Evaluation of antithrombotic prophylaxis and thrombotic events in children with COVID-19 or MIS-C: A tertiary pediatric center experience.

OBJECTIVES: COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis. METHODS: A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C. RESULTS: The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease. CONCLUSION: In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors; perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.

Dermatological aspects of tularaemia: a study of 168 cases.

BACKGROUND: Tularaemia is a zoonotic infectious disease caused by Francisella tularensis, an aerobic, uncapsulated, gram-negative coccobacillus. Several case reports have appeared on the dermatological manifestations of tularaemia, but relatively few longer-term studies are available. AIM: To identify skin features of tularaemia that aid in its diagnosis. METHODS: In total, 168 patients (68 male, 100 female) diagnosed with tularaemia were retrospectively examined. All dermatological data for these patients were evaluated. RESULTS: Of the 168 patients, 149 (88.69%) had tularaemia of the oropharyngeal type, 12 (7.73%) had the ulceroglandular type, 5 (2.9%) had the oculoglandular type and 2 (0.59%) had the pulmonary type. Secondary skin manifestations were found in 26 patients (15.47%). Sweet syndrome (SS) was found in 11 patients (6.54%), most of whom presented with the oropharyngeal form, while erythema nodosum (EN) was found in 7 patients (4.16%), dermatitis in 2 (1.19%), urticaria in 2 (1.19%), acneiform eruptions in 1 (0.59%), vasculitis-like eruptions in 1 (0.59%) and SS + EN in 1 (0.59%). Patients with the oropharyngeal form had a statistically significant (P < 0.001) higher number of skin findings than patients with the other forms. CONCLUSIONS: In clinical practice, tularaemia may present with various cutaneous manifestations, and dermatologists who work in endemic regions must be aware of the possibility of this disease.

Reliability of the i-STAT for the determination of blood electrolyte (K+, Na+, and CI-) concentrations in cattle.

BACKGROUND: Rapid determination of blood electrolyte concentrations can help determine electrolyte status and delivery of effective volume of electrolyte solutions in field conditions. OBJECTIVE: To evaluate reliability of the i-STAT, a point-of-care (POC) device, in measuring blood K(+), Na(+), and CI(-) concentrations in cattle. ANIMALS: Ninety-eight cattle with various diseases. METHODS: In this prospective study, blood samples collected from the jugular vein were processed for determination of K(+), Na(+), and CI(-) concentrations in blood and plasma using the i-STAT and auto-analyzer (Cobas C501), respectively. Blood and plasma electrolyte data were subjected to student t-test for comparison, the concordance analysis for agreement, accuracy, and precision, the Passing-Bablok regression and the Bland-Altman plot for reliability, and receiver operating characteristics curves for sensitivity (Se) and specificity (Sp). RESULTS: Plasma concentrations of K(+) (4.39 versus 4.2 mmol/L; P < .0001) and CI(-) (100.30 versus 99.4 mmol/L; P < .04) were greater than their concentrations in blood. Plasma and blood Na(+) concentrations were similar (136.95 versus 136.8 mmol/L). The i-STAT results were highly correlated with the Cobas C501 results (r = 0.970, 0.922, and 0.866 for K(+), Na(+), and CI(-), respectively). Regression equations fitting blood (Y) and plasma (X) concentration did not deviate from the identity line for K(+) (Y = -0.10 + 0.98 × X), Na(+) (Y = X), and CI(-) (Y = 3.04 + 0.96 × X). The mean bias (blood concentration - plasma concentration) was -0.20 for K(+) (P = .03), -0.16 for Na(+) (P = .12), and -0.87 for CI(-) (P = .93). The i-STAT had 76-100% Se and 87.7-100% Sp for assessing electrolyte statuses. CONCLUSIONS AND CLINICAL IMPORTANCE: The i-STAT yielded results that were in agreement with the auto-analyzer, with negligible biases in measurement of plasma K(+), Na(+), and CI(-) concentrations. The i-STAT is a reliable POC device and can be used in field condition to assess electrolyte status in cattle.

Evaluation of 4 point-of-care units for the determination of blood l-lactate concentration in cattle.

BACKGROUND: Despite being used commonly in bovine medicine, information on reliability of point-of-care (POC) lactate meters is limited. OBJECTIVE: To determine the validity of 4 commercially available POC lactate meters in cattle. ANIMALS: Cattle with various diseases (n = 120). METHODS: Blood samples collected from the jugular vein were processed immediately on POC lactate meters. Plasma l-lactate concentration was measured by the enzymatic-colorimetric method (ELISA). Data were subjected to Friedman's test for comparison, Passing-Bablok regression and Bland-Altman plot analyses for reliability, and receiver operating characteristics analysis for sensitivity (Se) and specificity (Sp). RESULTS: The POC lactate meters were highly correlated with ELISA (r = 0.98-0.99) despite disagreements among units. When regressed on ELISA, blood l-lactate concentrations generated from Accutrend Plus and Lactate Pro were linear up to 16.6 and 15.7 mmol/L, respectively, whereas those generated from i-STAT and Lactate Scout were linear up to 19.5 and 19.7 mmol/L, respectively. All POC lactate meters had a Se of 100% with Sp of 95.7-98.6% at a plasma l-lactate cut-off concentration of 4 mmol/L. i-STAT had the best accuracy (99.0%) and precision (99.8%), the best linear fit (y = -0.13 + 1.04X) yielding the lowest bias (-6.6%) as well as the highest Se (100%) and Sp (98.6%). CONCLUSIONS AND CLINICAL IMPORTANCE: Despite high correlation with the reference method, dilution is needed for Accutrend Plus/Lactate Pro and i-STAT/Lactate Scout if concentrations >15 and 20 mmol/L, respectively. i-STAT provided the most accurate and precise results.

