Neurological Lesions Research Articles

Intestinal pathology in goats challenged with Clostridium perfringens type D strain CN1020 wild-type and its genetically modified derivatives.

Clostridium perfringens type D is the causative agent of enterotoxemia in sheep, goats, and cattle. Although in sheep and cattle, the disease is mainly characterized by neurological clinical signs and lesions, goats with type D enterotoxemia frequently have alterations of the alimentary system. Epsilon toxin (ETX) is the main virulence factor of C. perfringens type D, although the role of ETX in intestinal lesions in goats with type D enterotoxemia has not been fully characterized. We evaluated the contribution of ETX to C. perfringens type D enteric pathogenicity using an intraduodenal challenge model in young goats, with the virulent C. perfringens type D wild-type strain CN1020; its isogenic etx null mutant; an etx-complemented strain; and sterile, non-toxic culture medium. The intestinal tract of each animal was evaluated grossly, microscopically, and immunohistochemically for activated caspase-3. Both ETX-producing strains induced extensive enterocolitis characterized by severe mucosal necrosis, apoptosis, and diffuse suppurative infiltrates. No significant gross or microscopic lesions were observed in goats inoculated with the non-ETX-containing inocula. These results confirm that ETX is essential for the production of intestinal lesions in goats with type D disease. Also, our results suggest that the intestinal pathology of type D enterotoxemia in goats is, at least in part, associated with apoptosis.

Gestational age, maternal smoking, neurological lesion and retinopathy predict strabismus at age 5.5 in preterm children.

Prematurity is a risk factor for strabismus, but the roles of intermediate factors like retinopathy of prematurity (ROP) and neurological lesions are less understood. We aimed to identify neonatal risk factors for strabismus at age 5.5 in preterm children. Data were extracted from the étude épidémiologique sur les petits âges gestationnels 2 cohort, a French prospective population-based study of preterm children born in 2011 with gestational age of 34 weeks or less. Strabismus was recorded during a medical interview at 5.5 years. Using a directed acyclic graph, intermediate and confounding factors were identified. Total and direct effects of gestational age on strabismus risk were analysed using generalised estimating equation. Among 2419 children assessed, 274 (52.6% male) presented strabismus at 5.5 years. The direct effect of gestational age remained significant after adjustment (p < 0.001). In the complete imputed model: maternal smoking during pregnancy (odds ratio, OR 1.8; 95% confident interval, 95% CI 1.3-2.6), neonatal severe cerebral lesions (OR 2.9, 95% CI 1.8-4.6) and severe ROP (OR 4.2, 95% CI 1.9-9.0) were independent risk factors. Special attention is needed regarding strabismus screening at age 5.5 in preterm children, even without severe cerebral lesions and ROP. Smoking cessation during pregnancy should be encouraged.

Functional popliteal angle test for identification of hamstring muscle spasticity in patients with a central neurological lesion

Functional popliteal angle test for identification of hamstring muscle spasticity in patients with a central neurological lesion

Evaluation of end-organ protection in newborns and infants after surgery of aortic arch hypoplasia: A prospective randomized study.

Surgical repair of aortic arch hypoplasia in children requires a "dry" surgical field with reliable end-organ protection. Perfusion strategies commonly involve deep hypothermic circulatory arrest (DHCA) and variations of the continuous perfusion techniques, such as selective antegrade cerebral perfusion (SACP) and full-flow perfusion with double aortic cannulation (DAC). We aimed to evaluate the end-organ protection in the surgery of aortic arch hypoplasia in newborns and infants using DHCA and DAC. 66 newborns and infants with aortic arch hypoplasia and biventricular anatomy were enrolled in this prospective study. Patients were randomly assigned into two groups according to the perfusion strategy - DHCA (n = 33); and DAC (n = 33). Primary endpoint: acute kidney injury (AKI), graded according to the KDIGO score. Secondary endpoints: neurological sequelae (pre- and postoperative MRI), in-hospital mortality. The lowest temperature was 32 (28; 34)°С in the DAC group and 23 (20; 25)°С in the DHCA group. The patients with DAC had lower incidence of AKI (6 patients (18.2%) versus 19 patients (57.6%); p = .017). In the multivariate analysis, the inotropic index at 48h was identified as a risk factor, increasing the risk of AKI by 4%. The DHCA group was associated with a 3.8-fold increase in the risk of AKI. There was no difference in hospital mortality between the DAC and DHCA groups (1 patient (3%) versus 3 patients (9.1%); p = .61). Neurological sequelae by MRI scan were observed in 18 patients (54.5%) in the DHCA group compared to 5 patients (15.15%) in the DAC group (p = .026). The only risk factor identified in the multivariate analysis for neurological lesions on MRI scan was the DHCA group, which increased the risk by 8.8 times. Surgical reconstruction of the aortic arch hypoplasia using the method of full-body perfusion reduces the incidence of neurological lesions and renal complications requiring renal replacement therapy compared with the deep hypothermic circulatory arrest in neonates and infants.

