Dynamic growth pattern of chinchilla (<i>Chinchilla lanigera</i>) kits during lactation

Se evaluó la aptitud de la función lineal y de la función exponencial creciente para describir el comportamiento dinámico del peso corporal de gazapos de chinchilla durante la lactancia. Los valores observados de las variancias residuales y de los coeficientes de determinación asignaron una leve ventaja al modelo lineal. La función lineal subestimó el peso al nacimiento mientras que la función exponencial lo sobreestimó sin diferenciarse en la magnitud de las diferencias de uno u otro signo entre los valores estimados y observados. La utilización del modelo lineal para caracterizar el crecimiento de gazapos machos proveniente de camadas con uno, dos o tres crías, entre el nacimiento y el destete a los 43 días de edad, permitió constatar que el aumento del tamaño de la camada de uno a dos gazapos, si bien disminuye ligeramente el peso inicial y la tasa de crecimiento predestete, no presenta un efecto detrimental de trascendencia sobre el crecimiento en dicha etapa. Por el contrario, la presencia de un tercer gazapo reduce de manera notoria tanto el peso inicial de los miembros de la camada como su aumento medio diario de peso hasta el destete. De acuerdo con lo relevado en este estudio resultaría más conveniente plantear como objetivo aumentar el número de pariciones por año, por ejemplo mediante un manejo adecuado del fotoperíodo, que aumentar el tamaño de la camada al parto por encima de dos gazapos.The ability of linear and exponential functions to describe the dynamic behavior of body weight of chinchilla kits during lactation was evaluated. Residual variance and coefficient of determination average values derived from each model assigned to linear function a slight advantage. While the linear function underestimated birth weight the exponential model overestimated it showing both models differences of similar magnitude between estimated and observed values. The use of the linear model to characterize the dynamic growth of male kits belonging to litters with one, two or three pups, between birth and weaning at 43 days of age, allowed to confirm that increasing litter size from one to two pups slightly decreases their initial body weight and their growth rate during lactation, without a detrimental effect on overall pre-weaning growth. By contrast, the presence of a third kit in the litter markedly reduces both initial body weight and daily body weight gain from birth to weaning. According to data surveyed in this study increasing the number of parturitions per female per year, for example through an appropriate management of photoperiod, would be more useful than increasing litter size at birth above two kits to increase the overall efficiency of the system.Facultad de Ciencias Veterinaria

Dynamic growth pattern of chinchilla (<i>Chinchilla lanigera</i>) kits during lactation

Se evaluó la aptitud de la función lineal y de la función exponencial creciente para describir el comportamiento dinámico del peso corporal de gazapos de chinchilla durante la lactancia. Los valores observados de las variancias residuales y de los coeficientes de determinación asignaron una leve ventaja al modelo lineal. La función lineal subestimó el peso al nacimiento mientras que la función exponencial lo sobreestimó sin diferenciarse en la magnitud de las diferencias de uno u otro signo entre los valores estimados y observados. La utilización del modelo lineal para caracterizar el crecimiento de gazapos machos proveniente de camadas con uno, dos o tres crías, entre el nacimiento y el destete a los 43 días de edad, permitió constatar que el aumento del tamaño de la camada de uno a dos gazapos, si bien disminuye ligeramente el peso inicial y la tasa de crecimiento predestete, no presenta un efecto detrimental de trascendencia sobre el crecimiento en dicha etapa. Por el contrario, la presencia de un tercer gazapo reduce de manera notoria tanto el peso inicial de los miembros de la camada como su aumento medio diario de peso hasta el destete. De acuerdo con lo relevado en este estudio resultaría más conveniente plantear como objetivo aumentar el número de pariciones por año, por ejemplo mediante un manejo adecuado del fotoperíodo, que aumentar el tamaño de la camada al parto por encima de dos gazapos.The ability of linear and exponential functions to describe the dynamic behavior of body weight of chinchilla kits during lactation was evaluated. Residual variance and coefficient of determination average values derived from each model assigned to linear function a slight advantage. While the linear function underestimated birth weight the exponential model overestimated it showing both models differences of similar magnitude between estimated and observed values. The use of the linear model to characterize the dynamic growth of male kits belonging to litters with one, two or three pups, between birth and weaning at 43 days of age, allowed to confirm that increasing litter size from one to two pups slightly decreases their initial body weight and their growth rate during lactation, without a detrimental effect on overall pre-weaning growth. By contrast, the presence of a third kit in the litter markedly reduces both initial body weight and daily body weight gain from birth to weaning. According to data surveyed in this study increasing the number of parturitions per female per year, for example through an appropriate management of photoperiod, would be more useful than increasing litter size at birth above two kits to increase the overall efficiency of the system.Facultad de Ciencias Veterinaria

Dynamic growth pattern of chinchilla (<i>Chinchilla lanigera</i>) kits during lactation

Se evaluó la aptitud de la función lineal y de la función exponencial creciente para describir el comportamiento dinámico del peso corporal de gazapos de chinchilla durante la lactancia. Los valores observados de las variancias residuales y de los coeficientes de determinación asignaron una leve ventaja al modelo lineal. La función lineal subestimó el peso al nacimiento mientras que la función exponencial lo sobreestimó sin diferenciarse en la magnitud de las diferencias de uno u otro signo entre los valores estimados y observados. La utilización del modelo lineal para caracterizar el crecimiento de gazapos machos proveniente de camadas con uno, dos o tres crías, entre el nacimiento y el destete a los 43 días de edad, permitió constatar que el aumento del tamaño de la camada de uno a dos gazapos, si bien disminuye ligeramente el peso inicial y la tasa de crecimiento predestete, no presenta un efecto detrimental de trascendencia sobre el crecimiento en dicha etapa. Por el contrario, la presencia de un tercer gazapo reduce de manera notoria tanto el peso inicial de los miembros de la camada como su aumento medio diario de peso hasta el destete. De acuerdo con lo relevado en este estudio resultaría más conveniente plantear como objetivo aumentar el número de pariciones por año, por ejemplo mediante un manejo adecuado del fotoperíodo, que aumentar el tamaño de la camada al parto por encima de dos gazapos.The ability of linear and exponential functions to describe the dynamic behavior of body weight of chinchilla kits during lactation was evaluated. Residual variance and coefficient of determination average values derived from each model assigned to linear function a slight advantage. While the linear function underestimated birth weight the exponential model overestimated it showing both models differences of similar magnitude between estimated and observed values. The use of the linear model to characterize the dynamic growth of male kits belonging to litters with one, two or three pups, between birth and weaning at 43 days of age, allowed to confirm that increasing litter size from one to two pups slightly decreases their initial body weight and their growth rate during lactation, without a detrimental effect on overall pre-weaning growth. By contrast, the presence of a third kit in the litter markedly reduces both initial body weight and daily body weight gain from birth to weaning. According to data surveyed in this study increasing the number of parturitions per female per year, for example through an appropriate management of photoperiod, would be more useful than increasing litter size at birth above two kits to increase the overall efficiency of the system.Facultad de Ciencias Veterinaria

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe