Effect of synbiotics on thyroid hormones, intestinal histomorphology, and heat shock protein 70 expression in broiler chickens reared under cyclic heat stress.

This study examined effect of a dietary synbiotic supplement on the concentrations of plasma thyroid hormones, expressions of heat shock protein 70 (HSP70), and intestinal histomorphology in broiler chickens exposed to cyclic heat stress (HS). Three hundred and sixty day old male Ross 708 broiler chicks were randomly distributed among 3 dietary treatments containing a synbiotic (PoultryStar meUS) at 0 (control), 0.5 (0.5×), and 1.0 (1.0×) g/kg. Each treatment contained 8 replicates of 15 birds each housed in floor pens in a temperature and lighting controlled room. Heat stimulation was established from days 15 to 42 at 32°C for 9 h daily. The results indicated that under the HS condition, both synbiotic fed groups had lower liver and hypothalamus HSP70 levels (P < 0.001) compared to control group; however, HSP70 mRNA expression was not different among treatments (P > 0.05). There were no treatment effects on the levels of triiodothyronine (T3) and thyroxine (T4) as well as T3/T4 ratio (P > 0.05). Compared to controls, 1.0× HS broilers had greater villus height in the duodenum (P < 0.01), and greater villus height and villus height:crypt depth ratios in the ileum (P < 0.01). There were no differences among treatments on the measured intestinal parameters in the jejunum (P > 0.05). The results suggest that the synbiotic may ameliorate the negative effects of HS on chicken health as indicated by the changes in the intestinal architecture and the levels of HSP70. Dietary synbiotic supplement could be a feasible nutritive strategy for the poultry industry to improve the health and welfare of chickens when exposed to hot environmental temperature.

Effect of a synbiotic supplement on cecal microbial ecology, antioxidant status, and immune response of broiler chickens reared under heat stress.

The aim of this study was to examine the effect of a dietary synbiotic supplement on the cecal microflora, antioxidant status, and immune response of broiler chickens under heat stress (HS). A total of 360 one-day-old male Ross 708 broiler chicks were randomly distributed among 3 dietary treatments containing a synbiotic (PoultryStar consists of Bifidobacterium animalis, Enterococcus faecium, Lactobacillus reuteri, Pediococcus acidilactici, and fructooligosaccharides) at 0 (control), 0.5 (0.5X), and 1.0 (1.0X) g/kg. Each treatment contained 8 replicates of 15 birds each housed in floor pens. Heat stimulation was at 32°C for 9 h daily from day 15 to 42. Heat stress-induced changes of cecal bacteria were detected using bacteria-specific agars, and spleen protein concentration and mRNA expression of interleukins and antioxidants were examined using ELISA and real-time PCR, respectively. Under the HS condition, synbiotic fed broilers regardless of dose had lower cecal enumerations of Escherichia coli and coliforms, and a lower heterophil/lymphocyte (H/L) ratio (P < 0.05) compared to controls. 1.0X group also had higher cecal enumerations of Bifidobacterium spp. and Lactobacillus spp., spleen glutathione peroxidase (GPx), and plasma nuclear factor erythroid 2-related factor 2 (Nrf-2), and a lower H/L ratio compared to both control and 0.5X groups (P < 0.05). However, there were no treatment effects on the levels of Enterococcus spp., the circulating monocytes, eosinophils, and basophils, Toll like receptor-4 (TLR-4), interleukin-6 (IL-6), interlukin-10 (IL-10), and their mRNA expression, as well as plasma Kelch-like ECH-associated protein 1 (Keap-1) (P > 0.05). These results suggest that the synbiotic could inhibit the negative effects of HS on broiler health through the reduction of cecal pathogens, regulation of stress reactions, and improvement of antioxidant status.

Effect of dietary synbiotic supplement on behavioral patterns and growth performance of broiler chickens reared under heat stress.

