Circadian influence on the preovulatory LH surge, ovulation, and prolactin concentrations in heifers

A novel circadian study of the effect of clock hours on the preovulatory LH surge, ovulation, and maximal PRL concentration was done in 13 nontreated Holstein heifers. Hourly blood sampling and hourly ultrasound examinations to detect the hour of ovulation began at 8 and 48 hours, respectively, after CL area (cm(2)) had decreased 15% from the area at 15 days postovulation. The resulting experimental period began at the beginning of postluteolysis (progesterone, <1 ng/mL) and encompassed a mean of 3.5 days until ovulation. The frequency of the peak of the preovulatory LH surge for the three 8-hour periods of a 24-hour day was different (P < 0.02) between 2:00 AM to 9:00 AM (N = 9), 10:00 AM to 5:00 PM (N = 3), and 6:00 PM to 1:00 AM (N = 1). The median was 6:00 AM. The frequency of ovulations for 8-hour periods was different (P < 0.02) between 3:00 AM to 10:00 AM (N = 9), 11:00 AM to 6:00 PM (N = 3), and 7:00 PM to 2:00 AM (N = 1). The median was 7:30 AM. Two or three clusters of PRL pulses occurred during the 3.5 days. Based on all available PRL pulse clusters (N = 36), the clock hours of the maximal concentration/cluster was greater (P < 0.0001) for 9:00 AM to 2:00 PM (N = 33 clusters) than for each of the three other 6-hour periods (N = 0, 1, or 2 per period). The median was 11:30 AM. The hypothesis was supported that the peak of the preovulatory LH surge, ovulation, and maximal PRL concentration during pulse clusters occur with greater frequency during certain clock hours in heifers.

Inhibition of prostaglandin biosynthesis during postluteolysis and effects on CL regression, prolactin, and ovulation in heifers

The beginning of postluteolysis (progesterone, <1 ng mL(-1)) in heifers was targeted by using 8 h after ultrasonic detection of a 25% decrease in CL area (cm2) and was designated Hour 0. Flunixin meglumine (FM; n=10) to inhibit PGF2α secretion or vehicle (n=9) were given intramuscularly at Hours 0, 4, 8, 16, 24, 32, and 40. The dose of FM was 2.5 mg/kg at each treatment. Blood sampling and measurement of the CL and dominant follicle were done every 8 h beginning 14 days postovulation in each group. Blood samples for detection of pulses of PRL and pulses of a metabolite of PGF2α (PGFM) were obtained every hour for 24 h beginning at Hour 0. Pulse concentrations of both PGFM and PRL were lower in the FM group than in the vehicle group. Concentration of PRL was greatest at the peak of a PGFM pulse. Neither CL area (cm2) nor progesterone concentration differed between groups during Hours 0 to 48 (postluteolysis). Ovulation occurred in nine of nine heifers in the vehicle group and in three of 10 heifers in the FM group. The anovulatory follicles in the FM group grew to 36.2±2.9 mm, and the wall became thickened from apparent luteinization. The hypothesis that PGF2α was involved in the continued P4 decrease and structural CL regression during postluteolysis was not supported. However, the hypotheses that pulses of PGFM and PRL were temporally related and that systemic FM treatment induced an anovulatory follicle were supported.

Appropriate length of epidural catheter in the epidural space for postoperative analgesia: evaluation by epidurography

In current practice, the length of epidural catheter that should be left in the epidural space is not standardised for effective postoperative analgesia. This prospective, randomised, double-blinded study aimed to determine the most appropriate length of epidural catheter that should be inserted into the epidural space for postoperative analgesia. We recruited 102 women and assigned them into three study groups (3, 5 and 7 cm insertion). An epidural catheter was inserted and epidurography was performed. Postoperatively, mean pain scores, motor and sensory levels, and any complications associated with the epidural catheter were recorded. No statistically significant difference for mean postoperative pain score was found at all study timings. Motor and sensory blockade was also statistically insignificant. Unilateral sensory analgesia developed in one patient in the 7 cm group and epidural catheter dislodgement was observed in four patients in the 3 cm group. In order to minimise catheter-related complications for postoperative analgesia, the most appropriate length that an epidural catheter should be left in the epidural space is 5 cm. You can respond to this article at http://www.anaesthesiacorrespondence.com.

