All 12 dogs showed evidence of nasal turbinate destruction on CT scan. Topical antifungal application in the nasal cavity and frontal sinuses was required for 10 dogs (83.3%), while 1 case was managed with systemic antifungal medication alone. 11 dogs were considered treatment successes (91.7%). CT scanning and rhinoscopy were found to be sensitive tools for diagnosing canine aspergillosis, while histopathology, cytology and fungal culture were less reliable diagnostic methods.
Comparison of tzanck smear with viral serology in varicellaEva Yustiana
This document summarizes a study comparing the Tzanck smear test to viral serology for diagnosing varicella (chickenpox). The study analyzed 50 patients with symptoms of varicella. The Tzanck smear, which examines skin scrapings for multinucleated giant cells, was positive in 66% of patients. Viral serology, which detects antibodies against the varicella virus, was positive in 90% of patients. Both tests showed matching positive results in 62% of patients. The study concludes that the Tzanck smear provides a quick diagnosis of varicella but may miss some cases, while viral serology confirms diagnosis but requires longer for results.
Knowledgeon Snake Bitediagnosis &Management among Internees in a Government M...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
IPD and pneumonia are important causes of disease in children in Bangalore, India. A study found the highest incidence of IPD was 46.01 per 100,000 in children 6-12 months. Pneumonia was the most common presentation of IPD. The incidence of clinical and radiological pneumonia was highest in children under 6 months at 4,800.88 and 1,771.32 per 100,000 respectively. Salmonella was the most common pathogen isolated. S. pneumoniae serotype distribution and antibiotic resistance was also examined.
Antibiogram of Bacterial Isolates at Hail General Hospital, KSA June 1 – Dece...iosrjce
This research study focused on the antibiogram of bacterial isolates at Hail General Hospital,
Kingdom of Saudi Arabia. It sought to answer the following questions: (1) What is the percentage distribution of
the isolates on the specimens when classified according to the following bacteria? Enterobacter aerogenes,
Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa,
Raoultella (K.) ornithinolytica. (2) What is the antibiogram result of the bacterial isolates? Descriptive research
using content analysis was employed wherein the Automated Sensitivity Testing Machine data obtained from the
Microbiology section of Hail General Hospital. The statistical tools were frequency and percentage. The results
revealed that based on the percentage distribution of the specimens, the highest number of isolates for
Enterobacter aerogenes, Enterobacter cloacae, Klebsiella pneumoniae and Proteus spp. was from throat swab,
urine for Escherichia coli and Psedomonas aeruginosa, ward swab and high vaginal swab for Raoultella (K.)
ornithinolytica. On antibiogram result, the most sensitive antibiotics for Enterobacter aerogenes was
Meropenem; Cirpofloxacin and Levofloxacin for Enterobacter cloacae; Imipenem for Escherichia coli;
Amikacin for Klebsiella pneumoniae; Ertapenem, Imipenem and Pip/Tazo for Proteus spp.; Pip/Tazo for
Pseudomonas aeruginosa, and Imipenem for Raoultella (K.) ornithinolytica. The most resistant antibiotics for
Enterobacter aerogenes, Escherichia coli, Klebsiella pneumonaie and Raoultella (K.) ornithinolytica was
Ampicillin; Amox/K Clav, Cefazolin and Cefoxitin for Enterobacter cloacae; Cefotaxime for Pseudomonas
aeruginosa and for Proteus spp. was Cefazolin. The researchers recommend for the conduct of an annual
antibiogram study by institution, disseminate the information through seminars/fora especially to clinicians,
conduct another study to include other hospitals and other types of bacteria.
This study examined the prevalence of cryptococcal meningitis (CM) among people living with HIV/AIDS (PLHAs) at a hospital in southern Odisha, India. Of 112 clinically diagnosed CM patients, 16 cases were confirmed via cerebrospinal fluid analysis, showing a prevalence of 14.3%. Males aged 21-40 were most commonly affected. The most common symptoms were fever, headache, altered sensorium, and neck stiffness. CD4 T-lymphocyte counts were below 100 cells/μl in 93.7% of confirmed cases. All patients responded initially to antifungal therapy but 2 died during hospitalization and 4 were lost to follow up. Early diagnosis and treatment of CM is
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
The Significance of Bacterial and Fungal Coinfection in the Setting of Viral ...Texas Children's Hospital
Keystone ECMO meeting 2018: To better characterize the frequency of bacterial and/or fungal coinfections in patients with viral pneumonias placed on ECMO and to understand their impact on mortality.
Comparison of tzanck smear with viral serology in varicellaEva Yustiana
This document summarizes a study comparing the Tzanck smear test to viral serology for diagnosing varicella (chickenpox). The study analyzed 50 patients with symptoms of varicella. The Tzanck smear, which examines skin scrapings for multinucleated giant cells, was positive in 66% of patients. Viral serology, which detects antibodies against the varicella virus, was positive in 90% of patients. Both tests showed matching positive results in 62% of patients. The study concludes that the Tzanck smear provides a quick diagnosis of varicella but may miss some cases, while viral serology confirms diagnosis but requires longer for results.
Knowledgeon Snake Bitediagnosis &Management among Internees in a Government M...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
IPD and pneumonia are important causes of disease in children in Bangalore, India. A study found the highest incidence of IPD was 46.01 per 100,000 in children 6-12 months. Pneumonia was the most common presentation of IPD. The incidence of clinical and radiological pneumonia was highest in children under 6 months at 4,800.88 and 1,771.32 per 100,000 respectively. Salmonella was the most common pathogen isolated. S. pneumoniae serotype distribution and antibiotic resistance was also examined.
Antibiogram of Bacterial Isolates at Hail General Hospital, KSA June 1 – Dece...iosrjce
This research study focused on the antibiogram of bacterial isolates at Hail General Hospital,
Kingdom of Saudi Arabia. It sought to answer the following questions: (1) What is the percentage distribution of
the isolates on the specimens when classified according to the following bacteria? Enterobacter aerogenes,
Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa,
Raoultella (K.) ornithinolytica. (2) What is the antibiogram result of the bacterial isolates? Descriptive research
using content analysis was employed wherein the Automated Sensitivity Testing Machine data obtained from the
Microbiology section of Hail General Hospital. The statistical tools were frequency and percentage. The results
revealed that based on the percentage distribution of the specimens, the highest number of isolates for
Enterobacter aerogenes, Enterobacter cloacae, Klebsiella pneumoniae and Proteus spp. was from throat swab,
urine for Escherichia coli and Psedomonas aeruginosa, ward swab and high vaginal swab for Raoultella (K.)
ornithinolytica. On antibiogram result, the most sensitive antibiotics for Enterobacter aerogenes was
Meropenem; Cirpofloxacin and Levofloxacin for Enterobacter cloacae; Imipenem for Escherichia coli;
Amikacin for Klebsiella pneumoniae; Ertapenem, Imipenem and Pip/Tazo for Proteus spp.; Pip/Tazo for
Pseudomonas aeruginosa, and Imipenem for Raoultella (K.) ornithinolytica. The most resistant antibiotics for
Enterobacter aerogenes, Escherichia coli, Klebsiella pneumonaie and Raoultella (K.) ornithinolytica was
Ampicillin; Amox/K Clav, Cefazolin and Cefoxitin for Enterobacter cloacae; Cefotaxime for Pseudomonas
aeruginosa and for Proteus spp. was Cefazolin. The researchers recommend for the conduct of an annual
antibiogram study by institution, disseminate the information through seminars/fora especially to clinicians,
conduct another study to include other hospitals and other types of bacteria.
