Weaning Research Articles

Management of external ventricular drain: to wean or not to wean?

PurposeExternal ventricular drain (EVD) is one of the most frequent procedures in neurosurgery and around 15 to 30% of these patients require a permanent cerebrospinal fluid (CSF) diversion. The optimal EVD weaning strategy is still unclear. Whether gradual weaning compared to rapid closure, reduces the rate of permanent CSF diversion remains controversial. The aim of this trial is to compare the rates of permanent CSF diversion between gradual weaning and rapid closure of an EVD.MethodsThis was a single-center, retrospective cohort study including patients between 2010 to 2020. Patients were divided into a weaning (WG) and non-weaning (NWG) group. The primary outcome was permanent CSF diversion rates, secondary outcomes included hospitalization time, EVD-related morbidity, and clinical outcome.ResultsOut of 412 patients, 123 (29.9%) patients were excluded due to early death or palliative treatment. We registered 178 (61.6%) patients in the WG and 111 (38.4%) in the NWG. Baseline characteristics were comparable between groups. The VPS rate was comparable in both groups (NWG 37.8%; WG 39.9%, p = 0.728). EVD related infection (13.5% vs 1.8%, p < 0.001), as well as non-EVD related infection rates (2.8% vs 0%, p < 0.001), were significantly higher in the WG. Hospitalization time was significantly shorter in the NWG (WG 24.93 ± 9.50 days; NWG 23.66 ± 14.51 days, p = 0.039).ConclusionGradual EVD weaning does not seem to reduce the need for permanent CSF diversion, while infection rates and hospitalization time were significantly higher/longer. Therefore, direct closure should be considered in the clinical setting.

Genomic predictions and GWAS for heat tolerance in pigs based on reaction norm models with performance records and data from public weather stations considering alternative temperature thresholds.

Genetic improvement of livestock productivity has resulted in greater production of metabolic heat and potentially greater susceptibility to heat stress. Various studies have demonstrated that there is genetic variability for heat tolerance and genetic selection for more heat tolerant individuals is possible. The rate of genetic progress tends to be greater when genomic information is incorporated into the analyses as more accurate breeding values can be obtained for young individuals. Therefore, this study aimed (1) to evaluate the predictive ability of genomic breeding values for heat tolerance based on routinely recorded traits, and (2) to investigate the genetic background of heat tolerance based on single-step genome-wide association studies for economically important traits related to body composition, growth and reproduction in Large White pigs. Pedigree information was available for 265,943 animals and genotypes for 8686 animals. The studied traits included ultrasound backfat thickness (BFT), ultrasound muscle depth (MDP), piglet weaning weight (WW), off-test weight (OTW), interval between farrowing (IBF), total number of piglets born (TNB), number of piglets born alive (NBA), number of piglets born dead (NBD), number of piglets weaned (WN) and weaning-to-estrus interval (IWE). The number of phenotypic records ranged from 6059 (WN) to 172,984 (TNB). Single-step genomic reaction norm predictions were used to calculate the genomic estimated breeding values for each individual. Predictions of breeding values for the validation population individuals were compared between datasets containing phenotypic records measured in the whole range of temperatures (WR) and datasets containing only phenotypic records measured when the weather station temperature was above 10°C (10C) or 15°C (15C), to evaluate the usefulness of these datasets that may better reflect the within-barn temperature. The use of homogeneous or heterogeneous residual variance was found to be trait-dependent, where homogeneous variance presented the best fit for MDP, BFT, OTW, TNB, NBA, WN and IBF, while the other traits (WW and IWE) had better fit with heterogeneous variance. The average prediction accuracy, dispersion and bias values considering all traits for WR were 0.36 ± 0.05, -0.07 ± 0.13 and 0.76 ± 0.10, respectively; for 10C were 0.39 ± 0.02, -0.05 ± 0.07 and 0.81 ± 0.05, respectively; and for 15C were 0.32 ± 0.05, -0.05 ± 0.11 and 0.84 ± 0.10, respectively. Based on the studied traits, using phenotypic records collected when the outside temperature (from public weather stations) was above 10°C provided better predictions for most of the traits. Forty-three and 62 candidate genomic regions were associated with the intercept (overall performance level) and slope term (specific biological mechanisms related to environmental sensitivity), respectively. Our results contribute to improve genomic predictions using existing datasets and better understand the genetic background of heat tolerance in pigs. Furthermore, the genomic regions and candidate genes identified will contribute to future genomic studies and breeding applications.

