Effectiveness of rehabilitation on pain and function in people affected by hemophilia

INTRODUCTION

Literature provides unclear evidence of the effectiveness of many physiotherapy interventions on pain intensity, quality of life, and functional ability in hemophilic patients, and suggests that rehabilitation programs should be focused on functional goals and the disability of patients.

AIM

The aim of the present study is to present the outcome of a case series of patients with hemophilia in which a rehabilitation program has been carried out on the basis of a specific individual patient's functional impairment.

METHODS

Fifty-one patients were enrolled: 32 patients (Rehab Group) received a rehabilitative treatment, 19 patients for different reasons (living far from the hospital, family problems) did not receive rehabilitation (Control Group). The rehabilitation program was planned with respect to the emergent problems: musculoskeletal pain, joint range of motion limitation, muscle flexibility, walking difficulties, the appearance of hematomas/hemartro, and postural problems. All the patients were assessed at baseline (T0), after 1 month (T1), and after 3 months (T2) through visual analogic scale for musculoskeletal pain, the Hemophilia Joint Health Score for joint range of motion, the Functional Independence Score in Hemophilia for disability, and postural assessment by visual inspection.

RESULTS

A significant reduction of pain and improvement of Hemophilia Joint Health Score and Functional Independence Score in Hemophilia score was found in the Rehab Group along with the follow-up. Pain in the Control Group was lower with respect to the other group at baseline and significantly decreased after 1 month.

CONCLUSION

A rehabilitation program focused on individual impairment of patients with hemophylia determined satisfying results in terms of pain control, functional, and disability improvement in 3 months follow-up.

Abortion in goats by Caprine alphaherpesvirus 1 in Spain

An abortion outbreak occurred in a goat herd of Murciano-Granadina breed in Almeria Region in Spain where 80 pregnant females aborted. All bacteriological and parasitological examinations resulted negative, whereas virological investigations and real-time PCR assay showed the presence of Caprine alphaherpesvirus 1 DNA in the pathological specimens from aborted foetuses. Nucleotide sequence analysis revealed that the DNA was highly close related to the Swiss strain E-CH (99.7%) and a little less extent to the Italian BA.1 strain (99.4%). Histopathological examination revealed multifocal, well-circumscribed, 50- to 200-μm-diameter foci of coagulative necrosis in the liver, lungs and kidneys of three foetuses. In the periphery of the necrosis, there were frequently epithelial cells with the chromatin emarginated by large, round, amphophilic intranuclear viral inclusion bodies. The source of the infection in the herd could not clearly find out even some hypothesis were formulated. This seems to be the first report of an abortion outbreak due to Caprine alphaherpesvirus 1 in a goat herd in Spain.

Histiocytic sarcoma of the nasal cavity in a horse

Histiocytic diseases in veterinary medicine have been revised in the last few decades, but these are considered relatively rare in horses. This report describes a 9-year-old female horse, Dutch Warmblood, presented for investigation of severe nasal bleeding. A multinodular bilateral mass of 5 cm, reddish to white in color, that invaded and destroyed the surrounding tissues, was observed during a clinical examination of the nostril The morphological features of the tumor cells were represented by cytologically bizarre, highly phagocytic, multinucleated giant cells. These findings, together with immunohistochemical results allowed a diagnosis of histiocytic sarcoma.

First Observation of an Hashimoto Thyroiditis-Like Disease in Horses from Eastern Europe: Histopathological and Immunological Findings

Among 622 slaughtered horses from eastern Europe, 156 thyroid glands were selected on the basis of macroscopic alterations (e.g., determination of volume and weight). In the 80% of these thyroids, microscopic alterations consistent with a diagnosis of Hashimoto thyroiditis-like disease were found. In particular, a subverted architecture of the thyroid gland with colloid rarefaction, lymphocytic infiltration, and fibrosis was noted. The confirmation of the histopathological diagnosis of an equine Hashimoto thyroiditis-like disease was provided by the increased serum concentration of thyroglobulin, of antithyroglobulin, and of antithyroid peroxidase autoantibodies. Despite evidence consistent with an Hashimoto thyroiditis-like disease in eastern European horses, the etiopathogenesis of this autoimmune disorder deserves further investigation. In this respect, in some horses histopathological alterations in the pituitary gland may suggest an as-yet-unidentified disorder within the hypothalamus-pituitary adrenal axis associated with Hashimoto thyroiditis.

