Genetic Sequence and Pathogenicity of Infectious Bursal Disease Virus in Chickens in Egypt During 2017-2021.

The continued circulation of infectious bursal disease virus (IBDV) in Egypt, despite the use of various vaccines, is a serious problem that requires continuous detection of IBDV. In the current study, real-time reverse transcriptase polymerase chain reaction testing of 100 diseased chicken flocks during 2017-2021 revealed the presence of very virulent IBDV (vvIBDV) in 67% of the flocks, non-vvIBDV in 11%, and a mixture of both vvIBDV and non-vvIBDV in 4%. Twenty-nine IBDV isolates were submitted for partial sequencing of the viral protein 2 hypervariable region (VP2-HVR), and 27 isolates were confirmed to be genogroup A3 (vvIBDV) with 96.3%-98.5% similarity to the global A3 (vvIBDV) and 88.9%-97% similarity to genogroup A1 vaccine strains. The remaining two isolates were non-vvIBDV and showed 91.1% and 100% identity with classical genogroup A1 strains, respectively. Furthermore, the sequence and phylogenetic analysis of VP1 (amino acids 33-254) of two selected isolates of A3, 5/2017 and 98/2021, clustered them as B2, vvIBDV-like, strains with high similarity (99.5%) to four Egyptian, 99% to Chinese and European, and 97.7% to Chinese and Polish vvIBDV isolates. Experimental infection of commercial broiler chickens with two vvIBDV-A3B2 isolates (5/2017 and 98/2021) showed no mortality despite typical tissue lesions, clear histopathological changes, and strong ELISA antibody response. Isolate 98/2021 was more pathogenic, as confirmed by histopathology, whereas isolate 5/2017 induced a stronger serological response. In conclusion, vvIBDV (A3B2) strains with two amino acid (aa) substitutions in VP1 as V141I and V234I as well as VP2 as Y220F and G254S are still circulating in Egypt.

Análisis de las secuencias genéticas y de la patogenicidad del virus de la enfermedad infecciosa de la bolsa de pollos en Egipto durante los años 2017­2021. La circulación continua del virus de la enfermedad infecciosa de la bolsa (IBDV) en Egipto, a pesar del uso de varias vacunas, continua siendo un problema serio que requiere la detección continua de este virus. En el presente estudio, se realizó una prueba de transcripción reversa y reacción en cadena de la polimerasa en tiempo real de 100 parvadas enfermas de pollos durante los años 2017­2021 y reveló la presencia de virus muy virulentos (vvIBDV) en el 67% de las parvadas, otros tipos diferentes a los muy virulentos en el 11%, y una mezcla de virus muy virulentos y otros tiposen un 4% de las parvadas. Se enviaron veintinueve aislados del virus de la enfermedad infecciosa de la bolsa para la secuenciación parcial de la región hipervariable de la proteína viral 2 (VP2-HVR), y se confirmó que 27 aislados pertenecían al genogrupo A3 (vvIBDV) con una similitud del 96.3% al 98.5% con el genogrupo A3 global (vvIBDV) y de 88.9% a 97% de similitud con las cepas vacunales del genogrupo A1. Los dos aislamientos restantes no resultaron ser muy virulentos y mostraron un 91.1% y un 100% de identidad con las cepas clásicas del genogrupo A1, respectivamente. Además, la secuencia y el análisis filogenético de la proteina VP1 (aminoácidos 33-254) de dos aislados seleccionados de genogrupo A3, 5/2017 y 98/2021, los agruparon como cepas B2, similares a virus muy virulentos, con alta similitud (99.5%) con cuatro aislamientos de Egipto, con similitud de 99% con aislados chinos y europeos, y de 97.7% con aislados muy virulentos chinos y polacos. La infección experimental de pollos de engorde comerciales con dos aislados muy virulentos tipo A3B2 (5/2017 y 98/2021) no mostró mortalidad a pesar de las lesiones tisulares típicas, los cambios histopatológicos claros y la fuerte respuesta de anticuerpos por ELISA. El aislado 98/2021 fue más patógeno, según lo confirmado por histopatología, mientras que el aislado 5/2017 indujo una respuesta serológica más fuerte. En conclusión, las cepas muy virulentas (A3B2) con dos sustituciones de aminoácidos (aa) en la proteina VP1 como V141I y V234I, así como en VP2 tales como Y220F y G254S, todavía circulan en Egipto.