195 The Impact of Developmental Housing Type on Toe Growth and Wear in Sows

Abstract Swine housing systems are ever-changing to improve animal husbandry. Recently, gilts are being transitioned from gestation stalls to pens with resulting phenotypic effects being unclear. Toe growth and wear are often negated during structural analysis, with objective data of their trends being limited. Therefore, the objective of this study was to determine the impact of housing type on toe growth and wear during gestation of golts. York x Landrace gilts (n = 321) were used at the UNL ENREC swine farm. Gilts were randomly assigned to either pen (4 pigs/pen; 2.09 m2/pig) or stall (2.06 x 0.48 m) housing at 210 days of age. For analysis, gilts were lifted in a Feet First Chute (Zinpro) to permanently mark the lateral toes on the left front and back feet at ~1 cm from the coronary band. Toe length above and below the mark was measured with a digital caliper. Measurements took place before breeding (PRE), at day 30 (D30), day 57 (D57), and day 100 (D100) of gestation, and at weaning (WEAN). Estimated marginal means were calculated with regards for development group, housing type, and initial toe lengths. From PRE to D100, stall housed gilts had greater (P &amp;lt; 0.01) front growth (32.5 vs. 26.8 mm), similar front wear (-25.3 vs. -23.4 mm), greater (P &amp;lt; 0.01) back growth (39.1 vs. 34.3 mm), greater (P &amp;lt; 0.01) back wear (-32.3 vs. -28.1 mm), a greater (P &amp;lt; 0.01) total front length (41.6 vs. 39.6 mm), and a slightly longer total back length (45.5 vs. 45 mm). From D100 to WEAN, pen housed gilts had more (P &amp;lt; 0.05) back wear (-5.12 vs. -4.32 mm) and subsequently less (P &amp;lt; 0.01) total back growth (4.88 vs. 6.50 mm); with no other differences showing significance. These results suggest that housing can alter feet conformation with stall developed gilts having longer toes when entering farrowing.

Effects of injectable vitamin C at weaning and prior to transit on growth performance of early-weaned beef steers

This study investigated the effects of injectable vitamin C (VC) at weaning and prior to transit on growth performance and immune function in early-weaned beef steers. On day 0, 91 Angus × Simmental steers (92 ± 4 kg) were weaned (65 ± 11 d of age), given vaccination boosters, blocked by age, and randomly assigned to weaning (WEAN) treatments: intramuscular injections (20 mL per steer) of VC (250-mg sodium ascorbate per mL; 5 g per steer) or saline (SAL). From days 0 to 48, steers were housed at the Dixon Springs Agricultural Center (Simpson, IL) in pens (six pens; N = 14 to 16 steers per pen) equipped with two to three Vytelle bunks to measure individual daily feed disappearance. On day 49, half of the steers in each WEAN treatment were randomly assigned to an additional injection treatment (20 mL per steer) of VC or SAL prior to transport (TRANS). After administering pretransit injections, all steers were loaded onto a commercial livestock trailer with equal representation of treatments across compartments. Steers were transported for 6 h (approximately 480 km) to the Illinois Beef and Sheep Field Laboratory (Urbana, IL). Upon arrival, steers were sorted into pens (six pens; N = 13 to 17 steers per pen) with 2 Vytelle bunks per pen. Steers were weighed on days 0, 1, 14, 48, 49, 64, 78, 106, and 107. Blood was collected (WEAN = 24 steers per treatment; TRANS = 12 steers per treatment) on days 0, 1, 2, 14, 49 (pre- and posttransit), 50, and 51. Data were analyzed using the MIXED procedure of SAS 9.4 with fixed effects of age block, WEAN, TRANS, and WEAN × TRANS. Plasma ascorbate concentrations were greater (WEAN × time P < 0.01) on days 1 and 2 for steers that received VC at weaning. Similarly, for steers that received VC on day 49 pretransit, ascorbate concentrations were greater (TRANS × time P = 0.04) on days 49 posttransit, 50, and 51. Treatments did not affect (P ≥ 0.13) body weight, average daily gain, or gain to feed throughout the trial. Serum Bovine Viral Diarrhea Virus type 1 and 2 antibody titers on days 14 and 51 were not affected (P ≥ 0.32) by treatment. Injectable VC administered to early-weaned beef steers at the time of weaning or pretransit increased plasma ascorbate concentrations but did not improve growth performance or antibody response to vaccination booster.

