Identification and Epidemiology of a Rare HoBi‐Like Pestivirus Strain in Bangladesh

The genus pestivirus of the family flaviviridae consists of four recognized species: bovine viral diarrhoea virus 1 (BVDV‐1), bovine viral diarrhoea virus 2 (BVDV‐2), classical swine fever virus and border disease virus. A new putative pestivirus species tentatively named as either ‘HoBi‐like pestivirus’ or BVDV‐3 has recently been identified in Brazil, Italy and Thailand. Despite reports of serological evidence of BVDV in Bangladesh, the types of the virus circulating in cattle have not been identified. We conducted surveillance in cattle from May 2009 to August 2010 in three government veterinary hospitals to characterize BVDV in cattle of Bangladesh. We tested serum for BVDV using an antigen‐capture ELISA. Of 638 cattle samples, 3% (16/638) tested positive for BVDV antigen. The ELISA‐positive samples were selected for further molecular detection and characterization of BVDV. Molecular analysis of the partial 5′ untranslated region (UTR) nucleotide sequences of BVDV‐positive samples identified the rare HoBi‐like pestivirus or BVDV‐3 virus circulating in cattle of Bangladesh. The identification of this rare HoBi‐like pestivirus or BVDV‐3 strain in Bangladesh warrants further surveillance to evaluate its impact on livestock production.     

HoBi‐like is the most prevalent ruminant pestivirus in Northeastern Brazil

The ruminant pestiviral species BVDV ‐1, BVDV ‐2 and BDV , along with the putative species HoBi‐like, may cause substantial economic losses in cattle, sheep and goats. Brazil's large size, variable biomes and wide range of ruminant animal production within different geographic regions suggest that the presence and prevalence of ruminant pestivirus may differ by regions within Brazil. This study investigated the genetic diversity of ruminant pestiviruses and determined the frequency of active infections within two states of the Northeast Region of Brazil, Maranhão and Rio Grande do Norte. Serum samples from 16,621 cattle and 2,672 small ruminants from 569 different herds residing in this region were tested by RT ‐PCR followed by DNA sequencing. Seventeen positive cattle were detected (0.1%) from fifteen different herds (2.64%). All isolates were classified as HoBi‐like pestiviruses based on phylogenetic analysis. All small ruminant samples tested negative. The findings presented herein suggest that the Northeast Region of Brazil has a uniquely high prevalence of HoBi‐like viruses. The increasing reports of HoBi‐like viruses detected in cattle in the field suggest that natural infection with these viruses may be more widespread than previously thought. The identification of HoBi‐like viruses as the most prevalent type of ruminant pestivirus circulating in the Northeast Region of Brazil indicates the need for both continued monitoring and determination of the extent of economic losses associated with HoBi‐like virus infections. In addition, it must be taken into account in the choice of diagnostic tests and in vaccine formulations.     

‘Workaholism’ and potential outcomes in well‐being and health in a cross‐occupational sample

This study examined ‘workaholism’ components (work involvement, drive, enjoyment of work) and potential outcomes in terms of psychological well‐being and health. A sample of 661 Norwegian cross‐occupational employees from six different organizations completed an online questionnaire measuring ‘workaholism’, job satisfaction, life satisfaction, insomnia and subjective health complaints. A short version of the Norwegian‐translated Workaholism Battery showed significant relationships with reports of psychological well‐being and subjective health. Enjoyment of work was positively associated with job and life satisfaction and negatively associated with symptoms of poor health. Work involvement and drive were the strongest predictors of job dissatisfaction. Both were positively related to symptoms of poor health. Drive was, in addition, negatively associated with life satisfaction. The results showed that it is important to discriminate between different ‘workaholic’ features when investigating associations between ‘workaholism’ and potential outcomes, which were related in predictable ways to outcomes in terms of psychological well‐being and health. Copyright © 2010 John Wiley & Sons, Ltd.     

