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Journal of Feline Medicine and Surgery Dec 2023The aim of this study was to describe the abdominal ultrasonographic findings in cats with confirmed or presumed feline infectious peritonitis (FIP).
OBJECTIVES
The aim of this study was to describe the abdominal ultrasonographic findings in cats with confirmed or presumed feline infectious peritonitis (FIP).
METHODS
This was a retrospective study performed in an academic veterinary hospital. The diagnosis of FIP was reached on review of history, signalment, clinical presentation, complete blood count, biochemistry panel, peritoneal fluid analysis, cytology and/or histopathology results from abnormal organs, and/or molecular testing (immunohistochemical or FIP coronavirus [FCoV] RT-PCR). Cats with confirmed FIP by molecular testing or with a highly suspicious diagnosis of FIP were included. Abdominal ultrasound examination findings were reviewed.
RESULTS
In total, 25 cats were included. Common clinical signs/pathology findings included hyperglobulinemia (96%), anorexia/hyporexia (80%) and lethargy (56%). Abdominal ultrasound findings included effusion in 88% and lymphadenopathy in 80%. Hepatic changes were noted in 80%, the most common being hepatomegaly (58%) and a hypoechoic liver (48%). Intestinal changes were noted in 68% of cats, characterized by asymmetric wall thickening and/or loss of wall layering, with 52% being ileocecocolic junction and/or colonic in location. Splenic changes were present in 36% of cats, including splenomegaly, mottled parenchyma and hypoechoic nodules. Renal changes were present in 32%, encompassing a hypoechoic subcapsular rim and/or cortical nodules. Mesenteric and peritoneal abnormalities were seen in 28% and 16% of cats, respectively. Most cats (92%) had two or more locations of abdominal abnormalities on ultrasound.
CONCLUSIONS AND RELEVANCE
The present study documents a wider range and distribution of ultrasonographic lesions in cats with FIP than previously reported. The presence of effusion and lymph node, hepatic and/or gastrointestinal tract changes were the most common findings, and most of the cats had a combination of two or more abdominal abnormalities.
Topics: Cats; Animals; Feline Infectious Peritonitis; Retrospective Studies; Coronavirus, Feline; Abdomen; Coronavirus Infections; Cat Diseases
PubMed: 38095890
DOI: 10.1177/1098612X231216000 -
Journal of Medical Internet Research Aug 2023Within the trauma system, the emergency department (ED) is the hospital's first contact and is vital for allocating medical resources. However, there is generally...
BACKGROUND
Within the trauma system, the emergency department (ED) is the hospital's first contact and is vital for allocating medical resources. However, there is generally limited information about patients that die in the ED.
OBJECTIVE
The aim of this study was to develop an artificial intelligence (AI) model to predict trauma mortality and analyze pertinent mortality factors for all patients visiting the ED.
METHODS
We used the Korean National Emergency Department Information System (NEDIS) data set (N=6,536,306), incorporating over 400 hospitals between 2016 and 2019. We included the International Classification of Disease 10th Revision (ICD-10) codes and chose the following input features to predict ED patient mortality: age, sex, intentionality, injury, emergent symptom, Alert/Verbal/Painful/Unresponsive (AVPU) scale, Korean Triage and Acuity Scale (KTAS), and vital signs. We compared three different feature set performances for AI input: all features (n=921), ICD-10 features (n=878), and features excluding ICD-10 codes (n=43). We devised various machine learning models with an ensemble approach via 5-fold cross-validation and compared the performance of each model with that of traditional prediction models. Lastly, we investigated explainable AI feature effects and deployed our final AI model on a public website, providing access to our mortality prediction results among patients visiting the ED.
