Morbidity and mortality in Holstein calves from birth to 145 days of age on a large dairy farm in Brazil / Morbidade e mortalidade em bezerras da raça Holandesa do nascimento aos 145 dias de vida, em uma grande fazenda produtora de leite no Brasil

The present study aimed to investigate the morbidity and mortality associated with the most common diseases during the rearing period of Holstein calves in a high-production dairy farm. The calves (n = 600) were allocated to three groups based on age: G1 (1-7 days, n = 216), G2 (30-40 days, n = 188), and G3 (69-85 days, n = 196). They were evaluated over 60 days at eight different times. The morbidity rates were 47.67% (286/600) for diarrhea, 73.00% (438/600) for bovine respiratory disease (BRD), and 3.83% (23/600) for umbilical inflammation (UI). The mortality rate was 2.33% (14/600) for all the animals studied. The morbidity differed in the groups, with higher rates of diarrhea (78.85%, 166/216) and UI (6.94%, 15/216) in G1, and the highest rate of BRD in G3 (79.59%, 156/196). Diarrhea was associated with the occurrence of BRD in G1 and G2. Even in farms with good management practices, there is high morbidity associated with diarrhea and BRD, with the morbidity rate for diarrhea decreasing and that for BRD increasing as the animals get older. In addition, diarrhea is an important risk factor for BRD, especially in younger animals.(AU)

O presente estudo objetivou investigar a morbidade e a mortalidade associadas às doenças mais comuns no período de criação de bezerras da raça Holandesa, em uma fazenda leiteira de alta produção. As bezerras (n = 600) foram alocadas em três grupos de acordo com a idade: G1 (1-7 dias, n = 216); G2 (30-40 dias, n = 188); G3 (69-85 dias, n = 196). Os animais foram avaliados durante 60 dias, em oito momentos diferentes. A morbidade foi de 47,67% (286/600) para diarreia, 73,00% (438/600) para doença respiratória bovina (DRB) e 3,83% (23/600) para inflamação umbilical (IU). A taxa de mortalidade foi de 2,33% (14/600), para o total de animais avaliados. A morbidade foi diferente entre os grupos, com maior frequência de diarreia (78,85%, 166/216) e IU (6,94%, 15/216) no G1, sendo a maior ocorrência de DRB no G3 (79,59%, 156/196). A diarreia foi associada à DRB no G1 e no G2. Mesmo em fazendas com boas práticas de manejo, há alta morbidade por diarreia e DRB, com a taxa de morbidade por diarreia diminuindo e a de DRB aumentando à medida que os animais envelhecem. Além disso, a diarreia é um importante fator de risco para DRB, especialmente em animais mais jovens.(AU)

Evolution of incidence, mortality and cost of nontraumatic abdominal emergencies treated in Brasil in a period of nine years

SUMMARY OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.

RESUMO OBJETIVO: Avaliar a evolução da Incidência, mortalidade e custo das urgências abdominais não traumáticas atendidas nos serviços de emergência do Brasil durante o período de nove anos. MÉTODOS: Este trabalho utilizou informações do DataSus de 2008 a 2016, (http://www.tabnet.datasus.gov.br). Foram analisados número de internações, valor médio das internações (AIH), valor total das internações, dias de permanência hospitalar e taxa de mortalidade das seguintes doenças: apendicite aguda, colecistite aguda, pancreatite aguda, diverticulite aguda, úlcera gástrica e duodenal, e doença inflamatória intestinal. RESULTADOS: A doença que teve o maior crescimento do número de internações foi a doença diverticular do intestino, com o valor de 68,2%. Ao longo dos nove anos não houve grandes variações da média de permanência hospitalar, sendo que o maior aumento foi o da úlcera gástrica e duodenal, com crescimento de 15,9%. A taxa de mortalidade da doença por úlcera gástrica e duodenal teve um aumento de 95,63%, consideravelmente significante quando comparada com as outras doenças. Todas tiveram seus valores de AIH aumentados, porém, a que proporcionalmente teve o maior aumento nos últimos nove anos foi a úlcera gástrica e duodenal, com um acréscimo de 85,4%. CONCLUSÃO: As urgências abdominais de origem não traumática são de extrema prevalência, por isso a importância em ter dados atualizados e comparativos sobre a taxa de mortalidade, o número de internações e os custos gerados por essas doenças, para melhor planejamento dos serviços públicos de saúde.

