Justificativa â A pneumonia hospitalar (PH) à causa de morbidade e mortalidade elevadas em pacientes hospitalizados. A terapia antimicrobiana empÃrica adequada e precoce pode salvar a vida de mais da metade dos pacientes com PH e deve ser baseada em padrÃes locais de sensibilidade a antimicrobianos. Praticamente todo tratamento de PH Ã, inicialmente, empÃrico. O objetivo deste trabalho à contribuir com o conhecimento do padrÃo regional de resistÃncia de microrganismos nesse contexto. Metodologia â Foram estudados 588 resultados de culturas de lavado bronco-alveolar (LBA) de pacientes internados em Fortaleza, processados na rotina de um laboratÃrio privado, no perÃodo de janeiro de 1996 a dezembro de 2001. Como resultado de pesquisa aos prontuÃrios mÃdicos desses pacientes, dois grupos foram criados: Grupo 1, com n=147, composto por pacientes com pneumonia hospitalar (PH) notificada segundo os critÃrios do Center for Disease Control and Prevention (CDC); Grupo 2, com n=382, pacientes com pneumonia nÃo-hospitalar (PNH). Utilizou-se a tÃcnica quantitativa de cultivo descrita nos trabalhos de Kahn e Jones (1987), Salata et al. (1987) e Carvalho (1997). IdentificaÃÃo e antibiogramas foram realizados no equipamento VITEK BioMerrieux, exceto para Streptococcus pneumoniae e Stenotrophomonas maltophilia cujos antibiogramas foram realizados pelo mÃtodo Kirby-Bauer e E-test respectivamente. Resultados â No Grupo 1, os cinco microrganismos mais freqÃentes foram Pseudomonas aeruginosa [56 casos (38,1%)], Staphylococcus aureus [24 casos (16,3%)], Klebsiella pneumoniae [12 casos (8,2%)], Acinetobacter spp [12 casos (8,2%)] e Serratia marcescens [10 casos (6,8%)]. No Grupo 2, encontraram-se, mais freqÃentemente, Pseudomonas aeruginosa [113 casos (29,6%)], Staphylococcus aureus [89 casos (23,3%)], Klebsiella pneumoniae [32 casos (8,4%)] e Acinetobacter spp [31 casos (8,1%)]. NÃo foi observada diferenÃa significativa entre os dois grupos para a etiologia. O mesmo ocorreu com o perfil de resistÃncia dos organismos, exceto para o Grupo 1 com S. aureus/oxacilina (p=0,027) e P. aeruginosa/piperacilina/tazobactam (p=0,003). No perfil de resistÃncia do conjunto total de amostras (n=751), destaca-se a de P. aeruginosa ao imipenem, de 40,8%; de Acinetobacter spp ao imipenem, de 10,0%; de Acinetobacter spp a Ampicilina/Sulbactam, de 44,3%; e de S. aureus a oxacilina, de 67,3%. O intervalo de tempo entre a data de internaÃÃo e a realizaÃÃo da cultura foi maior do que 7 dias em 60,18% dos casos. ConclusÃo - no trato respiratÃrio, o problema da multiresistÃncia bacteriana à evidente e preocupante com alta prevalÃncia de bacilos gram-negativos multiresistentes, marcadamente P. aeruginosa e Acinetobacter spp., assim como elevada resistÃncia a oxacilina nas amostras de Staphylococcus aureus. O Grupo 2 nÃo possui caracterÃsticas de pneumonia comunitÃria (PC), provavelmente, porque o tempo entre a internaÃÃo e a realizaÃÃo da cultura foi longo o suficiente para permitir a colonizaÃÃo do trato respiratÃrio superior pela microflora do ambiente hospitalar. à possÃvel que o Grupo 2 seja constituÃdo por pacientes com pneumonia comunitÃria severa refratÃria à antibioticoterapia que necessita internaÃÃo, ou que tiveram vÃrias internaÃÃes anteriores, com conseqÃente colonizaÃÃo por microflora hospitalar. InvestigaÃÃes subseqÃentes devem conferir atenÃÃo especial a esse aspecto. Pode ser Ãtil, neste contexto, o emprego de tÃcnicas de Biologia Molecular para melhor caracterizaÃÃo dos microrganismos isolados / Hospital acquired pneumonia (HAP) is associated with high morbidity and mortality in hospitalized patients. Early, appropriate, and adequate empiric antibiotic therapy can save lives of more than half of all HAP patients and must be based on local data. This study will provide local patterns of antibiotic resistance. Practically all primary therapy of HAP is empiric and information from surveillance program of a given hospital is very important. We studied 588 Bronchoalveolar lavage cultures results from hospitalized patients performed in a private lab during a period of 6 years from 1996 to 2001. As a result of searching patientâs records, two groups were assigned: Group 1, n=147, patients with HAP notified