Two-year multidisciplinary follow-up of COVID-19 patients requiring invasive and noninvasive respiratory support

BACKGROUND

COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV).

METHODS

Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan.

RESULTS

Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes.

CONCLUSIONS

Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.

Thymus and meat physicochemical measurements to discriminate calves treated with anabolic and therapeutic doses of dexamethasone

To preserve the Europe consumers' health, the use of glucocorticoids as growth promoters is prohibited in cattle fattening. In 2008, the Italian Ministry of Health associated to the official control a national monitoring plan based on the histological thymus analysis to identify animals illegally treated with corticosteroids. However, since corticosteroids are authorized and widely used for therapeutic purposes, it is necessary to verify whether the thymus histological test and some physicochemical traits in meat are able to discriminate doped calves from dexamethasone therapeutic treated ones. The aims of this study were (i) to establish whether the therapeutic and illicit corticosteroid treatments of calves could be differentiated through histological evaluation of thymus and by physicochemical meat traits; (ii) to identify a restricted number of physicochemical traits that could differentiate dexamethasone treated from untreated calves. Three groups of 15 calves each were included in this study: group dexamethasone therapeutic treatment treated with dexamethasone 21-phosphate disodium salt at a therapeutic dose (2 mg/kg of live weight for three consecutive days); group dexamethasone anabolic treatment orally treated with dexamethasone 21-phosphate disodium salt according to a presumed anabolic protocol (0.4 mg/day per animal for 20 days); group placebo control treated with a placebo served as control. Results demonstrated that groups could be easily discriminated by thymus microscopy as well as by two meat markers, namely, cooking loss and shear firmness or Warner-Bratzler shear force. The combination of thymus microscopic features and meat physicochemical traits could be used as a practical, economic and accurate screening strategy to discriminate between meat from illegally and therapeutically treated calves. This new reliable and simple tool could contribute to identify animals treated with dexamethasone in those countries where glucocorticoids are illegally used as growth promoters. More in general, this system could be included in the framework of official controls, and applied to verify suppliers' reliability by the meat industry.

Clinicopathologic and prognostic factors in short- and long-term surviving dogs with protein-losing enteropathy

INTRODUCTION

The aim of the present study was to investigate the differences in the characteristics of short- and long-term surviving dogs with protein-losing enteropathy (PLE) and to identify factors that predict its outcome. We retrospectively reviewed the medical records of 59 client- owned dogs with PLE diagnosed at three different hospitals between January 2009 and November 2013. The dogs were classified as either short-term (= 6 months; STs) or long-term (> 6 months; LTs) survivors. Clinical and clinicopathological variables were investigated between the groups and receiver operating characteristic (ROC) curve analysis was performed. Nineteen dogs were classified as STs and 40 as LTs. Body weight and blood urea nitrogen concentrations were significantly higher in the STs at diagnosis (P < 0.05). At 1 month after initiation of immunosuppressive therapy (data- driven cut-off, T1), chronic canine enteropathy clinical activity index (CCECAI) scores were higher (P < 0.01) and albumin, serum total protein and total cholesterol concentrations were lower (P < 0.01) in the STs. ROC curve analysis showed that CCECAI > 5 evaluated at T1 was the best predictor of poor outcome. Although the severity of clinical signs and the majority of clinicopathological findings at diagnosis did not influence the outcome, survival time was shorter in the dogs with high CCECAI scores at T1 and which did not respond to therapy.

An unusual case of intestinal leiomyositis in a Bernese mountain dog

A 1-year-old, female Bernese mountain dog was presented to the Veterinary Teaching Hospital of Turin University with a 3-month history of weight loss, intermittent anorexia, vomiting, constipation, and abdominal distension. Full-thickness biopsies from the stomach, duodenum, jejunum and ileum were collected for histological and immunohistochemical examination. Microscopic lesions displayed severe diffuse degeneration and loss of leiomyocytes, with lymphocytic leiomyositis, fibroplasia, angiogenesis, severe diffuse neuronal atrophy, and ganglioneuritis in the myenteric (Auerbach's) plexus. A diagnosis of chronic idiopatic intestinal pseudo-obstruction was made. Response to immunosuppressive therapy was poor and the dog was humanely euthanized. Unique findings were mononuclear infiltration composed predominantly of B-cell, angiogenesis and weak immunoreactivity for neuron-specific enolase.

