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2.
Medicine (Baltimore) ; 99(10): e19450, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150101

RESUMEN

RATIONALE: Myelodysplastic syndrome (MDS) can be complicated with Crohn disease (CD). Irritable bowel disease (IBD) associated with MDS has already been reported in the past; however, hematopoietic stem cell transplantation (HSCT) is rarely performed. Herein, we report a case of CD with MDS for HSCT. PATIENT CONCERNS: A 41-year-old man was hospitalized due to abdominal pain and intermittent fever for 40 days. Two years later, he was readmitted due to abdominal pain and diarrhea with fever for 10 days. DIAGNOSIS: Symptoms, laboratory examinations, and imaging findings of the patient were indicative of CD complicated with MDS. INTERVENTIONS: An allogeneic HSCT was performed. OUTCOMES: He died of severe lung infection 125 days post-transplantation. LESSONS: The number of cases of CD combined with MDS remains insufficient, and no consensus opinions are available to date. Hence, HSCT is a very potential treatment method. Additional experiences are needed to determine its effectiveness.


Asunto(s)
Enfermedad de Crohn/terapia , Síndromes Mielodisplásicos/terapia , Dolor Abdominal , Adulto , Enfermedad de Crohn/complicaciones , Resultado Fatal , Fiebre/etiología , Trasplante de Células Madre Hematopoyéticas , Humanos , Masculino , Síndromes Mielodisplásicos/complicaciones
3.
MMWR Morb Mortal Wkly Rep ; 69(10): 260-264, 2020 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-32163381

RESUMEN

Since implementation of Standard Precautions* for the prevention of bloodborne pathogen transmission in 1985, health care-associated transmission of human immunodeficiency virus (HIV) in the United States has been rare (1). In October 2017, the New York City Department of Health and Mental Hygiene (NYCDOHMH) and the New York State Department of Health (NYSDOH) were notified by a clinician of a diagnosis of acute HIV infection in a young adult male (patient A) without recognized risk factors (i.e., he was monogamous, had an HIV-negative partner, and had no injection drug use) who had recently been hospitalized for a chronic medical condition. The low risk coupled with the recent hospitalization and medical procedures prompted NYSDOH, NYCDOHMH, and CDC to investigate this case as possible health care-associated transmission of HIV. Among persons with known HIV infection who had hospitalization dates overlapping those of patient A, one person (patient B) had an HIV strain highly similar to patient A's strain by nucleotide sequence analysis. The sequence relatedness, combined with other investigation findings, indicated a likely health care-associated transmission. Nucleotide sequence analysis, which is increasingly used for detecting HIV clusters (i.e., persons with closely related HIV strains) and to inform public health response (2,3), might also be used to identify possible health care-associated transmission of HIV to someone with health care exposure and no known HIV risk factors (4).


Asunto(s)
Infección Hospitalaria/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Análisis de Secuencia de ARN , Resultado Fatal , VIH-1/genética , VIH-2/genética , Hospitalización , Humanos , Masculino , New York , ARN Viral/genética , Insuficiencia Renal Crónica/terapia
4.
Medicine (Baltimore) ; 99(9): e19256, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118733

RESUMEN

INTRODUCTION: We report here the case of a patient with chronic myeloid leukemia (CML) in the chronic phase who was diagnosed 1 year after receiving a diagnosis of autoimmune hemolytic anemia (AIHA). The objective was to assess if the CML patient progressed from AIHA and explore the underlying factors of the poor outcome after the achievement of molecular complete remission (MCR). PATIENT CONCERNS: A patient with AIHA underwent splenectomy because of poor response to immune inhibitors. The spleen biopsy showed reactive hyperplasia. DIAGNOSIS: The patient was diagnosed with CML because of over-expression of the BCR-ABL (P210) gene in the bone marrow (BM), 1 year after receiving the diagnosis of AIHA. INTERVENTIONS: The splenectomy was performed as the patient was unresponsive to the standard treatments consisting of immunoglobulin and dexamethasone. The removed spleen was sent for pathological examination. After she was diagnosed with CML, she received imatinib treatment. OUTCOMES: The spleen biopsy confirmed the translocation of 22q11/9q34. No BCR-ABL kinase domain mutation was detected and there was no expression of the WT1 or EVI1 genes. After splenectomy, the number of peripheral white blood cells was consistently higher than normal during the total therapy time for CML even though she showed MCR. Two years after CML was diagnosed, the patient died from severe infection. The BM gene array analysis displayed 3 types of chromosomal abnormalities: gain (14q32.33), uniparental disomy (UPD) Xp11.22-p11.1), and UPD Xp11.1-q13.1. LESSONS: AIHA may be a clinical phase of CML progression in this patient. Both splenectomy and prolonged oral tyrosine kinase inhibitors may have contributed to the high risk of infection and her subsequent death. In addition, the gain of chromosome 14q32.33 may be related to her poor outcome.


