Dietary supplementation with ß-mannanase and probiotics as a strategy to improve laying hen performance and egg quality.

The objective of this study was to assess the impact of ß-mannanase and probiotic on the performance, serum biochemistry, gut morphometric traits, and fresh egg quality of laying hens. A total of 120 cages, housing light-weight laying hens (36 weeks old), were randomly assigned to four different treatments. These treatments included a control group fed non-supplemented diets; diets supplemented with 300 g/ton of beta-mannanase; diets supplemented with 50 g/ton of probiotic; or diets containing both 300 g/ton of ß-mannanase and 50 g/ton of probiotics. The trial spanned a duration of 26 weeks and was divided into three productive phases, each lasting 28 days. The inclusion of ß-mannanase resulted in a significant improvement in the laying rate by 11% (p < 0.05) compared to the control treatment. Similarly, the addition of probiotics also enhanced the laying rate by 7% (p < 0.05), as well as the supplementation with combined additives (11.5%). Combined additives showed an increase in egg masses, and additive association improved by 13.9% (p < 0.001) in contrast to the control treatment. Overall, ß-mannanase and combined additives used during the supplementation period resulted in improvements in the weight of fresh eggs. These benefits were observed after a period of 14 weeks without supplementation (p < 0.05). Furthermore, significant differences were observed in the serum biochemistry and egg masses of birds that were fed diets containing both additives (ß-mannanase + probiotics) compared to the control group. Parameters such as uric acid, total cholesterol, and triglycerides displayed notable variations. The villi height: crypt depth showed differences with combined additives (ß-mannanase + probiotics). The ß-mannanase improved specific gravity, yolk height, length, and pH, and yolk color traits compared to the control treatment. The use of probiotics helped to improve yolk height, pH, and color score. Besides, combined additives (ß-mannanase + probiotics) improve yolk height, length, weight, pH, and better traits in yolk color. Hence, incorporating ß-mannanase and probiotics into laying hen diets proves to be a highly effective strategy for enhancing laying rate and overall health status, while simultaneously elevating certain quality attributes of fresh eggs.

Dietary supplementation with ß-mannanase and probiotics as a strategy to improve laying hen's welfare.

A trend toward animal welfare improvement is observed in animal production, in addition to restrictions imposed on the use of antimicrobials. This study's objective was to evaluate whether ß-mannanase and probiotic supplementation can change hen's behavior. Light weight laying hens (36 weeks old) were housed in cages randomly allocated to one of four different treatments: control group, fed non-supplemented diets; diets supplemented with 300 g/ton of ß-mannanase; diets supplemented with 50 g/ton of probiotic; or diets containing both 300 g/ton of ß-mannanase and 50 g/ton of probiotic. The behavior of 24 birds was recorded for a week using video cameras. The frequency and time of main behaviors (eating, walking, standing, sitting, drinking, and exploring) were analyzed in three periods per day (from 09:00 to 09:15; from 01:00 to 01:15, and from 04:00 to 04:15), as well as the time of other behaviors (leg-stretching and wings, scratching, wing-flapping, aggressive and non-aggressive pecks). Frequency and lesion scores were also analyzed using a visual score of three body regions: neck, tail, and cloaca; as well as comb injuries. ß-mannanase was able to increase the frequency of feeding behavior by 49% (P < 0.05) and hens also spend 20% (P < 0.05) more time in this behavior compared to the control treatment. The use of probiotics also enhanced by 39% (P < 0.05) the frequency and 19% the time (P < 0.05) and the supplementation with combined additives was able to increase by 29% (P < 0.05) the frequency and 25% (P < 0.05) the time in feeding behavior. ß-mannanase and probiotics also increased the frequency and time spent exploring behavior (P < 0.05) and promoted a higher frequency in standing behavior (P < 0.05) and decreased the time spent on sitting behaviors (P < 0.05). The combined additives showed less frequency and time in sitting behaviors (P < 0.05), while increased wing-flapping behavior (P < 0.05). All the treatments were able to reduce pecking (P < 0.05). Therefore, the addition of ß-mannanase and probiotics to laying hen diets is an effective strategy to improve bird welfare.

