Ischemic Necrosis Research Articles

Intracranial inoculation rapidly induces Nipah virus encephalitis in Syrian hamsters.

Nipah virus (NiV) is a highly pathogenic Paramyxovirus associated with outbreaks in Malaysia, Bangladesh, and India with high mortality rates. NiV infection causes fatal respiratory and neurological disease. The majority of survivors suffer from long-term neurological sequelae or late onset and relapsed encephalitis. The pathogenesis of neurological disease is complex and has not been able to be studied in current animal models as they are skewed towards the development of lethal respiratory disease rather than neurological disease. Although NiV neurological disease can be observed in animal models, there is currently no model where the majority of animals consistently develop neurological disease. Here, we developed a new Syrian hamster (Mesocricetus auratus) model to mimic neurological disease in humans. Hamsters were inoculated intracranially in the cerebellomedullary cistern with different doses of NiV, strain Malaysia. Intracranial NiV inoculation in the cerebellomedullary cistern resulted in a rapid progression towards severe neurological disease requiring euthanasia. High Nipah viral loads were detected in the brains, and NiV spread from the CNS to the lungs. Histopathologic examination of the brain showed ischemic necrosis, often accompanied by marked edema and hemorrhage. NiV antigen was detected primarily in meninges and cerebellum, but rarely observed in brain parenchyma. These histological lesions were different from the typical lesions observed in NiV-infected humans. Thus, despite the consistent development of neurological disease, intracranial inoculation does not result in a model representative of NiV neurological disease.

Unveiling a syndrome through recurrent hypoglycemia

Post-partum hypopituitarism, widely known as Sheehan syndrome, is an ischemic necrosis of the pituitary gland. This event is the result of profound hypotension that is usually caused by massive bleeding or less often in disseminated intravascular coagulation in the peripartum or more frequently during the postpartum period. The sequelae of this catastrophic event are generally subtle, with varying degrees of anterior pituitary hormonal deficiency. Despite this syndrome decreasing worldwide, some cases are occasionally diagnosed in underdeveloped countries because of the improvements and advances in obstetric overall care, and the long-standing experience and recognition of the syndrome, especially in developed countries. The syndrome often progresses slowly; therefore, clinicians face great challenges in making early diagnoses. The most distinctive feature is usually the history of postpartum bleeding, with failure of lactation, cessation of menstruation, and ill-health with vague symptoms that jeopardize the quality of the patient’s life. We had handled a young lady with previously mentioned symptoms but with striking bouts of recurrent hypoglycemia, especially during long fasting. The early noticeable constellation of symptoms and signs with classical history can facilitate early diagnosis, alleviate morbidity and mortality, and improve the overall quality of the patient's life. Most patients will lead a normal life after they have a timely diagnosis and receive the optimal hormonal substitutions.

Designing a Nasal Lining-Framework Complex for Reconstructing Total Nasal Defects.

To validate the feasibility of an innovative nasal lining-framework complex (NLFC) for reconstructing total nasal defects. Retrospective cohort study. This NLFC is composed of forearm flap and support framework. Twenty-four patients were followed up for a minimum of 17 months in 5 centers. Patients' medical history data were retrospectively analyzed. Visual Analog Scale (VAS) of surgeons and patients was used to evaluate the aesthetic effects and self-satisfaction. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and Rhinoplasty Outcome Evaluation (ROE) questionnaire were used for functional assessment. Reconstruction surgeries were all successfully completed. The flaps healed well in all patients, and there were no signs of ischemic necrosis. The healing time of the wound was 10 to 14 days, except for 1 case with infection. The nasal lining was reconstructed and no significant contracture was observed. The average VAS of surgeons was 4.29 ± 0.69 (range 3-5). The mean VAS score of patients was 3.75 ± 0.79 (range 2-5). There was a significant positive correlation between patients' and surgeons' VAS scores (P = .007, r = .5355). The results of the NOSE questionnaire showed that all patients had no obvious ventilation restriction, and only 3 patients mildly felt that the nasal inspirations were slightly insufficient during exercise or exertion. The mean ROE of the patients was 21 ± 1.96 (range 18-25). This NLFC is suitable for total nasal reconstruction, which can provide effective support to prevent flap collapse and retraction and ensure good nasal ventilation. Level IV, therapeutic study.

Responsively aggregatable nanochelator-mediated antiangiogenesis to enhance interventional therapies for liver cancer

Transarterial chemoembolization (TACE) requires the complete embolization of tumor vessels. However, after embolization, tumor hypoxia and angiogenesis increase, and copper ions (Cu2+) play a key role in the regulation of angiogenesis. Decreasing the undesirable release of Cu2+ into serum and tumor tissues is a major challenge in the use of TACE. In this study, we constructed an adhesive injectable thermosensitive hydrogel (poly(N-isopropylacrylamide-codopamine methacrylamide), PND) loaded with a small Cu chelator (SO-N) for use in synergistic tumor embolization; this agent is called PNDS. SO-N chelates Cu2+ in a highly selective manner and can effectively consume the biocopper that is involved in angiogenesis. In addition, the adhesive thermosensitive hydrogel rapidly formed a gel in situ, which further inhibited the local blood ny to the tumor and accelerated ischemic necrosis. Moreover, the ability of PNDS to efficiently chelate Cu2+ and inhibit angiogenesis was investigated in vitro. Our in vivo experiments demonstrated that PNDS can promote tumor necrosis, reduce tumor Cu2+ levels, inhibit angiogenesis and tumor metastasis, and greatly prolong rabbit survival. This study is the first to show elevated serum Cu2+ levels in liver cancer patients with TACE failure/refractoriness; PNDS provides a promising approach for improving the efficacy of TACE for liver cancer by regulating Cu homeostasis.

Unraveling the complexities of ısolated cecal necrosis: a comprehensive presentation clinical symptoms, management strategies, and outcomes in a series of patients

Isolated cecal necrosis (ICN) represents a rare yet clinically significant variant of ischemic colitis, characterized by ischemic injury to the cecal region due to prolonged disruption of intestinal blood flow. While ICN can arise from various causes, including atherothrombotic occlusions in cecal arteries and non-occlusive factors such as shock or chronic diseases, its pathogenesis remains multifactorial. Clinical presentation often mirrors acute appendicitis, with patients typically presenting with sudden right lower quadrant abdominal pain. Prompt diagnosis and surgical intervention are paramount to mitigate the risk of cecal perforation and improve patient outcomes. However, preoperative diagnosis can be challenging due to non-specific radiological findings, necessitating urgent surgical resection of the affected intestine. Despite documented cases in the literature, knowledge regarding ICN remains limited, underscoring the importance of detailed case reporting to enhance disease understanding and refine diagnostic and therapeutic approaches. Here, we present a retrospective analysis of 7 ICN cases diagnosed in our hospital between 2019 and 2024, aiming to contribute insights into the clinical spectrum, management strategies, and outcomes associated with ICN. Our study revealed a diverse array of clinical presentations, radiological features, surgical interventions, and pathological findings among ICN patients. Hypertension and diabetes mellitus emerged as common comorbidities, with acute abdomen and abdominal pain being predominant symptoms. Radiologically, cecal wall thickening was frequently observed. Surgical management predominantly involved right hemicolectomy, with varying techniques employed. Pathological examination unveiled histological alterations indicative of ischemic necrosis, inflammation, and perforation. Our findings underscore the importance of considering ICN in the differential diagnosis of acute abdominal pain, particularly in elderly patients with predisposing risk factors. Further research efforts are warranted to elucidate its pathophysiological mechanisms and optimize therapeutic approaches.

12224 Addressing Blood Glucose Fluctuations and Fasting Challenges in Sheehan Syndrome: A Case Study

Abstract Disclosure: H.A. Awadalla: None. A.N. Kiani: None. W. Taha: None. N.N. Solanki: None. A. Lattouf: None. A. Shermetaro: None. A. Taweel: None. Introduction: Sheehan's syndrome (SS) is a rare condition characterized by hypopituitarism resultingfrom ischemic necrosis of the pituitary gland due to severe postpartum hemorrhage.Patients may have hormonal insufficiencies, ranging from single pituitary hormoneinsufficiency to total hypopituitarism. The diagnosis of SS is often delayed due to itsnonspecific signs and symptoms, leading to many undiagnosed and untreated cases. Case Presentation:A 33-year-old African American female with a history of panhypopituitarism secondaryto Sheehan Syndrome presented with syncope, lightheadedness, and severehypoglycemia (blood glucose 12mg/dL). Despite regular food intake, she struggled withglycemic control, experiencing recurrent hypoglycemic episodes associated withnausea, vomiting, unintentional weight loss (25kg), and polydipsia/polyuria. Laboratoryfindings revealed low ACTH, sodium, cortisol, and elevated liver enzymes, consistentwith hypopituitarism. Cosyntropin stimulation test confirmed adrenal insufficiency. MRIshowed an empty sella. Initially treated with high-dose hydrocortisone, then transitionedto lower maintenance doses, she continued to experience glycemic fluctuations.Intravenous dextrose and insulin sliding scale were initiated. Upon discharge, she wasprescribed hydrocortisone and levothyroxine. Despite adjustments, hypoglycemiapersisted, managed with dietary modifications. This case underscores the challenges inmanaging Sheehan Syndrome-associated panhypopituitarism and the need for tailoredtreatment approaches to achieve metabolic stability. Conclusion: This case underscores the complexities of managing panhypopituitarism secondary toSheehan syndrome, emphasizing the importance of comprehensive hormonalreplacement therapy and thorough monitoring to achieve symptom control andmetabolic stability. Tailored treatment regimens and continuous assessments arecrucial to addressing individual hormone deficiencies and preventing associatedcomplications effectively in these patients. Presentation: 6/1/2024

8100 Late Onset Sheehan Syndrome 23 Years After Post-Partum Hemorrhage: A Rare Case

Abstract Disclosure: I. Dosunmu: None. A. Alvi: None. S. Kaufman: None. A. Malik: None. Introduction: Sheehan syndrome is defined as ischemic necrosis of pituitary gland following massive postpartum hemorrhage. The majority of cases remain undiagnosed for many years after delivery. We present a unique case of late onset of Sheehan syndrome 23 years after the last childbirth which was complicated by hemorrhage. Although the syndrome can present with panhypopituitarism, most patients have partial hormone deficiency which leads to a delay in the diagnosis. Patients can remain asymptomatic for many years until the body is exposed to stressful situations. This is what we believe caused our patient to develop hyponatremia after staying symptom free for 23 years. Case Description: A 46-year-old female with no medical history presented with abdominal pain and dark colored urine. Her initial vital signs were normal. Labs showed sodium of 132 mmol/L, AST of 552 U/L, ALT of 518 U/L, ALP of 196 U/L, GGT of 166 U/L. CT scan of abdomen, liver ultrasound, and liver biopsy were unremarkable. AMA was positive with value of 1.98, consistent with diagnosis of primary biliary cholangitis. On day 2 her blood pressure decreased to 76/42 mmHg and her sodium decreased to 129mmol/L and on day 5 her blood pressure was 88/43mmHg and her sodium decreased to 122mmol/L. TSH was found to be 2.54 uIu/ml. Upon further evaluation by endocrinology, patient appeared to have sluggish speech and appeared edematous particularly in her face. A free T4 was found to be less than 0.07 ng/dl and cortisol 0.5 mcg/dl, and ACTH 22.4 pg/ml, FSH of 4.2 mIU/ml, LH 1.3 mIU/ml. On further questioning, patient confirmed history of complicated childbirth 23 years ago requiring multiple transfusions and a hysterectomy and she reported agalactorrhea after delivery. Brain MRI confirmed empty sella and she was diagnosed with Sheehan syndrome. She was started on levothyroxine and hydrocortisone and ursodiol for PBC. Discussion: Delayed onset Sheehan's syndrome stems from inadequate blood supply or ischemia to the pituitary gland during childbirth. Diagnosis can be challenging due to its gradual onset and vague presenting symptoms. In our patient, the possibility of Sheehan syndrome was suspected after evaluation for hyponatremia revealed central hypothyroidism and secondary adrenal insufficiency. 
The immediate initiation of hydrocortisone followed by levothyroxine, resulted in the normalization of blood pressure and sodium and an increase in free T4 levels from <0.07 to 0.26 four days after hormone initiation. Early diagnosis and prompt treatment are crucial for the best outcomes. Our patient reported feeling much better and denied any symptoms 6 months after discharge. Conclusion: Delayed onset Sheehan's syndrome is a rare but important condition that can occur months or years after childbirth. Early diagnosis, proper medical management, and hormone replacement therapy are essential for improving the quality of life for affected women. Presentation: 6/2/2024

Low-dose estrogen release from silastic capsule enhanced flap wound healing in an animal model.

