Search

Abstract Background Limited current information exists regarding discospondylitis within breeds commonly affected by congenital vertebral body malformations. Hypothesis/Objectives Report the prevalence of discospondylitis in English and French bulldogs and investigate for possible associations of discospondylitis with congenital vertebral body malformations. Animals 108 client‐owned dogs. Methods Retrospective multi‐institutional study between June 2010 and 2020. Cases with a diagnosis of discospondylitis on computed tomography (CT) or magnetic resonance imaging (MRI) and complete medical records included. Signalment, discospondylitis location, presence of congenital vertebral body malformations, and the site of maximal kyphosis were recorded. Results The prevalence of discospondylitis was 3.4 (1.6‐6.7, 95% confidence interval [CI]) times higher in French bulldogs (P

IntroductionDifficulties in recruitment of veterinary specialists to academia is an ongoing problem for university teaching hospitals. The aim of this study was to determine the proportion of veterinary neurology specialists that plan to work in academia after their residency training and identify the main factors that may influence that decision.MethodsAn electronic survey was distributed to European College of Veterinary Neurology (ECVN) residents in training and those that completed their residencies within the previous 12 months.ResultsDespite similar numbers of residents training in clinical practice and academic institutions, most respondents (79.7%) planned to work in private practice. The most influential factors for deciding future workplace were quality of life, salary, location, and the number of other specialists (with specialists in subjects other than neurology viewed as more important than neurologists) working in the same institution. The most common reasons for not choosing academia were low compensation, excessive bureaucracy, and high administrative workload compared to private clinical practice.DiscussionAcademic institutions need to review support for academic staff and provide stronger mentorship to overcome these problems and ensure provision of high-quality undergraduate teaching in veterinary neurology as well as promoting advancement of the field through basic and applied research.

Abstract Background Meningoencephalitis of unknown origin (MUO) comprises a group of noninfectious inflammatory diseases affecting the central nervous system of dogs. Previous studies have reported individual risk factors for survival but prognostication for MUO remains challenging. Objectives Identify clinical prognostic variables in dogs with MUO. Animals A retrospective study of 447 dogs presented to 2 UK referral hospitals and diagnosed with MUO. Methods Medical records of dogs diagnosed with MUO were retrospectively reviewed. Multivariable logistic regression was used for the identification of risk factors for survival and Cox proportional hazards analysis for the identification of risk factors for clinical relapse. Results Eighty‐two percent (366/447) of dogs with presumptive MUO survived to discharge and 63.5% (284/447) were alive at 6 months; 36% of the latter (103/284) had persistent neurological deficits. Breed (pugs; P = .03), epileptic seizures (P

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

Metabolic/neurodegenerative encephalopathies encompass a wide list of conditions that share similar clinical and magnetic resonance imaging (MRI) characteristics, challenging the diagnostic process and resulting in numerous tests performed in order to reach a definitive diagnosis. The aims of this multicentric, retrospective and descriptive study are: (I) to describe the MRI features of dogs and cats with metabolic/neurodegenerative encephalopathies; (II) to attempt an MRI recognition pattern classifying these conditions according to the involvement of grey matter, white matter or both; and (III) to correlate the MRI findings with previous literature. A total of 100 cases were recruited, comprising 81 dogs and 19 cats. These included hepatic encephalopathy (20 dogs and three cats), myelinolysis (five dogs), intoxications (seven dogs and one cat), thiamine deficiency (two dogs and seven cats), hypertensive encephalopathy (three dogs and two cats), neuronal ceroid lipofuscinosis (11 dogs and one cat), gangliosidosis (three dogs and two cats), fucosidosis (one dog), L-2-hydroxyglutaric aciduria (13 dogs and one cat), Lafora disease (11 dogs), spongiform leukoencephalomyelopathy (one dog) and cerebellar cortical degeneration (four dogs and two cats). None of the hepatic encephalopathies showed the previously described T1-weighted hyperintensity of the lentiform nuclei. Instead, there was involvement of the cerebellar nuclei (8/23), which is a feature not previously described. Dogs with myelinolysis showed novel involvement of a specific white matter structure, the superior longitudinal fasciculus (5/5). Thiamine deficiency affected numerous deep grey nuclei with novel involvement of the oculomotor nuclei (3/9), thalamic nuclei, subthalamus and cerebellar nuclei (1/9). Cats with hypertensive encephalopathy had a more extensive distribution of the white matter changes when compared to dogs, extending from the parietal and occipital lobes into the frontal lobes with associated mass effect and increased brain volume. Lysosomal storage disease showed white matter involvement only, with neuronal ceroid lipofuscinosis characterised by severe brain atrophy when compared to gangliosidosis and fucosidosis. All patients with L-2-hydroxyglutaric aciduria had a characteristic T2-weighted hyperintense swelling of the cerebral and cerebellar cortical grey matter, resulting in increased brain volume. Lafora disease cases showed either normal brain morphology (5/11) or mild brain atrophy (6/11). Dogs with cerebellar cortical degeneration had more marked cerebellar atrophy when compared to cats. This study shows the important role of MRI in distinguishing different metabolic/neurodegenerative encephalopathies according to specific imaging characteristics.

