Factors influencing survival of rescued Amazonian manatees ( Trichechus inunguis ) during clinical rehabilitation in Peru

Relationship between Formula Concentration and Rate of Growth of Normal Infants

The Amazonian manatee (Trichechus inunguis) is an aquatic mammal (Family Trichechidae) that inhabits freshwater environments. It is endemic to the Amazon Basin, and occurs from Marajó Island (at the mouth of the Amazon River in Brazil) to the headwaters of the floodplain in Colombia, Peru and Ecuador. Little is known of the causes of death or the prevalence of zoonotic organisms in manatees from Peru; however, Leptospira spp. have been reported to cause mortalities in marine mammals. Here we evaluated the presence of Leptospira spp. antibodies in Amazonian manatees. To our knowledge, this is the first report of presence of antibodies against Leptospira spp. in aquatic mammals maintained in captivity in the Peruvian Amazon.

Manatee populations are declining worldwide, and all currently existing species are considered vulnerable by the IUCN. The most common problems during nurturing young Amazonian manatees, Trichechus inunguis, in rescue centres are of gastrointestinal nature leading to inappetence, diarrhoea, cachexia and even death. Endoparasites play an important role in the well-being of wildlife in captivity as well as in the wild, though information about relevant protozoan and metazoan endoparasites in Amazonian manatees is still scarce. Therefore, this study aimed to find endoparasites in T. inunguis by analyzing faecal samples from 23 Amazonian manatees which were kept in rescue centres in the Peruvian Amazon. The samples were screened for protozoan and metazoan parasites using coproscopical analysis and molecular tools. Out of twenty juvenile animals eleven were positive for at least one Eimeriidae. Two morphologically different, not yet genetically described Eimeria species were identified. One of them seems to be Eimeria trichechi which has only been described once in 1984 in Amazonian manatees from Brazil. It was not found to lead to clinical symptoms of coccidiosis in this study. The second, Eimeria sp. Type B was associated with clinical coccidiosis in a young Amazonian manatee, which showed gastrointestinal symptoms including diarrhoea, inappetence and cachexia. No other protozoan or metazoan parasite were detected in any of the samples. The present study is the first to investigate endoparasites in Amazonian manatees using molecular tools and is the first to identify an Eimeria species that could be associated with clinical symptoms in T. inunguis. With information from our study rescue centres can improve monitoring of parasites more effectively to reduce morbidity and mortality rates among rehabilitated manatees as well as improve the health status and fitness of animals for a successful release back into the wild.

BackgroundTo evaluate the association between rate of gestational weight gain and preterm birth varying prepregnancy body mass indices and trimester.MethodsData from Maternal and Newborn’s Health Monitoring System on 17475 pregnant women who delivered live singletons at ≥ 28 weeks of gestation between October 2013 and September 2014 from 12 districts/counties of 6 provinces in China and started prenatal care at ≤ 12 weeks of gestation was analyzed. Gestational weight gain was categorized by rate of weight gain during the 2nd and 3rd trimester, based on the 2009 Institute of Medicine guidelines. Multivariable binary logistic regression models were conducted to investigate the association between rate of gestational weight gain and preterm birth stratified by prepregnancy body mass indices and trimester.ResultsExcessive weight gain occurred in 57.9 % pregnant women, and insufficient weight gain 12.5 %. Average rate of gestational weight gain in 2nd and 3rd trimester was independently associated with preterm birth (U-shaped), and the association varied by prepregnancy body mass indices and trimesters. In underweight women, excessive gestational weight gain was positively associated with preterm birth (OR 1.93, 95 % confidence interval (CI): 1.29- 2.88) when compared with women who gained adequately. While in overweight/obese women, insufficient gestational weight gain was positively associated with preterm birth (OR 3.92, 95 % CI: 1.13–13.67). When stratifying by trimester, we found that excessive weight gain in 3rd trimester had a significantly positive effect on preterm birth (OR 1.27, 95 % CI: 1.02–1.58).ConclusionsExcessive gestational weight gain among underweight pregnant women, insufficient gestational weight gain among overweight/obese women and excessive gestational weight gain in 3rd trimester were important predictors of preterm birth.