Deep and extensive wounds usually cannot be closed directly by suturing or skin grafting. Flap transplantation is typically used to reconstruct large wounds clinically. The flap survival is based on a stable blood perfusion. It is established that estrogen promotes wound healing and angiogenesis, and regulates the inflammatory response, leading to enhanced flap survival after transplantation. However, estrogen concentrations administered in previous studies were significantly higher than physiological levels, potentially causing systemic side effects. Estrogen-sustained-release silastic capsules can maintain blood serum estrogen closer to physiological levels. This study aimed to investigate whether administering estrogen at a lower concentration, closer to physiological levels, could still enhance flap survival. This study was performed in a random skin flap model in ovariectomized (OVX) mice. Sustained-release estrogen silastic capsules were implanted into OVX mice to determine the functional role of estrogen in wound healing after flap transplantation. Flap blood perfusion was analysed using a colour laser Doppler scanner. Immunohistochemical staining of CD31, hypoxia-inducible factor 1 alpha (HIF-1α), alpha-smooth muscle actin (α-SMA), cleaved caspase 3 and apoptotic terminal dUTP nick end-labelling stain was used to investigate flap angiogenesis, tissue hypoxia, wound healing and cell death in the flap tissue, respectively. We observed that administering estrogen at a lower concentration enhanced superficial blood perfusion while reducing the flap's ischemic area and tissue necrosis. HIF-1α expression was significantly decreased in the dermis layer but not in the fascia, whereas cleaved caspase 3 levels decreased in the fascia but remained unchanged in the dermis. Additionally, there was no significant difference in CD31and α-SMA expression between the groups. In summary, the study showed that an estrogen silastic capsule maintained physiological estrogen levels and improved superficial perfusion, thereby reducing dermal hypoxia, and cell death in a mouse random pattern skin flap model. Although no significant promotion of angiogenesis was observed, the study suggests that appropriate estrogen supplements could enhance flap wound recovery.

The Mitochondrial Transplantation: A New Frontier in Plastic Surgery.

Challenges such as difficult wound healing, ischemic necrosis of skin flaps, and skin aging are prevalent in plastic surgery. Previous research has indeed suggested that these challenges in plastic surgery are often linked to cellular energy barriers. As the powerhouses of the cell, mitochondria play a critical role in sustaining cellular vitality and health. Fundamentally, issues like ischemic and hypoxic damage to organs and tissues, as well as aging, stem from mitochondrial dysfunction, which leads to a depletion of cellular energy. Hence, having an adequate number of high-quality, healthy mitochondria is vital for maintaining tissue stability and cell survival. In recent years, there has been preliminary exploration into the protective effects of mitochondrial transplantation against cellular damage in systems such as the nervous, cardiovascular, and respiratory systems. For plastic surgery, mitochondrial transplantation is an extremely advanced research topic. This review focuses on the novel applications and future prospects of mitochondrial transplantation in plastic surgery, providing insights for clinicians and researchers, and offering guidance to patients seeking innovative and effective treatment options.

Changes in the Release of Endothelial Extracellular Vesicles CD144+, CCR6+, and CXCR3+ in Individuals with Acute Myocardial Infarction.

Acute myocardial infarction (AMI) results from vulnerable plaque rupture, causing ischemic cardiomyocyte necrosis and intense inflammation. Paradoxically, this inflammation releases factors that aid heart repair. Recent findings suggest a role for extracellular vesicles (EVs) in intercellular communication during post-AMI cardiac repair. However, EVs' tissue origin and chemokine profile in the blood of patients with AMI remains unclear. This study characterized the tissue origin and chemokine receptor profile of EVs in the coronary and peripheral blood of patients with AMI. The results reveal that vesicles isolated from coronary and peripheral blood plasma are enriched in tetraspanin (CD9) and express CD81+, CD90+, and CD144+. The vesicle size ranged between 145 and 162 nm, with the control group exhibiting smaller vesicles (D10) than the AMI group. Furthermore, all vesicles expressed CCR6 and CXCR3, whereas a small percentage expressed CCR4. In addition, a decrease in CXCR3 and CCR6 expression was observed in coronary and peripheral AMI blood vesicles compared with the control; however, no difference was found between AMI coronary and AMI peripheral blood vesicles. In conclusion, our study demonstrates, for the first time, changes in the number of extracellular vesicles expressing CD144+, CXCR3, and CCR6 in the peripheral circulation of patients with AMI. Extracellular vesicles present in the circulation of patients with AMI hold excellent promise as a potential diagnostic tool.

