scholarly journals Investigation of an EHV-1 Outbreak in the United States Caused by a New H752 Genotype

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 747
Author(s):  
Nicola Pusterla ◽  
Samantha Barnum ◽  
Julia Miller ◽  
Sarah Varnell ◽  
Barbara Dallap-Schaer ◽  
...  
Keyword(s):  
Early Stage ◽  
Clinical Signs ◽  
Amino Acid Position ◽  
High Viral Load ◽  
The United States ◽  
Neurological Deficits ◽  
Diagnostic Challenge ◽  
Genotype I ◽  
Flunixin Meglumine ◽  
Nasal Secretions

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

scholarly journals Senecavirus A: An emerging pathogen causing vesicular disease in pigs

2019 ◽  
Vol 75 (02) ◽  
pp. 6200-2019
Author(s):  
WIESŁAW NIEDBALSKI ◽  
ANDRZEJ FITZNER
Keyword(s):  
Differential Diagnosis ◽  
Current Knowledge ◽  
Human Cancer ◽  
Clinical Signs ◽  
The United States ◽  
Geographic Region ◽  
Emerging Diseases ◽  
Cytolytic Activity ◽  
Control Measures ◽  
Nasal Secretions

Senecavirus A (SVA) is a single representative species of the Senecavirus genus within the family Picornaviridae. This review presents the current knowledge regarding SVA epidemiology, transmission, pathogenesis, clinical signs, differential diagnosis and control measures. SVA is not debilitating, but significant because of its resemblance to acute, highly contagious and economically devastating viral diseases, such as FMD. The incubation period of SVA is 4-5 days, the viremia period is short, lasting 3 to 10 days post infection (dpi). SVA shedding lasts up to 28 days. SVA can be shed by oral and nasal secretions and by faeces. The virus excretion peak occurs between 1 and 5 dpi, especially in oral secretions, which contain higher virus loads relative to nasal secretions and faeces. SVA lesions are found most frequently on the snout, lips and tongue, as well as on hooves, specifically, on coronary bands, dewclaws, hoof pads and in interdigital space. The vesicles quickly rupture to form ulcers that may be covered by serofibrinous exudates. The ulcers begin to repair in 7 days, and the regeneration of epithelium is usually complete within 2 weeks. Since clinical lesions induced by SVA are indistinguishable from those observed in other vesicular diseases of swine, accurate and reliable laboratory differential diagnosis is critical to the precise identification of the infectious agent. SVA has potential cytolytic activity and high selectivity for tumour cell lines with neuroendocrine properties versus adult normal cells. Because of its potential oncolytic activity, the virus can be useful in human cancer therapy. The example of SVA shows that the risk of emerging infectious diseases in swine populations is high and that emerging diseases of swine have significant potential impact on the productivity and economics of the pork industry. The SVA infection is currently limited to the United States, Canada, Brazil, China and Thailand. However, descriptions of the SVA infection in Asia suggest that the virus is not restricted to a specific geographic region and may be distributed on a global scale in the future.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Public Compliance With Social Distancing Measures and SARS-CoV-2 Spread

2021 ◽  
pp. 003335492110112
Author(s):  
Hongjie Liu ◽  
Chang Chen ◽  
Raul Cruz-Cano ◽  
Jennifer L. Guida ◽  
Minha Lee
Keyword(s):  
Growth Rate ◽  
Reproduction Number ◽  
Early Stage ◽  
Human Mobility ◽  
The United States ◽  
Density Change ◽  
Regression Coefficients ◽  
Daily Growth Rate ◽  
Daily Growth ◽  
Social Distancing

Objective We quantified the association between public compliance with social distancing measures and the spread of SARS-CoV-2 during the first wave of the epidemic (March–May 2020) in 5 states that accounted for half of the total number of COVID-19 cases in the United States. Methods We used data on mobility and number of COVID-19 cases to longitudinally estimate associations between public compliance, as measured by human mobility, and the daily reproduction number and daily growth rate during the first wave of the COVID-19 epidemic in California, Illinois, Massachusetts, New Jersey, and New York. Results The 5 states mandated social distancing directives during March 19-24, 2020, and public compliance with mandates started to decrease in mid-April 2020. As of May 31, 2020, the daily reproduction number decreased from 2.41-5.21 to 0.72-1.19, and the daily growth rate decreased from 0.22-0.77 to –0.04 to 0.05 in the 5 states. The level of public compliance, as measured by the social distancing index (SDI) and daily encounter-density change, was high at the early stage of implementation but decreased in the 5 states. The SDI was negatively associated with the daily reproduction number (regression coefficients range, –0.04 to –0.01) and the daily growth rate (from –0.009 to –0.01). The daily encounter-density change was positively associated with the daily reproduction number (regression coefficients range, 0.24 to 1.02) and the daily growth rate (from 0.05 to 0.26). Conclusions Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits.

