Search

This research was carried out on 51 local raised in three local cow herds in Erbil plain, for the period from 2016 to 2017. To estimate the most probable producing ability (MPPA) of cows and to study the effect of non-genetic factors affecting on daily milk production (DMP) and to estimate the repeatability for (DMP). The most probable producing ability (MPPA) of local cows was calculated by using the test day records and then the animals were ranked based on their MPPA values. Cow number 1237 inquired the highest value of MPPA (16.91 kg) for DMP among all tested cows in the three flocks. The overall mean for the (DMP) was 11.85 kg. The results of current study revealed that the effect of flock, parity, season of calving, services per conception and dry period length (days) had a significant effect (p<0.05) on (DMP).Repeatability estimates was (0.40).Knowledge of the (MPPA) values of cows helps in the conduct of selection programs through the application of the method of culling and replacement of cows. [ABSTRACT FROM AUTHOR]

This study was carried out using 94 ewes at Erbil plain - Kurdistan region-Iraq, during the period from May 2016 to April 2017. The overall mean mortality rates from birth to 7 days and from 8 days to weaning age were 8.6 and 6.6%, respectively. Age of dam, type of birth, weight of the dam at matting, Body Condition Score (BCS) and birth weight had an important significant (P<0.05) impact on lamb mortality from birth to 7 days and from 8 days to weaning age. This research revealed that a higher lamb mortality (4.2%) was registered for dams aged 2 years, while a lower mortality(6.6%) was found in dams aged 5-6 years, no significant differences in mortality among males and females were appeared, male lambs showed a higher mortality than females, type of birth showed an important impact (P<0.05) on lamb mortality. Single born lamb mortality was 5.5%, whereas that of the twin born lamb was significant (13.6%). Ewes with the (BCS) of 2-3 showed a higher mortality (14.2%), while those ewes with (BCS) more than 3 recorded the lowest lamb mortality (5.4%). Lambs weighting less than 3 kg at birth registered a higher mortality compared with lambs weighing 3 kg, or more which showed the lowest mortality. It has appeared from the results of this study that most of the non-genetic factors studied involve: Age of dam, type of birth, birth weight, and weight of the dam, and body condition score showed a substantial significant influence on lamb mortality between birth and weaning of Kurdi sheep. [ABSTRACT FROM AUTHOR]

Background: The activity of various of the enzymes affecting the metabolism of azathioprine are affected by allelic polymorphisms. Of these, thiopurine methyl transferase is the best known, but inosine triphosphate [...]

ARDS is characterized by hypoxemic respiratory failure, which can be refractory and life-threatening. Modifications to traditional mechanical ventilation and nontraditional modes of ventilation are discussed in Part 1 of this two-part series. In this second article, we examine nonventilatory strategies that can influence oxygenation, with particular emphasis on their role in rescue from severe hypoxemia. A literature search was conducted and a narrative review written to summarize the use of adjunctive, nonventilatory interventions intended to improve oxygenation in ARDS. Several adjunctive interventions have been demonstrated to rapidly ameliorate severe hypoxemia in many patients with severe ARDS and therefore may be suitable as rescue therapy for hypoxemia that is refractory to prior optimization of mechanical ventilation. These include neuromuscular blockade, inhaled vasoactive agents, prone positioning, and extracorporeal life support. Although these interventions have been linked to physiologic improvement, including relief from severe hypoxemia, and some are associated with outcome benefits, such as shorter duration of mechanical ventilation, demonstration of survival benefit has been rare in clinical trials. Furthermore, some of these nonventilatory interventions carry additional risks and/or high cost; thus, when used as rescue therapy for hypoxemia, it is important that they be demonstrated to yield clinically significant improvement in gas exchange, which should be periodically reassessed. Additionally, various management strategies can produce a more gradual improvement in oxygenation in ARDS, such as conservative fluid management, intravenous corticosteroids, and nutritional modification. Although improvement in oxygenation has been reported with such strategies, demonstration of additional beneficial outcomes, such as reduced duration of mechanical ventilation or ICU length of stay, or improved survival in randomized controlled trials, as well as consideration of potential adverse effects should guide decisions on their use. Various nonventilatory interventions can positively impact oxygenation as well as outcomes of ARDS. These interventions may be considered for use, particularly for cases of refractory severe hypoxemia, with proper appreciation of potential costs and adverse effects. [ABSTRACT FROM AUTHOR]