by Nosocomial Infection Commission according to Center for Disease Control and Prevention-CDC; Group 2, n=382, patients with No-Nosocomial Pneumonia. Bacteriologic cultures were done quantitatively with a threshold of >= 105 according to Kahn and Jones (1987), Salataet al. (1987) and Carvalho (1997). Identification and susceptibility tests were performed on VITEK BioMerrieux except for Streptococcus pneumoniae and Stenotrophomonas maltophilia. In patients from Group 1, the five most frequent agents were: P. aeruginosa 56 cases (38,1%), S.aureus 24 (16,3%), K. pneumonia 12 (8,2%), Acinetobacter spp 12 (8,2%) and S. marcescens 10 (6,8%). Group 2 shows: P. aeruginosa 113 (29,6%), Staphylococcus aureus 89 (23,3%), Klebsiella pneumoniae 32 (8,4%), Acinetobacter spp 31 (8,1%) and Candida spp 20 (5,2%). There was no significant difference between resistance profile of isolates when distributed in two groups except S. aureus/Oxacilina (p=0,027), P.aeruginosa/Piperacilina/Tazobactam (p=0,003). The resistance profile in total (n=751) was: P. aeruginosa/Imipenem 40,8%, Acinetobacter spp/Imipenem 10,0%, Acinetobacter spp/AmpicilinaSulbactam 44,3% e S. aureus/Oxacilina 67,3%. The time between admission date and culture request was more than 7days in 60,18% in both groups. Conclusion: a) drug-resistance in lower respiratory tract infection(LRTI) is a serious concern mainly with high prevalence of multi-R gram-negative like P. aeruginosa and Acinetobacter with high resistance for Imipenem and other β- IactÃmic and S. aureus with high resistance to Oxacilina. There was no significant difference between the two groups. Group 2 did not show characteristics of Community-Acquired Pneumoniae (CAP) maybe because of large intervals of time between admission and request of culture, or this kind of patient had either severe CAP with no response to prior multiple antimicrobial therapy or previous hospitalizations or even had recent hospitalization and consequent colonization. Forwards molecular studies should be performed on isolates to provide better characterization of lower respiratory tract pathogens.

Orientadores: Célia Regina Garlipp, Carlos Emilio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:20:39Z (GMT). No. of bitstreams: 1 Martinez_MayaraHidalgoMagri_M.pdf: 2010266 bytes, checksum: 23bb4f89ea7b258a0fd5fe0e20f6cc1f (MD5) Previous issue date: 2012 / Resumo: Infecção do trato urinário (ITU) é muito comum na prática clínica, acometendo pessoas de ambos os sexos em todas as faixas etárias. Para seu diagnóstico é importante definir rapidamente a presença de bacteriúria e piúria bem como a etiologia da doença através da urocultura. A urocultura é o teste microbiológico mais comum na prática laboratorial, embora seja um procedimento demorado e de custo relativamente elevado. Nosso objetivo foi avaliar a aplicação de um sistema automatizado de análise da urina (LabUMat/UriSed) como método de triagem para a investigação de ITU através da comparação de seus resultados com os das uroculturas. Analisamos amostras de urina de pacientes adultos e crianças de ambos os sexos provenientes de ambulatórios e enfermarias do Hospital de Clínicas da UNICAMP encaminhados às Seções de Líquidos Biológicos e Microbiologia da Divisão de Patologia Clínica para análise físicoquímica, sedimento e urocultura. Foram estabelecidos valores de cortes baseados na comparação dos resultados das uroculturas com os parâmetros urinários: leucócito-esterase, nitrito, leucócitos, bactérias e leveduras, sendo que a positividade de pelo menos um destes parâmetros classificava a amostra para uma triagem positiva para ITU. O estudo foi conduzido em três etapas: Na primeira etapa, a análise de 2126 amostras de urinas permitiu adotar um primeiro valor de corte para os parâmetros analisados: contagem de bactérias >11/campo; contagem de leucócitos >5/campo, presença de leveduras além de nitrito e leucócito-esterase positivos. Esses valores foram comparados com os resultados da urocultura em meio CLED e testados na rotina laboratorial. Em uma segunda etapa, com a finalidade de aprimorar o valor de corte dos parâmetros e aumentar o valor preditivo positivo sem comprometer o valor preditivo negativo, estabeleceu-se um novo