The only exclusively freshwater lineage of Sirenia, the Amazonian manatee (Trichechus inunguis) is listed by the IUCN as vulnerable, with populations projected to decline further during the coming decades. Given that illegal hunting, pollution, habitat disturbance and other impacts are ongoing, it is imperative to assess the distribution and abundance of this unique, elusive aquatic mammal. In this study, we used environmental DNA (eDNA) methods to test for T. inunguis presence at three locations along the longitudinal gradient of the Amazon River and its tributaries (Tefé, Manaus, Belém). At each location, water samples were collected at sites spanning a disturbance gradient from urban to protected reserves. We developed a field methodology to preserve DNA for up to 13 days or more without requiring freezing or cooling of samples. This method performed similarly to traditional cold-storage methods used for eDNA research. In the lab, DNA was extracted from the samples followed by PCR amplification, and Illumina sequencing. Detection of Amazonian manatee DNA was more than three times greater in the western Amazon (Tefé and Mamirauá Reserve) where human activity is low. Manatee DNA was detected at six sites in the central Amazon (Manaus) and in only two sites in the eastern Amazon near the coast (Belém) where human populations and impacts are greater. eDNA methodology was effective for detecting manatees and is expected to be useful for estimating their broader distribution as well as surveying other aquatic species in tropical rivers.

The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear. To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania. The weights of 8,428 women were measured monthly from 12 weeks of gestation to term. Prenatal dietary intake was estimated as the cumulative average of multiple 24-hour dietary recalls. The association between energy intake and percentage of energy from carbohydrate, protein, and total fat and rate of weight gain (grams per month) was estimated from generalized estimating equation models. Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age, maternal height, maternal mid-upper-arm circumference, parity, marital status, maternal occupation, maternal education, household wealth, season, and treatment regimen assignment. Body mass index (BMI) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain. A 6 g/month increase in rate of weight gain was associated with every 100-kcal increment in daily total energy intake (95% CI, 1 to 12; p = .03). Analyses substituting 5% of energy from fat by protein showed that weight gain would decrease by 72 g/month (95% CI, 6 to 140; p = .03); substituting 5% of energy from carbohydrate by protein decreased gain by 70 g/month (95% CI, 15 to 124; p = .01). Baseline BMI did not modify these associations. Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries.

Objective. The goals of our study were (1) to estimate the trends in maternal weight gain patterns and (2) to estimate the influence of variation in maternal weight and rate of weight gain over different time periods in gestation on variation in birth weight in African-American and non-African-American gravidas.Study Design and Setting. Data from a prospective cohort study in which pregnant women were monitored at multiple time points during pregnancy were analysed. Maternal weight was measured at three times during pregnancy: preconception (W0); 16–20 weeks gestation (W1); 30–36 weeks gestation (W2), in a cohort of 435 women with full-term singleton pregnancies. The relationship between gestational age-adjusted birth weight (aBW) and measures of maternal weight and rate of weight gain across pregnancy was estimated using a multivariable longitudinal regression analysis stratified on African-American race.Results. The aBW was significantly associated with maternal weight measured at any visit in both strata. For African-American women, variation in aBW was significantly associated with variation in the rate of maternal weight gain in the first half of pregnancy (W01) but not the rate of maternal weight gain in the second half of pregnancy (W12); while for non-African-American women, variation in aBW was significantly associated with W12 but not W01.Conclusion. Factors influencing the relationship between aBW and maternal weight gain patterns depend on the context of the pregnancy defined by race. Clinical decisions and recommendations about maternal weight and weight gain during pregnancy may need to account for such heterogeneity.

