Clinical and diagnostic imaging findings in a bengal tiger (Panthera tigris tigris) with cervical spondylomyelopathy: A case report.

An adult neutered male Bengal tiger (Panthera tigris tigris) presented with abnormal gait. Neurological examination showed poor left ambulatory hemiparesis, spontaneous proprioceptive deficit in the left anterior limb, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a caudal cervical spinal cord lesion. Pathological findings included increased cholinesterase and protein levels in the cerebrospinal fluid. Computed tomography examination revealed C2-C3 intervertebral disc herniation, C5-C6 intervertebral disc herniation associated with a reduction of the intervertebral space, and mild ventral dislocation of the C6 vertebra compared to C5. In addition, severe bilateral shoulder osteoarthritis and a hypoattenuating nodule in the left thyroid gland with an open etiology were observed. These findings were interpreted as indicating cervical spondylomyelopathy (CSM). Treatment included analgesic and steroidal anti-inflammatory therapy as well as movement restriction. Follow-up at 4 weeks showed modest improvement. Thus, CSM should be included in the differential diagnosis of tigers with neurological cervical signs.

Um tigre-de-bengala macho castrado adulto (Panthera tigris tigris) foi apresentado com uma marcha anormal. O exame neurológico mostrou hemiparesia deambulatória deficiente à esquerda, déficit proprioceptivo espontâneo no membro anterior esquerdo e diminuição do reflexo flexor nos membros anteriores. Os sintomas neurológicos sugeriram uma lesão da medula espinhal cervical caudal. Os achados patológicos incluíram aumento do nível de colinesterase e proteínas na bioquímica do LCR. O exame de TC revelou uma hérnia de disco intervertebral C2-C3, uma hérnia de disco intervertebral C5-C6 associada a uma redução do espaço intervertebral e leve deslocamento ventral da vértebra C6 em comparação com C5. Além disso, osteoartrite grave do ombro bilateral e um nódulo hipoatenuante da glândula tireoide esquerda com etiologia aberta. Esses achados foram interpretados como uma espondilomielopatia cervical (CSM). A terapia médica incluiu tratamento analgésico e anti-inflamatório esteroidal, bem como restrição de movimento. O acompanhamento por 4 semanas mostrou uma melhora modesta. A CSM deve ser incluída no diagnóstico diferencial em tigres com sinais neurológicos cervicais.

Discussion on critical points for a tailored therapy to cure hepatitis C virus infection

Hepatitis C virus (HCV) infects around 71 million people worldwide and in 2018 it is still a major health problem. Since 2011, anti-HCV therapy with availability of direct-acting antiviral drugs has revolutionized the clinical response and paved the way to eradication strategies. However, despite the high rate of sustained virological response, treatment failure may occur in a limited percentage of patients, possibly due to resistance-associated substitutions (RASs), either emergent or pre-existent even in minority viral populations. Clearly this problem may impair success of eradication strategies. With this background, several questions marks still exist around HCV treatment, including whether pan-genotypic treatments with complete effectiveness in any clinical conditions really exist outside clinical trials, the actual cost-effectiveness of genotyping testing, and utility of RAS detection in viral quasispecies by next generation sequencing approach. In this review, we describe these critical points by discussing recent literature data and our research experience.

Evolution of glomerular filtration rates and neutrophil gelatinase-associated lipocalin during treatment with direct acting antivirals

BACKGROUND/AIMS: Correct renal function evaluation is based on estimated glomerular filtration rates (eGFR) and complementary renal damage biomarkers, such as neutrophil gelatinase associated lipocalin (NGAL). The aim of this study was to evaluate eGFR and NGAL modifications and renal impairment during treatment with a direct acting antiviral (DAA) for chronic hepatitis C virus (HCV) infection. METHODS: A retrospective cohort study evaluated eGFR modification during treatment with DAA. Subgroup analysis on serum NGAL was conducted in those receiving sofosbuvir/ledipasvir, with complete follow-up until week 12 after the end of treatment (FU-12). RESULTS: In the 102 enrolled patients, eGFR reduction was observed (from 86.22 mL/min at baseline to 84.43 mL/min at FU-12, P=0.049). Mean NGAL increased in 18 patients (from 121.89 ng/mL at baseline to 204.13 ng/mL at FU-12, P=0.014). At FU-12, 38.8% (7/18) of patients had a plasmatic NGAL value higher than the normal range (36-203 ng/mL) compared with 11.1% (2/18) at baseline (χ2 =3,704; P=0.054). In contrast, eGFR did not change significantly over the follow-up in this subgroup. CONCLUSIONS: In conclusion, compared to a negligible eGFR decline observed in the entire cohort analyzed, a significant NGAL increase was observed after HCV treatment with DAA in a small subgroup. This could reflect tubular damage during DAA treatment rather than glomerular injury.