Clinical Signs, Activity Indices and Prognostic Indicators in Dogs with Idiopathic Inflammatory Bowel Disease

Background: Canine inflammatory bowel disease (IBD) includes a set of diseases characterized by the presence of recurrent gastrointestinal clinical signs and histologic evidence of intestinal inflammation. Diagnosis can only be made by excluding other possible causes of enteritis. Since the diagnosis of this disease is of great challenge to the veterinarians and currently very little work have been carried out in India, the present study was planned and conducted to study the clinicopathological changes and prognostic indicators of idiopathic inflammatory bowel disease (IBD) in dogs.Methods: After a detailed clinical, laboratoty and endoscopic examination, 33 IBD dogs with signs of chronic gastrointestinal disorders and histologic evidence of mucosal lymphocytic plasmacytic infiltration were selected for the study.Result: Moderate to severe form of IBD with haematochezia as a chief complaint was predominantly recorded. Haematobiochemical changes were not remarkable except a rise in serum alkaline phosphatase level. Decreased IgA expression was observed in serum by flowcytometry indicating impaired mucosal immunity in IBD dogs. It was observed that, increased clinical inflammatory bowel disease activity index score (CIBDAI), increased C-Reactive Protein, decreased cobalamin and folate may act as negative predictors in idiopathic IBD.

Subclinical ocular inflammation in persons recovered from ambulatory COVID-19

Coronavirus disease 2019 (COVID-19) is characterized by striking variability in clinical severity, and a hyperinflammatory response in the lung is associated with high mortality. Little is known about the extent and duration of inflammation in persons recovering from COVID-19. Here, we used spectral domain optical coherence tomography (SD-OCT) to detect the presence of inflammatory cells in the vitreous cavity, an immune-privileged microenvironment, in persons recovered from COVID- 19. Our results provide quasi-histologic evidence that neuroinflammation is present in persons who recovered from COVID-19, only one of whom required hospitalization. Our results also suggest that persons who feel that their recovery is incomplete have evidence of subclinical eye inflammation, which may be a marker of residual inflammation elsewhere as well.

Vasculitis Involving the Gastrointestinal System Is Often Incidental but Critically Important

Objectives This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. Methods GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. Results Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showed histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20% (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24% (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. Conclusions The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease.

Evidences of histologic Thrombotic Microangiopathy and the impact in renal outcomes of patients with IgA nephropathy

ABSTRACTIntroductionIgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. This paper aims to assess the impact of thrombotic microangiopathy (TMA) in the outcomes of Brazilian patients with IgAN.Materials and MethodsAnalysis of clinical data and kidney biopsy findings from patients with IgAN to assess the impact of TMA on renal outcomes.ResultsThe majority of the 118 patients included were females (54.3%); mean age of 33 years (25;43); hypertension and hematuria were observed in 67.8% and 89.8%, respectively. Median creatinine: 1.45mg/dL; eGFR: 48.8ml/min/1.73m2; 24-hour proteinuria: 2.01g; low serum C3: 12.5%. Regarding to Oxford Classification: M1: 76.3%; E1: 35.6%; S1: 70.3%; T1/T2: 38.3%; C1/C2: 28.8%. Average follow-up: 65 months. Histologic evidence of TMA were detected in 21 (17.8%) patients and those ones presented more frequently hypertension (100% vs. 61%, p <0.0001), hematuria (100% vs 87.6%, p=0.0001), worse creatinine levels (3.8 vs. 1.38 mg/dL, p=0.0001), eGFR (18 vs. 60 ml/min/1.73m2), p =0.0001), low serum C3 (28.5% vs. 10.4%, p =0.003), lower hemoglobin levels (10.6 vs. 12.7g/dL, p<0.001) and platelet counts (207,000 vs. 267,000, p=0.001). Biopsy findings of individuals with TMA revealed only greater proportions of E1 (68% vs. 32%, p = 0.002). Individuals with TMA were followed for less time (7 vs. 65 months, p<0.0001) since they progressed more frequently to chronic kidney disease (CKD) requiring renal replacement therapy (RRT) (71.4% vs. 21,6%, p<0.0001). Male sex, T1/T2, and TMA were independently associated with progression to CKD-RRT.ConclusionsIn this study patients with TMA had worse clinical manifestations and outcomes. In terms of histologic evidence, E1 distinguished patients with TMA from other patients. These findings indicate that vascular compartment may also be a prognostic marker in IgAN patients.

Defining chronic rejection in vascularized composite allotransplantation—The American Society of Reconstructive Transplantation and International Society of Vascularized Composite Allotransplantation chronic rejection working group: 2018 American Society of Reconstructive Transplantation meeting report and white paper Research goals in defining chronic rejection in vascularized composite allotransplantation

Objectives: This report summarizes a collaborative effort between the American Society of Reconstructive Transplantation and the International Society of Vascularized Composite Allotransplantation to establish what is known about chronic rejection in recipients of vascularized composite allografts, with an emphasis on upper extremity and face transplants. As a picture of chronic rejection in hand and face vascularized composite allografts emerges, the results will be applied to other types of vascularized composite allografts, such as uterine transplantation. Methods: The overall goal is to develop a definition of chronic rejection in vascularized composite allografts so that we can establish longitudinal correlates of factors such as acute rejection, immunosuppressive therapy, de novo donor-specific antibody and trauma/infection and other external factors on the development of chronic rejection. As Dr Kanitakis eloquently stated at the 2017 International Society of Vascularized Composite Allotransplantation meeting in Salzburg, “Before we can correlate causative factors of chronic rejection, we have to define what chronic rejection in VCA is.” Results: The first meeting report was presented at the sixth Biennial meeting of the American Society of Reconstructive Transplantation in November 2018. Based on collaborative efforts and descriptions of clinical cases of chronic rejection in vascularized composite allograft recipients, a working definition of chronic rejection in vascularized composite allografts with respect to overt functional decline, subclinical functional decline, histologic evidence without functional decline, and normal allograft function in the absence of histologic evidence of chronic rejection is proposed. Conclusions: It is the intent of this collaborative working group that these working definitions will help to focus ongoing research to define the incidence, risk factors and treatment regimens that will identify mechanisms of chronic rejection in vascularized composite allografts. As with all good research, our initial efforts have generated more questions than answers. We hope that this is the first of many updates.