Ornithobacterium rhinotracheale İnfeksiyonu kanatlılarda solunum bozuklukları, büyümede gerileme, ölüm oranında artış ile karekterize bir infeksiyondur. Oldukça yeni bir infeksiyon olmasına rağmen ...kısa sürede birçok ülkede saptanmıştır. Bu makalede kanatlı işletmelerinde büyük ekonomik kayıplara yol açan Ornithobacterium rhinotracheale İnfeksiyonu ele alınmıştır.
Ornithobacterium rhinotracheale infection is characterized by respiratory disease, decreased growth and increased mortality in avians. Although a reasonably new infection, it has been found in many countries in a short period. In this article, this infection, which causes large financial losses in avian enterprises, was investigated.
Bu raporda kahverengi yumurtacı piliçlerde A Vitamini'nin amiloid artropati oluşumu üzerine artırıcı etkisi bildirilmektedir. Çalışmada 36 dişi, 36 erkek piliç kullanıldı. Piliçler üç gruba ayrılarak ...çalışma süresince, birinci gruptakiler (A vitamini grubu) yüksek düzeyde (75.000 İ.Ü/kg) A vitaminli yemle, ikinci (Pozitif kontrol grubu) ve üçüncü (Negatif kontrol grubu) gruptakiler ise normal düzeyde A vitaminli yemle beslendi. Çalışmanın beşinci haftasında birinci ve ikinci gruplarda amiloid artropati oluşturmak amacıyla $10^9$ cfu/ml Enterococcus faecalis (0,25 mi), üçüncü grupta ise negatif kontrol olması amacıyla NaCI (% 0,9) enjeksiyonları (0,25 ml) tüm civcivlerin sol tibio-metatarsal eklemine uygulandı. Çalışmanın sonunda gruplar amiloid artropati oluşum oranı ve dokulardaki amiloid birikiminin şiddeti bakımından karşılaştırıldı. Sonuç olarak; amiloid artropati oluşumuna A vitamini, pozitif ve negatif kontrol gruplarında sırasıyla 19/20 (% 95), 18/24 (% 75) ve 0/24 (% 0) oranlarında rastlandı ve gruplar arası farklar istatistiki olarak önemli bulundu (P < 0,01). Ayrıca A vitamini grubunda şiddetli olgu sayısı 8/20 (% 42,1) iken, pozitif kontrol grubunda şiddetli birikimin hiç gözlenmemesi de anlamlı (P < 0,05) bulundu. Bu veriler ışığında; yemlerle yüksek düzeyde A vitamini alınmasının E. faecalis ile indüklenmiş kahverengi yumurtacı piliçlerde amiloid artropati oluşum oranını ve şiddetini artırdığı sonucuna varıldı.
The enhancing effect of vitamin A on the occurrence of amyloid arthropathy in Brown layer chickens is reported. In this study, 36 female and 36 male chickens were used. The chickens were allocated into 3 groups. Group 1 (Vitamin A group) was fed a diet which contained high levels of Vitamin A (75,000 I.U/kg), whereas group II (positive control) and group III (negative control) were fed a diet containing normal levels of vitamin A. In the fifth week of the experiment Enterococcus faecalis ($10^9$ cfu/ml) was injected into the left femoro-tibial joint in groups I and II (in order to produce amyloid arthropathy) and 0.9% NaCl (0.25 ml) in group III. At the end of the study, the amyloidosis occurrence rates and the severity of amyloid accumulation were compared. The occurrence of amyloid arthropathy in the vitamin A, the positive control and the negative control groups was 19/20 (95%), 18/24 (75%) and 0/24 (0%), respectively, and the differences among the groups were statistically significant (P < 0,01). Severe amyloid accumulation was observed in 8/20 (42.1%) chickens in the vitamin A group, while no severe accumulation was found in the positive control group (P < 0,05). In conclusion, these data showed that high levels of vitamin A in the diet can enhance the occurrence and the severity of amyloid arthropathy induced with E. faecalis in Brown layer chickens.
