Performance and methane emissions in dairy cows fed oregano and green tea extracts as feed additives.

Plant extracts have been proposed as substitutes for chemical feed additives due to their potential as rumen fermentation modifiers and because of their antimicrobial and antioxidant activities, possibly reducing methane emissions. This study aimed to evaluate the use of oregano (OR), green tea extracts (GT), and their association as feed additives on the performance and methane emissions from dairy between 28 and 87 d of lactation. Thirty-two lactating dairy cows, blocked into 2 genetic groups: 16 Holstein cows and 16 crossbred Holstein-Gir, with 522.6 ± 58.3 kg of body weight, 57.2 ± 20.9 d in lactation, producing 27.5 ± 5.0 kg/cow of milk and with 3.1 ± 1.8 lactations were evaluated (means ± standard error of the means). Cows were allocated into 4 treatments: control (CON), without plant extracts in the diet; oregano extract (OR), with the addition of 0.056% of oregano extract in the dry matter (DM) of the diet; green tea (GT), with the addition of 0.028% of green tea extract in the DM of the diet; and mixture, with the addition of 0.056% oregano extract and 0.028% green tea extract in the DM of the diet. The forage-to-concentrate ratio was 60:40. Forage was composed of corn silage (94%) and Tifton hay (6%); concentrate was based on ground corn and soybean meal. Plant extracts were supplied as powder, which was previously added and homogenized into 1 kg of concentrate in natural matter, top-dressed onto the total mixed diet. No treatment by day interaction was observed for any of the evaluated variables, but some block by treatment interactions were significant. In Holstein cows, the mixture treatment decreased gross energy and tended to decrease the total-tract apparent digestibility coefficient for crude protein and total digestible nutrients when compared with OR. During the gas measurement period, GT and OR increased the digestible fraction of the ingested DM and decreased CH4 expressed in grams per kilogram of digestible DMI compared with CON. The use of extracts did not change rumen pH, total volatile fatty acid concentration, milk yield, or most milk traits. Compared with CON, oregano addition decreased fat concentration in milk. The use of plant extracts altered some milk fatty acids but did not change milk fatty acids grouped according to chain length (short or long), saturation (unsaturated or saturated), total conjugated linoleic acids, and n-3 and n-6 contents. Green tea and oregano fed separately reduced gas emission in cows during the first third of lactation and have potential to be used as feed additives for dairy cows.

Partial rupture of the thigh adductor muscle in a dog: case report / Ruptura parcial do músculo adutor da coxa em um cão: relato de caso

Muscle injuries are often reported in humans, but uncommon in dogs. The etiology is degenerative or traumatic, and traumatic is more common in athletes. The diagnosis is obtained by a combination of orthopedic physical examination and imaging diagnosis, such as ultrasonography. Therapy aims to optimize healing and avoid complications. The present study reports a case of partial rupture of thigh adductor muscle in a dog presenting acute lameness of the right pelvic limb. Swelling and pain in the medial region of the thigh was noticed. Ultrasound examination confirmed partial rupture of the thigh adductor muscle. The treatment included non-steroid anti-inflammatory, warm compresses, and rest. Ultrasound examinations were useful in this case to evaluate the progression of the lesion, which was rapid and satisfactory.(AU)

Lesões musculares são frequentemente relatadas em humanos, mas pouco diagnosticadas em cães. Podem ocorrer de forma degenerativa ou traumática, sendo essa última a forma mais comum em atletas. O diagnóstico é obtido por exame físico ortopédico associado a exames de imagem, como ultrassonografia. A terapia deve ser instituída de modo a facilitar a cicatrização e evitar as complicações. O presente trabalho tem como objetivo relatar um caso de ruptura parcial de músculo adutor da coxa em um cão que apresentou claudicação aguda em membro pélvico direito, associado à tumefação e dor em região medial da coxa. O exame ultrassonográfico evidenciou ruptura parcial do músculo adutor da coxa. O paciente recebeu terapia anti-inflamatória, e foi indicado uso de compressas quentes e repouso. Foram realizados exames ultrassonográficos para acompanhamento da evolução do quadro, que foi rápida e favorável.(AU)

Drug shortages: the cycle of quantity and quality.

Shortages of pharmaceutical drugs pose a serious and growing threat to public health. Although the number of drugs in shortage in the United States in any given year is very small, the number of prescription drug shortages in the country nearly tripled between 2005 and 2010. Drug shortages are becoming more severe as well as more frequent. The affected medicines include cancer treatments, anesthesia drugs, and other drugs that are critical to the treatment and prevention of serious diseases and life-threatening conditions. (The White House, Office of the Press Secretary, Executive Order 13588-Reducing Prescription Drug Shortages (http://www.whitehouse.gov/the-press-office/2011/10/31/executive-order-reducing-prescription-drug-shortages)).

Experimental feasibility of multi-energy photon-counting K-edge imaging in pre-clinical computed tomography.

Theoretical considerations predicted the feasibility of K-edge x-ray computed tomography (CT) imaging using energy discriminating detectors with more than two energy bins. This technique enables material-specific imaging in CT, which in combination with high-Z element based contrast agents, opens up possibilities for new medical applications. In this paper, we present a CT system with energy detection capabilities, which was used to demonstrate the feasibility of quantitative K-edge CT imaging experimentally. A phantom was imaged containing PMMA, calcium-hydroxyapatite, water and two contrast agents based on iodine and gadolinium, respectively. Separate images of the attenuation by photoelectric absorption and Compton scattering were reconstructed from energy-resolved projection data using maximum-likelihood basis-component decomposition. The data analysis further enabled the display of images of the individual contrast agents and their concentrations, separated from the anatomical background. Measured concentrations of iodine and gadolinium were in good agreement with the actual concentrations. Prior to the tomographic measurements, the detector response functions for monochromatic illumination using synchrotron radiation were determined in the energy range 25 keV-60 keV. These data were used to calibrate the detector and derive a phenomenological model for the detector response and the energy bin sensitivities.

Tumor and normal tissue motion in the thorax during respiration: Analysis of volumetric and positional variations using 4D CT.

PURPOSE: To investigate temporospatial variations of tumor and normal tissue during respiration in lung cancer patients. METHODS AND MATERIALS: In 14 patients, gross tumor volume (GTV) and normal tissue structures were manually contoured on four-dimensional computed tomography (4D-CT) scans. Structures were evaluated for volume changes, centroid (center of mass) motion, and phase dependence of variations relative to inspiration. Only volumetrically complete structures were used for analysis (lung in 2, heart in 8, all other structures in >10 patients). RESULTS: During respiration, the magnitude of contoured volumes varied up to 62.5% for GTVs, 25.5% for lungs, and 12.6% for hearts. The range of maximum three-dimensional centroid movement for individual patients was 1.3-24.0 mm for GTV, 2.4-7.9 mm for heart, 5.2-12.0 mm for lungs, 0.3-5.5 mm for skin markers, 2.9-10.0 mm for trachea, and 6.6-21.7 mm for diaphragm. During respiration, the centroid positions of normal structures varied relative to the centroid position of the respective GTV by 1.5-8.1 mm for heart, 2.9-9.3 mm for lungs, 1.2-9.2 mm for skin markers, 0.9-7.1 mm for trachea, and 2.7-16.4 mm for diaphragm. CONCLUSION: Using 4D-CT, volumetric changes, positional alterations as well as changes in the position of contoured structures relative to the GTV were observed with large variations between individual patients. Although the interpretation of 4D-CT data has considerable uncertainty because of 4D-CT artifacts, observer variations, and the limited acquisition time, the findings might have a significant impact on treatment planning.

From psychiatric ward to the streets and shelters.

The issue of discharge from hospital ward to the streets is seldom explored in the literature, but all too commonly experienced by individuals experiencing psychiatric disorders. The Community University Research Alliance on Housing and Mental Health sought to determine how frequently people were discharged from psychiatric wards to shelters or the street in London, Ontario, Canada. A number of data sources were accessed to determine instances of discharges to shelters or the street. Data were analysed to determine the number of moves occurring between hospital and shelter or no fixed address. All datasets revealed the problem of discharge to shelters or the street occurred regularly. All data sources used have the difficulty of likely underestimating the extent of the problem. This type of discharge occurred at least 194 times in 2002 in London, Ontario, Canada. Policies that contribute to this problem include income-support policies, the reduction in psychiatric hospital beds and the lack of community supports. Without recognition, this problem is at risk of remaining invisible with no further improvements to the situation.

