Farm level bio-economic modelling of aquatic animal disease and health interventions.

A farm level bio-economic model, for aquatic animal production, of the relationships between inputs (e.g. purchased animals), outputs (e.g. harvested animals) and gross margin (GM) was developed to assess ex-ante the economics of disease and animal health interventions. Feed costs were calculated from estimates of food conversion ratio (FCR), animals harvested and mortality. The model was applied to a typical grow-out rainbow trout (Oncorhynchus mykiss) farm on Lake Titicaca, Peru and a typical shrimp (Paenus vannamei) farm in the Mekong Delta, Vietnam. The model was used in two analyses. Firstly, an approach to assess the burden of disease developed by the Global Burden of Animal Diseases (GBADs) project was adopted. Output under conditions of 'ideal health' was estimated by reducing mortality to zero and removing health costs. GM in both systems increased by approximately 25% when production was kept constant (and stocking rates reduced) and more than doubled if production was allowed to rise (and initial stocking increased). The increase in GM under conditions of ideal compared with current production provided an estimate of the maximum possible benefit from improved health management. Secondly, break-even analysis was used to assess the economics of vaccination against infectious pancreatic necrosis (IPN) vaccine (rainbow trout - RBT) and probiotics (shrimp). If initial stocking was kept constant, and production allowed to rise, break-even points for the intervention (when GM was the same with and without the intervention) were achieved when mortality was reduced by 16% in RBT fry and juvenile and 28% in shrimp. If production was kept constant and benefit realised by reduced initial stocking, the break-even point was achieved for i) vaccination of RBT when mortality in fry and juveniles was reduced by 39%, and ii) probiotics in shrimp production when there was a 15% reduction in mortality (nursery and grow-out), 10% increase in shrimp weight at harvest and 10% improvement in FCR. The results demonstrate how relatively simple models, parameterised with basic farm production data, can assess the burden of disease and quantify ex-ante the potential benefit of interventions. In the absence of trial data, these analyses support decision-making by farmers. The models can be adapted for many aquaculture systems. Farm level results can be extrapolated to estimate disease burden, and benefits of interventions, at regional or national level and thus support informed decision-making and allocation of resources to health management.

IL-1-dependent electrophysiological changes and cardiac neural remodeling in a mouse model of Kawasaki disease vasculitis.

Kawasaki disease (KD) is the leading cause of acquired heart disease in children. In addition to coronary artery abnormalities, aneurysms and myocarditis, acute KD is also associated with echocardiogram (ECG) abnormalities in 40-80% of patients. Here, we show that these ECG changes are recapitulated in the Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis mouse model. LCWE-injected mice developed elevated heart rate and decreased R wave amplitude, with significant differences in prolonged ventricular repolarization. LCWE-injected mice developed cardiac ganglion inflammation, that may affect the impulse-conducting system in the myocardium. Furthermore, serum nerve growth factor (NGF) was significantly elevated in LCWE-injected mice, similar to children with KD vasculitis, associated with increased neural remodeling of the myocardium. ECG abnormalities were prevented by blocking interleukin (IL)-1 signaling with anakinra, and the increase in serum NGF and cardiac neural remodeling were similarly blocked in Il1r1-/- mice and in wild-type mice treated with anakinra. Thus, similar to clinical KD, the LCWE-induced KD vasculitis mouse model also exhibits electrophysiological abnormalities and cardiac neuronal remodeling, and these changes can be prevented by blocking IL-1 signaling. These data support the acceleration of anti-IL-1 therapy trials to benefit KD patients.

More harm than good? The anatomy of misguided shielding of the ovaries.

OBJECTIVE: Popular gonad shield designs aim to provide coverage of the true pelvis, which is presumed to be the probable location of the ovaries. Shields are frequently placed inaccurately, especially in children, obscuring important orthopaedic landmarks on pelvic radiographs. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. METHODS: Using MRI examinations of the pelvis in women and children, we located 594 ovaries in 306 female patients aged from birth to 59 years. RESULTS: This study provides new evidence that bladder filling affects ovary position. A lower than expected number of patients had both ovaries within the pelvis if the bladder contained more than a moderate volume of urine. Bladder emptying should be achieved wherever practical if a shield is used. In children under the age of 7 years, more than half (19/37) had at least one ovary outside the true pelvis. There was a significant association between age and ovary position, with the percentage of patients with one or both ovaries outside the true pelvis decreasing with age (χ(2), p<0.0001). CONCLUSION: The embryological descent of the ovaries into the pelvis would appear to continue after birth, well into childhood. Current popular shield designs are therefore inappropriate for use in young children. Given the high risk of obscuring critical landmarks, coupled with the new evidence that even accurate placement will not necessarily protect the ovaries, the use of pelvic shields in girls should be reconsidered.

Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: a computed tomography-based study and literature review of Innominate Artery Compression Syndrome.

Respiratory compromise due to tracheal compression by the brachiocephalic trunk (BT), a condition first labeled as Innominate Artery Compression Syndrome (IACS), has been controversially attributed to an anomalous origin of this vessel to the left of, and hence crossing, the trachea. The aim of this study was to establish the normal relationship between the BT and trachea in infants, children, and young adults without obstructive respiratory symptoms. One hundred and eighty-one computed tomography (CT) examinations of the thorax, in three age groups, were reviewed. In axial cross section, the origin of the BT from the aortic arch was identified. The BT origin, with respect to the trachea, was recorded as for a clock face, approximated to the nearest half hour. There were 62 CTs in Group 1 (1 day to 3 years of age), 48 CTs in Group 2 (10-15 years), and 71 examinations in Group 3 (20-40 years). In 96.8% of Group 1, 91.7% of Group 2, and 74.6% of Group 3 the BT origin was to the left of the trachea, between the half past twelve and 3 o'clock positions. The BT origin occurred more the left in Group 1 when compared with the other two groups (P < 0.001). An origin of the BT to the left of the trachea is a normal finding in children and young adults without obstructive respiratory symptoms. There is a tendency for the origin to become progressively more rightward with age.

The toddler refusing to weight-bear: a revised imaging guide from a case series.

BACKGROUND: The previously mobile child who refuses to walk or weight-bear is a common presentation to the accident and emergency department, for which there are a number of causes. One uncommon cause is discitis, an inflammatory process of the intervertebral disc, which is easily diagnosed with spinal magnetic resonance imaging (MRI). A case series of three patients is presented of non-weight-bearing children in whom there was a delay in making the diagnosis of lumbosacral discitis. None presented with back pain, spinal symptoms or abnormal neurological findings, and a full range of movement of both hips was found. METHODS: All patients underwent conventional radiography and ultrasound, but diagnoses were made on spinal MRI, with two patients undergoing bone scintigraphy before this. RESULTS: The mean delay was 15.6 days (range 13-20) from presentation at the hospital to MRI. All three patients made a good clinical recovery with intravenous antibiotics. CONCLUSION: These cases are presented in order to heighten the awareness of this disease entity and its imaging findings, and suggest new guidelines for the appropriate radiological investigations in this clinical setting.

Olpadronate prevents the bone loss induced by cyclosporine in the rat.

The aim of the present in vivo experimental study was to investigate changes in bone turnover and bone mineral density (BMD) induced by cyclosporine (CsA) administration. The effectiveness of olpadronate (OPD) in preventing bone loss associated with CsA treatment was also evaluated. Forty male Sprague-Dawley rats (approximately 5 months old) were treated as follows: Group I: CsA+OPD vehicles (control); Group II: CsA 15 mg/kg + OPD vehicle; Group III: CsA 15 mg/kg + 4 ug OPD/100g rat; Group IV: CsA 15 mg/kg + 8 ug OPD/100g rat; Group V: CsA 15 mg/kg + 16 ug OPD/100g rat. CsA was administered by daily oral gavage and OPD by intraperitoneal injection once a week. Serum bone-alkaline phosphatase (b-ALP) and urinary deoxypyridinoline (DPyr) were measured on days 0, 14 and 30. Total skeleton, femur, lumbar spine, proximal, and middle tibia BMDs were measured on days 0 and 30. No significant differences were found between the CsA and the control groups as regards serum bALP levels, on days 14 and 30. CsA+OPD treated rats presented a transient increment in serum b-ALP on day 14 and a significantly lower level on day 30 compared to the control and CsA groups (P < 0.05). On days 14 and 30, DPyr excretion increased in the CsA group compared to control animals (P < 0.05). The three studied doses of OPD induced a significant decrease in DPyr excretion in the CsA group on days 14 and 30 (P < 0.05). Group V (receiving the highest dose of OPD) presented a significantly lower level of DPyr compared to the other two OPD-treated groups (P < 0.05). On day 30, the CsA group presented a significant reduction in proximal tibia, spine and whole femur BMDs (P < 0.05) compared to controls. On day 30, OPD treatment increased BMD of all the studied areas in CsA rats. Proximal tibia BMD of group V reached significantly higher values than the other studied OPD groups (P < 0.05). In summary, this study suggests that CsA-induced high bone resorption and trabecular bone loss is prevented by cotreatment with OPD. Moreover, it encourages the possible use of OPD to treat patients receiving CsA as immunosuppressive therapy.

