Use of Gamithromycin for the Treatment of Osteomyelitis Secondary to Foot Rot in a Sheep

Background: Lameness is one of the main causes of economic losses in sheep breeding, especially in the distal region of the limbs. Poor sanitation management, especially in terms of hygiene conditions and the introduction of animals without previous preventive care, is an important predisposing factor in sheep flocks. Interdigital phlegmon (foot rot) is a bacterial disease that causes pain, heat, edema, hyperemia in the region, and can lead to secondary processes such as osteomyelitis. This case report describes the use of gamithromycin for the treatment of osteomyelitis secondary to foot rot in a sheep.Case: An Ile-de-France ewe exhibiting signs of lameness, pain, heat, hyperemia and edema in the four digits was treated at the Veterinary Hospital of UNIPAMPA. The lesions were characterized by interdigital phlegmon, commonly known as foot rot, and the right thoracic limb was more affected, exuding a foul odor and purulent secretion. The affected limbs were treated topically with an antiseptic solution. The lesions healed completely except for the right thoracic limb, whose clinical condition worsened. Osteitis was suspected, and was confirmed by radiographic evaluation of the region. Treatment with ceftiofur was introduced, but proved to be ineffective. Nevertheless, the lesion was found to have worsened, and a new X-ray evaluation was made, which revealed dislocation of the distal phalanx as well as involvement of the middle and proximal phalanges. Thus, we decided to perform chemical arthrodesis of the distal interphalangeal joint. Before beginning this procedure, contrast X-rays were taken that revealed the development of a fistulous pathway connecting the distal interphalangeal joint to the proximal interphalangeal joint, which precluded this procedure. In view of the worsening of the condition, amputation of the distal and middle phalanges was performed, as well as scraping of the distal edge of the proximal phalanx. In the postoperative period, ceftiofur was used as antibiotic therapy and flunixin meglumine as analgesic, in addition to daily dressings with topical iodine. After this procedure, there was no improvement in lameness and the radiographic images showed worsening of the clinical condition. At this time, the antimicrobial therapy was replaced with tylosin. After beginning treatment with this antimicrobial, there was a slight decrease in lameness, but a fistulous pathway with purulent secretion was formed in the region corresponding to the distal portion of the first phalanx, as well as an increase in the bone lesion, which was observed radiographically. Due to the ineffectiveness of the drug therapy, it was replaced by gamithromycin, which was applied three times. After beginning this treatment, lameness receded and the wound stopped producing purulent secretion, and at the end of the applications of this active ingredient, there was complete resolution of lameness and improvement of the radiographic signs of the animal of this case report.Discussion: Antimicrobial therapy is an important factor in the treatment of interdigital phlegmon and of osteomyelitis, and should be performed properly using broad-spectrum antibiotics. In the case reported here, although antibiotics with those characteristics were used, the active ingredient had to be changed more than once. In this particular case, there was an improvement in the lameness and the wound, and in the radiographic signs of the proximal phalanx, only after the application of gamithromycin. Therefore, this drug can be considered as an alternative for the treatment of osteomyelitis in ruminants, especially in cases unresponsive to treatment with other antibiotics

Subsequent colic syndrome due to perirectal abscess in an equine model – Case report

Colic is the most frequent syndrome of equine digestive system, and impaction is the most common disease among its many etiologies. The small colon can suffer with intraluminal or extraluminal obstructions resulting from many causes. These obstructions present signs such as abdominal pain, poorly altered physiological parameters, dyskinesia and tenesmus. The aim of the present study is to describe a small colon impaction secondary to perirectal abscess in the pelvic musculature. The equine model was assisted at Veterinary University Hospital of Federal University of Pampa (Unipampa) and surgery was the therapy of choice; however, the animal ended up dying during anesthesia application. The ultimate diagnostic was provided by necropsy, which showed one abscess in the pelvic musculature, close to the terminal portion of the rectum. The relevance of the present study lies on the importance of using complementary diagnostic methods, as well as on the presentation of another cause of colic, which is little described in the literature. The present results allowed enhancing the prognostics and treatments applied to horses with this disease.