Asunto(s)
Anemia Hemolítica Autoinmune , Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico , Adolescente , Resultado Fatal , Femenino , Proteínas de Fusión bcr-abl/genética , Humanos , Mesilato de Imatinib/uso terapéutico , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/uso terapéutico , Esplenectomía
5.
MMWR Morb Mortal Wkly Rep ; 69(5): 121-124, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027626

RESUMEN

On November 3, 2018, the Utah Department of Health (UDOH) was notified of a suspected human rabies case in a man aged 55 years. The patient's symptoms had begun 18 days earlier, and he was hospitalized for 15 days before rabies was suspected. As his symptoms worsened, he received supportive care, but he died on November 4. On November 7, a diagnosis of rabies was confirmed by CDC. This was the first documented rabies death in a Utah resident since 1944. This report summarizes the patient's clinical course and the subsequent public health investigation, which determined that the patient had handled several bats in the weeks preceding symptom onset. Public health agencies, in partnership with affected health care facilities, identified and assessed the risk to potentially exposed persons, facilitated receipt of postexposure prophylaxis (PEP), and provided education to health care providers and the community about the risk for rabies associated with bats. Human rabies is rare and almost always fatal. The findings from this investigation highlight the importance of early recognition of rabies, improved public awareness of rabies in bats, and the use of innovative tools after mass rabies exposure events to ensure rapid and recommended risk assessment and provision of PEP.


Asunto(s)
Rabia/diagnóstico , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Práctica de Salud Pública , Utah
6.
West Afr J Med ; 37(1): 85-87, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030717

RESUMEN

BACKGROUND AND OBJECTIVES: Paragonimiasis is endemic in Eastern Nigeria. An upsurge was recorded after the Nigeria/Biafra war as protein lack in Biafra forced people to eat fresh water crabs. Its protean manifestations create confusion with several diseases. Elimination was assumed after a while and suspicion index fell. The interest in reporting this case follows its presentation outside the traditional endemic zone. RESULTS: The patient, though living in Eastern Nigeria and manifesting several pointers of Paragonimiasis, was treated as tuberculosis despite negative sputum AFB; without improving. He then presented up-country in Jos where history led to suspicion and confirmation of Paragonimiasis. By this time he had severe cor-pulmonale and died despite treatment. CONCLUSION: In this current economic downturn in Nigeria which may drive people to cheaper protein sources, a high index of suspicion should be raised for paragonimiasis when a patient presents with chronic cough productive of AFB-negative sputum and haemoptysis.


Asunto(s)
Paragonimiasis/diagnóstico , Paragonimus/aislamiento & purificación , Animales , Diagnóstico Diferencial , Resultado Fatal , Humanos , Enfermedades Pulmonares Parasitarias , Masculino , Nigeria , Paragonimiasis/parasitología , Paragonimus/clasificación , Esputo/parasitología , Tuberculosis Pulmonar/diagnóstico
8.
Mikrobiyol Bul ; 54(1): 163-170, 2020 Jan.
Artículo en Turco | MEDLINE | ID: mdl-32050887

