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1 section matches

Threshold behaviour in other mathematical models that incorporate asymptomatic carriers

The threshold behaviour that characterizes our model has been identified in other models of pathogen transmission incorporating asymptomatic carriage [28, 30] . In these studies, it was found that decreasing the proportion of new cases of symptomatic infection will only decrease a pathogen's basic reproduction number [28] and total prevalence [30] if carrier infectivity is sufficiently low. Here, we have shown that this threshold behaviour also applies to changes in the rate that established infections either become symptomatic or asymptomatic, and that it is the value of the relative reproduction potential of carriers, not just their relative infectivity, which is the critical determinant of this threshold behaviour.
7 section matches

A92

Backgrounds: Invariant natural killer T (iNKT) cells play a critical role in the pathogenesis of asthma. We previously reported the association between blood Th2-like iNKT cells and lung function in asthma patients and the suppressive effect of Toll-like receptor 5 ligand flagellin B (FlaB) on asthma in a mouse model. Objective: We investigated whether FlaB modulates the function of blood iNKT cells in asthma patients. Methods: Peripheral blood mononuclear cells (PBMCs) were treated with FlaB and then iNKT cells-derived and intracellular cytokines were determined by ELISA and flow cytometry, respectively, following the stimulation with a-galactosylceramide (a-GalCer). Foxp3 + iNKT cells were measured. To determine the effect of FlaB-treated dendritic cells (DCs) on iNKT cells, CD14 + monocyte-derived DCs and T cells from patients with house dust mite-sensitive asthma were co-cultured, in which intracellular cytokines of iNKT cells were determined. In some experiments, IL-10R mAb was used. Results: FlaB treatment reduced the productions of IL-4 and IL-17 from iNKT cells in PBMCs cultures, which effects were ameliorated following the addition of IL-10R mAb. FlaB-treated DCs decreased the frequencies of IL4 + and IL-17 + iNKT cells, which effects were eliminated after the addition of IL-10R mAb. In contrast, Foxp3 + iNKT cells were induced by FlaB treatment, which effect disappeared after the addition of IL-10R mAb. Conclusion: FlaB may inhibit Th2-and Th17-like iNKT cells and enhance Foxp3 + iNKT cells via DCs in an IL-10-dependent fashion in asthma patients. In patients with asthma phenotype in association with iNKT cells, FlaB will be the effective immunomodulator for iNKT cell-based immunotherapy. Background: Allopurinol, a xanthine oxidase inhibitor, has been used since the 1960s for gout, hyperuricaemia associated with treatment for malignancy and renal calculi due to hyperuricosuria. It is known as the leading cause of severe cutaneous adverse drug reactions (SCARs) comprising Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) and HyperSensitivity Syndrome (HSS)/Drug-Rash with Eosinophilia and Systemic Symptoms (DRESS) (Halevy et al. 2008) . In Vietnam, we observed a high prevalence of allopurinol-induced SCARs, likely due to both its common use and the high prevalence of HLA-B*5801 (6.5% -Hoa et. al. 2008) . The role of viral activation in SCARs is well established. We reviewed patients with allopurinol-induced SCARs to reveal possible non-genetic risk factors. Methodology: The clinical history, examination findings and results of laboratory investigations in eighty-eight confirmed cases of SCARs caused by allopurinol seen between 2011 and 2014 were surveyed. Results: A total of 88 patients comprised 33 SJS (37.5%), 3 TEN (3.4%) and 52 HSS/DRESS (59.1%). The mean age was 59.9±14.4 years (median 57.5) (SJS/TEN: 57.92±15.02 vs HSS/DRESS: 61.33±13.887, p =0.284) and a male preponderance was noted (male: female =62:26). Indications for allopurinol were chronic gout (22.7%), acute gout (12.5%), asymptomatic hyperuricaemia (45.5%) and unknown (19.3%). 100% of patients commenced allopurinol at a dose of 300mg or above. Co-medications were diuretics (3.4%), anti-hypertensive agents (18.2%), colchicine (12.5%), digoxin and probenecid (1.1%). Co-morbidities consisted of hypertension (29.5%), renal insufficiency (13.6%), diabetes (9.1%), dyslipidemia (5.7%), cardiac diseases (4.5%) and liver diseases (4.5%). The index-day was 17. 5 Background: Specific allergen immunotherapy (SIT) is an effective treatment for IgE-mediated allergic disease and involve with specific IgG4 (sIgG4) level increase. Elevation of sIgG4 is accompanied by increase in IgG-dependent serum inhibitory activity for IgE-facilitated allergen binding (IgE-FAB) assay. Objectives: As this 'functional' assay of inhibitory antibodies may be correlate more closely with clinical outcome, we investigated the time course of serum inhibitory activity for IgE-FAB during different period of Dermatophagoides pteronyssinus subcutaneous immunotherapy (Der p-SIT) in rhinitis and/or asthma patient. Methods: This study involved 20 adult patients with allergic rhinitis and/or asthma receiving a 156-week course of Der p-SIT, and 20 adult patients with allergic rhinitis and/or asthma receiving drug therapy only as control. Symptom and medication scores, forced expiratory volume in one second (FEV1), Der p-sIgG4 levels and the serum inhibitory activity at weeks 0, 4, 12, 16, 52, 104 and 156 were analyzed. Results: Rhinitis and/or asthma symptom and medication scores, as well as FEV1% predicted showed improvement at week 52, 104 and 156 than 0 week with significant difference in SIT patients (p<0.05), and Background: Periostin, an extracellular matrix protein, has been known to play an important role in the process of tissue remodeling. Recently periostin has been discovered as a novel mediator in allergic diseases such as bronchial asthma and atopic dermatitis; however, the role of periostin in patients with chronic rhinosinusitis (CRS) remains unclear. Therefore, the objective of this study was to investigte the role of periostin in the pathophysiology of CRS patients. Methods: We investigated periostin expression and its cellular origins in uncinate process mucosa (UP) and nasal polyp (NP) tissues by immunohistochemistry (IHC), quantitative reverse transcription PCR (qRT-PCR), and enzyme-linked immunosorbent assay (ELISA). Correlations between periostin expression and other inflammatory markers, including of interleukin (IL)-5, IL-13, IL-17A, interferon (IFN)-γ, were also explored. Results: Periostin expression was upregulated in NP mucosa from patients with CRSwNP compared with the uncinate process (UP) tissue of control, CRSsNP and CRSwNP patients. Overexpression of periostin in eosinophilic NP compared to non-eosinophilic NP was confirmed by qRT-PCR, and ELISA. There was a positive correlation between periostin protein concentration and Lund-Mackay CT scores in eosinophilic NP. Double IHC staining showed that tryptase + cells were one of the main sources of periostin among immune cells. In addition, periostin mRNA expression was positively correlated with the expression of tryptase + cells and total IgE homogenate in eosinophilic NP. Overexpression of epithelial integrin αV was detected in NP mucosa from CRSwNP patients compared with UP from control and CRSsNP. Moreover, in eosinophilic NP, the expression of epithelial integrin αV was higher than non-eosinophilic NP and positively correlated with the concentration of periostin. Furthermore, periostin mRNA expression in eosinophilic NP patients was positively correlated with IL-5, IL-13 and negatively related with IL-17A; however, there was no association between those and IFN-γ. Conclusions: Our data suggest a role for periostin in the pathogenesis of nasal polypogenesis, especially in eosinophilic NP. Therefore, periostin protein might be a new treatment target for patients with CRSwNP.