Role of Oral Valganciclovir in Sick Preterm with Cytomegalovirus Virus Infection and Ventilation Dependence

Cytomegalovirus (CMV) is the most common congenital viral infection in neonates. Postnatal infection regarding infants rarely has significant clinical consequences. However, preterm may be at higher risk of developing symptomatic postnatal CMV disease. A multipara woman delivered vaginally a male preterm infant at 30 weeks' gestation who was suspected of early-onset sepsis in view of chronic leaking. The baby developed severe hypoxemia, and persistent pulmonary hypertension after delivery, with progressive deterioration and minimal effect of advanced ventilation, antibiotics, and pulmonary vasodilators. Sepsis screen and cultures for bacteria and fungi were negative. The baby was having enlarged liver and spleen which was noticed on day 15 of life. TORCH titer of the baby revealed CMV IgM and subsequently, CMV was isolated in the urine and in the blood plasma by polymerase chain reaction. Oral valganciclovir improved hematological parameters of the baby and respiratory support could be weaned. CMV being the most common intrauterine infection should be considered in differential diagnosis in unusual presentation of suspected sepsis and oral valganciclovir can be considered as good option for treatment.

The Distribution Characteristics of Aerosol Bacteria in Different Types of Pig Houses

Simple SummaryMicrobial aerosols from pig houses can be released into the environment, posing a serious threat to biosafety and public health. At present, there are few studies on the structural characteristics of aerosol bacteria in piggeries at different growth stages. It is important to understand the characteristics of aerosol bacteria in pig houses to solve the problems of air pollution and disease control in pig houses at different growth stages. In this study, bacterial aerosol concentrations and bacterial communities were compared in pig houses at different growth stages in Hebei Province, China. It was found that bacterial concentrations, community richness, and diversity in the air increased with the age of pigs. There are many pathogenic bacteria in the microbial aerosols of piggery. Our study highlights the importance of more comprehensive research and analysis of microbial aerosols in pig houses. Precautions for air pollution should be instituted in pig houses, including wearing masks, rigorous disinfection, and hygiene procedures.With the development of modern pig raising technology, the increasing density of animals in pig houses leads to the accumulation of microbial aerosols in pig houses. It is an important prerequisite to grasp the characteristics of bacteria in aerosols in different pig houses to solve the problems of air pollution and disease prevention and control in different pig houses. This work investigated the effects of growth stages on bacterial aerosol concentrations and bacterial communities in pig houses. Three traditional types of closed pig houses were studied: farrowing (FAR) houses, weaning (WEA) houses, and fattening (FAT) houses. The Andersen six-stage sampler and high-volume air sampler were used to assess the concentrations and size distribution of airborne bacteria, and 16S rRNA gene sequencing was used to identify the bacterial communities. We found that the airborne bacterial concentration, community richness, and diversity index increased with pig age. We found that Acinetobacter, Erysipelothrix, Streptococcus, Moraxella, and Aerococcus in the microbial aerosols of pig houses have the potential risk of causing disease. These differences lead us to believe that disinfection strategies for pig houses should involve a situational focus on environmental aerosol composition on a case-by-case basis.

