RESUMEN
OBJECTIVE: The use of biological drugs to treat ulcerative colitis (UC) represents a clear added value; nevertheless, many patients do not have a sustained response to these drugs. Small molecules were recently approved for the treatment of UC in Portugal. This network meta-analysis aimed to compare the efficacy and safety of the different therapies, including biological and small molecules, in patients prior exposed to biological treatment. MATERIALS AND METHODS: A systematic review of the literature was performed on January 6, 2022, identifying all the relevant reports about the efficacy and safety of biologics (adalimumab, golimumab, infliximab, vedolizumab, ustekinumab) and small molecules (upadacitinib, filgotinib, tofacitinib) in the treatment of UC in Portugal. Network meta-analysis (NMA) was conducted using Bayesian Markov Chain Monte Carlo simulations. Results were presented in median Odds Ratio and Surface Under the Cumulative RAnking (SUCRA) score for each treatment. RESULTS: Treatment of UC is divided into two phases: induction and maintenance. Upadacitinib 45 mg was the most efficacious therapy in achieving clinical remission and response and endoscopic improvement in the induction phase. Concerning the maintenance phase, upadacitinib 30 mg performed better than ustekinumab formulations in clinical remission and response, and endoscopic improvement. Regarding safety, there were no significant differences between all the drugs included in the analysis. CONCLUSIONS: This network meta-analysis showed that upadacitinib reflects better efficacy compared to the available treatments for bio-exposed patients with moderate to severe UC. The safety profile is comparable to the other drugs.
Asunto(s)
Productos Biológicos , Colitis Ulcerosa , Humanos , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/inducido químicamente , Ustekinumab/uso terapéutico , Metaanálisis en Red , Portugal , Teorema de Bayes , Factores Biológicos/uso terapéutico , Productos Biológicos/efectos adversosRESUMEN
Displacement of the tendon of the superficial digital flexor muscle was diagnosed in 9 dogs (10 tarsi). Four of 10 displacements occurred in Shetland Sheepdogs. All dogs had an acute onset of lameness with swelling over the proximal end of the tuber calcanei. Lateral displacement occurred in 8 tarsi and medial displacement in 2 tarsi. Nonsurgical treatment (exercise restriction, bandaging, and administration of anti-inflammatory medication) was ineffective in the 5 dogs in which it was attempted. Surgical reconstruction of the supporting soft tissues resulted in return to normal function in 9 cases available for follow-up evaluation.
Asunto(s)
Perros/lesiones , Cojera Animal/etiología , Traumatismos de los Tendones/veterinaria , Animales , Cruzamiento , Perros/cirugía , Femenino , Estudios de Seguimiento , Miembro Posterior , Masculino , Estudios Retrospectivos , Traumatismos de los Tendones/etiología , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/terapia , Resultado del TratamientoRESUMEN
Medical records of 13 dogs with spinal meningiomas were reviewed. Breed predilections were not found. Males outnumbered females 9 to 4, and most of the dogs were middle-aged. All dogs had motor deficits of various degrees, and approximately half of the dogs had clinical signs of mild to moderate spinal pain. The remainder had histories of clinical signs suggestive of chronic discomfort. There was a prolonged (greater than 3 months) delay between the onset of signs and diagnosis, except in 3 dogs. The neurologic courses usually were progressive. Results of noncontrast spinal radiography were normal in 10 dogs; in 3 dogs, the lamina appeared scalloped. Results of myelography contributed to the correct diagnosis in 10 of 12 dogs; however, in 2 dogs, intradural/extramedullary tumors were thought to be intramedullary lesions. A preponderance of cervical meningiomas was found, accounting for 10 of 13 tumors. Lumbar meningiomas were found in the remaining 3 dogs. Surgery was performed in 9 of the dogs, six of which improved after surgery. Poor results were correlated with tumors that involved spinal cord segments of an intumescence, ventrally located tumors, iatrogenic trauma, and tumor invasion into adjacent neural parenchyma. Four of 13 spinal meningiomas were found to be invasive into the spinal cord itself.
Asunto(s)
Enfermedades de los Perros/cirugía , Meningioma/veterinaria , Neoplasias de la Médula Espinal/veterinaria , Animales , Enfermedades de los Perros/diagnóstico por imagen , Perros , Femenino , Masculino , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Radiografía , Estudios Retrospectivos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugíaRESUMEN
Fifteen dogs with stenosis of the lumbosacral portion of the spinal canal were treated by laminectomy, bilateral facetectomy, and foraminotomy. Concomitant disk extrusion, spondylosis, fracture, infection, neoplasia, hemivertebrae, and spinal bifida were not associated with the stenosis and attendant cauda equina compression. The predominant neurologic signs were intermittent hindlimb lameness and motor weakness; hindlimb muscle atrophy; presumed paresthesia with resultant dermatologic manifestations from self mutilation of the hindlimbs, tail, perineum, anal area, and genitalia; urinaryu or fecal incontinence, or both; and consistently elicitable pain on manipulation of the lumbosacral spine. Surgical decompression of the stenotic canal alleviated the clinical signs in all cases.
