Practical oxygen therapy for newborn piglets.

Aims: To evaluate the effect of a novel method of practical oxygen therapy on physiological parameters related to survival, weaning weight and preweaning mortality of neonatal piglets under commercial farm conditions. Methods: Piglets from hyperprolific sows born with signs of asphyxia, (n = 109; <6 on a score of respiration, meconium staining and activity) or very low birth weight (VLBW; n = 112; <1.05 kg) were selected for the study. Approximately half of each group (n = 55 VLBW piglets and n = 57 piglets with asphyxia) received 100% oxygen immediately after birth using a specially designed facemask for 45 seconds (VLBW) or 1 minute (asphyxiated). Physiological parameters (peripheral blood oxygen saturation (SpO2) blood glucose concentration and rectal temperature) were measured before oxygen treatment 5 minutes after birth (SpO2) and 24 hours later (SpO2, blood glucose concentration, temperature). Weight at birth, at 24 hours and at 21 days of age, preweaning mortality, and estimated colostrum intake were also recorded. Results: A significant treatment effect on SpO2 was observed (p = 0.013 and p < 0.001 for VLBW and asphyxiated piglets respectively). VLBW and asphyxiated piglets that received oxygen treatment had higher SpO2 after treatment (measured 5 minutes after birth, 97.7 and 97.8% respectively) compared to immediately after birth (93.3 and 86.8% respectively) while untreated piglets showed no variation. Blood glucose concentrations increased in all piglets between birth and 24 hours of age (p = 0.003 and p < 0.001 for asphyxiated and VLBW piglets respectively) and this was higher in asphyxiated piglets that received oxygen than those that did not (5.6 (SE 0.2) mmol/L; p < 0.05). Estimated colostrum intake was higher in asphyxiated (401.6 (SD 24.4) g/kg) and VLBW (374.9 (SE 23.4 g/kg) piglets that received oxygen than those that did not (273.2 (SE 24.1) g/kg; p < 0.001 and 249.0 (SE 22.5) g/kg; p < 0.001 respectively). Similarly weight at weaning was higher in asphyxiated (5.8 (SE 0.2) kg) and VLBW (4.9 (SE 0.2) kg) piglets that received oxygen therapy than control animals (4.9 (SE 0.2) kg; = 0.005 and 4.1 (SE 0.2) kg; p = 0.008 respectively). Furthermore, oxygen treatment markedly reduced preweaning mortality from 9/52 (17%) untreated to 1/57 (1.7%) oxygen-treated piglets suffering asphyxia at birth (p = 0.006). Conclusions: Oxygen therapy improves physiological and productive parameters in piglets born with signs of asphyxia or VLBW. The incorporation of this strategy as part of the farrowing routine enhances the advantages of rearing hyperprolific sows.

Fosfomycin residues in colostrum: Impact on morpho-physiology and microbiology of suckling piglets.

Fosfomycin is a broad-spectrum bactericidal antibiotic widely used in pig farms for the treatment of a wide variety of bacterial infections. In this study, the elimination of disodium fosfomycin in colostrum/milk of the sow and the impact of this antibiotic on the microbiota and intestinal morpho-physiology of suckling piglets were analyzed. The average amount of fosfomycin eliminated in colostrum (after administration of 15 mg/kg IM) during the first 10 hr postpartum was 0.85 µg/ml, and the mean residual amount ingested by the piglets was 0.26 mg/kg. The elimination profile of fosfomycin concentrations in colostrum occurs at a time of profound changes in the morpho-physiology of the gastrointestinal tract of the piglet. However, the studied concentrations did not produce imbalances on the microbiota or on the morpho-physiology of the gastrointestinal tract of the piglet. Concentrations of fosfomycin were maintained in the mammary gland above the MIC for more than 8 hr for pathogenic bacteria of productive importance. This would indicate that fosfomycin may be considered safe for the specific treatment of bacterial infectious processes in sows during the peri- and postpartum period. This first study with disodium fosfomycin stimulates awareness in the proper use of antimicrobials at farrowing.

Effect of chronic inhibition of converting enzyme on renal handling of salt and water: a study on a pediatric population.

BACKGROUND/AIMS: The effect of angiotensin-converting enzyme inhibition (ACEi) is amply documented in several pathological conditions. However, there are few reports about the effect of chronic ACEi on salt and water balance.The present work evaluates the effect of chronic ACEi on salt and water balance in a population of children receiving enalaprilchronically in order to reduce albuminuria elicited by auremic hemolytic syndrome. METHODS: Nine children aged from 9 to 19 years with normal glomerular filtration rate, normotension and with urinary concentration capacity preserved were treated with enalapril with doses ranging between 0.1 and 0.30 mg/kg/day. Diuresis, urinary absolute and fractional excretion of Na(+), K(+) and urea, creatinine clearance,osmolal clearance and tubular water reabsorption were measured under three experimental procedures: (1)with free access to water; (2) with a water load and (3) with water restriction. In the last group urinary antidiuretic hormone(ADH) was measured. These tests were performed ina paired way, just before starting ACEi treatment and after 6 months of enalapril treatment. RESULTS: Enalapril treatment diminished the urinary concentration capacity without affecting Na(+) and K(+) urinary excretion. Creatinine clearance was not modified except in the condition of water load where a fall in it was found after ACEi. ADH increased after enalapril treatment in children under water restriction. CONCLUSION: In these children chronic ACEi decreases urinary concentration capacity.

Disodium-fosfomycin pharmacokinetics and bioavailability in post weaning piglets.

Disodium-fosfomycin pharmacokinetics has been studied in different species after oral, intravenous, intramuscular and subcutaneous administration. At present there are neither documented clinical experiences of the use of fosfomycin in pigs nor any published studies in weaning piglets, although it is a period of high incidence of infectious diseases. The pharmacokinetics and the bioavailability of sodium fosfomycin were studied in post weaning piglets after intravenous and intramuscular administration of 15 mg/kg of body weight. Plasma concentrations were measured by a high-performance liquid ms/ms. After IV administration the area under the fosfomycin concentration:time curve in plasma was AUC(0-12) of 120.00 ± 23.12 µg h/ml and the volume of distribution (Vd) of 273.00 ± 40.70 ml/kg. The elimination was rapid with a plasma clearance of 131.50 ± 30.07 ml/kg/h and a T(1/2) of 1.54 ± 0.40 h. Peak serum concentration (Cmax), Tmax, AUC(0-12) and bioavailability for the IM administration were 43.00 ± 4.10 µg/ml, 0.75 ± 0.00 h, 99.00 ± 0.70 µg h/ml and 85.5 ± 9.90% respectively. Different authors have determined a minimum inhibitory concentration (MIC90) ranging from 0.25 µg/ml for Streptococcus sp. and 0.5 µg/ml for Escherichia coli. Considering the above, and according to the values of plasma concentration vs time profiles observed in this study, effective plasma concentrations of fosfomycin for sensitive bacteria can be obtained following IV and IM administration of 15 mg/kg in piglets.

Recuperación de la inmunoglobulina total y sus subclases en el síndrome nefrótico: deflazacort vs metilprednisona / No disponible

No disponible

Diseases of the nervous system: patients' aetiological beliefs.

BACKGROUND: Patients' opinions about the aetiology of their disease and the implications for compliance have not been well documented at this time. OBJECTIVE: To investigate prospectively aetiological beliefs of a cohort of neurological inpatients. METHODS: Within two days of admission, patients orally answered a short questionnaire regarding their beliefs about the aetiology of their disease and the possible influence of psychological factors, stress, fatigue, excessive work or other activities, poor lifestyle, conflict with another person, a tragic event, chance, and destiny. RESULTS: Of the 342 patients who participated in the study, 49% spontaneously said that they had no idea of what could have caused their disease, 15% gave a congruent medical explanation, 11% mentioned stress and fatigue as a precipitating factor, and 6% evoked a non-congruent medical explanation. Thirty six per cent thought that psychological factors had triggered their disease; such factors being blamed by a higher proportion of young patients and patients with chronic central nervous system diseases. The triggering factors most often blamed were stress (48%, especially by patients with headache), fatigue (51%), chance (54%), and destiny (43%). CONCLUSIONS: Patients' aetiological beliefs only partially concur with medical opinion and this may influence compliance with treatment. This statement should be explored and confirmed by further studies-for example, in cerebrovascular risk factor follow up.