Definition of Environmental Variables and Critical Periods to Evaluate Heat Tolerance in Large White Pigs Based on Single-Step Genomic Reaction Norms.

Properly quantifying environmental heat stress (HS) is still a major challenge in livestock breeding programs, especially as adverse climatic events become more common. The definition of critical periods and climatic variables to be used as the environmental gradient is a key step for genetically evaluating heat tolerance (HTol). Therefore, the main objectives of this study were to define the best critical periods and environmental variables (ENV) to evaluate HT and estimate variance components for HT in Large White pigs. The traits included in this study were ultrasound backfat thickness (BFT), ultrasound muscle depth (MDP), piglet weaning weight (WW), off-test weight (OTW), interval between farrowing (IBF), total number of piglets born (TNB), number of piglets born alive (NBA), number of piglets born dead (NBD), number of piglets weaned (WN), and weaning to estrus interval (IWE). Seven climatic variables based on public weather station data were compared based on three criteria, including the following: (1) strongest G×E estimate as measured by the slope term, (2) ENV yielding the highest theoretical accuracy of the genomic estimated breeding values (GEBV), and (3) variable yielding the highest distribution of GEBV per ENV. Relative humidity (for BFT, MDP, NBD, WN, and WW) and maximum temperature (for OTW, TNB, NBA, IBF, and IWE) are the recommended ENV based on the analyzed criteria. The acute HS (average of 30 days before the measurement date) is the critical period recommended for OTW, BFT, and MDP in the studied population. For WN, WW, IBF, and IWE, a period ranging from 34 days prior to farrowing up to weaning is recommended. For TNB, NBA, and NBD, the critical period from 20 days prior to breeding up to 30 days into gestation is recommended. The genetic correlation values indicate that the traits were largely (WN, WW, IBF, and IWE), moderately (OTW, TNB, and NBA), or weakly (MDP, BFT, and NBD) affected by G×E interactions. This study provides relevant recommendations of critical periods and climatic gradients for several traits in order to evaluate HS in Large White pigs. These observations demonstrate that HT in Large White pigs is heritable, and genetic progress can be achieved through genetic and genomic selection.

PSIV-5 Definition of environmental variables and critical periods to evaluate heat tolerance in maternal-line pigs based on single-step genomic reaction norms

Abstract Heat stress (HS) is a major welfare and economic issue in the swine industry. However, it is not a trivial task to appropriately quantify the environmental HS. Therefore, this study aimed to 1) define the critical periods and environmental descriptors (based on public weather station information) to evaluate heat tolerance (HT); and 2) estimate genetic parameters for HT in Large White pigs. The traits included in this study were: weaning weight (WW; kg), off-test weight (OTW; kg), total number of piglets born (TNB), number of piglets born alive (NBA), and number of piglets weaned (WN). The number of phenotypic records ranged from 6,059 (WN) to 172,984 (TNB), and genotypes were available for 8,686 animals. Seven climatic variables (maximum, minimum and average temperatures, average relative humidity, dew point, discomfort index and temperature-humidity index) based on public weather station records were compared based on three criteria [GxE estimate as measured by the slope term; theoretical accuracy of the genomic estimated breeding values (GEBV); deviation of GEBV per environmental value]. Relative humidity (for WN and WW) and maximum temperature (for OTW, TNB, and NBA) are the recommended environmental gradients for the studied traits. The acute HS (average of 30 days before measurement date) was the critical period recommended for OTW. For WN and WW, a period of 34 days prior to farrowing up to weaning is recommended. For TNB and NBA, the critical period of 20 days prior breeding to 30 days into gestation is recommended. In general, WN and WW were largely affected by the environment, while the remaining traits showed moderate correlations (OTW, TNB, and NBA). Heritabilities estimated for HT ranged from 0.08 (WW) to 0.25 (OTW). In summary, these results suggest that there is genotype-by-environment interaction for all traits analyzed, and genetic progress can be achieved through genetic selection.

