Poisoning by Brunfelsia uniflora in sheep and donkeys.

Farmers in the State of Piauí in northeastern Brazil reported nervous signs in ruminants and donkeys after ingestion of Brunfelsia uniflora at the start of the rainy season when the plant is flowering. Leaves of the plant, collected at the start or at the end of the rainy season, were administered in single doses of 5-20 g/kg body weight to 8 sheep and 3 donkeys. Two sheep and 1 donkey that ingested 10 g/kg of the plant in November at the start of the rainy season, when the plant was flowering, developed severe convulsions and diarrhea. One sheep was euthanized and autopsied, and no significant lesions were found. The other sheep and the donkey recovered. Four sheep and one donkey that ingested 10 or 20 g/kg of leaves collected in April, at the end of the rainy season, did not show clinical signs. One donkey that ingested 5 g/kg of leaves collected in November developed diarrhea and recovered. These results demonstrate the toxicity of B. uniflora for livestock and suggest that the plant is toxic at these doses only during the start of the rainy season.

The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission.

INTRODUCTION: Coagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit. METHODS: d-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinical variables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range). The main outcome measure was hospital mortality. RESULTS: Ninety patients with severe CAP admitted to the intensive care unit were evaluated. Overall hospital mortality was 15.5%. d-Dimer levels in nonsurvivors were higher than those in survivors. In the univariate analysis, d-dimer, SOFA, and APACHE II scores were predictors of death. The discriminative ability of d-dimer (area under receiver operating curve = 0.75 [95% confidence interval, 0.64-0.83]; best cutoff for d-dimer was 1798 ng/mL) for in-hospital mortality was comparable with APACHE II and SOFA and better than C-reactive protein. Moreover, the addition of d-dimer to APACHE II or SOFA score increased the discriminative ability of both scores (area under the receiver operating curve = 0.82 [0.72-0.89] and 0.84 [0.75-0.91], respectively). CONCLUSIONS: d-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA.

Poisoning of goats by the pods of Luetzelburgia auriculata.

Farmers report that the pods of Luetzelburgia auriculata cause digestive signs and death when ingested by goats. To demonstrate the toxicity of the pods of this plant 12 goats were divided into 4 groups of 3 goats each. Groups 1, 2, 3 and 4 were administered 2.5, 1, 0.5 and nil g of pods per kg body weight, respectively. Goats in Groups 1 and 2 developed decreased ruminal movements followed by anorexia, depression and soft feces or diarrhea. Goats in Group 1 died 59-106 h after first showing clinical signs. Goats in Group 2 also regurgitated rumen content, but all recovered 65-90 h after first showing clinical signs. The only clinical sign shown by goats in Group 3 was regurgitation of rumen content, and all goats recovered 5.5-24 h after first regurgitating. All goats in Group 4 remained normal. The goats that died were necropsied and found to have a reddish mucosa of the forestomachs that detached easily from the underlying tissues. Other lesions included diffuse reddening of the mucosa of the abomasum and intestine. Histological examination of the mucosa of the forestomachs showed diffuse ballooning degeneration of keratinocytes, with necrosis and vesicle and pustule formation in the epithelium. In some areas there was sloughing of the ruminal epithelium. These results demonstrate that the pods of L. auriculata are toxic and responsible for field outbreaks of poisoning in goats in the state of Piaui.

Plantas tóxicas para ruminantes e eqüídeos no Norte Piauiense / Toxic plants for ruminants and equidae in Northern Piauí

