Short- and medium-term prognosis of HIV-infected patients receiving intensive care: a Brazilian multicentre prospective cohort study.

OBJECTIVES: The characteristics of critically ill HIV-positive patients and the causes of their admission to intensive care units (ICUs) are only known through retrospective and unicentric studies. This study aims to fill this knowledge gap. METHODS: This is a prospective, multicentre cohort study of short- and medium-term prognostic factors. The setting consisted of ICUs of three tertiary referral hospitals from the three largest metropolitan areas in Brazil in the period January 2014 to November 2015. In all, 161 HIV patients over 18 years old were included. RESULTS: The clinical data of the outcomes (ICU mortality, hospital mortality and 90-day survival) were extracted from medical records using the REDCap®ï¸ web-based form and analysed with the MedCalc®ï¸ application. Median age was 41.7 [interquartile range (IQR): 34-50] years, the Simplified Acute Physiologic Score 3 (SAPS 3) was 64 (IQR: 56-74), and the Sequential Organ Failure Assessment Score (SOFA) was 6 (IQR: 4-9) points. The main causes of admission were sepsis (54.5%) and acute respiratory failure (13.7%). ICU and hospital mortality rates were 32.3% and 40.4%, respectively. In a multivariate analysis, time until ICU admission ≥ 3 days (P = 0.0013), performance status (Eastern Cooperative Oncology Group score, P = 0.0344), coma (Glasgow Coma Scale ≤ 8 points, P = 0.0213) and sepsis (P = 0.0003) were associated with increased hospital mortality. Coma (P = 0.0002) and sepsis (P = 0.0008) were independently associated with 90-day survival. CONCLUSIONS: Delayed ICU admission and the severity of critical illness determine the short- and medium-term mortality rates of HIV-infected patients admitted to the ICU, rather than factors associated with HIV infection. These results suggest that prognostic factors of HIV-infected patients in the ICU are similar to those of non-HIV-infected populations.

Sodium butyrate in post-hatch feed for broiler chicks / [Uso de butirato de sódio em rações pós-eclosão para pintos de corte]

This study was designed to determine adequate levels for sodium butyrate inclusion in pre-hatching and pre-starter feed in order to minimize the negative effects of post-hatch delayed placement on broiler chicks. Newly-hatched chicks were allotted in a completely randomized design, with five treatments, each comprising five replicates of ten birds each. Five dietetic levels of sodium butyrate (control, 0.050, 0.075, 0.100 and 0.200%) were used in the pre-starter feed offered to the chicks in the transporting box and during the pre-starter phase. Performance, yolk sac retraction, plasma glucose concentration, weight and histomorphometry of the small intestine were evaluated after 24 hours of feed access and at 7 days of age. A metabolic trial was performed when the chicks were seven to ten days of age. Supplementation of 0.1% sodium butyrate increased the development of broiler chicks' intestinal villi at seven days of age but was not able to improve performance in the pre-starter phase. Supplementation with sodium butyrate in a diet offered in the transportation box does not improve broiler performance in the pre-starter phase. Supplementation of up to 0.16% is recommended, in order to improve the metabolizability of the ether extract for broilers at seven days of age.(AU)

Objetivou-se, com este estudo, encontrar níveis adequados de inclusão de butirato de sódio em ração pós-eclosão e pré-inicial, buscando minimizar os efeitos negativos do jejum de pintos de corte. Os animais foram distribuídos em delineamento inteiramente ao acaso, com cinco tratamentos e cinco repetições de 10 aves cada. Foram utilizadas cinco suplementações de butirato de sódio (controle; 0,05; 0,075; 0,100 e 0,200%) na ração pré-inicial, fornecidas aos pintos na caixa de transporte e durante a fase pré-inicial. Após 24 horas de acesso ao alimento e aos sete dias de idade, foram avaliados desempenho, retração do saco vitelino, concentração de glicose plasmática, peso e histomorfometria do intestino delgado. De sete a 10 dias de idade, realizou-se ensaio de metabolizabilidade. A suplementação de 0,10% de butirato de sódio aumentou o desenvolvimento das vilosidades intestinais dos pintos de corte aos sete dias de idade, mas não foi capaz de melhorar o desempenho na fase pré-inicial. A suplementação com butirato de sódio em dieta oferecida na caixa de transporte não melhora o desempenho dos frangos na fase pré-inicial. Recomenda-se suplementação de até 0,16%, a fim de melhorar a metabolizabilidade do extrato etéreo para frangos de corte aos sete dias de idade.(AU)

Liver transplantation in children with biliary atresia and polysplenia syndrome.

Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in children. The polysplenia syndrome anomalies, which occur in approximately 10% of children with biliary atresia, may represent special difficulties at liver transplantation. We have reviewed our experience with this syndrome in 116 children with biliary atresia who underwent liver transplantation between March 1984 and December 1989. The main features of the polysplenia syndrome, which included absence of the inferior vena cava, preduodenal portal vein, midgut malrotation, aberrant hepatic artery, and situs inversus, were encountered in 12 of the 116 children (10.3%). Severe portal vein hypoplasia (3.5 mm or smaller) was also present in 7 of these children. Eight patients received a complete and four received a reduced liver graft. The vascular anomalies increased the technical difficulty of OLT but could be surmounted, although they did contribute to the peroperative death of one child. The 1-month survival rate was 83% for the 12 children with features of the polysplenia syndrome and 88% for the other 92 children with biliary atresia alone.

[Peripheral neuropathy possibly caused by amiodarone therapy]. / Amiodarona como provável etiologia de neuropatia periférica.

A 67 years-old man under amiodarone treatment for thirteen months due to a cardiac arrhythmia developed a mixed sensory-motor neuropathy. Proper diagnosis and withdrawal of the offending drug prompted marked improvement within months of his neurological dysfunction.

Evaluation of periapical changes following endodontic therapy: digital subtraction technique compared with computerized morphometric analysis.

OBJECTIVES: The aim of this study was to compare two methods for the evaluation of periapical lesion changes following endodontic therapy (digital subtraction technique and morphometric analysis) by outlining the radiolucent area. METHODS: 13 human anterior teeth with pulp necrosis and chronic periapical lesions were used. Periapical radiographs were taken immediately after endodontic therapy (0) and then 2 months, 4 months and 6 months post treatment, using an intraoral radiographic film holder stabilized with impression material. The films were processed in a standard manner and the digitized images were submitted to digital subtraction using Adobe Photoshop 6.0. New bone formation or bone resorption areas were then measured. In the morphometric analysis, the periapical lesions were outlined using VixWin 2000 and the area (in square millimetres) was recorded. The obtained data were submitted to agreement analysis for comparison of the two techniques. RESULTS: There was no correlation between the areas of radiographic changes detected by digital subtraction and periapical lesion outline (r = 0.02-0.45). The new bone formation areas observed by digital subtraction presented higher values, with bone changes being especially evident in the 2 month follow-up radiographs, which suggests a higher sensitivity for this method. CONCLUSIONS: Both methods are suitable for the evaluation of periapical lesion changes, but the digital subtraction technique is more sensitive for detecting radiographic periapical changes.

Microbiota intestinal e desempenho de frangos alimentados com rações elaboradas com sorgo ou milheto e complexo enzimático / Intestinal microflora and broiler performance fed with sorghum or pearl millet with enzymatic complexes

Avaliou-se a suplementação enzimática em rações contendo milheto ou sorgo sobre a microbiota intestinal e o desempenho de frangos. Foram alojados 420 pintos - ensaio de microbiota - e 1.200 pintos - ensaio de desempenho -, submetidos aos tratamentos com sorgo ou milheto suplementados ou não com complexo enzimático. O delineamento utilizado foi inteiramente ao acaso, com sete repetições de 15 aves cada, para o ensaio de microbiota, e em blocos ao acaso, com cinco repetições e 60 aves por parcela para desempenho. Foram realizadas pesquisas de bactérias Gram-negativas e contagem do número total de microrganismos aeróbios do intestino delgado. A suplementação enzimática não afetou a microbiota intestinal de frangos aos 14 e 28 dias de idade. Houve efeito da suplementação enzimática nas dietas com sorgo para conversão alimentar na fase pré-inicial. Nas dietas com milheto, a suplementação melhorou o ganho de peso no período de um a 35 dias de idade. No período total de criação, de um a 42 dias, não foi observado efeito da suplementação para milheto ou sorgo. Conclui-se que a utilização da suplementação de enzimas em rações com sorgo ou milheto pode melhorar os resultados de desempenho, dependendo da fase de crescimento de frangos de corte.

