Detection of clinical and subclinical Foot and Mouth Disease Virus in Cattle in Al-Najaf Province.

Foot-and-mouth disease (FMD) is a highly transmissible disease caused by Aphthovirus of the family Picornaviridae. This study aimed to investigate the serological approach (non-structural protein [NSP] analysis) of 3ABC enzyme-linked immunosorbent assay (ELISA) to diagnose FMD cattle in vaccinated and unvaccinated animals. A total of 84 serum specimens, including non-vaccinated, single-vaccinated, and multi-vaccinated samples, were collected from four districts in Baghdad Province, Iraq, to evaluate the antibodies to NSP of the FMD virus. The ELISA was used to detect antibodies (NSP) of FMDV in the serum of cattle. The result showed that the seroprevalence was estimated at 34% (29/84) in farm animals. The seroprevalence rates of FMD in relation to the age of infected animals were obtained at 21%, 7%, and 6% in 9-23-, 24-36-, and ≥ 36-month-old groups, respectively. The consequences of the examination of the sera from naive, immunized, and non-immunized infected farm animals applying 3ABC-ELISA were presented; accordingly, the incidence rates of FMD infection in non-vaccinated and vaccinated animals were 18 (75%) and 11 (18%) respectively. Negative results were recorded in the immunized group 49 (82%) higher than in the non-immunized group 6 (25%). Evaluation of NSP antibodies to isolate vaccinated animals from infected ones showed that the application of these assays was significantly useful for FMD prevention and control management programs in infected areas.

Microbiome Dysbiosis and Predominant Bacterial Species as Human Cancer Biomarkers.

PURPOSE: To evaluate bacterial agents as cancer biomarkers. METHODS AND RESULTS: Various bacterial species have been demonstrated to involve in human cancers. However, the data is not enough for better understanding of predominant specific species. Application of a rapid and early-diagnostic, cost-effective, non-invasive, and inclusive method is a crucial approach for obtaining valid results. The role of Helicobacter pylori (H. pylori) in gastric and duodenal cancer has been confirmed. From investigation among previous publications, we attempted to make it clear which bacterial species significantly and specifically increase in various cancer types. It was unraveled that there is significant change in Granulicatella adiacens (G. adiacens) in lung cancer (LC), Fusobacterium nucleatum (F. nucleatum) in colorectal cancer (CRC), H. pylori and Porphyromonas gingivalis (P. gingivalis) in pancreatic cancer, and Streptococcus spp. in oral cancer. CONCLUSION: Alteration in the cell cycle by means of different mechanisms such as inflammation, alteration in cell signaling, invasion and immune evasion, specific niche colonization, induction of DNA damage and mutation, expression of some microRNAs, and enhancing epigenetic effects are the most common mechanisms employed by bacterial species.

Correlation between neonatal calf diarrhea and the level of maternally derived antibodies.

Passively acquired antibodies through colostrum will protect calves against etiological agents of neonatal calf diarrhea. Among them enteric diseases due to strains of Enterotoxigenic Escherichia coli (ETEC) are the most commonly occurring form of colibacillosis in newborn calves. Specific antibodies against whole ETEC cells and total immunoglobulin G in dam serum, colostrum and calf serum were determined. There were significant differences (P=0.0005) between antibody titers in normal and diarrheic groups, in which diarrheic group had a higher titer. Total IgG concentration in diarrheic calves (20.86 ± 0.49), their dams (23.48 ± 0.54) and colostrum (33.40 ± 0.50) was less than normal group (P=0.0005). There was a highly significant positive correlation between dam total IgG with calf total IgG (r=0.022; ratio=52.11). Colostral anti-E. coli antibody had a highly significant positive correlation with anti-E. coli in calf serum (r=0.345; ratio=0.62). Anti-E. coli antibody in calf serum had a highly significant negative correlati with total IgG of dam serum, colostrum and calf serum. While the level of anti-E. coli antibodies in diarrheic group was considerably higher than normal group, our findings reported here are in agreement that immunity to diarrhea also might be correlated with maternal cells or cellular components as well as cytokines which are transferred by colostrum to neonatal calves. Nevertheless, the level of maternally derived antibodies is a promising indicator for passive immunity and protection against diarrhea in neonatal calves.

