Chronological echocardiographic evaluation of left ventricular systolic and diastolic function in term and premature neonatal calves.

Echocardiographic studies in human neonatology has demonstrated that prematurity can lead to cardiovascular dysfunction and especially compromises the left ventricular (LV) systolic and diastolic functions. As echocardiographic studies have not been performed on cardiovascular dysfunction in premature calves, we echocardiographically evaluated and compared the LV systolic and diastolic function in full-term and premature calves. We followed the hemodynamical changes of LV during first 3 days of life. Twenty premature calves and 10 healthy term calves were enrolled in the study. 2D, M-mode and Doppler echocardiographic examinations were performed at days 1, 2 and 3 after birth to evaluate LV systolic and diastolic functions. Our findings demonstrated that not only was there LV diastolic dysfunction (55% premature calves, 10% term calf at day 1; 65% premature calves, 10% term calf at day 2 and, 75% premature calves, 20% term calf at day 3), but also LV systolic dysfunction (55% premature calves, 60% term calf at day 1; 55% premature calves, 50% term calf at day 2, and 45% premature calves, 40% term calf at day 3) deteriorated in both term and premature calves. In conclusion, the present study, which was the first comparative echocardiographic assessment of LV systolic and diastolic functions in term and premature newborn calves, showed that both systolic and diastolic dysfunctions might occur in term and premature calves.

Effect of combinations of intravenous small-volume hypertonic sodium chloride, acetate Ringer, sodium bicarbonate, and lactate Ringer solutions along with oral fluid on the treatment of calf diarrhea.

The aim of this study was to compare effect of combinations of intravenous isotonic sodium bicarbonate (NaHCO3), acetate Ringer, lactate Ringer and small-volume hypertonic sodium chloride (NaCI) solutions along with oral electrolyte solutions (OES) on the treatment of neonatal calf diarrhea with moderate dehydration and metabolic acidosis. Thirty-two calves with diarrhea were used in the study. Calves were randomly assigned to receive acetate Ringer solution (n=8), lactate Ringer solution (n=8), isotonic NaHCO3 (n=8) and 7.2% saline solutions (n=8), and two liters of OES were administrated to all calves orally at the end of intravenous administration. Blood samples for blood gas and biochemical analyses were collected at 0 hours and at 0.5, 1, 2, 4, 6 and 24 hours intervals. All the calves had mild to moderate metabolic acidosis on admission. Increased plasma volume and sodium concentration, but decreased serum total protein were observed within 0.5 hours following administration of hypertonic 7.2% NaCI + OES, compared to other 3 groups. In conclusion, administration of intravenous hypertonic 7.2% NaCI solution in small volume along with OES provided fast and effective improvement of dehydration and acid-base abnormalities within short time in treatment of calf diarrhea with moderate dehydration and metabolic acidosis.

Groundwater Quality beneath an Asian Megacity on a Delta: Kolkata's (Calcutta's) Disappearing Arsenic and Present Manganese.

Kolkata, the capital city of West Bengal, exploits groundwater for public water-supply. The groundwater has been reported to be widely polluted by arsenic (As). Analysis for As in 280 groundwaters from across Kolkata, failed to detect As concentrations >10 µg/L from natural processes. Arsenic concentrations between 10 and 79 µg/L found in 14 of the 280 groundwaters are remnant from a pollution-plume emanating from a single factory site where Paris Green, an arsenical pesticide, was manufactured between 1965 and 1985. In 45% of groundwaters sampled, concentrations of Mn exceed 0.4 mg/L, a putative health guideline value for drinking water. Sporadic minor hazards are posed by Pb > 10 µg/L introduced into groundwater from well-fittings, from 4% of groundwaters with F concentrations between 0.75 and 1 mg/L, and the 14% of groundwaters containing more than 500 mg/L Na, concentrations that might contribute to excessive daily intake of Na. Compounding hazards from As, F, Mn, Na, and Pb, shows that 64% of public wells and 40% of municipal wells supply groundwater of suspect quality. Groundwaters comply with WHO Guideline Values for drinking water in terms of Cr, Cu, Co, NO2, NO3, Sb, Se, and U. Aesthetic guideline values for Fe, Mn, SO4, and Cl are exceeded for many groundwaters.

Venous lactate, pH and partial pressure of carbon dioxide levels as prognostic indicators in 110 premature calves with respiratory distress syndrome.

