Comparison of Clinical Measures Among Interstitial Lung Disease (ILD) Patients with Usual Interstitial Pneumonia (UIP) Patterns on High-Resolution Computed Tomography

PURPOSE

Idiopathic Pulmonary Fibrosis is a progressive and fatal interstitial lung disease (ILD) characterized by a typical radiographic or histologic usual interstitial pneumonia (UIP) pattern. In 2018, diagnostic categories of UIP based on computed tomography patterns were revised by the Fleischner Society. The study aimed to describe differences in comorbidities and spirometry in ILD patients that were characterized by high-resolution computed tomography (HRCT) images as having a typical, probable, indeterminate, and alternative diagnosis of UIP.

METHODS

We retrospectively studied 80 ILD patients from 2017 to 2019. Typical UIP was defined using the Fleischner Society diagnostic criteria for IPF. Atypical UIP was reached by consensus after a multidisciplinary clinical-radiological-pathological review of patient data. Baseline characteristics, comorbidities, and spirometry were compared among the four subgroups.

RESULTS

Among 80 patients, 59% were male, 61% had a history of smoking, and the mean age was 67.7 ± 10 years (SD). A typical UIP pattern was more frequently observed among patients with chronic obstructive pulmonary disease (COPD) (p < 0.001) and pulmonary hypertension (p = 0.03). Of 30 patients with COPD, 14 had emphysema, while 10 had IPF. After adjusting for forced expiratory volume in one second (FEV₁) in liters, change of FEV₁% from baseline to 6-12 months, age, and sex, only COPD remained significantly associated with typical UIP (p = 0.018). Tobacco use was not significantly associated with any radiographic type (p = 0.199).

CONCLUSION

Typical UIP was prevalent among COPD/emphysema patients. Although smoking has a strong association with IPF, we did not find a significant association with smoking and typical UIP in our cohort.

Acute Respiratory Decompensation Requiring Intubation in Pregnant Women with SARS-CoV-2 (COVID-19)

There is a current paucity of information about the obstetric and perinatal outcomes of pregnant novel coronavirus disease 2019 (COVID-19) patients in North America. Data from China suggest that pregnant women with COVID-19 have favorable maternal and neonatal outcomes, with rare cases of critical illness or respiratory compromise. However, we report two cases of pregnant women diagnosed with COVID-19 in the late preterm period admitted to tertiary care hospitals in New York City for respiratory indications. After presenting with mild symptoms, both quickly developed worsening respiratory distress requiring intubation, and both delivered preterm via caesarean delivery. These cases highlight the potential for rapid respiratory decompensation in pregnant COVID-19 patients and the maternal-fetal considerations in managing these cases.

Effects of deep sedation on sleep in critically ill medical patients on mechanical ventilation

Atypical EEG patterns not consistent with standard sleep staging criteria have been observed in medical intensive care unit (ICU) patients. Our aim was to examine the relationship between sleep architecture and sedation in critically ill mechanically ventilated patients pre- and post-extubation. We performed a prospective observational repeated measures study where 50 mechanically ventilated patients with 31 paired analyses were examined at an academic medical centre. The sleep efficiency was 58.3 ± 25.4% for intubated patients and 45.6 ± 25.4% for extubated patients (p = .02). Intubated patients spent 76.33 ± 3.34% of time in non-rapid eye movement (NREM) sleep compared to 64.66 ± 4.06% of time for extubated patients (p = .02). REM sleep constituted 1.36 ± 0.67% of total sleep time in intubated patients and 2.06 ± 1.09% in extubated patients (p = .58). Relative sleep atypia was higher in intubated patients compared to extubated patients (3.38 ± 0.87 versus 2.79 ± 0.42; p < .001). Eleven patients were sedated with propofol only, 18 patients with fentanyl only, 11 patients with fentanyl and propofol, and 10 patients had no sedation. The mean sleep times on "propofol", "fentanyl", "propofol and fentanyl," and "no sedation" were 6.54 ± 0.64, 4.88 ± 0.75, 6.20 ± 0.75 and 4.02 ± 0.62 hr, respectively. The sigma/alpha values for patients on "propofol", "fentanyl", "propofol and fentanyl" and "no sedation" were 0.69 ± 0.04, 0.54 ± 0.01, 0.62 ± 0.02 and 0.57 ± 0.02, respectively. Sedated patients on mechanical ventilation had higher sleep efficiency and more atypia compared to the same patients following extubation. Propofol was associated with higher sleep duration and less disrupted sleep architecture compared to fentanyl, propofol and fentanyl, or no sedation.

Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography

INTRODUCTION

Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes.

METHODS

This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence.

RESULTS

Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence (P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis (P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay (P = .35) or mortality (P = .34).

CONCLUSIONS

Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

Comparison of body adiposity index (BAI) and BMI with estimations of % body fat in clinically severe obese women

OBJECTIVE

Body adiposity index (BAI), a new surrogate measure of body fat (hip circumference/(height(1.5) - 18)), has been proposed as an alternative to body mass index (BMI). We compared BAI with BMI, and each of them with laboratory measures of body fat-derived from bioimpedance analysis (BIA), air displacement plethysmography (ADP), and dual-energy X-ray absorptiometry (DXA) in clinically severe obese (CSO) participants.

DESIGN AND METHODS

Nineteen prebariatric surgery CSO, nondiabetic women were recruited (age = 32.6 ± 7.7 SD; BMI = 46.5 ± 9.0 kg/m(2) ). Anthropometrics and body fat percentage (% fat) were determined from BIA, ADP, and DXA. Scatter plots with lines of equality and Bland-Altman plots were used to compare BAI and BMI with % fat derived from BIA, ADP, and DXA. BAI and BMI correlated highly with each other (r = 0.90, P < 0.001).

RESULTS

Both BAI and BMI correlated significantly with % fat from BIA and ADP. BAI, however, did not correlate significantly with % fat from DXA (r = 0.42, P = 0.08) whereas BMI did (r = 0.65, P = 0.003). BMI was also the single best predictor of % fat from both BIA (r(2) = 0.80, P < 0.001) and ADP (r(2) = 0.65, P < 0.001). The regression analysis showed that the standard error of the estimate (SEE), or residual error around the regression lines, was greater for BAI comparisons than for BMI comparisons with BIA, ADP, and DXA. Consistent with this, the Bland and Altman plots indicated wider 95% confidence intervals for BAI difference comparisons than for BMI difference comparisons for their respective means for BIA, ADP, and DXA.

CONCLUSIONS

Thus, BAI does not appear to be an appropriate proxy for BMI in CSO women.

Sex-based fMRI differences in obese humans in response to high vs. low energy food cues

Gender specific effects on human eating have been previously reported. Here we investigated sex-based differences in neural activation via whole-brain blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in response to high energy-dense (high-ED) vs. low-ED visual and auditory food cues in obese men vs. women in both fed and fasted states. The results show that in response to high vs. low ED foods in the fed state, obese men (vs. women) had greater activation in brain areas associated with motor control regions (e.g. supplementary motor areas) whereas women showed greater activation in cognitive-related regions. In the fasted state, obese men had greater activation in a visual-attention region whereas obese women showed greater activation in affective and reward related processing regions (e.g. caudate). Overall the results support our a priori hypothesis that obese women (vs. men) have greater neural activation in regions associated with cognition and emotion-related brain regions. These findings may improve our understanding of sex specific differences among obese individuals in eating behavior.

