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The term bronchoesophageal fistula is used for the abnormal communication between the esophageal lumen and the pulmonary bronchi. There are no reports of this condition in production animals, and its origin is unknown. A male Dorper sheep from the Veterinary Hospital of the Santo Amaro University, SP, Brazil, presented clinical signs of tachypnea, apathy, and coughing after eating. The animal died suddenly after a fever break. During the gross evaluation, a fistula was noticed in the middle third of the thoracic esophagus with communication to the right cranial lung lobe, forming an encapsulated area measuring 24.5 cm x 22.0 cm x 9.4 cm. Fibrous tissue delimited the pulmonary lobe and feed filled the compartment. This is a rare condition with unclear etiopathogenesis.

BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory disease of highly variable presentation, which determines a physical and psychological deterioration, with a negative impact on the quality of life of patients and knowing the patient’s perception of their health status is very important for a good management of PsA.ObjectivesTo assess an adjustment of the DAPSA according to the status of the PsAID-12 (Impact of the disease in psoriatic arthritis) and to analyze its relation in clinical practice with the minimal activity of the disease (Minimal Disease Activity or MDA) in psoriatic arthritis.MethodsMulticenter cross-sectional study, which recruited 200 patients, who met the criteria for Classification of Psoriatic Arthritis (CASPAR), in six Spanish rheumatology centers. At the time of the visit, demographic, clinical, laboratory data, HAQ (0-3) and PsAID12 (0-10) self-questionnaires were collected. Disease activity was measured using DAPSA (with its cut-off points), MDA status was obtained, and the PsAID12 index was calculated. When a PsAID≤4 was not reached, the DAPSA was scaled to a higher interval (DAPSA corrected) obtaining a new index, DAPSA-PsAID. All analyzes were performed using SPSS23 software. Differences were considered statistically significant if p < 0.05.ResultsOf the total number of patients, 55% were men, with an age of 55.2 ± 11.6 years; 75% had only peripheral involvement and 25% had pure or mixed axial involvement. 43% were on biological treatment (18% join to csDMARDs). The patients who reached the MDA were 102 (51%), 62.7% in men vs 37.3% in women (p 0.025). With the PsAID-corrected DAPSA, the proportion of patients in low activity-remission who did not reach the MDA was lower than with the standard DAPSA (see Table 1), 16.3% vs 27.6% (Kappa 0.750 vs 0.688). In the binary regression analysis for MDA status, adjusted for sex, an OR (95% CI) for DAPSA and DAPSA corrected for PsAID of 8.12 (1.88-35.04) and 12.31 (3.74-40.50), respectively, was obtained.Table 1.MDA N=102No MDA N= 98pHAQ≤0.5, n (%)82 (92.0)31 (36.5)DAPSA REM/LDA, n (%)98 (96.1)27 (27.6)PsAID≤4, n (%)92 (90.2)45 (45.9)DAPSA-PsAID REM/LDA, n (%)93 (91.2)16 (16.3)ConclusionA PsAID-corrected DAPSA could be a more reliable alternative to MDA than conventional DAPSA and facilitate clinician decisions in daily practice.References[1]Schoels MM, et al. Ann Rheum Dis 2016;75(5):811-8.[2]Gossec L, et al. Ann Rheum Dis. 2020 Jun;79(6):700-712.AcknowledgementsTo SOGAREDisclosure of InterestsGuillermo Gonzalez Arribas: None declared, Carlota Laura Iñíguez: None declared, Francisco Maceiras-Pan Speakers bureau: Janssen, Novartis, Lilly, Abbvie, UCB, Víctor Quevedo Vila: None declared, Luis Fernández-Dominguez Speakers bureau: Janssen, Novartis, UCB, José Antonio Mosquera Martínez: None declared, Carlos García-Porrúa Speakers bureau: Janssen, Novartis, Lilly, Abbvie, UCB, Jose L. Guerra-Vazquez: None declared, Jose Antonio Pinto Tasende Speakers bureau: Janssen, Novartis, Lilly, Abbvie, UCB, Celgene, Consultant of: Novartis, Janssen