DeBakey Type III Aortic Dissection Causing Bowel Necrosis: A Case Report

Rationale: Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality. Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic dissection. For DeBakey type III B patients involving most of the thoracoabdominal aorta, endovascular treatment to improve true lumen perfusion may have limited benefits. Organ reperfusion on-time is crucial. Patient concerns: A 38-year-old man was admitted with sudden severe upper abdominal pain. Emergency CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk, superior mesenteric artery, bilateral common iliac arteries and right external iliac artery, with thrombosis in the superior mesenteric artery. Diagnoses: The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery embolism. Enhanced chest CT showed the entry tear location and involvement of major arteries. Angiography confirmed partial blood flow in the superior mesenteric artery. Interventions: The patient underwent endovascular aortic stent-graft implantation through the left femoral artery, covering the descending aortic arch and sealing the entry tear. Postoperatively, the patient received intensive care, including ventilatory support, CRRT, anti-infection therapy, vasoactive drugs and lumbar cistern drainage. Outcomes: Two weeks postoperatively, the patient developed massive black stools, indicative of intestinal obstruction and necrosis. Exploratory laparotomy revealed ischemic necrosis and rupture of the stomach, small intestine, and colon. Despite surgical efforts, the patient’s condition deteriorated, leading to death from severe infection, acid-base imbalance and multiple organ failure.

Fusible and Radiopaque Microspheres for Embolization.

In this work, fusible microspheres loaded with radiopaque agents as an embolic agent for transcatheter arterial embolization (TAE) are developed. A poly(ethylene glycol) (PEG) and poly(ε-caprolactone) (PCL) multi-block copolymer basing polyurethane (PCEU) is synthesized and fabricated into blank microspheres (BMs). The microspheres are elastic in compression test. A clinical contrast agent lipiodol is encapsulated in the microspheres to receive fusible radiopaque microspheres (FRMs). The sizes of FRMs are uniform and range from 142.2 to 343.1µm. The encapsulated lipiodol acts as the plasticizer to reduce the melting temperature point (Tm) of PECU microspheres, thus, leading to the fusion of microspheres to exhibit efficient embolization in vivo. The performance of FRMs is carried out on a rabbit ear embolization model. Serious ischemic necrosis is observed and the radiopacity of FRMs sustains much longer time than that of commercial contrast agent Loversol in vivo. The fusible and radiopaque microsphere is promising to be developed as an exciting embolic agent.

A Osteocondrose e a Traumatologia do Desporto

Osteochondrosis is defined as a failure in the endochondral ossification process. There is no consensus on the etiology, with multiple factors involved. The initial events in the pathogenesis remain uncertain, but evidence points to ischemic necrosis of the ossification center, located in the bone epiphysis. Each osteochondrosis has a homonymous clinical diagnosis assigned based on location. The most affected areas include the hip (Legg-Calvé-Perthes disease), knee (Osgood-Schlatter disease, Sinding-Larsen-Johansson disease), foot (Sever’s disease), elbow (Panner’s disease) and spine (Scheuermann’s disease). The most common clinical manifestations are mechanical pain and functional limitation during or after physical activity. Many injury prevention strategies involve educating young people, coaches, family members and monitoring symptoms. Early diagnosis and a structured approach allow, in most cases, clinical resolution and avoid long-term sequelae. Osteochondrosis was first described by König in 1887 and, despite more than a century of studies, there are still many challenging questions to elucidate to better understand this pathology.

Sheehan's syndrome. A descriptive study of 4 cases at the main hospital of Dakar

Sheehan's syndrome or postpartum anterior pituitary necrosis results in pan hypopituitarism. This is an ischemic necrosis of the anterior pituitary gland secondary to a state of sudden shock during a postpartum hemorrhage. It is a serious complication of the postpartum period. Advances in obstetric care in developed countries have reduced the incidence of this disease. In black Africa its frequency is unknown with a few reported cases. The authors report 4 cases of Sheehan's syndrome treated at the Hôpital Principal de Dakar. This is a retrospective study carried out in the medical departments of the main hospital of Dakar over 5 years. Secondary amenorrhea of variable duration 1 to 10 years was noted in 3 patients. Clinical presentation consisted of a worsening in the general condition in all patients. Low cortisol levels were noted in most patients associated with an empty sella turcica on pituitary MRI. The outcome was favorable under treatment.