Fiber fractions and the corresponding exogenous enzyme can improve the growth performance of weaning piglets under poor sanitary conditions

Fiber fractions and the corresponding exogenous enzyme can improve the growth performance of weaning piglets under poor sanitary conditions

Blood transfusion practices in cardiac anesthesia

Objective We have studied the variability of blood transfusion on hemodynamics and its complications during cardiac surgeries at a single center in Egypt. Patients and methods A total of 35 patients of both sexes, with ages from 21 to 70 years, scheduled for open heart surgeries were prospectively enrolled in this observational study between December 2019 and June 2020. Hemodynamic variables, such as mean arterial blood pressure and heart rate were recorded before induction (T1), after endotracheal intubation (T2), immediately before cardiopulmonary bypass (CPB) (T3), 30 min into CPB (T4), 15 min after successful weaning (T5), after sternal closure (T6), and upon arrival in the ICU (T7). The total amount of administered blood and blood products transfused intraoperatively and on the first day postoperatively; the total amount of fluids administered, including the CPB prime volume; and the total intraoperative urine output were recorded. Moreover, the number of patients who needed inotropic support, recovery time, time to extubation in the first 24 h postoperatively, length of ICU stay, and postoperative complication were recorded. Results We found that 68.6% (24 patients) of patients undergoing cardiac surgery received blood and/or blood product transfusion intraoperatively, and 31.4% (11 patients) were not transfused blood, but 14.3% (five patients) of them received blood postoperatively. Moreover, there were significant increases in the numbers of American Sociological Association III patients in blood transfusion group compared with other group, with increased need for inotropic drug and increased postoperative morbidity and mortality. Conclusion Blood transfusion in cardiac surgeries was associated with more incidences of postoperative complication and worse outcomes.

Weaning in a Pandemic Situation - A Position Paper

ZusammenfassungDie logistischen und infektiologischen Besonderheiten und Erfordernisse in der Pandemie stellen die intensivmedizinischen Behandlungsteams vor außerordentliche Herausforderungen, die eine erfolgreiche Liberation von Patienten im prolongierten Weaning erschweren können. Gerade in der Pandemie gilt es daher, alle Potenziale zur Beatmungsentwöhnung und Dekanülierung von Patienten im prolongierten Weaning oder in der Langzeitbeatmung auszuschöpfen.Weaning-Zentren stellen Einheiten der intensivmedizinischen Betreuung mit besonderer Spezialisierung auf prolongiertes Weaning dar und sind integraler Bestandteil eines kontinuierlichen Versorgungskonzeptes dieser Patienten. Ein systematisches Weaning-Konzept in der Pandemie setzt strukturelle, personelle, apparative, infektiologische und hygienische Aspekte voraus.Im Mittelpunkt dieses Positionspapiers stehen als Ergänzung zur S2k-Leitlinie „Prolongiertes Weaning“ eine neue Klassifikation im prolongierten Weaning und zukünftig erforderliche Organisationsstrukturen für die Pandemie-Situation.Patienten der Kategorie A mit hohem Weaning-Potenzial bedürfen der strukturierten Respiratorentwöhnung in spezialisierten Weaning-Einheiten, um so die größtmögliche Chance auf erfolgreiches Weaning zu realisieren. Patienten der Kategorie B mit geringem oder aktuell nicht vorhandenem Weaning-Potenzial sollten verzögert nach einer Zwischenphase der weiteren Stabilsierung in einer außerklinischen Beatmungseinrichtung einen Weaning-Versuch erhalten. Patienten der Kategorie C ohne Weaning-Potenzial benötigen eine dauerhafte außerklinische Versorgung, alternativ eine palliativmedizinisch begleitete Beendigung der Beatmung. Die sich aus den 3 Kategorien ergebenden Aufgaben für die Weaning-Zentren werden im Positionspapier vertieft.Schließlich werden unter perspektivischer Betrachtung im Positionspapier folgende zukünftig denkbare Netzwerke und Register benannt: 1. lokal organisierte regionale Netzwerke von zertifizierten Weaning-Zentren, 2. ein zentrales, bundesweites Register der Weaning-Kapazitäten entsprechend dem DIVI-Register und 3. eine Registrierung der Patienten im schwierigen oder prolongierten Weaning.