BackgroundPatients with psoriatic arthritis (PsA) show an impact on the physical and psychological aspect of the disease and it can be measured with the PsA Impact of Disease (PsAID) questionnaire, and it is expected that the impact of the disease improves when the patient is in remission or low disease activity.ObjectivesTo determine the rate of low impact of the disease in patients with PsA in daily clinical practice, and to evaluate its relationship with its axial activity.MethodsA cross-sectional study was conducted in consecutive patients who met the CASPAR criteria, with positive clinical (DLI) and positive axial radiology, with or without peripheral involvement, and who were treated according to standard clinical practice (EULAR recommendations). Demographic, clinical, analytical data, HAQ index (0-3) and PsAID12 (0-10) were also collected. Patients were divided into 2 groups: those with a PsAID above 4 (high impact) or below 4 (low impact). Continuous variables are shown as median (Q1-Q3) and categorical variables as percentages and frequencies. The analyzes were performed using SPSS23 software. Differences were considered statistically significant if p < 0.05.ResultsOf the 269 patients evaluated with PsA, 72 patients with axial involvement were included, 40 men (55.6%), with a median age of 54.1 years (45.0-62.0) and disease duration of 7 years (2-11). Obesity (BMI>29.99) affected 28.3% and serum CRP level was 0.45 mgr/dl (0.08-1.10). The treatments of the patients were: NSAIDs 43.1%, corticosteroids 21.6%, csDMARD 52.9% and biological therapy 51.9%. The BASDAI was 4.2 (2.0-6.2) and the ASDAS-PCR was 2.4 (1.5-3.2), with 39.6% being in low activity or remission. The median PsAID total score was 3.9 (1.6-5.4), evaluated in 61 patients. The patients who achieved a PsAID12 ≤4 was 63% (see Table 1), more men and with a lower CRP. In addition, the low impact measured by the PsAID12 was associated with a lower BASDAI and ASDAS-PCR.PsAID≤4n=39PsAID>4n=22pAge, years54 (42-62)54 (49-66)0.284Male gender, n %28 (70)10 (43.5)0.038Disease duration, years7 (3-10)5 (1.2-9.5)0.432CRP, mgr/dl0.30 (0.04-0.79)1.04 (0.07-2.44)0.03BSA, %0.2 (0-1)0.5 (0-1.5)0.594BASDAI2.1 (0.8-4.0)6.1 (4.4-6.9)ASDAS-PCR1.5 (1.1-2-4)3.1 (2.3-3.4)ConclusionAlmost two thirds of patients with PsA with axial involvement in daily clinical practice had a low impact of the disease measured by PsAID12 and correlated with low activity in the BASDAI and ASDAS-PCR.References[1]Gossec L, et al. Annals of the Rheumatic Diseases 2014;73:1012-1019.Acknowledgementsto Galician Rheumatology Society (SOGARE)Disclosure of InterestsCarlota Laura Iñíguez: None declared, Guillermo Gonzalez Arribas: None declared, Francisco Maceiras-Pan Speakers bureau: Abbvie, Novartis, Janssen, Lilly, Jose L. Guerra-Vazquez: None declared, Víctor Quevedo Vila: None declared, Luis Fernández-Dominguez Paid instructor for: Janssen, Novartis, BMS, Carlos García-Porrúa Speakers bureau: Abbvie, Novartis, Janssen, Lilly, José Antonio Mosquera Martínez: None declared, Jose Antonio Pinto Tasende Speakers bureau: Abbvie, Novartis, Janssen, Lilly, Celgene, Consultant of: Janssen, Novartis

