Long-distance transport of hair lambs: effect of location in pot-belly trailers on thermo-physiology, welfare and meat quality.

Livestock transport exposes animals to a range of potential stressors that may compromise their welfare and final product quality, and those effects typically increase with the distance travelled. In North America, producers often use pot-belly vehicles for long hauls but little is known about their suitability for transporting lambs. We followed two long-distance trips using pot-belly trailers carrying 500 lambs (each) from Northern to Central Mexico in winter, to measure possible effects on animal welfare and meat quality. Sixty lambs per trip were placed at different locations within the pot-belly trailer. Animals were equipped with iButton Thermochron® temperature devices, which registered body temperature throughout pre- and post-slaughter stages. Despite the rather cool winter conditions, lambs placed in the "belly" and "nose" compartments had higher body temperatures at loading, during transport and lairage and after slaughter (carcass temperature). Those lambs also had higher levels of plasma cortisol, glucose and creatine kinase (CK), and a higher neutrophil/lymphocyte ratio. Regarding meat quality, ultimate pH (24 h) was higher in all locations, especially in LT4 location. Overall, the results suggest a link between thermal stress during transport, elevated physiological indicators of stress and poorer meat quality.

The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children.

Background: This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care. Methods: Non-concurrent cohort study. Passive follow-up of live-born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004-2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4-11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g). Results: Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight-specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education. Conclusions: The absence of crossing birthweight-specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women.

Modified Sugiura Operation for Idiopathic Portal Hypertension with Bleeding Oesophageal Varices. A Case Report.

A case of a 36 years old man presenting massive upper GI bleeding due to oesophageal varices developed in the context of an idiopathic portal cavernoma and extensive porto-splenic thrombosis is discussed. He underwent a successful modified Sugiura operation (oesophago-gastric devascularisation and splenectomy [OGDS]) completed with interventional endoscopic treatment of residual oesophageal varices. The benefit of the modified Sugiura procedure proposed for the treatment of upper GI variceal bleeding developed in the context of splanchnic venous thrombosis is discussed. The procedure is a valid therapy in the treatment of symptomatic extra-hepatic hypertension when other options are inapplicable.

Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

UNLABELLED: The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture. INTRODUCTION: To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival. METHODS: The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined. RESULTS: Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p = 0.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p < 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p = 0.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p= 0.185). CONCLUSIONS: If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Access to Liver Transplantation in Different ABO-Blood Groups and "Exceptions Points" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study.

BACKGROUND: In the Model for End-Stage Liver Disease (MELD) system, patients with "MELD exceptions" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding "MELD exceptions" situations and among ABO-blood groups. METHODS: A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of "exceptions points." RESULTS: No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P = .03). "Exceptions points" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with "exceptions points" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P < .01]; 18.4% vs 38.5% [P < .01], and 2.0 ± 2.6 vs 6.9 ± 7.0 [P < .01], respectively). Patients with refractory ascites had a higher mortality rate than those with other "exceptions" or without (48%). CONCLUSIONS: The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with "exception points," resulting in superior outcomes compared with those without exceptions.

Better Selection Criteria With Prognostic Factors for Liver Transplantation.

BACKGROUND: Liver transplantation has evolved significantly in recent years, with each advancement part of the effort toward increasing patient and graft survival as well as quality of life. The objective of this study was to evaluate the prognostic factors and selection criteria for liver transplantation. METHODS: Our study was a statistical analysis, logistic regression, and survival evaluation of a total of 80 liver transplants that were performed between June 1, 2016 and September 24, 2016. Recipient factors evaluated included age, retransplantation, hemodialysis, cardiac risk, portal vein thrombosis, hospitalization, fulminant hepatitis, previous surgery, renal failure, and Model for End-stage Liver Disease (MELD) score. Donor factors included age, cardiac arrest, acidosis, days in the intensive care unit, steatosis, and vasoactive drug use. RESULTS: Of the 80 patients transplanted, 65 deceased donor liver transplants (DDLTs) and 15 living donor liver transplants (LDLTs) were performed. LDLT overall 1-year patient survival was 77.5% and graft survival 75%, and DDLT overall patient survival was 89.23% and graft survival was 86.15%. On evaluated score criteria analyzed we observed a significant score on recipient (P = .01) and not significant on donor (P =.45). Isolated factors evaluated included recipient age (relative risk [RR] 3.15, 95% confidence interval [CI] 0.89 to 11.09; P = .074), retransplant (RR 4.22, 95% CI 1.36 to 13.1; P = .013), and hemodialysis (RR 4.23, 95% CI 1.45 to 12.31, P = .008). On donor evaluation, we observed moderate and severe steatosis (RR 3.8, 95% CI 0.86 to 16.62; P = .06). CONCLUSION: In conclusion, we demonstrate a relevant model of criteria selection of liver transplant patients that is able to make a better match between the donor and recipient allocation for a better graft and patient survival.

An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Spreading depression and the blood-brain barrier.

