A Presentation of Babesiosis in the Setting of Low-Grade Follicular B-cell Lymphoma.

Babesiosis is a tick-borne parasitic infection seen in the Northeast and upper Midwest regions of the United States. Clinically, this intra-erythrocytic parasitic infection can present in a variety of ways, including fever, fatigue, malaise, or myalgia. Of note, these presenting symptoms are very similar to symptoms that can also be seen in patients with low-grade lymphoma. Thus, differentiating between babesiosis infection and active, symptomatic low-grade lymphoma can be difficult. We present a patient with concurrent severe babesiosis infection and follicular lymphoma. This case report provides a unique overlap of Hematology/Oncology and Infectious Disease and the ensuing diagnostic challenges when both tick-borne illnesses and low-grade lymphoma present together. We suggest including babesiosis screening in the pretreatment evaluation for the use of rituximab in patients with the above symptomatology and geography. This will help rule out alternate confounding diagnoses of babesiosis infection before initiating immunosuppressive treatment for active, symptomatic low-grade lymphoma. Using immunosuppressive agents such as rituximab to treat suspected low-grade lymphoma, before ruling out tick-borne illnesses, can be harmful. Our goal is to reduce such instances.

Genome-wide association study of mammary gland tumors in Maltese dogs.

Background: A genome-wide association study (GWAS) is a valuable tool for investigating genetic and phenotypic variation in many diseases. Objective: The objective of this study was to identify variations in the genomes of Maltese dogs that are associated with the mammary gland tumor (MGT) phenotype and to assess the association between each biological condition and MGT phenotype in Maltese dogs. Methods: DNA was extracted from 22 tumor samples and 11 whole blood samples from dogs with MGTs. Genome-wide single-nucleotide polymorphism (SNP) genotyping was performed, and the top 20 SNPs associated with various conditions and genetic variations were mapped to their corresponding gene locations. Results: The genotyping process successfully identified 173,662 loci, with an overall genotype completion rate of 99.92%. Through the quality control analysis, 46,912 of these SNPs were excluded. Allelic tests were conducted to generate Manhattan plots, which showed several significant SNPs associated with MGT phenotype in intergenic region. The most prominent SNP, located within a region associated with transcription and linked to the malignancy grade of MGT, was identified on chromosome 5 (p = 0.00001) though there may be lack of statistical significance. Other SNPs were also found in several genes associated with oncogenesis, including TNFSF18, WDR3, ASIC5, STAR, and IL1RAP. Conclusion: To our knowledge, this is the first GWAS to analyze the genetic predisposition to MGT in Maltese dogs. Despite the limited number of cases, these analyzed data could provide the basis for further research on the genetic predisposition to MGTs in Maltese dogs.

Correlation between the Leaflet-Annulus Index and Echocardiographic Indices in Maltese Dogs with Myxomatous Mitral Valve Disease.

Myxomatous mitral valve disease (MMVD) is the most common chronic heart valve disease, leading to left-sided cardiomegaly in dogs. The leaflet-annulus index (LAI) was originally used in humans as a predictor of mitral regurgitation (MR) after mitral valve repair surgery. This index represents the quantity and severity of MR since it is affected by annular dilation. Recently, LAI was adapted to veterinary medicine, and its usefulness as an indicator of annular dilation on 2D transthoracic echocardiography in MMVD dogs was suggested. For this study, 135 Maltese dogs were selected and divided into groups of control, B1, and B2, according to the American College of Veterinary Internal Medicine consensus statement. The following data were collected: radiographic indices including the vertebral heart score and vertebral left atrial size, echocardiographic indices including the left-atrium-to-aortic-root ratio (LA:Ao), left ventricular internal diameter at diastole, normalized for body weight, and anteroposterior length and LAI measured on right parasternal long-axis view. The results showed a significant difference in LAI between each group, becoming smaller as the disease progressed. Also, there was a significant correlation between LAI and each index, showing the strongest correlation with LA:Ao. LAI could be helpful as a new indicator used for the determination of severity and prognosis in Maltese dogs with MMVD.

Comparison of Serum Bile Acid Concentrations Between Maltese and Other Breeds of Dogs With Portosystemic Shunt.