Background:Evidence suggests that inflammation plays a causal role in the development of Metabolic Syndrome (MetS) and elevated peripheral levels of proinflammatory mediators, such as C-reactive protein (CRP) confering cardiovascular and metabolic risk.Objectives:The objective of this study was to evaluate Metabolic Syndrome among patients with PsA naïve to biologics and to evaluate its association with inflammatory activity status previous start them.Methods:We performed a retrospective cross-sectional study of a cohort of patients ≥18 years of age, all patients with a diagnosis of PsA (CASPAR criteria), included in the Sueiro Cohort. Patients were managed according to a standard protocol adopted at the Rheumatology outpatient clinic of six hospitals and they were patients on follow-up for at least 6 months. Collected variables included age and gender, blood biochemistry, blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), HLA-B27 and rheumatoid factor, glucocorticoid, NSAID and conventional or biologic DMARD, smoking habit, hyperuricemia, type 2 diabetes mellitus, obesity (BMI kg/m2). MetS was defined by a combination of abdominal obesity, impaired fasting glucose, atherogenic dyslipidemia, and elevated blood pressure. Status of disease activity was supported by tender and swollen joint counts (TJC68 and SJC66) from patients who were going to start treatment with biologics and Patient-reported outcome measure were collected with Patient Global Assessment (0-10 cm) and Patient Pain Assessment (0-10 cm). Remission and low disease activity status was obtained by DAPSA score and its defined cut-off. Tests were two-tailed with a significance level of 5%. Data were analyzed using SPSS V21.0 statistical software (IBM Corp. NY, USA).Results:A total of 416 were included in the study: 222 PsA patients treated with csDMARD kept in remission or low disease activity and 194 patients needed to be treated with bDMARD. The mean age of the patients was 53.0 years (SD: 11.8). Two hundred and twenty-eight were males (56.2%).Fifty-six patients had MetS (13.8%) and it was more frequent in patients who were in clinical activity and they needed biologics (17.9% vs 10.4%, p 0.028) with mean (SD) of DAPSA of 16.7 (11.1). Patients starting treatment with biologics and with MetS had more proportion of patients older than 50 years (24.2 % vs 8.3%, p 0.006) and CRP >5 mgr/L (71.4% vs 52.6%, p 0.042) and DAPSA had higher values than in patients without MetS (18.6 vs 16.2) but there were not significant statistical differences. Binary regression analysis showed increased risk of MetS for age > 50 years old (OR 3.287 [95%CI: 1.258-8.591], p 0.015) and CRP > 5 mgr/L (OR 2.684 [95%CI: 1.141-6.313], p 0.024) but not for gender (OR 2.136 [95%CI: 0.932-4.893], p 0.073) neither for DAPSA>14 (OR 1.539 [95%CI: 0.695-3.409], p 0.288).Conclusion:Patients with PsA active despite csDMARD had more prevalence of MetS and this was associated with those patients over 50 years old and CRP higher than normal values. DAPSA was higher in patients with MetS but without reaching significant statistical difference.References:[1]Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Current Diabetes Reports. 2005;5:70–75Acknowledgements:I have acknowledgements to SOGARE.Disclosure of Interests:None declared.

Background:Psoriatic arthritis (PsA) has a prevalence of 0.17% in North-Western of Spain and patients suffer this disease have significant impact on daily life due to articular, dermatological and psychological symptoms. DAPSA VLDA/LDA (≤14) is a therapeutic goal recommended by EULAR for clinical practice.Objectives:Our aim was to assess the relationship between DAPSA index and PsAID questionnaire in routine clinical practice.Methods:We performed a cross-sectional study of patient and physician reported outcomes. We obtained clinical information of patients with PsA attending clinic from October 2018 to October 2019. Data were collected from clinical records concerning age, gender, disease duration, joint counts, dactylitis, enthesitis, body surface area (BSA) of psoriasis, laboratory results (ESR and CRP), HAQ, PsAID12, pain and global assessment from patient with numerical rating scale (NRS) and DAPSA index. Data were analysed using SPSS21. Logistic regression was used to assess patient reported outcomes which were associated with DAPSA VLDA/LDA.Results:Data were available for 210 patient visits, 43% females. DAPSA≤14 was in 143 patients (68.1%) and was associated with higher disease duration, OR 1.079 (1.020-1.142, 95% CI), p 0.008. DAPSA index was not associated with BSA (r 0.126, p 0.176).PsAID12 was evaluated in 156 patients and we saw that patients with DAPSA≤14 had significantly lower PsAID12 (mean 1.7 ± SD 1.7 vs. 3.9 ± 2.1), p< 0.0001. PsAID12 of less than 4 is considered a good outcome and all items of PsAID12 (Figure 1, mean values for NRS) were less than 4 in patients with DAPSA≤14. All components of PsAID12 except item 3 (skin problems) were associated with DAPSA≤14 on univariate analysis but only pain remained independent predictor on multiple regression analysis (p< 0.0001).Conclusion:In these PsA patients, DAPSA VLDA/LDA was associated with higher disease duration and with lower PsAID12. Pain is dominant symptom in patients with psoriatic arthritis, even in those with DAPSA≤14, and skin problems are not good represented in DAPSA index.References:[1]Gossec L, Ann Rheum Dis. 2014;73(6):1012–1019.[2]Di Carlo, et al: PsAID-12 in clinical setting. J Rheum 2017; 44:3Acknowledgments:SOGAREDisclosure of Interests:Carlos García-Porrúa: None declared, Luis Fernández-Dominguez: None declared, Jose L. Guerra-Vazquez: None declared, José Antonio Mosquera Martínez: None declared, Jose Pinto-Tasende Consultant of: Janssen, Novartis, Speakers bureau: Lilly, Janssen, Novartis, BMS, Pfizer, Celgene

