Multiple Undifferentiated Pleomorphic Sarcoma (Malignant Fibrous Histiocytoma) with Extradural Involvement in a 7-Year-Old Labrador Retriever

A 7-year-old castrated male Labrador retriever was referred for evaluation of progressive hind limb paresis of 4 weeks’ duration. On computed tomography and magnetic resonance imaging examination, masses were found in several regions including the lung, right kidney, and peritoneum. Additionally, an extradural mass at the region of T13–L1 was identified, which is assumed to related to the chief complaint, progressive hind limb paresis. With the consent of the owner, a dorsal laminectomy was performed to remove the mass and surrounding tissues for the palliation of the hind limb paresis. Hematoxylin and eosin staining and immunohistochemical examination revealed the mass to be consistent with an undifferentiated (high-grade) pleomorphic sarcoma. The patient presented with recurrence of the hind limb paresis, respiratory discomfort, and urinary incontinence. The owner declined treatment and the dog was euthanized. Systemic metastasis was confirmed on postmortem microscopic examination. To the authors’ knowledge, this is the first report describing multiple undifferentiated high-grade pleomorphic sarcoma with extradural involvement developing into the vertebral canal through the intervertebral space, resulting in spinal damage, in a dog.

Dyspnea: neurobiological and clinical aspects

The aim. The presented material reflects the results of studies by Russian specialists conducted under the auspices of the Russian Respiratory Society over the past 15 years. The article also includes the main provisions set out in the III Guidelines for dyspnea. A significant part of the manual is devoted to the recent achievements in studying neurophysiological processes in the brain structures during the development of dyspnea. These achievements were driven by image-diagnosis methods. An important aspect of this series of works for the clinical practice was identifying dyspnea domains and developing the instruments to assess severity.Results. Analysis of the data on dyspnea from the clinical practice showed a highly heterogenic clinical picture, which must be taken into account in the management of individual patients. A diagnostic algorithm for long-term follow-up of patients with dyspnea syndrome is also discussed. The attention of doctors is drawn to the features of dyspnea during COVID-19; the disproportion between the sensory perception of respiratory discomfort and the degree of oxygen desaturation is emphasized.Conclusion. It was concluded that in the Russian-speaking environment of patients, doctors should actively use a verbal characteristic of dyspnea - the “language of dyspnea”.

Guillain-Barre syndrome related to COVID-19: muscle and nerve biopsy findings

Background: The involvement of the peripheral nervous system (PNS) in COVID-19 is rare and, to date, morphological aspects from muscle and nerve biopsies have not been reported. Here, we describe a case of Guillain-Barré Syndrome (GBS) related to COVID-19 and demonstrate findings from peripheral nerve and skeletal muscle biopsies. A 79-year-old man presented with progressive weakness in both legs over one-week, evolving to both arms and urinary retention within 6 days. Four days earlier, he had a cough, febrile sensation and mild respiratory discomfort. On admission, his was afebrile, and without respiratory distress. A neurological examination disclosed asymmetric proximal weakness, diminished reflexes and no sensitive abnormalities. Three days later, the patient presented with bilateral facial weakness and proximal muscle strength worsened. Deep tendon reflexes and plantar responses were absent. Both superficial and profound sensitivity were decreased. From this point, oxygen saturation worsened, and the patient was placed on mechanical ventilation. CSF testing revealed one cell and protein 185 mg/dl. A chest CT showed the presence of ground-glass opacities and RT-PCR for SARS-CoV-2 was positive. The muscle biopsy revealed moderate neuromyopathic findings with positive expression for MHC-class I, C5b9, CD8 and CD68. The nerve biopsy showed inflammatory infiltrates predominantly with endoneurial compound formed by CD45 and CD68. The patient was treated with Oseltamivir for 9 days followed by IVIG for 5 days and died three days later of septic shock. Discussion: This is the first documented case of GBS associated with COVID-19 with a muscle and nerve anatomopathological study. A systematic review about neurological complications caused by COVID-19 described 11 patients with GBS. The morphological features reported in our patient showed signs of involvement of the immune system, suggesting that direct viral invasion could have played a role in the pathogenesis of peripheral nerve injury. Hereafter, further research will be necessary to understand the triggers for these cells migrating into the peripheral nerve.

