Petechiae Research Articles

First report of a severe nasopulmonary acariasis caused by Orthohalarachne diminuata Doetschman, 1944 (Acari: Halarachnidae) in a captive South American sea lion (Otaria flavescens Shaw, 1800).

Obligatory endoparasitic mites of the genera Halarachne Allman, 1847 and Orthohalarachne Newell, 1947 (Acari: Halarachnidae) parasitize different segments of the respiratory tract of marine mammals, including pinnipeds and sea otters, and infestations can cause asymptomatic to serious respiratory diseases. However, knowledge on biology, pathogenic potential and occurrence of halarachnid mites infesting pinnipeds, especially in captivity, is scarce. A two-year-old South American sea lion (Otaria flavescens Shaw, 1800) male, born and held at the Vienna Zoo, was anesthesized for routine pre-transport examinations, including computed tomography, bronchoalveolar lavage, and blood sampling. During the final phase of general anesthesia, the individual abruptly became apneic and died despite all attempts at resuscitation. At necropsy, 45 highly motile whitish millimeter-sized structures were macroscopically detected in the trachea, bifurcatio tracheae and main bronchi and were identified as adult stages of Orthohalarachne diminuata Doetschman, 1944 following morphological descriptions. After trepanation of the nasal cavity and sinus paranasalis, a total of 407 larval and 3 nymphal specimens distributed in clusters were detected. Macroscopically, sinus mucosa showed hyperemia and multiple petechial hemorrhages. Histopathological analyses of paranasal sinuses revealed mite cross-sections surrounded by sanioserous exudate and epithelial exfoliation. For the first time, O. diminuata was molecularly characterized and phylogenetically analyzed based on its 16S rDNA. Our study constitutes the first record of a severe O. diminuata infestation in captive O. flavescens and one of the few host-parasite records in general. We present clinical data and pathological results, the first scanning electron microscopic images of a O. diminuata larval stage and discuss the etiology of this autochthonous infestation, possible transmission pathways and detrimental effects. Further studies on biology and pathogenic effects of halarachnid mites, as well as on the development of non-invasive sampling techniques are essentially required for a better understanding of (ortho-)halarachnosis in pinnipeds held in zoological gardens.

Inclusion Body Disease and Columbid Alphaherpesvirus 1 Infection in a Eurasian Eagle-Owl (Bubo bubo) of Central Italy.

Hepatosplenitis or inclusion body disease is a fatal disease in owls caused by Columbid alphaherpesvirus 1 (CoHV-1). A few old case reports describe it worldwide. In Italy, knowledge regarding virus circulation and disease development is lacking. Four Eurasian eagle-owls (Bubo bubo), two adults and two juveniles, were submitted for postmortem examination showing aspecific clinical signs a few hours before death. Grossly disseminated petechial hemorrhages on serosal surfaces (n = 4), hepatic and splenic necrosis (n = 3), bilateral and symmetric necrosis of pharyngeal tonsils (n = 2), and diffuse and bilateral dark-red discoloration and firmness in lungs (n = 2) were seen. Tissues were sampled for histology, bacteriology, molecular testing, and transmission electron microscopy (TEM). On histology, disseminated petechial hemorrhages (n = 4) and necrosis of liver (n = 3) and spleen (n = 3) were seen, as well as lympho-histiocytic interstitial pneumonia and meningoencephalitis (n = 2). Intranuclear inclusion bodies (INIBs) were detected in one case. A panherpesviral PCR led to positive results in one case, identified in sequencing as CoHV-1. On TEM, intranuclear and intracytoplasmic virions with herpesviral morphology were seen in the same case. For the other three birds, the lack of PCR positivity, INIBs, and TEM detection could be linked to a possible reduction of the virus to undetectable levels. Death possibly occurred secondarily to bacterial infections, supposedly established during the acute phase of CoHV-1 infection. This paper reports the presence of CoHV-1in Italy and the development of a fatal form of the disease in a Eurasian eagle-owl.

Pathomorphological changes in the liver of broiler chickens caused by adeno-virus infection. Description of a spontaneous case in a private farm of the Lviv region

The article covers the results of pathomorphological studies of broiler chickens' liver (Cobb 500 cross) spontaneously damaged by Group I fowl adenovirus. Clinical signs of the disease in broiler chickens appeared on the 15th day of life and were manifested by a sharp decrease in water and feed consumption. The fowl was lethargic for several days, breathing hard, mostly sitting with its head down and eyes closed. During the breeding period, the mortality rate reached 13.2 %, accompanied by significant growth retardation. A peak of mortality was observed within 20–24 days of life. Antibody titers monitored by immunoenzymatic method using BioChek ELISA tests for infectious bursal disease (IBD), infectious bronchitis (IBV), and Newcastle disease (ND) virus were within normal post-vaccination levels. Pathological autopsy of broiler chickens revealed hepatomegaly, diffuse punctate and petechial hemorrhages under the Glisson's capsule, and military necrosis in the liver parenchyma. Hydropericarditis, pulmonary edema, renal dystrophy, and catarrhal enteritis were also detected in some cases. Liver fragments were selected for histological examination, fixed in a 10 % aqueous solution of neutral formalin, washed in water, and dehydrated in an ascending series of alcohols, followed by sealing and embedding in paraffin. Deparaffinized sections were stained with Mayer's hematoxylin and eosin. Optical examination of hepatocytes revealed large, round basophilic intranuclear inclusion bodies, multifocal necrosis of hepatocytes, stasis, and fatty dystrophy. According to the molecular genetic test results of broiler chickens' liver fragments, the DNA of Group I fowl adenovirus, serotype FAdV-11, was isolated.

Zanubrutinib Plus Rituximab for the Treatment of Elderly Unfit Patients with Previously Untreated Diffuse Large-B Cell Lymphoma

Background: Diffuse Large B-cell lymphoma (DLBCL) is common in the elderly patients, Some elderly patients can not tolerate the standard dose of R-CHOP due to age, poor physical condition, and severe complications. The overall response rate of elderly unfit DLBCL patients who received a reduced dose R-CHOP regimen was only 60%. It is extremely important to explore new therapeutic options. Zanubrutinib is a Bruton tyrosine kinase (BTK) inhibitor which was still in an exploratory phase in patients with DLBCL. The efficacy of Zanubrutinib plus Rituximab in elderly unfit Patients with DLBCL is still unknown. Methods: In the present study, a prospective, single-arm, single-center study was conducted (CHiCTR-2000039342).patients who fulfil the inclusion and exclusion criteria were enrolled. Inclusion criteria: patients aged ≥65 years, and treatment-naive pathologically confirmed with DLBCL, and assessed unfit by Comprehensive Geriatric Assessment(IACA). Unfit patients were defined as follows: i.e. IADL score ≤7, or age >75 years, or CCI score ≥3, or serum albumin <3.4 g/ml. Exclusion criteria: history of malignancy with chemotherapy or radiotherapy before, or serious infectious disease, or bleeding tendency, or hemophilia. Patients enrolled were planned to treat with Zanubrutinib combined with rituximab (Zanubrutinib 160 mg orally twice daily and rituximab 375 mg/m2 day1 iv, every 28 days, ZR regimen), for a total of eight courses. After induction therapy, maintenance treatment with Zanubrutinib 160mg orally twice daily was given until disease progression or unacceptable toxicity. Efficacy was evaluated by PET/CT or enhanced Computed Tomography scan every two to four months, treatment-related adverse effects were evaluated every month. This study was approved by the Ethics Committee of Beijing Hospital, National Center of Gerontology, Beijing, China. Results: From July 2020 to June 2022, A total of ten elderly unfit DLBCL patients who fulfil the inclusion and exclusion criteria were enrolled(CHiCTR-2000039342).The median age was 86.5 years (80-93 years). The most common comorbidities were cardiovascular disease, hypertension, diabetes mellitus. The female to male ratio was 6:4. Two patients were classified as GCB pathological subtype, Seven patients were diagnosed with stage III-IV. At a median follow up of 9.5 months(2-24months). Eight patients could be evaluated for efficacy. Overall response rate(ORR) was 87.5% (7/8) , five patients (62.5%) achieved complete response(CR). In two patients with GCB pathological subtype, one patient achieved CR, the other one had partial response (PR). In six patients with non-GCB pathological subtype, four patients achieved CR, one had PR, one achieved progression disease(PD) . Median progression-free survival (PFS) was not achieved, one patient had progressing at 8 months, and died due to disease progression, with overall survival (OS) of 11 months. ZR regimen was well-tolerated, three patients had grade 2 urinary tract infections, one had grade 2 respiratory infections, one had grade 1 Petechial hemorrhages, two had grade 2 skin rash, two had acute kidney injury. No grade 3 or higher adverse events were observed. Ten patients had a dose reduction due to toxicity. Two patients had discontinued Zanubrutinib due to adverse events for one to three weeks. In addition, two patients who met exclusion criteria were also off-label use of ZR regimen therapy. They were classified as GCB pathological subtype, and diagnosed with stage III or IV. One patient was 72 years old with IADL score of 6, CCI score of 4, previously diagnosis of lung cancer and renal cancer, treated with radiotherapy and surgery. This patient achieved PR after 2 cycles and had disease progression after 4cycles, with PFS of 4 months. He had grade 2 Petechial hemorrhages or skin rash. The other patient was 81 years old, previously diagnosis of decompensated liver cirrhosis ，with bleeding tendency, IADL score of 2, CCI score of 4.She achieved SD after 2 cycles and had disease progression after 4 cycles, with a PFS of 4 months, and died due to disease progression, with OS of 5 months. Conclusion: Zanubrutinib in combination with Rituximab may be a well-tolerated and effective regimen in elderly unfit DLBCL patients. Dose reduction may be required for some patients to improve tolerability. A large sample size clinical trial is needed to further validate this conclusion in the future. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Sudden Cardiac Death due to Giant Cell Myocarditis in a 37-Year-Old Female: Case Report

