TeHV3 outbreak characterization in captive Testudo spp.

Italian Tortoises species are considered either endangered or near threatened according to International Union for Conservation of Nature. When pet tortoises are abandoned or found injured or seized following illegal detention, they are sent to wildlife rehabilitation centers. From 2008, the Testudo spp. population housed in the WWF Vanzago’s oasis exhibited clinical signs compatible with Testudinid herpesviurs 3 (TeHV3) infection.  By the end of 2012 all Testudo had died. The presence of TeHV3 was investigated by molecular biology and pathology. All the tortoises housed in Vanzago resulted ELISA positive for the presence of anti-TeHV3 antibodies except one T. hermanni. Of these, 12 animals died and were all necropsied. Lesion frequency distribution was evaluate by histology. PCR was positive in 8/12 tortoises. To better complement the epidemiological evaluation of the virus in northern Italy, 20 retrospective cases were selected from the archive of the University of Milan. Of these, 5 were TeHV3 PCR positive. Lesions closely resembled those of the Vanzago’s population. These results are consistent with a high prevalence of TeHV3 in northern Italy. The finding of intranuclear inclusion bodies demonstrated to be specific but not sensitive. TeHV3 diagnostic pathological lesions have been reported to vary according with host immune response and by the viral replicative status. Molecular techniques were often necessary to confirm the infection. According to the literature and to our findings, T. hermanni spp. seems the species with higher mortality and lower antibody concentrations when infected with TeHV3.Italian Tortoises species are considered either endangered or near threatened according to International Union for Conservation of Nature. When pet tortoises are abandoned or found injured or seized following illegal detention, they are sent to wildlife rehabilitation centers. From 2008, the Testudo spp. population housed in the WWF Vanzago’s oasis exhibited clinical signs compatible with Testudinid herpesviurs 3 (TeHV3) infection.  By the end of 2012 all Testudo had died. The presence of TeHV3 was investigated by molecular biology and pathology. All the tortoises housed in Vanzago resulted ELISA positive for the presence of anti-TeHV3 antibodies except one T. hermanni. Of these, 12 animals died and were all necropsied. Lesion frequency distribution was evaluate by histology. PCR was positive in 8/12 tortoises. To better complement the epidemiological evaluation of the virus in northern Italy, 20 retrospective cases were selected from the archive of the University of Milan. Of these, 5 were TeHV3 PCR positive. Lesions closely resembled those of the Vanzago’s population. These results are consistent with a high prevalence of TeHV3 in northern Italy. The finding of intranuclear inclusion bodies demonstrated to be specific but not sensitive. TeHV3 diagnostic pathological lesions have been reported to vary according with host immune response and by the viral replicative status. Molecular techniques were often necessary to confirm the infection. According to the literature and to our findings, T. hermanni spp. seems the species with higher mortality and lower antibody concentrations when infected with TeHV3

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Diagnostic Accuracy of Cytology in Canine Splenic Lesions

Cytological evaluation of splenic lesions is a routine preoperative diagnostic technique. However, few studies have evaluated the utility of diagnostic cytology in canine splenic diseases (Ballegeer et al., 2007; Christensen et al., 2009; Watson et al., 2011). Our aim was to evaluate accuracy, sensitivity, specificity, positive and negative predictive value of cytology to diagnose canine splenic conditions using histopathology as the gold standard. Splenic cytological samples obtained between January 1998 and 2018 were retrospectively evaluated. Cases were included only when cytology and histology of the same lesion were available. All samples were blindly reviewed.  Ninety-two cases were included (65 neoplasms, 27 non-neoplastic lesions) and classified as: 36 true positive, 29 false negative, 26 true negative and 1 false positive. Splenic cytology had a diagnostic accuracy of 67.39%, a sensitivity of 55.38%, a specificity of 96.3%, a positive and negative predictive value of 97.3% and 47.27% (Tab.1). To our knowledge, this is the first study reporting conjunctively accuracy, sensitivity, specificity, positive and negative predictive value of cytology in the diagnosis of canine splenic disorders. The major limit of splenic cytology was a reduced sensitivity related to a high number of false negative results that strongly correlate with lesion distribution, size and type and with the blood storage function of the spleen resulting in hematic samples (Bertazzolo et al., 2005; O’Brien et al., 2013). Limitations were balanced by high specificity and positive predictive value making splenic cytology a valuable preliminary diagnostic tool to assist further diagnostic and therapeutic approaches in splenic disease

Lateral Approach for Excision of Maxillary Incisor Pseudo-Odontoma in Prairie Dogs (Cynomys ludovicianus)

AIM: To describe our experience with lateral approach for excision of maxillary pseudo-odontomas and to illustrate surgical outcomes and postoperative complications in seven pet prairie dogs.MATERIALS AND METHODS: Excision of 11 maxillary pseudo-odontomas was performed in seven prairie dogs with a lateral approach technique and clinical presentation, duration of surgery, time and type of post-surgical complications, presence or absence of symptom recurrence, time to follow-up, overall survival time and causes of death of each case were recorded.RESULTS: Duration of surgery, postoperative hospitalization and time to autonomous feeding were 54.8 min, 58 h and 1 day, respectively. Recurrence of respiratory symptoms was observed in four cases. Mean follow-up time was 632 days. Six out of seven cases were still alive at the end of the study.CONCLUSION: The lateral approach to excision showed good and promising results for treatment of maxillary pseudo-odontomas in prairie dogs

Primary angiocentric/angioinvasive T-cell lymphoma of the tympanic bulla in a feline leukaemia virus-positive cat

Case summary A 5-year-old neutered female feline leukaemia virus (FeLV)-positive domestic shorthair cat with a 5 month history of otitis media was referred for head tilt, stertor and dyspnoea. Computed tomography scan revealed soft tissue opacities inside the right tympanic bulla, with bone remodelling, and concurrent nasopharyngeal and intracranial invasion. Endoscopically guided bioptic samples were collected from the nasopharynx and middle ear. Histology revealed dense sheets of round, large, neoplastic cells, often surrounding or invading vascular walls. Neoplastic cells expressed CD3, FeLV p27 and gp70 antigens. A middle ear angiocentric/angioinvasive T-cell lymphoma was diagnosed. After improvement of clinical conditions following radiation therapy, the cat died unexpectedly. At necropsy, hepatic and splenic spread was detected. Relevance and novel information Primary middle ear tumours are rare and their diagnosis is often delayed as clinical signs mimic more common otological conditions. Multiple bioptic specimens are pivotal for a definitive diagnosis. The young age of the cat, serology and immunohistochemistry revealed a possible transforming role of FeLV

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

VENTILATORY ASSOCIATED BAROTRAUMA IN COVID-19 PATIENTS: A MULTICENTER OBSERVATIONAL CASE CONTROL STUDY (COVI-MIX-STUDY)

Background The risk of barotrauma associated with different types of ventilatory support is unclear in COVID- 19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. Methods This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. Results We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82- 10.03, p<0.001). ConclusionsC-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. Trial registration: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021). Keywords: COVID-19, acute respiratory failure, barotrauma, pneumothorax, High Flow Nasal Cannula, Invasive Mechanical Ventilation