Porcine circovirus genotypes and their copathogens in pigs with respiratory disease in southern provinces of Vietnam.

This study was conducted to investigate the genetic diversity of porcine circovirus type 2 (PCV2) and its coinfecting pathogens in pigs with respiratory disease in Vietnam. Samples from 127 clinical cases were obtained from different southern provinces of Vietnam from January 2018 to January 2020 for PCR and sequence analysis. The infection rate of PCV2 was 78.8%, and the major pathogens found in coinfections with PCV2 were porcine reproductive and respiratory syndrome virus, Mycoplasma hyopneumoniae, and Haemophilus parasuis. Forty-three PCV2-positive clinical samples were selected for amplification and sequencing of the ORF2 region. Phylogenetic analysis of PCV2 ORF2 showed that five of the sequences belonged to PCV2b (11.6%) and 38 belonged to PCV2d (88.4%), indicating that PCV2d strains were predominant in southern provinces of Vietnam. Alignment of the predicted amino acid sequences of the PCV2 capsid protein revealed polymorphic sites in the antibody recognition regions. This study demonstrates the prevalence of the PCV2d genotype in southern Vietnam and presents a comprehensive overview of the coinfecting pathogens associated with PCV2 in young pigs with respiratory disease.

Ventricular Tachycardia and Hospital Readmission in Patients Discharged From the Hospital After an Acute Myocardial Infarction.

Background: Although ventricular tachycardia (VT) occurring during hospitalization for an acute myocardial infarction (AMI) increases mortality risk, its relationship with 30-day postdischarge rehospitalization has not been examined. Methods: Using data from the Worcester Heart Attack Study, we examined the association between early (during the first 48 hours of admission) and late (after 48 hours from admission) VT with 30-day postdischarge all-cause and cardiovascular disease (CVD)-related rehospitalization while analytically controlling for several demographic and clinical factors. Results: The study population consisted of 3534 patients who were hospitalized with an AMI between 2005 and 2015 (average age, 67.2 years; 40.7% women); VT occurred in 452 patients (13.7%), with the majority of instances (81.2%) occurring within 48 hours of admission. The 30-day all-cause rehospitalization rate was 17.3%, with 70.9% of the hospitalizations related to CVD. The odds of rehospitalization were 1.63 times (95% confidence interval [CI] = 0.99-2.69) and 1.12 times (95% CI = 0.83-1.51) higher for patients with AMI who developed late VT and early VT, respectively, compared to patients who did not develop VT. The risk of rehospitalization among patients with late VT was higher (odds ratio = 2.22 (95% CI = 0.79-6.26) in those with ST-segment-elevation AMI, compared to those with non-ST-segment-elevation AMI (odds ratio = 1.45 (95% CI = 0.81-2.57); early VT was not associated with rehospitalization in patients with either AMI subtype. No significant association was present between the occurrence of VT and CVD-related rehospitalization. Conclusions: Patients who develop late VT may experience a higher risk of 30-day rehospitalization following hospital discharge for AMI, especially among those with ST-segment-elevation AMI. Larger studies are needed to confirm our findings.

Contexte: Bien qu'une tachycardie ventriculaire (TV) survenant pendant une hospitalisation pour un infarctus aigu du myocarde (IAM) augmente le risque de décès, son lien avec une réhospitalisation dans les 30 jours suivant le congé n'a pas fait l'objet d'étude. Méthodologie: À partir des données de l'étude Worcester Heart Attack Study, nous avons étudié le lien entre les TV précoces (dans les 48 heures de l'hospitalisation) et tardives (après 48 heures d'hospitalisation) et les réhospitalisations liées à une maladie cardiovasculaire et toutes causes confondues 30 jours après le congé, tout en tenant compte de manière analytique de plusieurs facteurs démographiques et cliniques. Résultats: La population de l'étude était composée de 3 534 patients qui ont été hospitalisés pour un IAM entre 2005 et 2015 (âge moyen, 67,2 ans; 40,7 % de femmes). Une TV est survenue chez 452 patients (13,7 %), la majorité des cas (81,2 %) dans les 48 heures de l'hospitalisation. Le taux de réhospitalisations toutes causes confondues à 30 jours était de 17,3 %, 70,9 % des cas étant liés à une maladie cardiovasculaire. Chez les patients ayant eu un IAM et ayant subi une TV tardive ou précoce, les risques de réhospitalisation étaient respectivement 1,63 fois (intervalle de confiance [IC] à 95 % = 0,99-2,69) et 1,12 fois (IC à 95 % = 0,83-1,51) plus élevés que chez ceux qui n'avaient pas développé de TV. Le risque de réhospitalisation chez les patients ayant subi une TV tardive était plus élevé (risque relatif approché = 2,22 [IC à 95 % = 0,79-6,26]) chez ceux ayant eu un IAM avec élévation du segment ST que chez ceux ayant eu un IAM sans élévation du segment ST (risque relatif approché = 1,45 [IC à 95 % = 0,81-2,57]). La TV précoce n'a pas été associée à la réhospitalisation chez les patients dans l'un ou l'autre des sous-types d'IAM. Aucun lien important n'a été observé entre la survenue d'une TV et la réhospitalisation pour une maladie cardiovasculaire. Conclusions: Chez les patients qui développent une TV tardive, le risque de réhospitalisation 30 jours après le congé de l'hôpital pour un IAM peut être augmenté, particulièrement lorsque l'IAM s'accompagne d'une élévation du segment ST. De vastes études sont nécessaires pour confirmer nos observations.

Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction.

