Development and implementation of a clinician report to reduce unnecessary urine drug screen testing in the ED: a quality improvement initiative.

BACKGROUND: Unnecessary testing is a problem-facing healthcare systems around the world striving to achieve sustainable care. Despite knowing this problem exists, clinicians continue to order tests that do not contribute to patient care. Using behavioural and implementation science can help address this problem. Locally, audit and feedback are used to provide information to clinicians about their performance on relevant metrics. However, this is often done without evidence-based methods to optimise uptake. Our objective was to improve the appropriate use of laboratory tests in the ED using evidence-based audit and feedback and behaviour change techniques. METHODS: Using the behaviour change wheel, we implemented an audit and feedback tool that provided information to ED physicians about their use of laboratory tests; specifically, we focused on education and review of the appropriate use of urine drug screen tests. The report was designed in collaboration with end users to help maximise engagement. Following development of the report, audit and feedback sessions were delivered over an 18-month period. RESULTS: Data on urine drug screen testing were collected continually throughout the intervention period and showed a sustained decrease among ED physicians. Test use dropped from a monthly departmental average of 26 urine drug screen tests per 1000 patient visits to only eight tests per 1000 patient visits following the initiation of the audit and feedback intervention. CONCLUSION: Audit and feedback reduced unnecessary urine drug screen testing in the ED. Regular feedback sessions continuously engaged physicians in the audit and feedback intervention and allowed the implementation team to react to changing priorities and feedback from the clinical group. It was important to include the end users in the design of audit and feedback tools to maximise physician engagement. Inclusion in this process can help ensure physicians adopt a sense of ownership regarding which metrics to review and provides a key component for the motivation aspect of behaviour change. Departmental leadership is also critical to the process of implementing a successful audit and feedback initiative and achieving sustained behaviour change.

Developing antimicrobial calcium alginate fibres from neem and papaya leaves extract.

OBJECTIVE: The aim of this study was to evaluate an alternative approach to developing antimicrobial alginate fibres using plant extracts, such as those from neem and papaya leaves. METHOD: Aqueous leaves extract from neem, papaya and their hybrid combinations were used as solvent to develop sodium alginate fibres. Sodium alginate polymer containing these extracts was extruded in a calcium chloride (CaCl2) bath to develop neem (NE), papaya (PE) and their hybrid combinations-based calcium alginate fibres (H-1 to H-5). The surface morphology, spectra, liquid absorption, tensile strength and antimicrobial activity of these developed fibres were measured. RESULTS: NE fibre showed greater tensile strength than PE. The liquid absorption property of all developed fibres decreased, but showed antibacterial properties against Staphylococcus aureus and reduced bacterial growth up to 85% when compared with pure calcium alginate fibre. CONCLUSION: Neem, papaya and hybrid extract-based calcium alginate fibres have the potential to be used as wound dressings.

Role of laparoscopic peritoneal biopsy in the diagnosis of peritoneal tuberculosis. A seven-year experience.

The diagnosis of asymptomatic abdominal tuberculosis,without characteristic laboratory and radiologic findings, is difficult. We therefore investigated the role of diagnostic laparoscopy in patients with suspected peritoneal tuberculosis(PTB). Patients admitted to Hamad General Hospital, Qatar,who underwent laparoscopic peritoneal biopsy for suspected PTB from January 2004 to December 2010 were retrospectively analysed. Factors assessed included patient age, sex, symptoms,clinical signs, CT scan findings, laparoscopic findings andhistopathological diagnosis. A total of 41 patients, 33 males(80.5%) and 8 females (19.5%), of mean age 31 years, underwent laparoscopic peritoneal biopsy for suspected PTB duringthe study period. Abdominal pain was the most common presenting symptom, observed in 33 (80.5%) patients.Computerized tomography (CT) of the abdomen showed as citesin 37 patients (90%), bowel nodules in 22 (54%), peritoneal thickening and nodules in 37 (90%) and enlarged mesenteric lymph nodes in 11 (27%). The classical gross laparoscopic appearance of peritoneal tuberculosis was observed in 38 patients (93%), whereas laparoscopic findings were normal in 3 patients (7%). Histopathological results confirmed granulomatous inflammation in 38 patients (93%). The sensitivity and specificity of gross laparoscopic appearance in diagnosing peritoneal TB were both 100%. Two patients experienced complications from laparoscopy (5%), but there were nolaparoscopy-related deaths. Laparoscopic peritoneal biopsy isa rapid and safe method of accurately diagnosing PTB.

