Oxidative stress and mitochondrial dysfunction play a role in myelodysplastic syndrome development, diagnosis, and prognosis: A pilot study

The imbalance between reactive oxygen species (ROS) production and their elimination by antioxidants leads to oxidative stress. Depending on their concentration, ROS can trigger apoptosis or stimulate cell proliferation. We hypothesized that oxidative stress and mitochondrial dysfunction may participate not only in apoptosis detected in some myelodysplastic syndrome (MDS) patients, but also in increasing proliferation in other patients. We investigated the involvement of oxidative stress and mitochondrial dysfunction in MDS pathogenesis, as well as assessed their diagnostic and prognostic values. Intracellular peroxides, superoxide, superoxide/peroxides ratio, reduced glutathione (GSH), and mitochondrial membrane potential (Δψ(mit)) levels were analyzed in bone marrow cells from 27 MDS patients and 12 controls, by flow cytometry. We observed that all bone marrow cell types from MDS patients had increased intracellular peroxide levels and decreased GSH content, compared with control cells. Moreover, oxidative stress levels were MDS subtype- and risk group-dependent. Low-risk patients had the highest ROS levels, which can be related with their high apoptosis; and intermediate-2-risk patients had high Δψ(mit) that may be associated with their proliferative potential. GSH levels were negatively correlated with transfusion dependency, and peroxide levels were positively correlated with serum ferritin level. GSH content proved to be an accurate parameter to discriminate patients from controls. Finally, patients with high ROS or low GSH levels, as well as high superoxide/peroxides ratio had lower overall survival. Our results suggest that oxidative stress and mitochondrial dysfunction are involved in MDS development, and that oxidative stress parameters may constitute novel diagnosis and/or prognosis biomarkers for MDS.

Portuguese consensus document for the management of alpha-1-antitrypsin deficiency

Alpha-1-antitrypsin deficiency (AATD) is a genetic autosomal codominant disorder caused by mutations in SERPINA1 gene. It is one of the most prevalent genetic disorders, although it remains underdiagnosed. Whereas at international level there are several areas of consensus on this disorder, in Portugal, inter-hospital heterogeneity in clinical practice and resources available have been adding difficulties in reaching a diagnosis and in making therapeutic decisions in this group of patients. This raised a need to draft a document expressing a national consensus for AATD. To this end, a group of experts in this field was created within the Portuguese Pulmonology Society - Study group on AATD, in order to elaborate the current manuscript. The authors reviewed the existing literature and provide here general guidance and extensive recommendations for the diagnosis and management of AATD that can be adopted by Portuguese clinicians from different areas of Medicine. This article is part of a supplement entitled "Portuguese consensus document for the management of alpha-1-antitrypsin deficiency" which is sponsored by Sociedade Portuguesa de Pneumologia.

Whole-herd risk factors associated with wean-to-finish mortality under the conditions of a Midwestern USA swine production system

Swine wean-to-finish (W2F) mortality is a multifactorial, dynamic process and a key performance indicator of commercial swine production. Although swine producers typically capture the relevant data, analysis of W2F mortality risk factors is often hindered by the fact that, even if data is available, they are typically in different formats, non-uniform, and dispersed among multiple unconnected databases. In this study, an automated framework was created to link multiple data streams to specific cohorts of market animals, including sow farm productivity parameters, sow farm and growing pig health factors, facilities, management factors, and closeout data from a Midwestern USA production system. The final dataset (master-table) contained breeding-to-market data for 1,316 cohorts of pigs marketed between July 2018 and June 2019. Following integration into a master-table, continuous explanatory variables were categorized into quartiles averages, and the W2F mortality was log-transformed, reporting geometric mean mortality of 8.69 % for the study population. Further, univariate analyses were performed to identify individual variables associated with W2F mortality (p < 0.10) for further inclusion in a multivariable model, where model selection was applied. The final multivariable model consisted of 13 risk factors and accounted for 68.2 % (R²) of the variability of the W2F mortality, demonstrating that sow farm health and performance are closely linked to downstream W2F mortality. Higher sow farm productivity was associated with lower subsequent W2F mortality and, conversely, lower sow farm productivity with higher W2F mortality e.g., groups weaned in the highest quartiles for pre-weaning mortality and abortion rate had 13.5 %, and 12.5 %, respectively, which was statistically lower than the lowest quartiles for the same variables (10.5 %, and 10.6 %). Moreover, better sow farm health status was also associated with lower subsequent W2F mortality. A significant difference was detected in W2F mortality between epidemic versus negative groups for porcine reproductive and respiratory syndrome virus (15.4 % vs 8.7 %), and Mycoplasma hyopneumoniae epidemic versus negative groups (13.7 % vs 9.9 %). Overall, this study demonstrated the application of a whole-herd analysis by aggregating information of the pre-weaning phase with the post-weaning phase (breeding-to-market) to identify and measure the major risk factors of W2F mortality.