Bu çalışmada Pasteurella'ların ve diğer aerobik bakteriyel etkenlerin koyun ve keçilerin pnömonili akciğer örneklerinden izolasyonu ve izole Pasteurella multocida ve Mannheimia haemolytica'mn kültür ...yöntemi ve polimeraz zincir reaksiyonu (PZR) ile identifikasyonu amaçlandı. Ayrıca şüpheli P. multocida izolatlarına fare patojenite testi yapıldı. Akciğer örneklerinin % 7 koyun kanlı ağarda 24-48 saatlik kültürü sonucunda, 350 koyun akciğerinden 15 (96 4,3) P. multocida ve 8 (96 2,3) M. haemolytica izole ve identifiye edildi. Keçilerden toplanan 150 akciğer örneğinden ise 1 (96 0,7) P. multocida ve 6 (96 4,0) M. haemolytica izole ve identifiye edildi. Akciğerlerden P. multocida ve M. haemolytica'nm izolasyon oranlarının karşılaştırılması sonucunda farkın istatistiksel olarak önemli olmadığı belirlendi (koyunlarda P = 0,2 ve keçilerde P = 0,12).
Fare patojenite testi ile koyunlarda 15 P. multocida izolatından 13 (96 86,7)'ü ve keçilerde ise izole edilen bir P. multocida izolatı pozitif bulundu.
P. multocida ve M. haemolytica izolatlarının tümünün PZR ile de pozitif olduğu saptandı. Bununla birlikte, toxA geninden hazırlanan primerlerin kullanılması ile yapılan PZR ile P. multocida izolatlarının hiçbirinde pozitif sonuç elde edilemedi.
Sonuç olarak bu çalışma, P. multocida ve M. haemolytica'nm doğru ve çabuk identifikasyonu için PZR'nin uygulanabilirliğini ortaya koymuştur.
The purpose of this study was to isolate Pasteurella spp and other aerobic bacterial agents from the lungs of sheep and goats with pneumonia and to identify Pasteurella multocida and Mannheimia haemolytica by both culture methods and polymerase chain reaction (PCR). In addition, mouse pathogenecity tests were carried out on suspected P. multocida isolates. In the examination of lung samples collected from sheep, 15 (4.3%) P. multocida and 8 (2.3%) M. haemolytica strains were isolated and identified. The numbers of species identified in the goat samples were 1 (0.7%) for P. multocida and 6 (4%) for M. haemolytica. The differences between the numbers of P. multocida and M. haemolytica strains isolated from the sheep and goat lung samples were not statistically significant (P = 0.2 in sheep and P = 0.12 in goats).
Thirteen (86.7%) P. multocida isolates were positive in the mouse pathogenecity test in sheep. One P. multocida isolate from goats was also positive- in the mouse pathogenecity test. .
All P. multocida and M. haemolytica strains that tested positive by culture also tested positive by PCR. However, no toxigenic P. multocida were detected in any isolates by PCR using primers derived from the toxA gene.
In conclusion, this study showed the feasibilty of PCR for the accurate and rapid identification of P. multocida and M. haemolytica.
