Genetic overlap between autoimmune diseases and non-Hodgkin lymphoma subtypes

Epidemiologic studies show an increased risk of non-Hodgkin lymphoma (NHL) in patients with autoimmune disease (AD), due to a combination of shared environmental factors and/or genetic factors, or a causative cascade: chronic inflammation/antigen-stimulation in one disease leads to another. Here we assess shared genetic risk in genome-wide-association-studies (GWAS). Secondary analysis of GWAS of NHL subtypes (chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma) and ADs (rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis). Shared genetic risk was assessed by (a) description of regional genetic of overlap, (b) polygenic risk score (PRS), (c)"diseasome", (d)meta-analysis. Descriptive analysis revealed few shared genetic factors between each AD and each NHL subtype. The PRS of ADs were not increased in NHL patients (nor vice versa). In the diseasome, NHLs shared more genetic etiology with ADs than solid cancers (p = .0041). A meta-analysis (combing AD with NHL) implicated genes of apoptosis and telomere length. This GWAS-based analysis four NHL subtypes and three ADs revealed few weakly-associated shared loci, explaining little total risk. This suggests common genetic variation, as assessed by GWAS in these sample sizes, may not be the primary explanation for the link between these ADs and NHLs

Setting up and equipping a reptile practice

The decision to start a reptile practice or incorporate reptiles into an existing practice should, like all business decisions, be based on research and planning detailed in a business plan. Internal marketing is the process of promoting the services to both the staff and existing clients. Reptiles frequently require prolonged hospitalization. The basic facilities required are: the enclosure itself, a heat source, humidity, light, hiding places, and handling aids. Many reptile pathogens are spread by direct contact or fomite. Biosecurity is therefore paramount and all patients must be barrier nursed. The surgical suite of most small animal practices can be easily modified to cater for reptilian patients. Most veterinary practices already have surgical instruments that could be used satisfactorily in reptilian patients. In addition to these, ophthalmic instruments are useful when operating on small patients. In addition to the surgical instruments, some ancillary equipment is useful

Differential diagnoses: a problem‐based approach

This chapter provides a guide to the differential diagnoses of the most common presenting signs of disease in the four major reptile taxa: snakes, lizards, chelonians and crocodilians. For each presenting sign, a list of differential diagnoses is provided. These lists include circumstances where the presenting sign represents a normal state for that group of reptiles. They also include the husbandry errors that will cause, or predispose to, these presenting signs. The lists are intended to give the clinician a starting point for the diagnostic process

Bayesian Decision Analysis: An Underutilized Tool in Veterinary Medicine

Bayesian inference and decision analysis can be used to identify the most probable differential diagnosis and use those probabilities to identify the best choice of diagnostic or treatment among several alternatives. In this retrospective case analysis, we surveyed three experts on the prior probability of several differential diagnoses, given the signalment and history of a ferret presenting for lethargy and anorexia, and the conditional probability of different clinical findings (physical, bloodwork, imaging, etc.), given a diagnosis. Using these data and utility estimates provided by other clinicians, we constructed a decision tree to retrospectively identify the optimal treatment choice between exploratory laparotomy and medical management. We identified medical management as the optimal choice, in contrast to the original clinical team which performed an exploratory laparotomy. We discuss the potential cognitive biases of the original clinical team. We also discuss the strengths, e.g., shared decision making, and limitations of a Bayesian decision analysis in the veterinary clinic. Bayesian decision analysis can be a useful tool for retrospective case analysis and prospective decision making, especially for deciding on invasive interventions or end-of-life care. The dissimilarity of expert-derived probability estimates makes Bayesian decision analysis somewhat challenging to apply, particularly in wide-ranging specialties like zoological medicine