Evaluation of peripheral and central olfactory pathways in HIV-infected patients by MRI.

AIM: To investigate peripheral and central olfactory pathways using cranial magnetic resonance imaging (MRI) in human immunodeficiency virus (HIV)-infected patients. MATERIALS AND METHODS: The cranial MRI images of 37 HIV-infected adult patients and 37 adults without HIV infection having normal cranial MRI results were included in the study. In both groups, olfactory bulb (OB) volume and olfactory sulcus (OS) depth; and insular gyrus and corpus amygdala areas were measured using cranial MRI. In the HIV group, disease duration, HIV RNA, and CD4 lymphocyte count and levels as a percentage were also recorded. RESULTS: The HIV group had significantly lower bilateral OB volumes, insular gyrus and corpus amygdala areas compared to the control group. The HIV group showed positive correlations between OB volumes, OS depths, insular gyrus, and corpus amygdala areas bilaterally. Increases in OB volumes and OS depths were associated with an increase in the insular gyrus area. The corpus amygdala and insular gyrus areas increased similarly. There was no significant correlation between age, gender, disease duration, CD4 lymphocyte count and per cent, HIV RNA values, and the measurement values of the central and peripheral olfactory regions. CONCLUSION: A decrease in olfactory regions of OB, insular gyrus, and corpus amygdala in HIV-infected patients shows that HIV infection may cause olfactory impairment. There is no correlation between disease duration and olfactory impairment. It may be related to neuroinflammation, HIV-related brain atrophy, acquired immunodeficiency syndrome (AIDS) dementia complex, or neurocognitive impairment, which are the other explanations for the olfactory impairment in HIV. The possible toxicity from antiretroviral therapy (ART) may be another cause that should be investigated further.

Evaluation of the retina with optical coherence tomography angiography (OCTA) in patients with coronavirus (COVID-19) infection.

PURPOSE: The goal of this study is to compare the optical coherence tomography angiography (OCTA) findings in Coronavirus (COVID-19) positive adult and pediatric patients with those of healthy volunteers with the same demographic characteristics. METHODS: The right eye of 157 adults infected with covid, 168 healthy adult volunteers, 40 children (6-18 years of age) infected with covid, and 44 healthy children (6-18 years of age) were included in this prospective study. All participants underwent ophthalmological examination and OCTA. The OCTA findings were evaluated. RESULTS: Deep nasal density (DND), deep inferior density (DID), and deep parafoveal density (DPD) were significantly lower in the pediatric covid-affected group (PCAG) than in the pediatric healthy control group (PHCG) (P=0.034, P=0.029, P=0.022 respectively). On the other hand, radial peripapillary capillary vessel density (RPCVD) intra-disc measurements were significantly higher in the PCAG compared to the PHCG (P=0.025). There was no significant difference between the OCTA measurements of the adult covid-affected group (ACAG) and the adult healthy control group (AHCG). CONCLUSION: In our study, significant differences were found in OCTA measurements between the covid group and the healthy control group in children. Retinal microvascular changes may occur in patients with covid infection, and these patients might be followed for long-term retinal changes.

Evaluation of YouTube videos as a patient information source on intravitreal injection procedures.