Bu çalışmada Elazığ'daki bir mezbahada kesilen toplam 8222 sığır akciğeri incelendi ve bu akciğerlerin 500 (% 6)'ünde pnömoni saptandı. Beşyüz akciğer örneğinin % 7 koyun kanlı ağarda 24-48 saatlik ...kültürü sonucunda, 36 (% 7,2) Staphylococcus aureus, 30 (% 6) Pastevrella multocida, 30 (% 6) Corynebacterium spp, 29 (% 5,8) Maya, 19 (% 3,8) Streptococcus spp, 18 (% 3,ö) Staphylococcus epidermidis, 13 (% 2,6) Escherichia mil, 11 (% 2,2) Bacillus spp, 10. (% 2) Pseudomonas spp, 9 (% 1,8) Mannheimia haemolytica, 8 (% l ,6) Actinobadllus spp, 6 (% 1,2) Klebsiella spp, 1 (% 0,2) Moraxella spp, l (% 0,2) Proteus spp ve 90 (% 18) miks olmak üzere toplam 311 (% 62,2) bakteri izole ve identifiye edildi. Şüpheli P. muitocida suşlarının 24 (% 80)'ünde fare inokulasyon testi ile pozitif sonuç alındı. Kültür pozitif P. multocida ve M. haemolytica suşlarının tümünün PZR ile de pozitif olduğu bulundu. Ayrıca, toxA geninden hazırlanan primerlerin kullanılmasrile yapılan PZR ile toksyenik P. multocida suşlarının varlığı araştırıldı ve P. multocida suşlarının hiçbirinin toksyenik olmadığı tespit edildi.
Lungs from 8222 cattle slaughtered at an abattoir in Elazığ were examined macroscopically, and pneumonia was detected in 500 (6.1%) lungs. These samples, were inoculated onto blood agar supplemented with 7% sheep blood for isolation of bacterial agents. A polymerase chain reaction (PCR) based upon the use of species-specific primers was carried out on DNA samples extracted from suspected Pasteurella spp. isolates. In addition, a mouse inoculation test was carried out on suspected Pasteurella multocida isolates. A total of 311 (62.2%) bacterial agents were isolated from the lung samples and were identified as 7.2% Staphylococcus aureus, 6% Pasteurella multocida, 6% Corynebacterium spp., 5.8% yeast, 3.8% Streptococcus spp, 3.6% Staphylococcus epidermidis, 2.6% Escherichia coll, 2.2% Bacillus spp., 2% Pseudomonas spp., 1.8% Mannheimia haemolytica, 1.6% Actinobadllus spp., 1.2% Klebsiella spp., 0.2% Moraxella spp., 0.2% Proteus spp., and 18% mixed bacteria.Twenty-four (80%) of the Pasteurella multocida isolates were positive in the mouse inoculation test in cattle. All P. multocida and M. haemolytica strains that were positive by culture were also found to be positive by PCR* However, toxigenic Pasteurella multocida was not detected in any isolates by PCR using primers derived from the toxA gene.
Bien que les déficits de l’olfaction constatés soient principalement dus à des accidents traumatiques de la face et à des infections variées de la sphère orobuccale, l’établissement de relations de ...tels déficits avec d’autres pathologies, en particulier neurodégénératives, suscite un grand intérêt en raison de son potentiel prédictif. Après un rappel des caractéristiques anatomiques et physiologiques du système de perception olfactif montrant les raisons de sa sensibilité à diverses affections, l’article rappelle les bases psychophysiques de la mesure olfactive et décrit les principes, les performances et les limites des principaux tests sensoriels commercialisés ou recommandés dans ce cadre par la littérature. Il décrit ensuite pour quelques principales pathologies ayant fait l’objet de telles études (infections respiratoires, maladies neurodégénératives ou nerveuses et cancers) l’origine causale probable du défaut d’olfaction constaté, sa nature et le type de test sensoriel le plus adapté à son diagnostic. La conclusion souligne les points limitant dans l’établissement du diagnostic et ouvre quelques perspectives de recherche sur l’origine de défauts de l’olfaction dans le domaine des déficits immunitaires.
Although olfactory deficiency is mainly related to facial post-traumatic accidents and various bacterial and viral infections of the respiratory area, the causal relation between other kind of diseases (in particular neurodegenerative) and olfactory deficiencies are extensively studied, in particular because of their potential applications in very early diagnostics. This paper first describes the anatomical and biological characteristics of the olfactory detection system and outlines the ones explaining the sensitivity of this perception to various pathological affections. It also describes the principles of psychophysics tests and of their use in the description and the evaluation of the various aspects of the detection of an odor (quality, intensity, pleasantness). The third part of the paper is devoted to a description, for different pathologies as infections, Parkinson, Alzheimer and cancers, of the possible causes of the olfactory associated dysfunctions and of the olfactory tests most currently used in their diagnostics. The conclusion outlines the limits of these tests, and shows some perspectives for future research.
