Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection: An Observational Study in Danish Small Animal Practices.

BACKGROUND: Clinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work-up could optimize treatment and reduce the risk of inappropriate use of antibiotics. HYPOTHESIS/OBJECTIVES: To describe and evaluate the impact of diagnostic work-up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease. ANIMALS: One hundred and fifty-one dogs presenting to 52 Danish veterinary practices. METHODS: Prospective, observational study. Clinical signs, diagnostic work-up, and prescriptions were recorded. Urine samples were submitted to a reference laboratory for quantitative bacterial culture (QBC) and susceptibility testing. The laboratory results were used as reference for assessing the appropriateness of DTT and COT. RESULTS: In the majority of dogs, veterinarians performed dipstick (99%), microscopic examination of urine (80%) and bacterial culture (56%). Fifty-one percent of dogs had urinary tract infection (UTI) based on reference QBC. Appropriate DTT was made for 62% of the dogs, while 36% were over-prescribed and 2% under-prescribed. Inappropriate use of second-line agents was found in 57% of the UTI cases. Performing microscopy-but not culture-significantly impacted DTT (P = 0.039) while no difference was seen in COT (P = 0.67). The accuracy of in-house microscopy and culture were 64.5 and 77%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Over-prescription of antibiotics was common among dogs with suspected UTI, regardless of the diagnostic work-up performed. Test inaccuracy under practice conditions and incoherence between diagnostic test results and decision-making both explained inappropriate and unnecessary use of antibiotics.

Acción de tutela y barreras de acceso a servicios de salud en labio y/o paladar hendido / Tutela and acces barriers to helth services to cleft lip and palate / Ação de tutela 1 e barreiras de acesso aos serviços de saude em pacientes com fissuras labiopalatinas

La investigación busca identificar barreras de acceso a servicios de salud para la atención integral de pacientes con labio y/o \r\npaladar hendido (LPH) a partir del análisis de acciones de tutela relacionadas con esta condición en un periodo de veinte años: \r\n1994-2014. Se identificaron tutelas interpuestas por familiares de niños con LPH; se construyó una matriz para organizar los datos \r\nmás relevantes (motivos de tutela, fallo y consideraciones para este); posteriormente, se hizo un análisis para identificar las barreras \r\ny la manera como la justicia resuelve la solicitud. En total, se analizaron once fallos de tutela. El principal motivo para interponerlas \r\nfue la negación por parte de la entidad promotora de salud de tratamientos para LPH por no encontrarse incluidos en el plan de \r\natención en salud (catalogados como estéticos) o por falta de infraestructura para su atención. Cinco de ellas fueron negadas por \r\nrazones administrativas o procedimentales, por dificultades en la afiliación a una entidad de salud o porque cesaron los efectos \r\nque motivaron la tutela. En las tutelas aceptadas, se obliga a realizar la atención integral, considerando la garantía del derecho a la \r\nsalud en conexidad con los derechos a la vida, la dignidad y los derechos de los niños. Conclusión: la principal barrera de atención para pacientes con LPH se relaciona con el hecho de que algunos tratamientos no están incluidos en el plan de atención en salud \r\nde Colombia; por tanto la acción de tutela, a la luz del derecho a la salud, permite aclarar imprecisiones del Sistema General de \r\nSeguridad Social y superar las barreras en la atención de individuos con labio y/o paladar hendido.

Objective: to identify access barriers to health services to \r\nachieve comprehensive care of patients with Cleft Lip and/or \r\nPalate (CLP), based on a "tutela," or writ of fundamental rights, \r\nanalysis related with this condition in a 20-year period, from \r\n1994 to 2014. Materials and methods: tutelas from parents of \r\nchildren with CLP were identified; a matrix to organize the \r\nrelevant data (reasons for the tutela, verdict and related consid\r\n-\r\nerations) was developed and an analysis carried out to identify \r\nthe barriers and how the issues were legally resolved. Results: \r\nthere were 11 tutelas reviewed and the main reasons for their \r\nfilings were: negation of treatment for conditions related to \r\nCLP, as they were not included in the health plan that regarded \r\nthe treatment as aesthetic intervention, or due to lack of infra\r\n-\r\nstructure for their attention. Five were denied due to lack of \r\nawareness of the attending agency, difficulties in affiliation to \r\na health provider, or due to cessation of the effects that led \r\nto the tutela. In those, which were accepted, comprehensive \r\nhealth was mandated, taking into consideration the right of \r\naccess to health in relation to the rights of life, dignity and chil\r\n-\r\ndren's rights. Conclusion: the main barrier to care for patients \r\nwith CLP is related to the fact that some treatments are not \r\nincluded in the health care plan of Colombia; therefore the \r\ntutela, in light of the right to health, can clarify ambiguites of \r\nthe General System of Social Security and overcome barriers in \r\nthe care of individuals with cleft lip and/or palate.

