Signs Of Respiratory Distress Research Articles

Neonatal tetanus with good outcomes at a regional referral hospital in Eastern Uganda: a case report

BackgroundNeonatal tetanus, though now rare in developed countries, is still a significant cause of mortality in developing countries. Mortality, which can be as high as 100% without medical intervention, can be reduced to less than 10% with intensive care. Low-resource settings still lack sophisticated intensive care that has been shown to improve outcomes in high-income countries. However, there are low-cost interventions that have been shown to improve outcomes such as the use of magnesium sulfate in the management of severe tetanus.Case presentationA 9-day-old term Itesot neonate presented to our facility with inability to breast feed, excessive crying, and stiffening of the body when touched that started on the fourth day of life. On admission, she had signs of respiratory distress, fever, and labile heart rate. A diagnosis of neonatal tetanus with autonomic dysfunction was made, and the neonate was started on diazepam and magnesium sulfate infusion. She showed remarkable improvement and was discharged after 24 days of inpatient care.ConclusionThere is still need to improve case management modalities for neonatal tetanus in low-income settings to improve outcomes. This case report summarizes how adopting a low-cost treatment modality for neonatal tetanus resulted in good outcomes at a regional referral hospital in Eastern Uganda.

Congenital diaphragmatic hernia: an unusual presentation

Congenital diaphragmatic hernia is a developmental defect of the diaphragm that allows herniation of abdominal contents into the thoracic cavity. It is usually diagnosed in the neonatal period. Late presenting cases are uncommon and difficult to diagnose, due to their rarity and diversity of semiology, with clinical presentation overlapping with other more frequent pathologies. We report a case of a 14-month-old male, with history of several episodes of bronchial hyperresponsiveness, that presented with a two-day history of nasal obstruction, emetizing cough and respiratory distress, without other associated symptoms. On physical examination we observed a 95% oxygen saturation, tachycardia, pallor, signs of respiratory distress, decreased breathing sounds in the left hemithorax and excavated abdomen. Chest radiography revealed the presence of intestinal loops in the left hemithorax, with contralateral mediastinal deviation, suggesting diaphragmatic hernia. Surgical correction was performed with direct closure of the posterolateral defect. This case highlights the importance of clinical evaluation and considering this entity in cases of persistent gastrointestinal or respiratory symptoms, in all age groups.

Unusual inhalation of a tissue piece in an infant

Foreign body inhalation is a major problem in children and is one of the most serious accidents in early childhood. It is considered a common cause of childhood morbidity and mortality. We present a unique and unusual case of inhalation of a piece of tissue in a 10-month-old infant admitted to the Pediatric Emergency Department of the Mohamed VI Teaching University Hospital in Marrakech in 2021. The patient was initially seen with acute dyspnea, persistent dry cough, and signs of respiratory distress. The auscultation revealed decreased vesicular murmurs in the right lung field. Chest radiography did not reveal the presence of the foreign body, justifying the use of rigid bronchoscopy for diagnostic and therapeutic purposes, and revealing the presence of a tissue in the bronchial area. Our case report is distinguished by the strange and atypical nature of the foreign body not reported in the literature. Prevention especially parental education is recommended to reduce the morbidity and mortality associated with this domestic accident. Keywords: foreign body; aspiration; choking; bronchoscopy.

Congenital cystic adenomatoid malformation: a rare serial case report

Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung malformation which a part of the lung becomes polycystic. CCAM accounts for 25% of congenital lung malformations and 95% of lung lesions. Case 1 was a 5-month-old female infant who was diagnosed with pneumothorax, with multiple cysts in the right lung, using chest computed tomography (CT). Thoracotomy lung resection was performed. Case 2 was one-day-old newborn infant who had respiratory distress with Downe score 3. Multiple cystic lesions with septations in left lung was observed on chest CT. Lobectomy inferior lobes of left lung was performed. Both patients were diagnosed as CCAM type 1 pathologically. CCAM can be detected in the gestation by ultrasonography or after delivery through the appearance of respiratory distress signs.

