The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study.

There are few data regarding postoperative hyperglycaemia in non-diabetic compared with diabetic patients following postoperative nausea and vomiting prophylaxis with dexamethasone. Eighty-five non-diabetic patients and patients with type-2 diabetes were randomly allocated to receive intravenous dexamethasone (8 mg) or ondansetron (4 mg). Blood glucose levels were measured at baseline and then 2, 4 and 24 h following induction of anaesthesia. In non-diabetic patients, the mean (SD) maximum blood glucose was higher in those who received dexamethasone compared with ondansetron (9.1 (2.2) mmol.l(-1) vs. 7.8 (1.4) mmol.l(-1) , p = 0.04). In diabetic patients, the mean (SD) maximum blood glucose was also higher in those who received dexamethasone compared with ondansetron (14.0 (2.5) mmol.l(-1) vs. 10.7 (2.4) mmol.l(-1) , p < 0.01). Multivariate analysis demonstrated that dexamethasone administration was a significant predictor of maximum postoperative blood glucose increase (p < 0.01) after adjusting for potential confounders. There was no interaction between baseline blood glucose level, or presence or absence of diabetes, and dexamethasone administration. We conclude that dexamethasone increases postoperative blood glucose levels in both non-diabetics and diabetics.

Serosurveillance and factors associated with the presence of antibodies against bluetongue virus in dairy cattle in two eco-zones of Nepal.

Cattle play an important role in the epidemiology of bluetongue (BT) by acting as reservoir hosts. However, the status of BT virus (BTV) in dairy cattle in Nepal is unknown. The objective of this study was to estimate the prevalence of BTV antibodies in dairy cattle in two eco-zones of Nepal, and to identify the factors associated with virus exposure. The authors conducted a cross-sectional serosurvey from March 2012 through February 2013 by sampling 131 dairy cattle from seven clusters (villages) in the Chitwan district in the Terai region (southern lowlands) and the Lamjung district in the Hills region (the middle part of Nepal). Of the 131 serum samples tested, 29.3% (95% confidence interval [CI]: 21.5-37.2) were positive for BTV antibodies. Herd-level seroprevalence was 45.7% (95% CI: 30.9-61.0). Bivariate analysis indicated a positive association between seroconversion to BTV and age, and an association with breed of cattle after controlling for clustering of animals within herds. Based on this model, cattle were more likely to become seropositive as they aged. Crossbred cattle were more likely to be seropositive than those of exotic breeds (odds ratio [OR] = 4.6; 95% CI: 1.5-14.1). The results indicate widespread exposure of dairy cattle to BTV in Nepal. The authors suggest that dairy cattle should be included in the surveillance plan for BTV infection in Nepal and that it is important to educate farmers about the possible impacts of this disease.

Les bovins jouent un rôle important en tant qu'hôtes réservoirs dans l'épidémiologie de la fièvre catarrhale ovine (FCO). Toutefois, au Népal le statut des bovins de races laitières au regard du virus de la FCO était inconnu. La présente étude a été conduite pour estimer la prévalence des anticorps dirigés contre la FCO chez les bovins laitiers dans deux zones écologiques du Népal et pour élucider les facteurs présentant un lien avec l'exposition virale. Les auteurs ont réalisé une enquête sérologique transversale de mars 2012 à février 2013, en prélevant 131 bovins laitiers répartis en sept groupes (villages) du district de Chitwan, région de Terai (plaines méridionales) et du district de Lamjung, région des Collines (centre du Népal). La présence d'anticorps dirigés contre la FCO a été détectée dans 29,3 % des 131 sérums testés (intervalle de confiance [IC] à 95 % : 21,5­37,2). À l'échelle des troupeaux, la prévalence sérologique était de 45,7 % (IC à 95 % : 30,9­61,0). L'analyse bivariée a fait apparaître une corrélation positive entre l'apparition d'anticorps dirigés contre la FCO et l'âge et, après vérification de la répartition des bovins par groupes au sein des troupeaux, une corrélation avec la race. D'après ce modèle, l'apparition d'anticorps devenait plus fréquente à mesure que les bovins prenaient de l'âge. De même, l'apparition d'anticorps était plus fréquente chez les bovins de races croisées que chez les bovins de race exotique (rapport de cotes = 4,6 ; IC à 95 % : 1,5­14,1). Ces résultats font état de l'ampleur de l'exposition des bovins laitiers au virus de la FCO au Népal. Les auteurs préconisent d'intégrer les bovins de races laitières dans le plan de surveillance de l'infection par le virus de la FCO au Népal et de sensibiliser les éleveurs sur les conséquences potentielles de cette maladie.

