A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis

Background: Isolated diaphragmatic palsy in the absence of progressive neuromuscular disease is uncommon. It poses diagnostic challenges and limited data are available regarding prognosis. We present retrospective cohort data from two large teaching hospitals in the United Kingdom. Method: 60 patients who were assessed either as inpatients or outpatients were included in this study. Patients with progressive neuromuscular disease were excluded. Clinical presentation, tests of respiratory muscle function (sitting/supine vital capacity, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP)) and outcomes were recorded. Results: For patients with diaphragmatic palsy, mean±sd seated and supine vital capacity pre-noninvasive ventilation (NIV) were reduced at 1.7±1.2 L and 1.1±0.9 L, respectively, with a mean±sd postural fall in vital capacity of 42±0.16%. The mean MEP/MIP and MEP/SNIP ratios for diaphragmatic palsy were 3 and 3.5, respectively. After a year of treatment with NIV, mean±sd upright and supine vital capacity had increased to 2.1±0.9 L and 1.8±1 L, respectively, and the mean±sd fall in vital capacity from sitting to supine reduced to 29±0.17%. MEP/MIP and MEP/SNIP ratios reduced to 2.6 and 2.9, respectively, from the pre-NIV values. The values of postural fall in vital capacity correlated (p < 0.05) with MEP/MIP and MEP/SNIP ratio (r2=0.86 and r2=0.7, respectively). Conclusion Tests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea, with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratio ≥2.7 points towards isolated diaphragmatic palsy. This needs to be confirmed by prospective studies

High prevalence of recurrent nocturnal desaturations in systemic AL amyloidosis: a cross-sectional pilot study

Objectives: Cardiac involvement and/or macroglossia with soft tissue deposits are risk factors for central sleep apnoea (CSA) and obstructive sleep apnoea (OSA), and common features of systemic AL amyloidosis. Little data exist on the occurrence of sleep-disordered breathing (SDB) or recurrent nocturnal hypoxia in amyloidosis, which this study sought to investigate. Methods: A total of 72 consecutive patients with systemic amyloidosis (mean age 69 years and mean BMI 25) were evaluated for occurrence of SDB, by overnight continuous pulse oximetry, and completed Epworth Sleepiness Score (ESS) and STOPBANG questionnaires. Patients included: AL cardiac (AL-C), AL macroglossia (AL-M), AL both (AL-CM) and transthyretin (ATTR). Results: Mean overnight oxygen saturations were 93% (SD ± 2, 95% CI 87–96) with abnormal oximetry (4% oxygen desaturation index (ODI) >5/hour): AC-C 84%, AL-M 57%, AL-CM 62% and ATTR 47%. NYHA class directly correlated with a higher 4% ODI, NYHA class I vs 3, (p = 0.01). Two-thirds of patients had STOPBANG scores >3 and abnormally high ESS scores (>10) were seen in up to 30% of patients. Conclusion: Recurrent nocturnal hypoxaemia, suggestive of sleep-disordered breathing, is frequent in systemic AL amyloidosis. The higher incidence in cardiac amyloidosis highlights CSA and recurrent hypoxia as possible mechanisms for morbidity/mortality in these cases. A detailed polysomnography study is planned to clarify and further investigate these findings

Is supplementation justified to compensate pastoral calves for milk restriction?

Competition for milk between calves and pastoral herders may reduce weaning weights, retard growth, and delay puberty in cattle. Calf supplementation could over-ride such effects and improve pastoral economies. To examine these issues in semiarid Ethiopia, 266 Boran calves (Bos indicus) were used in a 2x3 plus 1 factorial design contrasting graded levels of supplemental alfalfa hay (i.e., Medicago sativa L. with mean intakes of 0,344, and 557 g head -1 day on a DM basis) and supplemental water (i.e., with mean intakes of 0 and 3.8 liters head -1 day). The trial was repeated for animals born in 2 consecutive years. Treatments occurred over a background of simulated traditional management in which calves had limited access to grazing and water and were allowed to suckle about two-thirds of their dams daily milk yield. Traditionally managed controls received no supplements while other (positive) controls received no supplements but had greater access to milk. After 10 months of treatment calves were weaned and monitored. Supplementation with the high level of hay plus water markedly enhanced (P<0.01) all productive features of calves at weaning compared to traditionally managed controls, and was an effective substitute for milk forgone in both years. Despite high variability in milk intake, access to supplements, and weaned body size as calves, all male cattle converged in liveweight and other productive features by 3.5 years of age, largely due to compensatory growth of traditionally managed controls. Heifers also converged in various attributes at maturity, but those which had received hay plus extra water as calves still conceived 2.6 to 4.3 months earlier (P<0.05) than traditionally managed controls. We concluded that supplementation with hay and water can indeed compensate a young calf for typical levels of milk restriction here. Carry-over effects, however, were insufficent to justify large investments in supplementation considering the high inherent risks of production and traditions of marketing mature animals

Is Supplementation Justified to Compensate Pastoral Calves for Milk Restriction?

