EFECTO DEL SITIO DE DEPOSICIÓN DEL PLASMA SEMINAL SOBRE LA TASA DE OVULACIÓN Y FORMACIÓN DEL CUERPO LÚTEO EN ALPACAS

The present study was carried out to evaluate the effect of deposition site of seminal plasma on the ovulation rate and size of corpus luteum in alpacas. Non-lactating females bearing a ≥7 mm follicle detected by ultrasound were selected (n = 91). Follicular wave was synchronized by injecting 5 mg of LH and then, the presence of a dominant follicle ≥7 mm was determined 12 days later through ultrasound evaluation. Alpacas were assigned to one of six experimental groups: G1 (n=16) seminal plasma (SP) by intramuscular injection – i.m.; G2 (n=15) phosphate-buffered saline (PBS) i.m.; G3 (n=16) SP by intrauterine administration – i.u.; G4 (n=15) PBS i.u.; G5 (n=15) SP i.u. with curettage; G6 (14) PBS by i.u. with curettage. Ovulation rate and corpus luteum were determined by ultrasound evaluation on D2 and D8 (D0 = day of treatment). Serum samples were taken from the jugular vein on D0, D3 and D9 to determine progesterone profiles by radioimmunoassay. Ovulation rate was 93.7, 37.5, and 66.5% for G1, G3 and G5 respectively, while none ovulations were observed in the other three groups. Alpacas in G1 would produce 25 more ovulations than G3. Results of the present study suggested that the ovulation-inducing factor (OIF) present in seminal plasma is absorbed systemically and that the mechanical action of curettage would contribute to the absorption of the OIF present in seminal plasma.El estudio tuvo por objetivo evaluar el sitio de deposición del plasma seminal sobre la tasa de ovulación y formación del cuerpo lúteo en alpacas. Se seleccionaron 91 hembras no lactantes con folículos ≥7 mm detectados por ecografía transrectal. Se sincronizó la onda folicular con la aplicación de 5 mg de LH, y 12 días después, se determinó la presencia de un folículo dominante (≥7 mm). Las hembras se distribuyeron al azar en seis tratamientos: G1 =16 (Plasma seminal vía intramuscular), G2=15 (PBS vía intramuscular), G3=16 (Plasma seminal vía intrauterina), G4=15 (PBS vía intrauterina), G5 =15 (Plasma seminal vía intrauterina con curetaje), G6 =14 (PBS vía intrauterina con curetaje). La tasa de ovulación y presencia de cuerpo lúteo se determinó mediante ecografía el día D2 y D8 (D0 = inicio del tratamiento). Se tomó muestras de sangre los días D0, D3 y D9 para determinar perfiles séricos de progesterona mediante RIA. La tasa de ovulación fue de 93.8, 37.5 y 66.5% para G1, G3 y G5, respectivamente, y no se registraron ovulaciones en los otros grupos. Se encontró que las alpacas G1 producirían 25 veces más ovulaciones con respecto al G3. Los resultados sugieren que la absorción del factor inductor de ovulación (FIO) del plasma seminal es vía sistémica y que el curetaje facilitaría la absorción del FIO incrementando el efecto ovulatorio del plasma seminal

RELATIONSHIP BETWEEN THE SIZE OF MACROCYSTS OF SARCOCYSISTIS AUCHENIAE AND ITS VIABILITY IN CANIS FAMILIARIS

El objetivo del estudio fue determinar si el tamaño de los macroquistes de Sarcocystis aucheniae afectan la viabilidad y potencial biótico en los caninos domésticos. Se utilizaron 24 cachorros cruzados de 2.5 meses de edad, con pesos promedio de 2.6 kg., debidamente desparasitados y alimentados con una dieta casera exenta de carnes. Se obtuvo macrosquistes de S. aucheniae del cuello de alpacas y llamas en un camal local, clasificándolos en macroquistes grandes (>5 mm) y pequeños (1-3 mm). Diez cachorros fueron oralmente infectados con 500 macroquistes grandes (MG) y 12 cachorros con 500 macroquistes pequeños (MP), en ambos casos por dos días consecutivos. Además, 6 perros quedaron sin infectar como grupo control. Se recolectó diariamente muestras fecales a partir del 8º día post-infección y por un periodo de 22 días. Las muestras se analizaron por el método de flotación con solución de Sheather para determinar la presencia de ooquistes o esporoquistes de Sarcocystis sp. y el método de Stoll modificado para cuantificar su número por gramo de heces. Los resultados mostraron que animales infectados con MP presentaron una carga de esporoquistes 3.6 veces superior que aquellos infectados con MG; así mismo, el periodo prepatente promedio fue de 16.5 y 11.5 para los MG y MP, respectivamente.The objective of the study was to determine weather the size of Sarcocystis aucheniae macrocysts affect its viability and biotic potential in domestic canines. A total of 26 crossbred puppies, 2.5 month of age, 2.6 kg of body weight, were used. Puppies were dewormed and fed with a diet extent of meat. Macrocysts of S. aucheniae were obtained from alpaca and llama´s neck in the local slaughterhouse. Cysts were classified according to size in large (>5 mm) and small (1-3 mm) cysts. Ten puppies were orally infected with 500 large macrocysts (MG) and 12 puppies with 500 small macrocysts (MP), for 2 consecutive days, whereas 6 puppies were kept as controls. Fecal samples were daily collected and analyzed by the flotation method using the Sheather solution to determine the presence of oocysts and sporocysts of Sarcocystis sp. and the modified Stoll method to quantify the number of sporocysts per gram of feces. The results showed that the burden of sporocysts was 3.6 times more in puppies infected with MP than in those infected with MG. Furthermore, the average prepatent period was 16.5 and 11.5 days for MG and MP respectively

