The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models.

In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.

The Assessment of Risk in Cardiothoracic Intensive Care (ARCtIC): prediction of hospital mortality after admission to cardiothoracic critical care.

The models used to predict outcome after adult general critical care may not be applicable to cardiothoracic critical care. Therefore, we analysed data from the Case Mix Programme to identify variables associated with hospital mortality after admission to cardiothoracic critical care units and to develop a risk-prediction model. We derived predictive models for hospital mortality from variables measured in 17,002 patients within 24 h of admission to five cardiothoracic critical care units. The final model included 10 variables: creatinine; white blood count; mean arterial blood pressure; functional dependency; platelet count; arterial pH; age; Glasgow Coma Score; arterial lactate; and route of admission. We included additional interaction terms between creatinine, lactate, platelet count and cardiac surgery as the admitting diagnosis. We validated this model against 10,238 other admissions, for which the c index (95% CI) was 0.904 (0.89-0.92) and the Brier score was 0.055, while the slope and intercept of the calibration plot were 0.961 and -0.183, respectively. The discrimination and calibration of our model suggest that it might be used to predict hospital mortality after admission to cardiothoracic critical care units.

Granuloma piogénico en la edad pediátrica: reporte de un caso / Pyogenic granuloma in children: a case report

Granuloma Piogénico (GP) es una lesión reactiva producida por un crecimiento excesivo del tejido conectivo, es frecuente en la mucosa bucal muy especialmente en el tejido gingival. Se trata de una patología de crecimiento rápido, sangrante y se asocia a la presencia de irritantes locales, microtraumatismos, entre otros factores. Tiene importante predilección por el género femenino entre la segunda y quinta década de la vida. Lesiones como malformaciones vasculares, lesión periférica de células gigantes y sarcoma de Kaposi son sus principales diagnósticos diferenciales y el tratamiento de elección es la escisión quirúrgica. A continuación se presenta un caso clínico poco común debido a las características clínicas de la lesión y la edad del paciente, pues se trata de un infante del género masculino de 5 años de edad, que acudió a la Facultad de Odontología de la UCV, referido por su odontólogo general, debido a la presencia de una lesión tumoral en el sector posterior derecho maxilar, adyacente a la cara distal del 55 de 2.5cm de tamaño. Se realizó la escisión quirúrgica de la lesión posterior a la evaluación de los exámenes preoperatorios y fue analizada histopatológicamente, donde se confirmó el diagnóstico inicial de GP

Pyogenic Granuloma (PG), is a reactive lesion caused by an excessive connective tissue growth and it frequently appears on oral mucosa, especially the gingiva. The PG present fast growth, bleeding propensity and it is associated, among other factors, to local irritation and minor trauma. It has predilection for female patients between second and fifth decade of life. The main differential diagnosis can be made with lesions such as: vascular malformations, peripheral giant-cell lesion and Kaposi's sarcoma. Surgical excision is the treatment of choice. This article presents a case report of an uncommon lesion regarding its rare clinical features and age of the patient. A 5 year old male patient who attended the Facultad de Odontología of Universidad Central de Venezuela, referred by his dental practitioner, presented a tumor-like lesion. The lesion was 2.5 cm in size and located on posterior right maxilla next to distal surface of 55. Surgical excision was performed after full laboratory test evaluation. The histopathology findings confirmed initial diagnose of PG

Evaluación del desarrollo de babas (Caiman crocodilus crocodilus) alimentadas con una dieta medicada con antibiótico / Evaluation of development of the spectacle caiman (Caiman crocodilus crocodilus) fed with an antibiotic medicated diet

