Severe Signs Research Articles

Brain invasion of bovine coronavirus: molecular analysis of bovine coronavirus infection in calves with severe pneumonia and neurological signs.

Although the role of bovine coronavirus (BCoV) in calf diarrhea and respiratory disorders is well documented, its contribution to neurological diseases is unclear. This study conducted virological investigations of calves showing diarrhea and respiratory and neurological signs. An outbreak of diarrhea, respiratory, and neurological disorders occurred among the 12 calves in July 2022 in Istanbul, Türkiye. Two of these calves exhibited neurological signs and died a few days after the appearance of symptoms. One of these calves was necropsied and analyzed using molecular and histopathological tests. BCoV RNA was detected in the brain, lung, spleen, liver, and intestine of the calf that had neurological signs by real-time reverse transcription polymerase chain reaction. Immunostaining was also observed in the intestine and brain. A 622 bp S1 gene product was noted on gel electrophoresis only in the brain. Phylogenetic analysis indicated that the BCoV detected in this study had a high proximity to the BCoV strain GIb with 99.19% nucleotide sequence homology to the strains detected in Poland, Israel, Türkiye, and France. No distinct genetic lineages were observed when the brain isolate was compared with the respiratory and enteric strains reported to GenBank. In addition, the highest identity (98,72%) was obtained with the HECV 4408 and L07748 strains of human coronaviruses. The strain detected in a calf brain belongs to the GIb-European lineage and shares high sequence homology with BCoV strains detected in Europe and Israel. In addition, the similarity between the human coronaviruses (4408 and L07748) raises questions about the zoonotic potential of the strains detected in this study.

FROM DERMATOMYOSITIS SINE DERMATITIS TO A COMPLETE FORM OF JUVENILE DERMATOMYOSITIS: AN INTRIGUING CASE REPORT!

Although rare, juveniledermatomyositis (JD) is the mostcommoninflammatorymyopathy in children. It is a vasculopathycategorizedintoclassical and non-classicalsubtypes, the latter includingamyopathicdermatomyositis (DM) and dermatomyositis (DM) withoutdermatitis. DM sine dermatitisis a rarelydescribedphenotype, representing an atypicalformwith no classiccutaneous manifestations, complicatingdiagnosis, and isthereforeidentified on the basis of well-defined diagnostic criteria.In this article, we report the case of a twelve-year-oldchildpresentingwith muscle weakness and myalgias one monthprior to admission. Clinicalexaminationrevealed a progressive myogenic syndrome withdysphagia to solids, with no other multi-visceralinvolvement or signs of severity. Mucocutaneousexaminationwaspoor, revealingonlyleukokeratosis of the leftlateralborder of the tongue, with no otherassociated skin signs. Muscle enzymes wereelevated. A myositis-specificautoantibodyassayrevealed a positive anti-NXP2. Electromyographyshowed a diffuse emyogenic syndrome. MRI of the lowerlimbsshowed diffuse hypersignal in the muscle tissue. A diagnosis of dermatomyositis sine dermatitiswas made, and treatmentwasinitiatedwith oral prednisone 2 mg/kg/day, combinedwithsubcutaneous Methotrexate 25 mg/week. In the absenceimprovementafter 5 months of treatment, weswitched to mycophenolatemofetil (MMF) at a dose of 600 mg/m² twicedaily, with good progression.Afterlosinghissight and stoppingtreatment for a long time, the patient returnedaftertwoyearswith a full clinicalpicture of juveniledermatomyositis, withsevere muscle weakness and skin signs. This time, given the severity of the disease, ourtherapeuticapproachwas to switch to third-line treatmentwithinfliximab 5 mg/kg biotherapyadministered at specificintervals, with good improvement.