Incidence and characterization of polyglucosan bodies in the cerebella of montserrat orioles (Icterus oberi).

Polyglucosan bodies are accumulations of insoluble glucose polymers and proteins that form intracytoplasmic inclusions in the brain, large numbers of which can be indicative of neurodegenerative diseases such as Lafora disease. Montserrat orioles (Icterus oberi) are an icterid passerine endemic to Montserrat with conservation populations maintained in captivity abroad. We demonstrate that polyglucosan bodies are unusually abundant in the cerebellar molecular and Purkinje cell layers and cerebellar peduncles of captive-bred and wild-caught Montserrat orioles. The bodies are periodic acid-Schiff positive and diastase resistant and label with concanavalin A and for ubiquitin, consistent with those seen in humans. We found no association of the polyglucosan bodies with concurrent neurological lesions or clinical signs, nor with EPM2A and EPM2B gene mutations associated with Lafora disease. We conclude that an abundance of cerebellar polyglucosan bodies may be a normal finding in aged Montserrat orioles and not a threat to the captive breeding population.

Endoparasites of rabbits and hares.

Nematode, cestode, protozoan, microsporidian, and pentastomid parasites affect domesticated and wild rabbits, hares, and jackrabbits of the genera Brachylagus, Lepus, Oryctolagus, Pentalagus, and Sylvilagus. Some endoparasite infections are of limited or no significance, whereas others have potentially profound consequences. Accurate identification of endoparasites of rabbits, hares, and jackrabbits is an important facet of the work of veterinary pathologists engaged in lagomorph pathology. Here I review endoparasites from the pathologist's perspective, focusing on pathogenesis, lesions, and implications of infection. Stomach nematodes Graphidium strigosum and Obeliscoides cuniculi are infrequently pathogenic but may cause gastritis and gastric mucosal thickening. Nematodes Passalurus ambiguus, Protostrongylus spp., Trichostrongylus spp., and Trichuris spp. are rarely associated with disease. Adult Capillaria hepatica (syn. Calodium hepaticum) nematodes and non-embryonated eggs cause granulomatous hepatitis in wild Oryctolagus cuniculus and Lepus europaeus, resulting in multifocal, off-white, hepatic lesions, which may be misdiagnosed as hepatic eimeriosis. When the rabbit is an intermediate host for carnivore cestodes, the space-occupying effects of Cysticercus pisiformis and Coenurus serialis may have pathologic consequences. Eimeria stiedai is a major cause of white-spotted liver in O. cuniculus, particularly in juveniles. Enteric coccidiosis is a noteworthy cause of unthriftiness in young animals, and frequently manifests as diarrhea with grossly appreciable multifocal off-white intestinal lesions. O. cuniculus is the natural host for the zoonotic microsporidian Encephalitozoon cuniculi. Infection may be acute and focused mainly on the kidneys, or it may follow a chronic disease course, frequently with neurologic lesions. A latent carrier status may also develop.