Isolation and Molecular Detection of Mycoplasma gallisepticum in Commercial Layer Chickens in Sylhet, Bangladesh

Mycoplasma gallisepticum induced poultry diseases are associated with a huge economic crisis and have a considerable impact on the poultry industry worldwide. The aim of the current study was to isolate and perform molecular detection of MG circulating pathogenic strain in the commercial layer farms in the Sylhet district of Bangladesh. The entire study was conducted from January 2018 to January 2019 at three Upazilas of Sylhet district in Bangladesh. A total of 50 dead layer chickens (indicating signs of respiratory distress before death) were collected randomly from 15 different layer farms. The tissue samples, such as air sacs, trachea, and lungs, were taken from suspected dead chickens. Both cultural and PCR-based techniques were applied to identify Mycoplasma from tissue samples. The conventional PCR technique was implemented to amplify 185 bp DNA fragments for the MG. Out of 50 samples, 36% (18/50) and 70% (35/50) of MG were identified by cultural method and PCR, respectively. Based on the results of the study, it can be concluded that PCR is an easier, more sensitive, and less time-consuming method for the early diagnosis of MG in chickens, compared to cultural isolation and hence can lower the economic burden to poultry farmers caused by this disease.

Spontaneous Intraparenchymal Hemorrhage in Patients with COVID-19: A Prospective Study and Literature Review

Abstract Introduction Coronavirus disease 2019 (COVID-19) is a devastating pandemic that may also affect the nervous system. One of its neurological manifestations is intracerebral hemorrhage (ICH). Data about pure spontaneous intraparenchymal hemorrhage related to COVID-19 is scarce. In this study, we present some patients with COVID-19 disease who also had spontaneous intraparenchymal hemorrhage along with a review of the literature. Methods This single-center prospective study was done among 2,862 patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 1 and November 1, 2020. Out of 2,862 patients with SARS-CoV-2, 14 patients with neurological manifestations were assessed with a noncontrast brain computed tomography scan. Seven patients with spontaneous intraparenchymal hemorrhage were enrolled. Results All seven patients were male, with a mean age of 60.8 years old. Six patients (85.7%) only had minimal symptoms of COVID-19 without significant respiratory distress. The level of consciousness in two patients (28.5%) was less than eight, according to the Glasgow Coma Scale (GCS). Hypertension (71.4%) was the most common risk factor in their past medical history. The mean volume of hematoma was 41cc. Four patients died during hospitalization, and the others were discharged with a mean hospital stay of 42.6 days. All patients with GCS less than 11 died. Conclusion It concluded that ICH patients with COVID-19 are related to higher blood volume, cortical and subcortical location of hemorrhage, higher fatality rate, and younger age that is different to spontaneous ICH in general population. We recommend more specific neuroimaging in patients with COVID 19 such as brain magnetic resonance imaging concomitant with vascular studies in future. The impact of COVID-19 on mortality rate is not clear because of limited epidemiologic studies, but identifying the causal relationship between COVID-19 and ICH requires further clinical and laboratory studies.

Massive Pleural Effusion as a Rare Manifestation in Severe Neonatal Sepsis

BACKGROUND: Neonatal sepsis can be severe and has mortality rate. The pleural effusion is a rare sign of severe sepsis in newborn and only few studies that reported it. CASE PRESENTATION: We report a case of newborn who referred to our hospital because of dependent mechanical ventilator and severe sepsis. We found a massive pleural effusion and did the pleural drainage. After the drainage, the baby was extubate and discharge well with no signs of respiratory distress. CONCLUSION: Massive pleural effusion might be considered as a cause of dependent ventilator in severe neonatal sepsis.

A Newborn with Congenital Stridor.

A Newborn with Congenital Stridor.

Hordeum murinum aspiration revealed by a pneumopleurocutaneous fistula in a 15-month-old infant

BackgroundHordeum murinum is a specie of grass rarely reported among the aspirated foreign body. It has high tissue penetration power and may cause lung damages.Case presentationWe report the case of a 15-month-old girl who choke while playing in the grass without any evident cause. This episode was immediately followed by vomiting and coughing with traces of blood. While she was fine during the following week, she relapsed at day (D) 7 with fever. At D10, she was finally hospitalized for signs of respiratory distress. The chest CT-scan revealed a voluminous right sub pleural empyema with an aerial component, responsible for the collapse of the right lower lobe, and complicated by a pneumopleurocutaneous fistula to the right paravertebral muscles. Intravenous antibiotics were prescribed, but no invasive procedure was performed. At D18, the spikelet of a false barley spontaneously externalized through the fistula. Evolution was favorable thereafter with disappearance of the fever and progressive decrease of the biological inflammatory syndrome. The follow-up at 4 months was reassuring, with normal clinical evaluation, and complete regression of the empyema on the chest X-rays.ConclusionsHordeum murinum is a rare type of foreign body, and the aspiration often goes unnoticed. In these peculiar cases, CT-scans can be as informative as bronchoscopies, and the evolution is usually favorable after fistulization.

Re-Print- Artificial Respiration in Severe COVID-19 Cases: A Beneficial or Deleterious Treatment

The world over artificial respiration is employed as one of the intensive care treatment measures in severe cases of COVID-19 because of the significant respiratory distress patients develop. Nevertheless, the outcome is poor. Lethality varies from country to country and clinic to clinic between 50% and 90%. So the question arises as to whether the use of oxygen can be a risk factor in the treatment of acute inflammatory diseases in general and of COVID-19 in particular. Oxidative stress is the first and oldest step of cellular defense and starts before the activation of the immune system. This leads to an increase of intracellular oxygen in the mitochondria, followed by an elevated electron flow and the formation of superoxide as well as other reactive oxygen species and reactive nitrogen species. Superoxide reacts with nitric oxide, which is always present in inflammation, forming peroxynitrite, the strongest inducer of oxidative stress. This step induces the activation of nuclear factor kB, followed by the production of proinflammatory cytokines. The elevated levels of inducible nitric oxide synthase keep this cycle running. High amounts of superoxide have to be compensated and catabolized by manganese-superoxide dismutase 2 into hydrogen peroxide and in a second step by catalase into water. When using artificial respiration, these steps are accelerated considerably in the inflamed tissue of the lung, leading to a significant increase of the electron flow as well as an elevation of superoxide, oxidative stress, and water. As SARS-CoV-2 generally induces the production of proteins (and not only those necessary for viral reproduction), the water will remain in the tissue, causing edema and thus a wet lung syndrome associated with a growing oxygen diffusion distance to red blood cells. Ultimately, patients do not suffocate in spite of, but because of, the presence of high levels of oxygen. The limited number of patients who survive this deleterious treatment describe it as having had a sensation of drowning. The reasons will be discussed.

Silent Hypoxia in COVID-19: A Case Series

Background: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. Main Body: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO₂) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0–2 vs. median 5, IQR: 3–6, p < 0.001). In multivariate analysis, “silent hypoxemia” as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). Conclusion: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. “Silent” hypoxemia was more common in COVID-19 patients.

Managing an acute asthma exacerbation in children.

Children and youth with acute asthma exacerbations frequently present to an emergency department with signs of respiratory distress. The most severe episodes are potentially life-threatening. Effective treatment depends on the accurate and rapid assessment of disease severity at presentation. This statement addresses the assessment, management, and disposition of paediatric patients with a known diagnosis of asthma who present with an acute asthma exacerbation. Guidance includes the assessment of asthma severity, treatment considerations, proper discharge planning, follow-up, and prescription for inhaled corticosteroids to prevent exacerbation and decrease chronic morbidity.

Clinical features and prognosis of severe scorpion envenomation in children.

Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in the central area is Androctonus mauretanicus (Am) scorpion. Its venom can be lethal, especially for children. This study aimed to determine a clinico-epidemiological profile of severe scorpion envenomation among children and identify risk factors for mortality. This retrospective cohort study included 606 children admitted for severe scorpion envenomation (SSE) from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital. The mean age of envenomed children was 6.3 ± 4.2 years. Seventy-four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 h in 83% of cases. Bivariate analysis indicated that from 1 to 24 months of age (P = 0.001), hyperthermia (P = 0.022), episodes of diarrhea (P < 0.001), tachycardia (P < 0.001), abdominal distention (P < 0.001), skin marbling (P < 0.001), signs of respiratory distress (P < 0.001), irritability (P < 0.001), generalized seizures (P = 0.053), and Glasgow Coma Score (GCS) of 3 to 9 (P < 0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (P = 0.007), skin marbling (P = 0.006), and respiratory distress (P = 0.002), and GCS 3-9 (P = 0.007) were found to be independent risk factors for mortality in our patient population. Children are at high risk of developing serious complications, even death, from severe scorpion envenomation. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.