Estudio multicéntrico de la eficacia y seguridad de amoxicilina/sulbactam en niños con otitis media aguda / Multicentric study of the amoxicillin/sulbactam effectiveness and safety in children with acute otitis media

Introducción. La otitis media aguda (OMA) es una de las principales causas de enfermedad en la infancia, y el motivo más común de visita al médico durante los primeros dos años de vida, después de las enfermedades virales de las vías respiratorias superiores. Los gérmenes causales de OMA pueden ser resistentes a los antibióticos utilizados para combatir esta enfermedad; es por ello que surge la necesidad de buscar nuevas alternativas terapéuticas. Material y métodos. Del 1 de agosto al 31 de octubre de 1999, en el Centro Médico Nacional (CMN) "20 de Noviembre" del ISSSTE, el Instituto Nacional de Pediatría (INP) de la Secretaría de Salud y el CMN "La Raza" del IMSS, de la ciudad de México, se realizó un estudio prospectivo en un grupo de 53 niños, de entre tres meses y seis años de edad, cuyo peso era menor de 25 kilogramos. En la primera visita se practicó examen clínico, otoscopia, cultivo de secreción ótica, y se les administró amoxicilina/sulbactam (Trifamox IBL 500) a dosis de 50 mg/kg/día cada 12 horas durante diez días. Posteriormente, se practicó nueva evaluación clínica en los días 1, 3, 10 y 40 después de iniciar el tratamiento para evaluar el cumplimiento, los efectos adversos y la eficacia del antibiótico. Resultados. De los 53 niños estudiados, 27 fueron del sexo femenino y 26 del masculino, con una edad promedio de 34.3 meses, un peso promedio de 14.9 kg y un error estándar de 1.1. Todos cumplieron con el tratamiento. A 30 niños se les practicó miringotomía con toma de secreción ótica, y los microorganismos aislados fueron: Streptococcus pneumoniae 36.7 por ciento (11/30), Haemophilus influenzae 33.3 por ciento (10/30), Staphylococcus aureus 3.3 por ciento (1/30), Staphylococcus epidermidis 3.3 por ciento (1/30), Klebsiella oxytoca 3.3 por ciento (1/30) y ninguno en 20.1 por ciento (6/30). Los efectos adversos fueron: ninguno en 18.9 por ciento (10/53), diarrea 13.2 por ciento (7/53), náusea 5.7 por ciento (3/53), rash 3.8 por ciento (2/53), dolor abdominal 1.9 por ciento (1/53), caída del cabello 1.9 por ciento (1/53) y dolor ocular en 1.9 por ciento (1/53). Se observó curación clínica en 98.1 por ciento de los niños.Conclusiones. La administración de amoxicilina/sulbactam como antibiótico es eficaz y segura en los niños que padecen OMA.

[Pigment dispersion syndrome in a patient with megalocornea]. / Slndrome de dispersión pigmentaria en paciente con megalocórnea.

CASE REPORT: A case of a patient of 12 years old with megalocornea and bilateral pigment dispersion syndrome is reported. An ultrasound biomicroscopic study was performed with the UBM 840 (Zeiss-Humphrey, 50 MHz) and an iris concavity with an iridolenticular and iridozonular contact was observed. A new exam after pilocarpine instillation drops showed the resolution of the iris concavity, zonular and lenticular contact. DISCUSSION: The anterior chamber configuration of this patient analyzed with ultrasound biomicroscopy allowed us to understand the mechanism of the pigment dispersion syndrome.

Bioavailability of two oral formulations of cyclosporin A in uremic children before renal transplantation.

