Neurological complications in patients with Plasmodium vivax malaria from Karachi, Pakistan

BACKGROUND

Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide.

METHOD

We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan.

RESULTS

The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing.

CONCLUSION

P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax.

Association of Helicobacter pylori and protozoal parasites in patients with chronic diarrhoea

Introduction An association of Helicobacter pylori and common protozoal parasites in patients with abdominal discomfort and chronic diarrhoea is unclear and may be pathological. Materials and methods One hundred and sixty-one patients with diarrhoea were compared to 114 age and sex matched controls. Stool samples were examined by microscopy and DNA extracted for PCR with specific primers for H. pylori and protozoal parasites Blastocystis sp., Entamoeba sp. (Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii) and Giardia duodenalis (G. duodenalis). Results There was a marked difference in the presence of parasites between patients and controls: no parasite 42/75%, one parasite 42/15%, two or more parasites 16/10%, respectively (p < 0.001). Patients with diarrhoea were more likely to be infected with Blastocystis sp (p < 0.001), E. histolytica (p = 0.027) and E moshkovskii (p = 0.003). There was no difference in the frequency of H. pylori (p = 0.528), G duodenalis (p = 0.697) or E dispar (p = 0.425). Thirty-three patients and 27 controls had H. pylori infection. Of these, 22 patients and 6 controls were infected with Blastocystis sp (p = 0.001), 6 patients and no controls were infected with E. histolytica (p = 0.02), whilst 7 patents and 9 controls were infected with E dispar (p = 0.292). Conclusion In this population, diarrhoea is linked to infection with Blastocystis sp, E. histolytica and E moshkoviskii. In H. pylori infection, diarrhoea is linked to Blastocystis sp and E. histolytica infection. These associations may be linked pathogenically.

The emerging threat of schistosomiasis spread in Pakistan

Schistosomiasis is among the thirteen neglected tropical diseases of the world. While prevalent in a number of countries, it has only rarely been reported in Pakistan. Here we report a 25 year old male who acquired the infection during travel to Malawi and presented with haematuria and dysuria. He was successfully treated with praziquantel. The possibility of schistosomiasis becoming endemic in the country is discussed. A number of risk factors are present including dams, irrigation, increased travel and geographical proximity to endemic countries. The local presence of at least one snail species of potential hosts for Schistosoma mansoni is confirmed. We see that schistosomiasis endemicity is a possible threat in Pakistan. Solutions to prevent this include reducing travel to endemic areas, prompt recognition and treatment of cases, and health education.

Endocrinology of number of follicular waves per estrous cycle and contralateral or ipsilateral relationship between corpus luteum and preovulatory follicle in heifers

A 3-d extension of the luteal phase occurs in interovulatory intervals (IOIs) with a contralateral relationship between the corpus luteum (CL) and preovulatory follicle with 3 follicular waves (Contra-3W group). Concentrations of FSH, progesterone, LH, and estradiol-17β for the ipsilateral versus contralateral CL and/or follicle relationship and 2 versus 3 waves per IOI were studied in 14 heifers. Follicular waves and FSH surges were designated 1, 2, or 3, according to order of occurrence in the IOI. The day (day 0 = ovulation) of the FSH peak in surge 2 occurred earlier (P < 0.02) in 3-wave IOIs (day 6.3 ± 0.5) than in 2-wave IOIs (day 8.5 ± 0.5). Mean FSH was higher in 3-wave than in 2-wave IOI on 82% of the days in the IOI. Repeatability or individuality in FSH concentration was indicated by a correlation (r = 0.54, P < 0.04) in FSH concentrations between ovulations at the beginning and at the end of the IOI. Concentrations of LH and estradiol increased (P < 0.05) near the beginning of the luteolytic period in 2-wave IOI regardless of the CL and/or follicle relationship. In the Contra-3W group, LH and estradiol remained at basal concentrations concurrently with FSH surge 3 and extension of the luteal phase. The hypotheses were supported that FSH surge 2 occurs earlier in 3-wave IOIs than in 2-wave IOIs and that the development of 3-wave IOIs occurs in individuals with greater FSH concentrations. Extension of the luteal phase in the Contra-3W group was temporally associated with lower concentrations of LH and estradiol.

Follicular-phase concentrations of progesterone, estradiol-17β, LH, FSH, and a PGF2α metabolite and daily clustering of prolactin pulses, based on hourly blood sampling and hourly detection of ovulation in heifers

Circulating concentrations of hormones were determined each hour in 13 heifers from the end of the luteolytic period to ovulation (follicular phase, 3.5 days). Diameter of the preovulatory follicle was determined every 8 hours, and the time of ovulation was determined hourly. The diameter of the preovulatory follicle decreased 0.8 ± 0.1 mm/h in heifers when there was 1 to 3 hours between the last two diameter measurements before ovulation. The concentration of progesterone (P4) after the end of the luteolytic period (P4 < 1 ng/mL) changed (P < 0.0001), as shown by a continued decrease until Hour -57 (Hour 0 = ovulation), then was maintained at approximately 0.2 ng/mL until 2 hours before the peak of the LH surge at Hour -26, and then a decrease to 0.1 ng/mL along with a decrease in estradiol-17β. Concentrations of LH gradually increased (P < 0.007) and concentrations of FSH gradually decreased (P < 0.0001) after the end of luteolysis until the beginning nadirs of the respective preovulatory surges. A cluster of prolactin (PRL) pulses occurred (P < 0.0001) each day with approximately 24 hours between the maximum value of successive clusters. Hourly concentrations of a PGF2α metabolite decreased (P < 0.007) until Hour -40, but did not differ among hours thereafter. Novel observations included the gradual increase in LH and decrease in FSH until the beginning of the preovulatory surges and follicle diameter decrease a few hours before ovulation. Results supported the following hypotheses: (1) change in the low circulating P4 concentrations during the follicular phase are temporally associated with change in LH concentrations; and (2) PRL pulses occur in a cluster each day during the follicular phase of the estrous cycle.

173 USE OF CORPUS LUTEUM AREA AS A PREDICTOR OF ONGOING FUNCTIONAL LUTEOLYSIS IN DAIRY HEIFERS

The beginning of functional luteolysis in cattle ranges from Days 16–19 (Day 0 = ovulation). During functional luteolysis, luteal size and blood flow decrease in heifers. The wide range of beginning of luteolysis and the low sensitivity of quick progesterone (P4) assays preclude targeting an individual for a specific period of luteolysis. The present study aimed to evaluate the changes in area and blood flow of corpus luteum (CL) during spontaneous luteolysis and test the hypothesis that a decrease in CL area (cm2) is more efficient in targeting the luteolytic period than using a specific day postovulation. Blood sampling and ultrasound scanning of CL were done every 12 h from Days 13–22 in dairy heifers (Holstein) and was used for a retrospective study (Experiment 1; n = 6 heifers). The P4 concentrations, maximum CL area, and the percentage of CL area with coloured signals of blood flow were centralized to 12-h sample when the end of luteolysis (P4 < 1 ng mL–1) was detected. The percentage decrease in CL area and blood flow between Day 13 and the 12-h sample before the end of luteolysis were calculated. In Experiment 2, a blood sampling and transrectal ultrasonography of CL were performed every 8 h starting on Day 14 to determine the beginning and end of functional luteolysis (n = 20 heifers). The hour of detection of luteolysis was defined as the scan at 8-h intervals when maximum CL area decreased by 25 or 12.5% on Day 14. Based on P4 concentrations, the preluteolytic, luteolytic, and postluteolytic periods in each heifer were identified. The area and blood flow were measured by a duplex B-mode and pulse-wave colour Doppler ultrasound instrument. In Experiment 1, the retrospective study indicated a 25% decrease in CL area and 65% decrease in blood flow 12 h before the end of functional luteolysis. In Experiment 2, the 25% and 12.5% CL area decrease from Day 14 occurred, respectively, on Days 18.1 ± 0.6 and 17.2 ± 0.5 postovulation. The hypothesis that a decrease in CL area is more efficient in targeting ongoing luteolysis than using a specific day postovulation was supported. This was indicated by the greater (P < 0.05) frequency of heifers detected in luteolytic period (12 of 20 heifers) using the criteria of a 12.5% decrease in CL area than using a specific day (Table 1). Using a day postovulation for obtaining heifers in the luteolytic phase was only 0 to 30% effective for targeting luteolysis. In conclusion, the technique of using an ultrasonic 12.5% reduction in CL area is a good tool to detect ongoing luteolysis and may be useful as an experimental design to study factors related to the luteolytic period in cattle. Table 1.Percentage values of heifers in preluteolytic, luteolytic, or postluteolytic periods according to a decrease in CL area criteria or a day postovulation Supported by grants from FAPESP (2012/04004-8 to GP).