This study examined the effects of a dietary synbiotic supplement on the behavioral patterns and growth performance of broiler chickens exposed to heat stress (HS). Three hundred sixty 1-day-old male Ross 708 broiler chicks were distributed among 24 floor pens (15 chicks per pen); each pen was randomly assigned to one of 3 dietary treatments containing a synbiotic at 0 (control), 0.5 (0.5X) and 1.0 (1.0X) g/kg. From d 15 to 42, birds were exposed to HS at 32°C daily from 08:00 to 17:00. Five broiler chickens were randomly marked in each pen for behavioral observation. Instantaneous scan sampling was used to record the birds' behavioral patterns. Performance parameters were measured on d 7, 14, 28 and 42. The synbiotic fed birds exhibited more standing, sitting, walking, feeding, preening and less wing spreading and panting behaviors (P < 0.05) compared to birds fed the control diet. The synbiotic group also had higher BW, BW gain and feed intake on d 7, 14 and 42 (P < 0.05), and higher BW, feed intake and feed conversion ratio at d 28 (P < 0.01). There were no treatment effects on drinking behavior, BW gain on d 28 and feed conversion ratio on d 42 (P > 0.05). There were few dose-related differences of the synbiotic on production performance; namely, the 1.0X concentration resulted in the highest BW and feed intake on d 14 and 42 (P < 0.05), while BW gain was higher compared to the control group only on d 42 (P < 0.05). The results suggest that the synbiotic supplement may prove to be an important management tool for the broiler industry to diminish the negative effects of HS, potentially safeguarding the welfare and production of broiler chickens, particularly in areas that experience hot climates.

Prevalence and distribution of beta-lactamase coding genes in third-generation cephalosporin-resistant Enterobacteriaceae from bloodstream infections in Cambodia.

Resistance to third-generation cephalosporins in Gram-negative bacteria is emerging in Asia. We report the prevalence and distribution of extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase and carbapenemase-coding genes in cefotaxime-resistant Enterobacteriaceae isolates from bloodstream infections (BSI) in Cambodia. All Enterobacteriaceae isolated from BSI in adult patients at Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia (2007-2010) were assessed. Antimicrobial susceptibility testing was carried out by disc diffusion and MicroScan according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Screening for ESBL, plasmidic AmpC and carbapenemase-coding genes was performed by multiplex polymerase chain reaction (PCR) sequencing assays. Identification of the ST131 clone was performed in all CTX-M-positive Escherichia coli, using PCR targeting the papB gene. Out of 183 Enterobacteriaceae, 91 (49.7 %) isolates (84 BSI episodes) were cefotaxime-resistant: E. coli (n = 68), Klebsiella pneumoniae (n = 17) and Enterobacter spp. (n = 6). Most episodes were community-acquired (66/84; 78.3 %). ESBLs were present in 89/91 (97.8 %) cefotaxime-resistant isolates: 86 (96.6 %) were CTX-M, mainly CTX-M-15 (n = 41) and CTX-M-14 (n = 21). CTX-M of group 1 were frequently associated with TEM and/or OXA-1/30 coding genes and with phenotypic combined resistance to ciprofloxacin, sulphamethoxazole-trimethoprim and gentamicin (39/50, 78.0 %). Plasmidic AmpC (CMY-2 and DHA-1 types) were found alone (n = 2) or in combination with ESBL (n = 4). Eighteen E. coli isolates were identified as B2-ST131-O25B: 11 (61.1 %) carried CTX-M-14. No carbapenemase-coding genes were detected. ESBL among Enterobacteriaceae from BSI in Cambodia is common, mainly associated with CTX-M-15 and CTX-M-14. These findings warrant urgent action for the containment of antibiotic resistance in Cambodia.

Invited review: The impact of automatic milking systems on dairy cow management, behavior, health, and welfare.