valor de corte. Para tanto, foram analisadas 2075 amostras de urinas e com os seguintes valores de corte estabelecidos: contagem de bactérias 'maior ou igual'12,5/campo; contagem de leucócitos >5/campo, presença de leveduras e nitrito bem como leucócito-esterase positivo 'maior ou igual'2+. Esses valores foram comparados com os resultados das uroculturas em meio CLED e testados na rotina laboratorial. A fim de refinar e validar o teste de triagem para urocultura foram analisados, em uma terceira etapa, 1379 amostras de urina. Nesta etapa os valores de corte dos parâmetros foram: contagem de bactérias >12,5/campo, contagem de leucócitos >5/campo, presença de leveduras e leucócito - esterase positivos 'maior ou igual'2+. Nesta etapa as amostras cujos parâmetros urinários avaliados estavam abaixo do valor de corte, foram consideradas negativas para ITU e semeadas em meio CLED. As amostras em que pelo menos um dos parâmetros estudados estava acima do valor de corte, foram consideradas positivas, sendo semeadas em meio Chromagar a fim de se identificar presuntivamente os patógenos. O teste mostrou sensibilidade de 97%, valor preditivo negativo de 99%, valor preditivo positivo de 27%, especificidade de 59% e acurácia de 64%. Em todas as etapas observou-se uma potencial redução de 50% nas semeaduras de uroculturas. Os dados sugerem que o sistema automatizado LabUMat / UriSed é uma boa ferramenta para a triagem de ITU, especialmente se considerarmos os dados clínicos dos pacientes / Abstract: Urinary tract infection (UTI) is very common in clinical practice, affecting people of both genders in all age groups. For the laboratory diagnosis of UTI is of great importance the definition of significant bacteriuria and pyuria and a bacterial culture of a urine sample to establish the etiology of the disease. The quantitative urine culture is the commonest microbiology test in Clinical Pathology Laboratory practice, although it is a very time-consuming and expensive procedure. Our aim was to evaluate the performance of the LabUMat with UriSed System as a screening method for the investigation of UTI comparing its results with the outcome of urine culture. We studied urine samples from children and adults of both genders from outpatients and hospitalized patients from Clinical Hospital / UNICAMP referred to Body Fluids and Microbiology Laboratories at Division of Clinical Pathology for physicochemical analysis, sediment observation and urine culture. We established cut-off values based on the comparison of the outcome of urine cultures with urinary parameters: leukocyte esterase, nitrite and quantitative determination of bacteriuria, leukocyturia and presence of yeasts. A positivity of at least one parameter classified the sample as a positive screening of UTI. This study was conducted in three stages: In the first stage, the analysis of 2,126 urine samples allowed to adopt the first cut-off value for the parameters analyzed: quantification of bacteriuria (>11 elements/hpf), quantification of leukocyturia (>5 cells/hpf), presence of yeasts besides nitrite and leukocyte esterase positive. These values were compared with the outcome of uroculture in CLED agar medium culture and tested in the laboratory routine. In the second stage, in order to improve cut-off values of urinary parameters and increase the positive predictive value without compromising the negative predictive value, it was established a new cut-off value. We analyzed 2,075 urine samples with the following established cut-off values: quantification of bacteriuria (> or = 12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts, nitrite and leukocyte esterase positive (> or = 2+). These values were compared with the outcome of uroculture and tested in the laboratory routine. In order to refine and validate the screening test for uroculture were analyzed, in a third stage, 1,379 urine samples. In this stage the cutoff values of the parameters were: quantification of bacteriuria (>12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts and leukocyte esterase positive (> or = 2+). In this stage the urinary samples whose evaluated parameters were below the cut-off value were considered negative for UTI and were plated in