Sacral Fractures Treatment: Systematic Review and Meta-Analysis

Abstract Background The sacrum is a keystone structure that is important to the structural integrity of the base of the spinal column and posterior pelvic ring. Therefore, depending on the fracture pattern, fracture of the sacrum may have implications on posterior pelvic or spinopelvic stability. Sacral fracture classifications are based on fracture location, pattern of instability, and risk of neurologic deficits. Objective To review the literature about sacral fractures and to provide cumulative data about the outcome of different surgical modalities in management of sacral fractures. Patients and Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results We found 176 record; of them 82 unique records identified (duplicate removed) by the database searches; 94 were excluded based on title and Abstractreview; 82 article are searched for eligibility by full text review; 33 article cannot be accessed; 8 studies were reviews and case reports; 17 were not describing functional outcome; the desired procedure not used in 10 studies leaving 14 studies that met all inclusion criteria. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Conclusion Spinopelvic surgical stabilization represents the “gold standard” for sacral fractures treatment, this technique guarantees stability, neutralizes flexion deformation, allowing early mobilization of the patient, ensuring a reduction of comorbidities and a better recovery of neurologic lesions.

Case Report: Bell’s palsy: a neurological manifestation of COVID-19 infection

Background Coronavirus (COVID-19) is the causative agent of the most recent pandemic that hit the globe and has been the cause of a vast range of symptoms, including neurological symptoms. Bell’s palsy is an acute peripheral facial paralysis commonly associated with viral infections. Case presentation This case report describes a patient with incidental COVID-19 infection that led to acute unilateral peripheral facial paralysis, Bell’s palsy. Our patient is a 35-year-old male with no known comorbidities who was presenting with upper respiratory tract infection symptoms and was found to be positive for COVID-19. Soon after the onset of symptoms, he also developed right-sided facial weakness in association with his symptoms. A thorough examination revealed a peripheral neurological lesion. The diagnosis of Bell’s palsy secondary to COVID-19 virus infection was through the exclusion of other possible causes. Conclusions This case report suggests a potential link between Bell’s palsy and COVID-19, highlighting the importance of a comprehensive understanding of the neurological manifestations of COVID-19. Further research is essential to determine the significance of neuropathies in COVID-19 and enhance treatment strategies.

Human Periodontal Ligament Stem Cells (hPDLSCs) Spontaneously Differentiate into Myofibroblasts to Repair Diabetic Wounds.

Advanced glycation end product (AGE) accumulation due to diabetes causes vascular and neurological lesions, delaying healing. The use of stem cells could overcome these problems. Although many studies have shown the potential beneficial effects of stem cell therapies in the treatment of chronic and refractory skin ulcers, their delivery methods are still under investigation. Human periodontal ligament stem cells (hPDLSCs) can spontaneously differentiate into myofibroblasts in specific cultures; therefore, they have the potential to effectively treat diabetic wounds and may also have applications in the field of medical cosmetics. The myofibroblastic differentiation ability of hPDLSCs in the presence of AGEs was evaluated by the expression of α-SMA and COL1A1 using RT-qPCR and WB technology. Wound healing in diabetic mice, induced by streptozotocin (STZ) and assessed using H&E staining, Masson staining, and immunohistochemical (IHC) and immunofluorescence (IF) staining, was used to validate the effects of hPDLSCs. In the wound tissues, the expression of α-SMA, COL1A1, CD31, CD206, iNOS, and vimentin was detected. The findings indicated that in H-DMEM, the expression of COL1A1 exhibited a significant decrease, while α-SMA demonstrated an increase in P7 cells, ignoring the damage from AGEs (p < 0.05). In an STZ-induced diabetic C57BL/6J mice whole-skin defect model, the healing rate of the hPDLSCs treatment group was significantly higher than that in the models (on the 7th day, the rate was 65.247% vs. 48.938%, p < 0.05). hPDLSCs have been shown to spontaneously differentiate into myofibroblasts in H-DMEM and resist damage from AGEs in both in vivo and in vitro models, suggesting their potential in the field of cosmetic dermatology.

The Impact of Neurophysiological Monitoring during Intradural Spinal Tumor Surgery.

Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy.

