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Hydroxychloroquine is an antimalarial drug used in the treatment of human lupus erythematosus according to its immunomodulatory properties without causing systemic immunosuppression. In veterinary medicine, there are only two reports of its use in dermatology. To the authors knowledge, this is the first report of the use of Hydroxychloroquine in the treatment of the mucocutaneous lupus variant in a dog. A 9-year-old, male, 14kg, neutered, crossbreed dog was evaluated with a 2-year history of progressive pruritic erosive skin lesions around the genitals, perianal, anal, and periocular region as well as dyschezia and dysuria. Skin biopsies were consistent with mucocutaneous lupus erythematosus. 1.5mg/kg/day prednisolone was instituted for 30 days with only a partial response. Oral doxycycline was, therefore, added to the previous treatment, at a dosage of 14mg/kg twice daily and 400IU/day of vitamin E. After 30 days, complete remission was obtained, and the steroid treatment was gradually reduced. Hydroxychloroquine was further added, at a dosage of 7mg/kg/day for a period of 60 days. Doxycycline and prednisolone were eventually discontinued. Vitamin E and hydroxychloroquine were maintained daily with no recurrence observed for more than 6 months. Blood count and serum biochemistry were monitored throughout the treatment, revealing no alterations. In conclusion, the use of Hydroxychloroquine has contributed to the maintenance of clinical remission in this patient with mucocutaneous lupus erythematosus, without the need for immunosuppressant therapy. Further controlled studies are needed to confirm the usefulness of this medication in this condition. [ABSTRACT FROM AUTHOR]

Otitis externa caused by D. cati without the presence of other skin lesions is uncommon. Furthermore, there is no consensus regarding the most effective treatment for otodemodicosis in cats. Our goal is to report the successful treatment of otodemodicosis in two cats, caused by D. cati, with a single dose of a 250 mg fluralaner based spot-on. In case one, a 3-year-old, neutered male short-haired cat was presented with a three-week history of severe head pruritus. The cat had been diagnosed, two months before, with a neutrophilic nephritis of unknown cause. In case two, a 7-year-old, neutered male, short-haired cat was presented with a two-week history of facial pruritus. This cat was positive for feline immunodeficiency virus. Both cats were diagnosed with otodemodicosis through microscopical examination of samples obtained from the cerumen of both ears which revealed numerous live adult forms of D. cati. The cats were treated with a 250 mg fluralaner spot-on (Bravecto® Spot-on solution for cats, MSD Animal Health) with negative cerumen samples for Demodex mites at one (in case two) and three-month (case one) rechecks. These cases demonstrate that otodemodicosis is a differential diagnosis of head and neck pruritus in the cat, and that a single dose of the spot on fluralaner may represent an attractive option for treating otodemodicosis in feline patients. [ABSTRACT FROM AUTHOR]

Cholesteatoma is an epidermoid keratin cyst originating from the middle ear of dogs with ages ranging from 2 to 12 years. Ceruminous gland carcinoma is a malignant tumor of the ear canal, most reported in cats aged 7 to 13 years. For diagnosis, imaging tests are indicated, although confirmation occurs by histopathological examination. The recommended treatment for both conditions is ablation and lateral bulla osteotomy. An eight-year-old female crossbred dog with difficulty in swallowing, chewing and opening the mouth with a history of purulent unilateral external otitis for 10 months was referred for computed tomography, confirming the presence of hyperintense material on T2-weighted images obliterating the proximal portion of the right external auditory canal and projecting into the tympanic bulla to an extent of approximately 2.0 cm. Videofibroscopy was also performed, observing rupture of the tympanic membrane and the presence of material with a keratinous aspect, referred for histopathological analysis. The histopathological findings showed a morphological profile compatible with the diagnosis of cholesteatoma associated with mixed ceruminous gland carcinoma. After the procedures, oral corticosteroids were prescribed and an auricular solution with fluoroquinolone and corticosteroids was applied. Two weeks after the procedure, the patient returned, with a good clinical response, without external otitis, and was able to eat. The objective of this case report emphasizes the first occurrence of a cholesteatoma associated with otologic squamous cell carcinoma in dogs. [ABSTRACT FROM AUTHOR]

An evaluation was made of the larvicidal efficacy of lotilaner (Credeli®) in the treatment of dogs naturally infested with Dermatobia hominis larvae. A total of 12 dogs presenting at least three live D. hominis larvae were medicated. The animals were medicated orally with a single dose of no less than 20 mg/kg lotilaner. After drug administration, the animals remained at their homes, and observations were made to verify the larvicidal effect 6 hours after treatment. Live larvae were considered any parasite that exhibited motility after removal. For each animal was using the formula: 100 x [(total of live larvae before treatment - total live larvae after treatment) /total of live larvae before treatment] as criteria for evaluating lotilaner efficacy. A total of 98 larvae were counted in 12 dogs, with an average of 8.1 larvae per animal. The effectiveness of lotilaner was 80.6%. Nineteen larvae were found alive, albeit presenting hypomobility and lethargic behavior. However, note that the evaluation was performed just six hours after administration of the drug. Lotilaner administered orally in a single dose of 20 mg/kg showed 80.6% efficacy six hours after treating dogs naturally infested with D. hominis.

Mites of the species Lynxacarus radovskyi, which are commonly found on domestic cats in Brazil, can cause discomfort, itching, and alopecia. The development of new, safer and more effective treatments with a broad spectrum of activity, including the use of isoxazolines, is needed. The purpose of this study was to assess the efficacy of transdermal fluralaner in domestic cats naturally infested with L. radovskyi. Twenty cats were evaluated by trichograms and divided into two groups of 10 animals. The control group was not treated, while the treated group was given a single topical dose of fluralaner, as per the manufacturer's instructions. The cats were reassessed for the presence of L. radovskyi eggs and mites on days D+7, D+14, D+28, D+42, D+56, D+70, D+84, and D+98. As of D+42, all the animals (100%) tested negative for mites, and remained parasite-free until the end of the study, while the control group tested positive throughout the experiment. It can be concluded that a single dose of fluralaner applied topically was effective in treating cats naturally infested with L. radovskyi.

Context: Poor glucose control has been associated with increased mortality in COVID-19 patients with type 1 diabetes (T1D)., Objective: This work aimed to assess the effect of prevaccination glucose control on antibody response to the SARS-CoV-2 vaccine BNT162b2 in T1D., Methods: We studied 26 patients with T1D scheduled to receive 2 doses, 21 days apart, of BNT162b2, followed prospectively for 6 months with regular evaluation of SARS-CoV-2 antibodies and glucose control. Immunoglobulin G (IgG) to spike glycoprotein were assessed by enzyme-linked immunosorbent assay, and serum neutralization by a live SARS-CoV-2 assay (Vero E6 cells system). Glycated hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM), including time in range (TIR) and above range (TAR), were collected. The primary exposure and outcome measures were prevaccination glucose control, and antibody response after vaccination, respectively., Results: Prevaccination HbA1c was unrelated to postvaccine spike IgG (r = -0.33; P = .14). Of note, the CGM profile collected during the 2 weeks preceding BNT162b2 administration correlated with postvaccine IgG response (TIR: r = 0.75; P = .02; TAR: r = -0.81; P = .008). Patients meeting the recommended prevaccination glucose targets of TIR (≥ 70%) and TAR (≤ 25%) developed stronger neutralizing antibody titers (P < .0001 and P = .008, respectively), regardless of HbA1c. Glucose control along the study time frame was also associated with IgG response during follow-up (TIR: r = 0.93; P < .0001; TAR: r = -0.84; P < .0001)., Conclusion: In T1D, glucose profile during the 2 weeks preceding vaccination is associated with stronger spike antibody binding and neutralization, highlighting a role for well-controlled blood glucose in vaccination efficacy., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Angiosarcoma of the breast is one of the rarest malignancies. Breast angiosarcoma can be classified into primary when arising de novo and secondary to chronic lymphoedema or breast irradiation. Molecular pathways involved in angiosarcoma development have not been described clearly, yet some gene point mutations and protein altered expression levels have been detected. So far, their management is based above all on surgery. Hence, further studies starting from the few known key points may help to develop more effective strategies based both on target therapies, together with surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.07.38). The focused issue “Rare Tumors of the Breast” was commissioned by the editorial office without any funding or sponsorship. EE served as the unpaid Guest Editor for the focused issue and serves as the unpaid editorial board member of Translational Cancer Research from May 2018 to Apr 2020. The other authors have no other conflicts of interest to declare., (2019 Translational Cancer Research. All rights reserved.)

