A time-series assessment of the productive and reproductive performance of Balochi sheep.

This study was carried out to find the environmental factors which have a significant effect on the productive and reproductive characteristics of the Balochi sheep. The study used data from 729 ewes and 71 rams for a period of 13 years (2003 to 2016) at the Sheep Research Center, Yet Abad, Balochistan, Pakistan. The productive characteristics considered for current study were weight, birth weight (BW), 90 days weight (3 MW), 180 days weight (6 MW), 270 days weight (9 MW), 365 days (12 MW), and 2 years weight (24 MW). Reproductive characteristics measured were ewe age at first service (AFS), service period (SP) of ewe, age at 1st lambing (AFL) of ewe, lambing interval (LI), and sex ratio. Restricted maximum likelihood (REML) assessments of different characteristics were analyzed for the Balochi sheep on the basis of location, birth year (YOB), season of birth (SOB), type of birth (TOB), and sex of lamb. The average means ± SE for BW, WW, 6 MW, 9 MW, 12 MW, and 24 MW, were 3.28 ± 0.83, 17.20 ± 2.04, 21.94 ± 1.60, 26.20 ± 2.87, 30.21 ± 3.58, and 37.11 ± 2.84 for ram and 2.56 ± 0.53, 15.69 ± 1.45, 19.57 ± 1.77, 24.07 ± 2.70, 27.46 ± 2.09, and 34.61 ± 2.32 for ewes respectively. The results of reproductive performance of the Balochi sheep age of ewe at the time of breeding, age at first service (AFS), service period (SP), age at first lambing (AFL), and lambing interval (LI) were 1078 ± 2.2, 579.61 ± 0.6, 206.25 ± 0.2, 731.67 ± 0.3, and 256.60 ± 0.3 days respectively. The twining and lambing rates were 10.12% and 86.78%, while the sex proportion for ram and ewes was 50.12:49.37. Area, sex, and TOB had a significant (p < 0.05) effect on weight while TOB (twinning rate) was higher in Balochi sheep. These conditions affected the productive and reproductive performance of the Balochi sheep. At Sheep Research Center, Yet Abad, Balochistan, Pakistan, performed fundamentally better in all qualities such as weight gain and reproductive performance. Supplements were given with feed to get maximum profit from the sheep of Yet Abad farm. The birth weight of males was higher than that of females and single conceived Balochi sheep were heavier than that of twins. Thus, it was concluded that the Balochi sheep can be improved with better management practices, feeding, and disease control.

Considerations in wound care of patients living with dementia.

The prevalence of wounds and comorbidities such as dementia increases with age. Given projected rises in population ageing and growth, the likelihood of encountering an overlap in these conditions in clinical practice has increased. Clinicians provide wound care for patients in a variety of settings, drawing on different evidence-based clinical guidelines. Most research into wound care has excluded patients with dementia. Therefore, the aim of this review is to provide safe strategies and methods of implementation in those patients living with dementia.

A systematic review of the effect of surgeon and hospital volume on survival in aortic, thoracic and fenestrated endovascular aneurysm repair.

BACKGROUND: Endovascular aneurysm repair (EVAR) is becoming a mainstay in vascular surgery, both in metropolitan and regional hospitals. This review aims to assess the impact of hospital and surgeon volume on perioperative mortality specific to this surgery type to support the use of this treatment modality extensively. METHODS: A literature search was performed on multiple dedicated medical databases using a detailed search strategy with terms focusing on hospital volume and EVARs. Inclusion and exclusion criteria were used to screen and evaluate suitable sources, focusing on operators and hospitals performing EVARs and the morbidity/mortality as outcomes. The results were then appraised using a PRISMA framework. RESULTS: We reviewed 45 articles. Twelve articles met inclusion criteria for complete review. There was no level 1 evidence, and only a single systematic review and meta-analysis. EVAR and thoracic EVAR perioperative mortality had no correlation with hospital volume. Limited evidence was presented for fenestrated EVAR, where a mortality risk based on hospital volume remains unanswered. Open procedures for aneurysm repair had perioperative mortality outcomes that grossly correlated with hospital volume, supporting their use in high-volume centers. CONCLUSIONS: With open aneurysm repairs having an increased mortality risk in low-volume centers, and endovascular treatment options gaining momentum, there is considerable support for the use of EVAR and thoracic EVAR in smaller regional centers safely and effectively. There is very limited evidence in the use of fenestrated EVAR, which remains unanswered, but presents a significant opportunity for research.

