Ligament Laxity in Nonerosive Immune-Mediated Polyarthritis in Dogs: Five Cases (2009–2017)

2019 ◽  
Vol 55 (4) ◽  
pp. 210-214
Author(s):  
Fiona Whitworth ◽  
Sophie Adamantos ◽  
Polly Frowde ◽  
Richard Whitelock ◽  
Vicki L. Black
Keyword(s):  
Lupus Erythematosus ◽  
Clinical Signs ◽  
Poor Control ◽  
Immune Mediated ◽  
Ligament Laxity ◽  
Care Practices ◽  
Primary Care Practices ◽  
First Time ◽  
Multiple Episodes

ABSTRACT Ligament laxity is a known complication of erosive immune-mediated polyarthritis (IMPA) in dogs. The purpose of this study was to describe the occurrence and clinical features of carpal or tarsal ligament laxity in cases of nonerosive IMPA in dogs for the first time. Five client-owned dogs with a diagnosis of nonerosive IMPA and carpal or tarsal ligament laxity in which the influence of corticosteroids was excluded were identified. Medical records were reviewed, and data including signalment, investigative findings, and treatment regimen (e.g., surgical management) was extracted. Primary care practices were contacted to obtain follow-up, and the data was descriptively analyzed. The affected joints were either carpi and tarsi (n = 3) or carpi only (n = 2). In three cases, surgical arthrodesis was performed. Three dogs were euthanized (1 mo, 12 mo, and 5 yr) as a result of the severity of clinical signs and poor control. In the four dogs surviving >6 mo, multiple episodes of relapse were recorded, and multimodal immunosuppression was needed. The prognosis for the dogs described was poor, with none achieving control of the disease without ongoing immunosuppressive therapy. Damage to soft-tissue periarticular structures may be related to prolonged clinical disease or a more severe presentation. Jaccoud’s arthropathy in humans with systemic lupus erythematosus may represent a homologous presentation.

scholarly journals Depression risk in patients with heart failure in primary care practices in Germany

2016 ◽  
Vol 28 (11) ◽  
pp. 1889-1894
Author(s):  
Marcel Konrad ◽  
Jens Bohlken ◽  
Michael A Rapp ◽  
Karel Kostev
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Insurance ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Study Population ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

Vaccine Hesitancy in Pediatric Primary Care Practices

2018 ◽  
Vol 28 (13) ◽  
pp. 2071-2080 ◽  
Author(s):  
Salini Mohanty ◽  
Amy Carroll-Scott ◽  
Marissa Wheeler ◽  
Cecilia Davis-Hayes ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Vaccine Hesitancy ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Multiple Strategies ◽  
Efficiency And Effectiveness ◽  
Care Practices ◽  
Barriers And Challenges ◽  
Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

scholarly journals Prevalence of Hospital PCR Confirmed COVID-19 Cases in Patients with Chronic Inflammatory and Autoimmune Rheumatic Diseases

2020 ◽  
Author(s):  
José L. Pablos ◽  
Lydia Abasolo-Alcázar ◽  
José M. Álvaro-Gracia ◽  
Francisco J. Blanco ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Age Distribution ◽  
Reference Population ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Immune Mediated ◽  
Specific Factors

ABSTRACTBackgroundThe susceptibility of patients with rheumatic diseases, and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown.MethodsWe performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with SARS-CoV-2 positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups.ResultsPatients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Systemic autoimmune or immune mediated diseases (AI/IMID) patients showed a significant increase, whereas inflammatory arthritis (IA) or systemic lupus erythematosus (SLE) patients did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. IA patients on targeted-synthetic or biological disease-modifying antirheumatic drugs (ts/bDMARD), but not those on conventional-synthetic (csDMARD), had a greater prevalence despite a similar age distribution.ConclusionPatients with AI/IMID show a variable risk of hospital diagnosed COVID-19. Interplay of aging, therapies, and disease specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyze the specific factors involved in COVID-19 susceptibility.