Circadian influence on the preovulatory LH surge, ovulation, and prolactin concentrations in heifers

A novel circadian study of the effect of clock hours on the preovulatory LH surge, ovulation, and maximal PRL concentration was done in 13 nontreated Holstein heifers. Hourly blood sampling and hourly ultrasound examinations to detect the hour of ovulation began at 8 and 48 hours, respectively, after CL area (cm(2)) had decreased 15% from the area at 15 days postovulation. The resulting experimental period began at the beginning of postluteolysis (progesterone, <1 ng/mL) and encompassed a mean of 3.5 days until ovulation. The frequency of the peak of the preovulatory LH surge for the three 8-hour periods of a 24-hour day was different (P < 0.02) between 2:00 AM to 9:00 AM (N = 9), 10:00 AM to 5:00 PM (N = 3), and 6:00 PM to 1:00 AM (N = 1). The median was 6:00 AM. The frequency of ovulations for 8-hour periods was different (P < 0.02) between 3:00 AM to 10:00 AM (N = 9), 11:00 AM to 6:00 PM (N = 3), and 7:00 PM to 2:00 AM (N = 1). The median was 7:30 AM. Two or three clusters of PRL pulses occurred during the 3.5 days. Based on all available PRL pulse clusters (N = 36), the clock hours of the maximal concentration/cluster was greater (P < 0.0001) for 9:00 AM to 2:00 PM (N = 33 clusters) than for each of the three other 6-hour periods (N = 0, 1, or 2 per period). The median was 11:30 AM. The hypothesis was supported that the peak of the preovulatory LH surge, ovulation, and maximal PRL concentration during pulse clusters occur with greater frequency during certain clock hours in heifers.

Dynamics of circulating progesterone concentrations before and during luteolysis: a comparison between cattle and horses

The profile of circulating progesterone concentration is more dynamic in cattle than in horses. Greater prominence of progesterone fluctuations in cattle than in horses reflect periodic interplay in cattle between pulses of a luteotropin (luteinizing hormone; LH) and pulses of a luteolysin (prostaglandin F2alpha; PGF2alpha). A dose of PGF2alpha that induces complete regression of a mature corpus luteum with a single treatment in cattle or horses is an overdose. The overdose effects on the progesterone profile in cattle are an immediate nonphysiological increase taking place over about 30 min, a decrease to below the original concentration, a dose-dependent rebound 2 h after treatment, and a progressive decrease until the end of luteolysis. An overdose of PGF2alpha in horses results in a similar nonphysiological increase in progesterone followed by complete luteolysis; a rebound does not occur. An overdose of PGF2alpha and apparent lack of awareness of the rebound phenomenon has led to faulty interpretations on the nature of spontaneous luteolysis. A transient progesterone suppression and a transient rebound occur within the hours of a natural PGF2alpha pulse in cattle but not in horses. Progesterone rebounds are from the combined effects of an LH pulse and the descending portion of a PGF2alpha pulse. A complete transitional progesterone rebound occurs at the end of preluteolysis and the beginning of luteolysis and returns progesterone to its original concentration. It is proposed that luteolysis does not begin in cattle until after the transitional rebound. During luteolysis, rebounds are incomplete and gradually wane. A partial rebound during luteolysis in cattle is associated with a concomitant increase in luteal blood flow. A similar increase in luteal blood flow does not occur in mares.

Inhibition of prostaglandin biosynthesis during postluteolysis and effects on CL regression, prolactin, and ovulation in heifers

The beginning of postluteolysis (progesterone, <1 ng mL(-1)) in heifers was targeted by using 8 h after ultrasonic detection of a 25% decrease in CL area (cm2) and was designated Hour 0. Flunixin meglumine (FM; n=10) to inhibit PGF2α secretion or vehicle (n=9) were given intramuscularly at Hours 0, 4, 8, 16, 24, 32, and 40. The dose of FM was 2.5 mg/kg at each treatment. Blood sampling and measurement of the CL and dominant follicle were done every 8 h beginning 14 days postovulation in each group. Blood samples for detection of pulses of PRL and pulses of a metabolite of PGF2α (PGFM) were obtained every hour for 24 h beginning at Hour 0. Pulse concentrations of both PGFM and PRL were lower in the FM group than in the vehicle group. Concentration of PRL was greatest at the peak of a PGFM pulse. Neither CL area (cm2) nor progesterone concentration differed between groups during Hours 0 to 48 (postluteolysis). Ovulation occurred in nine of nine heifers in the vehicle group and in three of 10 heifers in the FM group. The anovulatory follicles in the FM group grew to 36.2±2.9 mm, and the wall became thickened from apparent luteinization. The hypothesis that PGF2α was involved in the continued P4 decrease and structural CL regression during postluteolysis was not supported. However, the hypotheses that pulses of PGFM and PRL were temporally related and that systemic FM treatment induced an anovulatory follicle were supported.

Induction of PGFM pulses and luteolysis by sequential estradiol-17β treatments in heifers

The effects of sequential induction of PGFM pulses by estradiol-17β (E2) on prominence of PGFM pulses and progesterone (P4) concentration were studied in heifers. Three treatments of vehicle (n = 12) or E2 (n = 12) at doses of 0.05 or 0.1 mg were given at 12-h intervals beginning on Day 15 postovulation. Blood samples were collected every 12 h from Days 13-24 and hourly for 12 h after the first and third treatments. On Day 15, all heifers were in preluteolysis and on Day 16 were in preluteolysis in the vehicle-treated heifers (n = 11) and either preluteolysis (n = 4) or luteolysis (n = 8) in the E2-treated heifers. Peak concentration of induced PGFM pulses during preluteolysis on Day 15 was greater (P < 0.04) than for pulses during preluteolysis on Day 16. The interval from ovulation to the beginning of luteolysis was shorter (P < 0.04) in the E2-treated heifers than in the vehicle-treated heifers. An E2-induced PGFM pulse was less prominent (P < 0.008) in heifers in temporal association with a transient resurgence in P4 than in heifers with a progressive P4 decrease. The hypothesis that repeated E2 exposure stimulates increasing prominence of PGFM pulses was not supported. Instead, repeated exposure reduced the prominence of PGFM pulses, in contrast to the stimulation from the first E2 treatment. Reduced prominence of a PGF(2α) pulse during luteolysis can lead to a transient resurgence in P4 concentration.