La baba, Caiman crocodilus crocodilus, criada en cautiverio puede sufrir estrés, que unido a otros factores, promueve el retraso y mortalidad en la época crítica de crecimiento, por lo que algunos algunos autores reportan el uso de antibióticos para contrarrestar estos efectos. Se evaluó el crecimiento de babas en cautiverio alimentadas con una dieta medicada con antibiótico (virginiamicina) y poblaciones con dieta no medicada, tomando como indicadores: medidas del largo total, grosor del cuello y grosor de la base de la cola y el peso de los animales. Se utilizaron 600 babas nacidas por incubación en el zoocriadero Kiubo (La Suareña, estado Aragua). Estos animales fueron medidos, pesados y evaluados clínicamente antes del inicio del ensayo y distribuidos al azar en un tanque tipo australiano (4 secciones). Las dietas fueron: Tratamiento 1: alimento comercial + proteína animal fresca, y Tratamiento 2: alimento comercial + antibiótico + proteína animal fresca. El análisis estadístico fue un diseño completamente aleatorizado, con evaluaciones en tres etapas o fases: Inicial, Intermedia y Final. En la fase inicial se encontraron diferencias significativas (P≤ 0,05) para todas las variables, siendo el tratamiento 1 el que resultó con mayores promedios. En la fase intermedia se observaron diferencias significativas (P≤0,05) para grosor de la base de la cola, largo total y peso; el grosor del cuello no presentó diferencia significativa. En la fase final se, detectaron diferencias significativas (P≤0,05) entre los tratamientos para la base de la cola y largo total; para el grosor del cuello y peso no hubo diferencias significativas. Se observó que el tratamiento 1 fue mejor que el tratamiento 2, para algunas variables, pero ambas dietas contribuyeron al incremento de la tasa de crecimiento, concluyéndose que no se recomienda el uso de antibióticos adicionados a la dieta, ya que incrementa los costos de producción y puede contribuir con la resistencia bacteriana en el hombre, mientras la cría en cautiverio de esta especie, depende principalmente del buen manejo de los mismos.

The spectacled caiman (Caiman crocodilus crocodilus) is a species raised in captivity that can suffer from stress, which, along with other factors, promotes growth delay and mortality during the critical time of growth. Some investigators report the use of antibiotics to counteract those effects. The growth of a population of spectacle caimans raised in captivity and fed with a diet supplemented with antibiotic (virginiamycin) was compared with the growth of the spectacle caiman population fed with a control diet was assessed. A total of 600 animals born through incubation at the Kiubo farm were used. Before the onset of the experiment, the animals were measured, weighed, clinically evaluated, and randomly distributed in four sections in an Australian tank. The following variables were measured using a metric tape: total length (TL), neck thickness (NT), base of the tail thickness (BTT). The weight was recorded with an electronic balance. The animals were submitted to the following treatments (T): Treatment 1 (T1): commercial diet + fresh animal protein; Treatment 2 (T2): commercial diet + fresh animal protein + antibiotic. The evaluations were carried out in three phases: Initial phase, Intermediate phase, and Final Phase. A totally randomized design with a covariance analysis was performed to analyze the data. The results show that during the initial phase, all variables showed statistically significant (P≤0.05) differences, reaching T1 the highest averages. During the intermediate phase, significant differences (P≤0.05) were found for BTT, TL, and weight. The NT was not significant. During the final stage, statistical differences (P≤0.05) were recorded among T for BTT and TL, but no differences were found for NT and weight. For some variables, T1 was better than T2, but both diets contributed to the increment of growth rate. It is concluded that the use of antibiotics supplemented in the diet, increases production costs and that breeding in captivity depends more on good handling.

Prevención de enfermedades podales mediante el recorte funcional de la pezuña al momento del secado en vacas lecheras confinadas en el trópico / Functional trimming at the dry off period to prevent foot diseases in confined dairy cows at the tropical area

Con el objetivo de evaluar el efecto del recorte funcional al momento del secado, para la prevención de enfermedades podales en vacas lecheras confinadas se utilizaron 47 vacas Pardo Suizo con más de dos partos al inicio del periodo seco. Se dividieron en dos grupos en forma aleatoria; a uno de ellos se le aplicó recorte funcional como grupo tratamiento y el otro, como grupo control. Se procedió a observar el comportamiento de las vacas en cuanto a la aparición de enfermedades podales durante los 5 primeros meses de su lactancia. Los resultados muestran que el 39 por ciento de las pezuñas presentó algún tipo de lesión podal, y en el 61 por ciento había ausencia de lesiones, así mismo se observó que de los animales que recibieron tratamiento, solo enfermaron el 4 por ciento de ellos y de los animales del grupo control enfermaron el 45,4 por ciento. El estudio comparativo de ambos grupos muestra diferencias estadísticas significativas (P<0,05). La mayor cantidad de lesiones que causaron claudicaciones en los animales que enfermaron en el transcurso del ensayo se observaron en los miembros posteriores en sus pezuñas laterales o externas y el promedio de días postparto para la aparición de claudicaciones fue de 72,6 días. Según los resultados se puede concluir que la quiropodia funcional al momento del secado, ayuda a prevenir la aparición de enfermedades podales en vacas lecheras confinadas en sus primeros meses de lactancia.