CLED agar medium culture. Samples which at least one of the parameters evaluated was above the cut-off value, were considered positive, and were plated in Chromagar commercial medium, in order to presumptively identify pathogens. The test showed sensitivity of 97%, negative predictive value of 99%, positive predictive value of 27%, specificity of 59% and accuracy of 64%. In all stages we observed a potential 50% reduction in sowing urocultures. The data suggest that the LabUMat with UriSed System is a good tool for screening for UTI, especially if we consider patients' clinical data / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Class of 2012 Abstract / Specific Aims: 1• Determine the results of urine culture and susceptibility testing for patients with uncomplicated UTI at an emergency department 2• Determine empiric antibacterial agents prescribed for treatment of uncomplicated UTI in the emergency department 3• Compare pathogen susceptibility pattern specific for patients with uncomplicated UTI compared to the overall institution antibiogram Examine the use of cephalexin for uncomplicated UTI in emergency department patients Methods: A retrospective electronic medical records of adult female patients admitted to University Medical Center in Tucson, Arizona, emergency department with a diagnosis of uncomplicated urinary tract infection (UTI) between June 1, 2010 and May 31, 2011 were collected. Different aspects of uncomplicated urinary tract infection (UTI) were characterized, and prescriptions for empiric antibiotic treatment were recorded. Culture results and susceptibility reports as well as antibacterial treatment decisions were studied to evaluate types of pathogens and resistance patterns along with therapy prescribed. The data was managed and analyzed by using SAS. All data was tabulated and described using summary statistics. Main Results: The dominant isolate of the study population was E.coli (88%). Cephalexin was prescribed 76% of the time, nitrofurantoin 8.4%, ciprofloxacin 7.6%, and TMP/SMX 5% of the time. The susceptibility rate of ampicillin was 50%, cefazolin 91%, ciprofloxacin 98%, nitrofurantoin 92%, and TMP/SMX 76%. Conclusions: Our study revealed that the resistant rate of TMP/SMX exceeded 20%; however, ciprofloxacin and nitrofurntoin susceptibility remains high. Cephalexin was the most commonly prescribed treatment, but not included in the antimicrobial susceptibility test (AST) panel.

No description available.

Class of 2015 Abstract / Objectives: In 2011, the American Academy of Pediatrics released an updated urinary tract infection guideline that addressed diagnosis, antibiotic treatment, and duration of therapy in children ages 2-24 months. The objectives of this study were to evaluate the appropriateness of antibiotic prescribing and compare outcomes between age groups. Methods: This retrospective chart review included patients aged 1 month through 12 years admitted to a regional academic medical center from January through July 2014 and diagnosed with UTI or pyelonephritis. Patients were identified using ICD-9 codes. Demographic information, antibiotic treatment, length of stay, and complications were collected and the chi square statistical test was used to compare results between age groups. Results: There were 104 patients included in this study. The most common bacteria cultured were Escherichia coli (85%). Ceftriaxone (71%) and cephalexin (30%) were the most commonly prescribed empiric and discharge antibiotic, respectively. Based on guideline recommendations and culture results, inappropriate antibiotic selection only occurred with 7% of the orders while inappropriate prescribing occurred 35% of the time. Readmission within 90 days occurred in 15% of patients aged 2-24 months (guideline age group) and in 14% of all other patients (P>0.05). Conclusions: There was no difference between age groups with respect to inappropriate antibiotic prescribing or complications for pediatric UTI treatment and inappropriate antibiotic dosing occurred more frequently than inappropriate selection. More research is necessary to assess the impact of the guidelines on prescribing practices and factors associated with inappropriate prescribing.

