Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients

BACKGROUND

The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis.

OBJECTIVES

Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS.

METHODS

This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality.

RESULTS

A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ± 13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P  < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI  = 0.80 vs. AUC SI  = 0.72, P  < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI  = 0.80 vs. AUC GRACE  = 0.85, P  < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI  = 0.80 vs. AUC TIMI  = 0.84, P  < 0.001).

CONCLUSION

The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.

Positive predictive value of the crusade score for bleeding events in patients with acute coronary syndromes on dual antiplatelet therapy with acetylsalicylic acid and clopidogrel

Introduction

Crusade score (CS) quantifies intrahospital major bleeding (IHMB) risk in patients admitted with acute coronary syndrome (ACS). Hemorrhagic risk after ACS increases with age, although, it's not considered in score estimation.

Purpose

Evaluate CS ability to predict IHBM risk according to different patient ages (higher or lower than 75 years) admitted with ACS diagnosis and submitted to double antiagreggation therapy with acetylsalicylic acid and Clopidogrel.

Methods

A retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with ACS and treated with double antiagreggation therapy with acetylsalicylic acid (AAS) and clopidogrel between October 2010 and January 2021 (n=8401). Were excluded patients submitted to coronary artery bypass grafting, with ticagrelor or prasugrel switch to clopidogrel during hospitalization.

Patients were divided into two groups according to their age (above or below 75 years) and then subdivided in 5 groups according to CS category of IHBM risk estimation: very low (CS ≤20, 3,1% risk predicted by the score), low (21 ≤ CS≤30, 5,5%), moderate (31 ≤ CS≤40, 8,6%), high (41 ≤ CS≤50, 11,9%) and very high risk (CS≥51, 19,5%). Then, the incidence of IHMB observed in each group during hospitalization (mean 5 days) was compared to the IHBM risk predicted by the CS.

Results

The IHMB rate was 1.78%, significantly lower than predicted by the Crusade score (7.1%, p&lt;0.001). Bleeding rates in each group of patients (above or below 75 years and according to CS calculation are depicted in Figure 1. CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years (see Figure 2).

Conclusion

As shown in different literature, crusade score overestimate bleeding risk after ACS compared to real-life cohorts. Despite the same trend observed in our cohort of patients, in this retrospective study, CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years in patients submitted to double antiaggregation with AAS and clopidogrel.

Funding Acknowledgement

Type of funding sources: None.

The diastolic blood pressure U-curve

Introduction

It is known that low diastolic blood pressure (DBP) at admission is associated with short-term cardiovascular events after acute coronary syndrome (ACS). However, there is a lack of further investigation into the nonlinear relationship between admission diastolic blood pressure (DBP) and adverse outcomes of ACS patients.

Objective

To investigate the relationship between admission diastolic blood pressure and subsequent cardiovascular mortality in patients with acute coronary syndrome.

Methods

Retrospective study of patients with ACS periodically included in our center registry between October/2012 and September/2018. Patients with class killip 4 at admission or that needed ionotropic support during hospitalization were excluded. The association between admission DBP and cardiovascular mortality during the follow-up period among this population was analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 70 mm Hg; Q2, from 71 to 80 mm Hg; Q3, from 81 to 90 mm Hg; Q4, above 90 mmHg.

Results

A total of 548 patients were included in this cohort study. Mean patient age was 65.9±13.1 years and 75.2% were men. A nonlinear relation was observed between DBP at admission and cardiovascular mortality over the follow-up.

During a median follow-up of 42 months (IQR: 27–59), 47 patients (8.6%) died from cardiovascular causes. After adjusting for potential confounders (age and diabetes mellitus), patients in Q3 had the lowest risk for cardiovascular death by Cox proportional hazard model (HR 0.44; 95% CI: 0.16–1.00). Meanwhile, compared with Q1, Q3 patients had significantly lower risk for cardiovascular death (HR 0.35, 95% CI: 0.13–0.92).

Conclusion

Among patients admitted for ACS, there is a U curve relationship between admission DBP and risk for cardiovascular death. These results could be explained by a reduction in diastolic coronary blood flow which influences myocardial oxygen supply relative to the necessary demand in an ACS.

Funding Acknowledgement

Type of funding sources: None.

Prognostic value of odor identification impairment in multiple sclerosis: 10-Years follow-up

BACKGROUND

Olfactory dysfunction has been linked to clinical severity variables in multiple MS populations. Though, its prognostic value is still unknown.

OBJECTIVE

The aim of this study was to explore the long-term outcome associated with Brief-Smell Identification Test (B-SIT) performance in a cohort of MS patients.