Improving Abdominal Aortic Aneurysm (AAA) Screening Uptake through Patient Engagement-Analysis and Outcomes of Strategies to Improve Uptake at a Regional Program Level.

BACKGROUND: To identify areas of health inequality that adversely affect patient engagement at a regional level within the National Abdominal Aortic Aneurysm Screening Program (NAAASP). Patient-reported improvements to services were implemented and analysis of subsequent uptake undertaken. METHODS: A prospective study of 390 men who failed to attend their AAA screening invitation. Nonattendees were contacted by post and telephone. Patients were analyzed as per ethnicity, working status, and Index of Multiple Deprivation quintile. Patient-suggested improvements to the service were recorded, analyzed, and implemented. Uptake data were then collected for the subsequent two years. RESULTS: The Screening Management and Referral Tracking system used by NAAASP is 97% accurate in holding patient contact details, and nonattenders are four times more likely to respond to telephone contact. Reasons for failing to attend screening invitations include factors that can be addressed at a regional level such as: inconvenient timings/locations of screening clinics and a lack of awareness or understanding of what AAA screening means as well as language/literacy barriers. The incidence of AAAs in the nonattendee group was almost 3 times that of our general (attending) population. Afro-Caribbean men were disproportionately less likely to attend for screening. After implementing patient-suggested improvements to the service, screening uptake increased from 75.2% (2015-16 screening year) to 81.3% (2017-2018). CONCLUSIONS: To date, no other studies have gone on to assess the effectiveness of interventions targeted at reducing inequalities in NAAASP attendance, but we show an increase in local screening uptake of 6% in a 2-year period after implementing improvement strategies. This article adds to existing literature by confirming external factors such as social deprivation adversely influence screening uptake and that AAAs are more prevalent in socially deprived groups. It reinforces the importance of regional attempts to contact and engage nonattenders as they may be most at risk of developing AAAs.

The role of nutrition in wound healing: an overview.

Wounds are a commonly encountered and complex entity in healthcare, and often require multidisciplinary involvement for their management. Wound care and healing are affected by a range of factors of which nutrition, a modifiable factor, plays an integral part. Familiarity with the phases of wound healing and the differing nutritional requirements at each stage is fundamental to managing wounds. Additionally, awareness of the signs of malnutrition, screening tools and educational resources for managing malnutrition in primary care settings are all vital to minimising malnutrition and its adverse effects on wound healing. This article reviews the phases of wound healing and the associated nutritional requirements required for optimal healing, the clinical signs of malnutrition and screening resources for identifying at-risk groups, as well as reviewing current guidelines for managing malnutrition in the inpatient and outpatient setting.

The management of malignant lower limb ulcers: clinical considerations.

Lower limb malignant ulcers are an uncommon finding, making diagnosis complex and their management costly. Yet, despite this, the increase in skin cancers over the past 30 years means that clinicians require an awareness and understanding of their existence, particularly in the primary care setting. Familiarity with common aetiologies and presentations is vital for prompt recognition, diagnosis and referral of wounds suspicious for malignancy. Lower limb malignant wounds often develop insidiously, with a wide variation in clinical presentation that overlaps between entities. Therefore, a fundamental algorithm for approaching lower limb ulcers that raise suspicion of malignancy should be possessed by all clinicians. This article reviews the clinical features of malignant wounds that should alert clinicians to the need for further evaluation, such as atypical location and appearance. The authors also highlight the various diagnostic and therapeutic modalities available and review current clinical guidelines for the referral and follow-up of suspicious lesions.

Different ambient management intervention techniques and their effect on milk production and physiological parameters of lactating NiliRavi buffaloes during hot dry summer of subtropical region.

