Left shift and toxic change in heterophils and neutrophils of non-mammalian vertebrates: A comparative review, image atlas, and practical considerations.

Heterophils and neutrophils are important first cellular responders to inflammatory conditions. In addition to quantitative shifts in the numbers of these cells in blood, inflammatory disease states often have accompanying increases in immature precursor stages (left shift) and/or evidence of toxic change on blood film evaluation. Recognition of left shift and toxic change morphologies is a salient diagnostic finding with clinical relevance across species. The objectives of this report are to (a) review heterophil and neutrophil function and structure across the vertebrate animal kingdom, (b) compare morphologic features of left shift and toxic change in heterophils and neutrophils of non-mammalian vertebrates (NMV) to mammals, (c) provide an image guide demonstrating the breadth of morphologic diversity of heterophil and neutrophil lineages in health and disease across taxa, and (d) discuss practical considerations for clinical pathologists and other professionals involved in the recognition and interpretation of observations in the inflammatory leukogram of NMV.

Livedo reticularis and bowel ischemia after carbon dioxide arteriography in a patient with CREST syndrome.

For 30 years, CO(2) gas has been used as a safe alternative to iodinated contrast agents for angiography in patients with renal insufficiency or allergy to iodine. CO(2) angiography is well tolerated when performed properly, and serious complications are rare. However, severe complications may occur if the physical properties of CO(2) and the specific pathophysiology of an individual patient are not carefully considered. The present report describes a case in which diffuse livedo reticularis, bowel ischemia, and renal insufficiency developed following CO(2) angiography in a patient with CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia).

Development of methodology and reference intervals for the analysis of the free-ranging Atlantic horseshoe crab Limulus polyphemus hemolymph.

BACKGROUND: The Atlantic horseshoe crab, Limulus polyphemus, is valuable to fishing and biomedical industries, for education in public aquaria, and of ecological importance because the eggs provide a critical food source for migratory shorebirds. While hematologic and biochemical analyses are fundamental tools for health assessment, reports are limited for the four extant species of horseshoe crabs; L polyphemus (East Coast North America), Carcinoscorpius rotundicauda (mangrove horseshoe crab Southeast Asia), Tachypleus gigas, and Tachypleus tridentatus (Southeast and East Asia). OBJECTIVES: This prospective study measured hemolymph values to determine RIs from free-ranging horseshoe crabs during the annual breeding aggregation in Delaware Bay, USA. METHODS: Near-shore animals were briefly manually restrained for hemolymph collection from the cardiac sinus. Hematologic samples (25 males, 25 females) were collected for hemocytometer counts using the Natt and Herrick method. A second set of 50 animals (25 males, 25 females) was sampled for biochemistry measurands, including copper concentration by spectrophotometer, osmolality by vapor pressure osmometer, and protein electrophoresis. RESULTS: Total hemocyte counts varied widely (RI 6600-44 300/µL). Electrolytes were consistent with osmoconformers living in seawater. There was a marked difference in sexes, with females showing much lower protein, glucose, and copper levels. Eleven females had multiple outliers, and all data were excluded from RI calculations. CONCLUSIONS: Further studies of this species outside of spawning season are needed. Expanding our knowledge of horseshoe crab health is important to decreasing morbidity and mortality in research applications and maximizing longevity and overall health in display settings.

Management of newborns exposed to mothers with confirmed or suspected COVID-19.

There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.

Hematologic disorders of fish.

Hematology can be a useful tool for monitoring health status, detecting illness, and following the progress of disease and response to therapy. Despite advances in fish medicine in recent years, interpretation of fish hematology often is hampered by a lack of meaningful reference values and the bewildering diversity of fish species. A multitude of intrinsic and extrinsic factors cause normal and abnormal variation in hematologic data. This article provides an overview of some of the hematologic abnormalities in fish induced by infectious agents and environmental, husbandry, and nutritional issues.

Work relationships between agency and permanent staff.

AIM: To explore the nature of the relationship between agency workers and permanent staff within care homes. METHOD: A qualitative design was used with an interpretative phenomenological analysis. RESULTS: Four key themes were identified: issues about the psychological contract of agency workers; agency stigmatisation; issues on both sides of the relationship; and power and shifts in attitude. CONCLUSION: This study builds on our psychological understanding of workplace practices and relationships between agency and permanent staff. It should enable practical and effective improvements to be made to the quality of working life and self-identity of all who work in care homes.

