Clinical Signs Research Articles

Evaluation of early and systematic ultrasound examination to determine postoperative dehiscence after small intestinal surgery (114 cases in dogs and cats).

To evaluate the feasibility and reliability of early ultrasound diagnosis for postsurgical bowel dehiscence and find the most reliable ultrasound criteria for dehiscence identification. Additionally, to determine the impact of early ultrasound detection of leakage in terms of survival and duration of hospitalization. Finally, to assess the need for systematized screening or checkup of the population at risk of dehiscence only. 31 cats and 83 dogs. A retrospective, records-based study was performed on 83 dogs and 31 cats (114 total) undergoing small intestinal surgery. Epidemiologic data, clinical signs, surgical procedures, pre- and postoperative ultrasound findings at 48 to 96 hours, hospitalization duration, complications, and general outcomes were recorded. Univariate and multivariate analyses were used to identify ultrasound findings associated with dehiscence. Dehiscence was suspected by ultrasound for 0 of 31 cats and 7 of 83 dogs (2 of 49 for enterotomy and 5 of 34 for enterectomy). Every suspected dehiscence was confirmed during revision surgery except one enterectomy revision, which was declined by the owner. Neither this case nor those without ultrasound evidence of dehiscence developed clinical signs of intestinal leakage. Direct visibility of wall discontinuity, presence of gas bubbles, and liquid in vicinity of the intestinal surgical site were statistically associated with early dehiscence. Survival rate after the second surgery was 83%. Median hospitalization time after the second surgery for dehiscence was 2 days (minimum, 2 days; maximum, 4 days). Postoperative ultrasound examination between 48 and 96 hours after intestinal surgery allows early and sensitive detection of intestinal dehiscence. Survival rate after revision surgery was significantly higher than that associated with septic peritonitis.

Conservative management of canine cleft palate can be a viable treatment option: 65 cases (2006-2023).

To evaluate nonsurgical management outcomes of cleft palate (CP) in dogs and identify any association between cleft size, prevalence of clinical signs, and quality of life (QoL). 65 dogs treated conservatively for CP from January 2006 through December 2023 were retrospectively identified. Diet, activity, medical history, and QoL were recorded for dogs that survived to the transition to solid food. Results were compared to those from 24 control dogs. Measurements of cleft area, width, and percentage of the hard palate occupied by the cleft were made with the use of calibrated photographs. Clefts were divided into 3 types: wide throughout, wide rostrally, and slit throughout. Sneezing was the most frequent clinical sign (43 of 65 over the past month, 34 of 65 when most affected). There was a greater frequency of material lodging in the cleft in the wide-throughout clefts (13 of 16 dogs) compared to the slit-throughout clefts (7 of 19 dogs). Veterinary removal of material was required in 10 of 68 episodes (7 of 31 dogs). There was no correlation between cleft size and prevalence of clinical signs or QoL. Sixty-three percent of dogs had a perfect QoL on a weighted scale, while 83.3% had a perfect score on a visual analog scale. Sixty-four of 65 owners would adopt another dog with a CP. Measures of QoL were favorable among dogs treated conservatively for CP. Conservative management appears to be a viable option for treatment of CPs in some dogs.

A case of diffuse hepatocellular carcinoma

A clinical case of a diffuse form of hepatocellular carcinoma is described in the article. The results of laboratory and instrumental examination carried out in the hospital were analyzed. The results of examination using computer tomography, ultrasound diagnostics and laboratory tests, as well as the difficulties to differentiate a tumor from other diseases are presented. Diagnosis of diffuse hepatocellular carcinoma is challenging in clinical practice due to the lack of specific clinical and biochemical signs, unconclusive imaging findings, and rapid progression. Without treatment, the life expectancy of patients is limited to eight months.

Assessing older adult physical activity levels in clinical settings: The modified PAVS for older adults.

