Clinical Signs Research Articles

Peri-mortem rigidity in a fatal case of severe salicylate poisoning.

There has been a previous case report of peri-arrest muscle rigidity in the setting of severe salicylate poisoning (serum salicylate concentration 1,500 mg/L), described as paratonia or rapid rigor mortis. We present an image of rapid rigor mortis in another fatal salicylate poisoning. We report a 42-year-old male with severe salicylate poisoning (peak salicylate concentration 1,600 mg/L). During the peri-arrest period, the patient developed isotonic flexion of the upper and lower extremities, the clinical signs of rapid-occurring rigor mortis. Despite resuscitative efforts, the patient died. Our patient is exhibiting peri-arrest rigidity in the upper extremities. Peri-mortem rigidity is due to depletion of adenosine triphosphate. Severe salicylate poisoning causes uncoupling of oxidative phosphorylation which prevents the production of adenosine triphosphate, which is required to release myosin from actin to allow the muscle to relax. A limitation of our report is that we did not definitively exclude other uncouplers of oxidative phosphorylation, such as 2,4-dinitrophenol. However, the history of aspirin ingestion was provided by the patient and corroborated by his mother, and it was confirmed by measurement of his salicylate concentration. We hypothesize that in our patient, rapid-occurring rigor mortis likely resulted from depletion of adenosine triphosphate. This occurred as a result of uncoupling of oxidative phosphorylation in the mitochondria from severe salicylate poisoning, as adenosine triphosphate is required for muscle relaxation.

Medicine in the 21st Century: How Not to Lose the Art of Healing?

In our time of advanced technologies, the Internet, and the enormous acceleration of all areas of humanitarian activity, medical scientists make outstanding discoveries and innovations that revolutionize diagnostic approaches and treatment options, improve patient care, and enrich the way to a healthier world. Is there still a place for the art of medicine in the era of innovations and artificial intelligence? Although modern technology in the field of medicine with computerization of every aspect (including electronic medical records, laboratory data entry, images, patients' monitoring systems, etc.), young physicians, while embracing that innovation, should be trained in the development of clinical thinking and the establishment of personalized connections to the patients. Young physicians should be taught to adopt the ability to see, hear, and feel a patient's problems, formulate optimal management, and be empathetic to the patient's emotions and suffering. Communication skills are a key to successful medical practice and a part of "the Introduction to Clinic" course in almost all medical schools, but a substantial lack of time in clinical settings creates new challenges for communication between medical students, clinical teachers, and patients in medical schools. In many areas around the world, including Ukraine, this problem has been aggravated by wars, epidemics, pandemics, and natural disasters. At the same time, developing clinical observational skills remains an integral part of medical education and the basis of medical art. The art of a careful physical exam should not be lost behind a computer screen. Dnipro State Medical University has traditions of integrating centuries-old world historical experiences of teaching the art of healing into the philosophical concept of forming the critical clinical thinking of medical students. Our medical school has incorporated "diagnosing the canvas" into its curriculum. A thematic gallery of diagnostic symptoms and signs from great artists of all times and peoples has been created, expanding the young physicians' educational horizons in clinical thinking, empathy, and mercy.