Over the last 100 yr, the dairy industry has incorporated technology to maximize yield and profit. Pressure to maximize efficiency and lower inputs has resulted in novel approaches to managing and milking dairy herds, including implementation of automatic milking systems (AMS) to reduce labor associated with milking. Although AMS have been used for almost 20 yr in Europe, they have only recently become more popular in North America. Automatic milking systems have the potential to increase milk production by up to 12%, decrease labor by as much as 18%, and simultaneously improve dairy cow welfare by allowing cows to choose when to be milked. However, producers using AMS may not fully realize these anticipated benefits for a variety of reasons. For example, producers may not see a reduction in labor because some cows do not milk voluntarily or because they have not fully or efficiently incorporated the AMS into their management routines. Following the introduction of AMS on the market in the 1990s, research has been conducted examining AMS systems versus conventional parlors focusing primarily on cow health, milk yield, and milk quality, as well as on some of the economic and social factors related to AMS adoption. Additionally, because AMS rely on cows milking themselves voluntarily, research has also been conducted on the behavior of cows in AMS facilities, with particular attention paid to cow traffic around AMS, cow use of AMS, and cows' motivation to enter the milking stall. However, the sometimes contradictory findings resulting from different studies on the same aspect of AMS suggest that differences in management and farm-level variables may be more important to AMS efficiency and milk production than features of the milking system itself. Furthermore, some of the recommendations that have been made regarding AMS facility design and management should be scientifically tested to demonstrate their validity, as not all may work as intended. As updated AMS designs, such as the automatic rotary milking parlor, continue to be introduced to the dairy industry, research must continue to be conducted on AMS to understand the causes and consequences of differences between milking systems as well as the impacts of the different facilities and management systems that surround them on dairy cow behavior, health, and welfare.

Dairy cow behavior affects the availability of an automatic milking system.

Facility design can affect the accessibility of an automatic milking system (AMS). In particular, gates and alleys positioned around the AMS may affect cow traffic and cow behavior, potentially affecting the duration of time the AMS is available for milking. Eighty-four Holstein cows of various parities and days in milk were randomly divided between 2 groups, each group having access to its own AMS. Cow locations and behaviors in the AMS entrance and exit areas, as well as in the adjacent holding area, were recorded continuously for 14 d. Cows receiving a "no-milking" decision (i.e., cow is rejected from the milking stall due to a recent milking event) took longer to exit the milking stall (18.2±1.33 s), and were more likely to circle and re-enter the AMS (0.8±0.15) compared with cows receiving a milking decision (16.2±1.09 s; 0.2±0.03). Cows exiting the AMS hesitated for long periods when another cow was near the exit gate (192.93±1.11 s) or in the general holding area (101.04±1.07 s). Cows in late lactation had a greater probability of hesitating in the exit alley for long periods (0.55±0.09) compared with cows in early lactation (0.15±0.07), regardless of whether cows were in the holding area. Primiparous cows were more likely to block other cows trying to exit (0.60±0.13) compared with multiparous cows (0.29±0.09). Occasionally, blocking events led to "back-up" events, in which the AMS became unavailable for new cow access due to a back up of cows through the exit alley into the milking stall. The AMS was empty (not occupied) for 10 and 18% (groups 1 and 2, respectively) of the day; therefore, it was possible that back-up events would simply reduce the amount of time the AMS was empty. The duration of back-up events and AMS empty events had a negative relationship in group 1 (r=-0.74), but no such relationship was observed in group 2. The differences in time budgets between the 2 groups suggest that the effect of back-up events on AMS availability may be dependent on group social dynamics.

Lactating dairy cows adapt quickly to being milked by an automatic milking system.

