Dynamics of culling risk with disposal codes reported by Dairy Herd Improvement dairy herds.

The objective was to describe the dynamics of culling risk with disposal codes for Holstein dairy cows reported by herds enrolled in the Dairy Herd Improvement program. Dairy producers could report 1 of 9 possible disposal codes or forego reporting a code. After edits, 3,629,002 lactation records were available for cows calving between 2001 and 2006 in 2,054 herds located in 38 states primarily east of the Mississippi river. The distribution of culled cows by disposal code was estimated by parity, days after calving, pregnancy status, cow-relative 305-d mature equivalent milk yield, herd-relative 305-d mature equivalent milk yield, and season. Of all herds, 57% reported all 8 different disposal codes excluding the codes dairy purposes and reason not reported. Hazard (risk) functions were calculated by parity, from 1 to 520 d since calving for open cows and from 1 to 280 d since conception for pregnant cows. Annualized live culling rate and death rate (reported code was death) were 25.1 and 6.6%, respectively. The primary disposal code was died (20.6% of all culling), followed by reproduction (17.7%), injury/other (14.3%), and low production and mastitis (both 12.1%). The risk of culling with various disposal codes varied with stage of lactation. Died and reproduction were the most frequently reported codes for cows leaving the herd during early and late lactation, respectively. Early lactation was also a critical period for culling with the disposal codes injury/other and disease, and the risk increased with days after calving for the codes low production and reproduction. The risk of culling with the disposal code died showed the greatest seasonal pattern with increased risk of death in spring and summer. A negative association was found between annualized live culling and death rates within herds. Compared with open cows, pregnant cows had a lower risk of culling with all reported disposal codes. In addition, the risk of culling was lower in high-producing cows with all disposal codes. In conclusion, the risk for culling by disposal code varied by parity, stage of lactation, season, pregnancy status, and milk yield.

Maternal and neonatal lipopolysaccharide and Fas responses are altered by antenatal risk factors for sepsis.

The diagnosis of neonatal sepsis is difficult, resulting in unnecessary treatment to minimize morbidity and mortality. We hypothesized that exposure to antenatal risk factors for sepsis alters the perinatal neutrophil phenotype. The study setting was a tertiary referral university-affiliated maternity and neonatal hospital. Neutrophils from adults, normal neonates, neonates with antenatal sepsis risk factors and their respective maternal samples were incubated alone, with agonistic Fas antibody or with lipopolysaccharide (LPS). Surface receptor CD11b expression and the percentage apoptosis (persistent inflammatory response) were assessed using flow cytometry. Both mothers and asymptomatic neonates exposed to maternal sepsis risk factors had increased spontaneous neutrophil apoptosis compared to their respective controls. Infants with sepsis were LPS and Fas hyporesponsive. Maternal neutrophils had a delay in apoptosis in all groups with enhanced LPS and Fas responses associated with neonatal sepsis. CD11b expression was not altered significantly between groups. Maternal neutrophil function is altered in neonatal sepsis and may have a diagnostic role. Neonatal sepsis was associated with LPS hyporesponsiveness, potentially increasing susceptibility to infection.

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection).

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection) is a rare condition first described in 1998. It describes the presence of obsessive-compulsive disorder (OCD) or tics with an episodic course, and a temporal relationship to Group A beta haemolytic streptococcal infection (GABHS). Recurrent episodes can be disruptive and upsetting for a child, but the best way to treat the condition has yet to be established. Penicillin prophylaxis has not proved effective, and other therapies are experimental. There is some evidence in the literature to support the role of tonsillectomy in improving the condition. We report a case of a 6-year-old boy who presented with tic and hemi-chorea associated with GABHS throat infection. He had a recurrence of his symptoms associated with a further GABHS infection, but has had no further symptoms following tonsillectomy. This case report lends further evidence to the role of tonsillectomy in the management of PANDAS.

Rapid-onset dystonia-parkinsonism: a clinical and genetic analysis of a new kindred.