scholarly journals Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States

2021 ◽  
Vol 18 (8) ◽  
pp. 4021
Author(s):  
Esteban Correa-Agudelo ◽  
Tesfaye B. Mersha ◽  
Adam J. Branscum ◽  
Neil J. MacKinnon ◽  
Diego F. Cuadros
Keyword(s):  
United States ◽  
Vulnerable Populations ◽  
Mortality Risk ◽  
Early Stage ◽  
The United States ◽  
National Average ◽  
Health Determinants ◽  
White Population ◽  
Latino Population ◽  
Related Mortality

We characterized vulnerable populations located in areas at higher risk of COVID-19-related mortality and low critical healthcare capacity during the early stage of the epidemic in the United States. We analyze data obtained from a Johns Hopkins University COVID-19 database to assess the county-level spatial variation of COVID-19-related mortality risk during the early stage of the epidemic in relation to health determinants and health infrastructure. Overall, we identified highly populated and polluted areas, regional air hub areas, race minorities (non-white population), and Hispanic or Latino population with an increased risk of COVID-19-related death during the first phase of the epidemic. The 10 highest COVID-19 mortality risk areas in highly populated counties had on average a lower proportion of white population (48.0%) and higher proportions of black population (18.7%) and other races (33.3%) compared to the national averages of 83.0%, 9.1%, and 7.9%, respectively. The Hispanic and Latino population proportion was higher in these 10 counties (29.3%, compared to the national average of 9.3%). Counties with major air hubs had a 31% increase in mortality risk compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19-related mortality risk also had lower critical care capacity than the national average. The disparity in health and environmental risk factors might have exacerbated the COVID-19-related mortality risk in vulnerable groups during the early stage of the epidemic.

scholarly journals Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1017
Author(s):  
Julian Zipfel ◽  
Meizer Al-Hariri ◽  
Isabel Gugel ◽  
Alexander Grimm ◽  
Volker Steger ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Signs ◽  
Complete Resection ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Surgical Interventions ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.

scholarly journals Analyzing the Research Evolution in Response to COVID-19

2021 ◽  
Vol 10 (4) ◽  
pp. 237
Author(s):  
Weirong Li ◽  
Kai Sun ◽  
Yunqiang Zhu ◽  
Jia Song ◽  
Jie Yang ◽  
...  
Keyword(s):  
Psychological Health ◽  
Early Stage ◽  
The United States ◽  
Growth Trend ◽  
Related Research ◽  
The United Kingdom ◽  
Control And Prevention ◽  
Cyclical Trend ◽  
And Coping ◽  
Number Of Authors

In order to understand how these studies are evolving to respond to COVID-19 and to facilitate the containment of COVID-19, this paper accurately extracted the spatial and topic information from the metadata of papers related to COVID-19 using text mining techniques, and with the extracted information, the research evolution was analyzed from the temporal, spatial, and topic perspectives. From a temporal view, in the three months after the emergence of COVID-19, the number of published papers showed an obvious growth trend, and it showed a relatively stable cyclical trend in the later period, which is basically consistent with the development of COVID-19. Spatially, most of the authors who participated in related research are concentrated in the United States, China, Italy, the United Kingdom, Spain, India, and France. At the same time, with the continuous spread of COVID-19 in the world, the distribution of the number of authors has gradually expanded, showing to be correlated with the severity of COVID-19 at a spatial scale. From the perspective of topic, the early stage of COVID-19 emergence, the related research mainly focused on the origin and gene identification of the virus. After the emergence of the pandemic, studies related to the diagnosis and analysis of psychological health, personal security, and violent conflict are added. Meanwhile, some categories are most closely related to the control and prevention of the epidemic, such as pathology analysis, diagnosis, and treatment; epidemic situation and coping strategies; and prediction and assessment of epidemic situation. In most time periods, the majority of studies focused on these three categories.

scholarly journals Serum Biomarker Signature-Based Liquid Biopsy for Diagnosis of Early-Stage Pancreatic Cancer

2018 ◽  
Vol 36 (28) ◽  
pp. 2887-2894 ◽  
Author(s):  
Linda D. Mellby ◽  
Andreas P. Nyberg ◽  
Julia S. Johansen ◽  
Christer Wingren ◽  
Børge G. Nordestgaard ◽  
...  
Keyword(s):  
Case Control Study ◽  
Early Stage ◽  
Stage Iv ◽  
The United States ◽  
Case Control ◽  
Stage I ◽  
Serum Biomarker ◽  
Patient Cohort ◽  
Biomarker Signature ◽  
Control Study

Purpose Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival of < 10% because of diffuse symptoms leading to late-stage diagnosis. That survival could increase significantly if localized tumors could be detected early. Therefore, we used multiparametric analysis of blood samples to obtain a novel biomarker signature of early-stage PDAC. The signature was derived from a large patient cohort, including patients with well-defined early-stage (I and II) PDAC. This biomarker signature was validated subsequently in an independent patient cohort. Patients and Methods The biomarker signature was derived from a case-control study, using a Scandinavian cohort, consisting of 16 patients with stage I, 132 patients with stage II, 65 patients with stage III, and 230 patients with stage IV PDAC, and 888 controls. This signature was validated subsequently in an independent case-control cohort in the United States with 15 patients with stage I, 75 patients with stage II, 15 patients with stage III, and 38 patients with stage IV PDAC, and 219 controls. An antibody microarray platform was used to identify the serum biomarker signature associated with early-stage PDAC. Results Using the Scandinavian case-control study, a biomarker signature was created, discriminating samples derived from patients with stage I and II from those from controls with a receiver operating characteristic area under the curve value of 0.96. This signature, consisting of 29 biomarkers, was then validated in an independent case-control study in the United States. The biomarker signature could discriminate patients with stage I and II PDAC from controls in this independent patient cohort with a receiver operating characteristic area under the curve value of 0.96. Conclusion This serum biomarker signature might represent a tenable approach to detecting early-stage, localized PDAC if these findings are supported by a prospective validation study.

scholarly journals Live Attenuated African Swine Fever Viruses as Ideal Tools to Dissect the Mechanisms Involved in Cross-Protection

Viruses ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 1474
Author(s):  
Elisabeth Lopez ◽  
Juanita van Heerden ◽  
Laia Bosch-Camós ◽  
Francesc Accensi ◽  
Maria Jesus Navas ◽  
...  
Keyword(s):  
Vaccine Development ◽  
African Swine Fever Virus ◽  
Virulent Strain ◽  
Sequence Similarity ◽  
Clinical Signs ◽  
African Swine Fever ◽  
Cross Protection ◽  
Sub Saharan Africa ◽  
Genotype I ◽  
Genotype Ii

African swine fever (ASF) has become the major threat for the global swine industry. Furthermore, the epidemiological situation of African swine fever virus (ASFV) in some endemic regions of Sub-Saharan Africa is worse than ever, with multiple virus strains and genotypes currently circulating in a given area. Despite the recent advances on ASF vaccine development, there are no commercial vaccines yet, and most of the promising vaccine prototypes available today have been specifically designed to fight the genotype II strains currently circulating in Europe, Asia, and Oceania. Previous results from our laboratory have demonstrated the ability of BA71∆CD2, a recombinant LAV lacking CD2v, to confer protection against homologous (BA71) and heterologous genotype I (E75) and genotype II (Georgia2007/01) ASFV strains, both belonging to same clade (clade C). Here, we extend these results using BA71∆CD2 as a tool trying to understand ASFV cross-protection, using phylogenetically distant ASFV strains. We first observed that five out of six (83.3%) of the pigs immunized once with 106 PFU of BA71∆CD2 survived the tick-bite challenge using Ornithodoros sp. soft ticks naturally infected with RSA/11/2017 strain (genotype XIX, clade D). Second, only two out of six (33.3%) survived the challenge with Ken06.Bus (genotype IX, clade A), which is phylogenetically more distant to BA71∆CD2 than the RSA/11/2017 strain. On the other hand, homologous prime-boosting with BA71∆CD2 only improved the survival rate to 50% after Ken06.Bus challenge, all suffering mild ASF-compatible clinical signs, while 100% of the pigs immunized with BA71∆CD2 and boosted with the parental BA71 virulent strain survived the lethal challenge with Ken06.Bus, without almost no clinical signs of the disease. Our results confirm that cross-protection is a multifactorial phenomenon that not only depends on sequence similarity. We believe that understanding this complex phenomenon will be useful for designing future vaccines for ASF-endemic areas.

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