Acetabular Aneurysmal Bone Cyst During the Syrian Conflict: A Case Report of Surgical Treatment and Outcomes.

Aneurysmal bone cysts (ABCs) are uncommon benign bone lesions that consist of blood-filled vascular spaces surrounded by fibrous tissue septa. Their diagnosis and surgical management are challenging in a war-torn region. In this case report, we present a rare case of a giant aneurysmal bone cyst located around the acetabulum in a 10-year-old female child who presented with an antalgic limp and left hip pain. The lesion was successfully treated with curettage and mixed autologous and synthetic bone grafts, and the follow-up for two years revealed a complete resolution of symptoms and radiological evidence of bone regeneration. This case highlights the successful surgical treatment of a challenging case of ABC in a difficult setting during the Syrian conflict.

Distal Radius Reconstruction Using Proximal Non-vascularized Fibula Graft in a Patient During the Syrian Conflict: A Case Study of Treatment Outcomes.

In conflict zones like Syria, accessing specialized medical care presents significant challenges. Here, we present the case of a 22-year-old female with a giant cell tumor in her distal forearm, exacerbated by limited access to healthcare due to the Syrian conflict. Despite these obstacles, we successfully performed en bloc resection and reconstructed the defect with a proximal non-vascularized fibular graft, restoring arm function. This case underscores the critical importance of adapting to adverse circumstances to deliver essential medical interventions in conflict-affected regions.

Prevalence of hepatitis B and C viruses among migrant workers in Qatar.

Limited data exist on viral hepatitis among migrant populations. This study investigated the prevalence of current hepatitis B virus (HBV) infection and lifetime hepatitis C virus (HCV) infection among Qatar's migrant craft and manual workers (CMWs), constituting 60% of the country's population. Sera collected during a nationwide COVID-19 population-based cross-sectional survey on CMWs between July 26 and September 9, 2020, underwent testing for HBsAg and HCV antibodies. Reactive samples underwent confirmatory testing, and logistic regression analyses were employed to explore associations with HBV and HCV infections. Among 2528 specimens tested for HBV infection, 15 were reactive, with 8 subsequently confirmed positive. Three samples lacked sufficient sera for confirmatory testing but were included in the analysis through multiple imputations. Prevalence of current HBV infection was 0.4% (95% CI 0.2-0.7%). Educational attainment and occupation were significantly associated with current HBV infection. For HCV infection, out of 2607 specimens tested, 46 were reactive, and 23 were subsequently confirmed positive. Prevalence of lifetime HCV infection was 0.8% (95% CI 0.5-1.2%). Egyptians exhibited the highest prevalence at 6.5% (95% CI 3.1-13.1%), followed by Pakistanis at 3.1% (95% CI 1.1-8.0%). Nationality, geographic location, and occupation were significantly associated with lifetime HCV infection. HBV infection is relatively low among CMWs, while HCV infection falls within the intermediate range, both compared to global and regional levels.

Correlation of Estrogen Receptor Alpha Serum Level with Gene Polymorphism and Its Effect on Women with Unexplained Infertility, Basra, Iraq.

Infertility of unknown etiology is considered a significant medical and health problem. This study focused on the role of the estrogen receptor alpha (ESRα) gene polymorphism, PvuII (rs2234693), and its effect on the amount of ESRα in the blood of women who cannot get pregnant for unknown reasons. A total of 184 females were evaluated, including 102 with unexplained infertility (UI) and 82 age-matched control females (with at least one living child and no history of infertility). Blood samples were collected, genomic DNA was isolated from blood samples, and the genotyping of the ESRα gene was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). ESRα expression levels were assessed by the ELISA. The study revealed that the mean serum level of ESRα was significantly higher in the case group than in the control group (P<0.05). Furthermore, the genotypes (TT, TC, and CC) and alleles (T and C) significantly influenced the plasma level of ESRα in the study population. Moreover, the presence of the C allele was considered a risk factor, and the polymorphism had a significant effect on ESRα expression level in women with UI.

