Statistical methodologies for evaluation of the rate of persistence of Ebola virus in semen of male survivors in Sierra Leone.

The 2013-2016 Ebola virus (EBOV) outbreak in West Africa was the largest and most complex outbreak ever, with a total number of cases and deaths higher than in all previous EBOV outbreaks combined. The outbreak was characterized by rapid spread of the infection in nations that were weakly prepared to handle it. EBOV ribonucleic acid (RNA) is known to persist in body fluids following disease recovery, and studying this persistence is crucial for controlling such epidemics. Observational cohort studies investigating EBOV persistence in semen require following up recently recovered survivors of Ebola virus disease (EVD), from recruitment to the time when their semen tests negative for EBOV, the endpoint being time-to-event. Because recruitment of EVD survivors takes place weeks or months following disease recovery, the event of interest may have already occurred. Survival analysis methods are the best suited for the estimation of the virus persistence in body fluids but must account for left- and interval-censoring present in the data, which is a more complex problem than that of presence of right censoring alone. Using the Sierra Leone Ebola Virus Persistence Study, we discuss study design issues, endpoint of interest and statistical methodologies for interval- and right-censored non-parametric and parametric survival modelling. Using the data from 203 EVD recruited survivors, we illustrate the performance of five different survival models for estimation of persistence of EBOV in semen. The interval censored survival analytic methods produced more precise estimates of EBOV persistence in semen and were more representative of the source population than the right censored ones. The potential to apply these methods is enhanced by increased availability of statistical software to handle interval censored survival data. These methods may be applicable to diseases of a similar nature where persistence estimation of pathogens is of interest.

The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students.

OBJECTIVE: The current study aimed to examine whether brief online stress reduction exercises supplemented with sleep improvement strategies would reduce stress, arousal, and sleep difficulties in college students who were not required to use the sleep improvement strategies for participation. PARTICIPANTS: A sample of 114 college student participants were enrolled because they were experiencing stress and/or wanted to improve their sleep. METHODS: Participants were randomized into an abbreviated progressive muscle relaxation, a mindful breathing, or a self-monitoring control condition for the 4-week intervention. Measures of physical relaxation, mindfulness, perceived stress, pre-sleep arousal, and insomnia symptom severity were collected. RESULTS: The APMR group improved on five of the six dependent measures and was significantly different than the SM group at posttest, but not different than the MB group. CONCLUSION: The results suggests promise for brief, online, scaled back stress reduction interventions to reduce stress, arousal, and sleep difficulties in college students.

Impact of Acid Suppression Therapy on Iron Supplementation in the Pediatric Intensive Care Unit.

OBJECTIVE: We assessed the impact of acid suppression therapy (i.e., ranitidine or proton pump inhibitors) on iron supplementation and its ability to maintain or alter laboratory values that are commonly associated with anemia. METHODS: This was a prospective, observational trial. The primary outcome was changes in serum iron levels from baseline. Secondary outcomes were changes in hemoglobin (Hgb) and hematocrit (Hct), transfusions, and maintenance of an alkalotic gastric pH. RESULTS: Thirty-four patients (mean 24 ± 43 months) met inclusion criteria. The serum iron levels increased to 50.9 ± 24.6 mcg/dL by day 3. The mean difference from baseline was 1.5 mcg/dL (95% CI, 1.14-1.98, p = 0.0056). Gastric pH increased to 4.68 ± 1.49 on day 5. The mean Hgb and Hct increased on day 5 to 10 ± 1.06 g/dL and 29.6% ± 3.27%, respectively. The mean difference of Hgb was 1.15 g/dL (95% CI, 0.51-1.78, p = 0.0009). The mean difference of Hct was 3.04% (95% CI, 1.11-4.97, p = 0.0032). CONCLUSIONS: The use of antacids along with oral ferrous sulfate supplementation did not affect the absorption of iron. Serum iron, Hgb, and Hct all showed statistically significant increases despite combined antacid and iron therapy. Thus, despite use of antacids, combination use showed increases in iron absorption.