Defunciones en niños a principios de los siglos XX y XXI en Boyacá-Colombia / Deaths in children during the early twentieth and twenty-first century in Boyacá, Colombia

Objetivo Comparar y analizar las Tasas Brutas de Mortalidad (TBM), la Mortalidad en Menores (MN) de 5 años por mil Nacidos Vivos (NV) y la Mortalidad Infantil (MI) en el departamento de Boyacá-Colombia, a comienzos de los siglos XX y XXI. Métodos Estudio descriptivo comparativo con enfoque histórico epidemiológico. Se utilizaron dos fuentes de datos, para las defunciones: registros parroquiales de 1912-1927 y el Boletín epidemiológico de Boyacá 2007; para la población los censos DANE 1912-1918-1927 y 2005. Se almacenaron y analizaron en Mysql®. Se calcularon tasas brutas, específicas por edad e infantil, proporciones de mortalidad y mortalidad por causas. Resultados Entre 1912-1927 se registra una media de 7 958 muertes, en comparación con 5 813 en el siglo XXI; la TBM pasó de 150 muertes a 42 por 10 mil habitantes; la TMI se redujo considerablemente pasando de 231 a 17 por cada 1 000 NV; aunque se pueden comparar las tasas especificas en menores de 8 años con las de menores de 5, existe variabilidad en el rango y en la construcción de la TM especifica y la definida por OMS- UNICEF. Conclusiones Existe un impacto en la reducción de mortalidad, mayor en el siglo XXI, debido a las políticas nacionales e internacionales de control de enfermedades inmunoprevenibles y muerte materna. La pandemia de gripa de 1918-19 afectó considerablemente la mortalidad en todos los grupos de población; las causas violentas ocupan lugares importantes en la mortalidad infantil en el siglo XXI.

Objective Comparing and analysing crude death (CDR), child mortality (CMR) 5-year per thousand live births (LBR) and infant mortality rates (IMR) in the Boyacá department, Colombia, during the early 20th and 21st centuries. Methods A descriptive epidemiological comparative historical approach was adopted. Two data sources were used for deaths: parish registers 1912-1927 and the Boyacá Epidemiological Bulletin 2007 population census for 1912-1918-1927 and 2005 (Colombian Statistics Bureau - DANE); data was stored and analysed in Mysql. Crude rates, age-specific and child mortality ratios and mortality were calculated by cause. Results 7,958 deaths were recorded from 1912-1927 compared to 5,813 in the 21st century. CDR dropped from 150 to 42 deaths per 10,000 inhabitants; the IMR became significantly reduced from 231 to 17 for every 1,000 LB. Although specific rates for children under 8 years of age could be compared to children under 5, there was variability in the range and construction of the specific MR and that defined by WHO-UNICEF. Conclusions There was a higher reduction in mortality in the 21st century due to national and international policies for controlling preventable diseases and maternal death. The 1918-19 flu pandemic significantly affected mortality in all population groups; violent causes were prominent in infant mortality in the 21st century.

Diagnóstico de enfermedades gastroenterológicas en provincia / Diagnosis of gastroenterological diseases in provincial setting

The “diagnosis of gastroenterological diseases in province setting” does not differ from the diagnosis made in the Metropolitan Region (MR). However, in the MR, there are more complex centers with greater numbers of gastroenterologists. The specialists are more concentrated in the private health sector, leaving the public health sector lacking medical hours, at the MR and province. Digestive pathologies expressed by mortality and hospital discharge rates, vary in the different regions of the country, particularly in the case of gastric cancer, which is more frequent in the less developed areas in the central and southern regions of the country. Regions are well equipped in terms of imaging and laboratory for gastroenterological purposes, in both public and private sectors, however, the private sector has achieved more development in the last years.

El “diagnóstico de enfermedades gastroenterológicas en provincia” no difiere mayormente con el que se hace en la Región Metropolitana (RM), no obstante existen centros con implementación más compleja y mayor número de especialistas en gastroenterología a nivel central. La distribución de gastroenterólogos es mayor en el área privada de salud, con gran carencia de horas médicas en el sistema público, tanto en la RM como en provincia. Las patologías digestivas expresadas por tasas de mortalidad y egresos hospitalarios difieren en las distintas zonas del país, especialmente el cáncer gástrico, en áreas más pobres, preferentemente zona centro sur del país. Las regiones cuentan con implementación en gastroenterología, imágenes y laboratorio tanto en el sector público, como privado, no obstante este último ha logrado mayor desarrollo en los últimos años.

