A simulation model to investigate interactions between first season grazing calves and Ostertagia ostertagi

AbstractA dynamic, deterministic model was developed to investigate the consequences of parasitism with Ostertagia ostertagi, the most prevalent and economically important gastrointestinal parasite of cattle in temperate regions. Interactions between host and parasite were considered to predict the level of parasitism and performance of an infected calf. Key model inputs included calf intrinsic growth rate, feed quality and mode and level of infection. The effects of these varied inputs were simulated on a daily basis for key parasitological (worm burden, total egg output and faecal egg count) and performance outputs (feed intake and bodyweight) over a 6 month grazing period. Data from published literature were used to parameterise the model and its sensitivity was tested for uncertain parameters by a Latin hypercube sensitivity design. For the latter each parameter tested was subject to a 20% coefficient of variation. The model parasitological outputs were most sensitive to the immune rate parameters that affected overall worm burdens. The model predicted the expected larger worm burdens along with disproportionately greater body weight losses with increasing daily infection levels. The model was validated against published literature using graphical and statistical comparisons. Its predictions were quantitatively consistent with the parasitological outputs of published experiments in which calves were subjected to different infection levels. The consequences of model weaknesses are discussed and point towards model improvements. Future work should focus on developing a stochastic model to account for calf variation in performance and immune response; this will ultimately be used to test the effectiveness of different parasite control strategies in naturally infected calf populations

Succinylcholine use and dantrolene availability for malignant hyperthermia treatment: Database analyses and systematic review

Editor\u27s Perspective What We Already Know about This Topic Dantrolene effectively treats malignant hyperthermia, but there are discrepant recommendations for dantrolene availability in facilities that stock succinylcholine for airway rescue but do not use volatile anesthetics. What This Article Tells Us That Is New The authors performed an analysis of data from three databases and a systematic literature review. Providers frequently use succinylcholine, including during difficult mask ventilation. Succinylcholine given without volatile anesthetics triggered 24 malignant hyperthermia events, 13 of which were treated with dantrolene. Fourteen patients experienced substantial complications, and one died. Delayed dantrolene treatment worsened patient outcomes. Background: Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene. The authors investigated (1) succinylcholine use rates, including for airway rescue, in anesthetizing/sedating locations; (2) whether succinylcholine without volatile anesthetics triggers MH warranting dantrolene; and (3) the relationship between dantrolene administration and MH morbidity/mortality. Methods: The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given. Results: Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities. Conclusions: Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used