Use of brodalumab for the treatment of chronic plaque psoriasis: a one-year real-life study in the Lazio region, Italy.

Background: Information is limited from real-life studies evaluating the efficacy and safety of brodalumab.Research design and methods: In this real-life study, we retrospectively examined a database of 90 patients with moderate-to-severe psoriasis treated with brodalumab (210 mg, s.c.) and followed for 1 year. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 4, 12, 24, 36, and 48 weeks. Predictors of a PASI response were evaluated by logistic regression.Results: After 48 weeks, 92.2% of patients (mean age 50.2 ± 15 years) treated with brodalumab achieved a PASI score of <3. PASI score decreased from 17.4 ± 10.3 at baseline to 1.7 ± 3.9 and 1.4 ± 3.7 at 12 and 24 weeks, and PASI 75, 90, and 100 response was achieved in 87.3%, 81.8%, and 72.7% of patients, respectively, at 48 weeks.Univariate regression revealed that previous exposure to anti-IL17A treatment was associated with poorer PASI response between 36 and 48 weeks. In difficult-to-treat cases previously having failed with other biologics, brodalumab significantly improved outcome, leading to complete remission.Conclusion: Brodalumab was observed to be effective and safe in patients with moderate-to-severe chronic psoriasis in a real-world setting.

A case of longitudinally extensive transverse myelitis in an 80-year-old patient with systemic lupus erythematous and anti-aquaporin 4 antibodies.

BACKGROUND: Systemic Lupus Erythematous is a systemic autoimmune disease with multiorgan inflammation. Clinical manifestations are variable and may involve the Central Nervous System. Acute transverse myelitis is a rare complication. Recent studies have shown an association between SLE, transverse myelitis and presence of anti-aquaporin 4 antibodies. CASE PRESENTATION: We describe the case of an 80-year-old woman with a subacute onset of right hemiplegia followed by left-sided ataxia. Cervical MRI revealed longitudinally extensive transverse myelitis. Blood examinations showed positivity for anti-nuclear antibodies, anti-double-stranded DNA antibodies, anti-phospholipid antibodies and anti-aquaporin 4 antibodies. CONCLUSIONS: Anti-aquaporin 4 antibody testing is of paramount importance in order to reach a correct diagnosis and to treat patients with the best therapeutic approach.

Clinical and histopathological characterization of eczematous eruptions occurring in course of anti IL-17 treatment: a case series and review of the literature.

Background: Real-life data often highlight the side effects of certain drugs not previously reported in randomized controlled trials (RCTs).Objective: To describe cutaneous inflammatory eruptions in psoriatic patients treated with an anti IL-17A agent (secukinumab or ixekizumab).Methods: Retrospective analysis of a cohort of patients with chronic plaque psoriasis who started an anti IL-17A agent between September 2016-February 2019 and who developed cutaneous inflammatory eruptions during treatment. A systematic review of similar events reported in the literature was performed.Results: Data of 468 patients were reviewed and 27 cutaneous inflammatory eruptions of 27 (5.8%) patients were collected. The eruptions appeared after a mean of 16.9 ± 17.0 weeks of therapy showing a classical acute eczema in 11 patients (40.7%), an atopic dermatitis-like rash in 11 patients (40.7%) and a psoriasiform eruption in 5 patients (18.5%). Histopathology of 12/27 cases showed epidermal spongiosis in all these variants.Conclusion: We described the clinic-pathologic features of some eczematous eruptions occurring in psoriatic patients, 3-4 months after treatment initiation with an anti IL-17A agent. Further investigations are needed to explain this phenomenon, that might be defined a paradoxical adverse event, based upon the role of IL17 in eczema pathogenesis.

Multi-detector CT angiographic imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair (EVAR).

BACKGROUND: Multidetector computed tomography (MDCT) angiography represents the standard of reference in the follow-up of patients after endovascular abdominal aortic aneurysm repair (EVAR), being effective in the detection of the full spectrum of possible complications on both axial and 3D images. METHODS: The purpose of this article is to review the normal CT angiography findings of the different types of stent-grafts and to describe the radiological findings of early and late complications after EVAR on axial and reconstructed images. A selection of cases of post-EVAR MDCT angiography is presented to learn the techniques most commonly used for endovascular treatment, the correct CT scanning technique to acquire the data, the full gamut of possible procedure-related complications and how these complications usually appear on CT images. CONCLUSION: MDCT angiography is an effective and specific technique in both the pre- and postoperative settings of EVAR procedures. A better understanding of the procedure, the devices, the normal postoperative imaging features and the possible procedure-related complications ensures optimal planning and follow-up of patients undergoing an EVAR procedure.

Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?

PURPOSE: This study was performed to evaluate whether dynamic computed tomography (CT) can provide functional vessel information predicting outcomes of aortic neck in patients undergoing endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: Twenty patients with and 20 without AAA were enrolled. Electrocardiographically (ECG)-gated data sets were acquired with a 64-slice CT scanner. Axial pulsatility measurements were taken at three levels: 2 cm above the highest renal artery; immediately below the lowest renal artery; 1 cm below the lowest renal artery. Three independent readers performed the measurements. Systolic and diastolic blood pressures were measured in the brachial artery to calculate arterial-wall distensibility expressed as pressure strain elastic modulus (Ep). Cross-sectional area change, wall distensibility and Ep value were statistically compared. RESULTS: No significant differences were found in terms of Ep values in the suprarenal and juxtarenal level. In the AAA group, a significantly higher value was obtained at the infrarenal level. A subgroup of patients with AAA (45%) had a significantly higher Ep value at the infrarenal level. CONCLUSIONS: Dynamic CT provided insight into the abdominal aorta pathophysiology. Identifying patients with higher infrarenal distensibility could change selection of graft size to improve proximal fixation.