Plasma cortisol levels in response to a cold pressor test did not predict appetite or ad libitum test meal intake in obese women

Heightened cortisol response to stress due to hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis may stimulate appetite and food intake. In this study, we assessed cortisol responsivity to a cold pressor test (CPT) as well as appetite ratings and subsequent test meal intake (TMI) in obese women. Following an overnight fast on two counterbalanced days, 20 obese women immersed their non-dominant hand for 2min in ice water (CPT) or warm water (WW) as a control. Plasma cortisol (ng/ml), heart rate, and blood pressure, as well as ratings of stress, pain, and appetite, were serially acquired. An ad libitum liquid meal was offered at 45min and intake measured covertly. Fasting cortisol was higher at 15min (mean peak cortisol) following the CPT compared to WW. Higher stress was reported at 2 and 15min for the CPT compared to WW. Pain, an indirect marker of the acute stress, systolic and diastolic blood pressure increased following the CPT at 2min compared to WW. Hunger decreased after the CPT at 2 and 15min, and desire to eat ratings were lower following CPT compared to WW. Subjects did not have greater test meal intake (TMI) following CPT compared to WW. There was also no significant relationship between cortisol levels following stress and TMI, indicating that cortisol did not predict subsequent intake in obese women.

Randomized pilot study of cabergoline, a dopamine receptor agonist: effects on body weight and glucose tolerance in obese adults

AIM

Dopaminergic hypofunction and hyperprolactinaemia have been implicated in the pathogenesis of obesity and glucose intolerance. The aim of this pilot study was to determine the efficacy of cabergoline, a dopamine receptor agonist, on body weight and glucose tolerance in obese non-diabetic persons with normal plasma prolactin levels.

METHODS

This 16-week double blind, placebo-controlled pilot study randomized non-diabetic obese adults (body mass index 30-42 kg/m(2) ) to placebo or cabergoline (0.25 mg twice weekly for 4 weeks followed by 0.5 mg twice weekly for the next 12 weeks). Of 40 subjects enrolled, 29 completed 16 weeks: 16 randomized to placebo and 13 to cabergoline. All subjects were counselled on a 500 kcal/day calorie deficit diet. A 75-g oral glucose tolerance test was performed at baseline and at 16 weeks.

RESULTS

As expected, prolactin levels decreased after cabergoline (p < 0.001). Weight loss was similar after placebo compared with cabergoline treatment: 1.0 vs. 1.2% body weight, respectively. Fasting glucose levels did not differ between groups after treatment, however, 90-min postprandial glucose and insulin decreased in the cabergoline group only (p = 0.029). HOMA-IR (homeostasis model of assessment) increased by 40% after placebo and 1.5% after cabergoline treatment.

CONCLUSIONS

This pilot study suggests that cabergoline therapy may improve glucose tolerance independent of weight loss, however, a larger, longer term study of dopamine receptor agonist therapy in obese individuals is warranted to confirm this finding.

Body adiposity index (BAI) correlates with BMI and body fat pre- and post-bariatric surgery but is not an adequate substitute for BMI in severely obese women

OBJECTIVE: Body Adiposity Index (BAI), a new surrogate measure of body fat (hip circumference/[height 1.5-18]), has been proposed as a more accurate alternative to BMI. We compared BAI with BMI and their correlations with measures of body fat, waist circumference (WC), and indirect indices of fat pre- and post-Roux-en-Y gastric bypass (RYGB). METHODS: Sixteen clinically severe obese (CSO) non-diabetic women (age = 33.9± 7.9 SD; BMI = 46.5±9.5 kg/m(2)) were assessed pre-surgery, and at 2 (n=9) and 5 mo (n=8) post-surgery. Body fat percentage (% fat) was estimated with bioimpedance analysis (BIA), air displacement plethysmography (ADP), and dual-energy x-ray absorptiometry (DXA). WC, an indicator of central fat, and both plasma leptin (ng/ml) and insulin (mU/l) concentrations were measured as indirect body fat indices. Pre- and post-surgery values were analyzed with Pearson correlations and linear regressions. RESULTS: BAI and BMI correlated significantly with each other pre-surgery and at each time point post surgery. BAI and BMI also correlated significantly with % fat from BIA and ADP; however, only BMI correlated significantly with % fat from DXA pre- and post-RYGB. BMI was the single best predictor of WC and leptin at 2 and 5 mo post-surgery and had significant longitudinal changes correlating with % fat from BIA and DXA as well as with leptin. DISCUSSION: Both BAI and BMI were good surrogates of % fat as estimated from BIA and ADP, but only BMI was a good surrogate of % fat from DXA in CSO women. Thus, BAI may not be a better alternative to BMI.

