Leprosy Mimicking as Rheumatoid Arthritis: A Case Report

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which mainly damages the skin and peripheral nerves, and can also infect joints and bones. Clinical manifestations are complex, varied, and often underdiagnosed. The clinical manifestations vary and are called "the great imitator". musculoskeletal features are common in leprosy but infrequently reported. A case of borderline lepromatous (BL) type leprosy was initially suspected as rheumatoid arthritis in a 20-year-old Balinese male who complained of pain and swelling in small joints, accompanied by lesions in the form of multiple erythema macules, round-shaped geography, indistinct boundaries, with bilateral distribution is almost symmetrical in the face, thoracoabdominal, and extremity regions. The diagnosis of BL type leprosy is based on history taking, physical examination, and investigations in the form of Ziehl-Neelsen stain and blood tests.

The mechanism and neural substrate of musical emotions in the audio-visual modality

Previous studies on multisensory integration (MSI) of musical emotions have yielded inconsistent results. The distinct features of the music materials and different musical expertise levels of participants may account for that. This study aims to explore the neural mechanism for the audio-visual integration of musical emotions and infer the reasons for inconsistent results in previous studies by investigating the influence of the type of musical emotions and musical training experience on the mechanism. This fMRI study used a block-design experiment. Music excerpts were selected to express fear, happiness, and sadness, presented under audio only (AO) and audio-visual (AV) modality conditions. Participants were divided into two groups: one comprising musicians who had been musically trained for many years and the other non-musicians with no musical expertise. They assessed the type and intensity of musical emotion after listening to or watching excerpts. Brain regions related to MSI of emotional information and default mode network (DMN) are sensitive to sensory modality conditions and emotion-type changes. Participants in the non-musician group had more, and bilateral distribution of brain regions showed greater activation in the AV assessment stage. By contrast, the musician group had less and lateralized right-hemispheric distribution of brain regions.

A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era

Background: Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.Methods: This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.Results: All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).Conclusion: When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.

Erythema Multiforme and its Clinicopathological Features in a Horse in Brazil

Background: Erythema multiforme (EM) is an immune-mediated skin disease which may manifest as cutaneous or mucocutaneous lesions. It is uncommon in horses. EM lesions have a symmetrical bilateral distribution; they are usually urticarial, necrotizing, and, less commonly, ulcerative. In equines, the trigger is usually unknown, and cases are often classified as idiopathic. Diagnosis is based on a thorough history and physical and histopathological examination of lesions. According to the clinical presentation and histopathological characteristics of the cutaneous lesions, this case is the first report to describe diagnosis and treatment of a horse with EM in Brazil. Case: A Quarter Horse filly was followed clinically for 12 months after sudden onset of skin lesions at 18 months of age. The initial lesions were non-alopecic papules with a symmetrical bilateral distribution. Six months after onset, the skin lesions maintained the original distribution pattern; however, they had progressed to papules and plaques with varying annular, arciform, serpiginous, targetoid, or alopecic appearance. At 8 months, the same distribution pattern and appearance remained, but the lesions had become more severe and extensive, with involvement of the labial commissures and perineal region, without any erosions/ulcerations, scaling/crusting, pain, or pruritus. At 12 months, new nodular lesions were found on the medial and lateral surfaces of the hind limbs, neck, bilateral trunk, and root of the tail. The lesions were firm, non-pruritic, and non-tender on palpation. Swabs were obtained from the papular lesions. Skin specimens were also obtained with a 6-mm punch and via incisional biopsy and histological sections were made. Bacterial and fungal cultures were negative. Appropriate stains did not identify fungal structures, were negative for acid-fast bacilli, and did not reveal any metachromatic granules in the sampled cell population. The histopathological findings were characteristic of immune-mediated disease, with a vacuolar interface dermatitis affecting the hair follicles more than the epidermis, necrotic keratinocytes, lymphocyte satellitosis, leukocytoclastic mixed vasculitis of the mid-dermis and deep dermis, and variable granulation tissue, consistent with erythema multiforme and leukocytoclastic vasculitis. Immunosuppressive therapy with corticosteroids and oral supplementation with omega-3 and omega-6 fatty acids and vitamin E were prescribed. After institution of therapy, no new lesions developed, the existing lesions remained stable (though permanent), and hair regrew in the previously alopecic areas. All physiological parameters remained normal throughout the follow-up period. Discussion: Erythema multiforme is rarely reported in horses. According to our literature review, this is the first description of EM in horses in Brazil. EM should be included in the differential diagnosis of horses that present with plaques in a diverse, geographic distribution and a negative initial dermatological screening examination. Further clinical investigation is warranted, with special attention to potential antigenic triggers. A thorough drug and dietary history and close attention to comorbidities are essential, as the suppression of potential culprit factors has important prognostic value and contributes to the elucidation of EM triggers.

