Postmortem PF4 antibodies confirm a rare case of thrombosis thrombocytopenia syndrome associated with ChAdOx1 nCoV-19 anti-COVID vaccination.

We report a case of cerebral venous sinus thrombosis, bilateral adrenal hemorrhage, and thrombocytopenia in a 70-year-old man found dead. He had previously received the ChAdOx1 nCoV-19 vaccine (Vaxzevria®, AstraZeneca) 18 days before, and had since developed unspecific and undiagnosed characteristics of what proved to be a rare case of vaccine-associated thrombocytopenia with thrombosis syndrome (TTS). He was found dead 1 week after the beginning of symptoms (day 25 post-vaccine). Autopsy yielded venous hemorrhagic infarction with the presence of thrombi within dural venous sinuses, and extensive hemorrhagic necrosis of the central part of the adrenal glands. Antibodies against platelet factor 4 (PF4) were strongly positive in postmortem fluids, as measured with an enzyme-linked immunosorbent assay (ELISA). This difficult diagnosis is usually made during the patient's lifetime. After eliminating differential diagnoses, we concluded on a fatal case of vaccine-induced immune TTS with positive anti-PF4 antibodies in cadaveric blood, 3 weeks after ChAdOx1 nCoV-19 vaccination. Specific search for anti-PF4 antibodies in cadaveric blood appears therefore paramount to assess postmortem cases of TTS associated with anti-COVID vaccines.

Management strategies to minimize the use of synthetic chemical acaricides in the control of the cattle tick Rhipicephalus (Boophilus) microplus (Canestrini, 1888) in an area highly favourable for its development in Argentina.

The aim of this work was to test the efficacy of winter-spring control strategies against Rhipicephalus (Boophilus) microplus (Canestrini, 1888) (Ixodida: Ixodidae) in an area highly favourable for its development in Argentina. Control schemes using three or four annual applications of synthetic acaricides were evaluated. Furthermore, the dynamics of the non-parasitic phases of R. microplus were analysed to provide a framework for the application of pasture spelling as a tool for tick control. The treatment schemes provided appropriate levels of efficacy against R. microplus and also prevented the occurrence of the major peak in abundance of this tick in autumn. A significant overall effect against R. microplus can be achieved when the control strategies tested in this study are applied within the area most ecologically favourable for this tick in Argentina. Analysis of the dynamics of the non-parasitic phase of R. microplus indicates that the spelling period required to achieve a significant reduction of larvae in pastures fluctuates between 12 and 17 weeks if spelling is initiated in spring or early summer, but between 20 and 28 weeks if spelling is started in late summer, autumn or winter.

Hepatic angiomyolipoma: what management?

An 80-year-old woman was referred for the surgical treatment of a 110-mm right hepatic tumor. The biopsy revealed an adenoma, and a right hepatectomy was performed. Histopathology indicated a major fat component with epitheliod cells, immunoreactivity for HMB45, Melan A, and smooth muscle actin, describing a hepatic epithelioid angiomyolipoma (AML). The AML belongs to the group of tumors with a Perivascular Epithelioid Cell differentiation. Its diagnosis is based on imaging and biopsy, and therefore might be difficult. Hepatic AML are mainly benign tumors; however, some tend to behave in a malignant manner. In case of histological proof, close clinical and radiological monitoring can be proposed if its size is less than 5 cm and no pejorative histological features are found. Nevertheless, follow-up is still required if resection is performed in search of recurrence or metastatic spread.

[Antenatal ear examination: When, how and why?] / L'examen des oreilles en anténatal : quand, comment et pourquoi ?

Antenatal ear examination is an integral part of the thorough examination of the fetal face. The discovery of an anomaly, whether it is made by chance or during a complementary in-depth examination, leads the practitioner to determine its isolated or associated character, in order to characterise its possible belonging to a syndromic entity. In this context, the realization of genetic analysis more precise and wider allowing a return of the results in a time compatible with an evolutive pregnancy, gives to the geneticist a central role in the management of these couples. The main challenge lies in obtaining a set of concordant clinical and biological clues, enabling the genetic results identified to be interpreted correctly, the optimised functioning of the ultrasound practitioner - geneticist duo is therefore fundamental. This results in a complex information to deliver, in the fact that the clinical translation of an ear anomaly in antenatal can go from an isolated aesthetic anomaly to a genetic syndrome with neurodevelopmental disorder. The objective of this work is to describe, from a methodological analysis of antenatal ears, the accessible malformative entities, isolated or associated, and to discuss the problems in the need or not to propose their screening.

Diagnosis of congenital abnormalities with post-mortem ultrasound in perinatal death.