Surveillance of cryptococcosis in Alabama, 1992-1994.

PURPOSE: Although cryptococcosis is a significant opportunistic infection among patients with human immunodeficiency virus (HIV), there is conflicting information on rates of cryptococcosis among HIV-positive and HIV-negative patients. Precise state-wide epidemiologic data for cryptococcosis are not available in Alabama. METHODS: We conducted an active laboratory and hospital medical record-based surveillance for cryptococcosis in Alabama from October 1, 1992 to September 30, 1994. A case of cryptococcosis was defined as a patient's initial episode of cryptococcal disease and based on either a positive culture for C. neoformans from any normally sterile site, a positive latex agglutination serologic test for cryptococcal antigen in CSF or serum, or histopathologic findings consistent with C. neoformans. RESULTS: Over the two year period, 153 cases were identified. The diagnosis was based on positive culture (37%), positive antigen (24%), positive autopsy culture (2%), and histopathologic findings (4%). Further, 33% of the total cases were diagnosed from combined positive culture, antigen, or histopathology. Of the total 153 cases, 55% were in HIV-positive patients and 44% were in HIV-negative individuals and one case (1%) had an unknown HIV status. The overall annual incidence rate of cryptococcosis was 1.89 cases per 100,000 population. The incidence was 1638.7 per 100,000 in the HIV-positive population and 0.84 per 100,000 in the HIV-negative population. CONCLUSION: The first Alabama statewide active surveillance system for cryptococcosis confirms previous observations that rates of cryptococcosis are consistently higher in HIV-infected individuals than in their HIV-negative counterparts. In Alabama, cryptococcosis occurs more commonly in urban residents and in men. Cryptococcosis in HIV-positive persons is more likely to occur in the 20 to 44 year age group, whereas cryptococcosis in HIV-negative persons is more likely to occur in those greater than 45 years old.

Mechanism of epinephrine-induced platelet aggregation.

We report that a genetic polymorphism of the alpha2-adrenergic receptor (A2AR) encoded by chromosome 10 is associated with hypertension and an increase in epinephrine-mediated platelet aggregation in humans. The mechanism responsible for this heritable contrast in sensitivity to epinephrine is unknown. We tested our hypothesis that epinephrine-induced platelet aggregation is mediated by activation of chloride transport. We measured epinephrine-mediated increases in optical density of gel-filtered platelets suspended in a bicarbonate-buffered physiological salt solution. Compared with platelets incubated in the control buffer (130 mmol/L NaCl), platelets incubated with either bumetanide, a Na/K/2Cl cotransport inhibitor; anthracene-9-carboxylic acid, a chloride channel blocker; or acetazolamide, an agent that blocks ATP-dependent chloride transport had significantly decreased aggregation responses to epinephrine. When measured fluorometrically, epinephrine significantly increased intraplatelet chloride concentrations. Chloride-dependent modifications of epinephrine-induced platelet aggregation were not attributable to changes in A2AR ligand binding characteristics or to the concentration of platelet cAMP. Finally, subthreshold concentrations of epinephrine also potentiated thrombin-induced platelet aggregation, and blockade of chloride transport diminished this synergistic action of epinephrine on thrombin-stimulated platelet aggregation. Heritable differences in epinephrine-mediated platelet aggregation may be attributable to genetic differences in chloride transport in platelets. Furthermore, because we observed a necessary role for chloride transport in epinephrine-mediated platelet aggregation, pharmacological agents that block chloride transport, such as diuretics, may provide salutary protection against vascular thrombosis in patients with hypertension independent of the effect of these drugs on blood pressure.

The potential of using billing data for emergency department injury surveillance.