Les formes familiales de sclérose latérale amyotrophique (SLAF) représentent environ 10 à 20 p. 100 des cas de SLA. Faire état d’une suspicion diagnostique de SLA chez un sujet qui connaît déjà le ...caractère dramatique de l’affection du fait d’antécédent familial est particulièrement délicat et nécessite une approche psychologique fondée sur les progrès récents de la prise en charge de la maladie. L’annonce d’une SLAF nécessite par ailleurs d’apporter des informations objectives sur le risque de transmission et sur les possibilités de dépistage pré-symptomatique. Bien qu’il soit possible actuellement de rechercher une mutation du gène SOD1, le faible pourcentage de SLAF liées à une mutation de ce gène (10 à 20 p. 100), le caractère non prédictif de la constatation d’une éventuelle mutation, les phénomènes de pénétrance incomplète compliquent la délivrance d’informations fiables permettant de spécifier clairement le risque de survenue d’une SLA chez un sujet dont l’un des membres de la famille est atteint.
Between 10 percent and 20 percent of amyotrophic lateral sclerosis cases are familial (FALS). The announcement of a diagnosis of ALS to a patient having relatives already affected with this disease must take into account the familial history and should focus on the improvement in management of ALS patients.
Diagnosis of FALS implicitly raises the notion of genetic factors and the possibility for an heritability of the disease (risk of ALS for relatives). Although it is possible to search for mutations in SOD1 gene in ALS patients and asymptomatic relatives, the incomplete penetrance of the disease, the low percentage (10 to 20 percent) of FALS linked to SOD1 mutation and the existence of non causal SOD1 mutations complicate the conclusions of genetic investigations concerning the real risk for a relative with a SOD1 mutation to develop ALS.
La dénutrition au cours de la SLA est multifactorielle. La diminution des apports alimentaires liée aux troubles de la déglutition joue un rôle majeur. Il existe également des anomalies métaboliques, ...marquées par une augmentation de la dépense énergétique de repos, d’origine inconnue. La prise en charge nutritionnelle est nécessaire, car la dénutrition est corrélée à la survie. L’évaluation nutritionnelle est recommandée tous les 3 à 6 mois, ou plus souvent si besoin. Elle est basée, après l’examen clinique, sur des techniques qui explorent l’état nutritionnel global des patients et leurs compartiments corporels. Le poids, la taille permettent de calculer l’indice de masse corporelle (IMC), qui indique une dénutrition au dessous de 18,5 (âge : 18-65 ans) ou de 20 kg/m
2 (âge > 65 ans). Une perte de poids de 5 à 10 p. 100 du poids usuel au cours des six derniers mois évoque également une dénutrition. L’épaisseur des plis cutanés reflète la masse grasse et la circonférence musculaire brachiale la masse maigre, mais ces mesures ont surtout un intérêt évolutif. L’impédancemétrie bioélectrique mesure la masse maigre, sous réserve d’utiliser la formule validée pour la SLA. L’entretien diététique, souvent difficile, oriente la prise en charge quand les patients peuvent encore s’alimenter
per os. La calorimétrie indirecte et l’absorptiométrie biphotonique sont des techniques fiables de mesures des dépenses d’énergie et des compartiments corporels, mais lourdes et peu utilisées dans cette pathologie. Au total, l’examen clinique, l’évaluation anthropométrique et l’impédancemétrie doivent constituer l’évaluation nutritionnelle minimale.