Class of 2011 Abstract / OBJECTIVES: To evaluate the appropriateness of discharge antimicrobial medications for UTI in an adult population based on therapy prescribed. METHODS: In this retrospective chart review study the appropriateness of discharge antimicrobial therapy for patients admitted to an academic medical center during 3 weeks in 2010 was assessed based on culture results, estimated renal function, reported drug allergies, route of administration, and change in UTI from in-house to discharge prescribed therapy. RESULTS: A total of 35 patients with discharge UTI antimicrobials within the study period met inclusion criteria and were evaluated. According to available urinary culture and susceptibility data, 22 of 35 (62.8%) of received an appropriate antimicrobial therapy. Based on reported gastrointestinal function, all 35 patients could take oral medications but two patients with an appropriate oral therapy option received intravenous therapy. All patients were discharged with antimicrobials that were appropriate according to patients’ reported drug allergies and only one patient received an antimicrobial agent that was inappropriately adjusted based on the patient’s estimated renal function. UTI antimicrobial therapies were the same at 24 hours prior to discharge and as the discharge antimicrobial in 100% of patient cases evaluated CONCLUSION: The antimicrobial UTI discharge therapy was evaluated for appropriateness based on urine culture results, patients’ allergies, and patients’ estimated renal function. Overall, antimicrobial therapy was only appropriate in 22 of 35 (62.8%) of patients based on the available culture results.

Urinary tract infections are generally preceded by transfer of organisms from the distal urethra to the bladder (20, 148). However, although urinary infections are predominantly due to pure cultures of Escherichia coli, the distal urethra contains a mixed flora in which E. coli is relatively uncommon and anaerobes predominate (73, 103). This discrepancy between the bladder and distal urethral flora may be due to differential adhesion or differential growth rates. In this dissertation I have tested the hypothesis that differential growth rates of urethral organisms in urine explains the predominance of E. coli as a pathogen. These experiments showed that the balance between bacterial growth and washout may have a pivotal role in the pathogenesis of infection and perhaps therefore in treatment. A model of the human bladder used for the pathogenesis studies was then used to study the activity of mecillinam and ampicillin under conditions simulating human urinary infection. The model proved realistic especially for synergy studies where shortcomings in conventional in vitro methods are a cause for concern. The following topics were studied. 1. Urine was chosen as a test medium for definitive experiments because growth rates of organisms other than E. coli were different in broth and in urine. A method for sterilizing urine in bulk was developed which did not affect growth supporting properties. 2. E. coli was shown to grow faster and to have a shorter lag period than almost all other organisms when studied in shake culture. 3. A continuous culture model of the human urinary bladder was employed for differential growth studies of organisms in sterilized human urine. This model reproduced many of the characteristics of the human lower urinary tract and enabled study of the balance between bacterial growth and the tendency of urine to wash organisms out of the tract. 4. Mixed cultures of approximately equal numbers of E. coli and a second potential urinary' pathogen were introduced into the bladder model and quantitative cultures performed at intervals up to 24 h. In 15 experiments E. coli eventually dominated the second pathogen which was sometimes undetectable at 24 h. Similar changes in bacterial populations seen in infected patients indicate that differential growth rates may be an important determinant of the pathogenicity of E. coli. 5. The use of the bladder model was then extended to investigations of antibiotic activity under realistic conditions. The value of the model for synergy studies with ampicillin and mecillinam was assessed by parallel conventional in vitro tests and an animal infection protection test*. The bladder model gave similar results to mammalian studies and appeared to be far superior to conventional methods. This model may be valuable in the initial assessment of new urinary antibiotics. 