Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial.

PURPOSE: The EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA ≥ 0.60. No difference was found in 28-day all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA ≥ 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0.6-0.89. METHODS: Post-hoc analysis of the EUPHRATES trial for the 194 patients with EAA ≥ 0.6-0.89 who completed two treatments (PMX or sham). The primary end point was mortality at 28 days adjusted for APACHE II score and baseline mean arterial pressure (MAP). Additional end points included changes in MAP, cumulative vasopressor index (CVI), median EAA reduction, ventilator-free days (VFD), dialysis-free days (DFD) and hospital length of stay. Subpopulations analyzed were site and type of infection and those with norepinephrine dose > 0.1 mcg/kg/min at baseline. RESULTS: At 28 days, 23 patients of 88 (26.1%) in the PMX group died versus 39 of 106 (36.8%) in the sham group [risk difference 10.7%, OR 0.52, 95% CI (0.27, 0.99), P = 0.047]. When unadjusted for baseline variables, P = 0.11. The 28-day survival time in the PMX group was longer than for the sham group [HR 0.56 (95% CI 0.33, 0.95) P = 0.03]. PMX treatment compared with sham showed greater change in MAP [median (IQR) 8 mmHg (- 0.5, 19.5) vs. 4 mmHg (- 4.0, 11) P = 0.04] and VFD [median (IQR) 20 days (0.5, 23.5) vs. 6 days (0, 20), P = 0.004]. There were no significant differences in other end points. There was a significant difference in mortality in PMX-treated patients with no bacterial growth on culture [PMX, 6/30 (20%) vs. sham, 13/31 (41.9%), P = 0.005]. The median EAA change in the population was - 12.9% (range: increase 49.2%-reduction 86.3%). The mortality in the above median EAA change group was PMX: 6/38 (15.7%) vs. sham 15/49 (30.6%), P = 0.08. CONCLUSIONS: These hypothesis-generating results, based on an exploratory post hoc analysis of the EUPHRATES trial, suggest measurable responses in patients with septic shock and an EAA ≥ 0.6 to 0.89 on changes in mean arterial pressure, ventilator-free days and mortality. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01046669. Funding Spectral Medical Incorporated.

Dairy technology adoption in smallholder farms in "Dejen" district, Ethiopia.

Factors influencing dairy technology adoption and impact on milk yield were studied in 240 smallholder farms in Dejen district, Ethiopia. The majority of the smallholders had more than 20 years of farming experience and were living at more than 10 km distance from market or trading centers (67% and 54% in that order). The dairy technologies studied included the use of crossbred animals, improved feed technologies and improved management practices. Application of acaricides, deworming, vaccination, heat-detection and haymaking had wide application (more than 80% adoption levels) while urea straw treatment, silage making, rotational grazing and fodder beet development were the least practiced ones. Only 20 percent of the cows were crossbred animals. It has been found that higher level of technology adoption is associated with better milk yield regardless of the breed of cattle (local or crossbred) owned by the farmers. Milk yields in local breeds increased by 0.07 times when the number of technologies increased by one unit. In crossbred cows, this rate of increase was five fold higher (0.38 times for one unit increase). Correlation coefficients between and within farm household characteristics and technologies adoption were, generally, significant. Male-headed households adopted significantly higher number of technologies than female-headed households (P < 0.001). Technology adoption rates increased significantly with increased education level and family size and decreasing distance from market or trade centers (P < 0.01). The level of technology adoption by smallholder farmers is still unsatisfactory and is highly dependent on gender, family size and level of education of smallholder farmers and location of farms.

Calf morbidity and mortality in smallholder dairy farms in Ada'a Liben district of Oromia, Ethiopia.

A longitudinal observational study on calf morbidity and mortality was conducted in smallholder dairy farms in Ada'a Liben district of Oromia, Ethiopia. A total of 185 calves from 112 market oriented smallholder dairy farms were selected randomly and regularly monitored for clinical health problems up to six months of age. Information on potential risk factors was collected by personal observation during the regular visit to farms and from questionnaire survey conducted during the study period. The overall incidences of crude morbidity and crude mortality were 62% and 22%, respectively. The most frequent disease syndrome was calf diarrhea with the incidence of 39% followed by joint ill 6%. The other disease conditions/syndromes diagnosed include navel ill, pneumonia, septicemic conditions, congenital problems and miscellaneous cases. Age of the calves, age at first colostrum ingestion and cleanness of the calf barns significantly influenced morbidity. Older calves (greater than three months of age) were at lower risk of crude morbidity than younger calves (less than three months of age) (HR = 0.42, P = 0.001). Higher risk of crude morbidity was observed in calves that ingested their first colostrum meal later than 6 hours of age compared to those that ingested colostrum earlier (HR = 2.24, P = 0.001). Similarly, calves housed in unclean barns were at higher risk of morbidity than calves housed in clean barns (HR = 1.75, P = 0.024). Of the 20 potential risk factors investigated, age was the only factor that was found significantly associated with mortality (HR = 0.04, P = 0.001). Calves older than three months of age were at lower risk of mortality than younger calves.

Husbandry practices and health in smallholder dairy farms near Addis Ababa, Ethiopia.

Our study was conducted from November 2001 to April 2002 in the Debre-Zeit area (near Addis Ababa), Ethiopia to assess the husbandry practices and to identify health constraints in 100 market-oriented smallholder dairy farms. A questionnaire survey, farm visit and animal examination were conducted. Thirty-eight percent of the smallholder farms were owned by women. Women-owned farms had more cows (median=3) than men-owned ones. The median herd size (including young animals) was four animals per farm. Median age, parity number and daily milk production of cows were, respectively, 5 years, 3 and 10l. The housing conditions were tie-stall barns for 53% and shades for the rest. About 48% of the herd were kept under poor housing conditions; land-resource limitation was mentioned as the major problem. Twenty percent of the farms were using hired labour. Mastitis (both clinical and subclinical) was the most-frequently encountered disease condition (prevalence at herd level 30%) followed by foot-and-leg problems. Farms owned by men or using hired labour had higher disease prevalences. The poor housing conditions were associated with the observed prevalences of health constraints.

Prevalence and aetiology of mastitis in cows from two major Ethiopian dairies.

The study was undertaken to determine the aetiology and prevalence of mastitis in hand-milked cows (n = 186) in two major Ethiopian dairies. The California Mastitis Test and culturing for bacteria revealed that 21.5% of the cows were clinically infected and 38.2% had subclinical mastitis. Most mastitis pathogens isolated from milk samples testing positive by the California Mastitis Test were Gram-positive cocci. Staphylococci constituted 57% of the isolates, of which the predominant cause of bovine mastitis was Staphylococcus aureus (40.5%). Other mastitis pathogens isolated include streptococci (16.5%), coliforms (9%) and corynebacteria (5%). Retrospective analysis of farm records indicated that mastitis was the second most important cause of culling and accounted for 27% of the cows removed from these two dairies.