Ominous Causes of Headache.

PURPOSE OF REVIEW: While primary headaches like migraines or cluster headaches are prevalent and often debilitating, it's the secondary headaches-those resulting from underlying pathologies-that can be particularly ominous. This article delves into the sinister causes of headaches, underscoring the importance of a meticulous clinical approach, especially when presented with red flags. RECENT FINDINGS: Headaches, one of the most common complaints in clinical practice, span a spectrum from benign tension-type episodes to harbingers of life-threatening conditions. For the seasoned physician, differentiating between these extremes is paramount. Headache etiologies covered in this article will include subarachnoid hemorrhage (SAH), cervical artery dissection, cerebral venous thrombosis, meningitis, obstructive hydrocephalus, and brain tumor.

Stimbiotic and wheat bran inclusion in maize or wheat-based diets for broiler chickens; effects on jejunal histomorphology, digesta oligosaccharides and caecal short-chain fatty-acids profiles.

1. A stimbiotic (STB) is any feed additive that stimulates caeca fibre fermentation, although the additive itself contributes little to the caeca short-chain fatty acid (SCFA) production. A 42 d experiment investigated the interactive effects of STB and wheat bran (WB) in broiler chickens receiving maize or wheat-based diets.2. The treatments were arranged in a 2 × 2 × 2 factorial (eight replicates each), the dietary factors being diet (maize-SBM or wheat-SBM), STB (with or without) and WB (0 or 50 g/kg). Jejunal tissue, gizzard, jejunal and ileal digesta and caecal contents were collected on d 18 and 42.3. Gizzard pH tended to decrease with STB (p = 0.06) supplementation and was lower in birds fed wheat- compared to maize-based diets on d 18 (p < 0.05). Birds receiving diets with WB had higher jejunum pH on d 18 (p < 0.05).4. Total short-chain fatty acids (SCFA) in the caeca on d 18 and isobutyrate on d 42 were higher (p < 0.05) for maize compared with wheat-based diets. However, on d 42, acetate, butyrate and total SCFA were higher (p < 0.05) for wheat-based compared with maize-based diets.5. On d 18, STB and WB inclusion increased villi height (VH; p < 0.05) and VH to crypt depth ratio (VH/CD), respectively (p < 0.05). On d 42, VH (p < 0.05) and VH/CD were higher in wheat-based diets (p < 0.05). The VH/CD ratio was lower with STB supplementation (p < 0.05). Marker-corrected pentose oligosaccharides (Pent)4 and (Pent)5 concentrations in the ileal digesta were reduced (p < 0.05) with STB supplementation. In addition, STB decreased (Pent)3 concentration in maize-, but not wheat-based diets (p < 0.05).6. In conclusion, both WB and STB influenced gastrointestinal pH and jejunum histomorphology of broilers without increasing oligosaccharide concentration in the ileum and SCFA in the caeca.

Determination of standardised ileal digestibility of amino acids in high-fibre feedstuffs and additivity of apparent and standardised ileal amino acids digestibility of diets containing mixtures of maize, sorghum, and soybean meal.

1. Two experiments were conducted to determine the coefficients of standardised ileal amino acid digestibility for selected high-fibre feedstuffs (Expt.1) and to assess the additivity of coefficients of apparent (cAIAAD) and standardised (cSIAAD) ileal amino acid digestibility for diets containing combinations of sorghum, maize and soybean meal.2. In Expt. 1, broiler chickens (324) were allocated to 54 metabolism cages (nine diets with six replicates). In Expt. 2, broiler chickens (315) were allocated to 63 metabolism cages (seven diets with nine replicates). The diets in Expt. 1 were a nitrogen-free diet plus eight semi-purified diets in which soybean meal (SBM), low-protein SBM (LPSBM), soybean hull, wheat bran, maize bran, rice bran, dried sugarbeet pulp or maize gluten feed were the only sources of protein in the respective diets. In Expt. 2, the seven diets were a nitrogen-free diet, and six semi-purified diets consisting of individual feedstuffs (SBM, maize, or sorghum) or combinations (maize and SBM; sorghum and SBM; or maize, sorghum, and SBM) as the only sources of protein.3. In both experiments, all the broiler chickens received the same maize-SBM diet formulated to meet nutrient requirements according to the breeder's recommendations from d 0 to 16. Allocated experimental diets were provided on d 16, and ileal digesta were collected on d 21.4. In Expt. 1, SBM and LPSBM had greater (P < 0.01) cSIAAD for indispensable and dispensable amino acids than the other feedstuffs. The rice bran had greater (P<0.01) cSIAAD values than wheat bran and maize bran, except for Leu, Cys, and Pro.5. In Expt. 2, predicted cAIAAD values for maize-SBM and maize-sorghum-SBM were generally lower (P<0.01) than actual values. The actual and predicted cSIAAD values for maize-SBM, sorghum-SBM and maize-sorghum-SBM combinations were not significantly different.6. It was concluded that the standardised amino acid digestibility of sorghum, when combined with other feedstuffs, was additive and that approximately three-quarters of total amino acids in the assayed high-fibre feedstuffs, except for dried sugarbeet pulp and maize gluten feed, were digestible.

Investigating possible impact, and interaction, of phytase supplementation during pre-experimental and experimental phases on assay of true phosphorus pre-caecal digestibility and total tract retention.

1. Two experiments were conducted to investigate whether the use of phytase in the pre-experimental or experimental phases of true pre-caecal phosphorus digestibility (TPD) assay influenced the assayed TPD values. In experiments 1 and 2, broiler chickens were randomly allocated to 12 treatments in a 2 × 2 × 3 factorial arrangement. The factors were pre-experimental phytase supplementation (+ or -), experimental phase phytase supplementation (+ or -) with varying soybean meal inclusion levels (450, 560, or 670 g/kg).2. The diets in the pre-experimental phase were based on maize-soybean meal, whereas the diet used during the experimental phase was semi-purified, with soybean meal as the only source of P. Both TPD and true phosphorus retention (TPR) were determined using regression for the P output (g/kg, dry matter basis), pre-caecal or total tract, against P intake (g/kg). Data for TPD and TPR were analysed as a 2 × 2 factorial (with or without pre-experimental or experimental phase phytase).3. In both experiments 1 and 2, there were no significant effects for pre-experimental phytase supplementation nor interaction of pre- and experimental phytase supplementation on any of the pre-caecal digestibility responses. Phytase supplementation during the experimental phase increased (P < 0.01) pre-caecal P digestibility and retention, as well as digestible and retained P intake, and decreased (P < 0.01) P output.4. In experiment 1, pre- and experimental phytase supplementation increased (P < 0.01) the coefficient of TPR. In experiment 2, there was no significant effect of pre-experimental phytase supplementation on coefficient of pre-caecal TPD. However, phytase supplementation in the experimental phase increased (P < 0.01) the coefficient of pre-caecal TPD.5. In conclusion, whether or not phytase was supplemented to a P-adequate diet in the pre-experimental phase of the TPD assay, it had no influence on assayed TPD or TPR value.