[The additive antiproteinuric effect of Enalapril and Losartan to normotensive patients with pathology proteinuria]. / Efecto antiproteinúrico del uso aditivo de Enalapril y Losartán en pacientes pediátricos normotensos con proteinuria.

UNLABELLED: The proteinuria is frequently the initial insult to the kidney and it usually followed by a progressive decline in the glomerular filtration rate. The angiotensin II mediate by glomerular permeselective function via the opening of large pores after elevations in transmembrane pressure and by acting on the glomerular pressure, too. There is evidence that angiotensin-converting enzyme inhibitors alone or with the angiotensin receptor-blockade may improve the glomerular size-selective function and the hemodynamic intrarenal accounted output of plasma proteins. We evaluated the Enalapril action only in two progressive doses (stage 1: 0.2 mg/kg/day and stage 2: 0.4 mg/kg/per day, respectively) and then we evaluated the combinated treatment (stage 3) with Enalapril (0.2 mg/kg/per day) + Losartan (0.8 mg/kg/day) in thirteen patients (2 female/ 11 male, mean age 12 yrs, r: 10y-16y) normotensive with middle or heavy proteinuria and normal glomerular filtration rate. The study lasted six months. In the three stages occurred decrease of the urinary protein, but only the stage 2 and 3 was significant (p < 0.05). And the three stages had significant reduction of the mean blood pressure, too (p < 0.05). On the other hand there has a good correlation between the less proteinuria and the descent of the mean blood pressure in the stage I (r: 0.75, p < 0.05) and the stage 2 (r: 0.70, p < 0.05), but this did not occur in the stage 3 (r: 0.37, p < 0.1). No patient had raise serum potassium; neither did they have decrease glomerular filtration rate or anaemia. CONCLUSION: The coadministration of Enalapril and Losartan was the most efficient treatment antiproteinuric effect. It was not only by the drug related reduction in systemic blood pressure. There weren't any adverse side effects in any patient dependent of the medication.

Evaluación de dos métodos rápidos para la determinación de microalbuminuria y de la relación albúmina/creatinina en orina / Evaluation of two rapid tests for the determination of microalbuminuria and the urinary albumin/creatinine ratio

Objetivo: La detección de microalbuminuria está justificada desde el punto de vista coste-beneficio en aquellos pacientes que presentan riesgo de desarrollar una lesión renal, en una etapa en la cual el proceso es aún reversible. En este estudio se evalúan los analizadores DCA 2000 y Clinitek 50 (Bayer®) que determinan simultáneamente albúmina y creatinina en orina para adoptarlos como métodos rápidos para la detección de microalbuminuria. Métodos Se analizaron 127 muestras de orina de pacientes pediátricos con diferentes enfermedades. Se determinaron la albúmina, la creatinina y la relación albúmina/creatinina en el analizador DCA 2000 y con las tiras Clinitek-microalbuminuria leídas en el analizador Clinitek 50, y se los comparó con los métodos utilizados habitualmente en el laboratorio. Resultados El coeficiente de correlación entre albúmina por nefelometría frente a DCA 2000 fue de 0,914, para creatinina por el método de Jaffe frente DCA 2000 de 0,970 y para la relación albúmina/creatinina calculada frente a DCA 2000 de 0,839. Considerando una concentración de albúmina de 30 mg/l como valor de corte para considerar una muestra como patológica, la sensibilidad, especificidad, los valores predictivos positivo y negativo para la detección de microalbuminuria en el DCA 2000 fueron de 100, 93, 84 y 100 por ciento; y para el Clinitek 50 de 91,7, 86, 55 y 98 por ciento, respectivamente. El análisis de las curvas ROC mostró una mayor utilidad diagnóstica del DCA 2000 para la detección de microalbuminuria. Conclusiones El analizador DCA 2000 muestra una buena correlación para albúmina y creatinina cuando se los compara con los métodos considerados de referencia, siendo la obtención inmediata de los resultados una ventaja importante. Las tiras Clinitek-microalbuminuria representan un método semicuantitativo, sencillo y de bajo coste para ser utilizado como prueba tamiz para la detección de microalbuminuria, no siendo útil para el seguimiento (AU)

[Evaluation of two rapid tests for the determination of microalbuminuria and the urinary albumin/creatinine ratio]. / Evaluación de dos métodos rápidos para la determinación de microalbuminuria y de la relación albúmina/creatinina en orina.