PDE4D and miR-203 are promising biomarkers for canine atopic dermatitis

BackgroundCanine atopic dermatitis (CAD) is a common genetically predisposed, inflammatory, and pruritic skin disorder that affects dogs globally. To date, there are no specific biomarkers available to diagnose CAD, and the current diagnosis is based on a combination of criteria including patient history, clinical signs, and exclusion of other relevant differential diagnoses.Methods and resultsWe examined the gene expression of phosphodiesterase 4D (PDE4D) in peripheral blood mononuclear cells (PBMCs), as well as miR-203 and miR-483 in plasma, in three groups: healthy dogs, CAD dogs, and other inflammatory pruritic skin diseases (OIPSD) such as pemphigus foliaceus, scabies, cutaneous lymphoma, and dermatophytosis. Our results showed that PDE4D gene expression in the CAD group is statistically higher compared to those in the healthy and OIPSD groups, suggesting PDE4D may be a specific marker for CAD. Nevertheless, no correlation was found between PDE4D gene expression levels and the lesion severity gauged by CAD severity index-4 (CADESI-4). We also showed that miR-203 is a generic marker for clinical dermatitis and differentiates both CAD and OIPSD inflammatory conditions from healthy controls.ConclusionsWe show that PDE4D is a potential marker to differentiate CAD from non-atopic healthy and OIPSD while miR-203 may be a potential marker for general dermatologic inflammation. Future study of PDE4D and miR-203 on a larger scale is warranted.

Clinical Case of Rare Genetic Disorder (Proud Syndrome) in a Child

Background. Proud syndrome is rare inherited disease with X-linked inheritance associated with mutations in the homeobox gene ARX. Typical clinical signs of this syndrome are severe mental retardation, intractable epilepsy, agenesis (dysgenesis) of corpus callosum. Less common features are genital abnormalities, microcephaly, facial dysmorphia, and skeletal malformations. Clinical case description. The article describes the clinical findings of Proud syndrome in girl A., admitted to Children’s City Clinical Hospital No. 1 in Nizhny Novgorod. The girl was born without asphyxia at term through natural vaginal delivery after the first uneventful pregnancy. Body weight at birth was 2600 g. The genealogical history is burdened by the presence of epilepsy in girl’s father relatives. There were no deviations in psychomotor skills development before disease onset. Hemi-convulsive seizures (switching sides) have appeared at the age of 6 months. These attacks had status course and were resistant to anticonvulsant therapy. Neuroimaging has revealed agenesis of corpus callosum. Regression of psychomotor development, new behavioral disorders (stereotypes and auto-aggression), hyperexcitability, and sleep disorders were observed in dynamics. The diagnosis of Proud syndrome was confirmed by identification of probably pathogenic mutation in the ARX gene (c.1111C>T, p. Arg 371*64). The features of anticonvulsant management were demonstrated in the patient. Conclusion. This clinical case presents typical clinical picture of Proud syndrome. The disease is non-curable. Such patients should be administered with syndromic therapy: constant anticonvulsant therapy, correction of behavioral disorders (classes with specialist on mental defects), neurologist, epileptologist, psychiatrist observations. Parental examination is crucial ARX mutation search in order to determine the prognosis for further child-bearing (parents refused to perform genetic study at the time of article writing).

Successful Treatment of Multiple Arterial Thrombosis in Premature Infant: Clinical Case

Background. Neonatal thrombosis remains a complex and urgent challenge due to the presence of certain features of the hemostasis system in newborns and the variety of clinical signs. Management approaches are still under consideration, therapeutic experience of thrombolytic therapy (TLT) remains limited and requires benefit-risk assessment. Clinical case description. Clinical case of premature infant with multiple arterial thrombosis diagnosed on the 1st day of life is presented. Modern diagnostic features have allowed to establish the right diagnosis quickly and to start the treatment in time despite the similarities of clinical signs with congenital heart disease. Conclusion. TLT and heparin therapy have saved the child’s life, reversed ischemia, and preserved lower limbs from death. Doctors must perform dynamic monitoring during TLT to diagnose and correct hemorrhagic complications in timely manner.

Outcomes Following Different Management of Mycotic Infrarenal Abdominal Aortic Aneurysms.

