Nutritional strategies to cope with reduced litter weight gain and total tract digestibility in lactating sows.

Twelve lactating sows were used to evaluate the effects of reducing dietary crude protein (CP) (14% vs. 12%) and increasing neutral detergent fibre (NDF) levels (18% vs. 22%) on litter performance, total tract apparent digestibility and manure composition in a 4 × 4 latin square arrangement during a 36-day lactation period. Diets were isoenergetic (2.9 Mcal ME/kg) and had similar total lysine content (0.9%). In addition, a second aim was to compare a reference external marker method (Cr2 O3 ) with an internal feed marker [acid-insoluble ash (AIA)] for the calculation of apparent total tract digestibility of nutrients in lactating sows. The reduction of dietary CP level in lactating sows had no effect on either live-weight or backfat thickness or apparent total tract digestibility of nutrients. However, the piglets' average daily gain (ADG) was reduced in low dietary CP diets, which suggests that sows reduced milk production due to an underestimation of certain essential amino acid requirements (e.g. valine). The increase of dietary NDF level did not affect sow and litter performance. Nevertheless, the total tract apparent digestibility of organic matter, CP and carbohydrates was reduced, and ether extract digestion was increased in high NDF compared to normal NDF diets equally balanced for ME and lysine content. The coefficients of total tract apparent digestibility of nutrients in lactating sows were greater when using AIA compared to Cr2 O3 marker, regardless of dietary CP or NDF level, but their coefficients of variation were lower in the former than in the latter. In lactating sows, a trade-off between litter performance and nutrient digestion is established when reducing dietary CP or increasing NDF levels while maintaining similar lysine content through synthetic amino acids and balancing metabolizable energy through dietary fat sources.

[Central Venous Catheters with Subcutaneous Reservoir with Implementation Braquial: An Alternative to Consider]. / Catéteres venosos centrales con reservorio subcutáneo de implantación braquial.

Administering treatments in patients with malignancies must be performed by nursing professionals with experience and knowledge of the pathology being treated, drugs, techniques and devices used for administration. The implantation of a venous access device with subcutaneous reservoir offers the possibility of multiple and long-term frequent injections and also blood extraction from a less invasive way. They are aesthetically more acceptable than external catheters, they have a lower risk of accidental release and infection, they require less care and they allow extra-hospital treatment. Another advantage to consider is that they cause less limitations in daily life, which is associated with an increased quality of life. Placement of devices with camera of brachial location, was done by the first time by venotomy technique with many doubts; however, the results of placement success and the decreased complications, improved significantly when the placement began performing by vascular radiology services using fluoroscopy and ultrasound. Particularly striking is the success rate (between 99% and 100%) with a 0% rate of placement complications (hemorrhage, pneumothorax). The infection rate is not flashy, remaining within normal parameters in relation to the pectoral systems. The rates of deep vein thrombosis (DVT) are assumable and they are consistent with other related studies. These devices are particularly useful in patients with abnormalities of chest wall such as dermal carcinoma and tumor shell in patients with breast cancer (tumour the bottom shell). And also when there are open wounds in the chest area, such as tracheotomy or fibrosis caused by radiation therapy, or in the presence of scars of flaps after surgery in head and neck cancer (or when it is expected that the patient will receive this surgery), severe kyphosis, obese patients and patients with respiratory failure.

Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine.

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.

External validation of the Simplified Acute Physiology Score (SAPS) 3 in Spain.

OBJECTIVE: To evaluate SAPS 3 performance in Spain, assessing discrimination and calibration in a multicenter study. DESIGN: A prospective, multicenter study was carried out. PATIENTS AND SETTING: A prospective cohort study was performed in Spanish hospitals between 2006 and 2011. MEASUREMENTS AND RESULTS: A total of 2171 patients were included in the study. The mean age was 61.4±16.09 years, the ICU mortality was 11.6%, and hospital mortality 16.03%. The SAPS 3 score was 46.29±14.34 points, with a probability of death for our geographical area of 18.57%, and 17.97% for the general equation. The differences between observed-to-predicted mortality were analyzed with the Hosmer-Lemeshow test, which yielded H=31.71 (p<0.05) for our geographical area and H=20.05 (p<0.05) for the general equation. SAPS 3 discrimination with regard to hospital mortality, tested using the area under the ROC curve, was 0.845 (0.821-0.869). CONCLUSION: Our study shows good discrimination of the SAPS 3 system in Spain, but also inadequate calibration, with differences between predicted and observed mortality. There are more similarities with regard to the general equation than with respect to our geographical area equation, and in both cases the SAPS 3 system overestimates mortality. According to our results, Spanish ICU mortality is lower than in other hospitals included in the multicenter study that developed the SAPS 3 system, in patients with similar characteristics and severity of illness.

