Treatment of small vessel disease with the paclitaxel drug-eluting balloon: 6-month angiographic and 1-year clinical outcomes of the Spanish multicenter registry

Background: small vessel disease (SMD) remains a major challenge because of the increased risk of restenosis. We sought to assess the efficacy and safety of a paclitaxel-eluting balloon (PEB) in patients with SMD. Methods and results: one-hundred and four patients with native coronary lesions in small vessels treated by using a PEB were included in this prospective multicenter registry. In each case, after regular balloon dilatation, a larger PEB was inflated for a minimum of 45-60 seconds. Patients were 65 ± 10 years old, 43% diabetic, and 58% presented acutely. Angiographic success was 93% (7% bailout BMS implantation due to coronary dissection). The rate of major adverse cardiac events (MACE) at 12 months was 4.8% (1.9% cardiac death, 1.0% MI, and 2.9% TLR). One definite stent thrombosis was reported at 6 months in a patient with bailout BMS implantation. At 7 months, late loss was 0.31 ± 0.2 mm. Bail-out BMS after DEB use, was an independent predictor of MACE, HR 18.74, 95%CI (2.58-135.84) and TLR, HR 30.99, 95%CI (2.79-344.07). Conclusion: the use of this PEB for the treatment of SMD provides excellent 1-year outcomes with only 4.8% MACE. The need for a bailout BMS was a strong predictor of MACE and TLR

Automated hemogram values for healthy dogs aged 1 to 6 years attended at the Veterinary Hospital - Universidad de Antioquia (Colombia), 2002-2009

ABSTRACT: A 6 year-old Holstein cow was euthanized after a 3 week course of progressive paraplegia. In spite of the increasing difficulties to rise and walk, the animal remained bright, alert, afebrile and with good appetite throughout most of the clinical course. Complete blood counts, biochemical profiles and analysis of the cerebrospinal fluid were reported within normal limits. Antibody was detected for bovine leukaemia virus using an enzyme-linked immunosorbent assay, supporting a tentative diagnosis of bovine leukosis. Post-mortem examination revealed a localized form of lymphosarcoma with few 2-5 cm nodular tumors confined to the walls of the gastrointestinal tract, particularly in the abomasum. In addition, soft grey tumors were found within the vertebral canal surrounding the lumbar spinal cord and associated nerve roots. Microscopic examination revealed the nodular masses were composed of neoplastic lymphocytes. Mass in the lumbar vertebral canal had extradural neoplastic lymphocytes infiltrating connective tissues around the spinal cord and spinal nerve roots. Unlike the more common chronic and wasting presentation of the disease with widespread lymphadenopathy, the rapid progression of the disease to total paraplegia in this animal could be explained by the localized presence of tumors in the spinal canal.RESUMEN: Una vaca Holstein de 6 años de edad fue sacrificada después de un curso de paraplejía progresiva de 3 semanas de duración. A pesar de las crecientes dificultades para levantarse y caminar, el animal se mantuvo alerta, sin fiebre y con buen apetito casi todo el transcurso de la enfermedad. Los análisis del hemograma, perfil bioquímico y líquido cefalorraquídeo no mostraron alteraciones fuera del rango normal. El análisis de ELISA frente al virus de la Leucosis Bovina resultó positivo, apoyando el diagnóstico diferencial de leucemia. El examen post-mortem reveló una forma localizada de linfosarcoma, con escasas y pequeñas tumoraciones nodulares de 2-5 cm confinadas a las paredes del tracto gastrointestinal, sobre todo en el abomaso. Además, los tumores estaban presentes en el canal vertebral rodeando la médula lumbar espinal y raíces nerviosas adyacentes. El examen microscópico reveló que las masas nodulares estaban compuestas de linfocitos neoplásicos; igualmente, el tejido conectivo rodeando la medula lumbar presentaba gran infiltración de dichos linfocitos. A diferencia de la presentación más corriente y crónica de la enfermedad en que existe un desgaste progresivo del animal asociado a una linfadenopatía generalizada, en este caso la rápida progresión de la enfermedad hacia una paraplejia total se podría explicar por la presencia de tumores localizados en el canal espinal

