Psoriasis (PsO), a chronic inflammatory, multisystemic, and multifactorial disease can cause endothelial dysfunction, artery calcification, and atherosclerotic disease. A higher incidence of vascular ...occlusive events has been observed in psoriatic patients compared to healthy controls, and multiple studies confirm the association between moderate-severe PsO and atherosclerosis, coronary artery calcification, and higher cardiovascular risk.
We sought to analyze atherosclerotic disease prevalence in epiaortic vessels of psoriatic and non-psoriatic patients to understand if PsO could represent an independent risk factor predisposing to atherosclerotic disease.
We evaluated 47 psoriatic patients without cardiovascular risk factors with color Doppler ultrasound (CDUS). If atheromatous plaques were detected, a computed tomography angiography (CTA) was performed. We evaluated 47 non-psoriatic patients without cardiovascular risk factors with CDUS. Atherosclerosis prevalence in both groups were statistically analyzed. CDUS performance was compared to CTA.
In the psoriatic group (mean age 50.9 years), 6 had atheromatous plaques and 12 had an intima-media thickness (IMT) > 1 mm (overall prevalence of atherosclerotic disease: 38.2%). All plaques detected with CDUS were confirmed at CTA. In the control group (mean age 51.3 years), CDUS revealed atheromatous plaques in 4 patients and IMT > 1 mm in 4 ones (overall prevalence of 17%). The difference of atherosclerotic disease prevalence between the groups was statistically significant (P < 0.05).
Our results highlight that PsO could be considered a predisposing factor for atherosclerotic disease development in epiaortic vessels, as it causes an increased IMT, that is also considered an independent cardiovascular risk factor.
Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the ...reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI); only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in some cases in which the pathological process appears irreversible, surgery becomes mandatory.
Objective: Pheocromocytoma (PHEO) is a rare catecholamines secreting tumor presenting with variable clinical setting, mostly with headaches, sweating, palpitation and poor controlled arterial ...hypertension. In 85–90% of cases, tumors are of adrenal gland origin while in 10–15% are commonly located in paravertebral sympathetic plexus. The prevalence of PHEO in hypertensive patients ranges between 0.1 and 0.6%; PHEO is extremely rare during pregnancy with a prevalence of 1 in 54000 pregnancies thus, delayed diagnose may cause life-threatening situations. Accurate identification of PHEO during the antenatal period reduces the risk of mortality for mother and fetus. Design and method: We described a case of 33 years old pregnant woman with a one-year history of grade I hypertension. Results: The patient has been previously evaluated by endocrinologist for the onset of “striae rubrae” associated with illness, muscle pain, asthenia, anxiety, palpitations and weakness; lab tests were negative for hypercortisolism thus clinicians hypothesized a “functional syndrome”. However, during the 28th week of gestation she was admitted to the emergency room because of severe headache and severe arterial hypertension. CT brain scan was negative for acute events, lab tests showed mild hypokalemia and proteinuria. An in depth revaluation of the clinical history revealed a treatment with metoclopramide taken one week earlier. Conclusions: Metoclopramide can stimulate catecholamine- and granin-derived peptide secretion from PHEO cells through activation of serotonin type 4 (5-HT4) receptors and induced PHEO crisis. Thus, under suspicion of PHEO exacerbated by metoclopramide we performed lab tests resulted positive for catecholamines secretion while aldosterone and renin levels were normal. Abdomen ultrasound and MRI showed oval lesion located in right adrenal gland confirming diagnosis of PHEO. We started treatment with alpha and beta blockers associated with calcium-antagonist; at 33th week, patient underwent a caesarean section and after seven weeks a videolaparoscopic right adrenalectomy, obtaining a normalization of blood pressure levels.
Simultaneous occurrence of pheochromocytoma and aldosterone-producing adrenocortical tumor has been rarely reported in patients with symptoms or findings suggestive for both neoplasms. Herein, we ...report and discuss on a challenging case of synchronous pheochromocytoma and aldosterone-producing adenoma incidentally detected in the same adrenal gland and documented by biochemical studies and pathological examination.
Treatment of psoriasis and psoriatic arthritis in patients with concomitant chronic, severe viral infections, particularly HIV or HBV, represents a challenge, due to contraindication to conventional ...immunomodulating systemic drugs and biologics, including anti-TNF alpha, anti-IL12/23, and anti-IL17 agents. Recently, apremilast, a selective inhibitor of phosphodiesterase E4 has been suggested to be a safe and effective therapeutic option in HIV-infected population with psoriatic arthritis. We report the case of a patient with psoriatic arthritis and concomitant HIV and HBV infection successfully treated with apremilast.
Our aim was to summarize and evaluate the current quality of evidence regarding the efficacy of therapies for cutaneous psoriasis (PsO) in patients with psoriatic arthritis (PsA).
A literature search ...of MEDLINE, Embase, Cochrane Library databases, and conference abstracts was conducted to identify interventional randomized controlled trials in patients with PsA between February 2013 and December 2021. Studies were included if PsO outcomes included achieving at least 75% improvement in the Psoriasis Area and Severity Index and the blinded comparison period was ≥ 10 weeks. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to assess quality of the evidence to inform and update the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations.
A total of 116 studies and 36 abstracts identified in the initial search were screened. A total of 37 studies (40 treatment arms) met the criteria for final inclusion. Phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and tyrosine kinase 2 inhibitors, interleukin 17 inhibitors (IL-17i), IL-12/23i, IL-23i, and tumor necrosis factor inhibitors (TNFi) had high-quality data broadly supporting the efficacy of each class for plaque PsO over placebo. Head-to-head studies with high-quality data supported both IL-17i and IL-23i over TNFi.
Several pharmacologic therapeutic classes have high-quality evidence demonstrating efficacy for cutaneous PsO in the PsA population. The findings will be integrated into the 2021 GRAPPA treatment recommendations, intended to guide selection of a therapeutic class where efficacy in 1 or more cutaneous or musculoskeletal domains is required.
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