Abstract Background A head turn is a clinically relevant abnormality identified on neurological examination and historically has been an isolated or concomitant sign of ipsilateral forebrain dysfunction. Experimental studies in quadrupedal mammals suggest that changes in head posture may be identified as originating in other parts of the central nervous system (CNS). Objectives To identify whether other locations within the CNS could give rise to a head turn and whether the head turn identified is isolated or concomitant with other deviations in head and body posture. Animals Forty‐nine client‐owned dogs with a presentation of a head turn, from 6 veterinary referral centers. Methods Multicenter observational prospective study including dogs with photographic evidence of a head turn, full neurological examination, and advanced imaging. Results Of the population, 15/49 had head turn only, 9/49 had head turn and head tilt only, 12/49 had head turn and body turn only, and 13/49 had head turn, head tilt, and body turn. Nearly all dogs with forebrain disease (23/24), and, all with brainstem and cerebellar disease, had an ipsilateral head turn and body turn (if present). In the cerebellar group, all head tilts were contralateral to the lesion location. In the cervical spinal cord group, all head turns, body turns and head tilts were contralateral to the lesion location. Conclusion A head turn, although most likely associated with, is not exclusively seen with forebrain disease. Certain combinations of head turn, head tilt and body turn suggest a neurolocalization other than the forebrain, with appropriate classification needed.

Weldability plays a crucial role in the journey of high entropy alloys towards their engineering applications. In this study, gas metal arc welding was performed to join an as-rolled CoCrFeMnNi high entropy alloy using Monel 400 as the filler wire. The present research findings demonstrate a favorable metallurgical chemical reaction between the Monel 400 filler and the CoCrFeMnNi high entropy alloy, resulting in compositional mixing within the fusion zone that promotes a solid-solution strengthening effect, counteracting the typical low hardness associated to the fusion zone of these alloys. The weld thermal cycle induced multiple microstructure changes across the joint, including variations in the grain size, existing phases and local texture. The grain size was seen to increase from the base material toward the fusion zone. An FCC matrix and finely sparse Cr-Mn-based oxides existed in both base material and heat affected zone, while in the fusion zone new FCC phases and carbides were formed upon the mixing of the Monel 400 filler. The role of the filler material on the fusion zone microstructure evolution was rationalized using thermodynamic calculations. Texture shifted from a γ-fiber (in the base material) to a strong cubic texture in the fusion zone. Digital image correlation during tensile testing to fracture coupled with microhardness mapping revealed that, stemming from the process-induced microstructure changes, the micro and macromechanical response differed significantly from the original base material. This study successfully established a correlation between the impact of the process on the developed microstructural features and the resultant mechanical behavior, effectively assessing the processing-microstructure-properties relationships towards an improved understanding of the physical metallurgy associated to these advanced engineering alloys. In conclusion, this work provides an important theoretical framework and practical guidance for optimizing the engineering applications of high entropy alloys.

Abstract Background Although idiopathic episodic head tremor (IEHT) in dogs is well‐known, little is known about structural brain lesions causing structural episodic head tremor (SEHT). Hypothesis/Objectives Describe semiology, magnetic resonance imaging (MRI) findings and outcome of dogs with IEHT or SEHT. We hypothesized that structural lesions affecting the middle cranial fossa or mesencephalic aqueduct could lead to SEHT. Animals One hundred dogs with IEHT (n = 71) or SEHT (n = 29). Methods Retrospective, multicenter, study of dogs with episodic (nonintentional) head tremor and brain MRI between 2004 and 2022. Results Lesions on MRI in SEHT dogs were localized to the middle cranial fossa (15/29), cerebrocortex (3/29), brainstem (2/29), fourth ventricle (1/29) or multifocal (8/29) with thalamus involvement (6/8). Secondary compression of the mesencephalic aqueduct (19/29), third ventricle or interthalamic adhesion or both (14/29) was common. The most common underlying condition in dogs with SEHT was a pituitary mass. Dogs with SEHT were older, had additional neurological signs and were more likely to be euthanized after diagnosis (P

IntroductionCanine meningoencephalitis of unknown origin (MUO) is a debilitating disease associated with high mortality. The prognostic value of magnetic resonance imaging (MRI) findings for predicting survival at 12 months and long-term relapse remains uncertain.MethodsThis was a retrospective cohort study evaluating the prognostic value of different MRI variables using multivariable logistic regression and Cox proportional hazards analysis.ResultsIn total, 138 dogs were presumptively diagnosed with MUO. The most common location for lesions identified on MRI were the white matter tracts of the corona radiata and corpus callosum, followed by the frontal, sensorimotor and temporal cortices. Lower T2 lesion load (p = 0.006, OR = 0.942, CI = 0.902–0.983) was associated with longer survival and higher T1 post-contrast lesion load (p = 0.023, OR = 1.162, CI = 1.021–1.322) was associated with relapse.DiscussionThis study has identified prognostic factors that may help identify dogs at higher risk of death and relapse and therefore guide treatment recommendations.

