Establishment of Reference Intervals of Hematological Parameters and Evaluation of Sex and Age Effect in the Miranda Donkey

The Miranda donkey is an autochthonous Portuguese breed that is considered endangered. Several studies have been carried out on this breed, but to the authors' best knowledge, no studies have been conducted on their clinical pathology. The aims of this study were to determine the hematological reference intervals (RIs) in healthy Miranda donkeys and to estimate the influence of age and sex. Blood samples from 75 clinically healthy animals were analyzed for 22 hematological parameters on the IDEXX ProCyte Dx, an automated hematology analyzer previously validated for the species. The RIs were estimated following the ASVCP guidelines with the Reference Value Advisor software. Regarding sex, no significant differences were found between groups. Regarding age, significant statistical differences (p < 0.05) were observed for red blood cells, red cell distribution width, white blood cells, lymphocytes, monocytes, platelets, plateletcrit (higher mean in young animals), mean corpuscular volume, mean corpuscular haemoglobin, neutrophils and eosinophils (higher mean in adults). The RIs described here can be used to evaluate and monitor the health status of animals and herds, as well as to guide diagnoses or select fit and healthy animals for reproduction, contributing to the preservation of the breed.

Explanatory model of symptoms of stress, anxiety and depression in the general population: Cross-sectional study during the COVID-19 pandemic

COVID-19 pandemic has had a great impact worldwide, specially affecting mental health and has undoubtedly taken part in human behaviour modification, increasing global health burden and with stress, anxiety and depression being the main contributors to this load. Because of the importance of this issue, the objective of this study was the creation of an explanatory model for the causal relationship of the main psychological variables: stress, anxiety and depression in the COVID-19 pandemic context. A cross-sectional study was carried out with a sample of 709 volunteers, sociodemographic variables and psychological symptoms were measured through a virtual DASS-21 questionnaire, during the COVID-19 pandemic, dated from November 2 to 6, 2020. A structural equation model using the weighted least squares means and the adjusted variance was employed for the creation and adjustment of the explanatory relational model. The results showed the presence of stress, anxiety and depression symptoms among the general population. The model showed an adequate fit (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; P = 0.000) and was able to explain more than 80% of depressive symptoms (R²  = 0.86) and more than 70% of anxiety symptoms (R²  = 0.72), in addition to showing a unidirectional causal relationship of long-term stress on anxiety, and anxiety on depressive symptoms, showing a linked behaviour of the same, in the adjusted model. It was also outlined that this model was characterized by being expressed mainly in women, with lower quality of sleep and at a younger age.

Optimization and use of near infrared imaging to guide lymph node collection in rhesus macaques (Macaca mulatta)

Background

Identification of lymph nodes (LNs) draining a specific site or in obese macaques can be challenging.

Methods

Indocyanine Green (ICG) was administered intradermal (ID), intramuscular, in the oral mucosa, or subserosal in the colon followed by Near Infrared (NIR) imaging.

Results

After optimization to maximize LN identification, intradermal ICG was successful in identifying 50–100% of the axillary/inguinal LN at a site. Using NIR, collection of peripheral and mesenteric LNs in obese macaques was 100% successful after traditional methods failed. Additionally, guided collection of LNs draining the site of intraepithelial or intramuscular immunization demonstrated significantly increased numbers of T follicular helper (Tfh) cells in germinal centers of draining compared to nondraining LNs.

Conclusion

These imaging techniques optimize our ability to evaluate immune changes within LNs over time, even in obese macaques. This approach allows for targeted serial biopsies that permit confidence that draining LNs are being harvested throughout the study.

AB0458 DISEASE ACTIVITY AT CONCEPTION PREDICTS LUPUS FLARE UP TO 2 YEARS AFTER BIRTH: A MULTICENTRE LONG TERM FOLLOW-UP STUDY

Background

Systemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregnancies exist.

Objectives

To assess predicting factors that might influence SLE disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months.

Methods

The study was design as an international retrospective, data-driven case collection study, enrolling 119 women with a first birth and with a strictly monitored follow-up period of 2 years.

Results

Table 1 shows pregnancy outcomes of all pregnancies. When considering disease manifestations, joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%and renal in 41%; 75% of patients were positive for anti-dsDNA, 49% for anti-ENA and 37% for anti-Ro/SSA positive. The mean SLE disease activity index 2000(SLEDAI-2k) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4.

Table 1.

Pregnancy outcomes of all pregnancies and relative breastfeeding data

Pregnancy CharacteristicsAll (214)%OutcomesLive births16979Miscarriages3717.3Stillbirths83.7Maternal and Foetal ComplicationsPrematurity3918.2Pre-eclampsia2310.7HELLP syndrome41.9Placental Infarction125.6Breastfeeding (all pregnancies)Any breastfeeding (n, %)10964.5*Exclusive breastfeeding (n, %)8751.5*Breastfeeding (after first birth)Any breastfeeding (n, %)8773.1**Any breastfeeding duration (months) (m±sd)10.29±10.04Exclusive breastfeeding*** (n, %)6252.1**Exclusive breastfeeding*** duration (months) (m±sd)6.07±6

*Percentages are calculated considering viable babies (total= 169)

**Percentages are calculated considering first birth (total= 119)

***Exclusive breastfeeding was defined as feeding infants only breast milk

At follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months(mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement(48%), followed by renal(33%), cutaneous(28%) and haematologic(20%).

Patients with remission of disease(SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares than those not in remission (18/49–37% vs. 43/70–61%;p=0.008) (Figure 1).

Figure 1.

Flare proportion: Survival Curve based on remission status at conception of the patients included in the study.

Patients who experienced a flare during pregnancy (17 patients), when compared to those who did not, had higher rates of flares during follow-up (76% vs. 47%, respectively, p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5, respectively, p<0.001), lower rate of remission of disease at conception (12% vs. 46%, respectively, p<0.001), lower rates of SLEDAI 2K at conception (5.9±5.6 vs. 2.3±4, respectively, p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%, respectively, p=0.009).

Remission of disease and flares during pregnancy remained significantly associated with the development of flares during follow-up after multivariate analysis.

Conclusion

Remission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.

References

[1]Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab 2019;33.

[2]Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005;52:514–521.

Disclosure of Interests

None declared

POS0462 HYDROXYCHLOROQUINE REDUCES THE TITERS OF ANTI-DOMAIN 1 ANTIBODIES OVER TIME IN PATIENTS WITH PERSISTENTLY POSITIVE ANTIPHOSPHOLIPID ANTIBODIES: RESULTS FROM THE APS ACTION CLINICAL DATABASE AND REPOSITORY (“REGISTRY”)

Background

Data on fluctuation of antibodies directed against domain 1 (anti-D1) of β2-glycoprotein I (β2GPI) are scarce. Patients with antiphospholipid syndrome (APS) and all three criteria tests for antiphospholipid antibodies (aPL) display higher titers of anti-D1, which correlate with anti-β2GPI levels.

