Repeatability and Feasibility of Pressure Algometry for Quantifying Mechanical Nociceptive Threshold in the Thoracic Region of Calves.

Pressure algometry can be used to quantify mechanical nociceptive threshold (MNT) in humans and animals. If reliable this may be a useful tool to examine calves for increased mechanical sensitivity, which may be induced by disease or pain. This study measures the repeatability and feasibility of pressure algometry using a handheld digital pressure algometer (PRODPlus, Top Cat metrology) using three serial measurements applied to six sites on the thoraces of 35 healthy calves by two different operators. The range of MNTs recorded in healthy calves was 1.2-25 Newtons (median = 10.1 IQR = 7.1-14.0). A multivariable mixed effects model identified that the MNT's recorded were influenced by Operator, Site, and Calf. Intra and inter-operator reliability were measured by intra-class correlation coefficients (ICCs). Based on average ICCs, intra-operator reliability at two sites was good; one site overlying the ventral aspect of the 6th intercostal space [ICC = 0.79 95% CI (0.63-0.89)] and the other overlying the dorsal aspect of the 9th intercostal space [ICC = 0.75 95% CI (0.56-0.87)]. Average ICCs for three other measurement sites were moderate or poor, and one site proved unfeasible. For inter-operator agreement average ICCs showed that agreement was also good at the same 6 and 9th intercostal space, [ICCs = 0.77 95% CI (0.35-0.90) and 0.77 95% CI (0.54-0.88), respectively], agreement was moderate for the remainder of the sites. This study identifies two sites that are potentially useful for monitoring of thoracic sensitivity as an indicator of pain in calves by means of pressure algometry using the average of three measurements. It also identifies sources of variability to be considered when applying the tool for clinical or research purposes.

Ovine infectious keratoconjunctivitis in sheep: the farmer's perspective.

The objective of this study was to gather current, farmer-reported data on the frequency of occurrence, risk factors and treatment practices for the sheep eye disease, ovine infectious keratoconjunctivitis (OIKC). A questionnaire regarding eye disease in sheep was completed by 135 farmers from four livestock markets. Most farmers (87%) had observed OIKC in their flock, 88% of these within the last 2 years. Farmers reported observing most cases in the winter months (51%) and fewest in the summer (10%). They proposed housing and forage feeding from racks as factors associated with OIKC. A variety of treatment protocols were used by farmers. The three most popular treatments used were: cloxacillin eye ointment, intramuscular oxytetracycline injection and topical tetracycline spray applied to the eye. Only 62% of treatments were considered very effective by the farmers, with no difference in farmer perceived efficacy between these three most commonly used treatments (p=0.6). Farmers used 15 different terms to describe a photograph of a sheep with OIKC, including many colloquial terms. We hypothesise that this could result in communication problems between veterinary surgeons and farmers.

Renal Outcomes in Children with Operated Spina Bifida in Uganda.

BACKGROUND: To describe the extent of renal disease in Ugandan children surviving at least ten years after spina bifida repair and to investigate risk factors for renal deterioration in this cohort. PATIENTS AND METHODS: Children who had undergone spina bifida repair at CURE Children's Hospital of Uganda between 2000 and 2004 were invited to attend interview, physical examination, renal tract ultrasound, and a blood test (creatinine). Medical records were retrospectively reviewed. The following were considered evidence of renal damage: elevated creatinine, hypertension, and ultrasound findings of hydronephrosis, scarring, and discrepancy in renal size >1cm. Female sex, previous UTI, neurological level, mobility, detrusor leak point pressure, and adherence with clean intermittent catheterisation (CIC) were investigated for association with evidence of renal damage. RESULTS: 65 of 68 children aged 10-14 completed the assessment. The majority (83%) reported incontinence. 17 children (26%) were performing CIC. One child had elevated creatinine. 25 children (38%) were hypertensive. There was a high prevalence of ultrasound abnormalities: hydronephrosis in 10 children (15%), scarring in 42 (64%), and >1cm size discrepancy in 28 (43%). No children with lesions at S1 or below had hydronephrosis (p = 0.025), but this group had comparable prevalence of renal size discrepancy, scarring, and hypertension to those children with higher lesions. CONCLUSIONS: Incontinence, ultrasound abnormalities, and hypertension are highly prevalent in a cohort of Ugandan children with spina bifida, including those with low neurological lesions. These findings support the early and universal initiation of CIC with anticholinergic therapy in a low-income setting.

Effect of blood ionised calcium concentration at calving on fertility outcomes in dairy cattle.