METHODS

A retrospective review of the clinical records was conducted in 149 patients who participated in a previous study, with a median follow-up of 121 months. Demographic and clinical data regarding the last clinical appointment with EDSS measurement were collected. Multiple Sclerosis Severity Scale (MSSS) and Age-Related Multiple Sclerosis Severity (ARMSS) scores were calculated. Date of the last clinical contact or death was recorded.

RESULTS

Among MS patients with progressive clinical course (n = 33), those with impaired B-SIT at baseline had greater change per month during follow-up (as measured by increases in MSSS and ARMSS scores) and a higher hazard of death. No significant associations were found among patients with relapsing and remitting MS (n = 116).

CONCLUSIONS

The study results demonstrate that odor identification impairment has prognostic value in progressive MS, suggesting that a brief odor identification measure can be a marker of neurodegeneration in progressive MS.

Short-term effects of Saharan dust intrusions and biomass combustion on birth outcomes in Spain

The objective of this study is to analyze the short-term effects of atmospheric pollutant concentrations (PM₁₀, NO₂ and O₃) and heat and cold waves on the number of pre-term births and cases of low birth weight related to Saharan dust advection and biomass combustion. The dependent variables used in this analysis were the total number of births, births with low weight (>2.500 g) and pre-term births (<37 weeks), that occurred at the province level. Data provided by the NSI included: days with Saharan dust intrusion or biomass advection classified in terms of information provided by MITECO for each of the nine regions in Spain. A representative city was selected for reach region in which the registered average daily concentrations of PM₁₀, NO₂ and O₃ (μg/m³) were used. These were also provided by MITECO. The daily maximum and daily minimum temperature (°C) used was those registered by the meteorological observatory station located in each province capital, provided by AEMET. Using Poisson log linear regression models, the associated relative risks (RR) were measured as well as the population attributable risk (PAR) corresponding to the variables that resulted statistically significant at p < 0.05 for days with and without intrusion of natural particulate matter. The results obtained show that the days with Saharan dust intrusion or advections due to biomass combustion- beyond the impact of PM₁₀, primary pollutants such as NO₂ (in Saharan intrusions), heat waves and O₃ - are associated with the number of births, low birth weight and pre-term birth. The RR and percent PAR of the pollutants and the heat waves are greater than those obtained for PM₁₀. The results of this study indicate that days with natural particulate matter due to biomass combustion or advection of Saharan dust put pregnant women at risk.

Sleep disturbances in Parkinson's disease are associated with central parkinsonian pain

Introduction

Sleep disturbances and pain are common non-motor symptoms in Parkinson’s disease (PD). This study aimed to explore the association between these two symptoms in a cohort of patients with PD.

Materials and methods

The Parkinson’s Disease Sleep Scale (PDSS-2) was used to identify sleep disturbances in a series of 229 PD patients. The identification and characterization of pain was performed by a semi-structured interview and by the application of the Ford classification and the Brief Pain Inventory (BPI). The Unified Parkinson’s Disease Rating Scale-III, Hoehn & Yahr (H&Y), and Schwab and England Independence Scale were used to assess motor symptoms and functional independence in off and on conditions. The Hospital Anxiety and Depression Scale (HADS) and SF-36 were applied to screen for anxiety and depression and to evaluate the quality of life. Non-parametric tests were used for group comparisons and logistic regressions were applied to explore predictors of sleep disturbances.

Results

Seventy-five (33%) patients had clinically relevant sleep disturbances (PDSS-2≥18) and 162 patients (71%) reported pain. Of those with pain, 38 (24%) had central parkinsonian pain. PD patients with sleep disturbances experienced more pain and had more severe motor symptoms, lower functional independence, more anxiety and depression symptoms, and worst quality of life. Among patients with pain, central parkinsonian pain was the subtype of pain with the highest odds of sleep disturbances, even when taking into account motor symptoms (H&Y off), motor fluctuations, intensity of pain (BPI), and symptoms of anxiety and depression (HADS).

Conclusions

The association between pain and sleep disturbances in PD appears to be dependent on subtype of pain. The close relationship between central parkinsonian pain and sleep disturbances in PD raises the possibility of common pathophysiological mechanisms. A better understanding of the relationship between sleep disturbances and central parkinsonian pain may contribute to the development of new care strategies in PD patients.

Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study

OBJECTIVES

Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.

DESIGN

Data were collected within a prospective cohort study (EPIHeart).

SETTING

Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.

PARTICIPANTS

Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview.

OUTCOME MEASURES

Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.