The aim of the present research was to evaluate the functional trimming effect at the dry off period to prevent the hoof diseases in confined milking cows. To do that 47 Brown Swiss cows with two or more parturition were studed at the beginning of the dry off period. The cows were divided in two groups in a random way. One group received the functional trimming as treatment and the other one serve as a control. The cows were monitor to look into the appearance of hoof diseases within the first 5 months of the milk yield period. The results show that 39 percent of the hoof had any kind of lesions and 61 percent of the hoof were without lesions, in the same way the treated animal group show only 4 percent of sick animals whereas in the control group were 45.4 percent. A comparison study of both groups show a significant statistically differences (P<0.05). The highest amount of lesions that causes lameness in the animals during the trial occur at the rear limb at the lateral claw and the average of days for the appearance of lameness was 72.6 days. From the results it was concluded that functional trimming at the dry off period help to prevent hoof diseases in confined cows at the beginning of the milk yield period.

Distribución y abundancia de los huevos de estróngilos digestivos en bovinosinfectados naturalmente / Distribution and abundance of digestive strongyles eggs in naturally infected bovines

Objetivo. Determinar la prevalencia, cargas parasitarias y distribución de las infeccionesnaturales con estróngilos digestivos dentro de rebaños bovinos de una zona ganadera delEstado Falcón en Venezuela Materiales y métodos. Se evaluaron cuatro fincas de bovinosdoble propósito. Los animales son tipo “Carora” (mestizaje de razas: Holstein, Pardo Suizo,Cebuínos). Durante siete meses se analizaron (Técnica de Mc Master) un total de 1140muestras. La muestra de cada finca se estratificó en cuatro grupo etarios (1: Becerros 0-6meses; 2: Mautes 7-12; 3: Novillas 13-24 y 4: Adultos >25 meses). Resultados. Losvalores de prevalencia promedio fueron: 31.06-50.36%. Se halló diferencia estadística (p ≤0,05)entre los niveles de prevalencia entre fincas y entre grupos etarios. Las infecciones sedistribuyeron de forma sobredispersada en cada rebaño, evidenciado por los bajos valoresde K (0.001-0.01). Conclusiones. Los valores de abundancia se afectaron más por elnúmero de animales con altas cargas que por la prevalencia. La mayoría de las infeccionesno revistió importancia clínica, las altas cargas parasitarias representaron 1.75-28.56% detodas las infecciones.

Estudio comparado de rentabilidad en centros de atención veterinaria especializados y diversificados en el estado Aragua

Fueron estudiados cincuenta y seis (56) Centros de Atención Veterinaria (CAV) ubicados en el estado Aragua, considerándose las variables: Ingresos Totales Anuales, Costos Fijos Anuales y Costos Variables Anuales. Se registraron elevados Costos Totales Anuales en los Centros de Atención Diversificados (CAVDIV), seguidos de los Centros de Atención Semidiversificados (CAVSD) y los Centros de Atención Especializados (CAVES). El análisis de los Ingresos Netos Anuales para los CAVDIV, CAVSD y CAVES reveló la misma tendencia, registrándose los montos de 64,7millones de Bolívares, 15,6 millones y 6,8 millones, respectivamente. Al analizar la variable Margen Bruto, se registraron de igual modo los mayores valores para los CAVDIV con un promedio anual de 75 millones de Bolívares, seguido por los CAVSD y CAVES con un promedio anual de 17 y 7 millones de Bolívares, respectivamente. El promedio de la variable Rentabilidad Anual para la totalidad de los CAV fue de 668,6% lo que significa que por cada 100 Bolívares invertidos en el centro se generaron Bs. 668.6 de Ingreso Neto, lo cual evidencia que los CAV son negocios económicamente rentables. La mayor rentabilidad fue registrada en los CAVES (1085,3%), seguidos por los CAVSD (756,13%) y CAVDIV (441,02%). Esta rentabilidad registrada en los CAVES no significa necesariamente que se generó un mayor beneficio económico al responsable del centro, sino que la retribución en Ingreso Neto por Capital Invertido fue proporcionalmente mayor en relación a los CAVSD y CAVDIV. Mediante un Análisis de Varianza se determinó el efecto del grado de diversificación sobre las variables Rentabilidad y Margen Bruto, encontrándose que no hubo efecto significativo sobre la Rentabilidad, pero si efecto significativo (p<0,05) sobre la variable Margen Bruto. Con una prueba de medias de Tukey se determinó que no se encontraron diferencias entre los CAVES y CAVSD, pero si presentaron diferencias entre éstos y los CAVDIV, por lo que se concluye que los CAVDIV logran economías de diversificación en su estructura de costos variables, que permite mayor Margen Bruto que otras formas especializadas y semidiversificadas de prestación de servicios veterinarios. Para todo el análisis se utilizó el paquete estadístico Statistix 7.0. La presente investigación plantea como objetivo principal analizar comparativamente la rentabilidad de Centros de Atención Veterinaria Especializados (CAVES), Semidiversificados (CAVSD) y diversificados (CAVDIV) existentes en el estado Aragua.

