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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Removing the pig from the stressful situation can prevent the episode.
Sedation and glucocorticoids may be beneficial.
Under anaesthesia, dantrolene sodium is a very effective treatment.
Genetic testing enables animals to be removed from the herd if they are positive for the gene. This means that the disorder is rare in the developed world these days.
Stress at slaughter should be minimised in all cases.
Truckloads or railcar loads of PSS-susceptible pigs may be found with a higher-than-average percentage dead on arrival after stressful events such as transport.
Initial signs of the onset of PSS are pyrexia, panting, sweating, tachycardia and arrhythmias. Chronic cases may show muscle atrophy.
Under halothane anaesthesia, pigs will suddenly become rigid and pyrexic.
The halothane challenge was the historical method of diagnosis.
Genetic testing via a PCR enables affected and carrier animals to be found.
Psychologist Melanie Joy has likened PSS to post-traumatic stress disorder in humans.
The main candidates for testing are those with a close relative who has suffered an episode of MH or have been shown to be susceptible. The standard procedure is the "caffeine-halothane contracture test", CHCT. A muscle biopsy is carried out at an approved research center, under local anesthesia. The fresh biopsy is bathed in solutions containing caffeine or halothane and observed for contraction; under good conditions, the sensitivity is 97% and the specificity 78%. Negative biopsies are "not" definitive, so any patient who is suspected of MH by their medical history or that of blood relatives is generally treated with non-triggering anesthetics, even if the biopsy was negative. Some researchers advocate the use of the "calcium-induced calcium release" test in addition to the CHCT to make the test more specific.
Less invasive diagnostic techniques have been proposed. Intramuscular injection of halothane 6 vol% has been shown to result in higher than normal increases in local among patients with known malignant hyperthermia susceptibility. The sensitivity was 100% and specificity was 75%. For patients at similar risk to those in this study, this leads to a positive predictive value of 80% and negative predictive value of 100%. This method may provide a suitable alternative to more invasive techniques.
A 2002 study examined another possible metabolic test. In this test, intramuscular injection of caffeine was followed by local measurement of the ; those with known MH susceptibility had a significantly higher (63 versus 44 mmHg). The authors propose larger studies to assess the test's suitability for determining MH risk.
Genetic testing is being performed in a limited fashion to determine susceptibility to MH. In people with a family history of MH, analysis for "RYR1" mutations may be useful.
A presumptive diagnosis can be made based on the history and clinical signs. Definitive diagnosis is achieved by direct or indirect fluorescent antibody testing (FAT), PCR, post mortem (signs include petechia and pulmonary congestion), histopathology or electron microscopy.
Because of the number of possible viral/bacterial precursors to BRD, there are a number of treatment options circling around the three main aggravators of the disease: Viruses, Bacteria, and Stress.
In the absence of vaccination (often because calves are bought unvaccinated), antibiotics can help to stop the bacterial factors of the disease. The Virginia Cooperative Extension recommends Micotil, Nuflor, and Baytril 100 as newer antibiotics that do not need daily dosing, but also notes that Naxcel, Excenel, and Adspec are effective as well.
François Madec, a French author, has written many recommendations on how reduce PMWS symptoms. They are mostly measures for disinfection, management, and hygiene, referred to as the "20 Madec Points" [Madec & Waddilove, 2002].
These measures have recently been expanded upon by Dr. David Barcellos, a professor at the Veterinary College in the Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil. He presented these points at "1st Universidade Federal do Rio Grande do Sul Symposium about swine management, reproduction, and hygiene".
He divided his points by pig growth stage, and they can be loosely summarized as:
- keep the gutters clean
- increase feeder space
- use pens or small cages with solid dividers
- avoid mixing pigs from different origins
- improve the quality of air
- decrease maximum capacity, giving each pig more room
- separate sick animals as soon as possible, and treat them in a hospital pen. If they do not respond to antibiotics in three days, they should be culled
- control access of people and other animals
- reduce invironmental stress factors such as gases and air currents
- use immunizations and preventive medications for secondary agents commonly associated with PMWS
Often no treatment is required. However, as porcine cytomegalovirus is a herpes virus it remains latent and sheds at times of stress. Therefore husbandry measures to minimise stress levels should be in place.
