Opportunistic fungal infections in dogs treated with ciclosporin and glucocorticoids: eight cases

Glucocorticoids are the standard of care for the treatment of immune-mediated disorders, and ciclosporin is increasingly being used off-label as an adjunct immunosuppressive drug in dogs. However, opportunistic infections can develop during combination immunosuppressive regimens. This case series describes atypical fungal infections in eight dogs treated with immunosuppressive dosages of glucocorticoids and ciclosporin. The median duration of combined treatment prior to the identification of fungal infection was 31 (range, 13 to 201) days, although two dogs received glucocorticoids for prolonged periods prior to the addition of ciclosporin. The estimated prevalence of serious fungal infections with this drug combination appears to be low (approximately 1 · 67%), but these infections led directly or indirectly to death or euthanasia in five of eight (63%) dogs. These cases highlight the need for frequent clinical monitoring of dogs receiving immunosuppressive dosages of glucocorticoids and ciclosporin.

The combination of a chemotherapy doublet (gemcitabine and capecitabine) with a biological doublet (bevacizumab and erlotinib) in patients with advanced pancreatic adenocarcinoma. The results of a phase I/II study

BACKGROUND

Preclinical data support the combined inhibition of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) pathways in the treatment of pancreatic cancer. Following a dose finding phase I study the efficacy and toxicity of a four-drug regimen utilising the cytotoxic doublet of gemcitabine and capecitabine (GemCap), with the biological doublet of erlotinib and bevacizumab were further assessed in patients with advanced pancreatic cancer.

PATIENTS AND METHODS

In a phase II expansion cohort, patients with chemonaive locally advanced or metastatic pancreatic cancer received gemcitabine (1000mg/m(2) D1, 8, 15), capecitabine (1400mg/m(2) D1-21), erlotinib (100mg daily) and bevacizumab (5mg/kg D1, 15) every 28days. The primary endpoint was radiological response rate by response evaluation criteria in solid tumours (RECIST). Computed tomography (CT) assessment was performed every 8weeks. Consolidation radiotherapy was considered in locally advanced patients following six cycles of treatment.

RESULTS

In total 44 patients (phases I & II) were recruited. The median cycles delivered were 6 (range 1-16). Confirmed radiological responses were seen in 23% (95% confidence interval (CI): 11-38%) of patients. The median progression-free and overall survival for the entire cohort was 8.4 and 12.6months, respectively. In patients with metastatic disease the median overall survival was 10.1months. Common grade 3/4 toxicities were; neutropenia 52%, lethargy 32%, diarrhoea 18% and hand-foot syndrome 18%.

CONCLUSION

The combination of gemcitabine, capecitabine, erlotinib and bevacizumab was feasible with a manageable toxicity profile and demonstrated encouraging efficacy data in a good performance status population.

Ammonia and odour emissions from UK pig farms and nitrogen leaching from outdoor pig production. A review

We reviewed specific literature for emissions of ammonia (NH3) and odours from all stages of pig production together with nitrogen (N) leaching from raising pigs outdoors. Emissions of NH3 decrease with decreases in the crude protein (CP) content of pig diets, at all stages of manure management. The CPs of pig diets have been greatly reduced by matching the CP content to the protein required at each stage of the animals' growth and by using synthetic essential amino acids to minimise total CP intake. The CP contents of the dietary ingredients needed to provide energy for the animals impose further limits to reductions in dietary CP. Housing systems have been designed and evaluated which offer potential for reducing NH3 emissions. However such designs may not be applicable at all stages of the pigs' development and the careful management needed to ensure their effective working may be costly and difficult to implement on commercial farms. The factors behind odour emissions are less well characterised. Reducing diet CP to 160 g CP kg(-1) has been shown to reduce odour emissions but further CP reductions may increase them. Some reductions in odour emissions from buildings can be achieved by careful management of the ventilation rate but the most effective measures to reduce emissions of NH3 and odours are to cover slurry stores and to inject slurry into soil. Changes in the feeding and management of outdoor pigs mean that N leaching losses may be up to 50% less than previously reported. No studies have been undertaken that compare the N leached from pigs raised outdoors, versus that arising from the application of pig manure from an equal number of housed pigs. As a precursor to any field study, current models could be used to provide a first estimate of any systematic differences.

