ABSTRACT
Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting.Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa.Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.
Subject(s)
Critical Care , COVID-19 , Intensive Care Units , Emergency Service, Hospital , Pandemics , Hospital AdministrationABSTRACT
El presente trabajo se realizó con la finalidad de evaluar la calidad nutricional de la harina de lenteja de agua (Lemna obscura) como ingrediente en la elaboración de alimento para tilapia roja (Oreochromis spp.). Se prepararon 3 dietas con niveles de inclusión de 15 por ciento (dieta A), 25 por ciento (dieta B) y 35 por ciento (dieta C) y una dieta control exenta de harina de Lemna. Estas fueron isocalóricas e isoproteicas con un nivel de 30 por ciento de proteína. Además se utilizó una dieta comercial (dieta D), con 40 por ciento de proteína, para compararla con las dietas experimentales. Los alevines se alimentaron durante 10 semanas consecutivas y cada catorce días, se evaluaron los parámetros más importantes como ganancia de peso, alimento consumido, factor de conversión alimentaria (FCA) y la relación eficiencia-proteica (REP). La comparación estadística reveló que no hubo diferencias significativas (P>0,05) en los valores de los resultados finales de la conversión entre las dietas Control A, B, C y D. En relación al peso promedio final, hubo diferencias significativas (P<0,05) entre los peces alimentados con la dieta B, con respecto a la dieta control y dieta comercial. No hubo diferencias significativas entre las dietas experimentales (P>0,05). Se demuestra en este estudio que la dieta con un 25 por ciento de inclusión resultó ser más eficiente en cuánto a los parámetros evaluados que la dieta control. Los excedentes de Lemna crecidos en el lago de Maracaibo o cultivados pueden ser utilizados como harina en las dietas para tilapia roja y representa una alternativa para reducir los costos de alimentación, siempre y cuando se utilice en combinación con otros ingredientes de alto contenido proteico.
The present work was carried out with the purpose to evaluate the nutritional quality of duckweed (Lemna obscura) meal as ingredient in the food elaboration for red tilapia (Oreochromis spp.). Three diets were prepared with inclusion levels of 15 percent (diet A), 25 percent (diet B) and 35 percent (diet C) and a control diet free of Lemna meal. The diets were isocaloric and isonitrogenous with 30 percent of protein. Furthermore, commercial diet (diet D) with 40 percent protein was used to compare with experimental diets. The fingerlings were fed during 10 weeks consecutive and fourteen days, were evaluated the most important parameters as weight gain, consumed food, feed convertion ratio (FCR) and the protein efficiency ratio (PER). The statistical comparison revealed that there were no significant differences (P>0.05) in the values of final results of convertion among diets control, A, B, C and D. In relation to weight average final there were significant differences (P<0.05) among the fish fed with the diet B with respect to the control diet and commercial diet. There were no significant differences among experimental diets (P>0.05). This study showed that diet with inclusion level 25 percent resulted to be more efficient in how much to the evaluated parameters that the diet control. The excesses of Lemna grown in the Maracaibo lake or cultivated can be used as meal in the diets for red tilapia and represents one alternative to reduce the feeding costs, as long as it used in combination with other ingredients of high protein content.
Subject(s)
Animals , Animal Feed/adverse effects , Flour , Nutritive Value , Tilapia , Animal Nutrition SciencesABSTRACT
Utilizando-se as tecnicas de microscopia eletronica e ELISA, rotavirus foram detectados em 4 (16%) de 25 especimes fecais de criancas portadoras de quadro diarreico agudo. Em 2 desses 4 materiais, apenas rotavirus foram detectados, sem quaisquer outros enteropatogenos contamitantes; nos outros dois foram observadas associacoes de rotavirus com Klebsiella sp em um caso e com cogumelos em brotamento em um outro