Intra-operative Doppler Flow Measurement do not Predict ‘At-risk’ Status of Infrainguinal Bypass Grafts

AIMS: Patients undergoing infrainguinal arterial reconstruction using vein conduits, frequently undergo intra-operative Doppler flow measurements to determine technical adequacy. The aim of this study was to determine the proportion of vein grafts with normal intra-operative haemodynamic parameters that were subsequently discovered to be 'at risk' on post-operative duplex surveillance scanning. METHODS: We prospectively collected data on 82, primary infrainguinal vein bypass grafts. Post papaverine graft flow and peripheral resistance were measured using the Scimed Opdop intra-operative Doppler machine. All grafts were determined to be technically adequate on the basis of measured peripheral resistance units (mPRU) being < or =1. At 1 week, a post-operative duplex surveillance scan was performed. At risk status was determined and compared to the intra-operative Doppler flow measurement. Statistical analysis was performed using the Mann-Whitney U-test. RESULTS: The post-operative duplex scan demonstrated that 53 (65%) of the 82 vein bypass grafts were diagnosed as being 'not at risk'; and 29 (35%) were regarded as at risk. When the groups were compared, there was no significant difference in intra-operative haemodynamic parameters between those not at risk and those at risk (P=0.19, Mann-Whitney U-test). The 1 month primary patency rate was 79% with a secondary patency rate of 100%. CONCLUSION: Despite normal intra-operative Doppler flow measurements, 35% of vein grafts were regarded as being at risk at the 1 week post-operative duplex surveillance scan. No single value may be universally applicable for identifying at risk grafts intraoperatively. Indeed, graft failure appears to be a multifactorial process.     

‘TRASH FOOT’ FOLLOWING OPERATIONS INVOLVING THE ABDOMINAL AORTA

Background : Acute lower limb ischaemia following aortic surgery is commonly termed ‘trash foot’. The exact cause of the ischaemia is unknown, but it has been attributed to athero-emboli from native arteries, thrombo-emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree. Methods : Review of 1601 aortic reconstructions performed between 1976 and 1995. Results : ‘Trash foot’ occurred in 32 patients (44 limbs): 23 cases followed aortic aneurysm repair and nine cases followed an aorto-femoral bypass for occlusive disease. Six cases of ‘trash foot’ (13.6%) underwent an early amputation (one above-knee, two below-knee and three cases of amputation of one or more toes) while a further nine cases (20.5%) underwent a delayed amputation (four above the knee, two below the knee and three cases of toe amputation). Eight patients (25%) with ‘trash foot’ died within 30 days of surgery. Conclusion : ‘Trash foot’ following aortic surgery is an unwelcome complication that is associated with a high morbidity and mortality. Attempts to reduce the incidence involve early mobilization and clamping of the iliac arteries, and irrigation of the aortic anastomosis and graft with heparin saline solution.     

Identification of Natural Infections in Sheep/Goats with HoBi‐like Pestiviruses in China

The natural infections of HoBi‐like pestiviruses in cattle have been reported in South America, Europe and Asia. In China, although the detections of HoBi‐like pestivirus have been reported, the epidemiological investigation was limited. From January 2014 to October 2015, several flocks of sheep/goats in Henan province in central China suffered respiratory diseases which were recovered slowly after antibiotics treatment. To test whether it is the HoBi‐like pestivirus caused this symptom, 49 serum samples and 22 nasal swabs were then collected for analysis by serology and RT‐PCR. Serological result revealed that prevalence of pestivirus in small ruminants was 12.2% (6/49) in central China. Sequence analysis of partial 5′‐UTR nucleotides of pestivirus‐positive samples suggested that HoBi‐like pestivirus might have circulated in sheep/goats of China for a period and have evolved into new genotype clusters. It is apparent that the study provides the molecular evidence of natural infections in goat/sheep species with HoBi‐like pestiviruses in China.     

Food‐specific IgG4‐guided exclusion diets improve symptoms in Crohn’s disease: a pilot study

Aim Exclusion diets have been shown to prolong remission in Crohn’s disease (CD). We assessed IgG4‐targeted exclusion diets in patients with CD. Method Forty patients with symptomatic CD were recruited. Their sera were tested for IgG4 antibodies to 14 specific food antigens and each subject’s four most reactive foods were excluded for 4 weeks. Disease activity was assessed using a modified CD activity index (mCDAI). Questionnaire and inflammatory markers were measured before and on completion of the exclusion diet. Results Eleven patients did not complete the study, leaving 29 for analysis. Of these, 26 (90%) reported symptomatic improvement with a reduction in mCDAI from a mean of 171–97.5 (P = 0.0001). The ESR fell from 23 to 17 mm/h (P = 0.021) and the IgG4 titres for the excluded foods fell from a mean of 3015–2306 mcgA/l (P = 0.003). Conclusion IgG4‐guided exclusion diets resulted in significant symptomatic improvement with an objective fall in an inflammatory marker. This approach may be useful in clinical practice.     