A118

Clinical and laboratory characteristics of nasal obstruction dominant allergic sensitization Seung-No Hong 1 , Doo Hee Han 1 , Chae-Seo Rhee 2 1 Seoul National University Hospital, South Korea; 2 Seoul National University Bundang Hospital Correspondence: Seung-No Hong -Seoul National University Hospital, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A118 Background: Allergic rhinitis (AR) is defined clinically by the symptoms including nasal obstruction, rhinorrhea, nasal itching, sneezing with a positive allergen sensitivity test. However a positive skin prick test (SPT) does not always imply the occurrence of clinical symptoms. If an asymptomatic allergen sensitized patient is accompanied with septal deviation (DSN) which could cause nasal obstruction, it can be easily confused with a typical symptomatic allergic rhinitis patient. Objective: The aim of this study was to investigate the clinical and laboratory characteristics of nasal obstruction dominant allergic sensitizers (NODS) based on an allergic rhinitis cohort study. Methods: Patients from a nationwide allergic rhinitis cohort study (ARCO) which was conducted by 8 university hospitals were investigated. Allergic rhinitis was diagnosed when there were at least one rhinitis symptoms with a positive SPT result. The NODS group included patients who had severe nasal obstruction with less other symptoms and positive skin prick test with septal deviation. Clinical and laboratory characteristics were compared between the NODS group and the typical allergic sensitization group. Results: Total 695 patients were included. The average age was 32.6 and 68% of the patients had septal deviation. Laboratory test results reveal that the eosinophil level was lower in NODS group while total IgE level did not show any difference. SPT analysis showed that House dust mite was less sensitized to NODS patients. There was significant sex difference that the male to female ratio was higher in the NODS group. However, no statistically significant difference was found by age, family history and BMI. Conclusion: Asymptomatic allergen sensitized people with septal deviation can mimic allergic rhinitis. When we met the allergen sensitized people with nasal obstruction predominantly, septal deviation should be considered before diagnosis of allergic rhinitis.

Conclusions

Based on our previous findings of the high levels of IL-13 and TGFbeta in NP and the present findings of the increased expression of filaggrin and periostin in NP irrespective of the atopic status, filaggrin may potentially play a role in the barrier function and periostin may play a role. Introduction: Although urinary tract infections (UTIs) are considered among the most common infectious disorders in humans, these usually follow an uncomplicated course. Various infections may have a role in inducing HAE attacks. Further, danazol treatment has been associated with hematuria. Our study intended to evaluate the abnormalities of the urinalysis of C1-INH-HAE patients. Methods: Urine specimens contributed by 139 C1-INH-HAE patients at the annual control visits were studied retrospectively (RBC and WBC counts, microorganisms). We analyzed these laboratory parameters in relation of the clinical symptoms and in view of the long-term danazol therapy. Results: Taking into account 3 randomly selected urine specimens, we found that the cumulative number of edematous attacks was higher in patients with than in those without bacteriuria (p=0.019, p=0.022, p=0.014). Considering the same patients (n=76), attack number was significantly higher (14.51 vs. 8.63) in patients with than in those without bacteriuria (p<0.0001). The cumulative incidence of microhematuria found upon a single or repeated examination was 74,8% after the annual check-up per patient. Taking into account an observation period of 3 years, the alterations detected in the urinary sediment were unrelated to treatment with or the dose of danazol. Conclusion: The cumulative incidence of microhematuria was substantially higher compared with the historical data of healthy individuals. As regards the background of this phenomenon, we did not found any relationship with danazol therapy. The main finding of our study was that the increase incidence of edema was associated with bacteriuria. This finding emphasizes the triggering role of bacteriuria in the occurrence of edematous episodes. Supported by OTKA grant 100886 and 112110. Background: Investigation of the role of Helicobacter Pylori (HP) and erosions or ulcers (EU) of upper gastrointestinal tract (esophagus, stomach or duodenum) independently from each other in the development of spontaneous urticaria. Methods: 36 adult patients, 5 with acute and 29 with chronic spontaneous urticaria were examined with upper gastrointestinal endoscopy (UGIE) and HP-testing in gastric biopsies, before and after treatment of the observed abnormalities. Results: HP was found in 26 patients, or 72, 2% (54,8; 85,8) , what was less than across able-bodied population of Moscow -87,9% (85,6; 90,0) 1 , difference insignificant. Wherein EU were found in 50,0% (32,9; 67,1) of patients, and gastric erosions in 41, 7% (25,5; 59,2) , what was 6,1 times more than in 1311 asymptomatic volunteers -6,8% (5,5; 8 ,3) 2 . Two patients with most severe urticaria had duodenal ulcer. Despite these facts, only 23 patients (15,3%) reported mild gastrointestinal complaints after thorough questioning. All 26 HP-positive patients received eradication therapy, and 4 HPnegative patients with EU received only antacid and antisecretory therapy. Second HP-determination by PCR after the therapy was carried out only in 13 patients with chronic spontaneous urticaria (11 HP-positive and 2 HP-negative at first UGIE, 10 patients with EU), as only 13 agreed for a new examination. Where in 7 from 11 HPpositive patients eradication was successful, and in 4 failed. From 7 patients with successful eradication remission was achieved in 2 cases, and in 5 cases there was no remission. In 4 patients with failed eradication remission was achieved also in 2 cases, and in 2 cases there was no remission. Fisher exact test with 1-tailed p=0,47, 2tailed p=0,58 showed highly insignificant result of eradication therapy in the treatment of urticaria in followed patients. At second UGIE, 3 patients from 10 with EU appeared with healed erosions. All of them showed complete remission of symptoms. Whereas 7 patients with unhealed EU, had no improvement at all. Fisher exact test showed significant difference with 1-tailed and 2-tailed p=0,008. Patients with acute spontaneous urticaria were not included in the statistical tests due to high possibility of spontaneous remission. Conclusions: Erosions of upper gastrointestinal mucosa seem to have a very important role in the development of spontaneous urticaria, independently from HP. Introduction: Natural killer (NK) cells are a subset of lymphocytes and that have an important role in innate immunity. NK cells release cytokines such as TNF-α IFN-ɣ during infection. These cytokines stimulate and increased activity of the innate and adaptive immune responses. NKG2D is one of the most stimulating NK receptors that bind to the MIC-A, MIC-B and ULBPs. These ligands are on the tumor and virusinfected cells,which leads to increasing NK secretion lytic proteins such as perforin, granzyme against target cells, and play an important role in the activation of cellular immune function, as well as destruction and elimination of cancer cells. Previous studies have confirmed G2 Vaccine has an important role in the control of asthma via affecting TH2 cells and controls allergic response through preventing increasing eosinophil, basophil, and inhibits TH2-related responses. Thus, in this study, we evaluated the effect of G2 Vaccine on the gene expression and NKG2D receptor presenting on NK cells in peripheral blood. Materials and Methods: To the obtain Nk cell, Blood mononuclear cells after isolation, The 1×10 6 of viable cells were cultured in medium RPMI 1640 and affects by G2 Vaccine in the times of 12, 24 and 48 hours at of 37°. G2 Vaccine is the buffalo spleen extracts that act as TH cells stimulants and first time has been registered by Saleh Mohaghegh Hazrati in IRAN. Then extracting RNA of the cells, cDNA synthesis was performed and gene expression was evaluated by Real-Time PCR. Also receptors presenting on the cell surface was evaluated via monoclonal antibodies by flow cytometry. Results: The results of our study have shown that G2 Vaccine leads to up-regulating gene expression and NKG2D receptor presenting on NK cells. This can lead to increasing NK cells cytotoxicity through this receptor. Conclusion: Due to the increasing NKG2D receptor on NK cells,that can increase NK cell cytotoxicity activity against viral infections and cancers Also, this Vaccine regulate the balance betweenTH1and TH2 and can induce the stimulation of Th1cells. Therefore, In the future this Vaccine can be used in the cancer immunotherapy and treatment of allergic diseases. Keywords: natural killer, NKG2D, flow cytometry, qRT-PCR, Immunotheraphy.