The aim of this paper was to describe the process for accrediting a paediatric hospital emergency department to ISO 9001:2015 standards. The implementation process began in February 2015 and lasted 18months.The project started with the decision by the Head of Department to improve service quality. A Quality Committee was established with representation of the medical, nursing and administrative staff. Training sessions were held on quality management systems and ISO standards for employees. A meeting took place among members of the Emergency Department to define the main processes, and 14 were identified, documented and included in the processes map. Workgroups were then created to review and redesign the medical and nurse protocols.Thirty-five medical and fifteen nursing protocols were incorporated into the management system, and quality indicators were established that allowed the whole process to be monitored. A risk register was created to record identified risks, their severity, likelihood of occurrence, and actions taken to prevent or reduce those risks. The Emergency Department underwent an external audit during June 2016, and was certified to the requirements demanded by the international ISO 9001:2015 standard.The conclusion is that implementation of a quality management system on ISO and its certification is completely achievable, and has contributed to better patient management.

A lipid nanoemulsion (LDE) resembling low-density lipoprotein can target malignant tumours. In in vivo and clinical studies, association of chemotherapeutic agents to LDE decreased their toxicity and increased pharmacological action. Here, safety of LDE as carmustine carrier (50 mg m(-2) , intravenous) combined with vincristine and prednisone for the treatment of dogs with lymphoma was tested and compared with commercial carmustine with vincristine and prednisone. In five dogs from LDE-carmustine and six from commercial carmustine, complete remission was achieved (P0.05). Partial remission occurred in two dogs from each group. In both groups, the median progression-free intervals (119 and 199 days) and overall survival times (207 and 247 days) were equal. Neutropenia was observed in both groups, but no other major toxicities occurred. Therefore, no difference was observed between the treatments. LDE-carmustine was shown to be safe and effective in a drug combination protocol, which encourages larger studies to investigate the use of this novel formulation to treat canine lymphomas.

This paper reports on the use a technique using cross-fostering (CF) as a tool to evaluate the possible transplacental toxicoses of I. carnea in an animal model (rat) used in a perinatal study to verify the possible toxic effects of I. carnea on the offspring from dams which had an intake of I. carnea during the gestation period.

Cyanide exposure through cassava consumption has been associated with the development of malnutrition-related diabetes mellitus (MRDM). However, there are few experimental reproductions of this disease. In the present study 42 rats received 0, 9.0 or 12.0 mg KCN/kg bw/d for 15 d, 26 pigs were dosed with 0, 2.0, 4.0 or 6.0 mg KCN/kg for 74 d, and 34 goats received 0, 0.3, 0.6, 1.2 or 3.0 mg KCN/kg for 5 mo. At the end of each experimental period, plasma samples were obtained for glucose and thiocyanate measurement, and the pancreas was collected for histopathologic study. No significant differences in plasma glucose concentrations occurred between groups. The pancreas had no pathology. Chronic cyanide exposure did not promote diabetogenic effects in rats, swine or goats, suggesting that cyanide is not responsible for MRDM in humans.

Industrial organic solvents present in glue are among the common used psychotropic drugs in Brazil and perhaps worldwide; but few data are available concerning the toxic effects of glue sniffing, with almost no information about immunotoxicity. This seems interesting because several drugs and environmental chemicals are recognized as potential immunotoxicants. The present study investigated the effects of forced inhalation of a toluene/n-hexane 1:1 mixture on hamster resistance to Mycobacterium bovis. Adult hamsters were divided at random into 3 equal groups. Animals of Groups E and E inhaled the mixture of toluene/n-hexane twice daily for 37 d. Group C was placed for the same period of time in identical chambers free of solvents. Two days after the beginning of the experiment, Groups E and C were injected ip with 0.5 ml of an activated suspension of M. bovis; Group E received the same volume of a control solution. Hamsters inhaling the toluene/n-hexane mixture (E) exhibited increased weight loss, increased scores of M. bovis colony forming units isolated from liver, lung and spleen, increased granulomatous areas in the liver, lung and spleen. Inhalation of the toluene/n-hexane mixture for 37 d also increased serum cortisol compared to control hamsters. Tuberculosis is an infection with an intracellular bacterium in which sensitivity is determined mainly by host response. The present data demonstrated impaired defense against M. bovis in hamsters inhaling a toluene/n-hexane mixture for 37 d. Since macrophages are the architectural and functional units of the granulomas in tuberculosis, and no data were found about glue solvent effects on cellular immunity, the present data suggest an indirect effect of glue solvents on macrophage/lymphocyte activity via stress induction and central nervous system stimulation of hormonal (ACTH/cortisol) secretion and/or autonomic nervous system activity.