PURPOSE: To determine the sensitivity and specificity of post-mortem ultrasound in the diagnosis of major congenital abnormalities of fetuses using conventional autopsy as the standard of reference. MATERIAL AND METHODS: All fetuses coming from terminations of pregnancy or intrauterine fetal deaths in a single institution were included. A total of 75 fetuses were included during the study period. The results of post-mortem ultrasound examinations were compared to those of conventional autopsy that served as standard of reference. RESULTS: Gestational age of the fetuses ranged from 15 to 38 weeks gestation. A complete post-mortem ultrasound assessment was possible in all fetuses. Regarding detection of brain abnormalities, post-mortem ultrasound had a sensitivity of 81.5% or 4/5 (95% CI: 63.3-91.8%), and a specificity of 97.9% (95% CI: 89.1-99.6%). Specificities for the diagnosis of thoracic, cardiac, urinary tract, spinal and bone abnormalities were 100%. CONCLUSION: Post-mortem ultrasound shows high sensitivity and specificity for the diagnosis of congenital structural abnormalities as compared to conventional autopsy, with the exception of congenital cardiac diseases.

Liability under post-tonsillectomy lethal bleeding of the tonsillar artery: a report of two cases.

Post-operative haemorrhage is a frequent complication of tonsillectomy: a primary haemorrhage occurring in the first hours is rapidly dealt with by the surgical team. A secondary haemorrhage, which commonly occurs once the child has returned home, can be fatal if it is not dealt with quickly. We present two cases of a lethal outcome in children following a secondary post-tonsillectomy haemorrhage, for which the parents filed legal proceedings. Medical liability can be exercised during all stages of health care. Performing an autopsy associated with histological analyses is found to be indispensable for the identification of the causes of bleeding, as well as its mechanism.

Determination of benzalkonium chloride in aqueous ophthalmic preparations by high-performance liquid chromatography.

A high-performance liquid chromatographic method is described for the determination of homologues of benzalkonium chloride in aqueous ophthalmic preparations. The technique involves direct injection of the sample on a 5-microns Spherisorb-CN column. The mobile phase is acetonitrile-triethylamine (0.1%, v/v) in water (pH 2.5; 40:60, v/v). Detection is carried out at 215 nm. The method is rapid, specific, reproducible and simple, and is especially useful for the assay of this preservative in stability studies and quality control procedures.

[Fatal hemorrhage in postpartum by rupture of a splenic artery aneurysm]. / Hémorragie létale dans le post-partum par rupture d'un anévrisme de l'artère splénique.

The maternal mortality is rare and when it arises, the family often puts the medical profession in guilty's position. We present the case of a 38-year-old woman, died in the post-partum in a context of intense back pains. The autopsy found an incidental hemorrhagic syndrome to a two-stage rupture of the splenic artery. We shall discuss the aetiology. The autopsy and the anatomopathological examination are practiced only in hardly more than a quarter of the cases while they will be important in proceedings and will allow the family to go into mourning.

Pequeños estróngilos de los equinos: Eficacia clínica y periodo de reaparición de huevos luego del tratamiento con moxidectina y pirantel

El control de los pequeños estróngilos de los equinos (grupo Ciatostoma) se basa casi exclusivamente en la aplicación de antihelmínticos. En nuestro país, el desarrollo de resistencia generalizada a los bencimidazoles, está limitando las alternativas químicas disponibles a las lactonas macrocíclicas (ivermectina y moxidectina) y al pirantel, consideradas como drogas de larga y corta acción respectivamente. La información actualizada sobre la actividad de estas drogas en el campo es crítica para determinar su eficacia y detectar el desarrollo de fenómenos de resistencia a los antihelmínticos. En los equinos el período de reaparición de huevos (PRH) luego del tratamiento es considerado como un indicador temprano de la presencia de resistencia. En el presente trabajo se evaluó la eficacia clínica y el PRH luego de tratamientos con moxidectina y pirantel en equinos adultos de cinco establecimientos de las provincias de Santa Fe y Córdoba naturalmente parasitados por pequeños estróngilos. La eficacia clínica determinada al día 15 pos tratamiento utilizando un test de reducción en el conteo de huevos, osciló entre el 99,8 y el 100% para la moxidectina y entre el 98,9 y el 98,8% para el pirantel. Por su parte en el presente estudio el PRH fue de al menos 100 días para la moxidectina y de 35 días para el pirantel. Estos resultados indican que ambas drogas se muestran activas para el control de estos nematodes y que las poblaciones estudiadas (alguna de ellas resistentes a bencimidazoles) permanecen actualmente susceptibles a la moxidectina así como al pirantel. Esta última droga es de uso limitado en nuestro país, pero su inclusión en los programas de control contra los pequeños estróngilos podría reducir la dependencia y la presión de selección sobre las lactonas macrocíclicas y contribuir a mantener la vida útil de las mismas.

The control of the small strongyles (Ciathostoma group) in horses is based on the application of anthelmintics. In our country, the development of generalized resistance to benzimidazoles is limiting the chemical alternatives available to macrocyclic lactones (ivermectin and moxidectin) and to pyrantel, considered as long-acting and short-acting drugs respectively. Updated information on the activity of these drugs in the field, is critical for determining its efficacy and detecting the development of anthelmintic resistance. In these horse nematodes the period of egg reappearance (ERP) after treatment is considered as an early indicator of the presence of resistance. The present study evaluated the clinical efficacy and ERP after moxidectin and pirantel treatments in adult horses naturally parasitized by small strongyles from five farms from Santa Fe and Córdoba provinces. Clinical efficacy determined at day 14 or 15 post treatment using a test of reduction in the egg count ranged from 98.9 to 98.8% for the pirantel and 99.8 to 100% for moxidectin. The ERP was at least 100 days for moxidectin and 35 days for the pirantel. These results indicate that both drugs are active for the control of these nematodes and that the populations studied (some of them resistant to benzimidazoles) remain currently susceptible to moxidectin as well as to pyrantel. This last drug is of limited use in Argentina, but its inclusion in the control programs against the small strongyls could reduce the dependence and the selection pressure on the macrocyclic lactones and contribute to maintain the useful life of the same ones.

