Regional and Distant Metastasis of Oral Squamous Cell Carcinoma in a Male Castrated Llama: A Case Report

A 19-year-old male castrated llama presented with a 3-year history of tooth root abscesses and an osseous mass on the left mandible. Surgical excision of the affected teeth and mass was performed, and histopathologic review indicated that the mass was an oral squamous cell carcinoma. The patient was admitted to the hospital again 4 months later in severe respiratory distress with submandibular edema, and bicavitary effusion. Necropsy results revealed regional and distant metastatic squamous cell carcinoma.

Education and Information Need for Emergency Physicians About Rare Diseases in China

Background: Rare diseases are serious and chronic disease that affect no more than 1 person in 2000. The patients suffering from RD may come to emergency department for life-threatening symptoms, such as acute aortic dissection, intracranial hemorrhage, and severe respiratory distress. Diagnostic delay of rare disease patients is common and often caused by low rare disease awareness among physicians. The main aim of this study was to investigate the Chinese emergency physicians’ basic knowledge, information access and educational needs regarding rare diseases. An online questionnaire was completed by Chinese emergency physicians during January and March 2021. Methods and Results: A total of 539 emergency physicians responded to the questionnaire-based study, including 200 females and 339 males. More than half of respondents were from Tertiary A hospital and had engaged in medical clinical work more than 10 years. Only 4.27% of respondents correctly estimated the prevalence of rare diseases. A few respondents knew the exact number of RD in the first official list of rare diseases in 2018. 98.5% of respondents rated their knowledge about rare diseases as rare or insufficient. Most of emergency physicians preferred to getting information by search engine instead of specialized websites of rare diseases. Lack of practice guidelines or consensus and were considered as the most important reason for diagnostic delay of RD. Practice guidelines or consensus and professional websites on rare diseases were urgently needed for emergency physicians.Conclusion: The investigation shows poor knowledge of emergency physicians regarding rare diseases. Practice guidelines and professional websites on rare diseases were the prominently urgent needs for emergency physicians. Specialized RD courses should also be added in medical education.

Staphylococcus lugdunensis Bacteremia with an Infected Aortic Thrombus in a Preterm Infant

Staphylococcus lugdunensis is a rare cause of late-onset sepsis in preterm infants. To our best knowledge, we report the fourth case of a male preterm infant who developed fulminant late-onset sepsis due to Staphylococcus lugdunensis with persistent bacteremia secondary to an infected aortic thrombus confirmed with two positive blood cultures. Our patient was an extremely low birth weight growth-restricted infant born at 27 weeks gestation and initially required an umbilical arterial catheter for blood pressure and blood gas monitoring. The course of this neonate was complicated by severe respiratory distress syndrome that evolved into chronic lung disease along with multiple episodes of tracheitis. Hemodynamically, the infant had a significant patent ductus arteriosus, and an episode of medical necrotizing enterocolitis followed by Staphylococcus lugdunensis septicemia. He was diagnosed with an infected aortic thrombus, probably the occult focus responsible for the persistent bacteremia. After a 6-week course of intravenous antibiotics and 4-week course of anticoagulant therapy, the infant responded and recovered without complications.

Concatenation of Pre-Trained Convolutional Neural Networks for Enhanced COVID-19 Screening Using Transfer Learning Technique

Coronavirus (COVID-19) is the most prevalent coronavirus infection with respiratory symptoms such as fever, cough, dyspnea, pneumonia, and weariness being typical in the early stages. On the other hand, COVID-19 has a direct impact on the circulatory and respiratory systems as it causes a failure to some human organs or severe respiratory distress in extreme circumstances. Early diagnosis of COVID-19 is extremely important for the medical community to limit its spread. For a large number of suspected cases, manual diagnostic methods based on the analysis of chest images are insufficient. Faced with this situation, artificial intelligence (AI) techniques have shown great potential in automatic diagnostic tasks. This paper aims at proposing a fast and precise medical diagnosis support system (MDSS) that can distinguish COVID-19 precisely in chest-X-ray images. This MDSS uses a concatenation technique that aims to combine pre-trained convolutional neural networks (CNN) depend on the transfer learning (TL) technique to build a highly accurate model. The models enable storage and application of knowledge learned from a pre-trained CNN to a new task, viz., COVID-19 case detection. For this purpose, we employed the concatenation method to aggregate the performances of numerous pre-trained models to confirm the reliability of the proposed method for identifying the patients with COVID-19 disease from X-ray images. The proposed system was trialed on a dataset that included four classes: normal, viral-pneumonia, tuberculosis, and COVID-19 cases. Various general evaluation methods were used to evaluate the effectiveness of the proposed model. The first proposed model achieved an accuracy rate of 99.80% while the second model reached an accuracy of 99.71%.

The challenging airway: Tracheal agenesis in the newborn

A preterm female presented with severe respiratory distress in the delivery room and was found to have tracheal agenesis with a tracheoesophageal fistula and a congenital heart defect. Tracheal agenesis is uncommon and is often associated with other congenital abnormalities. Although there are surgical options for repair, mortality remains high.

The use of N-terminal (1–76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department

Introduction: Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1–76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1–76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. Methods: All children aged 0–18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients’ demographic characteristics, presenting complaints, clinical findings, and N-terminal (1–76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. Results: This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1–76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1–76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. Conclusion: Using scoring systems in combination with N-terminal (1–76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.

Respiratory obstruction due to tonsillar lymphoglandular polyp in a brachycephalic dog: a case report

Background Respiratory distress is one of the most common afflictions of brachycephalic dogs. Dogs in respiratory distress usually present to the emergency service with a constellation of clinical signs including but not limited to: stertorous breathing, dyspnea, gagging, cyanotic mucus membranes, hyperthermia, and commonly a history of gastrointestinal signs. While Brachycephalic Obstructive Airway Syndrome is the most common cause of respiratory distress in dogs with brachycephalic conformation, any condition eliciting an inflammatory response in the oropharynx, can result in obstruction. There is no previous report of respiratory obstruction leading to emergency tonsillectomy caused by tonsillar polyps. Case presentation A 9-month-old male intact English bulldog presented to the emergency service in severe respiratory distress. Due to continued severe dyspnea and cyanosis the patient was induced with propofol (Propofol, Hospira) 4 mg/kg intravenously titrated to effect and tracheal intubation performed. Intubation was noted to be difficult due the presence of two, large, inflamed masses in the oropharynx region. The remainder of his physical exam was unremarkable. Minimum database blood work and chest radiographs revealed only minor abnormalities. The patient was placed under anesthesia and the masses were transected sharply using a carbon dioxide (CO2) laser (Aesculight, Bothell, WA, USA). Anesthesia and recovery were uneventful, and the patient was discharged the following day. Histopathology results of the masses revealed them to be benign lymphoglandular polyps. Conclusions This is the first report of bilateral tonsillar polyps causing life-threatening respiratory obstruction in a dog. Both masses were excised safely and completely with the CO2 laser. Difficulties inherent to oropharyngeal surgery include the hemorrhage, small working space, tissue swelling and difficult visualization. Surgical excision of these polyps alleviated all emergent and chronic clinical signs, and the patient’s remains healthy 12-months post-treatment.

Case Report: Neonatal Massive Pneumothorax Resulting in Compression Atelectasis Treated by Ultrasound-Guided Pleural Puncture Therapy: A Typical Case Based on Lung Ultrasound Finding

Atelectasis is a complication of different pulmonary diseases; however, neonatal compression atelectasis due to pneumothorax is rarely reported in the literature. Recently, we encountered a typical case of atelectasis. A preterm infant was admitted to the neonatal intensive care unit owing to severe respiratory distress. Lung ultrasound examination confirmed severe pneumothorax and large area of atelectasis. Lung re-expansion occurred when the air was drained from the pleural cavity.

Activation of Intracellular Complement in Lungs of Patients With Severe COVID-19 Disease Decreases T-Cell Activity in the Lungs

A novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), arose late in 2019, with disease pathology ranging from asymptomatic to severe respiratory distress with multi-organ failure requiring mechanical ventilator support. It has been found that SARS-CoV-2 infection drives intracellular complement activation in lung cells that tracks with disease severity. However, the cellular and molecular mechanisms responsible remain unclear. To shed light on the potential mechanisms, we examined publicly available RNA-Sequencing data using CIBERSORTx and conducted a Ingenuity Pathway Analysis to address this knowledge gap. In complement to these findings, we used bioinformatics tools to analyze publicly available RNA sequencing data and found that upregulation of complement may be leading to a downregulation of T-cell activity in lungs of severe COVID-19 patients. Thus, targeting treatments aimed at the modulation of classical complement and T-cell activity may help alleviate the proinflammatory effects of COVID-19, reduce lung pathology, and increase the survival of COVID-19 patients.

Fundamentals of vaping-associated pulmonary injury leading to severe respiratory distress

Vaping of flavored liquids has been touted as safe alternative to traditional cigarette smoking with decreased health risks. The popularity of vaping has dramatically increased over the last decade, particularly among teenagers who incorporate vaping into their daily life as a social activity. Despite widespread and increasing adoption of vaping among young adults, there is little information on long-term consequences of vaping and potential health risks. This study demonstrates vaping-induced pulmonary injury using commercial JUUL pens with flavored vape juice using an inhalation exposure murine model. Profound pathological changes to upper airway, lung tissue architecture, and cellular structure are evident within 9 wk of exposure. Marked histologic changes include increased parenchyma tissue density, cellular infiltrates proximal to airway passages, alveolar rarefaction, increased collagen deposition, and bronchial thickening with elastin fiber disruption. Transcriptional reprogramming includes significant changes to gene families coding for xenobiotic response, glycerolipid metabolic processes, and oxidative stress. Cardiac systemic output is moderately but significantly impaired with pulmonary side ventricular chamber enlargement. This vaping-induced pulmonary injury model demonstrates mechanistic underpinnings of vaping-related pathologic injury.