Participating in recommended levels of physical activity (PA) is critical for preventing functional decline, falls, and frailty, making it essential to identify older adults not meeting national PA guidelines. However, guidance on assessing older adult PA levels, particularly in clinical settings, is lacking. This article presents an overview of clinically feasible PA assessment tools for older adults, identifies gaps in current tools, and provides recommendations on addressing these gaps. We conducted a literature review on clinically feasible PA assessment tools, suggested modifications to an existing PA assessment for older adult patients, and highlighted opportunities for integrating the modified PA assessment tool in clinical settings. We identified 16 PA assessment tools used in clinical settings. The most widely used tool is the Physical Activity Vital Sign (PAVS), which has been successfully integrated into several electronic health records (EHR) and clinical practices. Most tools, including the PAVS, primarily focus on aerobic activities, with limited consideration for strength and balance. We recommend the use of a Modified PAVS for Older Adults that includes items on muscle-strengthening and balance activities to better align with national PA guidelines. We then identified several existing opportunities for broad implementation of the Modified PAVS for Older Adults within clinical settings. Widespread integration of the Modified PAVS for Older Adults will better support healthcare providers in identifying individuals not meeting national PA recommendations, assisting them in prescribing tailored PA prescriptions and better connecting their patients to appropriate resources and professionals for further support.

Cystine urolithiasis-free duration after first occurrence and treatment is longer for castrated dogs than for sexually intact male dogs.

To evaluate outcome in 60 dogs with cystine urolithiasis treated with surgical removal with and without castration and postoperative therapeutic diet to determine frequency of recurrence and urolith-free duration. Patient records were reviewed for dogs with documented cystine urolithiasis from September 2010 to December 2020. Medical records, client interviews, and referring veterinarians were contacted to document the absence of clinical signs associated with subsequent urolith formation and to evaluate risk factors for urolith reoccurrence. 80 patients were identified with cystine uroliths, with 60 qualifying for inclusion in the study. Seven dogs were neutered prior to surgery, and 25 dogs were neutered at the time of the first surgery. Recurrence occurred in 20 dogs; 17 of those patients were intact (85%) at the time of recurrent urinary signs. Of the 20 dogs with recurrence, 50% (10 of 20) were being treated with dietary modifications. The risk of recurrence among neutered pets was 23% versus 47% for intact pets, but this difference was not statistically significant; however, neutered pets had a longer urolithiasis-free duration. There was no statistically significant difference in risk of recurrence and urolith-free duration between pets with and without therapeutic diet management, (30% vs 32.5%) respectively. Multivariant analysis showed no significant interaction between surgical intervention with therapeutic diet, with nonsignificant hazard ratios (HRs) for neuter status (HR = 0.503), diet (HR = 1.056), and their interaction (HR = 4.32 to 9). Sexually intact (vs castrated) male dogs should be monitored more closely for recurrence of surgical cystine urolithiasis.

Case report: Combination technique of balloon dilation, membrane excision, and topical mitomycin C for the treatment of nasopharyngeal stenosis in a cat

A two-year-old neutered male Turkish Angora cat presented with respiratory signs, including chronic snoring sounds and dyspnea with open-mouth breathing. Nasopharyngeal stenosis (NPS) was diagnosed based on endoscopy and computed tomography (CT). An attempt was made to break down the membrane, causing stenosis in the nasopharynx through balloon dilation using a valvuloplasty balloon dilation catheter (12 mm × 3 cm) and retroflexed endoscope. The balloon size was selected according to the identified diameter of the stenotic site on nasopharyngeal CT images. The balloon was inflated with radiographic contrast medium and maintained for 2 min; the similar procedure was repeated four additional times. The stenotic membrane was excised after balloon dilation. Topical Mitomycin C (MMC) was then administered to the stenotic region. After 2 weeks, an additional MMC application was repeated to prevent recurrence. The cat remained free of clinical signs without recurrence for 12 months after the most recent procedure. In this study, effective treatment results were obtained using a combination of balloon dilation, membrane excision, and topical MMC for membranous nasopharyngeal stenosis in a cat.