Luteolysis and associated interrelationships among circulating PGF2α, progesterone, LH, and estradiol in mares

The changing concentrations and temporal relationships among a PGF2α metabolite (PGFM), progesterone (P(4)), LH, and estradiol-17β (E(2)) before, during, and after luteolysis were studied in 10 mares. Blood samples were collected every hour for ≥4 d beginning on day 12 after ovulation. The luteolytic period extended from a decrease in P(4) at a common transitional hour (Hour 0) at the end of preluteolysis and beginning of luteolysis to a defined ending when P(4) reached 1 ng/mL. The length of luteolysis was 22.9 ± 0.9 h, contrasting with 2 d in published P(4) profiles from sampling every 6 to 24 h. In mares with complete data for Hours -40 to -2 (n = 6), PGFM concentrations remained below assay sensitivity (n = 2) or two or three small pulses (peak, 29 ± 4 pg/mL) occurred. During luteolysis, the pulses became more prominent (peak, 193 ± 36 pg/mL). Rhythmicity of PGFM pulses was not detected by a pulsatility program during preluteolysis but was detected in seven of nine mares during luteolysis and postluteolysis combined. The nadir-to-nadir interval for LH pulses and the peak-to-peak interval between adjacent pulses were longer (P < 0.05) during preluteolysis than during luteolysis (nadir to nadir, 5.2 ± 0.3 h vs 3.6 ± 0.4 h; peak to peak, 9.4 ± 1.0 h vs 4.7 ± 0.5 h). Unlike reported findings in cattle, concentrations of P(4) decreased linearly within the hours of each PGFM pulse during luteolysis, and a positive effect of an LH pulse on P(4) and E(2) concentration was not detected. The reported balancing of P(4) concentrations between a negative effect of PGF2α and a positive effect of LH in heifers was not detected in mares.

Effect of dose of estradiol-17β on prominence of an induced 13,14-dihydro-15-keto-PGF(2α) (PGFM) pulse and relationship of prominence to progesterone, LH, and luteal blood flow in heifers

Various doses of estradiol-17β (E(2)) were used in heifers to induce a pulse of 13,14-dihydro-15-keto-prostaglandin F(2α) (PGFM). The effect of E(2) concentration on the prominence of PGFM pulses and the relationship between prominence and intrapulse concentration of progesterone (P(4)), LH, and luteal blood flow were studied. A single dose of 0 (vehicle), 0.01, 0.05, or 0.1 mg of E(2) was given (n = six/group) 14 d after ovulation. Blood samples were collected, and luteal blood flow was evaluated hourly for 10 h after the treatment. The 0.05-mg dose increased and the 0.1-mg dose further increased the prominence of the induced PGFM pulse, compared with the 0.0-mg dose and the 0.01-mg dose. The PGFM pulses were subdivided into three different prominence categories (<50, 50 to 150, and >150 pg/mL at the peak). In the 50 to 150 category, P(4) concentration increased (P < 0.05) between -2 h and 0 h (0 h = peak of PGFM pulse). In the >150 category, P(4) decreased (P < 0.05) between -1 h and 0 h, LH increased (P < 0.05) at 1 h, and luteal blood flow apparently decreased (P < 0.05) at 2 h of the PGFM pulse. The novel results supported the following hypotheses: (1) an increase in E(2) concentration increases the prominence of a PGFM pulse, and (2) greater prominence of a PGFM pulse is associated with a greater transient intrapulse depression of P(4) at the peak of the PGFM pulse. In addition, the extent of the effect of prostaglandin F(2α) on the increase in LH and changes in blood flow within the hours of a PGFM pulse was related positively to the prominence of the PGFM pulse.

Prevalences of Giardia lamblia and Cryptosporidium parvum infection in adults presenting with chronic diarrhoea

Giardia lamblia and Cryptosporidium parvum are both waterborne pathogens associated with diarrhoea in developing countries. In a recent study based at the Aga Khan University in Karachi, 334 adults aged 16-83 years (178 patients with chronic diarrhoea and 156 diarrhoea-free volunteers who acted as controls) were checked for infection with these parasites, using stool microscopy and/or PCR. Overall, 21 (6.3%) and 29 (8.7%) of the subjects were found positive for G. lamblia by microscopy and PCR, respectively, while the corresponding values for C. parvum were 13 (3.9%) and 14 (4.2%). Although, compared with the diarrhoea-free controls, the patients with diarrhoea were not significantly more likely to be found infected with Giardia, either by microscopy [15 (8.4%) v. six (3.8%); P=0.085] or PCR [19 (10.7%) v. 10 (6.4%); P=0.167], they were significantly more likely to be found infected with C. parvum, both by microscopy [11 (6.2%) v. two (1.3%); P=0.024] and by PCR [12 (6.7%) v. two (1.3%); P=0.014]. The 19 patients found PCR-positive for Giardia comprised 10 (67%) of the 15 found smear-positive for the same parasite but only nine (5%) of the 163 found smear-negative (k=0.545; P<0.001). Similarly, the 12 patients found PCR-positive for Cryptosporidium comprised all 11 (100%) patients found smear-positive for the same parasite but only one (0.6%) of the 167 found smear-negative (k=0.954; P<0.001). Although C. parvum was associated with chronic diarrhoea in the present study, the carriage of G. lamblia often appeared asymptomatic.

Effect of luteinizing hormone oscillations on progesterone concentrations based on treatment with a gonadotropin-releasing hormone antagonist in heifers

Close temporality has been reported between the episodic secretion of luteinizing hormone (LH) and progesterone (P4) during the midluteal phase and preceding the beginning of luteolysis in cattle. In the present studies, the relationship between LH and P4 was examined by blocking LH oscillations with the gonadotropin-releasing hormone (GnRH) antagonist, acyline. In a titration study, the minimal single acyline dose for blocking LH oscillations in heifers was 3 μg/kg. The main experiment compared LH and P4 concentrations and oscillations between a group treated with acyline on day 15 after ovulation (n = 8) and a control group (n = 4). Concentrations of P4 in blood samples collected every 8 h on days 13 to 18 indicated that acyline treatment did not alter the time that luteolysis began or the length of the luteolytic process. In blood samples collected every hour for 24 h beginning at the hour of treatment, acyline reduced the LH concentrations and blocked LH oscillations. The hourly LH means were 0.06 to 0.08 ng/mL, comparable to the mean concentration at the nadirs of LH oscillations in controls (0.07 ng/mL). During the hourly sampling, the GnRH antagonist produced the following P4 responses: (1) lower P4 concentrations, (2) fewer and reduced prominence of P4 oscillations, and (3) increased length and variability in the interval between the peaks of P4 oscillations. Results indicated that LH oscillations affect both the prominence and the rhythmicity of P4 oscillations during preluteolysis but not the onset and length of luteolysis.

Concomitance of luteinizing hormone and progesterone oscillations during the transition from preluteolysis to luteolysis in cattle

The temporal relationships of episodes of luteinizing hormone (LH) oscillations, 13,14-dihydro-15-keto-PGF2α (PGFM) pulses, and progesterone (P4) fluctuations during the latter portion of preluteolysis and the early portion of luteolysis were characterized. In Experiment 1, the detection of LH episodes in blood samples collected every 15 min for 8 h was compared with detection in the samples collected every hour in 4 heifers. The number of independently detected episodes/heifer (total = 7) was the same for the 15-min and hourly collection intervals. In Experiment 2, blood samples were collected every hour (n = 7 heifers) and retrospectively assigned to 15 h before and 15 h after the transitional hour between preluteolysis and luteolysis. During preluteolysis, compared with luteolysis, the amplitude of LH oscillations was greater (0.28 ± 0.03 vs 0.18 ± 0.03 ng/mL; P < 0.02) and the interval between peaks of LH oscillations was shorter (3.3 ± 0.3 h vs 4.3 ± 0.6 h; P < 0.04). The LH peaks occurred at the same hour as the peak of a P4 fluctuation in 77% and 29% of LH oscillations (P < 0.0009) during preluteolysis and luteolysis, respectively. In preluteolysis, synchrony between LH and P4 episodes occurred consistently during the P4 rebound after the peak of a PGFM pulse. In luteolysis, the LH peak preceded the peak of the P4 rebound. On a temporal basis, the hypothesis was supported that episodic LH accounts, at least in part, for the reported P4 rebound that occurs after the P4 suppression at the peak of a PGFM pulse.