Alterações gastrintestinais de pacientes críticos em uso de norepinefrina e terapia nutricional enteral / Gastrointestinal disorders of critical patients in use of norepinephrine and enteral nutrition therapy / Trastornos gastrointestinales de los pacientes críticos en el uso de la norepinefrina y la terapia nutricional enteral

A terapia nutricional em pacientes críticos com uso de vasoconstrictores é um desafio na prática clínica, tanto pelas alterações hemodinâmicas comuns da alimentação, quanto pelas mudanças na perfusão esplâncnica provocada por estas drogas. O objetivo do presente estudo foi avaliar as principais alterações gastrointestinais de pacientes críticos em uso de noradrenalina (norepinefrina) e terapia nutricional. Estudo retrospectivo realizado em uma Unidade de Terapia Intensiva (UTI) de emergências traumáticas da cidade de Salvador. Foram analisados pacientes em uso de terapia nutricional enteral e noradrenalina por no mínimo 48 horas. Os pontos de corte para dose de noradrenalina foram menor e igual que 0,3mcg/kg/min e maior que 0,3mcg/kg/min. Foram avaliados resíduo gástrico elevado, distensão abdominal, vômito e diarréia. Trinta e cinco pacientes foram estudados, sendo a maioria do sexo masculino (83%) com idade média de 37,3 mais ou menos 18,1 anos. O diagnóstico clínico mais frequente foi o traumatismo cranioencefálico (68,6%). A terapia nutricional precoce ocorreu em 91% dos casos e o tempo médio de uso da noradrenalina foi de 7,9 mais ou menos 5,6 dias. Os sintomas de intolerância mais frequentes foram distensão abdominal e resíduo gástrico elevado, ambos com frequência de 42,9%. Apenas nove pacientes (25,7%) tiveram suspensão provisória da terapia nutricional por alterações gastrointestinais, sendo resíduo gástrico elevado o motivo mais frequente. O tempo de uso da noradrenalina na concentração menor ou igual 0,3mcg/kg/min foi maior entre pacientes que apresentaram distensão abdominal comparado com aqueles que não tiveram esse sintoma (p < 0,05). Concluindo-se, a terapia nutricional enteral precoce foi possível nos pacientes que utilizaram noradrenalina em dose menos ou igual 0,3mcg/kg/min por tempo prolongado sem grandes prejuízos.

Nutritional support in critical patients with the use of vasoconstrictors is a challenge in clinical practice, both by hemodynamic common food, as by changes in splanchnic perfusion caused by these drugs. The aim of this study was to assess the main gastrointestinal disorders in critically ill patients using noradrenaline (norepinephrine) and nutritional therapy. Retrospective study on an Intensive Care Unit (ICU) of traumatic emergencies in the city of Salvador. We analyzed patients on enteral nutrition therapy and norepinephrine for at least 48 hours. The cutoff points for the dose of norepinephrine were smaller and less than 0.3 mcg/kg/min and greater than 0.3 mcg/kg/min. We evaluated high gastric residuals, abdominal distension, vomiting and diarrhea. Thirty-five patients were studied, most were male (83%) with mean age of 37.3 plus or minus 18.1 years. The most common clinical diagnosis was head injury (68.6%). Nutritional therapy occurred early in 91% of cases and mean duration of use of norepinephrine was 7.9 plus or minus 5.6 days. The most common symptoms of intolerance were abdominal distension and elevated gastric residuals, both with frequency of 42.9%. Only nine patients (25.7%) had temporary suspension of nutrition therapy for gastrointestinal disorders, and high gastric residue the most frequent reason. The time of use of noradrenaline in the concentration less than or equal to 0.3 mcg/kg/min was higher among patients who had abdominal distension compared with those without this symptom (p < 0.05). Concluding, nutritional therapy Early enteral possible in patients using norepinephrine dose less or equal to 0.3 mcg/kg/min for a prolonged period without large losses.