This study examined the prevalence of cryptococcal meningitis (CM) among people living with HIV/AIDS (PLHAs) at a hospital in southern Odisha, India. Of 112 clinically diagnosed CM patients, 16 cases were confirmed via cerebrospinal fluid analysis, showing a prevalence of 14.3%. Males aged 21-40 were most commonly affected. The most common symptoms were fever, headache, altered sensorium, and neck stiffness. CD4 T-lymphocyte counts were below 100 cells/μl in 93.7% of confirmed cases. All patients responded initially to antifungal therapy but 2 died during hospitalization and 4 were lost to follow up. Early diagnosis and treatment of CM is
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
The Significance of Bacterial and Fungal Coinfection in the Setting of Viral ...Texas Children's Hospital
Keystone ECMO meeting 2018: To better characterize the frequency of bacterial and/or fungal coinfections in patients with viral pneumonias placed on ECMO and to understand their impact on mortality.
This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
This study examined the efficacy and tolerability of oral methylprednisolone (MP) in combination with amoxicillin/clavulanic acid (AMX/C) in children with chronic rhinosinusitis (CRS). 45 patients aged 6-17 years with CRS were randomly assigned to receive either oral AMX/C with MP or AMX/C with placebo for 30 days. The MP group had greater reductions in total symptom scores and CT scan scores compared to the placebo group. The MP group also had higher rates of clinical recovery and improvement. Relapse rates and adverse effects were similar between groups. This randomized controlled trial provides evidence that short-term oral MP added to AMX/C is
This document describes a case report of a 2-year old girl diagnosed with leptospirosis caused by Leptospira inadai. She presented with a 2-week history of high fever, headache, and myalgia. Laboratory tests on her blood and urine were positive for leptospirosis by rapid serological tests but negative by Microscopic Agglutination Test (MAT), likely due to the infecting strain L. inadai not being included in the MAT panel. L. inadai was isolated from her urine culture and identified by PCR. She was successfully treated with antibiotics and discharged after 1 week. The case highlights the challenges of diagnosing leptospirosis given the limitations of
Comparative diagnosis of falciparum malaria infections by microscopy, two rd ...Alexander Decker
This document summarizes a study that compared the diagnostic performance of microscopy, two types of rapid diagnostic tests (RDTs), and nested polymerase chain reaction (nPCR) for detecting Plasmodium falciparum malaria infections. 540 patients in three states in northwestern Nigeria were tested using microscopy (the gold standard), Pf-HRP2 RDTs, Pf/PAN-pLDH RDTs, and nPCR. The sensitivities of the two RDTs were 82% and 75% respectively compared to microscopy, while nPCR had a sensitivity and specificity of 98% and 100%. Although nPCR is more accurate, its cost and need for specialized equipment and skills limit its use in routine clinical practice,
Corticosteroids for acute bacterial meningitis DR RML DELHI
This Cochrane review analyzed 25 studies with over 4,000 participants to evaluate the effects of corticosteroids for acute bacterial meningitis. The review found that corticosteroids significantly reduced hearing loss and neurological sequelae but did not reduce overall mortality. Corticosteroids were shown to be beneficial in high-income countries by reducing hearing loss, neurological sequelae, and mortality from S. pneumoniae meningitis, but no benefit was seen in low-income countries.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
Background & objectives: In Odisha, several cases of dengue virus infection were detected for the first time in 2010, the importance of dengue as a serious mosquito-borne viral infection was felt only in 2011 with the reporting of many more positive cases. This retrospective three year study was done to find out the seroprevalence of dengue Igm antibody and to know the predominant serotype of dengue virus among the patients suspected to have dengue virus infection in a tertiary care hospital in southern Odisha, India.
Methods: Blood samples from clinically suspected dengue cases admitted in the Medicine and Paediatrics departments of a tertiary care hospital were collected. These were processed for detection of dengue specific IgM antibody, carried out by the ELISA method. Dengue IgM antibody positive serum samples were tested for serotypic identification.
Results: of the 5102 samples tested, 1074 (21.05 %) were positive for dengue IgM. Maximum numbers of cases were found in 2012. Majority (47.86 %) of cases were detected in the month of September. The most common affected age group was 11 to 20 yr. DENV1 and DENV2 were the detected serotypes.
Interpretation & conclusions: Rapid increase in the dengue cases in 2012 became a public health concern as majority of cases were affecting the young adolescents. Most of the cases were reported in post-monsoon period indicating a need for acceleration of vector control programmes prior to arrival of monsoon.
Key words Dengue virus - IgM antibody - seroprevalence - serotype - vector control
Chikungunya as a Cause of Acute Febrile Illness in Southern Sri LankaYan'an Hou
This study investigated chikungunya virus (CHIKV) as a cause of acute febrile illness in southern Sri Lanka during a 2007 outbreak. Researchers enrolled 797 patients presenting with undifferentiated fever at a large hospital. Serology identified acute CHIKV infection in 3.5% of patients without acute dengue virus infection, and PCR/viral isolation confirmed 64.3% of these cases. Sequencing of CHIKV isolates showed they possessed the E1-226A residue and were closely related to contemporary Sri Lankan and Indian isolates. Except for more frequent and persistent musculoskeletal symptoms, acute CHIKV mimicked dengue and other febrile illnesses clinically. Only 1.
Bacille Calmette-Guérin (BCG) vaccine, intended to prevent tuberculosis, may also provide non-specific protection against other pathogens like coronaviruses. The BCG vaccine induces trained immunity through epigenetic and metabolic changes in immune cells. This results in enhanced immune responses to subsequent pathogens. Some studies show countries with widespread BCG use have lower COVID-19 incidence. While more evidence is needed, BCG's ability to boost general immune function means it warrants further study as a potential temporary measure until a coronavirus-specific vaccine is available.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
This document discusses the history and regulation of the drug thalidomide. It notes that thalidomide was discovered in the 1960s to cause birth defects but has continued to be studied to treat other conditions. In 1998, the FDA approved thalidomide under the brand name Thalomid to treat erythemanodosumleprosum, a complication of leprosy. Due to the risks of birth defects, the FDA took steps to strictly control the drug's use, distribution, and monitoring of patients, especially women of childbearing age, to prevent another public health issue. Research into thalidomide's use for other diseases continues.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
Tashia Seeba - Antibiotics and maxillofacial fractures Tashia Seeba
This study evaluated the necessity of routine antibiotic administration to prevent surgical wound infections in patients undergoing treatment for maxillofacial fractures. The study retrospectively analyzed 67 patients with 114 fractures who were divided into 3 groups: no antibiotics, penicillin antibiotics, or cefotaxime antibiotics. The overall surgical wound infection rate was 16.66%. Statistical analysis found no significant difference in infection rates between the groups, suggesting that prophylactic antibiotics may not alter the risk of surgical wound infections in patients with maxillofacial fractures. Delay in treatment and use of catgut sutures were found to have a positive correlation with higher infection rates.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
1) The study retrospectively reviewed 57 cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) treated at a hospital in Indonesia from 2009-2013.
2) All cases were treated with systemic corticosteroids alone, with dosages varying based on the severity of SJS or TEN.
3) Outcomes were generally positive, with 87.7% of patients improving, though the mortality rate was higher for TEN (36.4%) than SJS (7.7%). The most common causes were drug reactions like paracetamol.
This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
This study examined the efficacy and tolerability of oral methylprednisolone (MP) in combination with amoxicillin/clavulanic acid (AMX/C) in children with chronic rhinosinusitis (CRS). 45 patients aged 6-17 years with CRS were randomly assigned to receive either oral AMX/C with MP or AMX/C with placebo for 30 days. The MP group had greater reductions in total symptom scores and CT scan scores compared to the placebo group. The MP group also had higher rates of clinical recovery and improvement. Relapse rates and adverse effects were similar between groups. This randomized controlled trial provides evidence that short-term oral MP added to AMX/C is
This document describes a case report of a 2-year old girl diagnosed with leptospirosis caused by Leptospira inadai. She presented with a 2-week history of high fever, headache, and myalgia. Laboratory tests on her blood and urine were positive for leptospirosis by rapid serological tests but negative by Microscopic Agglutination Test (MAT), likely due to the infecting strain L. inadai not being included in the MAT panel. L. inadai was isolated from her urine culture and identified by PCR. She was successfully treated with antibiotics and discharged after 1 week. The case highlights the challenges of diagnosing leptospirosis given the limitations of
Comparative diagnosis of falciparum malaria infections by microscopy, two rd ...Alexander Decker
This document summarizes a study that compared the diagnostic performance of microscopy, two types of rapid diagnostic tests (RDTs), and nested polymerase chain reaction (nPCR) for detecting Plasmodium falciparum malaria infections. 540 patients in three states in northwestern Nigeria were tested using microscopy (the gold standard), Pf-HRP2 RDTs, Pf/PAN-pLDH RDTs, and nPCR. The sensitivities of the two RDTs were 82% and 75% respectively compared to microscopy, while nPCR had a sensitivity and specificity of 98% and 100%. Although nPCR is more accurate, its cost and need for specialized equipment and skills limit its use in routine clinical practice,
Corticosteroids for acute bacterial meningitis DR RML DELHI
This Cochrane review analyzed 25 studies with over 4,000 participants to evaluate the effects of corticosteroids for acute bacterial meningitis. The review found that corticosteroids significantly reduced hearing loss and neurological sequelae but did not reduce overall mortality. Corticosteroids were shown to be beneficial in high-income countries by reducing hearing loss, neurological sequelae, and mortality from S. pneumoniae meningitis, but no benefit was seen in low-income countries.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
Background & objectives: In Odisha, several cases of dengue virus infection were detected for the first time in 2010, the importance of dengue as a serious mosquito-borne viral infection was felt only in 2011 with the reporting of many more positive cases. This retrospective three year study was done to find out the seroprevalence of dengue Igm antibody and to know the predominant serotype of dengue virus among the patients suspected to have dengue virus infection in a tertiary care hospital in southern Odisha, India.
Methods: Blood samples from clinically suspected dengue cases admitted in the Medicine and Paediatrics departments of a tertiary care hospital were collected. These were processed for detection of dengue specific IgM antibody, carried out by the ELISA method. Dengue IgM antibody positive serum samples were tested for serotypic identification.
Results: of the 5102 samples tested, 1074 (21.05 %) were positive for dengue IgM. Maximum numbers of cases were found in 2012. Majority (47.86 %) of cases were detected in the month of September. The most common affected age group was 11 to 20 yr. DENV1 and DENV2 were the detected serotypes.
Interpretation & conclusions: Rapid increase in the dengue cases in 2012 became a public health concern as majority of cases were affecting the young adolescents. Most of the cases were reported in post-monsoon period indicating a need for acceleration of vector control programmes prior to arrival of monsoon.
Key words Dengue virus - IgM antibody - seroprevalence - serotype - vector control
Chikungunya as a Cause of Acute Febrile Illness in Southern Sri LankaYan'an Hou
This study investigated chikungunya virus (CHIKV) as a cause of acute febrile illness in southern Sri Lanka during a 2007 outbreak. Researchers enrolled 797 patients presenting with undifferentiated fever at a large hospital. Serology identified acute CHIKV infection in 3.5% of patients without acute dengue virus infection, and PCR/viral isolation confirmed 64.3% of these cases. Sequencing of CHIKV isolates showed they possessed the E1-226A residue and were closely related to contemporary Sri Lankan and Indian isolates. Except for more frequent and persistent musculoskeletal symptoms, acute CHIKV mimicked dengue and other febrile illnesses clinically. Only 1.
Bacille Calmette-Guérin (BCG) vaccine, intended to prevent tuberculosis, may also provide non-specific protection against other pathogens like coronaviruses. The BCG vaccine induces trained immunity through epigenetic and metabolic changes in immune cells. This results in enhanced immune responses to subsequent pathogens. Some studies show countries with widespread BCG use have lower COVID-19 incidence. While more evidence is needed, BCG's ability to boost general immune function means it warrants further study as a potential temporary measure until a coronavirus-specific vaccine is available.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
This document discusses the history and regulation of the drug thalidomide. It notes that thalidomide was discovered in the 1960s to cause birth defects but has continued to be studied to treat other conditions. In 1998, the FDA approved thalidomide under the brand name Thalomid to treat erythemanodosumleprosum, a complication of leprosy. Due to the risks of birth defects, the FDA took steps to strictly control the drug's use, distribution, and monitoring of patients, especially women of childbearing age, to prevent another public health issue. Research into thalidomide's use for other diseases continues.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
Tashia Seeba - Antibiotics and maxillofacial fractures Tashia Seeba
This study evaluated the necessity of routine antibiotic administration to prevent surgical wound infections in patients undergoing treatment for maxillofacial fractures. The study retrospectively analyzed 67 patients with 114 fractures who were divided into 3 groups: no antibiotics, penicillin antibiotics, or cefotaxime antibiotics. The overall surgical wound infection rate was 16.66%. Statistical analysis found no significant difference in infection rates between the groups, suggesting that prophylactic antibiotics may not alter the risk of surgical wound infections in patients with maxillofacial fractures. Delay in treatment and use of catgut sutures were found to have a positive correlation with higher infection rates.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
1) The study retrospectively reviewed 57 cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) treated at a hospital in Indonesia from 2009-2013.
2) All cases were treated with systemic corticosteroids alone, with dosages varying based on the severity of SJS or TEN.
3) Outcomes were generally positive, with 87.7% of patients improving, though the mortality rate was higher for TEN (36.4%) than SJS (7.7%). The most common causes were drug reactions like paracetamol.
Este documento proporciona una hoja de datos de seguridad para el producto Magnorgan de LIDA Plant Research. Contiene sulfato de magnesio y extractos vegetales. No se clasifica como peligroso. Se recomienda usar guantes y gafas protectoras al manipularlo. Debe almacenarse en un lugar fresco y ventilado entre 4°C y 28°C. No representa peligro para el medio ambiente. Los envases vacíos deben desecharse de forma segura y de acuerdo con la legislación aplicable.