Objectives

This project aims at evaluating predictors of the variation of anti-D1 titers over time in a large international cohort of persistently aPL positive patients.

Methods

AntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Registry was created to study the course of persistently aPL-positive patients with or without autoimmune disorders over at least 10 years. Inclusion criteria are positive aPL by Updated Sapporo Criteria tested within one year prior to enrolment. Patients are followed every 12±3 months with clinical data and blood collection. Patients with available blood samples from at least three time points were included in this analysis. Anti-β2GPI and anti-D1 IgG were tested by chemiluminescence (BioFlash, Werfen) at APS ACTION core laboratories. Positive results were defined as >20 CU, according to the manufacturer. Clinical data were retrieved from APS ACTION online database. Anti-D1 titers within the same subject were compared by Friedman’s test. A mixed linear model was built to identify predictors of the fluctuation of anti-D1 antibody titers over time.

Results

In this longitudinal study, 230 patients with anti-D1 tested at 4 time points were included (Table 1). Patients with thrombotic APS had anti-D1 titers significantly higher than those without thrombosis (p=0.022). Among 135 patients with at least one anti-D1 positive result, anti-D1 titers varied significantly over time (Friedman statistics: 508.5, p<0.0001; anti-D1 geometric mean at baseline 189.0; T1 132.3 [-15%]; T2 113.8 [-17%]; T3 109.2 [-6% versus T2, -38% versus T1]). Anti-D1 titers were significantly higher at baseline compared to T3 (p=0.029). In the 4 years of follow-up, 18 new thrombotic events occurred. Patients with double/triple aPL positivity displayed 12.5 fold increase [95%CI 7.4-20.0] in baseline anti-D1 titers. After adjustment for age, gender and number of positive aPL tests, the fluctuation of anti-D1 titers was associated with treatment with hydroxychloroquine (HCQ) at each time-point. In particular, treatment with HCQ, but not those with conventional immunosuppressors, was associated with a 1.3-fold decrease in anti-D1 titers [95%CI 1.1-1.5]. In the same multivariable model, incident vascular events were associated with a 1.5 fold increase of anti-D1 titers. A concomitant diagnosis of systemic lupus erythematosus did not affect the fluctuation of anti-D1 titers.

Table 1.

Demographic and Clinical Characteristics of 230 APS ACTION Registry Patients with anti-D1 tested ≥3 time points during the follow-up

Anti-D1 pos samplesAnti-D1 neg samplesp-valueOverall sample(n=135)(n=95)(n=230)Age [years] mean (SD)42.3 (11.8)48.8 (13.0)0.000145.0 (12.7)%Female (n)71.9 (97)65.3 (62)0.35869.1 (159)Associated systemic autoimmune disease39.3 (53)44.2 (42)0.53941.3 (95)aPL without APS19.3 (26)34.7 (33)0.01025.7 (59)Thrombotic APS54.1 (73)53.7 (51)53.9 (124)Obstetric APS11.9 (16)5.3 (5)9.1 (21)Thrombotic/+obstetric APS14.8 (20)6.3 (6)11.3 (26)aCL IgG89.5 (119/133)25.5 (24/94)<0.000163.0 (143/227)aCL, IgM36.1 (48/133)27.7 (26/94)0.23432.6 (74/227)Anti-2GPI, IgG93.2 (124/133)39.4 (37/94)<0.000170.9 (161/227)Anti-2GPI, IgM34.6 (46/133)21.3 (20/94)0.04329.1 (66/227)LA82.8 (82/99)59.5 (44/74)0.00172.8 (126/173)

Conclusion

Treatment with HCQ and vascular events during follow-up were identified as significant predictors of the fluctuation of anti-D1 antibody titers over time.

Disclosure of Interests

None declared.

Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU

INTRODUCTION

Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD.

AIM

To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence.

MATERIALS AND METHODS

Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied.

RESULTS

The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region.

CONCLUSIONS

This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Donkey welfare assessment in north-east Portugal

The well-documented versatility of donkeys (Equus africanus asinus) means that issues concerning their welfare can vary depending on how they are mainly used and their geographic location. The present study is the first assessment of donkey welfare to be systematically conducted in the Iberian Peninsula. This area is characterised by the coexistence of high levels of mechanisation and industrialisation, and human populations with low levels of formal education, still making use of donkeys in their daily work. This study aims to evaluate the main welfare problems affecting donkeys within this context. The welfare assessment was carried out in accordance with the first level of the AWIN protocol for donkeys. Only 37.6% of the animals evaluated showed all positive indicators, with no physical problem detected while the remaining 62.4% revealed at least one negative health indicator. Body Condition Score (BCS) was one of the main concerns, with around half of the donkeys exhibiting an inadequate body condition. Dental evaluation revealed similarly concerning results, with 62.8% of the animals assessed requiring treatment. Indications of hoof neglect were noted in 39.5% of the animals evaluated with a 9.84% incidence of lameness. Skin problems affected 26.7% of individuals. Only 41% of the animals displayed positive results for all behavioural indicators. Aside from BCS, the most prevalent problems were sub-optimal behaviour, pain reaction to cheek palpation, hoof disease and integument alterations. These issues should be prioritised, both as regards this specific donkey population and the education of their caretakers.

Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study

BACKGROUND

Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients.

METHODS

We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis.

RESULTS

Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (p = 0.067) and constipation (p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2,p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis.

CONCLUSION

We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.

Does the Introduction of Alien Species Represent a Sanitary Threat for Native Species? The Case of the Eastern Cottontail Sylvilagus floridanus in Italy

Introduction of alien species is a well-known threat to biodiversity. Where newly introduced, alien species may pose a risk for the local ecological community by competing for resources or by introducing pathogens. Sylvilagus floridanus is an American lagomorph introduced into Europe in the second half of 20th century, for hunting. This study evaluated the structure and epidemiological characteristics of the gastrointestinal parasite community in an introduced population of S. floridanus in the Province of Alessandria (Piedmont Region-Italy). Three alien parasites were reported out of 271 animals: Obeliscoides cuniculi in the stomach, Trichostrongylus calcaratus in the small intestine, and Passarulus nonnanulatus in the large intestine. All these nematodes are commonly reported in S. floridanus in its natural range, but they represent alien species in Europe. The report of these alien parasites is an example of the unexpected consequences caused by the introduction of non-native vertebrates. The documented introduction of new pathogens may alter the parasite community of the native lagomorphs, with possible long-term effects on local ecological dynamics.

