Meloxicam administration in the management of postoperative pain and inflammation associated with caesarean section in beef heifers: Evaluation of reproductive parameters.

Post-operative pain and inflammation are normal physiological reactions to caesarean section. Their management in cattle have rarely been investigated. This surgical procedure negatively affects reproductive function with, for example, a reduction in fertility resulting in an increase in calving interval. In this multicenter clinical trial, the objective was to evaluate the impact on reproductive performance of meloxicam injected before caesarean section to manage post-operative pain and inflammation. Meloxicam is a non-steroidal anti-inflammatory drug. One hundred and twenty-seven Charolais heifers (n = 127) were recruited from 47 farms in six French veterinary practices in the Burgundy region. The heifers underwent a non-elective standardized caesarean section operation. Heifers were randomly assigned to one of two groups: meloxicam (n = 66), intravenous meloxicam injection before surgery, or control (n = 61). Reproductive performance and health information were recorded from the time of the caesarean section to the next calving or to culling. In our study, meloxicam administration before caesarean section had no effect on the incidence of retained placenta (18.2% of treated vs 25.0% of control cows, p = 0.35). The pregnancy rate was higher in treated than in control cows (83.1% vs 67.8%, p = 0.04 after multivariate analysis) and a survival analysis showed that the median calving interval was 35 days shorter in the meloxicam (t50% = 417 days) compared to the control group (t50% = 452 days, p = 0.05). A trend was also observed for culling rate to be lower in treated (4.7%) compared to control cows (13.3%, p = 0.09). In conclusion, this study suggests that there is a beneficial effect of meloxicam administration before caesarean section on reproductive performance in Charolais heifers.

The frequency of occult solid malignancy in patients with polymyalgia rheumatica-like symptoms.

AIMS: We aim to evaluate the clinical usefulness of systematic screening for occult cancer in patients with polymyalgia rheumatic (PMR)-like symptoms in real-life practice. METHODS: All patients seen by rheumatologists in Burgundy, France, between March 2016 and December 2018 for new-onset PMR that met the 2012 ACR/EULAR classification criteria were prospectively included. Patients underwent systematic screening including determination of the erythrocyte sedimentation rate, serum C-reactive protein levels, thoracic, abdominal and pelvic computed tomography (CT-TAP) and, in men, serum prostate-specific antigen. The standardized incidence ratio (SIR) for cancers was calculated using 2012 national estimates of cancer incidence. Potential predictive factors for the diagnosis of cancer were then evaluated using univariate and multivariate analyses. RESULTS: Among the 118 patients included, nine cases of cancer were confirmed and diagnosed with CT-TAP: kidney carcinoma (n = 4), lung cancer (n = 2), pancreatic, colon, and ampullary carcinoma (n = 1 each). Among these cancers, five were localized (four kidney, and one ampullary carcinoma) and were treated with complete surgical resection. The expected incidence of cancer in the general population was 1.95, leading to an overall SIR of 4.6 (95% CI 2.4-8.9, p < 0.0001). An additional analysis was performed for the kidney carcinoma, and it showed a highly significant increase in SIR: 80.8 (95% CI 30.3-215.4). In 80% of patients, the PMR-like syndrome regressed during cancer treatment. No other predictive factors for cancer were found. CONCLUSION: Systematic screening for cancer including CT-TAP in real-life practice revealed occult solid malignancy, mostly early-stage cancer, in a relevant proportion of patients presenting PMR-like symptoms. The high proportion of kidney cancer (40%) is worth highlighting, especially considering that it is not one of the most frequent cancers after 50 years of age.

Study of professional practices among rheumatologists in Burgundy: initial corticotherapy in polymyalgia rheumatica.

To study the initial dose of corticoids prescribed by rheumatologists in the Côte d'Or, a French department of Burgundy, in the treatment of polymyalgia rheumatica (PMR), the clinical and biological data of patients who consulted rheumatologists of the Côte d'Or between March 2006 and December 2008 for PMR were collected. The statistical analyses concerned the initially prescribed dose of prednisone: the median, mean, and standard deviation were calculated cumulatively and then for individual rheumatologists; the Mann-Whitney test was used to compare the mean initial doses prescribed with regard to (a) the main practice of the practitioner (private-practice or hospital rheumatologist), (b) the presence of clinical signs of severity, (c) severity of the inflammatory syndrome, and (d) the presence of clinical relapse with the decrease in corticoids. Ninety-nine patients were included (age = 72 ± 8.6 years, 59% women). The mean dose of prednisone prescribed was 27.4 ± 12.4 mg/day. Considerable inter- and intra-individual variabilities in the doses prescribed were noted. There was no significant difference concerning the dose prescribed according to the clinical severity or the type of practice. However, the dose was significantly higher (34.3 ± 14.7 vs. 25.5 ± 11.1 mg/day) in patients with a high sedimentation rate. Clinical relapse was not statistically linked to the initial dose of corticoids. This evaluation of professional practices among French rheumatologists shows that the initial dose of prednisone prescribed in PMR varies considerably and is higher than the dose currently recommended in the literature (15 mg/day).