The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to predict mortality in acute myocardial infarction (AMI). However, data on the transition of SCAI stages and their association with mortality after AMI are limited. All patients with AMI admitted to Vietnam National Heart Institute between August 2022 and February 2023 were classified into SCAI stages A, B, and C/D/E at admission and were reevaluated in 24 hours. We used Kaplan-Meier estimate and multivariable Cox regression analysis to assess the association between SCAI stages transition and 30-day mortality. We included 139 patients (median age 69 years, 29.5% female). On admission, 50.4%, 20.1%, and 29.5% of patients were classified as SCAI stage A, B, and C/D/E, respectively. The proportion of patients whose SCAI stage improved, remained stable, or worsened after 24 hours was 14.4%, 66.2%, and 19.4%, respectively. The 30-day mortality in patients with initial SCAI stages A, B, and C/D/E on admission was 2.9%, 21.4%, and 61.0%, respectively (P < .001). The 30-day mortality was 2.4% for patients with baseline SCAI stage A/B who remained unchanged or improved, 30.0% for patients with baseline SCAI stage C/D/E who remained unchanged or improved, and 92.6% for patients with SCAI stage B/C/D/E who worsened at 24 hours after admission (log-rank P < .001). In patients with AMI, evaluating the SCAI stage shock stage on admission and reevaluating after 24 hours added more information about 30-day mortality.

Age and Sex Differences and Temporal Trends in the Use of Invasive and Noninvasive Procedures in Patients Hospitalized With Acute Myocardial Infarction.

Background Few studies have examined age and sex differences in the receipt of cardiac diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction and trends in these possible differences during recent years. Methods and Results Data from patients hospitalized with a first acute myocardial infarction at the major medical centers in the Worcester, Massachusetts, metropolitan area were utilized for this study. Logistic regression analysis was used to examine age (<55, 55-64, 65-74, and ≥75 years) and sex differences in the receipt of echocardiography, exercise stress testing, coronary angiography, percutaneous coronary interventions, and coronary artery bypass graft surgery, and trends in the use of those procedures during patients' acute hospitalization, between 2005 and 2018, while adjusting for important confounding factors. The study population consisted of 1681 men and 1154 women with an initial acute myocardial infarction who were hospitalized on an approximate biennial basis between 2005 and 2018. A smaller proportion of women underwent cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, while there were no sex differences in the receipt of echocardiography and exercise stress testing. Patients aged ≥75 years were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, but were more likely to receive echocardiography compared with younger patients. Between 2005 and 2018, the use of echocardiography and coronary artery bypass graft surgery nonsignificantly increased among all age groups and both sexes, while the use of cardiac catheterization and percutaneous coronary intervention increased nonsignificantly faster in women and older patients. Conclusions We observed a continued lower receipt of invasive cardiac procedures in women and patients aged ≥75 years with acute myocardial infarction, but age and sex gaps associated with these procedures have narrowed during recent years.

Solitary 18F-fluorodeoxyglucose avid spinous process cholangiocarcinoma metastasis proven on CT guided percutaneous needle bone biopsy.

A 65-year-old female with newly diagnosed cholangiocarcinoma was referred for a FDG PET/CT for initial staging. There was a region of moderate FDG avidity localizing to the hepatic hilum representing the primary site of malignancy. An unexpected moderately FDG avid focus was demonstrated in the spinous process of the T11 vertebra with no corresponding mass lesion seen on low dose CT and no evidence of distant metastatic disease elsewhere. A percutaneous CT guided needle bone biopsy was performed which confirmed a solitary T11 spinous process metastasis on histopathology.

Factors predicting positive CT mesenteric angiography results in lower gastrointestinal haemorrhage prior to consideration of intra-arterial angio-embolisation.

INTRODUCTION: Lower gastrointestinal haemorrhage (LGIH) is a challenging phenomenon in a comorbid, elderly population. CT mesenteric angiography (CTMA) allows localisation of the site of haemorrhage, and provides a target for interventional techniques, but the intermittent nature of LGIH makes it challenging to reliably demonstrate extravasation. This study aimed to identify objective factors that may predict scan outcomes. METHODS: In this retrospective cohort study, all patients undergoing CTMA for LGIH at Monash Health from January 2011 to December 2019 (n = 854) were included. Baseline patient characteristics included age, bowel resection/endoscopic intervention within the past 14 days, known bowel malignancy, anticoagulant/antiplatelet use, duration of symptoms, vital signs, transfusion requirements in the past 24 h and investigation results (recent haemoglobin levels, platelet count, international normalised ratio and creatinine levels). Univariate analysis was performed, and significant factors were entered into a multivariate model. RESULTS: The final multivariate model was statistically significant (P < 0.001) and consisted of bowel resection/endoscopic intervention within the past 14 days (OR = 2.15), use of antiplatelet agents (OR = 2.03), blood transfusion requirement greater than 3 units per 24 h (OR = 1.79), systolic blood pressure less than 100 mmHg (OR = 1.56) and heart rate greater than 100 beats per minute (OR = 1.52). CONCLUSION: The factors identified above are objective, independently associated with positive scan outcomes, readily available to radiologists and are useful for more judicious patient selection.

Incidental prostate-specific membrane antigen-avid meningioma detected on 68Ga-prostate-specific membrane antigen PET/CT.

A 70-year-old gentleman with a history of Gleason score 7 (3 + 4) prostate adenocarcinoma was treated with radical prostatectomy with clear surgical margins. Postoperatively his prostate specific antigen was undetectable. However, his prostate specific antigen was slowly rising and he was referred for a 68Galium-Prostate Specific Membrane Antigen (PSMA) PET/CT scan. Findings were suggestive of local prostatic cancer recurrence with no evidence of nodal or distant metastasis. An incidental PSMA avid focus was noted in the left frontal lobe, inseparable from the left frontal bone laterally. Subsequent MRI findings were consistent with meningioma. Meningioma is the most common primary brain tumor and may be a cause of false positive prostate cancer metastasis due to 68Ga-PSMA uptake.