Systemic cytokines/chemokines associated to radiographic abnormalities in pneumonia in children

Community-acquired pneumonia (CAP) diagnosis remains a challenge in paediatrics. Chest radiography is considered gold standard for definition of pneumonia, however no previous study assessed the relationship between immune response and radiographic-confirmed-pneumonia. We assessed association between cytokines/chemokines levels and radiographic abnormalities in children with CAP. Children < 5-years-old hospitalized with CAP were investigated in a prospective study at the Federal University of Bahia Hospital, Brazil. On admission, clinical data and biological samples were collected to investigate 20 aetiological agents and determine serum cytokines/chemokines levels; chest radiographs were performed. Among 158 patients, radiographic diagnosis of pneumonia was confirmed in 126(79.7%) and 17(10.8%) had pleural effusion. Viral, bacterial and pneumococcal infection were detected in 80(50.6%), 78(49.4%) and 37(23.4%) cases. By comparing the median concentrations of serum cytokines/chemokines between children with or without pleural effusion, interleukin(IL)-6 was higher (26.6[18.6-103.7] vs 3.0[0.0-19.8]; p < 0.001) among those with pleural effusion; and between children with or without radiographic-confirmed-pneumonia, IL-6 was higher in the first subgroup (4.5[0.0-23.4] vs 0.0[0.0-3.6]; p = 0.02) after having excluded cases with pleural effusion. Stratified analyses according to aetiology showed IL-6 increase in the radiographic-confirmed-pneumonia subgroup inside the pneumococcal infection (28.2[5.9-64.1] vs 0.0[0.0-0.0]; p = 0.03) subgroup. By multivariable analysis, with IL-6 as dependent variable, pneumococcal infection and pleural effusion showed independent association with IL-6 elevation [respective OR: 5.071 (95%CI = 2.226-11.548; p < 0.001) and 13.604 (95%CI = 3.463-53.449; p = 0.0001)]. Considering the cases without pleural effusion, the area under the curve of IL-6 to predict pneumococcal infection was 0.76 (95%CI = 0.66-0.86; p < 0.001). IL-6 increase is a potential biomarker of pneumococcal infection among children with CAP without pleural effusion upon admission.

SAT0341 PREDICTORS TO PROGRESSION TO SYSTEMIC SCLEROSIS IN A GROUP OF SECONDARY RAYNAUD PHENOMENON OBSERVED IN A LARGE SINGLE BRAZILIAN COHORT

Background:

The 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) allowed the inclusion of a subset of patients without skin involvement, emphasizing the need of early diagnosis of SSc.

Objectives:

In this setting, the objective of this study was to classify, according to ACR/EULAR SSc criteria, patients with Raynaud phenomenon (RP) and at least one SSc manifestation, except for skin involvement, and analyze predictors for development of SSc.

Methods:

This is a cross-sectional single-center analysis of consecutive patients presenting RP and a characteristic SSc manifestation (SSc autoantibody, SSc visceral involvement or SD pattern at nailfold capillaroscopy - NFC), without skin involvement, who attended a scleroderma outpatient clinic between 2010 and 2019. Patients were classified as SSc (according to ACR/EULAR SSc criteria) or undifferetiated connective tissue disease (UCTD) in their last medical visit and compared. Additionally, a longitudinal retrospective analysis of both groups was performed to find predictors for development of SSc. Data were obtained from an electronic register database. Statistical significance was set up as p<0.05.

Results:

Among 217 patients, 153 (70.5%) were classified as SSc, at the last medical visit, including 65 (30%) after the first investigation. During a comparable median follow-up [4.9±3.8 vs. 4.6±3.0 years;p=0.90], patients with SSc presented more frequently puffy fingers (PF:73% vs. 6.3%;p<0.01), pitting scars (87.4% vs. 4.7%;p<0.01), digital ulcers (25.2% vs. 1.6%;p<0.01), telangiectasias (52.3% vs. 7.8%;p<0.01), interstitial lung disease (ILD:66.7% vs. 34.4%;p<0.01), pulmonary hypertension (PH:18.3% vs. 7.9%;p=0.049) and esophageal dismotility (ED: 58.9% vs. 43.8%:p=0.02) than secondary RP patients without SSc. Moreover, SSc patients had more SD pattern at NFC (83.4%vs. 57.8%;p<0.01), anti-Scl70 antibody (16.6%vs. 3.1%;p<0.01), and nucleolar ANA pattern (22.5%vs. 10.9%;p=0.048). Furthermore, SSc patients were more frequently treated with immunosuppressive therapy (80.1%vs. 37.5%;p<0.01) and presented an increased death rate (9.9%vs. 1.6%;p<0.01 and Figure 1). For the analysis of the predictors to SSc, patients who had already fulfilled SSc criteria at baseline were excluded and 152 patients were analysed: 88 progressed to SSc and 64 remained as UCTD. After multivariate analyses, puffy fingers (OR=4.48; 95%CI 1.17-17.17;p=0.029) and a higher SSc score, both at baseline, (OR: 1.97; 95%CI 1.33-2.92;p<0.001) were predictors to SSc, while esophageal symptoms (OR=0.18; 95%CI 0.05-0.67; p=0.01) and absence of clinical symptoms (OR=0.08; 95%CI 0.01-0.40; p=0.002) were negative predictive factors. When analyzing the combination of SSc features, RP + PF + positive ANA (OR=15.5; 95%CI 4.5-53.1;p<0.001), RP + PF + positive ANA + SD-NFC (OR=12.3; 95%CI 2.8-54.2;p<0.001), RP + PF + SD-NFC (OR=12; 95%CI 2.79-54.1;p<0.01), and RP + lung disease (ILD/HAP) + SD-NFC (OR=3.0; 95%CI 1.1-10.5;p<0.04) were associated with classification as SSc, while combinations without non-RP clinical symptoms, as RP + SD-NFC (OR=0.027; 95%CI 0.003-0.210;p<0.001) and RP + anticentromere + SD-NFC (OR=0.050; 95%CI 0.007-0.440;p<0.001) were not associated with SSc.

Conclusion:

Among patients with RP and SSc features, but without skin involvement, those with SSc had a more severe disease with worse prognosis than UCTD with RP. Puffy fingers and a higher baseline SSc score, especially in combinations including PF or lung disease were predictors of SSc, reinforcing the strength of the ACR/EULAR classification criteria and the presence of specific non-RP symptoms.

Disclosure of Interests:

Valdirene Siqueira: None declared, Mariely Helbingen: None declared, Ana Paula Luppino-Assad: None declared, Henrique Carriço da Silva: None declared, Danieli Andrade: None declared, Ana Cristina Medeiros-Ribeiro: None declared, Percival D. Sampaio-Barros Consultant of: Abbvie, Boehringer Ingelheim, Lilly, Novartis, Speakers bureau: Abbvie, Janssen, Lilly, Novartis

Contribution of usage to endoscope working channel damage and bacterial contamination

BACKGROUND

Biofilm formation has been shown to be associated with damaged areas of endoscope channels. It was hypothesized that the passage of instruments and brushes through endoscope channels during procedures and cleaning contributes to channel damage, bacterial attachment and biofilm formation.