Molecular Characterization of Newcastle Disease Virus Genotype VII.1.1 from Egyptian Mallard Ducks with Nervous Manifestations

In Egypt, Newcastle disease virus (NDV) strains of genotype VII are known to be mild in domestic waterfowl and considered reservoirs. This is the first report for the detection of NDV GVII.1.1 from ducks showing severe clinical signs with high mortalities and nervous manifestations, additionally, isolation of NDV and molecular characterization for full HN and F genes were performed. In the current study, 16 backyard mallard duck flocks showing severe nervous signs with high mortalities were investigated by real-time RT-PCR using primers specific for the Fusion gene of NDV and matrix gene for avian influenza virus (AIV). Fourteen duck flocks tested positive for AIV and only two flocks tested positive for NDV infection. NDV was isolated from the trachea and brain of the same duck from each flock then full HN and F genes were sequenced. The phylogenetic analysis of the F and HN genes indicated that these strains were clustered with NDV genotype VII 1.1. The F gene had a specific mutation that cluster them in a new branch with with A11T in the signal peptide, N30S, T324A, and 480K in the hydrophobic heptad repeat (HRc) compared to the Lasota strain. The duck strains of NDV isolated from the brain had N294K in the hydrophobic heptad repeat-b (HRb) of F protein compared to the strains isolated from the trachea of the same duck, which may have a role in crossing the blood-brain barrier. The HN protein had a specific mutation that clustered them in a new branch with mutations of A4V, R15K in the cytoplasmic region, A28T in the transmembrane domain, and S76L in the HRa. In addition, HN protein had A50T, S54R T232N, P392S, and T443V, and multiple mutations were detected in the neutralizing epitopes specific to strains in the present study (N120G, K284R, S521T) that can alter virus antigenicity. The current study indicated the continuous evolution of NDV strains from genotype VII circulating in Egypt with increasing pathogenicity in ducks. The present findings demonstrated the urgent need for the vaccination of ducks and geese with killed NDV vaccines to reduce economic losses due to virus infection and prevent transmission to chickens helping in ND control in Egypt.

Identification, Genetic Characterization, and Pathogenicity of Three Feline Herpesvirus Type 1 Isolates from Domestic Cats in China.

(1) Background: Feline herpesvirus (FHV-1) is a significant pathogen in cats, causing respiratory and ocular diseases with consequential economic and welfare implications. (2) Methods: This study aimed to isolate and characterize FHV-1 from clinical samples and assess its pathogenicity. We collected 35 nasal and ocular swabs from cats showing symptoms of upper respiratory tract infection and FHV positivity detected by polymerase chain reaction (PCR). Viral isolation was carried out using feline kidney (F81) cell lines. Confirmation of FHV-1 presence was achieved through PCR detection, sequencing, electron microscopy, and indirect immunofluorescence assay. The isolated strains were further characterized by evaluating their titers, growth kinetics, and genetic characteristics. Additionally, we assessed the pathogenicity of the isolated strains in a feline model, monitoring clinical signs, viral shedding, and histopathological changes. (3) Results: Three strains of FHV-1 were isolated, purified, and identified. The isolated FHV-1 strains exhibited high homology among themselves and with domestic isolates and FHV-1 viruses from around the world. However, they showed varying degrees of virulence, with one strain (FHV-A1) causing severe clinical signs and histopathological lesions. (4) Conclusion: This study advances our understanding of the genetic and pathogenic characteristics of FHV-1 in China. These findings underscore FHV-A1 isolate as a potentially ideal candidate for establishing a challenge model and as a potential vaccine strain for vaccine development.

Neuropsychological profile of a patient with multiple sclerosis and psychiatric symptoms that masked and delayed the diagnosis. A case report using teleneuropsychology