Can Anti-Thyroid Antibodies Influence the Outcome of Primary Chronic Immune Thrombocytopenia in Children?

2020 ◽  
Vol 20 (3) ◽  
pp. 351-355 ◽  
Author(s):  
Paola Giordano ◽  
Maurizio Delvecchio ◽  
Giuseppe Lassandro ◽  
Federica Valente ◽  
Valentina Palladino ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Signs ◽  
Thyroid Antibodies ◽  
Chronic Itp ◽  
Immune Mediated

Background: Immune thrombocytopenia (ITP) is an acquired immune mediated disorder characterized by isolated thrombocytopenia. Pediatric ITP patients can develop autoantibodies such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO), even in the absence of clinical signs of autoimmune disease. Objective: The purpose of this article is to provide a review about: 1) the prevalence of positivity of anti-thyroid antibodies (TPO and TG) in pediatric patients with chronic ITP; 2) the role of autoimmune thyroiditis on the outcome of chronic ITP. Method: The authors individually completed a review of the literature for this article. Retrospective and prospective clinical studies with pediatric cohorts were considered. Results: From the analysis of data, we found 4 papers which included studies only on pediatric population, and which corresponded to selected criteria. Pediatric ITP patients have been shown to have a statistically significant prevalence of anti-thyroid antibodies over healthy controls (11.6-36% versus 1.2-1.3%). No correlation has been found between the platelet count and the prevalence of positive anti-thyroid antibodies at any time of the follow up. Conclusion: The results of our bibliographic research demonstrated that: a) pediatric patients with chronic ITP tend to have a statistically significant prevalence of anti-thyroid antibodies positivity respect to general pediatric population; b) there are no clear data about the role of autoimmune thyroiditis as prognostic factor for chronic course of ITP in pediatric age.

Recurrence and Late Sequelae after First-Time Deep Vein Thrombosis: Relationship to Initial Signs

1993 ◽  
Vol 8 (2) ◽  
pp. 62-67 ◽  
Author(s):  
C. Lagerstedt ◽  
C.-G. Olsson ◽  
B. Fagher ◽  
L. Norgren ◽  
L. Tengborn
Keyword(s):  
Clinical Signs ◽  
Plasminogen Activator Inhibitor ◽  
University Hospital ◽  
Poor Correlation ◽  
Plasminogen Activator Inhibitor 1 ◽  
Vein Thrombosis ◽  
Initial Symptoms ◽  
First Time ◽  
Pai 1

Objective: To investigate the relation between initial symptoms and long-term sequelae in first-time deep venous thrombosis (DVT). Design: Follow-up study of patients 6 years after an episode of suspected symptomatic DVT. Setting: Vascular laboratory, University Hospital of Lund. Patients: 66 patients, 19 with femoral DVT, 20 with calf DVT and 27 with normal phlebograms at initial investigation. Main outcome measures: Symptoms and signs of chronic venous insufficiency (CVI), foot volumetry and measurement of plasminogen activator inhibitor 1 (PAI-1) activity. Initial clinical signs and results at phlebography were compared with findings at follow-up. Results: Of patients with DVT, 11 (28%) had been treated for a recurrent DVT during follow-up. No relation was found between initial signs of DVT and late signs of CVI. Patients with DVT had significantly more signs of CVI but symptoms did not differ between the groups. Mean levels of PAI-1 activity were similar in the three groups, and patients with recurrent DVT did not differ. Refilling flow was related to the clinical CVI-score, and expelled volume was inversely related to the extension of DVT at phlebography. Conclusion: The recurrence rate is high in first-time DVT, but symptoms are mostly mild as long as after 6 years. There is a poor correlation between symptoms of CVI and objective findings. The late development of CVI cannot be predicted from the clinical signs in the acute phase. Levels of PAI-1 do not correlate with the degree of CVI.