As the occurrence of tuberculosis lymphadenitis in swine constitutes a public health risk, especially in immunosuppressed individuals, the distribution of tuberculoid lesions and the presence of microbacteria in lymph nodes and hepatic and muscular tissue in swine for slaughter, in the State of S. Paulo, SP (Brazil), in the period from 1993 to 1994, were studied. MATERIAL E METHOD: Tuberculous lesions in 60 carcasses of swine, slaughtered at abattoirs during the period 1993-1994, were studied. When macroscopic lesions were observed, a representative sampling of lymph nodes, hepatic and muscular tissues (masseter and diaphragm) were examined using histopathological and microbacterial isolation techniques.The macroscopic lesions were found predominantly in mesenteric lymph nodes. The MAI Complex (M.avium-intracellulare) was isolated mainly in the carcass group that showed lesions and was not found in the control group. Microorganisms of the MAI Complex were not isolated from hepatic and muscular tissues.No clear relationship between the type of mycobacteria isolated and the macroscopic lesions observed during the carcass inspection was found.

The acute, subchronic and chronic toxicities of 2,4-dichlorophenoxyacetic acid (2,4-D) were studied ir rats. Animals were exposed acutely (600 mg/kg), subchronically (200 ppm for 30 d) and chronically (200 ppm for 180 d) to 2,4-D by the oral route. Clinical, laboratory and histopathological methods were used as indicators of toxicity. After acute exposure, the herbicide decreased locomotor activity and induced ataxia, sedation, muscular weakness (mainly of the hind quarters) and gasping for breath; increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (AP), amylase activities and creatinine levels; decreased total protein (TP) and glucose levels; and increased hematocrit values. Subchronic and chronic 2,4-D exposures did not induce overt clinical signs or symptoms of intoxication. However, subchronic herbicide exposure increased AST activity and albumin and hematocrit values, and chronic exposure increased AST, AP and LDH activities, decreased amylase and glucose levels, but did not change hematocrit values. Chromatographic analysis of the serum of chronically exposed rats showed the presence of the herbicide; the amount found (3.76 +/- 1.16 micrograms/ml) suggested the absence of 2,4-D accumulation within the body. Although macroscopic or histopathological lesions were not observed in acutely, subchronically or chronically 2,4-D exposed rats, the laboratory data obtained suggest tissue injuries after dosing, since the results are considered early indicators of primarily hepatic and muscle tissue damage.

A case of arthropathy and soft tissue masses due to amyloid deposition in a patient with myeloma is reported. The radiologic and magnetic resonance findings of musculoskeletal amyloidosis are described. The amyloid masses show heterogeneous signal intensity, with a signal lower than muscle and intermingled areas of marked hyperintensity on T2-weighted images.

We report our eight year experience remission induction therapy in adult patients with acute myeloblastic leukemia. Overall 67 patients were treated, with a mean age of 43.3 years (range 15-75). Two treatment protocols were used. Complete remission (CR) was achieved in 23 patients of 39 receiving protocol A (58%). The 28 last patients were treated with the more aggressive protocol B, and CR was achieved in 23 patients (82%). CR was achieved in 68% of the overall group. The most outstanding predictive factors were age above 30 years, and M-5 morphology as indicating a poor prognosis.

The occurrence of leptospiral infection in cats was determined through the detection of specific antibodies based on the results of microscopic agglutination test and the attempts of isolation and histological demonstration of leptospires from the kidneys of these animals. Of 172 serum samples examined by microscopic agglutination test, 22 (12.8%) were positive with titers greater than or equal to 100. The most frequent serovar was pomona. In relation to the sex, significant differences were not seen; however the age distribution showed that feline leptospirosis is more frequent in adult cats. The attempts for isolation and demonstration of L. interrogans from renal parenchyma by culture or Warthin Starry technics were unsuccessful.

The authors report a case of ankylosing spondylitis complicated by a cauda equina syndrome presenting with a plantar perforating ulcer and lesions of neuropathic arthropathy of the foot. On the basis of an analysis of 54 cases published in the literature they review the principal aspects of this complication of ankylosing spondylitis. Neurological manifestations occur late after several decades of progression of the disease. Urinary sphincter problems are common whilst trophic disturbances remain rare. Myelography and, above all, lumbar CAT scan reveal characteristic and stereotyped anatomical lesions: widening of the dural sac in its posterior part with meningoceles eroding the posterior vertebral arch. The pathogenic mechanisms are unknown. The authors suggest that lesions may start with posterior epidural inflammation rather than a primary process of arachnoiditis as has been mentioned in earlier publications.