Foot‐and‐Mouth Disease Virus Serotype O Phylodynamics: Genetic Variability Associated with Epidemiological Factors in Pakistan

One of the most challenging aspects of foot‐and‐mouth disease (FMD) control is the high genetic variability of the FMD virus (FMDV). In endemic settings such as the Indian subcontinent, this variability has resulted in the emergence of pandemic strains that have spread widely and caused devastating outbreaks in disease‐free areas. In countries trying to control and eradicate FMD using vaccination strategies, the constantly evolving and wide diversity of field FMDV strains is an obstacle for identifying vaccine strains that are successful in conferring protection against infection with field viruses. Consequently, quantitative knowledge on the factors that are associated with variability of the FMDV is prerequisite for preventing and controlling FMD in the Indian subcontinent. A hierarchical linear model was used to assess the association between time, space, host species and the genetic variability of serotype O FMDV using viruses collected in Pakistan from 2005 to 2011. Significant (P < 0.05) amino acid and nucleotide variations were associated with spatial distance, but not with differences in host species, which is consistent with the frequent multi‐species infection of this serotype O FMDV. Results from this study will contribute to the understanding of FMDV variability and to the design of FMD control strategies in Pakistan. Viruses sequenced here also provide the earliest reported isolate from the Pan Asia II^ANT‐10 sublineage, which has caused several outbreaks in the Middle East and spread into Europe (Bulgaria) and Africa (Libya).     

Doppler‐guided haemorrhoidal artery ligation in patients with Crohn’s disease

Aim: The outcome of Doppler‐guided haemorrhoidal artery ligation (DGHAL) was assessed in patients with Crohn’s disease (CD) suffering from grade III haemorrhoids. Method: A retrospective study was carried out of patients with CD and symptomatic Grade III haemorrhoids treated by DGHAL. Perioperative and follow‐up data were retrieved from our database of patients undergoing DGHAL. Results: The study included seven men and six women. The mean age was 34 years old. All had CD without anorectal involvement. The median duration of haemorrhoidal symptoms was 6.3 years. There was no mortality, new incontinence, faecal impaction, urinary retention, abscess formation or persistent pain following the procedure. Mean pain score based on a visual analogue scale (VAS) decreased from 2.4 at 24 h postoperatively to 1.6 on the seventh postoperative day. All patients had completely recovered by the third postoperative day. At 18 months, three (77%) of the patients were asymptomatic and three had recurrent symptoms. Conclusion: Doppler‐guided haemorrhoidal artery ligation is safe and effective in treating Grade III haemorrhoids in patients with CD without rectal involvement.     

Diagnosis and Control Measures of the 2010 Outbreak of Foot‐and‐Mouth Disease A Type in the Republic of Korea

In January 2010, foot‐and‐mouth disease (FMD) occurred for the first time in 8 years in Korea. The outbreaks were because of A serotype, different from the O type, which had occurred previously in 2000 and 2002. The FMD outbreaks were identified in seven farms, consisting of six cattle farms where viruses were detected and one deer farm where only FMDV antibody was detected. The seven farms were within 9.3 km of each other. All susceptible animals within 10 km radius of the outbreak farms were placed under movement restrictions for 3–11 weeks. No vaccination took place to facilitate the clinical observation of infected animals and virus detection. After clinical observations and serological tests within the control zones showed no evidence of FMD infection, the movement restrictions were lifted, followed by FMD‐free declaration (23 March) at 80 days after the first outbreak on 2 January. This communication describes the outbreak of FMD A serotype, and control measures applied to eradicate the disease in Korea.     

Outcome of Three Commercial Serum ELISAs and Faecal Detection of Mycobacterium avium subsp. paratuberculosis in Consecutive Samples from a Cattle Herd with Low Prevalence of Paratuberculosis (Johne’s Disease)

Paratuberculosis (Johne’s disease) in ruminants is caused by Mycobacterium avium subsp. paratuberculosis (MAP). Owing to the lack of accurate laboratory tests, diagnosis is challenging in subclinically infected cattle. To evaluate the long‐term performance of serum ELISAs for the detection of paratuberculosis in a dairy herd with low MAP‐prevalence, three investigations of all the cows and the consecutive testing of 33 cows suspected to be infected with MAP and 30 cows classified as MAP free were performed over a period of 22 months. Blood samples were tested by three commercial serum ELISAs, MAP shedding was detected by bacteriological culture and polymerase chain reaction (PCR). The ELISA results varied in a wide range in the herd investigations with 1.2% to 18.8% positive samples, the faecal samples were positive for MAP between 1.8% and 4.9% in the three herd investigations. Over the study period, ELISA‐positive serum samples varied between 0.0% and 69.7% in MAP‐suspicious and 0.0% and 17.6% in MAP‐unsuspicious cows with a poor correlation between ELISAs and faecal shedding. The correlation coefficient of the optical density values of the three ELISAs varied between 0.348 and 0.61. Evidence of cow specific variations of residuals was found in all linear models. The linear mixed models showed relevant contribution of cow specific variation in explanation of the residual variances. They also showed significant effects of the explanatory ELISA, the group (MAP‐suspicious or MAP‐unsuspicious) and the time of sampling. It can be concluded that the choice of the laboratory test significantly influences the outcome of the testing for MAP and that none of the three ELISAs can be thoroughly recommended as single test for the early diagnosis of paratuberculosis in cattle. Test results should always be interpreted with caution to avoid erroneous decisions and the disappointment of those engaged in the abatement of paratuberculosis.     

Leptospirosis trends in China, 2007–2018: A retrospective observational study

Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re‐emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007–2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660–0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60–75), males, farmers, students and field workers were high‐risk populations. During the 2007–2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re‐emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China.     

Clinical features’ diagnostics and treatment of Hirschsprung’s disease in adults

Aim Hirschsprung’s disease first diagnosed in adulthood is symptomatic from early childhood in most cases. However, the condition is frequently masked when constipation is managed effectively by enemas and aperients. One third of the patients will experience progressive symptoms or complications, requiring urgent surgical intervention. Method Ninety patients with adult Hirschsprung’s disease were observed by a combination of investigations: barium enema, anorectal physiology, estimation of acetylcholinesterase activity and a 60 mm full‐thickness strip biopsy. The latter two modalities were performed in selected patients where there was diagnostic uncertainty. Single‐staged resections, mostly modified Duhamel procedures, were performed in patients who were stable and fit, and with only a limited degree of megacolon present, and no other complications. Otherwise patients were temporarily defunctioned prior to staged resection. All patients underwent surgical treatment. Long‐term functional outcomes were expressed as good, satisfactory or poor. Results Median age was 24.5 years, range 14–47 years, and 72.2% were men. Almost three quarters (73.3%) of the patients had symptoms dating from early childhood. Barium enema was diagnostic in 84.3%, and 36.2% had a positive, but weak rectoanal inhibitory reflex. Acetylcholinesterase staining was positive in 85.7%, but full‐thickness strip biopsy was positive in 100% of equivocal cases. A separate cadaveric study of unaffected individuals determined the true length of the normal physiological hypoganglionic zone, mean 24.4 mm and range 7.5–50 mm. Supra‐anal short segment Hirschprung’s disease was found in 5.6% patients, rectal involvement in 54.4%, rectosigmoid in 38.9% and total aganglionosis of the colon in 1.1%. Resection of the aganglionic zone and proximally dilated colon was performed as a single‐staged procedure in 67.8%. Staged surgery was carried out in 32.2%. A modified Duhamel procedure was performed in 91.2% of cases. A good or satisfactory functional outcome was achieved in 96.7%. Long‐term functional outcome after resection depends on the degree of preoperative megacolon present. Megacolon limited to the sigmoid colon was associated with a good outcome in 89.7%, but in only 66.7% with more proximal dilatation (P < 0.05). Conclusion Occasionally, Hirschsprung’s disease presents in adulthood, with ongoing symptoms from early childhood or with the development of functional obstruction, faecal impaction and megacolon in later life. Diagnosis often requires multimodal investigation. A 60 mm full‐thickness strip biopsy confirms aganglionosis in 100%. A modified Duhamel procedure is the operation of choice.     

A meta‐analysis of randomized controlled trials comparing antibacterial therapy with placebo in Crohn’s disease

Aim Background Antibacterial therapy has been investigated in several randomized, clinical trials compared with placebo for the management of Crohn’s disease. Evidences for the efficacy of intervention are increasingly required. Objectives To conduct a meta‐analysis of randomized trials to compare the effects of antibacterial therapy versus placebo in patients with Crohn’s disease. Method Search strategy A systematic literature search of Pubmed, EMBASE, Cochrane Library (April 1966 to July 2009) was conducted using specific search terms. Selection criteria Eligible studies were randomized controlled trials comparing antibacterial (antimycobacterial and broad‐spectrum antibiotic) therapy with placebo. Data collection and analysis Studies were reviewed to determine the number of participants, mean follow‐up, and the odds ratios (OR) for primary end point of clinical remission and clinical response were also abstracted. The meta‐analysis was performed using a fixed‐effects model or a randomized‐effects model according to the degree of heterogeneity. Results Eleven randomized placebo‐controlled clinical trials with 668 participants (364 patients in the treatment group and, 304 patients in the placebo group) were identified. Antimycobacterial agents were used in four of the trials and broad‐spectrum antibiotics were used in the other seven trials. Pooled analysis showed no significant differences in the rates of clinical remission [OR = 1.28, 95% confidence interval (CI): 0.87–1.90, P = 0.214] and clinical response (OR = 1.52, 95% CI: 0.91–2.55, P = 0.108) after receiving antibacterial treatment for 3 months or longer. Conclusion In this meta‐analysis, no evidence of benefit for antibiotics in patients with Crohn’s disease was found.     

Proof of Concept for the Inhibition of Foot‐and‐Mouth Disease Virus Replication by the Anti‐Viral Drug 2′‐C‐Methylcytidine in Severe Combined Immunodeficient Mice

Recent European contingency plans envisage emergency vaccination as an animal‐friendly control strategy for foot‐and‐mouth disease (FMD). Anti‐viral drugs may be used as an alternative or complementary measure. We here demonstrate that the nucleoside analogue 2′‐C‐methylcytidine (2′CMC) protects severe combined immunodeficient (SCID) mice against lethal FMD virus infection. In brief, SCID mice were inoculated with serotype A FMD virus and treated for five consecutive days with 2′CMC. All 15 treated mice remained healthy until the end of the study at 14 days post‐infection (dpi). At that time, viral RNA was no longer detected in 13 of 15 treated mice. All eight untreated mice suffered from an acute generalized disease and were euthanized for ethical reasons on average at 4 dpi. These results illustrate the potential of small molecules to control FMD.     

APOL1‐Associated End‐Stage Renal Disease in a Living Kidney Transplant Donor

Homozygosity for apolipoprotein‐L1 (APOL1) risk variants has emerged as an important predictor of renal disease in individuals of African descent over the past several years. Additionally, these risk variants may be important predictors of renal allograft failure when present in a living or deceased donor. Currently, there is no universal recommendation for screening of potential donors. We present a case of end‐stage renal disease with focal segmental glomerulosclerosis in a living donor 7 years following donor nephrectomy. Genetic assessment revealed homozygosity for the G1 high‐risk APOL1 variant.     

Results of combined medical and surgical treatment of recto‐vaginal fistula in Crohn’s disease

Aim Surgical repair of recto‐vaginal fistula (RVF) in Crohn’s disease (CD) has been associated with high rates of failure. The aim of this study was to compare the outcome in patients with CD who underwent RVF surgery with or without infliximab infusion. Method A retrospective review was carried out of 51 consecutive patients with CD treated for a symptomatic RVF between March 1998 and December 2004. Results Fifty‐one patients (mean age 39 years) underwent 65 procedures, including seton drainage (n = 35), advancement flap (n = 8), fibrin glue injection (n = 8), transperineal repair (n = 6), collagen plug placement (n = 4) and bulbocavernosus flap (n = 4). All patients were on medical treatment at the time of surgery and 26 patients had received preoperative infliximab treatment (minimum of three infusions, 5 mg/kg). Ten patients underwent preoperative diversion. At a mean follow up of 38.6 months, 27 fistulas (53%) had healed and 24 (47%) had recurred. Fistula healing occurred in 60% of patients treated with preoperative diversion, whereas 51% of nondiverted repairs were successful. Neither active proctitis nor infliximab therapy significantly affected fistula healing. Fourteen (27%) patients eventually required proctectomy. Conclusion RVF in CD is difficult to treat. Failure rates are significant despite repeated surgical interventions and concomitant medical treatment.