6. A representative array of organisms for the above study was selected following a survey of resistance patterns of 2000 clinical isolates of Enterobacteriaceae. An incidental by-product of this survey was the establishment of a breakpoint for mecillinam susceptibility in the Kirby-Bauer antibiotic disk test. 7. Work on the effect of mecillinam and/or ampicillin upon bacterial viability was extended to investigations of the relative contribution of permeability barriers and 3-lactamases to antibiotic susceptibility. Unlike ampicillin, mecillinam resistance of 77 clinical isolates of bacteria appeared to be independent of intracellular 3-lactamase levels, suggesting that the barrier effect may be more pronounced in bacterial resistance to mecillinam than to ampicillin. Kinetic studies using urine as a growth medium, and in particular the use of a bladder model have provided a unifying explanation of many features of both the pathogenesis and treatment of urinary infections. * Carried out by Dr. R.C. Cleeland. / Science, Faculty of / Microbiology and Immunology, Department of / Graduate

A series of 4 observational studies was performed on a Bovelder herd at Johannesburg Water’s Northern Farm. The heifer and cow breeding seasons started on 15 October and 1 November every year, and consisted of 50 d and 60 d of oestrus observation respectively, with once daily artificial insemination (AI). Five to 7 days after the AI period bulls were added in multi-sire groups for a period of 42 d. Pregnancy diagnoses were performed between 23 March and 26 April every year. The farming system had been in place for >25 years, with few deviations. In the first study, reproductive tract scoring (RTS) by transrectal palpation on a 5- point scale was performed 1 day before the start of breeding on a group of heifers (n = 272) born in 2002. Heifers with RTS 1 or 2 were estimated to be pre-pubertal, those with RTS 3 pubertal and those with RTS 4 or 5 post-pubertal. Pre-breeding body weight (BW) and body condition score (BCS) were recorded, and Kleiber ratio (KR) was calculated (average daily gain/end weight0.75). Heifers were followed until they weaned their first calves. The objectives of this study were to determine if RTS is a valid tool to predict reproduction and production performance in limited bred beef heifers, and to compare its predictive value with that of BW, BCS, age and KR. After adjustment for BW and age, RTS was positively associated with pregnancy rate to the 50 day AI season (P < 0.01), calf weaning weight (P < 0.01) and pregnancy rate to the subsequent breeding season (P < 0.01), and negatively associated with days to calving (P < 0.01). RTS was a better predictor of fertility than was vi KR, and similar in its prediction of calf weaning weight. It was concluded that RTS is a predictor of heifer fertility and compares well with other traits used as a predictor of production outcomes. It was further hypothesised that RTS may predict long-term reproductive performance due to its association with pregnancy outcome and days to calving after first breeding, combined with reports that heifers calving early tend to calve early in subsequent seasons and have increased lifetime production. In study 2, a 7-year longitudinal study, 292 beef cows in two age cohorts were observed from 1-2 d before their first breeding season (day of RTS), until they had weaned up to 5 calves. Years to reproductive failure was defined as the number of years until a cow failed to become pregnant during the AI season. Animals with RTS 1 or 2 were at increased risk of early reproductive failure compared to those with RTS 4 or 5 (HR = 1.4, 95% CI 1.0, 1.9) despite the fact that RTS was not associated with calving rate or days to calving after the second calving season. The predictive value of RTS was lower in the age cohort with a higher prevalence of anoestrus. Most animals with RTS 1 or 2 that were subsequently detected in oestrus were in early to mid di-oestrus at the time of scoring. It was concluded that RTS is a valid culling tool to improve long-term reproductive success in a seasonal breeding system, by excluding poor performing animals. It was further concluded that the predictive value of RTS decreases with increasing prevalence of anoestrus and at certain stages of the oestrous cycle. Apart from failure to calve, dystocia as a result of foeto-maternal disproportion is the cause of significant production loss in beef heifers. Internal pelvis area (PA) can be calculated as the product of vertical and horizontal diameter of the pelvis measured transrectally using a calliper device. In study 3, the effects of five culling strategies using prebreeding PA data on calving and dystocia rates and on pre-breeding and calf birth weight (BWT) were compared in 484 heifers. Multiple regression analyses were used to determine independent predictors of PA, calf BWT and dystocia. Hypothetical culling of 10 or 20% of heifers was applied within age