Superior Efficacy of Apathogenic Genotype I (V4) over Lentogenic Genotype II (LaSota) Live Vaccines against Newcastle Disease Virus Genotype VII.1.1 in Pathogen-Associated Molecular Pattern-H9N2 Vaccinated Broiler Chickens.

A comparison of the efficacy of apathogenic genotype I (V4) and lentogenic genotype II (LaSota) strains of live Newcastle disease virus (NDV) vaccines was performed following vaccination with pathogen-associated molecular pattern (PAMP) H9N2 avian influenza vaccine and challenge with velogenic NDV genotype VII.1.1 (vNDV-VII.1.1). Eight groups (Gs) of day-old chicks were used (n = 25). Groups 1-4 received a single dose of PAMP-H9N2 subcutaneously, while Gs (1, 5) and (2, 6) received eye drops of V4 and LaSota, respectively, as two doses. All Gs, except for 4 and 8, were intramuscularly challenged with vNDV-VII.1.1 at 28 days of age. No signs were detected in Gs 1, 5, 4, and 8. The mortality rates were 0% in Gs 1, 4, 5, and 8; 40% in G2; 46.66% in G6; and 100% in Gs 3 and 7. Lesions were recorded as minimal in Gs 1 and 5, but mild to moderate in Gs 2 and 6. The lowest significant viral shedding was detected in Gs 1, 2, and 5. In conclusion, two successive vaccinations of broilers with a live V4 NDV vaccine provided higher protection against vNDV-VII.1.1 challenge than LaSota. PAMP-H9N2 with live NDV vaccines induced more protection than the live vaccine alone.

Evaluation of a polarization-enhanced laparoscopy prototype for improved intra-operative visualization of peritoneal metastases.

Despite careful staging, the accuracy for preoperative detection of small distant metastases remains poor, creating a clinical need for enhanced operative staging to detect occult peritoneal metastases. This study evaluates a polarization-enhanced laparoscopy (PEL) prototype and assesses its potential for label-free contrast enhancement of peritoneal metastases. This is a first-in-human feasibility study, including 10 adult patients who underwent standard staging laparoscopy (SSL) for gastrointestinal malignancy along with PEL. Image frames of all detectable peritoneal lesions underwent analysis. Using Monte Carlo simulations, contrast enhancement based on the color dependence of PEL (mPEL) was assessed. The prototype performed safely, yet with limitations in illumination, fogging of the distal window, and image co-registration. Sixty-five lesions (56 presumed benign and 9 presumed malignant) from 3 patients represented the study sample. While most lesions were visible under human examination of both SSL and PEL videos, more lesions were apparent using SSL. However, this was likely due to reduced illumination under PEL. When controlling for such effects through direct comparisons of integrated (WLL) vs differential (PEL) polarization laparoscopy images, we found that PEL imaging yielded an over twofold Weber contrast enhancement over WLL. Further, enhancements in the discrimination between malignant and benign lesions were achieved by exploiting the PEL color contrast to enhance sensitivity to tissue scattering, influenced primarily by collagen. In conclusion, PEL appears safe and easy to integrate into the operating room. When controlling for the degree of illumination, image analysis suggested a potential for mPEL to provide improved visualization of metastases.

Cytokines, Serological, and Histopathological Assessment of Recombinant Vaccination Strategies for Combatting Infectious Bursal Disease in Broiler Chickens.