AIM

To compare surface roughness and bacterial attachment in used and new endoscope channels in vivo and in vitro.

METHODS

Surface roughness of 10 clinically used (retired) and seven new colonoscope biopsy channels was analysed by a surface profiler. For the in-vitro study, a flexible endoscope biopsy forceps was passed repeatedly through a curved 3.0-mm-diameter Teflon tube 100, 200 and 500 times. Atomic force microscopy was used to determine the degree of inner surface damage. The number of Escherichia coli or Enterococcus faecium attached to the inner surface of the new Teflon tube and the tube with 500 forceps passes in 1 h at 37^oC was determined by culture.

RESULTS

The average surface roughness of the used biopsy channels was found to be 1.5 times greater than that of the new biopsy channels (P=0.03). Surface roughness of Teflon tubes with 100, 200 and 500 forceps passes was 1.05-, 1.12- and 3.2-fold (P=0.025) greater than the roughness of the new Teflon tubes, respectively. The number of E. coli and E. faecium attached to Teflon tubes with 500 forceps passes was 2.9-fold (P=0.021) and 4.3-fold (P=0.004) higher compared with the number of E. coli and E. faecium attached to the new Teflon tubes, respectively.

CONCLUSION

An association was found between endoscope usage with damage to the biopsy channel and increased bacterial attachment.

Antiphospholipid syndrome damage index (DIAPS): distinct long-term kinetic in primary antiphospholipid syndrome and antiphospholipid syndrome related to systemic lupus erythematosus

BACKGROUND

Antiphospholipid syndrome (APS) is an acquired thrombophilia that affects young productive individuals, with permanent damage and negative impact on quality of life. Recently, a damage index specific for APS (DIAPS) was developed. There are, however, no data regarding the comparison of its performance and long-term damage in primary antiphospholipid syndrome (PAPS) and APS related to systemic lupus erythematosus (SLE; APS + SLE). The primary purpose of this study was therefore to compare the long-term damage in patients with these conditions.

METHODS

This is a retrospective analysis of a single tertiary center cohort followed for approximately 10 years using a standardized prospective electronic chart database. Fifty consecutive PAPS patients age matched with 50 APS+SLE patients were consecutively selected for the study, and DIAPS was calculated once a year during follow-up. Long-term damage and damage kinetics in both groups were compared.

RESULTS

PAPS and APS + SLE had comparable age (47.10 ± 12.4 vs. 44.04 ± 10.80 years; p = 0.19) and time of follow-up (9.40 ± 3.60 vs. 10.94 ± 4.50 years; p = 0.06). At diagnosis, PAPS had higher DIAPS than APS + SLE (1.72 ± 1.17 vs. 0.82 ± 0.96; p < 0.001). At the end of the 10-year follow-up, both groups presented comparable mean damage scores (2.04 ± 1.50 vs. 2.24 ± 1.61; p = 0.52). The damage increment throughout the observation period for PAPS was solely 35%, whereas for APS + SLE it was gradual, persistent and reached 139% at the end of follow-up, with a total damage increment for PAPS lower than APS + SLE (0.43 ± 0.30 vs. 1.22 ± 1.24; p < 0.001). Of note, the frequency of individuals who acquired damage was lower in PAPS than in APS + SLE (32% vs. 71%; p < 0.001). PAPS also had a longer delay in diagnosis than APS + SLE (4.00 ± 4.20 vs. 2.54 ± 3.05 years; p = 0.04). This delay was positively correlated with a higher damage score at diagnosis (r = 0.36, p < 0.001) in all groups.

CONCLUSION

We identified a distinct pattern of damage in PAPS and APS related to SLE. Damage in PAPS is an early event, while APS+SLE is associated with higher long-term damage, with a striking increment of damage along the follow-up. A diagnosis delay is correlated with higher damage scores. Damage surveillance therefore requires different approaches for these two conditions.

Insulin-like growth factor-1 short-period therapy improves cardiomyopathy stimulating cardiac progenitor cells survival in obese mice

BACKGROUND AND AIMS

Cardiovascular diseases are the main cause of mortality in obesity. Despite advanced understanding, the mechanisms that regulate cardiac progenitor cells (CPC) survival in pathological conditions are not clear. Low IGF-1 plasma levels are correlated to obesity, cardiomyopathy and CPC death, so this work aimed to investigate IGF-1 therapeutic potential on cardiomyopathy and its relationship with the survival, proliferation and differentiation of CPC in Western diet-induced obesity.

METHODS AND RESULTS

Male Swiss mice were divided into control group (CG, n = 8), fed with standard diet; and obese group (OG, n = 16), fed with Western diet, for 12 weeks. At 11th week, OG was subdivided to receive a daily subcutaneous injection of human recombinant IGF-1 (100 μg.Kg^-1) for seven consecutive days (OG + IGF1, n = 8). Results showed that IGF-1 therapy improved the metabolic parameters negatively impacted by western diet in OG, reaching levels similar to CG. OG + IGF-1 also demonstrated restored heart energetic metabolism, fibrosis resolution, decreased apoptosis level, restored cardiac gap junctions and intracellular calcium balance. Cardiomyopathy improvement was accompanied by increased CPC survival, proliferation and newly cardiomyocytes formation related to increased pAkt/Akt ratio.

CONCLUSION

These results suggest that only one week of IGF-1 therapy has cardioprotective effects through Akt pathway upregulation, ensuring CPC survival and differentiation, contributing to heart failure rescue.

Evolution of cytokines/chemokines in cases with community-acquired pneumonia and distinct etiologies

AIM

To compare the systemic cytokines/chemokines levels over time during the evolution of children hospitalized with community-acquired pneumonia (CAP) with and without pneumococcal infection.

METHODS

Children less than 5-years-old hospitalized with CAP were prospectively investigated in Salvador, Brazil. Clinical data and biological samples were collected to investigate 20 etiological agents and to determine serum cytokines/chemokines levels on admission and 2 to 4 weeks later. Cases with pneumococcal infection received this diagnosis irrespective of also having other etiologies.

RESULTS

A total of 277 patients were enrolled, however, serum sample was unavailable for cytokine measurement upon admission (n = 61) or upon follow-up visit (n = 36), etiology was undetected (n = 50) and one patient did not attend the follow-up visit. Therefore, this study group comprised of 129 cases with established etiology. The median (interquartile range) age and sampling interval was 18 (9-27) months and 18 (16-21) days, respectively. Established etiology was viral (52.0%), viral-bacterial (30.2%), and bacterial (17.8%). Pneumococcal infection was found in 31 (24.0%) patients. Overall, median interleukin-6 (IL-6; 10.6 [4.7-30.6] vs 21.0 [20.2-21.7]; P = .03), IL-10 (3.5 [3.1-4.5] vs 20.1 [19.8-20.4]; P < .001), and CCL2 (19.3 [12.4-23.2] vs 94.0 [67.2-117.8]; P < .001) were significantly higher in convalescent serum samples, whereas median CXCL10 (83.6 [36.4-182.9] vs 14.6 [0-116.6]; P < .001) was lower. Acute vs convalescent levels evolution of IL-10, CCL2, and CXCL10 did not differ among patients with or without pneumococcal infection. However, IL-6 decreased (27.8 [12.3-48.6] vs 20.8 [20.2-22.6]; P = .1) in patients with pneumococcal infection and increased (9.0 [4.2-22.6] vs 21.0 [20.2-21.7]; P = .001) in patients without it.