Clinical and subclinical hypocalcaemia are common in dairy cows, yet evidence in the literature assessing their impact on fertility is inconsistent. The aim of this prospective cohort study was to examine associations between blood ionised calcium concentration at calving and fertility outcomes in dairy cattle. Blood samples were taken from 137 Holstein cows from four commercial dairy herds within 24 hours of calving and analysed for blood ionised calcium using an Epocal Point of Care Analyser (Epocal, Ottawa, Canada). Data collected from routine veterinary fertility examinations and herd records were used to investigate the association of ionised calcium with the outcomes: time to first service, time to conception and endometritis. There were significant negative associations between blood ionised calcium concentration and time to first service (HR 1.33, P=0.001) and blood ionised calcium concentration and time to conception (HR 1.16, P=0.04). There was no significant association between blood ionised calcium concentration and endometritis. The results of this study imply that management policies that minimise the reduction in blood ionised calcium concentration in the periparturient dairy cow are likely to improve reproductive outcomes and should be considered as part of the multifactorial approach to optimising dairy cow fertility.

Quality of life among children with spina bifida in Uganda.

BACKGROUND: Children surviving after spina bifida repair often have significant disability, the consequences of which may be more profound in low-income countries. The aim of this cross-sectional study was to measure quality of life (QOL) reported by children with spina bifida in Uganda, and to define factors associated with QOL. METHODS: QOL was measured using both the Health Utilities Index (HUI3) Tool and a visual analogue scale (VAS) marked from 0 to 10. In keeping with the WHO definition of QOL, further analysis was conducted using subjective QOL scores (using the VAS). Multivariate regression was used to investigate the association between VAS scores and prespecified variables: age, sex, hydrocephalus, mobility, urinary continence, school attendance and family size. RESULTS: Sixty two of 68 surviving children aged 10-14 were able to complete all aspects of the assessment. There was poor correlation between the VAS and HUI3 Tool (Pearson correlation 0.488). On multivariate regression, the following variables were associated with a significant change in the 10-point VAS (change in score; 95% CI): male sex (-1.45; -2.436 to -0.465), urinary continence (1.681; 0.190 to 3.172), large family size (-1.775; -2.773 to -0.777) and hydrocephalus (-1.382; -2.374 to -0.465). CONCLUSIONS: Urinary continence and family size are potentially modifiable, the former by simple and inexpensive medical management. Enhanced investment in community-based rehabilitation and support is urgently needed. Delivery of family planning services is a national priority in Uganda, and should be discussed with families as part of holistic care.

Ten-year survival of Ugandan infants after myelomeningocele closure.

OBJECTIVE Myelomeningocele (MM) is a neural tube defect complicated by neurological deficits below the level of the spinal lesion and, in many cases, hydrocephalus. Long-term survival of infants treated for MM in a low- and middle-income country has never been reported. This retrospective cohort study reports 10-year outcomes and factors affecting survival for infants undergoing MM repair at CURE Children's Hospital of Uganda. METHODS Patients were traced by telephone or home visit. Survival was estimated using the Kaplan-Meier method. Multivariate survival was analyzed using the Cox proportional hazards model, investigating the following variables: sex, age at surgery, weight-for-age at surgery, motor level, and presence and management of hydrocephalus. RESULTS A total of 145 children underwent MM repair between 2000 and 2004; complete data were available for 133 patients. The probability of 10-year survival was 55%, with 78% of deaths occurring in the first 5 years. Most of the deaths were not directly related to MM; infection and neglect were most commonly described. Lesions at motor level L-2 or above were associated with increased mortality (HR 3.176, 95% CI 1.557-6.476). Compared with repair within 48 hours of birth, surgery at 15-29 days was associated with increased mortality (HR 9.091, 95% CI 1.169-70.698). CONCLUSIONS Infants in low- and middle-income countries with MM can have long-term survival with basic surgical intervention. Motor level and age at surgery were significant factors influencing outcome. Education of local health care workers and families to ensure both urgent referral for initial treatment and subsequent access to basic medical care are essential to survival.

The radiographic anatomy of the normal ovine digit, the metacarpophalangeal and metatarsophalangeal joints.

The aim of this project was to develop a detailed, accessible set of reference images of the normal radiographic anatomy of the ovine digit up to and including the metacarpo/metatatarsophalangeal joints. The lower front and hind limbs of 5 Lleyn ewes were radiographed using portable radiography equipment, a digital image processer and standard projections. Twenty images, illustrating the normal radiographic anatomy of the limb were selected, labelled and presented along with a detailed description and corresponding images of the bony skeleton. These images are aimed to be of assistance to veterinary surgeons, veterinary students and veterinary researchers by enabling understanding of the normal anatomy of the ovine lower limb, and allowing comparison with the abnormal.

Meconium periorchitis--a rare cause of a paratesticular mass.

We report a 9-month-old boy who presented with a hard paratesticular mass. Clinical and ultrasound findings were highly suggestive of malignancy and orchidectomy was performed. Histology confirmed the unexpected diagnosis of meconium periorchitis, a rare, benign condition resulting from intrauterine bowel perforation.

Intraosseous haemangioma of the mandible: a case report.

An unusual case of an endangering intraosseous haemangioma affecting the mandible in early childhood is presented. The early diagnosis was unclear until a surgical biopsy was performed. MRI confirmed the diagnosis. Successful emergent arterial embolisation and intralesional steroid injection were undertaken to control troublesome bleeding prior to medical treatment.