Neuroimaging, gut peptides and obesity: novel studies of the neurobiology of appetite

Two major biological players in the regulation of body weight are the gut and the brain. Peptides released from the gut convey information about energy needs to areas of the brain involved in homeostatic control of food intake. There is emerging evidence that human food intake is also under the control of cortical and subcortical areas related to reward and cognition. The extent to which gut hormones influence these brain areas is not fully understood. Novel methods combining the study of neural activity and hormonal signalling promise to advance our understanding of gut-brain interactions. Here, we review a growing number of animal and human studies using neuroimaging methods (functional magnetic resonance imaging, positron emission tomography) to measure brain activation in relation to nutrient loads and infusion of gut peptides. Implications for current and future pharmacological treatments for obesity are discussed.

Eliminating language barriers for non-English-speaking patients

OBJECTIVES

More than 31 million persons living in the United States do not speak English, therefore language discordance between the clinician and patient may hinder delivery of cost-effective medical care. A new language service was developed in which interpreters are trained in the skills of simultaneous interpretation commonly used at international conferences. The interpreters are linked from a remote site to headsets worn by the clinician and patient through standard communication wires. The service is called "remote-simultaneous interpretation," to contrast it with a traditional method of an interpreter being physically present at the interview and interpreting consecutively "proximate-consecutive interpretation." The aim of this study is to assess in a randomized protocol the quality of communication, interpretation, and level of patient, interpreter, and physician satisfaction with these two language services.

METHODS

The first postpartum visit with each of 49 mothers and their new born babies was assigned randomly to proximate-consecutive interpretation (control) or to remote-simultaneous interpretation (experimental). Main outcome measures included (1) the number of physician and mother utterances in the visit, (2) the quality of the interpretation, and (3) physician, interpreter, and mother preferences between the two services.

RESULTS

The remote-simultaneous interpreter service averaged 8.3 (10%) more physician utterances (95% confidence interval [CI] 4.3, 12.4) and 9.1 (28%) more mother utterances (95% CI 6.1, 12.1). On average, there were 2.8 (12%) fewer inaccuracies of physician utterances in experimental visits compared with control visits (95% CI -5.9, 0.4) and 3.0 (13%) fewer inaccuracies of mother utterances in experimental visits compared with control visits (95% CI -5.4, -0.6). Mothers and physicians significantly preferred the remote-simultaneous service to proximate-consecutive interpretation service. Interpreters stated that they thought mothers and physicians better understood each other using the remote-simultaneous service, although the interpreters preferred to work with the proximate-consecutive service.

CONCLUSIONS

Using remote-simultaneous interpretation to improve the quality of communication in discordant-language encounters promises to enhance delivery of medical care for the millions of non-English-speaking patients in the United States.

Adjusted 200-day scrotal size as a predictor of 365-day scrotal circumference

Data collected from 264 bulls of 13 beef breeds at the Michigan Bull Test Station was evaluated to determine if scrotal circumference (SC) adjusted to 200 d of age could be used to predict scrotal circumference at 1 yr of age. Scrotal circumference of each bull was recorded on arrival at the test station and at the time of breeding soundness examination (BSE) and was adjusted to 200 and 365 d of age, respectively. Bulls with adjusted SC>34.0 cm by 365 d of age averaged a larger SC at 200 d (P < 0.0001) and faster scrotal growth (P < 0.0001) than bulls with a 365 d adjusted SC </= 34.0 cm. For all bulls evaluated, mean values differed among breeds for the 200-d SC (P < 0.0001) and the 365-d SC (P < 0.0001) but not for scrotal growth over the test period (P = 0.0773). When only bulls with an SC exceeding 34.0 cm by 365 d were considered, differences among breeds were not significant for the 200-d SC (P = 0.3067), the 365-d SC (P = 0.4083), or scrotal growth (P = 0.9248). The adjusted 200-d SC was positively correlated (partial correlation coefficient = 0.6398) with the adjusted 365-d SC. Least squares linear regression suggests that the 200-d SC accounts for nearly half the variation in scrotal size at 1 yr of age (R(2) = 0.4553). Data from this study suggests that among the bulls evaluated, 200 d old calves with SC >/= 23.0 cm had a 95% probability of achieving SC > 34.0 cm by one year of age. Calves measuring < 23 cm at 200 d had a 54% probability of achieving > 34.0 cm scrotal size by one year. This information can contribute to the selection of breeding bulls that will achieve desirable scrotal size by one year of age.