Changes in biochemical composition of follicular fluid during reproductive acyclicity in water buffalo (Bubalus bubalis)

This study describes the changes in biochemical composition of follicular fluid during reproductive acyclicity in buffalo. A total of 73 pairs of ovaries collected from 26 reproductively acyclic and 47 reproductively cyclic buffaloes were used in the investigation. Ovarian follicles were classified into small (5.0-6.9 mm), medium (7.0-9.9 mm) and large (≥10.0 mm) sized categories depending upon their diameter. Follicular fluid was aspirated, processed and assayed for glucose, cholesterol, total protein, acid phosphatase and alkaline phosphatase. Glucose concentration was lesser in reproductively acyclic compared to cyclic buffaloes (19.3 ± 2.59 mg/dl compared to 32.6 ± 2.60 mg/dl; P<0.05), mainly due to difference in concentration between small sized follicles (12.4 ± 2.59 mg/dl compared to 28.0 ± 3.32 mg/dl; P<0.05). Cholesterol concentration was also lesser in reproductively acyclic compared to cyclic buffaloes (32.2 ± 2.14 mg/dl compared to 35.5 ± 2.16 mg/dl; P<0.05) and this was related to the lesser concentration found in large follicles (13.8 ± 3.45 mg/dl compared to 37.2 ± 4.10mg/dl; P<0.001). Total protein and acid phosphatase levels were not affected by either the reproductive cyclicity status or the follicular size (4.9 ± 1.07 g/dl to 6.0 ± 0.28 g/dl and 1.2 ± 0.17 U/dl to 2.5 ± 1.22 U/dl, respectively). An increased alkaline phosphatase activity was, however, observed in reproductively acyclic compared to cyclic buffaloes (27.5 ± 3.08 U/dl compared to 14.0 ± 1.09 U/dl; P<0.0001). In conclusion, results of the present study indicate an alteration in the biochemical composition of follicular fluid during reproductive acyclicity in buffalo. The findings provide further support to the notion that poor nutrition is an important factor triggering reproductive acyclicity in buffalo.

Bilateral follicular cysts in a water buffalo

The present short communication puts on record a case of bilateral, multiple follicular cysts in a water buffalo along with a detailed description of its ovarian biometry and follicular fluid composition. The ovarian weight and biometrical parameters were much higher than in normal cycling buffaloes. A total of three follicular cysts were observed, two on the right ovary and one on the left ovary, measuring 4.9, 3.0 and 2.6 cm yielding 21, 9 and 5 ml of follicular fluid, respectively. The cystic fluid was deep yellow in colour with a viscous consistency. The follicular fluid concentrations of glucose, total protein, cholesterol, acid phosphatase, calcium, phosphorus and progesterone in all the cysts were within the range reported previously in normal buffalo follicular fluid; however, the alkaline phosphatase concentration in cyst 1 and total bilirubin concentration in cysts 1 and 2 were higher than the values in normal follicular fluid. In contrast, the levels of urea nitrogen in cysts 1 and 3, and oestradiol in cyst 3 were lower than the normal values. All the three follicles had an oestradiol to progesterone ratio less than 1. The results of our study suggest that follicular cysts in buffalo are oestrogenically inactive and have an altered concentration of certain biochemical and hormonal constituents.

Phylogenetic relationships among Saccharum clones in Pakistan revealed by RAPD markers

Forty sugarcane genotypes (clones), including elite lines, commercial cultivars of Saccharum officinarum and S. barberi clones, were fingerprinted with 30 RAPD markers, using a PCR-based marker assay. The genetic distance for RAPD data was determined according to Nei, and relationships between accessions were graphed in a dendrogram. Genetic distance values ranging from 16.2 to 86.3% were observed among the 40 sugarcane accessions. The lowest genetic distance was found between genotypes US-406 and US-186. These two genotypes differed from each other in only 25 bands with 15 different primers. Genotypes Col-54 and CP-72-2086 were the second most similar group, with a genetic distance of 19.46%. The most dissimilar of all the accessions were CP-77-400 and US-133, with a genetic distance of 86.3%. RAPD fingerprints help sugarcane breeders clarify the genetic pedigree of commercial sugarcane varieties and can be used to evaluate the efficiency of conventional breeding methods.

