Pattern of antibiotic consumption in two Italian production chains differing by the endemic status for Porcine Reproductive and Respiratory Syndrome

The aim of this case study was to quantify antibiotic (AB) use in Italian weaning (W) and fattening (F) units differentiated for porcine reproductive and respiratory syndrome (PRRS) occurrence. Farms were classified as either PRRS negative (–) or PRRS positive (+) based on the circulation of the virus among the animals. In all the farms, the modified live PRRS virus (PRRSV) vaccine was provided to all the animals. In the PRRS– farms, the level of circulating antibodies was low, and the disease, in its clinical form, did not occur. In the PRRS+ farms, the level of circulating antibodies against the virus was high, and the disease was recurrent. Data regarding AB consumption were collected from 2017 to 2020, and the active compounds (ACs) were expressed as milligrams of AC/total kilogram of body weight (BW) produced. Each AC was classified into one of four categories according to the EuropeanMedicines Agency classification of ABs for prudent and responsible use in animals: Avoid, Restrict, Caution, and Prudence. Data regarding the ACs in each category were analyzed using a linear model that included production phase, PRRS status, and their interaction as factors. Performance parameters, average age of the pigs at the end of each phase, daily live weight gain, feed-to-gain ratio, total losses, cost index, and medication costs were significantly influenced by the PRRS chain. The use of class B ABs was not affected by production phase or PRRS status. Conversely, for class C ABs, interaction between the two factors (p = 0.02) was observed; W/PRRS+ and F/PRRS+ showed the greatest AB use for this class (p = 0.003). For class D ABs, the interaction was significant (p = 0.01); class C and D ABs were used more in the weaning (p = 0.07) than in the fattening phase (p = 0.003). For the weaning phase, the use of class C and D ABs was greater in the PRRS+ than in the PRRS– chain (p < 0.01). In conclusion, PRRS status affected the growth of pigs and economic performance. Moreover, PRRS status significantly influenced the use of ABs during all the growing periods with the greatest impact being on the weaning phase

Sepse tardia laboratorialmente confirmada em neonatos com peso de nascimento menor que 1500g

