Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry.

OBJECTIVES: The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). METHODS: We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. RESULTS: There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05). CONCLUSIONS: This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.

How has the COVID-19 pandemic affected our rheumatology patients using biological/targeted DMARDs?

INTRODUCTION: We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the course and treatment of patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biologic or targeted synthetic disease modifying and rheumatic drugs (b/tsDMARDs). METHODOLOGY: The study was carried out in two stages: in the first stage we investigated the delay of b/tsDMARD treatment in the first 3 months of the pandemic; in the second stage, we investigated all patients who decided to continue treatment after interruption in the 12-month period. RESULTS: A total of 521 patients were included in the study. The iRMD diagnosis was listed as spondyloarthritis (SpA) (54.3%), rheumatoid arthritis (RA) (25.7%), psoriatic arthritis (PsA) (8.4%), vasculitis (6.1%), and others (5.4%). Concurrent use of hydroxychloroquine (hazard ratio [HR] = 1.49), iv bDMARD use (HR = 1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR = 1.19) were determined as factors that reduced 12-month drug retention rates. The use of glucocorticoid (HR = 3.81) and having a diagnosis of interstitial lung disease/chronic obstructive lung disease (HR = 4.96) were found to increase the risk of being infected by SARS coronavirus 2 (SARS-CoV-2). CONCLUSIONS: It was shown that approximately 1/5 of iRMD patients using b/tsDMARDs delayed their treatment due to the fear of COVID-19 in the first three months of the pandemic process. However, with good communication with the patients, b/tsDMARD treatment was restarted and the 12-month drug retention status was quite high.

The effect of COVID-19 pandemic in a large series of patients with Takayasu arteritis.

BACKGROUND: Patients with inflammatory rheumatic diseases faced several challenges during the COVID-19 pandemic. Uncertainties such as the lack of evidence regarding the use of immunosuppressive (IS) therapies and deferred patient care because of limited health resources affected negatively on many aspects of treatment decisions and routine follow-up of the patients. In this study, we aimed to investigate the prevalence and severity of SARS-CoV-2 infection, the impact of the pandemic on delays in routine clinical follow-up, changes in IS treatment, and COVID-19 vaccination status of patients with Takayasu arteritis (TAK). METHODS: The study was performed between July and September 2021. TAK patients who registered in our database were investigated with regards to the COVID-19 infection and vaccination status, delays in routine clinical visits, changes in their IS treatments, and flares during the pandemic. Physical examination, laboratory tests, and imaging of the patients were performed and ITAS2010 scores were calculated. RESULTS: There were 56 adult TAK patients (87.5% female and median age 47 years). A total of 44 (78.6%) patients experienced a delay with routine follow-up visits to their physicians and about 20% of patients stopped their antirheumatic treatments without consulting their physicians. Compared to the pre-COVID-19 pandemic, 16 (28.5%) patients flared. In total group, 13 (23.2%) patients had a mild COVID-19 infection and about 90% of the patients had received the COVID-19 vaccine. DISCUSSION: Deferred patient care and disease flares are the most significant problems in TAK patients during the pandemic. The risk of TAK flares may outweigh the risk of COVID-19 infection.

Coexistence of Takayasu arteritis and chronic myeloid leukemia: Coincidental or paraneoplastic phenomenon?

Vasculitis may rarely be seen in the course of myeloproliferative neoplasms (MPN). In vasculitis associated with hematological diseases, mostly small- and medium-vessel involvement is expected, aortitis is very rare. It is not exactly known whether large-vessel vasculitis associated with MPN is a paraneoplastic phenomenon or coincidental. We aimed to present an uncommon case diagnosed with chronic myeloid leukemia and Takayasu arteritis concurrently.

TNF-α Inhibitors for the Management of Intractable Corneal Melt: Report of Three Cases and Review of the Literature.

OBJECTIVE: To report three consecutive cases with noninfectious corneal melting, whose disease progression could only be halted with tumor necrosis-α (TNF-α) inhibitor infusion, with a review of the relevant literature. MATERIALS AND METHODS: Patients with toxic epidermal necrolysis, severe alkaline burn, and Sjögren syndrome had experienced severe corneal melting following penetrating keratoplasty, Boston type 1 keratoprosthesis implantation or spontaneously, respectively. Topical autologous serum eye-drops, medroxyprogesterone, and acetylcysteine formulations; frequent nonpreserved lubrication; systemic tetracyclines and vitamin-C supplements; topical and systemic steroids and steroid-sparing agents; surgical approaches including amniotic membrane transplantation, tectonic graft surgery; and tarsorraphy failed to alter the disease courses. RESULTS: Upon consultation with the rheumatology clinic, TNF-α inhibitor infliximab (Remicade; Centocor Ortho Biotech Inc, Horsham, PA) 5 mg/kg infusion was planned for each patient. After 0-, 2-, and 6-week doses, monthly infusion at the same dose was maintained for 12 months because of severe and intractable course of their diseases. Each case showed dramatic improvements in corneal melts; and sterile vitritis in the eye with Boston keratoprosthesis responded, as well. CONCLUSIONS: Inhibiting TNF-α-mediated expression of matrix metalloproteinases responsible for collagen breakdown should be considered in refractory cases, as a means of globe salvage.

Evaluation of Pediatric Fingertip Injuries Using Etiology, Demographics and Therapy.