Genetic studies of "noble cane" for identification and exploitation of genetic markers

Forty genotypes (clones) of sugarcane, including elite lines, commercial cultivars of Saccharum officinarum and clones of S. barberi were fingerprinted with 50 SSR markers using a PCR-based marker assay. Nei's genetic distances for SSR data were determined and relationships between accessions were portrayed graphically in the form of a dendrogram. Genetic distance values ranging from 0.60 to 1.11 were observed among the 40 sugarcane accessions. The shortest genetic distance of 0.60 was seen between genotypes US-804 and US-130. These two genotypes differed from each other only in 10 bands, with 20 primers. The most dissimilar of the accessions were CP-77-400 and US-133, with a genetic distance of 1.11. SSR fingerprints can help sugarcane breeders to clarify the genetic pedigree of commercial sugarcane varieties and evaluate the efficiency of breeding methods.

DNA profiling of sugarcane genotypes using randomly amplified polymorphic DNA

DNA profiles of 40 sugarcane genotypes were constructed with 30 RAPD markers. Sugarcane genotypes of both Saccharum officinarum and S. barberi were included in this study. Multiple alleles were detected from each RAPD; there was a high level of polymorphism. On average, 7.93 alleles were produced per primer, giving a total of 238 alleles. The genetic distances between these genotypes were assessed with the POPGENE DNA sequence analysis software. A dendrogram was constructed from these data; cultivated species of sugarcane formed clusters with S. barberi genotypes. The 40 genotypes were clustered into two main groups; genetic distances ranged from 20.29 to 64.66%. These RAPD fingerprints will help sugarcane breeders to evaluate the efficiency of current conventional breeding methods and will help characterize the genetic pedigree of commercial sugarcane varieties. These data will also be valuable for conservation and utilization of the genetic resources in germplasm collections.

Genetic diversity of Saccharum officinarum accessions in Pakistan as revealed by random amplified polymorphic DNA

Genetic diversity of 20 sugarcane accessions in Pakistan was studied using 21 random amplified polymorphic DNA markers. The mean genetic distance between the cultivars was 39.03%, demonstrating that a large part of the genome is similar among the accessions. This probably arises from a lack of parental diversity, with few clones, which are themselves related, contributing to the parentage of these varieties. Among the varieties, none was found to be totally distinct and divergent from the others. We conclude that the current Pakistan commercial varieties have a limited genetic base and that there is a need to diversify commercial sugarcane lines in Pakistan by introducing new germplasm sources.

Lead-induced oxidative stress adversely affects health of the occupational workers

Lead is a persistent toxic metal and associated with impairment of various body functions in occupational workers. The main objective was to determine the lead-induced oxidative stress and adverse health effects by biochemical markers in industrial workers. One hundred and forty-eight males consisting of 87 lead-exposed industrial workers and 61 controls were included. Blood lead level (BLL) was determined on a 3010B ESA lead analyzer. Blood complete counts were done on a hematology analyzer. Biochemical markers including serum uric acid, urea, creatinine, phosphate, alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT) were measured on a Selectra E auto analyzer. Serum malondialdehyde (MDA) was measured spectrophotometrically and C-reactive protein (CRP) on Immulite-1000. Results revealed that lead-exposed workers had significantly high BLLs, median (range), 29.1 (9.0-61.1) microg/dL compared with controls, 8.3 (1.0-21.7) microg/dL. Oxidative stress (MDA, GGT) and inflammatory markers (high-sensitivity CRP) were significantly increased (P < or = 0.05). Blood pressure was raised, whereas hemoglobin was decreased in exposed group (P < or = 0.002). Serum urea, uric acid, phosphate, and ALT were significantly raised in lead-exposed workers (P < or = 0.001). Serum albumin, total proteins, and glomerular filtration rate (GFR) were decreased. Blood lead showed a significant positive correlation with serum GGT (r = 0.63), MDA (r = 0.71), CRP (r = 0.75), urea (r = 0.34), creatinine (r = 0.51), and uric acid (r = 0.29) (P < or = 0.01). It is concluded that lead exposure increases oxidative stress that correlates with adverse changes in hematological, renal, and hepatic function in the occupational workers. Elevated blood lead has positive correlation with oxidative stress, inflammatory and biochemical markers that might be used to detect impairment in the body function in lead exposed workers.

Therapeutic drug monitoring of amikacin in preterm and term infants

INTRODUCTION

Amikacin is a commonly-prescribed drug used for the empirical treatment of bacterial infections in neonates. A marked change in the pharmacokinetics of amikacin has been reported during neonatal life. Amikacin has a very narrow therapeutic range and can cause very serious side effects such as nephrotoxicity and ototoxicity. The current therapeutic dose of amikacin, i.e. 15 mg/kg of body weight, may increase the risk of toxicity in preterm infants with immature renal functions. We aimed to determine the frequency of amikacin toxicity in preterm as compared to term infants by measuring its serum trough levels following the administration of the current therapeutic dose.