Molecular diagnosis of polycystic echinococcosis due to Echinococcus vogeli in a Paraguayan immigrant in Argentina.

Polycystic echinococcosis due to Echinococcus vogeli is a rare parasitic infection that occurs in rural areas of Central and South America. Only molecular identification performed on formalin-fixed paraffin-embedded liver tissue samples gave an unequivocal diagnosis of this disease in a Paraguayan immigrant in Argentina.

Carry-over effects of body condition in the early pregnant ewe on peri-partum adipose tissue metabolism.

This study evaluated the carry-over effects of ewe body reserves during early pregnancy on peri-partum adipose tissue metabolism. Forty-nine multiparous ewes were divided in three categories according to their body condition score (BCS) at day 30 of pregnancy (BCS < 3, 2.5-2.75; BCS = 3; BCS > 3, 3.25-3.5). Live-weight (LW) and BCS gains from 1st to 4th month of pregnancy were greater in ewes with BCS < 3 and 3 than in >3 animals. In contrast, in the last month of pregnancy, there was BCS decrease in all groups, although LW continued increasing. There were no differences in LW or BCS across ewe categories during this period. Peripheral leptin levels throughout the three last weeks of pregnancy were greater in ewes with BCS > 3 than in the rest, but this difference did not persist after lambing. Plasma metabolites related to energy metabolism, milk yield and lamb growth were not affected by ewe BCS in early pregnancy. Long-chain saturated milk fatty acids (FA) (C16-C24) were greater in ewes with lowest BCS (<3 and 3). Ewes with greater BCS showed greater monounsaturated and lowest polyunsaturated milk FA content. Ewe post-mating body reserves affect both pre-partum leptinaemia and post-partum milk polyunsaturated fatty acids content, but it had little effect on lamb performance.

[Technical and functional standards and implementation of a clinical information system in intensive care units]. / Estándares técnicos y funcionales, y proceso de implantación, de un sistema de información clínica en unidades de cuidados intensivos.

INTRODUCTION: Clinical Information Systems (CIS) are becoming a useful tool for managing patients and data in the ICU. However, the existing CIS differ in their capabilities and technical requirements. It is therefore essential for intensivists, as the end clients of these applications, to define the suitable minimum specifications required in order to be operative and helpful. OBJECTIVES: The Spanish Society of Intensive Care Medicine and Coronary Units, through its Organization and Management Workgroup, has designated a group of clinical and software experts to draft a document with the recommendable technical and operating requirements of these systems. METHODS: The group was formed by ten people supported by managers or engineers from the five principal industries producing CIS in Spain. The project involved the following phases: a) Completion of a check list. This step was considered necessary in order to establish the precise current situation of CIS applications. b) Discussion of the results by the group of experts in a meeting and in online format. RESULTS: The requirements were grouped into four sections: technical, functional, safety and data management. All requirements were classified as basic and optional in order to allow the end user to choose among different options according to the existing budget, though ensuring a minimal set of useful characteristics. A chronogram for the installation process was also proposed.

Metabolic and luteal function in winter-calving Spanish beef cows as affected by calf management and breed.