Interstitial Lung Disease in a Woman with Rheumatoid Arthritis Treated with Denosumab: A Case Report

The present report describes the case of an 84-year-old female Japanese patient with rheumatoid arthritis (RA) who experienced exacerbation of interstitial lung disease (ILD) after denosumab (Dmab) treatment. The onset of RA occurred in 2008, and the patient had been treated with intravenous or subcutaneous injection of tocilizumab (TCZ) since 2009. In July 2013, she experienced a lumbar vertebral fracture and began treatment with 60-mg Dmab injection every 6 months in January 2014. The patient had a history of mild ILD and was evaluated for ILD by chest computed tomography (CT) imaging prior to the start of Dmab use. The vertebral fracture did not recur after the initiation of Dmab treatment, and her osteoporosis was successfully treated. However, she expressed a concern of exacerbations of cough and respiratory discomfort that had occurred since September 2019. The chest CT image in November 2015 showed minor ILD progression, whereas the image in September 2019 showed severe exacerbation of ILD. To treat this exacerbation, 10 mg of methylprednisolone (mPSL) and 2.5 mg of tacrolimus (TAC) were administered, and Dmab was discontinued. The patient was subsequently switched to oral bisphosphonate. The patient’s respiratory discomfort and the finding of interstitial lung lesion in CT imaging improved after Dmab discontinuation. This case showed that exacerbation of ILD may occur after Dmab treatment, and physicians should consider the risks of Dmab-related ILD in patients with RA complicated by ILD.

A Novel Concept for Surgical Management of a Traumatic Comminuted Cricoid Fracture

The cricoid plays 2 key roles: phonation and maintenance of the airway frame, both of which are lost in cases of comminuted cricoid fractures. The management of these 2 functions becomes a challenge in planning surgical treatment. We report the treatment course in a case of traumatic comminuted cricoid fracture that was resolved with good airway and phonatory functions. A 25-year-old man fell down the stairs and complained of respiratory discomfort and hoarseness of voice. A computed tomography scan showed comminuted cricoid fracture; therefore, surgery was performed to restore the patient’s airway and phonation functions. We found that the airway was maintained by the anterior part and that the phonation depended on the posterior part of the cricoid. This novel concept helped clarify the treatment goal in this case of comminuted cricoid fractures. Furthermore, it is important that the anterior part of the cricoid is reconstructed with sufficient internal diameter, while the posterior part of the cricoid is reconstructed in the correct position.

Biological Characterization of Locally Circulating Mycoplasma gallisepticum in Poultry

Mycoplasma gallisepticum (MG) is a pathogen of concern for poultry. Present study was conducted to determine the biological characteristics of a field isolate of MG, recovered from an MG-affected flock. This isolation was made through conventional method of MG cultivation, using modified Frey’s media after confirming the isolate by polymerase chain reaction (PCR). A total of 48 birds were segregated into experimental group (32 birds) and the control group (16 birds). To appraise primary site of infection, MG broth propagated culture containing 1x106 CFU/ml was inoculated intratracheally to each bird in the experimental group, whereas the control group was sham inoculated by uninoculated broth. The clinical signs and symptoms were recorded daily from day 1 to 21 post-infection (p.i.). Seroconversion monitoring was carried out, at day 5, 10, 15, 20 p.i. by Serum Plate Agglutination test (SPA) and Enzyme Linked Immunosorbent Assay (ELISA). To determine the dissemination pattern of MG, birds were sacrificed according to plan, swabbed from various organs and subjected to MG-specific PCR. Tracheal lesions and air sac lesions were scored after necropsy. Clinically, mild signs of respiratory discomfort were observed on day 5 p.i., which intensified on day 9 to 21 p.i. in the experimental group. PCR of tracheal swab samples was positive from day 7 to 21 p.i., and the swabs collected from lungs were positive for MG from day 9 to 21 p.i. The study concluded that, MG isolate from field showed limited dissemination pattern and is restricted to respiratory tract.