Transitioning a dairy herd to an automatic milking system (AMS) from a conventional parlor system may be stressful for the cow, as many changes occur during this process. Chronic stress may affect the welfare of the cow, and acute stress during milking can decrease milk yield. Therefore, it is important to quantify if and how long stress during adaptation to an AMS might persist. Seventy-seven cows with acceptable udder and teat conformation that would not interfere with adaptation to the AMS and that were lactating n = 18, early [0 to 100 d in milk (DIM)]; n = 27, mid (100 to 200 DIM); and n = 32, late (200+ DIM) for the full duration of the project were chosen for observation. All cows had been milked previously in a double-6 herringbone milking parlor. Four stress-related behaviors [step-kick behavior both before and after attachment of teat cups, elimination (urination and defecation instances), and vocalization] were recorded during milking by trained observers, whereas milk yield was automatically recorded by the AMS. Data were collected for 24-h periods beginning on the day the cows transitioned to milking in the AMS (d 0), and on d 1, 2, 4, 8, 16, and 32 thereafter. Instances of elimination and vocalization were greater on d 0 compared with all other days (elimination: d 0 = 3.1 ± 0.09, d 1 = 0.6 ± 0.07, and 0 ± 0 instances thereafter; vocalization: d 0 = 1.7 ± 0.07, d 1 = 0.05 ± 0.04, and 0 ± 0 instances thereafter). Milk yield increased between d 0 (18.3 ± 1.7 kg) and d 1 (30.9 ± 1.7 kg). Primiparous cows (n=28) were more likely than multiparous cows (n = 49) to display step-kick behaviors both before (8.3 ± 2.5; 5.5 ± 0.6, respectively) and after (15.6 ± 2.4; 13.3 ± 1.3, respectively) teat cup attachment during milking. Eight days after introducing the cows to the AMS, over 60% of the herd was milking voluntarily and 95% of the herd was milking voluntarily within a month, which suggests that cows did not find the AMS aversive. Greater elimination and vocalization behavior and lower milk yield on d 0 relative to subsequent days indicated initial stress and discomfort with the milking process in the new system; however, the cows appeared to adapt within 24h.

Inappropriate drug donations: what has happened since the 1999 WHO guidelines?

CONTEXT: Drug donations to developing countries may be part of medical relief operations in acute emergencies, development aid in non-emergency situations, or a corporate donations programme. After a number of documented inappropriate drug donations, the World Health Organization developed the 'Guidelines for Drug Donations', with the second and final version published in 1999. OBJECTIVES: We reviewed the medical literature on drug donations since the Guidelines publication in 1999. DESIGN: Literature was retrieved from PubMed and other on-line databases as well as from relevant websites providing medical literature for use in developing countries. We considered the following donations to be inappropriate: (i) essential drugs in excessive quantities; (ii) mixed unused drugs (unsorted medicines and free samples); and (iii) drug dumping (large quantities of useless medicines). RESULTS: We retrieved 25 publications dated after 1999, including 20 and 5 from the scientific literature and 'grey' literature (technical reports, working papers), respectively. New information concerned emergencies in East Timor, Mozambique, El Salvador, Gujarat State (India), Aceh (Indonesia) and Sri Lanka. Except for East Timor and Gujarat, inappropriate donations still occurred, accounting for 85%, 37%, 70% and 80% of donations in Mozambique, El Salvador, Aceh and Sri Lanka, respectively. Very little information was found on drug donations in non-emergency situations. CONCLUSION: There are few recent reports on the compliance of drug donations with the World Health Organization guidelines. For emergency situations, there is still room for improvement. Drug donations in non-emergency situations need to be evaluated. A reform of drug donations policy is needed.

Successful treatment of Staphylococcus epidermidis prosthetic valve endocarditis with linezolid after failure of treatment with oxacillin, gentamicin, rifampicin, vancomycin, and fusidic acid regimens.

We present a 49-y-old male, with a history of Marfan's disease and aortic and mitral valve replacement surgery, who was operated for a type III thoracoabdominal aneurysm. The postoperative course was compromised by a Staphylococcus epidermidis mitral valve endocarditis, which was successfully treated only after intravenous linezolid was included in the therapy.

[Antibiotic prophylaxis in cases of closed fractures and prostheses]. / Antibiotikaprophylaxe bei geschlossenen Frakturen und Prothesen.

Antibiotic prophylaxis can be administered systemically or locally when bone cement is used for the implantation of prosthesis. In closed fracture surgery parenteral broad spectrum antibiotics are advised with 1 dose (in case of a long halflife) or for at least 12 hours when an antibiotic with a shorter half life is used. With such a prophylaxis a reduction of the infection rate to about 3% can be achieved, and also an important reduction of the postoperative nosocomial infections. Such a prophylaxis is highly cost effective. In primary prosthesis implantation, a 24 hours prophylaxis is needed. The use of antibiotic loaded bone cement, used as prophylaxis in primary prostheses is effective too, and this kind of cement should be used in combination with systemic antibiotics. In prosthesis an infection rate of 0.2% should be achieved.