PURPOSE: To evaluate the content, reception and quality of YouTube videos on intravitreal injection (IVI) procedures as an educational resource for patients. METHODS: Our study was a retrospective, cross-sectional, register-based study. The terms "intravitreal injection," "intravitreal injection treatment," "eye injection," "eye injection treatment," "dexamethasone intraocular injection," "anti-VEGF injection," "Ozurdex®," "Lucentis®," and "Eylea®" were searched on YouTube. Video duration, total views, number of likes, number of dislikes, and number of comments were recorded. Quality and reliability of video content was assessed using the DISCERN questionnaire, Journal of the American Medical Association (JAMA) score, and the Global Quality Score (GQS). The video power index (VPI) was used to determine the popularity of the videos. RESULTS: One hundred eleven videos were included in the study. The mean duration was 4.30minutes, and the mean number of views was 27,415.90. The mean DISCERN, JAMA, and GQS scores were 45.39±9.7, 1.76±0.49, and 3.60±0.84 respectively. The mean VPI was 12.16±35.56 (0-277.80). Video publishers were as follows: 31 (27.9%) private hospital YouTube channels, 17 (15.3%) ophthalmologists, 45 (40.5%) health-related YouTube channels, 18 (16.2%) "other channels." Seventy-two (64.9%) of the main narrators of the videos were ophthalmologists. The DISCERN, GQS and JAMA scores were correlated (P = 0.001). There was no correlation between the VPI scores and the DISCERN, JAMA and GQS scores (P = 0.05). CONCLUSION: This study showed that YouTube videos on IVIs contain moderately useful information for patients. YouTube videos may be helpful for patients seeking information about IVIs, but physicians must be careful to correct any misunderstandings.

Fatal Peritoneal Migration of Strongylus edentatus in a Foal.

A 7-month-old female mixed breed foal with a 2-day history of recumbency and inability to open its mouth convulsed acutely and died and was submitted for necropsy examination. The foal was thin and large patches of haemorrhage were present throughout the peritoneal wall, the diaphragmatic surfaces and the retroperitoneum. Numerous nematode larvae were visible on the serosal surfaces and penetrated and embedded into the subserosa associated with the haemorrhages. The dorsal portion of the abdominal diaphragm had a partial tear and large numbers of nematodes were within the muscle fibres. Histologically, the larvae had a smooth cuticle, polymyarian/coelomyarian musculature and multinucleated intestinal cells, and were typically surrounded by haemorrhage, neutrophils, dense fibrovascular connective tissue and rare multinucleated giant cells. Parasitological examination identified the larvae as Strongylus edentatus based on the morphology of the buccal capsule. Additionally, there was severe muscle necrosis of the tongue and liver tissue analysis detected selenium deficiency. S. edentatus infections are uncommon in California, USA, and are typically non-lethal. In this case, the selenium deficiency may have led to immunosuppression, resulting in the hyperinfection with S. edentatus, and to the muscle damage and tear of the diaphragm. Although ivermectin treatment was indicated in the history, inadequate deworming or anthelmintic resistance may have played a role in the severity of infection.

Fracture resistance force of primary molar crowns milled from polymeric computer-aided design/computer-assisted manufactured resin blocks.

Purpose: To compare fracture resistance force (FRF) and failure types of crowns milled from resin nanoceramic (Lava Ultimate)-, and modified polymethylmethacrylate (PMMA) (Vita computer-aided design (CAD)-Temp)-, and PMMA (Telio CAD)-based CAD/computer-assisted manufactured (CAM) blocks. Materials and Methods: Three experimental groups of 10 milled crowns were arranged: Group-1 (Lava Ultimate), Group-2 (Vita CAD-Temp), and Group-3 (Telio CAD). Crowns were machined in sizes similar to a primary second molar stainless steel crown (SSC) and stored in water at 37°C for 30 days. The crowns were seated on Cr-Co dies. Their FRFs were measured using a universal test machine until fracture. FRFs and failure types were recorded and statistically analyzed (P < 0.05). Results: There were statistically significant differences among the groups for both FRFs and failure types. The sources of significant differences for FRFs and failure types were Group-3 and Group-1, respectively. CONCLUSION: Crowns milled from different chemical structural CAD/CAM blocks may be used for restoration of primary molar teeth.

West Nile Virus Infection in Sheep.

West Nile virus (WNV) infection has been detected in many species of birds and mammals, but scant information is available about the disease in small ruminants. West Nile virus was diagnosed in 6 sheep with neurological signs and encephalitis, in California between 2002 and 2014. All sheep had severe lymphoplasmacytic meningoencephalitis. Lymphoplasmacytic myelitis was also detected in 2 sheep where the spinal cord was examined. Brain tissue was positive for WNV detected by polymerase chain reaction in 6 of 6 sheep and by immunohistochemistry (IHC) in 5 of 6 sheep. Viral antigen was not detected by IHC in extraneural tissues in the 3 sheep examined. West Nile virus RNA was sequenced from 2 of 6 sheep, and each one clusters closely with WNV isolated from mosquito pools from nearby locations at similar times. West Nile virus was the most common cause of viral encephalitis in sheep diagnosed at this laboratory between 2002 and 2014, accounting for 6 of 9 sheep.