Comparative Study of Profitability in Specialized and Diversified Veterinary Care Centers in Aragua State Abstract A total of fifty-six (56) Veterinary Care Centers (CAV) located in the state of Aragua, were studied, considering the following variables: Total Annual Income, Annual Fixed Costs, and Annual Variable Costs. Annual Total Costs were higher at the Diversified Veterinary Care Centers (CAVDIV ) followed by the Semidiversified Veterinary Care Centers (CAVSD) and Specialized Veterinary Centers (CAVES). The analysis of Net Annual Income showed the same trend, with amounts of 64.7million Bs., 15.6 million Bs. and 6.8 million Bs. for CAVDIV, CAVSD and CAVES, respectively. When analyzing the Gross Margin variable, the highest values were for CAVDIV with an annual average of 75.0 million Bs., followed by CAVSD and then CAVES with an annual average of 7.0 and 17.0 million Bs. respectively. On average, Annual Profit for all, Veterinarian Care Centers was 668.6%, which indicates that for any 100 Bs. invested on the center, 668.6 Bs. was returned as Net Income, showing that was the CAV are very profitable from the economic business point of view. The highest profitability recorded was at the CAVES (1085.3%) followed by the CASD (756.1%) and then the CAVDIV (441.0%). It is important to joinpoint that the highest profitability recorded for the CAVES, does not necessarily has to be associated to a high economic profit accrued to the personal in charge of the center, but rather that the return of investment was proportionally greater than those of CAVSD y CAVDIV. The statistical package STATISTIX 7.0 was utilized for all statistics estimations. An ANOVA was used to analyzed the estimate the effects of the degree of diversification on Profitability and Gross Margin Variables. It was found that there was no significant effect of greater diversification on profitability. However, was significant on Gross Margin (p<0.05).Tukey test did not find differences between CAVES and CAVSD, but there were differences among these two and the CAVDIV. Therefore, it can be concluded that the CAVDIV reached economics of diversification in its variable costs structure, which allowed for a greater gross margin, not being the same for CAVES and CAVSD. This study intends to analyze as its main objective, from a profitability point of view, the comparison among the Specialty Centers for the Veterinary Care (CAVES), Semidiversified Centers for Veterinary Care (CAVSD) and Diversified Centers for Veterinary Care (CAVDIV), located in the state of Aragua, Venezuela.

[Risk of infections and glycemic control in type 2 diabetes mellitus]. / Riesgo de infecciones y control metábolico en pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Although association between Diabetes Mellitus (DM) type 2 and prevalence of infections is a frequently considered issue in current literature there is few evidence of it. The objective of this study has been to analyse the infection risk in DM type 2 patients according to their glycemic control level (Hb Aic%). PATIENTS AND METHOD: In this cohort-study of 740 patients, we evaluated the incidence rates of infectious episodes in DM2-type diabetic patients during a period of 5 years, from May, 1997 to May, 2002. RESULTS: The average period of follow-up was 4.26 years. We found no significant correlation (p=0.33) between higher levels of HbAic% and presentation of infections. Data clearly show a direct correlation between risk of infection and number of associated chronic diseases (p=0.035), age (p=0.007) and diabetes duration (0.012). We also found an unexplained association between more aggressive treatment and higher glycemic levels (Hb Aic%) (p=0.0001) and also higher infection risk (0.038). CONCLUSIONS: Although there is no association between risk of infection and glycemic control (Hb Aic%) among analysed patients, this study shows a clear correlation between risk of infection and number of complications or number of associated chronic diseases.

