Effect of dietary inclusion of spray-dried porcine plasma on performance, some physiological and immunological response of broiler chickens challenged with Salmonella sofia.

This study was conducted to investigate the effect of spray-dried porcine plasma (SDPP) in broiler chickens under Salmonella sofia disease challenge. The experiment comprised five starter diets: positive control (no supplement), diet supplemented with in-feed antibiotics (IFA; salinomycin 0.05% + zinc bacitracin 0.033%) and diets supplemented with SDPP at 10 or 20 g/kg diet. All four of these groups were challenged with S. sofia, while a fifth group was unchallenged and used as the negative control. The experimental diets were fed to 14 days; then, the birds were switched to commercial-type grower and finisher diets. Oral inoculation of the challenged groups with S. sofia occurred on day 8, 10 and 12. Body weight was significantly higher in the birds fed diets containing IFA and SDPP than in the challenged control group, but it was only significant in starter and grower phases. In general, there was an improvement in the weights of the immune-related organs, but it was only significant for the weight of the bursa of SDPP-fed birds at 13 days. At day 13, blood potassium content was lower and the concentrations of IgG and IgM tended to be lower in the birds fed on low-SDPP starter diets than those of the other groups. There were significant differences in the concentration of lactic acid in the ileum and acetic acid, formic acid, butyric acid and propionic acid in the caeca. Inclusion of SDPP to the starter diets of broiler chicks had positive effects on broiler performance, immunity and gut health during exposure to highly pathogenic conditions.

Subsequent growth performance and digestive physiology of broilers fed on starter diets containing spray-dried porcine plasma as a substitute for meat meal.

A 4 × 2 factorial experiment was conducted to investigate the effect of inclusion of spray-dried porcine plasma (SDPP), in lieu of meat meal, in the starter diet on performance and digestive physiology of broiler chickens between hatch and 35 d of age. Four levels of SDPP (0, 5, 10 or 20 g/kg) were included in the starter diets in lieu of meat meal on either wheat- or maize-based diets. Over the first 10 d, and throughout the 35-d experimental period, birds gained more body weight with increasing concentrations of SDPP regardless to the type of grain used. Inclusion of SDPP in the starter diet markedly improved feed per gain in the starter phase and across the 35-d study. There was no significant effect of the type of grain and its interaction with SDPP on the body weight gain and feed per gain for the two assessed periods. At d 10, the relative weight of the gizzard+proventriculus, spleen and liver increased with increasing concentrations of SDPP. At 24 d of age, the grain and SDPP inclusion significantly interacted, depressing the weight of bursa and spleen in birds that received the highest concentration of SDPP in the maize-based diet. Birds fed on the maize-based diets had higher relative weight of pancreas than those on the wheat-based diets. Increasing concentrations of SDPP in the starter diet improved the activities of maltase, sucrase and alkaline phosphatase at 24 d of age. The interaction of grain and SDPP concentration was significant for sucrase activity in birds on the wheat-based diets. Chickens on maize-based diets had higher alkaline phosphatase and maltase activities than those on wheat-based diets. Chicks that were offered SDPP-containing starter diets had longer villi, deeper crypts and lower villi/crypt than the control at 24 d of age regardless of the grain type used. Furthermore, longer villi and larger villi/crypt were found in chicken groups fed on wheat-based diets than those on maize-based diets. Chickens on maize-based diets had higher dressing percentage and relative breast weight than those on wheat-based diets at 35 d of age. It can be concluded that supplementation of starter diets with SDPP would be beneficial to the long-term growth of broiler chickens. The effect of the basal grain used in the diet is minimal.

Antenatal screening for pre-eclampsia: evaluation of the NICE and pre-eclampsia community guidelines.