Hyperlactatemia, hypercapnia, low pH and low oxygen saturation (SatO2) are commonly observed in premature calves. These clinical indicators are associated with increased mortality in preterm human newborns with respiratory distress syndrome (RDS). The aim of this study was to investigate the prognostic importance of venous pH, partial pressure of carbon dioxide (pCO2) and lactate level and which parameters are related with mortality in premature calves with RDS. All premature calves (52 male/58 female) were admitted to clinic within 12-24 hours after birth and blood samples were also taken into heparinised plastic syringes from the jugular vein within 30 minutes following admission. Diagnosis of RDS was made by both clinical signs and blood gas results. For the evaluation of independent samples, t test was used to compare the venous blood gas indicators of surviving and non-surviving premature calves. Receiver operating characteristics curves were used to determine a cut-off value in terms of lactate and pCO2 measurements among non-surviving and surviving calves. Venous pH, pCO2, SatO2, base deficit, bicarbonate (HCO3) and lactate levels showed a significant variance between surviving and non-surviving calves. Mean venous pH, pCO2, SatO2, lactate levels in non-surviving premature calves was 7.05, 78.9 mm Hg, 16.1 per cent and 9.50 mmol/l, respectively. Mean pH, pCO2, SatO2 and lactate levels in surviving premature calves were 7.29, 56.3 mm Hg, 25.5 per cent and 5.1 mmol/l, respectively. The cut-off values for lactate and pCO2 were 7.5 mmol/l and 63.5 mm Hg, respectively. In conclusion, the results of the study show that venous blood lactate and pCO2 have prognostic importance in premature calves with RDS.

Inhalational Ciclesonide found beneficial in prevention of fat embolism syndrome and improvement of hypoxia in isolated skeletal trauma victims.

BACKGROUND: Many studies have established intravenous corticosteroid as an effective prophylactic therapy in fat embolism syndrome (FES). However, its use is limited among surgeons because of systemic side effects. Inhalational steroids have least systemic effects and are widely used for several chest conditions (i.e., asthma), but their effectiveness in FES has not been established. QUESTION/PURPOSE: This study was sought to evaluate the (1) efficacy and (2) safety of inhalational Ciclesonide (CIC) in prevention of FES and treatment of hypoxemia in isolated skeletal trauma victims. METHODS: A nonrandomized prospective control trial was designed in which all patients between 18 and 40 years with isolated skeletal injury who presented within 8 h of injury were allocated to either Trial group or control group. Trial group patients received 640 mcg of inhalational CIC with a metered-dose inhaler at the time of admission, and at 24 h. Control group patients did not receive any prophylactic therapy. Both groups were evaluated for development of FES (Gurd's criteria) and hypoxemia (PaO2 <70 mmHg) for 72 h. The complications related to CIC administration were evaluated in trial group patients during their hospital stay. RESULTS: Of 35 patients in each group, two patients in Trial group and nine patients in control group developed FES (P = 0.022). Eight patients in Trial group had hypoxemia at the time of admission, six of them improved and one additional patient developed hypoxemia after inhalational CIC administration. In control group, ten patients had hypoxia at the time of admission, only one of them improved and remaining nine patients had persistent hypoxemia even after 72 h. Additionally, three patients developed hypoxemia. A significant improvement in hypoxemia and a significant decrease in the incidence of FES were observed in Trial group (P < 0.05) compared to control group. None of the patients presented with any complications or adverse effects of steroid in Trial group. CONCLUSION: Inhalational CIC is a safe and effective therapy for prevention of FES and also an effective drug for treatment of hypoxemia in orthopedic trauma victims. LEVEL OF EVIDENCE: Level III, therapeutic study.

An evaluation of fecal incontinence in women with urinary incontinence.

OBJECTIVE: To investigate the occurrence of and risk factors for fecal and/or gas incontinence in female patients having urinary incontinence. PATIENTS AND METHODS: 741 consecutive adult female patients presenting with urinary incontinence alone (group 1, n = 700) or urinary incontinence with fecal and/or gas incontinence (group 2, n = 41) were enrolled into the study. As potential risk factors for fecal and/or gas incontinence in this population, the following variables were investigated: age, body mass index, type of urinary incontinence, childbirth history, menopausal symptoms, history of pelvic surgery, neurological disease, diabetes mellitus, tobacco use, constipation, cystocele, rectocele. Quality of life was assessed with the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). RESULTS: Of the women having urinary incontinence, 5.5% also had fecal and/or gas incontinence. Associated risk factors were history of difficult delivery, postmenopausal symptoms, history of pelvic surgery and constipation. Fecal and/or gas incontinence was also associated with a lower quality of life in terms of both questionnaires. CONCLUSIONS: Women have urinary incontinence may have also fecal and/ or gas incontinence. Particularly if they have chronic constipation, postmenopausal symptoms or history of difficult delivery or pelvic surgery they must be evaluated for this additional symptom. So we can treat these patients appropriately and increase their quality of life.

Variable Presentations of Sinonasal Polypoid Masses: A Tertiary Institution Experience.

Background Lesions of the sinonasal area are varied, but they mostly present as polypoid masses which require meticulous work-up to reach at the most probable diagnosis. Objective Analysis of polypoid sinonasal masses in terms of etiology, clinical presentations, brief demographic profile, clinico-histologic correlate where possible, and follow-up results. Method In this descriptive, longitudinal study, 198 patients with polypoid sinonasal masses attending the otolaryngology clinic of a tertiary teaching institute were selected using proper selection criteria and analyzed through a pre-set proforma and algorithm for a diagnostic work-up (that included histopathology where necessary). Result Common presentations were nasal obstruction (~89%), discharge (~70%) and hyposmia (~22%). Though nearly 87% was clinically benign and 8% indeterminate, therapeutic and diagnostic interventions (including histopathology) showed 91% truly benign, of which polyposis formed the bulk. Sensitivity of clinical detection was 75% for benign lesions and 62% for malignancies. Diagnosis depended on histopathology in 52.52% cases, including the clinically malignant, the "grey zone", and more than 40% of the clinically benign lesions. There was male predilection (2.16 for benign lesions and 1.57 for malignant), rural preponderance, and above 60% of the patients were within 50-70 years. There was ~26% recurrence in the follow-up period of a minimum of one year, predominantly in polyposis (29.55%) and malignancies (~39%). Conclusion Presentations of polypoid sinonasal masses are variable, etiology of which is mostly benign. Proper clinico-histologic correlate is necessary for correct diagnosis. A low threshold of suspicion is required because of this variability, necessitating follow-up for further evaluation.

Computerized diagnosis of respiratory disorders. SVM based classification of VAR model parameters of respiratory sounds.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced METHODS for Studying Cardiovascular and Respiratory Systems". OBJECTIVES: This work proposes an algorithm for diagnostic classification of multi-channel respiratory sounds. METHODS: 14-channel respiratory sounds are modeled assuming a 250-point second order vector autoregressive (VAR) process, and the estimated model parameters are used to feed a support vector machine (SVM) classifier. Both a three-class classifier (healthy, bronchiectasis and interstitial pulmonary disease) and a binary classifier (healthy versus pathological) are considered. RESULTS: In the binary scheme, the sensitivity and specificity for both classes are 85% ± 8.2%. In the three-class classification scheme, the healthy recall (95% ± 5%) and the interstitial pulmonary disease recall and precision (100% ± 0% both) are rather high. However, bronchiectasis recall is very low (30% ± 15.3%), resulting in poor healthy and bronchiectasis precision rates (76% ± 8.7% and 75% ± 25%, respectively). The main reason behind these poor rates is that the bronchiectasis is confused with the healthy case. CONCLUSIONS: The proposed method is promising, nevertheless, it should be improved such that other mathematical models, additional features, and/or other classifiers are to be experimented in future studies.

Biodegradable stents for caustic esophageal strictures: a new therapeutic approach.

The treatment of caustic esophageal strictures is a challenging topic. Although traditional therapies have limited efficacy, most of these patients eventually require surgery. Biodegradable (BD) stents are newly designed stents for benign conditions. This is a retrospective case series of seven patients with caustic esophageal stricture. BD esophageal stents were inserted for palliation of dysphagia. The position of the stent was checked at 1, 4, 8, 12 16, 20, and 24 weeks and at the end of follow-up period. The follow-up period was 60 ± 23 (36-102) weeks. Complete dissolution of the stent occurred at 16 ± 4 (12-20) weeks. Three patients had partial/complete relief of dysphagia. The remaining four patients experienced tissue hyperplasia at the edges of the stent and required serial dilations. At the end of follow-up, all patients had partial or complete relief of dysphagia. Although BD stents have some efficiency, tissue hyperplasia is the main limiting factor. Further randomized trials are needed to determine efficiency of BD stents for caustic damage.

Prevalence of gastroesophageal reflux disease in premature calves.