Clinical characteristics of Severe Acute Respiratory Syndrome by COVID-19 in Indigenous of Brazil

BackgroundThe indigenous people of Brazil present several cases and deaths, affecting 158 peoples, with high vulnerability and limited access to health services.ObjectiveInvestigate the clinical characteristics of severe acute respiratory syndrome by COVID-19 in indigenous peoples of Brazil.MethodThe epidemiological, cross-sectional, and analytical study, from the data of the platform opendataSUS referring to the SIVEP-GRIPE in the period of 01/01/2020 until 31/08/2020. Profile variables, signs and symptoms, and risk factors/comorbidities. The data were analyzed by Bioestat 5.3.Results1,207 cases and 470 deaths. Profile: male gender (59.48%) mean age 53. Signs and symptoms: fever (74.23%), cough (77.71%), sore throat (35.62%), dyspnea (69.34%), respiratory discomfort (62.80%), O2 saturation <95% (56.42%); and associated with mortality: dyspnea (80.0%) and O2 saturation <95% (69.36%). Risk factors and comorbidities (45.89%) were associated with deaths (54.04%). Comorbidities: Chronic Cardiovascular Disease (18.97%) and Diabetes Mellitus (18.97%), and associated with deaths: Chronic Cardiovascular Disease (24.46%). There was significance in the survivors vaccinated for influenza (26.18%).ConclusionThe public and health policies of Brazil should be directed to control the dissemination of COVID-19 in this population, that COVID-19 evolves in the same intensity, however, the indigenous have vulnerabilities that can enhance the impact of the pandemic in this population.

Misconceptions of pathophysiology of happy hypoxemia and implications for management of COVID-19

In the article “The pathophysiology of ‘happy’ hypoxemia in COVID-19,” Dhont et al. (Respir Res 21:198, 2020) discuss pathophysiological mechanisms that may be responsible for the absence of dyspnea in patients with COVID-19 who exhibit severe hypoxemia. The authors review well-known mechanisms that contribute to development of hypoxemia in patients with pneumonia, but are less clear as to why patients should be free of respiratory discomfort despite arterial oxygen levels commonly regarded as life threatening. The authors propose a number of therapeutic measures for patients with COVID-19 and happy hypoxemia; we believe readers should be alerted to problems with the authors’ interpretations and recommendations.

Kinesio Taping® as an innovative therapeutic tool to prevent nasal septal lesions in newborns: a case study

Introduction: The immaturity of the integumentary system in premature newborns (PTNB), associated with ventilatory support, contributes to the higher occurrence of nasal trauma. Objective: This article reports on the case of a newborn submitted to Kinesio® Taping as an innovative prophylactic therapy for nasal trauma. Method: We report on Kinesio® Taping, a material frequently used to treat pain in athletes, as an innovative therapeutic tool to prevent nasal septal lesions in a PTNB undergoing noninvasive mechanical ventilation (NIMV), who, after 13 days on NIMV, presented with nasal septal lesions. Results: The Kinesio® Taping, was positioned to protect the nasal septum from friction caused by direct contact of the nasal prong, maintained NIMV pressure, adapted well to the shape of the nose and improved nasal trauma after 3 days of use. Conclusion: Given that breathing in this period of life occurs predominantly through the nose and maintaining the integrity of this mucosa reduces not only respiratory discomfort, but also deformities and the risk of infections. The present study presents KT as an innovative protective tool against nasal injury in premature newborns submitted to positive pressure ventilation using nasal prongs. Despite describing a single case, the results obtained were promising. However, studies with a larger sample and different groups are needed, primarily to compare with existing methods.

A musical intervention for respiratory comfort during noninvasive ventilation in the ICU

Discomfort associated with noninvasive ventilation (NIV) may participate in its failure. We aimed to determine the effect of a musical intervention on respiratory discomfort during NIV in patients with acute respiratory failure (ARF).An open-label, controlled trial was performed over three centres. Patients requiring NIV for ARF were randomised to either a musical intervention group (where they received a musical intervention and were subjected to visual deprivation during the first 30 min of each NIV session), a sensory deprivation group (where they wore insulating headphones and were subjected to visual deprivation during the first 30 min of each NIV session), or a control group (where they received NIV as routinely performed). The primary outcome was the change in respiratory discomfort before and after 30 min of the first NIV session.A total of 113 patients were randomised (36 in the musical intervention group, 38 in the sensory deprivation group and 39 in the control group). Median (interquartile range (IQR)) change in respiratory discomfort was 0 (−1; 1) between the musical intervention and control groups (p=0.7). Between groups comparison did not evidence any significant variation of respiratory parameters across time or health-related quality of life (HRQoL) at day-90. The Peri-traumatic Distress Inventory (PDI) at intensive care unit (ICU) discharge was reduced in musical intervention group patients. However, a 30 min musical intervention did not reduce respiratory discomfort during NIV for ARF in comparison to conventional care or sensory deprivation.