Reviving post-mortem diagnostics as a tool to increase porcine herd health and strengthen early detection of pig diseases - the PathoPig project 2014-2016.

INTRODUCTION: Post-mortem diagnostics are an important tool for disease diagnosis and therefore early detection of (re-)emerging animal diseases and zoonoses as well as nationwide disease surveillance programs. To counteract the decline of porcine necropsies in Switzerland over the last ten years, the Federal Food Safety and Veterinary Office (FSVO) launched a national project in 2014 called PathoPig. Post-mortem examinations of pigs from herds with health problems were financially supported by the FSVO. During the first 3 years of the project, the number of pig necropsies increased by 195% (mean). An underlying cause of disease was identified in 74% of the cases. These findings resulted in specific recommendations by the attending veterinarians or by the Swiss Porcine Health Service. A follow-up survey revealed that herd health had improved in 90% of the farms implementing the recommendations.

INTRODUCTION: Les diagnostics post-mortem constituent un outil important pour le diagnostic des maladies et, partant, la détection précoce des maladies animales et des zoonoses (ré)-émergentes ainsi que pour les programmes nationaux de surveillance des maladies. Pour contrer le déclin des nécropsies porcines en Suisse au cours des dix dernières années, l'Office fédéral de la sécurité alimentaire et vétérinaire (OSAV) a lancé en 2014 un projet national baptisé PathoPig. Les examens post-mortem des porcs provenant d'exploitations avec des problèmes de santé ont été soutenus financièrement par l'OSAV. Au cours des trois premières années du projet, le nombre de nécropsies porcines a augmenté de 195% (moyenne). Une cause sous-jacente de maladie a été identifiée dans 74% des cas. Ces constatations ont abouti à des recommandations spécifiques des vétérinaires participants ou du Service sanitaire porcin suisse. Une enquête de suivi a révélé que la santé des troupeaux s'était améliorée dans 90% des exploitations appliquant les recommandations.

Experiences with a voluntary surveillance system for early detection of equine diseases in Switzerland.

Clinical observations made by practitioners and reported using web- and mobile-based technologies may benefit disease surveillance by improving the timeliness of outbreak detection. Equinella is a voluntary electronic reporting and information system established for the early detection of infectious equine diseases in Switzerland. Sentinel veterinary practitioners have been able to report cases of non-notifiable diseases and clinical symptoms to an internet-based platform since November 2013. Telephone interviews were carried out during the first year to understand the motivating and constraining factors affecting voluntary reporting and the use of mobile devices in a sentinel network. We found that non-monetary incentives attract sentinel practitioners; however, insufficient understanding of the reporting system and of its relevance, as well as concerns over the electronic dissemination of health data were identified as potential challenges to sustainable reporting. Many practitioners are not yet aware of the advantages of mobile-based surveillance and may require some time to become accustomed to novel reporting methods. Finally, our study highlights the need for continued information feedback loops within voluntary sentinel networks.

An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study.

INTRODUCTION: A selective combination of C-reactive protein and albumin (termed the modified Glasgow Prognostic Score, mGPS) has been shown to have prognostic value, independent of tumour stage, in lung, gastrointestinal and renal cancers. It is also of interest that liver function tests such as bilirubin, alkaline phosphatase and γ-glutamyl transferase, as well as serum calcium, have also been reported to predict cancer survival. The aim of the present study was to examine the relationship between an inflammation-based prognostic score (mGPS), biochemical parameters, tumour site and survival in a large cohort of patients with cancer. METHODS: Patients (n=21,669) who had an incidental blood sample taken between 2000 and 2006 for C-reactive protein, albumin and calcium (and liver function tests where available) and a diagnosis of cancer were identified. Of this group 9608 patients who had an ongoing malignant process were studied (sampled within 2 years before diagnosis). Also a subgroup of 5397 sampled at the time of diagnosis (sampled within 2 months prior to diagnosis) were examined. Cancers were grouped by tumour site in accordance with International Classification of Diseases 10 (ICD 10). RESULTS: On follow up, there were 6005 (63%) deaths of which 5122 (53%) were cancer deaths. The median time from blood sampling to diagnosis was 1.4 months. Increasing age, male gender and increasing deprivation was associated with a reduced 5-year overall and cancer-specific survival (all P<0.001). An elevated mGPS, adjusted calcium, bilirubin, alkaline phosphatase, aspartate transaminase, alanine transaminase and γ-glutamyl transferase were associated with a reduced 5-year overall and cancer-specific survival (independent of age, sex and deprivation in all patients sampled), as well as within the time of diagnosis subgroup (all P<0.001). An increasing mGPS was predictive of a reduced cancer-specific survival in all cancers (all P<0.001). CONCLUSION: The results of the present study indicate that the mGPS is a powerful prognostic factor when compared with other biochemical parameters and independent of tumour site in patients with cancer.

Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions.

OBJECTIVE: To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. DESIGN: Reliability and validation study. SETTING: Radiology department at university hospital. PARTICIPANTS: Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. INTERVENTIONS: Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. MAIN OUTCOME MEASURES: Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). RESULTS: The UG intratester reliability (intraclass correlation coefficients [ICCs]) was .997 in flexion and .972 to .985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from .959 to .970 for flexion and from .856 to .898 for extension. Criterion validity (r) varied from .975 to .987 for flexion and from .390 to .442 for extension with the UG, and from .976 to .985 for flexion and .423 to .514 for extension with the PG. CONCLUSION: Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.

Economical microscope configuration for direct mycological examination with fluorescence in dermatology.

BACKGROUND: The use of fluorochromes such as Blankophor or Calcofluor allows to detect immediately and without ambiguity fungal elements in dermatological preparations. Whereas fluorescence microscopy is widely practised in clinical laboratories, it is not generally used in private practice because of the high price of a epifluorescence microscope. OBJECTIVE: To propose an economical microscope configuration to visualize fungal elements using fluorescence. METHODS: The preparations were examined with a standard microscope for routine observations, equipped with only two supplementary filters. RESULTS: Because the fungal elements produce a particularly bright fluorescence, a 25-watt halogen light is sufficient to visualize them in dermatological preparations: CONCLUSIONS: The proposed microscope configuration for direct mycological examination is particularly economical since equipment for epifluorescence and a vapour mercury lamp are not necessary.

An audit of out-of-hours advice services provided by hospice staff.

For those giving and receiving health care there will always be problems and queries which occur outside of normal office hours. Palliative care is no exception. It was found that Queenscourt Hospice in Southport was being used as an accessible point of contact for specialist palliative care advice by patients, relatives and health professionals. In response, an audit was undertaken to monitor the frequency and substance of the many drop-in visits and telephone calls to the hospice. The results showed that almost half of the calls/visits received are outside office hours. This article describes the nature of the calls and the advice offered by the staff taking the call. As the majority of the 'out-of-hours' calls/visits were taken by nursing staff, it was necessary for them to draw on their specialist palliative care knowledge and communication skills to make an assessment of how best to deal with each situation. As a result of the audit, several organizational and educational initiatives have been developed to further improve the service offered.

Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects.

