The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Ethical Concerns about Fashionable Dog Breeding

The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over time, there has been a shift in preferences from functionality to aesthetics, which has influenced the diverse sizes, shapes, and coats of dog breeds. This review looks at fashionable dog breeding and questions the ethics of prioritising looks over health and behaviour. It aims to alert potential owners, breeders, and regulators to the importance of considering a dog’s overall well-being, not just its appearance, which has resulted in fad breeding, leading to genetic disorders, health issues, and a loss of biodiversity. Ethical concerns arise from breeding brachycephalic breeds with respiratory conditions, inbreeding causing inherited disorders, and overbreeding popular breeds while shelter dogs remain unadopted. Additionally, the impact of cosmetic surgeries on popular dog breeds, as well as the neglect of behavioural traits in favour of physical characteristics and strict breeding practices are also considered. The current breeding model can have a negative impact on the emotional and cognitive well-being of dogs, resulting in issues such as aggression, anxiety, and other behavioural problems that can significantly reduce their overall quality of life. Unregulated breeding practices and the demand for rare breeds can lead to illegal breeding, compromising animal welfare. Prospective owners, veterinarians, kennel clubs, and legislators all need to play a responsible role in protecting animals

Student veterinarians’ ability to recognise behavioural signs of stress in dogs

Veterinarians’ perceptions of animal stress influence their practice. Therefore, the aim of this research was to evaluate how veterinary students perceive stress in dogs. Two hundred and eighteen 4th year veterinary students of the University of Cordoba (Spain) participated in the study. An online questionnaire measuring veterinary students’ perceptions of behavioral indicators of stress in dogs, their attachment to pets, and demographic measures (e.g. pet ownership, student gender) was administered to participants in university classes. Data show that veterinary students easily identified some stress indicators such as stereotypical behaviors, excessive barking and aggressiveness, but they were less likely to identify yawning, low activity and paw raising as indicators of stress. Understanding the basis of stress and having a companion animal influenced stress identification but participants’ gender, and attachment level to their pets, had no effect on ability to identify canine stress indicators. Misunderstandings about canine behavior might influence veterinary students’ ability to recognize subtle stress signs in dogs. However, a good understanding of the psycho-physiological basis of stress and personal experiences of dog ownership were associated with greater ability to identify behavioral stress signs in dogs, suggesting that additional training in canine stress might be beneficial for student veterinarians

Attitudes toward Animals of Students at Three European Veterinary Medicine Schools in Italy and Spain

The European Veterinary Code of Conduct recognizes the crucial role of veterinarians in improving animal welfare and maintaining its standards. However, several studies have claimed that veterinary students’ attitudes toward animals may worsen as they progress through their academic training. This study aimed to investigate students’ attitudes toward nonhuman animal use in three European veterinary medicine schools (Italy and Spain). For this purpose, 565 veterinary students completed a questionnaire consisting of a range of items grouped into four animal-use categories: “Research,” “Entertainment,” “Utilitarianism,” and “Veterinary Issues.” Items were scored on a 5-point Likert-type scale, with higher scores indicative of higher concern regarding animal welfare. Results showed that the use of animals for “Entertainment” and questions related to “Veterinary Issues” raised the most concern among the veterinary students, while the use of animals for “Research” was of least concern. Moreover, we also examined some potentially confounding factors: age, academic year (first to fifth), gender, previous experience with pets, and university. Female students had a higher concern for animal welfare compared with their male counterparts. Students in their earlier stages of training as veterinarians also exhibited a greater concern for animal welfare compared with those of later academic years. Other factors affecting students’ attitudes toward animal use were the age of the students and the university they were enrolled at. The findings of this study confirm that attitudes toward animal use are not homogeneous and are associated with students’ demographic, educational, and personal characteristics

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study) : Does nutrition really affect ICU mortality?

The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported. We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 ± 3.3 vs 8.4 ± 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 ± 2.1 vs 5.2 ± 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. ClinicaTrials.gov NCT: 03634943