A179

Background: Eosinophilia in specific conditions such as allergic diseases, helminthic infection, and drug-induced reaction is well recognized. In the present study, we evaluated the clinical characteristics of eosinophilia and change in prevalence over 10 years in recipients of health screening program at a tertiary hospital of South Korea. Methods: We collected the data of health screening program recipients at the health promotion center of Chung-Ang University Hospital from 2004 to 2013. Eosinophilia was defined when the absolute eosinophil count exceeds 500/μL in the peripheral blood. We reviewed health-related questionnaires and laboratory findings of health screening program which might be related to eosinophilia. Results: The cumulative prevalence of eosinophilia was 4.0% (1,963 out of 48,858). Most of eosinophilia cases (96.6%) were in mild degree (500 to 1500/μL). Eosinophilic subjects were older and more male-predominant (P<0.001, respectively). Subjects with eosinophilia showed lower level of FEV1%, FVC% and FEV1/FVC than those without eosinophilia (P<0.001, respectively). Of note, annual prevalence was in decreasing trend from 2004 to 2013 (OR=0.942, 95% CI: 0.926-0.958, P<0.001). Eosinophilic subjects showed higher positive rate for common parasite ELISA (P<0.001). The positive rate for ELISA to parasites increased with advancing age in subjects with eosinophilia (P=0.002). Conclusions: Eosinophilia in general, healthy population was not uncommon and usually in mild degree. The prevalence of eosinophilia decreased from 2004 to 2013, which might be related to decrease in parasitic infection in young Korean population. Purpose: Toxocariasis is the most common cause of peripheral blood eosinophilia in Korea and produces eosinophilic infiltration into various organs, including the lung. However, the prevalence of toxocariasis in the general population is rarely reported. Methods: We investigated the seroprevalence of Toxocara larval antibody among asymptomatic people who attended Samsung Medical Center for a health checkup, including low-dose chest computed tomography (CT) between March 2012 and December 2013. A total of 633 people (400 men and 233 women) were recruited. Results: The Toxocara-seropositive rate was 51.2% using the current cutoff value based on Toxocara enzyme-linked immunosorbent assay (ELISA) (67.0% for men and 24.0% for women). In the multivariate-adjusted model, age (odds ratio [OR], 1.08; 95% confidence intervals [CI], 1.05-1.11), male sex (OR, 3.47; 95% CI, 2.26-5.33), rural residence (OR, 1.55; 95% CI, 1.05-2.30), and history of raw liver intake (OR, 8.52; 95% CI, 3.62-20.11) were significantly associated with Toxocara seropositivity. When subjects were divided into 3 groups using cutoff values base on weak positive and strong positive control optical densities (ODs), the ORs for peripheral blood eosinophilia and serum hyperIgEaemia were 0.31 (95% CI, 0.02-2.89) in the weakpositive group and 36.64 (95% CI, 11.73-111.42) in the strong positive group compared to the seronegative group. Similarly, ORs for the solid nodule with surrounding halo were 2.54 (95% CI, 0.60-10.84) in the weak positive group and 15.08 (95 CI 4.09-55.56) in the strong positive group compared to the seronegative group. Conclusions: The study indicated that the Toxocara-seropositive rate obtained by using the current cutoff value based on ELISA was high in the asymptomatic population in Korea. The results of this study suggest that active toxocariasis may be more frequently seen in the Toxocara-strong positive group than in the Toxocara-weak positive group. Since a large proportion of adverse drug reaction (ADR) affects the skin, investigations of cutaneous drug hypersensitivity reaction (DHR) are important to evaluate their impact in dermatology and health care in generals as well as their burden for affected patients. However, little is known about the characteristics of drug-induced cutaneous reactions in Korean children.

Result

With this case, we wanted to point out that ornidazole, a commonly used anti-infection agent, can be the cause of fixed drug eruption in some cases. Also, it should be noted that fixed drug eruptions can occur for multiple drugs in the same patient. Background: Atopic dermatitis (AD) is characterized by skin barrier dysfunction. Few studies have used non-invasive skin measurement techniques to measure epidermis function in asymptomatic neonates. We therefore conducted a post-hoc analysis to determine whether skin barrier function in the first week of life predicted AD development and allergen sensitizationby age 32 weeks.

Conclusions

This study showed that most of children hospitalized with asthma in our setting were moderate exacerbation with frequent asthma, male, aged under 5 years old and first diagnosed at 2 years old, had history of hospitalization before, normal nutrition status, history of atopic in family, and cigarette smoking exposed. Keywords: asthma in children, hospitalized, characteristic Background: Allergic bronchopulmonary aspergillosis (ABPA) is known as type I and III allergic disease for Aspergillus. Clinical presentation of ABPA ranges from asymptomatic mucus plugs to severe asthmatic symptoms or destructive and fibrotic lung disease. The heterogeneity may reflect not only the different clinical stages of the disease, but also different phenotypes. We herein attempt to identify phenotypes in ABPA using cluster analysis. Methods: We analyzed the data of 332 patients with possible ABPA from national-wide survey in Japan executed between 2013 and 2014. Definition of possible ABPA were, (1) positive skin test or specific IgE for Aspergillus, and (2) either a) positive precipitation or IgG antibody for Aspergillus or b) mucoid impaction or bronchiectasis in chest computed tomography. Non-hierarchical cluster analysis using k-means method was performed. Results: Three clusters were identified. Cluster 1 (n=141) included the patients with later age at onset (mean ages, 68 years), femaledominance, and less frequent prevalence of asthma (76%). The patients in cluster 2 (n=95) were middle age at onset (55 years), female-dominant, and showed lower values of total serum IgE. Cluster 3 (n=96) was characterized with early-onset (37 years), maledominance, and frequent recurrences (59%). Conclusions: Three distinct clinical phenotypes were identified characterized by ages of onset, gender, asthma prevalence, total serum IgE levels, and the frequency of recurrences. Background: Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases, and little is understood about its pathogenesis. Eosinophils are considered to play a major role in its pathology, but we still know little which is causing chronic immune activation and persistent eosinophilic inflammation in CRS. Recently, type 2 innate lymphoid cells (ILC2s, lineage (-), CD45 (+), CD127 (+), CD294 (+)) were identified as a candidate, which produce highly levels of Th2 cytokines such as IL-5 and IL-13, which activates eosinophils. We hypothesized that ILC2s are enriched in blood and nasal polyps in patients with eosinophilic CRS (ECRS) and are associated with its pathology. Methods: FThe patients with CRS or pituitary adenoma (normal sinus) who underwent Endoscopic sinus surgery (ESS) in Jikei University Hospital were enrolled. We used PBMC and nasal polyps (NPs) from patients with CRS or normal subjects, and analyzed the amount of ILC2 by flow cytometry. We also investigated the distribution of ILC2s in NPs by immunohistochemistry. EDN and cytokines in NPs were measured by ELISA to investigate correlation with ILC2s. Lineage negative cells from nasal polyps were cultured in vitro with IL-33 or/and IL-2 to investigate the amount of cytokine produced by ILC2s. Results: EDN and Th2 cytokines are significantly higher in ECRS than non-eosinophilic CRS (NECRS). EDN had strongly correlated with the numbers of ILC2s in NPs. The counts of ILC2s in NPs were significantly higher in ECRS than NECRS. Immunostained ILC2 were showed accumulated in nasal polyps of ECRS, but not in NECRS or normal subjects. ILC2's CD25 surface expression in PBMC was significantly higher in ECRS than NECRS. ILC2's IL-17RB surface expression in NPs was significantly higher in NECRS than ECRS. Lineage negative cells from ECRS' NP, but not from NECRS' , produced IL-5 and IL-13 in both IL-2 and IL-33 stimulation. Conclusions: ILC2 are considered as candidate of the commander in ECRS, which strongly induce Th2 inflammation. There are possibility that ILC2s have several subtypes and the characteristic of ILC2s are differ from their environment.