The NICE and PRECOG guidelines are based on systematic reviews of risk factors for pre-eclampsia to identify mothers at risk before 20 weeks' gestation. Cases (64) and controls (112) were classified retrospectively as screen positive or negative as recommended by the two guidelines The NICE guideline had a higher sensitivity rate of 77% (95% CI 65-87%) vs 59% (95% CI 46-71%) but a lower specificity of 54% (95% CI 44-64%) vs 81% (95% CI 73-88%) with the PRECOG guideline. Based on an incidence of pre-eclampsia of 4% the positive predictive values of PRECOG and NICE guidelines were estimated at only 11% and 7%, respectively. The most discriminatory risk factor was history of pre-eclampsia in a previous pregnancy. Neither guideline has a reasonable performance and cannot be recommended for use in clinical practice. Resources should rather be focussed on development of new strategies to identify women at risk of pre-eclampsia.

A case series of interventional radiology in postpartum haemorrhage.

Postpartum haemorrhage (PPH) remains a significant cause of maternal morbidity and mortality in both developed and developing countries. In some instances, PPH can be anticipated and recent improvements in obstetric imaging techniques allow earlier and more reliable diagnosis of abnormalities associated with haemorrhage such as morbid placentation. However, the majority of PPH is unpredicted. Good practice notes published by the Royal College of Obstetricians and Gynaecologists state interventional radiology should be used as emergency intervention in PPH and should be considered when primary management has failed allowing arteries to be embolised to achieve haemostasis. Through collaboration between interventional radiology and maternity, appropriate guidelines need to be developed, on both emergency and elective of interventional radiology in the prevention and management of PPH. As there is mapping for neonatal services, in the future there should be consideration to develop obstetric trauma units. Maternity units which lack facilities for interventional radiology would be able to refer their cases (like placenta accreta) for safe management in units with 24 h interventional radiology services.

Role of interventional radiology in the management of morbidly adherent placenta.

The incidence of morbidly adherent placenta is rising and is directly proportional to the rate of rise of caesarean deliveries. Despite improvement in antenatal diagnosis, by accuracy of ultrasound and MRI techniques, placenta accreta is still associated with a high maternal morbidity rate. Management of pregnancies with a morbidly adherent placenta is extremely challenging and is becoming an increasingly common problem for maternity units globally. The main challenges include controlling the haemorrhage and dissection of the invaded tissues. Traditionally, these cases were managed by caesarean hysterectomy. There has now been a shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the aid of interventional radiology by means of insertion of occluding balloons into appropriate vessels. We describe three cases of morbidly adherent placentas, managed at our unit where meticulous preoperative planning, multidisciplinary approach and the key role of interventional radiology led to a safe outcome for both the mother and the baby.

Platelet activation and endogenous thrombin potential in pre-eclampsia.

INTRODUCTION: Platelets and the coagulation system may be involved in the pathogenesis of pre-eclampsia. We investigated whether platelet and coagulation activation markers, are elevated in pre-eclampsia. MATERIALS/METHODS: Case-control study in which activated platelets, platelet-monocyte/ neutrophil aggregates, platelet microparticles (measured by flow cytometry) and four markers of thrombin generation capacity (endogenous thrombin potential (ETP), peak height, lag time and time to peak) using the Calibrated Automated Thrombogram system were assessed in pregnant women of similar gestational age with (n=46) and without (n=46) pre-eclampsia, and in healthy non-pregnant women (n=42). RESULTS: The percentage of, CD62P+ platelets (p=0.013), CD62P+ platelet microparticles (p=0.029) and platelet-monocyte aggregates (p=0.019) were significantly higher in women with pre-eclampsia than the pregnant controls. Both groups of pregnant women had significantly higher ETP and peak height (p <0.001) than the healthy non pregnant group and the women with pre-eclampsia had significantly higher ETP and peak height (p<0.001) than the normotensive pregnant controls. CONCLUSION: In the most comprehensive laboratory analysis to date, we found evidence of both platelet and coagulation activation in women with pre-eclampsia.

Vitamin D in pregnancy-time for action: a paediatric audit.