Gastrointestinal helminthiasis presenting with acute diarrhoea and constipation: report of two cases with a second pathology

Gastrointestinal helminthiasis in developing countries contributes to malnutrition and anemia. Diagnosis and treatment of helminthiasis, especially with low worm load is an unmet public health need in such settings. The infection may sometimes become manifest when a second pathology leads to purgation of the gastrointestinal tract. Two cases of helminthiasis are presented in which the infections only became amenable to diagnosis due to acute diarrhoea caused by giardiasis and lactulose administration. In the first case, acute giardiasis revealed Ascaris lumbricoides infestation, and in the second case primary helminthiasis (strongyloidiasis) was revealed by lactulose, and also led to Vibrio cholera bacteremia. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes.

Luteal blood flow and concentrations of circulating progesterone and other hormones associated with a simulated pulse of 13,14-dihydro-15-keto-prostaglandin F2α in heifers

Progesterone and luteal blood flow effects of an i.u. 2-h infusion of 0.25 mg/h of prostaglandin F2α (PGF) that simulated a natural pulse of 13,14-dihydro-15-keto-PGF (PGFM) were compared to the effects of a single bolus i.u. injection of PGF (4 mg) that induced complete luteolysis in heifers. Blood sampling and an estimate of the percentage of luteal area with colour-Doppler signals of blood flow were performed every 2 min for 20 min and less frequently thereafter for 6 h. After the beginning of PGF infusion or a bolus injection, progesterone increased to a peak at 14 and 10 min respectively, and was accompanied by an increase in blood flow in the bolus group but not in the infusion group. Progesterone then decreased for 1 or 2 h and was accompanied by a continued elevation in blood flow in the PGF bolus group and by a slight increase in the PGF infusion group. Progesterone then rebounded in both groups, but the rebound was greater in the infusion group. Blood flow decreased during the descending arm of the progesterone rebound. Cortisol and prolactin began to increase 6 min after the bolus PGF injection but did not increase during or after PGF infusion. The increases in cortisol, prolactin and blood flow after a PGF bolus treatment but not during a simulated PGFM pulse indicated that the bolus treatment was pharmacologic, and its use may lead to faulty conclusions on the nature of physiologic luteolysis. The comparisons between progesterone and blood flow are novel.

Characteristics of pulses of 13,14-dihydro-15-keto-prostaglandin f2alpha before, during, and after spontaneous luteolysis and temporal intrapulse relationships with progesterone concentrations in cattle

Pulses of the prostaglandin F2alpha (PGF) metabolite 13,14-dihydro-15-keto-PGF (PGFM) were compared among heifers that were in the preluteolytic, luteolytic, and postluteolytic periods (n = 7 or 8 heifers/period). Hourly blood sampling was done in 18-h sessions 15, 16, or 17 days after ovulation. Hourly sampling and statistical identification of a PGFM pulse allowed novel comparisons of PGFM pulses among the three periods. Each period had a similar number of PGFM pulses (2.3 +/- 0.2). The pulses were more prominent during the luteolytic period than during the other periods, as indicated by significantly greater concentration for the peak and amplitude between nadir and peak. Significantly more fluctuations that did not meet the definition of a pulse occurred at the beginning of the preluteolytic period and end of the postluteolytic period than during the luteolytic period. The same nadir ended a pulse and began the next pulse in 85% of adjacent pulses. Seven heifers were selected objectively, based on a progesterone concentration >5 ng/ml at Hour -3 (Hour 0 = peak of PGFM pulse) and a progressive decrease in progesterone from Hours -3 to 0. Progesterone increased (P < 0.03) between Hours 0 and 1, remained at a mean plateau at Hours 1 and 2, and then decreased. Results support the hypothesis of a transient intrapulse rebound in progesterone during an individual PGFM pulse, but only during the first portion of luteolysis. These findings should be considered in future proposals on the mechanisms involved in the effects of PGF on progesterone concentrations.

Temporal relationships of the LH surge and ovulation to echotexture and power Doppler signals of blood flow in the wall of the preovulatory follicle in heifers

Changes in echotexture and blood flow in the wall of preovulatory follicles in heifers were studied in relation to the LH surge and ovulation in gonadotrophin-releasing hormone-induced (n = 7; Experiment 1) and spontaneous (n = 8; Experiment 2) ovulators. Ultrasonographic examinations and blood sampling were performed either every hour (Experiment 1) or every 6 h (Experiment 2). The interval from LH peak to ovulation in induced and spontaneous ovulators was 27.1 ± 0.3 and 34.5 ± 1.5 h, respectively. Follicle diameter did not increase between the LH peak and ovulation. In the induced ovulators, serration of the stratum granulosum was detected in one (14%), two (29%), three (43%) and four (57%) heifers at 4, 3, 2 and 1 h before ovulation, respectively. An initial increase in blood flow (P < 0.001) encompassed the LH peak in both experiments. In the induced ovulators, blood flow increased (P < 0.02) to maximum 3 h after the LH peak, maintained a plateau for 5 h, decreased (P < 0.05) between 9 and 14 h, increased (P < 0.05) again between 19 and 21 h and then decreased (P < 0.01) between 25 and 26 h (1 h before ovulation). The biphasic increase and decrease in blood flow and serration of the granulosum in the wall of the preovulatory follicle in cattle are novel findings.

219 FOLLICLE AND HORMONE DYNAMICS IN SINGLE- v. DOUBLE-OVULATING HEIFERS

The present experiment used the Day 4 ablation model for increasing the incidence of double ovulations in heifers. The objective was to compare follicle growth and plasma hormone concentrations associated with single v. double ovulations. Follicles ≥5 mm were ablated at 4 days post-ovulation to induce a prominent FSH surge and a new follicular wave, and 2 injections of PGF2 (12 h apart) were given 2 days later (Day 6) to favor ovulation. Beginning on Day 5, the 3 largest follicles of the induced wave were scanned twice a day until 36 h after the next ovulation. Blood samples were taken at 6-h intervals starting when the largest follicle reached ≥8.0 mm (expected deviation at 8.5 mm; Ginther et al. 1996) and continued until 36 h after the next ovulation. Concentrations of LH and FSH were measured by validated RIA for cattle (LH measured by Ginther et al. 1999; FSH measured by Adams et al. 1992) and concentrations of oestradiol measured by a commercially available RIA kit (Siddiqui et al. 2009). From a total of 31 heifers, 16 (52%) or 15 (48%) developed a single or more than 1 dominant (≥ 10 mm) follicle in the follicular wave after ablation, respectively. For heifers with 2 dominant follicles, the second-largest follicle ovulated in 9 (60%) heifers and the overall double ovulation rate was 29% (9/31). Follicle diameters and plasma hormone concentrations were compared between single ovulators (n = 12) and double ovulators (n = 8). Diameter of the preovulatory follicles did not increase between the LH peak and ovulation in either the single or double ovulations. In double ovulators, the interval from follicle deviation to the peak of the preovulatory LH surge was shorter (1.9 ± 0.2 days v. 2.5 ± 0.2 days; P < 0.02) and the diameter of the largest preovulatory follicle was smaller (12.2 ± 0.5 mm v. 13.3 ± 0.3 mm; P < 0.02) than in single ovulators, respectively. The LH concentrations of the preovulatory surge did not differ between single and double ovulators for 24 h on each side of the peak (main effect of hour only; P < 0.0001). When data were normalized to the LH peak, the peak of the preovulatory FSH and estradiol surges occurred in synchrony with the peak of LH surge for both groups. A group effect (P < 0.0001) for FSH resulted from a lower concentration averaged over hours in double ovulators. Estradiol showed a group by hour interaction (P < 0.008), reflecting greater concentrations in the double ovulators before and at peak. In conclusion, an increased Supported by the Eutheria Foundation, Cross Plains, WI, USA. Submission supported by FAPEMIG.