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

A diagnosis of breast cancer is considered a potential traumatic event associated with physical and psychological effects. In literature, an exploration of breast cancer experience in young women is lacking, able to shed light on the narrative processes of meaning-making of the experience in specific phases of treatment, as may be the initial impact with the onset of the cancer. Meaning-making processes are determinant aspects when dealing with traumatic events. The research took place at National Cancer Institute Pascale of Naples. We collected 50 ad hoc narrative interviews to explore the different domains of the experience with under-fifty women at the first phase of the hospitalization. The Narrative Interviews were analyzed through a qualitative methodology constructed ad hoc . Starting from the functions of meaning-making that the narrative mediate we have highlight the different modes to articulate the narrative functions: The Organization of Temporality: chronicled (38%), actualized (26%), suspended (18%), interrupted (16%), and confused (2%). The Search for Meaning: internalized (42%); generalized (24%); externalized (18%); suspended (16%). The Emotional Regulation: disconnected (44%), splitted (28%), pervasive (26%), and connected (2%). The Organization of self-other Relationship: supportive (46%), avoidant (22%), overturned (16%), and sacrificial (16%). The Finding Benefit: revaluating (38%), flattened (34%), and postponed (28%). The Orientation to Action: combative (38%), blocked (36%), and suspended (26%). Findings capture the impact with the onset of the cancer, identifying both risk and resource aspects. The study allows to identify a specific use of narrative device by under-fifty women who impacted with the experience of breast cancer. The ways in which meaning-making functions are articulated highlight the specificity of the first phase of the treatment of the cancer. From a clinical psychology point of view, our findings can be used as clinical narrative markers to grasp, in a diachronic way, the process of meaning-making, integration, and coping during the first phase of breast cancer experience in young women. We consider it valuable to increase longitudinal studies with young women to highlight trajectories of meaning-making during the different phases of the treatment to think about personalized intervention practices diachronically to the experience.

Background: Previous studies suggested that obesity and diabetes were correlated with breast cancer outcome. The aim of the present study was to investigate the prognostic effect of obesity and diabetes on the outcome of early breast cancer patients., Materials and Methods: Overall, 841 early breast cancer patients were prospectively enrolled between January 2009 and December 2013. Study population was divided into four groups: (1) patients without obesity or diabetes; (2) patients with only diabetes; (3) patients with only obesity; and (4) patients with both diabetes and obesity. Categorical variables were analyzed by the chi-square test and survival data by the log-rank test., Results: At diagnosis, obese and diabetic patients were more likely to be older ( p < 0.0001) and post-menopausal ( p < 0.0001) and to have a tumor larger than 2 cm ( p < 0.0001) than patients in groups 1-3. At univariate analyses, obese and diabetic patients had a worse disease-free survival ( p = 0.01) and overall survival ( p = 0.001) than did patients without obesity and diabetes. At multivariate analyses, the co-presence of obesity and diabetes was an independent prognostic factor for disease-free survival (hazard ratio=2.62, 95% CI 1.23-5.60) but not for overall survival., Conclusions: At diagnosis, patients with obesity and diabetes were older, had larger tumors and a worse outcome compared to patients without obesity or diabetes. These data suggest that metabolic health influences the prognosis of patients affected by early breast cancer., Competing Interests: CONFLICTS OF INTEREST The authors declare no potential conflicts of interest.