RESULTS
Our proposed AI model with the all-feature set achieved the highest area under the receiver operating characteristic curve (AUROC) of 0.9974 (adaptive boosting [AdaBoost], AdaBoost + light gradient boosting machine [LightGBM]: Ensemble), outperforming other state-of-the-art machine learning and traditional prediction models, including extreme gradient boosting (AUROC=0.9972), LightGBM (AUROC=0.9973), ICD-based injury severity scores (AUC=0.9328 for the inclusive model and AUROC=0.9567 for the exclusive model), and KTAS (AUROC=0.9405). In addition, our proposed AI model outperformed a cutting-edge AI model designed for in-hospital mortality prediction (AUROC=0.7675) for all ED visitors. From the AI model, we also discovered that age and unresponsiveness (coma) were the top two mortality predictors among patients visiting the ED, followed by oxygen saturation, multiple rib fractures (ICD-10 code S224), painful response (stupor, semicoma), and lumbar vertebra fracture (ICD-10 code S320).
CONCLUSIONS
Our proposed AI model exhibits remarkable accuracy in predicting ED mortality. Including the necessity for external validation, a large nationwide data set would provide a more accurate model and minimize overfitting. We anticipate that our AI-based risk calculator tool will substantially aid health care providers, particularly regarding triage and early diagnosis for trauma patients.
Topics: Humans; Artificial Intelligence; Retrospective Studies; Fractures, Bone; Republic of Korea; Emergency Service, Hospital
PubMed: 37642984
DOI: 10.2196/49283 -
Current Pharmaceutical Biotechnology 2024Monkeypox is a disease caused by the monkeypox virus, which is a type of orthopox virus that comes from the virus family Poxviridae. Its first case reported in animals... (Review)
Review
Monkeypox is a disease caused by the monkeypox virus, which is a type of orthopox virus that comes from the virus family Poxviridae. Its first case reported in animals and humans was in 1958 and 1970, respectively. It is a viral zoonosis disease with two modes of transmission: animal to human (via direct contact or eating the meat of an infected animal) and human to human (via contact or contact with skin lesions, body fluids, and infected person's contaminated objects). The literature depicts that monkeypox is less contagious among individuals in contrast to smallpox; the infection chain of monkeypox is nearly five to six patients approximately. It has two clades, the West African and the Central African (the Congo basin). The Congo basin subgroup of monkeypox is highly transmissible and severe. The symptoms of monkeypox include fever, lethargy, headache, lymphadenopathy, myalgia, myodynia, fainting, shivers, backache, and rashes on the face and extremities. The most common symptom of monkeypox is lymphatic hyperplasia or, lymph adenopathy or swollen lymph nodes. It is proven to be very useful in the diagnosis of monkeypox. The antiviral drugs that are used for its treatment are tecovirimat, brincidofovir and cidofovir. Tecovirimat has fewer side effects and it shows better therapeutic action in comparison to brincidofovir and cidofovir. For the prevention of monkeypox, the Center for Disease Control and Prevention recommends the administration of the same vaccine used for smallpox named INVAMUNE, which is currently in its third generation. Its first and second generations have adverse side effects in patients having HIV or atopic dermatitis.
Topics: Humans; Cidofovir; Cytosine; Mpox (monkeypox); Organophosphonates; Smallpox; Variola virus
PubMed: 37711132
DOI: 10.2174/1389201025666230914094444 -
Frontiers in Immunology 2023Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including metastatic renal cell carcinoma. However, ICI treatment can... (Review)
Review
BACKGROUND
Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including metastatic renal cell carcinoma. However, ICI treatment can lead to endocrine immune-related adverse events (irAEs) by overstimulating the patient's immune system. Here, we report a rare case of a new onset of diabetes mellitus (DM), caused by nivolumab, and we discuss the feasible treatment options with a focus on TNF antagonism.
CASE PRESENTATION
A 50-year-old man was diagnosed with metastatic renal cell carcinoma. Due to systemic progression, a combined immunotherapy with ipilimumab and nivolumab was initiated, according to the current study protocol (SAKK 07/17). The administration of ipilimumab was stopped after 10 months, due to partial response as seen in the computer tomography (CT), and nivolumab was continued as monotherapy. Fourteen months after the start of the treatment, the patient was admitted to the emergency department with lethargy, vomiting, blurred vision, polydipsia, and polyuria. The diagnosis of DM with diabetic ketoacidosis was established, although autoantibodies to β-cells were not detectable. Intravenous fluids and insulin infusion treatment were immediately initiated with switching to a subcutaneous administration after 1 day. In addition, the patient received an infusion of the TNF inhibitor infliximab 4 days and 2 weeks after the initial diagnosis of DM. However, the C-peptide values remained low, indicating a sustained insulin deficiency, and the patient remained on basal bolus insulin treatment. Two months later, nivolumab treatment was restarted without destabilization of the diabetic situation.
CONCLUSIONS
In contrast to the treatment of other irAEs, the administration of corticosteroids is not recommended in ICI-induced DM. The options for further treatment are mainly based on the low numbers of case series and case reports. In our case, the administration of infliximab-in an attempt to salvage the function of β-cells-was not successful, and this is in contrast to some previous reports. This apparent discrepancy may be explained by the absence of insulin resistance in our case. There is so far no evidence for immunosuppressive treatment in this situation. Prompt recognition and immediate start of insulin treatment are most important in its management.
Topics: Male; Humans; Middle Aged; Nivolumab; Ipilimumab; Carcinoma, Renal Cell; Antineoplastic Agents, Immunological; Infliximab; Kidney Neoplasms; Diabetes Mellitus; Insulins
PubMed: 37965350
DOI: 10.3389/fimmu.2023.1248919 -
Cureus Apr 2024Hyponatremia is an adverse effect of many antiseizure medications (ASMs). It occurs with interference with the normal balance of electrolytes within the body. Various... (Review)
Review
Hyponatremia is an adverse effect of many antiseizure medications (ASMs). It occurs with interference with the normal balance of electrolytes within the body. Various risk factors associated with the development of hyponatremia in patients taking these medications include age, gender, dosage, and combinations with other drugs. ASMs such as carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid have a higher risk of hyponatremia. Hyponatremia induced by an antiseizure medication can occur through various mechanisms depending on the drug's specific mechanism of action. Hyponatremia can be a potentially fatal side effect. Patients taking these medications need to be monitored closely for the signs and symptoms of hyponatremia. Acute hyponatremia, defined as developing in <48 hours, is more likely to show symptoms than chronic hyponatremia. Signs of acute hyponatremia include delirium, seizures, decerebrate posturing, and cerebral edema with uncal herniation. Chronic hyponatremia, defined as developing in >48 hours, can cause lethargy, dizziness, weakness, headache, nausea, and confusion. Hyponatremia is associated with longer hospital stays and increased mortality. Treatment varies based on the degree of severity of hyponatremia. Choosing a treatment option should include consideration of the drug causing the electrolyte disturbance, the patient's risk factor profile, and the severity of symptoms as they present in the individual patient. Healthcare providers should be aware of hyponatremia as a potential side effect of ASMs, the signs and symptoms of hyponatremia, the different treatment options available, and the potential complications associated with rapid correction of hyponatremia.
PubMed: 38707045
DOI: 10.7759/cureus.57535 -
BMJ Case Reports Apr 2024Catheter-related bloodstream infection (CRBSI) is one of the common healthcare-acquired infections imposing a high burden of morbidity and mortality on the patients....
Catheter-related bloodstream infection (CRBSI) is one of the common healthcare-acquired infections imposing a high burden of morbidity and mortality on the patients. Non-tuberculous mycobacterium is a rare aetiology for CRBSI and poses challenges in laboratory diagnosis and clinical management. This is a case of a woman in her early 60s with underlying end-stage renal failure, diabetes mellitus and hypertension presented with a 2-week history of high-grade fever postregular haemodialysis, vomiting, lethargy and altered mental status.Blood cultures from a permanent catheter and peripheral taken concurrently yielded , identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry, which established the diagnosis of CRBSI atypically presented with concurrent acute intracranial bleeding and cerebrovascular infarction at initial presentation. She was started on a combination of oral azithromycin, oral amikacin and intravenous imipenem, and the permanent catheter was removed. Despite the treatments instituted, she developed septicaemia, acute myocardial infarction and macrophage activation-like syndrome, causing the patient's death.
Topics: Humans; Female; Catheter-Related Infections; Mycobacterium Infections, Nontuberculous; Middle Aged; Anti-Bacterial Agents; Fatal Outcome; Bacteremia; Renal Dialysis; Kidney Failure, Chronic; Amikacin
PubMed: 38688568
DOI: 10.1136/bcr-2024-259761 -
The Canadian Veterinary Journal = La... Jan 2024A 6-year-old female huacaya alpaca was referred to the clinic for evaluation with a 1-month history of rapid weight loss, inappetence, lethargy, and severe leukocytosis...
A 6-year-old female huacaya alpaca was referred to the clinic for evaluation with a 1-month history of rapid weight loss, inappetence, lethargy, and severe leukocytosis refractory to medical management. Physical examination revealed a body condition score of 1 out of 5 and a large, firm structure palpable in the right caudoventral abdomen. Abdominal ultrasonographic examination revealed 3 masses with hyperechoic, swirling centers. The largest mass measured 15 cm in diameter with a 2-centimeter capsule, and extended from right of midline into the left inguinal region. Transrectal ultrasonography identified a small uterus and clear delineation between the abdominal masses. Complete blood (cell) count findings were consistent with marked systemic inflammation. Based on initial examination and laboratory findings, exploratory laparotomy was elected. Multiple mesenteric masses strongly adhered to the jejunum were observed within the abdomen. Due to the inoperable conditions and the poor long-term prognosis, the alpaca was euthanized under general anesthesia. Bacterial culture of fluid aspirated from the largest mass revealed . Key clinical message: Clinical progression and attempted treatment of in camelids have not been previously described and the bacterium should be considered as a differential diagnosis for abscessation and persistent leukocytosis. is also considered a zoonotic agent and proper precautions should be taken when handling cases of abdominal abscessation.
Topics: Female; Animals; Yersinia pseudotuberculosis; Camelids, New World; Leukocytosis; Laparotomy
PubMed: 38164383
DOI: No ID Found -
International Journal of Geriatric... Dec 2023Although delirium is well known to acute care clinicians, the features required for its diagnosis and how to understand and operationalize them remain sticking points in... (Review)
Review
OBJECTIVE
Although delirium is well known to acute care clinicians, the features required for its diagnosis and how to understand and operationalize them remain sticking points in the field. To clarify the delirium phenotype, we present a close reading of past and current sets of delirium diagnostic criteria.
METHODS
We first differentiate the delirium syndrome (i.e., features evaluated at bedside) from additional criteria required for diagnosis. Next, we align related features across diagnostic systems and examine them in context to determine intent. Where criteria are ambiguous, we review common delirium instruments to illustrate how they have been interpreted.
RESULTS
An acute disturbance in attention is universally attested across diagnostic systems. A second core feature denotes confusion and has been included across systems as disturbance in awareness, impaired consciousness, and thought disorganization. This feature may be better understood as a disturbance in thought clarity and operationalized in terms of neuropsychological domains thereby clearly linking it to global neurocognitive disturbance. Altered level of activity describes a third core feature, including motor and sleep/wake cycle disturbances. Excluding stupor (wherein mental content cannot be assessed due to reduced arousal) from delirium, as in DSM-5-TR, is appropriate for a psychiatric diagnosis, but the brain injury exclusion in ICD-11 is unjustified.
CONCLUSIONS
The delirium phenotype involves a disturbance in attention, qualitative thought clarity, and quantitative activity level, including in relation to expected sleep/wake cycles. Future diagnostic systems should include a severity threshold and specify that delirium diagnosis refers to a 24-h period.
Topics: Humans; Arousal; Attention; Delirium; Phenotype
PubMed: 38146182
DOI: 10.1002/gps.6046 -
Molecular Genetics and Genomics : MGG Sep 2023Tenacibaculosis is an ulcerative skin disorder that affects finfish. It is caused by members of the genus Tenacibaculum, resulting in eccentric behavioural changes,... (Review)
Review
Tenacibaculosis is an ulcerative skin disorder that affects finfish. It is caused by members of the genus Tenacibaculum, resulting in eccentric behavioural changes, including anorexia, lethargy, and abnormal swimming patterns that often result in mortality. Currently, species suspected of causing fish mortality include T. ovolyticum, T. gallaicum, T. discolor, T. finnmarkense, T. mesophilum, T. soleae, T. dicentrarchi, and T. maritimum. However, pathogenic members and the mechanisms involved in disease causation, progression, and transmission are limited due to the inadequate sequencing efforts in the past decade. In this study, we use a comparative genomics approach to investigate the characteristic features of 26 publicly available genomes of Tenacibaculum and report our observations. We propose the reclassification of "T. litoreum HSC 22" to the singaporense species and assignment of "T. sp. 4G03" to the species discolor (species with quotation marks have not been appropriately named). We also report the co-occurrence of several antimicrobial resistance/virulence genes and genes private to a few members. Finally, we mine several non-B DNA forming regions, operons, tandem repeats, high-confidence putative effector proteins, and sortase that might play a pivotal role in bacterial evolution, transcription, and pathogenesis.
Topics: Animals; Tenacibaculum; Fish Diseases; Flavobacteriaceae Infections; Genomics; Fishes
PubMed: 37225902
DOI: 10.1007/s00438-023-02031-3 -
Ophthalmic Plastic and Reconstructive...Saturday night retinopathy, the term coined by Jayam et al . in 1974, is a rare condition in which external compression of the orbit during a drug and alcohol stupor...
PURPOSE
Saturday night retinopathy, the term coined by Jayam et al . in 1974, is a rare condition in which external compression of the orbit during a drug and alcohol stupor causes a unilateral orbitopathy with ophthalmoplegia and ischemic retinopathy. This condition has been increasingly reported in the last decade, correlating with an increasing burden of substance use. This condition mirrors a similar entity typically reported in patients following spinal surgery, where a headrest supporting the patient's face compresses the orbit. The current authors combine these 2 entities, entitled external compressive ischemic orbitopathy, and present a comprehensive literature review describing this entity.
METHODS
A systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All related publications of vision loss in the setting of orbital compression were reviewed. Data collected included patient demographics, precipitating circumstances of vision loss, presenting ocular symptoms, outcomes, and ancillary imaging.
RESULTS
In total 31 articles were selected for inclusion, yielding 46 patients. A total of 10 patients suffered orbitopathy in the setting of a drug stupor, and 36 following prone-positioned surgery. However, 79% of patients presented with visual acuity of light perception or worse. Also, 86% of patients presented with ophthalmoplegia, 92% with proptosis and orbital edema, and 86% with varying degrees of retinal ischemia. When compared with iatrogenic cases, self-induced stuporous cases demonstrated worse presenting visual acuity, ophthalmoplegia, retinal and choroidal filling, and worse final outcomes.
CONCLUSION
External compressive ischemic orbitopathy is a severe vision-threatening condition that has been increasingly reported in the last decade.
Topics: Humans; Graves Ophthalmopathy; Stupor; Decompression, Surgical; Orbit; Exophthalmos; Vision Disorders; Ophthalmoplegia; Blindness; Retinal Diseases; Ischemia
PubMed: 37486344
DOI: 10.1097/IOP.0000000000002430