Abstract Background Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity. Objectives Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome. Animals One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation. Methods Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome. Results The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68‐0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56‐0.83). No association was found between NDS score and long‐term outcome. Conclusions and Clinical Importance The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.

In this paper we address possessor dative structures (PDSs) in European Portuguese (EP) and in the Mozambican variety of Portuguese spoken in Maputo, which is mainly in contact with the Bantu language Changana. Focusing primarily on data from EP, we argue that PDSs show microvariation across Romance. We account for this microvariation by extending to Romance languages the distinction between nuclear and non-nuclear external possession structures originally proposed for Bantu languages, and propose that the value of the formal nominal feature [ipart] is the source of the observed variation. We argue that the derivation of PDSs in EP involves movement of the possessor from the specifier position of a small clause for formal feature valuation, which accounts for the common properties of give-type verbs and possessor dative structures, as well as for the incompatibility of both constructions. We further adopt a corpus-based approach and an exploratory elicitation task for the discussion of possessor datives in urban MozP. The findings support the role of the formal feature [ipart] in the acceptability of sentences which do not converge with EP, arguably as a consequence of contact with Changana, but also show that Mozambican Portuguese exhibits convergence with the VP structure of EP.

This paper investigates the formation of spatial locative relativization in three African varieties of Portuguese. While research on relative constructions in Portuguese has deserved considerable attention in the literature, it tends to focus on the European and Brazilian varieties, with locative relativization being only marginally addressed. Using data extracted from spoken corpora of contemporary, urban varieties of Angolan, Mozambican, and Santomean Portuguese, we aim to discuss whether there is a correlation between syntactic and semantic variables and the selection of the two main locative relative morphemes, onde ‘where’ and que ‘that’. Overall, the three varieties at stake behave similarly with respect to the analyzed syntactic variables and follow the tendency found in Portuguese varieties toward the use of pied-piping and P-chopping as the dominant relativization mechanisms, independent of the syntactic relation between the antecedent and the relative clause. Semantically, we identified some fine-grained differences between the three varieties, with Santomean Portuguese generally being the outlier or one of the outliers. Crucially, definiteness of the head noun stands out as the one variable that plays a major role in the selection of the relative morpheme: [−definite] head nouns show a proportionally higher preference for que in both AP and STP, which is particularly visible with bare nouns in the latter. This motivates the hypothesis that less specified head nouns show a preference for the un(der)specified relative morpheme que. We further show that the role of language contact is at best very limited.

Abstract Background Status epilepticus (SE) is an emergency associated with serious consequences for both patient and owner. Data regarding risk factors for short‐term mortality or recurrence in dogs with SE is limited. Objective Identify risk factors associated with short‐term mortality (euthanasia or spontaneous death) and recurrence of SE in dogs. Animals One hundred twenty‐four client‐owned dogs that sustained an episode of SE. Methods Retrospective multicenter study using data collected from medical records of dogs presented in SE to the contributing institutions. Multivariable logistic regression analysis was performed using a manual backwards stepwise approach to identify risk factors associated with short‐term mortality and recurrence of SE after discharge. Results Short‐term mortality for affected dogs was 29.8%. Factors significantly associated with short‐term mortality included increased patient age, shorter duration of hospitalization, development of SE before arrival, and SE caused by a potentially fatal etiology. Status epilepticus recurred in 27% of dogs that survived to discharge. Factors significantly associated with recurrence of SE included prior history of pharmacoresistant epilepsy and predominance of a focal seizure phenotype. Conclusions and Clinical Importance Our results may be used to inform clinicians and dog owners regarding risk factors for both short‐term mortality and recurrence in dogs with SE.

A compra por impulso é um tema complexo e com variadas influências. Este estudo experimental tem por objetivo analisar o efeito da identidade social, das emoções e da marca do produto na tendência de jovens para comprar sapatilhas por impulso. Participaram 545 jovens portugueses, que responderam a um questionário online sobre um cenário experimental de compra de sapatilhas da marca Adidas. Os resultados indicam que o desconto influencia a compra impulsiva e as emoções positivas medeiam a relação entre identificação com jovens e compra por impulso. Também verificou-se uma propensão à apropriação da marca como um marcador identitário da juventude portuguesa. Assim, além das características do produto, os processos grupais poderão estar relacionados com este comportamento de compra.

