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Introduction: Enteric fever is an important tropical disease which takes an average of five days for defervescence even with effective antibiotic therapy. Zinc has been successfully used as an adjuvant in diarrhoeal disease. If addition of oral zinc can lead to reduction in time to defervescence, it will be a useful adjuvant in the therapy of enteric fever. Aim: To determine the effect of oral zinc supplementation, along with standard antibiotic therapy, for early defervescence among children with enteric fever. Materials and Methods: This double-blinded, randomised controlled trial was conducted at the Department of Paediatrics, ESICMC and PGIMSR, Chennai, Tamil Nadu, India from November 2014 to August 2016. A total of 58 children aged

Introduction: Enteric fever is an important tropical disease which takes an average of five days for defervescence even with effective antibiotic therapy. Zinc has been successfully used as an adjuvant in diarrhoeal disease. If addition of oral zinc can lead to reduction in time to defervescence, it will be a useful adjuvant in the therapy of enteric fever. Aim: To determine the effect of oral zinc supplementation, along with standard antibiotic therapy, for early defervescence among children with enteric fever. Materials and Methods: This double-blinded, randomised controlled trial was conducted at the Department of Paediatrics, ESICMC and PGIMSR, Chennai, Tamil Nadu, India from November 2014 to August 2016. A total of 58 children aged <12 years with enteric fever were included and were randomised to receive 40 mg elemental zinc per day (n=29) or placebo (n=29) for one week. All children received intravenous ceftriaxone (75 mg/kg every 12 hours) until five days after defervescence. The main outcome measures studied were time taken for defervescence of fever and resolution of toxaemia. Kaplan-Meier survival analysis was used to compare differences in the time to resolution of toxaemia and defervescence of fever between the two groups and the log-rank test was used to test for significance. Results: The mean age of the children of the two groups was 6.48±3.15 years and 7.55±2.59 years, respectively. The mean time for fever defervescence was shorter among the zinc supplemented children than among the children in the control group (2 vs 3 days, p-value=0.043). Resolution of toxaemia was noted earlier in the zinc group than in the control group (75% vs 43%, p-value=0.054). Conclusion: Zinc when used as an adjunct along with standard antibiotic therapy in children with enteric fever, resulted in earlier defervescence of fever. [ABSTRACT FROM AUTHOR]

Abstract Background In cows with acute toxic mastitis (ATM), the leukogram aids in the assessment of the severity of disease. The goal of our study was to compare the leukogram of 158 cows with ATM (cases) and 168 clinically healthy cows (controls). We hypothesised that the leukograms of surviving and non-surviving cows differ and that there are variables of the leukogram with sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM. The cows were examined clinically and underwent haematological and biochemical examination of blood and bacteriological culture of milk samples. Results All cows with ATM had a poor appetite or anorexia, and 34 cows (21.5%) were recumbent. A single quarter was affected in 119 cows (75.3%), two quarters in 37 cows (23.4%) and three quarters in two cows (1.3%). Bacteriological culture showed Gram-negative pathogens in 100 cows (63.3%), Gram-positive in 15 (9.5%) and yeast in 4 (2.5%). The median total leukocyte count of cases was 4300 cells/µL (interquartile range = 2300–8200/µL), which was significantly lower than 8000 cells/µL (6525–9300/µL) in controls. Except for band neutrophils and metamyelocytes, the counts of all components of the leukogram were lower in cases compared with controls. Significantly more cows with ATM had leukopenia (60.1 vs. 4.1%) or leukocytosis (10.1 vs. 3.0%) than controls. Diseased cows had significantly lower segmented neutrophil counts than controls (860 vs. 2598 cells/µL), and 69.5 and 17.3%, respectively, had counts below the reference interval. Cases had increased band (77.3%) and metamyelocyte (25.0%) counts compared with controls (0.6 and 0%, respectively). In diseased cows, eosinopenia occurred in 66.4% (controls, 1.8%), monocytopenia in 40.6% (4.2%) and lymphopenia in 60.2% (1.8%). Twenty-one diseased cows (16.4%) had a regenerative and 57 (44.5%) had a degenerative left shift. The median neutrophil-to-lymphocyte ratio was 0.97 in diseased cows and 0.63 in controls. Toxic changes in neutrophils including cytoplasmic basophilia and vacuolisation were seen in 101 (91.8%) of 110 blood smears of diseased cows. The leukogram of the surviving and non-surviving cows did not differ significantly, and the hypothesis was rejected. Conclusions ATM results in severe changes in the leukogram particularly leukopenia, lymphopenia, and degenerative left shift. The hypothesis that the leukograms of surviving and non-surviving cows differ was rejected. The leukogram has not sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM.

Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias. Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.