Predictive ability of fine-needle aspirate cytology for incompletely resected mast cell tumor surgical sites.

The goal of this study was to evaluate whether fine-needle aspirate cytology of a previous surgical site was predictive of recurrence for incompletely excised mast cell tumors (MCTs). Electronic medical records were searched for dogs diagnosed with MCTs; those with histologically confirmed, incompletely resected MCTs evaluated by scar aspiration cytology within 60 days after surgery were included for analysis. Variables were compared between groups using Fisher's exact test and logistic regression. Twenty-nine cutaneous and 7 subcutaneous tumors were evaluated. Local recurrence, confirmed by either histopathology or cytology, occurred in 13.8% of cases. No significant differences were identified for any variables other than surgical site cytology status. The negative predictive value of surgical site aspirate cytology without residual mast cell tumor was 93.5%, with an overall predictive accuracy of 88.9%. For the dogs evaluated in this report, surgical site aspiration cytology was predictive of local disease control for incompletely resected MCTs.

Capacité prédictive de la cytologie d'aspiration à l'aiguille fine de sites de chirurgie de résection incomplète de mastocytomes. L'objectif de la présente étude était d'évaluer si la cytologie d'aspiration à l'aiguille fine d'un site chirurgical antérieur permettait de prédire une récurrence lors de l'excision incomplète d'un mastocytome (MCT). Les dossiers médicaux électroniques furent examinés pour trouver des chiens avec un diagnostic de MCT; ceux avec confirmation histologique d'un MCT avec résection incomplète évaluée par cytologie d'une aspiration de la cicatrice en dedans de 60 jours après la chirurgie furent inclus pour analyse. Les variables furent comparées entre les groupes en utilisant le test exact de Fisher et une régression logistique. Vingt-neuf tumeurs cutanées et sept tumeurs sous-cutanées furent évaluées. Une récurrence locale, confirmée par histopathologie ou cytologie, est survenue dans 13,8 % des cas. Aucune différence significative ne fut détectée pour les différentes variables autres que le statut de la cytologie du site chirurgical. La valeur prédictive négative de la cytologie d'une aspiration du site chirurgical sans cellule résiduelle du mastocytome était de 93,5 % avec une précision prédictive globale de 88,9 %. Pour les chiens examinés dans cette étude, la cytologie d'une aspiration du site chirurgical était prédictive d'une maîtrise locale de la maladie lors de résection incomplète d'un MCT.(Traduit par Dr Serge Messier).

Eating Behaviors in Relation to Child Weight Status and Maternal Education.

BACKGROUND: The eating behavior of children is important to maintain a healthy weight. This current study explored the differences in children's eating behaviors and their relation to weight status and maternal education level, using the child eating behavior questionnaire (CEBQ). METHODS: The study recruited 169 participants aged between six and ten years. Multinomial logistic regression was conducted to examine the association between the CEBQ factors and children's body weight status. The association between the CEBQ scores and maternal educational levels was examined using a one-way analysis of variance (ANOVA). RESULTS: The multinomial logistic regression findings indicate that children in the obese group exhibited a significant increase in food responsiveness, enjoyment of food, emotional overeating, and a decrease in satiety responsiveness compared to normal weight children. The one-way ANOVA showed a significant difference in subscales under the food approach (food responsiveness, desire to drink, emotional overeating) and food avoidance (satiety responsiveness) based upon the child's weight status. The three subscales under the food approach category were significantly dependent upon the maternal education but did not have a significant association with food avoidance. CONCLUSIONS: The results suggest that the increase in food responsiveness and emotional overeating in obese children is influenced by maternal education.

Identification and Investigation of Autolysin Genes in Clostridium saccharoperbutylacetonicum Strain N1-4 for Enhanced Biobutanol Production.