Infectious bursal disease (IBD) represents a greatly transmissible viral disease found worldwide, causing significant health and production challenges in young chickens. The aim of this research was to assess the immune reaction induced by different vaccines targeting IBD. These vaccines included recombinant (Vac1; HVT-IBD vector), immune complex (Vac2; Bursa-Plex®), and intermediate plus (Vac3; Bursine plus) IBD vaccines. Our assessment relied on serological and histopathological analyses, as well as the pattern of immune-related cytokine expression in the bursal tissue. The vaccinated groups, along with a control positive (CP) group, were subjected to a vvIBDV challenge on their 28th day of life, while the control negative (CN) group received a mock vaccination with PBS. Our study revealed that Vac1 resulted in the most favorable growth performance, as well as maintained normal liver and kidney function, mitigating the impact of IBDV infection. Serological analysis using VP2 ELISA kits indicated that Vac1 induced the strongest immunological response among all vaccines. Histopathological examination demonstrated that Vac1 caused minimal lymphoid depletion observed in the lymphoid organs, followed by Vac2. Analysis of cytokine expression profiles showed significant upregulation in all vaccinated groups, particularly Vac1, during the pre-challenge period. Following IBDV infection, Vac1 resulted in a noteworthy increase in the expression of IL2 and IFN-γ, Vac2 showed a significant upregulation in TNF-α and granzyme, and both Vac1 and Vac3 exhibited increased levels of IL1ß and IL10. In conclusion, our study suggests that the various vaccines triggered immune responses against IBD through both humoral and cell-mediated immunity. However, recombinant followed by immune complex vaccines appeared to induce more robust immunity while also being safer for broiler chickens in contrast to the intermediate plus vaccine.

Corrigendum: Epidemiology, pathology, prevention, and control strategies of inclusion body hepatitis and hepatitis-hydropericardium syndrome in poultry: A comprehensive review.

[This corrects the article DOI: 10.3389/fvets.2022.963199.].

Epidemiology, pathology, prevention, and control strategies of inclusion body hepatitis and hepatitis-hydropericardium syndrome in poultry: A comprehensive review.

Infection with fowl adenoviruses (FAdVs) can result in a number of syndromes in the production of chicken, including inclusion body hepatitis (IBH), hepatitis-hydropericardium syndrome (HHS), and others, causing enormous economic losses around the globe. FAdVs are divided into 12 serotypes and five species (A-E; 1-8a and 8b-11). Most avian species are prone to infection due to the widespread distribution of FAdV strains. The genus aviadenovirus, which is a member of the adenoviridae family, is responsible for both IBH and HHS. The most popular types of transmission are mechanical, vertical, and horizontal. Hepatitis with basophilic intranuclear inclusion bodies distinguishes IBH, but the buildup of translucent or straw-colored fluid in the pericardial sac distinguishes HHS. IBH and HHS require a confirmatory diagnosis because their clinical symptoms and postmortem abnormalities are not unique to those conditions. Under a microscope, the presence of particular lesions and inclusion bodies may provide clues. Traditional virus isolation in avian tissue culture is more delicate than in avian embryonated eggs. Additionally, aviadenovirus may now be quickly and precisely detected using molecular diagnostic tools. Preventive techniques should rely on efficient biosecurity controls and immunize breeders prior to production in order to protect progeny. This current review gives a general overview of the current local and global scenario of IBH, and HHS brought on by FAdVs and covers both their issues and preventative vaccination methods.

Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via Sternotomy: A Randomized Controlled Trial.