Características de carcaça e da carne de suínos machos castrados e imunocastrados alimentados com diferentes níveis nutricionais / Carcass characteristics and meat of surgically castrated and immunocastrated pigs fed different nutritional levels

O trabalho foi realizado para avaliar as características de carcaça e carne de suínos machos castrados e imunocastrados alimentados com dietas contendo diferentes níveis nutricionais. O delineamento experimental foi inteiramente casualizado com quatro tratamentos principais (T1-suínos machos castrados alimentados com dieta basal; T2-machos imunocastrados alimentados com dieta basal; T3-machos imunocastrados alimentados com dieta basal+3% aminoácidos e energia; T4-machos imunocastrados alimentados com dieta basal+5% aminoácidos e energia) e dois tratamentos secundários com ou sem ractopamina dentro de cada tratamento principal. Os suínos machos castrados apresentaram peso de abate 3,3% inferior (P<0,05), peso de carcaça fria 1,4% superior (P<0,05) e peso de carré 13% superior (P<0,05) em relação aos machos imunocastrados. Suínos machos imunocastrados suplementados com 5% a mais de aminoácidos e energia apresentaram costela 19% mais (P<0,05) pesada e valores superiores (P<0,05) na coloração b* (amarelo-azul) na carne aos 45min e às 24h pós-abate em relação aos machos castrados alimentados com a dieta basal. A suplementação com 5% de aminoácidos e energia aumenta o peso e rendimento de costela e altera o valor da coloração b* (amarelo-azul) na carne aos 45min e às 24h pós-abate de suínos machos imunocastrados.

The study was carried out to evaluate the carcass characteristics and meat of surgically castrated and immunocastrated pigs fed with different nutritional levels. The animals were distribuited in a completely randomized experimental design with four main treatments (T1-surgically castrated pigs fed with basal diet; T2-immunocastrated pigs fed with basal diet; T3-immunocastrated pigs fed with basal diet+3% amino acids and energy; T4-immunocastrated pigs fed with basal diet+5% amino acids and energy) and two secondary treatments with or without ractopamine within each main treatment. The surgically castrated pigs had slaughter weight 3.3% lower (P<0.05), cold carcass weight 1.4% higher (P<0.05) and loin chop weight 13% higher (P<0.05) compared to immunocastred pigs. The immunocastrated pigs supplemented with 5% more amino acids and energy had rib 19% more heavier (P<0.05) and higher values (P<0.05) in the color b* (yellow-blue) in the meat to 45min and 24h post-slaughter compared with surgically castrated pigs fed with basal diet. Supplementation with 5% amino acids and energy increases weight and yield of rib and changes the value of color b* (yellow-blue) in the meat to 45min and 24h post-slaughter male pigs immunocastrated.

Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada / Predictors of major neurologic dysfunction after coronary bypass surgery

OBJETIVO: Avaliar a incidência e os fatores preditores de disfunção neurológica maior pós-operatória e a evolução clínica precoce em uma coorte não selecionada. MÉTODO: Um total de 1760 pacientes consecutivos submetidos a CRM isolada, no Hospital São Lucas da PUCRS, entre janeiro de 1997 e fevereiro de 2004, foram incluídos. Dados demográficos, informações do procedimento e desfechos perioperatórios foram coletados usando-se o protocolo do registro de dados da Unidade de Pós-Operatório de Cirurgia Cardíaca do nosso hospital. As variáveis consideradas estatisticamente significativas foram aquelas com p <0,05 e intervalo de confiança de 95 por cento. RESULTADOS: Na nossa amostra, 52 (3 por cento) pacientes evoluíram com disfunção neurológica maior (AVC). Na análise univariada, idade avançada, maior prevalência de doença pulmonar obstrutiva crônica (DPOC), doença cerebrovascular (DCV) prévia, média de fibrinogênio elevada, desenvolvimento de choque ou hipotensão grave, presença de taquicardia supraventricular (fibrilação atrial ou flutter), ocorrência de síndrome da resposta inflamatória sistêmica (SIRS) e ventilação mecânica prolongada estiveram associados ao desenvolvimento de AVC. Na análise multivariada, a história prévia de DCV e DPOC demonstraram ser preditores independentes para a ocorrência de disfunção neurológica maior. Ventilação mecânica prolongada também apresentou associação independente com o desfecho. Além disso, a ocorrência de AVC aumentou significativamente o tempo de internação hospitalar e a mortalidade intra-hospitalar. CONCLUSÃO: A disfunção neurológica permanece sendo relevante causa de morbidade hospitalar, no pós-operatório de CRM com circulação extracorpórea.