The propagation of spreading cortical depression was studied in rabbits during the reversible opening of the blood-brain barrier induced by hypertonic aqueous solutions of sodium chloride and sodium diatrizoate. The rupture of the blood-brain barrier was monitored by the leakage of Evans blue-albumin from pial vessels. Spreading depression was monitored by recording its characteristic slow voltage variations. Test substances were injected into the carotid artery or topically applied to the pia-arachnoid surface. Intracarotid injection of hypertonic solutions that open the blood-brain barrier do not block the propagation of spreading depression. Topical application of NaCl solutions can block the spread of the cortical depression reaction without opening the blood-brain barrier. Recurrent spreading depression waves at a mean frequency of one every 5 min, for 4 h do not cause the release of Evans blue-albumin complex from pial vessels.

GISEpi: a simple geographical information system to support public health surveillance and epidemiological investigations.

One important question for the implementation of a surveillance system concern the type of instrument that can provide timely information on the course of diseases and other health events. This may facilitate prompt implementation of prevention and intervention efforts, such as strengthening control action in one specific area or initiation of epidemiological investigation. Since health related variables of interest are often spatially distributed they require special tools for representation and analysis. Owing to their inherent ability to manage spatial information, geographical information systems (GIS) provide an excellent framework for the design of surveillance systems. This paper presents a simple information system, based on the concepts of GIS, designed for representation and elementary analysis of epidemiological data. An example of its potential use to support malaria control activities in Brazil is discussed.

[Inequality in health care use by the elderly in three districts in Rio de Janeiro]. / Estudo da desigualdade na utilização de serviços de saúde por idosos em três regiões da cidade do Rio de Janeiro.

This article analyzes social inequalities in health care services utilization by the elderly and tests the influence of place of residence. The study was based on a sample survey of residents 60 years of age and older from three different areas in the city of Rio de Janeiro. The multi-stage sampling method led to violations of the logistic regression assumptions which were considered in the data analysis stage. Need was the most important factor related to utilization. However, gender, type of service, income, and place of residence also showed positive impact on health care utilization. Moreover, the effect of the income was modified by place of residence. The area with the best living conditions (Copacabana) did not show inequalities in health care services utilization. The income gradient was more important in middle and lower-income areas, i.e., Méier and Santa Cruz, respectively.

[Urban hospital markets: a methodological approach]. / Mercados hospitalares em área urbana: uma abordagem metodológica.

This study developed a method for the construction of hospital markets in a metropolitan area, focusing on users of the Unified Health System (SUS) with hip fractures and admitted to municipal hospitals in Rio de Janeiro in 1994-1995. The study used a spatial smoothing technique based on a Kernel (quartic) estimate for constructing areas of care for each hospital and subsequently for hospital markets. Areas of the city were presented where there was a market domain and a secondary domain for treating patients with hip fractures. Hospital market analysis can help health planners organize resources in the health care system.

The correlation of CT findings and in-hospital mortality after cerebral infarction.

OBJECTIVE: To evaluate whether findings on computed tomography (CT) are useful to predict early mortality after acute cerebral infarction. METHODS: An admission CT was performed in 98 patients with disease-onset within 7 days; CT findings were analyzed using a checking list; their influence on hospital mortality was studied by logistic regression analysis. RESULTS: There were 29 hospital deaths. Uncal herniation and midline shift > 4 mm were strongly correlated with fatal outcome. Also associated with increased mortality: infarction of a whole hemisphere or in the distribution of internal carotid artery; massive (> 90% expected area) infarction in the territory of the anterior or posterior cerebral arteries; massive or submassive (> 50% expected area) middle cerebral artery infarction; large lesion volume (death in 9/13 patients with lesions > 50cm3); any degree of mass effect. In 68 patients with single middle cerebral artery lesions, extension of the lesion to adjacent vascular territories was also associated with a worse outcome. The number of lesions and the presence of contrast enhancement, hemorrhagic changes or cerebral atrophy did not influence outcome. CONCLUSIONS: CT findings indicating significant mass effect and large infarcts are associated with mortality after ischemic stroke. The best combination of clinical and CT variables to estimate death risk in individual patients remains to be determined.

Accessibility of selected hospitals and medical procedures by means of aerial and transit network-based measures.

OBJECTIVE: This report investigates the use of linear and travelled route (transit network-based) distances in estimating the accessibility of hospitals to patients, for some selected hospital admission diagnostics. METHODS: For patients admitted to 14 public hospitals in Rio de Janeiro City, during 1996, under the ICD-9 headings "Complications of Pregnancy, Childbirth and the Puerperium" and "Disorders of the Circulatory System", average distances between the patient's district of residence and hospital of admission were calculated (both as Euclidean and as network-based distances). Data were obtained from the country's public health data processing agency. Geographic co-ordinates were obtained for districts of residence from the postal codes of the patients' residences. Distances were estimated with the TransCAD Geographical Information System, based on a map of the city transit network. There were 8654 patients admitted under the "Complications of Pregnancy" heading and 3439 under "Disorders of Circulatory System". RESULTS: Variations of up to a factor of 5.3, and up to 34 km, could be identified between linear and network estimates. CONCLUSION: While recognizing that network estimates have advantages, the literature on accessibility frequently argues that aerial estimates are a good approximation for those. The present results show that this is not necessarily the case.