The bioavailability of two oral formulations of cyclosporin A (Sandimmun and Neoral) was assessed in 10 children with end-stage renal disease (ESRD), while at a steady state on a dialytic procedure. The study was performed according to a randomized, double blind, cross-over design, allowing a 1-month washout period between studies. Each patient received 2.5 mg/microg of oral cyclosporin A every 12 h, either Sandimmun (SAN) or Neoral (NEO). Serum concentrations of cyclosporin A were determined serially during a 24 h period, after the 5th dose of cylosporin. Serum concentrations against time curves were constructed and bioavailability of both medications, expressed as AUC and Cmax, were compared. A statistically significant increase was observed in the AUC and Cmax of NEO, which were 90% and 130% higher, respectively, than those of SAN. Considering that the internationally accepted criteria for bioequivalence allows a 20% variation in AUC and Cmax, it appears that Neoral and Sandimmun do not bear bioequivalence in children with ESRD. Notwithstanding, there were no significant differences in trough levels between both formulations. We conclude that, if trough levels are the only source of information for dosing design, Neoral could be substituted for Sandimmun on a 1:1 basis. However, a 1:1 drug substitution is not suitable when AUC is used in children with ESRD.

[Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis]. / Nefrostomía percutánea asociada a litotricia extracorpórea por ondas de choque en el tratamiento de la litiasis renoureteral.

From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

Self-entwinement of an active fixation pacemaker electrode.

We report a case in which an active fixation atrial lead tip became entwined on the proximal lead body during implantation. It was not possible to disengage the tip or to remove the resultant lead loop atraumatically through the insertion site. Removal of the lead was accomplished using a Dotter intravascular snare inserted via a femoral vein, with subsequent successful implantation of a new lead. This unusual technique-related complication emphasizes the need for meticulous fluoroscopic visualization during lead manipulation.

Nerve-entrapment syndromes from lower abdominal surgery.

Patients with a complaint of lower abdominal pain and a history of lower abdominal surgery, particularly inguinal herniorrhaphy, appendectomy, and procedures incorporating a Pfannenstiel incision, should have nerve entrapment considered in the differential diagnosis. Careful history and physical examination in conjunction with selected use of the ilioinguinal-iliohypogastric nerve block can confirm the diagnosis of nerve entrapment and preclude an unnecessary workup of these patients. Of the patients with nerve entrapment, most will experience complete relief of symptoms following serial injections and require no further treatment. The remainder will experience only temporary relief and require surgical interruption of the nerve involved. In those patients who obtain no relief from the nerve block, further workup for a source of their pain is warranted. Most of these patients were found to have a subclinical recurrence of an inguinal hernia.

Nerve entrapment after Pfannenstiel incision.

In a 16-month period, nine cases of iliohypogastric nerve entrapment were diagnosed in patients who had undergone a Pfannenstiel incision. Three patients experienced total relief with nerve blocks alone; four patients required surgical interruption of the iliohypogastric nerve to attain total relief; two patients received significant symptomatic relief with injection and desired no further treatment. The presentation, diagnosis, treatment, and prevention of entrapment of the iliohypogastric nerve as a complication of the Pfannenstiel incision are presented and discussed.

Changes in the manufacture of expanded microporous polytetrafluoroethylene: effects on patency and histological behavior when used to replace the superior vena cava.

Polytetrafluoroethylene (PTFE) has been used clinically and experimentally as a vein substitute. Since its introduction, changes have been made in the manufacture of the material. This study was designed to evaluate the effects of pore size (fibril length), PTFE cover, and spiral tube support on long-term patency and histological behavior when this material is used as a replacement for the precava in the dog. A graft of 30-mu pore size has adequate fibroblastic ingrowth, a neointima of 200 mu or less, and the best long-term patency. The PTFE cover results in less fibroblastic involvement of the prosthetic graft and prevents late occlusion caused by transmural fibrosis in the 90-mu graft. The spiral support does not affect patency and may be indicated when external pressure on the tube must be avoided.

Preferred surgical treatment for alveolar cell carcinoma.

An analysis of our experience with 48 patients having bronchiolar or alveolar cell carcinoma is reported. The remarkable biological variability of this peripheral tumor has important surgical implications. Basically, two dominant clinical presentations occur. In the less common diffuse or multinodular form, prolonged survival is infrequent regardless of the therapeutic approach. Often these patients die from respiratory compromise due to the tumor itself. In the more common localized or solitary form the prognosis for cure is good, approximating 47% or higher. Based on the material presented, lobectomy is the preferred method of surgical treatment. In patients manifesting multinodular disease, surgical resection rarely seems warranted. The concept of preserving pulmonary tissue is stressed.

Plasmacytoma arising in a pacemaker pocket.

A 48-year-old man developed a plasmacytoma in the subcutaneous pocket of a titanium covered pulse generator that had been inserted sixteen months previously. The tumor represented a cutaneous manifestation of myelomatosis. The presence of a pacemaker may affect the detection and treatment of tumors arising in the region of pulse generator pockets. Possible cause-and-effect relationships are explored.