Presentation of Severe Acute Respiratory Syndrome-Coronavirus 2 Infection as Cholestatic Jaundice in Two Healthy Adolescents

© 2020 Elsevier Inc. Liver abnormalities in severe acute respiratory syndrome-coronavirus 2 infection, including hepatitis and cholestasis, have been observed in adults and are associated with worse outcomes. We describe 2 adolescents with cholestasis and hepatitis with mild presentation of severe acute respiratory syndrome-coronavirus 2 lacking typical symptoms. Our intention is to raise index of suspicion for testing and protective equipment use

Epidemiological observations on pastern dermatitis in young horses and evaluation of essential fatty acid spot-on applications with or without phytosphingosine as prophylactic treatment

Background - Equine pastern dermatitis (EPD) is a common multifactorial clinical syndrome in horses. Treatment can be difficult;pathogenesis and triggering factors cannot always be determined. Objectives - To assess risk factors for developing EPD in a large group of horses kept under the same conditions and to analyse whether or not a spot-on containing essential fatty acids and antimicrobial agents is able to prevent the development of EPD or accelerate the healing process. Animals - Each year 50 young, privately owned, warmblood horses were prospectively included. Methods - All horses were examined weekly between August and October for the presence of typical EPD skin lesions. Additionally, in the first year, horses were randomly divided into three subgroups of intervention. The pastern areas were treated once weekly either with 0.6 mL of a spot-on containing essential fatty acids and aromatic oils, or a preparation containing additional antibacterial phytosphingosine, or not at all. Results - Nonpigmented pastern areas were affected significantly more often than pigmented pastern areas (P < 0.0001). The interaction between moisture and opportunistic pathogens seemed to be a major triggering factor for EPD. There was no difference in the occurrence of EPD in the three subgroups. The lesion scores of affected limbs in both spot-on groups were significantly lower compared to the control group. Conclusion and clinical importance - Moisture and lack of pigmentation predisposed to EPD. Topical application of the tested spot-on once weekly did not prevent the disease. A positive effect of both spot-on products on the severity of EPD lesions was detected

Randomized placebo-controlled trial of amlodipine in vasospastic angina

AbstractObjectives. This study was designed to assess the efficacy and safety of amlodipine, a long-acting calcium channel blocker, in patients with vasospastic angina.Background. Previous studies have established the value of short-acting calcium channel blockers in the treatment of coronary spasm.Methods. Fifty-two patients with well documented vasospastic angina were entered into the present study. After a single-blind placebo run-in period, patients were randomized (in a double-blind protocol) to receive either amlodipine (10 mg) or placebo every morning for 4 weeks. Twenty-four patients received amlodipine and 28 received placebo. All patients were given diaries in which to record both the frequency, severity, duration and circumstances of anginal episodes and their intake of sublingual nitroglycerin tablets.Results. The rate of anginal episodes decreased significantly (p = 0.009) with amlodipine treatment compared with placebo and the intake of nitroglycerin tablets showed a similar trend. Peripheral edema was the only adverse event seen more frequently in amlodipine-treated patients. No patient was withdrawn from the double-blind phase of the study because of an adverse event. Patients who completed the double-blind phase as responders to amlodipine or as nonresponders to placebo were offered the option of receiving amlodipine in a long-term, open label extension phase. During the extension, the daily dose of amlodipine was adjusted to 5 or 15 mg if needed and the rate of both anginal episodes and nitroglycerin tablet consumption showed statistically significant decreases between baseline and final assessment.Conclusion. This study suggests that amlodipine given once daily is efficacious and safe in the treatment of vasospastic angina