Laryngeal paralysis in a great Dane Dog : treatment by unilateralization of the arytenoid cartilage

Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A 5-year-old male Great Dane dog was referred to the Hospital de Clínicas Veterinárias (HCV) of the Federal University of Rio Grande do Sul (UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started 2 months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis (LP) is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. Laryngeal paralysis of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

How Much Does the Platelet Aggregate Influence the Total Leukocyte Count? Comparison Between Manual and Automated Impedance Methods in Domestic Cats

Background: Automated hematology analyzers have been developed to optimize the time between analyses and have promising precision and accuracy. Complete blood count (CBC) is often requested as part of veterinary clinical examination. Automated analyzers are often used to determine CBCs, since processing as well as container-related errors may occur owing to variable sizes, aggregates, white or red blood cell fragments, and effects of EDTA on cell morphology. Platelet aggregates frequently occur in felines, with studies reporting a prevalence of approximately 71%. The aim of the present study was to evaluate the influence of exercise aggregates on the global white blood cell count of domestic cats using automated hematological counters with the impedance method.Materials, Methods & Results: Blood samples of 140 cats, irrespective of age, sex, and breed, were collected into EDTA-containing tubes. The samples were obtained via routine clinical examinations at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (UFRRJ) and processed at the Veterinary Parasitology Experimental Chemotherapy Laboratory (LQEPV), belonging to the same institution. All the samples were processed on the Sysmex pocH-100iV Diff automated hematology apparatus according to the manufacturer's recommendations. Leukocyte counts were also manually determined using a duplicate Neubauer chamber. Standard dilutions were prepared immediately after the automated analysis. To identify the occurrence of platelet aggregates, a blood smear was made and visualized under a brightfield microscope at a magnification of 10× and scored 0 to 3 (G1, G2, G3, and G4) based on the aggregation intensity. In case of changes, the groups were subdivided according to the intensity of occurrence. Of the 140 samples analyzed, 76.4% (107/140) showed some degree of platelet aggregation. The maximum variation in leukocyte counts determined by the automatic and the manual technique in G1 was 2,500 cells. In G2, it was possible to identify a variation of 6,500 nucleated cells, whereas in G3, this value was 7,100 cells. In G4, where platelet aggregation was intense, the variation between counts was up to 15,000 nucleated cells. A significant difference of variation in total white blood cell count between manual and automated methods was observed when compared to animals that did not show any degree of platelet aggregation (P < 0.05). Of the total samples, 23.57% (33/140) comprised G1, 24.28% (34/140) G2, 22.14% (31/140) G3, and 30% (42/140) G4. Of the 140 samples analyzed, 107 showed aggregates, pseudo-thrombocytopenia, and changes in the total number of leukocytes.Discussion: Samples with higher platelet aggregate formation showed greater interference in global leukometry when analyzed using the hematological counter. White blood cell counts determined by automated analyzers should be interpreted with caution and compared to manual counts when there is significant platelet aggregation in the sample. The findings reinforce the importance of reconfirming the results obtained using an automated equipment in order to avoid misinterpretations that may influence diagnosis and therapy. It is essential to re-check the values obtained from an automated equipment with traditional methods in order to minimize possible errors generated by the equipment, since such errors may affect the clinical diagnosis and subsequently, the therapeutic approach chosen

Unilateralização da Cartilagem Aritenoide em Cão da Raça Dogue Alemão com Paralisia de Laringe

Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A 5-year-old male Great Dane dog was referred to the Hospital de Clínicas Veterinárias (HCV) of the Federal University of Rio Grande do Sul (UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started 2 months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis  (LP) is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. Laryngeal paralysis of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications. Keywords: aspiration pneumonia, laryngoscopy, stridor, upper airway obstruction. Título: Paralisia de laringe em cão Dogue Alemão - tratamento com unilateralização da cartilagem aritenoide Descritores: estridor, laringoscopia, obstrução das vias aéreas superiores, pneumonia aspirativa.Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A five-year-old male canine was treated at the Hospital de Clínicas Veterinárias of the Federal University of Rio Grande do Sul (HCV-UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started two months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. LP of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications. Keywords: stridor, aspiration pneumonia, upper airway obstruction, laryngoscopy

Unilateralização da Cartilagem Aritenoide em Cão da Raça Dogue Alemão com Paralisia de Laringe

Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A 5-year-old male Great Dane dog was referred to the Hospital de Clínicas Veterinárias (HCV) of the Federal University of Rio Grande do Sul (UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started 2 months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis  (LP) is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. Laryngeal paralysis of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications. Keywords: aspiration pneumonia, laryngoscopy, stridor, upper airway obstruction. Título: Paralisia de laringe em cão Dogue Alemão - tratamento com unilateralização da cartilagem aritenoide Descritores: estridor, laringoscopia, obstrução das vias aéreas superiores, pneumonia aspirativa.Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A five-year-old male canine was treated at the Hospital de Clínicas Veterinárias of the Federal University of Rio Grande do Sul (HCV-UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started two months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. LP of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications. Keywords: stridor, aspiration pneumonia, upper airway obstruction, laryngoscopy