Causas que afectan la producción en una unidad empresarial de base porcina camagüeyana, categorías implicadas

Background: pig production systems are exposed to economic losses from various diseases and health culls. Objective. Establish the order of participation of some causes of mortality in the Business Unit of Mixed Porcine Base, as well as the categories most involved. Methods: official information on economic losses due to mortality due to: enteropathies, respiratory diseases, health sacrifices and other causes was compiled in the categories of offspring, pre-fattening and fattening during the five-year period 2012-2016. From it, a linear regression was performed without error to establish the hierarchical relationship between causes of mortality using standardized coefficients (β) and an ANOVA, with Duncan's multiple comparison test, for the degree of affectation of the categories under study. Results: losses due to mortality amounted to 113 215.94 CUP; Its causes, all with significant impact, followed a descending order headed by enteropathies, and followed by respiratory diseases, health sacrifices and others. The most affected categories were young and pre-fattening. The prophylactic use of antibiotics prescribed for these rearing stays does not meet the expected effect. Conclusions: enteropathies, respiratory diseases, health slaughter and other causes had a significant influence on the mortality of pigs and pre-fattening pigs. The prophylactic use of antibiotics prescribed for these rearing stays does not meet the expected effect. Key words:  enteric disease, respiratory infection, porcine livestock, sanitary sacrifice (Source: MeSH)Antecedentes: los sistemas de producción de cerdos están expuestos a pérdidas económicas por enfermedades diversas y sacrificios sanitarios. Objetivo. Establecer el orden de participación de algunas causas de mortalidad en la Unidad Empresarial de Base Mixta Porcina, así como las categorías más implicadas. Método: se recopiló la información oficial relativa a pérdidas económicas debidas a mortalidad por: enteropatías, enfermedades respiratorias, sacrificios sanitarios y otras causas en las categorías crías, precebas y cebas durante el quinquenio 2012-2016. A partir de la misma se realizó una regresión lineal sin error para, mediante los coeficientes estandarizados (β), establecer la relación de jerarquía entre las causas de mortalidad y un ANOVA, con prueba de comparación múltiple de Duncan, para el grado de afectación de las categorías en estudio. Resultados: las pérdidas por concepto de mortalidad ascendieron a 113 215,94 CUP; sus causas, todas con impacto significativo, siguieron un orden descendente encabezado por enteropatías, y seguidas de enfermedades respiratorias, sacrificios sanitarios y otras. Las categorías más afectadas fueron crías y precebas. El uso profiláctico de antibióticos normados para estas estadías de crianza no cumple el efecto previsto. Conclusiones: las enteropatías, enfermedades respiratorias, sacrificios sanitarios y otras causas influyeron significativamente en las mortalidades de crías y precebas porcinas. El uso profiláctico de antibióticos normados para estas estadías de crianza no cumple el efecto previsto. Palabras clave: enfermedades respiratorias, enteropatías, porcicultura, sacrificio sanitario (Fuente: MeSH

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

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