Avec le F15, passez à l’étape suivante pour vous sentir mieux et avoir meilleure mine. Que vous commenciez tout juste à faire du sport et à manger plus sain, ou que vous ayez déjà de l’expérience en la matière : le F15 convient à tout le monde quel que soit son niveau. Si vous avez suffisamment d’expériences et de connaissances en matière de sport et nutrition, commencez directement par le F15 ADVANCED.
Pour qui :
Pour les personnes qui souhaitent, une fois le F15 INTERMEDIATE terminé, passer à l’étape suivante et pour les personnes déjà actives, qui sont à la recherche d’un programme avancé pour les aider à atteindre leurs objectifs. Ce programme vous permet de travailler à votre renforcement musculaire à l’aide d’exercices ciblés et d’entraînements de cardio avancés. La brochure contient un plan nutritionnel, un programme sportif, des informations et des conseils plus détaillés sur l’alimentation et la possibilité de mener une vie saine. Vous obtiendrez également un aperçu sur la façon dont l’alimentation et l’activité physique peuvent s’accorder à votre morphotype.
El documento presenta una guía de investigación sobre los artesanos de Usaquén. El objetivo general es conocer los hábitos y necesidades de los artesanos a través de observaciones de su rutina diaria para identificar oportunidades de diseño que mejoren la exhibición e identidad de los artesanos. Los objetivos específicos incluyen entender los procesos de los artesanos, comprender la relación entre artesanos y clientes, identificar las actividades diarias de los artesanos, y detectar nuevas oportunidades de
This document describes a set of slider functions in R for exploratory data analysis. The functions allow users to dynamically modify statistical plots by adjusting slider parameters. Sections provide an overview of the slider functions, examples of them in use, and details on their implementation. Key functions covered include slider.hist for histograms, slider.density for density plots, and slider.brush.pairs for brushing pairs plots. The document discusses how the slider functions are structured and customized for interactive use.
Unidad 2 Recursos y Herramientas con un uso pedagógicoyisselgerman
El documento habla sobre el uso de Internet y herramientas tecnológicas en la educación. Explica que el Internet es un excelente recurso educativo si se usa correctamente y ofrece ejemplos de cómo usarlo, como cursos en línea y sitios web educativos. También discute la importancia de capacitar a los maestros en el uso de estas herramientas para innovar la educación.
Este documento proporciona información sobre la seguridad de un producto químico llamado ALTACOR. Incluye detalles sobre la composición, identificación de peligros, primeros auxilios, medidas de protección y almacenamiento. El producto es clasificado como peligroso para el medio ambiente y debe manipularse y almacenarse con cuidado para evitar la contaminación acuática.
El documento trata sobre los líquidos y electrolitos corporales. Explica que los líquidos en el cuerpo tienen un volumen definido pero no forma fija y están compuestos principalmente de agua. Define electrolitos como minerales con carga positiva o negativa que se encuentran en los líquidos corporales como la sangre. También discute conceptos como osmolaridad, tonicidad y balance acuoso en el cuerpo.
Bacteriological and Mycological Profile of Chronic Suppurative Otitis Media I...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
—Fungal organisms are ubiquitous. A common location for these organisms to enter the human body is through the external acoustic canal, oral cavity, and pharynx and sino-nasal cavity. A study was conducted with clinical and mycological analysis of various fungal infections in ENT. Patients suspected for having fungal infections attending at Department of ENT were interrogated and analysed. Swabs collected from these cases were sent for direct microscopy by KOH mounts for fungal examination and fungal culture. Microbiological confirmed 100 cases were finally included in the study Histopathological examination of nasal mass and polyposis was also done. It was observed in this present study otomycosis was most common and accounted for 84% of the total cases followed by candidiasis in oral cavity and pharynx in 9%, allergic fungal rhinosinusitis in 4% and rhinosporidiosis in 3%. Aspergillus niger was that most common fungus isolated in 61% cases, followed by Candida albicans in 24% cases, Aspergillus flavus in 9% cases, Aspergillus fumigatus and Rhinosporodium seeberi in 3% cases each. All the cases of fungal infection of oral cavity and oropharynx were due to Candida albicans.
Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal rhinosinusitis seen in young, atopic patients presenting with chronic rhinosinusitis and nasal polyps. It is characterized by eosinophilic mucin containing fungal hyphae and positive fungal cultures. Diagnosis involves CT scans showing sinus opacification and bone erosion along with endoscopic examination of allergic mucin. Treatment involves functional endoscopic sinus surgery along with post-operative steroids to reduce the high recurrence rate associated with AFRS. Long-term follow up is needed given the risk of recurrence requiring repeat surgery.
Clinical Study of Foreign Bodies in Tracheo-Bronchialtree with Specific Atten...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
GeneXpert MTB/RIF: A Useful Tool for Rapid and Accurate Diagnosis of Tubercul...komalicarol
The primary objective of this study was to show the usefulness and
importance of GeneXpert MTB/RIF, a rapid test that simultaneously detects Mycobacterium tuberculosis complex (MTBC) and
resistance to rifampicin (RIF) in less than 2 hours.
This study aimed to detect the prevalence of fungal elements in patients with sinonasal polyposis undergoing endoscopic sinus surgery. 61 patients were included prospectively and fungal analysis was performed on resected polyp tissue. The prevalence of fungal infection was calculated and the most common fungal isolates identified. Statistical analysis was performed to analyze the results. Obtaining ethical clearance, the study followed a prospective cohort design and collected data on patients' demographics, clinical history, and postoperative fungal investigations to understand the role of fungi in sinonasal polyposis.
This document reviews nasal polyposis (NP), a common condition affecting up to 4% of the population. It discusses the unclear etiology of NP, associated with factors like allergy, asthma, and infection. Clinical features include nasal obstruction, anosmia, and polypoid masses visible during examination. Management involves medical therapy like corticosteroids as primary treatment and to prevent recurrence, as well as surgery for refractory cases. Recurrence is common even after treatment.
This document summarizes a study that evaluated the use of the Line Probe Assay (LPA) for rapid detection of Multi Drug Resistant Tuberculosis (MDR-TB) in Sudan. 300 smear-positive sputum samples were collected from TB patients and tested using LPA, culture-based drug susceptibility testing (DST), and conventional laboratory methods. Results found a high prevalence of MDR-TB in Sudan of 38% by DST and 37.3% by LPA. Comparison of LPA and DST results showed high accuracy of LPA for rapid detection of rifampin and isoniazid resistance with a sensitivity of 98.3% and specificity of 100%. LPA provided results within 2
Microbial Flora in Chronic Rhinosinusitis with and without Nasalpolyps by José Gameirodos Santos in Experiments in Rhinology & Otolaryngology
The most common microbial agents in the etiology of chronic rhinosinusitis are defined in the literature as Staphylococcus aureus, Staphylococcus coagulase-negative and Streptococcus spp. In healthy individuals these same microorganisms are also the most frequent (mainly Staphylococcus coagulase negative) ascolonizing flora agents. We often encounter a poly microbial colonization of the nose and sinuses. The contribution of the different pathogens for the disease remains sun certain. The aim of this study is to compare the microbial flora found in patients with chronic rhinosinusitis with and without nasal polyps.