Objective: Multiple sclerosis (MS) may include not only severe neurological signs and symptoms, but also cognitive and psychiatric disturbances. When psychiatric symptoms precede or are comorbid with MS, it poses a clinical challenge, because it may lead to a mistaken diagnosis of MS as a psychiatric disorder, delaying proper treatment. We describe the neuropsychological profile of a female patient with MS whose diagnosis was delayed due to neuropsychiatric symptoms. Method: A comprehensive analysis of the medical history and the results of a teleneuropsychological assessment of a 36-year-old Mexican woman with a diagnosis of relapsing–­remitting MS (RRMS) was performed. Results: The patient indicates a long history of psychotic, anxious, and depressive features years before the first neurological symptom that led to MS going unnoticed for several years. Language, attentional, perceptual, motor, and learning skills were found to be preserved. Short-term memory and spatial orientation problems were identified, with decreased processing speed and executive dysfunction, including working memory and planning deficits. Conclusions: The patient has a non-typical presentation of neuropsychological alterations with cognitive and behavioral symptoms that resemble dorsolateral frontal lobe syndrome. This case study highlights the importance of considering MS in differential diagnosis of patients with psychiatric symptoms, even in the absence of obvious neurological signs.

New coronavirus infection SARS-CoV-2 in adult patients with inborn errors of immunity

BACKGROUND: Diagnosis and treatment of COVID-19 in patients with primary immunodeficiency, or inborn errors of immunity, are often challenging. AIM: Description of the COVID-19 course and therapy of adult patients with primary immunodeficiency treated in medical organizations of Moscow Healthcare Department. MATERIALS AND METHODS: We analyzed a cohort of 68 patients over 18 years (median ― 35 years) with primary immunodeficiency; 91% of patients have primary immunodeficiency with predominantly antibody deficiencies. Altogether 90 cases of the new СOVID-19 were analyzed: in 68 cases infection occurred for the first time, in 22 cases it recurred. The duration of the disease ranged from 3 to 80 days. Duration of PCR-positivity ranged from 0 to 59 days, median 8 days. RESULTS: Patients with Wuhan and Delta strains had more severe inflammatory signs according to C-reactive protein and lactate dehydrogenase, in patients with Wuhan lung involvement on CT-scam was larger. In demonstrated group of patients higher C-reactive protein correlated with larger lung involvement, longer duration of the disease and PCR-positivity, significant lymphopenia also correlated with higher C-reactive protein. To our data regularity of intravenous immunoglobulin therapy and IgG trough level didn’t correlate with infection severity and duration of the disease and virus-carriage. Indirectly, the change in the spectrum of medicine used in patients of the analyzed group coincided with the virus strain evolution. Anti-inflammatory therapy was mainly presented by dexamethasone and antagonists to interleukin 6 or its receptor (anti-IL-6): 55% and 73% for Wuhan, 63% and 50% for Delta, 17% and 39% for Omicron. Then, preference was gradually given to the target anti-cytokine medicine. Etiotropic antiviral therapy was more often used to treat infection caused by Wuhan and Delta strains ― 32% and 38%, respectively (in 17% for Omicron). With shifting toward immunotherapy by specific against COVID-19 immunoglobulins and monoclonal antibody to SARS-CoV-2: 5% and 9% for Wuhan, 0% and 75% for Delta, 48% and 83% for Omicron, respectively. Immune and etiotropic therapy was not carried out in Wuhan in 39%, in Delta in 43%, in Omicron in 41% of cases. The overall mortality rate from COVID-19 in the analyzed group was 3%. CONCLUSION: Patients with primary immunodeficiency represent a vulnerable group to the SARS-CoV-2 virus with a high risk of not only severe, but also a protracted and undulating course of infection, what must be taken into account for the correct interpretation of the patient's condition and the timely administration of the appropriate therapy.