El ganado vacuno cumple una importante función en la epidemiología de la lengua azul por su intervención como hospedador reservorio. Pese a ello, en el Nepal se desconoce cuál es el estado del ganado lechero en relación con el virus de la enfermedad. Los autores describen un estudio destinado a estimar la prevalencia de anticuerpos contra el virus de la lengua azul en el ganado lechero de dos zonas ecológicas del Nepal y a determinar los factores asociados a la exposición al virus. En primer lugar, entre marzo de 2012 y febrero de 2013, se llevó a cabo un estudio serológico transversal con la obtención de muestras de 131 bovinos lecheros de siete agrupaciones (aldeas) de los distritos de Chitwan, región de Terai (vegas meridionales), y de Lamjung, región de las Colinas (en la zona central del país). De las 131 muestras de suero analizadas, resultaron positivas para los anticuerpos contra el virus de la lengua azul el 29,3% (intervalo de confianza [IC] al 95%: 21,5­37,2). La seroprevalencia de rebaño se cifraba en un 45,7% (IC 95%: 30,9­61,0). El análisis de dos variables puso de manifiesto una correlación positiva entre la seroconversión contra el virus de la lengua azul y la edad, así como una asociación con la raza del ganado, previo control de las agrupaciones de animales dentro de los rebaños. Según se desprende de este modelo, la probabilidad de que el ganado pase a ser positivo aumenta con la edad. Los animales de raza híbrida presentan mayor probabilidad de ser seropositivos que los de razas exóticas (razón de probabilidades = 4,6; IC 95%: 1,5­14,1). Estos resultados ponen de relieve una extendida exposición al virus en el ganado lechero nepalí. Los autores preconizan la inclusión del ganado vacuno lechero en el plan de vigilancia de la infección por el virus de la lengua azul en el Nepal y recalcan la importancia de hacer pedagogía entre los ganaderos acerca de las posibles repercusiones de la enfermedad.

Cholecystectomy, gallstones, tonsillectomy, and pancreatic cancer risk: a population-based case-control study in Minnesota.

BACKGROUND: Associations between medical conditions and pancreatic cancer risk are controversial and are thus evaluated in a study conducted during 1994-1998 in Minnesota. METHODS: Cases (n=215) were ascertained from hospitals in the metropolitan area of the Twin Cities and the Mayo Clinic. Controls (n=676) were randomly selected from the general population and frequency matched to cases by age and sex. The history of medical conditions was gathered with a questionnaire during in-person interviews. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression. RESULTS: After adjustment for confounders, subjects who had cholecystectomy or gallstones experienced a significantly higher risk of pancreatic cancer than those who did not (OR (95% CI): 2.11 (1.32-3.35) for cholecystectomy and 1.97 (1.23-3.12) for gallstones), whereas opposite results were observed for tonsillectomy (0.67 (0.48-0.94)). Increased risk associated with cholecystectomy was the greatest when it occurred ≤ 2 years before the cancer diagnosis (5.93 (2.36-15.7)) but remained statistically significant when that interval was ≥ 20 years (2.27 (1.16-4.32)). CONCLUSIONS: Cholecystectomy, gallstones, and tonsillectomy were associated with an altered risk of pancreatic cancer. Our study suggests that cholecystectomy increased risk but reverse causality may partially account for high risk associated with recent cholecystectomy.

Free-Roaming Dogs in Nepal: Demographics, Health and Public Knowledge, Attitudes and Practices.

