The vaginal and uterine blood flow changes during the ovsynch program and its impact on the pregnancy rates in Holstein dairy cows.

AIM: OvSynch is a hormonal protocol for synchronization of estrus and use of artificial insemination (AI) at an optimal time without adverse effects on the ovaries or uterus. This study investigated the use of noninvasive color Doppler ultrasound to assess changes in uterine and vaginal blood flow during the Ovsynch program for synchronization of estrus and its relation to the pregnancy rates in Holstein cows. MATERIALS AND METHODS: The experimental cows received an intramuscular dose of 10 µg of a GnRH analogue (G1), followed 7 days later with an intramuscular injection of synthetic prostaglandin F2α (P: PGF2α) analogue (500 µg cloprostenol sodium), and given a 10 µg, injection of the GnRH analogue (G2) i.m. 48 h after the PGF2α treatment, and the cows were bred 14-16 h after. Uterine and vaginal perfusion were investigated by performing transrectal Doppler ultrasonography of both the uterine and vaginal arteries in Holstein cows at different time points during the Ovsynch program to determine: peak systolic velocity (PSV), time-averaged maximum velocity (TAMV), the volume of blood flow (BFV), pulsatility index (PI), resistance index (RI), resistance impedance (S/D) and diameters of uterine (UA) and vaginal (VA) arteries. Steroid hormones were also assayed. Transrectal ultrasonography (TUS) was performed at 32 and 60 days to confirm the pregnancy per artificial insemination (P/AI). RESULTS: The uterine PSV, TAMV, and PV were greater at the time of the cloprostenol sodium and second GnRH injections (p<0.05) than at the time of the first GnRH injection. The vaginal PSV, PV were greater at the time of the cloprostenol sodium than at the time of the first and second GnRH injections (p<0.05). The receiver operating characteristic curve (ROC curve) indicated a high correlation between the uterine and vaginal blood flow and the rate of the pregnancy (p<0.05). The area under the ROC curve was 0.920 and 0.87 (p<0.05) for vaginal and uterine arteries respectively at time of G2. The serum levels of progesterone, estrogen and cortisol were correlated with the P/AI (p<0.05). The P/AI significantly decreased from 43.9 % at 32 d to 35.37 % at 60 d. CONCLUSION: These results indicate that noninvasive Doppler ultrasonography is a valid method to evaluate changes in the characteristics of uterine and vaginal blood flow in cows during the Ovsynch protocol. Furthermore, vaginal and uterine blood flow are two determinant factors for the higher conception rates in Holstein dairy cows.

Incidental Non-cardiac Findings in Coronary Computed Tomography Angiography: Is it Worth Reporting?

OBJECTIVES: The objectives of this study were to estimate the prevalence and significance of incidental non-cardiac findings (INCFs) in coronary computed tomography angiography (CCTA) using a dual-source multidetector computed tomography. MATERIALS AND METHODS: Retrospective review of all CCTA studies performed over a time period for various indications was included in the study. After exclusions, CCTA of 1713 patients was evaluated by two experienced cardiac radiologists for non-cardiac abnormalities in the full field-of-view limited contrast chest series. The scans were acquired from the level of the carina to just below the diaphragm. INCFs were classified into three categories: Significant, indeterminate, and insignificant findings based on their clinical impact and availability of prior imaging and clinical details. RESULTS: The study cohort consisted of 1123 males (mean age of 58 years) and 590 females (mean age of 64 years). INCFs were seen in 600 patients of 1713 patients. A total of 812 INCFs (47.5%) were found in 1713 patients. Of those, 568 (70%) were considered insignificant, 205 (25.2%) indeterminate, and 39 significant findings (4.9%). The prevalence of significant findings was 2.3%. Among the 39 significant findings, after correlating with clinical details and other imaging, nine were really significant findings (0.5%) and out of this, four turned out to be cancers (0.2%). CONCLUSION: Large number of INCFs can be found in CCTA with majority of them being insignificant or of minimal clinical impact. Although the proportion of significant findings is small and may not be cost beneficial, it is prudent to evaluate all the available data and to make appropriate classification of INCFs which can help in further management.

Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index.

BACKGROUND: Supraclavicular nerve block is a popular approach for anaesthesia for upper limb surgeries. Conventional methods for evaluation of block success are time consuming and need patient cooperation. The aim of this study was to evaluate whether the perfusion index (PI) can be used to predict and provide a cut-off value for ultrasound-guided supraclavicular nerve block success. METHODS: The study included 77 patients undergoing elective orthopaedic procedures under ultrasound-guided supraclavicular nerve block. After local anaesthetic injection, sensory block success was assessed every 3 min by pinprick, and motor block success was assessed every 5 min by the ability to flex the elbow and the hand against resistance. The PI was recorded at baseline and at 10, 20, and 30 min after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 10 min divided by the PI at the baseline. Receiver operating characteristic curves were constructed for the accuracy of the PI in detection of block success. RESULTS: The PI was higher in the blocked limb at all time points, and this was paralleled by a higher PI ratio compared with the unblocked limb. Both the PI and the PI ratio at 10 min after injection showed a sensitivity and specificity of 100% for block success at cut-off values of 3.3 and 1.4, respectively. CONCLUSIONS: The PI is a useful tool for evaluation of successful supraclavicular nerve block. A PI ratio of > 1.4 is a good predictor for block success.

Molecular characterization of Cysticercus tenuicollis of slaughtered livestock in Upper Egypt governorates

Objective To present the molecular characterization of Cysticercus tenuicollis (C. tenuicollis) of Taenia hydatigena (T. hydatigena) from livestock isolates in Egypt, and to introduce a detailed image of C. tenuicollis infection in ruminant animals in Upper Egypt. Methods The prevalence rates of C. tenuicollis infections among the slaughtered animals from different organs were determined using the amplification of sequencing of the MT-CO1 gene. Results In the present study the infection rates of C. tenuicollis were found to be 16% and 19% in sheep and goat samples respectively. Firstly we report one larval stage of T. hydatigena detected in the camel liver in Egypt. C. tenuicollis infection manifested a higher prevalence in females than in males. Those above two years of age manifested a higher infection rate than younger animals. The preferred site for the infection was the omentum: a 70% preference in sheep and a 68% preference in goats. The molecular characterization using the MT-CO1 gene of isolates from sheep, goats and camels corresponded to T. hydatigena. For this study, molecular characterizations of T. hydatigena were done for the first time in Egypt. Molecular tools are of great assistance in characterizing the C. tenuicollis parasite especially when the morphological character cannot be detected, because the metacestodes are frequently confused with infection by the hydatid cyst, especially when these occur in the visceral organs. In the present study, C. tenuicollis manifested high identity in the goat and sheep samples, while differences were found more frequently in the camel samples (10 base pair). Conclusions Clearly molecular diagnosis for C. tenuicollis infection significantly helps to differentiate it from such other metacestodes as hydatidosis, which manifests a completely different pathogenicity and requires different control programs.

Curriculum framework for a master's degree in community medicine: some reflections with reference to Saudi Arabia

This paper describes a skeleton of a new curriculum intended for the teaching of community medicine leading to a recognized master's degree. The curriculum should have a detailed course framework and a distinctive rationale and justification with aims and specific objectives, contents, teaching methods, proper evaluation, available resources, and a well defined time framework. It is a prerequisite to develop a comprehensive curriculum before any postgraduate course is started. This curriculum must address all the relevant issues outlined in this paper. The authors recommend that the semitheoretical construction of the curriculum could be utilized in Saudi Arabia or possibly elsewhere with appropriate modifications