Este trabalho teve por objetivo realizar um levantamento sobre as plantas tóxicas para ruminantes e equídeos na Mesorregião Norte do Piauí. Foram feitas 71 entrevistas a médicos veterinários, engenheiros agrônomos, técnicos agrícolas e produtores de 16 municípios, entrevistando pelo menos quatro pessoas por município. As plantas comprovadamente tóxicas que foram apontadas com maior frequência na região estudada foram Ipomoea asarifolia, que causa intoxicações em pequenos ruminantes em todas as áreas visitadas. Stryphnodendron coriaceum pelas mortes que ocasiona é, aparentemente, a planta que causa maiores perdas econômicas na mesorregião estudada. Enterolobium contortisiliquum também foi citada como causa importante de sinais digestivos, abortamentos e fotossensibilização em bovinos da região. Os entrevistados confirmaram a ocorrência de surtos de intoxicação em bovinos por Thiloa glaucocarpa no inicio do período chuvoso. Manihot spp. e Piptadenia macrocarpa são plantas cianogênicas apontadas como causa de mortes superagudas em bovinos. Outras plantas relatadas como tóxicas pelos entrevistados, mas sem que haja comprovação de sua toxicidade, foram Buchenavia tomentosa, Caesalpinia sp., Brunfelsia sp., Luetzelburgia sp., Hybantus ipecaconha, Phisalys angulata e Spondias luta. De acordo com os entrevistados os frutos de Buchenavia tomentosa causam sinais digestivos e abortos em caprinos, ovinos e bovinos. Produtores relatam surtos de intoxicação em caprinos que apresentam sinais digestivos e morte após a ingestão de favas de Luetzelburgia sp. Brunfelsia sp. é relatada como causa de alterações nervosas, no começo das chuvas, quando os animais ingerem as folhas e flores e os asininos são aparentemente mais afetados. Os frutos de Spondias luta foram mencionados como causa de diarréia em caprinos. Experimentos não publicados demonstraram a toxicidade de Brunfelsia sp. em ovinos e de Luetzelburgia sp. como causa de sinais digestivos e mortes ...

The objective of this study was to survey toxic plants for ruminants and equidae in northern Piauí. Seventy one persons were interviewed, including farmers, veterinary practitioners, agronomists, and agrarian technicians from 16 municipalities, performing at least four interviews in each municipality. The most common plant mentioned as a cause of poisoning was Ipomoea asarifolia, which is a well known cause of tremogenic disease in ruminants. Stryphnodendron coriaceum which causes digestive signs was referred as a common cause of death, and is probably the plant that causes most cattle deaths in the region. Enterolobium contortisiliquum was also mentioned as a frequent cause of digestive signs, abortion and photosensitization in cattle. Outbreaks of nephrosis caused by Thiloa glaucocarpa are frequent at the beginning of the raining season. Poisoning by the cyanogenic plants Manihot spp. e Piptadenia macrocarpa are a cause of peracute deaths. Other plants mentioned as toxic were Buchenavia tomentosa, Caesalpinia sp., Brunfelsia sp., Luetzelburgia sp., Hybantus ipecaconha, Phisalys angulata, and Spondias luta. Farmers report that goats are poisoned by the ingestion of the pods of Luetzelburgia sp., which causes digestive signs and death. The ingestion of the fruits of Buchenavia tomentosa is associated with digestive signs and and abortion in ruminants. Brunfelsia sp. is mentioned as a cause of nervous signs at the start of the raining season and donkeys are apparently more affected. The consumption of the fruits of Spondias luta are associated with diarrhea in goats. Recent unpublished experiments demonstrated the toxicity of Brunfelsia sp. as a cause of nervous signs and of Luetzelburgia sp. as a cause of digestive signs in goats. Experiments with other plants are necessary to confirm their toxicity.

Cortisol levels in patients with severe community-acquired pneumonia.

OBJECTIVES: To evaluate cortisol levels and prevalence of adrenal insufficiency in patients with severe community-acquired pneumonia (CAP). DESIGN AND SETTING: Retrospective cohort study in a 24-bed medical-surgical intensive care unit (ICU). PATIENTS: Forty patients with severe CAP admitted to the ICU from March 2003 and May 2005. MEASUREMENTS AND RESULTS: Random cortisol levels were measured up to 72 h after ICU admission. A threshold of 20 microg/dl was considered for the diagnosis of adrenal insufficiency. Median cortisol levels were 15.5 microg/dl (IQR 10.8-25.1), and 26 patients (65%) met the criteria for adrenal insufficiency. Other cutoff levels of cortisol were evaluated, and 30 patients (75%) had cortisol levels below 25 microg/dl and 19 (47.5%) had cortisol levels below 15 microg/dl. When only patients with septic shock (n=19) were evaluated, 12 (63%) had adrenal insufficiency. CONCLUSIONS: Relative adrenal insufficiency occurs in a high proportion of patients with severe CAP. This finding highlights the importance of measuring cortisol levels and may help explain the potential benefits of hydrocortisone infusion in these patients.