Thermographic Screening of Beef Cattle Metatarsal Growth Plate Lesions

Lameness represents one of the main causes of decreased productive performance and impaired animal welfare in the bovine industry. Young beef bulls are predisposed to develop diseases of the growing skeleton, especially growth plate lesions. Early diagnosis is indispensable for ensuring correct treatment, fast recovery and reduction losses. However, when dealing with beef cattle, this is not always possible. Fast and reliable diagnostic imaging techniques are necessary to improve dealing with lameness in beef animals. The aim of the present study was to examine the potential of thermographic imaging as a non-invasive tool for rapidly screening beef bulls for the presence of growth plate lesions. Here, 20 Charolais and Limousine beef bulls affected by growth plate lesions in one of the rear limbs were selected. IRT was performed on both hind limbs using a digital infrared camera (ThermaCam T420 Model, Flir Systems, Boston, MA, USA), prior to radiographic imaging and clinical examination. The temperature of healthy and affected limbs was measured in two regions: the area correspondent to the growth plate (AR01) and the whole area of the metatarsus (AR02). Growth plate lesions were found to increase the maximum, mean, and minimum temperatures in AR01; and the mean and maximum temperatures in AR02, therefore, indicating the potential of IRT as a reliable, practical tool for screening growth plate lesions in beef bulls.

Charles Bonnet syndrome as first manifestation of occipital infarction

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization

Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.

The impact of legionellosis into fatal outcomes of pneumonia in Irkutsk

Aim. To study the diagnosis of legionellosis in patients who died because of pneumonia in Irkutsk (2016-2018).Materials and Methods. We performed 65 autopsies of patients who died from pneumonia in Irkutsk (2016-2018), studied their case histories, and interrogated 510 tap water samples for Legionella pneumophila by means of inoculation and polymerase chain reaction.Results. Among 65 fatal pneumonia outcomes registered in Irkutsk during 2016-2018, legionellosis has been confirmed in three cases (4.6%). Two of these patients were at the late stages of HIV infection while the third, 74-yearold, patient had multiple comorbid conditions. Nosocomial infection was suspected in one of these cases. None of these three patients left Irkutsk during the last month of their life. The assumed transmission factor was tap water, as Legionella pneumophila was found in tap water samples collected in 2013 and 2015.Conclusion. Patients with severe pneumonia need screening for legionellosis to perform the correct treatment, particularly during COVID-19 pandemic.

The Cloud-Enabled Architecture of the Clinical Data Repository in Poland

In this article, the authors, using information-systems modeling techniques, and considering current national legal regulations, present the cloud-enabled architecture of a clinical data repository. The patient’s medical record is an important carrier of information necessary for accurate diagnosis and selection of the correct treatment process. Therefore, it is not surprising that since the beginning of the development of computer technologies, databases have been built to enable the management of a patient’s medical records. These systems were most-often deployed locally at individual healthcare units, which carried certain limitations both in terms of the security and availability of the stored information, and the possibility of exchanging it with other clinics. However, recent developments in the standardization of medical information exchange in Poland, together with the revolution in cloud computing, have opened up completely new perspectives for clinical-data-repository implementations helping to make them far more sustainable. Although, the practical aspects of implementing clinical-documentation repositories are studied both in forums of European countries and also around the world; so far, no similar research was conducted with respect to Poland. This study tries to fill that gap by proposing a flexible multi-variant cloud-enabled architecture of the system providing the services of a clinical-data repository. The goal of the work was to propose such a system architecture that allows having a system that is either cloud-agnostic, that uses specifically selected cloud services, or that is even deployable locally. Thanks to the use of cloud computing services, the implemented system is characterized by high availability, scalability, and the possibility of exchanging data between medical institutions, which enables the improvement in the quality of medical processes for the whole Polish population.

Optimal Type 2 Diabetes Mellitus Management and Active Ageing

Type two diabetes mellitus (T2DM) represents a chronic condition with increasing prevalence worldwide among the older population. The T2DM condition increases the risk of micro and macrovascular complications as well as the risk of geriatric syndromes such as falls, fractures and cognitive impairment. The management of T2DM in the older population represents a challenge for the clinician, and a Comprehensive Geriatric Assessment should always be prioritized, in order to tailor the glycated hemoglobin target according to functional and cognitive status comorbidities, life expectancy and type of therapy. According to the most recent guidelines, older adults with T2DM should be categorized into three groups: healthy patients with good functional status, patients with complications and reduced functionality and patients at the end of life; for each group the target for glycemic control is different, also according to the type of treatment drug. The therapeutic approach should always begin with lifestyle changes; after that, several lines of therapy are available, with different mechanisms of action and potential effects other than glucose level reduction. Particular interest is growing in sodium-glucose cotransporter-2 inhibitors, due to their effect on the cardiovascular system. In this review, we evaluate the therapeutic options available for the treatment of older diabetic patients, to ensure a correct treatment approach.