Backgound and Objectives: Premature newborns are exposed to multiple risk factors for late-onset sepsis: the immaturity of defense systems, low birth weight and low gestational age, use of invasive devices. Purpose to assess the occurrence and etiology of late-onset sepsis (ICSLC) in premature infants with birth weight less than 1500 g (VLBW) admitted to the Neonatal Intensive Care Unit (NICU) of a philanthropic reference in Belo Horizonte – Minas Gerais. Methodology: Cross-sectional study. We evaluated data from epidemiological surveillance system (SACIH®) and tokens active search of Hospital Infection Control Committee (HICC) of the institution, for January 2010 to December 2012. Results: were recorded in 1850 Health Associated Infection (HAI), these 1481 were of bloodstream infection (BSI), representing 80% of HAIs. Of ICS, 559 (37.7%) were early-onset and 922 (62.3%) late-onset. The density incidence of infections was 30.7 / 1.000patients-day. Were registered LCBI 256 patients, totaling 355 infections. Of these patients, 16 had LCBI more of a microbiological agent. 99 patients (38.6%) had more than one LCBI. Birth-weight average 985g and gestational age (GA) average of 28 weeks. Most frequent agents were Coagulase-Negative Staphylococcus 49.9% (n = 117), Klebsiella sp 17% (n = 60), Candida sp 12.4% (n = 44). The lethality rate associated with LCBI in VLBW was 6.8% (n = 23). Conclusion: Despite the technological advances in fetal medicine and increase the survival of VLBW infants, the late onset sepsis presents itself at high rates and high incidence, which represents a major cause of morbidity and mortality for these newborns. KEYWORDS: Sepsis. Premature. Newborn. Infection control.Justificativa e Objetivos: Recém-nascidos prematuros estão expostos a vários fatores de risco para a sepse tardia: imaturidade dos sistemas de defesa, baixo peso, baixa idade gestacional, uso de dispositivos invasivos. Objetivo é avaliar ocorrência e etiologia da sepse tardia laboratorialmente confirmada (ICSLC) em prematuros com peso de nascimento menor que 1500g (RNMBP), admitidos em Unidade de Terapia Intensiva Neonatal de uma instituição filantrópica de referência na região metropolitana de Belo Horizonte, Minas Gerais. Metodologia: Estudo transversal descritivo, onde foram avaliados dados do sistema de vigilância epidemiológica (SACIH®) e fichas de busca ativa do Serviço de Controle de Infecção da instituição, no período de janeiro de 2010 a dezembro de 2012. Resultados: Foram registradas 1.850 Infecções Relacionadas à Assistência à Saúde (IRAS), sendo 1.481 Infecções da corrente sanguínea (ICS), representando 80% das IRAS. Das ICS, 559 (37,7%) foram precoces e 922 (62,3%) tardias. A Densidade de Incidência (DI) das IRAS foi de 30,7/1.000pacientes-dia. DI para RNMBP foi de 24,75/1.000paciente-dia. Foram registrados 256 pacientes ICSLC, perfazendo 355 infecções. Destes, 16 apresentaram ICSLC com mais de um agente microbiológico e 99 pacientes (38,6%) tiveram mais de uma ICSLC. Peso de nascimento (PN) médio foi de 985g e idade gestacional (IG) média, 28 semanas. Agentes mais frequentes: Staphylococcus coagulase negativa 49,9% (n=117), Klebsiella sp 17% (n=60), Candida sp 12,4% (n=44). A taxa de letalidade associada à ICSLC em RNMBP 6,8% (n=23). Conclusão: Apesar dos avanços tecnológicos aumentarem a sobrevida dos recém-nascidos prematuros, a sepse tardia apresenta-se em altas taxas e com alta incidência, o que representa importante causa de morbi-mortalidade para esses neonatos. DESCRITORES: Sepse. Prematuro. Neonato. Controle de infecções

New Technologies to Dating Pregnancy at Birth

The chapter provides a vision of new methods of pregnancy dating at birth to overcome the high costs of existing approaches or lack of access to the existing technologies. The authors have presented a literature review on recent scientific reports exploring novel technologies, such as those based on the newborn’s skin maturity assessment as machine learning models based on clinical data. The effortlessness of new approaches based on simplified clinical systems contrasting with molecular genetics and newborns screening analytes is discussed, even in scientific validation. Without the intention of an exhaustive or systematic review, we searched databases for reports concerning postnatal gestational age, prediction or estimate, novel approach, low and medium-income countries since 2015. Therefore, the authors did not compromise to offer a comprehensive picture of all postnatal gestational age methods. On the other hand, prematurity identification at birth remains a challenge in many birth settings, mainly in a scenario with scarce resources. Although postnatal pregnancy dating methods have strengths and disadvantages, this information is critical to recognize the risk of the newborn during the first hours of life, justifying technological investments

Premature or small for gestational age discrimination: international multicenter trial protocol for classification of the low-birth-weight newborn through the optical properties of the skin