Necrotizing Enteritis and Hyperammonemic Encephalopathy Associated With Equine Coronavirus Infection in Equids.

Equine coronavirus (ECoV) is a Betacoronavirus recently associated clinically and epidemiologically with emerging outbreaks of pyrogenic, enteric, and/or neurologic disease in horses in the United States, Japan, and Europe. We describe the pathologic, immunohistochemical, ultrastructural, and molecular findings in 2 horses and 1 donkey that succumbed to natural infection with ECoV. One horse and the donkey (case Nos. 1, 3) had severe diffuse necrotizing enteritis with marked villous attenuation, epithelial cell necrosis at the tips of the villi, neutrophilic and fibrinous extravasation into the small intestinal lumen (pseudomembrane formation), as well as crypt necrosis, microthrombosis, and hemorrhage. The other horse (case No. 2) had hyperammonemic encephalopathy with Alzheimer type II astrocytosis throughout the cerebral cortex. ECoV was detected by quantitative polymerase chain reaction in small intestinal tissue, contents, and/or feces, and coronavirus antigen was detected by immunohistochemistry in the small intestine in all cases. Coronavirus-like particles characterized by spherical, moderately electron lucent, enveloped virions with distinct peplomer-like structures projecting from the surface were detected by negatively stained transmission electron microscopy in small intestine in case No. 1, and transmission electron microscopy of fixed small intestinal tissue from the same case revealed similar 85- to 100-nm intracytoplasmic particles located in vacuoles and free in the cytoplasm of unidentified (presumably epithelial) cells. Sequence comparison showed 97.9% to 99.0% sequence identity with the ECoV-NC99 and Tokachi09 strains. All together, these results indicate that ECoV is associated with necrotizing enteritis and hyperammonemic encephalopathy in equids.

Disease associated with equine coronavirus infection and high case fatality rate.

BACKGROUND: Equine coronavirus (ECoV) is associated with clinical disease in adult horses. Outbreaks are associated with a low case fatality rate and a small number of animals with signs of encephalopathic disease are described. OBJECTIVES: The aim of this study is to describe the epidemiological and clinical features of two outbreaks of ECoV infection that were associated with an high case fatality rate. ANIMALS: 14 miniature horses and 1 miniature donkey testing fecal positive for ECoV from two related disease outbreaks. METHODS: Retrospective study describing the epidemiological findings, clinicopathological findings, and fecal viral load from affected horses. RESULTS: In EcoV positive horses, 27% (4/15) of the animals died or were euthanized. Severe hyperammonemia (677 µmol/L, reference range ≤ 60 µmol/L) was identified in one animal with signs of encephalopathic disease that subsequently died. Fecal viral load (ECoV genome equivalents per gram of feces) was significantly higher in the nonsurvivors compared to animals that survived (P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE: Equine coronavirus had a higher case fatality rate in this group of miniature horses than previously reported in other outbreaks of varying breeds. Hyperammonemia could contribute to signs of encephalopathic disease, and the fecal viral load might be of prognostic value in affected horses.

Transmural ileal ganglioneuromatosis in a young Boer goat (Capra hircus).