Abstract Introduction/Objective Giant cell myocarditis (GCM) is a rare and aggressive inflammatory process that targets the myocardium and is often rapidly fatal. Most cases have been reported in young to middle aged adults with a slight male predominance. The etiology of this disease is largely unknown, however there is an association with multiple autoimmune disorders. Most patients present with rapidly progressive or fulminant heart failure, arrhythmias, heart block or sudden cardiac death. The incidence of GCM ranges from 0.007% to 0.051% and most cases are confirmed on autopsy examination. Here we present a case of GCM in a young female diagnosed on autopsy. Methods/Case Report A 37-year-old female presented with shortness of breath and chest pain for a 5-day duration. She had no past medical history and was otherwise well before the onset of symptoms. On admission, she was noted to have clinical findings consistent with heart failure and progressed to cardiogenic shock with ventricular arrhythmias within hours. Despite high dose corticosteroids and other supportive therapy, the patient remained in refractory, vasodilatory shock, in cardiac standstill and eventually died. Findings on autopsy included mild ventricular hypertrophy, petechial hemorrhages through out the atria and ventricles, as well as pulmonary edema and congestion. Microscopic examination showed a diffuse infiltrating pattern of inflammation within the heart, that was composed predominantly of lymphocytes, giant cells, scattered neutrophils, and eosinophils. The lymphocytes were CD3, CD4, CD8 positive and CD20 negative, consistent with a T-cell infiltrate. Gram and GMS stains were negative for bacterial and fungal microorganisms. Focal areas of necrosis without granuloma formation are also noted ruling out sarcoidosis. Results (if a Case Study enter NA) NA. Conclusion This case demonstrates a rapid manifestation of GCM in a previously healthy individual. GCM must be considered in the differential diagnosis when a young patient presents with cardiac symptoms. Early diagnosis and initiation of targeted therapy is critical for GCM patients' survival.

