Clinical Signs Research Articles

An update on nonsteroidal anti-inflammatory drug-induced urticaria.

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (HR-NSAIDs) are common adverse events related to the widespread use of over-the-counter NSAIDs for the treatment of a variety of inflammatory conditions. Urticaria is the most commonly reported immediate cutaneous clinical sign of HR-NSAIDs, but it can be a manifestation of pathophysiologically different clinical entities that require different therapeutic strategies. The aim of this study is to ease the identification of the correct phenotype of HR-NSAIDs in patients reporting urticaria associated with the intake of NSAIDs and provide updated information about their diagnosis and management. The study is a narrative review conducted by collecting the most relevant and up-to-date data related to the classification, pathophysiology, severity, and prognosis of NSAID hypersensitivity reactions. PubMed and Embase scientific databases were used as search engines to select relevant articles. Patients developing HR-NSAIDs can be divided into two categories: selective responders (SR), who develop reactions after the administration of a single specific NSAID due to an underlying IgE or T-cell mediated hypersensitivity mechanism, or cross-intolerant (CI), who develop reactions to more than one chemically unrelated NSAIDs due to abnormalities in the biochemical pathways related with prostaglandin metabolism, independently from an underlying immunological mechanism. Five major different categories of HR-NSAIDs have been identified: NSAIDs-exacerbated cutaneous disease (NECD), NSAIDs-induced urticaria/angioedema with/without respiratory and systemic symptoms of anaphylaxis (NIUAA), and NSAIDs-exacerbated respiratory disease (NERD), which are developed by CI patients, and single NSAIDs-induced urticaria, angioedema and/ or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR), which are developed by CI patients. In vivo and in vitro diagnostic tests have rarely been shown to be reliable in all these entities and therefore are not routinely used in clinical practice. The management in SR patients consists of strict avoidance of the culprit drug, while for cross-intolerance reactions oral tolerance tests with safe alternative drugs (e.g. weak COX-1 inhibitors or selective COX-2 inhibitors) can be performed. HR-NSAIDs are being observed with increasing frequency, however, the pathogenesis behind some NSAIDS-associated clinical entities is still unclear. Diagnosis is mostly based on a thorough clinical history and confirmed by a drug challenge test. Clinical management is based on strict avoidance and use of alternative tolerated medications. Overall, all therapeutic decisions depend on the correct identification of the type of reaction the patient experienced.

PRECOCIOUS PUBERTY: EPIDEMIOLOGY, CLINICAL PRESENTATION, DIAGNOSIS, AND ETIOLOGIES

Precocious puberty, defined as the onset of sexual characteristics before the age of 8 in girls and 9 in boys, can arise from various causes, including central and peripheral mechanisms. While central precocious puberty (CPP) originates from premature activation of the hypothalamic-pituitary axis, peripheral precocious puberty (PPP) results from gonadal or adrenal hormone secretion independent of hypothalamic control. We conducted a retrospective study spanning eight years, from 2015 to 2023, at the Mohamed 6 University Hospital in Marrakech, Morocco, to investigate the epidemiological, clinical findings, laboratory, and etiological aspects of precociuos puberty in 12 children. We found a predominance of CPP, particularly in girls, with breast development being the most common clinical sign. In boys, early puberty typically presented with pubic hair development and increased penile size. Diagnostic evaluation included hormonal assays and imaging studies, with elevated levels of gonadal hormones confirming the diagnosis. CPP was predominantly idiopathic in girls, while traumatic brain injury and CNS lesions were common causes in boys. Adrenal disorders, including congenital adrenal hyperplasia, accounted for PPP cases. Brain imaging was crucial for identifying central lesions, while adrenal imaging aided in diagnosing adrenal pathologies. Despite limitations such as retrospective design and incomplete data, our study emphasizes the importance of early recognition and appropriate diagnostic procedures for children showing signs of early puberty to optimize management and outcomes.

The seroprevalence of COVID-19 among people living with HIV in Morocco

The association of COVID-19 and HIV infection would seem deadly in terms of prognosis and the possibilities of viral clearance given the immunodeficiency. However, a lower seroprevalence has been reported in some studies compared to that found in the non-HIV population. The objective of this study is to determine the seroprevalence of COVID-19 among people living with HIV (PLHIV) in Morocco. This is a prospective study carried out in the infectious diseases department of the Ibn Rochd University Hospital in Casablanca. We included PLHIV who consulted the Infectious Diseases Day-Hospital service between January 18, 2021 and March 10, 2021. After informed consent, patients completed a survey and had blood drawn for SARS-CoV-2 antibody testing. The determination of IgG antibodies against SARS-CoV-2 in blood was carried out using chemiluminescence microparticle immunoassay technology. We included 418 PLHIV in the study, most patients were male (50.24%), the average age was 40 years, 90.2% of patients were on antiretroviral treatment, 56.7% had a viral load <20 copies/ml, and 47.37% had a CD4 count greater than 500 cells/μL. The IgG test was positive in 53 patients, representing a seroprevalence of 12.68%. None of the patients had clinical signs. Seroprevalence was higher in female patients (58.49%), aged between 30 and 40 years (41.51%), in patients with a negative viral load (64.15%) and a CD4 count greater than 500 cells/mm3 (49.6%). Our study showed that the seroprevalence of COVID-19 was higher among PLHIV compared to people without HIV infection. All the patients had asymptomatic forms which pushes us to evoke a theory, to demonstrate, of the action of antiretrovirals against SARS-CoV-2.

Assessment of hepatitis B virus infection and tuberculosis among people living with HIV at the Kankan Regional Hospital (Republic of Guinea)

Objective: The aim of this study was to determine the tuberculosis and hepatitis B virus co-infection among people living with HIV at the Kankan Regional Hospital (HRK) in Guinea and to describe the biological and clinical signs associated to the co-infections. Methods: It was 4 years retrospective study (January 1st, 2015-December 31st, 2018. data was collected from lab registers and hospitalization files. Results: On a total of 345 PVVH, HBsAg testing was carried out. Thus 9.3% (32/345) were co-infected with HIV/HBV with the presence of jaundice in 8.1% (28/345). All patients (100%) had oropharyngeal candidiasis (thrush). About 44.1% (152/345) of patients tested positive for tuberculosis, while 49.6% (171/345) presented with prurigo. The results of the study showed that the female gender was predominant with a sex ratio (M/F) = 0.69. The average age of the patients was 38.45±13.38 [16-80 years]. The most represented age group was ≥35 years (55.9%), followed by 25-29 years (16.8%) and 30-34 years (14.2%). More than half of the patients were married (51.6%), and singles accounted for 31.0%. On a socio-professional level, workers were in the majority (54.7%), followed by farmers (15.1%) and traders (14.5%). Conclusion: All of these results show that the prevalence of tuberculosis and hepatitis B was high among people living with HIV at the Kankan Regional Hospital.

Disseminated gonococcal infection: A case report of gonococcal polyarthritis

Neisseria gonorrhoeae (N. gonorrhoeae) is a sexually transmitted pathogen and its dissemination can lead to a variety of clinical signs and symptoms, such as arthralgias and arthritis. We report a case of an immunocompetent, 20-year- old patient with purulent arthritis due to disseminated gonococcal infection (DGI). Before discharge diagnosis, the patient was treated for rheumatoid arthritis, which worsened his clinical condition and delayed diagnosis. On further questioning, the patient reported urethral discharge, then the causative agent was identified by performing a PCR on the first stream of urine which came back positive for Neisseria gonorrhoeae. This case’s aim is to demonstrate an infrequently seen manifestation of Neisseria gonorrhoeae, since the incidence of N. gonorrhoeae infections has increased in recent years, and to highlight the need for awareness of extragenital manifestations of gonococcal infection especially in young adults.

Community-acquired acute kidney injury in Southeast Brazil and independent risk predictors: a prospective cohort study.

The prevalence and risk factors for community-acquired acute kidney injury (CA-AKI) are unknown. This study aimed to explore the incidence of CA-AKI in a tertiary care center and to depict the mainclinical characteristics related to this condition. This was a prospective cohort study involving patients admitted to theemergency department(Hospital de Clínicas, UNICAMP, Campinas, Brazil) between January 2019 and September 2021. Adults (≥ 18 yrs) who presented to the emergency room with symptoms potentially associated with an increased risk of AKI were included. Individuals with a prior diagnosis of stage 5 chronic kidney disease or with a confirmed COVID-19 infection were excluded. A score based on clinical signs and symptoms was assigned to predict the risk of severe AKI. Of the 261 patients enrolled, CA-AKI was diagnosed in 65 (25%). The CA-AKI group was older [57(± 14) vs. 51(± 18) years, p = 0.02] and had a lower baseline estimated glomerular filtration rate [103 (88-113) vs. 109 (97-121) mL/min/1.73 m2; p = 0.01]. Logistic regression showed that scores ≥ 7 points [odds ratio (OR) 2.8 (1.281-6.133), 95% confidence interval (CI), p = 0.01], age [OR 1.02 (1.007-1.044), 95% CI, p = 0.008] and liver disease [OR 2.6 (1.063-6.379), 95% CI, p = 0.03] were independently related to CA-AKI. The incidence of CA-AKI was not negligible among patients admitted to a tertiary care center; CA-AKI can be suspected on a clinical basis and confirmed by serum creatinine. Age, liver disease and higher scores in risk prediction tools were related to an increased incidence of CA-AKI.

Supplementing infant milk formula with a multi-strain synbiotic and osteopontin enhances colonic microbial colonization and modifies jejunal gene expression in lactating piglets.

A total of ninety-six weaned piglets were assigned to four dietary treatments in a 2 × 2 design. The treatments included: a standard milk formula (CTR); CTR + probiotics (6.4 × 108 cfu L-1Bifidobacterium longum subsp. infantis CECT 7210 and 1.1 × 108 cfu L-1Lactobacillus rhamnosus NH001) + prebiotics (galacto-oligosaccharides 4.36 g L-1 and human-milk-oligosaccharide 0.54 g L-1) (SYN); CTR + osteopontin (0.43 g L-1) (OPN); and CTR + SYN + OPN (CON). Daily records including feed intake, body weight, and clinical signs, were maintained throughout the 15-day trial. At the end of the study samples from blood, digestive content, and gut tissues were collected to determine serum TNF-α, intestinal fermentative activity (SCFA and ammonia), colonic microbiota (16S rRNA Illumina-MiSeq), histomorphology, and jejunal gene expression (Open-Array). No statistical differences were found in weight gain; however, the animals supplemented with osteopontin exhibited higher feed intake. In terms of clinical signs, synbiotic supplementation led to a shorter duration of diarrhoea episodes. Regarding gut health, the sequenced faecal microbiota revealed better control of potentially dysbiotic bacteria with the CON diet at day 15. In the colon compartment, a significant increase in SCFA concentration, a decrease in ammonia concentration, and a significant decrease in intraepithelial lymphocyte counts were particularly observed in CON animals. The supplemented diets were also associated with modified jejunal gene expression. The synbiotic combination was characterized by the upregulation of genes related to intestinal maturation (ALPI, SI) and nutrient transport (SLC13A1, SLC15A1, SLC5A1, SLC7A8), and the downregulation of genes related to the response to pathogens (GBP1, IDO, TLR4) or the inflammatory response (IDO, IL-1β, TGF-β1). Osteopontin promoted the upregulation of a digestive function gene (GCG). Correlational analysis between the microbiota population and various intestinal environmental factors (SCFA concentration, histology, and gene expression) proposes mechanisms of communication between the gut microbiota and the host. In summary, these results suggest an improvement in the colonic colonization process and a better modulation of the immune response when milk formula is supplemented with the tested synbiotic combined with osteopontin, benefiting from a synergistic effect.

Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases.

To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). Retrospective study. Small animal university veterinary teaching hospital. Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. The mean (SD) HR, SBP, and SI were 123/min (32.6), 147mmHg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145mmHg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P<0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P=0.04 and P<0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P<0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P=0.13, P=0.57, and P=0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P=0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.

Varicocele and Interventional Radiology: A Comprehensive Case Study on Diagnosis, Therapeutic Intervention, and Implications for Reproductive Health

ABSTRACT Male infertility is known to be influenced by varicocele, a common vascular aberration marked by aberrant dilatation of the pampiniform plexus veins within the scrotum. In this instance, a 38-year-old man showed up with scrotal discomfort and swelling, which are clinical signs of varicocele. Scrotal ultrasonography provided diagnostic confirmation, confirming the existence of varicocele and identifying a concomitant minor hemorrhage in the left scrotal sac. Despite the initiation of conservative measures, such as bed rest, cryotherapy, and analgesics, the patient’s clinical course was marked by persistent scrotal swelling and hematoma formation. Subsequently, interventional radiological techniques were employed, specifically coil deployment and varicocele embolization. These interventions demonstrated significant efficacy, leading to a notable reduction in the presenting symptoms. Follow-up assessments, conducted post intervention, indicated a complete resolution of both pain and hematoma. This clinical trajectory underscores the pivotal role of interventional radiology in managing varicocele-related complications. The multi-faceted nature of this case highlights the necessity of a comprehensive, inter-disciplinary approach integrating radiological interventions for the effective management of varicocele-associated symptoms, potentially optimizing reproductive health outcomes.

Antimicrobial Susceptibility of Canine and Feline Urinary Tract Infection Pathogens Isolated from Animals with Clinical Signs in European Veterinary Practices during the Period 2013–2018

Bacterial urinary tract infections (UTIs) occur frequently in companion animals and are often treated with antibiotics. However, antimicrobial resistance can severely hamper treatment success. Therefore, antimicrobial susceptibility monitoring is key. UTI isolates were obtained from dogs and cats in two collection periods (ComPath II: 2013–2014 and ComPath III: 2017–2018) as part of CEESA’s ComPath programme. Susceptibility testing of the UTI isolates (2021 in total) was carried out at one central laboratory using agar and broth dilution methodology as recommended by the Clinical and Laboratory Standards Institute. Escherichia coli was the most frequently isolated bacterium in UTI in both dogs (46.9%, 43.1%) and cats (61.2%, 48.3%) across ComPath II and ComPath III, respectively. The percentage of resistance in E. coli was low (&lt;10%) across both programmes in both dogs and cats except for trimethoprim-sulfamethoxazole (dogs ComPath III: 12.9%; cats ComPath II: 13.0%) and enrofloxacin (10.5%), marbofloxacin (11.4%), and doxycycline (98.8%) for dogs in ComPath III. Three (7.5%) of the 40 isolated S. aureus bacteria in total were MRSA and harboured mecA. The level of multidrug resistance (MDR) was generally low and ranged from 0.0% for feline coagulase-negative Staphylococcus spp. to 11.7% for canine Proteus spp., except for a peak of MDR observed in canine Klebsiella isolates from ComPath II (36.7%). Overall, antimicrobial resistance for most canine and feline UTI pathogens isolated during the ComPath II and ComPath III programmes was low (1–10%) to moderate (10–20%).

An overview of mycotoxicoses in rabbits.

Mycotoxicoses are usually a consideration in large animal species but can affect companion animals as well. Due to increasing interest and the ease of using rabbits as laboratory models, a growing number of published experimental studies discuss the effects of various mycotoxins on this species. However, the available evidence is fragmented and heterogeneous, and has not recently been collated in a review, to my knowledge. Although mycotoxicoses in rabbits are typically subclinical, clinical signs can include weight loss, anorexia, gastrointestinal disorders, stunted growth, reproductive abnormalities, and susceptibility to infections. An antemortem diagnosis typically relies on a comprehensive clinical history, and assessment of clinical signs and relevant laboratory findings, with confirmation of exposure achieved through the measurement of mycotoxin concentrations in feed or target organs. My review focuses on the clinicopathologic and histopathologic effects of the mycotoxins most important in rabbits, including fumonisins, ochratoxins, aflatoxins, trichothecenes, and zearalenone. This review offers a thorough overview of the effects of mycotoxins in rabbits, serving as a one-stop resource for veterinary practitioners, diagnosticians, and researchers.

Case report: Difficult diagnosis of Mycobacterium tuberculosis infection in patients after allogeneic hematopoietic stem cell transplantation: two case reports and a literature review

BackgroundMycobacterium tuberculosis (MTB) is a relatively infrequent infection encountered during hematopoietic stem-cell transplantation (HSCT). The identification of MTB following HSCT remains a complex task, with delayed detection and misdiagnosis potentially resulting in unfavorable outcomes. Metagenomic next-generation sequencing (mNGS) represents a novel, highly sensitive, and rapid diagnostic tool in clinical settings for discerning intricate infections and detecting exceedingly rare pathogensMethodsWith the aid of mNGS, we diagnosed MTB in the lymph nodes and lungs of two patients with hematological diseases following allogeneic peripheral blood hematopoietic stem cell transplantation. Both patients presented with a fever, localized symptoms, and clinical signs. Following inconclusive results from routine tests, impractical biopsy procedures, and unsuccessful responses to empirical treatments, mNGS was employed as a final recourse, revealing DNA fragments of MTB in blood samples.ResultsThe diagnoses were ultimately confirmed in conjunction with additional clinical evidence. The application of mNGS in MTB cases after allogeneic HSCT has rarely been reported. The mNGS technique can provide a prompt and highly sensitive indication leading to the definitive diagnosis of MTB in complex post-transplant scenarios.

Optic nerve sheath diameter correlates with both success and failure of hydrocephalus treatment in pediatric patients with pineal region lesions.

Pineal region lesions in children are heterogenous pathologies often symptomatic due to occlusive hydrocephalus and thus elevated intracranial pressure (ICP). MRI-derived parameters to assess hydrocephalus are the optic nerve sheath diameter (ONSD) as a surrogate for ICP and the frontal occipital horn ratio (FOHR), representing ventricle volume. As elevated ICP may not always be associated with clinical signs, the adjunct of ONSD could help decision making in patients undergoing treatment. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with pineal region lesions undergoing surgical treatment with respect to pre- and postoperative ONSD and FOHR as an indicator for hydrocephalus. Retrospective data analysis was performed in all patients operated for pineal region lesions at a tertiary care center between 2010 and 2023. Only patients with pre- and postoperative MRI were selected for inclusion. Clinical data and ONSD at multiple time points, as well as FOHR were analyzed. Imaging parameter changes were correlated with clinical signs of hydrocephalus before and after surgical treatment. Thirty-three patients with forty operative cases met the inclusion criteria. Age at diagnosis was 10.9 ± 4.6years (1-17years). Hydrocephalus was seen in 80% of operative cases preoperatively (n = 32/40). Presence of hydrocephalus was associated with significantly elevated preoperative ONSD (p = 0.006). There was a significant decrease in ONSD immediately (p < 0.001) and at 3months (p < 0.001) postoperatively. FOHR showed a slightly less pronounced decrease (immediately p = 0.006, 3months p = 0.003). In patients without hydrocephalus, no significant changes in ONSD were observed (p = 0.369). In 6/6 patients with clinical hydrocephalus treatment failure, ONSD increased, but in 3/6 ONSD was the only discernible MRI change with unchanged FOHR. ONSD measurements may have utility in evaluating intracranial hypertension due to hydrocephalus in patients with pineal region tumors. ONSD changes appear to have value in assessing hydrocephalus treatment failure.

Can Supercooled Phase Transitions Explain the Gravitational Wave Background Observed by Pulsar Timing Arrays?

Several pulsar timing array collaborations recently reported evidence of a stochastic gravitational wave background (SGWB) at nHz frequencies. While the SGWB could originate from the merger of supermassive black holes, it could be a signature of new physics near the 100 MeV scale. Supercooled first-order phase transitions (FOPTs) that end at the 100 MeV scale are intriguing explanations, because they could connect the nHz signal to new physics at the electroweak scale or beyond. Here, however, we provide a clear demonstration that it is not simple to create a nHz signal from a supercooled phase transition, due to two crucial issues that could rule out many proposed supercooled explanations and should be checked. As an example, we use a model based on nonlinearly realized electroweak symmetry that has been cited as evidence for a supercooled explanation. First, we show that a FOPT cannot complete for the required transition temperature of around 100 MeV. Such supercooling implies a period of vacuum domination that hinders bubble percolation and transition completion. Second, we show that even if completion is not required or if this constraint is evaded, the Universe typically reheats to the scale of any physics driving the FOPT. The hierarchy between the transition and reheating temperature makes it challenging to compute the spectrum of the SGWB. Published by the American Physical Society 2024

Infectivity of an emerging fish parasite Gyrodactylus sprostonae in juvenile carp (Cyprinus carpio)

AbstractThe gill monogenean ectoparasite Gyrodactylus sprostonae is an emerging pathogen within recreational UK carp fisheries, and a major cause of mortality in adult carp. This gill infection has only been noted in adult carp and not in juveniles, and no reports of its fundamental infection dynamics exist. The current study compared the infective potential of G. sprostonae between adult and juvenile common carp (Cyprinus carpio) and quantified parasite numbers on the body surface and gills of infected juveniles at two temperatures (14 and 24°C). G. sprostonae was able to infect the body surface and the gills of juvenile carp, and temperature significantly impacted the duration of infection and number of parasites. Interestingly, however, all juveniles under both temperature treatments lost their infections after a maximum of 40 days, with no observed clinical signs of parasitaemia or mortalities. This study therefore indicates that G. sprostonae does not appear to be harmful to juvenile common carp, and we discuss why this infection only seems to impact prised adult carp in the UK.

Retrospective review of the pathology of American pikas.

American pikas (Ochotona princeps) are small lagomorphs that live in mountainous talus areas of western North America. Studies on the histopathology of American pikas are limited. We summarize here the clinical histories, and gross and histologic findings of 12 American pikas, including 9 captive (wild-caught) and 3 wild animals. Death was often attributed to stress (transport, handling, anesthesia) with few-to-no premonitory clinical signs. Infection was the cause of death in 2 cases: 1 had bacterial pyogranulomatous dermatitis, cellulitis, and lymphadenitis with sepsis; the other case had oomycete-induced necrotizing colitis. Incidental parasitic infections included sarcocystosis, nematodosis (oxyurids), and ectoparasitism. Most animals with adequate nutritional status had periportal hepatic lipidosis; this finding was absent in all animals with adipose atrophy, and it is possible that periportal hepatic lipidosis is non-pathologic in American pikas. Three cases had myocardial necrosis that was considered the cause of death; the cause of necrosis was not determined, but it may have been caused by stress or vitamin E-selenium deficiency. Esophageal hyperkeratosis was noted in animals with a history of anorexia and negative energy balance; accumulation of esophageal keratin can result from lack of mucosal abrasion by ingesta. Several histologic findings that are likely normal in American pikas include splenic extramedullary hematopoiesis, thymic tissue in adults, and Clostridium sp. in the enteric lumen.

Immune cell populations in the tumour environment following calcium electropora-tion for cutaneous metastasis: a histopathological study.

Calcium electroporation (CaEP) involves injecting calcium into tumour tissues and using electrical pulses to create membrane pores that induce cell death. This study assesses resultant immune responses and histopathological changes in patients with cutaneous metastases. The aimed cohort comprised 24 patients with metastases exceeding 5 mm. Tumours were treated once with CaEP (day 0) or twice (day 28). Biopsies were performed on days 0 and 2, with additional samples on days 7, 28, 30, 35, 60, and 90 if multiple tumours were treated. The primary endpoint was the change in tumour-infiltrating lymphocytes (TILs) two days post-treatment, with secondary endpoints evaluating local and systemic immune responses via histopathological analysis of immune markers, necrosis, and inflammation. Seventeen patients, with metastases primarily from breast cancer (14 patients), but also lung cancer (1), melanoma (1), and urothelial cancer (1), completed the study. Of the 49 lesions treated, no significant changes in TIL count or PD-L1 expression were observed. However, there was substantial necrosis and a decrease in FOXP3-expression (p = 0.0025) noted, with a slight increase in CD4+ cells but no changes in CD3, CD8, or CD20 expressions. Notably, four patients showed reduced tumour invasiveness, including one case of an abscopal response. This exploratory study indicates that CaEP can be an effective anti-tumour therapy potentially enhancing immunity. Significant necrosis and decreased regulatory lymphocytes were observed, although TIL count remained unchanged. Several patients exhibited clinical signs of immune response following treatment.

Detection of Equine Parvovirus-Hepatitis Virus and Equine Hepacivirus in Archived Sera from Horses in France and Australia

Reports of newly discovered equine hepatotropic flavi- and parvoviruses have emerged throughout the last decade in many countries, the discovery of which has stimulated a great deal of interest and clinical research. Although commonly detected in horses without signs of disease, equine parvovirus hepatitis (EqPV-H) and equine hepacivirus (EqHV) have been associated with liver disease, including following the administration of contaminated anti-toxin. Our aim was to determine whether EqPV-H and EqHV are present in Australian horses and whether EqPV-H was present in French horses and to examine sequence diversity between strains of both viruses amongst infected horses on either side of the globe. Sera from 188 Australian horses and 256 French horses from horses with and without clinical signs of disease were collected. Twelve out of 256 (4.7%) and 6 out of 188 (3.2%) French and Australian horses, respectively, were positive for the molecular detection of EqPV-H. Five out of 256 (1.9%) and 21 out of 188 (11.2%) French and Australian horses, respectively, were positive for the molecular detection of EqHV. Australian strains for both viruses were genomically clustered, in contrast to strains from French horses, which were more broadly distributed. The findings of this preliminary survey, with the molecular detection of EqHV and EqPV-H in Australia and the latter in France, adds to the growing body of awareness regarding these recently discovered hepatotropic viruses. It has provided valuable information not just in terms of geographic endemicity but will guide equine clinicians, carers, and authorities regarding infectious agents and potential impacts of allogenic tissue contamination. Although we have filled many gaps in the world map regarding equine hepatotropic viruses, further prospective studies in this emerging field may be useful in terms of elucidating risk factors and pathogenesis of these pathogens and management of cases in terms of prevention and diagnosis.

Efficacy of Chlorhexidine Impregnated Wipes for the Local Dysbiosis in Atopic Dogs: A Multicentric Prospective Study

(1) Background: Dysbiosis is frequently observed in Canine Atopic Dermatitis (CAD). Antimicrobial treatment may be necessary to treat flare ups and the use of topical treatments is beneficial to prevent the development of bacterial resistance. Wipes are an easy way to apply antiseptic agents on the skin. The aim of this study was to evaluate the benefits of 3% chlorhexidine impregnated wipes (Pyoskin® wipes, MP Labo, France) on local areas of dysbiosis in dogs with CAD. (2) Methods: A total of 20 dogs suffering from CAD presented with localised areas of dysbiosis were included in this study. Affected areas were cleansed with the daily application of chlorhexidine wipes once a day for 14 days. Follow-up visits were scheduled after one and two weeks. Clinical signs (lesions and pruritus), dysbiosis scored by cytological counts (cocci and Malassezia) and investigator and owner global appreciation were evaluated. (3) Results: A statistically significant decrease in clinical scores and cytological counts were observed as soon as D7 and until D14. Both owner and investigator appreciation were considered high (4) Conclusions: The use of chlorhexidine impregnated wipes is a useful and easy way to manage localised dysbiosis in atopic dogs and allows limiting of systemic medication to prevent bacterial resistance.

Postoperative pneumonia after femoral fracture surgery: an in-depth retrospective analysis

BackgroundFemoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries.MethodsA retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS.ResultsOut of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p < 0.001, 95% CI: 1.454 to 3.789).ConclusionThis study accentuates the clinical significance of postoperative pneumonia in femoral fracture patients, with a noted incidence of 10.8%. A notable association with older age, prolonged hospital stays, and ICU admissions was observed, underscoring the necessity of addressing this complication to improve patient outcomes and healthcare resource allocation.