Eficacia del monepantel para el control de aislamientos de Haemonchus contortus y Trichostrongylus spp. con resistencia múltiple (ivermectina y febendazole) en caprinos

El monepantel es un nuevo antihelmíntico registrado en nuestro país exclusivamente para el control de los nematodes gastrointestinales de los ovinos y su uso ha sido direccionado mayormente hacia el control de parásitos resistentes a las clases de antihelmínticos disponibles actualmente. Estos mismos nematodes también parasitan a los caprinos, pero en estos rumiantes la patofisiología y la respuesta a los antihelmínticos es diferente, lo cual resulta en un mayor parasitismo y complejidad en el manejo de la resistencia. La presente comunicación informa sobre la eficacia del monepantel en dos hatos caprinos mantenidos bajo condiciones de campo y parasitados naturalmente por los géneros de nematodes gastrointestinales más comunes del área central de la Argentina (Haemonchus y Trichostrongylus) y portando alelos de resistencia múltiple (ivermectina y febendazole). El test de reducción en el conteo de huevos post tratamiento comparando diversas fórmulas, indicaron que en todos los hatos el monepantel por vía oral y a la dosis de 3,75 mg/kg de peso (1,5 veces mayor a la dosis ovina), resultó en eficacias del 99% al 100 %. Se realizan breves consideraciones sobre el uso potencial de esta droga en caprinos.

Monepantel is a new anthelmintic registered in Argentina exclusively for control of gastrointestinal nematodes of sheep and mostly directed toward controlling resistant parasites to current available classes of anthelmintics. The same nematodes also parasitize goats but pathophysiology and response are different in these hosts resulting in more severe parasitism and complexity in handling anthelmintic resistance. This report assess the efficacy of monepantel in goats maintained under field conditions and naturally parasitized by most common gastrointestinal nematodes from central Argentina (Haemonchus and Trichostrongylus) carrying alleles of multiple resistance (ivermectin and febendazole). According to the egg count reduction test, efficacies of 99% to 100% were observed after monepantel treatment at 3.75 mg/kg orally (1.5 ovine dose).

Monepantel y control de Haemonchus contortus en ovinos: Evaluación de la eficacia luego de cuatro años de uso en condiciones de refugio reducido

La resistencia de los nematodes ovinos a los antihelmínticos está generalizada en el centro-norte de la Argentina y la mayor preocupación actual es el aumento y dispersión de Haemonchus contortus portando alelos con resistencia múltiple. Actualmente los únicos antihelmínticos de amplio espectro sin documentación de resistencia en nuestro país son el monepantel y derquantel. Con la primera de estas drogas ya se han registrado casos de resistencia en Uruguay y Brasil por lo que es crítica la información actualizada sobre la actividad en el campo de estos antihelmínticos. Este estudio informa sobre la eficacia del monepantel luego de cuatro años de uso de esta droga sobre un aislamiento de H. contortus con resistencia múltiple (lactonas macrociclicas, closantel, levamisol y benzimidazoles) y bajo condiciones de refugio reducido. Se realizaron dos experiencias A y B (años 2014 y 2016 respectivamente) con corderos naturalmente parasitados y seleccionados en función del número de huevos por gramo de heces (≥ 250) los que fueron tratados con monepantel (2,5 mg/Kg oral). El test de reducción en el conteo de huevos post tratamiento comparando diversas fórmulas indicó que en ambas experiencias, la droga mantuvo una eficacia mayor al 97 % y que permanece activa para controlar este aislamiento de H. contortus luego de cuatro años de uso y bajo las particulares condiciones en las que se realizaron estos estudios.

Resistance to anthelmintics in sheep nematode is widespread in central-northern Argentina and current major concern is the rise and spread of Haemonchus contortus carrying multiple resistance alleles. Currently, monepantel and derquantel are the only broad-spectrum anthelmintics without documentation of resistance in our country. With the first of these drugs, have already been registered cases of resistance in Uruguay and Brazil so it is critical update on the activity in the field of these anthelmintics. This study aims to test the effectiveness of monepantel after four years of use of this drug on an isolation of H. contortus with multiple resistance (macrocyclic lactones, closantel, levamisole and benzimidazole) and under conditions of reduced refugia. Two experiences, A and B (2014 and 2016 respectively), were carried out with lambs naturally parasitized and selected by the number of eggs per gram of feces (≥ 250). In both experiences, the test of reduction in egg counts after treatment with monepantel (2.5 mgr/Kg orally) comparing various formulas indicated that the drug remained with efficacy greater than 97% after four years of use to control this isolation of H. contortus under the field conditions of these studies.