Ayurveda in the integrative management of bovine secondary recumbency-a case report.

Downer cow syndrome, or secondary recumbency, is a condition primarily affecting dairy cows, where the animal is unable to rise and stand, due to unknown cause. It is usually associated with poor prognosis. Terminal downers are euthanized in most countries. A four-year old Kasarkode dwarf-cow, post-calving was brought up laterally recumbent with heavy nasal discharge, labored breathing, loss of appetite and signs of dehydration on 6th day of its recumbency. Before this, the patient was diagnosed with milk fever and standard treatment with calcium borogluconate was administered intravenously. The animal was left to succumb under unprotected conditions, due to various constraints on euthanasia. After adopting the cow, Nasya was started immediately to avoid death due to sepsis and shock. The animal was drenched with Ayurvedic fluids containing deepana-pacana herbs. Sternal recumbency, warm and moistened muzzle was observed on the fourth day of commencing ayurvedic treatment. Respiratory distress was minimal. Drastic prognostic shift from "no hope" to "good" was possible within 6 days thanks to Nasya, and the animal was stable. Thereafter, integrative care comprising of antibiotics, rehydrating IV fluids, and supplementations, along with ayurvedic medicines was initiated. Ruminal-fluid obtained from slaughterhouse was used for ruminal-flora replacement. Rumination on 14th day, cow on its feet by 19th day and complete healing of decubital ulcers by approximately 40 days was recorded. A downed cow which did not respond to standard veterinary care was managed with Ayurveda-integrated veterinary care. Ayurveda herbs like bamboo leaves (Bambusa vulgaris), green chiretta (Andrographis paniculata) that cattle prefer eating during certain illness, turn out to be useful for Ayurvedic management. Hence, Ayurveda veterinary medicine might be, a good choice for integrative management of terminal downers, preventing early death in downed dairy cows.

Impact of Controlling Nutritional Status Score on Comprehensive Clinical Outcomes in Patients With Chronic Limb-Threatening Ischemia in a Local Area of Super-Aged Society.

PURPOSE: This study aimed to evaluate the relationship between nutritional status and hospital outcomes in patients with chronic limb-threatening ischemia (CLTI) in a local area of contemporary super-aged society of Japan. MATERIALS AND METHODS: We analyzed 131 consecutive patients with 179 lower limb diseases admitted to our hospital for the treatment of CLTI between April 2018 and March 2023. These 131 patients were divided into 3 groups according to hospital outcomes: home discharge (HD), out-of-home discharge (OD), and in-hospital death (ID). Patient and lesion backgrounds were compared among the 3 groups, and a multivariable regression analysis was used to analyze the interaction between malnutrition and composite hard endpoints. RESULTS: The median age was 82.8 years, and non-ambulatory patients comprised 61.8% of the study population. The HD group included more ambulatory and fewer patients with higher CONUT score or inflammation than OD or ID group. The Rutherford classification and Wound, Ischemia, and foot Infection stage were significantly more severe in the ID group than in the HD group. Endovascular treatment (EVT) was more often implemented in the HD (94.9%) and OD (81.7%) groups than in the ID group (60.0%). However, all EVT procedures in the ID group were performed until as distally as possible to achieve the target arterial path success contrary to some EVT procedures in the HD or ID group that targeted lesions only above the knee. Multivariate analysis showed that a non-ambulatory state (hazard ratio [HR]=3.65, 95% confidence interval [CI]=1.48-9.02) and a higher controlling nutritional status (CONUT) score (≥5) (HR=7.46, 95% CI=1.66-33.6) were significant predictors for composite endpoints (major amputation or ID). Patients with lower CONUT scores (≤4) showed better outcomes in all indices including overall survival, major amputation-free survival, and wound healing. CONCLUSION: Condition of the CLTI patients represented by higher CONUT score emerged as the most influential predictor of major amputation or ID. Furthermore, non-ambulatory status or condition of higher CONUT score affects the destination after discharge. Implementing multidisciplinary approaches to address patients' nutritional state and physical disability, in addition to revascularization, may enhance comprehensive prognoses in patients with CLTI. CLINICAL IMPACT: In this single-center retrospective study, we analyzed prognoses of 131 consecutive patients with 179 lower limb diseases admitted for the treatment of chronic limb-threatening ischemia (CLTI) between April 2018 and March 2023. Our main finding was that condition of the CLTI patients represented by higher controlling nutritional status (CONUT) score was the most significant predictor of either major amputation or in-hospital death. Furthermore, condition of higher CONUT score or non-ambulatory status affects the destination after discharge. This suggests that multidisciplinary approaches to address patients' nutritional state and physical disability, in addition to revascularization, may enhance the prognosis in patients with CLTI. This is the first report to evaluate nutritional status associated with comprehensive hospital outcomes in addition to previously reported hard endpoints, such as major amputation or overall survival, and will be of great help in future clinical practice.

Development of algorithms for estimating the Child Health Utility 9D from Caregiver Priorities and Child Health Index of Life with Disability.

PURPOSE: The primary aim was to determine Child Health Utility 9D (CHU9D) utilities from the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) for non-ambulatory children with cerebral palsy (CP). METHODS: One hundred and eight surveys completed by Australian parents/caregivers of children with CP were analysed. Spearman's coefficients were used to investigate the correlations between the two instruments. Ordinary least square, robust MM-estimator, and generalised linear models (GLM) with four combinations of families and links were developed to estimate CHU9D utilities from either the CPCHILD total score or CPCHILD domains scores. Internal validation was performed using 5-fold cross-validation and random sampling validation. The best performing algorithms were identified based on mean absolute error (MAE), concordance correlation coefficient (CCC), and the difference between predicted and observed means of CHU9D. RESULTS: Moderate correlations (ρ 0.4-0.6) were observed between domains of the CHU9D and CPCHILD instruments. The best performing algorithm when considering the CPCHILD total score was a generalised linear regression (GLM) Gamma family and logit link (MAE = 0.156, CCC = 0.508). Additionally, the GLM Gamma family logit link using CPCHILD comfort and emotion, quality of life, and health domain scores also performed well (MAE = 0.152, CCC = 0.552). CONCLUSION: This study established algorithms for estimating CHU9D utilities from CPCHILD scores for non-ambulatory children with CP. The determined algorithms can be valuable for estimating quality-adjusted life years for cost-utility analysis when only the CPCHILD instrument is available. However, further studies with larger sample sizes and external validation are recommended to validate these findings.

Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study.

PURPOSE: This study aimed to determine whether Cobb and pelvic obliquity corrections can be predicted using supine traction radiographs in patients with cerebral palsy (CP) who underwent posterior spinal fusion (PSF) from T2/3 to L5. METHODS: From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent PSF using pedicle screws in two quaternary centers with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed. RESULTS: A total of 106 patients aged 15.6 ± 0.4 years were included. All patients had significant correction of the Cobb angle (MC), pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL) without loss of correction at the last FU (LFU). Curve flexibility was significantly correlated with Cobb correction (δMC) immediately postoperatively (p < 0.0001, r = 0.8950), followed by the amount of correction in pelvic obliquity under traction (δPOT) (p = 0.0252, r = 0.2174). For correction in PO (δPO), the most significant variable was δPOT (p < 0.0001, r = 0.7553), followed by curve flexibility (p = 0.0059, r = 0.26) and the amount of correction in Cobb under traction (p = 0.0252, r = 0.2174). CONCLUSIONS: Cobb and PO corrections can be predicted using supine traction films for non-ambulatory CP patients treated with PSF from T2/3 to L5. The variables evaluated were interconnected, reinforcing preoperative planning for these patients. Comparative large-scale studies on patient-related clinical outcomes are required to determine whether this predicted correction is associated with improved surgical outcomes and reduced complication rates. LEVEL OF EVIDENCE: IV.

The role of ataluren in the treatment of ambulatory and non-ambulatory children with nonsense mutation duchenne muscular dystrophy - a consensus derived using a modified Delphi methodology in Eastern Europe, Greece, Israel and Sweden.

BACKGROUND: This paper details the results of an evaluation of the level of consensus amongst clinicians on the use of ataluren in both ambulatory and non-ambulatory patients with nonsense mutation Duchenne muscular dystrophy (nmDMD). The consensus was derived using a modified Delphi methodology that involved an exploration phase and then an evaluation phase. METHODS: The exploration phase involved 90-minute virtual 1:1 interviews of 12 paediatric neurologists who cared for 30-120 DMD patients each and had patient contact every one or two weeks. The respondents managed one to ten nmDMD patients taking ataluren. The Discussion Guide for the interviews can be viewed as Appendix A. Following the exploration phase interviews, the interview transcripts were analysed by an independent party to identify common themes, views and opinions and developed 43 draft statements that the Steering Group (authors) reviewed, refined and endorsed a final list of 42 statements. Details of the recruitment of participants for the exploration and evaluation phases can be found under the Methods section. RESULTS: A consensus was agreed (> 66% of respondents agreeing) for 41 of the 42 statements using results from a consensus survey of healthcare professionals (n = 20) experienced in the treatment of nmDMD. CONCLUSIONS: The statements with a high consensus suggest that treatment with ataluren should be initiated as soon as possible to delay disease progression and allow patients to remain ambulatory for as long as possible. Ataluren is indicated for the treatment of Duchenne muscular dystrophy that results from a nonsense mutation in the dystrophin gene, in ambulatory patients aged 2 years and older (see Summary of Product Characteristics for each country).

Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair - preliminary data

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.

Annoyance-rate-and-casualty-reality-based method of comfort evaluation of military ambulance / 医疗卫生装备

Objective To explore an method for comfort evaluation of the military ambulance to enhance ride comfort during casualty transport. Methods The method executed quantitative evaluation of vibrational comfort by the existing vibration comfortableness evaluation ways for non-ambulatory casualty, different reactions of casualty to vibrational excitement and annoyance rate analysis based on psychophysics, which took considerations on the ratio of injured sites at war or natural disaster conditions as well as susceptibility analysis. Trials of the the method were carried out on the vibrational comfort analysis of some military ambulance during the road test.Results The method had feasibility for vibration comfortableness evaluation of non-ambulatory casualty,and improved the traditional ways in quantitative analysis.Conclusion The method gains advantages over the international ways, and contributes to the related researches on vibration reduction.

Research on a new NBC casualty decontamination shelter / 医疗卫生装备

Objective To develop a new NBC casualty decontamination shelter,which can be used to decontaminate NBC casualties. Methods The shelter integrated the technologies of plate shelter expansion, auto waterway control, micro-environment control, rapid sewage collection and etc, and took considerations on decontamination requirements of the ambulatory and non-ambulatory casualties.It was designed combining fixed and extendable shelters,which realized double-side expansion by manual push and pull. The shelter was composed of the plate shelter, decontamination devices and facilities, water supply & heating system, waterway system, power supply and distribution system, lighting system, air conditioning and heating system and other accessories.Results The shelter could decontaminate the ambulatory and non-ambulatory casualties simultaneously,the decontamination water temperature ranged from the temperature of water source to 50 ℃, the mixing ratio of the decontamination water was from 0.2% to 2%, and the time consumed for deployment and withdrawal was not more than 20 min. Conclusion The shelter gains advantages in layout and technology, and enhances decontamination ability for NBC medical rescue.

Comparative Analysis of TKR in Preoperative Ambulatory and Non / 대한정형외과학회잡지

At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.