The objective was to present our experience on managing mycotic infrarenal abdominal aortic aneurysm (MIAAA) through a retrospective cohort study. Data of patients with MIAAA managed in our center from July 2016 to October 2022 were retrospectively analyzed. The diagnosis of MIAAA was made based on: (1) preoperative clinical signs of infection; (2) elevated serologic infection parameters; (3) para-aneurysmal infection features on enhanced computed tomography; and (4) positive blood or tissue cultures. All the patients received standard antibiotic therapy. Surgical management including endovascular aneurysm repair (EVAR), initial EVAR followed by open re-operation, and initial open surgical repair (OSR) were conducted according to disease seriosity, physical condition, and patient's will. Infection index and clinical outcome were evaluated during the follow-up time. A total of 23 patients (21 men; averaged=66.3 years, range=49-79 years) were included, with a mean follow-up time of 19.9 months (range=1-75 months). Bacteria culture from blood or tissue specimen was positive in 15 patients (Salmonella, n=8; Escherichia coli, n=3; methicillin-sensitive Staphylococcus aureus [MSSA], n=1; Klebsiella pneumoniae, n=1; Staphylococcus epidermidis, n=1; Mycobacterium tuberculosis, n=1). Seven patients received OSR as the initial surgical intervention, whereas 14 patients chose EVAR instead. The 2 conservatively managed patients (refused surgery) died within 30 days. The 7 patients who received initial OSR survived till now. Among the 14 patients who underwent initial EVAR, infection deteriorated without exception (14/14, 100%). Three of these patients refused re-operation and died within 6 months. Eleven patients received secondary surgical intervention (10 cases of aneurysm and endograft resection, thorough debridement, subclavian to bi-femoral artery bypass, or in situ aorta reconstruction; 1 case of laparoscopic debridement) and 7 survived the follow-up time. The overall mortality rate was 39.1% (9/23). The mortality rates differed greatly following different intervention methods (merely antibiotic management, 100%; initial open operation, 0%; initial EVAR without secondary operation, 100%; initial EVAR plus secondary operation, 36.4%). Open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely EVAR is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary OSR. The management of mycotic or primary-infected aortic aneurysm is challenging; treatment remains controversial. Our center has reviewed our experience over the past 6 years and found that open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely endovascular aneurysm repair (EVAR) is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary open surgical repair.

Outcomes of the Transungual Approach in 56 Consecutive Digital Subungual Glomus Tumours.

Background: Glomus tumour is a painful small tumour of the glomus body commonly located under the nail bed. The aim of this study is to evaluate the correlation of clinical diagnosis with MRI findings, determine the prevalence of the tumour at different subungual locations and determine the differences in outcomes (if any) between a longitudinal and a transverse nail bed incision for excision of the tumour. Methods: This retrospective study of 56 subungual glomus tumour was conducted from May 2010 to December 2021. Data with regard to gender, age at presentation, digit involved, presenting symptoms, duration of symptoms, clinical signs, need for MRI, anatomical location, surgical approach (longitudinal versus transverse), histopathology result, period of follow-up and complications were recorded. Results: All 56 (100%) patients presented with classic triad of symptoms. The average duration of symptoms was 52.9 months (range: 3-204 months). Eleven (20%) tumours were in the sterile matrix, 38 (68%) at the junction of sterile and germinal matrix and 7 (12%) in the germinal matrix. The tumours were excised through the longitudinal incision in 31 (55.3%) patients and transverse incision in 25 (44.7%). One (1.8%) tumour was intraosseous that was diagnosed intraoperatively and excised successfully. Average follow-up was 35.4 months (range: 6-120 months). There was no difference in outcomes (pain or nail deformity) between the two incisions. One patient (1.8%) has persistent pain that was due to a missed satellite lesion in the same digit. This was excised later with resolution of symptoms. There were no recurrences and all patients were cured after excision of tumour. Conclusions: Diagnosis of glomus tumour is usually clinical, and most are located at junction of sterile and germinal matrix. Tumour can be excised either by longitudinal or transverse nail bed incisions without any change of treatment outcome. Level of Evidence: Level IV (Therapeutic).