OBJECTIVE: The aim of this study was to evaluate the incidence and to identify possible predictors of major postoperative neurologic dysfunction (defined as stroke) and to evaluate early clinical outcome in a non-selected cohort. METHOD: A total of 1760 consecutive patients who underwent isolated CABG in the San Lucas Hospital -PUCRS, between January 1997 and February 2004, were enrolled. Demographic and laboratory data, informations regarding the procedure and perioperative endpoints were collected prospectively using a standard protocol of data register of the cardiac postoperative unit of our hospital. We considered statistically significant those variables with a p value no greater than 0.05 with a confidence interval of 95 percent. RESULTS: In this study, 52 (3 percent) patients presented with major neurologic dysfunction. On the univariable analysis advanced age, higher prevalence of obstructive pulmonary disease, previous cerebrovascular disease, higher mean value of fibrinogen, occurrence of shock or severe hypotension, presence of supraventricular tachycardia (atrial fibrillation or flutter), occurrence of the systemic inflammatory syndrome and prolonged mechanical ventilation were associated with stroke. On the multivariable analysis previous history of cerebrovascular disease and obstructive pulmonary disease presented as independent predictors for the occurrence of major neurologic dysfunction. Prolonged mechanical ventilation was also independently associated with the endpoint. Furthermore, the occurrence of stroke raised significantly the duration of hospital stay and in-hospital mortality. CONCLUSION: Neurological dysfunction is still a significant cause of morbidity after CABG.

Early discharge using five french guiding catheter for transfemural coronary stenting: a feasibility and safety study (EDU 5Fr study).

This study assessed the safety and efficacy of early discharge after percutaneous coronary intervention (PCI) using 5Fr guiding catheters with a femoral approach in 100 patients undergoing elective coronary stenting. Patients were treated with aspirin and thienopyridines for 72 hours before PCI, and unfractionated heparin 70 IU/kg (< or = 5,000 IU) intravenously after arterial puncture. PCI was performed by femoral access using 5Fr guiding catheters and immediate postprocedural arterial sheath removal. Patients were discharged within 8 to 12 hours. No closure devices were used. Early discharge using 5Fr catheters was successful in 97% of cases. No deaths, myocardial infarction, or vascular complications occurred at 24 hours and 30 days.

[Annual cost of ischemic heart disease in Brazil. Public and private perspective]. / Custo anual do manejo da cardiopatia isquêmica crônica no Brasil. Perspectiva pública e privada.

OBJECTIVE: To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil. METHODS: Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS: The 147 patients (65 +/- 12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24 +/- 8 months. The average estimated annual cost per patient was R$ 2,733.00, for the public sector, and R$ 6,788.00, for private and fee-for-service plans. Expenses with medications (R$ 1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R$ 4,626.00 vs. R$ 1,312.00, in SUS, and R$ 13,453.00 vs. R$ 1,789.00, for HMOs, p<0.01) on the results. CONCLUSION: The average annual cost of CAD management was high, being the pharmacological treatment the main determinant of public costs. Such estimates may subsidize economical analyses in this area, and foster related healthcare policies.

