Effect of dried leaves of Leucaena leucocephala on rumen fermentation, rumen microbial population, and enteric methane production in crossbred heifers

The effects of dietary inclusion of dried Leucaena leucocephala leaves (DLL) on nutrient digestibility, fermentation parameters, microbial rumen population, and production of enteric methane (CH4) in crossbred heifers were evaluated. Four heifers were used in a 4 × 4 Latin square design consisting of four periods and four levels of inclusion of DLL: 0%, 12%, 24%, and 36% of dry matter (DM) intake. Results showed that DM intake (DMI), organic matter intake, and gross energy intake (GEI) were similar (p > 0.05) among treatments. Apparent digestibility of organic matter, neutral detergent fiber, and energy decreased with increasing levels of DLL in the ration (p 0.05) rumen pH and total volatile fatty acids. Rumen microbial community was not affected (p > 0.05) by treatment. There was a linear reduction (p < 0.05) in CH4 emissions as the levels of DLL in the ration were increased. Results of this study suggest that an inclusion of 12% DM of ration as DLL enhances digestible CP and reduces daily production of enteric CH4 without adversely affecting DMI, rumen microbial population, and fermentation parameters

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estimación de la producción de metano entérico en ranchos de producción familiar de leche bovina en el sur del estado de Querétaro, México

El objetivo fue estimar el factor de emisión (FE) de metano (CH4) y pérdidas diarias de energía bruta (EB) convertida en CH4 (PCH4), por medio de ecuaciones de predicción del método nivel 2 del Panel Intergubernamental de Cambio Climático (IPCC) y con base en información técnica de ranchos del sistema familiar de producción de leche bovina. El estudio se realizó en 10 establos, y se obtuvo información técnica, tipo y cantidad de ingredientes ofrecidos al hato durante tres visitas en diferentes meses del año. La información técnica, junto con análisis de laboratorio del contenido de materia seca (MS) y EB de los ingredientes muestreados, se usó para estimar el consumo de MS y EB; usando la metodología del IPCC se estimó el FE y PCH4. Las mismas variables fueron estimadas usando las ecuaciones de predicción del IPCC. En vacas en ordeña el FE (81 y 70, kg CH4 año-1) y PCH4 (2.95 y 2.56, Mcal día-1) usando las ecuaciones del IPCC fueron similares a las obtenidas con las observaciones en ranchos; el FE ponderado por rancho fue similar (49.06 y 54.09, kg CH4 año-1), pero la PCH4 fue menor (1.11 y 1.97, Mcal día-1 P<0.01) usando las ecuaciones del IPCC con relación a las observaciones en ranchos. En general, a través del uso de información técnica de los ranchos fue posible estimar el FE y evidenciar una mayor PCH4 por rancho, y, en consecuencia, menor eficiencia energética, con respecto a la metodología del IPCC

Efecto de una subalimentación prolongada sobre el peso, la condición y la composición corporal de cabras adultas

To observe the response of mature goats to long-term feeding restriction and the effect on their body weight, condition and composition, an experiment was conducted with 21 adult, female, non-gestating, non-lactating Nubian goats. For a 9-wk stabilization period, the body weight and body condition score of each animal were measured weekly, along with their voluntary feed intakes. After the stabilization period, goats were randomly assigned to three groups, being offered 100%, 80%, and 60% of the feed intake observed during this period, for a 36-wk restriction period. Chemical analyses were performed on samples of carcass components, heart, kidneys, and intestines. Body weight and body condition score decreased with reduced feeding levels. Moreover, the proportion of bone increased, and that of the carcass soft tissues, kidney fat, and liver decreased, as did the dry matter contents of heart, kidneys, and rumen contents, kidney protein, heart, and ether extracts of the carcass soft tissue, heart and liver DNA, and the RNA:DNA and protein:DNA ratios in hepatic tissue. The C16:1 fatty acid content of the kidney fat of goats on treatment FL60 was increased, in restricted animals, C16:1, C18:1, and unsaturated fatty acids in the subcutaneous fat were all increased. These results suggest that the adaptation capability of adult goats to long-term undernutrition through the utilization of metabolic fuel from adipose tissue, skeletal muscle, liver, heart, and kidneys is an important survival characteristic for free-ranging animals kept in areas where drought conditions can last for several months, with consequent limitations on feed availability.Para determinar la respuesta de cabras adultas a una restricción alimenticia prolongada y el efecto en su peso, condición y composición corporal, se llevó a cabo un experimento usando 21 cabras hembras encastadas de Nubia, adultas, vacías y secas.Se registró durante nueve semanas el peso, condición corporal y consumo diario. Después se dividieron completamente al azar en tres grupos, para recibir durante 36 semanas los siguientes niveles de alimentación (NA): 100, 80 y 60, como porcentaje del consumo observado previamente. Se analizó químicamente el tejido disectable, corazón, riñón e intestinos. El peso y la condición corporal disminuyeron con la restricción alimenticia y se aumentó la proporción de hueso, se redujo la de tejido disectable (media canal derecha), grasa disectable (TA), grasa peri-renal e hígado, contenido total de materia seca de corazón, riñón y líquido ruminal, proteína del riñón y extracto etéreo del corazón y tejido disectable de la canal, concentración de ADN del corazón, hígado y TA visceral y relación ARN:ADN y proteína:ADN del hígado. En cuanto a la composición del TA visceral, el único ácido graso afectado fue C16:1, teniendo los animales con nivel de NA60 mayor proporción,pero en el TA subcutáneo, la restricción aumentó la proporción del C16:1, C18:1 y de ácidos grasos insaturados y redujo la proporción de los ácidos grasos saturados. Los resultados muestran la capacidad de adaptación de las cabras adultas a una malnutrición a largo plazo, mediante la utilización de combustibles metabólicos provenientes de tejido adiposo, músculo esquelético,hígado, corazón y riñón