RESUMEN

Meningococcal infections are important health problems causing high morbidity and mortality. Neisseria meningitidis have 13 serogroups. A, B, C, Y and W135 are the most common causes of invasive disease among those serogroups. The distribution of the serogroups differs according to the geographical regions and the age groups. In this case report, two cases of meningococcemia infected with serogroup C and Y of N.meningitidis rarely seen in our country were presented. First case was a two and a half year-old female patient who has admitted to our pediatric emergency unit with fever and rash spreading from lower extremities to her body. The patient had diffuse purpuric rash with generalized weakness and tendency to sleep at admission. The patient has been suspected as meningococcemia because of the skin rash, tendency to sleep and hypotension. Antibiotics treatment was started immediately and lumber puncture was performed. In blood tests, leukocyte count: 3600/mm3 (61% neutrophils), hemoglobin: 11.1 g/ dl, platelet count: 127.000/mm3 , C-reactive protein: 10 mg/dl, erythrocyte sedimentation rate: 6 mm/ hour, prothrombin time: 28.8 seconds (normal value= 11-16), prothrombin activity: 36%, international normalized ratio (INR): 2.13 (normal value= 1-1.5), activated partial thromboplastin time: 57.7 seconds (normal value= 25-35 sec), fibrinogen: 246 mg/dl (normal value= 200-400 mg/dl) and in cerebrospinal fluid protein: 21 mg/dl and glucose: 62 mg/dl were found. There were eight cells in the microscopic examination. Skin rashes were increased and the patient became hypotensive. No microorganisms were isolated in blood and cerebrospinal cultures. N.meningitidis serogroup C was isolated from the cerebrospinal fluid of the patient using polymerase chain reaction (PCR). The patient suffered from immune-mediated arthritis in the sixth day of treatment and nonsteroidal anti-inflammatory drugs were given. The patient has recovered with antibiotics, fresh frozen plasma and inotropic treatment. Second case was a 13 year-old male patient who has admitted three days after the first case with a pre-diagnosis of malignancy because of pancytopenia and fever. The patient had generalized weakness and a few petechial purpuric rashes at the facial region at admission. After the admission general status of the patient has worsened rapidly and he has died as a result of cardiovascular arrest. Blood tests in admission showed leukocyte count: 6000/mm3 (79% neutrophils), hemoglobin: 17.3 mg/dl, platelet count: 16.000/mm3 , C-reactive protein: 8.63 mg/dl, prothrombin time: 92.6 seconds, prothrombin activity: 10%, INR: 6.78, activated partial thromboplastin time: 231.5 seconds. Cerebrospinal fluid obtained from postmortem lumbar puncture showed no growth (protein: 95 mg/dl, glucose: 35 mg/dl) and N.meningitidis serogroup Y was detected by PCR. Two meningococcemia cases caused by two different serogroups which are rarely seen in our region in recent years were presented at the same time period in the same hospital. This case report pointed out that surveillance has a great importance in such diseases.


Asunto(s)
Infecciones Meningocócicas , Neisseria meningitidis , Adolescente , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Preescolar , Resultado Fatal , Femenino , Humanos , Masculino , Infecciones Meningocócicas/líquido cefalorraquídeo , Infecciones Meningocócicas/tratamiento farmacológico , Infecciones Meningocócicas/microbiología , Neisseria meningitidis/clasificación , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Serogrupo , Resultado del Tratamiento
9.
Arkh Patol ; 82(1): 52-55, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32096491

RESUMEN

Dengue fever is acute zooanthroponic infection from a group of vector-borne viral hemorrhagic fevers. Since 2013, Russia has introduced the mandatory registration of dengue fever cases. The paper presents data on the epidemiology, etiology, and pathogenesis of Dengue fever and describes a case of a fatal outcome in severe dengue fever and morphological changes in organs and tissues.


Asunto(s)
Dengue , Resultado Fatal , Humanos , Federación de Rusia
10.
Medicine (Baltimore) ; 99(6): e18984, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028408