scholarly journals 10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study

2021 ◽  
pp. annrheumdis-2020-218625
Author(s):  
Annemaria C. van Berkel ◽  
Dieuwke Schiphof ◽  
Jan H. Waarsing ◽  
Jos Runhaar ◽  
John M. van Ochten ◽  
...  
Keyword(s):  
Physical Functioning ◽  
Clinical Signs ◽  
Hip Osteoarthritis ◽  
Signs And Symptoms ◽  
Natural Course ◽  
Radiographic Osteoarthritis ◽  
American College Of Rheumatology ◽  
Clinical Signs And Symptoms ◽  
First Time

ObjectiveTo explore the natural course of hip osteoarthritis (OA) in a population of first-time presenters with hip complaints.MethodsData were collected at baseline and after 2, 5, 8 and 10 years on participants from the Cohort Hip and Cohort Knee study with early symptomatic hip OA. Descriptive statistics were used to analyse the natural course of the hip complaints with respect to clinical signs and symptoms, physical functioning and radiographic osteoarthritis (ROA) features.ResultsIn total, 588 participants were included with hip complaints and 86% completed the 10-year follow-up. The 10-year follow-up showed that 12% (69 participants) underwent hip replacement (HR), an increase of ROA of the hip (Kellgren and Lawrence score≥2) from 19% to 49%, and an increase in clinical hip OA according to the American College of Rheumatology criteria from 27% to 43%. All Western Ontario and McMaster Osteoarthritis Index subscales and physical activity remained on average constant during the 10-year follow-up for those who did not undergo an HR. The use of pain medication increased from 43% at baseline to 50% after 10 years.ConclusionOne out of nine participants with early hip problems received an HR during the 10-year follow-up. Prevalence of clinical hip OA and hip ROA increased steadily during the 10-year follow-up. Overall, we observed more hip OA, but fewer or stable complaints with respect to clinical signs and symptoms, and physical functioning. So it could be cautiously concluded that after 10 years, first-time presenters with hip complaints either received an HR or their symptoms remained stable.

scholarly journals Systemic Lupus Erythematosus Associated with Neurological Manifestations in a Border Collie Bitch

2021 ◽  
Vol 49 ◽  
Author(s):  
Isabel Rodrigues Rosado ◽  
Julia Perinotto Picelli ◽  
Juliana Gonzaga da Silva ◽  
Marina Cazarini Madeira ◽  
Taís Teixeira Zambarda ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Urinary Incontinence ◽  
Lupus Erythematosus ◽  
Clinical Signs ◽  
Neurological Manifestations ◽  
Systemic Lupus ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Immune Mediated ◽  
History Of