Abstract 15654: Mitral Valve Strands in a Patient With Cerebellar Infarcts

Case Description: A 56-year-old man with a history of hypertension, diabetes, hyperlipidemia, and ischemic stroke 2 years ago presented with left-sided weakness, unsteady gait, and vomiting for 12 hours. The patient was vitally stable, and examination revealed dysarthria, left ataxic hemiparesis, and chronic right facial droop. Magnetic Resonance Imaging (MRI) brain showed an evolving acute infarct in the left superior cerebellum with trace petechial hemorrhage, chronic small right posterior inferior cerebellar infarct, and chronic bilateral cerebellar lacunar infarcts. The patient had an implantable loop recorder placed after his previous stroke, which did not show any arrhythmias on interrogation. MRI Angiography of the head/neck did not show large vessel occlusions. Transesophageal echocardiography (TEE) ruled out a patent foramen ovale but did reveal multiple filamentous structures (&lt;5mm in size) on the atrial side of the posterior mitral valve leaflet (figure 1); these were consistent with fibrin valve strands, or Lambl’s excrescences (LE). Anticoagulation therapy was started, and surgical excision was recommended. Discussion: LE are rare fibrous/filamentous valvular strands caused by wear and tear at the closure lines of left-sided heart valves. LE can be associated with thromboembolic strokes and acute coronary syndromes; however, it can also be found incidentally. TEE is the gold standard in diagnosis. This is a middle-aged man without a clear cause of ischemic strokes, subsequently found to have LE on the mitral valve. There is a paucity of evidence on the management of LE due to its rarity. Prior case reports suggest the use of antiplatelets/anticoagulants in symptomatic patients and surgery in cases of recurrent thromboembolic episodes refractory to conservative treatment. Given multiple strokes, this patient was started on anticoagulation and will be evaluated for surgery. Further high-powered studies are needed to guide management.

Aplastic anemia following the severe acute respiratory syndrome coronavirus-2 vaccine.

Aplastic anemia following the severe acute respiratory syndrome coronavirus-2 vaccine.

Scurvy in United States in 2022 – A Rare Nutritional Deficiency which may have been forgotten in the Developed Countries

Purpose: Scurvy is a disease that has ancient relevance but is a rare occurrence in the present times, due to the advancements in studies and convenient access to professional nutritionists and other services that provide guidance and plans to fulfil all nutritional requirements. In this case report, the authors present the case of a 68 year old male who was diagnosed with scurvy. The diagnosis and treatment of this disease has seen to be greatly delayed due to the infrequency of the cases reported, causing serious consequences for the patient. Scurvy presents with a variety of symptoms affecting the skin and soft tissues such as perifollicular hemorrhages, petechiae, bruising, and arthalgrias.&#x0D; Methodology: The patient was prescribed 250 mg vitamin C supplements (also called Ascorbic acid) 3 times a day and was monitored after 2 weeks to note signs of improvements. Physical examination included observing petechial haemorrhages and bruises. Blood test should be recommended to assess vitamin C levels in blood after the prescribed duration of time.&#x0D; Findings: The signs and symptoms were resolved after regular intake of ascorbic acid supplements for 2 weeks.&#x0D; Recommendation: The findings signifies the need for consideration of scurvy as a possible diagnosis for petechial rash and easy bruising along with other differentials even during the modern era.

Pathological Studies on Hantaan Virus-Infected Mice Simulating Severe Hemorrhagic Fever with Renal Syndrome.

Hantaan virus is the causative agent of hemorrhagic fever with renal syndrome (HFRS). The Hantaan virus strain, Korean hemorrhagic fever virus clone-5 (KHF5), causes weight loss and renal hemorrhage in laboratory mice. Clone-4 (KHF4), which has a single E417K amino acid change in its glycoprotein, is an avirulent variant. In this study, KHF4 and KHF5 were compared to evaluate pathological differences in mice in vitro and in vivo. The characteristics of the two glycoproteins were not significantly different in vitro. However, the virulent KHF5 strain targeted the lungs and caused pneumonia and edema in vivo. Both strains induced high infectivity levels in the liver and caused hepatitis; however, petechial hemorrhage and glycogen storage reduction were observed in KHF5-infected mice alone. Renal hemorrhage was observed using viral antigens in the tubular region of KHF5-infected mice. In addition, an increase in white blood cell levels and neutrophilia were found in KHF5-infected mice. Microarray analysis of liver cells showed that CD8+ T cell activation, acute-phase protein production, and neutrophil activation was induced by KHF5 infection. KHF5 infectivity was significantly increased in vivo and the histological and clinicopathological findings were similar to those in patients with HFRS.

Leukocytoclastic vasculitis induced by medications displaying colocalizing lesional deposits for CD15, myeloperoxidase and HLA-DPDQDR: A Yin and Yang?

