Experience in using secukinumab in patients with axial psoriatic arthritis

Axial skeletal injury is observed in 25–70% of patients with psoriatic arthritis (PsA). Spondylitis frequently occurs subclinically, which leads to serious structural and functional disorders over time. An update shows that axial skeleton involvement in PsA is characterized by a more severe clinical course: these patients are observed to have a greater severity of peripheral arthritis, enthesitis, and dactylitis, skin and nail psoriasis, a higher CRP level, and worse functional status. In addition, the disease is more severe according to the patients' subjective assessment, as evidenced by questionnaires. Synthetic disease-modifying antirheumatic drugs used to treat peripheral PsA are not recommended for axial injury. When nonsteroidal anti-inflammatory drugs are ineffective, biological drugs (tumor necrosis factor-α inhibitors or interleukin-17A (IL-17A) inhibitors) should be prescribed immediately to patients with psoriatic spondylitis. The paper describes two clinical cases demonstrating the successful use of the IL-17A inhibitor secukinumab (SEC) in patients with axial PsA (axPsA). Given the positive experience with SEC in real clinical practice, it seems reasonable to prescribe it to patients at earlier stages of axPsA.

Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis

Objective(s)To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).Study designWe searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.ResultsAfter screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).ConclusionsFrom the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.

An isolated iliac vein injury due to blunt trauma by a bicycle handlebar without a pelvic fracture: A case report

Abdominal and pelvic blunt vascular trauma without skeletal injury is considered a rare condition. Iliac vein injuries are usually seen with penetrating trauma, whereas they result from blunt trauma very rarely. A 15-year-old boy was admitted who fell from a bicycle and got his left hypogastric region hit by the handlebar. He had an isolated left external iliac vein injury and massive bleeding related to this blunt trauma, which eventually resulted in hypovolemic shock and a huge regional hematoma. The hematoma compressed the left external iliac artery and triggered ischemia. In conclusion, prompt diagnosis and treatment are of utmost importance to save the extremities and lives of patients.

The place of modern α-2-agonists in the intraoperative sedation of trauma / orthopedic patients

Modern traumatological operations have a number of features: duration, a large pool of age-related patients with low functional reserves, forced position of the body, operations are often under regional anesthesia with a conserved consciousness, which requires special attention from the anesthesiologist. Intraoperative sedation by intravenous agents is used to prevent stress reactions associated with the effect of the patient’s presence on the operation. One of the classes is α-2 adrenergic agonists, drugs with antinociceptive, anxiolytic, sympatholytic activity, and at the same time, they have a number of side effects in the form of hypo/ hypertension, vasospasm, bradycardia. In this article the place of the modern α-2 agonist dexmedetomedine in the schemes of perioperative management of patients with skeletal injury was considered.

Female UK Army Service personnel are at greater risk of work-related morbidity on return to duty postpartum

IntroductionThe 2016 Interim Report on the Health Risks to Women in Ground Close Combat Roles highlighted an increased risk of skeletal injury and significant physiological changes, including increased ligament laxity and decreased bone mineral content, during the postpartum period. The report called for further research and a re-evaluation of postpartum policy to optimise the return of female Service personnel to arduous employment. The purpose of this study was to determine whether returning to duty is at greater risk of injury and illness in the first year postpartum than they were prepregnancy.MethodsFifty-five female UK Army Service personnel aged 18–41 years, who had given birth in the previous 4 years, completed a lifestyle questionnaire and gave written consent for a review of their medical records. The number of working days lost (WDL) due to illness, injury and combined illness and injury was obtained from medical records, for 1 year prepregnancy and 1 year postpartum. Female Service personnel returned to duty at different time-points postpartum, so data were expressed as WDL/week.ResultsWDL/week due to illness and combined illness and injury were higher postpartum compared with prepregnancy (p<0.05). WDL/week due to combined illness and injury was significantly lower prepregnancy (p<0.05) and at 0–26 weeks postpartum (p<0.05), compared with 26–52 weeks postpartum.ConclusionsPostpartum female UK Army Service personnel are at greater risk of illness and a combination of illness and injury in the year after giving birth, compared with prepregnancy. The study suggests female Service personnel are unprepared for the demands of full active duty in the first year postpartum.