Positive effect of FSH but not LH on early development of the dominant follicle in mares

The effects of FSH, LH or both on follicular growth and intrafollicular free insulin-like growth factor (IGF)-1 and oestradiol were investigated in mares after the beginning of deviation (largest follicle ≥ 20 mm; Hour 0). A single treatment with a gonadotropin-releasing hormone antagonist (acyline) was given at Hour 3 to suppress the concentrations of FSH and LH. Five groups (n = 5 mares per group) were evaluated in the present study: (1) control; (2) acyline treated; (3) acyline + recombinant equine (re) FSH treated; (4) acyline + reLH treated; and (5) combined acyline + reFSH + reLH treated. Beginning at Hour 3, reFSH and reLH were given at 6-h intervals in eight decreasing or increasing doses, respectively. The reFSH and reLH prevented the acyline-induced decreases in FSH and LH, respectively. Diameters and concentrations of intrafollicular free IGF-1 and oestradiol of the two largest follicles at Hour 48 did not differ significantly between the control and acyline + FSH groups, but were reduced (P < 0.05) similarly in the acyline and acyline + LH groups. The combination of reFSH and reLH was no more effective than reFSH alone. The results demonstrate a role for FSH but not LH in the growth of the largest follicle and intrafollicular concentrations of free IGF-1 and oestradiol during the 48 h after the beginning of deviation in mares.

Follicle and hormone dynamics in single versus double ovulating heifers

Follicles ≥5 mm were ablated at 4 day post-ovulation in heifers to induce a follicular wave, and prostaglandin F2α was given at day 6 to increase the incidence of double ovulations. Follicle diameters and plasma hormone concentrations were compared between single ovulators (n=12) and double ovulators (n=8). In double ovulators, the interval from follicle deviation to the peak of the pre-ovulatory LH surge was shorter (1.9±0.2 vs 2.5±0.2 days; P<0.02) and diameter of the largest pre-ovulatory follicle was smaller (12.2±0.5 vs 13.3±0.3 mm; P<0.02). The LH concentrations of the pre-ovulatory surge did not differ between single and double ovulators for 24 h on each side of the peak. When data were normalised to LH peak, the peak of the pre-ovulatory FSH and oestradiol (E2) surges occurred in synchrony with the peak of LH surge for both groups. Concentration of FSH for 24 h on each side of the peak showed a group effect (P<0.0001) from lower concentration in the double ovulators. A group-by-hour interaction (P<0.008) for E2 reflected greater concentration in the double ovulators before and at the peak. Results indicated that two pre-ovulatory follicles resulted in an earlier and greater E2 increase, leading to lower FSH concentration, an earlier LH surge, and ovulation at a smaller diameter. In conclusion, the difference in hormone concentrations during the pre-ovulatory period was an effect rather than a cause of double ovulations.

Relationship of vascular perfusion of the wall of the preovulatory follicle to in vitro fertilisation and embryo development in heifers

The effect of the extent of vascular perfusion of the wall of the preovulatory follicle on in vitro cleavage rate of the recovered oocyte and embryo development to >8 cells was studied in 52 heifers. Heifers received a luteolytic dose of prostaglandin F2α (PGF2α) when the largest follicle was ≥11 mm. An ovulation-inducing injection of GnRH was given 36 h later (hour 0), and collection of follicular fluid and the oocyte was done at hour 26. Vascular perfusion of the follicular wall was assessed by colour Doppler ultrasonography at hours 0 and 26. Each of the recovered oocytes (41/52; 79%) was mature (extruded polar body). Cleavage and embryo development were assessed at 48 h and 120 h respectively, after in vitro fertilisation (IVF). The percentage of cleaved oocytes and >8 cell embryos was 80% (31/39) and 55% (17/31) respectively. Vascular perfusion of the follicular wall was greater (lower pulsatility index; P<0.001) for follicles that produced cleaved versus non-cleaved oocytes and greater (P<0.04) for follicles that produced >8 cell versus ≤8 cell embryos. Percentage of follicular wall with Doppler signals of blood flow was greater (P<0.001) for >8 cell versus ≤8 cell embryos. Follicular-fluid concentration of free IGF1 was lower for cleaved oocytes (P<0.001) and >8 cell embryos (P<0.05), and oestradiol was lower (P<0.05) for >8 cell embryos. Results supported the hypothesis that greater vascular perfusion of the wall of the preovulatory follicle was positively associated with IVF and embryo development.

Induction of haemorrhagic anovulatory follicles in mares

A follicular wave and luteolysis were induced in mares by ablation of follicles > or =6 mm and treatment with prostaglandin F(2alpha) (PGF) on Day 10 (where ovulation = Day 0). The incidence of haemorrhagic anovulatory follicles (HAFs) in the induced waves (20%) was greater (P < 0.007) than in preceding spontaneous waves (2%). Hormone and follicle dynamics were compared between induced follicular waves that ended in ovulations (ovulating group; n = 36) v. HAFs (HAF group; n = 9). The day of the first ovulation or the beginning of HAF formation at the end of an induced wave was designated as post-treatment Day 0. The mean 13-day interval from Day 10 (PGF and ablation) to the post-treatment ovulation was normalised into Days 10 to 16, followed by Day -6 to Day 0 relative to the post-treatment ovulation. Concentrations of LH were greater (P < 0.05) in the HAF group than in the ovulating group on Days 10, 11, 12, 14, -3 and -2. The HAF group had greater (P < 0.003) LH concentrations on Day 10 of the preceding oestrous cycle with spontaneous ovulatory waves. The diameter of the largest follicle was less (P < 0.05) in the HAF group on most days between Day 13 and Day -1 and this was attributable to later (P < 0.002) emergence of the future largest follicle at 6 mm in the HAF group (Day 12.4 +/- 0.5) than in the ovulating group (Day 11.3 +/- 0.1). The results indicate that the high incidence of HAFs after PGF and ablation was associated with later follicle emergence and immediate and continuing greater LH concentration after PGF treatment, apparently augmented by an inherently high pretreatment LH concentration.