[Measles: optimum age and number of doses recommended for vaccination in Brazil]

Este estudo foi inicialmente conduzido em população adulta normal, compreendendo doadores de Banco de Sangue, estudantes universitários e parturientes, totalizando 889 indivíduos. Foi observado que cerca de 87% desta população apresentava anticorpos específicos para o sarampo, e que o mesmo porcentual de positividade observado nas gestantes, foi encontrado nos seus respectivos conceptos dada a passagem transplacentária dos anticorpos maternos. Foi verificado o declínio desses anticorpos após o 4.° mês, do recém-nato. Os resultados à vacinação contra o sarampo foi estudada em 1268 crianças divididas em três grupos: I) vacinadas aos 7 meses e revacinadas aos 15 meses; II) vacinadas aos 9 meses e III) vacinadas aos 7 meses e revacinadas aos 9 meses. Os resultados deste estudo indicam que apesar da resposta à vacinação ter sido mais eficiente no grupo de crianças maiores, é importante que se vacine aos 7 meses de idade, embora a porcentagem de soroconversão tenha sido de 50%. Esta medida deve ser levada em consideração, tendo em vista que a mortalidade por sarampo em crianças com menos de 1 ano representa a metade dos óbitos pela doença. Foi verificado que após a aplicação da 2.° dose, não houve diferença quanto à soroconversão, tanto no grupo revacinado 2 meses ou 8 meses após a 1.º dose da vacina. Portanto, a vacinação aos 7 meses é necessária, visando diminuir a mortalidade e a morbidade dentro do 1.º ano de vida, e a revacinação aos 9 meses, a fim de imunizar as crianças não beneficiadas com a 1.ª dose.

Next Generation of Voluntary PRRS Virus Regional Control Programs

Porcine reproductive and respiratory syndrome virus (PRRSV) became pandemic in the 1980's and today remains one of the most significant pathogens of the global swine industry. At the herd level, control of PRRSV is complicated by its extreme genetic diversity and its ability to persist in pigs, despite an active immune response. Ultimately, PRRSV control or elimination requires the coordination and active cooperation of producers and veterinarians at the regional level. Early voluntary PRRSV regional control programs focused on routine diagnostic testing and voluntary data-sharing regarding the PRRSV status of participants' herds, but no pre-defined action plans or decision trees were developed to secure project successes (or recover from failures). Given that control of PRRSV is paramount to producer profitability, we propose a coordinated approach for detecting, controlling, and ultimately eliminating wild-type PRRSV from herds participating in regional projects. Fundamental to project success is real-time, multi-platform communication of all data, information, and events that concern the regional project and project participants. New to this approach is the concept of agreed-upon action plans to be implemented by project participants in response to specific events or situations. The simultaneous and coordinated implementation of these strategies allows for early detection of wild-type PRRSV virus introductions and rapid intervention based on agreed-upon response plans. An example is given of a project in progress in the Midwest USA.

Porcine reproductive and respiratory syndrome virus RNA detection in tongue tips from dead animals

The control of porcine reproductive and respiratory syndrome virus (PRRSV) hinges on monitoring and surveillance. The objective of this study was to assess PRRSV RNA detection by RT-PCR in tongue tips from dead suckling piglets compared to serum samples, processing fluids, and family oral fluids. Tongue tips and serum samples were collected from three PRRSV-positive breeding herd farms (farms A, B, and C) of three different age groups: newborns (&lt;24 h), processing (2 to 7 days of age), and weaning (18 to 22 days of age). Additionally, processing fluids and family oral fluids were collected from 2–7 days of age and weaning age, respectively. In farms A and B, PRRSV RNA was detected in tongue tips from all age groups (100 and 95%, respectively). In addition, PRRSV RNA was detected in pooled serum samples (42 and 27%), processing fluids (100 and 50%), and family oral fluids (11 and 22%). Interestingly, the average Ct value from tongue tips was numerically lower than the average Ct value from serum samples in the newborn age. In farm C, PRRSV RNA was only detected in serum samples (60%) and family oral fluids (43%), both from the weaning age. Further, no PRRSV RNA was detected in tongue tips when pooled serum samples from the same age group tested PRRSV RNA-negative. Taken together, these results demonstrate the potential value of tongue tips for PRRSV monitoring and surveillance.

