Changes in neurosyphilis presentation: a survey on 286 patients.

Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

Gluten-free diet as a therapeutic approach in psoriatic patients: if yes, when.

Since most of the studies are mainly confined to cases reporting coincidence of psoriasis and celiac disease, the authors want to underline the utility of investigating the possible presence of an underlying celiac disease in normal practice for a better approach to the patient. It is necessary to carry out controlled studies on a large number of patients to evaluate the association between these two diseases and the benefits of a gluten-free diet, even when the intestinal symptomatology is not evident.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study.

BACKGROUND: It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. METHODS: Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. RESULTS: The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. CONCLUSION: Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

Role of peripheral eosinophilia in adverse cutaneous drug reactions.

OBJECTIVE: The objective of this retrospective study was to verify whether peripheral eosinophilia (PE) may be a marker of severity for adverse cutaneous drug reactions (ACDR). PATIENTS AND METHODS: We investigated for PE in sixty-three patients diagnosed as adverse cutaneous drug reactions. All the patients underwent blood tests at baseline visit. Only patients that showed a very likely connection between ACDR and the suspected causative drug were induced in the study. RESULTS: We found that 11 out of 63 patients (17%) presented PE for values ≥ 0.6 x 10(9) cells/l or for a percentage of total leukocytes ≥ 6%. These 11 patients compared to patients without eosinophilia had a longer recovery time, they showed diffuse severe cutaneous reactions and they all needed a systemic therapy compared to the 41% of patients without eosinophilia. CONCLUSIONS: These outcomes prompt us to believe that peripheral eosinophilia may be an index of severity for adverse cutaneous drug reactions. Therefore, we suggest physicians to always detect the presence of peripheral eosinophilia in order to not underestimate the reaction and to promptly start an appropriate therapy.