumatologists from various geographic locations (27 countries). Most participants were familiar with axSpA definitions and diagnostic criteria, demonstrating high expertise. Variations were seen in follow-up intervals and diagnostic preferences, reflecting clinical heterogeneity. Seventy-two (43.9%) individuals had a multidisciplinary team, frequently including rheumatologists, physiotherapists, and radiologists. Of the participants, 73 (44.5%) had online/telephone follow-up sessions. The pharmacological and non-pharmacological treatment approaches varied, pointing to the importance of personalized care. Glucocorticoid use varied among countries. Recognizing inflammatory back pain, interpreting radiographs, and diagnosing early was essential to medical education. This study provides beneficial data on healthcare professionals’ knowledge, perceptions, and practices regarding axSpA. While diagnostic familiarity and multidisciplinary approach are positives, there is a potential to standardize management, improve telemedicine services, remove barriers to physical activity, and optimize treatment options
Brown tumors in primary hyperparathyroidism initially interpreted as bone metastases and multiple gigantocelular tumors: case report
No full textBrown tumors or osteitis fibrosa cystica are a rare bone metabolism disorder that may mimic cancer metastasis. It represents a late manifestation of prolonged and mostly unrecognized hyperparathyroidism. In this case report we present a 44-year-old female patient with multiple lesions detected on bone scintigraphy and 18F- FDG-PET/CT, initially interpreted as a bone metastatic disease, rather than multiple gigantocellular bone tumors. Additionally, the presented case emphasizes the importance of a multidisciplinary approach in diagnosing brown tumors as part of hyperparathyroidism, and the treatment decision
The Interrelationship Between Disability and Psychological Distress in Chronic Nonspecific Low Back Pain Among Adults of Working Age Population
No full textChronic non-specific low back pain disability and depressive symptoms in working men and women: a cross-sectional study
No full textChronic non-specific low back pain (LBP) is a serious public health issue that impairs the functional abilities of working men and women. The burden and experience of chronic non-specific LBP are largely influenced by psychological and psychosocial aspects. The objective was to investigate the association between the severity of chronic non-specific LBP disability and depressive symptoms in a sample of Croatian working active men and women with an age distribution from 35 to 65 years. The Roland Morris Disability Questionnaire (RMDQ) assessed disability, whereas the Beck Depression Inventory-II assessed depressive symptoms. During the routine outpatient visit self-reported RMDQ and BDI-II were completed from 203 recruited patients, divided into categories concerning disability scores. The median (IQR) age of 48.59 ± 6.48 was in the lower and the median (IQR) age of 50.65 ± 7.68 in the higher disability category. Disability was significantly associated (p < 0.05) with higher age (r = 0.177), working experience (r = 0.161), LBP duration (r = 0.195), greater pain intensity (r = 0.474 during activity, r = 0.227 at rest), and BDI-II score (r = 0.466). Higher BDI-II scores were associated with confirmatory answers on the 15th, 19th, and 22nd questions in RMDQ (p < 0.05). In patients with chronic non-specific LBP, higher degrees of disability were linked to severe depressive symptoms, aging, longer working experience, and increased pain intensity. These findings support pretreatment screening for depressive symptoms in order to develop individually customized and efficient multidisciplinary therapies