Custo anual do manejo da cardiopatia isquêmica crônica no Brasil: perspectiva pública e privada / Annual cost of ischemic heart disease in Brazil: public and private perspective

OBJETIVO: Estimar o custo anual do manejo da doenca arterial coronária (DAC) em valores do SUS e convênios. MÉTODOS: Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internacões e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM). Valores de eventos cardiovasculares foram obtidos de internacões em hospital público e privado com estas classificacões diagnósticas em 2002. O preco dos fármacos utilizado foi o de menor custo no mercado. RESULTADOS: Os 147 pacientes (65n12 anos, 63 por cento homens, 69 por cento hipertensos, 35 por cento diabéticos e 59 por cento com IAM prévio) tiveram acompanhamento médio de 24n8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00) representou 80 por cento e 55 por cento dos custos ambulatoriais, e 41 por cento e 17 por cento dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, p<0,01). CONCLUSAO: O custo médio anual do manejo da DAC foi elevado, sendo o tratamento farmacológico o principal determinante dos custos públicos. Essas estimativas podem subsidiar análises econômicas nesta área, sendo úteis para nortear políticas de saúde pública.

Estabelecimento do ponto de corte da Troponina I como marcador de infarto do miocárdio em cirurgia de revascularização miocárdica / Serum concentrations of Troponin I in the detection of acute myocardial infarction in coronary artery bypass grafting

O objetivo do artigo foi estabelecer o ponto de corte da troponina I como marcador de infarto miocárdico perioperatório de CRM. Foram analisados 147 pacientes submetidos a cirurgia de revascularização miocárdica (CRM) de janeiro a dezembro de 2002 Hospital São Lucas da PUCRS. A dosagem de troponina I (valor de referência < 0,5 ng / ml) foi realizada por quimioluminiscência no pré-operatório, 6,12 e 24 horas após admissão na unidade de cuidados pós-operatório. Consideramos como infarto o surgimento de uma onda Q ou bloqueio de ramo esquerdo no ECG com aumento de CK = MB superior a 3 vezes o limite de referência ou aumento superior a 8 vezes sem alteração eletrocardiográfica. Nesta amostra, 18 pacientes tiveram infarto (12,24%). A média do nível de troponina I no pós-operatório nos pacientes com infarto foi 12,7 ± 13,7; 57,2 ± 31,7 e 45 ± 32,8 ng / ml na 6ª, 12ª e 24ª horas, respectivamente, comparando a 7,6 ± 11,4; 12,0 ± 18,7 e 8,4 ± 19,9 ng / ml nos demais pacientes. Houve diferença estatisticamente significativa entre os valores de troponina I nos pacientes com e sem infarto na 12ª e 24ªh. Como os valores de troponina I não apresentavam uma distribuição normal confeccionou-se uma curva ROC para determinação do melhor nível de sensibilidade e especificidade para os valores encontrados. Nos pacientes que apresentaram os critérios para IAM os valores de troponina I com maior sensibilidade e especificidade encontravam-se na 12ª hora, como determinado pela curva determinado pela curva ROC, tendo uma acurácia de 89%. Utilizando-se a dosagem da 12ª hora o nível de troponina I que apresentou o melhor perfil de sensibilidade e especificidade foi de 9,15 ng / ml (OR36, IC 95% = 4,7-283; p < 0,0001), com valores de 94,4 e 68,2% respectivamente. A determinação da tropina I na 12ª hora após o desclampeamento da aorta com valores de 9,15 ng / ml obteve, em nosso estudo, a melhor relação sensibilidade e especificidade para o diagnóstico de IAM.

Learning from panel boards: T-lymphocyte and B-lymphocyte self-tolerance game.