Real Life Clinical Impact of Antimicrobial Stewardship Actions on the Blood Culture Workflow from a Microbiology Laboratory

Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy.

Digital Representation of Measurement Uncertainty: A Case Study Linking an RMO Key Comparison with a CIPM Key Comparison

This paper considers a future scenario in which digital reporting of measurement results is ubiquitous and digital calibration certificates (DCCs) contain information about the components of uncertainty in a measurement result. The task of linking international measurement comparisons is used as a case study to look at the benefits of digitalization. Comparison linking provides a context in which correlations are important, so the benefit of passing a digital record of contributions to uncertainty along a traceability chain can be examined. The International Committee for Weights and Measures (CIPM) uses a program of international “key comparisons” to establish the extent to which measurements of a particular quantity may be considered equivalent when made in different economies. To obtain good international coverage, the results of the comparisons may be linked together: a number of regional metrology organization (RMO) key comparisons can be linked back to an initial CIPM key comparison. Specific information about systematic effects in participants’ results must be available during linking to allow correct treatment of the correlations. However, the conventional calibration certificate formats used today do not provide this: participants must submit additional data, and the report of an initial comparison must anticipate the requirements for future linking. Special handling of additional data can be laborious and prone to error. An uncertain-number digital reporting format was considered in this case study, which caters to all the information required and would simplify the comparison analysis, reporting, and linking; the format would also enable a more informative presentation of comparison results. The uncertain-number format would be useful more generally, in measurement scenarios where correlations arise, so its incorporation into DCCs should be considered. A full dataset supported by open-source software is available.

Isolation and Identification of Dermatophytes from Collegiate Runners

Competitive runners experience various risk factors that render them more susceptible to superficial cutaneous fungal infections, including the use of occlusive footwear, shared locker rooms, submission of feet to constant maceration, trauma, sweating, and having depressed immune function. The goal of this work was to assess the prevalence of athlete’s foot fungi in cross country runners at St. John Fisher College. Toe webs of 16 collegiate runners were sampled and volunteers surveyed about their shoe habits, foot hygiene, and average miles run per week. Lack of tinea pedis-causing fungi in asymptomatic cross- country runners shifted the study to investigate the identities of fungi morphologically similar to athlete’s foot and look for correlations with volunteers’ running habits and hygiene. Thirty-five distinct fungal cultures were isolated and compared to a known Trichophyton rubrum strain both microscopically and macroscopically. Four samples were preliminarily identified as tinea pedis-causing fungi and sequenced to confirm molecular identification. Fungal DNA was isolated, purified, and PCR amplified using primers for the internal transcribed spacer region, D1/D2 region of the 28S subunit, and β-Tubulin gene. Three of the four isolates were identified as Fusarium equiseti, a soil-borne plant pathogen with rare human pathogenicity reported. The fourth isolate was Beauveria bassiana, a common soil-borne pathogen that can infect immunocompromised individuals. Correct dermatophytic identification and understanding of the interplay between species is important to provide correct treatment, prevent spread among athletes and within facilities, and determine how opportunistic pathogens might play a role in people with immune suppressed function, which includes runners.

Acute abdominal pain and nephrotic syndrome: pediatric case reports and review of the literature

Background Acute abdominal pain in nephrotic syndrome (NS) is a well-known clinical symptom and is mainly related to peritonitis. The presence, although rare, of red umbilicus may guide the diagnosis as a suggestive sign of peritonitis also in the non-neonatal period. Instead, the association between intussusception and NS is quite limited. We reviewed all published cases in the literature, and to our knowledge, this is one of the few pediatric cases of spontaneous resolution of intussusception in the setting of NS. Finally, a review of the causes of abdominal pain during the course of NS was made. Cases presentation We report two pediatric patient cases who complained of acute abdominal pain during a relapse episode of their NS. The first case is a 4-year-old boy with NS (fourth relapse) who presented with acute abdominal pain, ascites, and red umbilicus. Our suspect of primary peritonitis was clinically confirmed because of the subsequent appearance of the classical peritoneal signs. The second case is a 4-year-old boy who developed an ileo-ileal intussusception during the treatment of his first NS relapse, with spontaneous reduction. Conclusions Gastrointestinal disorders are frequently encountered in the course of NS. The appearance of acute abdominal pain in children with NS requires quick management, both clinical and instrumental. A multidisciplinary team approach needs to be encouraged to lead to an accurate diagnosis and a correct treatment.