Tinea incognito due to Trichophytom rubrum after local steroid therapy.

The term "tinea incognito" refers to dermatophyte infections with clinical presentations that have been modified by the administration of corticosteroids. We describe a patient who had pustular inflammatory skin lesions due to Trichophyton rubrum after receiving treatment with potent topical corticosteroid creams.

Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release.

Recently we developed a validated computer program based on polychotomous logistic regression analysis using bronchoalveolar avage fluid (BALF) results to distinguish between the three most common interstitial lung diseases (ILD): sarcoidosis, idiopathic pulmonary fibrosis (IPF) and extrinsic allergic alveolitis (EAA) or drug-induced pneumonitis. One of the limitations of this program was that it was not useful in discriminating between infectious disorders and non-infectious disorders. Therefore, we added BALF samples obtained from patients with a confirmed bacterial pulmonary infection based on culture results > or = 10(4) cfum l(-1) (group I: n=31) to the study population mentioned above (group II: n=272). Notably, just one variable, i.e. the percentage of polymorphonuclear neutrophils, allowed us to distinguish between infectious and non-infectious disorders. The agreement of predicted with the actual diagnostic group membership was 99.67% (groups I and II). Additionally, 91.2% of the cases with ILD were correctly classified. In conclusion, this updated Windows version 2000 of the validated computer program provides a very reliable prediction of the correct diagnosis for an arbitrary patient with suspected pneumonia or with ILD given information obtained from BALF analysis results, and is thought to improve the diagnostic power of BALF analysis.

Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.

Although many investigations on the bacteriology of chronic sinusitis have been reported, there is still much discussion about the physiological flora of the nose and paranasal sinuses, the role of the various aerobic and anaerobic "pathogenic" bacteria, and the influence of the anatomical location from which samples for bacteriology are taken. We conducted a qualitative and semi-quantitative bacteriological examination of patients with chronic sinusitis undergoing a transnasal sinus operation (patient group), and of patients without chronic sinusitis undergoing a septoplasty (control group). In both groups brush smears of the inferior nasal turbinate and biopsies of the middle nasal turbinate were taken, with additional biopsies of the maxillary sinus and ethmoidal bulla in the chronic sinusitis group. In both groups coagulase-negative staphylococci were identified in almost all samples. Staphylococcus aureus was found in 22% (middle turbinate) to 33% (inferior turbinate) of the samples from the control group and in 33% (maxillary sinus, middle turbinate) to 50% (inferior turbinate) of the samples from the patient group. Other (pathogenic) aerobic bacteria were found much more rarely and only slight distinctions between control and patient group were observed. The concentrations of the different bacterial species (colony-forming units) were comparable in both groups. Strictly anaerobic bacteria and fungi were not identified. Only small discrepancies between the various methods and/or locations of sampling were found. Based on our bacteriological findings a differentiation between patients with and without chronic sinusitis was not possible. These results shed doubt on the clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.

Prevalence of macrolide resistance genes in clinical isolates of the Streptococcus anginosus ("S. milleri") group.

Twenty-two unrelated erythromycin-resistant anginosus group strains (3.2% resistance rate) were assessed for mechanisms of resistance. Streptococcus anginosus accounted for 16 of the 22 isolates. Fifteen isolates harbored the erm(B) gene. The erm(TR) and the mef(E) genes were carried by two isolates each. In three isolates, none of these resistance genes was detected by PCR.

Bronchoalveolar lavage fluid cytology in patients with Pneumocystis carinii pneumonia.