The impact of the Nitrates Directive on nitrogen emissions from agriculture in the EU-27 during 2000-2008

A series of environmental policies have been implemented in the European Union (EU) to decrease nitrogen (N) emissions from agriculture. The Nitrates Directive (ND) is one of the main policies; it aims to reduce nitrate leaching from agriculture through a number of measures. A study was carried out to quantify the effects of the ND in the EU-27 on the leaching and runoff of nitrate (NO3(-)) to groundwater and surface waters, and on the emissions of ammonia (NH3), nitrous oxide (N2O), nitrogen oxides (NO(x)) and dinitrogen (N2) to the atmosphere. We formulated a scenario with and a scenario without implementation of the ND. The model MITERRA-Europe was used to calculate N emissions on a regional level in the EU-27 for the period 2000-2008. The calculated total N loss from agriculture in the EU-27 was 13 Mton N in 2008, with 53% as N2, 22% as NO3, 21% as NH3, 3% as N2O, and 1% as NO(x). The N emissions and leaching in the EU-27 slightly decreased in the period 2000-2008. Total emissions in the EU in 2008 were smaller with implementation of the ND than without the ND, by 3% for NH3, 6% for N2O, 9% for NO(x), and 16% for N leaching and runoff in 2008. However, regional differences were large. The lower emissions with ND were mainly due to the lower N inputs by fertilizers and manures. In conclusion, implementation of the ND decreased both N leaching losses to ground and surface waters, and gaseous emissions to the atmosphere. It is expected that the ND will result in a further decrease in N emissions in EU-27 in the near future, because the implementation of the measures for the ND is expected to become more strict.

Filtration of sea louse, Lepeophtheirus salmonis, copepodids by the blue mussel, Mytilus edulis, and the Atlantic sea scallop, Placopecten magellanicus, under different flow, light and copepodid-density regimes

Population management of Lepeophtheirus salmonis in Canada currently relies on chemotherapeutants to remove attached stages of the ectoparasite. However, some populations of L. salmonis are developing resistance to chemotherapeutants making alternate management measures necessary. This article explores the ability of filter-feeding shellfish [i.e. blue mussels (Mytilus edulis) and Atlantic sea scallops (Placopecten magellanicus)] to consume the copepodid stages of L. salmonis in the laboratory under static and flowing water conditions, with variable copepodid densities, and with the aid of a light attractant. Mytilus edulis consumed copepodids under both static and flowing water conditions, and the proportion of individuals ingested was similar at low and high copepodid densities, suggesting that M. edulis was not saturated at the concentrations tested. Also, M. edulis consumed more copepodids when a light attractant was present, suggesting that lights may be useful to concentrate widely dispersed copepodids around cultured shellfish in the field. Finally, P. magellanicus consumed the same number of copepodids as an equivalent total wet weight of M. edulis. During each of the four separate experiments, shellfish consumed between 18 and 38% of the copepodids presented per hour, suggesting that both species are well suited for low level removal of copepodids over time.

Skeletal complications of bisphosphonate use: what the radiologist should know

Bisphosphonates are widely used for prevention of fractures in patients at risk, mainly in the presence of osteoporosis and bone metastases. A number of adverse effects of prolonged bisphosphonate treatment have emerged. We would like to highlight the skeletal complications from which a radiologist may be the first healthcare professional to recognise the association with bisphosphonate therapy. We illustrate these complications (namely osteonecrosis of the jaw and less well-known atypical femoral shaft fractures), presenting radiological findings in our patients. Recommendations for safer use of bisphosphonates are included in the conclusion of our review.

Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation

We present a series of 35 patients (19 men and 16 women) with a mean age of 64 years (36.7 to 75.9), who underwent total hip replacement using the ESKA dual-modular short stem with metal on-polyethylene bearing surfaces. This implant has a modular neck section in addition to the modular head. Of these patients, three presented with increasing post-operative pain due to pseudotumour formation that resulted from corrosion at the modular neck-stem junction. These patients underwent further surgery and aseptic lymphocytic vaculitis associated lesions were demonstrated on histological analysis. Retrieval analysis of two modular necks showed corrosion at the neck-stem taper. Blood cobalt and chromium levels were measured at a mean of nine months (3 to 28) following surgery. These were compared with the levels in seven control patients (three men and four women) with a mean age of 53.4 years (32.1 to 64.1), who had an identical prosthesis and articulation but with a prosthesis that had no modularity at neck-stem junction. The mean blood levels of cobalt in the study group were raised at 50.75 nmol/l (5 to 145) compared with 5.6 nmol/l (2 to 13) in control patients. Corrosion at neck-stem tapers has been identified as an important source of metal ion release and pseudotumour formation requiring revision surgery. Finite element modelling of the dual modular stem demonstrated high stresses at the modular stem-neck junction. Dual modular cobalt-chrome hip prostheses should be used with caution due to these concerns.