Relationship of Polymorphisms of the Mutation (225131) of the pou1f1 Gene with some Productive Traits in Iraqi Camel Females (Camelus bactrianus).

Camels are semi-ruminant placental mammals, classified as two-toed, padded-footed mammals, and belong to the family Camelidae, which includes the one-humped camels (Camelus dromedaries), and the two-humped camels (Camelus bactrianus), llama, Alpaca, Vicuna, and Guanaco. The study used 50 Iraqi single-humped camel females who belonged to private fields in the AL-Furat AL-Awsat region, which involved three Iraqi cities (Babylon, Diwaniyah, and Muthanna). All the Biotechnological and Molecular Genetics analyses were performed in the Altakadum Laboratory, Baghdad, in order to determine the genotypes and their distribution ratios for the POU1F1 gene and the relationship of the Polymorphism of the gene with some productive traits, growth characteristics (weight and body dimensions) and blood biochemical parameters of animals. The mutation 225131 was in the second exon region, in which there was a change in the amino acid C.49 CAA>CAC Gln>His. Three genotypes were discovered in this mutation in the second studied piece, which included the region of the first intron and the second exon, with a length of 777 base pairs using DNA sequencing technology. The results indicated that there were highly significant differences (P≤0.01) in the distribution ratios of the genotypes resulting from the mutation. The results also showed a significant relationship between these genotypes with somebody dimensions, as there was a significant superiority (P≤0.05) for individuals with mutant CC genotype over the wild AA and hetero AC genotypes in each of the traits, body height from the front (220.66±1.76, 215.12±0.92, 212.80 ±2.33) cm and body length (186.66±1.20, 179.47±1.10, 170.00±4.96) cm and head length (55.00±2.08, 50.78±0.46, 51.20 ±1.31) cm for the mutant, wild and hetero, genotypes respectively. Concerning the characteristics of the length of the milking season, daily and total milk production, and its chemical components, there was no significant relationship between the genotypes resulting from the studied mutation.

The utility of a standardised breath sampler in school age children within a real-world prospective study.

Clinical assessment of children with asthma is problematic, and non-invasive biomarkers are needed urgently. Monitoring exhaled volatile organic compounds (VOCs) is an attractive alternative to invasive tests (blood and sputum) and may be used as frequently as required. Standardised reproducible breath-sampling is essential for exhaled-VOC analysis, and although the ReCIVA (Owlstone Medical Limited) breath-sampler was designed to satisfy this requirement, paediatric use was not in the original design brief. The efficacy of the ReCIVA at sampling breath from children has been studied, and 90 breath-samples from 64 children (5-15 years) with, and without asthma (controls), were collected with two different ReCIVA units. Seventy samples (77.8%) contained the specified 1 l of sampled-breath. Median sampling times were longer in children with acute asthma (770.2 s, range: 532.2-900.1 s) compared to stable asthma (690.6 s, range: 477.5-900.1 s;p= 0.01). The ReCIVA successfully detected operational faults, in 21 samples. A leak, caused by a poor fit of the face mask seal was the most common (15); the others were USB communication-faults (5); and, a single instance of a file-creation error. Paediatric breath-profiles were reliably monitored, however synchronisation of sampling to breathing-phases was sometimes lost, causing some breaths not to be sampled, and some to be sampled continuously. This occurred in 60 (66.7%) of the samples and was a source of variability. Importantly, multi-variate modelling of untargeted VOC analysis indicated the absence of significant batch effects for eight operational variables. The ReCIVA appears suitable for paediatric breath-sampling. Post-processing of breath-sample meta-data is recommended to assess the quality of sample-acquisition. Further, future studies should explore the effect of pump-synchronisation faults on recovered VOC profiles, and mask sizes to fit all ages will reduce the potential for leaks and importantly, provide higher levels of comfort to children with asthma.