cohort after ranking by each of the following: unadjusted PA (PA); PA adjusted to 365 d of age (APA); PA:BW ratio (PA:BW); PA adjusted to the median BW of the group by the regression coefficient of PA on BW(BWPA) and PA similarly adjusted to the median lean BW (LBWPA). Dam parity, calf BWT and either BWPA or LBWPA were the only independent predictors of dystocia (P < 0.05), whereas the effect of PA tended to be significant only after adjusting for calf BWT (P = 0.08). After culling by PA or APA, retained heifers were heavier, had a higher calving rate and calves tended to be heavier at birth compared to culled heifers, but dystocia rates were not different. Although culling by PA:BW resulted in lower dystocia rate, it resulted in lower pre-breeding BW in retained than in culled heifers. Culling by BWPA and LBWPA had better sensitivity and specificity for dystocia than PA, and resulted in higher calving- and lower dystocia rates in the retained heifers, without affecting the pre-breeding BW or calf BWT. It was concluded that pelvimetry is a useful culling tool to aid in the management of dystocia in yearling heifers, and that adjustment of PA to median BW within age group improves its accuracy and avoids the undesirable side-effects of using unadjusted PA. The strong association of PA with calving rate resulted in the hypothesis for study 4, namely that PA can add prognostic value to RTS as a predictor of reproductive failure in beef heifers. Transrectal ultrasound (US) examination of the reproductive tract was also investigated in this study (n = 488) with the objective of identifying which ultrasonographic measures taken at a single point in time before the onset of breeding were independently associated with reproductive outcomes. In this study pregnancy failure was defined as the failure to become pregnant after the AI and bull breeding periods while anoestrus was defined as the failure to be detected in oestrus during the entire 50 d AI period. BCS, uterus horn diameter, absence of a CL, largest follicle of less than 13mm and PA were the pre-breeding examination variables that remained in prognostic models (P < 0.1). Combining either the model based on the three remaining US measures or RTS with PA provided more accurate prognostic models for pregnancy failure and anoestrus than using RTS alone (P < 0.05). It was concluded that US measures have prognostic value for pregnancy failure in restricted bred yearling heifers as a result of their association with anoestrus, and that smaller PA has additional value to identify poor performing heifers. In conclusion, pre-breeding examination is useful to identify beef cows with lower potential to reproduce successfully over the long term in a restricted breeding system. It is recommended that PA should always be included in such examination, either unadjusted or adjusted by BW, in herds with a low and high incidence of dystocia respectively, in combination with ultrasonography of the reproductive tract. When ultrasonography is not available, the accuracy of RTS by transrectal palpation can likely be improved by repeating it in low scoring animals after 7 days. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Production Animal Studies / unrestricted

The normal sonographic appearance of the adult canine gastrointestinal tract has been well described. Interpretation of ultrasonographic findings in puppies presented for gastrointestinal evaluation is difficult due to the lack of information on normal ultrasonographic findings. The gastrointestinal tract, jejunal lymph node size and appearance as well as the presence or absence of peritoneal fluid were prospectively investigated in a group of 23 normal, 7 – 12 week old Beagle puppies. The duodenal wall thickness was significantly greater than other parts of the gastrointestinal tract (mean 3.8 mm). The mean stomach wall thickness was 2.7 mm, mean jejunal wall thickness 2.5 mm and mean colonic wall thickness 1.3 mm. In addition, the mean thickness of the duodenal mucosal layer (2.7 mm) was significantly thicker than that of the jejunal mucosal layer (1.5 mm). The mucosa was isoechoic to the muscularis layer and had a crisp luminal-mucosal interface in all puppies. There were no intestinal corrugations observed and wall layering was distinct in all gastrointestinal segments. The homogenous, hypoechoic jejunal lymph nodes were easily found and their mean thickness measured 7.1 mm (± SD 2.2 mm). A mild amount of anechoic free peritoneal fluid was seen in all puppies. Conclusions drawn from this study were that prominent jejunal lymph nodes and a mild amount of anechoic free peritoneal fluid can be considered normal findings in puppies. Information from the above study was utilised to