Inhibition of poly(ADP-Ribosyl)ation reduced vascular smooth muscle cells loss and improves aortic disease in a mouse model of human accelerated aging syndrome

Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare genetic disorder associated with features of accelerated aging. HGPS is an autosomal dominant disease caused by a de novo mutation of LMNA gene, encoding A-type lamins, resulting in the truncated form of pre-lamin A called progerin. While asymptomatic at birth, patients develop symptoms within the first year of life when they begin to display accelerated aging and suffer from growth retardation, and severe cardiovascular complications including loss of vascular smooth muscle cells (VSMCs). Recent works reported the loss of VSMCs as a major factor triggering atherosclerosis in HGPS. Here, we investigated the mechanisms by which progerin expression leads to massive VSMCs loss. Using aorta tissue and primary cultures of murine VSMCs from a mouse model of HGPS, we showed increased VSMCs death associated with increased poly(ADP-Ribosyl)ation. Poly(ADP-Ribosyl)ation is recognized as a post-translational protein modification that coordinates the repair at DNA damage sites. Poly-ADP-ribose polymerase (PARP) catalyzes protein poly(ADP-Ribosyl)ation by utilizing nicotinamide adenine dinucleotide (NAD+). Our results provided the first demonstration linking progerin accumulation, augmented poly(ADP-Ribosyl)ation and decreased nicotinamide adenine dinucleotide (NAD+) level in VSMCs. Using high-throughput screening on VSMCs differentiated from iPSCs from HGPS patients, we identified a new compound, trifluridine able to increase NAD+ levels through decrease of PARP-1 activity. Lastly, we demonstrate that trifluridine treatment in vivo was able to alleviate aortic VSMCs loss and clinical sign of progeria, suggesting a novel therapeutic approach of cardiovascular disease in progeria.

Molecular Signature Associated With Acute Rejection in Vascularized Composite Allotransplantation.

A deeper understanding of acute rejection in vascularized composite allotransplantation is paramount for expanding its utility and longevity. There remains a need to develop more precise and accurate tools for diagnosis and prognosis of these allografts, as well as alternatives to traditional immunosuppressive regimens. Twenty-seven skin biopsies collected from 3 vascularized composite allotransplantation recipients, consisting of face and hand transplants, were evaluated by histology, immunohistochemistry staining, and gene expression profiling. Biopsies with clinical signs and symptoms of rejection, irrespective of histopathological grading, were significantly enriched for genes contributing to the adaptive immune response, innate immune response, and lymphocyte activation. Inflammation episodes exhibited significant fold change correlations between the face and hands, as well as across patients. Immune checkpoint genes were upregulated during periods of inflammation that necessitated treatment. A gene signature consisting of CCL5, CD8A, KLRK1, and IFNγ significantly predicted inflammation specific to vascularized composite allografts that required therapeutic intervention. The mechanism of vascularized composite allograft-specific inflammation and rejection appears to be conserved across different patients and skin on different anatomical sites. A concise gene signature can be utilized to ascertain graft status along with a continuous scale, providing valuable diagnostic and prognostic information to supplement current gold standards of graft evaluation.

Clinical and radiological characteristics of odontogenic orbital cellulitis

PurposeTo assess the radiological features and clinical outcomes of odontogenic orbital cellulitis.MethodMulti-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.ResultsFour patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25–56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration.ConclusionsOdontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.

Investigation into the Effects of Allergen Exposure and Topical Vinegar and Water Spray on Skin Barrier Parameters in Atopic Dogs

Increased skin pH and transepidermal water loss (TEWL) are documented in atopic people and dogs but no study has investigated how these parameters change during an allergy flare. Our primary aim was to challenge atopic beagles to dust mites and measure pH and TEWL during a flare of atopic dermatitis and correlate these parameters to clinical signs. A secondary aim was to evaluate in a randomized placebo-controlled study whether the daily application of 50/50 vinegar spray improves clinical signs and affects skin parameters despite the allergen challenge. Fifteen atopic dogs were challenged epicutaneously twice weekly for 2 weeks with allergen application on the inguinal and medial thigh areas. The severity of dermatitis was scored daily (CADESI-03). TEWL and pH were measured daily on the inguinal and medial thigh areas. A repeated measures ANOVA showed the significant effect of time, with increased pH (p < 0.0001), TEWL (p < 0.0001), and CADESI (p < 0.0001) during allergen challenge. Significant positive correlations were found between CADESI and pH (r = 0.3556; p < 0.0001), CADESI and TEWL (r = 0.36; p < 0.0001), and pH and TEWL (r = 0.45; p < 0.0001). Daily application of 50/50 vinegar did not improve dermatitis, pH, and TEWL compared to the control treatment. It can be concluded that both pH and TEWL are markers of disease severity in canine atopic dermatitis.

Hot topic: Epidemiological and clinical aspects of highly pathogenic avian influenza H5N1 in dairy cattle

On March 24, 2024, the US Department of Agriculture (USDA) confirmed the first case of highly pathogenic avian influenza (HPAI) H5N1 clade 2.3.4.4b in dairy cattle. Following this initial detection, the virus was found to have spread to other species, including humans. Since then, at least 192 dairy herds across 13 states have tested positive for the virus. The emergence of HPAI H5N1 in dairy cattle poses a serious threat to the dairy industry, requiring an approach that integrates human, animal, and environmental health. Enhancing biosecurity, improving surveillance, and advancing research are critical to managing this challenge. Swift adaptation is needed to protect both public health and dairy production. Through this work, we discuss the epidemiological and clinical aspects of HPAI H5N1 in cattle by reviewing the spatiotemporal situation of the disease across the United States, the clinical signs and testing leading to a confirmed case, and the surveillance and control measures implemented at the national and state levels. Further, considering pathogenesis and risk factors, we discuss surveillance and control measures to implement within herds, and note areas where research is needed to understand how to control this emerging disease.

Evidence of altered Redox Homeostasis in Trichothiodystrophy

Trichothiodystrophy (TTD) is a rare hereditary disease whose prominent feature is brittle hair. Additional clinical signs are physical and neurodevelopmental abnormalities and in about half of the cases hypersensitivity to UV radiation. Although the mutations involved in this condition have been characterized, the correlation between the molecular defects and the plethora of clinical symptoms is not well understood. Recently the presence of a redox unbalance in TTD has been suggested although not clear evidences have been reported on this aspect. Therefore, in the present study, we evaluated the redox status of fibroblasts isolated from a TTD patient. In addition, to understand the ability of TTD cells to respond to oxidative insults, the cells were challenged with H2O2 and mitochondrial O2- and mitochondrial membrane potential were measured in different oxidative conditions. In addition, NRF2/BACH protein levels were also analysed in response to H2O2. The results suggested an aberrant mitochondrial response to oxidative stimuli, an increased baseline oxidative stress status in TTD and an altered NRF2/BACH level. This study emphasises that altered redox homeostasis might play a role in TTD pathogenesis and mitochondria functionality could represent an alternative therapeutic target for this condition to improve patients clinical features.

A case of invasive aspergillus niger spondylodiscitis with epidural abscess following COVID-19 infection in an immunocompromised host with literature review