Asunto(s)
Enfermedades de los Perros/etiología , Enfermedades de la Columna Vertebral/veterinaria , Animales , Enfermedades de los Perros/cirugía , Perros , Femenino , Cojera Animal/etiología , Laminectomía/veterinaria , Vértebras Lumbares , Masculino , Parestesia/etiología , Parestesia/veterinaria , Sacro , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/cirugíaAsunto(s)
Neoplasias del Ventrículo Cerebral/veterinaria , Plexo Coroideo/patología , Enfermedades de los Perros/patología , Animales , Carcinoma/patología , Carcinoma/ultraestructura , Carcinoma/veterinaria , Neoplasias del Ventrículo Cerebral/complicaciones , Neoplasias del Ventrículo Cerebral/patología , Neoplasias del Ventrículo Cerebral/ultraestructura , Plexo Coroideo/ultraestructura , Enfermedades de los Perros/etiología , Perros , Masculino , Neoplasias Meníngeas/etiología , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/ultraestructura , Neoplasias Meníngeas/veterinariaAsunto(s)
Enfermedades de los Perros/diagnóstico , Neoplasias de la Médula Espinal/veterinaria , Animales , Enfermedades de los Perros/diagnóstico por imagen , Perros , Incontinencia Fecal/veterinaria , Cojera Animal , Mielografía , Dolor/veterinaria , Compresión de la Médula Espinal/veterinaria , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico por imagen , Incontinencia Urinaria/veterinariaRESUMEN
Seven dogs (3 Great Danes, 2 German Shepherd Dogs, 1 Weimaraner, and 1 Boxer) ranging in age from 1 1/2 to 9 years were examined because of acute neurologic signs involving the limbs. All dogs were nonambulatory--3 tetraparetic and 4 paraparetic. In each case, treatment was unsuccessful or not advised, and each dog was euthanatized. Necropsy revealed hemorrhagic infarcts of the gray and white matter as a result of fibrocartilaginous embolization in leptomeningeal and parenchymal vessels of the spinal cord. The emboli were derived from disk material herniated into the vertebral venous sinuses.
Asunto(s)
Enfermedades de los Perros/etiología , Embolia/veterinaria , Desplazamiento del Disco Intervertebral/veterinaria , Enfermedades de la Médula Espinal/veterinaria , Animales , Cartílago , Enfermedades de los Perros/patología , Perros , Embolia/complicaciones , Embolia/patología , Femenino , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/patología , Vértebras Lumbares/patología , Masculino , Necrosis , Médula Espinal/patología , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/patologíaAsunto(s)
Enfermedades de los Gatos/etiología , Enfermedades de la Médula Espinal/veterinaria , Animales , Cartílago , Gatos , Embolia/complicaciones , Embolia/veterinaria , Femenino , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/veterinaria , Necrosis , Enfermedades de la Médula Espinal/etiologíaRESUMEN
Primary spinal cord tumors were detected in 6 mature dogs. Two of the tumors were astrocytomas, 2 were meningiomas, and 2 were neurilemmomas. Five tumors were in the cervical portion and 1 was in the lumbar portion of the spinal cord.
Asunto(s)
Astrocitoma/veterinaria , Enfermedades de los Perros , Meningioma/veterinaria , Neurilemoma/veterinaria , Neoplasias de la Médula Espinal/veterinaria , Animales , Astrocitoma/patología , Astrocitoma/fisiopatología , Enfermedades de los Perros/patología , Enfermedades de los Perros/fisiopatología , Perros , Femenino , Masculino , Meninges/patología , Meningioma/patología , Meningioma/fisiopatología , Neurilemoma/patología , Neurilemoma/fisiopatología , Médula Espinal/patología , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/fisiopatologíaRESUMEN
Two dogs, one 4 months old and the other 1 year old, had histories of progressive posterior weakness. In both cases, there was severe asymmetric proprioceptive loss but appreciable preservation of strength. Benign, cystic expansile lesions involving the facets and lamina of the thoracic spine were observed radiographically; a single lesioons was demonstrated in the other. Examination of biopsy speciments taken at the time of laminectomy revealed the lesions to be osteocartilaginous exostoses (osteochondromas, ecchondromas, exostoses). The progress of dogs 1 and 2 has been monitored for 1 1/2 years and 9 months, respectively. Dog 1 has no weakness or proprioceptive loss; dog 2 has a mild proprioceptive loss in the right hindlimb.