RESUMEN

RATIONALE: Autoimmune hemolytic AQ5 anemia (AIHA) is an immune disorder caused by antibodies directed against unmodified autologous red blood cells. In rare cases, AIHA is comorbid with other immunological disorders; for instance, when AIHA is complicated with immunologic thrombocytopenic purpura (ITP) it is called Evans Syndrome (ES). These multiple autoimmune mechanisms are referred to as "immunological tolerance loss," which is known as a characteristic autoimmunity specific for AIHA. And there are no estimation of the risk for thromboembolism in the "immunological tolerance loss" case. PATIENT CONCERNS: A 66-year-old man was diagnosed with ES after autologous stem cell transplantation for malignant lymphoma. His background immunological status was complicated because AIHA was mixed-type (warm and cold antibody type). The direct/indirect Coombs tests were positive. The anticomplement antibody was positive and his cold hemagglutinin level had increased. Anticardiolipin antibodies were negative: anticardiolipin ß2GPI antibody ≤1.2 U/mL (<3.5), anticardiolipin immunoglobulin G antibody ≤8 U/mL (<10), and anticardiolipin immunoglobulin M antibody ≤5 U/mL (<8). DIAGNOSES: ITP and mixed-type AIHA. INTERVENTIONS: The patient achieved complete response by initial prednisolone therapy; however, he did not respond to corticosteroid therapy after AIHA recurrence. He required the red blood cell transfusion due to the progression of hemolytic anemia. OUTCOMES: On the fourth day of refractory treatment following AIHA recurrence, the patient had acute respiratory failure with severe hypoxia and died. The cause of death was identified as pulmonary embolism (PE) based on the laboratory data and echocardiography findings, and a literature search suggested rapidly progressive hemolysis-induced PE. LESSONS: Although infrequent, comorbid thromboembolism to AIHA is well documented; however, a mixed-type AIHA case complicated with thromboembolism has not been previously reported. The combined pathophysiology of AIHA and thromboembolism should be considered in the clinical course of hemolysis. Our case suggested multiple immunological background, ITP, and mixed type AIHA, could be associated to a risk for thromboembolism (TE).


Asunto(s)
Anemia Hemolítica Autoinmune/complicaciones , Embolia Pulmonar/etiología , Anciano , Anemia Hemolítica Autoinmune/diagnóstico , Resultado Fatal , Humanos , Masculino , Embolia Pulmonar/diagnóstico , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/diagnóstico , Trombocitopenia/complicaciones , Trombocitopenia/diagnóstico
12.
Medicine (Baltimore) ; 99(3): e18796, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011481

RESUMEN

RATIONALE: Type A aortic dissection (TAAD) is a life-threatening disorder yet it is hard to diagnose. The dissection might extend to the coronary artery causing ST-segment elevation myocardial infarction (STEMI). Physicians might not recognize this particularly early in its presentation and patients proceed to receive the primary percutaneous coronary intervention. We present such a case and found that the marked pressure difference between the radial and ascending aortae could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. PATIENT CONCERNS: A 58-year-old male was presented to our emergency department for the complaint of left side chest pain that lasted for an hour with concomitant hypotension. STEMI was diagnosed at that time. DIAGNOSIS: The emergent primary percutaneous intervention was performed. When the diagnostic catheter was advanced to the ascending aorta, the systolic aorta pressure became 20 mm Hg higher than radial systolic pressure. Due to the abnormally large pressure differential between the peripheral radial artery and central ascending aorta, TAAD was suspected. INTERVENTIONS: After angiography and computer tomography confirmed the diagnosis of TAAD, the patient was sent for emergent surgery. OUTCOMES: The patient was died because of extensive dissection and shock. LESSONS: We present such a case and found that the marked pressure difference between the radial and ascending aortae during catheterization could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. This clue had hinted our speedy examination of the occluded coronary artery and dissection flap, and led to an early and accurate diagnosis.


Asunto(s)
Aneurisma Disecante/complicaciones , Aneurisma Disecante/diagnóstico , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/etiología , Aneurisma Disecante/cirugía , Aorta , Presión Sanguínea , Catéteres , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/cirugía
13.
Medicine (Baltimore) ; 99(3): e18808, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011486

RESUMEN

RATIONALE: Malignant phyllodes tumors of the breast are rare, and there are currently no guidelines and a large number of clinical trials to guide the treatment of recurrence tumor. Here we reported a case of radiotherapy with apatinib for the treatment of recurrent malignant phyllodes tumor of the breast. PATIENT CONCERNS: A 58-year-old patient with massive breast mass was admitted to our hospital. Two months after surgical treatment, the tumor recurred in the chest wall scar. DIAGNOSES: The histopathologic diagnoses was right breast malignant phyllodes tumor with chondrosarcomas and osteosarcomas in some areas. INTERVENTIONS: The patient was first treated with surgery. Malignant phyllodes tumor recurred in the chest wall two months after surgery and was treated with radiotherapy and apatinib. OUTCOMES: With surgery, radiotherapy and apatinib treatment, the patient still died within several months. LESSONS: Apatinib and radiotherapy failed to obtain good therapeutic effect in the recurrence of breast malignant phyllodes tumor in this case.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/terapia , Quimioradioterapia , Recurrencia Local de Neoplasia/terapia , Tumor Filoide/terapia , Piridinas/uso terapéutico , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tumor Filoide/diagnóstico por imagen , Tumor Filoide/secundario
14.
MMWR Morb Mortal Wkly Rep ; 69(8): 207-211, 2020 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-32106217