Evidence-based commentary on the diagnosis, management, and further research of degenerative cervical spinal cord compression in the absence of clinical symptoms of myelopathy

Degenerative cervical myelopathy (DCM) represents the final consequence of a series of degenerative changes in the cervical spine, resulting in cervical spinal canal stenosis and mechanical stress on the cervical spinal cord. This process leads to subsequent pathophysiological processes in the spinal cord tissues. The primary mechanism of injury is degenerative compression of the cervical spinal cord, detectable by magnetic resonance imaging (MRI), serving as a hallmark for diagnosing DCM. However, the relative resilience of the cervical spinal cord to mechanical compression leads to clinical-radiological discordance, i.e., some individuals may exhibit MRI findings of DCC without the clinical signs and symptoms of myelopathy. This degenerative compression of the cervical spinal cord without clinical signs of myelopathy, potentially serving as a precursor to the development of DCM, remains a somewhat controversial topic. In this review article, we elaborate on and provide commentary on the terminology, epidemiology, natural course, diagnosis, predictive value, risks, and practical management of this condition—all of which are subjects of ongoing debate.

An epidemiological investigation into Mycoplasma bovis infection in U.S. bison (Bison bison): A case-control survey

Mycoplasma bovis (M. bovis) is an emerging pathogen in North American Bison (Bison bison) characterized by significant mor­bidity and mortality. Herds are reported to experience case fa­tality rates from 10 to 45%, with mature animals being primar­ily affected. To date, there are no published reports regarding the epidemiology of M. bovis within U.S. bison herds; this study serves as the first in-depth analysis of the prevalence, clinical signs and potential risk factors for M. bovis-associated disease in the United States.

Report on Mortalities of Nile Tilapia (Oreochromis niloticus) Due to Tilapinevirus tilapiae and Co-infecting Bacteria in Winter Season

Background: Tilapinevirus tilapiae, commonly known as Tilapia lake virus, is a major viral infection of cultured tilapia, causing severe rates of fatalites and has evolved as a serious hazard to the tilapia in the world. Predisposing factors, notably temperature and the development stage of the host play a decisive role in influencing the extent of pathogenesis and the mortality rate associated with the disease. The seasonality of TiLV outbreaks has been observed in multiple countries, with a higher frequency occurring during the summer months. Methods: In the current investigation, the occurrence of TiLV disease was examined in fry and fingerlings of tilapia during the winter season (January - February, 2020) in Pune District, Maharashtra, India. The disease was observed in fish reared in open cages (Case I) and in nursery rearing farm (Case II). Infected tilapia displayed generalized gross clinical signs. TiLV was identified and confirmed in both instances using a semi-nested reverse transcriptase PCR by amplifying TiLV genome segment 3 and further confirmed by histopathogical investigation. Result: The research demonstrated the vulnerability of early developmemtal stages of O. niloticus to TiLV disease, suggesting the potential occurrence of this infection during the winter season, characterized by lower temperatures. Additionally, microbial investigations exposed the prevalence of Aeromonas spp., predominantly associated with TiLV-positive fish. These results align with previous publications, underscoring the potential role of bacterial infectious agents (Notably aeromonads), in exacerbating TiLV disease during outbreaks.

FLASC – Fast Localized Abdominal Scan in Cattle

Rapid ultrasound examination has been used in human emer­gency medicine and adapted to small animal (FAST) and equine medicine (FLASH) for assessment of trauma or colic. Fast Lo­calized Abdominal Scan in Cattle (FLASC) is a focused assess­ment using the ultrasound that I have adapted to assist with all of my examinations when I do not have a clear idea what is causing clinical signs. This exam is tailored toward the most common things I find in beef cattle, but can be useful with all classes of cattle to assist in diagnosis.

Retrospective evaluation of traumatic pneumomediastinum in dogs and cats (2005-2022): 52 cases.