OBJECTIVE: To evaluate bronchoalveolar lavage (BAL) cytology and organism burden in patients with Pneumocystis carinii pneumonia (PCP) who were infected with the human immunodeficiency virus (HIV) and in those with other immunodeficiencies. STUDY DESIGN: BAL fluid samples from patients with PCP were selected (HIV-infected patients, n = 15; patients with other immunodeficiencies, n = 11). May-Grünwald-Giemsa-stained cytocentrifuge preparations were evaluated. Foamy alveolar casts (FACs) and P carinii clusters were counted. RESULTS: The numbers of FACs and P carinii clusters in BAL fluid samples of HIV-infected patients were significantly higher as compared to those in samples from patients with other immunodeficiencies. Striking cytologic findings observed in half the samples from both patient groups included the presence of foamy alveolar macrophages, activated lymphocytes, plasma cells and reactive type II pneumocytes. Furthermore, a peculiar cell type, "nonidentified cell" (NIC), was observed almost exclusively in BAL fluid samples from HIV-infected patients. CONCLUSION: BAL fluid samples from HIV-infected patients with PCP displayed higher organism burdens as compared to those from patients with other immunodeficiencies. Moreover, cytologic findings suggestive of noninfectious lung conditions were common in BAL fluid samples obtained from patients with PCP. Further study is required to elucidate the identity of the NIC cell type.

Cytocentrifugation conditions affecting the differential cell count in bronchoalveolar lavage fluid.

OBJECTIVE: To investigate variations in speed, duration and acceleration rate of the Cytospin 3 cytocentrifuge (Shandon Scientific Ltd., Astmoor, England) on the differential cell count of bronchoalveolar lavage (BAL) fluid samples. STUDY DESIGN: BAL fluid samples (n = 51) were cytocentrifuged at various combinations of speed (500, 1,200 and 2,000 rpm), acceleration rate (low, medium and high) and duration (5, 10, 15 and 20 minutes). The preparations were May-Grünwald-Giemsa stained and differentiated on 500 cells. Data were analyzed by mixed model repeated measurements ANOVA. RESULTS: The mean lymphocyte count was significantly higher at 1,200 rpm than at 500 rpm, whereas the macrophage count decreased. Between 1,200 and 2,000 rpm, the number of both cell types stabilized. Significantly higher numbers of lymphocytes were recorded at 10 and 15 minutes of cytocentrifugation than at 5 minutes. The acceleration rate did not influence the differential cell count. Seventeen BAL fluid samples were selected to test the diagnostic impact of cell damage using a validated computer program. In 1 of 17 samples the predicted diagnosis did not correspond between two different speeds (500 and 2,000 rpm). CONCLUSION: Variations in cytocentrifugation speed and duration affected the mean lymphocyte and macrophage counts of BAL fluid samples.

Correlation of leukocyte esterase detection by reagent strips and the presence of neutrophils: a study in BAL fluid.

STUDY OBJECTIVE: In the present study, we evaluated the leukocyte esterase (LE) area of a reagent strip designed for urinalysis for the semiquantitative measurement of the percentage of polymorphonuclear neutrophils (PMNs) in BAL fluid. DESIGN: Prospective. The relative PMN counts (obtained by conventional microscopy and expressed as a percentage of a 500 cell count) of consecutive BAL fluid samples were compared with the corresponding LE categories as read with a urine chemistry reader. LE categories were graded as follows: negative, trace, +, + +, and + + +. RESULTS: A total of 153 BAL fluid samples were included. The mean PMN counts of the negative LE category (4.1 +/- 4.3%; n = 43) and the + + + category (81.8 +/- 16.3%; n = 37) differed significantly from each other and from the mean PMN counts of the other categories. Within the trace, +, and + + categories, a considerable overlap of PMN counts was noted. Assignment of a BAL fluid to the negative LE category consistently predicted a PMN count < 20%. At a threshold value of 50% PMNs, the + + + LE category predicted the BAL fluid samples to the correct group (PMNs > 50% vs < 50%) with a sensitivity of 70.8% and a specificity of 97.1%. CONCLUSIONS: The reagent strips proved to be useful as a rapid test for semiquantitative measurement of the relative PMN counts in BAL fluid. However, the low predictive value for the exclusion of a high PMN count may limit their application.