Respuesta productiva de becerros Holstein alimentados con alfalfa de diferente calidad y enzimas fibrolíticas en la etapa pre y pos destete

The effect of fibrolytic enzyme (FE) supplements and alfalfa quality (i.e. fiber content) on calf productive performance, apparent feed digestibility, and rumen development during the pre- and post-weaning period was evaluated. Before weaning, calves were fed daily 4 L of milk (MI) and solid feed (starter concentrate (SC) + alfalfa hay) ad libitum. Thirty-six, Holstein calves (3 to 7 d of age) were distributed in a random block design with six treatments: 1) MI-SC + low-fiber alfalfa, 2) treatment 1 + FE, 3) MISC + medium-fiber alfalfa, 4) treatment 3 + FE, 5) MI-SC + high-fiber alfalfa, and 6) treatment 5 + FE. Experimental period was 105 d and animals were weaned at d 60. The FE supplement improved (P0.05) for dry matter (DM), crude protein (CP), and neutral detergent fiber (NDF). There were significant differences (P0.05) among treatments. Inclusion of FE improved daily weight gain and feed efficiency in the preweaning period.La adición de enzimas fibrolíticas (EF) y alfalfa de diferente calidad se evaluó en 36 becerros Holstein de siete días de edad, en los periodos pre y posdestete, sobre comportamiento productivo, digestibilidad aparente y evolución ruminal. Antes del destete, los animales fueron alimentados con 4 L de leche (LE), alimento iniciador (IN) y heno de alfalfa. Los tratamientos fueron: 1) LE-IN + alfalfa baja en fibra, 2) como 1 + EF, 3) LE-IN + alfalfa regular en fibra, 4) como 3 + EF, 5) LE-IN + alfalfa alta en fibra y 6) como 5 + EF. El experimento duró 105 días, con el destete el día 60. Las enzimas mejoraron (P0.05). La digestibilidad de materia seca (MS), proteína cruda (PC) y fibra detergente neutro (FDN) no cambió por la calidad de la alfalfa ni por EF (P>0.05) en ambos periodos, se observaron diferencias entre periodos (P0.05). Las enzimas mejoraron la ganancia de peso y la eficiencia sólo en el periodo predestete

Respuesta productiva de becerros Holstein alimentados con alfalfa de diferente calidad y enzimas fibrolíticas en la etapa pre y pos destete.

La adición de enzimas fibrolíticas (EF) y alfalfa de diferente calidad se evaluó en 36 becerros Holstein de siete días de edad, en los periodos pre y posdestete, sobre comportamiento productivo, digestibilidad aparente y evolución ruminal. Antes del destete, los animales fueron alimentados con 4 L de leche (LE), alimento iniciador (IN) y heno de alfalfa. Los tratamientos fueron: 1) LE-IN + alfalfa baja en fibra, 2) como 1 + EF, 3) LE-IN + alfalfa regular en fibra, 4) como 3 + EF, 5) LE-IN + alfalfa alta en fibra y 6) como 5 + EF. El experimento duró 105 días, con el destete el día 60. Las enzimas mejoraron (P0.05). La digestibilidad de materia seca (MS), proteína cruda (PC) y fibra detergente neutro (FDN) no cambió por la calidad de la alfalfa ni por EF (P>0.05) en ambos periodos, se observaron diferencias entre periodos (P0.05). Las enzimas mejoraron la ganancia de peso y la eficiencia sólo en el periodo predestete