An outbreak of ischaemic teat necrosis in a dairy herd in Taranaki, New Zealand

ABSTRACT Case History In spring 2021, on a seasonally calving, pastorally based, Taranaki dairy farm, 12 first-calving heifers (≤ 30 days post-calving) developed similar dry, red to black, crusting lesions on the medial aspect of the teat udder junction extending down the medial teat. Some cows had multiple teats affected. Treatment was initially unrewarding and did not slow the progression of the disease. Overall, 8/12 cows recovered, and 4/12 cows were culled, with three of the cows culled after a teat sloughed and the fourth after surgical amputation of a teat. Outbreaks of the same condition, on the same farm but affecting fewer animals, occurred in spring 2022 (n = 6) and spring 2023 (n = 3). Clinical Findings An initial scab-like or crusting lesion progressed to resemble a thick eschar consisting of very dry and hard dead tissue. The unaffected areas of the teat felt normal but immediately under the dead tissue, there was a warm, firmer area consistent with an inflammatory reaction. Removing the scab led to profuse bleeding, with no visible bed of granulation underneath the scab. There was no leaking of milk in those cows that lost a teat, and no smell to the lesions themselves. Serology and virology ruled out the involvement of bovine alphaherpesvirus (BoHV-2) bovine gammaherpesvirus (BoHV-4), orthopoxviruses (cowpox) and parapoxviruses (pseudocowpox). Histopathology of an affected and surgically amputated teat showed multifocal erosion and ulceration of the epidermis, covered by a thick serocellular crust. In areas of ulceration, there were numerous neutrophils, and the dermis was expanded by granulation tissue with variable numbers of neutrophils, eosinophils, and lymphocytes around small blood vessels. Diagnosis Based on the similarity of the history, presentation, and histopathological changes to those described for a novel disease reported in the UK, a diagnosis of ischaemic teat necrosis (ITN) was made. Clinical Relevance If ITN is an emerging condition in New Zealand and becomes as prevalent as it has in the UK, clinicians will be confronted with a significant new welfare problem in dairy cows. Anecdotally, there have been reports of other ITN outbreaks in New Zealand, and the Ministry for Primary Industries would be interested in collating reports from other New Zealand veterinarians.

Spectrum of Non-Obstructive Coronary Artery Disease and Its Relationship with Atrial Fibrillation.

This article aims to analyze the relationship between non-obstructive coronary artery disease (NOCAD) and atrial fibrillation (AF), exploring the underlying pathophysiological mechanisms and implications for clinical management. NOCAD and AF are prevalent cardiovascular conditions that often coexist, yet their interrelation is not well understood. NOCAD can lead to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, sustaining focal ectopic activity in atrial myocardium. Atrial fibrillation, on the other hand, the most common sustained cardiac arrhythmia, is able to accelerate atherosclerosis and increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, and thus promoting the development or worsening of coronary ischemia. Therefore, NOCAD and AF seem to be a complex interplay with one begets another.

First microscopic, pathological, epidemiological, and molecular investigation of Leucocytozoon (Apicomplexa: Haemosporida) parasites in Egyptian pigeons.

Leucocytozoon is an intracellular blood parasite that affects various bird species globally and is transmitted by blackfly vectors. This parasite is responsible for leucocytozoonosis, a disease that results in significant economic losses due to reduced meat and egg production. There is limited knowledge about the epidemiological pattern of leucocytozoonosis and its causative species in Egypt, particularly in pigeons. The current study involved the collection of 203 blood samples from domestic pigeons from various household breeders and local markets across Qena Province, Upper Egypt. Samples were initially examined for potential Leucocytozoon infection using blood smears, followed by an evaluation of associated risk factors. Molecular identification of the parasite in selected samples (n = 11), which had initially tested positive via blood smears, was further refined through nested PCR and sequence analysis of the mitochondrial cytochrome b gene to ascertain the Leucocytozoon species present. Additionally, histopathological examination of the liver, spleen, and pancreas was conducted on animals that tested positive by blood smears. Interestingly, 26 out of 203 samples (12.08%) had confirmed Leucocytozoon infections based on microscopic analysis. Additionally, all 11 samples that initially tested positive via blood smears were confirmed positive through nested PCR analysis, and their sequencing revealed the presence of Leucocytozoon sabrazesi, marking the first report of this parasite in Egypt. The study into potential risk factors unveiled the prevalence of Leucocytozoon spp. seems host gender-dependent, with males exhibiting a significantly higher infection rate (33.33%). Additionally, adult birds demonstrated a significantly higher infection prevalence than squabs, suggesting an age-dependent trend in prevalence. Seasonality played a significant role, with the highest occurrence observed during summer (37.25%). Histopathological examination revealed the presence of numerous megaloschizonts accompanied by lymphocytic infiltration and multiple focal areas of ischemic necrosis. To our knowledge, this is the first study to shed light on the epidemiological characteristics and molecular characterization of leucocytozoonosis in pigeons in Egypt. Further research endeavors are warranted to curb the resurgence of Leucocytozoon parasites in other avian species across Egypt, thereby refining the epidemiological understanding of the disease for more effective control and prevention measures.