Potential pandemic risk of circulating swine H1N2 influenza viruses

Influenza A viruses in swine have considerable genetic diversity and continue to pose a pandemic threat to humans due to a potential lack of population level immunity. Here we describe a pipeline to characterize and triage influenza viruses for their pandemic risk and examine the pandemic potential of two widespread swine origin viruses. Our analysis reveals that a panel of human sera collected from healthy adults in 2020 has no cross-reactive neutralizing antibodies against a α-H1 clade strain (α-swH1N2) but do against a γ-H1 clade strain. The α-swH1N2 virus replicates efficiently in human airway cultures and exhibits phenotypic signatures similar to the human H1N1 pandemic strain from 2009 (H1N1pdm09). Furthermore, α-swH1N2 is capable of efficient airborne transmission to both naïve ferrets and ferrets with prior seasonal influenza immunity. Ferrets with H1N1pdm09 pre-existing immunity show reduced α-swH1N2 viral shedding and less severe disease signs. Despite this, H1N1pdm09-immune ferrets that became infected via the air can still onward transmit α-swH1N2 with an efficiency of 50%. These results indicate that this α-swH1N2 strain has a higher pandemic potential, but a moderate level of impact since there is reduced replication fitness and pathology in animals with prior immunity.

Zuclopenthixol decanoate toxicity in an 8‐month‐old colt causing extrapyramidal neurological signs

SummaryZuclopenthixol decanoate is a dopamine antagonist licensed for human use to manage schizophrenia and paranoid psychosis. It is in the same drug class (thioxanthene) as fluphenazine decanoate, a drug whose use in horses is reported anecdotally for providing long‐acting sedation. This case study describes severe extrapyramidal signs seen in a Thoroughbred colt after zuclopenthixol decanoate administration. The colt was presented to a referral hospital for an unusual manifestation of colic signs. On admission, the colt began to show clear extrapyramidal neurological signs. The initial suspicion was of fluphenazine decanoate toxicity, which in the limited published literature is treated with intravenous formulations of diphenhydramine hydrochloride and benztropine mesylate. At the time of writing both were unavailable in the United Kingdom without an import license. The closest alternative option, oral diphenhydramine was administered alongside intravenous atropine and pergolide. Improvements in the colt's demeanour and neurological status was noted within 24 h. The colt was hospitalised for a total of 26 days and at time of discharge was clinically normal. Follow‐up communication 3 months after discharge confirmed that the colt had remained neurologically normal. Crucially, toxicology testing submitted to Cornell University was negative for common toxins, including fluphenazine decanoate. Specific secondary testing was performed after suspicion the administration of zuclopenthixol decanoate was raised, which was positive for this compound. Routine drug testing would, therefore, not identify the use of this behaviour modifying drug. Clinical data regarding the use of zuclopenthixol in animals is limited to its use in the translocation of wildlife to relieve stress and aid acclimatisation. To our knowledge, there is no available literature describing the administration of zuclopenthixol decanoate in equine patients.

Brucellosis (Malta Fever) In Pregnancy and Childbirth: A Case Report

Background: Brucellosis is a multi-organ infectious disease that can affect people of all ages. Systemic symptoms of brucellosis include back pain, headache, fatigue, weakness, general body pain, fever and chills, anorexia, muscle pain, sweating, weight loss, joint pain, cough, neurological symptoms, abdominal pain, diarrhea, and constipation. In this report, the case of a pregnant woman suffering from Malta fever with severe signs that she could not walk is reported. Case Presentation: In this paper, the case of a 28-year-old G3P2 female patient (third pregnancy, two normal deliveries) with 37 weeks of pregnancy and a history of brucellosis in the last two months, being under painkiller treatment, and who has been unable to walk (sacroiliitis) for two weeks, has been reported. Previously, treatment with gentamicin 2 times a day for 6 days was started, and in May 2022, the patient was admitted to Imam Reza Hospital in Mashhad by ambulance. After consultation with an infectious disease specialist, the patient received gentamicin IV QID at a dose of 5 mg/kg, ceftriaxone BID at a dose of 1 mg and IV, and rifampin QID at a dose of 600 mg and PO. She was subjected to CBC differential test twice a week, and BUN and CR assessments were performed every other day. She has received acetaminophen 500 mg PO and Q 6 hrs in the hospital during hospitalization. Radiography of the pelvis was done to check the bilateral sacroiliac joint; it has been found to be normal and no evidence of joint effusion has been seen. After a week of hospitalization and observation in the hospital, vaginal delivery was performed without any problems and she gave birth to a baby boy with an Apgar score of 9-10. Conclusion: Clinical manifestations of brucellosis in pregnant women are weakness, arthralgia, fever, fatigue, excessive night sweats, anorexia, muscle pain, chills, depression, weight loss, headache, and back pain. The most common symptoms are fever, hepatomegaly, spleen involvement, joint complications, and obstetric symptoms, including vaginal bleeding, postpartum endometritis, pelvic or groin pain, premature rupture of membranes, and chorioamnionitis. Rifampicin and trimethoprim- sulfamethoxazole for 6 to 8 weeks constitute the most common and recommended treatment.

