Major Clinical Signs Research Articles

Genotype-Phenotype Relationships and Endocrine Findings in Prader-Willi Syndrome.

Prader-Willi syndrome (PWS) is a complex imprinting disorder related to genomic errors that inactivate paternally-inherited genes on chromosome 15q11-q13 with severe implications on endocrine, cognitive and neurologic systems, metabolism, and behavior. The absence of expression of one or more genes at the PWS critical region contributes to different phenotypes. There are three molecular mechanisms of occurrence: paternal deletion of the 15q11-q13 region; maternal uniparental disomy 15; or imprinting defects. Although there is a clinical diagnostic consensus criteria, DNA methylation status must be confirmed through genetic testing. The endocrine system can be the most affected in PWS, and growth hormone replacement therapy provides improvement in growth, body composition, and behavioral and physical attributes. A key feature of the syndrome is the hypothalamic dysfunction that may be the basis of several endocrine symptoms. Clinical and molecular complexity in PWS enhances the importance of genetic diagnosis in therapeutic definition and genetic counseling. So far, no single gene mutation has been described to contribute to this genetic disorder or related to any exclusive symptoms. Here we proposed to review individually disrupted genes within the PWS critical region and their reported clinical phenotypes related to the syndrome. While genes such as MKRN3, MAGEL2, NDN, or SNORD115 do not address the full spectrum of PWS symptoms and are less likely to have causal implications in PWS major clinical signs, SNORD116 has emerged as a critical, and possibly, a determinant candidate in PWS, in the recent years. Besides that, the understanding of the biology of the PWS SNORD genes is fairly low at the present. These non-coding RNAs exhibit all the hallmarks of RNA methylation guides and can be incorporated into ribonucleoprotein complexes with possible hypothalamic and endocrine functions. Also, DNA conservation between SNORD sequences across placental mammals strongly suggests that they have a functional role as RNA entities on an evolutionary basis. The broad clinical spectrum observed in PWS and the absence of a clear genotype-phenotype specific correlation imply that the numerous genes involved in the syndrome have an additive deleterious effect on different phenotypes when deficiently expressed.

Hémoglobinurie chez l’enfant à Ouagadougou: prise en charge hospitalière et pronostic à court terme

IntroductionL’objectif de ce travail était d’analyser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de l’hémoglobinurie chez l’enfant au CHU Pédiatrique Charles-De-Gaulle de Ouagadougou.MéthodesIl s’est agi d’une étude transversale à visée descriptive sur la période allant du 01 juillet au 31 décembre 2014. Ont été inclus dans l’étude, tous les enfants âgés de zéro à 15 ans hospitalisés dans le Service de Pédiatrie Médicale du CHU Pédiatrique Charles-de-Gaulle, chez qui une hémoglobinurie macroscopique a été diagnostiquée pendant la période de l’étude.RésultatsTrente-huit patients ont été inclus dans l’étude. La fréquence hospitalière de l’hémoglobinurie était de 1,9%. L’âge moyen des patients était de 80,8 ± 44,1 mois (extrêmes = 21 et 168). Il s’agissait de 23 garçons (60,5%) et 15 filles (39,5%). Les principaux signes cliniques étaient: la fièvre (86,8%), les urines foncées « coca cola » (86,8%), la pâleur (63,2%), l’hépatomégalie (50%). Le débit de filtration glomérulaire DFG était inférieur à 80 mL/min/1,73m2 chez 23 patients (69,7%); 21 patients avaient un déficit en G6PD. Les principales étiologies présumées de l’hémoglobinurie étaient: le paludisme grave, les infections bactériennes et virales, le déficit en G6PD, la fièvre bilieuse hémoglobinurique. Les traitements administrés étaient: les dérivées de l’artémisinine, les antibiotiques et les antipyrétiques. Le recours à la dialyse a été nécessaire chez un patient.ConclusionL’hémoglobinurie est un symptôme qui pose surtout un problème de diagnostic étiologique dans notre contexte. Sa gravité réside dans le fait qu’elle peut provoquer une IRA sévère.

Алгоритм диференційованого вибору лікарських засобів при терапії гострого простого бронхіту у дітей

Purpose — to develop and study the effectiveness of the author's algorithm of differential choice as regards medicines in the inpatient therapy for acute bronchitis in children. Patients and methods. On the basis of correlation analysis and sequential Wald's analysis, the algorithm of differential choice of medicines (recombinant interferon alpha-2β; probiotical agent Bacillus subtilis; bacterial lysates OM-85; Ivy extract) which are to be used in management of children with acute simple bronchitis (ASB) was developed. The differential administration of medicines for management of ASB in children was shown to lead to the faster resolution of catarrhal and inflammatory syndromes, as well as contribute to the restoration of non-specific immunity indicators. The results of introduction of the algorithm of doctor's actions into healthcare practice have demonstrated that the estimated effectiveness of usage and likelihood of acquiring the final result are equal to 75–86%. Conclusions. Features of functioning of the system of non-specific respiratory tract defense in children of 1 to 6 years old with ASB, their clinical and anamnestic characteristics, as well as dynamics of ASB course according to BSS justify the necessity to reinforce standard inpatient therapy of ASB. The administration of recombinant interferon, probiotical agents, bacterial lysates and Ivy extract for children of 1to 6 years old with ASB in order to restore non-specific immunity was pathogenetically justified based on proved clinical and immunologic effectiveness along with their influence on major clinical signs of acute bronchitis according to Bronchitis severity score (BSS).

Prognostic Value of Neurological Status on Hospital Arrival for Short-Term Outcome in Patients With Cardiovascular Shock - Sub-analysis of the Japanese Circulation Society Cardiovascular Shock Registry.

Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality. Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.

Awareness and antibody detection of Newcastle disease virus in a neglected society in Nigeria

Aims:This study aimed to assess the level of awareness of rural poultry farmers on vaccination and to detect Newcastle disease virus (NDV) antibody in local birds (LB) and eggs in Kwara State, Nigeria.Materials and Methods:Data on farmers’ attitude, knowledge, practices, and experiences on ND mortality were obtained through an interview using a structured cross-sectional checklist. NDV antibodies were detected in sera and egg yolks of local chickens (LC) and guinea fowls (GF) using hemagglutination inhibition test.Results:A total of 83 interviewees, 287 sera and 121 egg yolk extracts, were examined. The study revealed that 98.8% (82/83) of the interviewee had never vaccinated their flock before. 90% of the interviewee had reported high mortality in birds within 1-6 months old, while the major clinical signs were cold (40.4%) and torticollis (30.8%). Evidences of LB exposure to wild-type NDV were confirmed by the detection of NDV antibodies in 20.8% and 0% of LC and GF, respectively. The mortality differences experiencedin <1 and 1-6 months old LB could be explained by the presence of maternally-derived NDV antibody (49.6%) in egg yolk.Conclusion:The study showed that LB suffers from NDV as a result of LB keepers’ ignorance and neglect by the government. This has limited local investment and subsequent contribution to gross domestic product. This study suggests that the key factors to the prevention of ND remain awareness creation about poultry vaccination, production of affordable vaccines, and availability/accessibility to veterinarian (or trained personnel).

Intra- Abdominal Injuries Following Blunt Abdominal Trauma-Analysis of 100 cases.

With the advent of industrialization, accelerated social violence, increasing road traffic accident and increasing use of machineries trauma has become the leading cause of mortality and disability. Considering trauma abdominal trauma is one where early diagnosis and accurate assessment and timely intervention can save the life of the victim in most of the instances. This is a prospective observational study that represents the experience of 100 consecutive patients of blunt abdominal trauma with suspected intra-abdominal injuries admitted in surgical words of RMCH, Rajshahi. The most of the patients were male (87%) and in active phase of life. RTA (53%) was the most common cause of blunt abdominal trauma and majority of the patients (38%) arrived in the hospital within 7-24 hours. Major clinical signs of intra-abdominal injuries were signs of peritonitis. The main investigation done was plain X-ray abdomen (71%) in erect posture, of which 55% cases showed free gas under the done of the diaphragm. Out of 100 cases 77 patients were operated upon and 23 patients were managed conservatively. The incidence of hollow viscus injury (57%) was higher than solid organs (36%) injury but only five patients came out to be a negative laparotomy. Of all operated cases fifty one were recovered uneventfully and only twenty three patients developed various postoperative complications. The most of the patients (40%) left the hospital within 11-14 days. Seven patients died on the day of admission but total mortality was nine (9%) in number.TAJ 2015; 28(2): 7-14

A Novel Full Length Anti-FLT3 CD3 Bispecific Antibody for the Treatment of Acute Myeloid Leukemia

FLT3 is a receptor tyrosine kinase expressed on the surface of acute myeloid leukemia (AML) patient blasts. FLT3 is the most frequently mutated gene in AML patients, and these mutations are associated with poor prognosis. Despite the development of small molecule inhibitors of FLT3 function and neutralizing FLT3 antibodies, there remains a need for antibodies that target the broad AML patient population with improved efficacy and safety.We chose to use Pfizer's proprietary full length humanized CD3 bispecific IgG molecule platform. The first step in the development was finding a suitable targeting epitope on FLT3 as not all epitopes result in optimal T cell activation in the context of CD3 binding. Through a combination of in vitro and in vivo studies, FLT3 antibodies targeting extracellular domain 4 of FLT3 were found to be more effective at AML cell depletion than other domains in the full-length bispecific IgG format, significantly outperforming the antibodies targeting the most membrane proximal region of domain 5. The final candidate antibody was engineered to have picomolar affinity for recombinant human FLT3 (<50 pM) to ensure that low levels of FLT3 present on AML (<5,000 per cell) could efficiently trigger T cell cytotoxicity.Anti-tumor activity of the final molecule was further characterized in vitro and in vivo. Three AML cell lines, Eol-1, Molm-13 and MV-411 express high, medium and low levels of FLT3, respectively, and were targeted by activated healthy donor T cells in the presence of the FLT3 bispecific with an efficiency that correlated with FLT3 surface density (EC50 range was 0.5 pM to 40 pM at E:T ratios of 1:1). Ability to target primary AML cells was confirmed in assays with primary AML blasts and autologous patient T cells (EC50s 7 - 15 nM, for E:T ratios of up to 1:50). In orthotopic xenograft models with the same set of cell lines, all three cell lines were efficiently eliminated by activated T cells in the presence of a single dose of FLT3 bispecific (dose range 10 to 100 μg/kg), confirming the anti-tumor activity of the bispecific antibody in vivo.The safety of Pfizer's FLT3 bispecific antibody was also studied in preclinical studies. We first analyzed gene expression of FLT3 and three other commonly considered AML targets (CD33, CD123, and CLL-1) in publicly available gene expression databases. FLT3 had the highest differential expression between AML and healthy tissues with blood and brain showing expression of low levels of FLT3 RNA. In tissue cross-reactivity studies, we detected little to no binding of the candidate FLT3 antibody to human brain tissue sections. In blood, the highest expression of FLT3 was in hematopoietic stem cells and progenitors, dendritic cells and monocytes consistent with previous publications and known roles of FLT3 in hematopoiesis and dendritic cell homeostasis. Of note, expression of FLT3 in monocytes and whole blood was the lowest compared to three other AML targets.To address any potential toxicities of FLT3 bispecific, we performed exploratory studies in cynomolgus monkeys. Affinity of FLT3 bispecific for cynomolgus FLT3 was ~20x lower than for human FLT3 (~1 nM), as determined in binding assays with cells expressing human and cynomolgus FLT3. No major clinical signs or toxicological findings were observed up to the highest dose level tested (3 mg/kg) following two administrations at weekly intervals. On target activity was demonstrated by nearly complete elimination of FLT3+ dendritic cells in the blood of treated monkeys two days after administration. In addition, we detected elimination of FLT3+ CD34+ stem cells in the bone marrow of treated monkeys two days after the second dose. Remarkably, both dendritic cells and FLT3+ CD34+ stem cells rebounded to baseline levels observed in control animals when analyzed at study termination, two weeks following the second dose. Consistent with minimal expression of FLT3 on healthy tissues and the presence of FLT3+ on rare blood subsets, cytokine increases typically associated with CD3 bispecific administration were minimal (only 6 to 17 and 46 to 89 fold over baseline for IFN-γ and IL-6, respectively, at the highest dose tested).In conclusion, the robust anti-tumor activity of Pfizer's FLT3 bispecific antibody combined with good tolerability in cynomolgus monkeys, reversible hematological toxicity and absence of non-hematological toxicity support its further clinical development in AML. DisclosuresDjuretic:Pfizer Inc.: Employment. Krishnamoorthy:Pfizer: Employment. Sommer:Allogene Therapeutics: Employment, Equity Ownership, Patents & Royalties. Dettling:Maverick Therapeutics: Employment. Poulsen:Allogene Therapeutics: Employment, Equity Ownership. Chen:Pfizer: Employment. Hu:Pfizer: Employment. Given Chunyk:Pfizer: Employment. Lindquist:Pfizer: Employment. Potluri:Pfizer: Employment. Rickert:Pfizer: Employment. Sasu:Allogene Therapeutics: Employment, Equity Ownership, Patents & Royalties. Chaparro-Riggers:Pfizer Inc.: Employment, Patents & Royalties. Yeung:Pfizer: Employment, Patents & Royalties.

Diagnosis of Johne's disease

Johne's disease is a chronic and highly contagious wasting disease of all ruminants caused by Mycobacterium avium ssp paratuberculosis (MAP). Major clinical signs include weight loss, pipestream diarrhea, edema, decreased milk production, and eventually death. In the US, Johne's disease affects ~70% of dairy herds, costing the industry up to $250 million per year in production loss. An estimated 5 to 10% of beef herds are also affected. Johne's disease represents a significant problem in goat and sheep herds as well; however, no serologic tests are currently licensed by the USDA for small ruminants.

High frequency of Mycoplasma pneumoniae among patients with atypical pneumonia in Tehran, Iran.

Mycoplasma pneumoniae is a major cause of atypical community-acquired pneumonia (CAP) with a prevalence range of 15-20% and up to 40% in adults and children, respectively. In Iran, the recorded frequency ranges between 1-6.15%. We aimed to investigate the frequency of M. pneumoniae among patients with atypical pneumonia acquired from the community. Over a period of 5 months between January and June 2017, 520 patients with suspected CAP, who had been to the hospital outpatient clinics of Tehran University, were enrolled in this study. Throat swab specimens were obtained from 110 outpatients who presented with symptoms of atypical pneumonia. M. pneumoniae was identified via culture and biochemical tests, such as fermentation of glucose and arginine, hemolysis, and hemadsorption. For confirmation, PCR was performed to amplify the gene fragment coding for p1 adhesin. The major and minor clinical signs of the patients were dyspnea (67.3%) and nausea (15.5%), respectively. Out of 110 specimens, 25 (22.7%) and 29 (26.4%) isolates were identified to be M. pneumoniae via culture and molecular assay, respectively. Comparing the results of the two methods, the PCR showed better sensitivity and rapidity for the detection of M. pneumoniae. There was a high congruence between culture and the PCR assay; kappa level was 'almost perfect' (κ=0.90). This is the first report of high frequency of M. pneumoniae in our region. This finding can serve as baseline information for further investigation and confirmation of the potential epidemics of M. pneumoniae pneumonia in our community.

Ritka örökletes anyagcsere-betegségek diagnosztikája: laboratóriumi vizsgálati megközelítések

Inherited errors of metabolism are rare genetic disorders characterized by diverse clinical and biochemical phenotypes. The complexity of signs and symptoms often presents a challenge for both clinicians and laboratory specialists. In many cases, prevention of permanent neurological symptoms or death in patients presenting these disorders is dependent on early diagnosis and introduction of appropriate therapy. For professionals it is indispensable to be familiar with the major clinical signs of inborn errors of metabolism and with the necessary and available laboratory studies to achieve an early diagnosis. The review tries to give a way of approach, diagnostic algorithm of laboratory measurements for the correct diagnosis in inherited errors of metabolism. The combination of biochemical and clinical signs, results of special metabolic investigations represent a portentous challenge in general practice. For the correct diagnosis of an inherited error of metabolism, the teamwork between clinicians and laboratory specialists is indispensable. Orv Hetil. 2017; 158(48): 1903-1907.

Descriptive Study on Skin Prick Test in Allergy Clinic Immanuel Hospital Bandung Indonesia

Allergy is a change of reaction or body's defense response to substances that are actually harmless. An estimated 10-20% of the population had been or are suffering from the disease. The purpose of this study was to thoroughly observe allergic patients on Allergy Clinic Immanuel Hospital Bandung from January 2013–January 2014 based on allergen, clinical sign, age and gender. This study use descriptive methods with retrospective data retrieval from medical record. We gathered 206 skin prick test (SPT) results and found that the highest incidence of allergy was between 31-40 years (22.33%), 64.54% were women, 43.20% of patients with dermatitis as the major clinical signs, 70.59% of patients allergic to house dust mite as a common environmental allergens, 24.84% of patients allergic to shrimp as the most common food allergens. In conlusion, allergic patients with SPT positive common at the age of 31-40 years, women, Dermatitis as a major clinical signs. The most common environmental allergens that cause allergy was house dust mite. The most common food allergens that cause allergy was shrimp.Keywords: allergy, dermatitis, Immanuel Hospital Bandung, skin prick test

GAD antibody-associated limbic encephalitis in a young woman with APECED.

The autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED) syndrome is a genetic disorder caused by a mutation in the autoimmune regulator (AIRE) gene. Immune deficiency, hypoparathyroidism and Addison’s disease due to autoimmune dysfunction are the major clinical signs of APECED. We report on a 21-year-old female APECED patient with two inactivating mutations in the AIRE gene. She presented with sudden onset of periodic nausea. Adrenal insufficiency was diagnosed by means of the ACTH stimulation test. Despite initiation of hormone replacement therapy with hydrocortisone and fludrocortisone, nausea persisted and the patient developed cognitive deficits and a loss of interest which led to the diagnosis of depression. She was admitted to the psychiatric department for further diagnostic assessment. An EEG showed a focal epileptic pattern. Glutamic acid decarboxylase (GAD) antibodies, which had been negative eight years earlier, were now elevated in serum and in the cerebrospinal fluid. Oligoclonal bands were positive indicating an inflammatory process with intrathecal antibody production in the central nervous system (CNS). The periodic nausea was identified as dialeptic seizures, which clinically presented as gastrointestinal aura followed by episodes of reduced consciousness that occurred about 3–4 times per day. GAD antibody-associated limbic encephalitis (LE) was diagnosed. Besides antiepileptic therapy, an immunosuppressive treatment with corticosteroids was initiated followed by azathioprine. The presence of nausea and vomiting in endocrine patients with autoimmune disorders is indicative of adrenal insufficiency. However, our case report shows that episodic nausea may be a symptom of epileptic seizures due to GAD antibodies-associated LE in patients with APECED.Learning points:Episodic nausea cannot only be a sign of Addison’s disease, but can also be caused by epileptic seizures with gastrointestinal aura due to limbic encephalitis.GAD antibodies are not only found in diabetes mellitus type 1, but they are also associated with autoimmune limbic encephalitis and can appear over time.Limbic encephalitis can be another manifestation of autoimmune disease in patients with APECED/APS-1 that presents over the time course of the disease.

Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali.

An alternative Community-based Management of Acute Malnutrition model with community health workers (CHWs) delivering treatment for uncomplicated severe acute malnutrition (SAM) was piloted in Mali. The capacity of the CHWs to evaluate, classify, and treat cases of uncomplicated SAM, to provide nutritional counselling to caretakers of children receiving treatment for SAM, malaria, pneumonia or diarrhoea and to correctly refer cases of complicated SAM, was assessed. This was done using direct observation by trained enumerators of the management of SAM cases using checklists, re-diagnosing the cases admitted for treatment and reviewing admissions cards and registers. One hundred twenty-five cases, assessed and treated by the CHWs, were observed. The majority of children were correctly assessed for the presence of major clinical signs (cough, diarrhoea, fever, and vomiting; 97.6%), and similarly most children were checked for the presence of danger signs (95.2%). Mid-upper arm circumference was correctly assessed in 96.8% of children and oedema was correctly assessed in 78.4% (The composite indicator, which includes all essential tasks to provide high-quality treatment, was achieved in 79.5% of cases. This paper concludes that well-trained and supervised CHWs are capable of managing cases of uncomplicated SAM. This suggests that such a strategy is an opportunity to increase access to quality treatment in Mali for SAM cases. However, further evidence is required to ensure that this level of care can be achieved at scale.