[CT-controlled percutaneous lumbar discectomy in therapy of radicular pain]. / CT-gesteuerte perkutane Nukleotomie mit dem Dissektor zur Therapie chronischer Rückenschmerzen mit radikulärer Ausstrahlung.

Percutaneous disc decompression using the Decompressor system is another treatment option for patients suffering from chronic discogenic leg pain. This is the first report on a patient undergoing this procedure under CT-control. A 49 year old man with radicular leg pain showed significant pain reduction after percutaneus decompression of a discal herniation at the L4/5 level. The new system enables qualitative and quantitative measures of the removed disc material. CT-control ensures exact positioning of the device.

Role of postoperative computed tomography in patients with severe liver injury.

BACKGROUND: The role of postoperative computed tomography (CT) in asymptomatic patients with severe liver injury has not been investigated. The aim of the present study was to investigate the nature and incidence of significant liver-related abnormalities detected by postoperative CT in asymptomatic patients with severe liver injury. METHODS: This was a prospective study of survivors with severe liver injury (grades III-V) who were treated surgically. The patients underwent CT to evaluate the liver after operation, irrespective of symptoms. RESULTS: During the study interval there were 181 patients with severe liver injury, of whom 49 fulfilled the criteria for inclusion. The overall incidence of liver-related complications detected by CT was 49 per cent (necrotic areas in the liver in seven patients, seven bilomas, four abscesses, three perihepatic collections and three false aneurysms). In the subgroup of 17 asymptomatic patients CT revealed four abnormalities: two large bilomas, one false aneurysm and one fluid collection. Two of these patients required therapeutic intervention and the other two remained under observation. CONCLUSION: In view of the incidence of asymptomatic significant liver abnormalities following operative management of severe liver injury, it is recommended that these patients undergo routine postoperative CT.

Effect on outcome of early intensive management of geriatric trauma patients.

BACKGROUND: Despite significant injuries elderly patients (aged 70 years or more) often do not exhibit any of the standard physiological criteria for trauma team activation (TTA), i.e. hypotension, tachycardia or unresponsiveness to pain. As a result of these findings the authors' TTA criteria were modified to include age 70 years or more, and a protocol of early aggressive monitoring and resuscitation was introduced. The aim of the present study was to assess the effect of the new policy on outcome. METHODS: This trauma registry study included patients aged 70 years or more with an Injury Severity Score (ISS) greater than 15 who were admitted over a period of 8 years and 8 months. The patients were divided into two groups: group 1 included patients admitted before age 70 years and above became a TTA criterion and group 2 included patients admitted during the period when age 70 years or more was a TTA criterion and the new management protocol was in place. The two groups were compared with regard to survival, functional status on discharge and hospital charges. RESULTS: There were 336 trauma patients who met the criteria, 260 in group 1 and 76 in group 2. The two groups were similar with respect to mechanism of injury, age, gender, ISS and body area Abbreviated Injury Score. The mortality rate in group 1 was 53.8 per cent and that in group 2 was 34.2 per cent (P = 0.003) (relative risk (RR) 1.57 (95 per cent confidence interval 1.13 to 2.19)). The incidence of permanent disability in the two groups was 16.7 and 12.0 per cent respectively (P = 0.49) (RR 1.39 (0.59 to 3.25)). In subgroups of patients with an ISS of more than 20 the mortality rate was 68.4 and 46.9 per cent in groups 1 and 2 respectively (P = 0.01) (RR 1.46 (1.06 to 2.00)); 12 of 49 survivors in group 1 and two of 26 in group 2 suffered permanent disability (P = 0.12) (RR 3.18 (0.77 to 13.20)). CONCLUSION: Activation of the trauma team and early intensive monitoring, evaluation and resuscitation of geriatric trauma patients improves survival.

Old age as a criterion for trauma team activation.