This experiment aimed at evaluating the effect of calf management and breed on the metabolic and luteal function of post-partum beef cows fed at maintenance. Fifty multiparous cows, 22 Parda de Montaña (PA) and 28 Pirenaica (PI), were assigned to either suckling once-daily for 30 min (RESTR) or ad libitum (ADLIB) from the day after calving. Blood samples were collected to analyse metabolites [non-esterified fatty acids (NEFA), beta-hydroxybutyrate, total protein and urea)], insulin-like growth factor-I (IGF-I) and progesterone (P4) at different intervals. Cows from RESTR maintained their live-weight (LW) over the first 3 months post-partum, whereas ADLIB cows lost nearly 4% LW. Both genotypes showed similar LW gains during this period (p > 0.10). Calf daily gains were lower in RESTR than in ADLIB treatment (p < 0.05), but similar across breeds (p > 0.10). Milk and lactose production were lower in RESTR cows than in ADLIB (p < 0.05). Milk and protein yield were greater in PA than in PI breed (p < 0.05). Serum NEFA, total protein and urea were higher in PI cows suckling ADLIB than in the rest (p < 0.05). Cows from PI breed had greater NEFA values than PA ones on the first week post-partum (p < 0.001). Circulating IGF-I was not affected by suckling frequency, breed nor their interaction (p > 0.10). Suckling frequency, but not breed, affected the interval from calving to first ovulation (p < 0.001), being shorter in RESTR than in ADLIB cows. In conclusion, the ad libitum suckling practice improved cow milk yield and offspring gain compared to once-daily suckling for 30 min from the day after calving, at the expense of impairing the onset of cyclicity. The effect of calf management was confounded with breed on the studied blood biochemical constituents, but any of these metabolites influenced the role of endocrine IGF-I in these genotypes.

Luteinizing hormone and growth hormone secretion in early lactating Spanish beef cows.

The episodic release of luteinizing hormone (LH) and growth hormones (GH) was studied in three suckling regimens and two breeds of Spanish suckled cows. Parda de Montaña (PA) cows (n = 21) were assigned to once-daily, twice-daily or ad libitum (ADLIB) suckling. Pirenaica (PI) cows (n = 7) were used to evaluate the breed effect in twice-daily suckling. Coccygeal blood samples were collected twice weekly during lactation to determine the interval from calving to first ovulation through peripheral progesterone. On day 32 ± 3 post-partum, jugular blood samples were drawn at 15 min intervals during 8 h to analyse circulating LH and GH. The interval to first ovulation was greater in PA cows suckling ADLIB than in restricted suckling treatment (RESTR1), whereas in RESTR2 it did not differ from the other two treatments. There were no differences between PA and PI cows in the interval to first ovulation. RESTR1 cows showed a tendency to have shorter LH peak widths than ADLIB cows. PA cows showed a tendency to have longer LH peak widths than their PI counterparts. There were no differences across treatments or breeds in any of the GH measures of secretion. The LH release was more affected by breed than by suckling frequency, whereas that of GH was not influenced by any of these parameters. The variables that best allowed discrimination between ADLIB and restricted nursing systems were the interval to post-partum first ovulation, LH peak number and the mean GH concentration.

Credence cues of pork are more important than consumers' culinary skills to boost their purchasing intention.

The role of consumers' culinary skills on purchasing cues of pork, with emphasis on niche demands (outdoor husbandry and/or certified organic), was assessed in cross-country regions of Spain (Catalonia and Aragon) and Portugal (North). A sample of 974 respondents answered an on-line survey with questions regarding consumer purchasing habits, product involvement and intrinsic and credence attributes. They also chose between two contrasting boneless pork loins and express willingness to pay (WTP) for different product scenarios with different pig farm facilities and for organic pork standards. Two optimal segments were identified based on food-related habits: 'uninvolved' and 'innovative cook lovers', both similarly balanced across socio-demographics, score for credence attributes or consumer involvement dimensions. Overall mean WTP premium across countries was 11.8% for marbled pork, 20.0% for outdoor pork and 24.3% for organic logo stamp. Credence cues of pork claiming health issues (absence of antibiotics and hormone residues) rather than consumers' culinary skills defined the WTP for niche pork in these regions.

Alfalfa but not milk in lamb's diet improves meat fatty acid profile and α-tocopherol content.