Assessment of volume status of pediatric hemodialysis patients.

Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy. A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis. A total 60 children (mean age 9.4 ± 2.8years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive. Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.

Epidemiology of sarcoptic mange in a geographically constrained insular red fox population

Background Sarcoptic mange is a skin disease caused by the contagious ectoparasite Sarcoptes scabiei, capable of suppressing and extirpating wild canid populations. Starting in 2015, we observed a multi-year epizootic of sarcoptic mange affecting a red fox (Vulpes vulpes) population on Fire Island, NY, USA. We explored the ecological factors that contributed to the spread of sarcoptic mange and characterized the epizootic in a landscape where red foxes are geographically constrained.MethodsWe tested for the presence of S. scabiei DNA in skin samples collected from deceased red foxes with lesions visibly consistent with sarcoptic mange disease. We deployed 96–100 remote trail camera stations each year to capture red fox occurrences and used generalized linear mixed-effects models to assess the affects of red fox ecology, human and other wildlife activity, and island geography on the frequency of detecting diseased red foxes. We rated the extent of visual lesions in diseased individuals and mapped the severity and variability of the sarcoptic mange disease.ResultsSkin samples that we analyzed demonstrated 99.8% similarity to S. scabiei sequences in GenBank. Our top-ranked model (weight = 0.94) showed that diseased red foxes were detected more frequently close to roadways, close to territories of other diseased red foxes, away from human shelters, and in areas with more mammal activity. There was no evidence that detection rates in humans and their dogs or distance to the nearest red fox den explained the detection rates of diseased red foxes. Although detected infrequently, we observed the most severe signs of sarcoptic mange at the periphery of residential villages. The spread of visual signs of the disease was approximately 7.3 ha/week in 2015 and 12.1 ha/week in 2017.ConclusionsWe quantified two separate outbreaks of sarcoptic mange disease that occurred > 40 km apart and were separated by a year. Sarcoptic mange revealed an unfettered spread across the red fox population. The transmission of S. scabiei mites in this system was likely driven by red fox behaviors and contact between individuals, in line with previous studies. Sarcoptic mange is likely an important contributor to red fox population dynamics within barrier island systems.Graphical

Effects of Adding Graphite to Epoxy Resin on its Mechanical Properties and Mild-to-Severe Wear Performance at its Heat Distortion Temperature

In this study, epoxy/graphite composites were fabricated based on different weight fractions (0, 3, 6, and 9 wt.%) of graphite powder for bearing applications. The mechanical and tribological properties were assessed. Adhesive wear tests covered the severe regions, where the interface temperature (IFT) exceeded the heat distortion temperature (HDT) of the epoxy. Graphite additions improved elastic modulus and hardness but decreased fracture strain and toughness of the composites. The tribological behaviors in the mild wear region were improved as the graphite content increased. In the mild wear region, the increase in graphite additions showed a good improvement by reducing the specific wear rate (SWR) and coefficient of friction (COF). In the severe wear region, the neat epoxy and higher graphite concentrations exhibited a dramatic increase in SWR, whereas the lowest addition of 3 wt.% exhibited good wear performance. For epoxy, the reason was that IFT exceeded its HDT, while the aggregation of graphite particles was the main reason in the case of higher graphite concentrations. SEM examinations showed severe wear signs—high ploughing and fracture—when IFT exceeded the HDT. However, by reducing the IFT, graphite additions did not show such severe wear features due to the accelerated heat dissipation.