CONCLUSION

The marked increase of IL-6 serum levels during the acute phase makes it a potential biomarker of pneumococcal infection among children with CAP.

Maxillary protaction with zygomatic anchorage in a growing class III patient

Maxillary protraction headgear with dental anchorage is commonly used in the treatment of class III malocclusion, but this treatment has been shown to have certain undesirable effects such as the loss of dental anchorage. These side effects can be reduced with the use of skeletal anchorage such as miniplates, mini screws and implants. This case report describes an orthopaedic treatment performed on a 10-year-old boy presenting a class III malocclusion with maxillary hypoplasia, for which a 10-month first phase of maxillary protraction was realised with zygomatic miniplates used as a skeletal anchorage. As a result, significant skeletal, dental and facial changes were observed.

Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study

OBJECTIVE

To evaluate the subsequent rate of thrombosis among women with obstetric antiphospholipid syndrome (Ob-APS) in a multicentre database of antiphospholipid antibody (aPL)-positive patients, and the clinical utility of the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), a validated tool to assess the likelihood of developing new thrombosis, in this group of patients.

DESIGN

Retrospective study.

SETTING

The Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository.

POPULATION

Women with Ob-APS.

METHODS

Comparison of clinical and laboratory characteristics and measurement of aGAPSS in women with Ob-APS, with or without thrombosis, after initial pregnancy morbidity (PM).

MAIN OUTCOME MEASURES

Risk factors for thrombosis and aGAPSS.

RESULTS

Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented with thrombosis, and 47 (63%) of these women developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age at diagnosis of Ob-APS, additional cardiovascular risk factors, superficial vein thrombosis, heart valve disease, and multiple aPL positivity increased the risk of first thrombosis after PM. Women with thrombosis after PM had a higher aGAPSS compared with women with Ob-APS alone [median 11.5 (4-16) versus 9 (4-13); P = 0.0089].

CONCLUSION

Based on a retrospective analysis of our multicentre aPL database, 63% of women with Ob-APS developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased the risk. Women with subsequent thrombosis after Ob-APS had a higher aGAPSS at entry to the registry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women.

TWEETABLE ABSTRACT

More than 60% of women with obstetric antiphospholipid syndrome had thrombosis after initial pregnancy morbidity.

Neurologic manifestations of antiphospholipid syndrome

Neurological involvement in antiphospholipid antibody syndrome (APS) is common, and its occurrence increases morbidity and mortality. Patients may present variable neurological involvement, such as cerebrovascular disease, cognitive dysfunction, headache, seizures, movement disorders, multiple sclerosis-like syndrome, transverse myelitis and ocular symptoms. Most neurological manifestations are associated with thrombosis of the microcirculation or of large vessels; nonetheless, there is compelling evidence suggesting that, in some cases, symptoms are secondary to an immune-mediated pathogenesis, with direct binding of aPL on neurons and glia. Herein we describe clinical characteristics and management of neurological APS manifestations.

Abstract P1-17-10: Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study

Background

The incidence of brain metastases among women with metastatic breast cancer (MBC) ranges from 10 to 30% depending of breast cancer (BC) subtype. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC and brain involvement.

Methods

LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival (OS) was defined as the time from the diagnosis of brain metastases and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private) among patients who developed brain metastases. Cox regression analysis was performed for identification of independent prognostic factors associated with survival after brain metastases diagnosis.

Results

Among the 690 MBC patients included in the LACOG-0312 study, 145 (21%) were diagnosed with brain metastases. Of them, 94 (71,75%) were covered by the Brazilian public health care and 37 (28,25%) had private coverage. Baseline characteristics such as age at MBC diagnosis, stage IV at diagnosis and tumor subtypes were similar between both groups.

Median time to develop brain metastases after diagnosis of MBC was 14 months in the whole population with no differences between public and private patients (13 vs. 17 months p=0.172).

Median OS from the date of brain metastases diagnosis was similar for both groups: 10.0 months in private and 9.0 months in public health insured patients (HR 0.92 – 95%CI 0.55-1.51; p=0.729). In a multivariable analysis including type of health care coverage, only the triple negative BC subtype was associated with a worse survival post brain metastases diagnosis.

Conclusion

Our study indicates that health care coverage is not associated with survival outcomes in patients with MBC and brain metastases. Potential differences in the access to optimal care such as radiotherapy, surgery and systemic treatments may not play a significant role in the survival of theses patients possibly due to small clinical benefit of the current treatment options for brain metastases in breast cancer.

Citation Format: Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-10.

Abstract P4-10-17: Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study

Background

Metastatic breast cancer (MBC) is an incurable disease in which latest therapies have evolving and improving patients survival. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. In Brazil patients with private health coverage have access to the most recent therapies, however the public health system does not provide several therapies approved for the treatment of MBC such as everolimus, trastuzuman, eribulin, TDM-1, pertuzumab among others. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC.

Methods

LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival was defined as the time from the diagnosis of MBC and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private). Cox regression analysis was performed for identification of independent prognostic factors associated with overall survival.

Results

A total of 634 patients with MBC were included in the study. Baseline characteristics by type of health care coverage was similar for visceral disease (43% in public and 44% in private, p=0.78), age at MBC diagnosis (median 62 years in public and 64 years in private, p=0.25), BC subtype (p=0.89), however more patients public insured were metastatic at diagnosis (42% vs. 33%) and had performance status &gt;= 2 (12% vs. 3%).

The proportion of patients that received any first-line systemic therapy was similar in both groups (95.2% in public and 95.5% in private, p=1.0), however more patients with private insurance received second (82% vs. 71.6%, p=0.013) and third line (56% vs. 45%, p=0.024) therapy compared to public health covered patients.

OS from the date of MBC diagnosis in whole population was 36 months. There was no difference in terms of OS between private (42 months) and public (35 months) health insured patients (p=0.65). OS by BC subtype was 15 months for triple negative, 23 months in HER2 positive, 44 and 42 months for Luminal A and B respectively. There was no difference in OS by type of health insurance coverage in any BC subtypes.

In a multivariate analysis type of health care coverage did not associate with survival, only triple negative (HR (95% CI) – 3.495 (2.448 - 4.989); p &lt;0.001), HER2 positive (HR (95% CI) - 2.287 (1.394 - 3.572); p = 0.001) BC subtypes and visceral metastases (HR (95% CI) – 1.413 (1.075 - 1.858); p &lt;0.013) were correlated with a worse survival.