Numerical Simulation of Moisture-Heat Coupling in the Drying Process of a Multi-Temperature Zone Belt Dryer

The multi-temperature zone distributed drying method solves the problem of uneven drying of the conventional belt dryer. Multi-temperature zone belt dryer is widely used in the drying of aquatic feed products. This paper presents a numerical simulation method for multi-temperature zone belt dryer. The computational fluid dynamics (CFD) was applied to simulate the drying process of materials in a multi-temperature zone belt dryer. The user-defined function (UDF) was used to study the moisture-heat coupling drying process to predict the airflow filed of the multi-temperature zone belt dryer. The results showed that there were vortexes in each drying chamber so that airflow velocity distribution of the material layer was not uniform. However, the multi-temperature zone distributed drying method can maximize the drying efficiency through the bilateral distribution of the air inlet. The temperature distribution in each temperature zone was relatively uniform, and the temperature difference between the two sides of the feed layer was massive. The moisture content of the materials in each temperature zone was very uniform, the drying unevenness was less than 1.0%, and the dryer has excellent moisture content uniformity.

Chest CT scan in patients with contusion and COVID-19, a comparative study with pure lung contusion

Background: Resource allocation for traumatic patients who are positive/negative for COVID-19 challenges the diagnosis. We designed this study to compare the chest CT appearances of COVID-19 patients associated with lung contusion versus patients with lung contusion only, to determine the differentiation capability of CT scan concerning the two conditions. Methods: CT-scans of 9 RT-PCR positive patients of lung contusion due to motor-vehicle-accident (COVID-19 with contusion group) and 16 consecutive patients with lung contusions of comparable severity scores from the pre-COVID-19 era (contusion only group) were revaluated retrospectively and blindly by three radiologists in consensus. The distribution and characteristics of presenting CT-scan findings; including presence, shape and distribution of Ground Glass Opacities and consolidations, presence of subpleural sparing, crazy-paving and Atoll sign. In addition, presence of effusions and cavities were compared between the two groups. Time course of the opacities was compared. Results: Bilateral distribution of opacities was noted in 100% of COVID-19 with contusion and 87.5% of contusion only group. There was no significant difference between Ground Glass Opacities or consolidation shapes (P=0.44 and P=0.66). Both Ground Glass Opacities and consolidations were more diffusely distributed in COVID-19 with contusion, while a predominantly peripheral distribution was more commonly seen in the contusion only group (P=0.03 and P=0.01 respectively). Subpleural sparing was noted in 93.8% of contusion only as compared to 44% of CC group (p=0.04). Appearance resembling Atoll sign was noted in 12.5% of the contusion only groups and none of the COVID-19 with contusion group (P=0.01). Time to resolution was significantly longer in COVID-19 with contusion (15±6 days) comparing to contusion only patients (P=0.02). Conclusion: 'Typical' chest CT findings including bilateral peripheral Ground Glass Opacities and consolidations, also crazy-paving and Atoll signs, as well as less typical findings such as subpleural sparing is seen in both lung contusion and COVID-19 pneumonitis. Time course of the lesions might be a better radiologic discriminator between the two entities.

Testicular Fibrous Hypoplasia in Cynomolgus Monkeys (Macaca fascicularis): An Incidental, Congenital Lesion

Testicular fibrous hypoplasia is an incidental lesion characterized by replacement of the testicular parenchyma by mature collagen. A retrospective survey of hematoxylin and eosin–stained testicular sections from 722 purpose-bred Asian and 90 Mauritian cynomolgus monkeys from 56 safety assessment studies conducted between 1999 and 2011 was performed. The incidence of the lesion increased markedly over time. No cases occurred between 1999 and 2004. Between 2005 and 2009, the incidence ranged between 8.1% and 11.0% of the monkeys examined and then rose to 26.1% in 2010 and 30.9% in 2011. Overall, the lesion was identified in 10.94% of Asian monkeys with the highest incidence in animals originating from China and Vietnam; severity ranged from minimal to severe and it occurred unilaterally (38.5%) and bilaterally (61.5%). In Mauritian monkeys, the lesion was predominantly minimal in severity, bilateral in distribution, and affected 6.6% of the animals examined. The lesion occurred regardless of sexual maturation status but when present in mature monkeys was often associated with cystic tubular atrophy of the seminiferous epithelium. Based on the morphological characteristics of the lesion and the unilateral/bilateral distribution, the lesion is considered to be a congenital or developmental abnormality.