BACKGROUND/AIM: Congenital portosystemic shunt (PSS) is a vascular anomaly forming a direct communication between portal and central venous systems, thus bypassing the liver. This condition is related to various clinical symptoms including those manifesting in the central nervous system, gastrointestinal tract, and urinary tract. Treatment of PSS includes medical management and surgery. When evaluating prognosis of dogs with PSS, serum biochemistry profiles including serum bile acid (SBA) and ammonia concentrations are routinely used as screening tests. However, the use of SBA concentration in Maltese is controversial because it can be measured above the reference range even in normal dogs of this breed. In addition, utilizing SBA levels to assess surgical prognosis of PSS is not widely understood in this breed. Thus, the present study evaluated whether SBA could be used as a screening test for PSS in Maltese dogs. MATERIALS AND METHODS: Medical records of dogs in the Veterinary Teaching Hospital from 2018 to 2020 were retrospectively reviewed. RESULTS: A total of 23 dogs with PSS and 30 Maltese dogs without PSS were analyzed. Although preoperative SBA levels were significantly higher in Maltese dogs (192 µmol/l) than in other dog breeds (137 µmol/l) with portocaval shunt, its concentrations were significantly decreased after surgery in both Maltese and other breeds of dogs. No significant difference was observed in postoperative SBA levels between Maltese and other dog breeds. The mean SBA levels for Maltese dogs without PSS (8 µmol/l) were within the reference interval (0-25 IU/l). CONCLUSION: Measuring pre- and post-operative SBA levels to evaluate prognosis of PSS might also be available for Maltese.

Babesiosis. Reporte de caso clínico en Venezuela. Revisión de literatura

Introducción: La babesiosis es una enfermedad causada por protozoos intraeritrocíticos con características clínicas que son similares a las de la malaria, se transmite a los seres humanos a través de la picadura de una garrapata infectada, ocasionalmente por transfusión. A nivel global la prevalencia de la enfermedad es desestimada; se desconoce esa proporción en Latinoamérica y Venezuela. Caso clínico: Paciente masculino de 29 años con fiebre de 15 días, ictericia, dolor abdominal, en quien se sospechó malaria por epidemiología y síntomas, se descartaron otras entidades como endocarditis, leptospirosis, tuvo serología positiva para ehrlichiosis, sin embargo, persistió clínica a pesar del tratamiento con cloroquina, clindamicina y doxiciclina; por tanto, se realizaron estudios complementarios con hallazgo de inclusiones intraeritrocíticas compatibles con babesiosis e inició terapia con clindamicina y quinina por 7 días con evolución satisfactoria. Discusión: El caso reportado requirió de un ejercicio clínico y apoyo interdisciplinario para un desenlace adecuado. Entre los diagnósticos diferenciales de enfermedades intraeritrocitarias se encuentra la babesiosis cuyos síntomas son inespecíficos, pero orienta su diagnóstico al indagar en el antecedente epidemiológico. El tratamiento incluye Atovacuona con Azitromicina o alternativas como Clindamicina con Quinina. Conclusiones: El presente caso fue bastante complejo dado su forma de presentación y al ser una enfermedad con una baja prevalencia en nuestro país, sin embargo, predominó el juicio clínico logrando el mejor resultado posible Esta publicación en línea ha sido corregida, en BVI 34 2 2023, DOI: https://doi.org/10.54868/BVI.2023.34.2.5, fecha de correción: 09 de septiembre 2024

Introduction: Babesiosis is a disease caused by intraerythrocyte protozoa with clinical characteristics that are similar to those of malaria, it is transmitted to humans through the bite of an infected tick, occasionally by transfusion. Globally, the prevalence of the disease is underestimated; this proportion is unknown in Latin America and Venezuela. Clinical case: A 29-year-old male patient with a 15-day fever, jaundice, abdominal pain, in whom malaria was suspected based on epidemiology and symptoms, other entities such as endocarditis, leptospirosis were ruled out, he had positive serology for ehrlichiosis, however, it clinical symptoms persisted despite treatment with chloroquine, clindamycin and doxycycline; therefore, complementary studies were conducted with findings of intraerythrocyte inclusions compatible with Babesiosis and started treatment with clindamycin and quinine for 7 days and presented satisfactory evolution. Discussion: The reported case required a clinical exercise and interdisciplinary support for an adequate outcome. Among the differential diagnoses of intraerythrocyte diseases is babesiosis whose symptoms are non-specific, but guides its diagnosis by inquiring into the epidemiological history. Treatment includes atovaquone with azithromycin or alternatives such as clindamycin with quinine. Conclusions: The present case was quite complex given its form of presentation and being a disease with a low prevalence in our country, however, clinical judgment predominated, achieving the best possible result This online publication has been corrected, in BVI 34 2 2023, DOI: https://doi.org/10.54868/BVI.2023.34.2.5, correction date: 09 September 2024

Dacryops with dacryolithiasis in a dog.