Conclusion

Our study suggestes that health care coverage is not associated with survival outcomes in patients with MBC. Potential differences in the access to optimal systemic treatments may not play a significant role in the survival of these patients. Real-world studies addressing the impact of new cancer therapies for different BC subtypes in MBC are needed.

Citation Format: Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-17.

Heme Drives Oxidative Stress-Associated Cell Death in Human Neutrophils Infected with Leishmania infantum

Free heme is an inflammatory molecule capable of inducing migration and activation of neutrophils. Here, we examine the heme-driven oxidative stress-associated cell death mechanisms in human neutrophils infected with Leishmania infantum, an etiologic agent of visceral leishmaniasis (VL). We first performed exploratory analyses in a population of well characterized treatment-naïve VL patients as well as uninfected controls, who were part of previously reported studies. We noted a positive correlation between serum concentrations of heme with heme oxygenase-1 (HO-1) and lactate deydrogenase, as well as, a negative correlation between heme values and peripheral blood neutrophils counts. Moreover, in vitro infection with L. infantum in the presence of heme enhanced parasite burden in neutrophils, while increasing the production of reactive oxygen species and release of neutrophilic enzymes. Additional experiments demonstrated that treatment of infected neutrophils with ferrous iron (Fe⁺²), a key component of the heme molecule, resulted in increased parasite survival without affecting neutrophil activation status. Furthermore, stimulation of infected neutrophils with heme triggered substantial increases in HO-1 mRNA expression as well as in superoxide dismutase-1 enzymatic activity. Heme, but not Fe⁺², induced oxidative stress-associated cell death. These findings indicate that heme promotes intracellular L. infantum survival via activation of neutrophil function and oxidative stress. This study opens new perspectives for the understanding of immunopathogenic mechanisms involving neutrophils in VL.

Systemic cytokines and chemokines on admission of children hospitalized with community-acquired pneumonia

Community-acquired pneumonia (CAP) is the main cause of death in children under-5 years worldwide and Streptococcus pneumoniae is the most common bacterial agent. However, it is difficult to identify pneumococcal infection among children with CAP. We aimed to assess association between any cytokine/chemokine and pneumococcal infection in childhood CAP. Furthermore, we evaluated the diagnostic value of cytokine/chemokine for pneumococcal infection. This prospective study was conducted at an Emergency Room, in Salvador, Brazil. Children <5-years-old hospitalized with CAP in a 21-month period were evaluated. On admission, clinical and radiological data were collected along with biological samples to investigate 20 etiological agents and determine serum cytokines (interleukin (IL)-8, IL-6, IL-10, IL-1β, IL-12, TNF-α, IL-2, IL-4, IL-5, γ-interferon), and chemokines (CCL2, CCL5, CXCL9, CXCL10) concentration. From 166 patients with etiology detected, pneumococcal infection was detected in 38 (22.9%) cases among which the median IL-6(pg/ml) was 31.2 (IQR: 12.4-54.1). The other 128 cases had other causative agents detected (Haemophilus influenzae, Moraxella catarrhalis, atypical bacteria and viruses) with the median IL-6 concentration being 9.0 (IQR: 4.1-22.0; p < 0.001). The area under the ROC curve for IL-6 to predict pneumococcal CAP was 0.74 (95%CI: 0.65-0.83; p < 0.001). By multivariate analysis, with pneumococcal CAP as dependent variable, IL-6 was an independent predictor for pneumococcal infection (OR = 5.56; 95%CI: 2.42-12.75, cut-off point = 12.5 pg/ml; p = 0.0001). The negative predictive value of IL-6 under 12.5 pg/ml for pneumococcal infection was 90% (95%CI: 82-95%). Independently significant difference was not found for any other cytokines/chemokines. Serum IL-6 concentration on admission is independently associated with pneumococcal infection among children under-5 years hospitalized with CAP.

Abstract P6-16-04: Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study

Background

Randomised clinical trials (RCT) are considered a gold standard generating efficacy and safety data supporting drug approval. However, real world data (RWD) reflecting health care delivery is becoming increasingly important. RWD on patient profiles and patterns of care in MBC are scarce in developing countries. As an example, observational studies suggest that despite guideline recommendations clearly indicating ET for hormone receptor positive MBC, a considerable proportion of patients in clinical practice begin chemotherapy in early lines of therapy. This pragmatic information addresses the uptake and applicability of the RCT results and should be able to help informing health care planning complementing RCT generated data. The objective of this study is to describe patient characteristics and evaluate actual physician-reported treatments for MBC in Brazil.

Methods

This analysis addresses the first 362 patients included in LACOG-0312, a retrospective study planning to recruit over 700 patients (cut-off date April 30th 2016) with recurrent locally advanced or MBC diagnosed in 2012 in 18 institutions across Brazil. Patient characteristics, type of health insurance coverage, treatment and survival outcome were analysed.

Results

Median age at BC diagnosis was 53 years and 37% were premenopausal. Regarding the educational level, 63.2% had completed elementary (primary) schooling, 75.7% were covered by the public health system while 24.3% had some form of private coverage. 70% of patients had hormone receptor positive (HR+) and 18% had HER2 positive tumors. Median disease free survival time from surgery was 29 months. Interestingly, 30% of patients underwent a biopsy of a metastatic site. Of the 362 patients, 349 (96.9%) received some form of palliative systemic therapy. Median time from diagnosis of metastatic disease to first-line therapy initiation was 46 days but a significant difference was noted between patients with public versus private health insurance (50 vs. 33 days p=0.012). Half of the patients received at least 3 lines of therapy (chemo or endocrine) to a maximum of 9 lines. In patients with HR+ tumors, endocrine therapy was administered in 47% in first, 65% in second and 61% in third-line, respectively. Median overall survival (OS) from diagnosis of metastatic disease was 34 months (CI 95%: 25.7-44.3) and no differences in OS were observed between patients with public or private coverage (34 months vs. 35 months p=0.808). Causes of death were cancer in 85.2% of patients and treatment toxicity in 3.6%.

Conclusion

Our study included a population with predominantly low educational level and mostly public health insurance. This likely corresponds to the majority of cases and reflects cancer care patterns in Brazil and many developing countries. A considerable proportion of patients were premenopausal at MBC diagnosis. More than half of HR+ patients received at least 3 lines of endocrine therapy although 54% of them had chemotherapy as the first systemic treatment. Patients from the public health system experienced a delay in starting first-line therapy but this didn't seem to jeopardize cancer outcomes in this setting.

Citation Format: Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-04.