Domestic dog health worsens with socio-economic deprivation of their home communities

Dogs play an important role in infectious disease transmission as reservoir hosts of many zoonotic and wildlife pathogens. Nevertheless, unlike wildlife species involved in the life cycle of pathogens, whose health status might be a direct reflection of their fitness and competitive abilities, dog health condition could be sensitive to socio-economic factors impacting the well-being of their owners. Here, we compare several dog health indicators in three rural communities of Panama with different degrees of socio-economic deprivation. From a total of 78 individuals, we collected blood and fecal samples, and assessed their body condition. With the blood samples, we performed routine hematologic evaluation (complete blood counts) and measured cytokine levels (Interferon-γ and Interleukin-10) through enzyme-linked immunosorbent assays. With the fecal samples we diagnosed helminthiases. Dogs were also serologically tested for exposure to Trypanosoma cruzi and canine distemper virus, and molecular tests were done to assess T. cruzi infection status. We found significant differences between dog health measurements, pathogen prevalence, parasite richness, and economic status of the human communities where the dogs lived. We found dogs that were less healthy, more likely to be infected with zoonotic pathogens, and more likely to be seropositive to canine distemper virus in the communities with lower economic status. This study concludes that isolated communities of lower economic status in Panama may have less healthy dogs that could become major reservoirs in the transmission of diseases to humans and sympatric wildlife

Automated hemogram values for healthy dogs aged 1 to 6 years attended at the Veterinary Hospital - Universidad de Antioquia (Colombia), 2002-2009 Valores de referencia del hemograma en perros sanos entre 1 y 6 años de edad, atendidos en el Hospital Veterinario - Universidad de Antioquia, 2002-2009 Valores de referência do hemograma de cães sadios entre 1 e 6 anos de idade atendidos no Hospital Veterinário da Universidade de Antioquia, 2002-2009