[Guidelines for planning studies to determine the resistance of infectious agents of veterinary relevance]. / Leitfaden zur Planung von Studien zur Erfassung der Resistenzsituation bei veterinärmedizinisch relevanten Infektionserregern.

This paper describes the most important criteria for the planning of statistically sound and representative studies on the prevalence of antimicrobial resistance among pathogenic bacteria from animals. The statistical design of the study is of particular importance and therefore described in some detail. The existing published data about antimicrobial resistance are mostly retrospective summaries of results and do not give a true picture of the resistance situation. The authors propose to conduct a pilot study initially because many basic elements for a sound study design are still not known. The systematic recording and assessment of the target variables including the necessary quality assurance are an important prerequisite. Moreover, potential cause variables can be further narrowed down and conclusively identified. To ensure the representativity of the cross-sectional study and avoid potential bias, it is important to achieve the highest possible response rate. This will form the basis of a scientifically sound resistance monitoring programme which should be the joint responsibility of regulatory authorities, industry and academia.

Synthesis and antibacterial in vitro activity of novel analogues of nematophin.

The synthesis and in vitro antibacterial activity of new derivatives and analogues of nematophin are described. It was shown that the unsubstituted amide NH-group is essential for bioactivity. Alkyl- or arylsubstitution at the 1-position results in a distinct increase of antibacterial activity. Addition of protein (blood or serum) to the culture media reduces the inhibitory activity on bacteria.

Association of enterohemolysin and non-fermentation of rhamnose and sucrose with Shiga-like toxin genes in Escherichia coli from calves.

Fecal Escherichia (E.) coli strains from calves were tested for simply detectable phenotypical features associated with Shiga-like toxin (SLT) genes. DNA hybridization with SLT-specific oligonucleotide gene probes (detection of genes for SLT-I and SLT-II) was the "gold standard" for the evaluation of Vero cell cytotoxicity, fermentation of several saccharides, beta-D-glucuronidase activity and production of alpha-hemolysin (alpha-Hly) or enterohemolysin (E-Hly). While SLTEC and non-SLTEC did not significantly differ in production of alpha-Hly, beta-D-glucuronidase activity and fermentation of D-sorbitol, production of E-Hly and non-fermentation of L-rhamnose (Rha) and D-sucrose (Suc) were associated with SLT genes. Sensitivity and specificity of the E-Hly+ phenotype were 53% and 88% for identification of calf SLTEC. When three markers were combined to form the parameter ["E-Hly+ or (Rha- and Suc-)"], sensitivity was higher (65%) and specificity was almost the same (85%). Production of enterohemolysin and inability to ferment rhamnose and sucrose were more often associated with the SLT-I gene than with SLT-II genes. Approximately 71% SLT-I+ E. coli were positive in the enterohemolysin assay. The test combination "E-Hly+ or (Rha- and Suc-)" and Suc-)" was most valuable for the presumptive identification of SLT-I+ E. coli (sensitivity 85%, specificity 83%). These data suggest that the phenotype "E-Hly+ or (Rha- and Suc-)" may be a helpful marker for the detection of SLT-I+ E. coli in SLTEC associated diarrhoea of calves.

Neutralizing antibodies against Shiga-like toxins from Escherichia coli in colostra and sera of cattle.

Previous or present infection with Shiga-like toxin producing E. coli (SLTEC) was detected by an indirect neutralization assay of antibody titer. Bovine colostra and sera blocked the cytotoxic effects of Shiga-like toxin on Vero cell monolayers. SLT neutralizing antibodies were present in 84.0% (189/225) of the colostrum samples from randomly chosen cows in Bavaria, Germany. While all of the colostra with neutralizing activity reacted with SLT-I, only 14.7% neutralized both SLT-I and -II. Approximately 93.0% (37/40) of sera from heifers had SLT neutralizing activity. To quantify the neutralizing antibodies, colostra were tested in the Vero cell assay for their capability to reduce the 50% cytotoxic dose (CD50) of SLT standards, where the neutralizing units/ml (nu/ml) equal the log10 of CD50 reduction. Almost half of reactive colostra (48.7%) reduced the CD50 of the SLT-I standard by 10(4) to 10(5) (4-5 nu/ml). Higher reactivity (5-7 nu/ml) was found in 46.5% of positive colostra. The remaining colostra samples had over 7 nu/ml. To determine if the colostra were blocking receptors for SLT on Vero cells, cells were preincubated with colostra, and SLT was later added. No neutralizing activity was detected, indicating the reactivity of colostra was directed against SLT. When the colostra were subjected to ammonium sulphate precipitation and DEAE anion exchange chromatography, high levels of neutralizing activity were found in the IgG1 containing fractions. Colostrum fractions were tested for SLT-I binding antibodies in a capture ELISA, based on the binding of SLT-I to the toxin receptor analogue P1-glycoprotein. Only fractions from colostra with over 5 nu/ml were reactive in this assay, indicating the ELISA was less sensitive than the Vero cell assay. The results support the theory that SLTEC exposure of cows in Germany is more widespread than expected from epidemiological studies based on bacterial isolation. This possibly indicates a higher risk of human SLTEC infection via beef and milk products.