Background: Ineffective management of postoperative pain following pediatric cardiac surgeries adversely affects a patient's postoperative course. The erector spinae plane (ESP) block has been described in the literature regarding perioperative pain management. We hypothesized that bilateral ESP blocks in pediatric patients would decrease intraoperative fentanyl consumption, reduce the need for postoperative morphine consumption, and improve pain scores. Objectives: The aim of this double-blinded randomized controlled trial was to assess the efficacy and safety of bilateral ESP blocks in pediatric patients undergoing cardiac surgeries through a median sternotomy. Methods: The study involved 98 children aged 6 months to 7 years who were American Society of Anesthesiologists (ASA) II and III and scheduled for cardiac surgery through a median sternotomy. Patients were divided randomly into 2 groups: the ES group (n = 50) who received bilateral ultrasound-guided ESP blocks, and the N group (n = 48) who received no block. The primary outcome was the total dose of administered fentanyl intraoperatively. Secondary outcomes included morphine consumption in the first 24 hours postoperatively; the length of time before the first need for postoperative analgesia; and FLACC (face, legs, activity, consolability, and cry) scores at the first and second hours postoperatively and every 4 hours, with readings taken for a period of 24 hours. Results: There were statistically significantly higher levels of administered fentanyl intraoperatively (6.7 ± 3 vs 4.3 ± 1.9 µg.kg-1) and postoperative morphine consumption (0.5 ± 0.2 vs 0.4 ± 0.2 mg.kg-1) in the N group compared with the ES group (P < 0.001). Moreover, the timing of the first rescue analgesia was significantly delayed in the ES group compared with the N group (231.6 ± 104.5 vs 108.8 ± 47.8 minutes). Conclusions: Bilateral ultrasound-guided ESP blocks can be used to reduce perioperative opioid consumption in pediatric patients undergoing cardiac surgery through a sternotomy. It also can be used to decrease postoperative pain scores.

Mid-term follow-up by speckle tracking and cardiac MRI of children post-transcatheter closure of large atrial septal defects.

This is a case-control study of our experience of mid-term follow-up of 40 children who had a transcatheter closure of very large atrial septal defects group (1). All cases had an atrial septal defect device size more than 1.5 times their weight, a ratio considered a contraindication for trans catheter closure (TCC) in some previous reports. The aim of this study is to report the outcomes and mid-term follow-up of transcatheter closure of large atrial septal defects using two-dimensional conventional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging, and as such to compare results of same echocardiographic examination of age-matched control group of 40 healthy children group (2). Cardiac MRI was performed on cases group (1) only to detect right ventricle and left ventricle volumes and function and early signs of complications. There was no difference between cases and matched healthy controls in terms of the assessment of left ventricle and right ventricle by two-dimensional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging. Similarly, there was no statistically significant difference between four-dimensional echocardiography and cardiac MRI in their respective assessment of both left ventricle and right ventricle volumes and function. We also detected no complications by echo or by cardiac MRI after a median follow-up period of 2 years and recorded a complete remodelling of right ventricle volumes in all children studied. This points to the safety and efficiency of transcatheter closure of large atrial septal defects in children on mid-term follow-up.

Polarization enhanced laparoscope for improved visualization of tissue structural changes associated with peritoneal cancer metastasis.

A polarization enhanced laparoscopy (PEL) imaging system was developed to examine the feasibility of utilizing PEL to augment conventional white light laparoscopy (WLL) in the visualization of peritoneal cancer metastases. The system includes a modified tip to illuminate tissue with linearly polarized light and elements in the detection path enabling recording of corresponding images linearly co- and cross-polarized relative to the incident light. WLL and PEL images from optical tissue phantoms with features of distinct scattering cross-section confirm the enhanced sensitivity of PEL to such characteristics. Additional comparisons based on images acquired from collagen gels with different levels of fiber alignment highlight another source of PEL contrast. Finally, PEL and WLL images of ex vivo human tissue illustrate the potential of PEL to improve visualization of cancerous tissue surrounded by healthy peritoneum. Given the simplicity of the approach and its potential for seamless integration with current clinical practice, our results provide motivation for clinical translation.

Hot red pepper powder as a safe alternative to antibiotics in organic poultry feed: an updated review.