RESULTS

Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).

CONCLUSIONS

While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.

Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort

OBJECTIVES

To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions.

DESIGN

Prospective cohort study.

SETTING

Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months.

PARTICIPANTS

Between August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up.

OUTCOME MEASURES

Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians.

RESULTS

Patients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers.

CONCLUSIONS

CR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.

Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study

OBJECTIVES

The aim of this study was to assess the proportion of patients with a first episode of acute coronary syndrome (ACS) reporting preceding chest pain, having previously sought medical care and undergone the performance of exams, and to identify the determinants of seeking medical advice and undergoing electrocardiogram (ECG).

METHODS

Within a cohort study, 690 patients with a first episode of ACS were evaluated. A questionnaire was applied to assess chest pain within the preceding 6 months of the event and health system resources utilization. Determinants were identified by logistic regression.

RESULTS

Preceding chest pain was reported by 61% of patients, 43% of these sought medical help, of whom less than half underwent ECG, and in 39% pain was attributed to a problem of the heart. Patients with hypertension were more likely to seek medical care (adjusted odds ratio, OR, 2.13, 95% CI 1.29-3.51), and former smokers (OR 0.52, 95% CI 0.28-0.99) and patients of a higher social class (OR 0.16, 95% CI 0.05-0.48) were less likely to seek medical care. The performance of ECG was associated with male sex (OR 2.56, 95% CI 1.11-5.87), health subsystem coverage (OR 3.88, 95% CI 1.11-13.53), and living in the northeastern region (OR 9.07, 95% CI 4.07-20.24), whereas cognitive impairment (OR 0.37, 95% CI 0.15-0.92) and being employed (OR 0.36, 95% CI 0.14-0.97) were inversely associated.

CONCLUSIONS

These results suggest there are opportunities to improve the diagnosis of myocardial ischemia before acute coronary events.

The New Great Imitator – Neuropsychiatric Symptoms of Lyme Disease

Introduction

Lyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.

Objectives

Identification of neuropsychiatric symptoms associated with Lyme disease.

Methods

Literature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.

Results

Since the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.

Conclusions

According to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychosis and/or Lyme disease: There is more than meets the eye

Introduction

Lyme disease (LD) caused by the spirochete Borrelia burgdorferi (Bb) results from human contact with rural environments and is transmitted by infected ticks (Ixodes spp.)

Objectives/aims

To report a case with LD and to highlight the importance of differential diagnosis in a first psychotic episode.

Methods

Case report and systematic review of the literature.

Results

We report a case of a 19-year-old man that was admitted because of strange behaviour with alienation, perplexity and persecutory delusions. He had one previous admission to an inpatient unit two years prior and was diagnosed with psychosis not otherwise specified. After being admitted to the psychiatric ward a medical work up was completed. The patient had had a long stay in a rural environment; so anti-body specific to Bb was ordered and came positive. LD was diagnosed based on cerebral magnetic resonance imaging (MRI) findings and the presence of Bb in the cerebrospinal fluid. During treatment with anti-psychotic and antibiotic there was a noticeable clinical amelioration correlated with improvement of MRI's perfusion patterns.

Conclusions

LD is relatively rare, but physicians need to be aware of typical neuropsychiatric symptoms, given that they may occur months to years after the initial infection. Prompt diagnosis and effective treatment are crucial to avoid the possibly irreversible mental illness. In the evaluation of a first psychotic episode LD should be considered and excluded, principally if there's an epidemiological context and no psychiatric family history. MRI may be another useful asset in the diagnostic evaluation of this condition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Effect of Obstructive Sleep Apnea in Acute Coronary Syndrome

The effect of obstructive sleep apnea (OSA) on clinical outcomes after acute coronary syndrome (ACS) is incompletely defined. We sought to determine the prevalence of OSA in patients with ACS and evaluate prognostic impact of OSA and continuous positive airway pressure (CPAP) therapy in these patients. This was a prospective longitudinal cohort study of 73 patients admitted on cardiac intensive care unit for ACS. Cardiorespiratory sleep study and/or polysomnography were performed in all patients. CPAP was recommended if Apnea-Hypopnea Index ≥5. The main study outcome was a composite of death for any cause, myocardial infarction, and myocardial revascularization. OSA was diagnosed in 46 patients (63%). Age and cardiovascular risk factors were not significantly different between groups. OSA was classified as mild (m-OSA) in 14 patients (30%) and as moderate-to-severe (s-OSA) in 32 patients (70%). After a median follow-up of 75 months (interquartile range 71 to 79), patients with s-OSA had lower event-free survival rate. After adjustment for gender, patients with s-OSA showed a significantly higher incidence of the composite end point (hazard ratio 3.58, 95% CI 1.09 to 17.73, p = 0.035). Adherence to CPAP occurred in 19 patients (41%), but compliance to CPAP therapy did not reduce the risk of composite end point (hazard ratio 0.87, 95% CI 0.31 to 2.46, p = 0.798). In conclusion, OSA is an underdiagnosed disease with high prevalence in patients with ACS. It is urgent to establish screening protocols because those have high diagnostic yield and allow identifying a group of patients with manifestly unfavorable prognosis.