El soporte nutricional en pacientes críticos con el uso de vasoconstrictores es un desafío en la práctica clínica, tanto por los alimentos comunes hemodinámicos, como por los cambios en la perfusión esplácnica causados por estas drogas. El objetivo de este estudio fue evaluar los principales trastornos gastrointestinales en pacientes críticamente enfermos con la noradrenalina (norepinefrina) y la terapia nutricional. Estudio retrospectivo de una Unidad de Cuidados Intensivos (UCI) de las emergencias traumáticas en la ciudad de Salvador. Se analizaron los pacientes en terapia de nutrición enteral y la noradrenalina durante al menos 48 horas. Los puntos de corte para la dosis de noradrenalina eran más pequeños y menos del 0,3 mcg/kg/min y mayor de 0,3 mcg/kg/min. Se evaluó alta residuos gástricos, distensión abdominal, vómitos y diarrea. Treinta y cinco pacientes fueron estudiados, la mayoría eran hombres (83%) con edad media de 37,3 más o menos 18,1 años. El diagnóstico clínico más frecuente fue la lesión en la cabeza (68,6%). La terapia temprana nutricional se produjo en el 91% de los casos y el tiempo promedio de uso de norepinefrina fue de 7,9 más o menos 5,6 días. Los síntomas más comunes de la intolerancia fueron distensión abdominal y aumento de residuos gástricos, ambos con una frecuencia del 42,9%. Sólo nueve pacientes (25,7%) tenían una suspensión temporal de la terapia nutricional para los trastornos gastrointestinales, y los residuos de alta gástrico la causa más frecuente. El tiempo de uso de la noradrenalina en la concentración menor o igual a 0,3 mcg/kg/min fue mayor entre los pacientes que habían distensión abdominal en comparación con aquellos sin este síntoma (p < 0,05). En conclusión, la terapia nutricional Los primeros posibles enteral en pacientes que utilizan dosis de noradrenalina menor o igual a 0,3 mcg/kg/min durante un período prolongado sin grandes pérdidas.

Clinicopathologic Characteristics and Therapeutic Outcomes of Primary Gastrointestinal Non-Hodgkin's Lymphomas in Central Anatolia, in Turkey

Primary gastrointestinal lymphoma is a common presentation of non-Hodgkin's lymphoma. The main controversy arises when many aspects of its classification and management are under discussion, particularly regarding roles for surgical resection. The aim of this study was to evaluate clinicopathologic characteristics and the therapeutic outcome of primary gastrointestinal non-Hodgkin's lymphoma. We carried out a retrospective analysis of 74 patients who were presented to our center with histopathological diagnosis of primary gastro-intestinal non-Hodgkin's lymphoma between 1990 and 2001. All patients have been staged according to Lugano Staging System. For histopathological classification, International Working Formulation was applied. The treatment choice concerning the surgical or non-surgical management was decided by the initially acting physician. Treatment modalities were compared using the parameters of age, sex, histopathological results, stage, and the site of disease. Of the 74 patients, 31 were female and 43 were male, with a median age of 49 years (range 15-80). The stomach was the most common primary site and was seen in 51 of 74 patients (68.9%). The intermediate and high grade lymphomas constituted 91.9% of the all cases. In a median follow-up of 29 months (range 2-128), 20 out of 74 patients died. There was a three year overall survival rate in 65.4% of all patients. The three year overall survival rate was better in stage I and II1 patients who were treated with surgery plus chemotherapy (+/-RT) than those treated with chemotherapy alone (93.7% vs. 55.6%, p<0.05). The stage and presence of B symptoms affected the disease free survival and overall survival significantly, but the histopathologic grade only affected the overall survival. On the basis of these results, we suggest that surgical resection is necessary before chemotherapy in early stage (stage I and II1) patients with gastrointestinal non-Hodgkin's lymphomas because of the significant survival advantage it would bring to the patient.

¿De qué mueren las mujeres en Chile? / What is the cause of death of chilean women?

We analyzed all death certificates issued 1991 to investigate the principal diseases cuasing death among chilean women. We calculated direct relative risks and their confidence intervals, highlighting those diseases causing a significantly higher number of deaths among women. The main causes of death, shared by men and women, were acute myocardial infarction, cerebrovascular diseases and bronchopneumonia. The diseases that caused more deaths among women were fractures of head of femur, gallbladder cancer, mitral valve disease, kidney infections and cholelithiasis