OBJECTIVE: Microalbuminuria screening is justified on the grounds of its cost-benefit ratio in patients at risk of kidney damage while the process is still reversible. The aim of the present study was to evaluate the DCA 2000 analyser and the Clinitek 50 system (Bayer), which simultaneously measure urinary albumin and creatinine levels to adopt them as rapid methods for microalbuminuria detection. METHODS: One hundred twenty-seven urine samples from pediatric patients with various disorders were assessed. Albumin, creatinine, and the albumin/creatinine ratio were determined using the DCA 2000 analyzer and the Clinitek 50 system, which were compared against the usual reference laboratory methods. RESULTS: The correlation coefficient of nephelometric values vs the DCA 2000 analyzer was 0.914 for albumin, 0.970 for creatinine and 0.839 for the albumin/creatinine ratio. At an albumin cut-off concentration of 30 mg/l, the sensitivity, specificity, positive predictive value and negative predictive value were 100 %, 93 %, 84 % and 100 % for the DCA 2000 analyzer and 91.7 %, 86 %, 55 % and 98 % for the Clinitek 50 system. ROC curve analysis showed that the DCA 2000 system was more effective than the Clinitek 50 in microalbuminuria screening. CONCLUSIONS: The data obtained with the DCA 2000 system showed close agreement with those obtained with reference laboratory methods. The immediate availability of results is a great advantage in clinical practice. The Clinitek-Microalbumin dipstick system is a semiquantitative method that is easy to use, low in cost, simple and useful for screening, but it is less reliable as a follow-up method.

[Sexual activity in cardiac patients. An empirical study]. / Actividad sexual en enfermos/as cardíacos/as. Un estudio empírico.

OBJECTIVES: The objectives of this study are to evaluate the beliefs and views linked to sexuality and sexual behaviour, and the emotional impact of a cardiac lesion. DESIGN: A retrospective cross-sectional study of the lived experience of sexuality after the appearance of the cardiac lesion. SETTING: Hospital and primary care. PATIENTS AND OTHER PARTICIPANTS: A sample of 30 people (12 women and 18 men) with a cardiac complaint, with an average age of 69.89 for women and 60.89 for men. 89% of the men had a stable partner (with an average age of 46.25), and 50% of the women (with an average age of 71.17). MEASUREMENTS AND MAIN RESULTS: Results showed that the appearance of disease was lived as a tough blow and imposed clear limitations on sufferers' lives. Specific sexual problems linked to cardiac complaints appeared, such as difficulties with erection (50%), reduction of libido (61.1%) and of intensity of pleasure (38.9%). Sexual activity was practically non-existent in the women surveyed. CONCLUSIONS: The need to contribute a proper intervention for cardiovascular patients involves recognising the need to develop adequate programmes of sexual counselling. Health-workers must also give information on these kinds of question to cardiac patients.

Actividad sexual en enfermos/as cardíacos/as. Un estudio empírico / Sexual activity in cardiac patients. an empirical study

Objetivo. El objetivo de este trabajo es llevar a cabo la evaluación de las creencias y opiniones vinculadas a la sexualidad y los comportamientos sexuales, así como el impacto emocional provocado por la lesión cardíaca. Diseño. Encuesta transversal retrospectiva de la vivencia de la sexualidad después de la aparición de la lesión cardíaca. Emplazamiento. Práctica hospitalaria y atención primaria. Pacientes u otros participantes. Una muestra de 30 sujetos (12 mujeres y 18 varones) con alguna dolencia cardíaca, con una edad media de 69,89 años para las mujeres y 60,89 años para los varones. Un 89 por ciento de éstos tiene pareja estable (con una edad media de 46,25 años) frente al 50 por ciento de las mujeres (con una edad media de 71,17 años). Mediciones y resultados principales. Los resultados muestran que la manifestación de la enfermedad es vivenciada como un duro golpe y ha impuesto claras limitaciones en sus vidas. Se comprueba la presencia de determinados problemas sexuales vinculados a la dolencia cardíaca, caso de dificultades con la erección (50 por ciento), disminución del deseo (61,1 por ciento) y de la intensidad del placer (38,9 por ciento). Actividad sexual prácticamente inexistente en las mujeres encuestadas. Conclusiones. La necesidad de aportar una adecuada intervención en los pacientes cardiovasculares implica reconocer la necesidad de desarrollar adecuados programas de counseling sexual, así como la necesidad de que el personal sanitario informe sobre este tipo de cuestiones a los/as pacientes cardíacos/as (AU)

Monosymptomatic primary enuresis: differences between patients responding or not responding to oral desmopressin.