Progesterone responses to intravenous and intrauterine infusions of prostaglandin F2α in mares

The hypotheses were tested that prostaglandin F2α (PGF) travels from the uterus to the ovaries via a systemic route in mares, as opposed to a local route in ruminants, and that one pulse of PGF produces only partial luteolysis. Intravenous (i.v.) and intrauterine (i.u.) infusions of PGF were performed 8 days after ovulation at a constant rate for 2 h. Plasma concentrations of PGF were assessed by assay of 13,14-dihydro-15-keto-PGF2α (PGFM). Total doses administered were as follows: 0, 0.05, 0.1, 0.5 and 1.0 mg, i.v., PGF and 0 and 0.5 mg, i.u., PGF (n = 4 mares per group). In addition, PGFM concentrations were determined for natural pulses from samples collected each hour during luteolysis (n = 5). Progesterone was similarly reduced by 4 days after treatment in the 0.5 mg i.v., 0.5 mg i.u. and 0.0 mg i.u. groups. The area under the PGFM curve in the 0.1 mg i.v. group was similar to the area for natural PGFM pulses. Progesterone decreased to a similar concentration by 12 h in the 0.1, 0.5 and 1.0 mg i.v. groups, but thereafter was greater (P < 0.05) in the 0.1 mg i.v. group. Progesterone concentrations reached <2 ng mL–1 6 days after treatment in the 0.05 and 0.1 mg i.v. groups and 2 days after treatment in the 0.5 and 1.0 mg i.v. groups. The results support the hypotheses of a systemic uteroluteal route for PGF transfer and that one pulse produces only partial luteolysis in mares.

Necessity of sequential pulses of prostaglandin F2alpha for complete physiologic luteolysis in cattle

The luteolytic effects of exogenous prostaglandin F2alpha (PGF) that did and did not simulate natural 13,14-dihydro-15-keto-PGF (PGFM) pulses were studied during mid-diestrus in 42 Holstein heifers. Plasma concentrations of PGF were assessed by assay of PGFM. In experiment 1, a single intrauterine injection of 4.0 mg of PGF into the uterine horn ipsilateral to the corpus luteum resulted in a precipitous progesterone decline, whereas sequential injections of 0.25 or 1.0 mg every 12 h resulted in a stepwise decrease (P < 0.05) following each injection. A progesterone increase occurred during the first 5 min before the luteolytic decrease but only for the 4.0-mg dose. From the results of experiment 2, a 2-h intrauterine infusion of a total of 0.5 mg of PGF was judged to best simulate a natural PGFM pulse. In experiment 3, simulation of sequential pulses at 12-h intervals resulted in a continuous precipitous decrease in progesterone to <1 ng/ml by the beginning of the fourth simulated pulse. In contrast, a single simulated pulse resulted in a 6-h progesterone decrease to a constant concentration for 3 days after treatment, followed by a return to control concentrations. The mean +/- SEM interval between the pretreatment and posttreatment ovulations was shorter (P < 0.05) in the group with sequential simulated pulses (14 +/- 1 day) than in the group with a single pulse (21 +/- 1 day). Results indicated that excessive PGF doses may stimulate nonphysiologic progesterone responses and supported the hypothesis that sequential PGF pulses are required to stimulate natural luteolysis in cattle.

Development of one vs multiple ovulatory follicles and associated systemic hormone concentrations in mares

Ablation of follicles > or = 6 mm in diameter and treatment with PGF2alpha 10 days after ovulation were used to induce the development of ovulatory waves. Comparisons were made between induced waves with one (33 waves, 72%) and multiple (13 waves, 28%) ovulatory follicles. Diameter deviation was defined as the separation of follicles into dominant and subordinate categories. Multiple ovulatory follicles were preceded by more (p < 0.001) follicles > or = 20 mm at the beginning of deviation, higher LH preceding deviation (approached significance, p < 0.08), lower (p < 0.05) concentrations of FSH on the day of deviation and thereafter, and higher (p < 0.0003) oestradiol by 2 days after deviation. During the peri-ovulatory period, systemic hormone concentrations for waves with multiple ovulations involved higher oestradiol before ovulation (approached significance, p < 0.07), lower FSH (p < 0.04) before and after ovulation, and both higher progesterone (p < 0.05) and lower LH (p < 0.05) beginning the day after ovulation. Results indicated that by the beginning of deviation there were more follicles > or = 20 mm and subsequently greater oestradiol production in waves that led to the development of multiple ovulatory follicles, and during the peri-ovulatory period differences between one and multiple ovulations were consistent with the negative effects of the ovarian hormones on the gonadotropins.

Follicle deviation in ovulatory follicular waves with one or two dominant follicles in mares

The follicle and hormone aspects of diameter deviation and development of one dominant (>/=28 mm) follicle (1DF) vs two dominant follicles (2DF) were studied in 32 ovulatory follicular waves in mares. Follicles were ranked each day as F1 (largest) to F3. The beginning of deviation was designated day 0 and preceded the first increase in the differences in diameter between F1 and F2 in the 1DF group and between a combination of F1 and F2 vs F3 in the 2DF group. One dominant follicle and 2DF developed in 21 (66%) and 11 (34%) waves, respectively. Double ovulations occurred in only one of the waves with 2DF. In 8/11 waves with 2DF, a second deviation occurred between F1 and F2 on 2.5 +/- 0.4 days after the first deviation. On day 0, 1DF and 2DF waves were similar in number of days after ovulation, number of follicles, difference in diameter between F1 and F2, and plasma concentrations of LH, estradiol and immunoreactive inhibin. The interval from maximum FSH concentration to day 0 was longer (p < 0.05) and FSH concentration was lower (p < 0.05) on days -1 to 4 in the 2DF group. The similarities on day 0 in the characteristics of 1DF and 2DF waves despite the differences in the declining portions of the FSH profile indicated that a specific day of the FSH decline or a specific concentration were not factors in initiating deviation. Unlike reported results in heifers, the results in mares did not indicate a hormonal basis for the development of 2DF or two deviations.

Effect of suppression of FSH with a GnRH antagonist (acyline) before and during follicle deviation in the mare

A GnRH antagonist (Acyline) was used to study the role of FSH in early development of a follicular wave in 61 mares. In Experiment 1, a single dose of 3 mg per mare, compared with 0 and 1 mg, suppressed both the FSH and follicle responses to exogenous GnRH. In Experiment 2, high concentrations of FSH were induced by two successive ablations of all follicles >/= 6 mm on days 10 and 13 (day 0 = ovulation). A single treatment with Acyline resulted in significantly greater suppression of plasma concentrations of FSH than a single treatment with charcoal-extracted follicular fluid (source of inhibin) or oestradiol. Suppression of FSH was not significantly different between the group treated with Acyline alone and a group treated with a combination of Acyline, inhibin and oestradiol. In Experiment 3, all follicles were ablated on day 10 to induce an FSH surge and a new follicular wave. Acyline treatment on day 10 resulted in an immediate decrease in FSH, without a significant effect on day of emergence of a new wave or growth of follicles from 7 to 11 mm on days 11-13. Treatment on day 15, a day before expected follicle deviation and after the peak of the wave-stimulating FSH surge, resulted in an immediate decrease in FSH and cessation of follicle growth. Results indicated that growth of follicles for about 2 days after wave emergence was independent of FSH. In contrast, during the decline in the wave-stimulating FSH surge and before follicle deviation, growth of follicles was dependent on FSH.

Characterisation of pulses of 13,14-dihydro-15-keto-PGF2alpha (PGFM) and relationships between PGFM pulses and luteal blood flow before, during, and after luteolysis in mares

Blood collections for characterising 13,14-dihydro-15-keto-PGF2alpha (PGFM) pulses in mares and colour-Doppler examinations for estimating percentage of corpus luteum with blood-flow signals were done hourly for a 24-h session on Day 15 (ovulation = Day 0; n = 13 mares) or during 12-h sessions from Days 12 to 16 (n= 10 mares). Luteolysis was defined as extending from the beginning of a precipitous decrease in progesterone until progesterone was <2 ng mL(-1). Comparisons were made among preluteolysis, luteolysis, and postluteolysis. Greater prostaglandin F2alpha activity (mean PGFM concentration per session) occurred during luteolysis than during preluteolysis and postluteolysis. Statistically-detected PGFM pulses were smaller during preluteolysis with a highly variable interval from the last pulse to the beginning of luteolysis. Either two or three pulses were detected in each 24-h session during luteolysis and postluteolysis, after excluding three of eight sessions with no pulses during postluteolysis. Statistically, 17% of pulses during postluteolysis were prominent outliers. The nadir-to-nadir interval during a pulse (5 h), the peak-to-peak interval between pulses (9 h), and the resulting 4-h gap between pulses were similar during and after luteolysis. The decrease in progesterone encompassed the PGFM pulses, without a detectable fluctuation during a pulse. The percentage of corpus luteum with blood-flow signals did not change during the ascending portion of a PGFM pulse and decreased within 2 or 3 h after the peak, even during preluteolysis. Results indicated that a reported increase in luteal blood flow in heifers during the ascending portion of a PGFM pulse does not occur in mares.