Globally, several studies have investigated the utilization and efficacy of promising medicinal herbal plants to enhance livestock and poultry production. The most commonly investigated phytobiotics in broiler ration were oregano, garlic, thyme, rosemary, black pepper, hot red pepper (HRP), and sage. Phytobiotics are classified on the basis of the medicinal properties of plants, their essential oil extracts, and their bioactive compounds. The majority of bioactive compounds in plants are secondary metabolites, such as terpenoids, phenolic, glycosides, and alkaloids. The composition and concentrations of these bioactive constitutes vary according to their biological factors and manufacturing and storage conditions. Furthermore, HRP is one of the most important and widely used spices in the human diet. Capsicum annum, that is, HRP, is a species of the plant genus Capsicum (pepper), which is a species native to southern North America and northern South America and is widely grown and utilized for its fresh or cooked fruits. Moreover, these fruits may be used as dried powders or processed forms of oleoresins. Researches have proven that C. annuum is the only plant that produces the alkaloid capsaicinoids. Approximately 48% of its active substances are capsaicin (8-methyl-N-vanillyl-6-nonemide), the main active compound responsible for the intense effects of HRP varieties and the main component inducing the hot flavor. This review aimed to highlight the effects of HRP as a phytobiotic in broiler nutrition and its mode of action as a possible alternative to antibiotics and clarify its impact on broiler and layer productivity.

Serratus Anterior Plane Block in Pediatric Patients Undergoing Thoracic Surgeries: A Randomized Controlled Trial.

OBJECTIVE(S): This study was designed to evaluate the efficacy and safety of serratus anterior plane block (SAPB) as an analgesic technique for thoracotomies in pediatric patients. DESIGN: Double-blinded randomized controlled trial. SETTING: A single-center study at Aboelrish Pediatric Hospital, one tertiary hospital of Cairo University Hospitals. PARTICIPANTS: Seventy pediatric patients aged six months-to-three years scheduled for thoracotomies. INTERVENTIONS: Patients were randomized into two groups, group SF and group F. Group SF received an ultrasound-guided SAPB (n = 35), whereas group F (n = 35) did not. All groups received an intraoperative fentanyl infusion (at 0.5 µg/kg /h). MEASUREMENTS: The primary outcome was the total dose of postoperatively administrated fentanyl in the first 24 hours. The secondary outcomes included the total dose of intraoperative additional fentanyl boluses; time of the first postoperative rescue analgesia; and postoperative Face, Legs, Activity, Cry, Consolability scale (FLACC) score values. MAIN RESULTS: The main results of this study showed that the administrated fentanyl in the 24 hours postoperatively was significantly lower in SF group than in F group (p value ˂ 0.001). In addition, significant decreases of the postoperative FLACC pain score (p value ˂ 0.001), reduction of intraoperative fentanyl consumption (p value ˂ 0.001), and delay of the first rescue analgesia (p value ˂ 0.001) were recorded in SF group in relation to F group without significant complications in both groups. CONCLUSIONS: Serratus anterior plane block can provide a safe, effective, and easy-to-perform regional technique for children undergoing thoracotomies.

Leucocytozoon caulleryi in Broiler Chicken Flocks: Clinical, Hematologic, Histopathologic, and Molecular Detection.

Despite the vast Egyptian poultry production, scanty information is available concerning the infection of haemprotozoan parasites as pathogens in commercial broilers. In the present study, we provided the first detection of leucocytozoonosis in five broiler chicken flocks in El-Beheira Egyptian governorate. Despite the low mortality rates in the affected flocks (0.3%-1% as a 5-day mortality), severe postmortem (hemorrhagic spots and scars) and histopathologic lesions appeared in different organs including skeletal muscles, liver, kidney, pancreas, abdominal cavity, and bursa of Fabricius. Evaluation of blood smears revealed gametocytes in erythrocytes and leukocytes. Conventional reverse transcriptase-PCR and partial sequence analysis of mitochondrial cytochrome oxidase b gene detected Leucocytozoon caulleryi. GenBank accession numbers of the five Egyptian L. caulleryi isolates were obtained. The five L. caulleryi were 99.9% identical to each other and 99.14% similar to the L. caulleryi mitochondrial DNA gene of Asian strains from India, Japan, Malaysia, South Korea, Taiwan, and Thailand.