To assess the physiological state of an animal, analysis and diagnostic tests comparable with defined reference values are necessary. These values are influenced by various factors and their definition should be based on the characteristics of each population. In the Veterinary Hospital of the University of Antioquia, universal reference values for hemogram are normally used. This represents a problem at the time of interpretation of results, due to local environmental factors that differ from the international ones, in which the reference values were originally defined. Objective: to determine reference limits of hemogram in clinically healthy dogs between 1 and 6 years of age, in the city of Medellín. Methods: retrospective study. In this study, medical records of healthy dogs attending the Veterinary Hospital of the Faculty of Agricultural Sciences of the University of Antioquia for ambulatory surgery, clinical examination, vaccination, and annual monitoring between 2002 and 2009 were analyzed. Information contained in medical records was collected using a questionnaire. The statistical analysis of the information was carried out using parametric and nonparametric methods. Results: reference limits were established. Significant statistically differences in some parameters of the hemogram in relation to variables such as age and breed of dogs were established. Conclusions: parameters of hemogram in evaluated dogs are related to physiological conditions such as age and race, as well as to environmental and nutritional conditions. Therefore, it is necessary to have reference values that match the characteristics of animals and the environment.<br>Para la determinación del estado fisiológico de un animal son necesarios análisis y pruebas diagnósticas comparables con valores de referencia definidos; estos valores se encuentran influenciados por diversos factores, y se establecen con base en las características propias de cada población. En el Hospital Veterinario de la Universidad de Antioquia se emplean valores de referencia universales para el hemograma, lo cual constituye un problema al momento de su interpretación, ya que los factores ambientales locales difieren de los internacionales donde los valores de referencia se definieron originalmente. Objetivo: determinar los límites de referencia del hemograma en perros entre 1 y 6 años de edad, clínicamente sanos de la ciudad de Medellín. Métodos: se diseñó un estudio retrospectivo para en el cual se analizaron historias clínicas de perros sanos que fueron llevados al Hospital Veterinario de la Facultad de Ciencias Agrarias de la Universidad de Antioquia a para cirugía ambulatoria, revisión general, vacunación, y control anual, entre los años 2002 y 2009. La información contenida en las historias clínicas se recopiló mediante el uso de una encuesta, y para su análisis se utilizó estadística paramétrica y no paramétrica. Resultados: se establecieron límites de referencia y se encontraron diferencias estadísticamente significativas en algunos parámetros del hemograma en relación con variables como edad y raza de los perros. Conclusión: los parámetros del hemograma en los perros evaluados se encuentran relacionados con condiciones fisiológicas como edad y raza, así como por condiciones medioambientales y de nutrición, por lo que es necesario tener límites de referencia que concuerden con las características propias de los animales y del medio.<br>O estado fisiológico de um animal é avaliado a partir de análises e provas diagnósticas comparáveis com valores de referência definidos. Esses valores estão influenciados por diversos fatores e são definidos com base nas características próprias de cada população. No Hospital Veterinário da Universidade de Antióquia são empregados limites de referência universais para o hemograma. Este é um problema no momento da interpretação, devido a que fatores ambientais locais são diferentes dos internacionais. Objetivo: o objetivo desta pesquisa foi determinar os limites de referência do hemograma em cães entre 1 e 6 anos de idade, clinicamente sadios, procedentes da cidade de Medellín. Métodos: foi desenhado um estudo retrospectivo no qual analisaram-se os prontuarios de cães sadios que foram submetidos a cirurgia ambulatória, revisão geral, vacinação e controle anual no Hospital Veterinário da Faculdade de Ciências Agrárias da Universidade de Antióquia entre os anos 2002 e 2009. A informação contida nos prontuarios foi recopilada mediante o uso de uma enquete e para sua análise utilizou-se estatística paramétrica e não paramétrica. Resultados: estabeleceram-se limites de referência e foram encontradas diferenças estatisticamente significativas em alguns parâmetros do hemograma como a idade e a raça dos cães. Conclusões: os parâmetros do hemograma nos cães avaliados estão relacionados com condições fisiológicas como idade e raça, assim como também por condições medioambientais e de nutrição. Por esta razão, é necessário ter limites de referência que estejam de acordo com as características próprias dos animais e do médio

One-year effectiveness and safety of ustekinumab in ulcerative colitis: a multicenter real-world study from Italy

Background: Efficacy and safety of ustekinumab for the treatment of ulcerative colitis (UC) has been demonstrated in clinical trials, but few real-world data are available so far. The aim of this study was to assess effectiveness and safety of ustekinumab in a cohort of refractory UC patients. Methods: Data of patients with moderate to severe UC treated with ustekinumab were retrospectively collected. Primary endpoint was steroid-free clinical remission at weeks 24 and 52 of therapy. Secondary endpoints were treatment response, endoscopic remission, treatment persistence at 12&nbsp;months and safety. Results: A total of 68 patients [males 63%; median (range) age 42 (16–72) years] were included. Almost all patients (97%) were biologics experienced. At weeks 24 and 52, 31% and 50% of patients achieved steroid-free clinical remission, 84% and 82% had clinical response, respectively. At the end of follow-up, there was a significant reduction of pMS from baseline (p&nbsp;&lt;&nbsp;0.001) and of steroid use (p&nbsp;&lt;&nbsp;0.001). At week 52, 22% of the available endoscopies (18/38) showed mucosal healing. The probability to persist in therapy at week 52 was 87%. Only one adverse event occurred. Conclusions: Data from our real-life cohort of refractory UC patients suggest satisfactory effectiveness and a good safety of ustekinumab

Real-Life Effectiveness and Safety of Golimumab and Its Predictors of Response in Patients with Ulcerative Colitis