Inhibition of complement factor C5a or C5aR for cholesterol crystal embolism–related vascular thrombosis with microvascular injury and its consequences

Cholesterol crystal embolism (CCE) implies immunothrombosis, tissue necrosis, and organ failure but no specific treatments are available. As CCE involves complement activation, we speculated that inhibitors of the C5a/C5aR axis would be sufficient to attenuate the consequences of CCE like that with systemic vasculitis. Cholesterol microcrystal injection into the kidney artery of wildtype mice initiated intra-kidney immunothrombosis within a few hours followed by a sudden drop of glomerular filtration rate and ischemic kidney necrosis after 24 hours. Genetic deficiency of either C3 or C5aR prevented immunothrombosis, glomerular filtration rate drop, and ischemic necrosis at 24 hours as did preemptive treatment with inhibitors of either C5a or C5aR. Delayed C5a blockade after crystal injection still resolved crystal clots and prevented all consequences. Thus, selective blockade of C5a or C5aR is sufficient to attenuate the consequences of established CCE and prospective inhibition in high-risk patients may be clinically feasible and safe.

Gastric perforation as a complication of Wilkie's syndrome.

Wilkie's syndrome, also known as Superior mesenteric artery (SMA) syndrome, is characterized by intestinal obstruction due to aortomesenteric duodenal compression caused by the reduction of the normal angle between (38-65º) to <25º or to a distance <8mm. The clinical presentation is usually non-specific (dyspepsia, postprandial abdominal pain) but sometimes presented as an acute intestinal obstruction syndrome (nausea, vomiting, gastric dilatation and abdominal distention). In this study, we report the case of a 22-year-old patient with a BMI of 16.5 who presented to the emergency room with acute intestinal obstruction caused by SAMS. He presented with massive gastric dilation that caused ischaemic necrosis of the gastric mucosa with subsequent perforation. It should be noted that only one case associated with Wilkie syndrome has been described in the literature. Therefore, given the rare incidence of complications associated with this syndrome and the favourable prognosis with conservative management, surgery is usually the last line of treatment. However, we must not forget that when necrosis appears, it is often extensive and requires urgent surgical treatment in most cases.

Preliminary study of a new magnetic compression technique for circumcision in dogs: An experimental animal model

IntroductionTraditional/ritual/medical circumcision can be associated with considerable intraoperative blood loss and a prolonged postoperative healing course. This study investigated the feasibility of the magnetic compression technique (MCT) for circumcision in beagle dogs. MethodsA set of magnetic rings including a daughter magnetic ring (DMR) and a parent magnetic ring (PMR) were designed for circumcision. In eight beagle dogs as the animal model, the DMR was placed between the penis and the foreskin through the glans, and then the PMR was placed outside the penis. The DMR and PMR automatically attracted together to compress the foreskin. The necrosis of the prepuce of the anterior penis was observed daily. The operation time and time to magnetic ring shedding were recorded. Healing of the foreskin stump was visually observed. ResultsThe magnetic rings were successfully installed in all eight dogs, and the operation process was without complication. The average operation time was 3.13 ± 0.92 min (range, 2–4.5 min). Postoperative X-rays showed good attraction of the magnetic rings. Daily post-operative observation showed progressive ischemic necrosis of the anterior foreskin and mild edema of the proximal foreskin. The dogs were generally in good condition and urinated freely. The magnetic rings fell off spontaneously 8–12 days after the operation, and the stump of the foreskin healed well. ConclusionThe MCT may be a new approach for circumcision in a canine model, which suggests its potential for use in humans.