Two experiments were conducted to examine the supplementation enzyme in broilers fed with sorghum or pearl millet. The intestinal microflora and broiler performance was conducted with 420 and 1.200 broiler chickens, respectively. The treatments consisted of sorghum or pearl millet diet with enzymatic complex. The microflora assay consisted of 15 birds per experimental unit in completed randomized delineament, with seven replicates, and the performance study consisted of 60 birds per experimetal unit in a randomized block design, with five replicates. A study of bacteria negative-gram and total number bacteria aerobic in the small intestine was carried out. The averages were compared by contrasts (performance) and the Kruskal-Wallis (bacteria) tests applied for the research. The enzyme supplementation did not affect the broiler intestinal microflora at the age of 14 and 28 days. Feed conversion in the pearl millet diets supplemented with enzymes was better in the initial phase. The body weight was better to treat enzymatic complex in diets pearl millet (at age of 1- 35 days), however, at the age of 1 to 42 days there was no effect of supplementation for millet or sorghum. The results showed that the sorghum or pearl millet diets supplemented with enzymes are a viable strategy to improve the nutritional value of the diets and performance results depending on the age of the broilers.

Efeito da temperatura ambiente e da idade do frango sobre o valor energético do farelo de soja / Effects of environmental temperature and age of broilers on energy value of soybean meal

Foram utilizados 288 pintos de corte Cobb, distribuídos em delineamento experimental inteiramente ao acaso, em esquema de parcelas subdivididas no tempo, sendo as três temperaturas de criação - fria, termoneutra e quente - as parcelas, e as três fases de avaliação - inicial, crescimento e final - as subparcelas, com seis repetições de seis aves cada. A dieta-teste foi obtida pela substituição de parte da ração basal pelo alimento-teste: 40 por cento do farelo de soja + 60 por cento da ração basal. Foram calculados os coeficientes de metabolizabilidade aparente e verdadeiro da matéria seca, do nitrogênio, do extrato etéreo da dieta-teste e os valores de energia metabolizável aparente e verdadeira (EMA e EMV), e corrigidas pelo balanço de nitrogênio do farelo de soja (EMAn e EMVn). Foram encontrados valores médios de EMAn do farelo de soja para aves criadas em temperatura fria, termoneutra e quente de 2110, 2016 e 2022kcal/kg, respectivamente, e para as fases de criação inicial, crescimento e final de 1840, 2052 e 2256kcal/kg, respectivamente. O valor de energia metabolizável do farelo de soja, os balanços e os coeficientes de metabolizabilidade dos nutrientes da dieta-teste aumentaram com a idade do frango de corte, porém não são afetados pela temperatura ambiente.

Two hundred and eighty-eight Cobb chicks were distributed in a completely randomized design with a split-plot arrangement with six replication of six chicks each, the main plots were in three temperatures (cold, thermo neutral and hot) and the secondary plot were by phase (initial, growing and final). The test diet was produced by replacing the basal diet with test food: 40 percent soybean meal+60 percent basal diet. The coefficient of apparent and true metabolizability of dry matter, nitrogen, ether extract of the test diet and apparent and true metabolizable energies (AME and TME) of soybean meal were calculated and energy values were corrected for nitrogen balance (AMEn and TMEn) of soybean meal, in kcal/kg, as fed basis. The mean values of AMEn observed for broiler chicks in cold, thermo neutral and hot temperature were 2110, 2016 and 2022kcal/kg, respectively, and the initial, growing and final phases were 1840, 2052 and 2256kcal/kg, respectively. The metabolizable energy values of soybean meal, the balance and coefficients of metabolizability of the nutrients of the test diet increased with the age of broiler; however, they were not affected by environmental temperature.

Avaliação da imunidade humoral em ratos submetidos à radiação eletromagnética não ionizante / Humoral immunity in rats subjected to non-ionizing electromagnetic radiation

The objective of this study was to verify using immunoglobulin dosimetry for IgA, IgG, IgM the possible alterations on the immune system of rats submitted to the non ionizing radiation used by cellular telephony...