Cost of mastitis and its prevention in four dairy cattle herds on St Croix, US Virgin Islands

Nonclinical mastitis in the dairy herds on St Croix, US Virgin Islands, represents a prevalent (97%) and severe problem (44% of quarters had California Mastitis Test results of 2 or 3). Streptococcus agalactiae (26%) and Staphylococcus aureus (22%) were the most prevalent pathogens. More than half (54%) of all organisms isolated and tested for resistance were resistant to ampicillin and benzyl penicillin; 29% were resistant to trimethoprim/sulfadiazine. Estimates of the loss of milk production suggested that there was a loss of 4.40 to 13.33 lb/cow/day. The yearly economic cost of prevention was estimated for each cow ($22.07); yearly income loss attributable to mastitis was estimated to be from $339 to $1,022/cow/yr. Suggestions for the prevention and control of mastitis are included.

The role of in bovine early embryonic death. III. The effect of the organism on embryos by day 21 postbreeding

A study using 11 healthy, mature Holstein-Friesian heifers was designed to determine whether 1) H. somnus induces gross and/or histopathological changes of the uterine tract and embryos, 2) H. somnus has a short and/or long-term effect on the ovarian activity, 3) prior exposure to H. somnus would modulate the effect of a second exposure to the organism. Superovulated heifers were artificially iseminated 12 and 24 h after standing estrus using high-quality, Haemophilus-free semen from a single ejaculate of one bull. Control heifers (Group 1, n = 2) were infused by intrauterine route, 12 h after the second insemination, with 10 ml of 0.85% sterile phosphate buffered saline (PBS) as a placebo. The treatment heifers were exposed by intrauterine infusion, 12 h after the second insemination, to approximately 1.5 x 10(9)H. somnus organisms (Iowa strain 1229) suspended in 10 ml of 0.85% sterile PBS. Group 2 (n = 2) treatment heifers were exposed 21 d prior to embryo recovery; Group 3 treatment heifers (n = 3) were exposed 5 mo prior to embryo collection; and Group 4 treatment heifers were exposed twice, 5 mo apart with the second exposure 21 d prior to embryo recovery. All animals were slaughtered and the whole genital tract was removed for pathological examination and embryo recovery. There were minimal pathological changes in the uterus. However, H. somnus significantly affected (P </= 0.001) the ovarian activity -as measured by the embryo/corpora luteum (E/CL) ratio. Treated animals developed a high number (44.4%) of cystic follicles (CF), while no control animal had a CF. These results suggest that H. somnus may have a short- and long-term effect on ovarian activity. Prior exposure to H. somnus did not protect the animals from the second exposure; in fact, it had an additive effect.

The use of embryo collection techniques in Holstein heifers: A model to study early embryonic death

Twenty-three cyclic Holstein heifers were purchased for use as embryo donors to study the effect of intrauterine exposure to Haemophilus somnus on the number, quality, and viability of embryos produced. Few problems were encountered using standard superovulation and nonsurgical embryo collection techniques on virgin heifers. Based on three or more ovulations, as determined by palpation per rectum of the ovaries at the time of embryo recovery, 28 of 30 heifers responded to the superovulation regimen. Of 29 nonsurgical recoveries, 27 produced one or more embryos. One hundred and seventy-six embryos and ova were collected from heifers synchronized, superovulated, and flushed 7 to 8 d after insemination.