A diagnosis of transmural ileal ganglioneuromatosis was made in a 15-day-old goat that was found dead following a period of diarrhoea and inappetence. Grossly, the entire length of the wall of the ileum was pale and firm with a variably segmental to transmural thickening. Microscopically, the ileal transmural thickening was due to a diffuse proliferation of both ganglionic and glial cells forming cell nests or packets that infiltrated the wall and into the mesentery surrounding a mesenteric lymph node. The neoplastic ganglionic cells were immunoreactive for S100, synaptophysin and triple neurofilament, while the glial spindle cells were immunoreactive with glial fibrillary acidic protein, S100 and laminin confirming their Schwann cell identity. Nerve fibres expressing neurofilament protein 200 and phosphorylated neurofilament (SMI-31) were observed rarely. Ganglioneuromatosis is defined as diffuse exuberant proliferation of all components of the intestinal ganglionic plexuses. In man, the transmural form has more grave clinical consequences than a focal pattern and is commonly associated with germline mutations in the RET proto-oncogene. Whether there is any comparable molecular genetic abnormality in animals remains unknown; however, ganglioneuromatosis needs to be included in the differential diagnosis of tumours of the autonomic enteric nervous system.

Temporal and geographic clustering of polyomavirus-associated olfactory tumors in 10 free-ranging raccoons (Procyon lotor).

Reports of primary nervous system tumors in wild raccoons are extremely rare. Olfactory tumors were diagnosed postmortem in 9 free-ranging raccoons from 4 contiguous counties in California and 1 raccoon from Oregon within a 26-month period between 2010 and 2012. We describe the geographic and temporal features of these 10 cases, including the laboratory diagnostic investigations and the neuropathologic, immunohistochemical, and ultrastructural characteristics of these tumors in the affected animals. All 9 raccoons from California were found within a localized geographic region of the San Francisco Bay Area (within a 44.13-km radius). The tight temporal and geographic clustering and consistent anatomic location in the olfactory system of tumor types not previously described in raccoons (malignant peripheral nerve sheath tumors and undifferentiated sarcomas) strongly suggest either a common cause or a precipitating factor leading to induction or potentiation of neuro-oncogenesis and so prompted an extensive diagnostic investigation to explore possible oncogenic infectious and/or toxic causes. By a consensus polymerase chain reaction strategy, a novel, recently reported polyomavirus called raccoon polyomavirus was identified in all 10 tumors but not in the normal brain tissue from the affected animals, suggesting that the virus might play a role in neuro-oncogenesis. In addition, expression of the viral protein T antigen was detected in all tumors containing the viral sequences. We discuss the potential role of raccoon polyomavirus as an oncogenic virus.

Fatty liver hemorrhagic syndrome in the backyard chicken: a retrospective histopathologic case series.

Fatty liver hemorrhagic syndrome, characterized by sudden death in overconditioned hens due to hepatic rupture and hemorrhage, is one of the leading noninfectious idiopathic causes of mortality in backyard chickens. Nutritional, genetic, environmental, and hormonal factors, or combinations of these, have been proposed yet not proven as the underlying cause. In an attempt to characterize the hepatic changes leading to the syndrome, this retrospective case study examined 76 backyard chickens that were diagnosed with fatty liver hemorrhagic syndrome between January 2007 and September 2012 and presented for necropsy to the diagnostic laboratory of the California Animal Health and Food Safety Laboratory System. A majority of the birds were female (99%), obese (97.5%), and in active lay (69.7%). Livers were examined histologically, and the degree of hepatocellular vacuolation (lipidosis), the reticular stromal architecture, the presence of collagenous connective tissue, and vascular wall changes were evaluated and graded using hematoxylin and eosin, Gomori's reticulin, oil red O, Masson's trichrome, and Verhoeff-Van Gieson stains. Interestingly, there was no correlation between lipidosis and reticulin grades; hepatocellular lipidosis was absent in 22% of the cases and mild in 26% of the cases. Additionally, there was evidence of repeated bouts of intraparenchymal hemorrhage before the acute "bleed-out" in 35.5% of the cases. These data are not supportive of the previously proposed causes and provide a framework for future studies to elucidate the pathogenesis of this condition. Furthermore, the data shown in this study support hemorrhagic liver syndrome as a more accurate name, as hepatic lipidosis is absent in a significant proportion of ruptured livers.

Temperature changes in the pulpal chamber and the sealing performance of various methods of direct pulp capping of primary teeth.

AIM: To compare changes in pulpal chamber temperature during the visible-light curing of direct pulp capping compounds and various modes of diode laser irradiation without prior placement of a pulp capping compound and the resultant seals. MATERIALS AND METHODS: Pulp exposure holes were made in 100 extracted human primary first molars, which were randomly assigned to ten equal groups. The holes were sealed by (a= Group 1, 2, 3, 4, 5, 6 and 7) different pulp capping compounds which were cured using various types of visible-light curing units or (b=Group 8, 9 and 10) diode laser irradiation without prior application of a pulp capping compound. Pulpal chamber temperatures were recorded during the procedure, and the resultant seals were examined under a scanning electron microscope. RESULTS: Visible-light curing of the pulp capping compounds and diode laser irradiation at a 0.7 W output power can cause non-injurious temperature rises in the pulpal chamber. At higher output powers of the diode laser, the temperature rises are sufficient to cause thermal injury. The seals were complete when pulp capping compounds were used for direct pulp capping, but were incomplete when laser irradiation without prior placement of a pulp capping compound was used for the identical purpose. CONCLUSION: The visible-light curing of pulp capping compounds is not harmful to vital pulp, and provides an effective seal of the pulp exposure hole. Laser irradiation is not an effective sealant, and can cause thermal injury to vital pulp at high output powers.

Sphingomyelin lipidosis (Niemann-Pick disease) in a juvenile raccoon (Procyon lotor).

A wild caught juvenile male raccoon with neurological disease was humanely destroyed due to poor prognosis. Necropsy examination revealed hepatomegaly, splenomegaly and multicentric lymphadenomegaly with diffuse hepatic pallor and pulmonary consolidation with pinpoint pale subpleural foci. Microscopically, there was marked pale cytoplasmic swelling of the central and peripheral neurons as well as the glial cells in the brain, accompanied by multiorgan infiltration by abundant foamy macrophages. Ultrastructural investigation revealed accumulation of concentrically arranged lamellar material within lysosomes of the affected neurons, macrophages and endothelial cells. Biochemical enzymatic analysis detected sphingomyelinase deficiency and lysosomal storage disease consistent with sphingomyelin lipidosis (Niemann-Pick disease [NPD]) was diagnosed. This is the first report of NPD in a raccoon.

An outbreak of sodium fluoroacetate (1080) intoxication in selenium- and copper-deficient sheep in California.

Sodium fluoroacetate is an organofluorine compound toxic to mammals, insects, and birds, currently registered for use only in livestock protection collars as a predacide in some North American states, with restricted use in California. A flock of 445 lambs and ewes in California were moved into a native pasture on a municipal refuse disposal site. Within 24 hours, 14 ewes were found dead, and the remaining sheep were moved off the site. Both ewes and lambs exhibited disoriented running, followed by apparent blindness, weakness, ataxia, coma, and death. Over the next 4 days, 63 ewes and 80 lambs died with a peak at 3 days after grazing the suspect pasture (157/445, 35% mortality). Two dead 4-month-old lambs and 2 ewes were submitted to the California Animal Health and Food Safety laboratory for necropsy. Grossly, there were bilateral diffuse pulmonary congestion and edema, hydrothorax and hydropericardium with fibrin clots, and multifocally extensive areas of epicardial petechiae, ecchymoses, and pallor. In 1 ewe, there was regional caudodorsal pulmonary hemorrhage and intraluminal tracheal clotted blood. Microscopically in all cases, there was multifocal acute myocardial degeneration and necrosis with nonsuppurative pleocellular myocarditis. Sodium fluoroacetate was detected in kidney from a lamb and a ewe at 27.5 and 12.5 parts per billion, respectively. All sheep were selenium deficient, and concurrent copper deficiency was diagnosed in 3. The pathological and toxicological findings were consistent with 1080 poisoning, possibly exacerbated by micronutrient deficiency. This outbreak raised an alert about the use of restricted products with potential lethal effect in animals in California.

Brain lesions associated with clostridium perfringens type D epsilon toxin in a Holstein heifer calf.