Competition for milk between calves and pastoral herders may reduce weaning weights, retard growth, and delay puberty in cattle. Calf supplementation could over-ride such effects and improve pastoral economies. To examine these issues in semiarid Ethiopia, 266 Boran calves (Bos indicus) were used in a 2 X 3 plus 1 factorial design contrasting graded levels of supplemental alfalfa hay (i.e., Medicago sativa L. with mean intakes of 0, 344, and 557 g head(-1) day(-1) on a DM basis) and supplemental water (i.e., with mean intakes of 0 and 3.8 liters head(-1) day(-1)). The trial was repeated for animals born in 2 consecutive years. Treatments occurred over a background of simulated traditional management in which calves had limited access to grazing and water and were allowed to suckle about two-thirds of their dams' daily milk yield. Traditionally managed controls received no supplements while other (positive) controls received no supplements but had greater access to milk. After 10 months of treatment calves were weaned and monitored. Supplementation with the high level of hay plus water markedly enhanced (P < 0.01) all productive features of calves at weaning compared to traditionally managed controls, and was an effective substitute for milk forgone in both years. Despite high variability in milk intake, access to supplements, and weaned body size as calves, all male cattle converged in liveweight and other productive features by 3.5 years of age, largely due to compensatory growth of traditionally managed controls. Heifers also converged in various attributes at maturity, but those which had received hay plus extra water as calves still conceived 2.6 to 4.3 months earlier (P < 0.05) than traditionally managed controls. We concluded that supplementation with hay and water can indeed compensate a young calf for typical levels of milk restriction here. Carry-over effects, however, were insufficient to justify large investments in supplementation considering the high inherent risks of production and traditions of marketing mature animals.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202

Superovulatory response, embryo recovery and progesterone secretion in Boran (Bos indicus) cows after treatment with either Pergovet or Pluset

This study examines superovulatory response, embryo recovery rates, embryo quality, return to natural estrus, and patterns of progesterone secretion and its relationship with superovulatory response and embryo quality in Boran cows after treatment with either a human menopausal gonadotropin (Pergovet) or a porcine gonadotropin (Pluset) at 2 levels of doses each. Data presented show: treatment regimen for Boran cows superovulated with Pergovet or Pluset, least square means for number of corpora lutea, follicular cysts and embryos recovery rates in Boran cows after treatment with either Pergovet or Pluset, least square means for induced estrus duration, return to natural estrus, number of corpora lutea, follicular cysts and embryo recovery rates in Boran cows during three consecutive superovulations after treatment with either Pergovet or Pluset, and least square means for progesterone concentrations commencing on the first day of superovulatory treatment (Day 1) to the day of induced estrus (Day 5) in Boran cows which yielded different numbers of embryos/ova

The reproductive performance of East African (Bos indicus) Zebu cattle in Ethiopia. 1. Oestrus cycle length, duration, behaviour and ovulation time

Reproductive performance of 28 East African Zebu cows in Ethiopia were investigated over a period of 217 days. Discussions and data on the length of oestrous cycle, the onset pattern of oestrus, duration of oestrus, mounting activity and vaginal mucus discharge included

Reproductive responses associated with ram introduction in mature tropical Menz ewes after a period of isolation

This study was undertaken using 48 mature Menz ewes (3-6 years of age) and averaging 31.5 (standard deviation (SD)=4.9) kg body weight, to evaluate oestrus synchronization, conception and lambing rates after ram introduction following a period of isolation (n=24) or constant exposure to vasectomized rams (n=24) on a low or high level of nutrition. The overall level of oestrus synchrony was low (27 percent), but was higher for animals previously isolated (38 vs. 17 percent). The mean interval from ram introduction to oestrus was 12.2 (SD=7.3) days, but this was significantly shorter for isolated ewes (9.4+1.2 vs. 14.8+1.7 days, P0.05). Oestrus after ram introduction included two peaks (at 6 and 13 days) which were influenced by the behaviour of previously isolated animals. Conception rates to first and second service of 86 percent and 14 percent, respectively, were confirmed by plasma progesterone determinations. Subsequent lambing rate was only 72 percent, suggesting high prenatal reproductive wastage. Lambing was compacted, except for ewes conceiving at their second oestrus. There was as many twins born to isolated ewes as to exposed ewes but substantially more to ewes that were heavier at mating. These data suggest that, although ram introduction after a period of isolation will not increase ovulation and twinning rate in isolated Menz sheep as judged by litter size, it is a natural tool that could be useful to match events of the reproductive cycle of tropical sheep with feed and other management resources