Lymphohistiocytic Proliferative Syndrome of Alligators (Alligator mississippiensis): a cutaneous manifestation of West Nile virus

ABSTRACT In 1999, there were reports of a new type of lesion in the hides of captive reared alligators from Florida. Similar lesions were first reported from alligator hides in Louisiana in 2001; however, it wasn’t until 2002 that small epizootics became apparent. In 2002, the Louisiana Department of Wildlife and Fisheries began a collaborative effort with the Louisiana State University School of Veterinary Medicine (LSU SVM) to help elucidate the etiology of “PIX” disease, later renamed Lymphohistiocytic Proliferative Syndrome of Alligators (LPSA). Preliminary work concluded that LPSA was a systemic disease affecting multiple tissues. Based on the results of this preliminary study, particularly the histopathologic evaluation of LPSA tissues, a viral etiology was established as the top differential for LPSA. Further work revealed that LPSA positive alligators were 476 (95% CI: 79.6, 2845.2) times more likely to be seropositive for WNV than LPSA negative alligators. At that point it was also becoming clear that the occurrence of LPSA matched the occurrence of WNV in alligator farms. Another project was performed to further elucidate the association between WNV and LPSA based on results of WNV serology, WNV RT-PCR, and histopathologic evaluation of animals with (treatment) and without (control) LPSA lesions. Results from this study revealed that in the treatment group, 97.5% (95%CI: 92.7-102.3 %) of the LPSA skin lesions (TxA) were positive for WNV via RT-PCR. Of the skins within the treatment group that had no LPSA lesions (TxB), 8% (95%CI: 0-16.9%) were positive for WNV. In the control group, all of the skin samples (CxS) were negative for WNV. All alligators in TxA were significantly (p=0.07-20) more likely to have RT-PCR WNV positive skin than those in CxS, and TxB (p=0.08-16). There was no significant difference in the recovery of WNV from the skins of alligators from TxB and CxS (p=0.24). The results of this work support the theory that LPSA is a cutaneous manifestation of chronic WNV exposure/infection in captive reared alligators. Therefore the epidemiology of LPSA follows the epidemiology of WNV and prevention, surveillance and control methods used for WNV should effectively decrease the occurrence of LPSA

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Pain and Its Control in Reptiles

Reptiles have the anatomic and physiologic structures needed to detect and perceive pain. Reptiles are capable of demonstrating painful behaviors. Most of the available literature indicates pure μ-opioid receptor agonists are best to provide analgesia in reptiles. Multimodal analgesia should be practiced with every reptile patient when pain is anticipated. Further research is needed using different pain models to evaluate analgesic efficacy across reptile orders

Endocardial fibrosarcoma in a reticulated python (Python reticularis)

A female, reticulated python (Python reticularis) of unknown age was presented with a history of lethargy, weakness, and distended coelom. Physical examination revealed severe dystocia and stomatitis. The reticulated python was euthanized due to a poor clinical prognosis. Postmortem examination revealed marked distention of the reproductive tract with 26 eggs (10-12 cm in diameter), pericardial effusion, and a slightly firm, pale tan mass (3-4 cm in diameter) adhered to the endocardium at the base of aorta. Based on histopathologic and transmission electron microscopic findings, the diagnosis of endocardial fibrosarcoma was made

Morbidity and Mortality of Mississippi Kites (Ictinia mississippiensis) Presenting to the Wildlife Hospital of Louisiana, USA

A review of hospital admissions for Mississippi Kites (Ictinia mississippiensis) 2014-20 found that most admissions were due to trauma, including ballistic trauma. Overall, 118/ 282 (42%) survived, including releases and transfers. This baseline data may enable earlier detection of epidemics and of human-animal conflict escalation in other kite populations