BACKGROUND: Elderly trauma patients have been shown to have a worse prognosis than young patients. Age alone is not a criterion for trauma team activation (TTA). In the present study, we evaluated the role of age > or = 70 years as a criterion for TTA. METHODS: The present study was a trauma registry study that included injured patients 70 years of age or older. Patients who died in hospital, were admitted to the intensive care unit (ICU) within 24 hours, or had a non-orthopedic operation were assumed to benefit from TTA. RESULTS: During a 7.5-year period, 883 elderly (> or = 70 years) trauma patients meeting trauma center criteria were admitted to our center. Overall, 223 patients (25%) met at least one of the standard TTA criteria. The mortality in this group was 50%, the ICU admission rate was 39%, and a non-orthopedic operation was required in 35%. The remaining 660 patients (75%) did not meet standard TTA criteria. The mortality was 16%, the need for ICU admission was 24%, and non-orthopedic operations were required in 19%. Sixty-three percent of patients with severe injuries (Injury Severity Score > 15) and 25% of patients with critical injuries (Injury Severity Score > 30) did not have any of the standard hemodynamic criteria for TTA. CONCLUSION: Elderly trauma patients have a high mortality, even with fairly minor or moderately severe injuries. A significant number of elderly patients with severe injuries do not meet the standard criteria for TTA. It is suggested that age > or = 70 years alone should be a criterion for TTA.

Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care?

OBJECTIVE: To evaluate the safety of a policy of selective nonoperative management (SNOM) in patients with abdominal gunshot wounds. SUMMARY BACKGROUND DATA: Selective nonoperative management is practiced extensively in stab wounds and blunt abdominal trauma, but routine laparotomy is still the standard of care in abdominal gunshot wounds. METHODS: The authors reviewed the medical records of 1,856 patients with abdominal gunshot wounds (1,405 anterior, 451 posterior) admitted during an 8-year period in a busy academic level 1 trauma center and managed by SNOM. According to this policy, patients who did not have peritonitis, were hemodynamically stable, and had a reliable clinical examination were observed. RESULTS: Initially, 792 (42%) patients (34% of patients with anterior and 68% with posterior abdominal gunshot wounds) were selected for nonoperative management. During observation 80 (4%) patients developed symptoms and required a delayed laparotomy, which revealed organ injuries requiring repair in 57. Five (0.3%) patients suffered complications potentially related to the delay in laparotomy, which were managed successfully. Seven hundred twelve (38%) patients were successfully managed without an operation. The rate of unnecessary laparotomy was 14% among operated patients (or 9% among all patients). If patients were managed by routine laparotomy, the unnecessary laparotomy rate would have been 47% (39% for anterior and 74% for posterior abdominal gunshot wounds). Compared with patients with unnecessary laparotomy, patients managed without surgery had significantly shorter hospital stays and lower hospital charges. By maintaining a policy of SNOM instead of routine laparotomy, a total of 3,560 hospital days and $9,555,752 in hospital charges were saved over the period of the study. CONCLUSION: Selective nonoperative management is a safe method for managing patients with abdominal gunshot wounds in a level 1 trauma center with an in-house trauma team. It reduces significantly the rate of unnecessary laparotomy and hospital charges.

Penetrating trauma in patients older than 55 years: a case-control study.

BACKGROUND: Multiple studies have compared young and elderly blunt trauma patients, and concluded that, because elderly patients have outcomes similar to young patients, aggressive resuscitation should be offered regardless of age. Similar data on penetrating trauma patients are limited. STUDY DESIGN: In a retrospective review, 79 patients with penetrating injuries and age > or =55 were blindly matched for Injury Severity Score (ISS) and Abbreviated Injury Scores (AIS) with 79 penetrating trauma patients aged 15-35 years, who were admitted to the hospital over the same 4 year period (June 1994-June 1998). Mortality rates and length of stay in the intensive care unit (ICU) and the hospital were compared between the two groups. RESULTS: The average ISS for all patients was 12 (range 1-75) and identical for both groups. Both groups had similar injuries and were evaluated by an equal number and type of diagnostic studies. The mean ISS was not different between severely injured older and younger patients who required ICU admission or died. Among 32 nonsurvivors (18 older and 14 younger), older patients were more likely than younger patients to present with normal vital signs, although the comparison did not reach statistical significance (50% vs. 13%, P=0.25). There was a clinically significant trend for longer ICU (15+/-30 vs. 3+/-2 days, P=0.096) and hospital stay (10+/-18 vs. 6+/-8 days, P=0.08) among older patients, but mortality rates were similar (23% in older vs. 18% in younger, P=NS). Furthermore, these outcome parameters showed no difference when both groups were classified according to severity of injury or physiologic response. CONCLUSIONS: Following penetrating trauma, older patients arriving alive and admitted to the hospital are as likely to survive as younger patients who have injuries of similar severity, but at the expense of longer ICU and hospital stays.

Aerodigestive injuries of the neck.

Cervical aerodigestive trauma is rare and most centers have a limited experience with its management. The purpose of this review was to study the epidemiology, diagnosis, and problems related to the early evaluation and management of these injuries. This was a retrospective study based on trauma registry and on chart, operative, radiological, and endoscopic reports. There were 1560 admissions with blunt or penetrating trauma to the neck. The overall incidence of aerodigestive trauma was 4.9 per cent (10.2% for gunshot wounds, 4.6% for stab wounds, and 1.2% for blunt trauma). All patients with aerodigestive trauma had suspicious signs or symptoms on admission. The most common life-threatening problem in the emergency room and directly related to the aerodigestive trauma was airway compromise. Twenty-nine per cent of patients with laryngotracheal trauma required an emergency room airway establishment because of threatened airway loss. Although rapid sequence induction was successful in the majority of cases, in 11.9 per cent there was loss of airway and a cricothyroidotomy was necessary. Overall, 9 per cent of cases with aerodigestive injuries were successfully treated nonoperatively. Thirty-six per cent of patients with laryngotracheal trauma and surgical repair were successfully treated without a protective tracheostomy. There was no mortality due to the aerodigestive injuries. Cervical aerodigestive trauma is rare. In conclusion, all patients with significant aerodigestive injuries requiring treatment had suspicious signs and symptoms. Airway compromise was a common problem in the emergency room. Loss of airway after rapid sequence induction is a potentially lethal complication and the trauma team should be ready for a surgical airway. Repair of laryngotracheal injuries without a protective tracheostomy is safe in selected cases.

The Trauma Program Manager role: a current examination.

PURPOSE: To describe the history and define current application of the Trauma Program Manger (TPM) role. To suggest that a professional networking group can assist a TPM to accomplish the significant demands of the role. SIGNIFICANCE TO CARE: Improved understanding of the current role. Enhanced effectiveness in fulfilling the current functions of the TPM role through networking. DESIGN: Literature review on the role of the TPM, discussing the growth, development and progression to its current form. Evaluation of one professional group of TPMs and how it aided members in accomplishing the significant demands of the role. METHODS OF EVALUATION: A 6-year retrospective review of the administrative records for a professional networking group of TPMs was conducted. Meeting content was sorted and tabulated into the 10 functional requirements of the TPM role. TPMs who were members of the group during the same 6-year period were surveyed regarding the perceived value of group participation relative to accomplishing each of the TPM role functions. CONCLUSIONS: The current form of the TPM role is significant and encompasses at least 10 distinct functions. A professional group of TPMs is a useful tool to aid individuals in fulfilling their TPM roles. This may be true for both novice and experienced TPMs. The professional group may serve as an adjunct to obtaining formal role education.

Sacral nerve root stimulation for the treatment of urge incontinence and detrusor dysfunction utilizing a cephalocaudal intraspinal method of lead insertion: a case report.

Sacral nerve root stimulation (SNRS) is known to be effective in the treatment of pelvic motor dysfunction(1-4). Bladder and urethral motor disorders commonly treated include urinary urge incontinence, voiding/detrusor dysfunction, and urgency/frequency syndromes. To date, neurostimulation specific to bladder and urethral dysfunction has applied a unilateral, trans-sacral approach. (Interstim, Medtronic, Minneapolis, MN) Despite some success, this method has been associated with technical failures in maintaining electrode position(5,6). As an alternative, this case report describes the selective epidural application of a cephalocaudal ("retrograde") lead insertion method in a patient with severe detrusor dysfunction and urinary urge incontinence(7).

Pediatric falls: is height a predictor of injury and outcome?

Falls account for a significant proportion of pediatric injuries and deaths. A retrospective review of pediatric patients (age 0-14 years) was performed to determine whether patterns of injuries and outcomes could be predicted on the basis of the height of the fall. In addition we evaluated the triage criterion "fall greater than 15 feet" for transport of patients to a trauma center. Patients were stratified by the height of the fall: greater than or less than 15 feet. The end points for analysis were the associated injuries and survival. Patients who fell less than 15 feet had a higher incidence of intracranial injuries (and fewer extremity fractures than patients who fell more than 15 feet). Skull fractures were the most frequent injury and were associated with an increase in intracranial injuries in both subgroups. In conclusion low-level falls are associated with significant intracranial injuries. The evaluation of patients sustaining low-level falls should not be limited on the basis of the height of the fall. Using falls of greater than 15 feet as a triage criterion for transport to a trauma center needs to be prospectively evaluated to ensure that critically injured patients are triaged appropriately.

Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls.

BACKGROUND: Cervical spine injuries are the most commonly missed severe injuries with serious implications for the patient and physician. The diagnosis of subluxations or spinal cord injuries in the absence of vertebral fractures, especially in unevaluable patients, poses a major challenge. The objective of this study was to study the incidence and type of cervical spine trauma according to mechanism of injury; identify problems and pitfalls in the diagnosis of nonskeletal cervical spine injuries. METHODS: Retrospective study of all C-spine injuries caused by traffic accidents or falls admitted over a 5-year period at a large Level I trauma center. Data were obtained from the trauma registry, review of patient charts, and radiology reports. RESULTS: During the study period, there were 14,755 admissions due to traffic injuries or falls who met trauma center criteria. There were 292 patients with C-spine injuries, for an overall incidence of 2.0% (3.4% in car occupants, 2.8% for pedestrians, 1.9% for motorcycle riders, and 0.9% for falls). The incidence of C-spine injuries in patients with a Glasgow Coma Scale score of 13 to 15 was 1.4%, 9 to 12 was 6.8%, and in < or =8 was 10.2% (p < 0.05). Of C-spine injuries, 85.6% (250 patients) were a vertebral fracture, 10.6% of the injuries (31 patients) were subluxation without fractures, and 3.8% (11 patients) were an isolated spinal cord injury without fracture or subluxation. Of the 31 patients with isolated subluxations, one-third required an early endotracheal intubation before clinical evaluation of the spine, because of associated severe head injury or hypotension. Adequate lateral C-spine films diagnosed or suspected 30 of the 31 subluxations (96.8%). The combination of plain films and computed tomographic (CT) scan diagnosed or suspected all injuries. Of the 11 patients with isolated cord injury, 27.3% required early intubation before clinical evaluation of the spine. The diagnosis of cord injury was made on admission in only five patients (45.5%). In three patients, the neurologic examination on admission was normal and neurologic deficits appeared a few hours later. In the remaining three patients (two intubated, one intoxicated), the diagnosis was missed clinically and radiologically. CONCLUSIONS: Isolated nonskeletal C-spine injuries are rare but potentially catastrophic because of the high incidence of neurologic deficits and missed diagnosis. In subluxations, the combination of an adequate lateral film and CT scan was reliable in diagnosing or highly suspecting the injury. A large prospective study is needed to confirm these findings, before a recommendation is made to remove the cervical collar if the findings of these investigations are normal. However, in isolated cord injuries, the diagnosis was often missed because of associated severe head trauma and the low sensitivity of the plain films and CT scans.

Effect of spinal cord stimulation on sensory nerve conduction threshold functional measures.

Background. Spinal cord stimulation (SCS) is being used with increasing frequency in the treatment of various chronic pain conditions. There is a paucity of reliable outcome data regarding changes in pain tolerance and peripheral sensory nerve function. The automated electrodiagnostic neuroselective sensory Nerve Conduction Threshold (sNCT) test measures painless current perception thresholds (CPTs) and atraumatic pain tolerance thresholds (PTTs). The ability of the sNCT test to independently evaluate small and large fiber function may have particular relevance for evaluating response to SCS. Methods/Results. Sixteen patients with implanted SCS systems and lower extremity neuropathic pain of greater than 6-months duration were tested using a standardized protocol, pre- and post-SCS. CPT and PTT measures (Neurometer, CPT/C Neurotron, Inc. Baltimore, MD) were obtained from the distal phalange of the most symptomatic extremity and at an ipsilateral asymptomatic control site. Only CPTs at the symptomatic site (2000 Hz only) and at the control site (5 Hz only) reached statistical significance. Changes in CPTs at other frequencies, and changes in PTTs at all frequencies (symptomatic and control sites) were not statistically significant. Conclusion. The results of this study appear to substantiate the postulates that both segmental and suprasegmental effects are involved in SCS-mediated analgesia. SCS modulates segmental large afferent fiber input as reflected by a statistically significant increase in large fiber CPTs (2000 Hz) at the symptomatic site post-SCS. A statistically significant increase in small fiber (5 Hz) CPTs at the control site suggests a central sensory (suprasegmental) modulating effect on nociceptive fiber activity. sNCT testing provided reliable outcome data for evaluating response to SCS.

Selective Nerve Root Stimulation (SNRS) in the Treatment of End-Stage, Diabetic, Peripheral Neuropathy: A Case Report.

Spinal cord stimulation (SCS) for the treatment of painful peripheral neuropathy (PN) has been met with mixed results. It has been suggested that early-stage symptoms that are sympathetically maintained (SMP) are more likely to respond to SCS, while progressive sympathetically independent symptoms (SIP) will not. Peripheral nerve stimulation (PNS), however, has successfully treated certain SIP presentations. With the advent of new selective nerve root stimulation (SNRS) strategies, the possibility of utilizing epidural, peripheral neurostimulation was investigated in a patient with endstage, diabetic, "dying back" peripheral SIP.

The effect of a quality improvement program on paramedic on-scene times for patients with penetrating trauma.

OBJECTIVE: To decrease paramedic on-scene times (OSTs) for major trauma patients through a focused quality improvement (QI) program. METHODS: A prospective study was conducted from 1993 through 1997 to determine the impact of a QI program on paramedic OSTs. All penetrating trauma patients transported by paramedics to Los Angeles County/USC Medical Center, a Level-1 trauma center, were included, and all cases with OSTs > 20 minutes were reviewed in detail for extenuating circumstances. Cases including multiple victims or unsecured scenes were considered "acceptable deviations." All others were considered "fallouts," which prompted extensive review with the paramedics and their field supervisors. RESULTS: Prior to the inception of the QI project there was a 4.1% fallout rate of penetrating trauma patients with OSTs > 20 minutes. This fallout rate fell to 1.5% in 1997 (p < 0.01). Mortality rates among these fallouts decreased from 5.1% to 0.8% during the study period (p < 0.01). CONCLUSIONS: An intensive QI program can have a significant, positive impact on paramedic OSTs among patients with penetrating trauma.

Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique.

Objective. The conventional technique used to stimulate the lumbar dermatomes is by stimulation of the dorsal columns of the spinal cord. Until recently, stimulation of nerve roots had not been successfully accomplished. We had performed selective nerve root cannulations for the placement of temporary catheters at cervical, thoracic, lumbar, and sacral levels in chronic pain patients using a caudad rather than craniad approach. We hypothesized that by stimulating the nerve roots we could improve paresthesia coverage in areas which cannot be covered effectively by spinal cord stimulation (SCS). To test this hypothesis, we have performed trials of nerve root stimulation (NRS) in patients who had failed SCS, or who were not candidates for SCS because their pain was otherwise inaccessible to stimulation. Methods. Five patients who had been unresponsive to conservative treatment, surgery, or SCS underwent 7-day trials with NRS. The diagnoses included: ilioinguinal neuralgia, discogenic low back pain, failed back syndrome, vulvodynia, and interstitial cystitis. We collected paresthesia maps, pain maps, pain visual analog scale (VAS) scores, and patient satisfaction ratings. Results. Paresthesia coverage was above 75% in all patients. VAS scores declined from a mean of 9 ± 1.0 to 2.4 ± 2.1 (p < 0.05, n= 5), all 5 patients requested permanent implantation, and 4 have been implanted so far. Conclusions. Lumbar and sacral NRS trials resulted in adequate paresthesia coverage and effective pain relief in all 5 patients. Further clinical trials to evaluate long-term success rates and safety are indicated. Detailed mapping studies are needed to evaluate the relationship between electrode placement and paresthesia patterns as well as the optimal stimulation parameters.