To establish animal feeding recommendations, it is required to quantify whether the effects of combining dietary alfalfa and milk on meat composition of light lambs are overlapped or independent. This experiment aimed to evaluate the separate effects of dietary alfalfa and milk access on the light lamb carcass quality (10-11 kg), meat colour, chemical composition, fatty acid profile and α-tocopherol content. Thirty-two lambs were assigned to one of four treatments in a 2 × 2 factorial design. The factors were the inclusion of dietary forage (grazed alfalfa vs. concentrate-fed indoors) and lactation length (weaning at a target live-weight of 13 kg vs. suckling until slaughter at 22-24 kg). Dietary alfalfa but not milk supply improved conjugated linoleic acid isomers (CLA), omega-3 fatty acids and α-tocopherol contents in lamb meat without affecting meat colour attributes. Milk supply affected more the fatty acid profile (more saturated) than the α-tocopherol content of meat. Thus, dietary alfalfa improved CLA, omega-3 fatty acids and α-tocopherol content in light lamb without affecting the meat colour, whereas lengthening the lactation period did not provide benefits in terms of meat colour or healthy nutrient composition.

Panic and epilepsy.

Research is presented to support a hypothesis that panic attacks, when they have the same clinical signs as the epileptic consciousness, should be diagnosed as partial seizures with a psychic content. After setting out the four clinical signs defining it (suddenness, automatic nature, great intensity and strangeness), an extensive review of the literature is made in search of scientific information to support the hypothesis, which reveals a wealth of concurring scientific evidence, at both the clinical and preclinical levels, to support the hypothesis presented here. In conclusion, new research is proposed with a view to drawing up interviews and clinical scales in order to quantify the four clinical signs objectively.

Epilepsy and psychiatry: automatic psychic paroxysms.

This study analyzes diverse psychic phenomena which, although always occurring with very characteristic clinical features, are sometimes diagnosed as epilepsy and sometimes as symptoms of different psychiatric disorders depending on the availability of an electroencephalogram. It is posited that these phenomena, whenever they are accompanied by the features characteristic of an epileptic consciousness (suddenness, automatic nature, great intensity and a strong sensation of strangeness) should be diagnosed as partial seizures with a psychic content, regardless of the availability of an EEG. The co-occurrence of these four clinical signs, which are relatively simple to objectivize, is a more reliable clinical criterion for diagnosis than a transcraneal electroencephalogram, which, as is known, is of little value in measuring the electrical activity of partial seizures. Moreover, an interpretation of this type makes it possible to reconcile scientific data from various neurosciences which thus far have seemed contradictory.

[Acute suppurative cholangitis]. / Colangitis aguda supurada.

1) Acute suppurative cholangitis is the most severe clinical form of bacterial biliary infection. 2) During a 14 year period, 29 patients were treated at the General Surgery Division A, of the Cosme Argerich General Hospital. 3) Patients were divided in two groups; a) acute suppurative cholangitis with (n:100 or b) without (n:19) evidence of biliary obstruction. In the former group, in addition to Charcot's triad, we found mental confusion and septic shock among clinical signs. 4) Gall stones were the most common cause of obstruction, followed by pancreatic and biliary carcinoma. 5) Diagnosis on admission was correct in 40% of patients. Charcot's triad was present in 19 of the 29 patients. 6) All 22 operated patients survived whereas 7 non operated patients died. 7) The high mortality observed was similar to that reported in other publications and could be partly due to delayed diagnosis, and the high frequency of multiple liver abscesses found at autopsy. 8) Newer diagnostic procedures have improved the differential diagnosis of obstructive jaundice. It is hoped that they will help in the earlier recognition of acute suppurative cholangitis and decrease the incidence of severe complications.

Influence of the type of forage supplied to ewes in pre- and post-partum periods on the meat fatty acids of suckling lambs.

The aim of this study was to evaluate the use of forage diets (grazing vs. hay) around the time of ewe parturition, on the fatty acids profile of suckling lamb meat (10-12kg body weight). Forty-eight multiparous single-bearing ewes were used. The experimental treatments were conducted during the last 5weeks of pregnancy and the 5weeks of lactation in a 2×2 factorial design. Ewes were fed ad libitum on pastures or hay in the autumn. Results showed that milk from grazing ewes during the pre-partum period had a higher content of PUFA and CLA (P<0.05) and VA, CLA in their suckling lambs' meat (P<0.05). The effect in post-partum feeding was greater, revealing higher CLA, PUFA/SFA, PUFA n-3 and PUFA n-6/n-3 in milk and meat (P<0.05). The CLA, VA and PUFA n-6/n-3 ratios are those that are most affected by grazing. Pre-partum grazing, regardless of post-partum feeding, improves FA composition, increasing CLA content in both milk and meat.