A 6-month-old dairy heifer calf with no premonitory signs was acutely down after the morning feeding and could not rise. On presentation, the heifer was in right lateral recumbency and moribund with opisthotonus and left hind limb paddling. Following euthanasia, gross examination of the brain revealed multifocal loss of gray-white matter distinction and extensive petechiae throughout the brainstem. On histopathological examination, there was striking white matter edema and marked perivascular proteinaceous edema surrounding many arterioles and venules (microangiopathy), mainly in the white matter of the internal capsule, thalamus, midbrain, cerebellum, and cerebellar peduncles. The perivascular neuropil was strongly positive for Alzheimer precursor protein A4. Clostridium perfringens epsilon toxin was detected in the intestinal contents. This is the first report of microangiopathy in postneonatal cattle associated with the detection of epsilon toxin in the intestinal contents.

Disseminated pleomorphic myofibrosarcoma in a grizzly bear (Ursus arctos horribilis).

The pathological and diagnostic features of a widely disseminated pleomorphic high-grade myofibroblastic sarcoma are described in a 23-year-old male brown bear (Ursus arctos horribilis). Firm, solid, white to tan neoplastic nodules, often with cavitated or soft grey-red necrotic centres, were observed throughout most internal organs, subcutaneous tissues and skeletal muscles on gross examination. Microscopically, the tumour consisted of pleomorphic spindle cells forming interlacing fascicles with a focal storiform pattern with large numbers of bizarre polygonal multinucleate cells, frequently within a collagenous stroma. Immunohistochemistry, Masson's trichrome stain and transmission electron microscopy designated the myofibroblast as the cell of origin. This is the first case of a high-grade myofibrosarcoma in a grizzly bear.

Epicardial coronary artery fibromuscular dysplasia, myocardial infarction and sudden death in a dog.

A 4-year-old male Shih Tzu died suddenly with the only history being slight lethargy during the previous 2 days. Gross and histopathological examination of the heart revealed severe segmental stenosis of the epicardial coronary artery branches and extensive areas of acute myocardial necrosis interspersed with areas of fibrosis. The segmental coronary artery stenosis was due to smooth muscle and myofibroblast proliferation in the tunica media. The smooth muscle cells and myofibroblasts disrupted the internal elastic lamina and extended into the tunica intima. Thickening of the intima and media was accompanied by fibrosis, consistent with fibromuscular dysplasia. The resulting stenosis led to myocardial infarction and cardiac insufficiency. This report details for the first time the vascular lesions in a case of sudden cardiac death in a dog afflicted with fibromuscular dysplasia of the coronary arteries.

Pulmonary artery obstruction due to papillary fibroelastoma on the pulmonary valve: a rare cardiac tumor.

Papillary fibroelastomas (PFEs) are primary cardiac tumors. They are rare benign tumors that occur on the endocardium of the heart, especially on the heart valves. The majority of these benign tumors have been observed on the left side of the heart and involved the aortic and mitral valves; however, occurrence on the right side of the heart has been infrequently reported, with only a few cases documented on the pulmonary valve. Most patients with PFEs are asymptomatic and the tumors are usually found incidentally. The tumors have the potential to cause systemic or pulmonary embolism or obstructive phenomena. We present a rare case of a papillary fibroelastoma occurring on the pulmonary valve with clinical presentation due to pulmonary artery obstruction. The tumor was removed surgically.

Ruptured aneurysm of noncoronary sinus of Valsalva: demonstration with magnetic resonance imaging.

There are few published reports regarding imaging findings of sinus of Valsalva aneurysms (SVA) with magnetic resonance imaging (MRI). We present an unusual form of ruptured SVA, emphasizing the diagnostic importance of MRI among a range of imaging techniques. This case report describes a case of idiopathic (thought to be congenital in origin), acutely symptomatic ruptured noncoronary SVA diagnosed by MRI and confirmed with conventional angiography and surgery. MRI accurately showed aneurysm size, location, and rupture into the right atrium and provided valuable information about this rare lesion.