Multicenter Study of Clinical Presentation, Treatment, and Outcome in 41 Dogs With Spinal Epidural Empyema.

There is limited information on canine spinal epidural empyema (SEE). The aim of this multicenter retrospective study is to describe the clinical presentation and outcome of dogs undergoing spinal surgery or conservative management for SEE. Forty-one dogs met the inclusion criteria; the SEE was treated surgically in 17 dogs and conservatively in 24 dogs. Two dogs underwent spinal surgery after failure of conservative management, meaning that 19 dogs in total had spinal surgery. Long-term (i.e., >6 months) follow-up was available in 35 dogs (19 conservatively treated and 16 surgically treated dogs). Recovery to a functional pet status was achieved in 15/19 (78.9%) conservatively treated and 12/16 (75%) surgically treated dogs. There was no significant difference (p = 1.000) in long-term outcome between conservatively and surgically treated dogs (78.9 and 75%, respectively). However, significantly more surgically treated dogs were non-ambulatory at presentation (9/17 vs. 5/24, p = 0.048) compared with conservatively treated dogs. This study suggests that conservative treatment may be appropriate for dogs with SEE that are ambulatory at presentation and that surgically treated dogs generally have good outcomes. Age may be a negative prognostic indicator as dogs with poor long-term outcomes were significantly older than dogs with a good long-term outcome (p = 0.048). A larger prospective randomized study may provide further insight on treatment and outcome of SEE in dogs.

Clinical presentation, MRI, histopathology and outcome in a cat with immune-mediated masticatory myositis.

CASE SUMMARY: A 4-year-old female spayed domestic shorthair cat was presented with facial swelling, ocular discharge and intermittent bilateral exophthalmos. Haematology revealed mild eosinophilia. Serum biochemistry showed a markedly elevated creatine kinase activity. MRI of the head revealed diffuse and severe changes of the masticatory muscles, including irregular areas compatible with fluid or necrosis within the abnormal muscle tissue. Cytological analysis of the left temporal muscle revealed eosinophilic and macrophagic inflammation. Bacterial and fungal cultures were negative. Serological titres against Toxoplasma gondii were compatible with previous exposure. A canine ELISA against masticatory muscle type IIM fibre proteins was positive at 1:4000 (reference interval <1:100). Histopathological examination of the left temporalis muscle revealed moderately severe and multifocal myositis. A diagnosis of immune-mediated masticatory myositis was made and immunosuppressive therapy was started. The cat initially responded to tapering doses of prednisolone, but subsequent relapses required therapy modulation. At the time of writing, 27 months after the initial diagnosis, the cat was in remission, but was diagnosed with diabetes mellitus, probably secondary to chronic glucocorticoid use. RELEVANCE AND NOVEL INFORMATION: To our knowledge, this is the first case report to describe the MRI appearance of masticatory myositis in a cat and the second to describe the clinical presentation, histopathology, response to treatment and outcome in a cat with this condition.

Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails.

Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-µm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.

Interaction of atrial fibrillation and antithrombotics on outcome in intracerebral hemorrhage.

OBJECTIVE: To analyze the clinical differences between patients with primary intracerebral hemorrhage (ICH) with and without atrial fibrillation (AF) and assess whether the effect of the antithrombotic pretreatment on outcome is modified by the presence of AF. METHODS: In this prospective observational study, researchers from 2 university hospitals included 1,106 consecutive patients with ICH. Clinical characteristics were described and stratified by presence of AF. In-hospital and 3-month mortality and 3-month disability were analyzed, considering antithrombotic pretreatment (none, antiplatelets, or oral anticoagulants) and AF (yes/no). RESULTS: AF was present in 21.9% of primary ICH cases. Patients with AF-ICH were older, with more vascular risk factors, more antithrombotic pretreatment, higher clinical severity, higher hematoma volume, and higher in-hospital and 3-month mortality. Do-not-resuscitate orders were applied more frequently in AF-ICH cases. After 2 different adjustment models, mortality remained significantly higher in patients with AF-ICH. However, after introducing previous antithrombotic treatment in the model, the adjusted odds ratio for 3-month mortality was 1.45 (95% confidence interval 0.74-2.85, p = 0.284) for patients with AF-ICH compared with non-AF cases. AF modified the effect of antithrombotic pretreatment on in-hospital (p int = 0.077) and 3-month mortality (p int = 0.008). Among patients without AF, antithrombotic pretreatment increased mortality; no effect was observed in patients with AF-ICH. CONCLUSIONS: Patients with AF and ICH had increased mortality; however, AF had no independent effect on mortality after adjustment for antithrombotic pretreatment. Conversely, antithrombotic pretreatment had a deleterious effect on outcome in patients with ICH without AF, but no detectable effect in patients with AF with ICH.