Estrogen receptor alpha gene (ESR1) polymorphism can contribute to clinical findings in systemic lupus erythematosus patients

Background

Estrogens have a modulatory effect on several immune responses, many of which are correlated to autoimmune diseases. Estrogens act through binding to their receptors, and an overexpression of these receptors has been identified in patients with different autoimmune diseases. Here we analyzed the association of a putative functional genetic variant in the main estrogen receptor (ERα) gene ( ESR1), and the susceptibility to clinical findings and severity of SLE.

Methods

A total of 426 individuals (266 healthy controls and 160 SLE patients) were genotyped for the polymorphism rs2234693 in the ESR1 gene. Allele and genotype frequencies were calculated and analyzed between cases and controls using Unphased software.

Results

The SNP rs2234693 was not associated with SLE per se but the minor allele rs2234693-C was correlated with the presence of nephritis and discoid skin rash. On the other hand, the rs2234693-CC genotype was correlated with the absence of arthritis as well as anti-ANA and anti-RNP autoantibodies. The comprehensive clinical analysis of these patients revealed a more severe status of the disease, characterized by a younger age of onset and higher number of organs involved when compared to European populations.

Conclusions

Minor allele rs2234693-C was associated with renal and cutaneous involvement, as well as the absence of arthritis, anti-ANA and anti-RNP autoantibodies.

Evaluating the feeding preferences of West Nile virus mosquito vectors using bird-baited traps

Background

The total contact rates (TCRs) between mosquito vectors and their potential hosts have a serious impact on disease transmission dynamics. Culex pipiens (sensu stricto) (s.s.) is considered the main vector of the West Nile Virus (WNV) in Europe and birds are the reservoir hosts. The results of our previous study showed that WNV seroreactors are significantly more prevalent among raptors compared to a range of other wild avian groups. The current study aims to assess the role of bird type (raptor vs others) and bird size on mosquito feeding preferences in a free-choice experiment using bird-baited traps.

Methods

From July to September 2014, a battery of six bird-baited traps was operated in twelve mosquito capture sessions. Eight bird species, belonging to five different orders, including raptors, were used. After each session, the trapped mosquitoes were collected and identified using standard keys. Two sets of independent generalized linear mixed models (GLMM) were used to assess mosquito vector feeding preferences (MFp) among different bird species and types.

Results

A total of 304 mosquitoes belonging to seven taxa were collected, C. pipiens being by far the most abundant (84.2 % of the total mosquito catch). Most C. pipiens were engorged (83.59 %). The selected model showed that 25.6 % of the observed variability of MFp is explained by the interaction between bird size and bird type, with C. pipiens preferring to feed on large birds, especially raptors. The proportion of engorged mosquitoes was 1.9-fold higher in large (22.88 %; range 0–42 %) than in medium-sized raptors (11.71 %; range 0–33 %), and was nearly the same in medium-sized (9.08 %; range 0–26 %) and large (8.5 %; 6–24 %) non-raptor species.

Conclusion

Culex pipiens showed an obvious preference for large raptors, which concurs with the higher seroprevalence to WNV in our previous study. The appreciable feeding by C. pipiens on large raptors makes them useful alternative sentinels to poultry for WNV surveillance. Thus, wildlife parks and rehabilitation centers can contribute to surveillance efforts to a greater extent.

Soft amphiphilic polyesters obtained from PEGs and silicon fatty compounds: structural characterizations and self-assembly studies

Transesterification polymerizations between a silicon fatty ester derived from methyl 10-undecenoate and polyethylene glycol (PEG) monomers generate amphiphilic biopolyesters ​showing abilities to form micelle and fiber structures.

Primary antiphospholipid syndrome: absence of premature atherosclerosis in patients without traditional coronary artery disease risk factors

OBJECTIVE

To investigate if patients with Primary Antiphospholipid Syndrome (PAPS) with venous and/or arterial thrombosis without traditional coronary artery disease (CAD) risk factors develop early atherosclerotic vascular damage.

METHODS

27 female patients with PAPS (Sidney criteria) and 27 age, body mass index (BMI), and sex matched controls were consecutively selected. Exclusion criteria were: black race, age ≥55 years, traditional cardiovascular risk factors, other thrombophilias or connective tissue diseases, corticosteroids use and pregnancy. All subjects underwent Pulse Wave Velocity (PWV) and Echo-Tracking (ET), both in carotidal bed, to analyse vascular functional properties.

RESULTS

Age (p = 0.92) and BMI (p = 0.91) were comparable in both groups. PAPS patients and controls had similar PWV (9.07 ± 1.08 m/s vs 9.42 ± 1.47 m/s, p = 0.34) as well as echo tracking parameters such as intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52), carotideal diameter (p = 0.26), distensibility (p = 0.92), compliance coefficients (p = 0.36) and elastic modulus (p = 0.78). Patients with exclusively venous thrombosis showed lower PWV than patients with arterial thrombosis (8.55 ± 0.70 m/s vs 9.56 ± 0.94 m/s, p = 0.01), but no difference regarding intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52) was observed.

CONCLUSION

Patients with PAPS do not seem to be at higher risk of developing premature atherosclerosis. Patients who suffered exclusively venous thrombosis seem to be at lower risk than those with exclusively arterial events. Other studies need to confirm our findings.

Eugenol como anestésico para oscar, Astronotus ocellatus

A utilização de anestésicos durante práticas de manejo na piscicultura é considerada uma medida mitigadora do estresse dos peixes. A espécie utilizada no experimento, o oscar, é um peixe nativo da Bacia Amazônica de grande importância para a piscicultura ornamental e amplamente difundida na aquariofilia mundial. O objetivo deste trabalho foi avaliar o efeito anestésico do eugenol sobre juvenis de oscar. Foram utilizados juvenis com peso de 4,61 ± 0,83 g e comprimento total de 6,36 ± 0,32 cm submetidos a diferentes concentrações de eugenol na água, em aquários distintos e posteriormente foi observada sua recuperação em aquários sem eugenol. Foram avaliadas quatro concentrações de eugenol: 40; 60; 80 e 100 mg/L. Os valores referentes ao tempo de permanência nos estágios de sedação e recuperação, bem como o tempo para completa sedação e retorno à natação normal foram avaliados e analisados via ANOVA (P

Craniofacial features and specific oral characteristics of Down syndrome children

AIM

This article intends to describe the characteristics of Down syndrome children in order to facilitate their management in the dental office.

METHODS

A review of literature was made limited to articles published between 2003 and 2013. The article is based on a literature search in PubMed and the authors' clinical experience with the patient group.

DISCUSSION

Individuals with Down syndrome are clinically characterized by generalized hypotonia, neurological, cardiac and respiratory problems and changes in their stomatognathic system. Almost all these patients have an occlusal disharmony, including anterior open bite, anterior and posterior crossbite, anterior proclination and underdevelopment of the maxilla and the midface. Dental anomalies such as hypodontia, peg-shaped teeth and enamel hypocalcification are also found. The dentomaxillofacial features have clinical implications in speech, nutrition, posture, ventilation and aesthetics, with enormous consequences in growth, development and social integration.