OBJECTIVE: To determine the availability of and sample statewide ED injury information obtained from hospital billing data for the purpose of demonstrating the feasibility of information acquisition for subsequent data linkage. METHODS: A retrospective, database investigation was conducted to obtain data describing a statewide stratified sample of ED patients. The aim was to collect a computerized billing summary record for each injured ED patient seen at each sampled hospital over a 1-year period. All 215 Pennsylvania acute care hospitals in 1991 were eligible for sample selection. Data collection for the project was conducted in 1993. Participants included directors of hospital medical records and billing departments. RESULTS: Twenty-four hospitals contributed data sets from the original target goal of 31 strata. The final combined data set contained 187,404 records with injury diagnoses from approximately 616,000 ED patient visits, representing a 12% sample of all annual statewide ED visits. Age, sex, date of visit, and primary diagnosis fields were completed from the retrieved data > 99% of the time. More than two-thirds of the sampled records had a social security number, and total charges were recorded > 90% of the time. Other variables such as name and address were contained in < 50% of the records submitted. E-codes were usually not available. CONCLUSIONS: Retrospective compilation of multihospital ED billing data to create a statewide ED data sample-with the potential for injury research and probabilistic database linkage-can be accomplished; there are, however, important limitations.

Injury surveillance: a statewide survey of emergency department data collection practices.

STUDY OBJECTIVE: To assess current emergency department data collection practices in Pennsylvania and determine whether existing data sources can be used as part of a statewide injury surveillance system. METHODS: Separate survey questionnaires requesting information on current ED patient data collection practices and attitudes were mailed to all directors of medical records, billing, and EDs in Pennsylvania (N = 212). RESULTS: Of the medical records department respondents, 92% indicated that ED registration data are retained in a computerized information system; 94% of respondents from billing departments reported that their ED patient registration system is integrated with an ED billing system. A total of 36% of EDs surveyed use a computerized ED patient logbook, and another 27% plan to begin a computerized log within 2 years. Dictation and transcription services that permit electronic retrieval of text are being used by 26% of EDs for patient medical records. CONCLUSION: Many elements for building a statewide ED injury surveillance system are in place in Pennsylvania, but they are as yet incomplete. Future studies should examine the feasibility of integrating existing ED data systems into statewide injury surveillance systems.

Subdural empyema: analysis of 32 cases and review.

Thirty-two patients with subdural empyema at the University Hospital (Birmingham, AL) during the period from June 1970 through June 1992 were identified retrospectively. Clinical presentations of patients, methods of diagnosis, results of microbiological tests, types of therapy used, and outcomes of patients are presented and compared with those found in prior reports. The patients were separated into three groups based on the etiology of their disease: sinusitis, trauma and/or neurosurgery, and other miscellaneous causes. Sinusitis accounted for 56% of the cases; the predominant organisms isolated from these patients were anaerobes and streptococci. No cases occurred secondary to otitis media. The overall mortality rate was 9%; however, 55% of patients had neurological deficiency at the time they were discharged from the hospital. Factors that affected survival were age (P < .007) and level of consciousness at presentation (P < .008).

Oerskovia xanthineolytica bacteremia in an immunocompromised patient with pneumonia.

Oerskovia species, which are Nocardia-like bacteria that have rarely been found to cause human disease, are usually found in association with a foreign body with removal of the infected focus being necessary for cure. We present a case of Oerskovia xanthineolytica bacteremia in a patient with metastatic breast cancer, community-acquired pneumonia, and a tunneled subcutaneous central venous catheter. Although the actual source of the bacteremia in this case is not proven, this patient's presentation with apparent lobar pneumonia and her improvement on antibiotics without catheter removal suggest that Oerskovia may be capable of causing primary pulmonary infection in the immunocompromised host.

Acupuncture for gastrointestinal disorders.

Acupuncture is best known for its application to various musculoskeletal pain-producing diseases. Acupuncture is, however, used for a large variety of internal medical diseases in humans and other animals. This chapter reviews some of the published literature on the use of acupuncture in gastrointestinal (GI) diseases, describes acupuncture points useful for a variety of GI diseases, briefly reviews how traditional Chinese medicine (TCM) treats GI disease, and gives some case examples of how acupuncture can be used in GI diseases.

[Sensitivity and specificity of a simplified, standardized 13C-urea breath test for the demonstration of Helicobacter pylori]. / Sensitivität und Spezifität eines vereinfachten, standardisierten 13C-Urea-Atemtests zum Nachweis von Helicobacter pylori.