In tropical countries, one of the major threats for diary animal production is climate change. Ambient management interventions are beneficial and are the dire need of animal production in tropics. Ambient management intervention and its effect on physiological performance of lactating NiliRavi buffaloes were investigated during the hot dry months (April to June) of Pakistan. Fifteen lactating NiliRavi water buffaloes of similar size, age, and same parity were randomly stratified into three groups, comprising of five animals in each group, designated as group S, SF, and SFS. Animals of group S (control) were kept just under the shade while the animals in group SF were provided shade plus fan, animals in group SFS were provided the shade, fan as well as sprinklers during the hot day hours between 10:00 AM to 6:00 PM. Shed conditions were same for all animals, isonitrogenous and isocaloric feed was provided to all animals. Milk production decreased with the increase in ambient temperature. Average dry matter intake in group S, SF, and SFS were 75%, 80%, and 90% of the total feed offered to the experimental animals, respectively. The mean rectal temperatures (°F) were 101.69, 101.19, and 100.85 in group S, SF, and SFS, respectively. Heat stress had pronounced effect on blood glucose level as indicated by the mean glucose concentration in group S and SFS being recorded at 78.04 mg/dl and 90.47 mg/dl, respectively. It is concluded that the buffaloes should be provided with sprinklers and fans to minimize heat load and maximize the production during hot dry season.

The Relationship Between Serum Interleukin-1α and Asymptomatic Infrarenal Abdominal Aortic Aneurysm Size, Morphology, and Growth Rates.

OBJECTIVE/BACKGROUND: In a pilot study, a relationship between abdominal aortic aneurysm (AAA) diameter and serum interleukin (IL)-1α levels was reported, and that endothelial cell (EC) activation in vitro in response to serum from patients with AAA was blocked by anti-IL-1α antibodies. The aim of the present study was to further investigate the relationship between serum IL-1α and asymptomatic infrarenal AAA size, morphology, and growth rates. METHODS: Serum IL-1α was measured using enzyme linked immunosorbent assay in 101 patients with asymptomatic, infrarenal AAA and related to aneurysm size, morphology, and growth rates. RESULTS: IL-1α was measured in 101 patients. There was no statistically significant difference in mean age between men and women. IL-1α was detectable in 62.4% of patients; median IL-1α titre was 3.26 pg/mL. There was no statistically significant relationship between IL-1α and maximum AAA antero-posterior diameter as measured by ultrasound (p = .649), AAA morphology (aortic length [p = .394], sac [p = .369], and thrombus volume [p = .629]) as measured on computed tomography, absolute increase in AAA diameter (p = .214), or AAA growth rate (p = .230). CONCLUSION: IL-1α is detectable in the majority of patients with infrarenal AAA, but the cause and clinical significance of this novel observation remains unknown.

Comparison of 2 Sample Processing Methods and 9 Commercial Immunoassays for the Detection of Interleukin-1α in the Serum of Patients with Abdominal Aortic Aneurysm.

BACKGROUND: For a cytokine to have a role as a clinically useful biomarker, it must be measureable in a practical, reliable, and reproducible manner. Furthermore, assays from different manufacturers should produce comparable results. The aim of this paper was to examine the effect of 2 sample processing methodologies and compare 9 commercially available immunoassays for their measurement of serum interleukin (IL)-1α in patients with abdominal aortic aneurysm. METHODS: Two sample processing methodologies and 9 manufacturers' immunoassays were compared. Each immunoassay was also tested for detection of both IL-1α isoforms. RESULTS: A positive signal for IL-1α was found in all serum samples, in all immunoassays, using both processing methods. In the majority, titer concentrations were unquantifiable with values below manufacturers' detectable range. Variability in titer concentrations was seen across all immunoassays. With the exception of 1 immunoassay, all were able to detect both IL-1α isoforms. CONCLUSIONS: Researchers wishing to measure serum cytokines levels should be aware that differences in sample processing methods and manufacturers' immunoassays can affect the results. This may result in misleading conclusions being drawn about biological processes underpinning a wide range of inflammatory diseases.

Effect of ambient management interventions on the production and physiological performance of lactating Sahiwal cattle during hot dry summer.

