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Scientific Reports Jun 2022Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and...
Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and mortality. However, the agents that compose the vaginal microbiota of sows and their changes during infections are not well understood. The first goal of this study was to characterize and compare the vaginal bacterial content of healthy (HE, n = 40) and purulent vulvar discharge sows (VD, n = 270) by a culture-dependent method and MALDI-TOF MS identification. Secondly, we performed 16S rRNA targeted metagenomic approach (n = 72) to compare the vaginal microbiota between these groups. We found a wide variety of bacteria, with Proteobacteria, Firmicutes, and Bacteroidota being the most abundant phyla in both groups, as well as Escherichia-Shigella, Streptococcus, and Bacteroides at the genus level. Most agents identified in the sequencing method also grew in the culture-dependent method, showing the viability of these bacteria. Alpha diversity did not differ between HE and VD sows, regarding sample richness and diversity, but a beta-diversity index showed a different microbiota composition between these groups in two tested herds. ANCOM analysis revealed that Bacteroides pyogenes were more abundant in VD females and can be a marker for this group. Other agents also require attention, such as the Streptococcus dysgalactiae and Staphylococcus hyicus found in remarkably greater relative abundance in VD sows. Network analysis revealed important positive correlations between some potentially pathogenic genera, such as between Escherichia-Shigella, Trueperella, Streptococcus, Corynebacterium, and Prevotella, which did not occur in healthy sows. We conclude that the alteration of the vaginal microbiota between healthy and purulent vulvar discharge sows, although not extreme, could be due to the increase in the relative abundance of specific agents and to associations between potentially pathogenic bacteria.
Topics: Animals; Bacteria; Female; Humans; Microbiota; RNA, Ribosomal, 16S; Swine; Vagina; Vulva
PubMed: 35650232
DOI: 10.1038/s41598-022-13090-8 -
Animal : An International Journal of... May 2023This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect... (Review)
Review
This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect reproductive performance. Metritis is characterized by fetid discharge from the uterus, with or without fever. Purulent vaginal discharge describes exudate that is >50% pus that may be attributable to uterine infection or cervicitis. Endometritis is inflammation of the uterus diagnosed by endometrial cytology with a proportion of neutrophils (typically ≥5%) that is associated with impaired fertility. Metritis and PVD are associated with uterine bacterial dysbiosis: changes in the microbiota to lesser diversity and greater abundance of pathogens, especially Gram-negative anaerobic bacteria, and Trueperella pyogenes in the case of PVD. Metritis is justifiably treated with approved antibiotics but criteria for more selective treatment without loss of performance are emerging. Purulent vaginal discharge is not synonymous with clinical endometritis, and greater precision in terminology is warranted. PVD is likely under-diagnosed and represents an opportunity for improved management in many herds. Endometritis seems in many cases to reflect persistent, dysregulated inflammation, for which the inciting cause is unclear. Postpartum uterine infection and inflammation have harmful effects on oocytes, embryo development, and the endometrium for at least three months, even if the disease is apparently resolved. Emerging concepts of the resolution and regulation of inflammation are promising for the improvement of prevention and therapy of endometritis.
Topics: Female; Cattle; Animals; Endometritis; Vaginal Discharge; Postpartum Period; Fertility; Puerperal Disorders; Inflammation; Cattle Diseases
PubMed: 37567665
DOI: 10.1016/j.animal.2023.100781 -
BMC Pulmonary Medicine Aug 2023Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently.
METHODS
To identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea.
RESULTS
Three hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68-6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 - 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 - 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 - 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 - 0.25) suggested against the diagnosis of AECOPD alone.
CONCLUSION
The study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.
Topics: Humans; Aged; Prospective Studies; Retrospective Studies; Pulmonary Disease, Chronic Obstructive; Dyspnea; Cough; Disease Progression; Acute Disease
PubMed: 37580731
DOI: 10.1186/s12890-023-02587-1 -
Reproduction (Cambridge, England) Aug 2023Clinical and subclinical endometritis are different manifestations of reproductive tract inflammatory disease in dairy cows. This review addresses the genesis of... (Review)
Review
IN BRIEF
Clinical and subclinical endometritis are different manifestations of reproductive tract inflammatory disease in dairy cows. This review addresses the genesis of clinical and subclinical endometritis considering metabolic stress, innate immune dysfunction, and shifts in the composition of the uterine microbiota in the postpartum period.
ABSTRACT
Up to half of dairy cows may develop one or more types of reproductive tract inflammatory disease within 5 weeks after calving. Clinical endometritis (CE) results from uterine bacterial dysbiosis with increased relative abundance of pathogenic bacteria associated with luminal epithelial damage. These bacteria cause endometrial stromal cell lysis, followed by massive polymorphonuclear neutrophil (PMN) migration, and pyogenesis. CE is defined as endometrial inflammation accompanied by purulent discharge. Purulent discharge is not always accompanied by uterine inflammation (being (rarely) vaginitis or (commonly) cervicitis), hence referred to as purulent vaginal discharge (PVD). Subclinical endometritis (SCE) is an asymptomatic uterine disease defined by a threshold of PMN on cytology that is associated with worse reproductive performance; it has not been linked with bacterial dysbiosis. Current evidence suggests that SCE is a result of metabolic and inflammatory dysfunction that impairs innate immune function and the ability of endometrial PMN to undergo apoptosis, necrosis, and ultimately achieve resolution of inflammation. CE and SCE are diagnosed between 3 and 5 weeks postpartum and commonly overlap, but they are considered distinct manifestations of reproductive tract inflammatory disease. This review addresses the genesis of CE and SCE in postpartum dairy cows considering metabolic stress, innate immune dysfunction, and shifts in the composition of the uterine microbiota.
Topics: Animals; Female; Humans; Cattle; Endometritis; Dysbiosis; Uterus; Reproduction; Postpartum Period; Inflammation; Cattle Diseases
PubMed: 37294111
DOI: 10.1530/REP-22-0452 -
Turkish Journal of Urology Dec 2017Superficial penile skin infections may be presented in different clinical situations that vary from simple infection to organ loss and serious morbidity and mortality....
Superficial penile skin infections may be presented in different clinical situations that vary from simple infection to organ loss and serious morbidity and mortality. Antibiotic treatment and, if necessary, urgent debridement is required. A 46-year-old male patient with the complaints of urethral discharge and pain admitted to our outpatient clinic. He declared that there were midpenil tenderness and erythema 14 days ago which occurred after sexual intercourse. Complete penile skin necrosis with purulent discharge was detected in physical examination. After wound debridement and 14-days of intravenous antibiotic treatment, wound site culture was negative and then full-thickness skin grafting was performed. Urgent antibiotic treatment should be given, especially for the skin infections of the genital area. Despite the rapid spread of antibiotic treatment, clinical presentation may worsen within hours. It should be noted that especially in diabetics and elderly patients with poor hygiene, the infection may spread to anogenital region and may lead to fulminant necrotizing fasciitis which can present with severe morbidity and mortality. Reconstructive surgery is planned after the control of infection and according to the amount of tissue loss.
PubMed: 29201525
DOI: 10.5152/tud.2017.17802 -
Theriogenology Oct 2020This study compares serum markers for systemic inflammation, and liver, mineral, and energy status in samples obtained -7, 1, 3, 5, 7, 14 ± 1, 21 ± 1, and 35 d...
This study compares serum markers for systemic inflammation, and liver, mineral, and energy status in samples obtained -7, 1, 3, 5, 7, 14 ± 1, 21 ± 1, and 35 d relative to calving from healthy dairy cows and those diagnosed with purulent vaginal discharge (PVD) or subclinical endometritis (SCE). Metabolites and markers measured in serum were total calcium, total protein, albumin, globulin, cholesterol, urea, glucose, gamma-glutamyl transferase, aspartate aminotransferase, glutamate dehydrogenase, β-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), haptoglobin (Hp), and insulin-like growth factor-1 (IGF-1). Holstein cows with no recorded clinical disease were classified healthy (neither PVD nor SCE; n = 38), PVD (n = 10) or SCE (n = 10) at 35 d postpartum. The cut-point for PVD was mucopurulent vaginal discharge or worse, measured with Metricheck, and for SCE > 5% endometrial polymorphonuclear cells (PMN). Purulent vaginal discharge and SCE were mutually exclusive categories. The association of each serum marker with reproductive tract health classification was fitted in mixed linear regression models, accounting for repeated measures, sampling day, parity, BCS, and interactions of reproductive tract status and day. Serum Hp concentrations were greater at 3, 5, 7, and 14 ± 1 d postpartum for SCE and at 7 and 35 d postpartum for PVD than in healthy cows. Albumin concentrations were lesser for PVD than healthy at 14 ± 1 d postpartum and lesser for SCE than healthy at 35 d postpartum. The week before calving, SCE had lesser total calcium than healthy cows, and at 7 and 14 ± 1 d postpartum PVD had lesser total calcium than healthy cows. At 14 ± 1 d postpartum, serum NEFA, BHB, and globulin were greater, and IGF-1 lower for SCE than PVD or healthy cows. For all other metabolites, no differences were found. Before diagnosis, PVD or SCE had more indication of postpartum systemic inflammation (high Hp and low albumin) than healthy cows, and markers of energy status were more compromised in SCE than in PVD or healthy cows. This supports the hypothesis that SCE is associated with maladaptation to postpartum metabolic demands and with metabolic inflammation.
Topics: Animals; Cattle; Cattle Diseases; Endometritis; Female; Lactation; Postpartum Period; Pregnancy; Vaginal Discharge
PubMed: 32622204
DOI: 10.1016/j.theriogenology.2020.06.005 -
Brazilian Journal of Otorhinolaryngology 2022Actinomycosis of the nasal cavity is very rare.
INTRODUCTION
Actinomycosis of the nasal cavity is very rare.
OBJECTIVE
The purpose of this study was to investigate the clinical features, treatment methods, and treatment results of actinomycosis of the nasal cavity in our hospital.
METHODS
We retrospectively enrolled 11 patients with histopathologically identified actinomycosis of the nasal cavity from January 2010 to May 2020.
RESULTS
This study included five males and six females. The most common symptom was purulent nasal discharge (36.4%). Nasal actinomycosis occurred in the maxillary sinus in 5 (45.5%) patients, the ethmoid sinus in two, the hard palate in two, the frontal sinus in one, and the nasal septum in one. After surgery, intravenous administration of antibiotics was performed on average for 7.4 days and oral antibiotics were prescribed for about 120.5 days. The clinical characteristics of the patients with nasal actinomycosis and the duration of antibiotic usage were not significantly different. Trauma was significantly associated with repeated nasal actinomycosis infections (p < 0.05).
CONCLUSION
Actinomycosis of the nasal cavity should be suspected when a patient with chronic sinusitis does not respond to medical therapy and has a history of dental treatment, local surgery or radiation therapy. Nasal can be sufficiently treated with antibiotics and endoscopic surgery.
Topics: Humans; Nasal Cavity; Retrospective Studies
PubMed: 34112606
DOI: 10.1016/j.bjorl.2021.05.003 -
Cureus Oct 2022Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to... (Review)
Review
Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to a permanent loss of light perception. It is generally an inflammation of the fluids present in the anterior and posterior chamber of the eye, consisting of vitreous and aqueous fluid. The inflammation is due to the infection of these fluids after their exposure during or after the cataract surgery. In today's situation, patient surgery is the most frequently preferred for the correction or treatment of the cataract. There are various factors causing endophthalmitis in cataract surgery. This condition occurs mostly by the entry of infective bacteria such as staphylococcus, gram-negative organisms, and streptococcus species. As well as fungi like aspergillus and candida. Cataract surgery has many risk factors that can be divided into preoperative, intraoperative, and postoperative phases. The most common symptom of this condition is pain in the eyes and redness, which sometimes leads to purulent discharge, causing decreased vision or loss of eyesight. The increasing inflammation of the vitreous fluid is the main identification of the condition. There is a surge of inflammatory cells in the space of the vitreous fluid. The condition can be classified into two types which are exogenous and endogenous. In these types, subtypes explain the postoperative complications of the disease. It is a rare condition, and the percentage of it occurring as a postoperative complication is very low. It generally targets the old age group of people. This narrative review article explains endophthalmitis as a postoperative complication of cataract surgery and its treatment modalities. The terms endophthalmitis, postoperative, cataract surgery, complications, and vitreous humor were used for the review article in PubMed.
PubMed: 36381712
DOI: 10.7759/cureus.30110 -
Pediatric Annals Jan 2023We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst....
We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst. Acute-on-chronic abdominal pain has one of the broadest and, in our case, ever-changing differential diagnoses. Exploratory laparoscopy revealed a severe pelvic inflammatory process with a large abscess and extensive omental and bowel adhesions, a left ovarian cyst, a shortened appendix with thickened tip, and purulent fluid in the cul-de-sac. These findings suggested a ruptured appendix leading to a large abscess with adjacent ovarian dermoid cyst, and an appendectomy was performed. Our patient responded well to continued intravenous antibiotics, and her drain was removed on the day of discharge. She was sent home with an additional 2 weeks of oral cefdinir and metronidazole. Follow-up ultrasound showed dramatic cyst resolution, and no further intervention was needed. .
Topics: Female; Humans; Adolescent; Child; Abscess; Dermoid Cyst; Abdominal Pain; Anti-Bacterial Agents; Appendectomy
PubMed: 36625800
DOI: 10.3928/19382359-20221114-05 -
Journal of Dairy Science Dec 2021Despite the rapid growth in popularity of the Jersey breed, most research on dairy cows in the United States has been done with the Holstein breed. Postpartum uterine... (Observational Study)
Observational Study
Despite the rapid growth in popularity of the Jersey breed, most research on dairy cows in the United States has been done with the Holstein breed. Postpartum uterine diseases negatively influence reproductive performance of dairy cows and limited data are available regarding predisposing factors for uterine diseases in Jersey cows. Our objectives were to determine the prevalence and risk factors for purulent vaginal discharge (PVD) and its effect on fertility of lactating Jersey cows. This was a retrospective observational study with data collected from 3,822 Jersey cows. The Metricheck device was used for PVD diagnosis, and positive cases (≥50% of pus in exudate) were further classified for severity using the following 4 categories based on the amount of pus observed: 50 to 60% pus in exudate, 60 to 90% pus in exudate, 90 to 100% pus in exudate, and 90 to 100% pus in exudate + uterine fluid detected by palpation per rectum. Univariable and multivariable regression analyzes were conducted to dissect the risk factors for PVD and severity of PVD in Jerseys cows. The major risk factors for PVD were calving-related problems, retained fetal membrane, metritis, and days in the close-up diet. A subgroup of cows (n = 740) was scored for body condition and locomotion scores and had blood sampled in the peripartum for determination of plasma concentrations of nonesterified fatty acids and β-hydroxybutyrate. In the multivariable analysis that considered data collected for the subgroup of cows, peripartum nonesterified fatty acids, postpartum β-hydroxybutyrate, and peripartum locomotion and body condition scores were not retained in the reduced model of predictors of PVD. Not surprisingly, pregnancy per artificial insemination following the first and second services was reduced in cows diagnosed with PVD compared with cows without PVD. In addition, PVD was associated with increased odds of pregnancy loss after the first service and reduced hazard of pregnancy by 305 d in milk. The stratification of PVD severity according to the amount of pus observed and the consistency of the uterus was meaningful, as observed by the differences in reproductive outcomes between cows with diverging amounts of pus in the retrieved exudate. Risk factors for PVD in Jersey cows was similar to previously reported for Holstein cows, and a strong detrimental effect of PVD on fertility was also observed in Jersey cows.
Topics: Animals; Cattle; Cattle Diseases; Female; Lactation; Pregnancy; Reproduction; Risk Factors; Vaginal Discharge
PubMed: 34482979
DOI: 10.3168/jds.2021-20502