Abnormal Obesity Phenotype Is Associated with Reduced eGFR among Diabetes Mellitus and Hypertensive Patients in a Peri-Urban Community in Ghana.

Background: Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia due to obesity and defects in insulin action. Significant complications of DM include kidney disease due to its association with hypertension and obesity. Thus, the contribution of the various obesity phenotypes to the kidney impairment observed among hypertensive and diabetes mellitus patients is of major concern. Aim: The study assessed the association between obesity phenotypes and reduced glomerular filtration rate among diabetes mellitus and hypertensive patients. Methods: Three hundred and ten (310) adult patients diagnosed with type 2 diabetes mellitus, hypertension, or both who attended the Presbyterian Hospital, Dormaa Ahenkro, from October 2016 to March 2017 were recruited for the study. Blood samples were collected to analyze biochemical parameters (fasting blood glucose (FBG), lipid profile, and creatinine). Questionnaires were used to collect sociodemographic information, and anthropometrics were appropriately measured. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation, and reduced eGFR was defined as eGFR <90 ml/min/1.73 m2. Results: The prevalence of metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically abnormal nonobese (MANO), and metabolically abnormal obese (MAO) phenotypes among the study participants was 30.65%, 4.50%, 52.90%, and 11.94%, respectively. The highest prevalence of reduced eGFR (29/37 (78.38%)) was seen among the MAO group. This was followed by the MANO, MHO, and MHNO with a reduced eGFR prevalence of 62.20%, 57.64%, and 37.89%, respectively. After normalization with MHNO, the reduced eGFR was 1.51, 1.64, and 2.06 times expressed in MHO, MANO, and MAO. For the total samples, when MHNO was maintained as a reference, reduced eGFR was significantly associated with MANO (aOR = 3.07 (95% CI = 1.76-5.35), P < 0.001) and MAO (aOR = 5.67 (95% CI = 2.66-17.27), P < 0.001) even after adjusting for age, gender, smoking, and alcohol intake. This association was maintained among the female study participants when stratified by gender, and in addition, among the female participants, reduced eGFR was also associated with MHO (aOR = 4.19 (95% CI = 1.06-16.53), P=0.041). Conclusion: There is a high prevalence of abnormal metabolic phenotypes among diabetes mellitus patients, and these were significantly associated with reduced eGFR among our study participants.

Clinical and epidemiological characteristics of lung cancer cases in Qatar.

This study documents for the first time the clinical and epidemiological characteristics of lung cancer cases in Qatar from 1998 to 2005. The age-standardized incidence rate was higher than that in many other Gulf countries: 8.95 per 100,000 (15.2 per 100,000 for males; 3.95 per 100,000 for females). Mean age at diagnosis was 57.5 years. Most patients were current smokers or ex-smokers at the time of diagnosis (82.5%). Unlike other Gulf countries, adenocarcinoma was the predominant type in both Qatari nationals and expatriates (43.9% of lung cancer types). Many cases were in an advanced stage at diagnosis (64.2% at stage IV). Incomplete information was available on mortality rate due to the migration of expatriates.

Assessment of Thyroid Function and Oxidative Stress State in Foundry Workers Exposed to Lead.