Clinical-pathological findings of otitis media and media-interna in calves and (clinical) evaluation of a standardized therapeutic protocol

Background

The aims of this field trial were to describe the clinical-pathologic findings in calves with otitis media (OM) and media-interna (OMI), to evaluate, through the development of a scoring system, the effectiveness of a standardized therapeutic protocol, and to identify the causative pathogens and their possible correlation with concurrent respiratory disease. All animals underwent physical and neurological examinations at three experimental time points: at diagnosis/beginning of treatment (T0), 1 week (T1) and 2 weeks (T2) after therapy was started, respectively. Follow-up telephone interviews with animal owners were conducted 1 month later. The therapeutic protocol consisted of tulathromycin (Draxxin®; Zoetis), oxytetracycline hydrochloride (Terramicina 100®; Zoetis), and carprofen (Rimadyl®; Zoetis).

Results

Twenty-two calves were enrolled. Physical and otoscopic examination at T0 revealed monolateral and bilateral otorrhea in 16 and 6 calves, respectively, with peripheral vestibular system involvement in calves presenting with neurological signs (n = 17; 77 %). A significant improvement of clinical and neurological scores was observed in 20 (90 %) calves, a full recovery in only 1 (5 %). One calf worsened between T0 and T1 and it was removed from the study. None of the other animals showed a worsening of clinical conditions and/or required further treatments at one month follow up. Mycoplasma bovis was isolated in 89 % of the affected ears either alone or together with P. multocida (n = 5), Streptococcus spp. (n = 1), Staphylococcus spp. (n = 1), and Pseudomonas spp. (n = 1). M. bovis either alone or together with these bacteria was also isolated from the upper and/or lower respiratory tract in 19 (86 %) calves.

Conclusions

This is the first prospective study to evaluate the effectiveness of a standardized therapeutic protocol for the treatment of OM/OMI in calves. The therapy led to clinical improvement in the majority of the calves. Persistence of mild clinical-neurological signs did not compromise productive performance. The numerical scoring system for clinical and neurological signs permitted objective evaluation of response to therapy. M. bovis was the pathogen most often isolated. This finding should be considered in the treatment of OM/OMI in calves. Moreover, respiratory tract infection should not be underrated, since it is one of the major risk factors for the development of OM/OMI.

Analysis of cerebrospinal fluid from cattle with central nervous system disorders after storage for 24 hours with autologous serum

BACKGROUND

We compared the changes in cell morphology, total and differential cell counts between cerebrospinal fluid (CSF) samples analyzed within an hour of collection (fresh sample) and after the addition of autologous serum and storage for 24 h (stored sample) in 27 cattle with central nervous system disorders.

RESULTS

There was a positive linear correlation between total and differential cell counts in the fresh and the stored samples. Cell morphology was preserved in all stored samples, except for increased vacuolization of mononuclear cells and cleaved nuclei of some small mononuclear cells. In the stored CSF samples, the total nucleated cell count and monocyte percentage were decreased (P = 0.01; P = 0.03), while the lymphocyte percentage was increased (P = 0.04). Mononuclear pleocytosis diagnosed in 20 fresh samples was cytologically confirmed in 12 of the 20 stored samples. In the remaining eight stored samples, the number of total nucleated cells was within the normal range. Neutrophilic pleocytosis was confirmed in all seven stored samples. The overall agreement rate between cytologic interpretation of the fresh and the stored CSF samples was 70 % (100 % for neutrophilic pleocytosis and 60 % for mononuclear pleocytosis).

CONCLUSIONS

Adding 11 % of autologous serum to CSF samples might allow delayed analysis with a good agreement rate for CSF cytological interpretation. Caution is nonetheless warranted, as animal age, anamnesis, and neurological presentation need to be considered when interpreting stored CSF without pleocytosis.

Seizure disorders in 43 cattle

Background

Large animals have a relatively high seizure threshold, and in most cases seizures are acquired. No published case series have described this syndrome in cattle.

Objectives

To describe clinical findings and outcomes in cattle referred to the Veterinary Teaching Hospital of the University of Turin (Italy) because of seizures.

Animals

Client‐owned cattle with documented evidence of seizures.

Methods

Medical records of cattle with episodes of seizures reported between January 2002 and February 2014 were reviewed. Evidence of seizures was identified based on the evaluation of seizure episodes by the referring veterinarian or 1 of the authors. Animals were recruited if physical and neurologic examinations were performed and if diagnostic laboratory test results were available.

Results

Forty‐three of 49 cases fulfilled the inclusion criteria. The mean age was 8 months. Thirty‐one animals were male and 12 were female. Piedmontese breed accounted for 39/43 (91%) animals. Seizures were etiologically classified as reactive in 30 patients (70%) and secondary or structural in 13 (30%). Thirty‐six animals survived, 2 died naturally, and 5 were euthanized for reasons of animal welfare. The definitive cause of reactive seizures was diagnosed as hypomagnesemia (n = 2), hypocalcemia (n = 12), and hypomagnesemia‐hypocalcemia (n = 16). The cause of structural seizures was diagnosed as cerebrocortical necrosis (n = 8), inflammatory diseases (n = 4), and lead (Pb) intoxication (n = 1).

Conclusion and Clinical Importance

The study results indicate that seizures largely are reported in beef cattle and that the cause can be identified and successfully treated in most cases.

Urinary tract infections in sows in Italy: accuracy of urinalysis and urine culture against histological findings

In order to investigate the prevalence of urinary tract infections (UTI) in sow, lower urinary tract (LUT), kidney and urine samples were collected at slaughterhouse from 65 multiparous culled sows. Histopathology was performed on urethra, urinary bladder and -kidney sections. Urine collected by cystocentesis was analysed for physical and biochemical parameters, in addition to microscopic examination of the sediment and quantitative culture ( > 10(5) CFU/ml urine). The diagnostic accuracy of urinalysis and urine culture was calculated for the parameters that correlated with histological diagnosis: bilateral chronic lesions were found in 54 per cent of kidney samples and diffuse/multifocal lymphoplasmacytic infiltration of the submucosa in 53 per cent of the bladder and 68 per cent of the urethra samples. In 49 per cent of cases, the co-occurrence of bladder and urethra lesions was statistically significant (P < 0.009). Turbid urine (80 per cent sensitivity, 50 per cent specificity), > 5 white blood cells per high-power field (34 per cent sensitivity, 90 per cent specificity), intracellular or free bacteria (43 per cent sensitivity, 90 per cent specificity), and urine culture (49 per cent sensitivity, 97 per cent specificity) correlated with a finding of histopathological changes in the bladder. UTI appears to be common in culled sows in northern Italy. Compared with histopathology, urinalysis and urine culture showed low sensitivity but high specificity in detecting UTI.

Sepsis and bacterial suppurative meningitis-meningoencephalitis in critically ill neonatal Piedmontese calves: clinical approach and laboratory findings

Sepsis (S) and bacterial suppurative meningitis-meningoencephalitis (M-ME) are common causes of death in bovine neonates. The aim of this prospective study was to evaluate the prevalence of S and M-ME in critically ill neonatal Piedmontese calves. Critically ill animals up to 15 days old referred by practitioners were registered according to their status and subsequently assigned to clinical standardized score. Calves with a clinical score > = 5 were further assessed under a clinical and clinical-pathological protocol to strengthen the suspicion of S and M-ME. Critically ill neonatal calves sent for necropsy were included in the study as well. Fifty-nine calves were investigated, 26 of which referred alive and 33 dead. Ten out of the 26 clinically evaluated calves were classified as suspicious of S on the basis of the clinical and clinical-pathological protocols. S was confirmed by positive bacteriologic culture in 7 cases and in 3 cases on the basis of necroptic lesions. Concomitant suppurative M-ME suspected in 6 of these 10 calves was subsequently confirmed by CSF analysis or histological findings. Of the 33 calves examined only post-mortem, 20 showed pathognomonic findings of S and 14 signs of M-ME. The prevalence of S and M-ME was 46 and 36 %, respectively. Clinical signs of S were confirmed to be vague and overlapping with other diseases. The developed protocol was highly accurate in predicting S in these neonatal calves.

Road transportation affects blood hormone levels and lymphocyte glucocorticoid and β-adrenergic receptor concentrations in calves

The effect of transportation on blood cortisol and catecholamine levels, lymphocyte glucocorticoid receptor (GR) and beta-adrenergic receptor (beta-AR) concentrations was investigated in calves. Blood samples were collected from 24 six-month-old calves before departure (T(0)), on arrival (T(1)), and at 24 h (T(2)) and one week (T(3)) after arrival. Animals were loaded and transported about 950 km, from the Midy-Pyrenes region (Cahors, France) to the Piedmont region (Italy), over a total of 14 h. Serum cortisol levels and plasma catecholamines (adrenaline, noradrenaline) were determined by radioimmunoassay. Lymphocyte GRs and beta-ARs were measured through binding assays. A significant (P < 0.05) increase in cortisol and catecholamine concentrations was observed immediately after transport. The increase in hormone levels at time T(1) was negatively correlated with lymphocyte GR and beta-AR concentrations. At times T(2) and T(3), blood cortisol and catecholamine levels and lymphocyte GRs and beta-ARs returned to normal. The results demonstrate the activation of the hypothalamic-pituitary-adrenal axis and the catecholaminergic system in long-term transported calves. However, these systems returned to normal within 24 h after the end of transport.