To describe the incidence, etiology, clinical signs, diagnostics, treatments, and outcome of noniatrogenic traumatic pneumomediastinum (TPM) in dogs and cats. Retrospective study of cases (2005-2022). University veterinary teaching hospital. Fifty-two patients (29 dogs, 23 cats). Data collected from the medical records included signalment, physical examination findings, animal trauma triage (ATT) score, clinicopathological data, imaging data, surgical intervention, length of hospitalization, supportive care, complications, and outcome. Most dogs presented with tachycardia and tachypnea, while cats presented with hypothermia and tachypnea. Subcutaneous emphysema, pneumothorax, and dyspnea were the most common clinical signs for both species. The median calculated ATT score was 3.5 in dogs and 4 in cats. The most common radiographic abnormalities other than pneumomediastinum were pneumothorax and lung contusions. The overall mortality rate was 18%, with a significantly higher survival rate in dogs (26/28 dogs [93%], 15/22 cats (68%); P=0.03). Outcome was unknown in 1 dog and 1 cat. The only significant difference in treatment between survivors and nonsurvivors was the requirement in dogs for positive pressure ventilation. The median hospitalization period was 2days for both species, with a shorter hospitalization in the nonsurvivors (0.6 vs 2days, respectively; P=0.006). TPM is an infrequent pathology in veterinary medicine and may be seen without an externally obvious injury. The most common causes for TPM in dogs were vehicular trauma and bite wounds, while high-rise syndrome was the most common cause in cats. Most of the cases have concurrent pneumothorax and require thoracocentesis; however, direct intervention to treat TPM is not usually required. The vast majority of cases did not undergo surgery to treat TPM. The prognosis for dogs with TPM was good but was guarded for cats.

Postpartum Surgical Emergency, in the General Surgery Department of the District Hospital of the Commune IV/ Bamako

Introduction: Postpartum is a period of physical and psychological upheaval with the possibility of surgical complications. Objective: To analyze the epidemiological-clinical, therapeutic and prognostic profile of postpartum surgical emergencies. Methods: This was a descriptive, cross-sectional study over 8 months (from August 2022 to March 2023) including all patients admitted to the general surgery service for acute surgical abdomen in the postpartum period. Result: Seven patients were retained with an average age of 28.33 6.89years. We found 4 cases (57.1%) of post-operative peritonitis, 1cas (14.3%) of appendicular abscess and 1 case (14.3%) of strangled white line hernia. Clinical signs were dominated by abdominal pain, conjunctival pallor and fever. Anemia was confirmed in 5 (71.4%) patients and we found leukocytosis in all patients. Laparotomy associated with hysterectomy was performed in 2cas, laparotomy avively of the banks and uterine suture in 2 cases, washing of the peritoneal cavity associated with abdominal drainage in 1 case, hernia cure in 1cas, an appendectomy in 1cas and a sigmoidectomy in 1cas; abdominal drainage was performed in all our patients. Conclusion: The occurrence of an abdominal surgical emergency in postpartum is serious and may involve the obstetric and vital prognosis of the patient. The involvement of all actors (surgeon, obstetrician and anesthesiologist resuscitator) in the management, remains essential to secure the periartum period.

Impact of the COVID-19 Pandemic on Obesity, Metabolic Parameters and Clinical Values in the South Korean Adult Population

This study aimed to evaluate the effects of the COVID-19 pandemic on obesity, metabolic parameters, and clinical values in the South Korean population. Data from the seventh and eighth National Health and Nutrition Examination Surveys were analyzed, comprising 3560 participants in 2018 (pre-COVID-19) and 3309 participants in 2021 (post-COVID-19). The study focused on adults aged 19 years and older who were overweight (BMI ≥ 25 kg/m2). The results showed a significant increase in waist circumference (approximately 2 cm), BMI (approximately 0.11 kg/m2), systolic blood pressure, fasting blood sugar (1.76 mg/dL higher), and glycated hemoglobin (0.14% higher) in the post-COVID-19 group compared to the pre-COVID-19 group. Additionally, the prevalence of hypercholesterolemia increased by 4% after the COVID-19 pandemic. These findings suggest an increased risk of obesity, abdominal obesity, and metabolic disorders, such as blood sugar disorders, in the post-COVID-19 period. Urine analysis revealed abnormal findings, including occult blood, urobilinogen, hematuria, proteinuria, ketone urea, glycosuria, and bacteriuria. The study highlights the negative impact of lifestyle changes, such as reduced physical activity and social gatherings, on physical vital signs and clinical values during the COVID-19 pandemic.