Presumptive diagnosis of leptospirosis before seroconversion: a review of 338 cases in Wallis and Futuna 2008 to 2015.

Leptospirosis is a common condition in Wallis and Futuna, and the definitive diagnosis needs to be established urgently at the first patient consultation, which is usually one to two days after the onset of clinical signs. As a diagnostic aid, a composite index was established based on data from 338 patients seen by the Wallis and Futuna admissions services between 2008 and 2015. The data taken into account include: age and sex of the patient, their home island, the consultation period and the results of leukocytes, platelets, CRP, creatinine and GGT tests combined with 2 major clinical signs, headache and conjunctival suffusion. Then 5 threshold limits were defined for this index, which indicates from very low risk to almost certain biologically confirmed leptospirosis. Other febrile diseases responsible for thrombocytopenia are not found in Wallis and Futuna, which probably explains the good statistical qualities of this index with a value of area under the curve equal to 0.821.

Outbreak of infectious pancreatic necrosis virus (IPNV) in farmed rainbow trout in China

Infectious pancreatic necrosis virus (IPNV) is a member of the Aquabirnavirus genus, which caused mass mortality (nearly 100%) in farmed rainbow trout (Oncorhynchus mykiss) in aquaculture farms in 2016, China. Major clinical signs included decreased appetite, mucous-like stools, and darkened pigmentation. Pathological changes in moribund fish were observed, such as marked vacuolar degeneration of the pancreatic cells with pyknotic nucleus and decreased zymogen granules, severe hemorrhage in the liver, and tumidness of respiratory epithelium in gills. In addition, the tissue fluid of diseased fish could produce a cytopathic effect (CPE) in RTG-2 cells. The presence of specific 206bp fragments by the reverse transcription-polymerase chain reaction (RT-PCR) using tissue homogenate of diseased fish and supernatant of infected cells revealed that IPNV could be confirmed. The pathogenicity test of cell culture supernatant detected cumulative mortality of 80%, and the clinical symptoms observed in the moribund and dead fish were similar to the naturally infected fish. Furthermore, the sequence analysis of VP2 gene showed that the isolated virus strain belonged to genogroup 1, and 97% homology with the Mexican IPNV isolate was found. To our knowledge, this is the first report on IPNV natural infection in the southwest of China.

Experimental infection of Aeromonas hydrophila in pangasius

Experimental infections of Aeromonas hydrophila in juvenile pangasius (Pangasianodon hypophthalmus) were studied. Five different challenge routes included intraperitoneal (IP) injection, intramuscular (IM) injection, oral administration, bath and agar implantation were used with different preparations of the bacteria to infect fish. The challenge experiments were continued for 15 days. A challenge dose of 4.6×106 colony forming unit (cfu) fish-1 was used for IP and IM injection and oral administration method. Generally, IP route was found more effective for infecting and reproducing clinical signs in fish that caused 100% mortality at the end of challenge. IM injection, oral and bath administration routes were also found effective for infecting and reproducing the clinical signs in fish to some extent. Agar implantation with fresh colonies of bacteria also caused 100% mortality of challenged fish very quickly with no visible clinical signs in fish. The major clinical signs of challenged fish included reddening around eyes and mouth, bilateral exophthalmia, hemorrhage and ulceration at fin bases and fin erosion.Progressive Agriculture 27 (3): 392-399, 2016

Cross-sectional Imaging Anatomy and Pathologic Conditions Affecting Thoracic Nerves.