Introduction: Women die due to complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and many are preventable or treatable. Maternal mortality in developing countries acts as one of the health indicators and reflects the efficiency of the nation health system. Aim: To analyse the cause of maternal death in tertiary care setting over a period of five years. Materials and Methods: The present study was a retrospective, observational study, conducted over a period of five years, from April 2015 to March 2020 in the Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar, Rajasthan, India. The case records and death review forms of all maternal mortality were collected from hospital records and studies. Data regarding age, parity, locality, booking status, mode of delivery, cause of death, neonatal outcome, etc were collected in pretested proforma and then statistically analysed. Results: There were 115 maternal deaths from April 2015 to March 2020. The average Maternal Mortality Ratio (MMR) over a period of five years was 243 per one lac live births in institute setting. Majority of maternal mortality were from toxaemia (25.2%), anaemia (20.8%), haemorrhage (20.0%) and sepsis (15.7%). Conclusion: High maternal mortality is an important issue regarding maternal care. Toxaemia (hypertensive disorder of pregnancy), haemorrhage, sepsis and anaemia are still the common cause of maternal death. It can be prevented/reduced by improving healthcare facility in rural area by ensuring round the clock availability of gynaecologist, anaesthetist, blood product, intensive care facility and timely referral of high risk pregnancies. Family welfare services should be improved to reduce unwanted pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Women die due to complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and many are preventable or treatable. Maternal mortality in developing countries acts as one of the health indicators and reflects the efficiency of the nation health system. Aim: To analyse the cause of maternal death in tertiary care setting over a period of five years. Materials and Methods: The present study was a retrospective, observational study, conducted over a period of five years, from April 2015 to March 2020 in the Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar, Rajasthan, India. The case records and death review forms of all maternal mortality were collected from hospital records and studies. Data regarding age, parity, locality, booking status, mode of delivery, cause of death, neonatal outcome, etc were collected in pretested proforma and then statistically analysed. Results: There were 115 maternal deaths from April 2015 to March 2020. The average Maternal Mortality Ratio (MMR) over a period of five years was 243 per one lac live births in institute setting. Majority of maternal mortality were from toxaemia (25.2%), anaemia (20.8%), haemorrhage (20.0%) and sepsis (15.7%). Conclusion: High maternal mortality is an important issue regarding maternal care. Toxaemia (hypertensive disorder of pregnancy), haemorrhage, sepsis and anaemia are still the common cause of maternal death. It can be prevented/reduced by improving healthcare facility in rural area by ensuring round the clock availability of gynaecologist, anaesthetist, blood product, intensive care facility and timely referral of high risk pregnancies. Family welfare services should be improved to reduce unwanted pregnancy.

Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias. Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Background: In cows with acute toxic mastitis (ATM), the leukogram aids in the assessment of the severity of disease. The goal of our study was to compare the leukogram of 158 cows with ATM (cases) and 168 clinically healthy cows (controls). We hypothesised that the leukograms of surviving and non-surviving cows differ and that there are variables of the leukogram with sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM. The cows were examined clinically and underwent haematological and biochemical examination of blood and bacteriological culture of milk samples. Results: All cows with ATM had a poor appetite or anorexia, and 34 cows (21.5%) were recumbent. A single quarter was affected in 119 cows (75.3%), two quarters in 37 cows (23.4%) and three quarters in two cows (1.3%). Bacteriological culture showed Gram-negative pathogens in 100 cows (63.3%), Gram-positive in 15 (9.5%) and yeast in 4 (2.5%). The median total leukocyte count of cases was 4300 cells/µL (interquartile range = 2300–8200/µL), which was significantly lower than 8000 cells/µL (6525–9300/µL) in controls. Except for band neutrophils and metamyelocytes, the counts of all components of the leukogram were lower in cases compared with controls. Significantly more cows with ATM had leukopenia (60.1 vs. 4.1%) or leukocytosis (10.1 vs. 3.0%) than controls. Diseased cows had significantly lower segmented neutrophil counts than controls (860 vs. 2598 cells/µL), and 69.5 and 17.3%, respectively, had counts below the reference interval. Cases had increased band (77.3%) and metamyelocyte (25.0%) counts compared with controls (0.6 and 0%, respectively). In diseased cows, eosinopenia occurred in 66.4% (controls, 1.8%), monocytopenia in 40.6% (4.2%) and lymphopenia in 60.2% (1.8%). Twenty-one diseased cows (16.4%) had a regenerative and 57 (44.5%) had a degenerative left shift. The median neutrophil-to-lymphocyte ratio was 0.97 in diseased cows and 0.63 in controls. Toxic changes in neutrophils including cytoplasmic basophilia and vacuolisation were seen in 101 (91.8%) of 110 blood smears of diseased cows. The leukogram of the surviving and non-surviving cows did not differ significantly, and the hypothesis was rejected. Conclusions: ATM results in severe changes in the leukogram particularly leukopenia, lymphopenia, and degenerative left shift. The hypothesis that the leukograms of surviving and non-surviving cows differ was rejected. The leukogram has not sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM. [ABSTRACT FROM AUTHOR]