Miniature ponies: 2. Endocrinology of the oestrous cycle

Plasma concentrations of FSH, LH, oestradiol and progesterone were studied daily during 12 interovulatory intervals and 21 periovulatory periods in nine Miniature ponies. The peak of the FSH surge that was temporally associated with emergence of the future ovulatory follicle occurred when the follicle was approximately 9 mm, compared with a reported diameter of 13 mm in larger breeds. The ovulatory LH surge involved a slow increase between Days 13 and 18 (ovulation=Day 0; 0.6+/-0.1 ng day(-1)), a minimal increase or a plateau on Days 18 to 21 (0.04+/-0.1 ng day(-1)), and a rapid increase after Day 21 (2.2+/-0.4 ng day(-1); P<0.0001). The end of the plateau and the beginning of the rapid increase occurred on the day of maximum concentration in the oestradiol preovulatory surge. An unexpected mean increase and decrease in LH occurred (P<0.04) on Days 5 to 9. Concentrations of oestradiol and progesterone seemed similar to reported results in larger breeds. Results indicated that in Miniature ponies the peak of the FSH surge associated with emergence of the future ovulatory follicle occurred at a smaller diameter of the future ovulatory follicle than in larger breeds, the ovulatory LH surge increased in three phases, and the ovulatory LH surge was followed by an LH increase and decrease during the early luteal phase.

Follicle and systemic hormone interrelationships during spontaneous and ablation-induced ovulatory waves in mares

The characteristics of ovulatory follicular waves were studied for spontaneous waves and waves induced during the next estrous cycle by ovarian follicle ablations and administration of PGF2alpha 10 days after ovulation in 21 mares. In the induced group, both the days of the FSH surge and day of deviation were more synchronized, LH concentrations were greater before and after deviation, estradiol concentrations were greater after deviation, and the ovulatory follicle grew at a faster rate (3.4+/-0.2 compared with 2.7+/-0.1 mm/day). The frequency of two dominant follicles/wave was not different between induced waves (7 of 21) and spontaneous waves (9 of 21), but both dominant follicles ovulated more frequently in induced waves (6 of 7 waves compared with 0 of 9).

Effects of age on follicle and hormone dynamics during the oestrous cycle in mares

The effects of age (young: 5–6 years; intermediate: 10–14 years; old: ≥18 years) on follicle and hormone dynamics during an interovulatory interval (IOI; n = 46) and on preovulatory oocytes and concentrations of follicular fluid factors (n = 44) were studied in mares. Old mares were not approaching senescence, as indicated by regular lengths of the IOI (19–27 days) during the period May–October. The IOI was 1 day longer (P < 0.05) in the old group than in the two younger groups and was associated with a slower (P < 0.05) growth rate of the ovulatory follicle. The old group had diminished follicle activity, as indicated by significantly smaller and fewer follicles. Concentrations of FSH did not differ among age groups, except that the maximum concentration was greater (P < 0.05) in the old group. Concentrations of LH were greater (age × day interaction; P < 0.03) in the young group throughout the ovulatory LH surge and may have played a role in a shorter (P < 0.05) interval from maximum diameter of the preovulatory follicle to ovulation. Maximum circulating concentrations of oestradiol during the preovulatory surge were greatest (P < 0.05) in the young group. No effects of age were detected on oocyte morphology. Concentrations of ovarian steroids in preovulatory follicular fluid were not affected by the age of the mares, but concentrations of free insulin-like growth factor-1 were greater (P < 0.05) in the old group. The results indicate the importance of considering the potential confounding effects of age in experimental protocols and for considering age in the development of theriogenology programmes.

Temporal relationships among LH, estradiol, and follicle vascularization preceding the first compared with later ovulations during the year in mares

Diameter of the preovulatory follicle, plasma concentrations of LH and estradiol, and vascularization of the follicle wall, based on color-Doppler signals, were characterized in 40 pony mares for 6 days preceding ovulation (Days -6 to -1; preovulatory period). Comparisons between the preovulatory periods preceding the first compared with a later ovulation during the year were used to study the relationships between LH and estradiol and between vascularization and estradiol. Diameter of the preovulatory follicle was greater (P<0.02) and concentration of LH was less (P<0.02) during the first preovulatory period, whereas concentration of estradiol was not different between the first and second preovulatory periods. Vascularized area (cm(2)) of the follicle wall increased at a reduced rate during the first preovulatory period, as indicated by an interaction (P<0.03) between day and group. Vascularized area was similar between the preovulatory groups on Day -6, and a reduced rate of increase resulted in a lesser (P<0.001) area on Day -1 before the first ovulation (1.4+/-0.1cm(2)) than before a later ovulation (2.2+/-0.2 cm(2)). Results demonstrated that follicle vascularization and the LH surge were attenuated preceding the first ovulation of the year with no indication that estradiol was involved in the differences between the first and later ovulations.

Negative Effect of Estradiol on Luteinizing Hormone Throughout the Ovulatory Luteinizing Hormone Surge in Mares1

The negative effect of estradiol-17beta (E2) on LH, based on exogenous E2 treatments, and the reciprocal effect of LH on endogenous E2, based on hCG treatments, were studied throughout the ovulatory follicular wave during a total of 103 equine estrous cycles in seven experiments. An initial study developed E2 treatment protocols that approximated physiologic E2 concentrations during the estrous cycle. On Day 13 (ovulation = Day 0), when basal concentrations of E2 and LH precede the ovulatory surges, exogenous E2 significantly depressed LH concentrations to below basal levels. Ablation of all follicles > or = 10 mm when the largest was > or =20 mm resulted in an increase in percentage change in LH concentration within 8 h that was greater (P < 0.03) than for controls or E2-treated/follicle-ablated mares. Significant decreases in LH occurred when E2 was given when the largest follicle was either > or =25 mm, > or =28 mm, > or =35 mm, or near ovulation. Treatment with 200 or 2000 IU of hCG did not affect E2 concentrations during the initial portion of the LH surge (largest follicle, > or =25 mm), but 2000 IU significantly depressed E2 concentrations before ovulation (largest follicle, > or =35 mm). Results indicated a continuous negative effect of E2 on LH throughout the ovulatory follicular wave and may be related to the long LH surge and the long follicular phase in mares. Results also indicated that a reciprocal negative effect of LH on E2 does not develop until the E2 surge reaches a peak.