During ALS, malnutrition may occur. The causes are multiple. A reduction in caloric and protein intakes, due to swallowing disorders, play a major role. Moreover, 2/3; of patients develop an hypermetabolism of unknown cause, leading to an increase in resting energy expenditure. Malnutrition, whose prevalence is 10-55 percent, is an independant significant prognostic factor for survival. Nutritional assessment is recommanded every 3-6 months at least, and more often if needed. After a simple clinical examination, nutritional assessment includes the measurement of weight (W) and height (H), in order to calculate the Body Mass Index (BMI=W/H
2;). BMI<18.5 (age: 18-65ys) or <20kg/m
2 (age>65ys) indicates malnutrition. A weight loss more than 5 to 10 percent of usual weight in the last six months is another malnutrition criterion. The measurement of skinfolds and the calculation of mid arm muscle circumference give informations on respectively fat mass and fat-free mass, but their interest is mainly during the follow-up, or for triceps skinfold when included in a validated bioimpedance formula. Bioimpedance analysis (BIA) is a simple bedside technique, recently validated for measurement of fat-free mass in ALS patients. The BIA phase angle could be an easy obtained parameter of severity. Dietary interview is important when patients still use oral route, but is difficult if they have elocution or writing problems. Indirect calorimetry and dual X-ray absorptiometry give reliable informations on respectively energy expenditure and body compartments, but remain scarcely used. Additional methods, like swallowing tests, psychological, digestive or respiratory assessments are often useful for optimal nutritional prescriptions. We recommand as minimal nutritional assessment a systematic clinical examination, anthropometric measurements and bioimpedance evaluation.
La prévalence de la malnutrition dans la SLA se situe entre 16 et 53 p. 100. Le pourcentage de perte de poids supérieur à 10 p. 100 ou de façon plus inconstante l’index de masse corporelle inférieur ...à 18,5 sont des critères pertinents de malnutrition car prédictifs de survie. La circonférence musculaire du bras et l’impédancemétrie bioélectrique permettent d’estimer la composition corporelle, mais leur impact sur l’évolution n’a pas encore été évalué. Le dosage de l’albuminémie n’a pas d’intérêt.
Besoins nutritionnels. En tenant compte du fait que la plupart des patients ont une augmentation de la dépense énergétique de 10 à 20 p. 100, les besoins énergétiques peuvent être estimés à environ 35 kcal/kg/j. Afin de limiter l’accumulation de masse grasse dans le sous-groupe de patients ayant une dépense énergétique diminuée, la surveillance du pli cutané ou de l’impédance pourrait être proposée mais leur intérêt reste à être évalué. En l’absence de donnée disponible sur les besoins protéiques des SLA, des apports compris entre 1 et 1,5 g/kg/j semblent raisonnables, sachant qu’il existe un risque de carence protéique lorsque les apports sont inférieurs à 1 g/kg/j et qu’une augmentation à 1,5 g/kg/j, considérée comme sans danger, pourrait être utile en cas d’hypercatabolisme. Les complémentations en créatine, en antioxydants ou en acides aminés n’ont pas fait la preuve de leur intérêt. Ces nutriments étant fournis par une alimentation équilibrée, des supplémentations spécifiques n’ont pas d’utilité à condition que le patient reçoive des apports protéino-énergétiques suffisants. Seul un apport systématique de vitamine D est justifié pour prévenir le risque ostéoporotique, en raison d’un état carentiel fréquent.
Place de la gastrostomie. On ne dispose pas d’étude de bonne qualité méthodologique évaluant la gastrostomie percutanée endoscopique (GPE) au cours de la SLA. Au vu de l’impact de la malnutrition sur la survie, la GPE doit être considérée lorsque les apports oraux deviennent insuffisants. Les études rétrospectives suggèrent que la GPE est habituellement posée trop tard au cours de l’évolution ce qui minimise le bénéfice qu’on pourrait en attendre. Les critères de décision de pose de GPE devraient faire l’objet d’études contrôlées randomisées. La mortalité dans le mois qui suit la GPE, d’environ 10 p. 100, est essentiellement due à une décompensation de l’état respiratoire et survient plus fréquemment chez les patients ayant une capacité vitale < 50 p. 100. Pour éviter une dégradation de la fonction pulmonaire dans ce sous-groupe de patients, la littérature suggère plusieurs pistes de travail : la réalisation plus précoce de la GPE, l’utilisation de la ventilation non invasive en péri-opératoire, et enfin l’utilisation de la technique de gastrostomie radiologique qui ne nécessite pas d’anesthésie générale. Quelle que soit la technique utilisée pour la gastrostomie, il faut recommander qu’elle soit réalisée par un centre en ayant l’expertise, car les patients atteints de SLA sont plus exposés que d’autres aux complications.
Prevalence of malnutrition in ALS ranges between 16 and 53 p. 100. The percentage of loss of weight greater than 10 p. 100 or, in a more inconstant way, body mass index lower than 18.5, are relevant criteria of malnutrition because predictive of survival. Arm muscle circumference and bioelectrical impedance analysis can assess body composition, but their impact on disease progression has not been evaluated. Measurement of serum albumin levels is of no interest.
Nutritional requirements. Considering that energy expenditure is increased 10 to 20 p. cent in the majority of patients, energy needs can be estimated to be approximately 35 kcal/kg/d. In order to limit the accumulation of fat mass in the sub-group of patients with decreased energy expenditure, monitoring of triceps skin fold or impedance could be proposed, but their interest remains to be evaluated. In the absence of available data on protein requirements in ALS, an intake ranging between 1 and 1,5 g/kg/d seems reasonable, knowing that there is a risk of deficiency when intake is less than 1 g/kg/d and that an increase to 1,5 g/kg/d, considered as harmless, could be useful in the event of hypercatabolism. Supplementation with creatine, antioxidants or amino acids has not proven to be effective. These nutrients being provided by a balanced diet, specific supplementations have no proven utility provided that the patient receives sufficient proteins and energy. Systematic supplementation with vitamin D is however warranted to prevent osteoporosis due to the known risk related to a common state of deficiency.
Relevance of gastrostomy. Studies with good methodological quality evaluating percutaneous endoscopic gastrostomy (PEG) in ALS are not available. Because of the impact of malnutrition on survival, PEG must be considered when oral intake becomes insufficient. Retrospective studies suggest that the PEG tube is usually inserted too late during the disease course, minimizing expected benefits. Criteria useful for making the decision to installation a PEG tube should be the subject of randomized controlled studies. Mortality in the month which follows PEG, approximately 10 p. cent, is primarily due to respiratory failure. It occurs more frequently among patients having a forced vital capacity < 50 p. cent. To avoid a degradation of pulmonary function in this sub-group of patients, several approaches are suggested in the literature : earlier PEG, peri-operative noninvasive ventilation, and radiological gastrostomy which does not require a general anesthesia. Whatever the technique used for gastrostomy, it should be carried out in an expert centre, because patients with ALS are more exposed to complications than others.
L’annonce de l’évolution et des étapes de la SLA demeure un domaine qui résiste à la mise en place de procédures rigides mais elle n’echappe cependant pas à un certain nombre de règles qui ont pour ...objectif de préserver une qualité de relation médecin-malade sans laquelle le suivi de ce type de maladie est illusoire. Cet objectif étant atteint, la prise en charge peut s’effectuer sous la forme d’un accompagnement dont le type varie en fonction de la vitesse évolutive de la maladie et, bien évidemment, des caractéristiques psychologiques et de l’entourage du patient. Cet accompagnement plastique ou adaptatif constitue, en dehors des objectifs de recherche thérapeutique l’enjeu majeur des centres SLA.
Operatory procedures can help to break bad news in ALS but the main goal of this unpleasant task stands in the quality of the relationship between the physician and his patient which must be preserved throughout the course of the disease. Plasticity is obviously the best way to characterize the appropriate kind of care in such a variable disease. The caregivers and the psychological factors must also be taken into account. As it is the case for therapeutic research, breaking bad news in ALS requieres a specific know-how which should be ideally performed by specialized teams within the framework of dedicated ALS centers.
