Current perspectives on defining and mitigating frailty in relation to critical illness.

Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.

Familial hypercholesterolemia: Is there a role for PCSK9 and thrombin generation?

INTRODUCTION: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease. The prevalence of FH has previously been reported as 1 in 500 in the general population. This study aimed to evaluate the proprotein convertase subtilisin/kexin 9 (PCSK9) levels, lipid profile and thrombin generation in FH patients undergoing treatment or not. METHODS: Eighty individuals with FH were selected and distributed in 2 groups: individuals treated with statins alone or conjugate therapy (statin + ezetimibe) (T = 53) and those non treated (NT = 27). PCSK9 levels were determined by ELISA, the lipid profile by colorimetric enzyme method and thrombin generation assay (TGA) by CAT method. RESULTS: Individuals treated with conjugate therapy (statin + ezetimibe) showed a significant reduction in the levels of total cholesterol (TC) low density lipoprotein cholesterol (LDLc) and in the potential for thrombin generation (ETP with low and high concentration of tissue factor), compared to the treated individuals with monotherapy (statins). PCSK9 was positively correlated with increased levels of TC, LDLc and triglycerides, while TGA parameters were positively correlated with PCSK9 and lipid profile. CONCLUSION: PCSK9 levels appear to be associated with components of the lipid and hemostatic profiles, in addition to being influenced by age. In general, our findings suggest that combined therapy for the treatment of FH is associated with a significant improvement in both lipid and hemostatic profiles assessed by TGA, suggesting a reduction in atherogenic and thrombogenic risks and, therefore, more promising compared to the use of statin monotherapy.

Qualidade da carne de ovinos terminados em confinamento com dietas com silagens de diferentes cultivares de sorgo / Meat quality of finishing feedlot lambs fed diets of assorted sorghum cultivars

Objetivou-se avaliar a influência de dietas contendo silagem de diferentes cultivares de sorgo sobre as características físicas e químicas na carne de ovinos sem padrão racial definido, com idade entre cinco e sete meses e peso vivo médio de 17,7±3,7kg, alimentados com dietas contendo silagem de diferentes cultivares de sorgo. O experimento foi conduzido na Estação Experimental Pendência, pertencente à Empresa Estadual de Pesquisa Agropecuária - Emepa, tendo um período experimental de 42 dias. Utilizou-se um delineamento inteiramente ao acaso, com cinco tratamentos (silagem de sorgo BRS 610, BRS 655, BRS 800, BRS 810 e Ponta Negra) e sete repetições. Ao atingirem o peso de abate de 26,24kg, os animais foram encaminhados ao abate. Procedeu-se à análise do pH, da cor, da perda de peso por cocção, da força de cisalhamento, bem como à determinação de umidade, proteínas, cinzas e lipídeos totais no músculo Longissimus dorsi. As dietas não influenciaram os parâmetros de pH (5,64), cor (L*23,13, a* 18,00, b*15,78), perdas de peso por cocção (34,43%), umidade (72,53%), proteína (24,08%), cinzas (1,09%) e lipídeos (2,99%). A força de cisalhamento diferiu entre as dietas, com a silagem do cultivar BRS 655 propiciando uma carne mais macia (2,10kgf/cm2). As silagens de sorgo utilizadas na confecção das dietas de cordeiros em confinamento não interferem nas características de qualidade da carne de ovinos sem padrão racial definido. Dietas contendo silagem de sorgo granífero BRS 655 proporcionaram uma carne mais macia.(AU)

This study aimed to evaluate the influence of diets containing silage of different sorghum cultivars on the physical and chemical characteristics in the meat of lambs. Thirty five animals of undefined breed with average age between 5 and 7 months and average body weight of 17. 7±3.7kg were used. The lambs were randomly assigned to five treatments (sorghum silage BRS 610, BRS 655, BRS 800, BRS 810 e Ponta Negra) with seven replicates. When they reach 26.24kg of weight, the animals were sent to be slaughtered. Proceeded to the analysis of pH, color, cooking losses, shear force, determination of humidity, protein, ash and total amount of lipids in the Longissimus dorsi. The diets did not influence the parameters of pH (5.64), color (L*23.13, a* 18.00, b*15.78), cooking losses (34.43%), humidity (72.53%), protein (24.08%), ash (1.09%) or lipids (2.99%). The shear force differed among the diets, with the silage of cultivar BRS 655 providing a tender meat (2.10kgf/cm2). The sorghum silages used in in the diets did not interfere in the meat quality characteristics of feedlot lambs. Diets containing sorghum grain silage BRS 655 provided a tender meat.(AU)

Milk adulteration: Detection of bovine milk in bulk goat milk produced by smallholders in northeastern Brazil by a duplex PCR assay.

The aim of this study was to investigate the adulteration of goat milk produced by smallholders in semiarid northeastern Brazil with bovine milk as an adulterant. The study was requested by the association of smallholder producers in the region to investigate and to inhibit adulteration practices as a need to ensure the quality and safety of goat milk. A duplex PCR assay has been developed and standardized. Further validation was performed in 160 fresh bulk goat milk samples. The detection limit of the duplex PCR was 0.5% bovine milk in goat milk and the results indicated that 41.2% of the goat milk presented to market was positive for bovine milk. Making the test available to the association of producers, together with extension activities, have been applied to reduce adulteration in goat milk sold to small-scale dairy plants and to ensure the species origin for goat milk in the state of Paraíba.

Risk factors associated with selected indicators of milk quality in semiarid northeastern Brazil.

The aim of this study was to gain information on quality traits, mainly bacterial and somatic cell counts of bulk milk, produced by small- and medium-scale producers in a semiarid northeastern region of Brazil and to identify and characterize possible risk factors associated with those quality traits. A cross-sectional study was performed on 50 farms. Bulk milk samples were collected for bacterial and somatic cell counts. Additionally, information about farm demographics, general management practices, hygiene, and milking procedures was also obtained. Multivariable analysis using logistic regression was performed with predictors previously identified by univariate analysis using a Fisher's Exact test. Aerobic mesophilic bacteria counts varied from 3.59 log to 6.95 log cfu/mL, with geometric mean of 5.27 log cfu/mL. Mean total coliform count was 3.27 log (1.52 log to 5.89 log) most probable number (MPN)/mL, whereas mean thermotolerant coliforms was 2.38 log (1.48 log to 4.75 log) MPN/mL. A high positive correlation was observed between aerobic mesophilic bacteria and coliform counts. Although most farms met the standard for the current regulations for total bacteria (88%) and somatic cell counts (94%), nearly half of the producers (46%) would have problems in achieving the 2012 threshold limit for total bacteria count if no improvement in milk quality occurs. Mean value for staphylococci was 3.99 log (2.31 log to 6.24 log) cfu/mL, and Staphylococcus aureus was detected in 33 (66%) farms. Premilking teat-end wash procedure (odds ratio=0.191) and postmilking teat dip (odds ratio=0.67) were associated with lower aerobic mesophilic bacteria and Staphylococcus aureus counts in bulk milk, respectively. Considering that the farm characteristics in this study are representative of the semiarid northeastern region, these findings encourage further investigations for supporting intervention measures intended to improve the quality of milk produced by smallholders.