A637

The Effects of Antihistamine Drugs on on-Road Driving Performance Aurora Van De Loo, Johan Garssen, Joris Verster Utrecht University, Netherlands Correspondence: Aurora Van De Loo -Utrecht University, Netherlands World Allergy Organization Journal 2016, 9(Suppl 1):A637 Background: Antihistamines can cross the blood-brain barrier and thus may cause drowsiness. As a result, daily activities such as driving a car may be impaired. The purpose of this review was to compare the effects of different antihistamines on driving performance. Methods: PubMed and cross references were searched to identify double-blind placebo-controlled clinical trials. Studies were selected that used the standardized 100-km on-road highway driving test in normal traffic to examine driving performance. Patient studies were excluded. Subjects are instructed to maintain a steady lateral position and a constant speed (95 km/h). The Standard Deviation of Lateral Position (SDLP, cm), i.e. the weaving of the car, is the primary outcome measure of the test. The magnitude of driving impairment for antihistamine drugs was compared to SDLP increments seen at Blood Alcohol Concentration (BAC) 0.05% (ΔSDLP= +2.4 cm) and BAC 0.08% (ΔSDLP= +4.3 cm), i.e. the most common legal limits for driving. Results: Eighteen studies were included. Regarding acute effects, impairment greater than BAC 0.08% was found after single dosages of diphenhydramine, emedastine, and hydroxyzine. Impairment after clemastine, triprolidine, mizolastine, acrivastine, dexchlorpheniramine, and mequitazine was comparable to BAC 0.05%. Results for cetirizine were mixed. No significant impairment was found for terfenadine, loratadine, levocetirizine, desloratadine, ebastine, bilastine, fexofenadine and rupatadine. Regarding sub-chronic effects (4-8 days of daily drug treatment), significant driving impairment was found for emedastine, diphenhydramine, clemastine, triprolidine, ebastine, and hydroxyzine. Mixed results were found for cetirizine, terfenadine and loratadine. No significant driving impairment was found for levocetirizine, acrivastine, fexofenadine, dexchlorpheniramine, bilastine, and mequitazine. Discussion: Antihistamine drugs may significantly impair driving performance. Impairment is often seen with acute use of first-and second-generation antihistamines, and the magnitude of impairment is comparable to that seen at legal BAC limits for driving. Tolerance to the impairing effect after chronic daily use of antihistamines develops slowly. The newer antihistamines levocetirizine, fexofenadine and desloratadine did not significantly impair driving performance. Abstract Anahylactic shock and astmatic status are both serious complications of allergic diseases that might have deadly outcome. As known in the literature, it's very rare to occur together in the same time in one patient. A 29-year-old-male athlete was introduced to our intensive care unit for experiencing anaphylactic shock and asthmatic status after running through grass fields near home. Upon arrival of emergency unit team, he had low blood preassure of 70/50 mmHg, and low oxygen saturation in 82% with altered mental status. After immediate application of epinephrine, prednisolone and salbutamol, his vital functions turned normal. He had mild asthma in childhood, but for the last 10 years, he had been asymptomatic without medication. For the recent 4 yeas, he had hay fever to grass pollen treated with intranasal glucocorticoid occasionaly and urticaria when exposed to almond and pork. Ten days before the reaction, he had an episode of hives while eating cake decorated with almond and after few minutes he had shortness of breathing, which was resolved on antihistamines. While testing sIgE, we found strong sensitization to grass and wheat, but not to insects or food he claimed to be eating. He was prescribed a self-injectable epinephrine and asked to avoid running thrue grass fields. We report a case of a male athlete who suffered from hypotension and asthmatic attack, provoked by grass polen. Keywords: anaphylactic shock, asthmatic status, grass polen Tel: 0038631315042 Background It is known that respiratory viral infection in infancy cause asthma. But the detailed mechanisms underlying the induction of allergic inflammation by virus infection are is not fully understood. Many papers have shown that, not only pathogen-derived factors such as virus DNA and RNA, factors released from dying or stressed cells, damage-associated molecular patterns (DAMPs), are recognized by immune cells and contribute to inflammation. Interestingly, host DNA as a DAMP is known to induce type 2 immune responses and exacerbates allergic inflammation. Host DNA is recognized by intracellular DNA sensors and activates cyclic GMA-AMP synthase (cGAS). Then activated cGAS generates cyclic GMP-AMP(cGAMP) as a second messenger. We hypothesized that host DNA release from damaged cells by virus participates in allergic inflammation via the action of cGAMP. In this study, we investigated the effect of cGAMP on the onset of asthma. Methods House dust mite antigen (HDM) was administered intranasally to C57B/6J mice with or without cGAMP as an adjuvant, and then mice were challenged with intranasal administration of house dust mite antigen (HDM) on days 7, 9, 11, and 13. Twenty-four hours after last challenge, we collected blood, BALF, lungs. Serum antibodies were measured by ELISA, and cells in BALF were analyzed by FACS. We performed similar experiment using gene-knockout mice to evaluate the factors involved in this inflammation model.
5 section matches
Although there was a range in severity of MR in each group, all dogs were asymptomatic, untreated and stage B1 or B2 during the observation period. All data were collected at each time point. Using each dog as its own control for echocardiographic evaluation, the end-point LVDd increased in diameter (35.1% in 18 weeks dogs, 19.9% in 6 weeks dogs) and left atria dimensions increased (27.3% in 18 weeks dogs and 31.2% in 6 weeks dogs) and the fractional shortening increased (22.6% in 18 weeks dogs, 24.3% in 6 weeks dogs). Compared to baseline, the LVDs dimension increased (18.7% at 18 wks in the 18 weeks dogs, and 8.6% in the 6 weeks dogs). At endpoint catheterization, the forward LV stoke volume decreased (35.2% in 18 weeks dogs, 22.2% in 6 weeks dogs) in all dogs.

C14

These results suggest certain echocardiographic techniques available for CO measurement are comparable to invasively measured CO. Specifically, 2D MOD using the right long axis and left apical 4-chamber views, or RT3DE from the right long axis view, had excellent agreement with TD. The excellent correlation between methods indicates a close relationship between select techniques, although they are not interchangeable. CO is underestimated by the noninvasive techniques studied here compared to TD. The differences between TD and noninvasive measures may be due to errors of the method, patient stroke volume variability, heart rate fluctuation, or inaccuracies of TD. One of the major limitations of this study is the small number of patients, which allows preliminary conclusions only. A larger prospective study is needed to delineate the benefits and constraints of these methods. Myxomatous mitral valve disease (MMVD) is the most common heart disease in the dog. Angiotensin converting enzyme (ACE) inhibitors are frequently recommended for management of dogs with MMVD and asymptomatic cardiac enlargement. However, the benefit of ACE inhibition in dogs before the onset of congestive heart failure (CHF) is controversial, with different studies showing conflicting results. A variable response to ACE inhibitor therapy has also been observed in human beings with heart disease and in some cases this has been attributed to a polymorphism in the ACE gene. We have previously demonstrated a polymorphism in the canine ACE gene, although the clinical significance of this finding is unknown.

C18

PREVALENCE OF DIROFILARIA IMMITIS ANTIGEN IN CLIENT-OWNED PET DOGS BEFORE AND AFTER SERUM HEAT TREATMENT. Laura Nafe, Susan Little, Paul DeMars, Ryan Baumwart, Nalani Yamada, Eileen Johnson. Oklahoma State University, Stillwater, OK, USA Pet dogs are routinely screened for heartworm disease as a component of annual wellness evaluation. Recent evidence suggests that antigen-antibody complexes in canine serum may preclude accurate diagnosis of heartworm disease with commercially available Dirofilaria immitis antigen assays. The objective of this study was to determine whether normal dogs presenting to the Oklahoma State Veterinary Teaching Hospital Community Practice Service for annual veterinary care warrant heat treatment of serum to confirm a negative heartworm antigen test by 4DX Snap (Idexx). Serum and EDTA samples were collected from 201 clientowned pet dogs between December 2014 and October 2015. Dogs ranged in age from 10 months to 15 years (median 4 yrs) and included 108 males and 93 females. Complete survey results (available for 194/201 dogs) revealed 139 dogs (72%) received heartworm preventative regularly over the past year. All EDTA samples were evaluated for microfilaria and serum samples for D. immitis antigen before and after heat treatment using a commericial assay (DiroCHEK, Zoetis). Four dogs (2%) tested positive for D. immitis antigen on 4DX Snap Test (Idexx) and 2 were microfilaremic. On DiroCHEK antigen testing 2 dogs were positive before and after heat treatment, 1 dog was positive after heat treatment only, and 1 dog was negative before and after heat treatment despite being microfilaremic. One dog received heartworm preventative (Heartgard; Merial) regularly (2/12 doses missed). Heat treatment does not appear to improve detection of D. immitis antigen in asymptomatic pet dogs undergoing routine heartworm disease testing with 4DX Snap Test (Idexx). of the mechanisms behind increased concentrations of these cardiac biomarkers in azotemic dogs is warranted for correct interpretation of test results. The aim of this study was to investigate the association between measured glomerular filtration rate (GFR) and plasma concentrations of cTnI and NT-proBNP in stable canine CKD patients.