Clinical and genetic characterisation of dystrophin-deficient muscular dystrophy in a family of Miniature Poodle dogs.

Four full-sibling intact male Miniature Poodles were evaluated at 4-19 months of age. One was clinically normal and three were affected. All affected dogs were reluctant to exercise and had generalised muscle atrophy, a stiff gait and a markedly elevated serum creatine kinase activity. Two affected dogs also showed poor development, learning difficulties and episodes of abnormal behaviour. In these two dogs, investigations into forebrain structural and metabolic diseases were unremarkable; electromyography demonstrated fibrillation potentials and complex repetitive discharges in the infraspinatus, supraspinatus and epaxial muscles. Histopathological, immunohistochemical and immunoblotting analyses of muscle biopsies were consistent with dystrophin-deficient muscular dystrophy. DNA samples were obtained from all four full-sibling male Poodles, a healthy female littermate and the dam, which was clinically normal. Whole genome sequencing of one affected dog revealed a >5 Mb deletion on the X chromosome, encompassing the entire DMD gene. The exact deletion breakpoints could not be experimentally ascertained, but we confirmed that this region was deleted in all affected males, but not in the unaffected dogs. Quantitative polymerase chain reaction confirmed all three affected males were hemizygous for the mutant X chromosome, while the wildtype chromosome was observed in the unaffected male littermate. The female littermate and the dam were both heterozygous for the mutant chromosome. Forty-four Miniature Poodles from the general population were screened for the mutation and were homozygous for the wildtype chromosome. The finding represents a naturally-occurring mutation causing dystrophin-deficient muscular dystrophy in the dog.

Aplicación de un modelo híbrido de aprendizaje basado en problemas como estrategia de evaluación e interrelación ‘multiasignaturas’ / Application of a hybrid model of problem-based learning as a strategy for assessment and the integration of ‘multiple subjects’

Se ha diseñado e implementado un modelo 'híbrido' de aprendizaje basado en problemas (ABP) como estrategia de enseñanza, evaluación e interrelación de las asignaturas de 'Fisiopatogenia' y 'Semiología' del grado de medicina de la Universitat Internacional de Catalunya. El modelo hibrido ha sido diseñado sobre la plataforma de tecnología de la información Moodle que facilita su desarrollo con menos recursos. El ABP implementado funciona como una actividad integradora que trata de fomentar el desarrollo de competencias transversales y el pensamiento complejo, en un entorno de aprendizaje activo. Promueve en el estudiante la construcción de su propio conocimiento para el desarrollo de competencias como el razonamiento clínico y la toma de decisiones, al tiempo que posibilita la integración de los conocimientos procedentes de distintas asignaturas. Los resultados de este trabajo han reflejado un alto grado de satisfacción del alumnado con la metodología fundamentada en el ABP, habiéndose logrado una participación activa en el proceso enseñanza aprendizaje

A 'hybrid' model of problem-based learning (PBL) was designed and implemented as a teaching strategy, assessment and means to integrate knowledge related to the subjects 'Physiopathogenesis' and 'Semiotics' of Medicine in the Universitat Internacional de Catalunya. The hybrid model was designed within the e-learning platform, Moodle, which facilitates the development of PBL methodology but with fewer resources. PBL functions as an integrative activity which seeks to promote development of generic skills and complex thought in an active learning environment. PBL encourages students to construct their own knowledge for the development of skills such as clinical reasoning and decision-making, while enabling the integration of knowledge from different subjects. The outcomes of this project indicate a high degree of student satisfaction with this PBL-based methodology as has been manifested by the achievement of active participation in the teaching-learning process

Estudio sobre la prevalencia de alteraciones morfo-estructurales de las extremidades inferiores en corredores afectados por el síndrome de la cintilla iliotibial / Study on the prevalence of morphostructural alterations of the lower extremities in runners affected by iliotibial band syndrome

Se practica estudio sobre la prevalencia de alteraciones morfoestructurales de las extremidades inferiores en corredores afectados por el síndrome de la cintilla iliotibia. Participan 19 sujetos diagnosticados por el síndrome de la cintilla iliotibial a los que se les práctica test de confirmación de diagnóstico, exploración goniométrica de la rodilla y del pie, así como un examen baropodométrico. Se realizan también encuestas acerca de la intensidad del dolor y el tiempo que tarda el dolor en aparecer durante la actividad física. Se concluye que el 100% de los sujetos presenta algún tipo de alteración morfoestructural o funcional de las extremidades inferiores (AU)

Study is performed on the prevalence of morphostructural alterations of the lower limbs in runners affected by the syndrome iliotibia streak. Involved 19 subjects diagnosed by iliotibial band syndrome, those who underwent diagnostic confirmation test, goniometer scan of the knee and foot, and a baropodometric review. Surveys about pain intensity, pain takes time to appear during physical activity were made. We conclude that 100% of the subjects have some form of alteration, functional or morphostructural of the lower extremities (AU)

Estudio evolutivo sobre el período posquirúrgico en la técnica de Ogalla / Evolutionary study on postoperative period in the art of Ogalla

Introducción: La onicocriptosis es una afección frecuente de la lámina ungueal, que cursa con dolor e inflamación del canal lateral de la uña, en la que el extremo distal de ésta interacciona de una forma anormal con el surco ungueal lateral o medial, o con ambos, clavándose y en ocasiones produciendo infección. Existen numerosas técnicas quirúrgicas para solucionar la onicocriptosis, aunque nos vamos a centrar en las técnicas de las matricectomías químicas modificación por Ogalla, siendo el objetivo realizar una descripción del periodo posquirúrgico en pacientes operados de onicocriptosis para valorar su buena evolución clínica en este periodo postoperatorio. •Material y método: Se realizó un estudio de observación, descriptivo y prospectivo sobre una serie de 32 casos clínicos operados de onicocriptosis en un canal ungueal, sin coexistencia de exóstosis subungueal en el quirófano de nuestra clínica, donde se analizó el número de días de postoperatorio, el número de curas, el número de recidivas y quistes posquirúrgicos, y el número de infecciones en este periodo. Se obtuvieron los resultados mediante una hoja de recogida de datos durante un periodo posquirúrgico de dos meses. •Resultados: Al finalizar los dos meses de seguimiento mostraron una excelente evolución clínica en el periodo posquirúrgico de todas las variables analizadas en la técnica de cirugía ungueal de Ogalla para solucionar la patología de onicocriptosis. •Conclusiones: El análisis de los resultados obtenidos sobre las diferentes variables a estudio avala la hipótesis de que el periodo posquirúrgico en la técnica de la matricectomía química modificada por Ogalla ofrece una evolución clínica más satisfactoria(AU)

Introduction: Onycochryptosis is a common form of a nail disease that can result in pain and/or inflammation of the lateral edge of the toenail, where its distal edge interacts in an abnormal way with the medial or lateral nail groove, or both, digging into the skin and causing infection. There exist different surgical techniques in order to solve this condition; however, we are going to focus on the Ogalla’s technique. The objective is to describe the postoperative course on those patients who underwent this operation, in order to assess their clinical evolution over that period. •Material and methods: We conducted a prospective descriptive observational study in our clinic, with 32 clinical cases that underwent ingrown toenail surgery of one nailfold without presenting subungual exostoses. The postoperative days, the number of cures, the number of recurrences, the postoperative cysts and the number of infections during this period of time were analysed. Data was obtained during the 2 months of the postoperative period. •Results: After a follow-up period of 3 months, all the analysed variables showed an excellent clinical evolution of the postoperative course using Ogalla’s technique. •Conclusions: The results of the studied variables support the hypothesis that Ogalla’s technique offers a very satisfactory postoperative clinical evolution(AU)

Severe nucleoside-associated lactic acidosis in human immunodeficiency virus-infected patients: report of 12 cases and review of the literature.

Lactic acidosis is a rare but often fatal complication reported in some human immunodeficiency virus (HIV)-infected patients treated with nucleoside-analogue reverse-transcriptase inhibitors. We report a series of 12 patients with HIV infection treated with nucleoside analogues who developed unexplained metabolic acidosis. We have also reviewed 60 additional published cases. The aim of the present study is to describe the clinical picture, prognostic factors, and final outcome for nucleoside-associated lactic acidosis. The mortality rate is high: 33% for our patients, and 57% for the patients described in the literature. In the multivariate analysis, a lactate serum level of >10 mM (odds ratio [OR], 13.23; 95% confidence interval [CI], 2.96-59.25) was the only factor associated with higher mortality. The administration of specific therapy with cofactors against acidosis was associated with a lower mortality (OR, 0.17; 95% CI, 0.04-0.73). We conclude that specific therapy with cofactors may improve the outcome for patients with this syndrome.