Leucocytozoon caulleryi en parvadas de pollos de engorde: detección clínica, hematológica, histopatológica y molecular. A pesar de la vasta producción avícola en Egipto, se dispone de escasa información sobre la infección de parásitos hemoprotozoarios como patógenos en pollos de engorde comerciales. En el presente estudio, se proporciona la primera detección de leucocitozoonosis en cinco parvadas de pollos de engorde en la gobernación egipcia de El-Beheira. A pesar de las bajas tasas de mortalidad en las parvadas afectadas (0.3% -1% como mortalidad de 5 días), aparecieron graves lesiones post mortem (manchas hemorrágicas y cicatrices) e histopatológicas en diferentes órganos, incluidos músculo esquelético, hígado, riñón, páncreas, cavidad abdominal y bolsa de Fabricio. La evaluación de los frotis de sangre reveló gametocitos en eritrocitos y leucocitos. Mediante un método de transcripción reversa con PCR convencional y el análisis parcial de secuencias del gene del citocromo oxidasa b mitocondrial se detectó Leucocytozoon caulleryi. Se obtuvieron los números de acceso de la base de datos GenBank de los cinco aislados de los L. caulleryi egipcios. Los cinco L. caulleryi eran 99.9% idénticos entre sí y 99.14% similares al gene del ADN mitocondrial de L. caulleryi de cepas asiáticas de India, Japón, Malasia, Corea del Sur, Taiwán y Tailandia.

Efficacy of Dexmedetomidine Versus Morphine as an Adjunct to Bupivacaine in Caudal Anesthesia for Pediatric Thoracic Surgeries: A Randomized Controlled Trial.

BACKGROUND: Caudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants. OBJECTIVES: This prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients. METHODS: Fifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression. RESULTS: The results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups. CONCLUSIONS: The use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.

Conducting a medical examination in the COVID-19 era: an Egyptian experience.

BACKGROUND: On 12 December 2019, a severe respiratory disease was recently reported in Wuhan, known as COVID-19 caused by severe acute respiratory syndrome coronavirus 2. The coronavirus crisis has unequivocally had a marked influence on medical education, particularly in terms of the delivery of assessment. Institutions were forced to implement several changes to medical exam due to COVID-19 pandemic. Written exams were carried out online. Clinical exams were repeatedly canceled or postponed this year. Some institutions carried out clinical exams using remote OSCE stations or without patients. We present our experience in conducting the medical exam in the COVID-19 era. MAIN BODY: Medical exam of the Egyptian Fellowship was canceled in 2020 due to COVID-19 pandemic. The candidates were disappointed and increasingly anxious. After 1 year delay, the internal medicine board decided to carry out the exam after implementing several changes. Changes included the written and clinical exams. The medical exam was successfully conduced in the COVID-19 era. CONCLUSION: Conducting a medical exam in the COVID-19 era carries a great challenge for the institutions. Institutions should allow for some degree of flexibility when carrying out exams to prevent suffering of the candidates from the difficult circumstances.

COVID-19: pathogenesis, advances in treatment and vaccine development and environmental impact-an updated review.

Diseases negatively impact the environment, causing many health risks and the spread of pollution and hazards. A novel coronavirus, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has led to a recent respiratory syndrome epidemic in humans. In December 2019, the sudden emergence of this new coronavirus and the subsequent severe disease it causes created a serious global health threat and hazards. This is in contrast to the two aforementioned coronaviruses, SARS-CoV-2 (in 2002) and middle east respiratory syndrome coronavirus MERS-CoV (in 2012), which were much more easily contained. The World Health Organization (WHO) dubbed this contagious respiratory disease an "epidemic outbreak" in March 2020. More than 80 companies and research institutions worldwide are working together, in cooperation with many governmental agencies, to develop an effective vaccine. To date, six authorized vaccines have been registered. Up till now, no approved drugs and drug scientists are racing from development to clinical trials to find new drugs for COVID-19. Wild animals, such as snakes, bats, and pangolins are the main sources of coronaviruses, as determined by the sequence homology between MERS-CoV and viruses in these animals. Human infection is caused by inhalation of respiratory droplets. To date, the only available treatment protocol for COVID-19 is based on the prevalent clinical signs. This review aims to summarize the current information regarding the origin, evolution, genomic organization, epidemiology, and molecular and cellular characteristics of SARS-CoV-2 as well as the diagnostic and treatment approaches for COVID-19 and its impact on global health, environment, and economy.

