Acquired hemophilia A is a disorder of rare entity, resulting in spontaneous bleeding in individuals with no history of bleeding disorders. It is believed to be caused by spontaneous inhibition of clotting factor VIII by autoantibodies, and is usually associated with other autoimmune conditions. The hallmark of this condition is mucocutaneous bleeding leading to ecchymosis, melena, hematoma or hematuria. Our discussion revolves around the case of an elderly male with no history of anticoagulant use presenting with hematuria. Imaging showed left kidney hemorrhage, his labs were significant for a prolonged partial thromboplastin time (PTT), and subsequent tests revealed low factor VIII levels and high factor VIII inhibitor levels, which led to the diagnosis of acquired hemophilia A in the patient. He was managed with medications resulting in normalization of factor VIII levels.

| Two commercial vaccines against the Lasota strain of Newcastle disease (ND), the Lasota vaccine-1 and vaccine-2, and two vaccines against the Mukteswar strain of Newcastle disease, the Mukteswar vaccine-1 and vaccine-2, were assessed for their effectiveness and impact on the productivity of broilers. 75 days old broiler chicks overall were divided into five equal groups and given the following labels: A, B, C, D, and E. Each group was then split up into pens with a maximum of five birds in each pen. On days 14 and 21, the birds in groups B, C, D, and E received active immunisation against ND using Lasota-1, Lasota-2, Mukteswar-1, and Mukteswar-2, respectively, leaving A as the control group left uninfected. On days 21 and 35 of the study, the serum HI antibody response to these four immunisations was assessed. As evidence of its strong efficacy, Group C, which had received the Lasota (vaccine-2) vaccination, displayed high antibody titers throughout the experiment. In terms of geometric mean titers, there was a significant difference (p 0.05) between the groups. On days 7, 14, 21, and 35 of the experiment, data on other performance indicators, including as feed intake, water intake, total body weight, and feed conversion ratio (FCR), were gathered. Throughout the course of the trial, there were significant differences in these performance metrics (p 0.05). There was no discernible difference in the productive performance of the broilers between the vaccinated groups, and the unvaccinated broilers (control group) performed better in terms of weight growth and FCR than the vaccinated groups. According to the data, group C of broilers given Lasota vaccine-2 proved to be more effective in terms of producing antibodies in broilers, while unvaccinated broilers performed better in terms of productivity compared to the vaccinated flock. However, it was advised that the decision on which vaccine to use depend not only on the aforementioned elements but also on the specifics of a given region, including the organization of veterinary services, prior knowledge, population distribution, communication infrastructure, and climate.

Introduction: Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia that can present as orthostatic tachycardia, dizziness, nausea, and anxiety, and many other symptoms that can be debilitating enough to cause functional impairment. The cardiopulmonary exercise test (CPET) has become a reliable test for evaluating the functional capacity (fc) in POTS patients. The test requires utilization of a bicycle ergometer, blood pressure apparatus, ECG, pulse oximeter, and a face mask that measures the oxygen uptake and carbon dioxide release. The 6-minute walk test (6MWT) is another test that can also be utilized to assess fc in patients. Objective: The aim of this study is to differentiate whether the 6MWT and CPET give similar results with regards to fc in POTS patients. Methods: A total of 27 POTS patients visiting the clinic consented to participate in the voluntary study. There were 2 males and 25 females, with ages between 16 to 58 years. For the 6MWT, we used wrist worn pulse oximeter, electronic tablet device, sphygmomanometer and a lap counter. Patients walked in a straight flat corridor which was marked at 3 meter intervals, for six minutes. At the end of 6 minutes, patients were asked to stop and the six minute walk distance (6MWD) was recorded. The predicted 6MWD, the distance the patient was expected to walk based on patient’s sex, age, height and weight was calculated by the application installed on the tablet. The percentage of the predicted 6MWD that was actually walked by the patients was calculated (6MWD % predicted), and considered as their fc. Using the electronic medical records, we obtained their CPET fc results, where fc was calculated as a percentage of the predicted maximal oxygen uptake per unit body weight per unit time (VO 2max ) that was actually consumed. The VO 2max measurement depends on patient’s sex, age, weight and height. Pearson correlation coefficient was used to compare the results of the 6MWT (6MWD % predicted) and CPET (fc). Results: Pearson correlation coefficient shows that there is no linear association between the CPET (fc) results and 6MWT (6MWD % predicted) results in POTS patients, with p=0.3368. Conclusion: The results convey no statistically significant association between the CPET (fc) results and the 6MWT (6MWD % predicted) results in POTS patients; the results of the 6MWT were not similar to that of the CPET in terms of fc testing in POTS patients. This suggests that the 6MWT has limited utility in POTS patients.

Introduction: The cardiopulmonary exercise test (CPET) helps assess exercise tolerance in patients. The CPET is a better predictor of general health status and functional capacity (fc) when compared with resting cardiac and pulmonary function testing measurements (1). The test makes use of a bicycle ergometer with the patient being fitted with ECG leads, blood pressure cuff, pulse oximeter, and a face mask which determines the amount of oxygen consumed and carbon dioxide released. The predicted peak oxygen consumption per unit body weight per unit time (VO2max) is calculated based on patient’s sex, age, weight and height (2). Fc is measured as a percentage of VO2max that was actually consumed. Objective: Our study evaluates any relationship between the CPET fc results and patient’s sense of overall well-being, which provides a subjective measure of their quality of life. Methods: In this retrospective study, we randomly selected 299 patients who visited the clinic using electronic medical records from May-June 2019. There were 260 females and 39 males, with ages between 16-82 years. Patient history was analyzed to look for “overall health rating” scores; how they felt about their overall health on a scale of 1 to 10, with 1 denoting feeling the worst and 10 indicating feeling the best of their health. Their CPET fc results were analyzed at the same time, where values <55% meant severely reduced fc, ≥55% but <70% meant moderately reduced fc, ≥70% but <80% meant mildly reduced fc, and ≥80% meant normal fc. Logistic regression was used to look for an association between the values of the overall health rating and CPET fc results, where patient’s age and sex were used as control variables. Results: With each score increase in the overall health rating, the odds of the fc value being normal than being mildly/moderately/severely reduced increases by 1.2 times, given the patient sex and age remain constant (95%CI (0.76,0.98), p = 0.019<0.05). Conclusion: The results reveal a statistically significant association between the patients' overall health rating and their CPET fc results. The higher the numerical value of the overall health rating and the better the patients feel about their health, the greater the probability that the patient will also have a better CPET fc result. Thus the CPET fc can be used as an objective value to assess a patient’s overall well being.

Chronic mesenteric ischemia (CMI) is a condition defined by a state of attenuated blood circulation in the mesenteric vasculature affecting one or more abdominal viscera, and is more common in the female and elderly populations. Amongst the many causes, it occurs most frequently in connection with diffuse atherosclerosis. Its presentation is variable with symptoms such as weight loss, nausea, vomiting, diarrhea and/or constipation, with postprandial pain classically present in the majority of the cases; this, in addition to the chronic course of the disease, makes timely diagnosis a challenge. Physical examination may reveal signs of malnutrition and other findings usually linked with the underlying medical condition. It can have grave consequences if not managed promptly. In our case, an 81-year-old woman came in with loss of appetite, nausea, vomiting, diarrhea and/or constipation, and weight loss. Computed tomography angiography (CTA) of the abdomen/pelvis confirmed chronic occlusion of the mesenteric vessels. She was treated surgically. This discussion is based on chronic mesenteric ischemia and its nonspecific symptomatology, particularly its association with weight loss.