Background and aim Prophylactic pancreatic stent placement (PPSP) is recommended in high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis (PEP). Only a few societies, including the European Society of Gastrointestinal Endoscopy (ESGE), provide guidance on stent management, recommending assessment of spontaneous passage within 5-10 days and endoscopic removal, if retained. However, evidence on real-life adherence to these recommendations remains limited. The primary aim was to assess clinical practices related to PPS removal, methods, timing, and adherence to current guidelines. Methods An online 13-item survey was distributed via professional networks and social media between November 2024 and February 2025 to assess current PPSP and removal practices. Results In all, 322 valid responses were collected (Europe = 285; non-EU = 32; not disclosed = 5). Centers were stratified by annual ERCP volume (procedures/years): <300 (28.3%), 300-500 (31.7%), and >500 (40.1%). Approximately 40% of respondents did routinely place a PPS in high-risk situations. PPSP was most often inserted after >2 pancreatic duct cannulations (83.5%) or papillectomy (58.7%). Straight 5 Fr, 5 cm stents predominated (54% and 85.4%, respectively). Removal practices varied: 62.7% performed endoscopic retrieval, 47% within one week and 41.6% within four weeks; 55% had no fixed follow-up schedule. Complications of nonremoval were reported by 22.7% of the centers-mainly pancreatitis (63%)-yet 96% considered these rare. Overall, 31.7% followed ESGE or internal guidance, while 23.6% reported following no guidance. Conclusions The PIRATE survey reveals that most centers apply heterogenous follow-up removal practices despite presence of guidelines.
OBJECTIVES:To compare proliferative (PLN) and membranous (MLN) lupus nephritis (LN) regarding clinical and laboratory presentation and long-term outcomes, and to investigate predictors of progression to chronic kidney disease (CKD). METHODS:Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Rheumatic Diseases Portuguese Registry - Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Cox regression survival analysis was used to investigate predictors of CKD. RESULTS:A total of 260 patients were included. Median follow-up was 8 years (IQR 11; minimum 1, maximum 35 years). MLN patients presented with significantly lower serum creatinine [0.70 (IQR 0.20; minimum 0.50, maximum 1.30) mg/dl vs 0.80 (IQR 0.31; minimum 0.26, maximum 2.60) in PLN, P = 0.003]. Proteinuria levels did not differ between groups (P = 0.641). Levels of complement were reduced in PLN but nearly normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (P < 0.001). One year after the beginning of treatment, 62% of the patients achieved EULAR/ERA-EDTA complete response, with a further 5% achieving partial response. Patients with lower proteinuria at diagnosis were more likely to achieve a complete renal response at one year; however, proteinuria at diagnosis or at one year did not predict long-term CKD. Estimated glomerular filtration rate (eGFR) ≤75 mL/min/1.73 m2 at one year was the strongest predictor of progression to CKD (HR 23 [95% CI 8-62], P < 0.001). Other possible predictors included the use of azathioprine for induction of remission, older age at diagnosis and male sex. CONCLUSION:Proteinuria levels did not predict LN histologic class in our cohort. eGFR cutoff of 75 mL/min/1.73 m2 after one year of treatment was strongly predictive of progression to CKD.
Spontaneous coronary dissection (SCAD), although rare, is a significant cause of acute coronary syndrome (ACS) in young patients, particularly women without notable risk factors. Due to the limited number of cases reported in the literature and the scarcity of prospective studies, uncertainties remain regarding the most appropriate therapeutic approach. Observational studies of small sample sizes suggest a benefit in adopting a conservative strategy, reserving revascularization for cases with ongoing ischemia, hemodynamic instability, or high-risk anatomy. The aim of this study was to analyze our local experience regarding the epidemiology and therapeutic approach to SCAD, with a particular focus on cases that underwent revascularization. We conducted a single-center, retrospective study of patients that underwent urgent catheterization procedures between January 2022 and October 2024. Patients with SCAD were selected. Electronic medical records were reviewed and sociodemographic, clinical, catheterization data, medical treatment, and follow-up were assessed. Out of 257 catheterizations performed for suspected ACS, six patients were included (2.3%), 5 of whom were women, with a mean age of 49.8 ± 7.1 years (range: 41-61). The mean maximal troponin level was 17356 ± 16562 ng/L (range: 2090-49646). There was a low prevalence of cardiovascular risk factors: dyslipidemia (n=3), hypertension (n=2), and overweight (n=1). There was an history of previous ACS in 2 cases. Electrocardiographically, 2 patients presented with ST-segment elevation. The most frequently involved vessel was the left anterior descending artery (n=2) (figure 1). A conservative strategy was adopted in 4 cases, although stenting was necessary in two (figure 2). In one case, evidence of ongoing ischemia (chest pain and new ST elevation) warranted the implantation of a single stent, while in another, four sequential stents were implanted to restore the coronary flow and prevent the progression of the dissection. The mean left ventricle ejection fraction after the event was 53.7% (range: 46.0-61.0). The outpatient therapy included dual antiplatelet therapy (n=6), beta-blockers (n=6), ACE inhibitors (n=3), calcium channel blockers (n=2), and statins (n=4). Screening for arterial disease in other territories revealed splenic and renal aneurysms in only one patient. One patient underwent a follow-up coronary angiography 6 months after the event, which confirmed complete resolution of the dissection with no observed recurrence. Our results are consistent with those reported in the literature, notably affecting young women with few cardiovascular risk factors. However, one-third of our cohort required urgent revascularization, highlighting the challenges in consistently adopting a conservative strategy. Further research with larger patient cohorts and a prospective design is necessary to define the best therapeutic approach.
Background: Spondyloarthritis (SpA) comprise a complex group of inflammatory arthropathies that can involve both axial and peripheral joints, often associated with extra-musculoskeletal manifestations, particularly psoriasis. The distinction between Psoriatic Arthritis (PsA) with axial involvement and axial SpA (axSpA) with concomitant psoriasis has been a topic of debate, potentially influencing clinical decisions. Objectives: To identify clinical and demographic characteristics associated with clinician's decision to diagnose patients with psoriasis and axial disease as axSpA or as PsA with axial involvement in practical clinical settings. Methods: All adult patients registered in the Rheumatic Portuguese Disease Register (Reuma.pt) with the clinical diagnosis of PsA with axial involvement (axPsA) or axSpA with concomitant psoriasis were included. Bivariate and multivariate analysis were performed to identify clinical and demographic characteristics associated with the clinical diagnosis of axPsA or axSpA. Results: Out of 854 patients, 88.3% (n=754) received a diagnosis of axPsA and 11.7% (n=100) were diagnosed with axSpA with psoriasis. The diagnosis of axPsA included concomitant peripheral involvement in 82.2% of patients (n=620) and exclusive axial involvement in 17.8% (n=134). In axSpA diagnosis, the prevalence of concomitant peripheral involvement was 48% (n=48). Considering the whole cohort, axSpA diagnosis was associated with less peripheral involvement (OR 0.20, 95% CI 0.13-0.31; p<0.001), younger age at diagnosis (axSpA 36.7 ± 9.4 vs axPsA 43.8 ± 13.1; p<0.001) and at symptom onset (axSpA 30.1 ± 9.7 vs axPsA 39.6 ± 12.9; p<0.001) and higher positivity for HLA-B27 (OR 8.95; 95% CI 5.24-15.28; p<0.001) (Table 1). Regarding extra-articular manifestations, uveitis (OR 7.59; 95% CI 4.5-12.81; p<0.001) and inflammatory bowel disease (OR 21.02; 95% CI 8.01-55.18; p<0.001) were associated positively, while dactylitis was associated negatively with axSpA diagnosis (OR 0.13; 95% CI 0.06-0.29; p<0.001). axSpA patients more commonly received bDMARDs (OR 3.82; 2.13-6.84; p<0.001) and had a longer time from symptom onset until start of first bDMARD (axSpA 13.7 ± 9.3 vs axPsA 9.5 ± 9.1; p<0.001). Cardiovascular comorbidities were negatively associated with axSpA (OR 0.53; 95% CI 0.32 - 0.88; p<0.013). Multivariate analysis identified HLA-B27 positivity, younger age at symptom onset, presence of uveitis and inflammatory bowel disease and lower prevalence of dactylitis as independently associated with axSpA diagnosis. When considering patients with exclusive axial involvement (N=186), axSpA diagnosis was associated with a younger age at diagnosis (axSpA 36.4 ± 10.3; vs axPsA 43.9 ± 13.8; p<0.001) and at symptom onset (axSpA 29.3± 10.1 vs axPsA 38.3 ± 13.6; p<0.001), a higher prevalence of HLA-B27 (OR 8.55; 95% CI 3.59-20.4; p<0.001) and uveitis (OR 7.7; 95% CI 3.0-19.2; p<0.001) (Table 2). Regarding treatment, axSpA patients were more frequently treated with bDMARDs (OR 4.59; 95% CI 2.13 - 9.90; p<0.001) and had a longer time from symptom onset until start of first bDMARD (axSpA 14.8 ± 10.2 vs axPsA 8.5 ± 7.9; p<0.001). However, multivariate analysis did not identify any variables independently associated with the diagnosis of axPsA or axSpA. Conclusion: Patients with axPsA diagnosis exhibit more frequently concomitant peripheral involvement, whereas those with axSpA diagnosis have more often exclusive axial involvement, are younger and more frequently HLA-B27 positive. However, when considering patients with exclusive axial involvement, no differences could be identified between axSpA with psoriasis and axPsA diagnosis. In clinical practice, clinicians tend to diagnose patients with psoriasis as axSpA when axial involvement predominates and there are no peripheral manifestations. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
