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Animals : An Open Access Journal From... Nov 2023In this study, strain C24 was isolated from cases of winter mortalities of hatchery-reared European seabass () broodstock in Türkiye. The first mortalities were...
In this study, strain C24 was isolated from cases of winter mortalities of hatchery-reared European seabass () broodstock in Türkiye. The first mortalities were reported in September 2016 and occurred annually in early autumn/late winter until the end of February 2019, when 15% of accumulated mortality was recorded. Diseased moribund fish exhibited general septicemic signs, including dermal ulcerations with hemorrhagic margins, distended abdomens, and hemorrhages below the pectorals, pelvic fins, and at the operculum. Postmortem findings showed congestion in several internal organs, hemorrhagic ascitic fluid, and congested prolapsed anal openings. The representative bacterial isolate strain C24 was characterized as Gram-negative, motile, nitrite-producing, and as vibrio static agent O/129-sensitive. The full-length 16S rRNA sequence (Accession No. ON778781) and gene sequence (Accession No. ON792326) of the C24 strain showed high similarity to strains. Moreover, the whole-genome average nucleotide identity (ANI) values (ANI > 97.7%) against four strains above the species demarcation limit unambiguously identified the C24 isolate as a member of this species. A preliminary virulence-gene analysis showed that the isolate C24 encoded at least three exotoxins, including two aerolysins and a thermolabile hemolysin. The experimental infection showed that the C24 isolate exhibited low to moderate virulence in experimentally infected European seabass juveniles. Interestingly, antimicrobial susceptibility testing revealed that the C24 isolate was susceptible to nalidixic acid, ciprofloxacin, and several other antibiotics but resistant to tilmicosin, kanamycin, streptomycin, and ampicillin. To our knowledge, this study is the first to report that could be considered an emerging bacterial pathogen in Türkiye, and it may threaten the international European seabass production.
PubMed: 38003197
DOI: 10.3390/ani13223580 -
The American Journal of Case Reports Feb 2024BACKGROUND Cloaca malformations result from a disproportion of apoptosis, cell growth, and maturation. The range of cloacal malformations is extensive and diverse, with...
BACKGROUND Cloaca malformations result from a disproportion of apoptosis, cell growth, and maturation. The range of cloacal malformations is extensive and diverse, with a lack of a straightforward classification system. Cloacal dysgenesis sequence (CDS), also known as urorectal septum malformation sequence, is a rare cloaca variant described as the absence of a perineal orifice. Prenatal magnetic resonance imaging and antenatal ultrasounds may reveal a cloacal malformation; however, many patients are not diagnosed with cloacal malformation until birth. CASE REPORT We present a case of a female neonate delivered by a 23-year-old G2P1T1A0L0 mother who had received comprehensive prenatal care. During pregnancy, bilateral multicystic dysplastic kidneys were identified prenatally, leading to the in utero placement of a vesicoamniotic shunt. The physical exam revealed a distended abdomen with reduced abdominal musculature and laxity, ascites, a vesicoamniotic shunt in place, absent urethra, ambiguous genitalia with no vaginal opening, no perineal opening, and clubfoot. Abdominal radiograph showed findings consistent with significant abdominal ascites. An exploratory laparotomy was performed that included diverting colostomy, mucous fistula creation, tube vaginostomy, removal of the vesicoamniotic shunt, and suprapubic tube placement. The patient recovered well from this operation with no complications. CONCLUSIONS CDS is an uncommon condition in pediatric patients, and although sonographic findings can reveal urinary tract abnormalities, prenatal imaging might not always identify CDS. Our case underscores the uniqueness of the case and the significance of early detection and immediate medical and surgical intervention.
Topics: Infant, Newborn; Animals; Female; Pregnancy; Humans; Child; Young Adult; Adult; Ascites; Cloaca; Ultrasonography, Prenatal; Abnormalities, Multiple; Vagina
PubMed: 38412145
DOI: 10.12659/AJCR.942203 -
Cureus Mar 2024Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor function and is often accompanied by secondary musculoskeletal issues. Severe scoliosis, a...
Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor function and is often accompanied by secondary musculoskeletal issues. Severe scoliosis, a lateral curvature of the spine over 40 degrees, poses a significant challenge for individuals with CP, impacting their mobility and overall well-being. While the association between scoliosis and gastrointestinal complications is acknowledged, the occurrence of colonic volvulus with necrosis in the context of CP and severe scoliosis is rare and complex. This case report emphasizes the importance of clinical awareness in managing gastrointestinal complications in patients with CP and severe scoliosis. An 11-year-old female presented with gastroenteritis and a concurrent viral upper respiratory tract infection. She experienced complications such as greenish vomiting, hematemesis, abdominal distention, and constipation. The patient has a medical history of epilepsy and was diagnosed with quadriplegic CP at four months old due to viral meningitis. She is currently on anti-epileptic medications and receives regular follow-ups with neurology. Severe lumbar scoliosis of more than 50 degrees Cobb angle is also noted. Physical examination revealed dehydration, bilious content in nasogastric tube (NGT) aspiration, tender abdomen, and an empty digital rectal examination. Some laboratory findings showed elevated levels of erythrocyte sedimentation rate (ESR), prothrombin time (PT), blood urea nitrogen (BUN), and sodium, while albumin levels were decreased, and white blood cell (WBC) count was mildly elevated. Abdominal computed tomography (CT) with contrast showed a distended ascending colon with air and swirling of the mesentery. The distal half of the large bowel was not dilated, and fecal matter was present. The small bowel appeared to be collapsed, and there was moderate free fluid in the peritoneal cavity, indicating colonic volvulus involving the proximal large bowel. The patient underwent surgery, which involved deflating and removing the distended colon, resecting the gangrenous colon, and performing an ilio-sigmoid anastomosis to restore gastrointestinal continuity. Postoperatively, the patient received close monitoring in the pediatric intensive care unit (PICU), received total parenteral nutrition (TPN) for five days, gradually progressed feeding, and showed overall improvement in her condition. In conclusion, this case report highlights a rare occurrence of colonic volvulus in a patient with CP and severe scoliosis. It emphasizes the complex relationship between neurological and musculoskeletal disorders in gastrointestinal complications. A multidisciplinary approach is important for optimal management. It shows the importance of musculoskeletal factors in patients with neurological conditions. Overall, it contributes to the medical literature and emphasizes tailored management strategies for gastrointestinal issues in such patients.
PubMed: 38650790
DOI: 10.7759/cureus.56743 -
Cureus Feb 2024Drug-induced liver injury (DILI) has a symptomatic profile that mimics many forms of hepatic injury. In patients presenting with symptoms suspicious of acute liver...
Drug-induced liver injury (DILI) has a symptomatic profile that mimics many forms of hepatic injury. In patients presenting with symptoms suspicious of acute liver injury, it is important that clinicians effectively rule out more common causes while simultaneously maintaining a broad differential diagnosis that includes DILI. In this report, we present the case of a 41-year-old African American male who was admitted to the hospital for two weeks' duration of worsening jaundice, right upper quadrant pain, pruritus, and acholic stools after terbinafine use for an acute episode of onychomycosis. Physical examination showed evidence of jaundice, scleral icterus, and a soft non-distended abdomen. Initial laboratory results at admission showed significant elevation of total bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase. Careful review of the patient's medications, a clinical workup to rule out primary causes of hepatobiliary pathology, and confirmatory liver biopsy showing benign hepatic parenchyma with marked cholestasis including bile plugs and bile granulomas provided sufficient evidence supporting terbinafine use as the inciting factor. The emphasis of this case is to highlight the symptoms, diagnostic measures, and suspected pathophysiology of terbinafine-induced hepatotoxicity.
PubMed: 38510874
DOI: 10.7759/cureus.54453 -
Cureus Jul 2023is the most common infection and is mostly asymptomatic in infected individuals. Only a few cases of collagenous gastritis associated with infection have been...
is the most common infection and is mostly asymptomatic in infected individuals. Only a few cases of collagenous gastritis associated with infection have been reported in the previous literature. We report a case of a 54-year-old female presenting with heartburn and epigastric pain associated with bloating, gas, and sometimes constipation. The physical examination was unremarkable with a soft, non-tender, and non-distended abdomen. Upper endoscopy showed erythema in the stomach with non-erosive gastritis. Our patient was diagnosed with -associated chronic active gastritis with collagenous gastritis on histologic evaluation of the gastric biopsy specimen. After treatment with eradication therapy, patients with collagenous gastritis associated with infections showed a significant improvement in collagenous gastritis on endoscopy.
PubMed: 37602016
DOI: 10.7759/cureus.42172 -
Circulation Research Jun 2024Vein graft failure following cardiovascular bypass surgery results in significant patient morbidity and cost to the healthcare system. Vein graft injury can occur during...
BACKGROUND
Vein graft failure following cardiovascular bypass surgery results in significant patient morbidity and cost to the healthcare system. Vein graft injury can occur during autogenous vein harvest and preparation, as well as after implantation into the arterial system, leading to the development of intimal hyperplasia, vein graft stenosis, and, ultimately, bypass graft failure. Although previous studies have identified maladaptive pathways that occur shortly after implantation, the specific signaling pathways that occur during vein graft preparation are not well defined and may result in a cumulative impact on vein graft failure. We, therefore, aimed to elucidate the response of the vein conduit wall during harvest and following implantation, probing the key maladaptive pathways driving graft failure with the overarching goal of identifying therapeutic targets for biologic intervention to minimize these natural responses to surgical vein graft injury.
METHODS
Employing a novel approach to investigating vascular pathologies, we harnessed both single-nuclei RNA-sequencing and spatial transcriptomics analyses to profile the genomic effects of vein grafts after harvest and distension, then compared these findings to vein grafts obtained 24 hours after carotid-carotid vein bypass implantation in a canine model (n=4).
RESULTS
Spatial transcriptomic analysis of canine cephalic vein after initial conduit harvest and distention revealed significant enrichment of pathways (<0.05) involved in the activation of endothelial cells (ECs), fibroblasts, and vascular smooth muscle cells, namely pathways responsible for cellular proliferation and migration and platelet activation across the intimal and medial layers, cytokine signaling within the adventitial layer, and ECM (extracellular matrix) remodeling throughout the vein wall. Subsequent single-nuclei RNA-sequencing analysis supported these findings and further unveiled distinct EC and fibroblast subpopulations with significant upregulation (<0.05) of markers related to endothelial injury response and cellular activation of ECs, fibroblasts, and vascular smooth muscle cells. Similarly, in vein grafts obtained 24 hours after arterial bypass, there was an increase in myeloid cell, protomyofibroblast, injury response EC, and mesenchymal-transitioning EC subpopulations with a concomitant decrease in homeostatic ECs and fibroblasts. Among these markers were genes previously implicated in vein graft injury, including , , and , in addition to novel genes of interest, such as and . These genes were further noted to be driving the expression of genes implicated in vascular remodeling and graft failure, such as , , , and By integrating the spatial transcriptomics and single-nuclei RNA-sequencing data sets, we highlighted the spatial architecture of the vein graft following distension, wherein activated and mesenchymal-transitioning ECs, myeloid cells, and fibroblasts were notably enriched in the intima and media of distended veins. Finally, intercellular communication network analysis unveiled the critical roles of activated ECs, mesenchymal-transitioning ECs, protomyofibroblasts, and vascular smooth muscle cells in upregulating signaling pathways associated with cellular proliferation (MDK [midkine], PDGF [platelet-derived growth factor], VEGF [vascular endothelial growth factor]), transdifferentiation (Notch), migration (ephrin, semaphorin), ECM remodeling (collagen, laminin, fibronectin), and inflammation (thrombospondin), following distension.
CONCLUSIONS
Vein conduit harvest and distension elicit a prompt genomic response facilitated by distinct cellular subpopulations heterogeneously distributed throughout the vein wall. This response was found to be further exacerbated following vein graft implantation, resulting in a cascade of maladaptive gene regulatory networks. Together, these results suggest that distension initiates the upregulation of pathological pathways that may ultimately contribute to bypass graft failure and presents potential early targets warranting investigation for targeted therapies. This work highlights the first applications of single-nuclei and spatial transcriptomic analyses to investigate venous pathologies, underscoring the utility of these methodologies and providing a foundation for future investigations.
Topics: Animals; Dogs; Transcriptome; Single-Cell Analysis; Male; Tissue and Organ Harvesting; Female; Signal Transduction; Gene Expression Profiling
PubMed: 38808504
DOI: 10.1161/CIRCRESAHA.123.323939 -
World Journal of Clinical Cases Sep 2023Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound. Solitary liver cysts are divided into...
BACKGROUND
Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound. Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts, depending on the biliary connection. While some solitary liver cysts are symptomatic in childhood, even in newborns, they are often found incidentally in adults.
CASE SUMMARY
A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting, respiratory problems, and abdominal bloating complaints. On examination, the abdomen was greatly distended and extremely tight. She had repeated vomiting for 3 d, no stool output, and decreased urine. The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm × 10 cm × 14 cm, extending from the liver or right kidney to the pelvis. In the magnetic resonance imaging examination of the patient, a solitary cystic structure of 10 cm × 10 cm × 14 cm in the right abdomen was observed, extending to the pelvis and possibly originating from the liver. The patient was operated fenestration after her fluid and electrolytes improved. Oral nutrition was initiated on the 2 postoperative day, and the drain was removed on the 5 postoperative day. The patient visited the outpatient clinic control 1 mo later with no clinical complaints.
CONCLUSION
Congenital liver cysts are usually followed without complications. They rarely reach gigantic dimensions and may cause respiratory distress, intestinal obstruction and recurrent vomiting. Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.
PubMed: 37731578
DOI: 10.12998/wjcc.v11.i26.6246 -
International Journal of Surgery Case... Sep 2023Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear...
INTRODUCTION AND IMPORTANCE
Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear significance. We present three patients from the past twenty years with spontaneous splenic rupture due to peliosis, two of whom had hematologic malignancy, to draw attention to a possible correlation.
CASE PRESENTATION
A 31-year-old male with essential thrombocytopenia and antiphospholipid-antibody syndrome presented with worsening abdominal pain and hypotension. The patient denied any trauma. Computed-tomography demonstrated hemoperitoneum and splenic rupture with innumerable blood-filled splenic cysts. An uncomplicated emergency open splenectomy was performed with shed-blood reinfusion. The patient was discharged on postoperative day five. The patient developed acute myelogenous leukemia and died six years later. A 44-year-old otherwise healthy male presented with left upper-quadrant and shoulder pain without reported trauma. Computed-tomography (CT) imaging revealed splenomegaly, multiple splenic cystic lesions, and free intraperitoneal blood. A laparoscopic splenectomy, complicated by a pancreatic leak that was managed with a drain, was performed. The patient was discharged on postoperative day three and was well at 37 months follow-up. A 78-year-old male with splenomegaly and chronic anemia on warfarin for atrial fibrillation presented in shock with a distended abdomen after falling from a standing height. The patient was resuscitated with two units of packed red blood cells and underwent emergent abdominal exploration. The spleen was ruptured. An open splenectomy was performed and four liters of intraperitoneal blood were evacuated. Pathology confirmed splenic peliosis and historic diffuse large B-cell lymphoma. The patient had an excellent response to chemotherapy but died 12 years later.
CLINICAL DISCUSSION
Splenic peliosis is a rare vascular phenomenon of unclear etiology. Several toxic and pharmaceutical agents have been associated with spontaneous splenic rupture in patients with peliosis. There are also a number of reported patients who were noted to have hematologic disorders, suggestive of a potential association to the pathophysiology of peliosis.
CONCLUSION
Based on our clinical experience and focused literature review, it appears likely that there is a relationship between splenic peliosis and hematologic malignancy.
PubMed: 37633196
DOI: 10.1016/j.ijscr.2023.108676 -
Journal of Surgical Case Reports Dec 2023A female patient in her 60s with a history of Parkinson's disease developed epigastric and retrosternal chest pain, with associated vomiting. On examination, she had a...
A female patient in her 60s with a history of Parkinson's disease developed epigastric and retrosternal chest pain, with associated vomiting. On examination, she had a distended abdomen with no focal peritonism. A computed tomography (CT) pulmonary angiogram was organized, which demonstrated no evidence of pulmonary emboli, but an incidental finding of gas within the liver peripheries and gastric fundal wall. A plain film abdominal radiograph demonstrated a significantly distended stomach. Thus, acute gastric dilatation was diagnosed. A nasogastric tube was introduced and intravenous fluids were given promptly. An urgent CT scan of abdomen and pelvis with intravenous contrast demonstrated interval reduction with only minor residual gas evident within the left lobe of the liver and gastric fundal wall. We report the case of transient portal venous gas, secondary to acute gastric dilatation, most likely caused by a combination of opioid analgesia and gastric dysmotility from Parkinson's disease.
PubMed: 38164213
DOI: 10.1093/jscr/rjad705 -
Annals of Medicine and Surgery (2012) Nov 2023Plasma cell leukaemia is an uncommon plasma cell dyscrasia with a very poor prognosis. It is more common among males and usually presents between 55 and 65 years of age.
INTRODUCTION
Plasma cell leukaemia is an uncommon plasma cell dyscrasia with a very poor prognosis. It is more common among males and usually presents between 55 and 65 years of age.
CASE PRESENTATION
A 34-year-old male presented to Al-Assad hospital with unremitting back pain. He was given analgesics but his pain was unresponsive to treatment, and due to the COVID-19 pandemic, he refused a computed tomography scan in the hospital. Later that year, he presented again with weight loss, nausea, abdominal pain, melena, and ascites. He was pale with a moderately distended abdomen. Laboratory tests revealed anaemia, thrombocytopenia, hypercalcemia, increased total proteins, and elevated lactate dehydrogenase. Flow cytometry findings of the bone marrow aspirate showed the presence of 30% of plasma cells, positive for CD38, CD56, and kappa light chains. He was diagnosed with secondary plasma cell leukaemia and started on chemotherapy; however, he could not continue his treatment due to myeloid inhibition. He passed away 5 months later.
CLINICAL DISCUSSION
Multiple myeloma was not suspected in the patient due to his young age. The diagnosis was delayed even further due to the COVID-19 pandemic. His multiple myeloma progressed into secondary plasma cell leukaemia and had uncommon features like small intestinal polyps. Even though there has been groundbreaking advancements in chemotherapy, plasma cell leukaemia still possesses a fatal prognosis.
CONCLUSION
This report showcases a rare age presentation with unique manifestations of secondary plasma cell leukaemia. Multiple myeloma should be a differential diagnosis for cases with unexplained back pain despite an unclassical age.
PubMed: 37915713
DOI: 10.1097/MS9.0000000000001284