Approximately 16% of deaths in patients with ARDS results from refractory hypoxemia, which is the inability to achieve adequate arterial oxygenation despite high levels of inspired oxygen or the development of barotrauma. A number of ventilator-focused rescue therapies that can be used when conventional mechanical ventilation does not achieve a specific target level of oxygenation are discussed. A literature search was conducted and narrative review written to summarize the use of high levels of positive end-expiratory pressure, recruitment maneuvers, airway pressure-release ventilation, and high-frequency ventilation. Each therapy reviewed has been reported to improve oxygenation in patients with ARDS. However, none of them have been shown to improve survival when studied in heterogeneous populations of patients with ARDS. Moreover, none of the therapies has been reported to be superior to another for the goal of improving oxygenation. The goal of improving oxygenation must always be balanced against the risk of further lung injury. The optimal time to initiate rescue therapies, if needed, is within 96 h of the onset of ARDS, a time when alveolar recruitment potential is the greatest. A variety of ventilatory approaches are available to improve oxygenation in the setting of refractory hypoxemia and ARDS. Which, if any, of these approaches should be used is often determined by the availability of equipment and clinician bias. [ABSTRACT FROM AUTHOR]

Aspiration-related syndromes comprise a broad spectrum of diseases affecting the airways and lung parenchyma resulting from inadvertent entry of oropharyngeal or gastric contents into the respiratory tract. The diagnosis can be challenging given lack of self-reported symptoms and unwitnessed or silent aspiration events. Aspiration is a common finding in healthy individuals suggesting that host defenses play a critical role in the pathophysiology. In the absence of strict criterion, a high index of suspicion is necessary based on recognition of established risk factors and identification of characteristic imaging findings. Conditions predisposing to altered levels of consciousness and neuromuscular weakness can lead to dysphagia, impaired cough reflux, and subsequent aspiration. The most salient feature on imaging is the anatomic location of the abnormalities, with the superior segments of the lower lobes and posterior segments of upper lobes involved in the recumbent position, and basilar segments of lower lobes in the upright position. Acute syndromes include pneumonia, pneumonitis, and foreign body aspiration. In the more indolent form of aspiration, bronchiectasis, diffuse bronchiolitis, and interstitial lung disease can develop. A detailed understanding of associated radiographic findings for these syndromes can help to implicate aspiration as the cause for imaging abnormalities and ultimately optimize patient management., Competing Interests: None declared., (Thieme. All rights reserved.)

Topic Importance: The incidence of pulmonary nodules and masses in non-HIV immunocompromised patients has significantly increased due to advancements in hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and the widespread use of chemotherapy and immunosuppressive therapies. Differentiating between infectious and non-infectious causes is critical for appropriate diagnosis and management, especially as radiological and clinical presentations can be nonspecific., Review Findings: This review provides a practical framework for evaluating pulmonary nodules and masses in non-HIV immunocompromised patients, incorporating clinical, immunological, and radiological features. It emphasizes the importance of differentiating between infectious and non-infectious etiologies based on imaging and clinical context. The review highlights the importance of correlating imaging features with the patient's immune status and underlying clinical conditions to narrow down the differential diagnosis., Summary: Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiological and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in non-HIV immunocompromised individuals, providing a valuable tool for clinical practice., (Copyright © 2024. Published by Elsevier Inc.)

