Observações clínicas, anatomopatológicas e tratamento de seis casos de dermovilite exsudativa vegetante crônica (cancro da ranilha) de eqüinos Clinical aspects, anatomopathologic observations and treatment of six cases of chronic hypertrophic pododermatitis (equine canker)

Relataram-se oito casos de dermovilite exsudativa vegetante crônica em seis eqüinos de diferentes raças, com idades entre 14 meses e 19 anos. A lesão iniciava-se pelo aparecimento de um tecido podofiloso infiltrativo na região da ranilha e da sola do casco, caracterizado por crescimento rápido e desordenado, de aspecto papiliforme, de coloração esbranquiçada na raiz e escura nas pontas, com secreção necrótica de odor extremamente fétido. Microscopicamente, observou-se a presença de exuberante tecido epidérmico proliferativo, entremeado por escasso tecido conjuntivo. Bactérias gram negativas, associadas à má higiene e umidade, estão incluídas entre os fatores etiológicos, porém prescindem de confirmação científica. Os eqüinos foram divididos em dois grupos de tratamento. No primeiro grupo, constituído de três éguas jovens e um potro, portando lesões em apenas um membro, realizou-se inicialmente remoção cirúrgica da massa invasiva, seguida de cauterização das bordas restantes e posterior aplicação, diária, local de substâncias anti-sépticas. Em três desses pacientes ocorreram recidivas da lesão inicial, com rápido crescimento de tecido hiperplásico, atingindo quase toda a ranilha e metade da sola. Dois animais desenvolveram deformidades do casco, denominadas encastelamento. O segundo grupo, constituído por um macho e uma fêmea, com lesões em dois membros, após o debridamento cirúrgico do tecido, receberam aplicações diárias de ácido pícrico a 5%, associado ao uso local de oxitetraciclina. Embora um desses casos tenha requerido uma segunda intervenção cirúrgica para remoção da massa, os eqüinos apresentaram após um período de dois a três meses total desaparecimento do tecido infiltrativo. A utilização de ácido pícrico a 5% e oxitetraciclina local associada ao debridamento cirúrgico prévio mostrou-se mais eficiente que a utilização de substâncias anti-sépticas no tratamento da dermovilite exsudativa vegetante crônica de eqüinos.<br>Chronic hypertrophic pododermatitis cases in six horses of different breeds, aging 14 months to 19 years are described. The lesion begun with a infiltrative tissue in the frog and sole regions of the hoof, characterized by a fast and disorganized growth, with a papillary aspect, white colored in the roots and dark on the extremity, with a necrotic secretion and an extremely fetid odor. Microscopically, an exuberant epidermic proliferative tissue was observed, intermingled with little connective tissue. The horses were divided into two treatment groups. In the first group, including three young mares and a foal, showing lesions in only one limb, a surgical resection of the invasive mass was performed, followed by cauterization of the remaining edges and subsequent daily local application of antiseptic substances. In three of these horses, recurrence of the initial lesion occurred, with fast growth of hyperplasic tissue, affecting almost all the frog and half of the sole. Two horses developed contraction deformities of the hoof. In the second group, one male and one female, each with lesions in two limbs, after surgical debridement of the tissue, the animals received daily applications of picric acid 5%, associated to local use of oxitetracyclin. Although one of these cases required a second surgical intervention for removal of the mass, the horses showed after a period of two to three months total absence of the infiltrative tissue. The use of local picric acid 5% and oxitetracyclin associated to previous surgical debridement showed to be more efficient than the use of antiseptic substances in the treatment of chronic hypertrophic pododermatitis

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation: The GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores &gt;2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores &gt;2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score &gt;2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores &gt;2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores &gt;2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007. © 2020 Hellenic Society of Cardiolog