During summer season, increase in the environmental temperature in the subtropical regions of Pakistan is negatively affecting the performance of dairy animals. The study objective was to determine the effect of ambient management (90 days) on productive and physiological performance of lactating Sahiwal cows during hot dry summer season. Fifteen lactating cows during the early lactation stage, having similar parity (3), daily milk production (6.2 l), were randomly allocated to three treatments, 5 cows each, i.e., (1) kept under roof shade only, (2) provision of fans along with roof shade, and (3) provision of roof shade, fans, and sprinklers designated as S, SF, and SFS, respectively. The fans were of 360-rpm capacity and showers were on for 40 min after every 90-min interval from 9:00 to 21:00 h. THI values were 81.1 ± 0.7, 80.5 ± 0.7, and 77.7 ± 0.4 under S, SF, and SFS treatments, respectively. Cows were milked twice daily. Respiration rate (RR) and rectal temperature (RT) data were collected at 14:00 h on daily basis. The daily milk production was significantly higher in cows under SF (7.9 ± 1 kg) followed by SFS (6.9 ± 1.2 kg) and S (6.1 ± 0.9 kg) treatments. The mean RT (101.0 ± 0.04 °F) was significantly lower in cows under SFS than that on SF and S treatments and similarly mean RR was also lower (21.2 breaths/min) in cows under SFS followed by SF and S treatments. It is concluded that milk production and physiological performance in Sahiwal cows can be improved by fan-assisted ventilation during hot dry summer in subtropical regions.

How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database.

OBJECTIVE/BACKGROUND: Abdominal aortic aneurysm (AAA) maximum antero-posterior diameter (MAPD) is the parameter most commonly used to inform the timing of surgical intervention. However, other factors, such as growth rates and patient comorbidities are likely to be important considerations as they may influence AAA related complications including rupture, operative outcomes, and the clinical and cost effectiveness of continued surveillance. METHODS: This was a retrospective analysis of a 20 year period of a single centre AAA surveillance database. In total, 5363 AAA measurements in 692 patients were analysed for patient demographics, including comorbidity and drug history, growth and rupture rates, and cause of death. RESULTS: A significant proportion of patients (n = 73; 11%) were kept under surveillance despite having a MAPD < 30 mm. Overall, mean aneurysm growth rate was 2.3 mm/year. Elective repair was undertaken in 20.1% and those who required surgical intervention had significantly faster growth rates. Only 3.9% of patients in surveillance ruptured, 40.7% of whom had a MAPD <55 mm at their last scan. Of the 214 deaths recorded, only 11.7% were related to AAA. The majority of patients who died in surveillance did so from malignancy. Patients with larger AAA (MAPD > 40 mm) on entry into surveillance were significantly more likely to receive surgical intervention, as were those whose AAA expanded >4 mm/year. Females had significantly higher growth rates, and those with diabetes had significantly smaller growth rates. Other comorbidities and drug history were not associated with AAA growth, or 5 and 10 year surgery free survival. CONCLUSION: The results highlight several areas for service improvement. Specifically, it is important not to maintain surveillance in patients who are very unlikely to ever grow to a point where AAA surgery would be contemplated on grounds or age and/or comorbidity. Similarly, patients should be discharged from surveillance when this likelihood becomes apparent.

Potential new treatment for non-freezing cold injury: is Iloprost the way forward?

INTRODUCTION: Non-freezing cold injury (NFCI) remains largely under-reported, and is of particular importance in the armed forces where its prevalence is greatest. Iloprost, a synthetic prostaglandin I2 analogue, has previously been used with some success in the treatment of vasospastic and freezing cold injuries, although its role in NFCI remains unclear. CASE REPORT: An Iloprost infusion was used to treat the long-term sequelae of an ex-soldier suffering with ongoing pedal pain and loss of function 20 years after the initial NFCI insult sustained on military exercise. Following 5 days of iloprost infusion, he reported 4 weeks of markedly reduced pain and increased mobility before symptom relapse. A second infusion was thus given 3 months later, which resulted in increased pain and analgesic requirements. DISCUSSION: The use of iloprost in the treatment of NFCI is discussed and its use in a condition which physicians consistently struggle to treat effectively is considered. Careful counselling is recommended as symptoms may be worsened.

Giant-cell tumor of the patella in a skeletally immature girl.