A Case Report of Autopsy: Large Mass of Pulmonary Metastatic Calcification in a Patient with End-Stage Renal Disease

Abstract Introduction/Objective Metastatic calcifications are reported in patients with end-stage renal disease (ESRD) in radiology literature but there are no pathologic reports regarding this clinical scenario in autopsy. Methods/Case Report We report the case of a 27-year-old African American man with nephrotoxic injury secondary to gentamicin treatment at a young age leading to ESRD requiring dialysis who then later developed congestive heart disease and arrhythmia. Prior to the patient’s last hospitalization, he had normal breath sounds with no signs of respiratory distress, rales, or wheezing. Imaging of the chest showed a patchy density in the right lung and a large parenchymal calcification. During autopsy, the patient was found to have bilateral markedly small and atrophic kidneys (left kidney weight: 27.5 g, size: 5.7 x 4.4 x 3.0 cm and right kidney weight: 30.6 g, size: 5.9 x 4.4 x 3.1 cm). Microscopically, the kidneys showed diffuse global glomerulosclerosis, atrophy of cortex, severe interstitial fibrosis, and tubular atrophy with thickened arteries as well as many foci of calcifications. A large mass measuring 3.5 x 2.4 x 1.9 cm was identified in the right middle lobe of the lung. Sections of the mass revealed large calcifications which were confirmed microscopically. In addition, concentric heart hypertrophy was identified with heart weight of 925 g and left ventricle measuring up to 2.2 cm. Calcifications (ranging from 0.2 – 0.5 mm) were also identified on the left atrial wall as well as a 1.2 x 0.8 x 0.6 cm mitral valve nodule along with additional microcalcifications within the myocardium. Results (if a Case Study enter NA) NA Conclusion In conclusion, our autopsy case supports previous radiologic reports that metastatic calcification can be dramatically present in the lung in patients with ESRD.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

A CLOG IN THE RV: RIGHT VENTRICULAR THROMBUS IN TRANSIT

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Right ventricular (RV) thrombi are an uncommon condition associated with pulmonary embolism. They may form within the cardiac chamber due to structural heart disease or presence of foriegn objects such as a ventricular assist device, or may represent a thrombus in transit from a peripheral source. We present the case and imaging of a patient who presented with extensive thrombosis involving the right ventricle and pulmonary arteries, in the context of periprocedural interruption of anticoagulant therapy. CASE PRESENTATION: A 35-year-old woman with a history of hypothyroidism, polycystic ovaries, and recently diagnosed metastatic cholangiocarcinoma presented with sudden onset right sided sharp chest pain and shortness of breath, in association with left calf pain. She had been on rivaroxaban for a history of venous thromboembolism, which had been interrupted peri-procedurally for implantation of a port. Physical examination was notable for hypoxia (oxygen saturation 85% on room air), hypotension (96/48 mm Hg), tachypnea, and signs of respiratory distress. Laboratory workup showed elevated N-terminal proBNP (748 pg/mL), with normal troponin. Computed tomography (CT) imaging of the chest with contrast demonstrated a large right ventricular thrombus extended through the pulmonic valve into the main pulmonary artery and its bifurcations, with numerous bilateral lobar, segmental and subsegmental emboli. Systemic anticoagulation with heparin was initiated. She was deemed not to be a candidate for catheter based thrombolysis, owing to the position of the thrombus, and neither for open cardiac surgery, given the late stage of her malignancy. She was started on a morphine infusion for relief of pain, and was transitioned to hospice shortly thereafter. DISCUSSION: In one study RV thrombus was found to be present in about 4% of cases of pulmonary embolism.[1] RV thrombi can be classified into various groups, depending on the shape and mobility of the thrombus.[2] We present this case to demonstrate the imaging findings of extensive RV thrombosis contiguous with thrombosis in the main pulmonary artery. There are no guidelines and little evidence on the best approach to the treatment of RV thrombi. While thrombolysis is indicated in patients with a massive pulmonary embolism, its utility in patients with RV thrombosis without hemodynamic instability remains less clear. Catheter based thrombolysis can be challenging, as in our patient, if the anatomy of the thrombus is such that it precludes adequate placement of the catheter. CONCLUSIONS: The diagnosis and management of RV thrombus is challenging; further studies and guidelines are warranted. REFERENCE #1: Casazza F, Becattini C, Guglielmelli E, et al. Prognostic significance of free-floating right heart thromboemboli in acute pulmonary embolism: results from the Italian Pulmonary Embolism Registry. Thromb Haemost. 2014 Jan;111(1):53-7. REFERENCE #2: Naeem K. Floating thrombus in the right heart associated with pulmonary embolism: The role of echocardiography. Pak J Med Sci. 2015 Jan-Feb; 31(1): 233–235. DISCLOSURES: No relevant relationships by Dan Kazmierski, source=Web Response No relevant relationships by Si Li, source=Web Response No relevant relationships by jacob miller, source=Web Response No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Dhaval Patel, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response

A RARE CASE OF RIGHT-SIDED TRICUSPID VALVE ENDOCARDITIS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Right-sided endocarditis is a well-known condition that occurs predominantly in intravenous drug users (IVDA) and patients with cardiovascular implantable electronic devices, central venous lines, and congenital heart disease. The objective of this report is to describe a rare case of right-sided endocarditis that leads to cardiogenic shock and death. CASE PRESENTATION: A 29-year-old caucasian male with a history of polysubstance abuse, acromioclavicular joint septic arthritis, status epilepticus secondary to cerebral septic emboli, presented to the emergency department with complaints of shortness of breath, generalized weakness, and malaise. He was noted to have significant respiratory distress requiring initially noninvasive mechanical ventilation, he was intubated due to worsening respiratory failure. Cardiovascular examination revealed a pansystolic murmur heard over the left parasternal border. Transthoracic echocardiogram showed severe tricuspid valve regurgitation and moderately dilated right ventricle with an ejection fraction of 63%. A transesophageal echocardiogram revealed severe 3+ to 4+ tricuspid valve regurgitation along with large vegetation on the anterior leaflet of the tricuspid valve measuring 2.2 cm x 0.8 cm. There is the involvement of the subvalvular apparatus with another large vegetation measuring 1.1 cm x 0.8 cm on the chordal apparatus (FIGURE 1). The patient was found to be in cardiogenic versus septic shock related to tricuspid valve recurrent infective endocarditis. Despite the patient being placed on intravenous antibiotics and two pressors he still continued to deteriorate. Discussion with the family decided to make the patient comfort-care. The patient ultimately expired. DISCUSSION: Right-sided infective endocarditis (RSIE) patients represent 5-10% of all infective endocarditis cases, making it a rare clinical entity. It is most commonly seen in patients with a history of IVDA; however, it is also seen in patients on dialysis, congenital heart disease, immunocompromised states patients, and patients who have an intracardiac device. The diagnosis of RSIE is often delayed due to its signs and symptoms relatively different than left-sided infective endocarditis which is the specific target of the modified duke's criteria. Common symptoms include cough, hemoptysis, dyspnea, chest pain, and persistent fever. The primary diagnostic modalities are echocardiography and positive blood cultures. The mainstay of medical treatment is antibiotics; however if refractory then surgery is indicated in cases of right-sided heart failure due to severe tricuspid regurgitation, persistent bacteremia, refractory to culture-directed antibiotics, and tricuspid valve vegetations greater than 20 mm in length. CONCLUSIONS: Clinicians should be aware of the variety of presentations a patient with suspected endocarditis could have as disease prognosis relies on a prompt diagnosis. REFERENCE #1: Narvaez Muñoz Adrian Fernando, Ibarra Vargas Daniela Albina. Right-Sided Infective Endocarditis, Infective Endocarditis, Peter Magnusson and Robin Razmi. IntechOpen. March 24th 2019 REFERENCE #2: Varona J., Guerra J. Tricuspid Valve Endocarditis in a Nonaddicted Patient Without Predisposing Myocardiopathy. Revista Española De Cardiología (English Edition) 2004;57(10):993–996. REFERENCE #3: Ye R., Zhao L., Wang C., Wu X., Yan H. Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respiratory Medicine. 2014;108(1):1–8. DISCLOSURES: No relevant relationships by Adeeb Alquthami, source=Web Response No relevant relationships by Nishad Barve, source=Web Response No relevant relationships by HANAD BASHIR, source=Web Response No relevant relationships by NICOLE LAO, source=Web Response No relevant relationships by Gauranga Mahalwar, source=Web Response

Suspicion of tooth aspiration during general anaesthesia in a paediatric patient – a case report

Foreign body aspiration or suspicion of it is a serious medical condition, which can cause life-threatening complications, especially in paediatric population. More than 80% of foreign body aspirations occur in children under three years of age. Children are a particularly vulnerable group due to specifi c anatomy of the airway. Symptoms of aspiration vary from suff ocation, coughing to complete absence of symptoms, which is why a diff erential diagnosis between aspiration and ingestion is sometimes very diffi cult. A six-year-old boy was admitted for elective surgery to correct vertical strabismus. At the pre-anaesthesia evaluation, the child was classifi ed as an ASA II patient, due to frequent laryngitis and bronchitis. The Mallampati score was 1 with no wobbly teeth recorded. After anaesthesia induction, the airway was secured with a laryngeal masksize 3.0 without complications. Upon awakening of the patient and removal of the laryngeal mask, blood was observed in the lodge of the lower left incisor and a lack thereof. The patient was without signs of respiratory distress. An emergency chest X-ray ruled out a foreign body in the airway, and subsequent X-rays of the abdomen revealed the presence of teeth in the projection of the stomach. The child was discharged to home care without complications. The clinical picture of foreign body aspiration under anaesthesia may be atypical and asymptomatic. Therefore, even the slightest suspicion of aspiration, especially in anaesthesia procedures, should be ruled out or confi rmed. Complications are most often the result of late-recognized aspiration.

A Cell Line Adapted Infectious Laryngotracheitis Virus Strain (BΔORFC) for in ovo and Hatchery Spray Vaccination Alone or in Combination with a Recombinant HVT-LT Vaccine.

To produce more-stable, live attenuated vaccines for infectious laryngotracheitis virus (ILTV), deletion of genes related to virulence has been extensively pursued. Although its function remains unknown, the open reading frame C (ORF C) is among the genes potentially associated with viral virulence that is nonessential for replication in vitro. Earlier results indicated that the ILT virus with deletion of the ORF C gene (BΔORFC) was suitable and safe for eye drop administration but was not sufficiently attenuated for in ovo administration. The objective of this study was to evaluate the safety and protection efficacy of a cell line-adapted, gene-deleted strain (BΔORFC) of ILTV when administered in ovo and/or spray (SP) by itself, or in combination with the recombinant HVT-LT (rHVT-LT) vaccine. Results indicated that vaccination with the BΔORFC strain, either by itself or in combination with an rHVT-LT vaccine, did not affect hatchability, and only marginal signs of respiratory distress were recorded for groups of chickens that received the BΔORFC strain via SP. The replication and seroconversion induced by the BΔORFC strain after in ovo and SP administration was very limited, whereas the replication of the rHVT-LT vaccine was delayed when combined with the BΔORFC strain in ovo. Compared to rHVT-LT or BΔORFC when administered alone, dual vaccination with rHVT-LT + BΔORFC was more effective in mitigating clinical signs of the disease and reducing challenge virus load in the trachea. To our knowledge, this study provides the first proof of concept that ILTV strains can be sufficiently attenuated for early vaccination in ovo or at hatch; also, this study documented the benefits of using a dual (recombinant and live attenuated) hatchery vaccination strategy for ILTV.

The impact of routine pulse oximetry use on outcomes in COVID-19-infected patients at increased risk of severe disease: A retrospective cohort analysis.

The phenomenon of silent hypoxaemia has been described in patients with COVID-19 pneumonia, which is characterised by low oxygen saturation levels of &lt;90% in those who appear clinically well and do not show signs of significant respiratory distress. To assess the impact on clinical outcomes for high-risk COVID-19 patients using a pulse oximeter to monitor oxygen saturation levels in a home setting. We performed a retrospective cohort analysis using data from a large South African insurance administrator. Patients were categorised as high risk, based on age and specific underlying clinical conditions, or from predictive models derived from medical scheme administrative claims data. The impact of pulse oximetry home monitoring on COVID-19 clinical outcomes was investigated by the use of Cox proportional hazard models. Between 2 March 2020 and 31 October 2020, of 38 660 patients analysed, 8 115 were in the intervention group. The 60-day mortality rate for the evaluated high-risk population was 1.35%. After adjusting for age and comorbidity differences, the intervention group was found to have an adjusted hazard ratio of 0.52 (p&lt;0.0001). No statistical significance was found between the intervened and control groups for admission to hospital, admission to intensive care unit (ICU) and use of mechanical ventilation. The intervention group had a lower median C-reactive protein (CRP) level on admission (p=0.03). After adjustment for admission CRP levels, elevated CRP was associated with an increased mortality (p&lt;0.0001), while the statistical significance in mortality between the intervention and the control group was lost. High-risk COVID-19 patients who used a pulse oximeter to monitor oxygen saturation levels had significantly lower mortality rates compared with other high-risk patients. The mortality benefit may be explained by earlier presentation to hospital, as suggested by lower initial CRP levels.