Biobutanol is a valuable biochemical and one of the most promising biofuels. Clostridium saccharoperbutylacetonicum N1-4 is a hyperbutanol-producing strain. However, its strong autolytic behavior leads to poor cell stability, especially during continuous fermentation, thus limiting the applicability of the strain for long-term and industrial-scale processes. In this study, we aimed to evaluate the role of autolysin genes within the C. saccharoperbutylacetonicum genome related to cell autolysis and further develop more stable strains for enhanced butanol production. First, putative autolysin-encoding genes were identified in the strain based on comparison of amino acid sequence with homologous genes in other strains. Then, by overexpressing all these putative autolysin genes individually and characterizing the corresponding recombinant strains, four key genes were pinpointed to be responsible for significant cell autolysis activities. Further, these key genes were deleted using CRISPR-Cas9. Fermentation characterization demonstrated enhanced performance of the resultant mutants. Results from this study reveal valuable insights concerning the role of autolysins for cell stability and solvent production, and they provide an essential reference for developing robust strains for enhanced biofuel and biochemical production.IMPORTANCE Severe autolytic behavior is a common issue in Clostridium and many other microorganisms. This study revealed the key genes responsible for the cell autolysis within Clostridium saccharoperbutylacetonicum, a prominent platform for biosolvent production from lignocellulosic materials. The knowledge generated in this study provides insights concerning cell autolysis in relevant microbial systems and gives essential references for enhancing strain stability through rational genome engineering.

Outcomes of Children Who Present to the Emergency Department After Hematopoietic Cell Transplantation.

OBJECTIVES: Our primary objective was to describe emergency department (ED) presentation, treatment, and outcomes for children after hematopoietic cell transplantation (HCT). Our secondary objective was to identify factors associated with serious infection in this population. METHODS: This is a retrospective review of HCT patients who presented to our university children's hospital ED from January 1, 2011, to June 30, 2013. Emergency department presentation, treatment, and outcomes were described. Descriptive statistics were used to compare children with definite serious infection with those without serious infection. Multiple binary logistic regression was performed for risk factors associated with definite serious infection. RESULTS: Fifty-four HCT patients (132 encounters) presented to our ED. Most were transplanted for a malignant (46%) or metabolic (36%) diagnosis and were recipients of bone marrow (51%) or umbilical cord blood (45%). Fever was the most common complaint (25%). Emergency department laboratory (64%) or imaging (58%) studies were frequently obtained. Admission was common (n = 70/132, 53%), with 79% (n = 55) of admissions to intensive care or bone marrow transplant units. Thirty-five encounters had definite serious infection, 5 had probable serious infection, and 92 had no serious infection. Fever (P < 0.001) and high-risk white blood cell (WBC) count of less than 5 or greater than 15 k/µL (P < 0.001) were associated with definite serious infection. Fever (odds ratio = 8.84, 95% confidence interval = 2.92-26.73) and high-risk WBC (odds ratio = 6.67, 95% confidence interval = 2.24-19.89) remained significantly associated with definite serious infection in our regression model. CONCLUSIONS: Children presenting to the ED after HCT require extensive support and resources, with more than half requiring admission. Fever and high-risk WBC are associated with serious infection.

National trends in prescription proton pump inhibitor use and expenditure in the United States in 2002-2017.

OBJECTIVES: In the United States, proton pump inhibitors (PPIs) are one of the most commonly prescribed classes of drugs, but contemporary data on national-level utilization patterns for PPI use are limited. This study examined the trends in prescription PPI use and expenditures, overall and by patient subgroups, and identified predictors of PPI use. METHODS: Prescription PPI use was identified from the 2002-2017 Medical Expenditure Panel Survey data using the brand and generic names. Trends in PPI use were examined overall and by patients' sociodemographic characteristics and disease status. Trends in brand and generic PPI users and total and average PPI expenditures were also examined. A multivariable model was used to identify patient factors associated with PPI use. RESULTS: The overall proportion of PPI users increased from 5.70% in 2002-2003 to 6.73% in 2016-2017 (P value = 0.011). Increased trends in PPI use were observed among U.S. adults aged 65 years and older, both males and females, non-Hispanic whites, non-Hispanic blacks, Hispanics, Asians, in all 4 geographic regions, with public health insurance, and those who were obese (all P value < 0.05). Whereas PPI use increased significantly, the average PPI expenditure per patient decreased significantly. Multivariable results found that participants who were aged 25 years or older, were female, were non-Hispanic whites, resided in the Northeast, had higher incomes, had public or private health insurance, were obese, were married had a higher likelihood of using PPIs. CONCLUSION: Increased PPI use was observed among most of the patient subgroups. Understanding the utilization patterns of PPIs could help practitioners identify potential treatment disparities and monitor the safety of PPI use.