ABSTRACT In a study of antibiotic resistance in Staphylococcus aureus, specific cell wall mutants were previously generated for the peptidoglycan biosynthesis gene murF, by the insertion of an integrative plasmid. A collection of 30 independent mutants was obtained, and all harbored a variable number of copies of the inserted plasmid, arranged in tandem in the chromosome. Of the 30 mutants, only 3, F9, F20 and F26, with a lower number of plasmid copies, showed an altered peptidoglycan structure, lower resistance to β-lactams and a different loss-of-function mutation in rho gene, that encodes a transcription termination factor. The rho mutations were found to correlate with the level of oxacillin resistance, since genetic complementation with rho gene reestablished the resistance and cell wall parental profile in F9, F20 and F26 strains. Furthermore, complementation with rho resulted in the amplification of the number of plasmid tandem repeats, suggesting that Rho enabled events of recombination that favored a rearrangement in the chromosome in the region of the impaired murF gene. Although the full mechanism of reversion of the cell wall damage was not fully elucidated, we showed that Rho is involved in the recombination process that mediates the tandem amplification of exogeneous DNA fragments inserted into the chromosome. IMPORTANCE The cell wall of bacteria, namely, peptidoglycan, is the target of several antibiotic classes such as β-lactams. Staphylococcus aureus is well known for its capacity to adapt to antibiotic stress and develop resistance strategies, namely, to β-lactams. In this context, the construction of cell wall mutants provides useful models to study the development of such resistance mechanisms. Here, we characterized a collection of independent mutants, impaired in the same peptidoglycan biosynthetic step, obtained through the insertion of a plasmid in the coding region of murF gene. S. aureus demonstrated the capacity to overcome the cell wall damage by amplifying the copy number of the inserted plasmid, through an undescribed mechanism that involves the Rho transcription termination factor.

Intervertebral disc disease, including intervertebral disc extrusions and protrusions, is the most common spinal cord disorder in dogs. Atypical and uncommon intervertebral disc herniations include intradural/intramedullary disc extrusion, intervertebral foraminal disc extrusion and intervertebral disc herniation (Schmorl's node). Intradural/extramedullary disc extrusion is the least common type of intervertebral disc herniation in veterinary medicine, characterized by extruded disc material within the intradural space. To date, only one study has been published in veterinary medicine reporting intradural/extramedullary disc extrusions. In this study, low field MRI was used, and the authors could not find any MRI features to diagnose with confidence an intradural/extramedullary disc location of the extruded disc material. The aim of this study was to describe the high field (1.5T) MRI characteristics of surgically confirmed intradural/extramedullary disc extrusions. This is a retrospective, multicentric and descriptive study. Inclusion criteria was surgical confirmation of intradural/extramedullary disc extrusion by durotomy and complete MRI study of the spine. Seven cases were included. Images were reviewed by a radiology resident and a certified radiologist, with emphasis on the following signs: “Golf-tee sign” (widening of the subarachnoid space cranial and caudal to the lesion), “Beak sign” (pointed and sharp compressive lesion) and “Y sign” (division of the dura and arachnoid layers). MRI showed a “Y sign” in all the cases (7/7) seen from the T2-weighted sagittal views, while “Golf-tee sign” was not recognized in any of the cases (0/7). Additionally, “beak sign” was present in half of the cases (4/7). “Y sign” maybe a reliable MRI feature for identifying intradural/medullary disc extrusions from the MRI study. As the arachnoid is peeled from the dura by the disc herniation there is a splitting of the arachnoid mater and the ventral dura. The intradural disc material will be surrounded by CSF signal intensity margin, giving the appearance of a Y, which can be identified from the T2-weighted sagittal images.

In this paper we compare dative ditransitive structures in nativized and nativizing urban varieties of Portuguese spoken in Angola, Mozambique, and São Tomé and Príncipe, using a corpus-based approach. It is shown that the expression of the Recipient exhibits considerable variation within and across these varieties, as well as at intraspeaker level. Despite the use of non-canonical patterns, namely prepositional structures with em and para and double object constructions, the canonical European Portuguese pattern with Case marker a is predominant in our data. Moreover, the pronominalized counterparts of these different realizations show much less variation and strong convergence toward dative clitic lhe(s). To account for the data, we propose a Larsonian VP-shell in which Recipients as extended DPs occur internally to a K(ase) projection whose functional head can be spelled out as a, em or para. Recipients in double object constructions, on the other hand, are treated as plain DPs which may pronominalize as dative clitics or, less commonly, as strong pronouns. Overall, our hypothesis weakens the role of language contact, which has often been assumed as a critical factor in the literature, but still allows for (individual) grammars that show evidence of being substrate-induced.

