Effects of feeding 25-hydroxyvitamin D3 with an acidogenic diet during the prepartum period in dairy cows: Mineral metabolism, energy balance, and lactation performance of Holstein dairy cows.

Our objective was to determine the effects of feeding 25-hydroxyvitamin D3 [25(OH)D3], or vitamin D3 (cholecalciferol) on plasma, mineral, and metabolite concentrations, mineral balance, mineral excretion, rumination, energy balance, and milk production of dairy cows. We hypothesized that supplementing 3 mg/d of 25(OH)D3 during the prepartum period would be more effective than supplementing vitamin D3 at the National Research Council (2001) levels to minimize calcium imbalance during the transition period and improve milk production of dairy cows. Forty multiparous, pregnant nonlactating-Holstein cows were enrolled in this study. Body weight, body condition score, parity, and milk yield in the previous lactation (mean ± standard deviation) were 661 ± 59.2, 3.46 ± 0.35, 1.79 ± 0.87, and 33.2 ± 6.43 kg/d, respectively. Cows were enrolled into the blocks (n = 20 for each treatment) at 30 d of the expected day of calving to receive an acidogenic diet (373 g/kg of neutral detergent fiber and 136 g/kg of crude protein, dry matter basis; -110 mEq/kg) associated with the treatments: (1) control (CTRL), vitamin D3 at 0.625 mg/d (equivalent to 25,000 IU of vitamin D3/d) or (2) 25(OH)D3 at 3 mg/d (equivalent to 120,000 IU of vitamin D3/d). All cows were fed with the base ration for 49 d after calving. Blood samples were taken on d 7, 0, 1, 2, 21, and 42, relative to calving. No effect of treatment was observed for prepartum dry matter intake or body condition score. A trend for increase of ionized Ca was observed for the cows fed 25(OH)D3, compared with the CTRL, but no effect of treatment was detected for total Ca or total P. Feeding 25(OH)D3 increased colostrum yield. The plasmatic concentration of 25-hydroxyvitamin D3 was increased with 25(OH)D3 supplementation. 25-Hydroxyvitamin D3 supplementation increased plasma glucose concentration at parturition. The postpartum dry matter intake was not influenced by treatments. Feeding 25(OH)D3 increases milk yield, 3.5% fat-corrected milk, and energy-corrected milk and improves milk yield components in early lactation. Overall, these findings suggest that 25(OH)D3 at 3 mg/d can improve the energy metabolism and lactation performance, compared with the current-feeding practice of supplementing vitamin D3 at 0.625 mg/d.

Blood pressure control in a registry of clinical practice, PINNACLEBRAZIL REGISTRY

INTRODUCTION: The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top ranking cause of all deaths globally. PURPOSE: We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guidelinederived recommendations, after one year of the clinical practice registry METHODS: Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in "real world" clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated RESULTS: Currently, PINNACLEBrazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9%(baseline) and 57.3% (followup). Percentage of patients who had a blood pressure < 140/90 mm Hg, or who had a blood pressure >= 140/90 mm Hg and were prescribed >= 2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. CONCLUSION: The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. (AU)

Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983.

Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. The current study was aimed at describing and comparing the patients on the malnutrition ward, in 2001 and 1983. The study gathered indices of nutritional status and secondary diagnoses from the notes of all children (aged between 6 months and 5 years) discharged from the malnutrition ward for a period of l year (January-December 2001), and from data (collected in January-December 1983) for the malnutrition ward. Data was entered and analysed using Epi-Info 6 and SPSS statistics package. The ethics committee of the hospital approved the study. Data was collected for 558 children in 2001 and 833 in 1983. There was no gender difference, average age was 21.7 months in 2001 and 23.8 months in 1983 and the average hospital stay was 13.1 and 14.3 days, respectively. In 2001, 33 per cent had kwashiorkor, 26 per cent marasmus, and 28 per cent marasmic kwashiorkor. Three hundred and twenty children (82 per cent) were <2 Z-scores below the median weight-for-age and 252 children (65 per cent) were <3 Z-scores. Forty per cent had malaria, 65 per cent anaemia, 53 per cent bronchopneumonia, 14 per cent TB, 36 per cent diarrhoea, and 12 per cent HIV/AIDS. In 1983, 49 per cent had kwashiorkor, 17 per cent marasmus, and 11 per cent had marasmic kwashiorkor. A total of 494 children (81 per cent) were <2 Z-scores below the median weight-for-age and 335 children (55 per cent) were <3 Z-scores. Eighteen per cent had malaria, 37 per cent anaemia, 28 per cent bronchopneumonia, 6 per cent TB, 8 per cent diarrhoea, and 4.4 per cent measles/post-measles. A comparison between the clinical status of 1983 with that of 2001 shows little difference in age, gender or length of stay. There were fewer admissions in 2001, although a higher percentage of severely underweight children and the 2001 group had more secondary infections, especially malaria, bronchopneumonia and anaemia. Clinical malnutrition at a referral hospital level, in spite of the remarkable Mozambican economic growth, shows signs of following the depressing pattern for much of Eastern Africa. A prospective study including HIV tests and anthropometric data for this and the city's other hospitals is warranted. Discussion needs to be prompted on a local level about malnutrition and the use of guidelines.