RESUMEN

In January 2018, the Wisconsin Department of Health Services, Division of Public Health (DPH), received a report of a culture-confirmed case of Legionnaires' disease. The patient, who was immunocompromised, had died at a local hospital 10 days after being admitted. DPH and an infection preventionist from the hospital investigated to determine the source of the infection and prevent additional cases. Because the case was suspected to be nosocomial, health care facility water samples were tested for Legionella. When these samples were negative, water sources in the patient's home were tested. These tested positive for Legionella pneumophila, and the bacteria remained after an attempt to remediate. The patient and home isolates were identified as L. pneumophila serogroup 3, sequence type 93, by whole-genome multilocus sequence typing. A second resident of the home did not become ill. This case highlights the potential for immunocompromised persons and others at risk for Legionnaires' disease to be exposed to Legionella through home water systems containing the bacteria and demonstrates the difficulty of home remediation. This case also illustrates the role of lower respiratory tract specimens in the identification of less common Legionella infections (e.g., L. pneumophila serogroup 3) and confirmation of the infection source.


Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Vivienda , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/diagnóstico , Anciano , Resultado Fatal , Humanos , Legionella pneumophila/clasificación , Serotipificación , Wisconsin
15.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-LISBR1.1-46946

RESUMEN

Portal do Ministério da Saúde- Publicado: Segunda, 20 de Janeiro de 2020, 21h28 Apresenta um vídeo com esclarecimentos sobre o Arenavírus, informa sobre a situação atual do virús em São Paulo e disponibiliza o Boletim epidemiológico


Asunto(s)
Arenavirus/patogenicidad , Fiebre Hemorrágica Americana/virología , Resultado Fatal
16.
Z Gastroenterol ; 58(1): 57-62, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31931541

RESUMEN

The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.


Asunto(s)
Carcinoma Hepatocelular/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Neoplasias Hepáticas/complicaciones , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Comorbilidad , Resultado Fatal , Humanos , Hipertensión/complicaciones , Resistencia a la Insulina , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad/complicaciones
18.
J Zoo Wildl Med ; 50(4): 956-965, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926528

RESUMEN

Nephrolithiasis has been reported in several aquatic mammals including bottlenose dolphins (Tursiops truncatus), small clawed otters (Amblonyx cinereus), European river otters (Lutra lutra), North American river otters (Lontra canadensis), northern elephant seals (Mirounga angustirostris), Florida manatees (Trichechus manatus latirostris), and California sea lions (Zalophus californianus). Compositions of calculi in previous cases were predominantly calcium oxalate or ammonium acid urate. Xanthine urolithiasis is rare in veterinary medicine. Primary cases (without exposure to xanthine dehydrogenase inhibitors) occur as a consequence of hereditary xanthinuria, although the causal mutation has only been discovered in a subset of cases. Five captive juvenile giant otters (Pteronura brasiliensis) from two facilities were diagnosed with nephrolithiasis: three siblings from one set of parents and two siblings from another pair. Serum analyte assays revealed renal compromise in affected individuals. Computed tomography (CT) confirmed the presence of nephrolithiasis in one individual. Postmortem evaluation identified extensive bilateral nephrolithiasis on gross necropsy in four of five cases. Calculus analyses identified 100% xanthine composition. Histologic examination revealed marked nephrolithiasis with associated tubular necrosis and gastric mineralization. Nutrient composition of the diet including mineral and purine content was assessed. No association between diet and nephroliths was found in this study. This is the first report of xanthine nephrolithiasis in aquatic mammals. The potential role of diet and genetics in xanthine nephrolithiasis in the small inbred population of giant otters under human care needs further investigation to assess the implications of this disease process for the long-term captive management of this species.


Asunto(s)
Nefrolitiasis/veterinaria , Nutrias , Xantina/química , Animales , Resultado Fatal , Femenino , Riñón/química , Riñón/patología , Masculino , Nefrolitiasis/mortalidad , Nefrolitiasis/patología
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