Leukocytoclastic vasculitis is an inflammatory disease of small blood vessels; circulating immune complexes are part of the disease. A 57-year-old female presented with a sudden appearance of palpable purpura with petechial hemorrhages on the lower limbs after taking multiple medications. Skin biopsies were stained for H&amp;E, direct immunofluorescence (DIF) and immunohistochemistry (IHC). The DIF revealed strong staining with multiple immunoglobulins and other markers in small dermal blood vessels, including those around skin appendices The IHC was positive for myeloperoxidase. CD15, myeloperoxidase and HLA-DPDQDR on the upper dermal blood vessels, as well as on inflammatory cells and debris around the vessels. These findings have not been previously documented and may indicate that circulating immune complexes activate the neutrophils.

Outpatient human coronavirus associated conjunctivitis in India.

BackgroundViral conjunctivitis (pink eye) can be highly contagious and is of public health importance. There remains significant debate whether SARS-CoV-2 can present as a primary conjunctivitis. The aim of this study was to identify pathogens associated with outpatient infectious conjunctivitis during the COVID-19 Delta surge.MethodsThis prospective study was conducted in the spring and summer months of 2021. 106 patients with acute conjunctivitis who presented to the Aravind Eye Center in Madurai, India were included. One anterior nasal swab and one conjunctival swab of each eye were obtained for each enrolled patient. Samples were subsequently processed for unbiased metagenomic RNA deep sequencing (RNA-seq). Outcomes included clinical findings and codetection of other pathogens with SARS-COV-2 in patients with conjunctivitis.ResultsAmong the 13 patients identified with human coronavirus RNA fragments in their swabs, 6 patients had SARS-COV-2 infection, 5 patients had coinfections of SARS-CoV-2 and human adenovirus (HAdV), 1 patient had a coinfection with human coronavirus OC43 and HAdV, and 1 patient had a coinfection of Vittaforma corneae and SARS-CoV-2. 30% had bilateral disease and symptoms on presentation. Petechial hemorrhage was noted in 33% of patients with SARS-COV-2 infection. No patients with SARS-CoV-2 or SARS-CoV-2 and HAdV infections had subepithelial infiltrates on presentation. All patients denied systemic symptoms.ConclusionsAmong the patients presented with conjunctivitis associated with human coronavirus infection, over 50% of the patients had co-infections with other circulating pathogens, suggesting the public-health importance of broad pathogen testing and surveillance in the outpatient conjunctivitis population.

A Comparative Study on Pathological Changes in the Small Intestine of Sheep and Goat Experimentally Infected with Trichostrongylus colubriformis.

BackgroundTrichostrongylus colubriformis, also called hairworm, is a genus of parasitic roundworm affecting gastro-intestinal tracts of a ruminant. Gross and microscopic lesion characterizations and comparing its effect in the small intestine of sheep and goats experimentally infected with T. colubriformis were undertaken in the study.MethodsDuring the study period, 13 sheep and 14 goats were included in the experiment. The larvae of T. culibriformis were obtained from abattoirs and larvae were recovered by Bearmann techniques. The infective larvae of T. culibriformis (L3) as a single dose of 10,000 per-animal was administered orally to infected groups of sheep and goats. Blood was collected for hematological and serum biochemical analysis. Tissues for gross and histopathologic lesions characterization were collected from killed infected animals at 56 days.ResultsFrom the infected group, the total recovered mean worm burden was recorded as higher in goats (P<0.05) than sheep, with an establishment rate of 50.16% and 34.46%, respectively. The total mean PCV, Hb, and albumin values recorded in the infected groups of sheep and goats were significantly (P<0.05) lower than non-infected control of both animal groups. In goats, the total serum protein was significantly (P<0.05) lower in the infected group than the non-infected control group. Gross lesions found were enteritis with petechial hemorrhages, edema, hyperemia, and mucosal slough, which were marked in the duodenum (62.69%) and jejunum (33.33%) in sheep and 47.05% duodenum and 45.09% jejunum in goats. The microscopic lesions developed by T. colubriformis were subtotal villus atrophy, hemorrhage, straightened and elongated dilated crypts, loss of epithelium, mucosal erosion, and infiltration of inflammatory cells.ConclusionThe present study showed that T. colubriformis infection caused physiological and pathological changes of the small-intestine in sheep and goats, with more severe infection in goats than sheep, although they were under the same management condition.