The benefit of adding lidocaine to ketamine during rapid sequence endotracheal intubation in patients with septic shock: A randomised controlled trial.

BACKGROUND: Patients with septic shock commonly require endotracheal intubation under general anaesthesia in the operating theatre, the emergency department, and the intensive care unit. Hypotension is a serious complication after induction of general anaesthesia, especially in patients with circulatory failure. No randomised controlled trials had previously investigated protocols for induction of anaesthesia in septic shock patients. The aim of the current work is to compare two protocols, lidocaine-ketamine combination versus ketamine full-dose for rapid-sequence endotracheal intubation in patients with septic shock. METHODS: Forty-four adult patients, with septic shock, scheduled for emergency surgical intervention were enrolled in this randomised, double-blinded, controlled study. Patients were randomised to receive either 1 mg/kg ketamine (ketamine group, n = 22) or 0.5 mg/kg ketamine plus 1 mg/kg lidocaine (ketamine-lidocaine group, n = 22) for induction of anaesthesia in addition to 0.05 mg/kg midazolam (in both groups). Our primary outcome was the mean arterial pressure (MAP). Other outcomes included frequency of post-induction hypotension, heart rate, and cardiac output. RESULTS: Forty-three patients were available for final analysis. The average MAP reading in the first 5 min post-induction was higher in ketamine-lidocaine group than in the ketamine group {82.8 ± 5.6 mmHg and 73 ± 10.2 mmHg, P < 0.001}. Furthermore, the incidence of post-intubation hypotension was lower in the ketamine-lidocaine group than in the ketamine group {1 patient (5%) versus 17 patients (77%), P < 0.001}. The ketamine-lidocaine group showed higher MAP in almost all the readings after induction compared to ketamine group. Other haemodynamic variables including cardiac output and heart rate were comparable between both study groups. CONCLUSION: Lidocaine-ketamine combination showed less incidence of hypotension compared to ketamine full-dose when used for rapid-sequence endotracheal intubation in patients with septic shock. REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT03844984?cond=NCT03844984&rank=1.

Modified-ramped position: a new position for intubation of obese females: a randomized controlled pilot study.

BACKGROUND: Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position, termed modified-ramped position, during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization. METHODS: Sixty obese female patients scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the ramped position (n = 30), the patient head and shoulders were elevated to achieve alignment of the sternal notch and the external auditory meatus; while in the modified-ramped position (n = 30), the patient shoulders were elevated using a special pillow, and the head was extended to the most possible range. Our primary outcome was the incidence of failed laryngoscopic insertion in the oral cavity (the need for patient repositioning). Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of the mask ventilation, and Cormack-Lehane grade for laryngeal view. RESULTS: Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscope in the oral cavity in comparison to one patient (3%) in the modified-ramped position (p < 0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position. CONCLUSION: Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position. CLINICAL TRIAL REGISTRATION: Identifier: NCT03640442. Date: August 2018.

Respiratory and Reproductive Impairment of Commercial Layer Chickens After Experimental Infection with Gallibacterium anatis Biovar haemolytica.

