Imagine that: cholinesterase inhibitor treatment of complex visual hallucinations of unknown aetiology.

Introduction: Our objective is to highlight the value of the neurophenomenological classification of complex visual hallucinations (VHs). This approach enabled the authors to successfully treat VHs of uncertain aetiology with cholinesterase inhibitors because the content of the hallucinations suggested dysfunction in cholinergic modulated networks.Methods: We utilise the single case report to describe the nature and content of chronic VHs experienced by a 49-year-old woman following a prolonged admission to ITU. Despite extensive investigation, no clear cause was identified for these hallucinations and the patient did not respond to rationalisation of medications or trials of antipsychotics. We therefore adopted the neurophenomenological approach to classifying and treating her VHs.Results: After several years of distressing visual hallucinations, a course of Rivastigmine was trialed despite no evidence suggestive of a Parkinsonian syndrome. Nevertheless, the patient reported a dose-effect response with significant reduction in the frequency and intensity of her hallucinations, almost to complete resolution.Conclusions: At present there is limited evidence about the medical management of visual hallucinations. This case report suggests that cholinesterase inhibitors may be of benefit, even in the absence of clear parkinsonsian features, if the form and content of the VHs suggest dysfunction in cholinergic modulated attentional networks.

Influence of sumac (Rhus Coriaria L.) and ginger (Zingiber officinale) on egg yolk fatty acid, cholesterol and blood parameters in laying hens.

The aim of the study was to evaluate the potential effect of different levels of sumac (Rhus coriaria L.) seed powder and ginger (Zingiber officinale) root powder on egg yolk fatty acid composition, blood/yolk cholesterol in laying hen. A total of 63 (ATAK-S: Domestic Turkish Laying Hens) laying hens (average weight: 1470 g each hen, 25-weeks of age) were assigned to seven treatment diets including sumac seed (S) and ginger root powder (G) at 0 g/kg (control), 10 g/kg (S1), 20 g/kg (S2), and 30 g/kg (S3); 10 g/kg (G1), 20 g/kg (G2), or 30 g/kg in rations respectively, for 8 weeks. After a two-week adaptation period to cages, the hens were allocated to 7 groups with 9 replicates of 1 hen in per cage each. The replications were allotted equally into the upper and lower cages to minimize the effects of cage level. In this study, egg yolk cholesterol had a decrease (p <0.05) in supplemented diet( sumac seed and ginger root powder). Fatty acid content in yolk; saturated fatty acid, monounsaturated fatty acids, polyunsaturated fatty acids and rate of n6/n3 were not significant (p <0.05). However, dietary supplementation with sumac and ginger powder reduced and yolk/blood cholesterol concentrations in laying hens. Supplementation of sumac and ginger affected on HDL, there was found a significant effect (p < 0.05) in treatment groups. Moreover, LDL positively decreased in all treatment groups compared with the control group. The findings of this study suggested that feeding sumac and ginger tend to be decreasing cholesterol levels in both yolk and blood on laying hens. It can be concluded that ginger root and sumac seed powder can be used as an effective feed additive to improve fatty acid composition and yolk and blood cholesterol in ATAK-S laying hens.

Fetal assessment for anesthesiologists: are you evaluating the other patient?

Suboptimal communication between anesthesiologists and obstetricians can be associated with unintended poor maternal and neonatal outcomes, especially for emergency cesarean deliveries. Obstetricians use the results of antepartum and intrapartum fetal assessments to assess fetal well-being and to make decisions about the timing and method of delivery. Because abnormal results may lead to the need for urgent or emergency cesarean deliveries, these decisions may directly impact anesthetic care. Lack of familiarity with fetal assessments and the significance of the results may thus hinder the communication necessary for optimal patient care. In this review article, we discuss the current antepartum and intrapartum fetal assessment modalities, including the nonstress test, biophysical profile, Doppler velocimetry, electronic fetal heart rate monitoring, fetal electrocardiogram (STAN-ST waveform analysis), and fetal pulse oximetry. The physiologic basis behind these modalities and the available evidence regarding their utility in clinical practice are also reviewed. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring categories, which are incorporated into the American College of Obstetricians and Gynecologists guidelines for intrapartum care, is examined. The implications of test interpretation to the practice of obstetric anesthesiology is also discussed. Anesthesia provider understanding of fetal assessment modalities is essential in improving communication with obstetricians and improving the planning of cesarean deliveries for high-risk obstetric patients.