BACKGROUND: Exposure to lead (Pb) has been associated with endocrine, hematological, gastrointestinal, renal and neurological problems in humans. However, effects on the thyroid gland are controversial. OBJECTIVES: The aim of the present study was to assess thyroid function in foundry workers occupationally exposed to Pb and the mechanism of oxidative-antioxidant imbalance. METHODS: Thyroid function parameters and markers of oxidative stress were examined in 59 adult males who had been occupationally exposed to Pb. The results were then compared to those of 28 male subjects who had no history of Pb exposure or thyroid abnormalities and served as a control group. RESULTS: Mean blood lead levels (16.5±1.74 µg/dl) were significantly higher among the exposed workers compared to those of the control group (12.8±1.16 µg/dl, (p <0.001)). The exposed group had significantly increased free triiodothyronine (FT3), free thyroxine (FT4) and significantly decreased thyroid stimulating hormone (TSH) (1.77±0.44 µIU/ml), whereas the control group had a TSH level of 2.61±0.94 µIU/ml (p< 0.0001). A state of oxidative stress was indicated by the significant increase in mean levels of malondialdehyde (MDA) and significant decrease in glutathione (GSH) (p < 0.0001). There was a significant positive correlation (r=0.358, p <0.05) between blood lead levels (BLL) and duration of employment, while BLL showed a significant negative correlation with TSH (r =-0.486, p <0.001), and GSH (r =-0.336, p <0.05). Of the occupationally exposed workers, 32.76% had elevated thyroid hormones. The results showed a significant positive relationship between GSH and TSH (ß coefficient=0.274, p < 0.05), MDA with FT3 (ß coefficient=0.355, p < 0.05) and FT4 (ß coefficient = 0.491, p < 0.0001) among exposed workers. CONCLUSIONS: Workers exposed to Pb dust proved to be at risk for hyperthyroidism, which was found to have a significant role in oxidative-antioxidant imbalance present among workers with increasing duration of exposure. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Ethical Committee of the National Research Centre in Egypt (NRC) under the registration number 15225. COMPETING INTERESTS: The authors declare no competing financial interests.

MicroRNA-146a expression and microRNA-146a rs2910164 polymorphism in Behcet's disease patients.

Behcet's disease is a chronic, multisystem, inflammatory disease of unknown etiology. Oral ulcers, genital ulcers, cutaneous lesions, and ocular and articular involvement are the prominent features of the disease. The aim of the study was to assess expression of microRNA-146a and its gene polymorphism in Egyptian Behcet's disease (BD) patients and to evaluate their possible relation with clinical manifestations and activity. This is a case-control study, included 47 BD Egyptian patients, recruited from the Rheumatology outpatient clinic, Kasr Alainy Hospital, Cairo University Hospitals, and 50 healthy controls. BD activity was assessed using the BD Current Activity Score. Quantitative expressions of serum microRNA-146a and microRNA-146a rs2910164 SNP genotyping were performed by real-time polymerase chain reaction (RT-PCR). P values < 0.05 were considered statistically significant. Serum microRNA-146a expression was significantly higher in BD patients than in controls (7. 27 ± 4.11, 1.13 ± .37) (P < 0.001). There was a significant association between microRNA-146a expression and eye activity (P = 0.033) and vascular activity (P = 0.041). miRNA-146a rs2910164 genotyping revealed that the frequency of CC genotype was higher in controls (12 vs 8.5%) and the frequency of GG genotype of rs2910164 was higher in the BD patients (59.6 vs 24%) (P = 0.138). MicroRNA-146a expression in Egyptian BD patients is significantly higher than that in controls; there is significant association between microRNA-146a expression and eye and vascular activity of BD. The frequency of CC genotype of rs2910164 was decreased; frequency of GG genotype of rs2910164 was increased in BD patients as compared to controls, suggesting that GG genotype of rs2910164 confers susceptibility to BD while CC genotype has a protective role against BD development.

How early can pancreatic cancer be recognized? A case report and review of the literature.

The early symptoms of pancreatic cancer are often very vague. They may precede the diagnosis by years and go unrecognized. This makes pancreatic cancer one of the cancers with the worst survival rates. The progression rate of the early phase might be slower than previously thought. Here, we report a case where symptoms, including thromboembolism and new-onset diabetes mellitus, preceded the diagnosis of pancreatic cancer by 6 years or longer. The awareness of the early symptoms of pancreatic cancer is required for being vigilant and further diagnostic tests. A simple clinical model utilizing certain risk factors and symptoms for pancreatic cancer will help stratify the patients for further screening tests.

Vitamin E regulates mitochondrial hydrogen peroxide generation.