© Zilma Reis, Gabriela Vitral, Rodney Guimarães, Juliano Gaspar, Enrico Colosimo, Sergio Taunde, Nilza Mussagy, Rita Rosado Santos, Diogo Ayres-De-Campos, Roberta Romanelli. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.07.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.Background: A low birth weight is an independent risk factor for adverse infant outcomes and a predictor of chronic disease in adulthood. In these situations, differentiating between prematurity and small for gestational age (SGA) or simultaneous conditions is essential to ensuring adequate care. Such diagnoses, however, depend on reliable pregnancy dating, which can be challenging in developing countries. A new medical optoelectronic device was developed to estimate gestational age (GA) at birth based on newborn skin reflection. Objective: This study will aim to evaluate the device's ability to detect prematurity or SGA, or both conditions simultaneously as well as predict short-term pulmonary complications in a cohort of low-birth-weight newborns. Methods: This study protocol was designed for a multicenter cohort including referral hospitals in Brazil and Mozambique. Newborns weighing 500-2500 g will be eligible for inclusion with the best GA available, considering the limited resources of low-income countries. Comparator-GA is based on reliable last menstrual period dating or ultrasound assessment before 24 weeks' gestation. Estimated GA at birth (Test-GA) will be calculated by applying a novel optoelectronic device to the newborn's skin over the sole. The average difference between Test-GA and Comparator-GA will be analyzed, as will the percentage of newborns who are correctly diagnosed as preterm or SGA. In addition, in a nested case-control study, the accuracy of skin reflection in the prediction of prematurity-related respiratory problems will be evaluated. The estimated required sample size is 298 newborns. Results: Teams of health professionals were trained, and standard operating procedures were developed following the good practice guidelines for the clinical investigation of medical devices for human participants. The first recruitment started in March 2019 in Brazil. Data collection is planned to end in December 2020, and the results should be available in March 2021. Conclusions: The results of this clinical study have the potential to validate a new device to easily assess postnatal GA, supporting SGA identification when pregnancy dating is unreliable or unknown.This research was supported by a Grand Challenges Exploration grant from the Bill & Melinda Gates Foundation (Grant No. OPP1128907, Contract; http://www.gatesfoundation.org/) and the Fundação de Amparo a Pesquisa de Minas Gerais, Brazil (Grant Nos AUC-00032-15 and PPM 0247/16; http://www.fapemig.br/en/; nonprofit sector). This study is funded by Fundação Oswaldo Cruz – Rio de Janeiro, Brazil, Grand Challenges Canada’s programs, Government of Canada – Toronto, Canada (Grant No. R-ST-POC-1807-13515).info:eu-repo/semantics/publishedVersio

Afinal, para que serve a escola?: representação feita por adultos alfabetizados e analfabetos

The aim of this paper is to investigate adult illiterate and semi-literate's opinion about school, as well as their underlying representations about the social role of that institution. More especifically, we try to determine whether people's concrete schoolling experience, together with literacy, drive them to have opinions about school which would show to be different from illiterate, or semi-literate adults.Este trabalho tem por objetivo investigar qual a opinião que grupos de adultos alfabetizados e não alfabetizados fazem da escola, bem como as suas representações subjacentes acerca do papel social dessa instituição. Mais especificamente, procura-se verificar se a experiência concreta com a vida escolar, aliada à alfabetização, leva as pessoas a terem opiniões sobre a escola que seriam diferentes daquelas opiniões de pessoas analfabetas, com pouca, ou nenhuma, experiência escolar

Neutrophil gelatinase-associated lipocalin and acute kidney injury in endovascular aneurysm repair or open aortic repair: a pilot study

Introduction: Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR). Materials and methods: Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline. Results: Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) vs AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 – 263) ng/mL for bNGAL, P = 0.029). Conclusions: Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

AbstractBackgroundHealthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce.ObjectiveTo identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.MethodsThis case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences.ResultsDuring the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041).ConclusionsShortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection

Dissociative experiences and psychopathology among Italian and Portuguese inmates

The association between dissociation and psychopathological symptoms is well established, yet studies with inmates are lacking. If higher rates of dissociation and psychiatric symptoms are reported in inmate samples, it is not clear whether they represent two separate, albeit related, characteristics. We examined the association between dissociation and psychopathological symptoms among 320 Italian subjects (122 inmates and 198 community participants) and a Portuguese inmate sample (n = 67). Then, we tested whether dissociation and psychopathology levels were higher among inmates. Both hypotheses were supported, confirming the relevance of dissociative, paranoid, and psychotic symptoms among inmates, as well as their interrelations. Notably, the group difference in dissociation remained significant after partialing out the variance associated with other psychopathological symptoms. Conversely, only the difference in paranoid symptoms remained—marginally—significant when controlling for the influence of dissociation. This finding suggests that dissociation may have unique relevance for the psychological functioning of inmates