PREVALENCIA DE Cystoisospora suis EN GRANJAS PORCINAS INTENSIVAS DE LA REGIÓN CENTRAL DE VENEZUELA / PREVALENCE OF Cystoisospora suis IN SWINE INTENSIVE HERDS AT THE CENTRAL REGION OF VENEZUELA

Entre enero y junio de 2014 se condujo una investigación en la región central de Venezuela con la finalidad de determinar la prevalencia del enterococcidio Cystoisospora suis en granjas porcinas intensivas. Para la determinación parasitaria se seleccionaron 572 camadas con signos de diarrea, así como 1.712 muestras fecales de cerdos adultos. Todas las muestras se cultivaron en dicromato de potasio al 2,5% y posteriormente se procesaron mediante una técnica coproparasitológica. Los resultados señalan que C. suis se encontró en 55 granjas (82,1%) y 210 camadas (36,7%), con los mayores valores de prevalencia en las dos primeras semanas de vida (P < 0,05). Al referir los resultados en cerdos adultos se encontró correlación significativa (rho = 0,35; P < 0,05) entre excreción de ooquistes en lechones y madres, lo que sugiere que cerdas madres podrían actuar como fuentes de infección. Se encontró correlación entre el número de partos de la cerda y los valores de prevalencia en camadas y cerdas lactantes (P < 0,05) lo que indica que, a mayor número de partos, disminuye la prevalencia. Probablemente estos hallazgos se asocian con mecanismos inmunológicos desconocidos. Se concluye que C. suis se encuentra ampliamente distribuido en Venezuela y que el enterococcidio puede ser controlado mejorando las condiciones higiénicas de las granjas; sin embargo, hay mecanismos inmunológicos aún sin dilucidar que podrían incidir en la cadena de transmisión del protozoario.

It was carried out an investigation at the central region of Venezuela from January to June 2014 with the aim to determine the prevalence of coccidian Cystoisospora suis in intensive swine herds. For parasitic determination 572 litters were selected with signs of diarrhea. Likewise, 1.712 fecal samples were also collected in mature pigs. Stool samples were cultured in a 2.5% potassium dichromate solution and later processed by coprological technique. The results of this investigation indicated that C. suis was observed in 55 herds (82.1%) and 210 litters (36.7%) with the highest prevalence values in first two weeks of age (P < 0.05). Regarding to mature pigs, there was a significant correlation (rho = 0.35; P < 0.05) among oocysts excretion in piglets and sows, suggesting that sows may act as infection sources. Sows parity was statistically correlated with the prevalence values in litters as in lactating sows (P < 0.05). This might indicate that as parity increase, prevalence decreases in these groups. Probably these findings are associated with unknown immunologic mechanisms. It is concluding that C. suis is broadly distributed in Venezuela and it could be controlled by improving conditions sanitary herd, however, non elucidated immunologic mechanisms might be involved in the protozoa transmission cycle.

Validation of the use of exogenous gonadotropins (PG600) to increase the efficiency of gilt development programs without affecting lifetime productivity in the breeding herd.

The objective of this study was to validate the use of exogenous gonadotropin (PG600) treatment for stimulating estrus in noncyclic gilts and to compare lifetime productivity of gilts recorded as having natural (NAT) versus PG600-induced (PG600) first estrus in a commercial setting. Prepubertal Camborough gilts ( = 4,489) were delivered to a gilt development unit (GDU) with the goal of delivering known cyclic breeding-eligible females to the sow farm (SF). A boar exposure area (BEAR) was designed to facilitate stimulation and detection of puberty by providing fence line and direct contact (15 min daily) with mature boars over an intensive 28-d period, starting at approximately d 160 (d 0). At d 14, nonpubertal gilts were mixed in new pen groups. At d 23, noncyclic "opportunity" gilts with no record of vulval development and required to meet breeding targets, were eligible for treatment with PG600 to induce puberty. Overall, 77.6% ( = 3,475) of gilts exhibited standing estrus (NAT = 2,654; PG600 = 821) and were eligible for shipping to the SF at approximately 35 d, and 76.6% of gilts that were administered PG600 exhibited the standing reflex within 13 d of treatment. Ultimately, 72.0% of gilts entering the GDU were delivered to the SF as breeding-eligible females. Considering the gilts delivered, a greater proportion of NAT than PG600 gilts were successfully bred ( < 0.001) and had better farrowing rates to first service, and overall farrowing rates (including gilts that returned to estrus and were rebred) were greater for NAT compared to PG600 gilts ( < 0.001) . Farrowing rates at second and third parity were similar between NAT and PG600 gilts; however, at fourth parity, a greater proportion of NAT gilts farrowed. In comparison, considering only gilts served, there was no difference ( > 0.05) in the proportion of NAT and PG600 gilts farrowing a third litter, but a greater proportion of NAT than PG600 gilts farrowed their fourth litter ( < 0.001). There was no difference between NAT and PG600 gilts for litter size at parity 1 through 4 or total pigs born over 4 parities ( > 0.05). A negative correlation ( < 0.0001) was detected between age at puberty and lifetime growth rate at puberty, and growth rate classification affected age and weight at puberty. However, retention rates and total sow productivity to parity 4 were not affected by growth rate classification at puberty.

Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial.

BACKGROUND: The purpose of this study was to compare gastrointestinal tolerance to two enteral feeding protocols in critically ill patients. METHODS: A prospective, randomized controlled trial, that involved 96 consecutive patients expected to stay in the intensive care unit for > or =3 days and who had no contraindications to enteral feeding. The patients were randomized to either the current protocol (group I; gastric residual volume threshold, 150 mL, optional prokinetic) or proposed feeding protocol (group II; gastric residual volume threshold 250 mL, mandatory prokinetic). Gastrointestinal intolerance was recorded as episodes of high gastric residual volume, emesis, or diarrhea. The time to reach the goal rate of feeding and the percentage of nutritional requirements received during the study period were also recorded. RESULTS: Nineteen of 36 patients (19/36 = 0.53) in group I had one or more episodes of high gastric residual volume, compared with 10 of 44 patients (10/44 = 0.23) in group II (p < .005). There was no statistical difference between the two protocols with regards to emesis, diarrhea, or the total episodes of intolerance. The patients in group II reached their goal rates on average in 15 hours and received 76% of their nutritional requirements, compared with 22 hours and 70% in group I; however, these differences were not statistically significant. CONCLUSIONS: The incidence of enteral feeding intolerance was reduced by using a gastric residual volume of 250 mL along with the mandatory use of prokinetics. The study showed a trend of improved enteral nutrition provision and reduced the time to reach the goal rate in group II. These improvements support the adoption of the proposed feeding protocol for critically ill patients.

The C-reactive protein to prealbumin ratio correlates with the severity of multiple organ dysfunction.

BACKGROUND: This study evaluates the correlation between a ratio of two hepatic proteins, C-reactive protein (CRP) and prealbumin (PALB), and the severity of organ dysfunction as measured by the multiple organ dysfunction score (MODS). METHODS: A prospective cohort study was undertaken in critically ill patients (n = 70) by measuring the serum levels of CRP and PALB, the energy expenditure via indirect calorimetry, and severity of organ dysfunction by the MODS. All three variables were recorded for a period of 5 days from admission and then assessed for correlation to each other and to the length of stay and mortality in the intensive care unit. RESULTS: The CRP/PALB ratio showed a statistically significant correlation at 48 hours (r = 0.45, P < .01) and 120 hours (r = 0.53, P < .01). This ratio showed higher degrees of correlation when applied to patients with a diagnosis of sepsis, multiple organ dysfunction, or single organ dysfunction, r = 0.71 and 0.56 at 48 and 120 hours, respectively. Receiver operating characteristics (ROC) curves show that a ratio of 2.07 correlated with a MODS of 16 with a sensitivity of 92% and a specificity of 71%. CONCLUSIONS: This study demonstrates a strong correlation between the severity of organ dysfunction and the ratio of two hepatic proteins, CRP and PALB. There was no correlation between the degree of energy expenditure and the MODS, Acute Physiology and Chronic Health Evaluation II score, or the ratio of CRP/PALB. The use of inflammatory markers may be an easy, inexpensive method of assessing severity of illness in the critically ill.

Use of desmopressin acetate to reduce blood transfusion requirements during cardiac surgery in patients with acetylsalicylic-acid-induced platelet dysfunction.