Utilizing productivity and health breeding-to-market information along with disease diagnostic data to identify pig mortality risk factors in a U.S. swine production system

Aggregated diagnostic data collected over time from swine production systems is an important data source to investigate swine productivity and health, especially when combined with records concerning the pre-weaning and post-weaning phases of production. The combination of multiple data streams collected over the lifetime of the pigs is the essence of the whole-herd epidemiological investigation. This approach is particularly valuable for investigating the multifaceted and ever-changing factors contributing to wean-to-finish (W2F) swine mortality. The objective of this study was to use a retrospective dataset ("master table") containing information on 1,742 groups of pigs marketed over time to identify the major risk factors associated with W2F mortality. The master table was built by combining historical breed-to-market performance and health data with disease diagnostic records (Dx Codes) from marketed groups of growing pigs. After building the master table, univariate analyses were conducted to screen for risk factors to be included in the initial multivariable model. After a stepwise backward model selection approach, 5 variables and 2 interactions remained in the final model. Notably, the diagnosis variable significantly associated with W2F mortality was porcine reproductive and respiratory syndrome virus (PRRSV). Closeouts with clinical signs suggestive of Salmonella spp. or Escherichia coli infection were also associated with higher W2F mortality. Source sow farm factors that remained significantly associated with W2F mortality were the sow farm PRRS status, average weaning age, and the average pre-weaning mortality. After testing for the possible interactions in the final model, two interactions were significantly associated with wean-to-finish pig mortality: (1) sow farm PRRS status and a laboratory diagnosis of PRRSV and (2) average weaning age and a laboratory diagnosis of PRRS. Closeouts originating from PRRS epidemic or PRRS negative sow farms, when diagnosed with PRRS in the growing phase, had the highest W2F mortality rates. Likewise, PRRS diagnosis in the growing phase was an important factor in mortality, regardless of the average weaning age of the closeouts. Overall, this study demonstrated the utility of a whole-herd approach when analyzing diagnostic information along with breeding-to-market productivity and health information, to measure the major risk factors associated with W2F mortality in specified time frames and pig populations.

Harnessing sequencing data for porcine reproductive and respiratory syndrome virus (PRRSV): tracking genetic evolution dynamics and emerging sequences in US swine industry

Porcine reproductive and respiratory syndrome virus (PRRSV) is the most important swine pathogen affecting the United States of America (USA), leading to significant economic losses. Despite advances in diagnostic testing, there remains a gap in understanding the genetic evolution of PRRSV, especially in tracking the emergence of novel sequences and their spread across different regions and production stages. This research addresses this gap by developing a systematic methodology for directly collecting and analyzing PRRSV ORF5 sequences from veterinary diagnostic laboratories. The study aimed to identify trends among collected sequences and emerging PRRSV sequences by integrating nucleotide sequence data with metadata, providing critical insights into their geographic distribution, collected specimens, swine age groups, lineages, variants, and restriction fragment length polymorphism (RFLP) patterns. As of December 2024, the database housed 115,643 PRRSV ORF5 sequences. Sublineages 1B, 1A, 1H, and 1C.5 were the major wild-type PRRSV sequences detected over time, whereas vaccine-like strains comprised mostly of sublineages 5A and 8A. A novel sequence detection system was implemented, categorizing sequences based on similarity thresholds, ambiguities, and length criteria, identifying 167 novel sequences for the period between 2010 and 2024, whereas only three had continued detection in the field over time, forming clusters of detection. The analysis of these novel sequences highlighted significant trends, including the dominance of grow-finish animals in sequence origin and the high number of detections of sublineage 5A. Production sites located in states with the largest swine inventory have contributed to the most frequent detection of new PRRSV strains. Additionally, the development of a web-based tool provides end users with the capability to search sequences similar to their query sequence, providing macroepidemiological information and genetic sequence features to support PRRSV management and control. Real-time PRRSV sequencing data analysis informs producers and veterinarians of any upcoming novel sequences and trends of detection. The findings are intended to enhance current surveillance efforts and support more effective strategies for managing PRRSV outbreaks, ultimately safeguarding animal health, economic sustainability in the swine industry, and ultimately contributing to national food production sovereignty through pork-derived products.

Development of a pig wean-quality score using machine-learning algorithms to characterize and classify groups with high mortality risk under field conditions

Mortality during the post-weaning phase is a critical indicator of swine production system performance, influenced by a complex interaction of multiple factors of the epidemiological triad. This study leveraged retrospective data from 1723 groups of pigs marketed within a US swine production system to develop a Wean-Quality Score (WQS) using machine learning techniques. The study evaluated three machine learning models, Random Forest, Support Vector Machine, and Gradient Boosting Machine, to classify groups having high or low 60-day mortality, where high mortality groups represented 25 % of the groups among the study population with the highest mortality values (n=431; 60-day mortality=9.98 %), and the remaining 75 % of the groups were of low mortality (n=1292; 60-day mortality=2.75 %). The best-performing model, Random Forest (RF), outperformed the other ML models in terms of accuracy (0.90), sensitivity (0.84), and specificity (0.92) metrics, and was then selected for further analysis, which consisted of creating the WQS and ranking the most important factors for classifying groups as high or low mortality. The most important factors ranked through the RF model to classify groups with high mortality were pre-weaning mortality, weaning age, average parity of litters in sow farms, and PRRS status. Additionally, stocking conditions such as stocking density and time to fill the barn were important predictors of high mortality. The WQS was developed and correlated (r = 0.74) with the actual 60-day mortality of the groups, offering a valuable tool for assessing post-weaning survivability in swine production systems before weaning. This study highlights the potential of machine learning and comprehensive data utilization to improve the assessment and management of weaned pig quality in commercial swine production, which producers can utilize to identify and intervene in groups, according to the WQS.

[The adverse effects of antihypertensive therapy: the perception of patients]

OBJECTIVES

To determine the prevalence of side effects of antihypertensive therapy as patients perceive them, their distribution and association with several sociodemographic and clinical characteristics.

DESIGN

Cross-sectional survey, made by telephone on a randomized sample of national scale, selected from the telephone directories.

PARTICIPANTS

Of a randomized sample of 4480 people contacted, 3374 were interviewed, and 1425 hypertensive patients were identified. Of this group, 1000 (70%) completed the interview, and 425 (30%) refused to participate.

METHODS

Patients were interviewed by telephone by a company of market studies. Epi Info was used for statistical analysis. Associations between the occurrence of side effects and the sociodemographic and clinical variables were analysed by logistic regression.

MAIN RESULTS

44.3% of the patients surveyed (45.6% male and 43.6% female), experienced side effects. These were more common among the youngest (50.4%) and the oldest (45.5%). There was a tendency towards an inverse relationship with social class and a significant association (p = 0.009) with the region of residence, the South showing the lowest rate of side effects (26.3%). The analysis of the associations between side effects and the clinical variables showed that only the regularity of medication was close to statistical significance (p = 0.06). The other clinical variables (time since knowledge of hypertension, substitution of medication, number of drugs and current medication) did not show any association with the perception of side effects.

CONCLUSIONS

This study showed a high prevalence of side effects referred by patients under antihypertensive therapy (44.3%). Among several sociodemographic and clinical characteristics, the only significant statistical association found was with region of residence (the South with the lowest rate). The patients' perception of side effects of antihypertensive therapy is admitted as a potential conditioner of compliance and a cause for deficient blood pressure control to be prevented.

Primary endometrial B-cell lymphoma: case report

The female genital tract is usually involved with lymphoma as part of disseminated disease. Primary lymphoid neoplasms of the female genital tract are rare; the frequency was reported to be 2% among extranodal lymphomas in women. Most of the time, primary female genital tract lymphoma occurs in the ovary and cervix, whereas endometrial lymphoma is extremely rare. The case of an 89-year-old patient that presented with postmenopausal bleeding is reported. An endometrial polypoid formation was found on hysteroscopic examination and the biopsy revealed a diffuse large B-cell lymphoma. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were surgically performed. The histologic diagnosis was primary diffuse large B-cell lymphoma of the endometrium. Adjuvant therapy was not performed. Five months after initial diagnosis, the patient died. Only a few case reports of primary endometrial lymphoma have been published; therefore, information concerning etiologic factors, histologic type, treatment and prognosis is limited.

[Non-cholera vibrios in enterobacteriologic routine]

Of 3250 diarrheal stools received for microbiologic diagnosis at a private clinical laboratory in Recife, Brazil, strains of Vibrio were isolated from 55 (1.7%). The study was carried out from May 1989 through May 1991. For recovering Vibrio, fecal samples were enriched in alkaline peptone water supplemented with 2% NaCl and subcultured on thiosulfate-citrate-bile salts-sucrose agar (TCBS). Of the recovered species, V. parahaemolyticus was most commonly found (24 strains), followed by V. furnissii (15 strains), V. cholerae non-01 (6 strains), V. alginolyticus (4 strains), V. fluvialis (2 strains), and Vibrio sp. (1 strain). The low isolation rate of Vibrio raises doubts about the cost-effectiveness of the use of TCBS in the routine enterobacteriologic workup of clinical laboratories.

[Human gastroenteritis associated with Vibrio fluvialis in Recife]

Due to the low number of reports about vibrio gastroenteritis in Brazil, it was decided to report one case of human gastroenteritis from who only Vibrio fluvialis has been found in patient stools. The main clinical epidemiological and microbiological aspects related to that microorganism are discussed. Probably, this is the first report of gastroenteritis caused by Vibrio fluvialis in the country.

Using diagnostic data from veterinary diagnostic laboratories to unravel macroepidemiological aspects of porcine circoviruses 2 and 3 in the United States from 2002-2023

Porcine circoviruses (PCVs), including porcine circovirus 2 (PCV2) and porcine circovirus 3 (PCV3), have been associated with clinical syndromes in swine, resulting in significant economic losses. To better understand the epidemiology and clinical relevance of PCV2 and PCV3, this study analyzed a dataset comprising diagnostic data from six veterinary diagnostic laboratories (VDLs) in the United States of America. The data comprised of polymerase chain reaction (PCR) test results, sample type, and age group for PCV2 and PCV3 submissions from 2002-2023. Findings indicated a decrease in the percentage of PCV2-positive submissions after introducing a commercial PCV2 vaccine in 2006 and a resurgence in positivity after 2018, particularly in breeding herds, associated with an increased number of submissions using processing fluid samples. After its first report in the U.S. in 2016, PCV3 detection had an upward trend in the percentage of positive cases, peaking in spring 2023. PCV3 detection was more frequent in adult/sow farms, while PCV2 was more frequently detected in the wean-to-market category. An additional analysis used results from tissue diagnostic data from 2019-2023 from one VDL to associate PCR cycle threshold (Ct) values with the probability of confirming a PCV2 or PCV3 disease diagnosis confirmation. An interpretative PCR Ct cutoff for PCV2 and PCV3 diagnoses was assessed based on the logistic regression model associating Ct values with the presence of tissue lesions. The analysis considered only cases tested for PCV2 and PCV3 by PCR with tissue evaluations by diagnosticians. An interpretative Ct cutoff of 22.4 for PCV2 was associated with a high probability of confirming a diagnosis of PCV2 clinical disease through histopathology. For PCV3, the interpretative cutoff with the highest performance was 26.7. These findings contribute to the ongoing efforts to monitor and understand the clinical relevance of PCV2 and PCV3 PCR results, identifying potential disease challenges.

Assessing the detection and interaction of Lawsonia intracellularis and porcine circovirus 2 in low and high-performance wean-to-finish pig groups in different porcine reproductive and respiratory syndrome virus detection scenarios

Introduction

Effective disease management strategies are essential for achieving optimal pig performance, ensuring high-quality animal health and welfare, and maintaining the economic viability of swine systems. Thus, understanding factors that lead to more or less severe disease are critically important. Porcine circovirus type 2 (PCV2) and Lawsonia intracellularis (L. intracellularis) are endemic pathogens in the U.S., affecting herds with varying degrees of subclinical and clinical disease and impact on performance. While these are common pathogens, their interaction with PRRSV and performance has seldom been investigated. This study investigated the detection dynamics of L. intracellularis, PRRSV, and PCV2, and their association with productivity impacts in wean-to-finish groups within a Midwest U.S. production system.

Methodology

This observational field study involved batches of growing pigs from PRRSV-stable or PRRSV-negative sow farms. Oral fluids were collected longitudinally from weaning until market age, and tested using quantitative PCR for each of the aforementioned pathogens. The study included 36 batches with a total of 46,446 growing pigs, resulting in 4,000 oral fluid samples. Then, batches were categorized based on key performance indicators (mortality and average daily gain), PRRSV detection timing and total genomic copies of each pathogen.

Results

Nineteen groups were characterized as high-performance and seventeen as low-performance. Mortality ranged from 5 to 9% in high-performance groups and 10.3-20.9% in low-performance groups. Average daily gain ranged from 0.68-0.86 kg in high-performance groups and 0.63-0.81 kg in low-performance groups. L. intracellularis and PCV2 were detected in most groups, with significant differences in detection rates between high and low-performance groups. Groups with relatively high genomic copies of PCV2 and L. intracellularis that had PRRSV detection presented higher mortality rates (15.75%).

Discussion

This study expanded our understanding of PRRSV, PCV2, and L. intracellularis co-detections and their impact on swine populations.