The first outbreak of citrobacteriosis caused by Citrobacter gillenii in reared Russian sturgeon (Acipenser gueldenstaedtii) in Turkiye.

Russian sturgeon (Acipenser gueldenstaedtii) is an endangered fish species and also an important resource for the sturgeon aquaculture industry in Turkiye. Recently, a fatal and persistent bacterial disease occurred in the reared sturgeon kept in a trout farm in Turkiye. The disease outbreak has been with notable external signs including petechial hemorrhages and systemic anemia. This outbreak lasted for six weeks, and cumulative mortality reached around 35.00 - 40.00%. In this study, no parasitic and viral agents were observed in the sturgeons. Citrobacter gillenii was isolated from the diseased fish and identified by biochemical and molecular methods including API 20E and 20NE and 16S rRNA gene region sequencing, respectively. As a result, C. gillenii was identified for the first time in Russian sturgeon in Turkiye. The sequence was also deposited under the Genbank with MW057770 accession number. According to the result of disc diffusion method, bacteria were sensitive to enrofloxacin, streptomycin, amoxicillin and oxytetracycline and resistant to penicillin, trimethoprim/sulfamethoxazole, florfenicol and erythromycin. Also, ampC, sul1 and floR resistance genes were detected in the isolated bacteria. The results of this study provide important information for the diagnosis and treatment of this newly emerged disease of Russian sturgeon.

Effective laser correction of multiple teleangiectasia on the face

Telangiectasia is a persistent dilation of small-caliber skin vessels (arterioles, venules, capillaries) of a non-inflammatory nature, manifested by polymorphously convoluted and dilated vessels. Telangiectasias are classified according to the cause of occurrence, the form of changes in the vascular pattern, time and localization, and are also divided into 3 large groups ― essential (idiopathic); symptomatic in various diseases; congenital and hereditary syndromes and diseases accompanied by vascular anomalies. In addition, telangiectasias can be single and multiple, located locally or disseminated, differ in shape, location, color; sometimes they bleed. Differential diagnosis is carried out with flaming and telangiectatic nevus; multiple senile, glomerular, bundle angiomas; Fabry angiokeratoma, Sivatts poikiloderma. In addition, telangiectasia is a typical clinical symptom in the erythematous-telangiectatic form of rosacea, systemic scleroderma, discoid lupus erythematosus, nodular form of basal cell carcinoma, hyper- and atrophic scars, late radiation dermatitis.&#x0D; The article describes a case from the clinical practice of effective treatment of telangiectasias on the skin of the face using a neodymium crystal laser, which is of interest, among other things, due to the complexity of diagnosis within the existing International Classification of Diseases 10 revision, therefore the diagnosis is made syndromally based on macro- and microscopic morphological features. In addition, there is no single approach to the treatment of the pathology in question. External therapy, as well as systemic drugs, are often ineffective, sclerotherapy and exposure to a high-power vascular laser have a more pronounced clinical effect (broadband light; neodymium laser; pulsed dye laser; alexandrite, diode, ruby laser). Based on the recommendations of the laser manufacturer on percutaneous vascular coagulation and modern theories about the pathogenesis of telangiectasias, an algorithm for treatment with a long-pulse laser with a wavelength of 1064 nm on a clinical example is proposed. By prescribing a course of treatment of vascular malformation by laser percutaneous coagulation, we expect to obtain the destruction of pathologically dilated vessels of the papillary and mesh layer of the dermis by gluing the walls of the vessels (preferably) or complete thrombosis of their lumen while maintaining the structures of the dermis and epidermis intact. Laser percutaneous vascular coagulation has demonstrated excellent treatment results in a short period of time, significantly reducing the number of pathologically altered vessels. The rehabilitation period after laser coagulation of blood vessels did not exceed 3 days and was manifested by moderate edema of soft tissues in the area of laser exposure, hyperemia and single petechial hemorrhages, which resolved themselves.&#x0D; Laser coagulation of skin telangiectsies is a highly effective method with a long-term clinical effect.