Experimental copper poisoning in the camel (Camelus dromedarius).

Copper sulphate was administered by the oral or intravenous route to five dromedary camels. Two camels (1 and 2) receiving copper sulphate at 200 mg per kg per day by drench died within 8 days and camel 3, receiving 100 mg per kg per day by the same route, was slaughtered on day 172. Intravenous injection of 2 mg per kg per day caused the death of camel 4 on day 95 and camel 5, treated similarly, was slaughtered on day 138. Anorexia, dullness, diarrhoea, dehydration and recumbency in camels 1 and 2 were probably clinical signs of copper toxicity. Camels 3, 4 and 5 lost weight. Jaundice was not a prominent clinical sign. The main lesions in camels 1 and 2 were fatty change and necrosis of the liver cells, dilatation and necrosis of kidney tubules, catarrhal abomasitis, enteritis and congestion of the blood vessels of the heart. In camels 3, 4 and 5 the hepatic lesions were mild, with leucocytic infiltration and gastrointestinal and heart lesions were either mild (camel 3) or absent (camels 4 and 5). Cytoplasmic copper granules in hepatic cells were generalized in distribution but more concentrated in the centrilobular zone. In the kidney these granules were confined to the cells of the proximal convoluted tubules. Copper accumulated in the liver and kidneys of all the camels and zinc accumulated in the liver and kidneys of those receiving copper sulphate intravenously. Macrocytic hypochromic anaemia developed in camels 3, 4 and 5 and haemoconcentration in camels 1 and 2. The concentration of serum copper, zinc and iron increased in animals 1, 2 and 4, and unbound iron binding capacity decreased in four camels. There was a rise in the activity of gamma GT, GOT, LDH and CPK in the serum of all the animals. Serum ALP activity, however, increased in camels 1 and 2 and decreased in camels 3, 4 and 5.

Mineral content of milk, colostrum, and serum as affected by physiological state and mineral supplementation.

A 22-mo experiment was conducted to determine effects of mineral supplementation of cows on mineral elements in milk, colostrum, and blood serum. Purebred Brahman beef cows grazing pastures grown on sandy and well-drained soils were allotted to three treatments of 12 cows each as follows: control, a complete commercial mineral mixture, control plus dietary and injected Se, and control plus fortified mineral mixture. Milk and serum were analyzed for minerals 2 consecutive yr at parturition and 3 mo postpartum. Mean cow serum, Ca, Mg, P, and packed cell volume values were higher at parturition than 3 mo later, whereas serum Cu was highest at 3 mo. Mean serum concentrations were affected by year with higher Ca and hemoglobin and lower Cu concentrations in 1982 than in 1981. Increasing dietary Se resulted in higher serum Se. Colostrum was higher in Mg, P, Cu, Fe, Se, and Zn than milk, whereas milk was higher than colostrum in Mn. Means for treatment X time showed cows fed dietary and dietary plus injected Se and vitamin E had more Se in milk than milk from cows fed no supplemental Se.

Mineral status of grazing beef cattle in the warm climate region of Florida.

An experiment was conducted to determine the mineral status of purebred Brahman beef cattle grazing Bermuda--Bahia pastures grown on sandy, well-drained soils in Central Florida. Soil, plant, blood serum and liver tissue concentrations of calcium, potassium, sodium, magnesium, manganese and cobalt were generally adequate. Sixty-nine per cent of forages and 40% of serum samples were deficient in phosphorus. Seventy-five per cent of soils, 38% of forages and 18% of liver samples were deficient in copper. Sixty-nine per cent of forage samples were low, less than 30 ppm, in iron. All samples of forage, liver and serum were deficient in selenium. Likewise, all soil and forage samples and 47 and 88% of serum and liver samples, respectively, were deficient in zinc. Mineral elements most likely deficient and needed in supplements for grazing cattle on sandy, well-drained soils in the warm climate region of Central Florida are phosphorus, copper, selenium and zinc.