ABSTRACT The objective of this research was to evaluate a possible corrective measure against negative metabolic states, as occurs in the advanced stage of gestation in ewes, and that sometimes produces a disease called pregnancy toxaemia. In the present research, we found that the joint administration of i.v. lysine-vasopressin (0.08 IU/kg body weight, BW) and an oral glucose solution (50 g) produces an increase in blood glucose, which persists for some time (up to 6 h); therefore, it could be used in the treatment of pregnancy toxaemia. This therapy is based on the fact that lysine-vasopressin induces gastric groove closure in adult ruminants, enabling orally administered glucose to reach the abomasum directly, from where it rapidly passes into the intestine and is immediately absorbed. We can say that the tested treatment causes a significant increase in blood glucose in ewes affected by toxaemia caused by fasting, which, although less marked than conventional therapy with intravenous drip glucose, remains longer, regularizing other parameters indicative of energy metabolism in fasting ewes.

A case of toxaemia secondary to pyloric foreign body obstruction in two four-month-old African lion cubs were presented in this article. The lion cubs were presented to the school of veterinary medicine with a complaint of weight loss and stunted growth despite having a normal appetite and seizures. Definitive diagnosis was made based on gross pathology after attempting various symptomatic treatments. This article therefore is meant to discourage the use of blankets as bedding in holding enclosures for warmth and comfort post-weaning in captive lion cubs and indeed wild cats in general as they tend to eat bedding that has been soiled with food.

Pathological and epidemiological findings in sudden infant death syndrome (SIDS) suggest an infectious aetiology with indications of involvement of staphylococcal enterotoxins (SEs). While SEA, SEB and SEC have been found in the sera and tissues of SIDS cases, little is known about the role of intestinal Staphylococcus aureus or the roles of later-described toxins SEE, SEG, SEH, SEI and SEJ in SIDS. We used a molecular-based approach to define whether the intestinal tract could be a source of SEs to support the staphylococcal toxic shock hypothesis for SIDS. Intestinal contents from 57 SIDS infants and faeces from 79 age- and gender-matched live comparison infants were cultured and tested for S. aureus and sea-b-c-e-g-h-j and TSST using PCR. High proportions of infants in both groups carried toxigenic and nontoxigenic S. aureus. Significantly greater proportions of SIDS compared with comparison babies were positive for S. aureus (68.4% vs. 40.5%) and for SE genes (43.8% vs. 21.5%), suggesting a possible role in SIDS. The results indicate that colonization by S. aureus with SE genes is common in infants; however, their detection is unlikely to be a strong predictive tool for SIDS. Other factors (including immune response) may reveal a specific susceptibility to SEs in SIDS infants. [ABSTRACT FROM AUTHOR]

Pituitary abscess is a rare disorder and its presenting manfestations are non-specific therefore, the diagnosis is usually made either postoperatively or at postmortem. We describe four such cases seen over a period of 10 years. All the patients presented with fever, systemic signs of toxaemia and endocrine dysfunctions. Two of them had pre-existing pituitary pathology. A preoperative diagnosis of pituitary abscess was considered in all in view of characteristic MR findings. Three patients underwent transsphenoidal drainage of abscess, whereas the remaining one succumbed to sepsis and was diagnosed at necropsy. Offending organisms including Pseudomonas, Acinetobacter and Staphylococcus were isolated in three cases respectively. During follow-up for 4 years, 2 patients are doing well, one had a recurrent abscess after 1 year and required redo-surgery. [ABSTRACT FROM AUTHOR]

Uraemic toxemia is a condition resulting due to the retention of toxic waste metabolite of urine like urea, creatinine etc. in the blood. Which may prove fatal many a times. The retention of urine may be a sequelee of severe dehydration leading to oliguria followed by anuria or due to the nephritis in a animals. It has been observed that nephritis is oftenly associated with pyometra also. In the present study the elevated levels of urea and creatinine were alarmingly elevated and was life threatening also. However the timely diagnosis & surgical intervention could save and prolong the life of bitch. [Vet. World 2009; 2(4.000): 146-147]

A case of toxaemia secondary to pyloric foreign body obstruction in two four-month-old African lion cubs were presented in this article. The lion cubs were presented to the school of veterinary medicine with a complaint of weight loss and stunted growth despite having a normal appetite and seizures. Definitive diagnosis was made based on gross pathology after attempting various symptomatic treatments. This article therefore is meant to discourage the use of blankets as bedding in holding enclosures for warmth and comfort post-weaning in captive lion cubs and indeed wild cats in general as they tend to eat bedding that has been soiled with food. [ABSTRACT FROM AUTHOR]

The problems of diagnosing an exanthem as due to contact with mercury are fully discussed. This diagnosis should be considered if any patient with erythroderma of obscure origin is investigated. [ABSTRACT FROM AUTHOR]

Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient., Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I 2 statistics. Funnel plots were used for the assessment of publication bias., Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5-5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03-0.84) and 0.1 (0-0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies., Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Anaesthesia.)