Coronary angiography causes Rumpel-Leede symptoms

BackgroundRumpel Leede sign (RLS) is a clinical presentation observed at the extremities due to pressure applied externally. The appearance ranges from scattered pin-point rashes to an entire arm covered with petechial hemorrhage depending upon the severity. This phenomenon is relatively uncommon in clinical practice.Case presentationA 64 year old female patient developed a rash in the normal skin area below the compression area on the second day of single catheter coronary angiography. The patient's rash resolved without treatment after 3 days.ConclusionsWe report a case of hypertension and hyperlipidemia with a petechial rash on the skin under the tourniquet compressed by the radial artery after coronary angiography, which is consistent with the Rumpel-Leede phenomenon. clinicians should be watchful of these symptoms.

Petechial hemorrhages, ethanol, and opioids in victims from intoxication

Petechial hemorrhages are of interest to forensic pathologists because of their association with pressure on the neck. This study shows the associations between ethanol, opioids in blood and the risk of petechiae in conjunctivae and eye lids of 865 medico-legally examined victims from intoxication, 112 (12.9 %) with petechiae. Livor mortis on the front, face down body position, higher body weight, and younger age of the victims were independently associated with higher risk of petechiae. These variables were used for adjustment in the logistic regression analyzes. We found associations between ethanol, opioids, and the risk of petechiae when analyzed simultaneously. The association between ethanol and the risk of petechiae differed in opioid negative and positive victims (interaction, p = 0.028). In the opioid negative group, the association was J-formed, victims with low to medium level ethanol having lower risk (OR = 0.77) than those without ethanol or opioids, whereas high ethanol level gave a 4-fold higher risk (OR = 3.97). In the opioid positive group, the J-formed pattern was reversed. Victims with low to medium level ethanol had more than 4 times higher risk (OR = 4.65), whereas high level ethanol gave a slightly elevated risk (OR = 1.34) only compared to no ethanol or opioids. The results suggest that ethanol and opioids have a complex association with the risk of petechiae independent of livor mortis, initial body position, body weight, and age in victims from intoxication. Of practical value for the post-mortem examination is that the pathologist must consider both the ethanol level and the presence of opioids when judging the significance of petechiae in the eye regions.

Novel Animal Model of Spontaneous Cerebral Petechial Hemorrhage Using Focused Ultrasound in Rats.

Background and Objectives: Petechial cerebral hemorrhages can be caused by various factors, such as traumas, cerebral infarctions, and aging, and is related to the disruption of the blood–brain barrier or the cellular damage of blood vessels. However, there is no animal model that recapitulates cerebral petechial hemorrhages. Materials and Methods: Here, we implemented a petechial hemorrhage using a novel technology, i.e., microbubble-assisted focused ultrasound (MB + FUS). Results: This method increases the permeability of the blood–brain barrier by directly applying mechanical force to the vascular endothelial cells through cavitation of the microbubbles. Microbubble-enhanced cavitation has the advantage of controlling the degree and location of petechial hemorrhages. Conclusions: We thus generated a preclinical rat model using noninvasive focal MB + FUS. This method is histologically similar to actual petechial hemorrhages of the brain and allows the achievement of a physiologically resembling petechial hemorrhage. In the future, this method shall be considered as a useful animal model for studying the pathophysiology and treatment of petechial cerebral hemorrhages.

A retrospective study on Schistosoma spindale infection in domestic ruminants, Andhra Pradesh, India.

The present study was undertaken to determine the prevalence of Schistosoma spindale infection in domestic ruminants in Krishna district, Andhra Pradesh by coprological and necropsy examination. Examination of 177 buffaloes, 283 sheep and 166 goats faecal samples (n = 626) revealed 2.25, 2.82 and 1.80% of S. spindale infection, respectively. Necropsy examination of 21 buffaloes, 185 sheep and 217 goats revealed 14.2, 1.08 and 3.68% of S. spindale infection, respectively. Overall, microscopic examination of faecal smears revealed 2.39% (n = 15) prevalence of S. spindale infection in ruminants in the study area, while 3.07% (n = 13) of ruminants were found to be positive for S. spindale during postmortem examination. Adult worms collected from the mesenteric veins were processed and identified as S. spindale. Grossly, the infected livers were found with petechial haemorrhages, cirrhotic changes and pinpoint granulomas in parenchymatous tissue. Histological sections of livers revealed microgranulomas with infiltration of mononuclears, eosinophils and fibroblast cells surrounding the Schistosome ova. The intestinal mucosa was thickened, edematous and haemorrhagic with copious mucous exudates. Cut section of infected intestines revealed severe inflammatory reactions in the mucosa and sub mucosa and granulomatous changes surrounding the Schistosoma eggs.

