Use of a citrus by-product in broilers diets

The European Union is about to ban antibiotics as growth promoters in animal feeds. Organic products have been recently revalued and the animal science research showed a great interest in the study of alternative natural nutraceutical products in animal feeding. Flavonoids are plant pigments able to inhibit or kill many bacterial strains, to destroy some pathogenic protozoa and to scavenge free radicals

Letter to the Editor commenting on “Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: a randomized trial”

We have read with very great interest the study published by Arora S et al.: “Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: a randomized trial”, especially for the attention paid to the key points in the management of breast surgery: postoperative analgesia optimization, incidence of postoperative nausea and vomiting reduction, prevention of the onset of chronic pain and functional impotenc

Antimicrobial susceptibility to zinc bacitracin of Clostridium perfringens of rabbit origin

Zinc bacitracin is widely used in Italian rabbit farms to control both Epizootic Rabbit Enteropathy (ERE) and clostridiosis, and field results demonstrate useful activity. Nevertheless, data regarding the in vitro efficacy of zinc bacitracin against clostridia of rabbit origin are not available. In this study, the minimal inhibitory concentrations (MICs) of zinc bacitracin were evaluated in 123 C. perfringens strains isolated from rabbits in Italian fattening units. The agar dilution method was performed in Brucella Agar supplemented with laked sheep blood, haemin and vitamin K1, as recommended in NCCLS document M11-A6. Most strains (94.3%) had low MIC values (£ 0.5 mg/ml), and a few strains (4%) were inhibited by a concentration of 1 mg/ml. Two isolates (1.6%) had a MIC value of 16mg/ml. The MIC values of ATCC reference strains showed a good fit between each batch. MIC required to inhibit the 90% of organisms was 0.5 mg/ml and the presence of only two strains with MIC=16 mg/ml revealed the susceptibility to zinc bacitracin of Italian isolates of C. perfringens from rabbit and the absence of acquired resistance.Agnoletti, F.; Bacchin, C.; Bano, L.; Passera, A.; Favretti, M.; Mazzolini, E. (2007). Antimicrobial susceptibility to zinc bacitracin of Clostridium perfringens of rabbit origin. World Rabbit Science. 15(1):19-22. doi:10.4995/wrs.2007.609192215

Antibiotic De-Escalation in Emergency General Surgery

Background. Antibiotic treatment in emergency general surgery (EGS) is a major challenge for surgeons, and a multidisciplinary approach is necessary in order to improve outcomes. Intra-abdominal infections are at high risk of increased morbidity and mortality, and prolonged hospitalization. An increase in multi-drug resistance bacterial infections and a tendency to an antibiotic overuse has been described in surgical settings. In this clinical scenario, antibiotic de-escalation (ADE) is emerging as a strategy to improve the management of antibiotic therapy. The objective of this article is to summarize the available evidence, current strategies and unsolved problems for the optimization of ADE in EGS. Methods. A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. Results. There is no universally accepted definition for ADE. Current evidence shows that ADE is a feasible strategy in the EGS setting, with the ability to optimize antibiotic use, to reduce hospitalization and health care costs, without compromising clinical outcome. Many studies focus on Intensive Care Unit patients, and a call for further studies is required in the EGS community. Current guidelines already recommend ADE when surgery for uncomplicated appendicitis and cholecystitis reaches a complete source control. Conclusions. ADE in an effective and feasible strategy in EGS patients, in order to optimize antibiotic management without compromising clinical outcomes. A collaborative effort between surgeons, intensivists and infectious disease specialists is mandatory. There is a strong need for further studies selectively focusing in the EGS ward setting