Relationships of Follicle Versus Oocyte Maturity to Ultrasound Morphology, Blood Flow, and Hormone Concentrations of the Preovulatory Follicle in Mares1

The effects of ultrasound morphology, vascularity, and follicular-fluid hormones of the preovulatory follicle on oocyte recovery rate and on follicle and oocyte maturity rates were studied for 60 spontaneous and solitary preovulatory follicles in mares. An ovulation-inducing dose of hCG was given when the follicle was >or=32 mm (Hour 0), and a procedure for oocyte recovery was done 30 h later (Hour 30). Between Hours 0 and 30, diameter of the follicle increased less and circulating estradiol (E2) concentrations decreased more in groups with successful versus nonsuccessful oocyte recovery and in groups with mature versus immature recovered oocytes, as indicated by significant interactions of group and hour. Significant differences in blood-flow end points between groups were not detected. At Hour 30, the frequency of granulosa serration, an indicator of impending ovulation, was higher (P < 0.001), and the number and expansion of granulosa cells in the lavaging fluid, indicators of follicle maturity, were greater in the oocyte-recovery group and in the oocyte-mature group. Follicular-fluid concentrations of E2, progesterone, and free insulin-like growth factor (IGF) 1 were not different between the oocyte-recovery and -nonrecovery groups. Concentration of progesterone was significantly greater, and E2 and free IGF1 were less in the oocyte-mature than in the immature groups. Results indicated that the post-hCG oocyte-recovery and oocyte-maturity rates were positively affected by follicle maturity. Greater follicular-fluid progesterone and lower E2 and free IGF concentrations were associated temporally with maturation of the oocyte but not with maturation of the follicle.

Elevated plasma testosterone concentrations during stallion-like sexual behavior in mares (Equus caballus)

Mounting interactions in mares isolated from stallions and the relationship to stage of the estrous cycle and level of circulating hormones were studied for 3 years in a herd averaging 105 mares. Mares were assigned to mounting, standing, and control groups. A control mare was selected by being within 1 day of the number of days after ovulation in a mounting mare. A total of 15 mounting interactions were detected by chance observation during the 3 years. A blood sample was collected immediately after the mounting interaction from each mare in the three groups, and a transrectal ultrasonographic examination of the reproductive tract was done. Two mounting interactions occurred during the early luteal phase and 13 during the follicular phase. The interactions that occurred during the follicular phase were used for comparisons among groups. The interval between mounting and the next ovulation, diameter of the two largest follicles, and the number of follicles larger and smaller than 20 mm were not different significantly among the mounting, standing, and control groups. Testosterone concentrations were higher (P<0.01) in the mounting group (17.7+/-2.3 pg/ml) than in standing group (10.9+/-0.5 pg/ml), and the difference between the mounting group and the control group (12.8+/-0.6 pg/ml) approached significance (P<0.08). Concentrations of androstenedione, estradiol, estrone, and progesterone did not differ significantly among groups. Results indicated that mounting behavior between mares is rare, usually occurs during the follicular phase, and is related to high circulating concentrations of testosterone.

Comparative features and outcomes of malaria at a tertiary care hospital in Karachi, Pakistan

OBJECTIVES

A comparison of clinical and laboratory features, diagnostic methods, drug treatment, and outcomes for patients hospitalized with malaria by Plasmodium species.

METHODS

Records of 521 patients hospitalized during the four and half-year study period were analyzed.

RESULTS

Infections were caused by Plasmodium vivax (51.8%), Plasmodium falciparum (46.5%), P. vivax plus P. falciparum (1.3%), and Plasmodium malariae (0.4%). Vomiting (odds ratio (OR)=1.86, p=0.001) and abdominal pain (OR=1.60, p=0.024) occurred more frequently in patients infected with P. falciparum compared to P. vivax; this was also the case for hepatomegaly, splenomegaly and jaundice. Low hemoglobin levels were common but were significantly lower with P. falciparum, and creatinine levels were significantly higher with P. falciparum. Treatment regimens consisted of single drug therapy (61.5%), appropriate combination therapy (15.8%), and inappropriate combination therapy (22.7%). Antimalarials given alone included chloroquine (38.7%), quinine (19%) and doxycycline (1.5%). The overall mortality was 1.7% (n=9) and nearly 56% of patients developed disease complications, most commonly thrombocytopenia (36.4%), anemia (23.4%), and thrombocytopenia plus anemia (32.7%).

CONCLUSIONS

Despite resistance, chloroquine was prescribed in patients with malaria requiring hospitalization. We found a high proportion of single antimalarial drug use as well as inappropriate combination therapy (22.7%), and inadequate use of primaquine terminal prophylaxis. Physicians need to be acquainted with malaria treatment guidelines in an endemic zone.

Follicle selection in cattle and horses: role of intrafollicular factors

The eminent event in follicle selection during a follicular wave in monovular species is diameter deviation, wherein one follicle continues to grow (developing dominant) and other follicles (subordinates) begin to regress. In cattle, the IGF system, oestradiol and LH receptors are involved in the intrafollicular events initiating deviation as indicated by the following: (1) concentrations of free IGF-I and oestradiol in the follicular fluid and number of LH receptors in the follicular wall increase more dramatically in the future dominant follicle than in the future subordinate follicles before the beginning of deviation and (2) ablation of the largest follicle (LF) or injection of recombinant human IGF (rhIGF)-I into the second LF at the expected beginning of deviation increases the concentrations of oestradiol in second LF before the expected beginning of deviation between second LF and third LF. In horses, an increase in free IGF-I, oestradiol, inhibin-A and activin-A is greater in the future dominant follicle than in other follicles before the beginning of deviation. However, free IGF-I is the only one of these four factors needed for the initiation of deviation in horses as indicated by the following: (1) ablation of LF at the expected beginning of deviation increases the concentrations of free IGF-I in second LF before the beginning of deviation between second LF and third LF but does not increase the other factors; (2) injection of rhIGF-I into second LF at the expected beginning of deviation causes second LF to continue to grow and become a codominant follicle and (3) injection of IGF-binding protein-3 into LF at the expected beginning of deviation causes LF to regress and second LF to become dominant. Thus, the dramatic changes in the IGF system in LF compared to other follicles before the beginning of deviation play a crucial role in the events that lead to the beginning of diameter deviation in both cattle and horses. Oestradiol and LH receptors also play a role in cattle. These intrafollicular events prepare the selected follicle for the decreasing availability of FSH and increasing availability of LH. The other follicles of the wave have the same future capability but do not have adequate time to attain a similar preparatory stage.

Effect of prostaglandin F2alpha on ovarian, adrenal, and pituitary hormones and on luteal blood flow in mares

The effect of a single injection of prostaglandin F2alpha (PGF) during mid-diestrus on systemic concentrations of progesterone, LH, FSH, estradiol, and cortisol and on blood flow to the corpus luteum was studied in 10 controls and 10 PGF-treated mares. Blood flow was assessed by estimating the percentage of corpus luteum with color-Doppler signals of blood flow during real-time scanning of the entire structure and by the diameter of the vascular pedicle near its attachment to the ovary. Treatment was done 8 days after ovulation and 0 h was immediately before the treatment. Examinations and collection of blood samples were done at 0 h, every 5 min until 1h, and then at 1.5, 2, 4, 8, 12, 24, 48, and 72 h. The concentrations of estradiol did not change, but progesterone, LH, FSH, and cortisol increased significantly within 5 min. Concentrations of LH and FSH in the PGF group remained elevated until a temporarily lower concentration at 8 or 4h, respectively, rebounded to 12h, and then slowly decreased. Cortisol remained elevated, until a decrease between 1 and 4h. Progesterone in the PGF group increased significantly until 10 min after 0 h and then decreased by 40 min to below the concentrations in controls. Within the PGF group, progesterone decreased significantly by 45 min to below the concentrations at 0 h. The values for each of the two indicators of blood flow did not differ significantly between the PGF and control groups until a decrease at 24h in the PGF group. Results did not support the hypothesis that the immediate transient post-PGF increase in progesterone was associated with an increase in luteal blood flow. Luteolysis, as indicated by decreasing progesterone, began well before the beginning of a decrease in luteal blood flow.