Background: Few eligible patients in the United States participate in lung cancer screening (LCS) with low-dose computed tomography (LDCT)., Objective: What is the efficacy of interventions to increase LCS participation?, Design: We performed a systematic review following a prespecified protocol registered in PROSPERO (CRD42021283984). In June/July of 2021, we searched Ovid MEDLINE, Embase, Cochrane, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Epistemonikos from 1946 to October 2021 to identify studies evaluating interventions to increase LCS participation., Participants: Thirteen of 2761 studies met inclusion criteria for data extraction. Of these, six had results available (five RCTs and one prospective observational study). The studies had predominantly White and non-Hispanic participants., Main Measures: An intention-to-treat analysis was used to calculate each study's relative risk (RR) to increase LCS. Effect sizes were pooled using a random-effects model with a subgroup analysis for multi- versus single-step interventions. Risk of bias was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I)., Key Results: Overall, the proportion of screening LDCTs performed did not improve in the intervention group relative to the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I 2  = 91%). Subgroup analysis suggests that interventions targeting multiple barriers may increase LCS participation (RR [95% CI] for multistep vs single-step; 2.68 [1.77, 4.05] vs 0.99 [0.89, 1.10], P < 0.01). Quality assessment revealed that three of five RCTs showed some concerns or high risk of bias., Conclusion: Evidence on efficacy of interventions to increase LCS participation is limited due to a small number of prospective studies performed in non-diverse populations with critical risk of bias. Further, overall, studied interventions did not improve lung cancer screening participation, though interventions targeting multiple barriers may have some benefit., Competing Interests: Declarations: Conflict of Interest: The authors declare that they do not have a conflict of interest., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Introduction: Radiology scoring systems are critical to the success of lung cancer screening (LCS) programs, impacting patient care, adherence to follow-up, data management and reporting, and program evaluation. LungCT ScreeningReporting and Data System (Lung-RADS) is a structured radiology scoring system that provides recommendations for LCS follow-up that are utilized (a) in clinical care and (b) by LCS programs monitoring rates of adherence to follow-up. Thus, accurate reporting and reliable collection of Lung-RADS scores are fundamental components of LCS program evaluation and improvement. Unfortunately, due to variability in radiology reports, extraction of Lung-RADS scores is non-trivial, and best practices do not exist. The purpose of this project is to compare mechanisms to extract Lung-RADS scores from free-text radiology reports., Methods: We retrospectively analyzed reports of LCS low-dose computed tomography (LDCT) examinations performed at a multihospital integrated healthcare network in New York State between January 2016 and July 2023. We compared three methods of Lung-RADS score extraction: manual physician entry at time of report creation, manual LCS specialist entry after report creation, and an internally developed, rule-based natural language processing (NLP) algorithm. Accuracy, recall, precision, and completeness (i.e., the proportion of LCS exams to which a Lung-RADS score has been assigned) were compared between the three methods., Results: The dataset includes 24,060 LCS examinations on 14,243 unique patients. The mean patient age was 65 years, and most patients were male (54 %) and white (75 %). Completeness rate was 65 %, 68 %, and 99 % for radiologists' manual entry, LCS specialists' entry, and NLP algorithm, respectively. Accuracy, recall, and precision were high across all extraction methods (>94 %), though the NLP-based approach was consistently higher than both manual entries in all metrics., Discussion: An NLP-based method of LCS score determination is an efficient and more accurate means of extracting Lung-RADS scores than manual review and data entry. NLP-based methods should be considered best practice for extracting structured Lung-RADS scores from free-text radiology reports., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors have no conflicts of interest related to the submission of this manuscript. Dr. Bade is a site PI on industry-sponsored trials for Nucleix, Delfi Diagnostics, and Biodesix., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Topic Importance: As interstitial lung abnormalities (ILAs) are increasingly recognized on imaging and in clinical practice, identification and appropriate management are critical. We propose an algorithmic approach to the identification and management of patients with ILAs., Review Findings: The radiologist initially identifies chest CT scan findings suggestive of an ILA pattern and excludes findings that are not consistent with ILAs. The next step is to confirm that these findings occupy > 5% of a nondependent lung zone. At this point, the radiologic pattern of ILA is identified. These findings are classified as non-subpleural, subpleural nonfibrotic, and subpleural fibrotic. It is then incumbent on the clinician to ascertain if the patient has symptoms and/or abnormal pulmonary physiology that may be attributable to these radiologic changes. Based on the patient's symptoms, physiological assessment, and risk factors for interstitial lung disease (ILD), we recommend classifying patients as having ILA, at high risk for developing ILD, probable ILD, or ILD. In patients identified as having ILA, a multidisciplinary discussion should evaluate features that indicate an increased risk of progression. If these features are present, serial monitoring is recommended to be proactive. If the patient does not have imaging or clinical features that indicate an increased risk of progression, then monitoring is recommended to be reactive. If ILD is subsequently diagnosed, the management is disease specific., Summary: We anticipate this algorithmic approach will aid clinicians in interpreting the radiologic pattern described as ILA within the clinical context of their patients., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: B. B. was Site Principal Investigator for clinical trials for Biodesix, Delfi Diagnostics, and Nucleix; and received support for investigator-initiated research for the American Cancer Society, VA Central Office, and Northwell Health, Department of Medicine, Medicine Service Line. None declared (Z. K., H. H., K. B., J. P., A. H., P. J. M., S. M., D. G., M. Q. C., L. K., K. J., S. C., R. R., J. N., A. B., S. R.)., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Novel strategies are needed to improve low rates of lung cancer screening (LCS) in the US. Seeking to determine hospitalists' perspectives on leveraging hospitalizations to identify patients eligible for LCS, we performed qualitative interviews with eight hospitalists from two hospitals within a large integrated healthcare system. The interviews used semi-structured questions to assess (1) knowledge and practice of general screening and LCS guidelines from the United States Preventive Services Task Force (USPSTF), (2) identification of smoking history, and (3) hospitalists' views on how data obtained during hospitalization may be utilized to improve general screening and LCS post hospitalization. We ultimately reached the conclusion that hospitalists would support a dedicated program to identify hospitalized patients eligible for LCS and facilitate testing after discharge. Efforts to identify patients and arrange subsequent screening should be performed by team members outside the inpatient team., Competing Interests: Declaration of interests The authors have nothing to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)