Search

A novel SARS-CoV-2 infection, causing the disease designated as COVID-19 principally affecting the respiratory tract, lung at alveolar and interstitial levels, has recently emerged. Systemic sclerosis (SSc) is an autoimmune connective disease characterized by vascular abnormalities and diffuse and progressive fibrosis of the skin and internal organs. Raynaud phenomenon occurs in virtually all patients affected by SSc and in most cases represents the onset symptom of the disease, since it could appear several years before the overt illness. Although the exact pathophysiologic pathways leading to RP and SSc are still unknown, several infectious agents, especially viruses, have been suggested as possible triggering factors. Here authors describe the first case of a Raynaud phenomenon secondary to Systemic sclerosis following SARS-CoV2 infection.

Background: CTIBL in breast cancer (BC) women is wellknow. It is commonly, but not exclusively, related to aromataseinhibitors. The “Nota 79” by AIFA contemplatesthe primary prevention of fracture risk in BC women inadjuvant hormonal treatment with bisphosphonates or denosumab,at osteoporosis dosage. At the Modena CancerCenter we started a collaboration with oncologists hematologistsand bone specialists in order to offer thebest tailored treatment in high risk fracture patients.Patients and Methods: patients newly diagnosed with BCin hormonal treatment fill-out a form, in order to evaluatethe risk factors for osteoporosis, and based on the resultsand the bone density they are referred to the osteoncologyunit along with serological and urinary markers of boneturn-over.Results: in over 18 months of activity, more than 600patients have been screened by self-completed questionnaire.From the analysis of the first 400 questionnairesemerged that 61% had one or more risk factors, 20%received supplement of vitamin D, and approximately 5%were on bisphosphonates. At baseline, the measurement ofthe height, the evaluation of the spine at the chest X ray orby morphometry highlighted asymptomatic vertebral fracturesin few patients. Several patients presented with secondaryhyperparathyroidism, that required correctionbefore to start any treatment with antiresorptive agents.Cases with hypercalciuria were also corrected along withantiresorptive therapy. Few cases demonstrated high boneturn-over with CTX levels above the limits. The treatmenthas been individualized based on the medical history andcomorbidities, oncological treatment and the bone turnover.All the patients have been informed of the possiblerisk of osteonecrosis of the jaw; dental medical history wascollected for each patient, but orthopanthomography andodontoiatric evaluation was prescribed in selected patients.Vitamin D level was corrected before any therapy andimprovement of the dietary habits and physical activitywas highly recommended. Data analysis is still ongoing.Conclusions: all the patients receiving AIs require the preventionof CTIBL, but the limited resources pushed us toselect, at this time, the patients with special needs to beevaluated in multidisciplinary group. The complexity of thebone health requires attentive evaluation by bone specialistsin selected cases before to start antiresorptive agents.Supplemental data will be presented at the meeting.

Objective : The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Methods : Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey—MOS SF-36). A sample of 258 patients was readministered the WOMAC 7–10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal–Wallis test. Results : All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test–retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity ( P =0.03). Also, WOMAC pain score was inversely correlated ( P =0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. Conclusion : The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

Children with cerebral palsy (CP) and quadriplegia or severe diplegia suffer from highly reduced mobility and consequent constipation. Clinicians recommend standing frames to exercise the support reaction in this population, sharing the opinion that the upright position may facilitate intestinal transit, although no evidence supports this assumption. We conducted this study to determine the effects of the standing frame on spontaneous evacuation in children with CP. Moreover, we studied its effects on the frequency of induction of evacuation, the characteristics of the stool and the pain suffered by the child due to constipation and/or evacuation. We implemented a single-subject research design in one chronically constipated child with CP and quadriplegia, Gross Motor Function Classification System Level V. To monitor the effects of the standing frame, we measured the outcome of interest throughout the study using a daily diary and the Bristol Stool Scale. This study was approved by the local Ethics Committee. This study has several limitation; primarily, the use of a single-subject research design only makes possible the visual analysis of data obtained from a unique patient. So, by themselves, data obtained do not allow us any generalization for the target population. Future research should verify our results collecting more data and also investigating the effect of the standing-frame on respiratory functions. Although the standing frame did not affect the frequency of evacuations or the characteristics of the stool, its employment reduced the inductions of evacuation and the related pain suffered by the child. However, this study has several limitations, such as the lack of generalization due to the fact that we studied a unique patient and the overall brevity of the study due to external circumstances. Therefore, we suggest future research to verify our results, also investigating the effect of the standing frame on respiratory functions. Relevance to clinical practice. The standing frame may positively influence the management of constipation of these children, possibly improving their quality of life.

Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae and it is mainly characterized by self-limiting lymphadenopathy in the draining site of a cat scratch or bite. We report a patient with history of fever, swelling lymph nodes, vasculitic-like skin lesions, and positivity of Bartonella serology initially considered as expression of a disimmune disease.