Long-Term Efficacy of Mepolizumab at 3 Years in Patients with Severe Asthma: Comparison with Clinical Trials and Super Responders

The efficacy mepolizumab in severe asthmatic patients is proven in the literature. Primarily to study the effect of mepolizumab on exacerbations, steroid dependence, and the continuation of efficacy in the long term. Secondarily to evaluate the effect of the drug on nasal polyps. Analyzing data from SANI (Severe Asthma Network Italy) clinics, we observed severe asthmatic patients treated with mepolizumab 100 mg/4 weeks, for a period of 3 years. 157 patients were observed. Exacerbations were reduced from the first year (-84.6%) and progressively to 90 and 95% in the second and third ones. Steroid-dependent patients decreased from 54% to 21% and subsequently to 11% in the second year and 6% in the third year. Patients with concomitant nasal polyps, assessed by SNOT-22, showed a 49% reduction in value from baseline to the third year. The study demonstrated the long-term efficacy of mepolizumab in a real-life setting.

Analgesia pós-operatória com metadona em gatos: administração epidural e intramuscular

Compararam-se os efeitos analgésico, sedativo e neuroendócrino decorrentes da administração epidural e intramuscular da metadona em gatas submetidas à ovariossalpingoisterectomia (OSH). Todos os animais foram tranquilizados com acepromazina, 0,1mg kg-1 IM, seguindo-se a indução e manutenção anestésica com tiopental sódico, 12mg kg-1 IV, e halotano, respectivamente. Após a estabilização anestésica, os animais foram distribuídos em três grupos, com oito animais cada, tratados com metadona pela via epidural (EP) ou intramuscular (IM) 0,2mg kg-1, respectivamente, ou com solução salina (S) 0,2mL kg-1. Foram avaliados: graus de analgesia e de sedação, necessidade de analgesia de resgate, efeitos adversos e concentração sérica de cortisol. Os graus de analgesia e de sedação e o cortisol não diferiram entre os tratamentos. Analgesia de resgate foi administrada quatro, nove e 11 vezes nos tratamentos EP, IM e S, respectivamente. Nos tratamentos IM e S, a suplementação analgésica foi necessária a partir da primeira hora pós-cirúrgica, enquanto no tratamento EP, somente a partir da terceira hora após a OSH. Conclui-se que a administração de metadona pela via epidural resulta em menor quantidade do analgésico pós-operatório, e que a analgesia é mais prolongada quando comparada à obtida pela via intramuscular, em gatas submetidas à OSH.

[Urography with magnetic resonance: a new method for the study of the renal collecting system in patients without obstructive uropathy]

A new MR technique is proposed to study the renal collecting system and the proximal ureteral portion in patients without obstructive uropathy, using fat-suppressed Turbo Spin Echo sequences, after drug-induced distension of the urinary tract. Nine normal volunteers and 16 patients (11 with renal stones, 1 with bilateral pyeloureteral junction stenosis, 1 with renal ptosis, 1 with ureteral hyperkinesia, 1 with renal tumor and 1 with a symptomatic renal cyst) were submitted to MR-Urography, performed with a 3D non-breath-hold fat-suppressed Turbo SE sequence (TR = 3000 ms, TE = 800 ms, 6 acquisitions, Turbo Factor = 128, Matrix = 128 x 256 or 256 x 256, acquisition time = 5 min 15 sec or 10 min 36 sec) on the coronal plane. With these acquisition parameters, parenchymal signal can be completely suppressed while enhancing fluid signal. These acquisitions were post-processed with the MIP algorithm to obtain very similar images to those of conventional urography. The maximum filling of the renal collecting system was obtained with the i.v. administration of 250 ml saline solution within 2-3 minutes and then the i.v. injection of 20 mg furosemide. The renal collecting system was optimally depicted in all the volunteers and the patients, except for 2 cases because of malfunctioning respiratory gating. Anatomical detailing was really improved after the diuretic administration, especially in the study of the major caliceal systems. To conclude, MR-Urography permits accurate morphological detailing of the renal collecting system also in patients without obstructive uropathy.

Radiological changes and circulating immune complexes in patients with urinary schistosomiasis

The degree of infection and the urographic picture was correlated to the presence and level of circulating immune complexes (CICs) in 69 patients affected by urinary schistosomiasis. Patients were divided into 2 groups: those eliminating less and those eliminating more than 25 eggs/10 ml of urine. Radiological changes in the urinary tract were present in 67% of patients, the most frequent finding being single or multiple filling defects in the bladder. CICs were present in 39 patients. A positive correlation was found between the presence and level of CICs and the output of Schistosoma haematobium eggs, as well as between the presence of CIC and single or multiple filling defects of the bladder. Our findings indicated that CICs were present in patients with urinary schistosomiasis, but the different incidence in patients with a large egg output and radiological filling defects suggests a possible pathogenic role only in the earlier phase of the infection.