Cholangiocarcioma in a cat

A 7-year-old, intact female Domestic Shorthair cat was referred to University Veterinary Hospital (UVH), UPM for diagnostic workup of a hepatomegaly observed on abdominal radiographs. Physical examination revealed no significant findings except for a distended abdomen. Hematology and serum biochemistry findings included a regenerative anaemia, left shift neutrophilia and a 10-fold elevation in gamma-glutamyltranspeptidase (GGT). Abdominal ultrasound revealed heterechoic liver lobes with irregular margins and presence of nodular and cyst-like structures predominantly affecting the left lobes. A mild ascites was also noted. A fine needle aspiration of the liver was performed and cytology results confirmed a cholangiocarcinoma. Generally, the outcome for cholagiocarcinoma is poor and there is limited information regarding the prognosis for patients with cholangiocarcinoma following chemotherapy or surgery

Melioidosis: a localized osteomyelitis in a cat

Melioidosis is a zoonotic disease as a result of infection by Burkholderia pseudomallei. It is of significant public health concern due to its ubiquitous nature with high morbidity and mortality in humans and animals. In cats, the disease is usually reported with abscess formation in lung, liver and spleen, however, isolated articular melioidosis is rare. A 1-year-old, a female Domestic Shorthair cat was presented to University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM) with swollen right elbow and non weight bearing lameness of the right forelimb. Physical examination revealed pyrexia, soft tissue swelling and pain upon palpation of the right elbow joint. Radiographs of the right forelimb revealed osteolysis at the distal third of the humerus and proximal radius and ulna, cortical thinning at the olecranon and soft tissue swelling around the elbow joint. Bacterial culture of the joint fluid revealed positive growth for Burkholderia pseudomallei. Unfortunately, the owner opted to euthanise the cat citing personal reasons. Upon necropsy, there was presence of multiple caseous nodules within the right elbow joint cavity only and none of the other limbs, lung, spleen and liver was affected. It is important for veterinarian to be aware of septic arthritis and osteomyelitis form of melioidosis

A Methodology for Cell Merging Circuit Transformation on Post-placement High Speed Design

This paper proposes a localize circuit transformation algorithm to further optimize the post-placement netlist in order to improve the overall timing of a design. The proposed algorithm reduces the total cell delay and net delay of timing violation paths by replacing a small group of cells (form up by two to three cells) that are placed close to each other with a functional equivalent standard cell available in the technology library. The algorithm has been implemented and applied to a number of optimized postplacement netlists which have went through conventional post-placement circuit transformation optimization processes such as gate relocation, cell re-sizing, repeater insertion and cell replication. The experimental results show that on average, this algorithm is able to further improve the timing of the optimized post-placement netlist by 27.75%, while keeping the design area increase by 0.2%

Disease prevalence and clinicopathological changes in senior and geriatric cats presented to University Veterinary Hospital, Universiti Putra Malaysia

This retrospective study reports on the prevalence of disease, clinicopathological changes and diagnosis in senior and geriatric cats presented to University Veterinary Hospital (UVH), Universiti Putra Malaysia between 2009 and 2011. The age distribution of cats presented to UVH, level of preventive health care and cost of treatment per cat per annum were also determined. The majority of the feline patients were less than 3 years old. Senior and geriatric cats made up 1.4% of all cats in the study. Kidney disease, dental disease, neoplasia and feline upper respiratory tract disease were the most commonly reported disorders in senior and geriatric cats. Furthermore, blood lymphocytes count and albumin level were significantly lower in older cats compared to adult as a result of immuno-senescence and age-related physiological changes. Preventive care was poor for senior and geriatric cats, with only 9% presented for wellness examination. In general, cost of veterinary care was significantly lower for those that received preventive health care than those that did not. The results from this study can be used by veterinary practitioners to better understand, anticipate health problems of senior and geriatric cats and to encourage clients to subscribe to a semi-annual wellness programme for their older cats

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Prevalence of pancreatitis in cats presented to University Veterinary Hospital UPM from 2013-2014

Pancreatitis is a common disease in cats and clinically important as it can lead to significant morbidity and mortality if not properly managed. However, its clinical signs are often vague and diagnosis remains challenging. In Malaysia, there are limited tests for feline pancreatitis resulting in possible underdiagnosed cases. Therefore the objectives of this study were to determine the prevalence of feline pancreatitis in cats presented to University Veterinary Hospital, UPM as well as the prevalence of concurrent pancreatitis with inflammatory bowel disease and hepatitis. Additional objective was to determine the clinical pattern of pancreatitis in cats if any. Two populations of cats were included in this study. The first population of cats included 50 clinically ill cats presented with the complaint of vomiting, diarrhea, jaundice or increased liver enzymes. The second population included 30 cats that had died or that were humanely euthanized. The pancreas, liver and small intestines were sampled for postmortem examination. The prevalence of pancreatitis in clinically ill cats was 32% (n=16) based on abnormal fPLI test results and typical ultrasonographic findings. 44% (n=7) of cats with pancreatitis had concurrent liver disease, 12% (n=2) had gastrointestinal disease and 19% (n=3) had both. There was no observable clinical pattern seen in cats diagnosed with pancreatitis. For the necropsy cases, the prevalence rate of pancreatitis was 84% (n=25) with acute pancreatitis accounting for 17% and chronic pancreatitis 67% of cases. The diagnosis of pancreatitis is difficult and should be based on a combination of compatible clinical and laboratory findings, abdominal ultrasonography, specific immunoassays for pancreatitis and histopathology