Beef quality of young Angus×Nellore cattle supplemented with rumen-protected lipids during rearing and fatting periods.

This work evaluated the beef quality parameters of 108 bulls randomly administered to three treatments during rearing in pastures and two treatments during fatting in feedlots, including mineral and rumen-protected lipids. Meat and fat color, cooking yield, shear force, sensorial traits and chemical and fatty acid compositions were evaluated. Generally, the beef quality parameters were not affected by the rumen protected lipids; however, supplementation with rumen-protected lipids during the rearing period yielded darker beef and brighter fat and increased beef tenderness in meat aged for 28days compared to the meat from animals that received only mineral supplementation. In addition, the percent of meat polyunsaturated fatty acids was negatively affected by the inclusion of protected lipids, yielding 5.58 and 3.72% in animals fed with and without rumen-protected lipids, respectively, during the fatting period.

Ten years' evaluation of potential pancreas donors in São Paulo, Brazil.

BACKGROUND: Pancreas transplantation is a treatment for advanced type 1 diabetes and offers significant improvement in quality of life. Recent advances in surgical techniques and immunosuppression regimes lead to good outcomes. However, despite significant higher rates of multiorgan donors in Brazil, pancreas transplantation seems to have remained stable. This study aimed to investigate the acceptance rate of potential pancreas donors in the past 10 years in São Paulo State. METHODS: We retrospectively evaluated potential pancreas donors characteristics and its acceptance rate in São Paulo State in the past 10 years. We divided this period into 2 eras: 1st era from January 2003 to January 2008; and 2nd era from January 2008 to January 2013. Data were obtained from São Paulo's government official website. RESULTS: During the whole period, 5,005 deceased donors of all ages were available for pancreas transplantation. According to eras, we had 1,588 donors in the 1st and 3,417 in the 2nd era. In the 2nd era, donors >49 years old were significantly more common (P < .001). Blood test abnormalities, donor comorbidities, and high dosage of vasopressors also were significantly higher in the 2nd era. Rate of graft acceptance had a significant decrease in the 2nd era, from 46.4% to 25% (P < .05). CONCLUSIONS: Despite greater organ availability, pancreas transplantations performed in São Paulo State remained stable. Rate of graft acceptance is dramatically lower in more recent years.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

OBJECTIVES: The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. METHODS: A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. RESULTS: Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. CONCLUSION: Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Management of uncommon hernias in cirrhotic patients.

BACKGROUND: Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high. OBJECTIVE: We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures. METHOD: Review of hospital charts of selected rare cases of herniae in cirrhotic patients. CONCLUSION: Elective surgical approaches can treat even uncommon hernias in cirrhotic patients with good results.

Manejo pré-abate de ovelhas de descarte: perdas de peso corporal, qualidade da carne e comportamento animal / Pre-slaughter management of discard ewes: body weight losses, meat quality and animal behavio

Objetivou-se com este estudo conhecer o comportamento de ovelhas da raça Santa Inês em diferentes estágios fisiológicos durante o manejo pré-abate, assim como a perda de peso corporal, valores de hematócrito do sangue das mesmas e a qualidade da carne. Utilizaram-se 21 ovelhas de descarte, que foram distribuídas nos respectivos tratamentos: T1 = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e abatidas um dia após o desmame dos mesmos; T2 = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros e posteriormente foram abatidas; e T3 = ovelhas que permaneceram por 60 dias em confinamento e que não pariram durante o ano. O peso das ovelhas após o transporte foi menor para as do tratamento 1 em comparação às do tratamento 2. Os valores de hematócrito no sangue das ovelhas antes do transporte, após o mesmo e após o jejum dos animais no curral de espera não diferiram entre si, com valor médio de 58,50%. Concluiu-se que a qualidade da carne proveniente de ovelhas de descarte em diferentes estágios fisiológicos não é alterada pelo manejo pré-abate, quando realizado de maneira correta (evitando o estresse animal), quanto ao pH da carne.

The aim of this study was to know the behavior of Santa Inês ewes in different physiological stages during the pre-slaughter management, as well as their body weight loss, blood hematocrit values and meat quality. 21 discard ewes were used, arranged into the following treatments: T1 = ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning; T2 = ewes which remained in lactation for 60 days with their respective lambs and one more period of approximately 30 days without the lambs and afterwards slaughtered; and T3 = ewes which remained in confinement for 60 days and did not give birth during the year. The weight of ewes after transportation was lower for T1 in comparison with T2. Blood hematocrit values of ewes before and after transportation and after fast in the waiting pen were not different among the treatments, with mean value of 58.50%. We concluded that the quality of meat of discard ewes in different physiological stages is not altered by pre-slaughter management, when correctly performed (avoiding animal stress), concerning meat pH.