BACKGROUND: Rapid-onset dystonia-parkinsonism (RDP) is an autosomal dominant disorder linked to chromosome 19q13 that is characterized by sudden onset of primarily bulbar and upper limb dystonia with parkinsonism. METHODS: The authors evaluated 12 individuals from three generations of an Irish family and obtained detailed medical records on a deceased member. The authors describe the clinical, psychiatric, and genetic features of the affected individuals. RESULTS: Five of eight affected members developed sudden-onset (several hours to days) dystonia with postural instability. Four of the five also had bulbar symptoms. Two have stable focal or segmental limb dystonia. One has intermittent hemidystonia with dysarthria that comes on abruptly in times of stress or anxiety. Three had a history of profound difficulty socializing, and at presentation two developed depression. Three patients had a trial of dopamine agonists without benefit. Genetic analysis suggests linkage to chromosome 19 with lod score of 2.1 at zero recombination. CONCLUSION: This is the third reported family with chromosome 19q13 rapid-onset dystonia-parkinsonism. Psychiatric morbidity appeared common in affected members of this family and may be part of the RDP phenotype.

Hemoptysis in patients with septic pulmonary infarcts from tricuspid endocarditis.

Three drug addicts with tricuspid valve endocarditis and pulmonary cavitation secondary to septic pulmonary infarcts developed massive hemoptysis. Two patients died of asphyxia and one survived. Both who died were improving clinically and had negative blood cultures when the fatal hemoptysis occurred. Therefore, however slight it may be, hemoptysis occurring in association with septic pulmonary infarcts associated with endocarditis may require prompt and aggressive measures.

Antimicrobial activity of antituberculosis agents against anaerobic bacteria.

Anaerobic infections may coexist with tuberculosis, and can be mistaken for one another. The effect of therapy with antituberculosis chemotherapeutic agents against anaerobic bacteria (with the exception of rifampin) is unknown. We therefore examined the in vitro efficacy of certain commonly used antituberculosis agents (rifampin, isoniazid, and ethambutol) against 370 strains of anaerobic bacteria, including 86 isolates of Bacteroides fragilis. Rifampin at a concentration of 2 microgram/ml inhibited 91 percent of all anaerobic isolates. Both ethambutol and isoniazid were totally ineffective against any of the anaerobes tested, even at 64 microgram/ml. Therapy with rifampin in an unsuspected anaerobic infection can be misdiagnosed for tuberculosis. Therefore, when tuberculosis is suspected, isoniazid and ethambutol can be used and rifampin withheld until the acid-fast bacilli are demonstrated by additional diagnostic procedures, such as transtracheal aspiration.

Administration in ambulatory care.

Deficiencies in management of U.S. Department of Veterans Affairs (USDVA) ambulatory care programs have been documented in the literature and were reaffirmed by conference participants. These represent significant barriers to developing an effective and efficient system of outpatient health care delivery for veterans and to expanding educational opportunities for trainees. Based on impact and feasibility rankings from the symposium, review of the literature, and the personal experiences of USDVA ambulatory care managers, several recommendations emerged: (1) implement a system of matrix management; (2) invest in a leader; (3) develop "user-friendly" management information systems; (4) utilize existing resources efficiently; (5) embrace quality assurance; and (6) improve support from clerical and diagnostic services, nursing, and pharmacy personnel. Although intervention from leadership at the level of the USDVA Central Office will be necessary, many of these recommendations can be adopted by managers at the local facilities. The biggest challenge is to change the attitudes of clinical and support staff whose responsibilities have traditionally been inpatient-oriented.

Cerebral tuberculomas in Northern Ireland.

Two children presenting with very different clinical pictures were both found to have intracranial tuberculomas. This condition, although rare in developed countries, should be suspected in any child with enhancing cerebral lesions or cranial computed tomography.

Rapid onset dystonia-parkinsonism in a 14-year-old girl.

A painful dystonia of rapid onset and associated parkinsonian features is described in a girl aged 14 years. The condition is refractory to treatment and has led to severe neurological disability. Her father had presented with a similar picture.

Oviposition behavior of Aedes triseriatus (Diptera: Culicidae): prevalence, intensity, and aggregation of eggs in oviposition traps.

The oviposition behavior of the treehole mosquito Aedes triseriatus (Say) was studied by counting the eggs laid in 300 oviposition traps weekly for one season (May-October) in Illinois. Eggs were aggregated spatially among traps each week, and temporally among weekly samples and for individual traps over weekly counts. Aggregation could be associated with a nonrandom dispersion pattern of oviposition events and with the oviposition of 20-60 eggs per event. Thus, females were laying clumps of eggs in an overdispersed manner. The greatest number of eggs was found in late July when prevalence (proportion of traps with eggs) and intensity (number of eggs per positive trap) peaked simultaneously. Intensity also peaked in May and prevalence peaked in mid-June and early September. When traps from which eggs were removed each week were compared with traps in which eggs were allowed to accumulate, prevalence was naturally higher in the latter group. However, the intensity of eggs was similar in both groups, indicating that more eggs were laid in traps from which eggs were removed. Thus, the presence of eggs on oviposition surfaces was associated with a decrease in further oviposition.