In Nepal, most dogs are free to roam and may transmit diseases to humans and animals. These dogs often suffer from malnutrition and lack basic health care. Minimal information is available about their demographics and about public attitudes concerning dogs and diseases. We carried out a study in Chitwan District (central Nepal), to collect baseline data on free-roaming owned dog demographics, assess knowledge, attitudes and practices of dog owners concerning dogs and rabies, evaluate rabies vaccination coverage and anthelmintic treatment of dogs, measure dogs' response to rabies vaccination and assess dog health through body condition scores and parasites. We conducted household interviews with owners of free-roaming female dogs (n = 60) and administered dogs with rabies vaccination and anthelmintics. Dog owners regularly fed free-roaming dogs but provided minimal health care; 42% of respondents did not claim ownership of the dog for which they provided care. We collected skin, faecal and blood samples for parasite identification and for measuring rabies virus-specific antibodies. Ninety-two per cent of dog owners were aware of the routes of rabies virus transmission, but only 35% described the correct post-exposure prophylaxis (PEP) following a dog bite. Twenty-seven per cent of the dogs had measurable rabies virus-specific antibody titres and 14% had received anthelmintics in the previous year. Following rabies vaccination, 97% of dogs maintained an adequate antibody titre for ≥6 months. Most dogs appeared healthy, although haemoprotozoans, endoparasites and ectoparasites were identified in 12%, 73% and 40% of the dogs, respectively. Poor skin condition and parasite load were associated. Seventy-four per cent of the females had litters in 1 year (mean litter size = 4.5). Births occurred between September and February; we estimated 60% mortality in puppies. We concluded that vaccination coverage, PEP awareness and anthelmintic treatment should be emphasized in educational programmes focussed on animal welfare, veterinary and public health.

The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery.

Essentials We evaluated antibody status, thromboembolism and survival after cardiac surgery. Positive antibody tests are common - over 50% are seropositive at 30 days. Seropositivity did not increase thromboembolism or impair survival after cardiac surgery. Results show heparin induced thrombocytopenia antibody screening after surgery is not warranted. SUMMARY: Background Heparin-induced thrombocytopenia (HIT) is a prothrombotic response to heparin therapy with platelet-activating, anti-platelet factor 4 (PF4)/heparin antibodies leading to thrombocytopenia associated with thromboembolism. Objective We tested the hypothesis that anti-PF4/heparin antibodies are associated with thromboembolism after cardiac surgery. Methods This multicenter, prospective cohort study collected laboratory and clinical data up to 30 days after surgery and longer-term clinical follow-up data. The primary outcome variable combined new arterial or venous thromboembolic complications (TECs) with all-cause death until 90 days after surgery. Laboratory analyses included platelet counts and anti-PF4/heparin antibody titers (GTI ELISA), with a confirmatory excess heparin step and serotonin release assay. Chi-square testing was used to test the relationship between our outcome and HIT antibody seropositivity. Results Initially, 1021 patients were enrolled between August 2006 and May 2009, and follow-up was completed in December 2014. Seropositivity defined by OD > 0.4 was common, being almost 20% preoperatively, > 30% by discharge, and > 60% by day 30. Death (1.7% within 30 days) or TECs (69 in total) were more likely if the partient was seronegative (OD < 0.4), but positivity defined by OD > 1.0 or including an excess heparin confirmatory step resulted in equal incidence of death or TECs, whether the patient was seronegative or seropositive. Incorporating the serotonin release assay for platelet-activating antibodies did not alter these findings. Conclusions Seropositivity for anti-PF4/heparin antibodies does not increase the risk of death or thromboembolism after cardiac surgery. Screening is not indicated, and seropositivity should only be interpreted in the context of clinical evidence for HIT. TRIAL REGISTRATION: Duke IRB Protocol #00010736.

Impact of livestock hygiene education programs on mastitis in smallholder water buffalo (Bubalus bubalis) in Chitwan, Nepal.

