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Gill diseases cause serious losses in farming of Atlantic salmon and the number of agents involved increases. Salmon gill poxvirus (SGPV) and the gill disease in causes where SGPV apparently was the only disease-causing agent were initially characterized. Recently, it was further shown that SGPV can be a common denominator in widely different multifactorial gill diseases. Here, we present the challenge of diagnosing gill disease with SGPV in salmon fry of 0,3-5 grams. Apoptosis of gill lamellar epithelial cells and hemophagocytosis was also observed in fry similar to findings in smolts and grow-out fish. Using our newly developed immunohistochemistry method, we further demonstrate that some of the apoptotic epithelial cells covering the oral cavity were positive for SGPV. Thus, SGPV is not restricted to respiratory epithelium alone and may infect the fish at very early life stages. Furthermore, as the cases examined here are from Norway, Faroe Island and Scotland, we show that SGPV is more widespread than previously reported.

Background Hereditary thrombophilia testing identifies genetic conditions that can predispose patients to an increased risk of venous thromboembolism (VTE); these conditions include Factor V Leiden, Factor II G20210A gene mutation, protein C deficiency and protein S deficiency. Testing as an inpatient can be challenging as acute thrombosis and anticoagulation can confound the study results. As a result, major society guidelines do not recommend routine hereditary thrombophilia testing in an acute setting. Objective The purpose of this study is to retrospectively review the ordering patterns and outcomes of hereditary thrombophilias in inpatients. Methods All hereditary thrombophilias ordered for inpatients between May 2016 to April 2019 at four major academic centers, Foothills Medical Centre, Peter Lougheed Centre, South Health Campus and Rockyview General Hospital in Calgary, Alberta were retrospectively reviewed. The primary outcome was the indication for thrombophilia testing and the results of the testing. Secondary outcomes included patient demographics and thrombosis risk factors. Results 428 patients were identified as having had hereditary thrombophilia testing as inpatients. 411 patients had a documented thrombotic event with 400 patients (93.4%) having an event within 30 days of their testing. 287 patients (69%) were on anticoagulation at the time. 60.1% of patients had a venous thrombosis, with pulmonary embolism being the most common (28.2%) while 39.9% of patients had an arterial thrombosis with 19% being a stroke. 177 (43%) of patients had another provoking risk factor at the time of their thrombosis, including malignancy, recent major surgery, pregnancy and exogenous estrogen use. The majority of testing was ordered by General internal medicine (30.1%) and neurology (25%). Only 3.9% of patients had hematology involvement at the time of their testing. 77 (18%) patients had a positive thrombophilia screen with heterozygous Factor V Leiden (11.4%) and heterozygous Factor II G20210A (5.1%) variant being the most common. Prior VTE was associated with an increased likelihood of a positive thrombophilia result (RR 2.15, CI 1.43-3.23, p= 0.0002) but family history, arterial thrombosis, and venous thrombosis at unusual sites were not. Conclusion The utility of hereditary thrombophilia testing is limited in an inpatient setting, particularly for patients with acute thrombosis and on anticoagulation. The majority of tests were ordered inappropriately and resulted in unnecessary costs to the healthcare system. This study indicates the need for further interventions to improve physician education and adherence to guidelines.

We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.

The hypothesis that the Stephan pH responses of dental plaque would be different in caries-active and -inactive individuals was tested in 20 seven-year-old and 19 14-year-old Kenyan children. In each age group, half the children had ≥ 2 dentin cavities; the other half had no such lesions. With a palladium-touch microelectrode, interdental plaque pH was monitored between m1/m2 in each quadrant in the primary dentition and in the four molar/premolar regions in the permanent dentition. pH was also monitored in caries cavities in the occlusal surfaces of lower first molars and on the tongue. pH was measured before and up to 60 min after the children rinsed with 10 mL of 10% sucrose. Caries status of the individual was unrelated to plaque pH in comparable non-carious sites in both of the age groups. The pH minimum in the maxilla was about 0.5 pH units lower than that in the mandible. Active occlusal caries lesions had a resting pH value of about 5.5, about 1 pH unit lower than that of sound surfaces. The pH dropped to about 4.5 in caries lesions and recovered slowly. In sound occlusal sites, a pH drop to about 6.0 was followed by a relatively rapid return to the resting value. Thus, when the mean values were considered, the classic Stephan curve response was evident. However, when the pH changes at single sites were considered at various time intervals, a substantial, erratic fluctuation was observed. The tongue had a resting pH value of 7.0, which dropped to about pH 5.5 and remained low for more than 60 min.