In Vitro Elicitation of Intestinal Immune Responses in Teleost Fish: Evidence for a Type IV Hypersensitivity Reaction in Rainbow Trout

In fish the gut immune system has been the subject of few investigations until now. Here, we provide novel morphological and immunological data on the gut isolated from rainbow trout Salmo gairdneri. The pyloric (P) and terminal (T) segments of trout gut, when morphologically examined, evidenced lymphocytes and macrophages (MØ) loosely dispersed in the intestinal mucosa and in the lamina propria in the absence of typical Peyer's patches-like structures. Furthermore, incubation of P and T sections with Candida albicans (Ca) and functional analysis of supernatants generated some interesting results. In fact, active supernatants, when compared with controls, exhibited cytokine-like activities attributable to the presence of interferon (IFN)-gamma and migration inhibiting factor (MIF), respectively. In particular, IFN-gamma-like activity gave rise to an enhancement of Ca phagocytosis by MØ, whereas MIF inhibited MØ migration in agarose. Taken together, these in vitro data suggest that the gut-associated lymphoreticular tissue in fish possesses the appropriate armamentarium to mount a type IV hypersensitivity response when challenged by microbial antigens.

Modifications of serum and cellular parameters in trotters after a race. Macrophage migration inhibitory activity reduction and serum beta-glucan elevation

Trotters are exposed to a chronic prolonged stress, such as daily training and frequent races during their active lifespans. There is evidence that trotters undergo very often lethal lung infections after a race, and therefore, is likely that modifications of certain physiologic cellular parameters could account for the increased susceptibility to microbial diseases. Here, we demonstrate that in 7 trotters after a race either serum values (e.g., glycaemia, triglycerides, transaminases, gamma-glutamyltransferase, cholinesterase, amylase, alkaline phosphatase, total proteins, serum albumin, sodium, blood urea nitrogen, lactic dehydrogenase, creatine phosphokinase, and creatinine) or hematological parameters (red blood cell count, hemoglobin, lymphocyte and monocyte count) were increased. At the same time, in the same animals after a race, macrophage migration inhibitory factor activity was depressed, thus indicating an impaired T-lymphocyte response. Finally, increased levels of circulating beta-glucans in some horses, after a race, may suggest a reduced clearance of fungal cell wall components. Taken together, these findings indicate a condition of multiple organ dysfunction, such as the liver, the kidney, the pancreas, and skeletal muscles, as well as a reduced cell-mediated immune response in trotters, after a race.

A phylogenetic comparison between acute monocytic leukemia cells and monocytes-macrophages in lower vertebrates

In humans, monocytes and macrophages (Mphi) play a central role in immune regulation, tissue maintenance and pathogen control. In lower vertebrates, a few studies have been conducted on Mphi like cells. In acute monocytic leukemia monocytic cells, as immature cells restrained in one of the phases of their ontogenesis, would offer the opportunity to rebuild an archaic condition helpful to understand the phylogenesis. Therefore, aim of this work was to characterize in the Rainbow trout (Salmo Gairdneri Richardson) Mphi and compare them with acute leukemia monocytic cells. In the trout, Mphi's morphology is similar to that of mammals. In particular, Mphi possess an irregular embryoshaped nucleus occupying 2/3 of the cell, while the peripheral cytoplasmic profile is irregular with extroflexed plasmalemma and pseudopods. A morphological transition towards Mphi is featured by a wavy hyaline classical membrane and an irregular and extroflexed surface. Some aspects of erythrophagocytosis represented a finding of great interest indicating that the hemocatheretic function could take place directly in circulation. This condition, also observed in human acute monocytic leukemia, suggests that the information to the erythrophagocytosis is restrained under physiological conditions. Non-specific esterases, which are positive in human Mphi smear and Mphi from human lymph node tissue, were also positive in the teleost studied but with a dysomogeneous pattern. Consequently non-specific esterase system is phylogenetically conserved. A lack of immune-reactivity with the anti-CD68 monoclonal antibody (MoAb) on smear and trout tissue sections was observed. On the contrary, strong positivity was detected on human lymph node sections. In trout, the presence of Mphi and circulating Mphi like cells exhibiting an erythrocatheretic function in the circulation would indicate a primordial function that has later been replaced by the liver and the spleen.

[Comparative macroscopic and microscopic anatomical observations on pyloric ceca in some bony fish]

The authors report the variable number of pyloric caeca of some species of fish and describe their macroanatomy. They also describe and compare the microanatomy of pyloric caeca in three species; in particular they point out the thickness of tunica muscularis, the shape and length of villi which protrude into the lumen and the variable number of goblet cells. The tunica muscularis is very strong in Uranoscopus and consists of three strata: external and inner longitudinal strata, middle circular stratum. The tunica muscularis is less thick in Diplodus and in Scorpaena. The lamina propria and epithelium form villi which protrude into the lumen. They are covered with columnar epithelium and goblet cells which are more numerous in Uranoscopus and Scorpaena and less numerous in Diplodus. At last the authors describe in pyloric caeca of Scorpaena the presence of a network which engages all the lumen; it consists of connective tissue septa which directly derive from the lamina propria and is covered with the same columnar epithelium and goblet cells.

[Presence of epithelial crypts in the chamois (Rupicapra rupicapra L.) epididymis. Preliminary note]

The Authors refer the presence of epithelial crypts in the epididymis of chamois, previously described only in the bull by Nicander, in the camel by Singh, in the cat by Arrighi and in the roe-buck by Gentile et al. These crypts consist of cavities bored into the epithelium lining the epididymis and are rounded by the epithelial cells which are, sometimes, squamous and thin. Some crypts open into the lumen of the epididymis, some others crypt are filled with floccular, gelatinous material and, at times, with spermatozoa. The Authors think to undertake other morphological researches to find out the physiologic meaning of crypts, which could have an important role in the seasonal reproductive biology of wild ruminants.

[Comparative microscopic anatomy of the urinary bladder of various domestic and wild ruminants]

The Authors focus their interest on the microanatomical differences between urinary bladders of some domestic (sheep and cattle) and wild Ruminantia (roe and chamois). Sixteen urinary bladders of the following species have been studied by Azan, Masson and Weigert staining methods: Three urinary bladders of Ovis aries (L.) and Bos taurus (L.) drawn from animals of both sexes; seven urinary bladders drawn from female of Capreolus capreolus (L.); three urinary bladders from both sexes specimens of Rupicapra rupicapra (L.). It is possible to summarize the data on the compared microanatomy of urinary bladder in the following way: it presents three tunics: mucosa, muscularis and adventitia. The tunica mucosa is composed of lamina propria and transitional epithelium, and presents typical plicae which give a peculiar aspect to the lumen. In roe deer the lamina propria presents several smooth muscle fibers which are organized in an evident "muscularis mucosae" which is absent in all the studied species. The tunica muscularis is composed of two longitudinal (outer and inner) muscle layers and a middle circular layer. In roe this tunica is thicker and more powerful than in other species, and the single layers are more evident because of the presence of many connective septa. The tunica adventitia is composed of loose connective tissue, and some elastic fibers. Unexpectedly, the Chamois, which belongs to wild Ruminants as the roe, does not present a "muscularis mucosae". Therefore the authors suppose that the presence of "muscularis mucosae" in roe could be due to the ethology peculiar of this species which is accustomed to mark the boundary of its territory by staling frequently.

[Innervation of the urinary bladder of Ovis aries L]

The authors have extended a preliminary study about the innervation of urinary bladder, confirming the previous results pointing out the presence of metasympathetic ganglions in the wall of urinary bladder. Therefore nine urinary bladders of Ovis aries of different age and both sexes have been studied by Ruffini, Bodian and Bielschowsky's staining methods. It's possible summarize the data on the innervation of urinary bladder in the following way: in the tunica adventitia there are motor and sensitive bundles of myelinated nervous fiber. The formers, after many divisions, penetrate into the tunica muscularis contacting bundles of smooth muscle fibers, while the latters after several divisions after giving rise to thinner bundles, produce Pacini-like and Ruffini-like sense corpuscles and free nervous terminations. Furthermore, some metasympathetic ganglions of different size have been detected throughout the running of the bundles. In the tunica submucosa a diffuse and peculiar non myelinated network is observed, arising from the vegetative nervous fibers.

[Histological alterations of the visual organ following high grade barometric depression limited to the cranium]

The Authors describe the histologic report of the eye and the first part of optic nerve of young goats and rabbits exposed to high grade barometric depression (850/cm2) limited to cranium.

[Air embolism due to limited high grade barometric depression as evidenced in vivo]

The Authors supply documentary evidence for the aeroembolism of auricular lobe vessels photographed in transillumination of living albino rabbits exposed to high grade barometric depression (850 g/cm2) limited on the top of the head.