The impact of living on the streets on latency children's friendships.

OBJECTIVE: This is a study to evaluate friendships in latency street boys of Porto Alegre, RGS, Brazil. METHODS: A sample of 30 latency street boys was compared with a sample of 51 latency boys living with their low income families, using the Cornell Interview of Peers and Friends (CIPF). RESULTS: The two groups had a significantly different CIPF global scores, and the boys of the street group had the highest mean score. Also, boys of the street had significantly lower developmental appropriateness, self-esteem and social skills scores than boys living with a family. CONCLUSIONS: The urgent need for intervention street children, especially on boys of the street, is emphasized.

Quimioterapia y radioterapia en el cáncer de ovario: mitos y realidades / Drug therapy and radiotherapy in the ovarian neoplasm: myths and realitys

236 pacientes con carcinoma epitelial del ovario fueron estadificadas y reestadificadas según la clasificación de la FIGO de 1985. Objetivos: 1) valorar la quimioterapia como adyuvante en estadios iniciales y terapéutica en estadios avanzados usando esquemas de mono o poliquimioterapia. 2) Evaluar la radioterapia como terapia de consolidadción rescate. 3) Comparar la utilidad de la quimioterapia de segunda línea vs. la radioterapia en pacientes con second look positivo. Como esquemas de monoquimioterapia se utilizó melfalán y como poliquimioterapia de segunda línea, esquemas basados en platino en aquellas pacientes respondedoras al mismo. Resultados: cuando se realiza la comparación para la muestra global no se hallaron diferencias significativas con respecto a la sobrevida y al período libre de enfermedad con mono o poliquimioterapia. En los estadios avanzados si se halló diferencia significativa con respecto al período libre de enfermedad en las pacientes que fueron tratadoas con poliquimioterapia (p<0,025). En los estadios IAB, se registraron diferencias estadísticamente significativas en la sobrevida de las que hicieron adyuvancia (78 vs. 31 por ciento) y las que hicieron seguimiento (p<0,005). En los estadios IIIc no se hallaron tampoco diferencias significativas en ambos grupos (MQT vs. PQT) con respecto a la sobrevida pero sí en el período libre de enfermedad (p<0,025). Radioterapia como arma de consolidación rescate. Al comparar los casos con cirugías completas con posterior quimioterapia adyuvante y second look negativo que realizaron seguimiento posterior (n=19) con las que consolidaron con radioterapia (n=9), no se hallaron diferencias estadísticamente significativas con respecto a la sobrevida ni al TLE. En las que tuvieron LR < 0 > de 2 cm. con quimioterapia posterior y second look negativo y que hicieron seguimiento (n=30), la sobrevida fue del 24 por ciento, en las que consolidaron con RT ésta fue del 66 por ciento (p<0,02) y el TLE fue de 29 y 70 por ciento respectivamente. Al comparar en los estadios avanzados con LR < 0 > de 2 cm. que realizaron quimioterapia posterior y tuvieron Second look positivo, las terapias de rescate (QT vs. RT) se registraron diferencias estadísticamente significativas entre ambos grupos, con respecto a la sobrevida: QT (n=18): 10 por ciento vs. RT (n=20): 37 por ciento (p<0,025). Conclusiones: 1) no hemos comprobado diferencias estadísticamente significativas en la sobrevida global de todas las pacientes tratadas con mono o poliquimioterapia. En los estadios avanzados tratados con esquemas basados en platino hallamos diferencias significativas con respecto al TLE. En los estadios iniciales (IAB), se registró un beneficio en términos de sobrevida en las que realizaron quimioterapia adyuvante. 2) La radioterapia demostró ser de utilidad en aquellas pacientes con LR menores de 1 cm., confinadas a la pelvis o microscópicas en abdomen. 3) Las alternativas terapéuticas de consolidación rescate o salvataje no aseguran mejoría de la sobrevida o un TLE aceptable

Avaliaçäo retrospectiva do atendimento em pronto socorro pediátrico / Attendance at urgent pediatric care unit

Estudou-se o atendimento clínico no Pronto Socorro (PS) de Pediatria do Hospital Säo Paulo, da Escola Paulista de Medicina. verificando-see volume de atendimento, sazonalidade das consultas e diagnósticos apurados. As doenças mais diagnosticadas foram as infecçöes de vias aéreas superiores e broncoespasmo. Por meio de análise retrospectiva critica-se o sistema de registro dos atendimentos utilizados na época do estudo, sugerindo-se uma padronizaçäo de condutas e anotaçäo de diagnósticos, por sistema informatizado. Conclui-se que o atendimento do PS é constante durante todo o ano, com pequena diminuiçäo no período de férias escolares