OBJECTIVE: To determine whether desmopressin acetate (DDAVP) has the ability to reduce blood loss in patients with a known bleeding tendency. DESIGN: A randomized, double-blind, placebo controlled study. SETTING: A university teaching hospital. PATIENTS: Men under the age of 70 years who had taken acetylsalicylic acid within 7 days of scheduled coronary artery bypass surgery. Patients with an abnormal hematologic profile or a history of bleeding or who were receiving heparin or undergoing repeat coronary bypass surgery were excluded. Forty-four patients were randomized with restriction in blocks of 10; 20 received DDAVP and 24 received a placebo. MAIN OUTCOME MEASURES: Blood loss and blood transfusion requirements. RESULTS: Patients treated with DDAVP lost significantly (p < 0.01) less blood than those receiving a placebo (1543 mL versus 2376 mL respectively). Nineteen patients had a blood loss of more than 2000 mL; 15 of these were in the placebo group. Significantly (p < 0.02) fewer patients receiving DDAVP required blood transfusion (9 versus 18). CONCLUSIONS: DDAVP reduces blood loss during cardiac bypass surgery in patients who have taken acetylsalicylic acid within 7 days before operation.

New and simple equations to estimate the energy and fat contents and energy density of humans in sickness and health.

Two formulas were derived to estimate the energy content of the human body which use only body mass, total body water by 3H2O dilution space and body minerals assessed by anthropometry. The formulas were tested in a body composition database of 561 patients and 151 normal volunteers using established metabolizable energy values for protein, fat and glycogen. Total body protein was determined by in vivo neutron activation analysis (IVNAA), body water by dilution of tritium and body minerals from skeletal frame size. Body glycogen was assumed to be 14.6% of the mineral component. Body fat was obtained by difference, body mass less the sum of water, protein, minerals and glycogen. The standard deviation in the estimate of body energy content was 30 MJ or 4.1% of the energy content of reference man. Two formulas for body energy content were derived by regression with body mass, total body water and body minerals or height. Two formulas for energy density and formulas for percentage body fat were similarly derived.

Effect of body positions and splints in bioelectrical impedance analysis.

The objective of this study was to evaluate body composition as measured by bioelectric impedance analysis using splints and body positions differing from the standard supine position. Forty-three patients, randomized into two groups of different body positions, and 101 healthy volunteers were prospectively studied. Resistance and reactance of body tissues were measured by bioelectric impedance analysis. Body composition is described by a three-compartment model composed of body fat, body cell mass, and extra cellular mass. The patients were measured in the standard supine position and then randomized into two groups. They were then remeasured with the appropriate splinting device or position change. Volunteers were measured in the standard supine position and all four alternative positions. There was a statistically significant difference demonstrated in whole body resistance, whole body reactance, body cell mass, and the ratio of extracellular mass to body cell mass in some body positions. The percentage of change with different body positions and splints, when compared with the standard supine position, was generally below 2%, a clinically insignificant difference. We conclude that the reliability of resistance and reactance as measured by bioelectric impedance analysis is clinically valid using any of the tested body positions and/or splints. The three-compartment model may be a useful concept to measure body composition changes in both healthy and sick persons.

Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.

Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. The PaO2/FIO2 was significantly (p less than .05) better from half an hour after extubation until 24 h postextubation in the nasal CPAP group, but was decreased for the remainder of the study in both groups. Incidence of atelectasis/consolidation was not different in both groups during the study period. We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.

Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients?

Sixty-five surgical ICU patients at high risk of developing acute erosive gastritis and bleeding received prophylactic antacid treatment to maintain a gastric pH of at least 5.0. A similar control group of 61 patients received no specific prophylaxis. All patients in both groups developed microscopic bleeding; however, microscopic bleeding did not influence outcome. In the control group, eight (13.1%) patients developed moderate visible bleeding, as compared to seven (10.8%) patients in the antacid group, an insignificant difference. A single patient in the control group developed severe GI bleeding due to acute erosive gastritis. Antacid prophylaxis did not prevent macroscopic bleeding and there was no correlation between the number of risk factors in individual patients and the rate of upper GI bleeding. We conclude that antacid is not required to prevent upper GI bleeding in high-risk critically ill patients.

Acute respiratory failure in severe blunt chest trauma.

From 1973 through 1980 144 patients with chest trauma were treated. Concomitant acute respiratory failure was considered severe in 125 (83%). Morbidity and mortality were found to be related to the presence of shock, head injury Glasgow score 3-4, and size of the flail segment, but not by the extent of the thoracic or intrathoracic injuries. Mortality for the whole group and for the flail chest group were 8.3 and 9.5%, respectively. Treatment was analyzed in two historical periods: In the first, 1973 through 1976, controlled mandatory ventilation and tracheostomy were used in 83 and 70% of the cases, respectively. In the second period, 1977 through 1980, intermittent mandatory ventilation plus soft-cuff endotracheal tube were used in 77% of the cases. Ventilator time did not vary in these two periods but the lung oxygen transport was better in the group treated with intermittent mandatory ventilation.