Introduction and importance: Aspergillosis is defined as an opportunistic infection which may spread hematogenously. COVID-19 infection has not been reported as a direct cause or risk factor. Its treatment (e.g., corticosteroids) significantly increases the risk for invasive infections. Respiratory system remains the main target and the Aspergillus fumigatus is the most responsible subtype. Other species like Aspergillus (A) flavus, A. niger and A. nidulans follow in frequency. Other included sites are the skeletal muscular system and the entire spine leading to spondylodiscitis. Only a total of 118 cases of Aspergillus spondylodiscitis have been reported in the literature and only 21 cases reporting spinal epidural abscess were identified. Case presentation: The authors report a new rare case of invasive A. Niger spondylodiscitis with epidural and iliopsoas abscesses in a 63-year-old North African female patient with history of coronavirus infection (COVID-19) treated with high doses of corticosteroids. The patient had favorable medical and radiological outcomes after 6 months of antibiotic and antifungal therapy. Clinical Discussion: Fungal spondylodiscitis is a rare pathology that may be lethal. Immunosuppression plays a determining role. Discovertebral contamination results from hematogenous dissemination, found in the majority of cases in adults. The main symptom is segmental spinal pain with inflammatory pattern most often predominating in the thoracolumbar spine. Clinical signs of spinal cord compression such as paresthesias, radiculalgia, paraplegia can sometimes be associated. Diagnosis of such spondylodiscitis is based on cultures and/or histology, whereas in most cases it was made by MRI. Epidural abscess remains a rare entity. The authors will explore the current literature in more detail to dissect and explain this rare entity. Conclusion: Aspergillus spondylodiscitis remains a rare and very demanding clinical entity. Early diagnosis and well-targeted medical treatment seem the ideal solution given that this type of infection has a poor prognosis.

Dedicator of cytokinesis 8 (DOCK8) mutation impairs the differentiation of helper T cells by regulating the glycolytic pathway of CD4+ T cells.

Dedicator of cytokinesis 8 (DOCK8) deficiency is a primary immunodeficiency disease caused by mutations in exon 45 of the DOCK8 gene. The clinical signs primarily consist of increased serum IgE levels, eczema, repeated skin infections, allergies, and upper respiratory tract infections. Using CRISPR/Cas9 technology, we generated a DOCK8 exon 45 mutation in mice, mirroring the mutation found in patients. The results indicated that DOCK8 mutation impairs peripheral T cell homeostasis, disrupts regulatory T cells (Tregs) development, increases ICOS expression in Tregs within peripheral lymph nodes (pLn), and promotes Th17 cell differentiation within the spleen and pLn. Upon virus infection, DOCK8 mutation CD4+ T cells have a Th2 effector fate. RNA-bulk sequencing data revealed alternations in the mTOR pathway of DOCK8 mutant CD4+ T cells. We observed that DOCK8 mutation upregulates the glycolysis levels in CD4+ T cells, which is related to the Akt/mTOR/S6/HIF-1α pathway. In summary, our research elucidates that DOCK8 regulates the differentiation of helper T cells by modulating the glycolytic pathway in CD4+ T cells, thereby advancing the comprehension and offering potential treatment of diseases in DOCK8-deficient patients.

Dictyocaulosis in cattle: Retrospective analysis of 20 outbreaks in Central Argentina

Bovine lungworms (Dictyocaulus viviparus) are nematodes which cause a respiratory disease known as verminous bronchitis or pneumonia. In this paper, we describe 20 outbreaks of bovine dictyocaulosis recorded between 2000 and 2023 in Central Argentina. Outbreaks occurred more frequently during the autumn-winter season (from April to August) and affected cattle under 1 year old in beef production systems. An average morbidity and mortality of 26.22 % and 8.44 % were registered, respectively. The main clinical signs observed were respiratory distress (coughing, tachypnea, dyspnea, and nasal discharge), weight loss, weakness, decubitus, and diarrhea. Necropsies were performed in thirty-one calves, heifers, and steers. Gross findings included diffuse interstitial or multifocal pneumonia, with marbled appearance intermingling atelectasis and red-gray firm areas of consolidation, and subpleural and interlobular emphysema and edema. Microscopically, lungs were characterized by abundant edema and mixed intra-alveolar multifocal to coalescent infiltrate. Frequently, adult worms and/or larvae were spotted in the bronchi or alveoli, respectively. Some cases exhibited proliferation of type 2 pneumocytes and hyaline membranes covering the alveolar septa. Co-infections with gastrointestinal nematodes were frequently found in fecal samples. Given the perspective of anthelmintic resistance and future changes in environmental conditions due to climate change, integrated parasitic control strategies are mandatory and should be tailored to each production system. The information gathered in this research provides an overview of lungworm infections in livestock production systems from Central Argentina and could be useful for surveilling, monitoring and designing strategic interventions for the control of this important parasitic disease in the region.

Fumaric acid per se and in combination with methotrexate arrests inflammation via moderating inflammatory and oxidative stress biomarkers in arthritic rats

Objective: Fumaric acid is a dicarboxylic acid that belongs to the phenolic class enriched in fruits and vegetables that are traditionally used for the treatment of various ailments. The research was planned to find out the anti-inflammatory and anti-arthritic activities of fumaric acid using in-vitro and in-vivo assays. Moreover, safety study was also done. Materials and methods: The 0.1 ml complete Freund’s adjuvant was injected in left hind paw in all Wistar rats except normal rats at day 1 to induced arthritis. The treatment with fumaric acid at 10, 20, 40, and fumaric acid 40 mg/kg together with methotrexate (MTX) was administered to immunized rats at 8th day via oral gavage and continued till 28th day though, MTX was administered as standard control. Results: The fumaric acid notably (p < 0.0001) lessened the paw edema and arthritic scoring, reinstated body and immune organ weight, and oxidation status in treated rats. Fumaric acid notably restored altered C-reactive protein, rheumatoid factor, liver function tests, ESR, WBCs, RBCs and Hb levels in treated rats. The fumaric acid in combination noticeably (p < 0.01–0.0001) suppressed the expression of TNF- α, IL-6, IL-1β, NF-kβ, and COX-2, and over expressed IL-4, and IL-10 in contrast to other treated groups. Fumaric acid had presented a dose-dependent antioxidant, anti-inflammatory and anti-arthritic activities while notable activity exhibited by fumaric acid in combination with MTX. The fumaric acid exhibited non-significant clinical signs of toxicity and mortality in acute toxicity study. The LD50 was more than 2000 mg/kg. Conclusion: Fumaric acid in combination can be used as disease-modifying anti-rheumatic drug but it will need extensive pre-clinical and clinical studies.

Demographic and Clinical Features of Visceral Leishmaniasis in Chad: A Prospective Cross-Sectional Survey.

Visceral leishmaniasis (VL), caused by the protozoan Leishmania donovani complex, is endemic in many parts of the world. Little known in Chad, VL has been recently documented from previously nonendemic areas. We report an epidemiological investigation of VL in the Léré district hospital in southwestern Chad. After informed consent, 40 VL patients were enrolled in the study. Diagnosis made using the formalin serological test was confirmed by polymerase chain reaction on blood samples. Clinical parameters were obtained from the physician or nurse caregiver, and from patients. Of a total of 40 serology positive patients, L. donovani DNA was found in 33 (82.5%), with 55% being male patients. The most affected age groups were 15-29 (47.5%) and 0-14 (32.5%) years. Fever, weight loss, and pallor were frequent symptoms. Notably, splenomegaly and hepatomegaly were uncommon clinical signs. Common comorbidities included malaria (25%) and hepatitis B (15%), followed by gastric ulcer (10%) and tuberculosis (7.5%). These comorbidities were concurrent with VL and were diagnosed microscopically in blood and serum for malaria and tuberculosis, respectively, and by the rapid diagnostic test using serum for hepatitis B and gastric ulcer. Thirty-five percent of cases were treated with meglumine antimoniate, and three patients (7.5%), all with comorbidities, died. Sixty percent of patients lived close to the main town. Our data demonstrate that VL is endemic in the health district of Léré. Improving health education regarding L. donovani infection in endemic areas of Chad and providing training of health workers on early detection and management of VL are needed to help save lives.

Evaluation of the clinical features of an outpatient cohort with Marfan syndrome

Marfan syndrome is a connective tissue disease with autosomal dominant inheritance and variable clinical presentation. The main clinical manifestations recognition could contribute to early diagnosis and cardiovascular complication prevention. We aimed to evaluate the clinical profile of a Marfan syndrome outpatient cohort. MethodsRetrospective cross-sectional study was carried out with outpatients over 12 years of age whose electronic medical records contained the clinical information and complementary exams necessary for study inclusion. Data were analyzed using descriptive statistics and comparisons were performed using student's t-test and chi-square or Fisher's exact test. P-values<0.05 were considered statistically significant. Results75 patients (29.5 ± 13.4 years) were included and 43(57 %) were female. Positive family history for the syndrome was observed in 55(73 %) patients and ectopia lentis in 37(49 %). Positive systemic score (≥7) was identified in 60(80 %) individuals and the most frequent score components were: skin striae in 64(85 %), scoliosis in 59(79 %), wrist and thumb sign in 45(60 %), moderate or severe myopia in 43(57 %) and plain flat foot in 40(53 %). Cardiovascular symptoms occurred in 17(23 %) patients: dyspnea in 10(13 %) and palpitations in 6(8 %). Mitral valve prolapse was observed in 32(43 %) participants and aortic root dilation (z-score ≥ 2) in 53(71 %), without significant difference between the groups with or without these alterations concerning sex, age, or symptom presence. ConclusionClinical profile of a Marfan syndrome outpatient cohort includes adolescents and young adults, most without cardiovascular symptoms and with a high incidence of skeletal, ophthalmological, and cardiovascular involvement. Recognizing these clinical signs could contribute to early disease diagnosis in the general population.

Female hyperandrogenism

Hyperandrogenism in women is a clinical syndrome resulting from an excess of circulating androgens in the blood. They can be produced either in the ovary or the adrenal gland. The clinical manifestations are highly variable. Patients present characteristic physical signs (alopecia, hirsutism, acne) as well as menstrual cycle irregularities. The most common cause of hyperandrogenism in women of childbearing age is polycystic ovary syndrome. There are specific criteria to establish a clear diagnosis of this syndrome. Nevertheless, in the presence of hyperandrogenism, a differential diagnosis must be made among other possible causes, such as congenital adrenal hyperplasia, use of drugs (anabolic agents), or the presence of androgen-secreting tumors. The specific treatment of this disease is usually chronic and aimed at controlling secondary symptoms of the disease, attempting to improve patients’ quality of life.

AI-Driven Realtime Monitoring of Early Indicators for Ichthyophthirius multifiliis Infection of Rainbow Trout.

A novel video-based real-time system based on AI (artificial intelligence) was developed to detect clinical signs in fish exposed to pathogens. We selected a White Spot Disease model involving rainbow trout as the experimental animal and the parasitic ciliate Ichthyophthirius multifiliis as a pathogen. We compared two identical fish tank systems: one tank was infected by co-habitation, whereas the other tank was kept non-infected (sham infection). The two fish tanks were separately video monitored (full top and side view) during the course of infection, during which fish were removed whenever they developed clinical signs (direct visual inspection by the observer). Image analysis (object detection, classification and tracking) was used to track behavioural changes in fish (in every recorded video frame), focusing on movement patterns and spatial localisation. Initially, the two fish groups (infected and non-infected) exhibited similar behaviour and non-infected fish did not change behaviour during the 15 d observation period (from 5 d before infection until 10 dpi). At 4, 7, 8, 9 and 10 dpi some infected fish showed clinical signs (equilibrium disturbance, gasping and lethargy) and were removed from the experiment. Anorexia occurred from 5 dpi and a gradual progression of gasping behaviour was noted, whereas the frequency of fish flashing (rubbing/scratching against objects) was low. Equilibrium disturbances and the development of white spots in the skin appeared to be a much later (8-10 dpi at this temperature) indicator of infection. The video analysis showed a general distribution of non-infected fish in all parts of the fish tank during the entire experiment, whereas infected fish already at 4-5 dpi moved towards higher water currents in the top and bottom positions. This change of fish positioning within the tank appeared as a promising early indicator of infection. The study suggests that continuous monitoring of fish behaviour using AI can potentially optimise the timing of humane endpoints, indicate disease signs earlier and thereby improve animal welfare in both animal experimentation and in aquaculture settings.