The mitochondrial electron transport system consumes more than 85% of all oxygen used by the cells, and up to 5% of the oxygen consumed by mitochondria is converted to superoxide, hydrogen peroxide, and other reactive oxygen species (ROS) under normal physiologic conditions. Disruption of mitochondrial ultrastructure is one of the earliest pathologic events during vitamin E depletion. The present studies were undertaken to test whether a direct link exists between vitamin E and the production of hydrogen peroxide in the mitochondria. In the first experiment, mice were fed a vitamin E-deficient or-sufficient diet for 15 weeks, after which the mitochondria from liver and skeletal muscle were isolated to determine the rates of hydrogen peroxide production. Deprivation of vitamin E resulted in an approximately 5-fold increase of mitochondrial hydrogen peroxide production in skeletal muscle and a 1-fold increase in liver when compared with the vitamin E-supplemented group. To determine whether vitamin E can dose-dependently influence the production of hydrogen peroxide, four groups of male and female rats were fed diets containing 0, 20, 200, or 2000 lU/kg vitamin E for 90 d. Results showed that dietary vitamin E dose-dependently attenuated hydrogen peroxide production in mitochondria isolated from liver and skeletal muscle of male and female rats. Female rats, however, were more profoundly affected by dietary vitamin E than male rats in the suppression of mitochondrial hydrogen peroxide production in both organs studied. These results showed that vitamin E can directly regulate hydrogen peroxide production in mitochondria and suggest that the overproduction of mitochondrial ROS is the first event leading to the tissue damage observed in vitamin E-deficiency syndromes. Data further suggested that by regulating mitochondrial production of ROS, vitamin E modulates the expression and activation of signal transduction pathways and other redox-sensitive biologic modifiers, and thereby delays or prevents degenerative tissue changes.

Antioxidant and oxidative status in tissues of manganese superoxide dismutase transgenic mice.

Manganese superoxide dismutase (Mn-SOD) plays an important role in attenuating free radical-induced oxidative damage. The purpose of this research was to determine if increased expression of Mn-SOD gene alters intracellular redox status. Twelve week old male B6C3 mice, engineered to express human Mn-SOD in multiple organs, and their nontransgenic littermates were assessed for oxidative stress and antioxidant status in heart, brain, lung, skeletal muscle, liver, and kidney. Relative to their nontransgenic littermates, transgenic mice had significantly (p <.01) higher activity of Mn-SOD in heart, skeletal muscle, lung, and brain. Copper, zinc (Cu,Zn)-SOD activity was significantly higher in kidney, whereas catalase activity was lower in brain and liver. The activities of selenium (Se)-GSH peroxidase and non-Se-GSH peroxidase, and levels of vitamin E, ascorbic acid and GSH were not significantly different in any tissues measured between Mn-SOD transgenic mice and their nontransgenic controls. The levels of malondialdehyde were significantly lower in the muscle and heart of Mn-SOD mice, and conjugated dienes and protein carbonyls were not altered in any tissues measured. The results obtained showed that expression of human SOD gene did not systematical alter antioxidant systems or adversely affect the redox state of the transgenic mice. The results also suggest that expression of human SOD gene confers protection against peroxidative damage to membrane lipids.

Oxidative stress and antioxidant status in mouse kidney: effects of dietary lipid and vitamin E plus iron.

The purpose of this study was to determine the effects of dietary fat, vitamin E, and iron on oxidative damage and antioxidant status in kidneys of mice. Sixty 1-month-old male Swiss-Webster mice were fed a basal vitamin E-deficient diet that contained either 8% fish oil + 2% corn oil or 10% lard with or without 1 g all-rac-alpha-tocopherol acetate or 0.74 g ferric citrate per kilogram of diet for 4 weeks. Significantly (P < 0.05) higher levels of lipid peroxidation products, thiobarbituric acid reactants (TBAR), and conjugated dienes were found in the kidneys of mice fed with fish oil compared with mice fed lard irrespective of vitamin E status. Mice maintained on a vitamin E-deficient diet had significantly higher renal levels of TBAR, but not conjugated dienes, than the supplemented group. Fish oil fed mice receiving vitamin E supplementation had lower levels of alpha-tocopherol than did mice in the lard fed group. Significantly higher levels of ascorbic acid were also found in the kidneys of mice fed with fish oil than were found in mice fed lard. The levels of protein carbonyls and glutathione (GSH), and activities of catalase, superoxide dismutase, selenium (Se)-GSH peroxidase, and non-Se-GSH peroxidase were not significantly altered by dietary fat or vitamin E. Dietary iron had no significant effect on any of the oxidative stress and antioxidant indices measured. The results obtained provide experimental evidence for the pro-oxidant effect of high fish oil intake in mouse kidney and suggest that dietary lipids play a key role in determining cellular susceptibility to oxidative stress.