Aortic to caudal vena cava ratio measurements using abdominal ultrasound are increased in dogs with confirmed systemic hypertension.

Chronically sustained systemic hypertension in dogs can damage the kidneys, eye, brain, heart, and vessels. In human medicine, systemic hypertension has been implicated as the most common risk factor for aorta dilation, which can progress to an aneurysm. Abdominal ultrasound has been commonly used to monitor the size of the abdominal aorta in people with systemic hypertension. In this retrospective cross-sectional abdominal ultrasound study, evaluation of the size of the abdominal aorta relative to the caudal vena cava was performed in 18 control dogs and 128 dogs with confirmed systemic hypertension. Preexisting conditions contributing to systemic hypertension in these dogs were renal disease, hyperadrenocorticism, diabetes mellitus, adrenal tumors, and previous administration of phenylpropanolamine or palladia. The abdominal aorta and caudal vena cava were assessed from longitudinal images cranial to the trifurcation with measurements made from outer border to outer border of the walls, being careful not to compress the caudal vena cava that would alter its size. Our hypothesis was the ratio of the diameter of the abdominal aorta to caudal vena cava would be higher in dogs with systemic hypertension compared to dogs with normal blood pressure. The mean abdominal aorta-caudal vena cava ratio was 1.028 in control dogs with a normal blood pressure and 1.515 in dogs with systemic hypertension. In dogs with confirmed systemic hypertension, the abdominal aorta was dilated compared to the caudal vena cava in the caudal abdomen. An increase in the abdominal aorta-caudal vena cava ratio in a dog should raise suspicion for the presence of systemic hypertension and prompt evaluation of blood pressure.

Retrospective evaluation of serum/plasma iron, red blood cell distribution width, and nucleated red blood cells in dogs with acute trauma (2009-2015): 129 cases.

OBJECTIVE: To compare the prognostic value of admission hematologic parameters serum/plasma iron, red blood cell distribution width (RDW), and nucleated red blood cells (nRBCs) in dogs presenting with acute traumatic injury. DESIGN: Retrospective observational study (2009-2015). SETTING: University teaching hospital. ANIMALS: One hundred and twenty-nine clinical dogs presenting within 24 hours of acute traumatic injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred and twenty-nine dogs met the inclusion criteria and 109 (84.5%) survived, while 20 (15.5%) died or were euthanized in hospital. Patients with blunt force trauma comprised 79.8% of the patient population; dogs with penetrating trauma comprised 20.2% of cases. Hypoferremia occurred in all nonsurvivors, and the median serum/plasma iron concentration was significantly lower in nonsurvivors than survivors (P = 0.028). Normal or increased serum/plasma iron had 100% specificity and 100% positive predictive value for survival. Red blood cell distribution width was not significantly different between groups (P = 0.417). The presence of nRBCs was significantly associated with nonsurvival (P = 0.030), although the absolute nRBC concentrations were not significantly different (P = 0.070). A multiple logistic regression model found age, type of injury, presence of nRBCs, and serum/plasma iron to be independent predictors of survival with an area under the receiver operator characteristic curve of 0.813. CONCLUSIONS: The presence of nRBCs and low serum/plasma iron are associated with mortality in patients with acute trauma; however, red blood cell distribution width was not associated with survival. Absence of hypoferremia was highly associated with a favorable prognosis in this patient population. These parameters may warrant inclusion in trauma scoring systems.

