Nephrocalcinosis in farmed salmonids: diagnostic challenges associated with low performance and sporadic mortality

Disease conditions that involve multiple predisposing or contributing factors, or manifest as low performance and/or low-level mortality, can pose a diagnostic challenge that requires an interdisciplinary approach. Reaching a diagnosis may also be limited by a lack of available clinical profile parameter reference ranges to discriminate healthy fish from those affected by specific disease conditions. Here, we describe our experience investigating poorly performing rainbow trout (Oncorhynchus mykiss) in an intensive recirculation aquaculture, where reaching a final diagnosis of nephrocalcinosis was not as straightforward as one would wish. To list the issues making the diagnosis difficult, it was necessary to consider the creeping onset of the problem. Further diagnostic steps needed to ensure success included obtaining comparative data for fish blood profiles and water quality from both test and control aquacultural systems, excluding infections with salmonid pathogenic agents and evaluating necropsy findings. Major events in the pathophysiology of nephrocalcinosis could be reconstructed as follows: aquatic environment hyperoxia and hypercapnia → blood hypercapnia → blood acid-base perturbation (respiratory acidosis) → metabolic compensation (blood bicarbonate elevation and kidney phosphate excretion) → a rise in blood pH → calcium phosphate precipitation and deposition in tissues. This case highlights the need to consider the interplay between water quality and fish health when diagnosing fish diseases and reaching causal diagnoses

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

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Rizikove faktory zilni trombozy u mladych osob.

The major risk factors of venous thrombosis can be divided in acquired and genetic ones. Thrombosis is a disease that affects both the young and the old people. Although the risk factors playing a role in young adults are qualitatively the same as those playing a role in older adults, risk factors being specific to young adults are oral contraceptives, pregnancy and puerperium. We will present data on importance of risk factors of venous thromboembolism (VTE) in consecutive patients with the firts or recurrent VTE before the age of 50. Our results suggest that young patients with VTE without any known laboratory risk factors impaired fibrinolysis as reflected by the decreased Global fibrinolytic capacity. We confirmed high prevalence of MTHFR C667T mutation in our young thrombophilic (TP) patients in concordance with similar cohorts. Assessment of excessive platelet aggregation in response to low concentrations of adenosine diphosphate and epinephrine may be useful in patients with evidence of unexplained venous thrombosis with normal values in the routine hypercoagulation test panel. We assessed the low prevalence of total cancer and the low incidence of occult malignancy during follow-up in cohort of consecutive young patients with VTE. It seems that a simple routine investigation with careful history taking, physical examination and basic laboratory tests are sufficient to detect occult cancer in this age population. Inherited TP prevails in these young TP patients but the risk of occult malignancy exists as well.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

THE PREVALENCE OF CARDIOMETABOLIC RISK FACTORS AND THE TEN-YEAR RISK OF FATAL CARDIOVASCULAR EVENTS IN PATIENTS WITH SCHIZOPHRENIA AND RELATED PSYCHOTIC DISORDERS

Background: People suffering from schizophrenia have a significantly shorter lifespan compared to the general population. The majority of deaths are caused by physical diseases, including cardiovascular events. The aim of this cross-sectional study was to predict the risk of premature cardiovascular mortality and assess the prevalence of cardiometabolic risk factors in a sample of Czech patients with schizophrenia and related psychoses. Subjects and methods: We reviewed data from 129 subjects treated in an outpatient clinic that specialised in psychoses. The main collected variables included basic physical parameters (height, weight, waist circumference, blood pressure), smoking habits, laboratory data (glucose level, serum lipid level) and an electrocardiograph (ECG). We calculated the ten-year risk of fatal cardiovascular events using the Systematic Coronary Risk Evaluation (SCORE) chart. Results: The most prevalent risk factors were being overweight (70% of patients had a BMI over 25), dyslipidaemia (70% of patients) and smoking (43% of patients). According to the SCORE diagram, there was a high risk of fatal cardiovascular events over a ten-year period in 10% of the study group. The percentage was even higher (24%) when the latest European guidelines for cardiovascular disease prevention were used to calculate the risk. Conclusions: Our outcomes indicate even higher cardiometabolic morbidity rates in patients with psychoses than those referenced in the literature

Data_Sheet_1_Nephrocalcinosis in farmed salmonids: diagnostic challenges associated with low performance and sporadic mortality.PDF

Disease conditions that involve multiple predisposing or contributing factors, or manifest as low performance and/or low-level mortality, can pose a diagnostic challenge that requires an interdisciplinary approach. Reaching a diagnosis may also be limited by a lack of available clinical profile parameter reference ranges to discriminate healthy fish from those affected by specific disease conditions. Here, we describe our experience investigating poorly performing rainbow trout (Oncorhynchus mykiss) in an intensive recirculation aquaculture, where reaching a final diagnosis of nephrocalcinosis was not as straightforward as one would wish. To list the issues making the diagnosis difficult, it was necessary to consider the creeping onset of the problem. Further diagnostic steps needed to ensure success included obtaining comparative data for fish blood profiles and water quality from both test and control aquacultural systems, excluding infections with salmonid pathogenic agents and evaluating necropsy findings. Major events in the pathophysiology of nephrocalcinosis could be reconstructed as follows: aquatic environment hyperoxia and hypercapnia → blood hypercapnia → blood acid-base perturbation (respiratory acidosis) → metabolic compensation (blood bicarbonate elevation and kidney phosphate excretion) → a rise in blood pH → calcium phosphate precipitation and deposition in tissues. This case highlights the need to consider the interplay between water quality and fish health when diagnosing fish diseases and reaching causal diagnoses.</p

Systolic blood pressure and mortality in acute symptomatic pulmonary embolism

BACKGROUND: The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined. METHODS: To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). RESULTS: There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP 190 mmHg). Consistent findings were also observed for 30-day PE-related death. CONCLUSIONS: In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP <70 mmHg.status: publishe