Screening for Fabry disease in left ventricular hypertrophy: documentation of a novel mutation

BACKGROUND

Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy.

OBJECTIVE

To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy.

METHODS

The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased.

RESULTS

A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test - [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation.

CONCLUSION

In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5).

Follicular bronchiolitis as phenotype associated with CD25 deficiency

Regulatory T cells [Tregs ; CD4(+) CD25(+) forkhead box protein 3 (FoxP3(+) )] are subsets of T cells involved in the maintenance of peripheral self-tolerance by actively suppressing the activation and expansion of autoreactive T cells. Signalling through the interleukin-2 receptor (IL-2R) contributes to T cell tolerance by controlling three important aspects of regulatory T cell (Treg ) biology. CD25 is the α-chain of the IL-2R that, in concert with the β-chain and γ-chain, constitutes the complete IL-2R. CD25 contributes only to IL-2 binding affinity but not to the recruitment of signalling molecules. However, its importance in the development of a normal immune response is emphasized by the finding that a truncation mutant of CD25 results in an immunodeficiency in humans characterized by an increased susceptibility to viral, bacterial and fungal infections. In 1997, Sharfe et al. described an infant with severe bacterial, viral and fungal infections. Counts of autologous T lymphocytes were moderately low, T cells displayed a weak proliferative response to mitogens in vitro and the patient displayed no rejection of an allogeneic skin graft. However, unlike children with severe combined immunodeficiency (SCID), besides not having circulating T cells, the patient also developed peripheral lymphocytic proliferation and autoimmune primary biliary cirrhosis. We present the first female Argentine patient with mutation in CD25 associated with chronic and severe inflammatory lung disease (follicular bronchiolitis with lymphocyte hyperplasia), eczema and infections. She has no expression of CD25 on CD4(+) T cells and an extremely low amount of Tregs . The molecular study confirmed homozygous missense mutation in the alpha subunit of the IL-2 receptor (CD25αR) (c. 122 a > c; p. Y41S).

[Giant tumoral lesion in the left atrium: an uncommon case of undifferentiated cardiac sarcoma]

Primary cardiac tumors are rare, with an incidence ranging from 0.0001% to 0.030%; 80% are benign, while sarcomas account for 95% of malignant tumors. The authors report the case of a 75-year-old patient with a giant mass in the left atrium. The final diagnosis was of an undifferentiated cardiac sarcoma. This tumor represents a real challenge not only for timely diagnosis, but especially the therapeutic approach to adopt.

Polybrominated diphenyl ethers (PBDES) and polychlorinated biphenyls (PCBS) in mussels and two fish species from the estuary of the Guanabara Bay, Southeastern Brazil

The present investigation aimed to analyze PBDE and PCB contamination in mussels (Perna perna) and two commercially important fish species, croaker (Micropogonias furnieri) and mullet (Mugil liza), in the Guanabara Bay, the most important Brazilian estuary, by gas chromatography coupled to mass spectrometry, in order to further knowledge regarding these compounds in the southern hemisphere. This is also the first report of PBDE in this mussel species in the Guanabara Bay. Fish were captured in September (dry season, winter) and March (wet season, summer) 2007 and September 2008. Mussels were collected in August (dry season, winter) 2006, in February (wet season, summer) 2007, and in August 2007 (winter). The results show that all samples showed higher PCB contamination when compared to other ecosystems around the world. On the other hand, PBDEs presented lower concentrations in 41 % of the samples. Croakers presented the highest PCB and PBDE levels, with mullet showing intermediary values and mussels, the lowest.