interpret findings of a prospective clinical study on the ultrasonographic appearance of the gastrointestinal tract of puppies suffering from parvoviral enteritis. Forty puppies between six and 24 weeks of age were examined ultrasonographically within 24 hours of admission for canine parvoviral enteritis confirmed on faecal transmission electron microscopy. A clinical score (assessing habitus, appetite, vomiting, faecal consistency, mucous membranes, abdominal palpation and borborygmi) was attributed to each puppy prior to the ultrasonographic examination. Sonographic findings included fluid filled small intestines in 92.5% of cases, and stomach and colon in 80% and 62.5% of cases respectively. Generalised atony was seen in 30 cases and weak peristaltic contractions indicative of functional ileus observed in the remaining 10 cases. The duodenal and jejunal mucosal layer thicknesses were significantly reduced when compared to values obtained in the normal Beagle puppies with mean duodenal mucosal layer measuring 1.7 mm and jejunal mucosal layer 1.0 mm. Additionally, a mucosal layer with diffuse hyperechoic speckles was seen in the duodenum (15% of cases) and the jejunum (50% of cases). The luminal surface of the duodenal mucosa was irregular in 22.5% of cases and the jejunal mucosa in 42.5% of cases. In all of these puppies, changes were accompanied by generalised indistinct wall layering. Small intestinal corrugations were seen within the duodenum in 35% of cases and within the jejunum in 7.5%. A mild amount of anechoic free peritoneal fluid was observed in 26 cases and was considered within normal limits for puppies and a moderate amount of anechoic free peritoneal fluid was observed in six cases. The jejunal lymph node size was within normal limits for puppies and thus parvoviral enteritis does not appear to be associated with ultrasonographic evidence of regional lymphadenopathy. There was a tendency for animals with the most dramatic ultrasonographic changes to be in poor condition clinically i.e. they had a low clinical score. Each of the above described changes cannot be considered pathognomonic for canine parvoviral enteritis but in combination, are suggestive of the disease. It is hoped that information from this study may alert the clinician as to the possibility of underlying parvoviral enteritis in puppies presented for abdominal ultrasound for investigation of gastrointestinal disease. Further studies are needed to document the ultrasonographic appearance of other paediatric gastrointestinal diseases such as severe verminosis, giardiasis, coccidiosis and distemper etc. before further conclusions can be drawn from this study. Daily ultrasonographic examinations of puppies suffering from canine parvoviral enteritis are needed to further understand the progression of this disease over time as well as the possible ultrasonographic indicators of clinical improvement or deterioration. / Dissertation (MMedVet)--University of Pretoria, 2009. / Companion Animal Clinical Studies / unrestricted

Immunofluorescence was used to study immunoreactivity (IR) for corticotropin-releasing factor (CRF) in the guinea pig enteric nervous system. CRF-IR was expressed in both the myenteric and the submucosal plexuses of all regions of the large and small intestine and the myenteric plexus of the stomach. CRF-IR nerve fibers were present in the myenteric and submucosal plexuses, in the circular muscle coat, and surrounding submucosal arterioles. Most of the CRF-IR fibers persisted in the myenteric and submucosal plexuses after 7 days in organotypic culture. CRF-IR was not coexpressed with tyrosine hydroxylase-IR or calcitonin gene-related peptide-IR fibers. The proportions of CRF-IR cell bodies in the myenteric plexus increased progressively from the stomach (0.6%) to the distal colon (2.8%). Most of the CRF-IR myenteric neurons (95%) had uniaxonal morphology; the remainder had Dogiel type II multipolar morphology. CRF-IR cell bodies in the myenteric plexus of the ileum expressed IR for choline acetyltransferase (56.9%), substance P (55.0%), and nitric oxide synthase (37.9%). CRF-IR never colocalized with IR for calbindin, calretinin, neuropeptide Y, serotonin, or somatostatin in the myenteric plexus. CRF-IR cell bodies were more abundant in the submucosal plexus (29.9-38.0%) than in the myenteric plexus. All CRF-IR neurons in submucosal ganglia expressed vasoactive intestinal peptide-IR and were likely to be secretomotor/vasodilator neurons. CRF-IR neurons did not express IR for the CRF1 receptor. CRF 1-IR was expressed in neuronal neighbors of those with CRF-IR. Collective evidence suggests that VIPergic secretomotor neurons might provide synaptic input to neighboring cholinergic neurons.