Zinc about it – zinc and calf immunity

Micronutrients, such as vitamins and trace minerals, are critical for supporting growth, performance, health and maintaining redox balance. Zinc (Zn), an essential micronutrient, aids the functioning of innate and adaptive immune cells. This scoping review aims to assemble and evaluate the evidence available for the role of Zn within calf immunity. Relevant literature was identified within Web of Science, PubMed, and CABI using search terms specific to the major innate and adaptive immune cell populations. There was no evidence that Zn supplementation altered neutrophil, natural killer cell, or T-cell functions. However, there was limited evidence to support Zn supplementation with reduced monocyte numbers, but there was no evidence to associate the monocytopenia with improvements in monocyte function. There is moderate evidence to suggest that Zn supplementation was beneficial for maintaining epithelial barriers of integumental and mucosal surfaces. The evidence supports supplementation above the current industry recommendations for improving immunoglobulin (Ig) production, with the strongest results being observed for IgG and IgM. Moreover, Zn supplementation was associated with reduced proinflammatory cytokine production, which may reduce inflammation-associated hypophagia and warrants further investigation. Furthermore, Zn reduced the duration of clinical signs in animals facing respiratory disease and diarrhea. However, consensus is needed about the optimal dose, route, and Zn formulation most appropriate for supporting immunity. In conclusion, while the literature supports that Zn could enhance calf immunity, there is insufficient evidence to adequately determine the extent to which Zn impacts innate immune cell and T-cell functions. Determination of the immune cell functions susceptible to modification by Zn supplementation is an important knowledge gap for enhancing the understanding of Zn and calf immunity.

Incidence of Various Types of Bleeding Disorders Associated with Canine Vector Borne Diseases in Chennai, Tamil Nadu, India

Background: Animals with various stages of bleeding tendencies are often presented with obvious blood loss and life threatening complications, although some animals are relatively stable, showing only minimal clinical signs. Canine vector-borne diseases and associated bleeding disorders are commonly encountered in routine practice with high morbidity and mortality. Diagnosis, therapeutic outcome and management of bleeding disorders have always been challenging. The objective is to study the incidence of various types of bleeding disorders with their clinical features in CVBD in the city of Chennai, Tamil Nadu. Methods: During the study period (2018-2020) a total of 76, 051 dogs were presented to the Madras Veterinary College Teaching Hospital, Chennai. Sixteen thousand five hundred and twenty nine (16529) dogs were presented with signs of bleeding disorders. Dogs affected with vector borne diseases had various stages of bleeding tendencies (1593 dogs) were subjected to detailed clinical, haematological, biochemical and coagulation profile assessments. Under each etiological group, the dogs were further divided into three groups based on various stages bleeding disorders in order to evaluate the clinicopathological changes in dogs. Result: The observed incidence of bleeding disorders due to canine vector borne diseases in this study were Babesiosis 41.87 per cent, Ehrlichiosis 52.7 per cent and hepatozoonosis 5.5 per cent. The incidence of Ehrlichiosis, Babesiosis and H. canis in the study population was found to be 5.2 per cent, 4.04 per cent and 0.53 per cent. Dogs due to E. canis, 51 per cent had anaemia and thrombocytopenia, 26.1 per cent had pancytopenia and 22.9 per cent had pancytopenia and DIC. Dogs due to B. gibsoni, 47.7 per cent had anaemia and thrombocytopenia, 28.5 per cent had pancytopenia and 23.8 per cent had pancytopenia and DIC.