The prevalence of Gallibacterium anatis in poultry production has increased over the last two decades. However, only a few studies have explored the pathogenicity of this bacterium in commercial layer chickens. This trial studied the aspects of the pathogenicity of a Gallibacterium anatis biovar haemolytica local Egyptian isolate (previously registered as strain B14 with GenBank accession no. KJ026147). We used 500 base pairs of a 16S ribosomal RNA gene and the 16S-23S ribosomal RNA intergenic spacer, partial sequence in an experimental infection trial in commercial White Shaver layer chickens aged 19 wk. The hens were divided into three groups of 40 birds each. The hens in Groups 1 and 2 were experimentally infected through the intranasal (IN) and intravenous (IV) routes, respectively, with a dose of 0.2 ml/bird containing 1.2 × 109 colony-forming units/ml. In contrast, Group 3 was kept as a noninfected control group. Both IN and IV infections resulted in a delayed egg laying for 1 wk and a significant (P ≤ 0.05) drop in egg production by 7.81% and 10.28% compared with the control group over 7 wk. Severe lesions in the form of hemorrhagic pneumonia, catarrhal tracheitis, ovarian follicle and oviductal regression, and septicemia were evident on necropsy, demonstrating the pathogenicity of G. anatis as a primary pathogen.

Role of Pigeons in the Transmission of Avian Avulavirus (Newcastle Disease-Genotype VIId) to Chickens.

Newcastle disease is an acute fatal disease of poultry. The aim of this study was to determine the dynamics of the transmission of avian avulavirus (velogenic viscerotropic Newcastle disease-genotype VIId) from either intramuscularly (IM)- or intranasally (IN) infected 8-week-old Egyptian Baladi pigeons in contact with commercial Arbor Acres broiler chickens (4 weeks of age). The mortality of IM infected chickens and pigeons was 10/10 for chickens and 8/15 for pigeons, while the mortality of IN infected chickens and pigeons was 7/10 for chickens and only 1/15 for pigeons. The concentration of viral shedding in the oropharynx was higher than that in the cloaca for both IN and IM infected pigeons. Pigeons infected IN continued shedding the virus from the oropharynx from the 4th day post-infection (dpi) up to the 16th dpi, while IM infected pigeons stopped oropharyngeal shedding at the 11th dpi. Chickens in contact with infected pigeons developed severe respiratory, digestive and nervous signs. The mortality rates in chickens in contact with IM and IN infected pigeons were 2/5 and 3/5, respectively. Chickens in contact with IM infected pigeons showed higher viral shedding titres in both the oropharynx and cloaca than chickens in contact with pigeons infected IN. In conclusion, free-range pigeons are considered an efficient carrier and transmitter of NDV-VIId compared to commercial broiler chickens raised in open houses.

Muscovy ducks infected with velogenic Newcastle disease virus (genotype VIId) act as carriers to infect in-contact chickens.

This work was designed to study the dynamics of transmission of Newcastle disease virus (NDV), genotype VIId, from Muscovy ducks (Cariana moscata) infected either by intramuscular (IM) or intranasal (IN) inoculation, to in-contact broiler chickens (Gallus gallus). IM-infected Muscovy ducks (G1d) exhibited only 5% mortality, and the concentration of virus shed from the cloaca was greater and for longer period than virus shed from the trachea. In contrast, IN-infected ducks (G2d) exhibited no mortality, and virus shedding from the trachea was higher than that from the cloaca starting from 4 days post infection (dpi) and continued up to 16 dpi, while in IM-infected ducks (G1d), tracheal shedding stopped at 11 dpi. Chickens in contact with IM-infected and IN-infected ducks, G1c and G2c, respectively, not only developed severe clinical symptoms and death (80% and 20% mortality, respectively), but also shed the virus at higher concentrations than infected ducks. G1c chickens had higher viral shedding titers in both the trachea and cloaca than G2c chickens until 11 dpi. All broiler chickens infected by IM route (G3c) died, while the IN route of infection resulted in lower mortality (70%) in G4c. Generally, all IM-infected birds produced an earlier and higher level of NDV hemagglutination inhibition (HI) antibody titer, along with higher rates and shorter periods of viral shedding than those infected by the intranasal route. Our conclusion is that Muscovy ducks are efficient carriers of NDV-genotype VIId and transmit the virus to contact chickens.