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Casearia sylvestris na permeabilidade gástrica à sacarose em equinos submetidos a protocolo de indução de úlcera gástrica

Estudos em animais de laboratório sugerem um efeito antiulcerogênico do extrato de Casearia sylvestris. Esse extrato ainda não foi estudado para a profilaxia e/ou o tratamento de úlceras gástricas em equinos. Para avaliar a influência do extrato de C. sylvestris na permeabilidade gástrica à sacarose, seis equinos adultos foram submetidos a modelo de indução de úlceras gástricas. Os animais foram submetidos ao teste de permeabilidade à sacarose antes e ao término do protocolo de restrição alimentar intermitente, para detecção de ulceração gástrica. Durante os sete dias da indução, os animais foram submetidos a tratamentos diários via sondagem nasogástrica com extrato de C. sylvestris (9mg kg-1 de peso corpóreo) ou veículo (ágar). Após intervalo de 32 dias em piquete, para permitir a cicatrização das úlceras induzidas, cada animal foi submetido novamente ao protocolo de indução de úlcera gástrica, e os tratamentos foram alternados. Dessa forma, cada animal foi submetido a ambos os tratamentos em períodos distintos. A concentração de sacarose na urina foi determinada para cada amostra obtida, por cromatografia líquida de alto desempenho e detecção amperométrica pulsátil. Não foram observadas alterações nos exames clínicos e hemogramas. O tratamento com o extrato de C. sylvestris evitou o aumento da concentração de sacarose urinária (P<0,05) quando comparado ao veículo, sugerindo um efeito antiulcerogênico gástrico em equinos. Estudos mais amplos incluindo gastroscopia são necessários para avaliar a possibilidade de usar o extrato para a profilaxia e/ou o tratamento das úlceras gástricas em equinos.Studies on laboratory animals suggest an antiulcergonic effect of Casearia sylvestris extract. This extract has not yet been tested for the prophylaxis and/or treatment of gastric ulcers in horses. In order to evaluate the influence of C. sylvestris extract on gastric sucrose permeability, six adult horses underwent a protocol of gastric ulcer induction. All animals were submitted to sucrose permeability testing before and at the end of gastric ulcers induction by intermittent feed deprivation, for detection of gastric ulcers. During the seven days of induction, the animals were submitted to daily treatment by nasogastric tubing with C. sylvestris extract (9mg kg-1 b.w.) or vehicle (Agar). After 32 days of pasture turnout, in order to allow healing of induced ulcers, each animal underwent a second induction protocol, in which treatments were alternated. By this manner, each animal was submitted to both treatments in distinct periods. The urine sucrose concentration was determined for each sample obtained, by high performance liquid chromatography and pulsed amperometric detection. No alterations in clinical examination and hemograms were detected. Treatment with C. sylvestris extract avoided the increase on urine sucrose concentration (P<0.05) when compared to the vehicle, suggesting an antiulcer preventive effect for equine gastric ulcers. More extensive studies including gastroscopy are necessary to evaluate the possibility of employing this extract for the prophylaxis and/or treatment of gastric ulcers in horses

Actas del IV congreso sobre la enseñanza del español en Portugal : Universidade de Évora 2, 3 y 4 de junio de 2011

Resumen basado en el de la publicación.Se recogen las comunicaciones y talleres presentados durante el IV Congreso sobre la enseñanza del español en Portugal que se celebró en las instalaciones de la Universidade de Évora los días 2, 3 y 4 de junio de 2011. Se presentaron un total de once comunicaciones y catorce talleres a cargo de profesores de español de todos los niveles educativos y de representantes de editoriales españolas. Durante el congreso fue posible asistir tanto a ponencias de contenido académico como a talleres y presentaciones de experiencias de aula por lo que el evento generó bastante interés y contó con una asistencia de 200 profesionales.ES

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)