Descriptive evaluation of a camera-based dairy cattle lameness detection technology

Lameness in dairy cattle is not a disease but a clinical sign of im­paired locomotion, with the main causative agents being painful foot lesions. Lameness compromises economic, environmental, and social sustainability goals of the U.S. dairy industry. Com­bining technology and farm data may be a more precise and less labor-intensive tool for lameness detection, particularly with regard to early detection. The study objective was to describe the association between average weekly autonomous camera-based (AUTO) mobility scores and cows with lesion (LAME) and with­out lesions (TRIM) to see if this technology can detect lameness occurrence earlier.

Prevalence and risk factors for Anaplasma marginale seropositivity in cattle in California

Bovine anaplasmosis, a tick-borne disease caused by Anaplasma marginale, imposes considerable economic bur­den on cattle industries throughout the world. Clinical signs of bovine anaplasmosis include fever, weight loss, lethargy, jaundice, abortion and death. The severity of the disease in­creases with age, and calves under 1 year of age generally do not progress to clinical disease or develop mild disease. Once infected, cattle remain persistently infected carriers for life. Climate change and drought conditions may affect the distri­bution and prevalence of tick populations and tick-borne dis­eases and re-evaluating the seroprevalence of Anaplasma would provide a better understanding of the disease dynamics in California. To our knowledge, there has been no updated study regarding the distribution of Anaplasma infection status in California since 2008, and the information on weather factors related to the disease is also limited. There is an urgent need to evaluate the prevalence of Anaplasma infection in different regions of California. The goal of this study is to estimate the seroprevalence of Anaplasma infection in California cattle over time, and the specific goal is to identify potential risk factors for infection including animal demographics, region, Anaplasma seroprevalence of wild ruminants, Dermacentor tick species presence, and weather effects.

A practical approach to neurologic disease in small ruminants

Veterinarians often shy away from a deep dive into cases with a neurologic component, often due to the complexity of the sys­tem and confusion around lesion localization. It is common to rely on treatments that are generically known to help with the most common or most treatable neurologic conditions and let the chips fall where they may. There is value, however, in hav­ing a working understanding of the characteristic clinical signs associated with each segment of the nervous system not only for the sake of the affected animal, but also for the benefit of the population in assessing risk. In this presentation, I will focus on the clinical signs associated with each segment of the nervous system to facilitate lesion localization and provide a list of differ­ential diagnoses for diseases affecting each segment.

Free Flap Monitoring Using Infrared Thermography: An Objective Adjunct to Clinical Monitoring

Abstract Background Early detection of free flap compromise is critical for salvage of the flap. Various methods of free flap monitoring have been described, but clinical assessment is the standard method for among all. In this study, role of infrared thermography is evaluated for free flap monitoring. Methods In patients undergoing free flap surgery, monitoring was done using standard clinical parameters and infrared thermography as per our institutional protocol. Mean temperature difference (∆T) between the flap and the surrounding skin was calculated using the temperature readings from the thermal images intra- and postoperatively. The accuracy of infrared thermography in flap monitoring was assessed in comparison to the standard clinical protocol. Results Forty-one flaps were included in the analysis, out of which five flaps got compromised. It was observed that the mean temperature difference was higher (mean ∆T 0.20–0.59 vs. 2.38–3.32) when there was a flap compromise, and this temperature difference was evident even before the development of clinical signs. The temperature difference in venous thrombosis (mean ∆T 1.0–2.7) was found to be slightly lower than in arterial insufficiency (mean ∆T 2.1–4.4). For a ∆T cutoff value of 2°C, the thermal camera had a sensitivity of 88.6%, specificity of 98.9%, positive predictive value of 93.9%, and negative predictive value of 97.7%. Conclusion Infrared thermography is a valuable and noninvasive objective tool in free flap monitoring, which can detect flap compromise (increasing value of ∆T) even before it becomes clinically evident.