ABSTRACT
Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic. Methods: Pre-pandemic analysis of practice (November 2019 - January 2020) led us to the intervention of all referrals straight to MDT without an unnecessary prior clinical encounter, with secondary planned investigations and clinical assessment thereafter. Completion of audit loop and analysis included referral information, MDT outcome, imaging, and clinical correspondence with descriptive analysis. Results: Post-intervention 61 patients were referred to the MDT over an 18-month period (February 2020 - October 2021). 90% of patients were referred following CT scans. Median age 71 (range 32-93), 38% of patients had no additional breast imaging and 74% of patients did not require a tissue biopsy. 15% (n=9) were diagnosed with new breast cancer, 36% were new benign, with 34% already known lesions. 16% of patients required no further intervention. Conclusion: 15% of incidentalomas were diagnosed as malignancies, compared to local 3-4% from one stop clinics. Prompt referral to MDT accelerates triple assessment and tissue diagnosis. Streamlining of patient care optimised appropriate clinical encounters for vulnerable patients. Early senior radiological assessment at the MDT of incidentalomas during COVID-19 provided confirmation of benign features and therefore no further intervention and reassurance for 16% of patients.
ABSTRACT
INTRODUCTION: Three outbreaks of fatal diarrhoea occurred in bush dog (Speothos venaticus) groups at two zoological collections in the United Kingdom between 2009 and 2017. In all cases, the predominant clinical signs were diarrhoea, anorexia and severe loss of condition. Despite supportive treatment, a number of fatalities occurred during each outbreak. Common gross post mortem findings were emaciation, with erythema, mucosal haemorrhage, and ulceration of the gastrointestinal tract. Histopathological features included villus blunting and fusion, crypt epithelial loss and lymphoid depletion, supporting a viral aetiology and canine coronavirus was suspected. Diagnosis was confirmed on the basis of serology (rising antibody titres) and the detection of viral nucleic acid using polymerase chain reaction. The canine coronavirus was subtyped as type 2a, which is known to cause systemic fatal disease in immature domestic dogs. To the authors' knowledge, these are the first reported cases of fatal diarrhoea associated with canine coronavirus type 2a in bush dogs. These outbreaks suggest that adult bush dogs are highly susceptible to canine coronavirus infection and may succumb to viral enteritis.
INTRODUCTION: Trois foyers de diarrhée mortelle sont survenus dans des groupes de chiens de brousse (Speothos venaticus) dans deux parcs zoologiques au Royaume-Uni entre 2009 et 2017. Dans tous les cas, les signes cliniques prédominants étaient la diarrhée, l'anorexie et une grave perte de condition. Malgré un traitement de soutien, un certain nombre de décès sont survenus au cours de chaque épidémie. Les résultats macroscopiques courants post-mortem étaient l'émaciation, un érythème, des hémorragies des muqueuses et des ulcération du tractus gastro-intestinal. Les caractéristiques histopathologiques comprenaient un émoussement et une fusion des villosités, une perte épithéliale des cryptes et une déplétion lymphoïde, ce qui confortait une étiologie virale. Un coronavirus canin a été suspecté. Le diagnostic a été confirmé sur la base de la sérologie (augmentation des titres d'anticorps) et de la détection d'acide nucléique viral par amplification en chaîne par polymérase. Le coronavirus canin a été sous-typé comme type 2a, qui est connu pour provoquer une maladie systémique mortelle chez les chiens domestiques immatures. À la connaissance des auteurs, il s'agit des premiers cas signalés de diarrhée mortelle associée au coronavirus canin de type 2a chez les chiens des buissons. Ces épidémies suggèrent que les chiens des buissons adultes sont très sensibles à l'infection par le coronavirus canin et peuvent succomber à une entérite virale.