A project implemented from 2003 to 2005 trained women in Chitwan District, Nepal, in hygienic dairy production using a process of social mobilization. The aim of this research was to assess if the prevalence of mastitis in water buffalo in the households of women who were trained was lower one year after training than in untrained households, if the training influenced knowledge and practices for the prevention or control of mastitis, and if these practices and knowledge were associated with a lower prevalence of mastitis. A total of 202 households from Eastern and Western Chitwan District were included in the study. Of these, 60 households had participated in the project and 142 had not. Milk samples were collected from 129 households (33 project households and 96 non-project households). Clinical mastitis was determined using visual inspection of udders and detection of macroscopic clots and flakes in milk. The California Mastitis Test was used to diagnose sub-clinical mastitis from milk samples, and the IDEXX SNAP test to identify the presence of tetracycline residues. The prevalence of mastitis in trained households (39.4%) was 43.78% of that in untrained households (60.4%), lower but not significantly so (p=0.08, 95% CI 0.17-1.12). Thirteen indicators of knowledge or practice for the control or prevention of mastitis were more likely to occur in trained households, four significantly so (not consuming milk from sick buffalo (p=0.001), using soap to wash hands before milking (p=0.001), discarding milk after antibiotic usage (p=0.01), and choosing appropriate flooring for their livestock (p=0.03)). Trained households that discarded milk from sick buffalo were 2.96 times more likely to have at least one animal with mastitis in the household (p=0.03, 95% CI 1.15-7.65). Trained households that knew to wash buffalos' teats after milking were less likely (OR 0.25) to have mastitis in their herd (p=0.02, 95% CI 0.08-0.80). Of the 138 buffalos tested, only one tested positive for tetracycline residues.

Trends in pancreatic cancer incidence in nine SEER Cancer Registries, 1973-2002.

BACKGROUND: The evolution of pancreatic cancer incidence in the last three decades in the United States remains unclear. This study was conducted to investigate this problem, using data from the nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program. PATIENTS AND METHODS: The incidence data in 1973-2002 were age standardized to the 2000 USA standard population and analyzed by the joinpoint regression. RESULTS: For the nine registries combined, pancreatic cancer incidence in men significantly decreased by 0.62% per year from 1973 to 2002. Incidence in women increased until 1984 and slowly declined thereafter. A rise in incidence, although not statistically significant, has been noted in young and middle-aged adults (<60 years) since 1994. Changes in incidence over time substantially differed among the nine SEER registries compared. Incidence decreased in most age-, sex-, and race-specific groups of the populations covered in the nine registries during the period examined. Conversely, a statistically significant increase in incidence was observed among women in Hawaii and Iowa and among old adults (> or =60 years) in Seattle and Utah. CONCLUSIONS: Pancreatic cancer incidence significantly decreased from 1973 to 2002 in men and increased until 1984 and then declined slowly in women in the United States.

Normal somatic cell count and subclinical mastitis in Murrah buffaloes.

This study was conducted to investigate the normal somatic cell count (SCC) and to define subclinical mastitis in Murrah buffaloes. Data were collected from 60 clinically normal buffaloes stationed at five farms of Chitwan Nepal and Buffalo Research Center, Hissar, India. Somatic cell count was measured using the Newman-Lampert staining technique. The upper limit of SCC was determined >or=200 000/ml of milk based on the mean +/- 2SD of a total SCC. Abnormal data of the SCC was repeatedly removed, which lie beyond the values of more than mean + 2SD until all the data come to lie within (mean + 2SD). Averages of SCC of right front and right hind quarters were significantly higher than left front and left hind quarters. Nearly 94% of California mastitis test (CMT) negative quarters were having somatic cells >or=200 000/ml. The mean SCC of CMT positive quarter was significantly higher (P < 0.01) than CMT negative quarters. Subclinical mastitis was diagnosed on the basis of samples with SCCs >or=200 000/ml with positive bacterial cultures. Subclinical mastitis was found in 21.7% buffaloes and 8% of the quarter foremilk samples. Neutrophil counts were significantly higher in subclinical mastitis milk.