Inflammatory bowel diseases (IBD) are gastrointestinal tract pathologies of unknown etiology; they have an alternating trend, with active and silent phases. IBD are classified in two main forms: ulcerative colitis (UC) and Crohn’s disease (CD). Both have chronic and recurrent course, gastrointestinal symptoms, and extraintestinal manifestations. The altered immune response role seems to be important both in UC and CD. In the majority of cases, CD begins with abdominal pain, diarrhea, decrease in appetite, and weight loss; there can be also perianal fistulas, rhagades, and perianal recurrent abscesses. In addition, retarded growth and delayed puberty can precede the development of the disease or can even be predominant at onset. Growth retardation is found in 40% of IBD patients, but the underlying mechanism of this and other extra-intestinal manifestations are partially known: the main hypotheses are represented by malnutrition and inflammatory response during the active phase of the disease. The increased level of pro-inflammatory cytokines can influence growth, but also the onset of puberty and its progression. In addition, it could be essential to clarify the role and the possible effects of all the currently used treatments concerning growth failure and delayed puberty.

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Outcomes of insulin analogues in pediatric diabetes camps are poorly investigated; no data is available about insulin degludec (IDeg).Our aim was to assess impact of insulin therapy adopted by the participants to a 4-day diabetes camp held in 2017, hypothesizing a possible excess risk of hypoglycemia in patients treated with IDeg. Overall, 40 children with type 1 diabetes (mean age 13.4±3.0 years; 62.5% males) attended the camp (20.0% on continuous subcutaneous insulin infusion and 80.0% on multiple daily injections - MDI). Among children in MDI regimen, 71.9% were treated with IDeg as basal insulin and 28.1% with glargine U100 (IGlar). All patients used Lispro or Aspart as short-acting insulin. Daily plan of the camp included educational sessions, physical exercise, 3 main meals and 2 snacks. At the arrival, IGlar and short-acting insulin doses were revised according to existing guidelines, while IDeg dose was revised based on an empirical individualized approach. At the arrival, insulin doses were reduced in 22 participants (-19.4±10.5%), while doses were increased in 17 children (+17.8±12.7%), based on individual needs. No statistically significant between-group difference emerged in mean blood glucose and glucose variability. No excess risk of hypoglycemia was found in the IDeg group. The study suggests similar effectiveness and safety of different insulin schemes when associated with appropriate diabetes education and management, and flexible dose adjustments. Despite its longer halflife and the lack of a validated algorithm, IDeg was not associated with an excess risk of hypoglycemia.

Background:The metacarpophalangeal and metatarsophalangeal joints are very demanded during high intensity exercises, and may be affected by osteoarthritis, fractures, luxations and rupture of the suspensory apparatus. Thus, arthrodesis may be indicated to restore joint stability and accelerate the ankylosis process. The most commonly used surgical techniques have been associated with postoperative complications, including infection and failure of the implants, so it is important to develop procedures that are less invasive procedures and promoting stable fixation. Therefore, the aim of this work is to report the use of the modified steel basket technique for metatarsophalangeal arthrodesis in a foal with hyperextension of the joint due to rupture of the digital flexor muscles. Case: A 2-day-old male foal was admitted to clinical care, presenting multiple cutaneous wounds caused by dogs bites, located in the tarsus and thigh of the hindlimb. The animal presented in standing position and had no difficulty of movement, being initially treated through daily cleaning of the cutaneous wounds and systemic antibiotic therapy. Hyperextension of the metatarsophalangeal joint was evidenced after 20 days, being approached through tenotomy and tendon shortening, followed by tenorrhaphy and immobilization for 30 days. Due to the failure of the treatment, it was opted for metatarsophalangeal arthrodesis by modified steel basket technique. The procedure involved the implantation of a steel basket of 25.0 mm in diameter x 25.0 mm long in a 24.0 mm hole created on the dorsal surface between the third metacarpal and the proximal phalanx. The basket was filled with bone extracted from drilling and fixed with two cortical screws at an angle of 25° toward proximoplantar and distoplantar direction. Immobilization of the limb was performed postoperatively with synthetic plaster cast for 45 days and, due to the persistence of lameness, maintained with Robert Jones banding and plantar splint for another 15 days. At 90 days after surgery, radiographic control showed signs of degeneration and joint fusion, and grade 2 claudication (1-5) was observed during locomotion. At six months after surgery, discrete claudication (grade 1/1-5) was evident. The aesthetic and functional result was considered satisfactory and the animal was then ridden and used for leisure. Discussion: In this report, arthrodesis was indicated due to hyperextension of the metatarsophalangeal joint caused by the rupture of the digital flexor muscles, since these structures, together with the suspensory apparatus, assist in the support of the joint. Several techniques have been descrited for arthrodesis of metacarpal/metatarsophalangeal joints in horses, being the technique described by Bramlage the most employed and successful one. However, complications related to the techniques such as infection and implant failure were evidenced in one study. The technique of the modified steel basket is characterized by the promotional of effective intervertebral arthrodesis in cases o...

Background:No data exist about the changes induced by the transition from firstgeneration long-acting insulins to second-generation long-acting analogues in the paediatric population.Objective: To assess changes in insulin/carbohydrate ratio (I:CHO) after the first 6 months of degludec therapy in a paediatric population with type 1 diabetes previously treated with glargine U100. Subjects: All patients treated with degludec under routine clinical practice conditions were retrospectively analysed. Methods: Nonprofit observational retrospective study. Changes during the followup in mean CHO/I ratio were assessed using longitudinal linear models for repeated measures. Rate of hypoglycaemia, ketoacidosis and adverse events was evaluated.Results: Overall, 51 children (mean age 13.8 ± 4.6 years; mean diabetes duration 5.8 ± 3.9 years) started therapy with degludec in the period between April 2017 and April 2018. I:CHO ratio before starting degludec therapy significantly differed among the three meals, being the lowest at breakfast and the highest at dinner. After introducing degludec, I:CHO ratio at lunch (−1.29 95% CI −2.02;−0.57) and at dinner (−3.08 95% CI −4.35;−1.8) significantly decreased, while it slightly increased at breakfast (+1.37 95% CI 0.47;2.28). No episodes of severe hypoglycaemia, ketoacidosis and adverse event were recorded during 6 months. Conclusions:Our data show that the use of degludec is associated with a significant change in the I:CHO ratio at the different meals compared to the previous glargine therapy. This could derive from the flat and prolonged pharmacokinetic profile of degludec. This has important clinical implications for daily insulin dose adjustments.