Clinical Improvement in Patients with Morbus Hansen Borderline Tuberculoid Lesions with 3-Month Multibacillary Regimen Therapy

Background/Aim: Morbus Hansen (MH) is a chronic infectious disease caused by Mycobacterium leprae. The disease has an average incubation period of 3-5 years. Morbus Hansen (MH) has various clinical, microbiological and histopathological features. In the following, a new case of MH is reported with a clinical manifestation of Borderline Tuberculoid (BT) type MH. The patient was treated with the MDT MB regimen for 3 months and had clinical improvement. Case Report: A 23-year-old boy with complaints of sudden feeling of heat, tingling and cramping from the tip of his right foot to the sole of his right foot. He also complaining about black lesions on both hands, right elbow, face, chest and back. The diagnosis of gout, fungus and dermatitis can be ruled out after microscopic examination of AFB on the right, left ear lobe, and foot lesions showed negative results and histopathological examination results showed Morbus Hansen type BT. The risk factor for contracting Morbus Hansen is the patient has lived in a dormitory for 2.5 years and it is known that there are people who suffer from a similar disease in that environment. The patient was treated using a multibacillary regimen for 3 months and the lesions improved and the numbness decreased. Treatment plan during the case for 12-18 months. This case is unique due to the clinical manifestation has not significant characteristic for MH, AFB is not found from ear lobe smear. MH established after skin biopsy done. Conclusion: It was reported that one MH case with TB for 3 months had clinical improvement, with plans to continue treatment for 12-18 months. Keywords: Borderline Tuberculoid; Morbus Hansen, Multibacillary.

Comparison of Behavioral Time Budget and Welfare Indicators in Two Local Laying Hen Genotypes (Atak-S and Atabey) in a Free-Range System

Free-range systems are considered to improve bird health and welfare, thereby satisfying consumer demands. Behavioral time budget, fear level and clinical welfare indicators were compared for two Turkish laying hen genotypes, Atak-S (brown) and Atabey (white), reared in a free-range system. A total of 420 laying hens (210 Atak-S, 210 Atabey) were studied between 19 and 72 weeks of age. Higher percentages of eating and drinking behavior, feather pecking, and explorative pecking were observed for Atak-S hens, whereas Atabey hens were preening, walking–standing, and resting more. The duration of tonic immobility was longer, and the number of inductions was lower in Atabey compared with Atak-S hens. Atabey hens had less keel bone damages and better plumage conditions on the breast, wing, and tail at 56 and 72 weeks of age than Atak-S hens. Footpad dermatitis was more common in Atabey hens at 40 weeks, whereas Atak-S hens had a higher prevalence of footpad dermatitis with moderate lesions at 72 weeks of age. These findings indicate that free-range Atak-S hens may be more prone to keel bone damage and development of feather pecking, but they showed less foot lesions and were less fearful.

Pleiotropic Loci Associated With Foot Disorders and Common Periparturient Diseases in Holstein Cattle

Lameness is an animal welfare issue that incurs substantial financial and environmental costs. This condition is commonly caused by digital dermatitis (DD), sole ulcers (SU), and white line disease (WLD). Susceptibility to these three foot disorders is due in part to genetics, indicating that genomic selection against these foot lesions can be used to reduce lameness prevalence. It is unclear whether selection against foot lesions will lead to increased susceptibility to other common diseases such as mastitis and metritis. Thus, the aim of this study was to determine the genetic correlation between causes of lameness and other common health disorders to identify loci contributing to the correlation. Genetic correlation estimates between SU and DD and between SU and WLD were significantly different from zero (p < 0.05), whereas estimates between DD and mastitis, DD and milk fever, and SU and metritis were suggestive (p < 0.1). All five of these genetic correlation estimates were positive. Two-trait genome-wide association studies (GWAS) for each of these five pairs of traits revealed common regions of association on BTA1 and BTA8 for pairs that included DD or SU as one of the traits, respectively. Other regions of association were unique to the pair of traits and not observed in GWAS for other pairs of traits. The positive genetic correlation estimates between foot disorders and other health disorders imply that selection against foot disorders may also decrease susceptibility to other health disorders. Linkage disequilibrium blocks defined around significant and suggestive SNPs from the two-trait GWAS included genes and QTL that were functionally relevant, supporting that these regions included pleiotropic loci.

Diabetic Foot: its grades and mode of presentation at a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan

Introduction: Diabetic foot is defined as the foot of diabetic patients with ulceration, infection, and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs of this disease. Objectives: To describe the presentation, distribute the diabetic foot lesions according to Wagner’s classification, and determine the outcome of diabetic foot ulceration in a tertiary care hospital of Peshawar, Pakistan. Materials & Methods: This study was conducted in the Surgery department of Rehman Medical Institute Peshawar. Thirty nine (39) patients with diabetic foot disease presenting from Jan 2018 to Dec 2019 were included in the study. The patients were evaluated and managed by classifying their disease according to Wagner’s classification for diabetic foot disease. Statistical analysis was done by using SPSS version 26 for descriptive statistics. Results: The most common age of presentation with diabetic foot lesion was between 41-70 years; out of 39 patients, 28 (71.8%) were males and 11 (28.2%) were females. Their mode of presentation was as follows- 22 cases (56.4%) with Ulcer, 9 cases (23.1%) with Cellulitis, 7 cases (17.9%) with Gangrene, and 1 case (2.6%) with Abscess. The most common grade of presentation were grades 3 and 4 Wagner’s lesion followed by Grade 1, and Grade 2. Debridement was the most common treatment modality (56.2%), followed by Amputation (41%). Conclusion: Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step towards lower extremity amputation. Diabetic foot lesions can be easily graded according to the Wagner classification and helps in correlating appropriate treatment to the grade of the lesion for a better outcome.