C23

Signalment data including age, sex, and weight were not significantly different in dogs diagnosed with AT compared to dogs not diagnosed with AT. Dogs with AT were commonly diagnosed concurrently with PLN. Contrary to previous reports, cardiac disease was not a common concurrent diagnosis in the dogs with AT included in this study. The function of right ventricle (RV) has gained increased recognition over the past years. In pulmonary hypertension (PH) patients, this led to the reconceptualization of the RV as part of right ventricular pulmonic circulation unit and the acknowledgement that RV function is a major determinant of prognosis in pulmonary arterial hypertension. With this in mind, we sought to investigate the RV systolic function in dogs with post-capillary PH ascribed to mitral valve disease (MVD). Twenty nine dogs with PH (2.5-17.2 kg; 7-15 years) and 51 dogs without PH (1.5-32.0 kg; 2-16 years) were recruited into this prospective cross-sectional observational study. The PH group was subdivided into mild PH (n = 19), moderate PA (n = 6), and severe PH (n = 4). Several breeds were represented. All animals underwent a complete echocardiogram, which included the measurement of RV fractional area change (RV FAC); tricuspid annular plane systolic excursion (TAPSE); RV free-wall longitudinal systolic velocity (tricuspid annular S´wave), and RV fractional shortening (RV FS % ). For improved statistical analysis and normalization of data according to animal size, a body weight-indexed TAPSE (TAPSE BW-indexed ) was created. Some standard echocardiographic indices of congestion and LV function, including early-to-late LV filling velocities ratio (E/A), isovolumic relaxation time (IVRT), E-to-IVRT ratio (E/IVRT), left atrium-to-aorta ratio (LA/Ao), and LV fractional shortening (LV FS % ) were recorded as well. The data was not normally distributed. The Mann-Whitney test showed no differences (P > 0.05) to exist for RV FAC, RV FS % , TAPSE, TAPSE BWindex , and tricuspid annular S´wave between dogs with PH and those without PH. Also, the analysis of the subdivided PH group showed no statistical difference between the three degrees of PH. Spearman correlation coefficients between RV systolic data and LV indices of congestion and function showed a significant positive correlation between TAPSE and E/IVRT (R = 0.3917, P = 0.0003), TAPSE and LA/Ao (R = 0.3298, P = 0.0029), and TAPSE BW-indexed and LV FS% (R = 0.2757, P = 0.0166). Finally, a significant positive correlation was documented between RV FAC and RV FS % (R = 0.3507, P = 0.0100), as well as between TAPSE and tricuspid annular S´wave (R = 0.4575, P < 0.0001). Because only a few animals with severe PH were recruited into this study, the absence of association between the severity of PH and the identification of RV systolic impairment needs further investigation. Nevertheless, we observed a downward trend for RV FS %, TAPSE, TAPSE BW-indexed , and tricuspid annular S´wave along with the aggravation of PH. Our study found correlations between a few congestion and LV function parameters, which may prove useful in monitoring RV function in dogs with severe MVD and overt signs of post-capillary PH. Since the majority of PH cases were mild, it is likely that only a few had reactive PH, which may explain why RV function of either group behaved very similarly. Also, it is not clear whether RV remodeling and impairment would be stronger if pre-capillary PH dogs had been included in this investigation. Decreased heart rate variability (HRV) has been found in dogs in congestive heart failure (CHF) and previous studies have acknowledged the use of HRV indices as prognostic indicators in patients with mitral valve disease (MVD). The vasovagal tonus index (VVTI) is an unconventional time domain indicator of HRV, which is mainly influenced by cardiac parasympathetic tone. In this cross-sectional observational study, we sought to investigate the VVTI in dogs with MVD. Electrocardiographic recordings of 30 dogs (7-16 years, 3.5-15.5 kg) previously classified into ACVIM stages A (controls), B, or C (10 dogs each group) were used to calculate the VVTI. For this, 20 consecutive R-R intervals were measured from each ECG recording (R-R1 to R-R20), and the index was obtained from the formula VVTI = LN [VAR (R-R1 -R-R20)], where LN: natural logarithm and VAR: variance. Bad quality ECG tracings and recordings from dogs with non-sinus rhythms or animals undergoing anti-arrhythmic treatment were not included in this investigation. Also, we recorded the BW-indexed LV in diastole and systole, wall stress index in diastole and systole, fractional shortening, left atrium-to-aorta ratio, mitral E wave, mitral E/A, isovolumetric relaxation time, and the E-to-IVRT ratio. All data underwent the Shapiro-Wilk test to check for normal distribution, while ANOVA, followed by Tukey's test, were used to compare the VVTI between groups. Pearson's test was used to search for linear correlations between the VVTI and the echocardiographic data. The mean values (with lower and upper 95% CI of mean) of VVTI for dogs in stages A, B, and C were, respectively: 8.45 (7.36 -9.54), 6.09 (4.47 -7.71) and 6.34 (5.01 -7.68). A significant difference was found between groups (P = 0.0189), with the mean VVTI being significantly higher in control animals as compared to dogs with stage B MVD (P < 0.05). When it comes to the relationship between VVTI and cardiac rhythms, a significant difference existed between animals in sinus rhythm (SR), sinus arrhythmia (SA), and sinus tachycardia (ST) (P = 0.0083). The lowest VVTI was documented for dogs in ST (5.82; 95% CI 4.14 -7.49), while the higher was found for animals presenting SR (8.27; 95% CI 7.40 -9.15). Significant negative correlations were found between VVTI and LA/Ao (R = À0.3699; P = 0.0443), as well as between VVTI and heart rate (R = À0.4864; P = 0.0064). Although no correlation existed between body weight and the VVTI, age and VVTI attained a significant negative correlation (R = -0.3827; P = 0.0369). The negative correlation between VVTI and heart rate is likely ascribed to the role played by the parasympathetic tone in VVTI, therefore producing higher values when slower rates and irregular rhythms are present. Even though uncontrolled conditions during ECG recording, including stress and agitation, may increase HR, the lower VVTI found in animals exhibiting sinus tachycardia may suggest a sustained sympathetic activation. Although further investigation is warranted, the confidence intervals of this study point to the VVTI <5 being a potential prognostic indicator for CHF, whereas a VVTI >7.7 is likely suggestive of reduced risk for congestion. This is supported by the correlation between VVTI and LA/Ao, as well as the difference between the means of control dogs (stage A) and stage B MVD animals. (6%), Poodle (6%) and Dachshund (6%), besides a mongrel dog (6%). There was a predominance of female dogs (71%). The most common clinical manifestations observed were syncope (71%), presyncope (24%), dyspnea (18%) and exercise intolerance (12%). Twelve percent of the dogs were asymptomatic. The most frequent electrocardiographic changes found were sinus arrest (75%), junctional escape rhythm (73%), supraventricular tachycardia (53%) and sinus arrhytmia (53%). Forty-seven percent of the dogs presented tachycardia-bradycardia syndrome. Only 24% of the animals received pacemaker implants, given the high percentage of animals unable to go through chirurgical/anesthetic procedures (29%), and the presence of asymptomatic animals. The dogs that received pacemaker implants lived for 20.4 months (mean value), whereas the ones that were treated conservatively lived for 10.8 months (mean value). These values showed benefit to those patients who received pacemaker implants, but was hindered by the high percentage of comorbidities in older animals, besides the small number of patients enrolled in this retrospective study.

GI27

ALICAM studies from 65 dogs were evaluated retrospectively by a board-certified internist. The average study consisted of 21,003 images obtained over 16 hours. Patients evaluated included 55 dogs with clinical signs of gastrointestinal disease and 10 asymptomatic dogs. The patients ranged in age from 4.5 months to 13.7 years old and in weight from 7.8 to 72 kg. Images representative of normal mucosa and common lesions were saved and logged.
15 section matches

ESCG-O-12

Other: none related to this presentation. The use of NTproBNP, Troponin I (high-sensitivity, cTnI) and PDK4 pre-screening for occult dilated cardiomyopathy(ODCM) in the Doberman pinscher(DP) has been previously reported. The aim of this prospective collaborative study was to identify robust pre-screening recommendations for DP utilizing the current generation of commercially available diagnostic tests. A cohort of asymptomatic DP were evaluated at the American Doberman National Specialty show in 2012, 2013, and 2014 (N = 449, median age 5 years, range 1-12). Evaluations consisted of auscultation, echocardiography (echo), 3-minute ECG (ECG), NTproBNP (Cardiopet Plus R ), cTnI, and PDK4. DP were classified as affected (ODCM) if their LVIDs was > the PROTECT entry criteria with or without VPCs (N = 22). DP were classified as normal (NL) if their LVIDd and LVIDs < PROTECT entry criteria and they had no VPCs (NTproBNP:N = 373, cTnI:N = 368, PDK4;N = 253). ROC analysis comparing ODCM and NL was done for NTproBNP, cTnI, and PDK4. Overall accuracy (percent correctly classified) was considered for individual tests as well as a variety of combinations. The goal of combining tests was to eliminate false negatives while minimizing false positives. The AUC for NTproBNP, cTnI and PDK4 was 0.91, 0.90 and 0.65 respectively with the percentage correctly classified equal to 81.8, 80.7 and 56.1 (including 4 false negatives for PDK4) when a cut-off of 548 pmol/l, 0.139 ng/mL or a positive PDK4 (hetero-or homozygous) were used respectively. When the cutoffs for NTproBNP and cTnI are used in combination the AUC was 0.95 and 91.3% were correctly classified (0 false negatives, 30 false positives).

ESVC-O-4 SERUM AND URINE CARDIAC TROPONIN I IN CATS

Disclosures: No disclosures to report. Sudden death (SD) commonly occurs in dog breeds with a high predisposition to VPDs and VT, occuring in about 30% of asymptomatic Doberman pinschers (DP) and 50% of DP with CHF, and reported in 31% of boxers with ARVC. In human patients with atrial fibrillation (AF) on anticoagulant therapy for stroke prevention (n = 18113), cardiac death (SD and progressive heart failure) has been reported to account for 37.4% of all deaths. The objective of this study was to evaluate the incidence of SD in Irish wolfhounds (IW) with DCM and/or AF.

ESVC

Disclosures: No disclosures to report. Deciding whether a cardiac murmur is innocent or the result of a congenital cardiac anomaly could be challenging. The gold standard method to differentiate innocent murmurs from congenital cardiac anomalies is echocardiogram, performed by a skilled operator. The present study investigated whether objective auscultation-criteria can differentiate innocent from pathologic murmurs in asymptomatic puppies between 1.5-9 months of age. The null-hypothesis was that a systolic murmur with an intensity of 1-2 out of 6 with a musical character is innocent.
Disclosures: No disclosures to report. The objective of this study was to evaluate left atrial (LA) function by left atrial total fractional area change (LA-FACtotal) and left atrial ejection fraction (LAEF) in dogs affected with chronic mitral valve disease (CMVD) naturally acquired with and without congestive heart failure (CHF). Our hypothesis was that LA-FACtotal and LAEF decrease with severity of CMVD. Eighty dogs were included in a prospective observational cross-section clinical study, grouped according to CMVD severity based on echocardiographic evaluation and clinical signs. The dogs were equally distributed in each group: A, B1, B2 and C, according to American College of Veterinary Internal Medicine staging system. Indicators of LA function were calculated with the following equations: LA-FACtotal = 100 9 (LAmaximum area -LAminimum area)/LAmaximum area, measured by apical 4 view; and LAEF = 100 x (LAmaximum volume -LAminimum volume)/LAmaximum volume, by biplane area-length method from the left apical 4 and 2chamber views. LA-FACtotal showed lower values (P < 0.0001) in group C (31.88%, P25-75% = 26.47-41.12) compared with groups A (52.75%, P25-75% = 48.08-56.07), B1 (48.38%, P25-75% = 42.57-51.91) and B2 (46.15%, P25-75% = 41.17-50). Group C had lower LAEF (40.69%, P25-75% = 34.89-52.09) than groups A (68.12%, P25-75% = 64.96-69.91), B1 (58.72%, P25-75% = 52.25-64.60) and B2 (56.98%, P25-75% = 52.08-61) (P < 0.0001). Left atrial function, assessed by LA-FACtotal and LAEF, was reduced in dogs with CMVD and CHF compared with healthy and asymptomatic CMVD groups.

ESVC-P-

The purpose of this study was to assess the prevalence of HCM in a feline population. In order to achieve this goal echocardiograms were made in all cats older of 6 years clinically asymptomatic with or without cardiac murmur. All echocardiograms were made according to the guidelines of the ACVIM published in 1993. Diagnosis of ventricular hypertrophy was made from the right parasternal window using the B mode to measure the diameter of the LVFW and the IVS in diastole. Cats with more than 6 mm of wall thickness measured T4, Bun, Crea, Blood pressure. Only cats within the normal limits of the later parameters were considered HCM positive.
In conclusion, slightly higher serum CRP concentrations were found in dogs with CHF whereas the severity of asymptomatic MMVD showed limited association with serum CRP concentrations.

ISCAID-P-4 DETECTION OF FELINE CORONAVIRUS SPIKE GENE MUTATIONS AS

In this monocenter study a prevalence rate of 16.3% in dogs and 6.4% in cats was detected, which is in good accordance with previous studies. The study further highlights a high rate (34%) of asymptomatically G. duodenalis infected animals. As potential zoonotic assemblages were detected, transmission of Giardia from small animals to humans (and vice versa) cannot be excluded. Especially young and not dewormed animals had a higher prevalence.

ISCAID

Five different breeds were included: Chihuahua (n = 9), Toy poodle (3), German shepherd (1), Jack Russell terrier (1), and Shiba dog (1). The median age was 1.9 (0.7-7.4) years. Ten dogs were asymptomatic, while the other 5 dogs showed decreased appetite (3), vomiting (3), ascites (2), seizure (1), and diarrhea (1). All dogs showed elevated liver enzymes, with high alanine aminotransferase levels (median, 306 U/L; 38-1374 U/L) in 13 dogs and high gamma-glutamyl transpeptidase levels (median, 12 U/L; 3-19 U/L) in 11. Gallbladder agenesis was confirmed using laparoscopy in 12 dogs and laparotomy in 3. Liver biopsy samples were obtained from all dogs. Additional computed tomography cholangiography was performed for 12 dogs using a 16-slice multidetector computed tomography (MDCT) scanner following the intravenous administration of contrast medium (meglumine iotroxate). The obtained images were analyzed on a workstation, and they revealed an absent gallbladder in 9 dogs and a vestigial gallbladder in 3. The common bile duct was dilated in 5 dogs. For all dogs, laparotomy or laparoscopy was used to visualize the gallbladder and liver abnormalities, including malformed lobes and surface irregularities. Acquired portal systemic collaterals were visually confirmed in 5 dogs, who also exhibited hypoplasia of the portal vein on histological examination.
In conclusion, most animals with gallbladder agenesis were asymptomatic in our study, indicating a good long-term prognosis. However, symptoms associated with portal hypertension must be monitored in animals with primary portal vein hypoplasia.

ESVC-P-8 QUANTIFICATION OF SYSTOLIC AND DIASTOLIC RIGHT

Disclosures: No disclosures to report. The objective of this study was to evaluate left atrial (LA) function by left atrial total fractional area change (LA-FACtotal) and left atrial ejection fraction (LAEF) in dogs affected with chronic mitral valve disease (CMVD) naturally acquired with and without congestive heart failure (CHF). Our hypothesis was that LA-FACtotal and LAEF decrease with severity of CMVD. Eighty dogs were included in a prospective observational cross-section clinical study, grouped according to CMVD severity based on echocardiographic evaluation and clinical signs. The dogs were equally distributed in each group: A, B1, B2 and C, according to American College of Veterinary Internal Medicine staging system. Indicators of LA function were calculated with the following equations: LA-FACtotal = 100 9 (LAmaximum area ÀLAminimum area)/LAmaximum area, measured by apical four view; and LAEF = 100 9 (LAmaximum volume À LAminimum volume)/ LAmaximum volume, by biplane area-length method from the left apical four and two-chamber views. LA-FACtotal showed lower values (P < 0.0001) in group C (31.88%, P25%-75% = 26.47-41.12) compared with groups A (52.75%, P25%-75% = 48.08-56.07), B1 (48.38%, P25%-75% = 42.57-51.91) and B2 (46.15%, P25%-75% = 41.17-50). Group C had lower LAEF (40.69%, P25%-75% = 34.89-52.09) than groups A (68.12%, P25%-75% = 64.96-69.91), B1 (58.72%, P25%-75% = 52.25-64.60) and B2 (56.98%, P25%-75% = 52.08-61) (P < 0.0001). Left atrial function, assessed by LA-FACtotal and LAEF, was reduced in dogs with CMVD and CHF compared with healthy and asymptomatic CMVD groups.

ESVC

The purpose of this study was to assess the prevalence of HCM in a feline population. In order to achieve this goal echocardiograms were made in all cats older of 6 years clinically asymptomatic with or without cardiac murmur. All echocardiograms were made according to the guidelines of the ACVIM published in 1993. Diagnosis of ventricular hypertrophy was made from the right parasternal window using the B mode to measure the diameter of the LVFW and the IVS in diastole. Cats with more than 6 mm of wall thickness measured T4, Bun, Crea, Blood pressure. Only cats within the normal limits of the later parameters were considered HCM positive.
The study included 188 client-owned dogs with different severities of MMVD. Disease severity was determined by medical history, physical examination, echocardiography and response to diuretic therapy. Dogs were allocated into groups based on ACVIM consensus statement guidelines ( In conclusion, slightly higher serum CRP concentrations were found in dogs with CHF whereas the severity of asymptomatic MMVD showed limited association with serum CRP concentrations.

ISCAID

In this monocenter study a prevalence rate of 16.3% in dogs and 6.4% in cats was detected, which is in good accordance with previous studies. The study further highlights a high rate (34%) of asymptomatically G. duodenalis infected animals. As potential zoonotic assemblages were detected, transmission of Giardia from small animals to humans (and vice versa) cannot be excluded. Especially young and not dewormed animals had a higher prevalence.

ISCAID-P-

Five different breeds were included: Chihuahua (n = 9), Toy poodle (3), German shepherd (1), Jack Russell terrier (1), and Shiba dog (1). The median age was 1.9 (0.7-7.4) years. Ten dogs were asymptomatic, while the other five dogs showed decreased appetite (3), vomiting (3), ascites (2), seizure (1), and diarrhea (1). All dogs showed elevated liver enzymes, with high alanine aminotransferase levels (median, 306 U/L; 38-1374 U/L) in 13 dogs and high gamma-glutamyl transpeptidase levels (median, 12 U/L; 3-19 U/L) in 11. Gallbladder agenesis was confirmed using laparoscopy in 12 dogs and laparotomy in three. Liver biopsy samples were obtained from all dogs. Additional computed tomography cholangiography was performed for 12 dogs using a 16-slice multidetector computed tomography (MDCT) scanner following the intravenous administration of contrast medium (meglumine iotroxate). The obtained images were analyzed on a workstation, and they revealed an absent gallbladder in nine dogs and a vestigial gallbladder in three. The common bile duct was dilated in five dogs. For all dogs, laparotomy or laparoscopy was used to visualize the gallbladder and liver abnormalities, including malformed lobes and surface irregularities. Acquired portal systemic collaterals were visually confirmed in five dogs, who also exhibited hypoplasia of the portal vein on histological examination.
In conclusion, most animals with gallbladder agenesis were asymptomatic in our study, indicating a good long-term prognosis. However, symptoms associated with portal hypertension must be monitored in animals with primary portal vein hypoplasia.
1 section matches

Abstract

Background: The way we formulate a mathematical model of an infectious disease to capture symptomatic and asymptomatic transmission can greatly influence the likely effectiveness of vaccination in the presence of vaccine effect for preventing clinical illness. The present study aims to assess the impact of model building strategy on the epidemic threshold under vaccination.
9 section matches

A61

Therapeutic options in a case of severe psoriasis associated with both HIV infection and hepatitis C virus previously treated with fumaric acid esters Rodica Olteanu 1 , Roxana Ion 1 , Alexandra Zota 1 , Isra Ennour Jaballah 1 Background Psoriasis represents a chronic, immune-mediated skin condition with genetic backgrounds characterized by sharply defined erythematous, scaly plaques with limited or extensive involvement. However, there is a challenge when the patient presents with other diseases and treatment must be adapted carefully, especially when dealing with a patient that has both HIV infection and hepatitis C virus. Case report Herein we describe a case of a 35-year-old Caucasian male, with a personal history of psoriasis vulgaris with the onset at the age of 20. The patient received treatment with fumaric acid esters for 4 weeks in Germany, with a favorable clinical response, but due to financial issues the treatment was discontinued. He was admitted to our dermatology department for the assessment of a generalized skin eruption involving the trunk, buttocks, arms, feet and the scalp, characterized by pruritic, sharply demarcated erythematous plaques, covered by silvery scale with a tendency to develop erythoderma and inverse psoriasis. The fingernails were affected and also the distal interphalangeal joints. The patient was also tested for HIV, viral hepatitis and syphilis. The results showed the presence of HIV infection and hepatitis C. As far as treatment was concerned during the hospitalization, topical therapy was applied including emollients, keratolytics and potent corticoids with a good clinical outcome. Due to the laboratory findings, the patient was referred to the infectious disease specialist in order to continue the investigations and start treating the HIV infection and viral hepatitis C. Moderate to severe cases can be treated with topical therapy, phototherapy as a first line and as a second line oral retinoids can be an option with careful monitoring for potential adverse events. More refractory and severe disease can be treated with TNF-alpha inhibitors. The positive role of the highly active antiretroviral therapy was observed because it led to the improvement of the psoriasis in our patient too. Conclusions HIV associated psoriasis is often refractory to traditional therapies, but when the patient has also hepatitis C virus, treatment is even more challenging as it requires careful consideration. The particularity of this case is represented by the fact that the patient was not tested for HIV infection before being treated with fumaric acid esters. The generalized psoriasis eruption in a young patient should lead to more investigations including HIV testing. Consent Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. The authors focused on the characterization of the humoral immune profile developed against gangliosides in asymptomatic HIV-infected patients. Host immune response to the viral infection might be influenced by these antibodies.

Methods

We investigated 32 asymptomatic HIV-infected patients (with no treatment, without neurologic manifestations) and 32 non-HIV-infected volunteers. The determination of antiganglioside antibodies of IgM type directed against GM1, GM2, GM3, GD1a, GD1b, GT1b, GQ1b was performed by immunoblot technique, using EUROLine kits. The evaluation of the results was realized using EUROLine scan software. After reading the signal intensity on the strips marked with ganglioside antigens, the interpretation of the results was made. A cut-off value equal to 10 was established (according to manufacturer's instructions). The results were considered positive at values of the signal intensity greater than 10, and negative at values lower than 10.

Results

Antiganglioside autoantibodies identified in asymptomatic HIV-infected patients and in the control group exhibit different serologic profiles. In HIV infected patients the prevalence of autoantibodies of IgM type against gangliosides was as follows: 28.12 % anti-GM1, 6.25 % anti-GM2, 9.37 % anti-GM3, 6.25 % anti-GD1a, 3.12 % anti-GD1b, 0 % anti-GT1b, 3.12 % anti-GQ1b. In the control group antiganglioside antibodies of IgM type were absent.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Background Almost 80 % of the individuals present asymptomatic enterovirus infection with one of the 71 known serotypes. A small percentage of the patients may experience a self-limited non-specific rash along with flu-like symptoms, clinically indistinguishable from other viral infections. Rarely, enteroviruses can be held responsible for severe manifestations such as acute aseptic meningitis, encephalitis, hepatic, pulmonary or cardiac complications.

Background

Group B streptococci (GBS) are major causes of morbidity and longterm disability in babies born-to-mothers colonized or infected with this germ [1] . Neonatal GBS infection is prevented by intra-partum antibiotics, and all asymptomatic pregnant women should be screened for GBS through vaginal and intra-rectal cultures at 35-37 weeks of pregnancy [2] .

Results

We studied 120 pregnant women with a median (IQR) gestational age of 30 (26.5, 33) weeks. The patient sample was representative for Southern Romania: 82 (68.3 %) from urban areas, 79 (65.8 %) from the Bucharest-Ilfov area, 32 (26.7 %) Southern, 5 (4.2 %) South-Eastern and 2 (1.7 %) from the South-Western area of Romania, while two patients were from Ukraine and Moldova. One-fourth of the patients (32, 26.7 %) had previous obstetrical medical history: uterine scarring (n = 24, 75 %), uterine fibroids (n = 2, 6.3 %), history of preeclampsia (n = 2, 6.3 %), and cervical scarring, septate uterus, history of placenta praevia, or history of intrauterine death (n = 1, 3.1 % each). None of the vaginal cultures yielded GBS while 7 (5.8 %) of the cervical cultures grew GBS. The patients did not consent to intra-rectal cultures, therefore the real prevalence of GBS colonization may be somewhat underestimated. The mean age ± SD of patients with positive GBS cultures was 30.03 ± 6.4 years; cultures were collected at a median gestational age of 38.5 ± 1.6 weeks. Urine cultures were performed in all but one case of GBS colonization and only one of them yielded asymptomatic GBS bacteriuria requiring treatment during pregnancy along with standard intra-partum antimicrobial prophylaxis for GBS colonization. The prevalence of GBS colonization was slightly higher in patients from urban areas (6/82, 7.3 % vs. 1/36, 2.8 %) but the difference failed to reach statistical significance, probably due to the small number of overall positive cultures (p = 0.674, χ(1) = 0.924). The prevalence of GBS was not influenced by obstetrical history (p = 0.187, χ(1) = 2.703), patient age (p = 0.951, Z = 0.062), or gestational age (p = 0.620, Z = −0.496), and GBS colonization increased the odds of C-section 12-fold (OR: 12.242, CI95 %: 2.420-61.933, p = 0.005, χ(1) = 13.392).
Toxocariasis prevalence in our geographic region is 51.7 %, with no significant gender differences. We can say that the majority of cases (66.5 %) were in the age group of 30-39 years and 40-49 years, while the minimum number of cases was found in the age group 60-69 years -(4 cases). The gender distribution of cases shows that 91 % of cases were women, 122 cases (67.77 %) being owners of pets (dogs). General clinical manifestations were represented by latch edema (44.44 %), headache (43.33 %), paresthesia (36.66 %), sweating (35.55 %), hoarseness (27.77 %), exanthemas (21.11 %) and abdominal pains (11.11 %). Locating ocular larvae of T. canis occurred more often in older children (10-16 years) and in adults. In the studied cases we met decreased visual acuity in 9 cases, 6 cases of uveitis, 2 cases with retinal granuloma, and 4 cases of endophthalmitis, all cases being hospitalized in Ophthalmology Clinics for appropriate therapy. Biochemical tests useful for diagnosis were represented by: major hypereosiniphilia, hyperleukocytosis, increasing ESR and gammaglobulin. In our study, leukocytosis was found in 62 % of cases and hypereosiniphilia in 88 %. For the certain diagnosis of toxocariasis we used serological methods which consisted in determination of specific Toxocara antibodies. Toxocara antibodies were present in all studied patients. The result was positive in 96 (69.56 %) cases and negative in 42 (30.43 %) cases. An IgG antibody titer of 1/100 was found in 40.5 % cases. The described complications and sequelae were met in 42 cases: respiratory disorders, ocular larva migrans, splenomegaly, uveitis, chorioretinitis and hepatomegaly. Conclusions Toxocariasis is characterized by expression of polymorphic clinical manifestations, from asymptomatic to various clinical forms with severe expression. What is needed in terms of future control programs is the radically development of new approaches, such as the effectiveness of molecular vaccines or based on DNA, offering the possibility of lifelong protection. The most pyogenic infections in the oro-maxillo-facial region are of odontogenic origin and are mixed infections, involving aerobic and anaerobic bacteria. The microbiological investigation is not commonly performed in such infections. The aim of the present study was to identify at species level a collection of 31 isolates of anaerobic Gram-positive cocci, stored in ultra-freezer at the laboratory of the Microbiology Department, Faculty of Dentistry, University of Medicine and Pharmacy (U.M.F.) "Carol Davila" -Bucharest. The strains had been previously isolated from pus samples collected by needle aspiration from 31 patients among those treated for different types of odontogenic abscesses (vestibular abscess, submandibular abscess, etc.) at the Department of Oro-Maxillo-Facial Surgery, U.M.F. "Carol Davila" -Bucharest, during March 2012 -March 2014.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Background The aim of this study was to identify the risk factors and their impact on psychopathology and quality of life among people living with HIV/AIDS in Romania, in order of obtaining a risk psychological profile. Methods For this purpose, 85 HIV-positive patients (18-57 years, 45 men and 40 women) under antiretroviral therapy, were evaluated using psychometric clinical instruments: 5 scales, 3 questionnaires and 2 inventories for measuring depression, anxiety, psychosis, mania, posttraumatic stress, substance use disorders, personality dimensions of the big five model and the quality of life with the main domains: physical health, psychological health, level of independence, social relationships, environment, spirituality/religion/personal beliefs. We analyzed the following probable risk factors: age, sex, urban/ rural location, level of education attained, marital status, serostatus (asymptomatic/symptomatic/AIDS converted), modes of HIV transmission and perception of health state.

Results

For every studied variable (psychopatological or quality of life indicators) a generalized linear model (GLM) was elaborated where we included the probable risk factors. Level of education attained, sex and marital status are important factors of risk for the state of health (both psysical and psychological) and quality of life among people living with HIV/AIDS. Level of education is significantly associated with depressive disorder (<0.001), anxiety disorders (0.019; 0.002; <0.001), post traumatic stress disorder (0.004), obsessive-compulsive disorder (0.011), substance use abuse (0.01), neuro-cognitive function (<0.001) and with quality of life indicators: health (0.04), psychological (<0.001), social relationships (0.001), environment (<0.001), and overall quality of life perception (0.007). Sex is strongly associated with global cognitive function (0.030), depressive disorder (0.011), substance use abuse (0.017), somatic symptom disorder (0.026), physical (0.009) and spirituality domain (0.01). Marital status is associated with global cognitive function (0.016), depressive disorder (0.005), anxiety disorders (0.012; 0.039; <0.001), obsessive-compulsive disorder (0.006), emotional stability (0.041) and psysical domain (0.036), social relationships (0.009) and overall quality of life perception (0.003). Age is a risk factor regarding cognitive decline (0.021; 0.042; 0.049), while the serostatus (asymptomatic/symptomatic/AIDS converted) is associated with depression (0.022), social phobia (0.003), substance use disorders (0.007), perceived stress (0.041) and general health condition (0.004). Subjects who perceived themselves as sick have a higher risk of substance abuse (0.004), isolation (0.024) and antisocial behaviour (0.048).
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Discussion and Conclusions

Contact tracing has identified asymptomatic infections, but studies of their frequency and transmissibility have been limited. Many of those infected are health care workers in whom these questions could be systematically studied. Relatively little is known about the natural history of human asymptomatic infections. Further studies of virus shedding, seroconversion, and transmission in asymptomatic infections are needed. Some evidence suggests that secondary cases have lower average CFRs and that subsequent links in the chain of MERS-CoV infection may decrease in severity.