METHODS

A comparative study was conducted at the neonatal intensive care unit of the Military Hospital, Rawalpindi, Pakistan. A total of 104 infants (52 term and 52 preterm) receiving amikacin at a dose of 15 mg/kg of their body weight, once daily for bacterial infection, were included. After clinical evaluation, serum creatinine levels were measured at admission and on the third day. Amikacin trough levels were taken after 72 hours of therapy and measured on the TDx Abbot Drug Analyser.

RESULTS

The gestational age range was 37-40 weeks in term and 29-36 weeks in preterm infants. The term and preterm infants had a median weight of 2.8 kg and 2.1 kg, respectively. The preterm infants had significantly higher median (range) 11.33 (1.50-42.60) ug/ml levels of serum amikacin as compared to 8.5 (2.8-33.0) ug/ml in term infants (p-value is less than 0.01). The preterm infants had a high frequency of toxic 32 (62 percent) and subtherapeutic 12 (23 percent) levels, as compared to 11 (21 percent) and 5 (10 percent) in term infants, respectively. Serum amikacin levels revealed a positive correlation with post-dose serum creatinine (r equals 0.48; p-value is less than 0.05).

CONCLUSION

This study demonstrated that the current practice of amikacin treatment for bacterial infection needs to be adjusted due to unique pharmacokinetic variability in preterm infants. There is a need for regular therapeutic drug monitoring and renal function assessment in all infants receiving amikacin therapy in order to avoid nephrotoxicity.

Anaemia and cancer treatment: a conceptual change

Anaemia is the most common haematological abnormality in cancer patients, and unfortunately, it is often under-recognised and undertreated. The aetiopathology of anaemia in cancer patients is complex and is usually multifactorial. There is enough evidence suggesting that tumour hypoxia in anaemic patients has a negative impact on the treatment outcomes in cancer patients. The use of recombinant human erythropoietin is becoming a new standard of care in cancer patients. Various well-controlled studies have shown that the use of erythropoietin (EPO) increases the haemoglobin level, thereby decreasing the need for frequent transfusions and improving the tumour responses, cancer-free survival and quality-of-life parameters in cancer patients. However, a few recent clinical trials failed to replicate the survival benefit. Hence, a free unrestricted use of EPO is to be avoided. The past belief that anaemia does not matter in cancer patients is now considered invalid and is being seriously challenged. This article aims to present some recent findings on the impact of anaemia on outcomes, with discussion on the possible causes and effects. The benefits of the use of EPO analogues in cancer-related anaemia are also presented.

Vasopressin for the management of catecholamine-resistant anaphylactic shock

Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation; it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. Currently, there is no algorithm or guideline for the management of anaphylaxis that include the use of vasopressin. We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure.

Resetting the detection level of cord blood thyroid stimulating hormone (TSH) for the diagnosis of congenital hypothyroidism

An appraisal of a 17-year primary thyroid stimulating hormone (TSH) screening programme for the detection of congenital hypothyroidism was carried out to establish the reference interval of cord blood TSH in unaffected infants; the mean cord blood TSH concentration of affected infants and the incidence of congenital hypothyroidism in the Najran province of Saudi Arabia. Our findings show a reference interval of cord blood TSH of 2.0-16.8 mU/l in unaffected infants; a mean cord blood TSH concentration of 399 mU/l in affected infants; a false positive rate for the diagnosis of at-risk infants of 1.02% and a congenital hypothyroidism incidence rate of 34/100 000 (1 : 2931) live births. These findings suggest that there is a need to reset the cord blood TSH concentration for the detection of at-risk infants. We suggest that the detection level of cord blood TSH for the recognition of at-risk infants can be set at 90 mU/l rather than the recommended level of 30 mU/l. This should reduce the false positive rate for detection of infants at risk of congenital hypothyroidism.

Widow inheritance and HIV/AIDS in rural Uganda

Despite current efforts to combat HIV/AIDS through behavioural change, ingrained socio-cultural practices such as widow inheritance in south-western Uganda has not changed. Low education, unemployment, dowry, widows' socioeconomic demands and the inheritor's greed for the deceased's wealth, influence widow inheritance. Voluntary counselling and testing is needed for the widows and their inheritors; formal dowry should be removed from marriage and widow inheritance stripped of its sexual component.