Comparison of growth performance of weaned pigs based on ideal protein of Korea swine feeding standard and US nutrient requirements of swine

Comparison of growth performance of weaned pigs based on ideal protein of Korea swine feeding standard and US nutrient requirements of swine

Effect of zinc supplementation on plasma zinc concentrationin malewistar rats

The study was conducted on 72 weaned Wistar male rats for 8 weeks from 4 to 12 weeks of age and they were divided into 3 groups as control: rats fed diet without zinc supplementation, T1 and T2: rats fed diet containing zinc sulphate @ 50mg and 100mg/kg body weight/day, respectively. Blood samples were collected on 6, 8, 10 and 12 weeks of zinc supplementation and zinc concentration in plasma was estimated. In both the treatment groups, T1 and T2 showed an increasing trend of plasma zinc levels with advancing age and the values were differ significantly (P<0.01). Plasma zinc concentration showed no particular trend in control group with advancement of age.Significantly higher (P<0.01) T1 values recorded as compared to control values from 8 to 12 weeks of age. In T2 group, the values found significantly higher (P<0.01) from 6 to 12 weeks of age. Comparing between treatment groups, T2 levels were found significantly higher (P<0.01) than those of T1 from 8 to 12 weeks. Present study revealed that plasma zinc concentration during growth period of male wister rat was affected by zinc supplementation and zinc @ 50 mg/kg had better result than zinc supplementation @100 mg/kg body weight/day.

Intercorrências mamárias relacionadas à amamentação em uma maternidade amiga da criança

Objetivo: Identificar a frequência de complicações mamárias relacionadas à amamentação em uma Maternidade Amiga da Criança em uma cidade da Bahia. Métodos: Trata-se de um estudo transversal, exploratório, descritivo, com abordagem quantitativa, em que foi aplicado um questionário semi-estruturado. Estabeleceu-se como critério de inclusão puérperas com 18 anos ou mais, que estivessem no alojamento conjunto no segundo dia de hospitalização, internadas ou acompanhando seus recém-nascidos. Foram excluídas mulheres que não pariram na maternidade e estavam internadas por algum outro motivo, ou com alguma deficiência auditiva, inviabilizando a aplicação do instrumento. Resultados: As puérperas apresentaram idade entre 18 e 35 anos, eram solteiras, consideravam-se de cor preta e tinham com uma renda maior ou igual a dois salários mínimos. Observou-se que a complicação que apresentou a maior frequência foi o trauma mamilar 36 (58%), seguido de ingurgitamento 22 (35,4%). Conclusão: As complicações mamárias trazem para mãe desconforto e dor durante amamentação. Portanto, torna-se de suma importância que a puérpera obtenha do acolhimento e instruções de como lidar com as complicações objetivando a prevenção e redução da frequência de intercorrência mamária e consequente redução dos índices de desmame precoce.

Spontaneous Breathing Trial with Pressure Support-Ventilation versus “T-Tube” for Head Trauma Patient: A Randomized Controlled Clinical Trial

Background: Assessing patients’ readiness for weaning through spontaneous breathing trial (SBT) is a reliable method for improving weaning and extubation outcomes. Until now, there are controversies over the best SBT method. Objective: This study aimed to compare the clinical outcomes of the T-piece and pressure support ventilation (PSV) SBT methods among patients with traumatic brain injury. Methods: In this randomized controlled trial, 72 patients under mechanical ventilation were purposively recruited from the intensive care unit of Shahid Rajaei hospital, Qazvin, Iran, and randomly allocated to an intervention and a control group. SBT was conducted in the intervention and control groups through the T-piece and PSV (with pressure support of less than 8 cm H2O), respectively. The groups were compared with each other respecting weaning outcomes, extubation success, length of mechanical ventilation, length of hospital stay, and mortality rate. Data were compared using the Chi-square and the independent-sample t-tests. Results: Weaning success rate in the T-piece group was significantly greater than the PSV group (P=0.024), while the post-weaning length of hospital stay in the T-piece group was significantly shorter than the PSV group (P=0.05). There were no significant differences in respecting extubation success rate and length of mechanical ventilation between the groups (P>0.05). Conclusion: The T-piece method for SBT could be better tolerated by patients with traumatic brain injury compared with PSV.