OBJECTIVES: In this study, 354 pediatric cases were evaluated and treated at the emergency service department due to fingertip injuries in a four years period. The data were studied using etiology, demographics, treatment and complications. This study aims to draw attention to fingertip injuries that are very common in childhood and to help developing preventive strategies. METHODS: Of the 354 patients, 191 were boys and 163 were girls. Their ages ranged from six months to 17 years. These patients were studied concerning sex, injured hand and fingers, injury mechanism, injury zone, selected treatment modalities and complications. All interventions were performed under local anesthesia at the emergency service department. Patients were discharged on the same day. RESULTS: In our study group, the male patients (54%) were more affected than the girls (46%). It was observed that the right hand (65.3%) was much more vulnerable to the injury than the left hand (34.7%). It was determined that the most injured fingers were middle fingers in the 136 (38.4%) of the patients, followed by the ring finger (33.9%). Injury was most frequent at five years old patient group. The most frequent type of injury was crush type injuries with a rate of 83.3%, and among crush type injuries, the most common mechanism was trapping of fingers in the doors or windows. While many of these injuries required surgical intervention, appropriate patients were treated with wound care and secondary wound healing. CONCLUSION: In childhood, hand injuries are quite frequent and fingertip injuries constitute the majority of these entities. These childhood injuries lead to significant functional, aesthetic and psychological sequelae in these patients. The knowledge about the etiology, distribution and mechanisms of these injuries will enable the development of preventive measures in this regard.

Reliability and Validity of the Turkish Version of the ABILHAND-Kids Survey in Children with Cerebral Palsy.

OBJECTIVES: The aim of the present study is to develop a Turkish version of the ABILHAND-Kids Survey, which evaluates upper extremity function in children with cerebral palsy (CP), and to carry out a validity and reliability study of the survey for Turkish CP patients. MATERIALS AND METHODS: Between November 2016 and March 2017, a total of 109 pediatric CP patients (62 males, 47 females; mean age 9.3±2.9 years; range, 6 to 15 years) followed in our outpatient clinic were included. The demographic characteristics and type of CP of the patients were recorded. A functional evaluation was made using the ABILHAND-Kids and Manual Ability Classification System (MACS) surveys. The reliability of the surveys was tested based on internal consistency (Cronbach's α) and test-retest (intraclass correlation coefficient [ICC]) methods. The validity of the approach was evaluated using converted scores from an ABILHAND-Kids Rasch analysis and a correlation of the MACS levels. RESULTS: The ICC value for the test/retest reliability was 0.98 and internal consistency was 0.94. A strong negative correlation was found between the Turkish version of the ABILHAND-Kids and MACS surveys (r=-0.849; p<0.001). A Rasch analysis indicated good item fit, unidimensionality, and model fit. CONCLUSION: The Turkish version of the ABILHAND-Kids survey is a reliable and valid scale for the assessment of manual ability in Turkish children with CP.

The effectiveness of pulsed ultrasound treatment on pain, function, synovial sac thickness and femoral cartilage thickness in patients with knee osteoarthritis: a randomized, double-blind clinical, controlled study.

OBJECTIVE: This study aims to investigate the efficacy of therapeutic pulsed ultrasound on pain, function, synovial sac and femoral cartilage in knee osteoarthritis. DESIGN: Randomized, double-blind, controlled study. SETTING: Dokuz Eylul University, Department of Physical Medicine and Rehabilitation. SUBJECTS: A total of 96 patients with knee osteoarthritis. INTERVENTIONS: Participants were randomized into two groups; Group I (n = 48, pulsed ultrasound) and Group II (n = 48, sham ultrasound). The sessions were held three times a week for 8 weeks. The study continued for 12 weeks (with 4 weeks follow-up). All participants performed exercises at home for 12 weeks. MAIN MEASURES: Knee pain (at rest and ADLs) was assessed using the visual analog scale (VAS). Functionality was assessed using the Timed Up and Go test and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Femoral cartilage and synovial sac thickness was measured using ultrasonography. All evaluations were performed at the baseline, at the 8 and 12 weeks after baseline. RESULTS: The study was completed with a total of 75 patients (n = 39 in group I and n = 36 in group II). The mean (SD) pain at ADLs score at baseline and week 12 was 7.2 (2.1), with 3.6 (2.9) in the group I, and 6.7 (2.0) and 4.3 (2.2) in the group II, respectively. Both groups presented significant improvements in terms of pain and function (P < 0.001). There was no difference between groups for any parameters. CONCLUSION: Treatment of pulsed ultrasound has no positive effect on knee pain, function, femoral cartilage and synovial sac thickness in knee osteoarthritis.

Complete penile skin necrosis.

Superficial penile skin infections may be presented in different clinical situations that vary from simple infection to organ loss and serious morbidity and mortality. Antibiotic treatment and, if necessary, urgent debridement is required. A 46-year-old male patient with the complaints of urethral discharge and pain admitted to our outpatient clinic. He declared that there were midpenil tenderness and erythema 14 days ago which occurred after sexual intercourse. Complete penile skin necrosis with purulent discharge was detected in physical examination. After wound debridement and 14-days of intravenous antibiotic treatment, wound site culture was negative and then full-thickness skin grafting was performed. Urgent antibiotic treatment should be given, especially for the skin infections of the genital area. Despite the rapid spread of antibiotic treatment, clinical presentation may worsen within hours. It should be noted that especially in diabetics and elderly patients with poor hygiene, the infection may spread to anogenital region and may lead to fulminant necrotizing fasciitis which can present with severe morbidity and mortality. Reconstructive surgery is planned after the control of infection and according to the amount of tissue loss.

''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.

BACKGROUND: The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. METHODS: A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. RESULTS: The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p < 0.0001). The preoperative mean nipple pressure threshold value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p < 0.0001) There were no patients determined as having bottoming-out deformity. No breast asymmetry was encountered at the late follow-up period. All patients, except the scarred ones, were satisfied with the results. CONCLUSION: In this study, we achieved an internal fascial reconstruction using a pair of triangular and quadrangular dermal flaps suspended to the rib periosteum. We believe that our modifications will contribute to decreasing the disadvantages of the inferior pedicle breast reduction technique. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .