Biventricular tissue tracking demonstrating associations between left ventricular myocardial extracellular volume, pulmonary artery pressure, and reduced right ventricular ejection fraction in patients with systemic lupus erythematosus using cardiovascular MRI.

AIM: To investigate the feasibility and prognostic value of biventricular strain analysis for patients with systemic lupus erythematosus (SLE) and relationship to left ventricular (LV) myocardial fibrosis, pulmonary hypertension (PAH), and right ventricular (RV) ejection fraction (RVEF). MATERIALS AND METHODS: A total of 50 SLE patients (47 women; 34.4±12 years) and 15 controls (13 women; 32.9±8.6 years) were imaged via echocardiography and a 3 T magnetic resonance imaging (MRI). Pulmonary artery systolic pressure (sPAP) was assessed using echocardiography. Biventricular global circumferential strain (GCS), global longitudinal strain (GLS), global circumferential strain rate (GCSR), and global longitudinal strain rate (GLSR) as well as LV myocardial extracellular volume (ECV) were derived for each subject. RESULTS: Elevated LV ECV was significantly associated with LV GCS (beta -0.428, p=0.000), GLS (beta 0.404, p=0.000), GCSR (beta -0.350, p=0.006), GLSR (beta -0.445, p=0.000) and RV GCS (beta -0.373, p=0.000), and the presence of reduced RVEF was significantly associated with LV GCS (beta -0.338, p=0.002), GLS (beta -0.465, p=0.000) and RV GCS (beta -0.465, p=0.000). Raised sPAP was significantly associated with RV GLS (beta 0.445, p=0.000) and GCSR (beta -0.387, p=0.001). Moreover, there were significantly correlations between LV and RV strain and strain rate. CONCLUSIONS: Biventricular strain analysis may be a better prognostic tool for patients with SLE as it allows greater comprehensive analysis and more definitive treatment planning compared to separate assessment of LV or RV contractility.

Identifying factors contributing to slow growth in pigs.

Pigs that grow slower than their contemporaries can cause complications for animal welfare and profitability. This study was conducted to investigate factors that may contribute to slow growth of pigs. Pigs ( = 440) farrowed by 65 sows were monitored from birth to market. Pigs were categorized as slow, average, and fast growers based on market weight adjusted to 170 d of age (slow growers were <105 kg, average growers were between 105 and 125 kg, and fast growers were >125 kg). Blood samples were collected from 48 focal pigs at 9 and 21 wk of age and analyzed for hormone and free AA concentrations. Data were analyzed using the Mixed and Logistic procedures of SAS. Slow-growing pigs accounted for 10% of pigs marketed, average growers accounted for 49% of pigs marketed, and fast growers accounted for 41% of pigs marketed. Compared with fast growers, slow growers were lighter at birth ( < 0.01), at weaning ( < 0.01), and at nursery exit ( < 0.01) and had less backfat ( < 0.01) and smaller loin muscle area ( < 0.01) at marketing at 21 wk of age. Slow growers had lower plasma concentrations of IGF-1 ( = 0.03) and insulin ( < 0.001) during the nursery period and lower concentrations of leptin ( < 0.001) and insulin ( < 0.001) during the finishing period compared with average and fast growers. Serum concentrations of several essential, nonessential, and total free AA were less for slow growers during both the nursery and finishing periods compared with average and fast growers. Gilts were more likely to become slow growers than barrows (odds ratio = 2.17, 95% confidence interval = 1.19 to 3.96, = 0.01). Litter size and parity of the pigs' dam were not associated with slow growth. These results suggest that low concentrations of IGF-1, insulin, leptin, and AA may contribute to or be associated with slow growth in pigs.

Preweaning mortality in group-housed lactating sows: hormonal differences between high risk and low risk sows.

This study used an endocrinological approach to explain the differences between sows that have higher vs. lower preweaning mortality in a group-farrowing system. The association between sows that had 2 or more piglets die within the first 72 h postfarrowing (high risk) or sows that had 1 or no piglets die within the first 72 h postfarrowing (low risk) with changes in serum hormone concentrations was investigated. Multiparous sows (n = 63; parity 2 to 7) from 4 contemporary breeding groups, each mated within a week, were used. Sows were housed in a group-farrowing system where 8 sows farrowed in individual pens and shared a communal feeding and dunging area in each room. Reproductive performance, including total born, born alive, and stillborn per litter, individual weight of piglets at birth and weaning (at 5 wk postfarrowing), litter size at weaning, preweaning mortality of piglets, and sow BW before farrowing and after weaning, were recorded for all sows. Of these sows, 14 sows from 2 breeding groups were selected randomly for blood sampling through an indwelling ear vein catheter. A blood sample was collected daily from each sow 2 d prefarrowing through 2 d postfarrowing. Serum samples were analyzed for prolactin, oxytocin, cortisol, and urocortin concentrations using RIA. Among the 14 sows, 7 sows lost 2 or more piglets during the first 72 h after farrowing and were classified as high risk sows, and the other 7 sows lost 0 or 1 piglet during the same period and were classified as low risk sows. Catheters in 11 sows (5 high risk sows and 6 low risk sows) remained functional for the entire sampling period. Results indicate that high risk sows farrowed larger litters (live born = 13.8 ± 0.50 vs. 11.3 ± 0.48 piglets; P = 0.03) with lighter piglets (1.4 ± 0.04 vs. 1.7 ± 0.05 kg; P < 0.001) compared with low risk sows. In addition, high risk sows had greater oxytocin concentrations (0.09 vs. 0.07 ng/mL; SE = 0.02, P = 0.01), which might be associated with larger litters farrowed, compared with low risk sows. There were no differences between high risk and low risk sows (P > 0.30) in terms of serum prolactin, cortisol, or urocortin concentrations. These results suggest that litter size and birth weight of piglets played an important role in preweaning mortality of piglets and hormone concentrations in sows were not associated with piglet mortality in the group-farrowing system used.

Molecular characterization of high-level-cholera-toxin-producing El Tor variant Vibrio cholerae strains in the Zanzibar Archipelago of Tanzania.

Analysis of 1,180 diarrheal stool samples in Zanzibar detected 247 Vibrio cholerae O1, Ogawa strains in 2009. Phenotypic traits and PCR-based detection of rstR, rtxC, and tcpA alleles showed that they belonged to the El Tor biotype. Genetic analysis of ctxB of these strains revealed that they were classical type, and production of classical cholera toxin B (CTB) was confirmed by Western blotting. These strains produced more CT than the prototype El Tor and formed a separate cluster by pulsed-field gel electrophoresis (PFGE) analysis.

An investigation of the success of production-based sow removal and replacement in the context of herd performance.

Production-based removal and replacement has been used as a method to improve sow herd performance. Limited data are available as to the reliability of this approach. The purpose of this investigation was to use a retrospective case-control study to assess the success of replacement events when herd productivity was greater or less than the mean for removal events attributed to problems with fertility, fecundity, or old age. For each of 3 herds, 1,000 consecutive sows removed between parities 1 and 6 for reasons of fertility, fecundity, or old age were matched to sows with similar histories that were retained in the herd (controls) and to gilts that were first bred into the herd around the time of the case removal events. Controls and gilts were followed until their next parity or removal event, and the outcome was measured as a standardized calculation of born alive per mated female per year. Herd performance at the time of the case removal events was categorized according to greater or less than the mean for fertility or fecundity on monthly farrowing rates and average piglets born alive per litter. Success of removal/replacement events were evaluated according to removal reason and contemporary herd performance. A model was developed to estimate production and financial implications of changes to productivity-based culling, using a Monte Carlo simulation with a 1,000-iteration run. Born alive per mated female per year from gilts was greater (P = 0.0001) than from controls in 1 of 3 herds when herd fertility was greater than the mean, 1 of 3 herds when herd fertility was less than the mean (P = 0.0065), 3 of 3 herds when herd fecundity was greater than the mean (P < 0.030), and 2 of 3 herds when herd fecundity was less than the mean (P < 0.020). The financial model sensitivity analysis indicated greater likelihood of economic advantage for a scenario without production-based removals in parities 1 to 6.

Impulse oscillometry: an alternative modality to the conventional pulmonary function test to categorise obstructive pulmonary disorders.

Impulse oscillometry (IOS) was introduced as an alternative modality to the conventional pulmonary function test (cPFT) to test lung mechanics. The objective of this study is to assess the use of IOS as an alternative, or in conjunction with cPFT, to categorise an obstructive respiratory disorder as chronic obstructive pulmonary disease (COPD) or asthma. Patients referred to the PFT laboratory, with different diagnoses of obstructive airways disorders, completed a standardised respiratory questionnaire prior to testing. All recruited subjects completed both modalities of PFT. A total of 146 patients were included. The overall mean age was 51+/-18.4 SD. The majority were non-smokers (68.7%). A standardised diagnosis of asthma was found for 51 subjects, while COPD was diagnosed in 36 subjects and 59 subjects were categorised as normal. The sensitivity of IOS in relation to asthma was 31.3% and 19.6% for cPFT. Among cases of COPD, the cPFT had better sensitivity (47.4%) than IOS (38.95%). The specificity was comparable for IOS and cPFT in relation to asthma and COPD. IOS had better sensitivity (45.8%) in detecting normal subjects than cPFT (28.8%), while specificity was comparable (80.5% and 86.2%, respectively). IOS may replace cPFT where the latter cannot be carried out due to feasibility or lack of cooperation. It can, however, discriminate between diseased and non-diseased subjects.

Pig characteristics associated with mortality and light exit weight for the nursery phase.

One thousand and ten weaned pigs that were reared in 1 nursery in Iowa from weaning (17 +/- 2 days ) until 10 weeks of age were evaluated. A weaning weight threshold of 3.6 kg maximized the sensitivity and specificity to correctly predict the likelihood of dying or being light in weight at exit from the nursery (< or = 14.5 kg). Weaning weight < or = 3.6 kg (OR = 2.92), barrow (OR = 1.75), and sow unit (A versus B, OR = 2.14) were significant predictors of mortality in the nursery. Birth weight < or = 1.0 kg (OR = 2.66), weaning weight < or = 3.6 kg (OR = 8.75), gilt (OR = 1.4), sow unit (OR = 2.38), and gilt as nursing sow at weaning (OR = 1.66) were significant predictors of being lightweight at nursery exit. Eighteen per cent of the nursery deaths and almost half of lightweight nursery pigs could be prevented if there were no lightweight pigs at weaning.

Epidemiological, microbiological & electron microscopic study of a cholera outbreak in a Kolkata slum community.

BACKGROUND & OBJECTIVE: Epidemics of cholera caused by Vibrio cholerae O1 or O139 have been reported from different parts of India. Factors such as unsafe water supply, poor environmental sanitation, indiscriminate defaecation and lack of personal hygiene are mainly responsible for continued transmission of this disease. We report here epidemiological and microbiological findings of a localized outbreak of cholera, which occurred during March and April 2004 in the eastern part of Kolkata city. METHODS: The affected slum area has a population of 4409, predominantly muslims. Patients suffering from acute watery diarrhoea attended the health outposts organized by National Institute of Cholera and Enteric Diseases, Kolkata and International Vaccine Institute, South Korea as part of a routine surveillance programme at the locality as well as the emergency medical camp organized by the Kolkata Municipal Corporation. Stool and water samples were collected and tested for diarrhoeagenic pathogens in the laboratory. Bacteriophages specific for V. cholerae were isolates and studied electron microscopically for morphology. RESULTS: A total of 89 diarrhoea cases were reported giving an attack rate of 2 per cent. V. cholerae O1 biotype ElTor, serotype Ogawa was isolated as a sole pathogen from 15 (15.8%) of 89 stool samples screened. Water samples (2 from tube wells, 3 from municipal taps and 1 from well) showed presence of coliform bacilli with high MPN (Most Probable Number) count. Bacteriophages specific to V. cholerae were isolated from 2 of 6 water samples examined. A leakage was detected in the main pipeline supplying drinking water to that area. INTERPRETATION & CONCLUSION: The outbreak was caused by V. cholerae O1 (Ogawa) biotype ElTor. The presence of phages in the water samples was an additional indicator for V. cholerae contamination in this community. Occurrences of such outbreaks support vaccination against cholera as an alternative strategy.

Application of broken-line analysis to assess floor space requirements of nursery and grower-finisher pigs expressed on an allometric basis.

Few issues in swine production are as complex as floor space allowances. One method for pork producers to calculate floor space allowance (A) is to convert BW into a 2-dimensional concept yielding an expression of A = k * BW(0.667). Data on ADG, ADFI, and G:F were obtained from published peer-reviewed studies. Five data sets were created: A = grower-finisher pigs, fully slatted floors, and consistent group size; B = grower-finisher pigs and fully slatted floors (group size did not need to be consistent); C = grower-finisher pigs, partially slatted floors, and consistent group size; D = grower-finisher pigs, partially slatted floors (group size did not need to be consistent); and E = nursery pigs, fully slatted or woven wire floors (group size did not need to be consistent). Each data set was analyzed using a broken-line analysis and a linear regression. For the broken-line analyses, the critical k value, below which a decrease in ADG occurred, varied from 0.0317 to 0.0348. In all cases the effect of space allowance on ADG was significant (P < 0.05). Using the linear analyses based on data with k values of < 0.030, the critical k values for the 4 grower-finisher data sets did not differ from those obtained using the broken-line analysis (0.0358 vs. 0.0336, respectively; P > 0.10); however, none of the linear regressions explained a significant proportion of the variation in ADG. The slopes for the nonplateau portion of the broken-line analyses based on percent values varied among data sets. For every 0.001 decrease in k (approximately 3% of the critical k value), ADG decreased by 0.56 to 1.41%, with an average value of 0.98% for the 5%-based analyses. The use of an allometric approach to express space allowance and broken-line analysis to establish space requirements seem to be useful tools for pig production. The critical k value at which crowding becomes detrimental to the growth of the pig is similar in full- and partial-slat systems and in nursery and grower-finisher stages. The critical point for crowding determined in these analyses approximated current recommendations to ensure the welfare of pigs.

Shigellosis remains an important problem in children less than 5 years of age in Thailand.

This is a review of existing data on the burden of shigellosis in Thailand to determine trends, vulnerable groups, predominant species and serotypes, and antimicrobial resistance patterns. Diarrhoea and dysentery morbidity and mortality data from 1991 to 1999 was collected from the routine surveillance system and demographic data from the government census. International and local literature published between 1988 and 2000 was systematically reviewed. Based on the routine surveillance system, the annual incidence of bacillary dysentery decreased from 1.3 to 0.2/10,000 persons per year. The remaining burden is highest in children <5 years of age at 2.7/10,000 persons per year. In comparison, a prospective study utilizing active surveillance found an incidence in children <5 years of age that was more than 100-fold higher at 640/10,000 persons per year. Despite the decrease in morbidity and mortality based on routinely collected data, shigellosis remains an important problem in children <5 years of age in Thailand.

The burden of cholera in the slums of Kolkata, India: data from a prospective, community based study.

AIMS: To conduct a prospective, community based study in an impoverished urban site in Kolkata (formerly Calcutta) in order to measure the burden of cholera, describe its epidemiology, and search for potential risk factors that could be addressed by public health strategies. METHODS: The study population was enumerated at the beginning and end of the study period. Surveillance through five field outposts and two referral hospitals for acute, watery, non-bloody diarrhoea was conducted from 1 May 2003 to 30 April 2004. Data and a stool sample for culture of Vibrio cholerae were collected from each patient. Treatment was provided in accordance with national guidelines. RESULTS: From 62 329 individuals under surveillance, 3284 diarrhoea episodes were detected, of which 3276 (99%) had a stool sample collected and 126 (4%) were culture confirmed cholera. Nineteen (15%) were children less than 2 years of age, 29 (23%) had severe dehydration, and 48 (38%) were hospitalised. Risk factors for cholera included a household member with cholera during the period of surveillance, young age, and lower educational level. CONCLUSIONS: There was a substantial burden of cholera in Kolkata with risk factors not easily amenable to intervention. Young children bear the brunt not only of diarrhoeal diseases in general, but of cholera as well. Mass vaccination could be a potentially useful tool to prevent and control seasonal cholera in this community.

Laboratory model to evaluate the role of aerosols in the transport of porcine reproductive and respiratory syndrome virus.

The aim of this study was to develop a model to evaluate the aerosol transmission of porcine reproductive and respiratory disease virus (PRRSV). PRRSV (MN 30-100 strain, total dose 3 x 10(6) virus particles) was aerosolised and transported up to 150 m and a portable air sampler was used to collect air samples at 1, 30, 60, 90, 120 and 150 m (five replicates at each distance) and the air samples were tested by TaqMan PCR and virus isolation. The infectivity of the aerosolised PRRSV was tested by exposing six PRRSV-naive pigs for three hours to aerosolised virus that had been transported 150 m. PRRSV RNA was detected in all five replicate air samples collected at 1, 30, 60 and 90 m, in four of the five collected at 120 m, and in three of the five collected at 150 m. Infectious PRRSV was detected by virus isolation at 1 and 30 m (all five replicates), 60, 90 and 120 m (three of the five) and 150 m (two of the five). There was a 50 per cent reduction in the log concentration of PRRSV RNA every 33 m. Three of the six pigs exposed to PRRSV-positive aerosols became infected, and PRRSV RNA was detected in air samples and on swab samples collected from the interior of the chambers that housed the infected pigs while they were being exposed.

Mixed models applied to the study of variation of grower-finisher mortality and culling rates of a large swine production system.

Large scale production systems for swine are frequently organized in a hierarchical structure. Consequently, important production parameters, such as mortality and culling, can be analyzed at different levels. The major aims of this study were to assess variance components (VC) of mortality and culling rates attributed to sites and to barns within a site, and subsequently to investigate the impact of average entry weight, days on feed (length of the production turn), and season on the magnitude of the VC. Then, data from a large farm with 3 sites were collected during 5 y. In total, 1720040 pigs distributed in 1502 all-in/all-out grower-finisher groups were included. Linear mixed models were fitted for mortality and culling rates. The barn was modeled as the residual component (barn-to-barn variations) with production turn and site nested within production turn as random intercept variance components. Barn-to-barn pig group variation was the largest VC for mortality (63.08%), when no predictors were included in the models. Predictors, such as pigs placed on quarters 2 and 3, low average entry weight, and shorter production turn length, were associated together with higher mortality. The explained proportion of variance due to these predictors was about 12.05% and the VC for barn, site, and production turn were 67.6%, 17.6%, and 14.8%, respectively. Barn-to-barn variation was also the largest VC for culling rate (46.2%), but the same predictor mentioned above explained only about 1.4% of the variation. The VC for barn, site, and production turn were 46.8%, 21.3%, and 31.8%, respectively. Since the variability among barns far exceeded the variability among sites, the barn should be used as experimental unit in studies with grower-finisher mortality, culling rate, or both, as outcome variables.

Vaccines against cholera, typhoid fever and shigellosis for developing countries.

Enteric diseases, such as cholera, typhoid fever and shigellosis, still produce a significant burden, especially among the poor in countries where these illnesses are endemic. Older-generation, parenteral, whole-cell vaccines against cholera and typhoid fever were abandoned in many countries as public health tools because of problems with insufficient protection and/or inadequate safety profiles. Modern-generation licensed vaccines are available for cholera and typhoid fever, but are not widely used by those in greatest need. A number of experimental candidates exist for all three diseases. Future research should focus on generating the evidence necessary to obtain a consensus on the deployment of existing vaccines against cholera and typhoid fever, and on clinical evaluation of pipeline vaccine candidates against all three diseases.

Risk factors for mortality in grow-finishing pigs in Belgium.

The present study investigated risk factors for mortality in grow-finishing pigs of 137 pig herds belonging to one integration company during a period of 2.5 years. Mortality data, expressed as the number of dead pigs divided by the number of pigs placed in the fattening unit were investigated retrospectively. The following potential risk factors were evaluated: type of pig herd, season and year of placement in the fattening unit, pig density in the municipality, management practices (density of the pigs in the barn, origin of the pigs), housing conditions and feeding practices. The overall average mortality percentage was 4.70%. Three variables in a multivariable regression model were significantly associated with mortality: season of placement in the fattening unit, origin of the piglets and duration of the fattening period. Pigs placed in October, November and December, were at higher risk than pigs placed in other months. Herds that purchased pigs from a merchant, used pigs from other herds with an excess of piglets for filling their fattening units or herds that purchased pigs from more than five origin herds also suffered higher mortality. The mortality also increased in case of longer duration of the fattening period. This study documented for the first time that in addition to seasonal effects and a longer duration of the fattening period, purchasing feeder pigs from one or a limited number of herds is of crucial importance to achieve low mortality in the grow-finishing pigs.

Evolution in the recommendations for oral rehydration therapy according to World Health Organisation guidelines: where to go from here?

Guidelines on the use of oral rehydration salts (ORS) have been revised over the years based on evidence from research studies and clinical experience. This paper charts the evolution in oral rehydration therapy (ORT) in the context of World Health Organisation (WHO) recommendations. Diarrhoeal disease case management, with ORT as its cornerstone, has had tremendous success in terms of implementation and outcome. To further decrease global diarrhoeal morbidity and mortality, there should be increased efforts to accelerate the introduction of safe, effective, and affordable against diarrhoeal pathogens such as cholera and rotavirus.

An extended field test of the WHO severe malnutrition guidelines in hospitals in developing countries: preliminary observations.

The WHO has published guidelines for the inpatient management of severe malnutrition. A qualitative study in hospitals in developing countries is being conducted to document the re-organisation of the clinical ward and support services required to implement these guidelines and to gain an impression of the feasibility and sustainability of such a re-organisation. Following a postal survey of experts in the management of malnutrition in children in developing countries, hospitals were contacted and asked if they were interested to participate in the study. If so, they were requested to submit background information about admission patterns, the frequency of malnutrition, and current practice. Based on this information, hospitals are selected for a preliminary visit. Following this, and the final selection, a paediatrician conducts three visits to the study hospital over a one-year period to appraise the current practice, assist the health staff in recognising the strengths and shortcomings of their current management, help them find locally appropriate solutions, support the implementation process through a participatory approach and assess the outcome. A structured survey instrument is used to guide the assessment and identification of problems. Results of the first visit, which documents the existing situation, and changes identified by staff and implemented during the second visit are presented.

Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia.

Malaria and malnutrition cause high morbidity and mortality in rural sub-Saharan Africa. To explore the relationship between nutritional status and malaria, a cohort of Gambian children under 5 years of age was followed weekly during one malaria season. Anthropometric measurements were made at the beginning and at the end of the season. A total of 55/107 (51.4 per cent) children with baseline stunting, defined as having a height-for-age z-score below -2 standard deviations, subsequently experienced malaria episodes, compared to 145/380 (38.2 per cent) children who were not stunted (RR = 1.35; 95 per cent CI, 1.08-1.69; p value = 0.01). Neither wasting (weight-for-height z-score below -2 standard deviations) nor undernutrition (weight-for-age z-score below -2 standard deviations) influenced susceptibility to malaria. Adjustment for characteristics of age, sex, and ethnicity did not significantly change the risk ratios. Malaria had no effect on the nutritional status from the beginning to the end of the malaria season. Our findings suggest that chronically malnourished children may be at higher risk for developing malaria episodes.