A simplified 13C-urea breath test (UBT) for detection of Helicobacter pylori (Hp) infection was evaluated in 50 patients. Following upper gastrointestinal endoscopy the patients received 100 ml of a liquid test meal with 100 mg 13C-urea. Breath samples were obtained at baseline and 30 minutes respectively. The UBT was positive (difference of 13CO2 enrichment exceeding 5%) in 33/35 patients with culture-proven Hp infection and negative in 14/15 patients in whom microbiological culture, histology and a urease test (CLO-test) were negative. We conclude that in view of its high sensitivity (94%) and specificity (93%) the UBT is useful for rapid, non-invasive diagnosis of Hp infection.

Helicobacter pylori infection in healthy people: a dynamic process?

Epidemiological studies using serological tests have shown that a large proportion of healthy people have antibodies against Helicobacter pylori (anti-Hp). It is uncertain whether the presence of anti-Hp indicates active infection or only past exposure to the micro-organism. In this study we determined anti-Hp with a specific enzyme linked immunosorbent assay in 100 healthy volunteers who were at the same time investigated for active H pylori infection by means of the 13C-urea breath test. Forty nine per cent had a high anti-Hp titre, but only 24% had active H pylori infection. Our study suggests that a considerable number of healthy people previously infected with H pylori have spontaneously eliminated this microorganism. We suggest that the inability of ulcer patients to eliminate H pylori may be important in the pathogenesis of peptic ulcer disease.

Penicillin-induced hemolytic anemia and acute hepatic failure following treatment of tetanus in a horse.

Acute, severe hemolytic anemia occurred in a horse being treated for tetanus with intravenous penicillin and tetanus antitoxin. During treatment, the horse developed a positive direct antiglobulin test and a high titer (maximum 1:1024) of IgG anti-penicillin antibody. The horse recovered from the tetanus and penicillin induced hemolytic anemia, but later developed acute hepatic failure, probably resulting from the administration of equine origin tetanus antitoxin.

Evaluation of 13C-urea breath test in the detection of Helicobacter pylori and in monitoring the effect of tripotassium dicitratobismuthate in non-ulcer dyspepsia.

Sixty nine patients with non-ulcer dyspepsia have been studied with endoscopy, biopsy, quick urease (CLO) test, Helicobacter pylori culture, and the 13C-urea breath test before and after treatment with tripotassium dicitratobismuthane (DeNol) two tablets twice daily for four weeks. Symptoms of non-ulcer dyspepsia were recorded using a standard questionnaire. Using H pylori culture as the gold standard, the sensitivity of the 13C-urea breath test was 90%, the specificity 98.6%, and the accuracy 94.8% with a positive predictive value of 98.2% and a negative predictive value of 92.5%. Conversion rate from H pylori positive to negative status after treatment with tripotassium dicitratobismuthate was 17.9%. Symptoms of non-ulcer dyspepsia improved appreciably after treatment irrespective of H pylori status. The 13C-urea breath test is an accurate research tool suitable for serial testing and population surveys.

Right dorsal colitis.

Moderate to severe ulcerative colitis of the right dorsal colon was diagnosed by necropsy or by exploratory celiotomy and biopsy in 13 horses with a primary clinical complaint of either colic, diarrhea, or weight loss. Clinical signs varied from acute fulminating diarrhea (possibly with fever), colic, dehydration, endotoxic shock and death, to a chronic condition manifested by mild intermittent colic up to several months in duration, and weight loss with or without mild diarrhea. In a large percentage of the horses, those affected had been hypovolemic and received nonsteroidal anti-inflammatory drugs (NSAID) or had received inappropriately high doses of phenylbutazone before the onset of illness. Experimental treatment of two horses with high doses of a phenylbutazone oral paste preparation (6 gm once daily for 5 days) and limitation of their water intake to approximately one half of maintenance requirement (for 5 days) resulted in reproduction of ulcerative colitis involving only the right dorsal colon, which was apparent at necropsy examination 11 and 15 days after initiation of drug use. It was concluded that localized ulcerative lesions in the right dorsal colon may be a previously unreported manifestation of toxicity due to the administration of NSAID.