Effects of Sweet and Forge Sorghum Silages Compared to Maize Silage without Additional Grain Supplement on Lactation Performance and Digestibility of Lactating Dairy Cows

\ua9 2024 by the authors. This study investigated the effects of replacing maize silage (MZS) with high-sugar sorghum silage (HSS) or forage sorghum silage (FSS) without additional grain supplement in the diets of dairy cows on nutrient digestibility, milk composition, nitrogen (N) use, and rumen fermentation. Twenty-four Chinese Holstein cows (545 \ub1 42.8 kg; 21.41 \ub1 0.62 kg milk yield; 150 \ub1 5.6 days in milk) were randomly assigned to three dietary treatments (n = 8 cows/treatment). The cows were fed ad libitum total mixed rations containing (dry matter basis) either 40% MZS (MZS-based diet), 40% HSS (HSS-based diet), or 40% FSS (FSS-based diet). The study lasted for 42 days, with 14 days devoted to adaptation, 21 days to daily feed intake and milk production, and 7 days to the sampling of feed, refusals, feces, urine, and rumen fluid. Milk production was measured twice daily, and digestibility was estimated using the method of acid-insoluble ash. The data were analyzed using a one-way ANOVA in SPSS 22.0 according to a completely randomized design. Dietary treatments were used as fixed effects and cows as random effects. The results indicate that MZS and HSS had greater crude protein but less neutral detergent fiber (NDF), acid detergent fiber (ADF), acid detergent lignin (ADL), and a lower pH than FSS (p ≤ 0.04). High starch contents in MZS and water-soluble carbohydrate (WSC) contents in HSS were observed (p < 0.01). While the highest starch intake was observed for the MZS-based diet, the highest WSC intake was noted for the HSS-based diet, and the highest NDF, ADF, ADL intake was observed for the FSS-based diet (p ≤ 0.05). The diets, including MZS and HSS, had greater digestibility than that of FSS (p ≤ 0.03). Feeding MZS- and HSS-based diets increased the yield, fat, and protein content of the milk, as well as feed conversion efficiency (p ≤ 0.03). However, feeding the MZS- and HSS-based diets decreased the contents of milk urea N, urinary urea N, and urinary N excretion more than the FSS-based diet (p ≤ 0.05). The N use efficiency tended to increase relative to diets containing MZS and HSS compared with FSS (p = 0.06 and p = 0.09). Ruminal ammonia-N and pH were lower, but total volatile fatty acids, acetate, and propionate were higher in cows fed the HSS- and MZS-based diets compared to those fed the FSS-based diet (p ≤ 0.03). It appears as though replacing MZS with HSS in the diet of cows without additional grain supplements has no negative influence on feed intake, milk yield, N utilization, or ruminal fermentation

Educating and Informing Patients Receiving Psychopharmacological Medications: Are Family Physicians in Pakistan up to the Task?

Introduction: Studies have shown a high prevalence of psychiatric illnesses among Patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if Patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management. Methods: A cross-sectional study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital Karachi, Pakistan. Details about the prescriptions and Patient education were acquired from the Patients after their consultations. Results: A total of 354 adult Patients were interviewed during 3 days. Among them, 73 (20.6%) were prescribed psychopharmacological medications. Among Patients receiving psychopharmacological medicines, 37 (50.7%) did not know their diagnosis, 50 (68.5%) were unaware of the disease process, 52 (71.2%) were unaware of alternative treatments, 63 (86.3%) were not cautioned about the potential adverse effects of the drugs, 24 (32.9%) were unaware of the duration of treatment and in 60 (82.2%) of the participants an appropriate referral had not been discussed. For all aspects of education, Patients prescribed psychopharmacological medications knew less as compared to those Patients that were prescribed other medications. Discussion: The practice of imparting information to Patients who receive psychopharmacological medications seems to be inadequate in Pakistan. We have hypothesized about the possible reasons for our findings, and identified a need for further research to determine the cause for such findings and to address them accordingly. At the same time there is a need to educate family physicians in Pakistan about the special importance of providing adequate information to such Patients

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability