Clinical Signs Research Articles

Identification of Recombinant Aichivirus D in Cattle, Italy

Kobuviruses (KoVs) are a group of small, non-enveloped RNA viruses classified in the genus Kobuvirus within the Picornaviridae family, comprising Aichivirus species A to F. KoVs have been identified in humans and several mammals, including domestic ungulates. This study investigated the presence of KoVs in a collection of bovine stool samples (n = 38) obtained from animals with enteritis or without clinical signs. By RT-PCR screening, KoV RNA was detected in 10/ 38 animals (26.3%). Six of the ten positive animals had enteric signs. On sequence analysis of the amplicons, eight strains were related to species Aichivirus B, commonly identified in cattle. In contrast, two strains (ITA/2019/572-1 and ITA/2020/bovine/30-2), displayed the highest nt identity (up to 97.1%) to cattle, yak, and goat Aichivirus D strains. On whole genome analysis, strains ITA/2019/572-1 and ITA/2020/30-2 showed 88.9% nt identity to each other and 87.8–90.3% nt to the bovine kobuvirus strain CHN/2021/ON730709 identified in China. Interestingly these three Aichivirus D strains showed a recombinant makeup, clustering with D1 genotype in the capsid region and with D2 genotype in the non-structural genes. These findings suggest that Aichivirus D KoVs are common components of livestock virome. Understanding the genetic diversity of KoVs in animals will be useful to improve the diagnostics and gather epidemiological data.

Comparison of Single-Stage and Dual-Stage Approaches for Nonunion Repair in the Absence of Evident Infections

OBJECTIVE: This study aimed to determine if routine dual-stage nonunion repair (DSR) surgery lead to better outcomes than single-stage nonunion (SSR) repair surgery in fracture nonunions without evident clinical or laboratory signs of infection. METHODS: Design: Retrospective comparison study Setting: Level One Trauma Center affiliated with an academic teaching hospital Patient selection Criteria: Skeletally mature patients diagnosed with fracture nonunion between June 2013 and January 2022 were included. Patients with previous non-operative treatment, definitive external fixation, previous or current diagnosis of FRI, or less than 12 months of follow-up were excluded. Outcome measures and comparison: Patient characteristics and details of the primary and the revision surgery were recorded. Comparison of the primary outcome measures - FRI, recalcitrant nonunion, and implant failures were performed between SSR and DSR groups RESULTS: A total of 113 patients met the eligibility criteria. Eighty-six patients (mean age 44.8 years, range – 17 – 80 years, 64 percent males) underwent SSR, while 27 patients (mean age 50.8 years, range 21-77 years, 52 percent males) underwent DSR. Seventy six percent underwent SSR and 24 percent underwent DSR. Baseline characteristics were similar between groups (open fractures, p=0.918; smoking, p=0.86; lower limb fractures, p=0.238; Diabetes, p=0.503; ESR, p=0.27; CRP, p=0.11; age, p=0.11; CCI, p=0.06) except for a higher rate of DSR in cases initially treated elsewhere (p = 0.015) and in obese patients (p=0.044). Bone grafting was more frequent in DSR using plates (p = 0.030). No significant differences were observed in subsequent infections (6.97 % vs 7.41 %, p=0.939), persistent nonunion (28.2 % vs 14.81 %, p=0.169), or implant failure (19.76 % vs 22.22 %, p=0.782) between SSR and DSR. CONCLUSION: No difference was found in infection, recalcitrant nonunion, and implant failure between single stage repair and dual stage repair for nonunions without overt signs of infection. The study challenges the routine use of DSR, questions the necessity of subjecting patients to two surgical procedures, and advocates for a more judicious approach in the absence of overt FRI in a fracture nonunion. LEVEL OF EVIDENCE: Level III

Novel Approach to Fat Reduction: A Phase I Study Evaluating Safety and Tolerability of STP705 in Abdominoplasty

Background: RNAi therapeutics are a rapidly developing technology with broad medical applications predicated on reducing the expression of genes with key links to disease pathogenesis. The TGF-β1/Smad3 and COX-2 signaling pathways are strongly implicated in obesity and type 2 diabetes. Reducing the expression of TGF-β1 and COX-2 may have benefits in fat reduction procedures. The aim of this study was to assess the safety and tolerability of STP705 (a TGF-β1/COX-2 siRNA complex in a polypeptide nanoparticle vehicle) injections in persons undergoing abdominoplasty. A secondary aim was to make initial histologic observations on the efficacy of STP705 injections in inducing adipocyte apoptosis for the purpose of focal fat reduction. Methods: The study treatment consisted of 3 rounds of treatment with 7 subcutaneous abdominal injections of STP705 or placebo. Eight female subjects aged 18-65 years received 120 μg, 240 μg, or 360 μg STP705 in 0.5 or 1.0 ml doses (per injection) or an equivalent amount of placebo injected randomly across seven 1 cm2 areas. Treatments were administered 28 days apart with follow-ups occurring at 2 and 7 days’ post-procedure. Tissue samples from each of the 7 injection sites were harvested from total abdominoplasty excisional specimens obtained 28 days after the final injection. Safety assessments were conducted, including physical examination, clinical laboratory tests, electrocardiograms, evaluation of local skin reactions (LSRs), and collection of adverse events (AEs). Lipolytic and inflammatory effects of STP705 were assessed by blinded histologic analysis of harvested tissue samples. Results: There were no clinically significant changes in clinical labs, vital signs, or ECGs. The incidence of LSRs was low throughout the study. There were 3 moderate AEs deemed likely to be related to STP705 injection; none required intervention, and all resolved without dose modification. Histology revealed marginally dose-dependent tissue response with adipocyte destruction and fat remodeling. Conclusion: In general, STP705 was well tolerated at all concentrations and volumes studied. STP705 demonstrated excellent safety, and initial histologic analysis is suggestive of its efficacy in adipocyte destruction. The lack of cutaneous side effects with STP705 injection is an advantage over current treatments for similar indications.

Characteristics and outcome of 73 dogs with iron EDTA molluscicide ingestion in Melbourne, Australia (2013–2019)

IntroductionThe objective of this study was to describe the clinical features, treatments and outcomes of dogs with iron ethylenediaminetetraacetate (EDTA) molluscicide ingestion. We aimed to identify potential predictors of serum iron concentration >54 μmol/L; a cut‐off recommended for initiating treatment of human iron toxicosis.MethodsMedical records across four veterinary hospitals (2013–2019) for dogs with known or suspected iron EDTA molluscicide ingestion were reviewed for signalment, clinical signs, clinicopathological data, treatment regimens and outcomes. Clinical signs of dogs with serum iron concentrations either below or above a cut‐off of 54 μmol/L were compared using Fisher's exact test. Association between serum iron and urine discolouration was tested using logistic regression.ResultsSeventy‐three dogs were included. The most frequent characteristic was abnormal faeces (n = 47, 64%) as determined by rectal examination, with more dogs that had serum iron >54 μmol/L showing this clinical sign (24/35), compared to dogs with serum iron <54 μmol/L (4/13) (P = 0.025). Clinicopathologic abnormalities included increased base excess (n = 20/49, 20%), hyperglycaemia (n = 13/57, 23%) and hyperlactataemia (n = 12/57, 21%). Fifty‐four dogs received deferoxamine chelation (74%), during which 25/42 (60%) dogs had discoloured urine despite all dogs having subsequent iron concentrations <54 μmol/L. Admission serum iron concentration was associated with urine discolouration during hospitalisation (odds ratio 1.046, 95% confidence interval 1.008–1.107, P = 0.011). Sixty‐nine dogs (95%) survived to discharge, with 10 dogs (14%) transferred to another veterinarian.ConclusionsIron EDTA molluscicide ingestion caused predominantly gastrointestinal clinical signs, and abnormal faeces, as well as urine discolouration during chelation therapy, which may indicate an elevation of serum iron concentration on presentation. Outcome was excellent.

Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study

AbstractBackgroundType A acute aortic dissection (TAAAD) is a serious cardiovascular disease with a high mortality rate and prompt diagnosis is the key to survival. However, misdiagnosis is common in the Emergency Department (ED). The aim of this study is to evaluate the rate of misdiagnosis, factors associated with misdiagnosis and patient outcomes.MethodsThis retrospective cohort study recruited 91 patients with TAAAD at the ED of a tertiary university hospital in Hong Kong from 2013 to 2022. Patients were divided into the following two groups: correct diagnosis (60 patients) and misdiagnosis (31 patients) of TAAAD. Clinical symptoms, signs, and investigations were analyzed as factors associated with misdiagnosis by multivariate analysis. In‐patient mortality, 30‐day mortality, 1‐year mortality, and hospital length of stay (LOS) were compared between the two groups.ResultsThe misdiagnosis rate of TAAAD was 34.1% (31/91). Absence of severe intensity pain (OR = 6.01, 95% confidence interval [CI] = 1.41–25.63, p = 0.015), less urgent triage category (OR = 4.46, 95% CI = 1.77–11.22, p = 0.002), and absence of point‐of‐care ultrasound exam (POCUS) (OR = 13.00, 95% CI = 3.05–55.40, p = 0.001) were associated with misdiagnosis. There were no statistically significant differences between correct diagnosis and misdiagnosis groups in patient outcomes including in‐hospital mortality (28.3% vs. 38.7%), 30‐day mortality (28.3% vs. 38.7%), 1‐year mortality (30.0% vs. 41.9%), or hospital LOS (15.5 ± 15.6 days vs. 14.7 ± 15.5 days).ConclusionsOne‐third of cases in our study were misdiagnosed. The absence of severe intensity pain, less urgent triage category, and absence of POCUS ultrasound exam were independent factors associated with misdiagnosis. More widespread use of POCUS of the aorta and heart may help to improve the diagnosis of TAAAD in the ED.

Hypogalactia as a cause of neonatal hypernatremia

Neonatal hypernatremia is a condition in which the concentration of sodium in the blood of a newborn child exceeds 145 mmol/l. The causes of this pathology may be kidney disease, endocrine problems, transdermal water loss, iatrogenic sodium overload. In addition, dehydration due to insufficient breastfeeding remains one of the important factors leading to hypernatremia. Clinical signs include: significant weight loss, decreased skin turgor, anxiety, fever, seizures, and direct hyperbilirubinemia. The main complications of this condition are intracranial hemorrhages, venous sinus thrombosis and acute renal tubule necrosis. Infusion therapy and adequate oral nutrition are used to correct hypernatremia. The article presents a clinical case of hypernatremia in a newborn child caused by hypogalactyly in the mother. The purpose of the demonstration is to raise awareness and alertness among pediatricians and neonatologists about the possibility of this problem.

Dengue Cardiomyopathy Treatment Strategy Optimisation by Integrating Point-of-Care Ultrasound with VExUS

Dengue fever is an arthropod-borne viral disease that is widespread throughout the world. Herein, we report a case of dengue cardiomyopathy that was detected and treated to best effect using point-of-care ultrasound (POCUS) and the VExUS score. A 75-year-old lady with no known comorbidities presented with a 10-day history of fever, vomiting, loose stool, and poor appetite. Upon arrival, she was febrile and hypotensive. Bedside POCUS showed poor left ventricular systolic function, inferior vena cava measuring 2.27cm and VExUS grading of 2 to 3. Dengue serology IgM and IgG were positive and NT-proBNP raised at 12500pg/ml. Instead of fluid resuscitation, diuretic and inotropes were initiated along the line of cardiogenic shock secondary to dengue cardiomyopathy. Serial normal cardiac enzymes and electrocardiogram excluded acute coronary syndrome. She was discharged well, and repeated echocardiography one-month post discharge showed normal left ventricular systolic function with no clinical signs or symptoms of heart failure.

The Relationship Between Type 2 Diabetes Mellitus and The Incidence of Acute Ischemic Stroke

Background: Ischemic stroke is a cerebrovascular disease characterized by focal or global neurological deficits with clinical signs lasting 24 hours or more caused by disruption of blood supply to the brain. Stroke is the second leading cause of death in the world with 6.7 million deaths every year. The prevalence of stroke in Indonesia according to Riskesdas in 2018 reached 10.9%, namely around 2,120,362 people in Indonesia. Type 2 diabetes mellitus is a major risk factor for ischemic stroke. Data from the International Diabetes Federation (IDF) shows that in 2021 there will be 537 million cases of DM in adults aged 20-79 years, with an estimated increase to 643 million in 2030. With the estimated number of sufferers of type 2 diabetes mellitus continuing to increase, it can be concluded that ischemic stroke sufferers also continue to increase. Methods: Observational analytic with cross-sectional design. Sampling was taken from medical record data at the Regional General Hospital. Dr. Chasbullah Abdulmadjid Bekasi City with a total of 87 patients who met the inclusion criteria Results: The results of research conducted using Chi-Square Analysis showed that there was no significant relationship between type 2 diabetes mellitus and acute ischemic stroke with a P value of 0.698. The results of the Pearson Chi-Square analysis and Fisher exact test accepted H0 and rejected H1 (there was no relationship). Conclusions: There is no significant relationship between type 2 diabetes mellitus and the incidence of acute ischemic stroke Keywords: Type 2 diabetes mellitus, Ischemic, Stroke

The association of limited or painful spinal range of motion with lumbar disc degeneration: the back complaints in older adults (BACE) study.

We currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs. We used the baseline data from the'Back Complaints in Older Adults' (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets. We included 675 patients with a mean age of 66.52years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing. Our study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD.

Feed-induced hypersalivation in horses from Austria, Germany and Switzerland.

While previous reports come mostly from the southern Americas, several outbreaks of hypersalivation in horses were observed in Middle Europe from 2016 to 2018. To describe feed-induced hypersalivation in European horses. Analysis of feedstuffs. Veterinarians and horse or stable owners were encouraged to submit feedstuffs from case outbreaks of hypersalivation in which, infectious diseases or other systemic causes of the syndrome were ruled out and intoxication was suspected. Feedstuff analysis was performed, including gross examination, microscopic analysis of fine particles, and for hay and forage mycological culturing and mycotoxin testing. Eleven case outbreaks were investigated. Typical clinical findings in the horses were either foamy saliva around the mouth or serous salivation with puddles forming on the ground. Some horses also showed lesions of the gingival mucosa and/or the tongue. Foamy hypersalivation, sometimes combined with lesions of tongue and/or gingiva, was associated with finding of ergot sclerotia and ergot alkaloids in hay or pasture plants (ergocornin and ergocorninin having the highest concentrations). Serous hypersalivation with massive loss of fluid was associated with the fungus Rhizoctonia spp. As indicated by the detection of traces of swainsonine, mycotoxin production on the forage was seen as likely cause. The cessation of clinical signs took days to weeks after diet change, probably depending on the duration, type and amount of toxin intake. Small number of case outbreaks, records of clinical findings and horses' management were incomplete and were reported by horse owners. Hypersalivation due to mycotoxins in the feed has become an emerging problem for horses in middle Europe.

Analysis of the clinical manifestations and diagnostic process of the pleural effusion associated with constrictive pericarditis

ObjectivesThe primary objective of this study is to analyze the clinical manifestations, diagnostic procedures, and outcomes of patients with pathologically confirmed constrictive pericarditis who presented with bilateral pleural effusions. We aim to outline a stepwise diagnostic approach that could assist clinicians in identifying CP in similar cases.MethodsIn this study, we conducted a retrospective analysis of 19 cases of pathologically confirmed constrictive pericarditis. These patients were admitted to our hospital between January 2019 and December 2022 after pericardial stripping. The collected data included imaging findings, clinical manifestations, pleural effusion characteristics, postoperative pathology, and the diagnostic process.ResultsIn this study, the age of the 19 patients ranged from 25 to 74 years, with a median age of 59 years. All patients presented with bilateral pleural effusions, with or without pericardial lesions such as pericardial effusion or thickening. Pleural effusion biochemistry did not exhibit specific characteristics, and both etiology and pleural pathology were negative. Radiographic examinations, including cardiac ultrasound and chest CT, revealed signs of pericardial thickening and/or pericardial effusion or no abnormalities. Pericardial stripping was performed in all patients, and the postoperative pathology confirmed various degrees of thickened pericarditis, consistent with constrictive pericarditis. During a follow-up period of 6–18 months, most patients (17 out of 19) showed favorable recovery with no recurrence of bilateral pleural effusions.ConclusionThis study emphasizes the importance of pleural effusion as a clinical sign of constrictive pericarditis and highlights that a stepwise diagnostic approach, guided by clinical presentation and imaging, can enhance its recognition, particularly in cases with bilateral pleural effusions.

Antemortem diagnostic tests for the detection of Aspergillus infection in birds: a systematic review.

Aspergillosis remains a common and life-threatening disease in captive and wild birds all over the world. Diagnosis is currently based on clinical signs or lesions, diagnostic imaging and a variety of biological tests. This systematic review aimed to compare the accuracy of antemortem diagnostic tests for Aspergillus infection in birds. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search was conducted on PubMed, Scopus, Web of Science, CAB until January 2024. The methodological quality was assessed with QUADAS 2 risk of bias tool. The thirteen studies, selected for the review, included results from a wide variety of birds (mainly Spheniciformes but also Falconiformes, Psittaciformes, and Galliformes) from wildlife rehabilitation centers, zoological parks or veterinary practices. Aspergillus infection was mainly confirmed by fungal culture and/or histopathology. Serum markers included Aspergillus components (galactomannan, ß-D-glucan, mannoproteins and gliotoxin), anti-Aspergillus antibodies, 3-hydroxybutyrate as well as protein electrophoresis and acute phase molecules. Sensitivity and specificity displayed a large amount of variation despite threshold arrangement. Disparities in the number of individuals per study did not allow for reliable comparison. Platelia Ag Assay (Bio-Rad), the most commonly used test in the studies, demonstrated moderate specificity and low sensitivity. Overall, non-specific tests demonstrated more consistent performance, whereas specific tests showed greater variability. Based on current knowledge, none of these tests provide sufficient accuracy to reliably detect Aspergillus infection in birds in clinical practice.

Novel Biomarkers as Potential Predictors of Decompensated Advanced Chronic Heart Failure—Single Center Study

Background/Objectives: Heart failure (HF) remains a major therapeutic and diagnostic challenge nowadays. Albeit, acute decompensated HF is associated with several clinical signs such as dyspnea or edema, it remains a challenge to use easy accessible and suitable tools, such as biomarkers, to distinguish between patients at risk for an acute decompensation of their heart failure and compensated, stable HF patients. Existing biomarkers, such as natriuretic peptides or troponin, are not specific and can be elevated due to several other disease conditions, such as myocardial infarction, atrial fibrillation, or valve diseases. Therefore, the aim of this study was to analyze the predictive potential of four novel cardiovascular biomarkers—the soluble urokinase-type plasminogen activator receptor (suPAR), heart-type fatty acid binding protein (H-FABP), vascular cell adhesion molecule 1 (VCAM-1), and growth/differentiation factor 15 (GDF-15) for the detection of cardiac decompensation in patients with HF. Methods: In this study, 146 patients were prospectively enrolled and the serum biomarker concentrations were analyzed using Enzyme Linked Immunosorbent Assay (ELISA). We correlated the biomarker concentrations with clinical and biochemical parameters of all patients and the predictive value for detection of cardiac decompensation was assessed. Results: A significant increase in the levels of suPAR (1.6-fold-change, p < 0.0001), H-FABP (2.2-fold-change, p = 0.0458), VCAM-1 (1.6-fold-change, p < 0.0001), and GDF-15 (1.7-fold-change, p = 0.0009) was detected in all patients with acute decompensated HF in comparison to patients with compensated HF. Univariate logistic regression analysis revealed a significant association of biomarker plasma concentration with the risk for a cardiac decompensation (suPAR: p < 0.0001; VCAM-1: p < 0.0001, H-FABP: p = 0.0458; GDF-15: p = 0.0009). Conclusions: In conclusion, the investigated novel cardiovascular biomarkers suPAR, GDF-15, VCAM-1, and H-FABP could be a valuable tool to facilitate therapeutic decisions in patients with heart failure and suspicion of a cardiac decompensation. Parameters such as renal function should be taken into account. Further studies on novel biomarkers are required to find reliable, sensitive, and specific tools that will enable the early detection of patients with acute decompensation.

Retrospective analysis and clinical features of periapical tissue regeneration

Background: Chronic periodontitis is associated with changes in periapical tissues. Untimely diagnosis and lack of appropriate mechanical treatment increase the incidence of chronic periodontitis. Periodontitis that causes destructive changes due to long-term inflammation of periapical tissues is of particular concern. Thus, the treatment of destructive periodontal diseases is a pressing issue in modern dentistry. Aim: To assess periapical tissue regeneration following treatment in chronic periodontitis patients. Materials and Methods: A retrospective analysis of the destruction and regeneration of periapical tissues before and after treatment during 3–6 months was performed in 20 patients. Results: A retrospective analysis of X-ray findings in 20 patients revealed bone destruction of varying degrees. Low-quality root canal preparation was due to various factors, primarily the anatomy and topography of root canals. Of the 20 patients who required treatment for chronic periodontitis with varying degrees of destruction, 16 came back for follow-up appointments and received endodontic treatment. Following treatment, X-ray findings were used to identify taper root canal preparation and assess the quality of obturation up to the root apex. X-ray examination was performed after 3 months in patients with clinical signs of periodontitis and after 6 months in patients without clinical signs of periodontitis. After 3 months, X-ray findings showed a reduction in bone destruction in the causative tooth area, indicating an improvement. Conclusion: The study of periapical tissue regeneration following treatment in chronic periodontitis patients revealed that effective apical preparation, as well as appropriate irrigation and root canal filling, promote regeneration in periodontitis. Healing of periapical tissues is essential for effective root canal treatment.

Study of rotavirus genotypes G and P in one Egyptian center-cross-sectional study.

Rotavirus-associated gastroenteritis is a common health problem in children, different variations of rotavirus genotypes differ according to geographic locations and the practice of wide-scale vaccination. Therefore, the present study aimed to detect both the G and P genotypes of rotavirus in children ≤ 5 years old in one center in Egypt as a cross-sectional study, to correlate the genotypes with various demographic and clinical data in infected children and to evaluate the common mixed genotypes G and P in infected children. The cross-sectional study included children with acute gastroenteritis ≤ 5 years old from January 2023 till March 2024 recruited from Mansoura University Children's Hospital, Egypt based upon laboratory diagnosis by exclusion of bacterial and protozoa pathogens. The stool samples were obtained from each child and subjected to detection of rotavirus antigen by enzyme-linked immunosorbent assay (ELISA) followed by genotypes identification of G and P genotypes by nested polymerase chain reaction (PCR). A nested PCR study for rotavirus genotypes revealed that G1 was the most common genotype (24.7%) followed by G2 (21.1%), G3 (20%), G9 (20%), and G4 (14.1%). The genotyping of the P genotype revealed that P9 was the commonest genotype (24.7%), followed by P4 (21.2%), P10 (20%), P8 (17.6%) and P6 (16.5%). The commonest combined genotypes of G and P were G1P4 (85.7%), G3P8(88.2%), followed by G2P6 (77.8%) and G9P9(76.5%) and G4P9 (66.7%) followed by G4P10 (33.3%), G9P10(23.5%), G2P10(22.2%), G1P10 (14.3%), G3P10(11.8%). The distribution was significant (P = 0.001). The positive rotavirus antigen was more frequently detected in females (55.3%) than males (44.7%, Odd ratio 0.2, 95% CI 0.22-0.71, P = 0.001). There was a significant association between the summer season and positive rotavirus antigen (P = 0.001) and rural residence of the patients (Odd ratio 6,9 95%CI 3,5-13.5, P = 0.001). The significant associated clinical sign with positive rotavirus antigen was fever (Odd ratio 3,3, 95%CI 1,8-6.05, P = 0.001). The genotypes G and P were significantly associated with positive rotavirus antigen as all cases positive by antigen had been detected by nested PCR with the commonest genotypes G4 (24.7%, P = 0.001) and genotype P9 (24.7%, P = 0.001). The present study highlights the common genotypes of rotavirus at one center in Egypt, G1, G2, and G3 were the commonest G genotypes. As regard genotype P the commonest genotypes were P9, P4, and P10. The commonest combined genotypes were G1P4, G3P8, G2P6. There was no effect of the practice of rotavirus vaccination at limited rates at private health sections as the rotavirus is still a major pathogen of acute gastroenteritis in children. There is a need for the inclusion of rotavirus vaccination in the national program of children vaccination in Egypt.

Managing Urticarial Vasculitis: A Clinical Decision-Making Algorithm Based on Expert Consensus.

Urticarial vasculitis (UV) is a rare and difficult-to-treat, small-vessel leukocytoclastic vasculitis presenting with recurrent long-lasting wheals. So far, no guidelines and treatment algorithms exist that could help clinicians with the management of UV. In this review, we describe evidence on systemic treatments used for UV and propose a clinical decision-making algorithm for UV management based on the Urticarial Vasculitis Activity Score assessed for 7 days (UVAS7). Patients with occasional UV-like urticarial lesions and patients with UV with skin-limited manifestations and/or mild arthralgia/malaise (total UVAS7 ≤7 of 70) can be initially treated using the step-wise algorithm for chronic urticaria including second-generation H1-antihistamines, omalizumab, and cyclosporine A. Patients with UV with more severe symptoms (UVAS7 >7), especially those with hypocomplementemic UV, may require a multidisciplinary approach, particularly if underlying diseases, for example, systemic lupus erythematosus, cancer, or infection, are present. Immunomodulatory therapy is based on clinical signs and symptoms, and the drug availability and safety profile, and includes systemic corticosteroids, dapsone, hydroxychloroquine, anti-interleukin-1 agents, and other therapies. The level of evidence for all UV treatments is low. Prospective studies with current and novel drugs are needed and could provide further insights into UV pathogenesis and treatment.

Preclinical delayed toxicity studies of BCMA CAR T-cell injection in B-NDG mice with multiple myeloma

PurposeBased on the efficacy data from the previous study of B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T-cell injection, we further examined the delayed toxicity for 8 weeks after a single dose of BCMA CAR T-cell injection to observe possible toxic reactions.MethodsB-NDG mice transplanted with multiple myeloma (MM) cells were given a single dose of BCMA CAR T-cell injection at two dosages or human normal T cells and then subjected to examinations including clinical signs, weight and food intake measurements, haematology, blood biochemical analysis, cytokine assay, T-lymphocyte subpopulation quantification and histopathology on days 28 and 56 after dosing. In addition, quantitative polymerase chain reaction (qPCR) was used to quantify DNA fragments in different tissues to assess the tissue distribution of CAR and provide a basis for its preclinical safety evaluation and clinical dosing.ResultsIn the delayed toxicity study, no mortality or significant toxic effects such as reductions in food intake, body weight, relevant biochemical parameters and target organ weights were observed in the BCMA CAR T-cell-treated groups. Compared to the model group, restorative changes in clinical signs and clinicopathology indicating therapeutic effects were seen in the BCMA CAR T-cell-treated groups. Human-derived cytokines interleukin-2 (IL-2), IL-4, IL-6, IL-12, IL-10, tumor necrosis factor α (TNF-α), and interferon-γ (IFN-γ) could be detected in all cancer cell–bearing mice by cytokine level measurement. IFN-γ levels showed a geometric increase due to the graft versus host disease (GVHD) response induced in the mice, while the levels of the other cytokines did not show significant changes. Histopathological examination indicated that the BCMA CAR T-cell treatment groups showed mixed cellular infiltration of human-derived T cells, cancer cells, and inflammatory cells in several target organs including the liver, spleen, lung, and kidney, and some of them showed mild tissue damage, but the number of the animals and the severity of damage were significantly less than those of the T-cell control group as well as the model group. The results of the tissue distribution study showed that BCMA CAR T cells were mainly concentrated in the kidney, lung, bone marrow and the related immune organs/tissues, and the distribution of BCMA CAR T cells was highly consistent with that of MM cells, suggesting that BCMA CAR T cells could follow the cancer cells during metastatic targeting of the tissues.ConclusionsThe present study demonstrated a low toxicity of BCMA CAR T-cell injection, with manageable side effects and good anticancer activity and without observable adverse effects. This study provides data to support future clinical studies of BCMA CAR T-cell injection for MM.

BN SO46 - PANDORA's BOX- When anatomy trumps the pathology

Abstract Background Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible. Method After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure. Results Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh. Conclusion Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.

Epidemiological, Clinical and Biological Aspects of Childhood HIV in Libreville

Introduction: Human immunodeficiency virus (HIV) infection is a chronic viral infection characterized by the progressive destruction of CD4 T lymphocytes. Its prevalence in Gabon is estimated 4.1% with approximately 2,500 affected children. This pathology remains a real public health problem on a global scale. The objective of our work was to describe the epidemiological, clinical and biological aspects of HIV-positive children in Libreville. Materials and Methods: This is a retrospective study which involved patients followed in the four major pediatric care centers in Libreville from January 2015 to December 2022. We included all complete medical records of children and adolescents aged 0 to 19 years with positive HIV serology or PCR. Results: The mean age was 10.6 ± 5.1 years. The 10-14 year old group represented 32.3%. The sex ratio was 1.13 male to female. In our study 46.9% were orphans and they were more affected by academic delay (51.9% versus 45.7%). The clinical signs were dominated by fever (40.6%). The main opportunistic infection found was digestive (7.3%) and tuberculosis represented the first co-infection (13.2%). We had 5.2% of patients with acute malnutrition. Conclusion: HIV-AIDS in children remains a public health problem given its socio-economic impact on the population. The cost of follow-up assessments and hospitalizations are among the problems that slow down the regular follow-up of our patients.

Construction, molecular characterization, and safety assessment of purB mutant of Salmonella Gallinarum

This study involves the development and molecular characterization of the isogenic markerless knockout mutant SG ΔpurB, a genetically engineered live attenuated strain aimed at controlling Salmonella Gallinarum (SG) infection in poultry. The mutant was generated by deleting the purB gene using λ-Red recombination technology, impairing adenylosuccinate lyase, necessary for purine biosynthesis. An 1,180 bp deletion was engineered within the purB gene, leaving a residual 298 bp genomic scar resulting in a purine auxotrophic mutant. Phenotypically, SG ΔpurB showed a 66.5% reduction in growth in LB broth compared to the wild-type strain and failed to grow in minimal media without adenosine. Growth was restored to near wild-type levels with 0.3 mM adenosine supplementation, demonstrating the strain’s conditional attenuation. In vivo pathogenicity assessments revealed that oral inoculation of SG ΔpurB into 3-day-old chickens at a dose of 2 × 108 CFU resulted in zero mortality, compared to an 80% mortality rate in chickens challenged with the wild-type strain. The SG ΔpurB strain exhibited significantly reduced clinical signs and lesion scores, with clinical sign scores dropping from 2.5/3 with the wild-type to 0.4/3 with the ΔpurB mutant, and lesion scores decreasing from 2.9/3 to 0.3/3. Additionally, the mutant was efficiently cleared from liver and spleen tissues by 14 days post-inoculation, unlike the wild-type strain, which persisted until the experiment’s end on day 21. The SG ΔpurB mutant shows potential as a safe alternative for preventing fowl typhoid, highlighting the promise of targeted genetic attenuation in developing effective vaccines for poultry diseases.