To estimate the relationship between the rate of gestational weight gain before the 50-g, 1-hour oral glucose challenge test screening for gestational diabetes mellitus (GDM) and subsequent risk of GDM. We conducted a nested case-control study (345 women with GDM and 800 women in the control group) within a multiethnic cohort of women delivering between 1996 and 1998 who were screened for GDM at 24-28 weeks of gestation. GDM was diagnosed according to the National Diabetes Data Group plasma glucose cut-offs for the 100-g, 3-hour oral glucose tolerance test. Women's plasma glucose levels, weights, and covariate data were obtained by medical record chart review. After adjusting for age at delivery, race/ethnicity, parity, and prepregnancy body mass index, the risk of GDM increased with increasing rates of gestational weight gain. Compared with the lowest tertile of rate of gestational weight gain (less than 0.27 kg/week [less than 0.60 lb/wk]), a rate of weight gain from 0.27-0.40 kg/wk (0.60-0.88 lb/wk) and 0.41 kg/wk (0.89 lb/wk) or more, were associated with increased risks of GDM (odds ratio 1.43, 95% confidence interval 0.96-2.14; and odds ratio 1.74, 95% confidence interval 1.16-2.60, respectively). The association between the rate of gestational weight gain and GDM was primarily attributed to increased weight gain in the first trimester. The association was stronger in overweight [corrected] and nonwhite women. High rates of gestational weight gain, especially early in pregnancy, may increase a woman's risk of GDM. Gestational weight gain during early pregnancy may represent a modifiable risk factor for GDM and needs more attention from health care providers.

We investigated the paradox of why Amazonian manatees Trichechus inunguis undergo seasonal migrations to a habitat where they apparently fast. Ten males were tracked using VHF telemetry between 1994 and 2006 in the Mamiraua and Amana Sustainable Development Reserves, constituting the only long-term dataset on Amazonian manatee movements in the wild. Their habitat was characterized by analysing aquatic space and macrophyte coverage dynamics associated with the annual flood-pulse cycle of the River Solimoes. Habitat information came from fieldwork, two hydrographs, a three-dimensional model of the water bodies and classifications of Landsat-TM/ETM+ images. We show that during high-water season (mid-May to end-June), males stay in varzea lakes in association with macrophytes, which they select. We then show that, during low-water (October–November), the drastic reduction in aquatic space in the varzea leads to the risk of their habitat drying out and increases the manatees' vulnerability to predators such as caimans, jaguars and humans. This explains why males migrate to Ria Amana. Based on data on illegal hunting, we argue that this habitat variability influences females to migrate too. We then use published knowledge of the environment's dynamics to argue that when water levels are high, the habitats that can support the largest manatee populations are the varzeas of white-water rivers, and we conjecture that rias are the species' main low-water refuges throughout Western Amazonia. Finally, we warn that the species may be at greater risk than previously thought, because migration and low-water levels make manatees particularly vulnerable to hunters. Moreover, because the flooding regime of Amazonian rivers is strongly related to large-scale climatic phenomena, there might be a perilous connection between climate change and the future prospects for the species. Our experience reveals that the success of research and conservation of wild Amazonian manatees depends on close working relationships with local inhabitants

Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I=survivable, IIA=uncertain but likely survivable, II=uncertain, IIB=uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge). When possible, status at last follow-up was recorded for those discharged from the hospital. Prognostic accuracy was assessed using unweighted, multi-level likelihood ratios (LRs). The final cohort included 143 fetuses/infants distributed nearly evenly among the three diagnosis groups. Over half (64%) were assigned an uncertain prognosis, but most of these could be divided into 'likely survivable' or 'likely non-survivable' subgroups. Overall survival for the entire cohort was 62% (89/143). All but one of the fetuses assigned a non-survivable prognosis suffered fetal demise or died before hospital discharge. The neonatologist's antenatal prognosis accurately predicted the probability of survival by prognosis group (LR I=4.56, LR IIA=10.53, LR II=4.71, LR IIB=0.099, LR III=0.040). The LRs clearly differentiated between fetuses with high and low probability of survival. Eleven fetuses (7.7%) had misalignment between the predicted prognosis and outcome. Five died before discharge despite being given category I or IIA prognoses, whereas six infants with category IIB or III prognoses survived to discharge, though some of these were discharged to hospice care. The neonatologist's antenatal prognosis accurately predicted fetal-neonatal outcome. Infants with non-survivable or uncertain but likely poor prognoses had a very low probability of survival, whereas those with good or uncertain prognoses had a high probability of survival. There were few cases of prognostic failure with most occurring in fetuses with one major or multiple anomalies. The few cases of prognostic failure suggest a need for caution. Honest disclosure of prognostic uncertainty and shared decision-making with families utilizing their personal values is critical in the antenatal encounter.

Background: Low birth weight babies is the result of being small for gestational age (i.e. under 10th percentile of the reference population) and preterm (i.e. before 37 weeks of gestation. Preterm infants have higher protein, calorie requirement, which cannot be met with unfortified breast milk feeds.Methods: This study was conducted prospectively in the Department of Pediatrics, Rajah Muthiah Medical College and Hospital, Chidambaram from October 2016 to April 2018. 20 low birth weight babies were selected by randomization technique and they were administered with 2 grams of oral colostrum fortified lactoferrin daily for 4 weeks. The rate of weight gain, length gain and head circumference gain were assessed prospectively for a period of 4 weeks. They were analysed statistically by ANOVA and tabulated. Babies weighing less than 2.5 kg and on exclusive breast feeding, were included. Babies more than 2.5kg and less than 1kg, at risk for neonatal sepsis, congenital heart disease, necrotizing enterocolitis were excluded from the study.Results: In the present study, 20 low birth weight babies were included. 11 maternal risk factors were identified. Out of which anemia stands as a single risk factor. The rate of weight gain in oral colostrum fortified lactoferrin, is 320 grams with P value of 0.703 which is not statistically significant. The rate of length gain is 3.3cm, p value is 0.093 which is statistically insignificant. The rate of head circumference gain in oral colostrum fortified lactoferrin is 2.8cm, with the p-value of 0.001 which is statistically significant.Conclusions: The rate of weight and length gain was normal, but the rate of head circumference gain is significantly increased in oral colostrum fortified lactoferrin supplementation.

An ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic

To estimate the effect of second- and third-trimester rate of gestational weight gain on pregnancy outcomes using the revised Institute of Medicine guidelines. This is a retrospective cohort study of singleton live births in upstate New York between January 2004 and December 2008. Women were grouped by prepregnancy body mass index (BMI) and rates of second- and third-trimester gestational weight gain were calculated. Women were then classified as having less than, within, or greater than recommended rates of gain. Maternal and neonatal outcomes were assessed based on rate of weight gain within each BMI class. Of 73,977 women meeting inclusion criteria, 4% were underweight, 48% normal weight, 24% overweight, and 24% obese: 13% class I, 6% class II, and 5% class III, respectively. After controlling for potential confounding variables, less than recommended rates of second- and third-trimester weight gain were associated with increased odds of small-for-gestational-age neonates in all BMI groups except obese classes II and III. Greater than recommended rates of weight gain were associated with increased odds of large-for-gestational-age neonates in all BMI groups and increased odds of cesarean delivery in all BMI groups with the exception of underweight and obese class III women. Suboptimal second- and third-trimester rates of gestational weight gain in the most obese women, even with net weight loss, do not increase the odds of small-for-gestational-age neonates. Excessive rates of gestational weight gain increase the odds of large-for-gestational-age neonates regardless of BMI. II.

372. Does smoking cessation in pregnancy affect rate of gestational weight gain?

Plasma leptin influences gestational weight gain and postpartum weight retention