Efeito da melatonina exógena frente ao trato digestório da prole de camundongos submetidos ao desmame precoce: uma revisão sistemática

O presente estudo é uma revisão sistemática com o objetivo de caracterizar os principais achados na literatura, que relatam a ação da melatonina exógena frente ao sistema digestório de camundongos que sofreram desmame precoce. A pesquisa bibliográfica foi realizada no PubMed, BVS e SCIELO utilizando as seguintes palavras chaves: melatonin, stress e digestive tract. Foram encontrados no total 118 artigos nas 3 bases de dados analisadas. No entanto, após aplicar os critérios de inclusão / exclusão, restou apenas 1 artigo. O artigo encontrado aborda a ação da melatonina frente ao intestino delgado de camundongos que foram desmamados precocemente. Coletivamente, a suplementação de melatonina melhora o ganho de peso corporal e a morfologia intestinal, enquanto exerce pouco efeito frente a proliferação celular e apoptose, assim como nas células caliciformes e células Paneth no íleo de camundongos em desmame.

Crecimiento de corderos y productividad en ovejas Pelibuey mantenidas bajo condiciones tropicales de producción

El objetivo fue evaluar los efectos de época y año de nacimiento, tipo de parto, sexo y número de parto sobre el crecimiento predestete y la productividad de las ovejas en ovinos de raza Pelibuey que producen bajo un sistema semi-extensivo en el trópico húmedo de México. Se usaron datos de 323 ovejas Pelibuey a partir de registros de producción de 2011-2017. Se evaluaron los pesos al nacimiento (PN) y al destete (PD, a 60 d), así como los pesos de camada al destete (PCD). Adicionalmente, se evaluó prolificidad, mortalidad hasta el destete y kilos de cordero producido por oveja en un ciclo de 240 días (PC240d). Todos los factores afectaron (P≤0.05) las variables de respuesta. Los corderos procedentes de partos múltiples tuvieron menor (P&lt;0.05) PN y PD, pero mayor (P&lt;0.05) PCD, PC240d y mortalidad que los corderos procedentes de partos simples. Los corderos nacidos en época de seca tuvieron mayores (P&lt;0.05) PN y PD, mientras que las ovejas tuvieron mayores PCD y PC240d, comparado con otras épocas del año. Las ovejas primíparas tuvieron corderos más livianos (P&lt;0.05) al nacimiento y al destete, así como menor (P&lt;0.05) prolificidad, PCD y PC240d que las ovejas multíparas (≥3 partos). El año de nacimiento afectó (P&lt;0.05) PN, PD, tasa de mortalidad y características de productividad. En conclusión, se observó un mejor desempeño en el crecimiento predestete para corderos Pelibuey nacidos de ovejas multíparas y con parto simple en la época de seca. Sin embargo, la productividad de la oveja fue mejor con la presencia de partos dobles, en tiempo de sequía, y con el aumento en número de partos.

Fatores associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso: revisão integrativa

Objetivo: Relatar os fatores associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso. Método: Trata-se de uma revisão integrativa, utilizando periódicos nas bases de dados: BVS e Scielo. Primeiro elaborou-se a pergunta norteadora “Quais fatores estão associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso?”; seguido pela busca na literatura, coleta de dados, análise crítica dos estudos incluídos, discussão dos resultados e por fim apresentação da revisão integrativa. Foram estabelecidos como critérios de inclusão artigos originais e completos nos últimos cinco anos. Excluindo teses e dissertações, textos incompletos, artigos editoriais, resumos, ou publicações fora do período estabelecido. Resultados e discussão: Foi possível verificar que apesar das diversas estratégias de incentivo a amamentação exclusiva para recém-nascidos de baixo peso, como por exemplo, Banco de Leite Humano, Hospital Amigo da Criança e método canguru, muitos estudos mostram que ainda existe alto percentual de desmame precoce no Brasil, mesmo em neonatos de baixo peso. Alguns fatores associados a isso são a idade materna, volta ao mercado de trabalho pela mãe, parto cesariano, uso de chupetas e outros líquidos antes dos seis meses de idade. Conclusão: O Aleitamento materno exclusivo se mostra fundamental para melhoria das condições de saúde do recém-nascido. Fatores que vão desde o tipo de parto ao incentivo pela equipe de saúde podem contribuir para a manutenção desse aleitamento. Destaca-se a importância de maiores estudos acerca dos métodos efetivos de incentivo e principais motivos que levam ao desmame precoce.