The role of in early embryonic death. I. The effect of the organism on embryos by day 8 postbreeding

A study using 23 healthy, mature, virgin Holstein-Friesian heifers was designed to determine if H. somnus caused detrimental effects in early bovine embryos and the mechanism(s) that induced these effects. Superovulated heifers were artificially inseminated 12 and 24 h after standing estrus using highquality, Haemophilus-free semen from a single ejaculate of one bull. Treatment heifers (n=12) were exposed by intrauterine infusion 12 h after the second insemination to approximately 1.5 x 10(9)H. somnus organisms (Iowa strain 1229) suspended in 10 ml of sterile 0.85% phosphate buffered saline (PBS). Control heifers (n=11) were inseminated and the infused with sterile PBS. Embryos were recovered 8 d after the second insemination using non-surgical technique and evaluated microscopically and graded on their estimated survivability. Representative embryos were also examined for in vitro culture survival time, histopathological changes, vital stain uptake and bacterial contamination. Following embryo recovery, uterine flush solution was centrifuged at 10,000 x G. Sediment was submitted for bacteriologic examination and supernatant preserved for quantitation of H. somnus immunoglobulins. Results to date indicate that H. somnus had a detrimental effect on early bovine embryos. H. somnus was recovered from the tissues of one treated animal. Significantly more (P </= 0.005) degenerated embryos were recovered from H. somnus -infected heifers than from control heifers. Embryos from H. somnus -infected heifers survived in culture media for a significantly (P </= 0.005) shorter time than embryos from control heifers.

Anthelmintic activity of ivermectin in pigs naturally infected with Ascaris and Trichuris

The anthelmintic efficacy of ivermectin administered by subcutaneous (SC) injection or orally via the drinking water was investigated in feeder pigs naturally infected with Ascaris suum and Trichuris suis. Group 1 pigs (n = 5) were given drinking water as a placebo, group 2 pigs (n = 5) were given ivermectin by SC injection (300 micrograms/kg of body weight), and group 3 pigs (n = 5) were given ivermectin in water also at a dosage rate of 300 micrograms/kg of body weight. At necropsy 11 days later, the mean worm counts in group 1 pigs were 4 for Ascaris and 50.2 for Trichuris. All adult and juvenile ascarids were removed from the intestine in groups 2 and 3 pigs. Compared with the number of Trichuris in group 1 pigs, the number of Trichuris was reduced by 91.2% and 78.1%, respectively, for the orally and SC treated pigs.

Use of prostaglandin F2 alpha in the treatment of unobserved estrus in lactating dairy cattle

A field trial was conducted to evaluate the use of prostaglandin F2 alpha (PGF2 alpha) (lutalyse)a in lactating dairy cattle with unobserved estrus in the presence of a functional corpus luteum (CL) and clinically normal reproductive tract. Seventy-three Holstein and 9 Jersey cows, weighing between 340.0 and 772.7 kg, were allotted to treatment and control groups. All treated cows were inseminated within 80 hours after treatment as assigned by this trial. Control cows were inseminated at the first observed estrus. Of the treated cows, 50% showed estrus within 80 hours after treatment. In this trial, 96% of the treated cows and 92% of the control cows were determined to have at least 1 functional CL on the day of treatment. For the treatment group and the control group, mean serum progesterone concentrations were 4.1 ng and 3.5 ng (P less than 0.2, by Student's t test), respectively, on day of treatment and were 0.4 ng and 5.0 ng (P less than 0.005, by Student' t test) on day 5 after treatment. Pregnancy rates were 57% for treated and 47% for control cows (P = 0.5, by X2). Days from treatment to first-observed estrus, treatment to first service, and treatment to conception were significantly reduced in the treatment group compared with these criteria for the control group (P less than 0.05, 0.005, and 0.01 respectively). It was concluded that induction of luteolysis with PGF2 alpha in lactating dairy cattle with unobserved estrus and a palpable functional CL will be an effective addition to reproductive health programs.