BACKGROUND: A 10-year-old castrated male Maltese dog was presented with chronic swelling that had been present for at least 5 years in the medial canthus of the right eye (OD). OBJECTIVES: To describe the treatment outcome of dacryops with dacryolithiasis. METHODS: Bilateral patency of the nasolacrimal system was confirmed by flushing of both upper and lower puncta. Ocular ultrasonography revealed a well-defined, oval-shaped, heterogeneous mass with several hyperechoic foci. Dacryocystorhinography revealed no connection between the mass and lacrimal canaliculus. Gentle blunt dissection of the fibrous connective tissue around the cystic mass was performed. The mass was removed, which intraluminally contained multiple calculi. RESULTS: Histopathologically, the cystic structure was lined by simple cuboidal epithelium and surrounded by smooth muscle actin positive myoepithelial cells consistent with dacryops derived from the lacrimal glandular ductal system. In addition, several spherical basophilic minerals were observed in the lumen, which were identified as dacryoliths. CONCLUSION: Surgical removal of this dacryops with dacryolithiasis was curative without recurrence after four months.

Echocardiographic parameters and indices in 23 healthy Maltese dogs.

BACKGROUND: Echocardiography is a primary tool used by veterinarians to evaluate heart diseases. In recent years, various studies have targeted standard echocardiographic values for different breeds. Reference data are currently lacking in Maltese dogs and it is important to fill this gap as this breed is predisposed to myxomatous mitral valve disease, which is a volume overload disease. OBJECTIVES: To establish the normal echocardiographic parameters for Maltese dogs. METHODS: In total, 23 healthy Maltese dogs were involved in this study. Blood pressure measurements, thoracic radiography, and complete transthoracic echocardiography were performed. The effects of body weight, age and sex were evaluated, and the correlations between weight and linear and volumetric dimensions were calculated by regression analysis. RESULTS: The mean vertebral heart size was 9.1 ± 0.4. Aside from the ejection fraction, fractional shortening, and the left atrial to aorta root ratio, all the other echocardiographic parameters were significantly correlated with weight. CONCLUSION: This study describes normal echocardiographic parameters that may be useful in the echocardiographic evaluation of Maltese dogs.

Occupation and amyotrophic lateral sclerosis risk: a case-control study in the isolated island population of Malta.

Objective: Amyotrophic lateral sclerosis (ALS) is a mostly sporadic neurodegenerative disease. The role of environmental factors has been extensively investigated but associations remain controversial. Considering that a substantial proportion of adult life is spent at work, identifying occupations and work-related exposures is considered an effective way to detect factors that increase ALS risk. This process may be further facilitated in population isolates due to environmental and genetic homogeneity. Our study investigated occupations and occupational exposures potentially associated with ALS risk in the isolated island population of Malta, using a case-control study design. Methods: Patients with ALS and randomly identified matched controls (1:1) were recruited throughout a four-year window, from 2017 through 2020. Data on educational level, residence, main occupation, smoking, and alcohol history were collected. Results: We found that compared to controls (44.4%), a higher percentage (73.7%) of ALS patients reported a blue-collar job as their main occupation (OR 2.04, 95% CI 1.2-3.72; p = 0.0072). Through regression analysis, craft and related trades occupations such as carpentry and construction (ISCO-08 major group 7), were found to be positively associated with ALS, with patients in this occupational category found to be more prone to develop bulbar-onset ALS (p = 0.0297). Overall, patients with ALS reported a significantly higher exposure to work-related strenuous physical activity (OR 2.35, 95% CI 1.53-3.59; p = 0.0002). Conclusion: Our findings suggest that manual workers particularly those working in the carpentry and construction industries have an increased ALS risk, possibly due to a history of intense or sustained physical activity.

The First Identification of the Uniqueness and Authentication of Maltese Extra Virgin Olive Oil Using 3D-Fluorescence Spectroscopy Coupled with Multi-Way Data Analysis.

The potential application of multivariate three-way data analysis techniques, namely parallel factor analysis (PARAFAC) and discriminant multi-way partial least squares regression (DN-PLSR), on three-dimensional excitation emission matrix (3D-EEM) fluorescent data were used to identify the uniqueness and authenticity of Maltese extra virgin olive oil (EVOO). A non-negativity constrained PARAFAC model revealed that a four-component model provided the most appropriate solution. Examination of the extracted components in mode 2 and 3 showed that these belonged to different fluorophores present in extra virgin olive oil. Application of linear discriminate analysis (LDA) and binary logistic regression analysis on the concentration of the four extracted fluorophores, showed that it is possible to discriminate Maltese EVOOs from non-Maltese EVOOs. The application of DN-PLSR provided superior means for discrimination of Maltese EVOOs. Further inspection of the extracted latent variables and their variable importance plots (VIPs) provided strong proof of the existence of four types of fluorophores present in EVOOs and their potential application for the discrimination of Maltese EVOOs.

The Modern Use of an Ancient Plant: Exploring the Antioxidant and Nutraceutical Potential of the Maltese Mushroom (Cynomorium Coccineum L.).