Coliform Bacteria Monitoring in Fish Systems: Current Practices in Public Aquaria.

Public aquaria evaluate coliform indicator bacteria levels in fish systems, but the purpose of testing, testing methods, and management responses are not standardized, unlike with the coliform bacteria testing for marine mammal enclosures required by the U.S. Department of Agriculture. An online survey was sent to selected aquaria to document current testing and management practices in fish systems without marine mammals. The information collected included indicator bacteria species, the size and type of systems monitored, the primary purpose of testing, sampling frequency, test methods, the criteria for interpreting results, corrective actions, and management changes to limit human exposure. Of the 25 institutions to which surveys were sent, 19 (76%) responded. Fourteen reported testing for fecal indicator bacteria in fish systems. The most commonly tested indicator species were total (86%) and fecal (79%) coliform bacteria, which were detected by means of the membrane filtration method (64%). Multiple types and sizes of systems were tested, and the guidelines for testing and corrective actions were highly variable. Only three institutions performed additional tests to confirm the identification of indicator organisms. The results from this study can be used to compare bacterial monitoring practices and protocols in fish systems, as an aid to discussions relating to the accuracy and reliability of test results, and to help implement appropriate management responses. Received August 23, 2015; accepted December 29, 2015.

Hematology of the sandbar shark, Carcharhinus plumbeus: standardization of complete blood count techniques for elasmobranchs.

BACKGROUND: Standardized hematologic methods and reference intervals have not been established for cartilaginous fishes (sharks, skates, and rays) despite the large number of animals displayed in zoos and aquariums worldwide. OBJECTIVE: The focus of this study was to validate CBC methods for sandbar shark (Carcharhinus plumbeus) blood, based on criteria established in human medicine, for the following tests: RBC count, total WBC count, PCV, hemoglobin (Hgb) concentration, and WBC differential percentages. METHODS: Replicate CBCs were performed using blood samples from 5 captive sandbar sharks. Three protocols for RBC and total WBC counts were compared, as were different centrifugation times for PCV determination, and 2 methods for Hgb concentration. Means, minimum and maximum values, and CVs were compared to CAP and CLIA performance guidelines for human tests. RESULTS: Total WBC counts in a diluent modified for elasmobranch blood, Hgb concentration by the cyanmethemoglobin method after removal of nuclei, and WBC differential percentages showed acceptable performance. PCV results were acceptable when tubes were centrifuged for at least 5 minutes. Total RBC counts by all 3 methods exceeded the acceptable error for manual counts of human cells. CONCLUSIONS: Standardized CBC tests can be used as health assessment tools for elasmobranchs. Total RBC counts should be viewed as estimates.

Multi-family psychoeducation groups in the treatment of children with mood disorders.

This study examined the impact of adjunctive multi-family psychoeducation groups (MFPG) on mood-disordered children aged 8 to 11 and their families. Participants were 35 children and 47 parents from families randomly assigned to either immediate MFPG plus treatment as usual (n = 18) or a 6-month wait-list condition plus treatment as usual (n = 17). At the 6 month follow up, immediate treatment families reported: Increased parental knowledge about childhood mood symptoms; increased positive family interactions as reported by the parent; increased perceptions of parental support as reported by children; and increased utilization of appropriate services by families. Expected impact on decreasing negative family interactions was not found. Results are largely consistent with hypothesized findings and support the need to further investigate the adjunctive role of psychoeducation in the treatment of childhood mood disorders.

Preserving whole blood in formalin extends the specimen stability period for manual cell counts for fish.

BACKGROUND: Total blood cell counts for fish are challenging, especially due to cell fragility. Thrombocyte aggregation, cell distortion, and lysis can occur within hours of collection; therefore, hemocytometer counts may not be possible for large sample numbers. Preserving whole blood in formalin offers a simple way to extend the specimen stability period for cell counts. OBJECTIVES: The objectives of this study were to characterize and compare the analytical performance of the Natt-Herrick method for fish blood cell counts using freshly collected and formalin-fixed specimens. METHODS: Specimens from 11 elasmobranch species (n = 36) were compared for WBC counts. WBC, RBC, and thrombocyte counts from 50 striped bass, Morone saxatilis, were compared including 2 time points for the formalin-preserved cells (appr. 1-week and 1-month storage). Coefficient of variation (CV), bias, and total error (TEcalc ) were calculated. TEcalc was compared with allowable total error (TEa ) defined by the Clinical Laboratory Improvements Amendment (CLIA) for human blood cell counts. RESULTS: The CV and TEcalc for fresh and fixed WBC and thrombocyte counts met CLIA limits. In both the fresh and preserved cells, the RBC CV and TEcalc were nearly 3 times higher than the TEa . CONCLUSIONS: Preserving freshly collected blood in 10% formalin is a reliable method to maintain cell morphology for manual counts for up to 1 month post collection. This is especially useful for field studies, where laboratory access is limited. Further evaluation is needed to determine the clinical usefulness of the manual RBC count in fish.