PB2097: ZANUBRUTINIB PLUS RITUXIMAB FOR THE TREATMENT OF ELDERLY UNFIT PATIENTS WITH PREVIOUSLY UNTREATED DIFFUSE LARGE-B CELL LYMPHOMA

Background: Diffuse Large B-cell lymphoma (DLBCL) is common in the elderly patients, Some elderly patients can not tolerate the standard dose of R-CHOP due to age, poor physical condition, and severe complications. The overall response rate of elderly unfit DLBCL patients who received a reduced dose R-CHOP regimen was only 60%. It is extremely important to explore new therapeutic options. Zanubrutinib is a Bruton tyrosine kinase (BTK) inhibitor which was still in an exploratory phase in patients with DLBCL.The efficacy of Zanubrutinib plus Rituximab in elderly unfit Patients with DLBCL is still unknown. Aims: This study was conducted to investigate the efficacy and safety of Zanubrutinib plus Rituximab in elderly unfit Patients With Previously Untreated Diffuse large-B cell Lymphoma in China. Methods: In the present study, a prospective, single-arm,single-center study was conducted (CHiCTR-2000039342). patients who fulfil the inclusion criteria were enrolled. Inclusion criteria: patients aged ≥65 years, pathologically confirmed DLBCL,and assessed unfit by Comprehensive Geriatric Assessment(IACA). Unfit patients defined as follows: i.e. IADL score ≤7, or age >75 years, or CCI score ≥3, or serum albumin <3.4 g/ml. Patients enrolled were planed to treat with Zanubrutinib combined with rituximab (Zanubrutinib 160 mg orally twice daily and rituximab 375 mg/m2 day1 iv, every 28 days, ZR regimen), for a total of eight courses. After induction therapy, maintenance treatment with Zanubrutinib 160mg orally twice daily was given until disease progression or unacceptable toxicity. Efficacy was evaluated by PET/CT or enhanced Computed Tomography scan every two months, treatment-related adverse effects were evaluated in every one month. This study was approved by the Ethics Committee of Beijing Hospital, National Center of Gerontology, Beijing, China. Results: From July 2020 to December 2021, a total of eight elderly unfit DLBCL patients were enrolled. one patient was 72 years old with IADL score of 6, CCI score of 4. the other seven patients were aged over 80 years. the most common comorbidities were cardiovascular disease, hypertension, diabetes.The female to male ratio was 6:2. four patients were classified as GCB pathological subtype, six patients were diagnosed with stage III-IV. At a median follow up of 8 months (2-19months). two patients achieved complete response(CR), and remained in CR at months 8. four patients achieved partial response(PR), with one patient disease progression(PFS 8 months), one patient achieved stable disease (SD) after 2 cycles and have disease progression after 4cycles, with a progression-free survival (PFS) of 4 months. one patient was refractory to treatment and withdrew after 2 cycles. One patients died due to disease progression, with overall survival(OS) of 11 months, ZR regimen was well-tolerated, with grade 2 urinary tract infections in 4/7 patients, grade 2 respiratory infections in 2/7, grade 1 Petechial hemorrhages in 3/7, grade 2 skin rash in 2/7, and grade 2 deep vein thrombosis in 1/7. No grade 4 or higher adverse events were observed. Seven patients had a dose reduction due to toxicity. The regular doses of Zanubrutinib can be tolerated was 160 mg qdA1-80mg qdP1. Two patients had discontinued Zanubrutinib due to adverse events for one to three weeks. Image:Summary/Conclusion: Zanubrutinib in combination with Rituximab may be a well-tolerated and effective regimen in elderly unfit DLBCL patients. Dose reduction may be required for some patients to improve tolerability. A large sample size clinical trial is needed to further validate this conclusion in the future.

Indicators of correct targeting in stereotactic biopsy of intracranial lesions.

Background: Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.Methods: Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.Results: Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.Conclusion: This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.