The agroforestry heritage system of Sabana De Morro in El Salvador

Traditional agroforestry systems are recognized as having great importance for providing multiple benefits for local communities all over the world, especially in tropical countries. Thanks to their multifunctional role, they can support small farmers, contribute to hydrogeological risk reduction, water regulation, preservation of soil, agrobiodiversity and landscape, as well as being examples of mitigation and adaptation towards climate change. The Globally Important Agricultural Heritage Systems (GIAHS) programme of the Food and Agriculture Organization (FAO) aims to identify agricultural systems of global importance, preserving landscape, agrobiodiversity and traditional knowledge, through dynamic conservation principles. The Sabana de Morro is a traditional agroforestry system located in El Salvador based on cattle grazing in pastures with the presence of Crescentia alata and Crescentia cujete trees, locally called Morro or Jícaro. We documented the main characteristics of this system, that has never been deeply studied, in the Municipality of Dolores, in accordance with the five GIAHS criteria, and through detailed land use mapping, to assess the relations between landscape structure, agrobiodiversity and traditional silvopastoral practices. Sabana de Morro proved to be based on strong interactions between trees, cattle and farmers. The pulp of the Morro fruits is eaten by grazing cattle, completing their feeding and giving a peculiar taste to the locally produced cheese. Morro trees provide shade for the animals while cattle contribute by spreading their seeds that also take advantage of the manure. Results show that this agroforestry system contributes to the preservation of a rich agrobiodiversity and of the traditional landscape. At the same time, it supports local farmers’ livelihood and is consistent with the aim of the GIAHS programme, even if further surveys and research are needed to assess the real possibility of the inclusion in this FAO programme

Study of the Failure Mechanism of a High-Density Polyethylene Liner in a Type IV High-Pressure Storage Tank

The use of Type IV cylinders for gas storage is becoming more widespread in various sectors, especially in transportation, owing to the lightweight nature of this type of cylinder, which is composed of a polymeric liner that exerts a barrier effect and an outer composite material shell that primarily imparts mechanical strength. In this work, the failure analysis of an HDPE liner in a Type IV cylinder for high-pressure storage was carried out. The breakdown occurred during a cyclic pressure test at room temperature and manifested in the hemispherical head area, as cracks perpendicular to the liner pinch-off line. The failed sample was thoroughly investigated and its characteristics were compared with those of other liners at different stages of production of a Type IV cylinder (blow molding, curing of the composite material). An examination of the liner showed that no significant chemical and morphological changes occurred during the production cycle of a Type IV cylinder that could justify the liner rupture, and that the most likely cause of failure was a design-related fatigue phenomenon

Sepsis Team Organizational Model to Decrease Mortality for Intra-Abdominal Infections: Is Antibiotic Stewardship Enough?

Introduction. Sepsis is an overwhelming reaction to infection with significant morbidity, requiring urgent interventions in order to improve outcomes. The 2016 Sepsis-3 guidelines modified the previous definitions of sepsis and septic shock, and proposed some specific diagnostic and therapeutic measures to define the use of fluid resuscitation and antibiotics. However, some open issues still exist. Methods. A literature research was performed on PubMed and Cochrane using the terms “sepsis” AND “intra-abdominal infections” AND (“antibiotic therapy” OR “antibiotic treatment”). The inclusion criteria were management of intra-abdominal infection (IAI) and effects of antibiotic stewardships programs (ASP) on the outcome of the patients. Discussion. Sepsis-3 definitions represent an added value in the understanding of sepsis mechanisms and in the management of the disease. However, some questions are still open, such as the need for an early identification of sepsis. Sepsis management in the context of IAI is particularly challenging and a prompt diagnosis is essential in order to perform a quick treatment (source control and antibiotic treatment). Antibiotic empirical therapy should be based on the kind of infection (community or hospital acquired), local resistances, and patient’s characteristic and comorbidities, and should be adjusted or de-escalated as soon as microbiological information is available. Antibiotic Stewardship Programs (ASP) have demonstrated to improve antimicrobial utilization with reduction of infections, emergence of multi-drug resistant bacteria, and costs. Surgeons should not be alone in the management of IAI but ideally inserted in a sepsis team together with anaesthesiologists, medical physicians, pharmacists, and infectious diseases specialists, meeting periodically to reassess the response to the treatment. Conclusion. The cornerstones of sepsis management are accurate diagnosis, early resuscitation, effective source control, and timely initiation of appropriate antimicrobial therapy. Current evidence shows that optimizing antibiotic use across surgical specialities is imperative to improve outcomes. Ideally every hospital and every emergency surgery department should aim to provide a sepsis team in order to manage IAI

Implementation of an enhanced recovery program after bariatric surgery: Clinical and cost-effectiveness analysis

Enhanced recovery after surgery (ERAS) programs are perioperative evidence-based interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6±10.9 days, whereas in the ERABS cohort it was 7.1±2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive care unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety