Leptospiral meningoencephalitis in a raccoon dog

Neuroleptospirosis is a rare disease caused by pathogenic Leptospira interrogans in humans; however, it has not been fully studied in animals. A young wild raccoon dog was found convulsing in the recumbent position and died the next day. Histologic examination revealed nonsuppurative meningoencephalitis in the cerebrum, cerebellum, midbrain, and medulla oblongata. The lesions consisted of mixed infiltrates of Iba1-positive macrophages and CD3-positive T cells, with a small number of CD79α-positive B cells and myeloperoxidase-positive neutrophils. In the frontal cortex, perivascular cuffs and adjacent microglial nodules were distributed diffusely, especially in the molecular layer. Glial nodules were comprised of Iba1- and myeloperoxidase-positive activated microglia. Immunohistochemistry revealed leptospires in mononuclear cell perivascular cuffs, but not in glial nodules. Neuroleptospirosis was accompanied by Leptospira-related nonsuppurative interstitial nephritis, pulmonary edema and hemorrhage, and coronary periarteritis, as well as Toxocara tanuki in the small intestine and nonspecific foreign-body granulomas in the lungs and stomach.

Platypnea–orthodeoxia syndrome associated with COVID-19 pneumonia: a case report

Background Platypnea–orthodeoxia syndrome (POS) is a rare clinical condition characterized by respiratory distress and/or hypoxia developing in the sitting/upright position, which is relieved in the recumbent position. This syndrome is known to have an intracardiac shunt as its primary etiology. Here, we report the case of a patient who was found to have POS without an intracardiac shunt while recovering from coronavirus disease (COVID-19) pneumonia. Case presentation A 73-year-old woman was diagnosed with severe COVID-19 pneumonia and was managed according to our institutional protocol. Although her oxygenation improved at rest, oxygen saturation dropped to lower than 80% when she was in the sitting position. She had no patent foramen ovale or other intracardiac shunts. She showed gradual improvement and was discharged under home oxygen therapy 28 days after admission. Conclusions This report highlights the importance of continuous bedside monitoring of pulse oximetry during positional changes, even if it is stable at rest, in patients with moderate to severe COVID-19.

Headache due to Bilateral Subacute Subdural Hematomas following Intracranial Hypotension Caused by Cervical Disc Herniation

Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF) and typically causes orthostatic headache which is relieved by lying in a recumbent position. We describe the case of a 44-year-old male suffering from orthostatic headaches accompanied by symptomatic cervical disc herniation, for which he had an anterior cervical discectomy and fusion (ACDF). Computerized tomography of the brain at the emergency department 1 week after this procedure showed bilateral subacute subdural hematomas. In retrospect, the positional headache had been present for 3 months prior to the ACDF, and magnetic resonance imaging of the cervical spine prior to the ACDF already showed signs of an extradural CSF collection indicating intracranial hypotension. This case highlights the possibility of SIH caused by a spinal dural leak due to cervical disc herniation.

Rare presentation of atrial myxoma: chest pain, dysphagia and left upper extremity weakness

Atrial myxoma is a benign primary heart tumour, which can be found incidentally on imaging studies. It is usually located in the left atrium and may manifest as dyspnoea, chest pain, heart failure, cough, shortness of breath when rising from a recumbent position, haemoptysis, hoarseness and as a source of cardiac embolism. However, dysphagia caused by an atrial myxoma has been reported only twice in the literature. We present a 53-year-old Caucasian man with a chronic history of dysphagia caused by an atrial myxoma, in which surgical resection resulted in complete resolution of his dysphagia.

Agreement between ECG values obtained in the sternal recumbent position and right lateral recumbency in goats

The aim of the study was to analyze if body positioning during electrocardiogram recording has an influence on the results in goats. Forty-seven Polish White Improved and Polish Fawn Improved goats from a large dairy herd selected for sanitary culling due to caprine arthritis-encephalitis virus (CAEV) infection, ranging from 2-12 years (median 5.5 years) were included in the study. ECG records were obtained from each goat in the sternal recumbent position and in right lateral recumbency using ASPEL AsCARD Mr. Silver machine with a frequency range of 0.05-150 Hz. The signals from leads I, II, III, aVR, aVL and aVF were recorded for 30 seconds. The mean values of P, QRS, T, PQ, QT, P-R duration (in sec) and P, Q, R, S, T waves amplitude (mV) were measured and analyzed. Values obtained in both positions did not differ significantly.

Impact of Diffusion, Ultrafiltration, and Posture on Total Body Electrical Resistance in Patients on Hemodialysis

Background Monitoring of hydration in patients on hemodialysis (HD) by currently available bioelectrical impedance analysis (BIA) methods is hampered by limited accuracy. This may be caused by changes in total body electrical resistance (TBER) that are induced by processes other than ultrafiltration (UF). To identify these sources of error we examined the impact of UF, diffusion, and postural change (PC), separately. Methods Extracellular TBER (TBERe) was measured by bioimpedance spectroscopy every 30 min in 23 patients on HD, for 2 hours during diffusion-only (DO), followed by 2 hours UF-only (UFO). The impact of PC from upright to semi-recumbent position was assessed by a 2-hour TBERe measurement on the day after HD. Results TBERe increased by 23.5 ± 12.4 Ω (P < 0.001) during DO and by 40.0 ± 16.2 Ω (P < 0.001) during UFO. PC, evaluated on a separate day, was associated with an increase in TBERe of 27.6 ± 26.0 Ω (P < 0.001). TBERe changes during DO were mainly attributed to PC and to a lesser extent to electrolyte exchange. Extrapolation of the data to a conventional 4-hour HD session indicates that about 32% of the total increase in TBERe is not related to UF. Conclusions A significant part of the increase in TBER during HD is not related to UF but can be attributed to other processes such as the effects of PC and diffusion-related electrolyte exchange. These factors have to be taken into account when TBER-guided UF is considered.

Do Handcycling Time-Trial Velocities Achieved by Para-Cycling Athletes Vary Across Handcycling Classes?

The classification system for handcycling groups athletes into five hierarchical classes, based on how much their impairment affects performance. Athletes in class H5, with the least impairments, compete in a kneeling position, while athletes in classes H1 to H4 compete in a recumbent position. This study investigated the average time-trial velocity of athletes in different classes. A total of 1,807 results from 353 athletes who competed at 20 international competitions (2014–2018) were analyzed. Multilevel regression was performed to analyze differences in average velocities between adjacent pairs of classes, while correcting for gender, age, and event distance. The average velocity of adjacent classes was significantly different (p < .01), with higher classes being faster, except for H4 and H5. However, the effect size of the differences between H3 and H4 was smaller (d = 0.12). Hence, results indicated a need for research in evaluating and developing evidence-based classification in handcycling, yielding a class structure with meaningful performance differences between adjacent classes.