A Glimpse into the Prognostic Factors of Outcomes for Isolated, Operated Severe Traumatic Head Injury Patients in a Resource Constrained Trauma Center Setup

Abstract Background Severe traumatic brain injury (STBI) continues to burden health care in developing countries. This study focuses on STBI patients undergoing surgical intervention to understand the factors affecting their outcomes in a constrained trauma center setup. Aim This aims to study the epidemiological and clinical factors to understand the long-term morbidity, mortality risks, and triaging among STBI patients requiring surgery. Methods A prospective observational study was conducted on 227 isolated STBI patients with Glasgow Coma Scale (GCS) ≤ 8 who underwent surgical evacuation of intracranial lesions. Patients were classified based on their neurological status and lesions on computed tomography head. Postoperative data on complications were collected. At 6-month follow-up, patients with Glasgow (Extended) scores of 7 to 8 were deemed good outcomes, and scores of 1 to 6 were deemed poor. Cox regression analysis was used to identify independent influencing factors, with p &lt; 0.05 as statistically significant. Results The clinicoradiological factors including age (p = 0.02), asymmetric pupillary reaction (p = 0.002), low presenting pulse rate (p = 0.041), and low systolic and diastolic blood pressure (p = 0.016 and p &lt; 0.0001, respectively), low GCS (p = 0.011), midline shift &gt; 5 mm (p &lt; 0.0001), and obliterated basal cisterns were significantly associated with poor outcome. Tracheostomy, respiratory tract infection, bedsore, meningitis, deep vein thrombosis, cerebrospinal fluid leak, and bone flap site infection were significantly associated with survival of the patients (p = 0.036). The most common cause of mortality during home care included respiratory tract infection and was associated with the care of the tracheostomized. GCS (p &lt; 0.0001), age (p = 0.005), and alcohol use (p = 0.034) were independent predictors for the outcome of patients. Conclusion This study helps clinicians predict prognosis, postoperative recovery, manage challenges, counsel caregivers, and predict long-term patient outcomes.

Insuficiencia cardíaca secundaria a mordedura de serpiente. La visión del intensivista: reporte de caso

Background: Ophidic accident is a neglected disease that affects tropical countries. Latin America is the second region after Africa, with the most cases worldwide. Local lesions accompany its clinical course up to systemic affectations such as renal, hematological, and neurological lesions. Cardiac complications are rare, especially in patients who do not have cardiovascular risk factors. There are reports of acute myocardial infarction, but there is little information about heart failure due to Bothrops spp. Case report: We present the case of a 25-year-old man without cardiovascular risk factors who was admitted to the intensive care unit and developed heart failure with cardiogenic shock and multi-organ failure secondary to a snake bite. Conclusions: Although the characteristic clinical course of a bothropic ophidian accident and its systemic manifestations are mainly related to coagulation abnormalities, there are cardiovascular complications within its clinical presentation that, although rare, if not detected promptly and not adequately managed, are associated with high morbidity and mortality.

A temporoparietal infarct lesion presented as the first-episode mania in an elderly male

The occurrence of late-onset mania after 50 years of age for the 1st time is generally rare and is generally, but not necessarily, secondary to an organic lesion. Various underlying causes include neurological lesions, tumors, thyroid-related disorders, parathyroid abnormalities, electrolyte imbalances, and vascular lesions. After 75 years of age, the incidence of reported mania was 2/100,000, which is very rare. The main concern for such cases is to rule out secondary causes in assessment, diagnosis, and perspectives related to clinical management. We present a case where the first manic episode occurred at the age of 77 years with underlying infarcts in the temporal and parietal regions as seen in MRI brain contrast images.

Spatial clusters, temporal behavior, and risk factors analysis of rabies in livestock in Ecuador

