Consistent detection of bovine papillomavirus in lesions, intact skin and peripheral blood mononuclear cells of horses affected by hoof canker.

REASONS FOR PERFORMING THE STUDY: Equine hoof canker is a chronic proliferative pododermatitis of as yet unknown aetiology. Like equine sarcoid disease, canker is a therapy-resistant disorder characterised by hyperkeratosis, acanthosis and a marked tendency to recur. HYPOTHESIS: There is an association of sarcoid-inducing bovine papillomaviruses of types 1 and 2 (BPV-1, BPV-2) with hoof canker disease. METHODS: Using PCR-based techniques, we assessed canker tissue, intact skin and/or peripheral blood mononuclear cells (PBMCs) of 25 canker-affected horses for the presence of sarcoid-associated BPV-1 and -2. RESULTS: Conventional PCR revealed BPV-1/-2 DNA in 24/24 canker, 12/13 skin and 10/11 PBMC DNA isolates. Using inverse PCR, full-length BPV episomes were detected in 1/5 canker specimens. Sequencing of viral early and late genes amplified from canker, intact skin and PBMC DNA of 2 cases revealed an overall identity of 98% to BPV-1. Viral DNA loads amounted to ≤16 copies per cell in canker tissue and intact skin, and to ≤0.35 copies per PBMC, as determined by quantitative PCR. Using RT-PCR, the viral major oncogene E5 was shown to be transcribed in 2/4 canker tissue specimens and 5/7 PBMC isolates. Immunocapture PCR from 7 canker and 6 skin extract supernatants revealed capsomere-associated viral DNA in one canker and one skin sample. Hoof tissue, skin and PBMCs collected from 13 individuals with no signs of canker or BPV-related malignancies scored negative throughout the experiments. CONCLUSION: These findings suggest that the observed presence of BPV-1/-2 in canker-affected horses is not coincidental but indicative of an active contribution to hoof canker disease. POTENTIAL RELEVANCE: The use of antivirals and/or immune modulators may help improving canker therapy.

The impact of day care on ventilation tube insertion.

OBJECTIVE: To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion. DESIGN: A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance. SETTING: Private practice in a mid-sized, southeastern university town. PATIENTS AND CONTROLS: This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study. INTERVENTIONS: Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. MAIN OUTCOME MEASURES: The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded. RESULTS: Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.

Bovine papillomavirus type 1 and Equus caballus papillomavirus 2 in equine squamous cell carcinoma of the head and neck in a Connemara mare.

In January 2010, 18 months after excision of an ocular squamous cell carcinoma (SCC), a Connemara mare presented with anorexia and periorbital/parotideal lesions. Post mortem examination revealed these lesions as forming one entity, with 2 additional growths in the retropharyngeal region and the left jugular groove, respectively. The lesions were confirmed histopathologically as SCCs. Using PCR, peripheral blood mononuclear cells (PBMCs) from 2008 and 2010, tumour tissue, intact skin and vulval mucosa were screened for Equus caballus papillomavirus type 2 (EcPV-2) and bovine papillomavirus types 1 and 2 (BPV-1/2) DNA. Whereas PBMCs from 2008 scored negative, EcPV-2 DNA was present in PBMCs and SCCs from 2010. Furthermore, reverse transcription PCR revealed EcPV-2 E6 transcripts in these samples. BPV-1/2 DNA, but not RNA, was demonstrated in the periorbital/parotideal mass, the SCC of the jugular groove, vulval mucosa and intact skin, but not in the pharyngeal SCC and PBMCs. Sequencing revealed a 99% similarity of EcPV-2 amplicons with the published EcPV-2 sequence. BPV-1/2 amplicons corresponded to BPV type 1. This report is the first to describe co-presence of BPV-1 and EcPV-2 DNA in a pony affected by an uncommon form of nongenital SCC, and the detection of EcPV-2 transcripts in lesions and PBMCs.

Child abuse.

Child abuse or maltreatment is well documented in the United States. The Department of Health and Human Services and the American Medical Association estimate that at least 1 million incidents of physical, emotional and/or sexual maltreatment occur each year; child abuse is reported to cause 2,500 to 5,000 deaths annually. A 1990 study found that approximately 22.6 out of every 1,000 children in the United States experienced abuse or neglect, yet only half of these incidents were reported to child protective service agencies. Organizations and resources for physicians dealing with child abuse are provided in Table 1.

Patient identification and bystander-initiated actions in acute myocardial ischemia.

From the onset of symptoms of acute myocardial ischemia to initiation of emergency medical services is a delay over which health-care professionals have the least control. Treatment modalities greatly depend upon rapid recognition and early therapy. Patient identification of specific symptoms can be helpful and recognition can be improved by targeted, public educational efforts. Completion of a seamless 9-1-1 system in Florida is necessary as well as instruction in its proper use. Simplified cardiopulmonary resuscitation instruction needs to be given to those persons most likely to be exposed to a sudden cardiac death victim. The physician's office staff should be educated so they can enlighten patients regarding the need for rapid treatment in acute situations. Appropriate utilization of automatic external defibrillators needs to be studied.

Vocal cord paralysis following carotid endarterectomy: the paradox of return of function.

In a series of 411 consecutive carotid endarterectomies 29 patients were identified with vocal cord paralysis. All patients were symptomatic, although in many these symptoms were subtle and rapidly resolved. There was a statistically significant predominance of left-sided paralysis. Excluding three patients who died during the initial year of follow-up return of normal voice was noted in 22 patients, but complete return of vocal cord function was present in only 15. Apposition of the contralateral vocal cord against a paralyzed vocal cord allowed for production of normal voice in five patients. Less than 1% of patients remained with symptoms at one year following endarterectomy. We conclude that vocal cord paralysis is a common complication of carotid endarterectomy; the voice becomes an unreliable guide as to its resolution. We recommend laryngoscopic examination of all patients who undergo bilateral carotid endarterectomy.