BACKGROUND: We reported on a case of a giant-cell tumor of the patella which occurred in a skeletally immature patient. This combination of unusual age of presentation and atypical location made our case clinically and radiologically unique. CASE REPORT: A 13-year-old girl presented with complains of knee pain and swelling. After radiological investigations and percutaneous needle biopsy a diagnosis of giant-cell tumor of the patella was made, for which the patient underwent patellectomy with en bloc resection of the lesion and the diagnosis was confirmed by histopathological examination. CONCLUSIONS: It was concluded that early diagnosis may be difficult in such cases and hence, GCT should be considered in the differential diagnosis of a destructive lesion of the patella, regardless of the age of presentation.

Anomalies Unveiled: A Fascinating Case Study of Type I Pulmonary Artery-to-Left Atrium Fistula.

The pulmonary artery-to-left atrium (LA) fistula is one of the rare and unique structural causes of silent cyanosis. This correctable abnormality can be identified by having a high index of clinical suspicion and appropriate investigations using echocardiography and cardiac computed tomography (CT). We report an eight-year-old child who had worsening exertional dyspnea, long-standing central cyanosis, and recurrent infections. A large-sized fistula connecting the right pulmonary artery (RPA) to the LA with all the right- and left-sided pulmonary veins showed normal drainage into the LA, suggesting a type I RPA-to-LA fistula, which was diagnosed on cardiac CT. Percutaneous closure using the occluder device is planned as further management for the patient.

Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study.

BACKGROUND: The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis. METHODS: Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM). RESULTS: The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001). CONCLUSION: US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions.

Multivariate Analysis of Effective Dose and Size-Specific Dose Estimates for Thorax and Abdominal Computed Tomography.

The study aimed to compute the effective dose (E) and size-specific dose estimate (SSDE) of routine adult patients undergoing thorax and abdominal computed tomography (CT) imaging and to present their multivariate analysis. All adult thorax and abdominal CT examinations conducted from March 2022 to June 2022 were prospectively included in this study. The Water Equivalent Diameter (Dw) and SSDE of all the examinations were computed from CT dose index volume (CTDIvol) and Dose length product (DLP) displayed on the dose report in the CT console. The multivariate statistical analysis was performed to investigate the correlation of SSDE and E on CTDIvol, Dw area of the region of interest (ROI) (AreaROI), body mass index (BMI), conversion factor (fsize) and hounsfield (HUmean) number in the ROI at 95% level of significance (P < 0.05). The linear regression analysis was performed to investigate the dependence of SSDE and E on other parameters for both abdominal and thorax patients. A total number of 135 (Abdomen = 61 and Thorax = 74) measurements were performed. The mean value of effective dose for abdomen and thorax patients was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv, respectively. The SSDE was observed to be 13.24 ± 3.61 and 13.04 ± 3.61 mGy for thorax and abdomen respectively. The multivariate analysis suggests that SSDE for abdominal CT is found significantly dependent on CTDIvol, Dw and fsize with P < 0.05 and E is found to be significantly dependent on DLP, AreaROI, Dw and fsize at 95% level of confidence for abdominal CT imaging. SSDE for thorax CT was found significantly dependent on BMI, CTDIvol, HUmean, Dw and fsize at 95% level of confidence. Furthermore, E was observed dependent on DLP at P < 0.05. The linear regression analysis also shows that E is strongly correlated with DLP (r = 1.0) for both thorax and abdominal CT, further the SSDE was observed strongly correlated with CTDIvol with r = 0.79 and r = 0.86 for abdomen and thorax CT respectively. A strong correlation was observed between BMI and for Dw abdominal CT imaging (r = 0.68). The mean value of SSDE for thorax is slightly greater than abdomen. The average value of effective dose for abdomen and thorax measurements was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv and , correspondingly. SSDE for both abdomen and thorax CT is significantly dependent on CTDIvol, Dw and fsize at 95% level of confidence. The strong correlation was also observed E on DLP and SSDE on CTDIvol for both Abdomen and Thorax CT. The strong dependence of Dw on BMI (r = 0.68) is due to the excessive fat concentration around the stomach and abdomen.

Listeria monocytogenes endograft infection after fenestrated endovascular aneurysm repair-a case report.

An extremely uncommon cause of endograft infections, Listeria monocytogenes graft infections are associated with high morbidity and mortality. Best managed with complete graft resection and long-term antibiotic therapy, we present a rare case of L. monocytogenes aortic graft infection managed successfully with direct sac drainage and lifelong suppressive antibiotic therapy.