Riesgo de infecciones y control metabólico en pacientes con diabetes mellitus tipo 2 / Risk of infections and glycemic control in type 2 diabetes mellitus

Fundamento y objetivo: La asociación entre diabetes mellitus (DM) tipo 2 y la prevalencia de infecciones es una situación frecuente a considerar en la practica clínica. Sin embargo, la evidencia de esta mayor susceptibilidad en los diabéticos para contraer infecciones es escasa. El objetivo de este estudio ha sido analizar el riesgo de infección en pacientes DM tipo 2 según el grado de control glucémico (Hb Aic por ciento).Pacientes y método: Estudio de cohortes históricas sobre 740 pacientes. Se evaluaron las tasas de incidencia de episodios infecciosos en diabéticos tipo 2 durante un periodo de 5 años, desde mayo de 1997 hasta mayo de 2002.Resultados: La media de seguimiento en los diabéticos fue de 4,26 años. No se encontraron diferencias significativas en la presentación de infecciones en relación al control metabólico de los pacientes (p=0,33).Existe un mayor riesgo de infección en diabéticos con un número de procesos crónicos asociados elevado (p=0,035). Existe un mayor riesgo de infección cuanto más elevada es la edad del paciente (p=0,007) y a más años de evolución de la enfermedad (p=0,012). Se observó que los pacientes tratados con medidas higiénico-dietéticas sin otro tratamiento farmacológico tenían mejores controles de Hb Aic por ciento (p=0,0001), y menor riesgo de infecciones (p=0,038) que los tratados con insulina más ADO combinados. Conclusiones: No existe correlación entre el grado de control glucémico (Hb Aic por ciento) con la frecuencia de infecciones en los pacientes diabéticos estudiados. Sí aparece un mayor riesgo de infección en aquellos con un número de procesos crónicos asociados elevado (AU)

Clinical cross-reactivity among foods of the Rosaceae family.

BACKGROUND: Foods from the Rosaceae botanical family have been increasingly reported as causes of allergic reaction. Patients frequently have positive skin tests or radioallergosorbent test results for multiple members of this botanical family. OBJECTIVE: Our purpose was to investigate the clinical cross-reactivity assessed by double-blind, placebo-controlled food challenge (DBPCFC) of Rosaceae foods (apricot, almond, plum, strawberry, apple, peach, and pear). METHODS: Thirty-four consecutive adult patients complaining of adverse reactions to Rosaceae were included in the study. Skin prick tests and CAP System (FEIA) were performed with Rosaceae foods in all patients. Clinical reactivity to Rosaceae was systematically evaluated by open food challenges (OFCs), unless there was a convincing history of a recent severe anaphylaxis. Positive reactions on OFCs were subsequently evaluated by DBPCFCs. RESULTS: Twenty-six and 24 patients had positive skin prick tests and CAP FEIA with Rosaceae, respectively; from these 88% and 100% had positive tests with >/=2. No evidence of clinical reactivity was found in 66% percent of positive skin prick tests and 63% of positive specific IgE determinations to fruits. A total of 226 food challenges (including OFC and DBPCFC) were performed in the 28 patients with positive skin prick tests or CAP System FEIA. Of 182 initial OFCs carried out, 26 (14%) reactions were confirmed by DBPCFCs. Overall, 40 reactions were considered positive in 22 patients with positive skin tests or CAP FEIA. Thirty-eight reactions had been previously reported, the remaining two were detected by systematic challenges. Most reactions were caused by peach (22 patients), apple (6), and apricot (5). Ten patients (46%) were clinically allergic to peach and other Rosaceae. CONCLUSION: Positive skin test and CAP System FEIA should not be taken as the only guide for multi-species dietary restrictions. Nevertheless, the potential clinical allergy to other Rosaceae should not be neglected. If the reported reaction is confirmed, current tolerance to other Rosaceae should be precisely established unless there has been ingestion without symptoms after the reaction.