One research priority is to determine the role and nature of malignant hyperthermia in FSS. Such knowledge would benefit possible surgical candidates and the anaesthesiology and surgical teams who would care for them. MH may also be triggered by stress in patients with muscular dystrophies. Much more research is warranted to evaluate this apparent relationship of idiopathic hyperpyrexia, MH, and stress. Further research is wanted to determine epidemiology of psychopathology in FSS and refine therapy protocols.
There are little data on prognosis. Rarely, some patients have died in infancy from respiratory failure; otherwise, life expectancy is considered to be normal.
White dog shaker syndrome (also known as idiopathic steroid responsive shaker syndrome, shaker dog syndrome and "little white shakers" syndrome; Latin name Idiopathic Cerebellitis) causes full body tremors in small dog breeds. It is most common in West Highland White Terriers, Maltese, Bichons, and Poodles, and other small dogs. There is a sudden onset of the disease at one to two years of age. It is more likely to occur, and the symptom is worse during times of stress. Nystagmus, difficulty walking, and seizures may occur in some dogs.
The cause is unknown, but it may be mediated by the immune system. One theory is that there is an autoimmune-induced generalized deficiency of neurotransmitters. Cerebrospinal fluid analysis may reveal an increased number of lymphocytes. Treatment with corticosteroids may put the dog into remission, or diazepam may control the symptoms. Typically the two drugs are used together. There is a good prognosis, and symptoms usually resolve with treatment within a week, although lifelong treatment may be necessary.
There is currently no specific treatment for the virus. A vaccine is available, but only experimentally. It has not been released to the public due to the risk it poses to already exposed birds.
Therapeutic intervention is limited to treating secondary infections. The individual bird can sometimes recover, but this is rare. If only the feathers are affected and the bird suffers no other symptoms, it can usually experience an acceptable quality of life. But if the bird's beak or nails are affected, veterinarians will recommend euthanasia.
The management of the disease lies thus mostly in prevention. Every new bird that enters a pen with other birds should be quarantined first and be tested for BFDV. Birds which are known carriers should not be introduced into new pens, especially not if those contain young birds.
Porcine circoviral disease (PCVD) and Porcine circovirus associated disease (PCVAD), is a disease seen in domestic pigs. This disease causes illness in piglets, with clinical signs including progressive loss of body condition, visibly enlarged lymph nodes, difficulty in breathing, and sometimes diarrhea, pale skin, and jaundice. PCVD is very damaging to the pig-producing industry and has been reported worldwide. PCVD is caused by porcine circovirus type 2 (PCV-2).
The North American industry endorses "PCVAD" and European use "PCVD" to describe this disease.
Unlike most food allergies, it may be possible for the alpha-gal allergy to recede with time, as long as the person is not bitten by another tick. The recovery period can take anywhere from eight months to five years. This recovery potential is not confirmed. More research needs to be conducted to determine why some patients seem to recover and some do not.
Tiamulin, chlortetracycline or tilmicosin may be used to treat and prevent the spread of the disease.
Vaccination is a very effective method of control, and also has an effect on pig productivity.
Eradication of the disease is possible but the organism commonly reinfects herds.
Modern medical treatment for computer-induced medical problems like carpal tunnel syndrome include splints, surgery, corticosteroids, and physiotherapy therapy.
Alternative medicine for computer-induced medical problems has also been shown to be effective, notably acupuncture.
Various investigations aid the diagnosis.