BACKGROUND: Gastroesophageal reflux (GER) is the presence of gastric contents proximal to the stomach. Pathologic consequences secondary to GER are termed gastroesophageal reflux disease (GERD). OBJECTIVES: The purpose of this study was to determine the prevalence of GER and GERD in premature calves by endoscopic examination. ANIMALS: Ten healthy and 51 premature calves were included in the study. All premature calves also had respiratory distress syndrome. METHODS: Esophagoscopy of premature calves was conducted by fiber optic endoscopy. Abnormalities such as increased saliva, hyperemia, hemorrhage, petechiae, presence of abomasal content in the esophagus, and relaxation of the lower esophageal sphincter (LES) were evaluated by endoscopy. RESULTS: The prevalence of GERD and GER in the premature calves was 55 and 67%, respectively. Hyperemia and hyperemia with hemorrhage or petechiation of the esophageal mucosa were determined by endoscopic examination. Hyperemia was commonly observed in the distal esophageal mucosa, although a few hyperemic areas also were observed in other portions of the esophagus. In addition to these abnormalities, LES relaxation, abomasal fluid in the distal esophagus, abomasal content in the esophagus, and increased saliva also were observed in premature calves with GER. CONCLUSIONS: The prevalence of both GER (67%) and GERD (55%) in premature calves was high in the study. Endoscopy provides a practical, rapid, noninvasive, and reasonably accurate method for determining the presence of GER and GERD in premature calves.

Benign biliary papillomatosis in a patient with a choledochal cyst presenting as haemobilia: a case report.

Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.

Tuberculosis in a renal allograft recipient presenting with intussusception.

Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11(th) postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

Serum amyloid A and haptoglobin concentrations and liver fat percentage in lactating dairy cows with abomasal displacement.

BACKGROUND: There has been increased interest in measuring the serum concentration of acute phase reactants such as serum amyloid A [SAA] and haptoglobin [haptoglobin] in periparturient cattle in order to provide a method for detecting the presence of inflammation or bacterial infection. OBJECTIVES: To determine whether [SAA] and [haptoglobin] are increased in cows with displaced abomasum as compared with healthy dairy cows. ANIMALS: Fifty-four adult dairy cows in early lactation that had left displaced abomasum (LDA, n = 34), right displaced abomasum or abomasal volvulus (RDA/AV, n = 11), or were healthy on physical examination (control, n = 9). MATERIALS AND METHODS: Inflammatory diseases or bacterial infections such as mastitis, metritis, or pneumonia were not clinically apparent in any animal. Jugular venous blood was obtained from all cows and analyzed. Liver samples were obtained by biopsy in cattle with abomasal displacement. RESULTS: [SAA] and [haptoglobin] concentrations were increased in cows with LDA or RDA/AV as compared with healthy controls. Cows with displaced abomasum had mild to moderate hepatic lipidosis, based on liver fat percentages of 9.3 +/- 5.3% (mean +/- SD, LDA) and 10.8 +/- 7.7% (RDA/AV). [SAA] and [haptoglobin] were most strongly associated with liver fat percentage, r(s) = +0.55 (P < .0001) and r(s) = +0.42 (P = .0041), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: An increase in [SAA] or [haptoglobin] in postparturient dairy cows with LDA or RDA/AV is not specific for inflammation or bacterial infection. An increase in [SAA] or [haptoglobin] may indicate the presence of hepatic lipidosis in cattle with abomasal displacement.

Adenosine-induced cardiac standstill to facilitate endovascular embolisation of cerebral arteriovenous malformations in children.

This report describes three children, aged eight to 11 years, with high-flow cerebral arteriovenous malformations who underwent interventional neuroradiological procedures involving glue (N-butyl cyanoacrylate) embolisation under general anaesthesia. The procedure was facilitated by relative hypotension induced by esmolol infusion and intravenous adenosine boluses. To allow controlled deposition of N-butyl cyanoacrylate into the arteriovenous malformations, glue injection was synchronised with the onset of adenosine-induced brief cardiac standstill. This resulted in satisfactory obliteration of the arteriovenous malformations nidus in all cases. The haemodynamic modulations, including the adenosine-induced brief cardiac standstill, was noted to not affect the BIS values in our patients. All patients had satisfactory obliteration of their arteriovenous malformations and had good neurological outcomes at one-year follow-up.

The studies on the aetiology of diarrhoea in neonatal calves and determination of virulence gene markers of Escherichia coli strains by multiplex PCR.