Immunology is a vast, complex and challenging subject. To facilitate students' understanding, the authors have created a T-lymphocyte and B-lymphocyte self-tolerance game. The T-lymphocyte self-tolerance game consisted of 24 cardboard pieces with illustrations and statements about self-tolerance mechanisms and one large panel board. The B-lymphocyte panel board consisted of 11 cardboard pieces with illustrations and statements about self-tolerance mechanisms, and two large panels. Students had to associate mechanisms of self-tolerance with the corresponding cardboard pieces. In total, 120 students attended the session. Of these, 95.8% considered that the panel board facilitated their understanding; 95% affirmed they understood how T- and B-lymphocyte self-tolerance worked. Students' grades improved significantly. The good results obtained show the value of using a panel board when approaching a subject that is vast and complex.

Hemodynamic effects of sildenafil in patients with stable ischemic heart disease.

BACKGROUND: Recently the new specific phosphodiesterase-5 inhibitor sildenafil was introduced into therapy for erectile dysfunction. The hemodynamic effects of sildenafil may be potentially hazardous for patients with cardiac disease. Sildenafil has been reported to augment the hypotensive effects of nitrates. There is sparse information regarding the systemic and pulmonary hemodynamic effects of a single oral dose of sildenafil in patients with stable angina. METHODS: Male patients referred for coronary angiography with diagnosis of chronic stable angina were enrolled in this study to assess the acute hemodynamic effects of sildenafil. Patients receiving long-acting or sublingual nitrates for the last 6 h before the study were excluded. Hemodynamic measurement were taken during right and left heart catheterization in the basal state and 60 min after 50 mg of oral sildenafil. RESULTS: Twelve patients (age 53+/-7 years) were studied. All had stable angina CCS class II or III. Four had previous myocardial infarction. By coronary angiography, seven patients had at least one coronary artery with >70% stenosis, four had at least one with 50-70% stenosis, and one had only intimal irregularities. There were no significant effects of sildenafil on systemic or pulmonary arterial pressure, left ventricle end diastolic pressure, cardiac output, and systemic or pulmonary vascular resistance (P>0.05 for all). No adverse events were observed. CONCLUSION: A single oral dose of sildenafil had no significant hemodynamic effect in supine patients with stable angina. Isolated administration of sildenafil does not appear to be associated to adverse cardiovascular effects.

Caracteristicas associadas ao abandono do acompanhamento de pacientes hipertensos atendidos em um ambulatório de referência / Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56 percent) of whom dropped out of the follow-up. The mean age was 52.3 + or -12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients

Tratamento anti-hipertensivo na prevenção de acidente vascular encefálico: qual a regra? / Antihypertensive treatment in prevention of stroke: which drug?

A eficácia de tratamentos anti-hipertensivos medicamentosos em reduzir a incidência de acidentes vasculares encefálicos (AVEs), em pacientes hipertensos, foi uma das primeiras a ser demonstrada em ensaios clínicos randomizados. A magnitude do benefício foi a prevista pelos estudos observacionais. Diuréticos tiazídicos e betabloqueadores, empregados na maioria dos estudos, tiveram eficácia preventiva de AVE similar, mas somente os primeiros, em baixa dose, foram capazes de prevenir doença coronariana. Vários representantes de todos os grupos de anti-hipertensivos mais novos têm, globalmente, reproduzido o efeito de diuréticos e betabloqueadores, em ensaios clínicos recentes, sem demonstrar vantagens de outra natureza. Uma exceção é a doxazosina, bloqueador alfa que mostrou-se definidamente menos eficaz que clortalidona em prevenir a incidência de AVE. Tomando-se o resultado desses estudos em conjunto com a ampla vantagem em termos de custo-efetividade, caracteriza-se que diuréticos tiazídicos em baixa dose, preferencialmente associados a poupador de potássio, são a primeira opção anti-hipertensiva com vistas à prevenção de AVE.

Papilomatose de laringe / Laryngeal papillomatosis

A papilomatose de laringe é a neoplasia benigna que mais frequentemente acomete a laringe, tanto em crianças quanto em adultos, causada pelo papiloma virus humano, em especial pelos tipos 6 e 11. A apresentação clínica é variável e a evolução praticamente imprevisível, devido especialmente ao alto grau de recorrência típico desta entidade...