CONCLUSIONS

When planning the dental treatment of patients with Down syndrome, dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach.

Activated zeolite--suitable carriers for microorganisms in anaerobic digestion processes?

Plant cell wall structures represent a barrier in the biodegradation process to produce biogas for combustion and energy production. Consequently, approaches concerning a more efficient de-polymerisation of cellulose and hemicellulose to monomeric sugars are required. Here, we show that natural activated zeolites (i.e. trace metal activated zeolites) represent eminently suitable mineral microhabitats and potential carriers for immobilisation of microorganisms responsible for anaerobic hydrolysis of biopolymers stabilising related bacterial and methanogenic communities. A strategy for comprehensive analysis of immobilised anaerobic populations was developed that includes the visualisation of biofilm formation via scanning electron microscopy and confocal laser scanning microscopy, community and fingerprint analysis as well as enzyme activity and identification analyses. Using SDS polyacrylamide gel electrophoresis, hydrolytical active protein bands were traced by congo red staining. Liquid chromatography/mass spectroscopy revealed cellulolytical endo- and exoglucanase (exocellobiohydrolase) as well as hemicellulolytical xylanase/mannase after proteolytic digestion. Relations to hydrolytic/fermentative zeolite colonisers were obtained by using single-strand conformation polymorphism analysis (SSCP) based on amplification of bacterial and archaeal 16S rRNA fragments. Thereby, dominant colonisers were affiliated to the genera Clostridium, Pseudomonas and Methanoculleus. The specific immobilisation on natural zeolites with functional microbes already colonising naturally during the fermentation offers a strategy to systematically supply the biogas formation process responsive to population dynamics and process requirements.

Hypertrophic pulmonary osteoarthropathy with positive antinuclear antibodies: case report

A male Afro-descendant patient, 57 years old, complaining of polyarticular involvement and weight loss for 18 months, with a load of 13.5 pack years of smoking. On physical examination there was pain on palpation of the right knee and right leg, with signs of inflammation on the knee. We also observed digital clubbing in all fingers. Antinuclear antibodies (ANA) and anti-Sm antibodies were positive. X-rays of the legs and arm showed cortical thickening of long bones. The computed tomography demonstrated a large mass located in the middle lobe of the right lung. The anatomopathological study revealed a bronchial adenocarcinoma. The history of polyarticular involvement associated with positive anti-Sm and ANA antibodies could lead to an erroneous diagnosis of systemic lupus erythematosus. Considering the bad consequences of delayed diagnosis in this patient, the medical team should be alerted for suspecting and look for a lung cancer under these circumstances.

Heme oxygenase-1 promotes the persistence of Leishmania chagasi infection

Visceral leishmaniasis (VL) remains a major public health problem worldwide. This disease is highly associated with chronic inflammation and a lack of the cellular immune responses against Leishmania. It is important to identify major factors driving the successful establishment of the Leishmania infection to develop better tools for the disease control. Heme oxygenase-1 (HO-1) is a key enzyme triggered by cellular stress, and its role in VL has not been investigated. In this study, we evaluated the role of HO-1 in the infection by Leishmania infantum chagasi, the causative agent of VL cases in Brazil. We found that L. chagasi infection or lipophosphoglycan isolated from promastigotes triggered HO-1 production by murine macrophages. Interestingly, cobalt protoporphyrin IX, an HO-1 inductor, increased the parasite burden in both mouse and human-derived macrophages. Upon L. chagasi infection, macrophages from Hmox1 knockout mice presented significantly lower parasite loads when compared with those from wild-type mice. Furthermore, upregulation of HO-1 by cobalt protoporphyrin IX diminished the production of TNF-α and reactive oxygen species by infected murine macrophages and increased Cu/Zn superoxide dismutase expression in human monocytes. Finally, patients with VL presented higher systemic concentrations of HO-1 than healthy individuals, and this increase of HO-1 was reduced after antileishmanial treatment, suggesting that HO-1 is associated with disease susceptibility. Our data argue that HO-1 has a critical role in the L. chagasi infection and is strongly associated with the inflammatory imbalance during VL. Manipulation of HO-1 pathways during VL could serve as an adjunctive therapeutic approach.

Isolated osseous ovarian metaplasia: case report

BACKGROUND

Some ovarian metaplasias may contain bone or osteoid tissue. The most common tumors presenting these alterations are teratomas and mixed mesodermal tumors with heterologous elements.

CASE REPORT

We report the case of a woman who, during gynecologic follow-up for chronic anovulation at the age of 31 years, presented a solid ovarian ultrasonographic image with calcifications. After laparoscopy and histological examination it was found to be an isolated ovarian osseous metaplasia.

CONCLUSION

A rarely occurring condition, ovarian osseous metaplasia continues to be of uncertain clinical significance.

Genetic analysis of the cultivated potato Solanum tuberosum L. Phureja Group using RAPDs and nuclear SSRs

The Solanum tuberosum L. Phureja Group consists of potato landraces widely grown in the Andes from western Venezuela to central Bolivia, and forms an important breeding stock due to their excellent culinary properties and other traits for developing modern varieties. They have been distinguished by short-day adaptation, diploid ploidy (2n = 2x = 24), and lack of tuber dormancy. This nuclear simple sequence repeat (nSSR or microsatellite) study complements a prior random amplified polymorphic DNA (RAPD) study to explore the use of these markers to form a core collection of cultivar groups of potatoes. Like this prior RAPD study, we analyzed 128 accessions of the Phureja Group using nuclear microsatellites (nSSR). Twenty-six of the 128 accessions were invariant for 22 nSSR markers assayed. The nSSR data uncovered 25 unexpected triploid and tetraploid accessions. Chromosome counts of the 102 accessions confirmed these nSSR results and highlighted seven more triploids or tetraploids. Thus, these nSSR markers (except 1) are good indicators of ploidy for diploid potatoes in 92% of the cases. The nSSR and RAPD results: (1) were highly discordant for the remaining 70 accessions that were diploid and variable in nSSR, (2) show the utility of nSSRs to effectively uncover many ploidy variants in cultivated potato, (3) support the use of a cultivar-group (rather than a species) classification of cultivated potato, (4) fail to support a relationship between genetic distance and geographic distance, (5) question the use of any single type of molecular marker to construct core collections.

[Gastric volvulus]

Gastric volvulus is a rare condition in pediatric population in which there is an abnormal rotation of one part of the stomach around itself. It's a surgical emergency. We report a six year old female admitted in the emergency due to upper abdominal distention, nausea without vomiting, physical exam revealed upper abdominal distention and abdominal tenderness, no bowel sounds. Laparotomy was performed and a gastric volvulus with occlusive vascular involvement was found. In the post operative period she required a second laparotomy due to adhesions in small bowel.