Can We Rely on the Activated Clotting Time to Measure Heparin Anticoagulation? A Clinical Evaluation of Two ACT Monitors.

The sensitivity to heparin during cardiopulmonary bypass (CPB) is determined by patient-specific characteristics and is assessed by the whole blood activated clotting time (ACT). We aimed to examine reliability measures between two different ACT monitors using Bland-Altman analysis: bias should not exceed 50 ± 50 seconds for measurements performed during CPB or 10 ± 10 seconds before and after CPB. The ACT response should be linear in relation to the concentration of heparin in plasma. Twenty patients (n = 20) aged 20-80 years and admitted for coronary artery bypass surgery were enrolled to this clinical observational study. ACT values and antifactor Xa were sampled: 1) before induction of anesthesia, 2) after heparin bolus, 3) during CPB at the start of rewarming, 4) at weaning from CPB, and 5) after heparin reversal. The evaluation comprised the Hemostasis Management System Plus™ (HMS, Medtronic Inc., Minneapolis, MN) and i-STAT™ (Abbott, Point of Care Inc., Princeton, NJ). Bias for the HMS Plus™ vs. i-STAT™ was +105 ± 119 seconds for measurements during CPB and +2.8 ± 11.7 seconds before and after CPB. Associated limits of agreement for the observed bias were ±235 and ±23 seconds, respectively. Inter-device correlation of ACT values was .46 (p < .001) during CPB; otherwise .48 (p = .02). Both devices produced ACT values unrelated (<10%) to the measured heparin concentration. The use of multivariable regression analysis demonstrated an independent association between the ACT measurement and hematocrit, however, not with the plasma concentration of heparin. ACT monitors demonstrate unacceptable bias differences, combined with wide limits of agreement. The ACT response correlated with hematocrit, but not with the actual heparin concentration.

Hemophagocytic Lymphohistiocytosis in a Patient With Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening entity resulting from the dysregulated activation of T-lymphocytes. Secondary HLH (sHLH) complicates various medical conditions. Similar to 2009 H1N1 influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to trigger a cytokine storm in a subset of individuals. The patient of 64 years old presented himself in the emergency department with cough and fever, and was subjected to the nasopharyngeal swab and tested positive for SARS-CoV-2, as expected from epidemiological data. Hospitalized in cohort isolation, he initially presented a multi-organ impairment and specifically a worsening of his renal function, initial coagulopathy, lymphopenia modest thrombocytopenia and systemic inflammatory commitment. During the course of the 6th day, a picture of a probable cytokine storm and clear multiple organ failure (MOF) was evident. Therefore a clinical diagnosis was made according to HScore criteria of secondary hemophagocytic lymphohistiocytosis. We started high-dose steroid therapy (dexamethasone 8 mg bid). And after 36 h, the patient was significantly improved: alert, oriented, weaned from non-invasive ventilation (NIV) and stable blood chemistry. In conclusion, in coronavirus disease 2019 (COVID-19) positive patients with evidence of cytokine storm and acute respiratory distress syndrome (ARDS), the levels of blood triglycerides and ferritin are useful and often decisive to comfort the diagnosis of sHLH if cytopenia of one or more lines is revealed. J Med Cases. 2020;11(10):327-329 doi: https://doi.org/10.14740/jmc3515