FREQUENCY OF SARCOCYSTIS SP. IN SHEEPDOGS FROM ALPACA ASSOCIATION BREEDERS, MARANGANÍ, CUSCO

El objetivo del estudio fue determinar la frecuencia de Sarcocystis sp. en perros pastores de asociaciones alpaqueras del distrito de Maranganí, Cusco, durante las dos épocas del año (seca y lluviosa). El trabajo se realizó entre abril de 2005 y febrero de 2006. Se colectaron 211 muestras fecales de perros pastores de los productores alpaqueros de la zona. Las heces fueron analizadas mediante el método de flotación con solución de Sheather para determinar la presencia de ooquistes o esporoquistes de Sarcocystis sp. Se encontró una frecuencia de 42.3 ± 9.2% (47/111) y 72.0 ± 8.8% (72/100) en la época seca y lluviosa, respectivamente. Los resultados muestran una asociación significativa entre la tasa de infección y la época del año (p<0.05). El mes de noviembre presentó la mayor tasa (77.8 ± 12.1%, 35/49) y en mayo se obtuvo la menor tasa (17.6 ± 12.8%, 6/34). Además, se encontró diferencias significativas entre grupos etáreos (p<0.05).The aim of the study was to determine the frequency of Sarcocystis spp. in sheepdogs of alpaca farm associations at Maranganí, Cusco, during the dry and rainy season (April 2005 until February 2006). Fecal samples (n = 211) were collected and evaluated using the method of flotation with Sheather solution to observe sporocysts of Sarcocystis spp. The frequency during the dry and rainy season was 42.3 ± 9.2% (47/111) and 72.0 ± 8.8% (72/100) respectively. The results showed an association between the rate of infection and the time of the year (p<0.05), where November had the highest rate (77.8 ± 12.1%, 35/ 45) and March had the lowest (17.6 ± 12.8%, 6/34). In addition, significant difference was found due to age of the dog (p<0.05)

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

SARCOCISTIOSIS Y LA EFICIENCIA PRODUCTIVA DE LA ALPACA.

El presente estudio tuvo por objetivo determinar el efecto de la infección experimental del Sarcocystis lamacanis en crías de alpacas, sobre la ganancia de peso, hematocrito y producción de fibra. El estudio se realizó con 63 crías de alpacas de cinco meses de edad, distribuidas en tres grupos tratados y dos controles. Los grupos tratados estuvieron compuestos de 13, 12 y 13 animales y recibieron 1,000, 2,500 y 5,000 esporoquistes de Sarcocystis sp., vía oral, respectivamente. Un grupo control, no infectado, estuvo conformado por 12 animales compartiendo el mismo hábitat de los grupos tratados y donde no existía restricción al acceso de perros, y el otro grupo control de 13 animales se mantuvo en una zona de pastoreo aparte, con cercos que impedían el acceso de perros. El inóculo se obtuvo de perros infectados con miocardio de alpacas conteniendo microquistes de Sarcocystis lamacanis. Se registró mensualmente el peso vivo y se tomaron muestras de sangre. En la esquila se registró el peso de vellón. Los resultados de ganancia de peso y niveles de hematocrito evidenciaron una disminución de sus valores a partir de la inoculación de los esporoquistes, siendo el más afectado el de 5,000 esporoquistes. Además, en este grupo se obtuvo el 92.3% de mortalidad entre el primer y tercer mes post infección.El presente estudio tuvo por objetivo determinar el efecto de la infección experimental del Sarcocystis lamacanis en crías de alpacas, sobre la ganancia de peso, hematocrito y producción de fibra. El estudio se realizó con 63 crías de alpacas de cinco meses de edad, distribuidas en tres grupos tratados y dos controles. Los grupos tratados estuvieron compuestos de 13, 12 y 13 animales y recibieron 1,000, 2,500 y 5,000 esporoquistes de Sarcocystis sp., vía oral, respectivamente. Un grupo control, no infectado, estuvo conformado por 12 animales compartiendo el mismo hábitat de los grupos tratados y donde no existía restricción al acceso de perros, y el otro grupo control de 13 animales se mantuvo en una zona de pastoreo aparte, con cercos que impedían el acceso de perros. El inóculo se obtuvo de perros infectados con miocardio de alpacas conteniendo microquistes de Sarcocystis lamacanis. Se registró mensualmente el peso vivo y se tomaron muestras de sangre. En la esquila se registró el peso de vellón. Los resultados de ganancia de peso y niveles de hematocrito evidenciaron una disminución de sus valores a partir de la inoculación de los esporoquistes, siendo el más afectado el de 5,000 esporoquistes. Además, en este grupo se obtuvo el 92.3% de mortalidad entre el primer y tercer mes post infección

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

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