In the continuous scientific search for new safe and effective drugs, there has recently been a rediscovery of natural substances as a potential reservoir of innovative therapeutic solutions for human health, with the prospect of integrating with and sometimes replacing conventional drugs. Cynomorium coccineum subsp. coccineum is a holoparasitic plant well known in ethnopharmacology, although its current use as a curative remedy is reported only in some ethnic groups of North Africa and the Arabian Peninsula. Often known as 'Maltese mushroom' due to its unique appearance and the absence of chlorophyll, C. coccineum is present in almost all of the Mediterranean Basin. It is only recently that a few research groups have begun to look for confirmation of some of its traditional uses to highlight previously unknown biological activities. Here, we review the recent scientific findings on the plant's phytochemistry and the most significant descriptions of some of its antioxidant and biological activities (antimicrobial, anticancer, pro-erectile, and anti-tyrosinase enzyme) both in vivo and in vitro. Some of these may be promising from the perspective of food and cosmetic formulations. The purpose of this review is to provide an initial impetus to those who, in the foreseeable future, will want to increase the knowledge and possible applications of this plant full of history, charm, and mystery.

Multiple tuberous and tendinous xanthomas diagnosed on fine-needle aspiration cytology-report of a rare case.

Xanthomas are papulonodular skin lesions present in lipoprotein metabolism disorders, which result in cholesterol deposits in subcutaneous tissue, tendons, ligaments, periosteum, etc. A 11-year-old male presented with multiple soft tissue swellings, prominently over joints. Fine-needle aspiration (FNA) from multiple sites had similar appearance with foamy histocytes and giant cells. Oil Red O and polarized microscopy were also positive for fat. We describe an unusual case of tendinous and tuberous xanthoma diagnosed by cytology. Acquaintance with fine-needle aspiration cytology findings in xanthomas can help to avoid the need of surgical biopsy, as xanthomas can regress on medical therapy alone.

Demographic Study of Hip Fractures in the Maltese Islands.

INTRODUCTION: Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting. OBJECTIVE: To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands. METHOD: All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association. RESULTS: A moderate negative correlation (r = -0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days. CONCLUSION: Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.

Non-radial growth of helical homopolymer crystals: breaking the paradigm of the polymer spherulite microstructure.

Radial symmetry is essential for the conventional view of the polymer spherulite microstructure. Typically it is assumed that, in the course of the spherulite morphogenesis, the lamellar crystals grow radially. Using submicron X-ray diffraction, it is shown that in banded spherulites of poly(propylene adipate) the crystals have the shape of a helix with flat-on crystals winding around a virtual cylinder of about 6 µm in diameter. The helix angle of 30° implies that the crystal growth direction is tilted away from the spherulite radius by this angle. The implications of the helical crystal shape contradict the paradigm of the spherulitic microstructure. The radial growth rate of such spherulites does not correspond to the crystal growth rate, but to the propagation rate of the virtual cylinder the ribbons wind around.

Meningoencefalite necrotizante de cão Maltês / Necrotizing meningoencephalitis of Maltese dog

A Meningoencefalite Necrotizante (MEN) é uma encefalopatia causada por uma disfunção inflamatória de característica necrotizante. O objetivo deste relato é descrever os aspectos clínicos e anatomopatológicos da Meningoencefalite Necrotizante (MEN) em um cão Maltês. A doença tem um caráter necrótico único e está relacionada intimamente à Encefalite do Cão Pug (ECP) devido a suas semelhanças, bem como à Leucoencefalite Necrotizante (LEN). Embora o primeiro relato de caso de ECP tenha mais de 15 anos e o primeiro relato de caso de MEN em Maltês tenha 11 anos, há muito a ser revelado sobre a etiologia e os mecanismos imunopatológicos da doença. Neste trabalho, relata-se o caso de um cão Maltês com sinais que foram compatíveis com a MEN. Foram detectadas nas imagens macroscópicas, cavitação cerebral, e na microscopia, perda de células do parênquima em certas regiões do córtex cerebral. A partir dessas descobertas descreve-se o primeiro caso de MEN em cão Maltês no Brasil.

The Necrotizing Meningoencephalitis (NME) is an encephalopathy caused by an inflammatory dysfunction with necrotic characterization. The aim of this report is to describe the anatomopathological features of the NME in a Maltese dog. The disease has a unique necrotic pattern and is closely related to Pug Dog Encephalitis (PDE) because of their similarity as well as to Necrotizing Leukoencephalitis (NLE). Although the first PDE report has more than 15 years and the first Maltese NME report has 11 years there is a lot to be unveiled about the etiologic and the immunopathologic mechanisms of the disease. Here we report one case of a Maltese dog with signs that were compatible with NME. The gross morphology pictures with the cerebral cavitation and the histological loss of parenchymal cells in some regions of the cerebral cortex were detected. Based on these findings, we describe the first case of NME in Maltese dog in Brazil.