- ACTH (cosyntropin) stimulation test
- Cortisol level (to assess the level of glucocorticoids)
- Fasting blood sugar
- Serum potassium (to assess the level of mineralocorticoids)
- Serum sodium
The winter-over syndrome is a condition found in individuals who "winter-over" throughout the Antarctic (or Arctic) winter. It has been observed in inhabitants of research stations in Antarctica, as well as in polar bases such as Thule, Alert and Eureka. It consists of a variety of behavioral and medical disturbances, including irritability, depression, insomnia, absentmindedness, aggressive behavior, and irritable bowel syndrome.
Possible contributing causes of winter-over syndrome include stress, social isolation, subsyndromal seasonal affective disorder and polar T syndrome.
A traditional skin prick allergy test for allergy to meat may give a false negative answer. Blood tests for IgE response indicating alpha-gal allergy have not been approved by the U.S. Food and Drug Administration (FDA), and must usually be purchased by private individuals, but are available and are in use. Determination of specific IgE to alpha-gal testing is commercially available. The highest sensitivity is observed with skin and basophil activation tests with cetuximab which is, however, limited by its high costs.
Treatment is symptomatic and aims to prevent dehydration in young pigs, using products such as electrolyte and energy supplements. Good biosecurity protocols such as adequate quarantine, isolation of cases, and disinfection help prevent entry or spread of the disease in the herd. In Canada, the Canadian Swine Health Board developed detailed protocols on how to adequately disinfect transportation vehicles for live hogs and ensure the quality of the disinfecttion protocol.
Ketones in the urine or blood, as detected by urine strips or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by high glucose levels (hyperglycemia) and low insulin levels combined with certain other systemic stresses. DKA can be arrested if caught quickly.
Ketones are produced by the liver as part of fat metabolism and are normally not found in sufficient quantity to be measured in the urine or blood of non-diabetics or well-controlled diabetics. The body normally uses glucose as its fuel and is able to do so with sufficient insulin levels. When glucose is not available as an energy source because of untreated or poorly treated diabetes and some other unrelated medical conditions, it begins to use fat for energy instead. The result of the body turning to using fat instead of glucose for energy means ketone production that is measurable when testing either urine or blood for them.
Ketone problems that are more serious than the "trace or slight" range need immediate medical attention; they cannot be treated at home. Veterinary care for ketosis/ketoacidosis can involve intravenous (IV) fluids to counter dehydration, when necessary, to replace depleted electrolytes, intravenous or intramuscular short-acting insulin to lower blood glucose levels, and measured amounts of glucose or force feeding, to bring the metabolism back to using glucose instead of fat as its source of energy.
When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine. The urine testing strip bottle has instructions and color charts to illustrate how the color on the strip will change given the level of ketones or glucose in the urine over 15 (ketones–Ketostix) or 30 (glucose–Ketodiastix) seconds. Reading the colors at those time intervals is important because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is more accurate.
At present, there is only one glucometer available for home use that tests blood for ketones using special strips for that purpose–Abbott's Precision Xtra. This meter is known as Precision, Optium, or Xceed outside of the US. The blood ketone test strips are very expensive; prices start at about US$50 for ten strips. It is most likely urine test strips–either ones that test only for ketones or ones that test for both glucose and ketones in urine would be used. The table above is a guide to when ketones may be present.
Benign fasciculation syndrome is a diagnosis of exclusion; that is, other potential causes for the twitching (mostly forms of neuropathy or motor neuron diseases such as ALS) must be ruled out before BFS can be assumed. An important diagnostic tool here is electromyography (EMG). Since BFS appears to cause no actual nerve damage (at least as seen on the EMG), patients will likely exhibit a completely normal EMG (or one where the only abnormality seen is fasciculations).
Another important step in diagnosing BFS is checking the patient for clinical weakness. Clinical weakness is often determined through a series of strength tests, such as observing the patient's ability to walk on his or her heels and toes. Resistance strength tests may include raising each leg, pushing forward and backward with the foot and/or toes, squeezing with fingers, spreading fingers apart, and pushing with or extending arms and/or hands. In each such test the test provider will apply resisting force and monitor for significant differences in strength abilities of opposing limbs or digits. If such differences are noted or the patient is unable to apply any resisting force, clinical weakness may be noted.