Abstract Background The pathophysiology of changes in magnetic resonance imaging (MRI) detected after a seizure is not fully understood. Objective To characterize and describe seizure‐induced changes detected by MRI. Animals Eighty‐one client‐owned dogs diagnosed with idiopathic epilepsy. Methods Data collected retrospectively from medical records and included anatomical areas affected, T1‐, T2‐weighted and T2‐FLAIR (fluid‐attenuated inversion recovery) appearance, whether changes were unilateral or bilateral, symmetry, contrast enhancement, mass effect, and, gray and white matter distribution. Diffusion‐ and perfusion weighted maps were evaluated, if available. Results Seizure‐induced changes were T2‐hyperintense with no suppression of signal on FLAIR. Lesions were T1‐isointense (55/81) or hypointense (26/81), local mass effect (23/81) and contrast enhancement (12/81). The majority of changes were bilateral (71/81) and symmetrical (69/71). The most common areas affected were the hippocampus (39/81) cingulate gyrus (33/81), hippocampus and piriform lobes (32/81). Distribution analysis suggested concurrence between cingulate gyrus and pulvinar thalamic nuclei, the cingulate gyrus and parahippocampal gyrus, hippocampus and piriform lobe, and, hippocampus and parahippocampal gyrus. Diffusion (DWI) characteristics were a mixed‐pattern of restricted, facilitated, and normal diffusion. Perfusion (PWI) showed either hypoperfusion (6/9) or hyperperfusion (3/9). Conclusions and Clinical Importance More areas, than previously reported, have been identified that could incur seizure‐induced changes. Similar to human literature, DWI and PWI changes have been identified that could reflect the underlying metabolic and vascular changes.

ABSTRACT Dysphagia is described as a highly relevant comorbidity of Alzheimer’s disease (AD). However, there is a scarcity of studies aiming at the characteristics and progression of dysphagia. Objective: The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. Methods: Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project’s (EPHPP) tools. Results: A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. Conclusions: Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.

Abstract Background Vestibular dysfunction is relatively common in dogs, with a prevalence of 0.08% reported in primary veterinary care in the UK. There are several studies investigating how to differentiate between peripheral and central vestibular disease but only limited information regarding the possible underlying causes for peripheral vestibular dysfunction in dogs. This study therefore aimed to describe the clinical signs, magnetic resonance imaging findings (MRI), underlying causes and outcome in a large population of dogs diagnosed with peripheral vestibular disease. Results One hundred eighty-eight patients were included in the study with a median age of 6.9 years (range 3 months to 14.6 years). Neurological abnormalities included head tilt (n = 185), ataxia (n = 123), facial paralysis (n = 103), nystagmus (n = 97), positional strabismus (n = 93) and Horner syndrome (n = 7). The most prevalent diagnosis was idiopathic vestibular disease (n = 128), followed by otitis media and/or interna (n = 49), hypothyroidism (n = 7), suspected congenital vestibular disease (n = 2), neoplasia (n = 1) and cholesteatoma (n = 1). Long-term follow-up revealed persistence of head tilt (n = 50), facial paresis (n = 41) and ataxia (n = 6) in some cases. Recurrence of clinical signs was observed in 26 dogs. Increasing age was associated with a mild increased chance of diagnosis of idiopathic vestibular syndrome rather than otitis media and/or interna (P = 0.022, OR = 0.866; CI 0.765–0.980). History of previous vestibular episodes (P = 0.017, OR = 3.533; CI 1.251–9.981) was associated with an increased likelihood of resolution of the clinical signs whilst contrast enhancement of cranial nerves VII and/or VIII on MRI (P = 0.018, OR = 0.432; CI 0.251–0.868) was associated with a decreased chance of resolution of the clinical signs. Conclusions Idiopathic vestibular disease is the most common cause of peripheral vestibular dysfunction in dogs and it is associated with advanced age. Incomplete recovery from peripheral vestibular disease is common, especially in dogs presenting with cranial nerve enhancement on MRI but less so if there is previous history of vestibular episodes.