Role of radiotherapy in early breast cancer: an overview

Radiotherapy has an established role in reducing the local relapses in breast cancer patients. The objective of this review was to investigate whether radiotherapy or its omission after breast surgery has measurable consequences on local tumor recurrence and patient survival. The late excess of cardiac deaths has also been published in various reports but important advances in the delivery of radiotherapy have overcome this problem to the extent that, excess cardiac deaths do not appear to be occurring in more recent trials. In this article some recent data, suggesting that radiotherapy following mastectomy and/or breast conserving surgery has a beneficial effect on survival is reviewed. Omission of radiotherapy is associated with a large increase in risk of ipsilateral breast tumor recurrence and with a small increase in the risk of patient's mortality.

Customer focused incident monitoring in anaesthesia

The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external customers. Only 30% of the complaints came from the operating room. Thirty-four per cent of all incidents related to communication, behaviour and delay in service. A requirement to teach communication skills and stress handling formally in anaesthesia training programmes, and at the time of induction of staff into the department, has been identified.

Factors influencing the choice of anesthesia as a career in a developing country

Career choice in medicine is influenced by several factors. Our aim was to look at reasons for choice of anesthesia as a career in a cohort of doctors applying for the residency training in a university hospital in a developing country. A semi-structured interview form is used in our department and includes a question related to career choice. Each applicant is interviewed by two faculty members independently. All interview forms between 1992 to 2004 were reviewed and the reason for choosing anesthesia was coded in different categories. The sample consisted of 167 applicants and 334 forms. There were 29 females and 138 males. The mean age of the applicants was 28 years. Sixty two percent chose anesthesia because of general interest and nature of the specialty, 24% of these mentioned had no specific reasons, 17% thought the specialty was intellectually challenging, 8% liked the technical aspect, 5% were interested in physiology and pharmacology, 2% liked the operating room environment, and 6% liked the immediate results. The second major group (36%) cited the reason as better economic opportunities. Sixteen percent were influenced by friends or relatives in their choice. Twenty six percent chose anesthesia primarily because of their interest in critical care, pain management or emergency management. Our data indicates that selection of career in anesthesia in our county is strongly related to the nature of specialty and future employment opportunities. A significant number were influenced by family and friends. This pattern is different from that reported from Australia and United States.

Dengue haemorrhagic fever with unusual prolonged thrombocytopaenia

We describe a case of dengue haemorrhagic fever with prolonged thrombocytopaenia. A 22-year-old Malay man with no prior illness presented with a history of fever and generalised macular rash of four days duration. Initial work-up suggested the diagnosis of dengue haemorrhagic fever based on thrombocytopaenia and positive dengue serology. Patient recovered from acute illness by day ten, and was discharged from the hospital with improving platelet count. He was then noted to have declining platelet count on follow-up and required another hospital admission on day 19 of his illness because of declining platelet count. The patient remained hospitalised till day 44 of his illness and managed with repeated platelet transfusion and supportive care till he recovered spontaneously.

Radiation exposure of trainee anaesthetists

This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.

An audit of postoperative minor complications of anesthesia

OBJECTIVE

To look at minor complications attributable to anesthesia in adult surgical patients at our Institution and to identify various contributing factors.

DESIGN

Descriptive cross sectional audit.

SETTING

Aga Khan University Hospital, Karachi, Pakistan.

STUDY PARTICIPANTS

Seven hundred and thirty surgical patients undergoing elective surgery were recruited.

INTERVENTIONS

This was a non-interventional study and data was collected prospectively based on predefined criteria.

MAIN OUTCOME MEASURES

The incidence of nausea, vomiting, sore throat, headache, drowsiness, phlebitis, dizziness, myalgia, transient nerve palsy, conjunctivitis, ringing of ears, low backache, lip injury, dental injury or any other minor complications were looked at.

RESULTS

Nausea, sore throat and vomiting were the highest reported complications. The incidence of nausea, drowsiness and dizziness was less in patients more than sixty years of age. Incidence of nausea and vomiting was higher in ASA 1 patients and in surgery lasting less than ninety minutes. Headache and dizziness were reported high in certain surgical specialties.

CONCLUSION

The overall rate of minor complications following anesthesia was 12.6%. No complications were reported by 30% of the study population. The data has given us a benchmark for patient information and will be used for risk reduction in our Department of Anaesthesiology.