While in many cases they are not directly visualized, awareness of the thoracic nerves and their courses at cross-sectional imaging is important for radiologists. An understanding of the normal function of each nerve is important, as many patients present with neurologic signs and symptoms that can be used to reinforce search patterns for disease and detection of supportive radiologic abnormalities. In the case of primary neoplasms, understanding the expected presence of a nerve in the location of a mass can enhance and improve the accuracy of differential diagnoses. Even in the absence of neurologic symptoms, secondary involvement of these structures by malignancy or close proximity to other intrathoracic disease can prompt significant alterations in oncologic or surgical management. The major components of the thoracic nervous system with which the thoracic radiologist must be familiar are the phrenic, vagus, recurrent laryngeal, intercostal, and long thoracic nerves in addition to the sympathetic chain and brachial plexus. The anatomic structure and course of each component are described including its major functions. Major clinical signs and symptoms attributable to nerve dysfunction or disease are reviewed as well as any associated radiologic signs. Emphasis is placed on primary and secondary malignant involvement of the nerves and iatrogenic and traumatic injuries. Online supplemental material is available for this article. ©RSNA, 2016.

Development of a rapid antibody test for point-of-care diagnosis of animal African trypanosomosis

Trypanosoma congolense and T. vivax are the main causative agents of animal African trypanosomosis (AAT), a disease which hinders livestock production throughout sub-Saharan Africa and in some parts of South America. Although two trypanocidal drugs are currently available, the level of treatment is low due to the difficulty in diagnosing the disease in the field. The major clinical signs of AAT such as anaemia, weight loss, and infertility, are common to several other endemic livestock diseases. Current diagnostic methods, based on the visualization of the parasite in the blood, or on the detection of its DNA or the antibodies it triggers in the host, are not suitable for direct use in the field as they require specialized equipment and personnel. Thus, we developed a quick-format diagnostic test (15min) based on the recombinant TcoCB and TvGM6 antigens for detection of T. congolense and T. vivax, respectively, aimed at providing farmers and veterinarians in the field with the means to conduct a quick diagnosis. The specificity and sensitivity of the test were evaluated using sera from experimentally infected cattle, and fresh blood when possible. The prototype, which includes both antigens, shows a specificity of 95.9 (95% C.I., 90.4%–100%) and a sensitivity of 92.0% (95% C.I., 85.9%–98.1%) for T. congolense and 98.2% (95% C.I., 94.7%–100%) for T. vivax. The high levels of sensitivity and specificity of this rapid test, the possibility of using directly whole blood, and the ease of interpreting the result, all contribute to make of this test a valuable candidate to contribute to the control of AAT in the field. However, further tests with more representative, numerous and fresh reference samples are necessary in order to compare this test with the ELISA, the current gold standard serological test for trypanosomosis.

SLC13A5 is the second gene associated with Kohlschütter–Tönz syndrome

BackgroundKohlschütter–Tönz syndrome (KTZS) is a rare autosomal-recessive disease characterised by epileptic encephalopathy, intellectual disability and amelogenesis imperfecta (AI). It is frequently caused by biallelic mutations in ROGDI. Here, we report...

Pneumonectomie pour poumon détruit post-tuberculeux : une série de 26 cas opérés

A retrospective study over a period of 5years (2009to 2014) was realized. Are involved in the study all patients admitted to the thoracic surgery department of CHU Hassan II with tuberculosis lung destroyed and operated during the study period. This is a series of 26patients, including 17men and 9women treated and cured for pulmonary tuberculosis of which 2for multiresistant tuberculosis. The average age was 38.8years. Hemoptysis (77%) and recurrent respiratory infections (65.4%) were the major clinical signs. Aspergilloma have been reported on cavitary lesion in 23% of cases and in 11.5% pyothorax was associated. Extra-pericardial pneumonectomy was performed in 65.4%, intra-pericardial pneumonectomy in 19.3% and pleural-pneumonectomy in 15.3%. The outcome was favorable in 23patients. We noted a pyothorax on pneumonectomy cavity in 3patients. Postoperative mortality was 7.7%. The regularly clinical and radiological control of all patients is satisfactory with a mean of 41months. Pneumonectomy for tuberculosis lung destroyed remains effective in young patients with an acceptable complication rate.