The purpose of this study was to determine aetiological agents of diarrhoea in neonatal calves and to investigate virulence gene markers of Escherichia coli strains isolated from calves by multiplex polymerase chain reaction (PCR). Eighty-two diarrhoeic calves and 18 healthy calves were used as subjects. Faeces were taken from the rectums of all the calves and were subjected to bacterial culture. Antigen enzyme-linked immunosorbent assay (ELISA) was performed to detect rotavirus, coronavirus and E. coli K99 in faeces of all the calves. A multiplex PCR was used to characterize E. coli strains in all the calves. Escherichia coli was isolated from 37 faeces samples, Enterococcus ssp. was isolated from 22 faeces samples and Salmonella was isolated from one faeces sample in diarrhoeic calves. Furthermore, only E. coli was isolated from all 18 faeces samples of healthy calves. Of the 37 E. coli isolated from diarrhoeic calves, K99 (18.9%), F41 (18.9%), heat-stable enterotoxin a (STa) (18.9%), Shiga toxin 1 (Stx1; 13.5%) and Shiga toxin 2 (Stx2; 5.4%) and intimin (8.1%) genes were identified by multiplex PCR. Of the 18 E. coli isolated from healthy calves, K99 (16.6%) and intimin (55.5%) genes were identified by PCR. A total of 15 rotavirus, 11 coronavirus and 11 E. coli K99 were detected in diarrhoeic calves by the antigen ELISA. As a result, this study shows that rotavirus, coronavirus, E. coli and Enterococcus ssp. were determined to play a role in the aetiology of diarrhoea in the neonatal calves. K99, F41, STa, Stx1 and Stx2 were found as the most common virulence gene markers of E. coli strains isolated from calves with diarrhoea. Multiplex PCR may be useful for characterization of E. coli isolated from calves.

The effect of regular long term training on antioxidant enzymatic activities.

AIM: It has been reported that exercise induces oxidative stress and causes adaptations in antioxidant defenses. The purpose of the present study was to investigate the effects of regular long term training on antioxidant enzymatic activities consisting of superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) in a group of basketball players engaged in a physical training program. METHODS: SOD, GPX and GST activities were measured as an indicator of antioxidant defenses in long term trained basketball players and compared with non-sporting age matched controls. Independent samples t test was used to compare the data between the two groups. RESULTS: SOD, GPX and GST levels were significantly higher in basketball players than sedentary controls (P < 0.05, P < 0.05 and P < 0.01, respectively). CONCLUSION: Data suggest that regular long term training can induce antioxidant response to the oxidative stress. These results support the possibility that the beneficial effect of physical exercise on oxidative stress might be associated with increased antioxidant defenses.

Foreign body in ENT--general practitioner's duty.

Foreign body in ENT region is an age-old problem. Introduction of foreign body in ear, nose and throat is specially seen in children. There are many types of foreign body seen in the ear, nose and throat. They can aspirate into larynx, trachea and bronchus. How to manage the removal of foreign body in ear, nose and throat had been discussed in a nutshell. General practitioners should be skilled enough to remove foreign body with their limited resources and they should know when to send the cases to an ENT specialist or to a hospital.

False positive 18F-FDG PET scan in adrenal oncocytoma.

18F-FDG whole-body positron emulsion tomography (18F-FDG PET) has become an established imaging modality for a variety of cancers. Today, 18F-FDG PET is utilized to differentiate benign from malignant non-functioning adrenal masses. In this report, a 25-year-old woman presented with a 2-month history of left flank pain. Abdominal CT revealed a left 6.5 x 4.5 cm adrenal mass with regular margins and focal calcification. To make a differential diagnosis, 18F-FDG PET was performed. Preoperative laboratory studies showed that the mass was non-functioning. A left adrenalectomy was performed through a left subcostal incision. The final pathologic evaluation revealed adrenal oncocytoma. We present the disassociation between preoperative 18F-FDG PET and pathologic findings of a benign adrenocortical oncocytoma.

Changes in abdominal dimensions during late gestation and early lactation in Holstein-Friesian heifers and cows and their relationship to left displaced abomasum.

The changes in abdominal dimensions and contour during late gestation and early lactation were investigated in 44 Holstein-Friesian cattle, 20 normal heifers and 17 normal cows, and seven cows that had a left displaced abomasum (LDA) surgically corrected by a right flank omentopexy in a previous lactation. Abdominal measurements were made eight times during the six months spanning the last trimester of pregnancy and the first three months of lactation, they included the circumference of the thorax and abdomen, the depth and width of the abdomen, the vertical distance between the ventral abdomen and the descending duodenum, the height at the withers, and the length of the trunk. There were significant changes in these dimensions during the last trimester of pregnancy, immediately after parturition and during the first three months of lactation. The depth of the abdomen and the vertical distance between the ventral abdomen and the descending duodenum were greater in the cows with a previous history of LDA than in those without.

Assessment of total thrombus load in symptomatic patients with venous thromboembolism.

Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1,552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.