Lack of clinical weakness along with normal EMG results (or those with only fasciculations) largely eliminates more serious disorders from potential diagnosis.
Especially for younger persons who have only LMN sign fasciculations, "In the absence of weakness or abnormalities of thyroid function or electrolytes, individuals under 40 years can be reassured without resorting to electromyography (EMG) to avoid the small but highly damaging possibility of false-positives". "Equally, however, most subspecialists will recall a small number of cases, typically men in their 50s or 60s, in whom the latency from presentation with apparently benign fasciculations to weakness (and then clear MND) was several years. Our impression is that a clue may be that the fasciculations of MND are often abrupt and widespread at onset in an individual previously unaffected by fasciculations in youth. The site of the fasciculations, for example, those in the calves versus abdomen, has not been shown to be discriminatory for a benign disorder. There is conflicting evidence as to whether the character of fasciculations differs neurophysiologically in MND".
Another abnormality commonly found upon clinical examination is a brisk reflex action known as "hyperreflexia". Standard laboratory tests are unremarkable. According to neurologist John C. Kincaid:
The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses and can provide a better picture of how well the condition is managed.
A 2003 study of canine diabetes caregivers who were new to testing blood glucose at home found 85% of them were able to both succeed at testing and to continue it on a long-term basis. Using only one blood glucose reading as the reason for an insulin dose increase is to be avoided; while the results may be higher than desired, further information, such as the lowest blood glucose reading or nadir, should be available to prevent possible hypoglycemia.
Urine strips are not recommended to be used as the sole factor for insulin adjustments as they are not accurate enough. Urine glucose testing strips have a negative result until the renal threshold of 10 mmol/L or 180 mg/dL is reached or exceeded for a period of time. The range of negative reading values is quite wide-covering normal or close to normal blood glucose values with no danger of hypoglycemia (euglycemia) to low blood glucose values (hypoglycemia) where treatment would be necessary. Because urine is normally retained in the bladder for a number of hours, the results of urine testing are not an accurate measurement of the levels of glucose in the bloodstream at the time of testing.
Glucometers made for humans are generally accurate using canine and feline blood except when reading lower ranges of blood glucose (<80 mg/dL), (<4.44 mmol/L). It is at this point where the size difference in human vs animal red blood cells can create inaccurate readings. Glucometers for humans were successfully used with pets long before animal-oriented meters were produced. A 2009 study directly compared readings from both types of glucometers to those of a chemistry analyzer. Neither glucometer's readings exactly matched those of the analyzer, but the differences of both were not clinically significant when compared to analyzer results. All glucometer readings need to be compared to same sample laboratory values to determine accuracy.
It is ethically difficult when it comes to dealing with diagnosed patients, for many of them deny their poor conditions and refuse to accept treatment. The main objectives of the doctors are to help improve the patient’s lifestyle and wellbeing, so health care professionals must decide whether or not to force treatment onto their patient.
In some cases, especially those including the inability to move, patients have to consent to help, since they cannot manage to look after themselves. Hospitals or nursing homes are often considered the best treatment under those conditions.
When under care, patients must be treated in a way in which they can learn to trust the health care professionals. In order to do this, the patients should be restricted in the number of visitors they are allowed, and be limited to 1 nurse or social worker. Some patients respond better to psychotherapy, while others to behavioral treatment or terminal care.
Results after hospitalization tend to be poor. Research on the mortality rate during hospitalization has shown that approximately half the patients die while in the hospital. A quarter of the patients are sent back home, while the other quarter are placed in long time care. Patients under care in hospitals and nursing homes often slide back into relapse or face death.
There are other approaches to improve the patient’s condition. Day care facilities have often been successful with maturing the patient’s physical and emotional state, as well as helping them with socialization. Other methods include services inside the patient’s home, such as the delivery of food.