The medical-management-of-rhinosinusitis 1997-otolaryngology---head-and-neck-...Joel Mathew
The document discusses the medical management of rhinosinusitis. It begins by explaining that the management depends on factors like the duration and severity of a patient's symptoms, and that acute and chronic rhinosinusitis are treated differently. It then provides definitions for different types of rhinosinusitis established by the American Academy of Otolaryngology-Head and Neck Surgery. The document goes on to discuss the pathophysiology, microbiology, and treatment options for various forms of rhinosinusitis.
A total number of 74 coagulase negative Staphylococci were isolated from orthopaedic patients in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. They were further characterized into various Staphylococci species using API STAPH identification kit: Staph xylosus (31.1%), Staph lentus (10.8%), Staph hominis (10.8%), Staph cohnii cohnii (5.4%), Staph epidermidis (4.1%) others were Staph cohnii ureal., Staph hyicus, Staph lugdunensis (2.7% each) Staph caprae , Staph capitis, Staph haemolyticus, Staph scuiri, Staph chromogenes and Staph warneri (1.4% each). Microcossus spp was 8.2% while 13.5% isolates were undetermined. Kirby Baurer disk method was used for the antibiotics susceptibility test, the result showed gentamicin and ciprofloxacin to be most active (96.6%), followed by vancomycin (93.1) and pefloxacin (87.9). The isolates were resistant to ampicillin (96.6), amoxicillin clavulanic acid (65.5%), clindamycin 41.4%). The aim of this study is to classify the coagulase negative Staphylococci isolates into species and to determine their antibiotic susceptibility
This study evaluated the diagnostic accuracy of a Trypanosoma cruzi Loop-mediated isothermal amplification (Tc LAMP) kit for detection of T. cruzi infection in congenital, acute, and reactivated Chagas disease. Clinical samples from 46 patients were tested including those with confirmed congenital Chagas disease, recipients of organs from infected donors, cases of oral transmission, and coinfected HIV/T. cruzi patients. The Tc LAMP kit showed high sensitivity (93%) and specificity (100%) compared to quantitative PCR used as the reference standard. The agreement between Tc LAMP and qPCR was almost perfect. The Tc LAMP kit accurately detected T. cruzi infection
This study analyzed 25 cases of unilateral proptosis seen over 3 years at a tertiary care center in India. Most cases were in patients over 60 years old, and the majority were male. Inflammation was the most common cause, seen in 32% of cases. Clinical exams and imaging tests like CT and MRI were used to diagnose the cause. 52% of cases were treated medically with antibiotics and steroids, while 48% required surgery with some also receiving radiation or chemotherapy. The majority of patients, 60%, had improved conditions after treatment.
Study of Bacterial Isolates and their Susceptibility Pattern in Chronic Suppu...iosrjce
This study examined bacterial isolates and antibiotic susceptibility patterns in 120 patients with chronic suppurative otitis media (CSOM) in Iraq. Pseudomonas aeruginosa was the most commonly isolated bacteria (37.5%), followed by Staphylococcus aureus (20.83%) and Streptococcus pneumoniae (16.67%). Ciprofloxacin and ceftazidime were the most effective antibiotics, with high resistance to trimethoprim, carbenicillin, lincomycin and erythromycin. Understanding local bacterial causes and antibiotic susceptibility is important for guiding treatment of CSOM.
This study investigated the prevalence of oral lesions like geographic tongue and fungiform papillary glossitis in patients with atopic diseases compared to non-atopic patients. The study found:
1) Fungiform papillary glossitis was the most common oral lesion in both atopic and non-atopic groups, present in 31% and 23% respectively. Atopic patients with this lesion had significantly higher serum IgE levels.
2) Geographic tongue was rare, found in only 2% of both groups.
3) For the two atopic patients with geographic tongue, prick testing identified the mites Dermatophagoides pteronyssinus and Dermatophagoides farinae as allergens
Study on Sensitivity Pattern of Micro-Organisms in Respiratory Tract Infectio...iosrjce
Wide reports in literatures from different parts of the world revealed that antibiotics are
used both widely and indiscriminately. RTIs comprise the most common indication for consulting a general
practitioner, and obtaining an antibiotic prescription.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
ESA/ACT Science Coffee: Diego Blas - Gravitational wave detection with orbita...Advanced-Concepts-Team
Presentation in the Science Coffee of the Advanced Concepts Team of the European Space Agency on the 07.06.2024.
Speaker: Diego Blas (IFAE/ICREA)
Title: Gravitational wave detection with orbital motion of Moon and artificial
Abstract:
In this talk I will describe some recent ideas to find gravitational waves from supermassive black holes or of primordial origin by studying their secular effect on the orbital motion of the Moon or satellites that are laser ranged.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
1. Megan Work
ABSTRACT
Objective: To review the imaging findings and treatment decisions in cases of Canine Aspergillus that have
presented to the Small Animal Hospital.
Method: Twenty dogs that had presented to the University of Glasgow Small Animal Hospital with a history of
chronic nasal discharge that had had a CT scan of the head were identified by searching through the Electronic
Patient Record. From these 20 cases, twelvedogs were identified as having been diagnosed with Canine
Aspergillosis; only these 12 dogs were included in this study.
Results: All twelvedogs showed evidence of nasal turbinate destruction on CT scan, and other common
radiographic findings include soft tissue material in frontal sinuses, cribiformplate lysis, and frontal and
maxillary bone lysis. Rhinoscopy allowed visualisation of fungal plaques in 66.7% of cases. Ten of the 12 dogs
(83.3%) required application of a topical antifungal agent in the nasal cavity and frontal sinuses fortreatment;
only one case was able to be managed on systemic antifungal medication alone. 80% of the dogs that received
topical antifungal application required more than one treatment. Three dogs with evidence of cribiform plate
destruction underwent topical antifungal application; 0% developed neurological signs post-treatment. Eleven
dogs were considered treatment successes (91.7%).
Diagnostic test results and treatments used in dogs
diagnosed with Canine Aspergillus
A retrospectivestudy of12 dogs
Introduction:
Fungal rhinosinusitis is an invasive infection that involves the nasal cavity and frontal sinuses
in dogs; Aspergillusfumigatus isthe most commonly isolated organism in affectedcases, causing
destructive rhinitis and sinusitis. Affecteddogs oftenpresent witha history of chronic nasal
discharge, ulceration or depigmentation of the nasal planum, and nasal pain/head-shyness.
Mesaticephalic and dolichocephalic breeds are considered more likely to be affectedby the
disease (Sharp, 1989).
Suspicion of an Aspergillus infectionis often formed on the basis of clinical signs, and a
combination of diagnostic methods such as advanced diagnostic imaging,
rhinoscopy/sinuscopy, cytology,histopathology,or fungal culture are valuable to aid in reaching
a definitive diagnosis (Sharman MJ et al2012). Serological tests whichidentify antibodies to
Aspergillusspp. are also available and offergood sensitivity and excellent specificity for
sinonasal aspergillosis; serological testing is thought to be particularly useful in cases in which
performing advanced imaging studies is not a viable option, or when infection cannot be
confirmed by other methods (PomtantzJS et al. 2007). Howeverit should be noted that a
diagnosis of sinonasal aspergillosis cannot be excluded on the basis of negative serological
results.
Fungal colonies typically establish in the frontal sinuses, howeverthe disease leads to
damage of many surrounding structures and so Aspergillus infectionoftenresults in destruction
2. Megan Work
of the nasal turbinates. This damage can extend caudally and cause destruction of the cribiform
plate. Computed tomography (CT) is considered to be the most sensitive advanced imaging
technique for assessment of the bones surrounding the nasal cavity;typicalradiological signs
evident in affecteddogs include destruction of the nasal turbinate bones, mucosal thickening,
soft tissue material in the sinuses, and reactive maxillary, frontal, and vomer bones. CT also
allows assessment of the integrity of the cribiform plate, and is considered more sensitive to
changes in the cribiformplate when compared to radiography (Saunders et al 2002, Saunders et
al 2003). Rhinoscopy and sinuscopy are also commonly used diagnostic tools, whichoften
confirmthe diagnosis of fungal rhinosinusitis by direct visualisation of fungal plaques in the
nasal cavity and/or frontalsinuses. These endoscopic methods also allow evaluation of the
intranasal and intrasinusal soft tissue, and assessment of nasal turbinate destruction.
Treatment of fungal rhinosinusitis can be difficultand demanding, and requires compliance
from pet owners as well as the patients. Systemic treatments using oral antifungal medications
such as Itraconazoleare considered to have poor efficacy,andrequire prolonged administration
periods. Systemic antifungal medications also carry risks of hepatotoxicity,anorexia, and skin
reactions. Topicalantifungal treatment has been shown to be more efficaciousin treatment of
fungal rhinosinusitis, howeverintegrity of the cribiformplate is considered an important factor
in treatment options for fungal rhinosinusitis; topical infusion of antifungal agents is potentially
contraindicated if the cribiform plate is not intact because of the risk of developing a meningitis
or encephalitis.
MaterialsandMethods:
The Electronic Patient Record (EPR) in the University of Glasgow Small Animal Hospital was
searched forcases that had had a CT scan of the head, and had subsequently been diagnosed
with Aspergillus. Themost recent twenty cases were selected, and from these cases a total of
twelvedogs were eligible to be included in this retrospective study; inclusion criteria required a
history of chronic nasal discharge, findings consistent with fungal rhinosinusitis on CT imaging,
and response to antifungal therapy. Cases were excluded from the study if the definitive
diagnosis was not fungal rhinosinusitis (n=7; final diagnoses forthese exclusions were nasal or
oral tumours), and if the complete medical history was not available (n=1).
Data was collected by examining the case reports to the referring veterinary surgeon forthe
original twenty cases, and any information not included in these reports was searched for using
the EPR. If any data was still absent, paper records were inspected and only if the required
information was then not able to be obtained could a case be excluded on the basis of
inadequate medical history. Collected data included the patient breed, sex, and age at
presentation.
Information regarding the cases’ clinical
signs, investigations, and treatments
prescribed/performed was gathered and
recorded using a tally system. Information
regarding persisting clinical signs after
completion of treatment was also collected
and recorded.
Case No. Age at
Presentation
Breed Sex
1 2 years Labrador M E
2 9 years Border collie M E
3 5 years Retriever F N
4 2 years Border collie M N
5 11 years Retriever M E
6 2 years Retriever M N
7 10 years Cocker spaniel F N
8 11 years Retriever M E
9 4 years Collie-X M N
10 5 years Rough collie M N
11 4 years German
shepherd
M N
12 9 years Border collie F E
Table 1: Signalmentof casesincludedinthe study.
3. Megan Work
The cases were then divided into categories according to the treatment they underwent;
these categories included systemic medication only,topical treatment only, surgical
debridement only,and the combination of systemic medication plus topical treatment. Cases in
whichtopical antifungal agent application was performed were further divided into one of two
groups: cribiformplate intact or not-intact.
The final twelve cases that were included in the study have been summarised in Table 1.
Results:
A total of 12 cases were included in this retrospective study (Table 1). Seven different breeds
were identified in this study, almost all of which were mesaticephalic breeds withthe exception
of the dolichocephalic German shepherd dog. Collie-type breeds (71.4%) and Retrievers
(57.1%) were recognised as the most frequently diagnosed. The number of male dogs
diagnosed with fungal rhinosinusitis was greater than the number of female dogs diagnosed
with the condition; howeverneutering status did not seem to be a significant factorwith 55.6%
affectedmales neutered, and 66.7% affectedfemales neutered. Patients ranged fromtwo to 11
years of age (mean 6.2 years) at initial presentation to the Small Animal Hospital. All dogs
included in this study had clinical and radiological findings consistent withan active nasal
aspergillosis infection,and responded positively to antifungal treatment.
The presenting complaint in all twelvepatients was chronic nasal discharge; in 58.3% of dogs
this was unilateral, while the other 41.7% was bilateral; 25% of cases reported epistaxis or
blood tinged mucus in the nasal discharge. Other frequently reported clinical signs at time of
referral included sneezing (n=9), nasal pain/head-shyness (n=8), nasal planum depigmentation
(n=3) and weight loss (n=3). In all cases airflow was normal from both nostrils. Two dogs
(16.7%) had also been exhibiting neurological signs prior to presentation, both of whichhad
evidence of cribiform plate destruction on CT scan.
All cases received a CT scan of the nose/head during investigations, and 100% showed nasal
turbinate destruction. Softtissue material in the frontal sinuses was commonly reported (n=8)
and 25% of cases demonstrated septal and maxillary lysis. Cribiform plate lysis was evident in
41.7% of dogs (n=5). Rhinoscopy was performed in all twelvedogs, howeverdirect
visualisation of fungal plaques in the nasal cavity was only achieved in 66.7% of cases (n=8);
twodogs had subsequent sinuscopy performed as an additional diagnostic tooland this
revealed presence of fungal plaques in the frontal sinuses in both of these patients. 58.3% of
cases had a diagnosis of Aspergillus infectionconfirmedby the presence of fungal hyphae in
cytology fromimpression smears and/or consistent histopathological findings fromnasal pinch
biopsies (n = 7);two of these cases received additional confirmation of the diagnosis from
positive fungal cultures. One further dog’s nasal discharge grew a positive fungal culture, and
one dog had had a serology panel run forAspergillus at the referring veterinary practice,which
was positive. Therefore 25% of cases (n = 3) did not gain a cytological/culturaldiagnosis,
howevereach of these cases showed presence of fungal plaques on rhinoscopy and so the final
diagnosis was still considered to be fungal rhinosinusitis.
4. Megan Work
Ten of the 12 dogs (83.3%)required application of a topical antifungal agent in the nasal
cavity and frontal sinuses; only one case was able to be managed on systemic antifungal
medication alone. 80% of the dogs that received topical antifungal application required more
than one treatment. Similarly, intranasal instillation of Clotrimazole was utilised in 16.7% cases
(n=2).
Twodogs (16.7%) required rhinotomy forsurgical debridement of fungal plaques and
necrotic nasal turbinates, and one of these cases also required a frontal sinusotomy. Both of
these patients had evidence of cribiform plate destruction on CT scan. One of these patients
recovered wellwith almost complete resolution of clinical signs, while the other required an
additional 8 week treatment with systemic antifungal medications after a relapse in clinical
signs.
One case (8.3%) in this study was successfully managed using only systemic antifungal
medication.
Fungal rhinosinusitis is frequently complicated by a bacterial rhinitis; 75% of the cases in this
study required at least one course of an antibiotic agent. Amoxicillin-clavulanic acid was the
most commonly prescribed option (n = 5), with Doxycycline(n= 3) and Cephalexin (n = 1)
prescribed in other cases. It should be noted that these antibiotics were chosen based on
culture and sensitivity from nasal discharge in all cases.
Of the fivedogs that had shown evidence of cribiform plate lysis/destruction, 60% required
topical application of an antifungal agent in the frontal sinuses tocure the disease. None of the
dogs that received sinus instillation of Clotrimazole displayed any neurological signs post-
treatment.
After completion of treatment, 41.7% of cases (n=5) were described to be doing well
clinically;owners reported no concerns, with complete resolution of nasal discharge and
sneezing. Of these fivecases, 80% had been treated with topical antifungal instillation. Outwith
these fivecases, three dogs (25%) were reported to be sneezing occasionally,and three dogs
(25%) continued to show nasal discharge intermittently after completing treatment. One case
was considered a treatment failure.
Discussion:
This study concurswith the consensus that mesaticephalic and dolichocephalic dogs are
predisposed to canine aspergillosis. A disease predilection in Retriever dogs has been
consistently reported by many authors (Sharp NJH, 1989; Lefebvre J et al.2005); while
Retrievers were largely represented in this study, there were a greater proportion of Collie-type
breeds identified. Breed predilection in Collie dogs have not been previously recognised in
canine aspergillosis; howeverthe high representation in this study may reflectthe frequently
presented breeds to the University of Glasgow Small Animal Hospital, and so may not be a true
overrepresentation. Conversely, German shepherd dogs have a recognised breed predilection
for this condition, while this study only contained one dog of this breed. A typical age range of
0.5 – 13.5 years has been reported, and these findings are consistent with this as all cases in this
study fall within this reported age range. In literature, male dogs seem to be more likely to
develop fungal rhinosinusitis; this study concurs withthose findings, withmale dogs three
times more likely to be diagnosed with fungal rhinosinusitis.
5. Megan Work
Clinical signs that are frequently reported in cases of fungal rhinosinusitis include chronic
mucopurulent nasal discharge, nasal pain / head-shyness, ulceration or depigmentation of the
nasal planum, and bouts of epistaxis (Sharp, 1989). In this study, all dogs werepresented with a
history of chronic nasal discharge, but only 25% had reports of epistaxis. Other commonly
described clinicalsigns in this retrospective study included sneezing (n = 9), nasal pain/head-
shyness (n = 8), nasal planum depigmentation (n = 3) and weight loss (n = 3); while some of
these signs are consistent withprevious literature, it should be noted that in this study
incidence of epistaxis and nasal planum depigmentation was relatively low and so a diagnosis of
fungal rhinosinusitis should not be excluded on the basis of absence of these signs. Conversely,
sneezing is rarely mentioned in literature while in this study, sneezing was a major finding
reported in 75% of cases. Facial deformity/asymmetry and poor airflow from nostrils were not
common clinical findings in previous studies regarding dogs diagnosed with fungal
rhinosinusitis, and seem to be associated more with nasal neoplastic processes. This study
concurs withthose conclusions.
Based on the results of this study, computed tomography (CT) and rhinoscopy/sinuscopy –
alone or in combination – are sensitive and reliable investigations for the detection of intranasal
and intrasinusal evidence of disease. Commonly reported radiological findings of fungal
rhinosinusitis include destruction of the nasal turbinate bones, cribiform plate lysis, mucosal
thickening, soft tissue material in the sinuses, and reactivemaxillary, frontal, and vomer bones
(Saunders et al 2002, Saunders et al 2003). In this study, all of these radiological findings were
reported in at least one case. Evidence of nasal turbinate destruction was present in 100% of
cases, and so should be considered the most important radiological feature of fungal
rhinosinusitis. Rhinoscopy and sinuscopy are considered to be valuable in the assessment of
intranasal and intrasinusal soft tissue material, and oftenfacilitate direct visualisation of fungal
plaques in the nasal cavity and sinuses (Saunders JH et al. 2004, Johnson LR et al. 2006). In this
study, fungal plaques in the nasal cavity werevisualised via rhinoscopy in 66.7% of cases; two
cases in whichfungal plaques were not visualised in the nasal cavity subsequently underwent
sinuscopy, in whichfungal plaques were able to be visualised in the frontal sinuses. This
positively correlates with previous studies regarding the worth of performing these procedures
as part of an investigation of nasal disease, as direct visualisation of fungal plaques was possible
in 83.3% of cases. Histopathology, cytology,and fungal culture were all considered to be less
reliable means of diagnosis, with 25% (n=3) of cases that demonstrated radiological and
rhinoscopic changes consistent with fungal rhinosinusitis unable to be diagnosed using these
methods.
The most common treatment option in this retrospective study was bilateral frontal sinus
trephination with instillation of a topical antifungal agent, Clotrimazole, withoutconcurrently
administering systemic antifungal drugs (n = 5). This technique involvesusing catheters placed
non-surgically into the sinuses and performing a short flush of 1% Clotrimazole followedby
instillation of a 1% Clotrimazole cream as a depot agent. This technique allowsfor a shorter
duration of anaesthesia when compared withthe alternative 1-hour instillation technique,
avoids potential complications arising from surgically-placed indwelling catheters, and
theoretically provides improved persistence in the frontal sinuses as a result of the instillation
cream’s viscosity (Sissener TR et al. 2006). In one study it was claimed that 92.9% of dogs that
underwent this therapy required only one treatment; however in this study, 83.3% of dogs that
received this topicaltreatment required more than one instillation, 3 weeks apart. Despite this,
6. Megan Work
all cases that underwent this treatment did show an improvement after the initial therapy. This
method of applying a topical antifungal agent was combined with the use of systemic
antifungals in 16.7% of cases (n=2); of these two cases, one required only one topical treatment
while the other dog required two treatments. Both of these dogs required a further 4 weeks of
systemic medication after topicalapplication of Clotrimazole before an acceptable resolution of
clinical signs was reached, withonly intermittent nasal discharge reported at recheck
examination.
In this study, two cases (16.7%) underwent intranasal instillation of topicalantifungal. One of
these dogs was not prescribed any systemic medication alongside the topical treatments, and
required twointranasal instillations before complete resolution of clinical signs. The other case
in which this intranasal option was elected forwas a dog whichhad exhibited evidence of
cribiformplate destruction on CT scan, however after twointranasal topical treatments as well
as twomonths of systemic antifungal medication (Itraconazole),a repeat CT scan and sinuscopy
showed signs consistent of progression of the disease into the frontal sinuses – this dog then
received a third intranasal instillation and a right frontal sinus trephination for topical
treatment.
Twocases underwent rhinotomy for surgical debridement of fungal plaques and necrotic
turbinates, after being unsuccessfully managed on systemic antifungal medication. One of these
cases receivedtopical antifungal treatment, while the other did not; the dog that did not receive
topical treatment relapsed with severe clinical signs within 4 weeks of completing the
medication course, and required a further month of systemic antifungal medication. The case
whichunderwent rhinotomy and topical instillation of Clotrimazole recovered wellwith
complete resolution of clinical signs, aside from occasional unproductive sneezing.
Five cases showed evidence of cribiform plate lysis on CT scan, which carries a guarded
prognosis. This is considered to be a contraindication of utilising topical antifungal therapy due
to the risk of developing neurological signs. Neurological signs can develop in these cases either
as a consequence of antifungal treatment or as a result of intracranial extension of fungal
organisms. Complications associated with destruction of the cribiform plate may arise prior to
intervention, for instance due to fungal disturbance of the dura; or may arise followingsurgical
intervention with topical antifungal treatment – communication between the nasal and
intracranial cavities post-surgery can lead to the patient developing neurological signs such as
seizuring, as a result of the instilled antifungal agent causing irritant-induced
meningoencephalitis. Furthermore, in one study pneumocephalus was reported after surgical
treatment for fungal rhinosinusitis in which there was direct communicationbetween the nasal
and intracranial sinuses (Launcelott ZA et al. 2016).
Of the fivecases with evidence of cribiformplate lysis on CT scan, only 20% were able to be
treated using systemic antifungal medication exclusively. The remaining 80% (n=4) were
treated with systemic antifungal medication but at recheckinvestigations – including repeat CT
and rhinoscopy – evidence of persistent/progressive disease was discovered. These four cases
required more aggressive therapy; one dog received rhinotomy with debridement of fungal
plaques and necrotic turbinates only;one dog received rhinotomy and sinusotomy for
debridement combined with topicalantifungal application; and the remaining two dogs each
underwent sinus trephination with instillation of Clotrimazole. The dog that did not receive any
topical antifungal treatment had a relapse of symptoms 3 months after the surgical procedure,
while the three dogs that did receivetopical treatment showed almost complete resolution of
clinical signs. These findings imply that surgical debridement and systemic antifungal
7. Megan Work
treatment was not sufficient to treat the fungal infection in this study, and concurwith previous
publications that topical infusion with an antifungal agent is associated withgreater success
(Claeys S et al.2006).
Of the three cases with evidence of cribiform plate lysis that received intrasinusal topical
antifungal infusion, 0% developed neurological signs followingtreatment. This is not consistent
with many publications, as it is considered a contraindication to perform topical antifungal
infusion in patients with evidence of destruction of the cribiformplate; however,this finding
could reveal that this risk has previously been over-estimated. Furthermore, cases with
cribiformplate destruction carry a guarded-poor prognosis; it couldbe considered that prompt
intervention with the more efficacioustopical treatment may improve chances of survival when
compared to delayed topical treatment followingunsuccessful systemic medication and
worsening clinicalsigns. When presented witha fungal rhinosinusitis case, however, it is
paramount to educate the owners of all risks associated with the treatments and to gain
informed consent.
Of the twelvedogs included in this study, 75% were prescribed concurrent antibiosis to treat
a secondary bacterial rhinitis. The antibiotic medications prescribed were chosen based upon
culture and sensitivity results from nasal discharge in all cases. Secondary bacterial
complications in nasal disease are frequently reported, and are thought to be a consequence of
extensive nasal turbinate destruction and impaired mucociliary clearance of nasal debris
(Schuller et al. 2004). This factoris important when evaluating clinical improvement following
treatment of fungal rhinosinusitis; many patients that are cured from the disease will exhibit
intermittent sneezing and/or nasal discharge after completion of treatment as a result of this
impaired nasal clearance and nasal turbinate destruction. In this study, one case was
considered a failure of treatment, as after receiving prolonged treatment withsystemic
antifungal medications as well as rhinotomy and surgical debridement of fungal plaques, the
dog had a relapse in clinical symptoms 3 months after completing treatment; this dog had
evidence of cribiform plate lysis. 25% (n=3) of dogs were reported to occasionally sneeze
followingcompletion of treatment but were otherwise clinically well, and 25% (n=3) exhibited
intermittent nasal discharge only post-treatment. The remaining fivecases (41.6%) were
described as being back to normal by their owners, with complete resolution of clinical signs.
With only one case considered a treatment failure, the overall treatment success rate of this
study was 91.7%.
Conclusion:
Based on the findings of this retrospective study, it can be concludedthat fungal
rhinosinusitis is a disease that most commonly affectsdogs of mesaticephalic and
dolichocephalic breeds, and that males are more likely to be affected. Chronic nasal discharge,
sneezing, and nasal pain/head-shyness are commonly reported clinicalsigns, with nasal planum
ulceration/depigmentation less frequently described. Computed tomography and
rhinoscopy/sinuscopy are valuable diagnostic tools in the investigation of nasal disease, and
often facilitateidentification of turbinate destruction and fungal plaques respectively.
Histology, cytology,and fungal culture are more sensitive but less specific in the diagnosis of
fungal rhinosinusitis. There are a variety of therapeutic options available; topical infusion with
an antifungal agent is more efficaciousalthough often requires more than one treatment before
resolution of clinical signs. Informed consent fromowners is essential when considering
treatment of a case with evidence of cribiform plate destruction.
8. Megan Work
References:
Claeys A, Lefebvre JB, Schuller S, Hamaide A, & Clercx C. Surgical treatment of canine nasal
aspergillosis by rhinotomy combined with enilconazole infusion and oral itraconazole. Journal of
Small Animal Practice (2006) 47, 320-324
Johnson LR, Drazenovich TL, Herrera MA, & Wisner ER. Results of rhinoscopy alone or in
conjunction with sinuscopy in dogs with aspergillosis: 46 cases (2001-2004). JAVMA (2006) Mar 5:
738-742
Launcelott ZA, Palmisano MP, Stefanacci JD, & Whitney LB. Ventricular pneumocephalus, cervical
subarachnoid pneumorrhachis, and meningoencephalitis in a dog following rhinotomy for chronic
fungal rhinitis, JAVMA (2016) Feb 4: 430-435
Lefebvre J, Kuehn NF, Wortinger A, et al. Computed tomography as an aid in the diagnosis of
chronic nasal disease in dogs, Journal of Small Animal Practice (2005) 46, 280-285
Pomrantz JS, Johnson LR, Nelson RW, et al. Comparison of serologic evaluation via agar gel
immunodiffusion and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs, JAVMA
(2007);230(9): 1319-1323
Sharman MJ & Mansfield CS. Sinonasal aspergillosis in dogs: a review, Journal of Small Animal
Practice 2012; 53: 434-444
Saunders J & Van Bree H. Comparison of radiography and computed tomography for the diagnosis
of canine nasal aspergillosis. Veterinary Radiology and Ultrasound (2003) 44, 414-419
Saunders J., Zonderland J., Clercx C., Gielen I., Snaps F., Sullivan M., & Van Bree H. Computed
tomographic findings in 35 dogs with nasal aspergillosis. Veterinary Radiology and Ultrasound
(2002) 43, 5-9
Saunders JH et al. Radiographic, magnetic resonance imaging, computed tomographic, and
rhinoscopic features of nasal aspergillosis in dogs, JAVMA (2004) Dec 1:225(11): 1703-12
Schuller S & Clercx C. Long term outcome in dogs with sinonasal aspergillosis treated with
intranasal infusion of enilconazole, Journal of Veterinary Internal Medicine (2004) 18: 785-786
Sharp NJH. Nasal aspergillosis, In: Current Veterinary Therapy, 10th edn (1989) USA pp1106-
1109
Sissener TR, Bacon NJ, Friend E, Anderson DM & White RAS. Combined clotrimazole irrigation
and depot therapy for canine nasal aspergillosis, Journal of Small Animal Practice (2006) 47, 312-
315