Maternal vitamin D deficiency is a significant public health issue. This retrospective multicentre audit was undertaken to identify the scale of maternal vitamin D deficiency in London, using infant vitamin D deficiency as a surrogate marker. During January 2006 to June 2008, 74 infants presented with symptomatic vitamin D deficiency, a prevalence of 1.6 per 1000 deliveries in London. Of these, 49% were hypocalcaemic at presentation and 27% had hypocalcaemic seizures. A telephone survey in June 2008 showed that no London National Health Service antenatal units had departmental guidelines on vitamin D. This audit is presented to raise awareness of current recommendations and the sequelae of maternal vitamin D deficiency.

Gestational surrogacy: a feasible option for patients with Rokitansky syndrome.

Rokitansky syndrome is a developmental defect characterized by agenesis of the uterus and vagina but normal gonads and secondary sexual characters. It is not commonly transmitted as a dominant genetic trait. Surrogacy, which is legally and ethically accepted in the UK and other countries, has made it possible for the patients with this syndrome to have their own genetic children. Six patients with Rokitansky syndrome underwent 11 ovarian stimulation cycles that resulted in 11 fresh and three frozen embryo transfer procedures into six prospective surrogate mothers. Both commissioning and surrogate couples were properly screened and counselled and their treatment was approved by the clinic internal review committee (ethics committee). The treatment cycles resulted in six clinical pregnancies (42.9% pregnancy rate per embryo transfer and 54.5% per oocyte retrieval) and three live births (21. 4% per embryo transfer, 27.3% per retrieval and 50% per patient). Gestational surrogacy is a viable treatment for patients with Rokitansky syndrome. Such patients should be well informed and supported to be able to have a family using their own genetic gametes.

The efficacy of local anaesthesia for percutaneous epididymal sperm aspiration and testicular sperm aspiration.

A total of 37 percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm aspiration (TESA) procedures were performed under local anaesthesia (LA) on 34 men between June and November 1996. Local anaesthesia was achieved by injecting 10 ml of 1% lignocaine solution along the sides of the vas deferens near the external inguinal ring (spermatic cord block). Sperm retrieval was successful in 92% of the procedures. Of the 37 procedures, in 29 the patients felt either no pain or mild discomfort while in six they experienced moderate but tolerable pain. Analgesia was incomplete in two procedures and was supplemented with i.v. sedation. Vasovagal reflex in two procedures was reversed by i.v. atropine. In 24 procedures patients felt relaxed, whilst in 13 they felt anxious. In 32 procedures the patients expressed overall satisfaction. If the procedure was to be repeated, after 29 procedures the patients requested LA again, while after four procedures they preferred i.v. sedation and after four were undecided. LA is adequate for PESA and TESA in a large proportion of patients. Prior discussion of LA technique with the patient is necessary. Back-up facilities for i.v. sedation and atropine should be available.

Cumulative experience of percutaneous epididymal sperm aspiration (PESA) with intracytoplasmic sperm injection.

OBJECTIVE: Our objective was to evaluate the recovery rate of spermatozoa from the epididymis using a percutaneous aspiration technique and to assess the fertilisation rate after intracytoplasmic sperm injection. MATERIALS AND METHODS: Fifty-four patients with azoospermia had a total of 59 cycles at IVF with intracytoplasmic sperm injection (ICSI). The cause of the azoospermia was failed vasectomy reversal in 23 cases, congenital absence of the vas in 22 cases, partial testicular failure in 5 cases, and retrograde ejaculation in 2 cases, while the remaining 2 patients had erectile disorders. RESULTS: A total of 741 oocytes was collected and 521 metaphase II oocytes were subsequently microinjected. Normal fertilisation occurred in 274 oocytes (52.6%), and of these, 234 cleaved (85.4%). In 54 cycles, embryo transfer of more than one embryo occurred (91.5%) and a total of 155 embryos was replaced. The pregnancy rate was 30.5% per cycle and 33.3% per embryo transfer. The implantation rate was 14.2%; failure of fertilisation occurred in two cycles, while in three other cycles the embryos did not cleave. CONCLUSIONS: Percutaneous epididymal sperm aspiration can be used successfully to retrieve sperm in men with azoospermia due to obstructive, or nonobstructive, disorders. The technique is simple, cost-effective, and associated with fewer complications than an open microsurgical operation.