This study aimed to evaluate the anti-proteinuric effect of a very-low-protein diet supplemented with essential amino acids and keto analogs in patients with moderate to advanced chronic kidney disease and proteinuria already treated with both ACE inhibitors and angiotensin-receptor blockers. The study was a prospective randomized controlled cross-over trial comparing a very-low-protein diet (VLpD) and a low-protein diet (LpD). We enrolled 32 consecutive patients between June 2000 and June 2005. They were randomized to receive a VpLD (group A) or an LpD (group B) for 6 months; thereafter, patients of both groups were switched to the other diet (group A to LpD; group B to VpLD) for a further 6 months. Finally, all patients were randomized again within each group to receive either LpD or VLpD and were followed for another year. The VLpD group showed a significant reduction of urinary protein excretion during the diet period, with a nadir at the fourth month of treatment; the amount of urinary protein reduction was about 58%. Serum advanced glycation end products (AGE) significantly decreased in 10 patients (5 of group A, 5 of group B; -18% and -19%, respectively) during VLpD. Univariate analysis showed that proteinuria correlated indirectly with VpLD and directly with AGE. This study demonstrates that in patients with moderate to advanced chronic kidney disease and severe proteinuria, a VLpD reduces both proteinuria and serum AGE, even in the presence of complete inhibition of the renin-angiotensin system.

Background: Previous studies have demonstrated an increased basal metabolic rate in cancer patients. However, no previous study has investigated the changes in energy expenditure and substrate oxidation after administration of a glucose load. Furthermore, the role of tumor necrosis factor-alpha (TNF-alpha) on cancer-induced metabolic changes is still a neglected area., Methods: In 25 cancer patients and 16 healthy subjects matched with regard to age, body mass index, and fat-free mass, indirect calorimetry was made before and after administration of a glucose load (75 g per subject, administered orally)., Results: Cancer patients had fasting plasma concentrations of insulin (74 +/- 3.3 vs. 67 +/- 4.1 pmol/L; P < 0.05), lactate (0.68 +/- 0.11 vs. 0.41 +/- 0.1 mmol/L; P < 0.05), free fatty acids (884 +/- 121 vs. 342 +/- 76 mmol/mL; P < 0.001), and TNF-alpha (1.23 +/- 0.31 vs. 0.45 +/- 0.11 ng/mL; P < 0.01) greater than controls, whereas plasma glucose concentrations (4.8 +/- 0.5 vs. 5.1 +/- 0.3 mmol/L; P = not significant) were not different from controls. Indirect calorimetry at baseline demonstrated that basal metabolic rate, fat oxidation, and protein oxidation were significantly greater in cancer patients than in controls. After administration of the glucose load, carbohydrate oxidation progressively rose in both cancer patients and controls, with no differences between the two groups, whereas glucose uptake (59.3 +/- 3.8 vs.69.1 +/- 3.6 g/kg fat-free mass [FFM] x 240 minutes; P < 0.01) and storage (49.1 +/- 4.1 vs. 60.2 +/- 3.3 g/kg FFM x 240 minutes; P < 0.05) were markedly reduced in cancer patients as compared with controls. Finally, glucose-induced thermogenesis (GIT) was lower in cancer patients than in controls., Conclusions: This study demonstrated that GIT is lower in cancer patients than in healthy subjects matched with regard to age and body mass index. An overactivity of the glucose fatty acid cycle is responsible for such results. Plasma concentrations of TNF-alpha might play a modulating role in the metabolic changes that occur after administration of a glucose load. The role of TNF-alpha on glucose and lipid metabolism in cancer patients would be a worthy subject of future investigations.