The forage type (grazing versus hay pasture) fed to ewes and the lamb sex affect fatty acid profile and lipogenic gene expression in the longissimus muscle of suckling lambs.

Meat intramuscular fat (IMF) contributes to meat quality and consumer acceptance. Molecular events that occur during IMF deposition and the identification of genes that are differentially expressed during this process are important to the design of an optimal nutrition plan for animals. In the present study, we examined the effect of the forage type (grazing vs. hay pasture) fed to ewes and the effect of lamb sex on the LM fatty acid (FA) profile and gene expression of suckling lambs (10 to 12 kg of BW at slaughter); ewes received pasture hay (PH) or grazed pasture (GRE). Forage type had a significant effect on IMF FA profile. Ewes grazing green forage (GRE) promoted the formation and deposition of vaccenic acid (C18:1n-7), CLA, and PUFA n-3 in LM from their suckling lambs (P < 0.05). We found that forage type affected the expression of the sterol regulatory element binding transcription factor 1 (SREBF1) gene in females. However, in males, it modulated stearoyl CoA desaturase (SCD) gene expression (P < 0.05). Moreover, our results showed that females, independent of the diet of the ewes (PH or GRE), are predisposed to develop fat and to upregulate the expression of key genes of transcriptional factors PPARA, CEBPB, SREBF1, and lipoprotein lipase (LPL) and SCD (P < 0.05). The data suggest that SREBF1, SCD, and most likely CEBPB gene expression in young suckling lambs is modulated by both lamb sex and forage type fed to ewes. Fatty acid indicators PUFA, n-6/n-3, CLA, and SFA are closely related to LPL, SCD, PPARA, and CEBPB gene expression depending on animal sex or the diet of ewes. This study suggests that grazing pasture affects FA composition promoting greater vaccenic, CLA, and total PUFA n-3 FA in female and male suckling lambs, and it is mediated through the regulation of lipogenic enzyme expression.

Rumen fermentation and histology in light lambs as affected by forage supply and lactation length.

This study determined whether the rumen fermentation and histology traits may reflect the feeding strategy in light lambs (22-24 kg). Thirty-two single Rasa Aragonesa lambs were assigned to one of four treatments in a 2×2 factorial design. The factors were the inclusion of forage in the diet (alfalfa grazing vs. concentrate-fed indoors) and lactation length (weaning at 13 kg vs. suckling until slaughter). A multivariate canonical analysis discriminated individuals among feeding strategies. The main function differentiated weaned concentrate-fed lambs from the rest according to dorsal sac papillae height, ventral sac muscular layer thickness and the proportion of rumen valerate. The second function differentiated suckling concentrate-fed lambs from the rest according to plasma urea levels. Lactation length played an important role on rumen histology and protein utilization, especially in concentrate-fed lambs. Alfalfa grazing light lambs had similar rumen morphometric measures and fermentation characteristics, regardless of milk access.

Resultados de la Colecistectomía Video-laparoscópica en pacientes con Colecistostomía Percutánea por Colecistitis Aguda Litiásica / Results of Video-laparoscopic Cholecystectomy in Patients with Percutaneous Cholecystostomy for Acute Calculous Cholecystitis

Cholecystitis is the inflammation of the gallbladder wall. The Tokio 2013 guidelines classify this pathology in light , moderate and severe, being the latest the most commonly associated with organic dysfunction. Although videolaparoscopic cholecystectomy (VLPC) is the gold standard for the management of a lithiasic biliary tract pathology, those patients with organic dysfunction are benefitiated with an urgent or earlier drainage of the gallbladder through a percutaneous approach. This is due because the risks for these patients are greater under general anesthesia. This temporization could allow an improvement of the comorbidities and then perform an elective cholecystectomy. The placement of a percutaneous cholecystectomy (PC) originates a process of adherencies that could make difficult the surgical act of the cholecystectomy, extending the operative time or increasing the risk for lesions on the biliary tract. The reports related to the results of VLPC in patients with PC are scarce. The aim of the present report was to present a revision of the authors´ experience with the videolaparoscopic cholecystectomy in patients with previous percutaneous cholecystectomy.