Objetivo: identificar barreiras de acesso aos serviços de saúde \r\npara atenção integral de pacientes com fissuras labiopalatinas \r\n(FLPs), partindo da análise das ações do procedimento cons\r\n-\r\ntitucional relacionadas com essa condição, em um período \r\nde 20 anos: 1994-2014. Materiais e métodos: identificaram-se \r\nprocedimentos constitucionais interpostos pela família das \r\ncrianças com FLPs; foi criada uma matriz para organizar os \r\ndados mais relevantes (motivos do procedimento constitu\r\n-\r\ncional, conclusão e considerações para esta) logo, foi feita uma \r\nanálise para identificar as barreiras e o modo como a justiça \r\nas resolve. Resultados: foram analisados 11 procedimentos \r\nconstitucionais. As principais razões para interpô-los: negação \r\ndos tratamentos para FLPs, por não se encontrarem inclusas \r\nno plano de saúde (estéticos) ou pela ausência de infraestru\r\n-\r\ntura para seu atendimento. Cinco deles foram negados: pelo \r\ndesconhecimento perante à entidade encarregada da atenção, \r\ndificuldades na afiliação a um plano de saúde ou porque \r\ncessaram os efeitos que os motivaram. Nos aceitos, obriga-\r\nse a realizar a atenção integral, considerando-se a garantia \r\ndo direito em conexão com os direitos à vida, dignidade e \r\ndireitos das crianças. Conclusão: A principal barreira para cuidar \r\nde pacientes com FLP está relacionado com o fato de que \r\nalguns tratamentos não estão incluídos no plano de saúde \r\nda Colômbia; portanto, a tutela, à luz do direito à saúde, pode \r\nesclarecer imprecisões do Regime Geral da Segurança Social \r\ne superar as barreiras no cuidado aos indivíduos com fissuras \r\nlabiopalatinas.

Composition and nutritive value of yeast biomass and yeast protein concentrates.

Yeast biomass (Saccharomyces sp.) produced in local breweries as a by-product was utilized in this study. Percent proximate composition, amino acid composition, and protein nutritive value were determined for the yeast cell biomass (YC), a sodium perchlorate extracted and isoelectrically precipitated protein concentrate (P-PC), and a sodium trimetaphosphate treated extract followed by isoelectrical precipitation (TMP-PC). Protein concentrates averaged 75% protein as compared to 48.5% in the yeast biomass. Precipitation of the protein in the presence of either sodium perchlorate or sodium trimetaphosphate was reduced to 71% and 51% of the cell RNA content, respectively. Protein nutritive value was 70% of casein when measured by the protein efficiency ratio (PER), and over 90% of casein when net protein utilization (NPUa) was the criteria of evaluation.

Comparison of Petrifilm method to conventional methods for enumerating aerobic bacteria, coliforms, Escherichia coli and yeasts and molds in foods.

The Petrifilm plates method was compared to conventional methods (PCA, VRBA, Levine EMB agar and OGYE agar) for enumeration of mesophilic aerobic bacteria, coliforms, Escherichia coli, and yeasts+molds in six homogeneous lots of different food groups (pasteurized milk, yoghurt ice cream, eggs, minced meat, fresh strawberries and frozen green beans). For all the microbiological criteria except for yeasts and molds and mesophilic aerobic bacteria in frozen green beans, the mean values of counts with Petrifilm plates were higher than those obtained with traditional methods. The correlation coefficient of Petrifilm aerobic bacteria, coliforms, and yeasts + molds v. PCA, VRBA and OGYE agar for each microbiological criterion for a composite of six food products were 0.897, 0.861 and 0.981, respectively.

Eficacia del legrado uterino por aspiración en el tratamiento del aborto incompleto, Hospital Hilario Sánchez-Masaya dic. De 1989 a sept. De 1990 / Effectiveness of the uterine legrado for aspiration in the treatment of the incomplete abortion, Hospital Hilario Sánchez-Masaya dic. Of 1989 to sept. Of 1990

Se estudia en el Hospital Hilario Sánchez de Masaya, en el período Noviembre de 1989 a septiembre de 1990, un total de 460 expedientes de pacientes que fueron tratadas con aspiración manual con jeringa de y cánula karman, seleccionándose 299 con diagnóstico de aborto incompleto, de estos 80 pacientes les fue valorado el post-operatorio a los 7 días en consulta externa. Se estudia además, 80 expedientes que fueron sometidos a legrado instrumental, 40 de estas pacientes fueron visitadas en el domicilio para obtener información sobre la evolución post-operatoria; se compara y analiza la eficacia del legrado pos aspiración manual en el tratamiento del aborto incompleto. Se determinó que las pacientes que sufren de aborto incompleto son mujeres en edad reproductiva y no están en los extremos ni son adolescentes, si son viejas. La mayor parte ha tenido mas de 3 hijos y poseen bajo nivel cultural, generalmente son casadas o con unión estable. La principal indicación del legrado por aspiración es el tratamiento de aborto incompleto pero también se usa como diagnóstico y tratamiento del sangrado disfuncional y restos post-parto. No se reportan complicaciones moyaores en el primer año de implementado el procedimiento, dichas complicaciones son principalmente sangrado aumentado y laceraciones de cuello siendo en su mayoria ocasionadas cuando el operador es un médico interno. El seguimiento a los 7 días en consulta externa, demostró que las complicaciones referidas por las pacientes son mínimas, principalmente el dolor pélvico, y se quejan más cuando el procedimiento fue realizado por un médico interno, casi la mitad de las pacientes opinó que el trato del personal de salud, es diferentes según los turnos matutinos y vespertinos, siendo mejor el primero. El uso de métodos anticonceptivos tiene una baja prevalencia entre la población femenina en estudio. El grupo de legrado por aspiración demostró las ventajas anteriomente mencionadas y los resultados del estudio sugieren