Influence of Sweep Length on Rice Stink Bug (Hemiptera: Pentatomidae) Capture and Reliability of Population Density Estimates.

The rice stink bug, Oebalus pugnax (F.), is a key pest of heading rice, Oryza sativa L. (Poales: Poaceae), in the southern United States. Sweep net sampling is the recommended method for sampling rice stink bug in rice, but there currently exists no specific recommendation for sweep length, and a large amount of variation likely exists amongst samplers. The objectives of this study were to determine the role that sweep length plays in sampling accuracy and determine the feasibility of using sweep lengths smaller than 180°. When monitoring sweep lengths by consultants, producers, and researchers, a large amount of variation in sweep length and a significant linear relationship between sweep length and rice stink bug catch per 10 sweeps was observed. Sweep length was then controlled at three levels (0.8, 1.8, and 3.5 m) and a change from 0.8 to 1.8 m in sweep length led to an increase on average of 2.28 rice stink bugs per 10 sweeps. These data suggest knowledge of sweep length is vital, and paired with large amounts of observed variation in sweep length, recommending a specific sweep length is ideal. Using Taylor's values, it was determined that 1.8 m sweeps resulted in density estimates that were as reliable as 3.5 m (180°) sweeps, suggesting a longer sweep length was not necessary. A 1.8 m sweep length recommendation would create an easier sampling regimen that is still reliable, which could lead to more accurate action threshold decisions being made for rice stink bug if it increases adoption in consultants and producers.

Comprehensive Clinical and Laboratory Follow-up of a Female Patient With Ebola Virus Disease: Sierra Leone Ebola Virus Persistence Study.

The clinical, virologic, and immunologic findings in a female Ebola virus disease patient are described. During the long-term follow-up, Ebola virus RNA was detectable in vaginal fluid before 36 days after symptom onset, with nearly an identical genome sequence as in acute phase blood. Ebola-specific T cells retained activation at 56 days after disease onset.

Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review.

BACKGROUND: Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease. OBJECTIVE: Document outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association-recognized programs. DESIGN: Descriptive, retrospective chart review. PARTICIPANTS/SETTING: Four random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained. OUTCOME MEASURES: Weight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio. ANALYSIS: Mixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters. RESULTS: Significant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001). CONCLUSIONS: Reductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

Delay discounting and its association with food purchasing considerations and food availability in the home in south-east Alabama, USA.

OBJECTIVE: Certain factors, such as food quality, label content and grocery characteristics, may be considered when purchasing foods. Food availability in the home has been shown to influence dietary behaviours, also associated with delay discounting (DD). The present study sought to characterize the relationships between DD, food purchasing considerations and healthfulness of foods in the home. DESIGN: A cross-sectional, online survey of adults (n 477) was conducted with the following measures: DD, consideration of food quality (nutrition, taste) and grocery characteristics (price, ease of preparation, shelf-life) while shopping, use of food labels and food availability in the home. DD was assessed by the area under the delay discounting curve (AUC) using a binary choice task. Greater AUC reflects lower DD. Structural equation modelling was used to allow AUC to simultaneously predict purchasing considerations and foods in the home. SETTING: Online survey.ParticipantsAdult employees in south-east Alabama, USA. RESULTS: DD was negatively associated with food label use and emphasis on food quality when shopping (P<0·001). In the final model, DD was associated with availability of healthful foods in the home and emphasis on food quality and grocery characteristics. About 33 % of the variance in shopping behaviours, 5 % in food label use, 7 % in availability of healthful foods and 4 % in availability of unhealthful foods was explained by DD. CONCLUSIONS: Individuals with lower DD appear to be more thoughtful in making food purchasing decisions and have healthful foods available in the home more frequently than individuals with higher DD.

Ambulatory care preceptors' perceptions on SOAP note writing in advanced pharmacy practice experiences (APPEs).

INTRODUCTION: Descriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs. METHODS: A survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types. RESULTS: The survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%. CONCLUSIONS: Preceptors' perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.

Decreased Pseudomonas aeruginosa detection in children after separation of pediatric from adult cystic fibrosis clinics: A single center experience.

BACKGROUND: The impact of separating the adult from pediatric patients on Pseudomonas aeruginosa (P. aeriginosa) detection in the respiratory cultures of patients was examined at the University of Minnesota CF Center. METHODS: This study was a retrospective review using data recorded in the University of Minnesota CF Database between 1995 and 2010. Respiratory culture results obtained during routine University of Minnesota Cystic Fibrosis (CF) Center. CF clinic encounters of two cohorts of pediatric and adult CF patients (pre- and post-separation) were analyzed for presence of P. aeruginosa. RESULTS: The odds of a pediatric patient having P. aeruginosa were significantly less if the first culture was obtained after separation of pediatric and adult clinics. Being diagnosed by newborn screening or introduction of inhaled tobramycin did not affect this outcome. This reduction in P. aeruginosa was not detected in the adult cohort. CONCLUSIONS: Separation of pediatric and adult CF clinics has contributed to decrease in P. aeruginosa detection in pediatric patients.

Low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism.

BACKGROUND: Low-dose ACTH stimulation testing would lower cost and may increase sensitivity for identification of partial ACTH deficiency. HYPOTHESIS: (1) The low-dose ACTH stimulation test will provide comparable results to the standard-dose ACTH stimulation test in dogs suspected of hypoadrenocorticism and (2) partial ACTH deficiency exists in dogs and can result in chronic, intermittent gastrointestinal signs. ANIMALS: Thirty-one client-owned dogs suspected of having hypoadrenocorticism. METHODS: Prospective study. Dogs suspected of having hypoadrenocorticism received 1 µg/kg cosyntropin IV for the first ACTH stimulation test; the second test was performed 4 h later and dogs received 5 µg/kg cosyntropin IV. Blood samples were obtained pre-ACTH and 1 hour post-ACTH for each dose (4 measurements total). Samples for endogenous ACTH measurement were obtained at the time of initial blood collection. RESULTS: No significant difference was observed in the basal cortisol concentration before administration of a 1 µg/kg versus before a 5 µg/kg dose of cosyntropin (P = .544). For dogs suspected of having hypoadrenocorticism, the ACTH-stimulated cortisol concentrations in response to both doses of ACTH were equivalent (90% confidence interval [CI], 80.5-97.2%; P = .04). No cases with partial ACTH deficiency were identified conclusively. CONCLUSIONS AND CLINICAL IMPORTANCE: A 1 µg/kg dose of cosyntropin is equivalent to a 5 µg/kg dose of cosyntropin for screening dogs suspected of hypoadrenocorticism. The existence of partial ACTH deficiency was not identified in this small group of dogs.

Use of the Animal Trauma Triage Score, RibScore, Modified RibScore and Other Clinical Factors for Prognostication in Canine Rib Fractures.

OBJECTIVES: To characterize the clinical features among dogs sustaining rib fractures and to determine if age, type and severity of injury, entry blood lactate, trauma score and rib fracture score were associated with outcome. METHODS: A retrospective study was performed to include dogs that were presented with rib fractures. Risk factors evaluation included breed, age, body weight, diagnosis, presence of a flail chest, bandage use, puncture wound presence, rib fracture number, location of the fracture along the thoracic wall, hospital stay length, body weight, other fractures, pleural effusion, pulmonary contusions, pneumothorax and occurrence of an anaesthetic event. A retrospective calculation of an animal trauma triage (ATT) score, RibScore and Modified RibScore was assigned. RESULTS: Forty-one medical records were collected. Motor vehicular trauma represented 56% of the rib fracture aetiology, 41% of patients sustained dog bites and one case was of an unknown aetiology. Significant correlations with risk factors were found only with the ATT score. All patients that died had an ATT score ≥ 5. The ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% sensitive and 81% specific for predicting mortality. A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival. Mean hospital stay was 3 days longer for dog bite cases. CLINICAL SIGNIFICANCE: There was no increased mortality rate in canine patients that presented with the suspected risk factors. The only risk factor that predicted mortality was the ATT score.

Effect of blood contamination on results of dipstick evaluation and urine protein-to-urine creatinine ratio for urine samples from dogs and cats.

OBJECTIVE To evaluate effects of blood contamination on dipstick results, specific gravity (SG), and urine protein-to-urine creatinine ratio (UPCR) for urine samples from dogs and cats. SAMPLE Urine samples collected from 279 dogs and 120 cats. PROCEDURES Urine pools were made for each species (dogs [n = 60] and cats [30]). Blood was added to an aliquot of a pool, and serial dilutions were prepared with the remaining urine. Color and dipstick variables were recorded, and SG and UPCR were measured. For cats, 1 set of pools was used; for dogs, 2 sets were used. Comparisons were made between undiluted urine and spiked urine samples for individual colors. Repeated-measures ANOVA on ranks was used to compare dipstick scores and UPCR results; χ2 tests were used to compare proteinuria categorizations (nonproteinuric, borderline, or proteinuric). RESULTS Any blood in the urine resulted in significantly increased dipstick scores for blood. In both species, scores for bilirubin and ketones, pH, and SG were affected by visible blood contamination. No significant difference for the dipstick protein reagent results was evident until a sample was visibly hematuric. The UPCR was significantly increased in dark yellow samples of both species. Proteinuria categorizations differed significantly between undiluted urine and urine of all colors, except light yellow. CONCLUSIONS AND CLINICAL RELEVANCE Any degree of blood contamination affected results of dipstick analysis. Effects depended on urine color and the variable measured. Microscopic blood contamination may affect the UPCR; thus, blood contamination may be a differential diagnosis for proteinuria in yellow urine samples.

Study on the persistence of Zika virus (ZIKV) in body fluids of patients with ZIKV infection in Brazil.

BACKGROUND: Zika virus (ZIKV) has been identified in several body fluids of infected individuals. In most cases, it remained detected in blood from few days to 1 week after the onset of symptoms, and can persist longer in urine and in semen. ZIKV infection can have dramatic consequences such as microcephaly and Guillain-Barré syndrome. ZIKV sexual transmission has been documented. A better understanding of ZIKV presence and persistence across biologic compartments is needed to devise rational measures to prevent its transmission. METHODS: This observational cohort study will recruit non-pregnant participants aged 18 years and above with confirmed ZIKV infection [positive reverse transcriptase-polymerase chain reaction (RT-PCR) test in blood and/or urine]: symptomatic men and women in ZIKV infection acute phase, and their symptomatic or asymptomatic household/sexual infected contacts. Specimens of blood, urine, semen, vaginal secretion/menstrual blood, rectal swab, oral fluids, tears, sweat, urine and breast milk (if applicable) will be collected at pre-established intervals and tested for ZIKV RNA presence by RT-PCR, other co-infection (dengue, Chikungunya, HIV, hepatitis B and C, syphilis), antibody response (including immunoglobulins M and G), plaque reduction neutralization test (if simultaneously positive for ZIKV and dengue), and ZIKV culture and RNA sequencing. Data on socio-demographic characteristics and comorbidities will be collected in parallel. Participants will be followed up for 12 months. DISCUSSION: This prolonged longitudinal follow-up of ZIKV infected persons with regular biologic testing and data collection will offer a unique opportunity to investigate the presence and persistence of ZIKV in various biologic compartments, their clinical and immunological correlates as well as the possibility of ZIKV reactivation/reinfection over time. This valuable information will substantially contribute to the body of knowledge on ZIKV infection and serve as a base for the development of more effective recommendation on the prevention of ZIKV transmission. TRIAL REGISTRATION: NCT03106714 . Registration Date: April, 7, 2017.