Rabies, a globally distributed and highly lethal zoonotic neglected tropical disease, has a significant impact in South America. In Ecuador, animal rabies cases are primarily linked to livestock, and hematophagous bats play a crucial role in disease transmission. This study aims to identify temporal trends, spatial patterns, and risk factors for animal rabies in Ecuador between 2014 and 2019. Epidemiological survey reports from the official Animal Rabies Surveillance Program of the Phyto and Zoosanitary Regulation and Control Agency of Ecuador (AGROCALIDAD) were used. The Animal Rabies Surveillance Program from AGROCALIDAD consists of an official passive surveillance program that receives reports from farmers or individuals (both trained or untrained) who have observed animals with neurological clinical signs and lesions compatible with bat bites, or who have seen or captured bats on their farms or houses. Once this report is made, AGROCALIDAD personnel is sent for field inspection, having to confirm the suspicion of rabies based on farm conditions and compatibility of signs. AGROCALIDAD personnel collect samples from all suspicious animals, which are further processed and analyzed using the Direct Fluorescent Antibody (DFA) test for rabies confirmatory diagnosis. In this case, study data comprised 846 bovine farms (with intra-farm sample sizes ranging from 1 to 16 samples) located in different ecoregions of Ecuador; out of these, 397 (46.93%) farms tested positive for animal rabies, revealing six statistically significant spatial clusters. Among these clusters, three high-risk areas were identified in the southeast of Ecuador. Seasonality was confirmed by the Ljung-Box test for both the number of cases (p < 0.001) and the positivity rate (p < 0.001). The Pacific Coastal lowlands and Sierra regions showed a lower risk of positivity compared to Amazonia (OR = 0.529; 95% CI = 0.318 – 0.883; p = 0.015 and OR = 0.633; 95% CI = 0.410 – 0.977; p = 0.039, respectively). The breeding of non-bovine animal species demonstrated a lower risk of positivity to animal rabies when compared to bovine (OR = 0.145; 95% CI = 0.062 – 0.339; p < 0.001). Similarly, older animals exhibited a lower risk (OR = 0.974; 95% CI = 0.967 – 0.981; p < 0.001). Rainfall during the rainy season was also found to decrease the risk of positivity to animal rabies (OR = 0.996; 95% CI = 0.995 – 0.998; p < 0.001). This study underscores the significance of strengthening the national surveillance program for the prevention and control of animal rabies in Ecuador and other countries facing similar epidemiological, social, and geographical circumstances.

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson's disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson's disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

CD4+ CD11b+ T cells infiltrate and aggravate the traumatic brain injury depending on brain-to-cervical lymph node signaling.

We aim to identify the specific CD4+ T-cell subtype influenced by brain-to-CLN signaling and explore their role during the acute phase of traumatic brain injury (TBI). Cervical lymphadenectomy or cervical afferent lymphatic ligation was performed before TBI. Cytokine array and western blot were used to detect cytokines, while the motor function was assessed using mNss and rotarod test. CD4+ T-cell subtypes in blood, brain, and CLNs were analyzed with Cytometry by time-of-flight analysis (CyTOF) or fluorescence-activated cell sorting (FACS). Brain edema and volume changes were measured by 9.4T MRI. Neuronal apoptosis was evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. Cervical lymphadenectomy and ligation of cervical lymphatic vessels resulted in a decreased infiltration of CD4+ T cells, specifically CD11b-positive CD4+ T cells, within the affected region. The population of CD4+ CD11b+ T cells increased in ligated CLNs, accompanied by a decrease in the average fluorescence intensity of sphingosine-1-phosphate receptor-1 (S1PR1) on these cells. Administration of CD4+ CD11b+ T cells sorted from CLNs into the lateral ventricle reversed the attenuated neurologic deficits, brain edema, and lesion volume following cervical lymphadenectomy. The infiltration of CD4+ CD11b+ T cells exacerbates secondary brain damage in TBI, and this process is modulated by brain-to-CLN signaling.

The VP1/2 Protein of a New Recombinant PRV Strain Promotes the Infectivity and Pathogenicity of PRV in Northeastern China

Pseudorabies virus (PRV) is an acute infectious disease characterized by neurological and respiratory symptoms. In order to have a better understanding of the current prevalence of PRV in northeastern China, a strain of PRV was isolated by us. Then, protein structure analysis and pathogenicity testing of the virus were performed to give insight into the characterization of the isolated PRV strains. In this study, the PRV strain named CH/HLJPRVJ/2023 was isolated and identified. Genome-wide phylogenetic analysis shows CH/HLJPRVJ/2023 and HeN1 have higher homology. The CH/HLJPRVJ/2023 strain had the highest homology with HeN1 strain (97.3%) and the lowest homology with Bartha-K61 (89.2%). Recombinant evolution analysis shows CH/HLJPRVJ/2023 shows many variants in OBP, AN, UL21, UL17, VP11/12, and VP1/2 fragments, which predict its unique genetically. VP1/2, an effector protein of capsid transport and neuroinvasion, has mutations and deletions in its amino acids, which cause changes in the protein conformation of CH/HLJPRVJ/2023. Besides the typical neurologic and respiratory lesions, infection with highly pathogenic CH/HLJPRVJ/2023 can lead to damage to the colonic villi and colonic barrier in piglets. This study will provide a basis for knowledge about the prevalence, genetic evolution, and vaccine optimization of endemic PRV strains in northeastern China.