Background Golimumab is a new anti-TNF-alpha monoclonal antibody for patients with ulcerative colitis. Aims To assess the short- and long-term effectiveness and safety of golimumab in daily clinical practice and to identify predictors of response. Methods Consecutive patients treated with golimumab in 22 Italian centers were enrolled. Clinical, laboratory, and endoscopic data were prospectively collected before and during treatment. A subgroup of patients completed a questionnaire to assess personal satisfaction with a golimumab autoinjector system. Results A total of 196 patients were included. After 3 months, 130 patients were responders (66.3%) and showed significant reductions in mean partial, total, and endoscopic Mayo scores and in mean ESR, C-reactive protein, and fecal calprotectin levels (p &lt; 0.001). Multivariate analysis revealed that a higher total Mayo score (p &lt; 0.001, OR 1.5, 95% CI 1.2-1.8) and naive status to anti-TNF-alpha (p = 0.015, OR 3.0, 95% CI 1.2-7.5) were predictive of a favorable response. Seventy-seven (39.3%) of the 130 responders maintained a response at month 12 of therapy. There were 17 adverse events, 28 patients needed hospitalization, and 15 patients underwent surgery. Self-administration of the drug was appreciated by most patients. Conclusions The efficacy and safety of golimumab in daily clinical practice were confirmed for the short- and long-term treatment of patients with active ulcerative colitis. Patients naive to the anti-TNF-alpha monoclonal antibody and those with a higher total Mayo score were more likely to respond to golimumab

Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results from the SoCOVID-19 Survey

none46nononeFantini M.C.; Biancone L.; Dragoni G.; Bezzio C.; Miranda A.; Ribaldone D.G.; Bertani A.; Bossa F.; Allocca M.; Buda A.; Mocci G.; Soriano A.; Guglielmi F.W.; Bertani L.; Baccini F.; Loddo E.; Privitera A.C.; Sartini A.; Viscido A.; Grossi L.; Casini V.; Gerardi V.; Ascolani M.; Di Ruscio M.; Casella G.; Savarino E.; Stradella D.; Pumpo R.; Cortelezzi C.C.; Daperno M.; Ciardo V.; Nardone O.M.; Caprioli F.; Vitale G.; Cappello M.; Comberlato M.; Alvisi P.; Festa S.; Campigotto M.; Bodini G.; Balestrieri P.; Viola A.; Pugliese D.; Armuzzi A.; Saibeni S.; Fiorino G.Fantini, M. C.; Biancone, L.; Dragoni, G.; Bezzio, C.; Miranda, A.; Ribaldone, D. G.; Bertani, A.; Bossa, F.; Allocca, M.; Buda, A.; Mocci, G.; Soriano, A.; Guglielmi, F. W.; Bertani, L.; Baccini, F.; Loddo, E.; Privitera, A. C.; Sartini, A.; Viscido, A.; Grossi, L.; Casini, V.; Gerardi, V.; Ascolani, M.; Di Ruscio, M.; Casella, G.; Savarino, E.; Stradella, D.; Pumpo, R.; Cortelezzi, C. C.; Daperno, M.; Ciardo, V.; Nardone, O. M.; Caprioli, F.; Vitale, G.; Cappello, M.; Comberlato, M.; Alvisi, P.; Festa, S.; Campigotto, M.; Bodini, G.; Balestrieri, P.; Viola, A.; Pugliese, D.; Armuzzi, A.; Saibeni, S.; Fiorino, G

Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care

Background and aims:Restructuring activities have been necessary during the lockdown phase of the coronavirusdisease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-careprocedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. Weaimed to investigate how IBD management was restructured during the lockdown phase, the impact of therestructuring on standards of care and how Italian IBD units have managed post-lockdown activities.Methods:A web-based online survey was conducted in two phases (April and June 2020) among the Italian Groupfor IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuingscheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdownphase.Results:Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visitsand 7% of follow-up visits were regularly done, while&gt;70% of follow-up scheduled visits and 5% of first visits weredone virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% ofbiological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modifiedmanagement of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biologicaltherapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtualclinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future.Conclusion:Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to bemaintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, suchas virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 er

Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results From the SoCOVID-19 Survey

none46noneFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, GionataFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, Gionat