Retrospective study of late febrile seizures.

This retrospective study documents the clinical features, electroencephalographic data, and outcome of 50 children with a history of seizures with fever that occurred after 5 years of age. Children with afebrile seizures before the onset of febrile seizures were excluded. Outcome was based on a cross-sectional survey and the follow-up period was 1-13 years. Of the 50 children, 40 had two or fewer febrile seizures after 5 years of age, and febrile seizures did not occur after 10 years of age. Twenty had complex febrile seizures, and 16 had a first-degree relative with febrile seizures. Five developed afebrile seizures, and 18 had educational difficulties. Epileptiform electroencephalographic abnormalities were observed in 22 but were not predictive of later afebrile seizures. Febrile seizures that occur after 5 years of age recur infrequently and cease by 10 years of age. The risk of developing afebrile seizures in this group is small.

Effect of lameness on the calving-to-conception interval in dairy cows.

OBJECTIVE: To examine the relationship between lameness and the duration of the interval from calving to subsequent conception in lactating dairy cows. DESIGN: Cohort study. ANIMALS: 837 dairy cows. PROCEDURE: Cows affected with lameness were classified into 1 of 4 groups on the basis of types of disease or lesions observed, including foot rot, papillomatous digital dermatitis, claw lesions, or multiple lesions. Cows not affected with lameness were classified as healthy. Time from calving to conception was compared between lame cows and healthy cows. RESULTS: 254 (30%) cows were affected with lameness during lactation. Most lame cows (59%) had claw lesions. Lame cows with claw lesions were 0.52 times as likely to conceive as healthy cows. Median time to conception was 40 days longer in lame cows with claw lesions, compared with healthy cows. Number of breedings per conception for lame cows with claw lesions was significantly higher than that for healthy cows. CONCLUSION AND CLINICAL RELEVANCE: Claw lesions were the most important cause of lameness, impairing reproductive performance in dairy cows, as indicated by a higher incidence of affected cows and a greater time from calving to conception and a higher number of breedings required per conception, compared with healthy cows.

Follicular atrophoderma in association with congenital pseudarthrosis of the tibia.

Follicular atrophoderma has always been associated with other congenital malformations including, Conradi-Hünermann syndrome, Bazex's syndrome and keratosis palmaris et plantaris dissipata. Congenital pseudarthrosis of the tibia has usually been associated with neurofibromatosis. We report a case of follicular atrophoderma in association with congenital pseudarthrosis of the tibia: a previously unreported association with, in our case, a good outcome for the pseudarthrosis.

A new method for monitoring mosquito oviposition in artificial and natural containers.

A new method is described for the direct measurement of Aedes albopictus, Ae. atropalpus, Ae. triseriatus and Orthopodomyia signifera oviposition in artificial and natural containers. Seed germination papers were mounted on the insides of can-traps, tree holes and discarded tires to obtain a direct measure of mosquito oviposition. This durable paper substrate was removed weekly while minimizing the disruption of the oviposition habitat. After the germination papers were dried, the aforementioned mosquito eggs were hatched successfully and reared in the laboratory through the adult stage.

Penetration rate of two pesticide carriers at a large used-tire storage facility in Chicago, Illinois.

During August 1987, a large and concentrated infestation of Aedes albopictus was discovered on the property of a tire recapper and gasket manufacturer in Chicago, IL, in a densely populated urban environment. The infestation called for special abatement procedures because of the large number of tires and the varied ways they were stacked. An effective method for delivering pesticides into the cavity of each tire is described. Corncob granules, when applied to stacked tires, effectively penetrated this larval habitat at rates of 85% in column-stacked piles, 93% in random-stacked piles and an average of 95% in shingle-stacked piles. By comparison, gypsum pellet carriers sustained penetration rates of 37% in shingle-stacked piles and 87% in random-stacked piles.

Audit of the management of convulsive status epilepticus in children: the need for a uniform treatment strategy.

We conducted a two-year prospective audit to review the paediatric management of Convulsive Status Epilepticus (CSE) in Ireland. Our audit showed that there is considerable variability in the management of CSE in this country. In order to provide optimum care for this potentially life-threatening condition a uniform management strategy is required. We propose a protocol for the treatment of CSE, which should ensure uniform management and optimum care and also provide a template for further study and audit of this important disorder.