BACKGROUND AND PURPOSE: A new parallelogram goniometer was designed by the Rehabilitation Centre of the Royal Ottawa Health Care Group in 1983. The advantage of using such a goniometer is that the clinician is not required to estimate the joint axis of rotation when taking a measurement. The parallelogram goniometer has obtained a good intratester and intertester reliability when measuring active range of motion of hip abduction on eight individuals with hip pathologies. However, the validity of the parallelogram goniometer has not been examined. The purposes of this study were to examine the intratester and intertester reliability and the criterion validity of the parallelogram and universal goniometers for active knee flexion on healthy individuals. SUBJECTS: Sixty healthy university students (44 females and 16 males; mean age of 20.6 yrs.) participated to this study. METHODS: Measurements with the universal and parallelogram goniometers were taken in two different positions, the smaller and larger angles of active knee flexion. All measurements were taken by two trained testers. A radiograph was taken in both positions to serve as the 'gold standard'. The sequence of the measurements and radiographs were randomly selected. The intra and intertester reliability of both goniometers were established by calculating the intraclass correlation coefficients (ICCs) using the repeated-measures ANOVA. The criterion validity was examined by calculating Pearson product-moment correlation coefficients (tau) between each goniometric and radiologic measurements. A 0.05 level of significance was chosen for each statistical test. RESULTS: Intratester reliability ranged from good to excellent for the small angles (ICC = 0.85 and 0.87) and the large angles (ICC = 0.91 and 0.96) when using the parallelogram goniometer. Intertester reliability was fair for the small angles of flexion (ICC = 0.43 to 0.52) and good to excellent for the large angles of flexion (ICC = 0.82 to 0.88). The parallelogram goniometer was found to have greater validity when measuring the large angles of knee flexion (r = 0.73 and 0.77) compared to the small angles of knee flexion (r = 0.33 and 0.41). Similar results of reliability and validity were obtained with the universal goniometer. CONCLUSION: The results of this study have clinical importance. The use of the parallelogram goniometer was found to be as reliable and valid as the universal goniometer when measuring active knee flexion. However, the parallelogram goniometer offered clinicians the advantages of obtaining precise angular measurements with fewer adjustments, and a faster application technique. Further studies on the parallelogram goniometer are necessary among individuals presenting with altered range of motion at different joints.

Food and microbiological problems in the newborn: data and practice.

We have reviewed the relationships of food, nutrition and feeding practices to various infections in the newborn. Tentative conclusions are made: (a) the initial use of human milk (raw or pasteurized) continues to offer advantages in the care of babies in intensive care; (b) attempts to mimic the microbiological effects of breast milk by manipulation of the composition of infant formulas have so far achieved little success, but this is a rapidly developing field; (c) we are wary of the widespread use of breast milk "fortifiers" until there is evidence that they do not adversely affect the protective properties of breast milk; (d) the doubtful advantages of nasojejunal feeding need to be weighed against the increased bacterial contamination of the upper small bowel; (e) systems monitoring in milk kitchens and the handling of feeds in the neonatal unit are an integral part of comprehensive neonatal care; (f) to limit nosocomial infection, particular attention to the faecal-food-oral route is necessary since there is potential for multiplication of initial contamination of food.

Sorrento studies of diet and fecal flora in the newborn.

The fecal flora of a breast-fed baby is very different from that of a bottle-fed baby. This paper reviews five previous studies, performed at this hospital concerning the effect of various dietary components (whey proteins, casein, lactoferrin, iron, nucleotides) on the fecal flora. The babies received either breast milk or one of the test formulas from birth. Fecal samples were examined by quantitative microbiological methods at 4 and 14 days and at various intervals thereafter. By 14 days differences in the fecal flora were established. Among breast-fed babies bifidobacteria, lactobacilli and staphylococci were predominant organisms, whereas in the formula-fed babies the predominant organisms were enterococci, coliforms, and Bacteroides. A whey-based formula without bovine lactoferrin, iron or nucleotides gave a flora a little closer to but still remote from the breast-fed one. Despite extensive modification of cow's milk in the manufacture of a modern infant formula, the fecal flora of bottle-fed babies remains substantially different from that of breast-fed babies.

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae.

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.

Faecal short chain fatty acids in breast-fed and formula-fed babies.

The intestinal flora of breast-fed infants differs from that of formula-fed infants. It is thought that this difference in flora may be one important reason why breast-fed babies suffer less from gastrointestinal disease. Differences in intestinal flora are reflected in the profile of faecal short chain fatty acids (SCFA). Very little is known about faecal concentrations of SCFA in babies fed breast milk or infant formula. In this study, faecal SCFA were measured in babies at two and four weeks of age who had been either exclusively breast fed or bottle fed from birth. There was no significant difference in total faecal SCFA concentrations between breast-fed and formula-fed babies when lactate was included. The formula-fed group, however, had less lactic acid and higher concentrations of propionic and n-butyric acids than breast-fed babies. Very few babies had significant levels of n-butyric acid, although this SCFA is believed to be important for the health of the colonic mucosa of adults.