Ascitis en el paciente no cirrótico

Ascites, defined as the abnormal accumulation of fluid in the peritoneal cavity, is mainly due to cirrhosis and portal hypertension (PHT). However, in 20% of cases, it is not related to these diseases. Given its varied etiology, it is essential to study it in order to determine therapeutic management. The pathophysiology of non-cirrhotic ascites is not usually related to cirrhosis-associated PHT, and understanding these mechanisms facilitates the etiologic diagnosis. Symptoms include abdominal distension, weight gain, postprandial fullness, and even dyspnea. The physical examination may be normal in cases of very mild ascites. An increase in abdominal circumference may be identified in more advanced or severe cases and signs associated with the underlying disease may also appear. The International Club of Ascites classification categorizes it according to the amount and abdominal distension. The initial evaluation includes a medical history, physical examination, abdominal ultrasound, and ascitic fluid analysis. Diagnostic paracentesis is crucial for identifying the cause, analyzing characteristics of the fluid such as its appearance and content, especially the protein concentration and the serum ascites albumin gradient, which will allow differentiating the different causes. In Western countries, the most frequent causes are tumor and heart diseases while in developing countries, infectious diseases, especially tuberculosis, are the most prevalent.

An Attenuated Vaccine Virus of the Neethling Lineage Protects Cattle against the Virulent Recombinant Vaccine-like Isolate of the Lumpy Skin Disease Virus Belonging to the Currently Established Cluster 2.5.

Lumpy skin disease (LSD) is an emerging transboundary and highly infectious viral disease mainly affecting cattle. The fact that it was initially confined to Africa and then spread beyond its geographical range to other regions, including the Middle East, Turkey, Europe, the Balkans, Russia and Asia, is an indication of the underestimation and neglect of this disease. Vaccination is considered the most effective way to control the spread of LSDV, when combined with other control measures. LSD is now on the rise in Southeast Asia, where the circulating virus belongs to recombinant lineage 2.5. In this study, we evaluated the efficacy of an attenuated LSDV strain belonging to the Neethling cluster 1.1 by challenge with a virulent recombinant vaccine-like LSDV isolate "Mongolia/2021" belonging to cluster 2.5. Some of the vaccinated animals showed an increase in body temperature of 1-1.5 °C above the physiological norm, without clinical signs, local reactions, vaccine-induced viremia or generalization, demonstrating the efficacy and safety of the vaccine strain against a recombinant strain. Furthermore, all the vaccinated animals showed strong immune responses, indicating a high level of immunogenicity. However, the control group challenged with "Mongolia/2021" LSD showed moderate to severe clinical signs seen in an outbreak, with high levels of virus shedding in blood samples and nasal swabs. Overall, the results of the present study demonstrate that the attenuated LSDV Neethling strain vaccine has a promising protective phenotype against the circulating strains, suggesting its potential as an effective tool for the containment and control of LSD in affected countries from Southeast Asia.

Diagnostic Approach to Equine Testicular Disorders.

Management of breeding stallions is crucial to equine reproduction. The longevity of the breeding career is the ultimate objective, whether the stallion is used for natural cover or for semen collection and artificial insemination. Stud farm veterinarians should be aware of the techniques used to evaluate testicular function and the diagnostic approach to testicular disorders in cases of emergency. This paper presents the clinical methods used to evaluate testicular health, including palpation, ultrasonography, biopsy, and fine-needle aspiration. The discussion of testicular disorders is broken down into four categories: congenital disorders (cryptorchidism, monorchidism, and testicular hypoplasia), differential diagnosis of scrotal enlargement, differential diagnosis of causes of progressive testicular enlargement, and differential diagnosis of testicular asymmetry or reduction in size with an emphasis on testicular degeneration. The sudden increase in testicular size is often accompanied by severe clinical signs and is a major cause for referral of stallion for surgery. Testicular disorders are illustrated with clinical cases seen by the authors.

Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus.

To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT). This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery. All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (P < 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups. Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.

Impact of the Introduction of Artesunate on the Management of Severe Malaria in Casamance (Senegal): A Comparative Analysis of Data From 2016 and 2020

Background: the implementation of different control strategies, including the treatment of severe forms with injectable artesunate, has made it possible to significantly reduce malaria in Senegal. Despite everything, malaria remains a concern in Senegal, especially in the southern regions, hence the interest in studying these characteristics and their evolution over time. Objectives: describe the epidemiological, clinical and evolving aspects of severe malaria before and after implementation of artesunate treatment. Patients and methods: retrospective, cross-sectional, descriptive and analytical study focusing on cases of severe malaria admitted in two health structures in the Vélingara district in 2016 and 2020. The severity of diagnosis was made based on the current criteria of the WHO and confirmation made by thick blood smear and/or HRP2 rapid diagnostic test. The data was entered into Excel and analyzed with Epi-info version 7.2.6. Results: In 2016, 357 cases of serious malaria were recorded from January 1st to December 31st, with 75.6% in October and December. The average age is 16.2 ± 12.9 years, with a predominance of the age group 6-15 years (38,94%). There was a male predominance and the sex ratio was 1.01. Coma (57%), convulsions (34%) and jaundice (14%) were the most common signs of severity. Under treatment with quinine salts (97%) and artemether (3%), the lethality was 5%. Factors significantly associated with death were rural origin (p:0.009), coma (p:0.000), hepatomegaly (p:0.03) and diffuse hemorrhages (p:0.03). In 2020, 456 cases were collected from July 1st to December 31st, with 75.44% in October and November. The average age was 15.38±15.36 years (1 to 85 years) with a predominance of age group 6 to 15 years (46.49%). There was a male predominance and the sex ratio was 1.06. The signs of severity were dominated by prostration (52.63%), repeated convulsions (17.11%), coma (7.9%) and jaundice (7.2%). All patients were treated with injectable artesunate with a lethality of 3.5%. Death was significantly associated with coma (p:0.000) and the occurrence of respiratory failure (p:0.000). Conclusion: severe malaria remained a childhood pathology with neurological manifestations predominating in Vellingara. A drop in lethality is observed with the generalization of artesunate-based treatment.

Impact of fucosyltransferase 1-mediated epidermal blood group antigen H on anti-inflammatory response in atopic dermatitis.

The presence of the blood group H2 antigen on the membrane of red blood cells determines blood type O in individuals and this H2 antigen serves as a precursor to the A and B antigens expressed in blood types A and B, respectively. However, the specific involvement of ABH antigens in skin diseases is unknown. Therefore, we aim to investigate the expression of ABH antigens in skin tissue of patients with atopic dermatitis (AD) and MC903-induced AD-like mice. We demonstrated that the expression of ABH antigen is primarily located in the granular and horny layers of the skin in healthy control individuals. However, in patients with AD, the expression of the ABH antigen was absent or diminished in these layers, while the H2 antigen expression increased in the spinous layers of the affected skin lesions. Then, we investigated the biological function of blood group H antigen mediated by fucosyltransferase 1 (Fut1) in the skin, utilizing an AD mouse model induced by MC903 in wild-type (WT) and Fut1-knockout mice. After the application of MC903, Fut1-deficient mice, with no H2 antigen expression on their skin, exhibited more severe clinical signs, increased ear swelling, and elevated serum IgE levels compared with those of WT mice. Additionally, the MC903-induced thickening of both the epidermis and dermis was more pronounced in Fut1-deficient mice than that in WT mice. Furthermore, Fut1-deficient mice showed a significantly higher production of interleukin-4 (IL-4) and IL-6 in skin lesions compared with that of their WT counterparts. The expression of chemokines, particularly Ccl2 and Ccl8, was notably higher in Fut1-deficient mice compared with those of WT mice. The infiltration of CD4+ T cells, eosinophils, and mast cells into the lesional skin was significantly elevated in Fut1-deficient mice compared with that in WT mice. These findings demonstrate the protective role of H2 antigen expression against AD-like inflammation and highlight its potential therapeutic impact on AD through the regulation of blood group antigens.

Pathological and phylogenetic characteristics of fowl AOAV-1 and H5 isolated from naturally infected Meleagris Gallopavo

BackgroundIn this study, we investigated the prevalence of respiratory viruses in four Hybrid Converter Turkey (Meleagris gallopavo) farms in Egypt. The infected birds displayed severe respiratory signs, accompanied by high mortality rates, suggesting viral infections. Five representative samples from each farm were pooled and tested for H5 & H9 subtypes of avian influenza viruses (AIVs), Avian Orthoavulavirus-1 (AOAV-1), and turkey rhinotracheitis (TRT) using real-time RT-PCR and conventional RT-PCR. Representative tissue samples from positive cases were subjected to histopathology and immunohistochemistry (IHC).ResultsThe PCR techniques confirmed the presence of AOAV-1 and H5 AIV genes, while none of the tested samples were positive for H9 or TRT. Microscopic examination of tissue samples revealed congestion and hemorrhage in the lungs, liver, and intestines with leukocytic infiltration. IHC revealed viral antigens in the lungs, liver, and intestines. Phylogenetic analysis revealed that H5 HA belonged to 2.3.4.4b H5 sublineage and AOAV-1 belonged to VII 1.1 genotype.ConclusionsThe study highlights the need for proper monitoring of hybrid converter breeds for viral diseases, and the importance of vaccination programs to prevent unnecessary losses. To our knowledge, this is the first study that reports the isolation of AOAV-1 and H5Nx viruses from Hybrid Converter Turkeys in Egypt.

A CASE OF RIGHT HEART FAILURE: WHEN IT IS NOT PULMONARY EMBOLISM

Abstract A 66–year–old patient, showing exertional dyspnea and atypical chest pain, came to our attention with instrumental findings at echocardiogram of right ventricular failure and was hospitalized due to worsening signs and symptoms of right heart failure. Signs of right ventricular strain and the McGinn–White sign (S1Q3T3 pattern) were seen on the ECG, leading to the suspicion of pulmonary thromboembolism (PE). Pulmonary CT angiography confirmed bilateral PE involving the main pulmonary artery. Oral anticoagulant therapy was initiated with initial partial benefit and relief of symptoms. However, after four weeks, the patient was readmitted for severe heart failure and signs of low cardiac output. Echocardiography showed the presence of a conspicuous, mobile, isoechoic mass occupying most of the main pulmonary artery, suggesting thrombosis. The patient underwent urgent surgical thromboendoarterectomy extended to the third segmental left branches and to the second segmental right branches of the pulmonary artery; a severe pulmonary valve regurgitation was observed and therefore the valve was replaced with a Edwards–Magna pericardial bioprosthetic valve. ECMO (Extracorporeal Membrane Oxygenation) was initiated due to haemodinac instability. In the postoperative period, the severe heart failure worsened, unresponsive to pharmacological treatments and mechanical support, leading to the patient passing away in the following days. Unexpectedly, histological analysis of the surgical specimen revealed neoplastic cells with vascular/endothelial differentiation; fluorescence in situ hybridization (FISH) detected the MDM2 gene (cfr.23–F–00275), involved in the p53 protein regulation mechanisms, which is consistent with a diagnosis of angiosarcoma. Pulmonary–artery angiosarcomas are extremely rare (few anecdotical cases are described in literature) and resemble the CT–signs and clinical features of PE, seriously delaying the diagnosis. They are usually associated with a worse prognosis than PE, one and a half months survival time when inoperable. Radical surgery, associated with thirty six and a half months survival time, is often unfeasible because of locally advanced disease or metastatic disease already present at diagnosis. The main differences with PE are the more proximal and almost–occluding involvement of the pulmonary artery, the absence of peripheral vein thrombosis and the absence of response to anticoagulant therapy.