Clinical study, management of diabetic foot and its complications

Background: Diabetic foot infections are frequently polymicrobial. Hyperglycemia, impaired immunologic responses, neuropathy and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. The aim of the study was to study the benefit and outcome of the different treatment modalities for the diabetic foot.Methods: This study was conducted comprising 100 patients with diabetic foot in the department of general surgery at Rajiv Gandhi government general hospital, MMC from January 2019 to June 2020, over 12 months. Data were collected by detailed history, clinical examination, wound or ulcer and were recorded in the pre-designed proforma. Wagner’s classification, examination findings, blood investigations, renal function test, a swab of the wound, X-ray and treatment provided were collected.Results: Commonest presenting lesion was ulcers (44%), followed by gangrene (24%) and cellulitis (20%). The commonest site of the lesion was the dorsum of the foot (32%), followed by forefoot (28%) and toes (22%). Trivial trauma is the initiating factor in more than half of the cases. More than half of the patients, 82% had an infection. The most common microorganism grown from culture was Staphylococcus aureus (30%).Conclusions: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in a high-risk diabetic patient. Infection in a diabetic foot is potentially limb-threatening and always requires urgent diagnostic and therapeutic attention.

PREVALENCE OF LAMENESS AND ASSOCIATED FOOT LESIONS IN SAHIWAL DAIRY COWS

Lameness is 3rd most prevalent disease after mastitis and infertility, in the dairy industry today and is an important welfare issue causing significant impact on dairy economics. Lameness leads to involuntary culling of lactating dairy cattle due to significant effect on production and reproduction.Mostly lameness occurs due to foot lesions irrespective of breed, management and of animal. Two hundred and four Sahiwal dairy cows were evaluated for lameness and associated claw lesionsin the study from local dairy farms of Punjab. Clinical lameness (lameness score 2 & 3) was evident in 6 per cent of animals. After lameness scoring, each animal was restrained in chute and hooves were examined before and after paring 1 mm of hoof tissue from weight bearing surface. Seventy three per cent animals had at least one lesion in their hooves. On animal level, under run soles (45%) were found to be most prevalent claw lesion followed by white line lesions (29%), overgrown soles (7%), cork screw hooves (5%), sole avulsions (5%), sole hemorrhages (3%), heel erosions (3%), double soles (2%) and wall cracks (1%). At claw level, prevalence of lesions was 35.3 per cent, among which under run soles were the most prevalent lesion (19.3%) followed by white line lesions (16.3%), overgrown soles (2.82%), cork screw hooves (1.84%), sole avulsions (1.47%), sole hemorrhages (1.04%), heel horn erosions (0.61%), double soles (0.49%), wall cracks (0.25%) and toe hemorrhages (0.12%). Lactation length and parity had no effect on lameness. Comparatively more lesions were seen in hind limb hooves (56.8%) as compared to forelimb hooves (43.2%). Fore lateral and hind medial claws had more lesions (58.8% and 76.47%, respectively) as compared to contralateral claws 52.9% and 70.5%, respectively). Overall, a low prevalence of clinical lameness was seen in Sahiwal dairy cows.

A Cross-Sectional Epizootiological Study and Risk Assessment of Foot-Related Lesions and Lameness in Intensive Dairy Sheep Farms

Foot-related lameness, foot-diseases and lesions are emerging issues in dairy sheep; however, relevant epizootiological studies are scarce, and risk factors have not been elucidated. The objectives of this cross-sectional study were (i) to address this dearth of knowledge by investigating the epizootiology of lameness-related foot-lesions and diseases, and (ii) to assess the impact of potential risk factors on foot health, in intensive dairy sheep farms. Thirty farms were assigned in two representative clusters using a multivariate statistical analysis. Three farms per cluster and 100 multiparous milking ewes per farm (total n = 600) were selected and enrolled in the study. Foot-related lameness, ovine interdigital dermatitis (OID), infectious footrot (IFR), white line disease, hoof wall cracks, as well as health and welfare traits were recorded. Overall prevalence of foot-related lameness was 9.0% and was primarily associated with IFR; however, additional infectious and non-infectious foot diseases and lesions also contributed. Among infectious foot diseases, OID was the most prevalent (21.3%) followed by IFR (8.0%); WLD and hoof wall cracks were the most prevalent non-infectious foot-lesions (37.7% and 15.3%, respectively). IFR and OID prevalence increased with age (p < 0.05) and BCS (p < 0.01), respectively, suggesting that host-related factors and husbandry practices are important determinants of its occurrence.