OBJECTIVES: To evaluate the 24-h diuresis, urinary osmolality, plasma arginine vasopressin (AVP) and urinary prostaglandin E2 (PGE2) before and during desmopressin treatment in patients with monosymptomatic primary enuresis (MPE), and to investigate the possible depressor effect of desmopressin on the detrusor in such patients with urodynamically confirmed bladder instability. PATIENTS AND METHODS: Seven healthy children (control group) and 11 consecutive patients with MPE (mean age 10.4 years, range 7-15) were assessed using laboratory tests, renal and bladder ultrasonography, and video-urodynamic investigations. A 24-h inpatient assessment with a controlled water intake of 20 mL/kg per day included determinations of diuresis, urinary osmolality, AVP and PGE2 in both normal children and those with MPE. After 30 days of treatment at optimal doses of desmopressin, all children were hospitalized and re-evaluated during desmopressin treatment; all completed 3 months of treatment at optimal doses. At the end of this period, patients whose symptoms improved by > or = 80% were defined as 'responders' while those in whom they did not were defined as 'non-responders'. RESULTS: After treatment, six of the 11 patients with MPE were 'responders' and five 'non-responders'. Urodynamic evaluation showed bladder instability in seven of the 11 patients with MPE but in those with bladder dysfunction, urodynamic studies carried out during desmopressin treatment showed no changes in detrusor activity. There were significant differences in the morning values of AVP between normal children and responders (P < 0.03), and between responders and non-responders (P < 0.02); none of the non-responders had AVP levels of < 2.5 pg/mL, while none of the responders exceeded this value. At midnight, responders had the lowest mean AVP and non-responders the highest; this correlated with the highest PGE2 value in the nonresponders at 00.00-08.00 hours. Non-responders had an overnight mean PGE2 level greater than that in normal subjects or responders. CONCLUSIONS: Polyuria occurred in all patients with MPE, independently of the response to desmopressin. Responders had the lowest AVP values over the 24 h; the morning AVP levels differentiated normal subjects from enuretic patients and responders from non-responders. In patients with MPE, clinically undetected bladder instability was unrelated to the results of treatment and there were no urodynamic changes during desmopressin treatment. The differences between enuretic patients suggested a different aetiology of MPE, probably related to an increase in PGE2 concentration and an antagonistic mechanism of action of AVP or desmopressin.

Renal response to a protein meal in children with single kidneys.

The renal response of healthy adults to an oral protein load results in a significant increase of renal plasma flow (RPF) and glomerular filtration rate (GFR) 100 to 150 min after the meal. The renal response to protein loading of single kidney adults is unclear and it has not been evaluated yet in children. Therefore, we studied 8 children 10.2 +/- 1.1 years old, 6.7 +/- 1.41 years after nephrectomy (SK) and 4 healthy children (C). RPF was estimated by para-amino-hippurate clearance (Cpah) and GFR by inulin clearance (Cin) before and after an oral protein load of 1.5 g protein/kg body wt and expressed in ml/min/1.73 m2 BSA. Mean baseline Cin were similar in SK and in C (90 +/- 8 vs 103 +/- 12) while baseline Cpah was lower in SK (339 +/- 19 vs 481 +/- 36, p less than 0.005). After the meal GFR and RPF increased significantly in C (155 +/- 18 and 783 +/- 68, p less than 0.005 and p less than 0.05 vs baseline values, respectively) whereas no significant GFR and RPF changes were seen in SK (81 +/- 9 and 350 +/- 42, respectively). However, the 3 SK children with lower protein intake showed a mild vasodilating response. We conclude that in single kidney children hyperfiltration occurs at baseline conditions and the renal response to acute protein loading is partially or completely blunted, being modulated by protein intake.