Communicating hydrocephalus as a complication of isolated CNS angiitis--a case report.

A sixty-six-year-old man presented with headache, left hemiparesis, right crural monoparesis, and urinary and fecal incontinence. A picture consistent with cerebral angiitis was seen angiographically. After systemic angiitis and CNS infection were excluded, the diagnosis of isolated angiitis of the central nervous system was made. The patient responded well to corticosteroid therapy. However, a few months after initial presentation, he developed signs and symptoms suggestive of hydrocephalus. Serial CT scans of the head and radioisotope cisternography confirmed this diagnosis. The communicating hydrocephalus that developed was considered a complication of the CNS angiitis. A review of the literature on angiitis of the CNS is presented and the mechanism of the development of hydrocephalus is discussed.

Effect of dietary protein quality and fatty acid composition on plasma lipoprotein concentrations and hepatic triglyceride fatty acid synthesis in obese cats undergoing rapid weight loss.

OBJECTIVE: To determine effects of dietary lipid and protein on plasma lipoprotein and free fatty acid concentrations and hepatic fatty acid synthesis during weight gain and rapid weight loss in cats. ANIMALS: 24 ovariohysterectomized cats. PROCEDURE: Cats were fed a high energy diet until they gained 30% of their ideal body weight and then randomly assigned to receive 1 of 4 weight reduction diets (6 cats/diet) at 25% of maintenance energy requirements. Diets contained a low or high quality protein source and a lipid source deficient or sufficient in long chain essential fatty acids. Plasma samples and liver biopsy specimens were obtained before and after weight gain and during and after weight loss for determination of free fatty acid, triglyceride, and lipoprotein concentrations. Synthesis of these substances was measured by use of isotope enrichment. RESULTS: Plasma total cholesterol concentration and concentration of lipoprotein fractions increased after weight gain, compared with baseline values. Weight loss resulted in a significant decrease in concentrations of all lipoprotein fractions except high density lipoprotein. High density lipoprotein concentration was significantly greater in cats fed diets containing an oil blend, compared with cats fed diets containing corn oil. Fatty acid synthesis after weight loss was below the detection limit of the measurement technique. CONCLUSIONS AND CLINICAL RELEVANCE: In cats undergoing rapid weight loss there is neither increased triglyceride synthesis nor decreased transport of very low density lipoproteins from the liver, suggesting that their involvement in the development of hepatic lipidosis may be minimal.

Influence of dietary protein and lipid on weight loss in obese ovariohysterectomized cats.

OBJECTIVE: To determine effects of dietary lipid and protein on development of hepatic lipidosis (HL) and on physical and biochemical indices following rapid weight loss in cats. ANIMALS: 24 ovariohysterectomized cats. PROCEDURE: Cats were fed a high energy diet until they gained 30% of their ideal body weight and then randomly assigned to receive 1 of 4 weight-reduction diets (6 cats/diet) at 25% of maintenance energy requirements per day. Diets contained a low or high quality protein source and a lipid source deficient or sufficient in long chain essential fatty acids (LCEFA). Serum and plasma samples and liver biopsy specimens were obtained for biochemical analyses and determination of hepatic lipid content before and after weight gain and during and after weight loss. RESULTS: Irrespective of weight-reduction diet fed, all cats lost weight at a comparable rate (4.51 to 5.00 g/d/kg of obese body weight). Three cats developed hepatic lipidosis. Significant changes in plasma insulin, cholesterol, triglyceride, and serum glucose concentrations were detected after weight gain and weight loss in all diet groups, but values for these variables did not differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Cats can lose 25 to 30% of their obese body weight over 7 to 9 weeks without developing overt clinical signs of HL, provided that weight-reduction diets are highly palatable, contain a high quality protein, have a source of LCEFA, and are fortified with vitamins and microminerals. However, rapid weight loss may increase risk factors associated with development of diabetes mellitus.