Background: Systemic lupus erythematosus (SLE) is an immune-mediated and multisystemic disorder which etiology is believed to be multifactorial. Its clinical signs vary accordingly to affected organs, cutaneous lesions being the most frequently observed. There are few reports of SLE in dogs with neurological manifestations. Therefore, the aim of this report is to describe a case of SLE in a dog with indicative signs of nervous system involvement.Case: A 6-year-old Border Collie bitch was referred to the Veterinary Hospital (HVU) of the University of Uberaba (UNIUBE) with a history of  with cluster seizures, inappetence and urinary incontinence. Erythema and flaking of nasal plan were noted on physical examination, and splenomegaly on abdominal palpation. Thrombocytopenia and slightly increased ALT were found on blood tests. Ehrlichiosis was suspected and doxycycline was prescribed together with phenobarbital for the control of seizures. In the follow-up visit, the dog was still presenting urinary incontinence, thrombocytopenia and splenomegaly. Also, an ulcer on the nasal mucocutaneous junction was observed. The patient went through a neurological examination which indicated thalamocortical lesion. Cerebrospinal fluid samples were obtained for cytology, culture and canine distemper test, and serology tests for leishmaniasis, toxoplasmosis and neosporosis were done. No alterations were found in these exams. The histopathology of the nasal lesion was proceeded and showed results consistent with lupus erythematosus. It was prescribed a 15-day course of prednisolone at immunosuppressive dose. The patient showed clinical improvement with this treatment. Azathioprine was started along with gradual removal of prednisolone. After twenty days of discontinuation of this drug, the dog presented epileptic seizures, urinary incontinence, thrombocytopenia, increased ALT and worsened nasal lesion. Prednisolone at immunosuppressive dose was reintroduced and the dose of azathioprine, increased. One week past this, the patient showed inappetence and an extensive hematoma in the thoracic region. Lab exams confirmed drug-induced acute pancreatitis. All medications were interrupted, the patient was hospitalized, and treatment for pancreatitis was initiated, but the dog passed away.Discussion: For involving multiple body systems and for presenting varied clinical signs, diagnosing SLE can be challenging in clinical routine. The dog from this report was a Border Collie; this breed is considered to be predisposed to this disease. The animal had a history of being exposed to solar radiation for a large part of the day, had dyspigmentation of nasal plan and had no application of sunscreen, predisposing the occurrence of SLE. Neurological signs are uncommon in SLE, but the seizures and the urinary incontinence were the main reasons for the dog’s guardian to look for medical assistance. The suspicion for SLE was raised due to cutaneous manifestations and persistent thrombocytopenia along with splenomegaly. Histopathological findings are essential for diagnosing SLE, as well as antinuclear antibody tests. Nonetheless, due to financial limitations, this last test was not performed. Azathioprine is an immunomodulating drug largely used along with glucocorticoids when treating SLE; however, this medication is prone to induce side effects as the ones presented by the dog from this report. Therefore, it is concluded that SLE should be considered as a differential diagnosis in patients showing cutaneous, hematological, systemic and neurological manifestations, considering the variety of signs caused by this disorder.Keywords: seizures, dog, immune-mediated encephalopathy. Lúpus eritematoso sistêmico associado a manifestações neurológicas em cadela da raça Border CollieDescritores: crises epilépticas, cão, encefalopatia imunomediada.

scholarly journals Renal-Limited “Lupus-Like” Nephritis: How Much of a Lupus

2017 ◽  
Vol 7 (2) ◽  
pp. 43-48 ◽  
Author(s):  
Asmaa S. Abu Maziad ◽  
Jose Torrealba ◽  
Mouin G. Seikaly ◽  
Jared R. Hassler ◽  
Allen R. Hendricks
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Poor Prognosis ◽  
Antinuclear Antibody ◽  
Clinical Signs ◽  
Small Subset ◽  
Systemic Lupus ◽  
Intravenous Cyclophosphamide ◽  
Antibody Tests

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by development of autoantibodies to nuclear and cytoplasmic antigens. A small subset of SLE patients who had the typical clinical features of SLE was reported to show persistently negative antinuclear antibody tests. Our report describes a 5-year-old male who presented with histopathological findings suggestive of lupus nephritis with no clinical signs or symptoms of SLE and negative autoantibodies. He was treated with corticosteroids, mycophenolate mofetil, and monthly intravenous cyclophosphamide. During the 2-year follow-up period, the proteinuria resolved and kidney function improved with continued negative autoantibody workup. This case presents a category of renal-limited “lupus-like” glomerulonephritis which can be challenging to treat and carries a poor prognosis.

scholarly journals Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ermengol Coma ◽  
Núria Mora ◽  
Leonardo Méndez ◽  
Mència Benítez ◽  
Eduardo Hermosilla ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Change ◽  
Paired Data ◽  
Negative Change ◽  
Negative Effect ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Impact ◽  
Quaternary Prevention

Abstract Background To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. Methods Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator’s percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. Results We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of − 2.69% (95%CI − 3.17% to − 2.23%) in March and − 3.41% (95%CI − 3.82% to − 3.01%) in April; and the control of blood pressure with a reduction of − 2.13% (95%CI − 2.34% to − 1.9%) and − 2.59% (95%CI − 2.8% to − 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of − 2.86% (95%CI − 3.33% to − 2.39%) and − 4.13% (95%CI − 4.55% to − 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. Conclusions The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.

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