Neurological examination of clinically healthy pigeons (Columba livia domestica), mute swans (Cygnus olor), common buzzards (Buteo buteo), common kestrels (Falco tinnunculus) and northern goshawks (Accipiter gentilis).

A neurological examination is essential for determining the localisation of neurological lesions. However, in avian species, quantitative data regarding the practicability and feasibility of neurological tests are very limited. Therefore, the aim of this study was to establish normative data for the neurological examination of clinically healthy birds of different species. Forty-two domestic and feral pigeons (Columba livia domestica), 42 mute swans (Cygnus olor), 12 common buzzards (Buteo buteo), 24 common kestrels (Falco tinnunculus) and six northern goshawks (Accipiter gentilis) were examined. All birds underwent a predefined neurological examination. Interobserver variations between three examiners were investigated in 11 pigeons and 11 mute swans. All postural reaction tests, except for the drop and flap reaction in mute swans, provoked a consistent response in pigeons and mute swans, whereas postural reaction tests of the legs in raptors were often not performable. Cranial nerve tests and most of the spinal reflexes revealed variable responses in all birds. The gastrocnemius reflex was not provokable in any bird. Interobserver agreement was almost perfect (Gwet's AC1 coefficient ≥0.81) for 16 of 21 parameters in the examination in pigeons and for 14 of 21 in mute swans. The inclusion of free-ranging birds, which were not used to handling and for which limited information regarding age, history of previous diseases, etc. was available, may have influenced the results. The normative neurological examination data provided in this study will help improve clinicians' interpretation of neurological examinationresults in the respective bird species.

Non-Polio Enteroviruses Isolated by Acute Flaccid Paralysis Surveillance Laboratories in the Russian Federation in 1998-2021: Distinct Epidemiological Features of Types.

More than 100 types of non-polio enteroviruses (NPEVs) are ubiquitous in the human population and cause a variety of symptoms ranging from very mild to meningitis and acute flaccid paralysis (AFP). Much of the information regarding diverse pathogenic properties of NPEVs comes from the surveillance of poliovirus, which also yields NPEV. The analysis of 265 NPEV isolations from 10,433 AFP cases over 24 years of surveillance and more than 2500 NPEV findings in patients without severe neurological lesions suggests that types EV-A71, E13, and E25 were significantly associated with AFP. EV-A71 was also significantly more common among AFP patients who had fever at the onset and residual paralysis compared to all AFP cases. In addition, a significant disparity was noticed between types that were common in humans (CV-A2, CVA9, EV-A71, E9, and E30) or in sewage (CVA7, E3, E7, E11, E12, and E19). Therefore, there is significant evidence of non-polio viruses being implicated in severe neurological lesions, but further multicenter studies using uniform methodology are needed for a definitive conclusion.

Anesthesic Management of a Patient Presenting a Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disease that progresses in relapses and remissions. The disease affects preferentially the small joints but an extension to the cervical spine poses a particular problem for anaesthesia because of the risk of difficult and/or dangerous intubation due to the aggravation of neurological lesions linked to the occurrence of subluxation of the axis on the atlas. Treatments such as Non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids should be considered perioperatively, as it is important not to discontinue them, knowing that they increase the risk of sepsis as do other treatments (methotrexate) which have an immunosuppressive effect. The pre-anaesthetic evaluation of patients must also look for systemic damage (pericarditis, chronic interstitial lung disease) likely to interfere with the anaesthetic management. The latter must favour, as far as possible, loco-regional anaesthesia. Intubation through a fibrocope is the least traumatic technique. Taking care of the discomfort of the installation on a table, which is particularly harmful to these patients, and programming a multimodal analgesia as well as the continuation of treatment of RA.