Diet and faecal flora in the newborn: nucleotides.

Breast milk contains nucleotide salts that are only present in minimal amounts in modern infant formulas prepared from cows' milk. Nucleotides have been suggested as cofactors for the growth of bifidobacteria in vitro. Bifidobacteria are found to be more numerous in the faeces of breast fed babies compared with those of formula fed babies. Faecal flora were examined at 2 weeks of age in 32 babies who from birth had been fed a whey based formula supplemented with nucleotide monophosphate salts, 33 babies fed an unsupplemented formula, and 21 breast fed babies. Faecal flora were also examined at 4 weeks, and 7 weeks but with fewer babies in each group. Most differences were found at 2 weeks of age when more babies fed the nucleotide supplemented formula were colonised with Escherichia coli and more had E coli as the dominant organism in their faecal flora. Fewer of these babies were colonised with bifidobacteria. The counts of bifidobacteria and enterococci were reduced in the nucleotide supplemented group but bacteroides accounted for a higher percentage of the total flora in this group of babies. Supplementation of a formula with nucleotide salts did not make the faecal flora closer to that of breast fed infants as the growth of bifidobacteria was discouraged. While there may be arguments to support the addition of nucleotides to infant formula the results of this study do not support their addition for the enhancement of bifidobacteria in the faecal flora.

Faecal flora in the newborn. Effect of lactoferrin and related nutrients.

Bifidobacteria, lactobacilli and staphylococci are the predominant organisms in the faeces of breast fed babies whereas in formula fed babies coliforms, enterococci and bacteroides predominate. In vitro studies suggest that the mechanisms responsible are probably related to the acid base properties of the formula and 'immunological' proteins such as lactoferrin and sIgA. In human babies however the addition of bovine lactoferrin to an infant formula has little effect on the faecal flora and does not move it in the direction of the breast fed baby. There are various possible explanations of this lack of effect, e.g., inactivation of the lactoferrin when it is added to a formula, and immunological responses in the intestine to a foreign protein. We consider the most likely explanation is that other factors necessary for the optimum activity of lactoferrin were not present or in inappropriate concentration, e.g. sIgA, lysozyme, citrate, bicarbonate. If human lactoferrin is added to an infant formula it may be these other factors will require attention if the lactoferrin is to have a significant effect. An iconoclastic interpretation which cannot be completely excluded is that the hypothesis of lactoferrin bacteriostatic activity is based on in vitro studies and is not a reflection of what happens in babies. The faecal flora of a breast fed baby is very different from that of a baby receiving either cow's milk or a modern infant formula (Figure 1). Among breast fed babies bifidobacteria lactobacilli and staphylococci are the predominant organisms, whereas in formula fed babies the predominant organisms are enterococci, coliforms, and bacteroides (1).

Diet and faecal flora in the newborn: iron.

The faecal flora of a baby receiving a modern infant formula is substantially different from that of a breast fed baby. This difference is a little less when whey based formulas are used. The addition of bovine lactoferrin has no effect and there is some evidence that the presence of added iron in a formula moved the faecal flora further away from that of a breast fed baby. the iron content of currently used infant formulas is much higher than that of breast milk. The effect of the addition of iron to both whey and casein based formulas on the faecal flora was examined in further detail. Faecal flora were examined at 14 days of age in 33 babies receiving a whey formula fortified with iron, 29 babies receiving a whey formula without iron, 29 babies receiving a casein formula fortified with iron, and 24 babies receiving casein formula without iron. Subsequently fewer babies in each group were examined at week 7, 11, and 15. The addition of iron to both casein and whey formulas discouraged colonisation and growth of staphylococci and bacteroids but encouraged the colonisation and growth of clostridia and enterococci. The type of protein and not the iron content had more effect upon the growth of bifidobacteria; both whey formulas, fortified or not, encouraged the colonisation by bifidobacteria. If an infant formula, for use in the first few months, is to mimic the physiological effects of breast milk, there may be microbiological arguments for not fortifying it with iron. However, large empirical trials would be necessary before advocating such a policy.