Levedura de cana-de-açúcar spray dry na alimentação de suínos na fase de crescimento e terminação

Foi estudado o valor nutricional (digestibilidade total e ileal) de duas leveduras spray dry (cana-de-açúcar - LEV35 e cerveja+cana-de-açúcar - LEV40) e o efeito da sua inclusão em rações para suínos na fase de crescimento e terminação. Os valores de ED (kcal/kg) da LEV35 e da LEV40 foram 3.496 e 3.901 e EM (kcal/kg) foram 3.475 e 3.862, respectivamente. Os valores de lisina, metionina+cistina e treonina digestível para a levedura de cana-de-açúcar e da levedura de cerveja+cana-de-açúcar são 2,66 e 2,64, 1,11 e 1,03, 1,95 e 1,92, respectivamente. No desempenho foram utilizados 40 suínos com peso inicial de 34,39± 7,57kg (crescimento) e de 62,45± 5,68kg (terminação), distribuídos em delineamento inteiramente casualizado com cinco níveis de inclusão (0, 5, 10, 15 e20%) da LEV35. Na fase de crescimento, houve piora do GDP e da CA com o aumento da inclusão. Na fase de terminação, porém, houve efeito quadrático para o CDR, sendo o melhor nível 3.32%. Da mesma forma, ocorreu piora linear para o GDP, CA, peso de carcaça quente, rendimento de carcaça fria e peso de pernil. Os resultados sugerem que a adição de níveis crescentes da LEV35 pode prejudicar o desempenho dos suínos.

Glicerina semipurificada vegetal e mista na alimentação de coelhos em crescimento

Dois experimentos foram conduzidos com o objetivo de determinar a energia digestível da glicerina semipurificada vegetal e mista e o desempenho de coelhos em crescimento alimentados com dietas contendo os coprodutos. No ensaio de digestibilidade, foram utilizados 108 coelhos da raça Nova Zelândia Branco, com 45 dias de idade, distribuídos ao acaso em nove tratamentos (0, 4, 8, 12 e 16% de inclusão de glicerina vegetal e mista na dieta), com 12 repetições. Para o ensaio de desempenho, utilizaram-se 180 coelhos da raça Nova Zelândia Branco, dos 32 aos 70 dias de idade, distribuídos ao acaso em arranjo fatorial 2 x 4 (dois tipos de glicerina e quatro porcentagens de inclusão: 3, 6, 9 e 12%) mais uma dieta referência, com 10 repetições e dois animais por unidade experimental. Glicerinas vegetal e mista apresentaram energia digestível de 4.048 e 3.697kcal/kg MS, respectivamente. Entre 32 e 50 dias de idade dos coelhos, a dieta com 12% de glicerina mista prejudicou (P<0,05) o ganho de peso (32,14 g/dia), a conversão alimentar (3,57) e o custo por quilo de ganho de peso (R$ 2,08) em relação à dieta referência (39,42g/dia, 2,87 e R$1,69, respectivamente). Dos 32 aos 70 dias, o ganho de peso (30,11g/dia) e a conversão alimentar (3,99) dos animais que receberam 12% de glicerina mista na dieta foram piores (P<0,05) em relação aos da dieta referência (34,00g/dia e 3,65, respectivamente). Para as características de desempenho, dos 32 aos 70 dias, não foram verificadas diferenças (P>0,05) entre a inclusão de glicerina vegetal na dieta e a dieta referência, porém a maior viabilidade econômica (P<0,05) foi com 12% de inclusão (R$1,89 x R$2,15, respectivamente). A glicerina vegetal pode ser incluída em até 12% da dieta e a mista, em até 9%, diminuindo o custo de produção sem afetar o desempenho animal.

Method of using increasing levels of substitution of the basal diet by test feedstuffs in pig digestibility trials

Two experiments were carried out to study the methodology of using increasing levels of substitution of the basal diet with fibrous test feedstuffs (sticky coffee hull - SCH) in digestibility trials with pigs. In Experiment 1, a digestibility trial was conducted using 30 crossbred barrows, allotted in a randomized block design. In Experiment 2, 42 growing and 42 finishing pigs were used, allotted in a completely randomized design, with six diets and seven replicates, with one animal per experimental unit. The six diets consisted of: a control diet, four diets using SCH ME values as obtained in Experiment 1 plus a diet using SCH ME value estimated by linear regression equation for 15% substitution. The digestibility study indicated that the use of increasing levels of substitution (7, 14, 21 and 28%) reduced SCH digestibility. ME values, as-fed basis, were 2,456, 2,377, 2,247 and 1,945kcal/kg. The overall results indicate that higher levels of substitution overestimate the energy value and that the method of increasing levels of substitution of the basal diet with feedstuffs test can be used to more accurately estimate the energy values of fibrous feedstuffs for pigs. For growing and finishing pigs respectively, up to 28% and 15% of sticky coffee hull can be used without impairing pig performance and economic feasibility.