Determination of hematology and plasma chemistry reference intervals for 3 populations of captive Atlantic sturgeon (Acipenser oxyrinchus oxyrinchus).

BACKGROUND: The imperiled status of Atlantic sturgeon (Acipenser oxyrinchus oxyrinchus), a large, long-lived, anadromous fish found along the Atlantic coast of North America, has prompted efforts at captive propagation for research and stock enhancement. OBJECTIVE: The purpose of this study was to establish hematology and plasma chemistry reference intervals of captive Atlantic sturgeon maintained under different culture conditions. METHODS: Blood specimens were collected from a total of 119 fish at 3 hatcheries: Lamar, PA (n = 36, ages 10-14 years); Chalk Point, MD (n = 40, siblings of Lamar); and Horn Point, Cambridge, MD (n = 43, mixed population from Chesapeake Bay). Reference intervals (using robust techniques), median, mean, and standard deviations were determined for WBC, RBC, thrombocytes, PCV, HGB, MCV, MCH, MCHC, and absolute counts for lymphocytes (L), neutrophils (N), monocytes, and eosinophils. Chemistry analytes included concentrations of total proteins, albumin, glucose, urea, calcium, phosphate, sodium, potassium, chloride, and globulins, AST, CK, and LDH activities, and osmolality. RESULTS: Mean concentrations of total proteins, albumin, and glucose were at or below the analytic range. Statistical comparisons showed significant differences among hatcheries for each remaining plasma chemistry analyte and for PCV, RBC, MCHC, MCH, eosinophil and monocyte counts, and N:L ratio throughout all 3 groups. Therefore, reference intervals were calculated separately for each population. CONCLUSIONS: Reference intervals for fish maintained under differing conditions should be established per population.

ASVCP quality assurance guidelines: control of preanalytical and analytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching in veterinary laboratories.

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and provides recommendations for control of preanalytical and analytical factors related to hematology for mammalian and nonmammalian species, hemostasis testing, and crossmatching and is adapted from sections 1.1 and 2.3 (mammalian hematology), 1.2 and 2.4 (nonmammalian hematology), 1.5 and 2.7 (hemostasis testing), and 1.6 and 2.8 (crossmatching) of the complete guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.

Multifamily psychoeducation groups (MFPG) for families of children with bipolar disorder.

OBJECTIVES: Multi-family psychoeducation groups (MFPG) have been developed and tested for adults, but not for children with bipolar disorder (BPD). We present data from a pilot study of our manual-driven MFPG treatment for families of children with mood disorders and address two questions: Do families of children with BPD and families of children with major depressive disorder/dysthymic disorder (MDD/DD): 1) differ at treatment entry?; 2) benefit equally from intervention? METHOD: A total of 35 children (n=16, BPD; n=19, MDD/DD) aged 8-11 years and their parents were randomized into immediate MFPG plus treatment as usual (TAU) or wait-list + TAU and assessed periodically. RESULTS: At baseline, there was a trend toward parents in BPD families being more knowledgeable about mood symptoms than parents in MDD/DD families (p < 0.04). Additionally at baseline, children with BPD evidenced greater mood severity historically and a trend toward more hospitalizations, day treatment, outpatient treatment, medication trials, and placement in special education classrooms than children with MDD/DD. Immediately following and 4 months post-treatment, both BPD and MDD/DD families described having gained knowledge, skills, support, and positive attitudes during treatment. MDD/DD families increased their knowledge of symptoms to the same level as BPD families. CONCLUSIONS: While BPD families enter treatment with more impaired children and more extensive treatment histories, both BPD and MDD/DD families benefit from intervention. The clinical issues concerning combining families of children with bipolar and depressive spectrum illnesses in groups are discussed. Clinical impressions suggest that such combinations are clinically feasible and potentially beneficial.