The epidemiology of inflammatory diseases affecting the central nervous system (CNS) in dogs is largely unknown. We aimed to report the relative proportion of different causes of inflammatory disease affecting the CNS in dogs and identify predictors for infectious vs. immune-mediated conditions and predictors for the most common diseases affecting the brain and the spinal cord. This was a retrospective cohort study over a 10-year period in 2 referral institutions using multivariable and multinomial logistic regression for identification of risk factors. In total, 1,140 client-owned dogs diagnosed with inflammatory disease affecting the CNS were included. Fifteen different diagnoses were identified, with immune-mediated (83.6%) disease being more common than infectious conditions (16.4%). The most common immune-mediated conditions diagnosed were meningoencephalitis of unknown origin (47.5%) and steroid-responsive meningitis–arteritis (30.7%), and the most common infectious conditions were discospondylitis (9.3%) and otogenic intracranial infection (2.2%). Older age (p < 0.001, OR = 1.019, 95% CI: 1.014–1.024), higher body weight (p < 0.001, OR = 1.049, 95% CI: 1.025–1.074), male sex (p = 0.009, OR = 1.685, 95% CI: 1.141–2.488), longer duration of the clinical signs before presentation (p < 0.001, OR = 1.011, 95% CI: 1.006–1.017), progressive nature of the clinical signs (p < 0.001, OR = 2.295, 95% CI: 1.463–3.599), identification of a possibly associated preceding event (p = 0.0012, OR = 1.93, 95% CI: 1.159–3.213), and hyperesthesia on presentation (p < 0.001, OR = 2.303, 95% CI: 1.528–3.473) were associated with a diagnosis of infectious diseases. Our data shows that immune-mediated diseases are more common than infectious conditions as a cause for inflammatory CNS disease in dogs. The risk factors for the most common diagnoses were identified from signalment, history, and findings of the physical and neurological examinations to give valuable information that can guide clinicians with their investigations.

White dot syndromes are a group of inflammatory chorioretinopathies that share pathologic features involving lesions in the external retinal layers and choroid. This report describes a case of acute visual loss due to a white dot syndrome superimposed on severe diabetic retinopathy (DR), leading to a challenging diagnosis. A 53-year-old man with severe DR was referred with acute unilateral vision loss, with the presumptive diagnosis of diabetic macular edema. The clinical examination and complementary diagnostic tests revealed the absence of diabetic macular edema but showed disruption of the outer retinal layers and choroidal thickening. Laboratory and imaging testing excluded other etiological factors, so an inflammatory chorioretinopathy superimposed on severe DR was considered. Following the initial presentation, without any therapeutic intervention, rapid anatomical and functional improvement was objectified. This case demonstrated that in rare cases, an inflammatory chorioretinopathy may go unnoticed in the presence of preexisting retinopathy, and the true cause of vision loss may initially be misdiagnosed.

Introduction: To measure and interpret short-term pressure variation after intravitreal injections (IVIs) of the antivascular endothelial growth factor drug aflibercept (Eylea©), and to identify variables and risk factors for increased pressure spikes. Materials and Methods: A prospective study was conducted on 103 eyes treated with intravitreal aflibercept (Eylea©). Intraocular pressure (IOP) was measured using the Icare®cTA01i tonometer immediately before and 1, 5, and 20 min after the procedure. Patient data were reviewed according to age, gender, diagnostic, phakic status, and glaucoma history. Results: Mean values of IOP before and 1, 5, and 20 min after the injection were 14.89 (±4.19) mmHg, 36.77 (±11.46) mmHg, 24.17 (±7.81) mmHg, and 16.54 (±5.26) mmHg, respectively. Significant differences were found in patients with a history of glaucoma, 20 min after the injection (P = 0.006). No significant differences were found between phakic and pseudophakic patients (P = 0.379). Discussion and Conclusion: More than three-quarters (76.7%) of the patients had an IOP higher than 30 mmHg 1 min after the injection. Almost half (47.57%) had an IOP higher than 40 mmHg. Phakic status did not seem to affect IOP after IVIs. Patients with a history of glaucoma may have a slower postinjection IOP decrease, shown by a mean IOP difference of 3.72 mmHg, 20 min after the injections. These patients are at a greater risk for progressive worsening of their glaucoma due to repeated IOP spikes after multiple IVIs. IOP should be closely monitored, and a low threshold for optimizing topical therapy should be established.

Alzheimer’s disease (AD) is the most common age-related cause of dementia among elderly people. AD is a severe neurodegenerative disorder characterized by progressive memory and cognition loss that leads to disability and inevitably to death and is considered as an urgent public health problem. It is the third leading cause of death after cancer and heart disease. According to an update in 2020 of the estimates given in the World Alzheimer Report 2015, there are over 50 million people worldwide living with dementia in 2020. This number will almost double every 20 years, reaching 152 million in 2050. AChE inhibitors are the mainstay drugs for early disease stages. In this work we report on the development of a synthetic route to yield open chain sugar amides from commercially available carbohydrates. The synthetic pathway starts with diacetone glucose (DAG), which is converted into perbenzyl d-glucono-1,4-lactone in six steps. Reaction with aromatic or aliphatic amines in dichloromethane under reflux (0.5 h to 2 h) afforded the corresponding amides in high yield (80–95%). Bis(amidation) of a diamine was also accessed by this procedure in 3 h but the reaction product was isolated in a very low yield (13%). Docking studies and evaluation of acetylcholinesterase inhibition were carried out and the results will be disclosed.

Self-harm is a common finding during adolescence and skin-cutting a frequent method of non-suicidal self-injury. However, suicide attempts with severe neck cutting injuries are infrequently reported. Here, we report in detail the case of an adolescent with no prior psychiatry history or self-harm behaviours who had a first suicide attempt with complete external jugular vein laceration. Careful psychiatric evaluation and history reveal exposure to significant adverse childhood experiences. Our aim with this case report is to illustrate and discuss the influence of trauma during early childhood and dissociative symptomatology in suicidal behaviour during adolescence.

Background: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: “deafness” and “stroke”, or “hearing loss” and “stroke” or “auditory agnosia” and “stroke”. Results: We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl’s gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. Conclusions: Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.

Introduction: Cataracts are a major cause of preventable childhood blindness. Visual prognosis of these patients depends on a prompt therapeutic approach. Understanding pediatric cataracts epidemiology is of great importance for the implementation of programs of primary prevention and early diagnosis. Material and Methods: We reviewed the clinical cases of pediatric cataracts diagnosed in the last 12 years at Hospital Pedro Hispano, in Porto. Results: We identified 42 cases of pediatric cataracts with an equal gender distribution. The mean age at diagnosis was 6 years and 64.3% of patients had bilateral disease. Decreased visual acuity was the commonest presenting sign (36.8%) followed by leucocoria (26.3%). The etiology was unknown in 59.5% of cases and there was a slight predominance of nuclear type cataract (32.5%). Cataract was associated with systemic diseases in 23.8% of cases and with ocular abnormalities in 33.3% of cases. 47.6% of patients were treated surgically. Postoperative complications occurred in 35% of cases and posterior capsular opacification was the most common (25%). Discussion: The report of 42 cases is probably the result of the low prevalence of cataracts in this age. Although the limitations of our study include small sample size, the profile of children with cataracts in our hospital has characteristics relatively similar to those described in the literature. Conclusion: Given the high proportion of idiopathic pediatric cataracts, prevention of the disease remains a challenge worldwide.

Purpose: To report a case of pterygium surgery with conjunctival autograft followed by focal necrotizing scleritis due to foreign body entrapment in the scleral bed. Case Report/Results: This is a case report of a 76-years-old male patient who underwent nasal pterygium surgery and developed focal necrotizing scleritis secondary to foreign body entrapment under conjunctival autograft. One month following surgery, slit-lamp examination demonstrated a progressive thinning of the surgical area with focal inflammatory signs. A small synthetic fiber was identified to be trapped under the graft. A second intervention was performed with foreign body removal and a new conjunctival graft. Despite the surgery, focal scleral melting continued to progress and the patient was placed under systemic corticotherapy and submitted to amniotic membrane graft with epithelial side up. During the follow-up period there was a good tissue response. Conclusion: Despite being a safe and quick procedure, pterygium surgery can sometimes elicit new challenges.

A diabetes mellitus (DM) é uma doença que vem aumentando exponencialmente nos últimos anos de vida dos indivíduos, e uma opção de tratamento farmacológico é feito através dos hipoglicemiantes orais (HO). Em virtude de serem substâncias amplamente utilizadas e terem como principal via de excreção a urinária, este tratamento pode provocar variações nos resultados dos parâmetros urinários. Portanto, este estudo tem a finalidade de avaliar a interferência causada pelo uso de hipoglicemiantes no exame de urina. Para esta investigação, foi feita uma pesquisa bibliográfica em diferentes bases de dados, selecionando os artigos pertinentes ao tema: diabetes, interferências laboratoriais e tratamento farmacológico. Os HO podem ser classificados em três grupos de acordo com o mecanismo de ação: estimuladores de insulinas pelo pâncreas, como sulfoniluréias e metiglinidas; as sensibilizadoras de insulina, são as biguanidas, as tiazolidinedionas e as redutoras da absorção de carboidratos, que são as inibidoras da alfa-glicosidase. O exame de urina é uma ferramenta complementar no controle da DM devido a sua fácil coleta e baixo custo. As classes de hipoglicemiantes orais identificados como potencialmente interferentes no exame de urina foram as biguanidas (metformina) e as sulfoniluréias (tobultamida, tolazamida, glicazida, clorpropramida). Resultam em interferência nos parâmetros densidade, proteínas, glicose, cetonas e bilirrubinas, levando a um diagnóstico inadequado e um tratamento insatisfatório gerando prejuízos ao bem estar do paciente.

Use of digital flashcards promotes active recall, spaced repetition, and self-assessment academic principles. This work explores the association and dose-dependent effect of this study method and locomotor (LP) and cardiovascular physiology (CP) grades. A single-faculty cohort study of medical LP and CP students was conducted, and 155 and 676 flashcards, respectively, were created through Moodle. An exploratory analysis examined three exam results (2019), and a confirmatory study used a fourth exam (2021) in another CP cohort. Of 685 students enrolled, 558 participated in the exploratory analysis: 319 (69%) for LP and 311 (84%) for CP, of which 203 LP and 267 CP students were flashcard users. Median grades were higher among flashcard users, and the number of cards reviewed was positively correlated with grades (r = 0.275 to 0.388 for LP and r = 0.239 to 0.432 for CP, P < 0.001). Multiple linear regression models confirmed a positive dose-dependent association between results and the number of flashcards studied: for every 100 LP cards reviewed, exam grades increased 0.44-0.75 on a 0-20 scale range (P < 0.001), and for every 1,000 CP flashcards, results raised 0.81-1.08 values (P < 0.05). These findings were confirmed in the 2021 CP cohort of 269 participants, of whom 67% were flashcard users. Digital flashcard revision has a consistent positive dose-dependent association on LP and CP grades.

Hypopigmentation is a progressive dermatological condition caused by a reduction in the skin pigment, melanin. Its treatment is considered a challenge due to the lack of a highly efficient single therapy. Currently, the main treatments include photochemotherapy, application of corticosteroids and immunosuppressants, and laser. Khellin-based gel-in-oil emulsions appear as a promising alternative since they ensure a concentration of the drug, a natural furanochromone, at the desired location, skin surface. Khellin promotes repigmentation as it forms a dark colored complex after solar irradiation. The aim of this study was the development and characterization (e.g., rheological behaviour, droplet size, tackiness, adhesion and spreadability) of three topical gel-in-oil emulsions prepared with different emollients, formulated through a cold emulsification process, and suitable for the incorporation of khellin. In vitro studies were performed to evaluate the drug release and permeation profiles across artificial membranes and excised human skin, respectively, using Franz-type vertical diffusion cells. The W/O emulsions developed showed macroscopic appearance, shear-thinning behavior with a mean droplet size from 3.28 to 4.28 μm, suitable for topical application. In vitro studies revealed permeation values of about 1% of khellin across the stratum corneum, making these gel-in-oil emulsions promising for preclinical and clinical studies. The cold process, being an easy and low energy production method, represents an innovative strategy to produce khellin-based gel-in-oil emulsions to treat patients with hypopigmentation.

Purpose: We report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab. Methods: We report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented. Results: His best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment. Conclusions: Intravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.

Over the past few years, there has been an increase in cases of allergic contact dermatitis caused by acrylates, because of the growing popularity of artificial nails. Pathological reactions to artificial nails typically occur on or around the nail area. Eyelid contact dermatitis due to artificial nails is rarely seen, especially in a nonoccupational setting. The authors report the case of a 45-year-old female accountant who developed eyelid dermatitis due to artificial nails.

Benign recurrent sixth nerve palsy in children is rare. It typically occurs following viral illness or immunization, and prognosis is usually excellent. However, it is always a diagnosis of exclusion given the more serious alternative causes. Therefore, a thorough examination with brain imaging is recommended. The authors report a child with six recurrent episodes of isolated benign sixth nerve palsy.

Purpose. To describe a case of peripheral ulcerative keratitis associated with type II cryoglobulinemia in the context of Hepatitis C infection. Methods. Case report and literature review. Results. A 36-year-old male patient presented to our emergency department with unilateral moderate pain in his right eye, associated with redness and photophobia. Medical background elicited a history of Hepatitis C and IV illicit drug abuse. Ocular examination revealed a BCVA of 20/30 of the affected eye and slight discomfort with eye movement. Biomicroscopy revealed a ring shaped peripheral corneal ulcer, with a dense white stromal infiltrate sparing the limbus, plus an adjacent area of mild anterior diffuse nonnecrotizing scleritis. No intraocular inflammation was present. Posterior segment was normal. The patient was placed under oral prednisolone (1 mg/Kg/day) with gradual tapering. A dramatic clinical response occurred, with complete resolution of the clinical condition. Systemic analytic workup aiming at autoimmune and infectious diseases was negative, except for high HCV-viral load and the presence of type 2 cryoglobulins. Conclusion. Albeit rare, cryoglobulinemia, even in the absence of systemic vasculitis, should be considered in the differential diagnosis of PUK, when systemic workout for autoimmune diseases is negative.

Bacteria have to avoid recognition by the host immune system in order to establish a successful infection. Peptidoglycan, the principal constituent of virtually all bacterial surfaces, is a specific molecular signature recognized by dedicated host receptors, present in animals and plants, which trigger an immune response. Here we report that autolysins from Gram-positive pathogenic bacteria, enzymes capable of hydrolyzing peptidoglycan, have a major role in concealing this inflammatory molecule from Drosophila peptidoglycan recognition proteins (PGRPs). We show that autolysins trim the outermost peptidoglycan fragments and that in their absence bacterial virulence is impaired, as PGRPs can directly recognize leftover peptidoglycan extending beyond the external layers of bacterial proteins and polysaccharides. The activity of autolysins is not restricted to the producer cells but can also alter the surface of neighboring bacteria, facilitating the survival of the entire population in the infected host.