Severe thiamine deficiency in sheep with acute ruminal lactic acidosis.

BACKGROUND: Thiamine status of ruminants is adversely affected in acidic rumen conditions. However, there have been limited published case study data related to thiamine deficiency of ruminants with acute ruminal lactic acidosis (ARLA). HYPOTHESIS: Thiamine deficiency would occur in sheep with ARLA. ANIMALS: Thirteen Ak-Karaman (white Karaman) sheep with ARLA, aged 1 year (ARLA group) and 10 healthy Ak-Karaman sheep, aged 1 year (control group) were used. METHODS: After clinical examination, rumen fluid samples of all sheep were obtained with a stomach tube and examined immediately. Blood samples were taken from a jugular vein of the sheep. Erythrocytic transketolase enzyme activity and hence thiamine pyrophosphate (TPP) effect were determined according to Clausen's method. RESULTS: History revealed that all sheep in the ARLA group had accidentally consumed excessive amounts of cracked barley. During clinical examination of the ARLA group, disturbed general condition, engorged scleral vessels, moderate to severe dehydration, and ruminal atony were recorded in the sheep. The results of the ruminal fluid analyses of the ARLA group demonstrated characteristics of ARLA. The results of clinical and ruminal fluid examination of control group were normal. The mean TPP effect (%) in the ARLA group (109 +/- 28) was significantly higher than in the control group (22.2 +/- 3.7) (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: The present study revealed that severe thiamine deficiency occurred in sheep with ARLA. This result indicates that thiamine administration to sheep suffering from acute ruminal acidosis caused by overconsumption of readily fermentable carbohydrates could be beneficial in alleviating thiamine deficiency caused by ruminal acidosis.

Treatment of premature calves with clinically diagnosed respiratory distress syndrome.

BACKGROUND: Respiratory distress syndrome (RDS) has been reported previously in premature calves. However, there have been no published data on the effect of surfactant replacement therapy in the treatment of premature calves with RDS. HYPOTHESIS: Surfactant replacement therapy added to the standard treatment for premature calves clinically diagnosed with RDS would increase the viability of the calves. ANIMALS: Twenty-seven premature calves with clinically diagnosed RDS. METHODS: Twenty calves were instilled intratracheally with bovine lung surfactant extract and provided with standard treatment for RDS (surfactant group). Seven calves were given only standard care for RDS without surfactant therapy and placed in the control group. Standard treatment for newborn calves with RDS includes warming, administration of intranasal oxygen, fluid replacement, administration of antibiotics, and immunoglobulin solution. Arterial blood samples were collected from the calves at 3 observation points, the first just before treatment (hour 0) and at 2 hours (hour 2) and 24 hours (hour 24) after treatment was started to determine if ventilation was adequate, improving, or deteriorating. Blood gases, pH, bicarbonate, and lactate concentrations were measured. RESULTS: In the surfactant group, mean partial pressure of oxygen significantly increased at hours 2 and 24. Mean partial pressure of carbon dioxide decreased and mean arterial blood pH increased at hour 24 in the surfactant group compared with the control group (P < .05). Of the 20 calves in the surfactant group, 12 survived and 8 died. All 7 calves in the control group died. CONCLUSIONS AND CLINICAL IMPORTANCE: The results of this study suggest that surfactant replacement therapy may reduce neonatal deaths in premature calves with clinically diagnosed RDS.

Application of adaptive heuristic criticism control (AHCC) to dye wastewater.

This paper presents an experimental application of AHCC to study the coagulation process of wastewater treatment in a dye plant. Also this study includes a series of tests in which an AHCC control was used for pH control. The performance results of the AHCC controller are compared with the results obtained by using a conventional proportional-integral-derivative (PID) algorithm. It is useful to compare PID with AHCC to illustrate the extreme range of the nonlinearity of the dye wastewater treatment process. Although the removal of pollutants from wastewater is similar with AHCC and PID, our results show excellent AHCC performance in the region where conventional PID control fails.

Investigation of lectin activity in Theileria annulata piroplasms.

Adhesion to target cells is an essential step in the pathogenesis of many protozoal infections. Some protozoa have been reported to have a lectin activity involved in their attachment to the cell surface. The ligand-receptor interaction involved in Theileria annulata infection is unclear at present, in spite of the fact that some aspects of the process have been investigated. To this end, T. annulata piroplasms have been screened for lectin activity. Blood taken from infected cattle was first depleted of leukocytes and then subjected to ammonium chloride lysis in order to isolate the piroplasms. The piroplasms were homogenised and a crude membrane extract was prepared by centrifugation. To investigate lectin activity in piroplasm proteins, a simple screening procedure was employed for analysing piroplasm proteins binding to various lectin ligands. Numerous immobilised lectin ligands (L-fucose-sepharose, N-acetyl-neuraminic acid-sepharose, N-acetyl-D-galactosamine-agarose, N-acetyl-D-glucosamine-agarose, D-mannose-agarose, beta-D-glucose-agarose, alpha-methyl-D-mannoside-agarose) were incubated with T. annulata piroplasm crude membrane extract. The ligand-bound proteins were eluted and separated by a brief centrifugation and determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). The present study suggests that a 32 kDa protein of piroplasm binds to D-galactosyl residues of the agarose matrix and that the binding is inhibited by galactose and not by the other monosaccharides tested.