SARS-CoV-2 Mu variant in dogs visiting veterinary clinics during the third pandemic peak in Eastern Colombia

The global presence of SARS-CoV-2 in household pets is acknowledged, yet documentation remains scarce, leaving many regions unexplored. Thus, our study sought to fill this gap by investigating SARS-CoV-2 presence in dogs visiting veterinary clinics during the third pandemic peak in eastern Colombia. We collected and analyzed 43 oropharyngeal and rectal swabs using real-time PCR assays targeting the Envelope Gene of SARS-CoV-2. Out of these, two dogs tested positive, indicating an infection rate of 4.7%. Further examination through complete sequencing and phylogenetic analysis revealed the lineage B.1.621 for the SARS-CoV-2 genome. Consequently, our study unveils the first documented cases of Canis lupus familiaris infected with the Mu variant of SARS-CoV-2, the variant with the most death burden during the whole pandemic in Colombia. Remarkably, these cases presented mild and reversible respiratory and gastrointestinal symptoms, or no clinical manifestations at all. This sheds light on the virus's interaction with our four-legged companions, offering valuable insights into its transmission dynamics and potential effects on animal health.

Seroprevalence and coprological prevalence of liver fluke Fasciola hepatica in cattle and sheep from Santander department, Colombia

Fasciola hepatica is a parasite with a worldwide distribution that affects several mammals, including humans, and is considered a public health problem. Therefore, the aim of this study was to determine the prevalence of Fasciola hepatica in humans, cattle and sheep, as well as to evaluate factors associated with the prevalence. A total of 185 serum samples from sheep, 290 from cattle, and 114 from humans were collected and processed using an in-house developed ELISA to detect IgG antibodies against F. hepatica. Additionally, 185 stool samples from sheep and 290 from cattle were examined using a Dennis sedimentation technique. Risk factors were analyzed using epidemiological surveys. The overall seroprevalence was 46.5% (86/185) in sheep, 32.5% (94/289) in cattle, and no humans tested positive for the infection. The coprological prevalence was 47.7% (86/180) in sheep and 33.7% (98/290) in cattle. Female gender and cattle living with alternate grazing management showed 2.5 and 6.5 times higher probability of infection, respectively. Bovines coexisting with sheep exhibited a higher risk of infection (odds ratio [OR]=4.3) compared to those without sheep. We concluded that F. hepatica in cattle and sheep has an endemic behavior, and therefore represents a problem of public health for rural communities.

The first report of Dirofilaria repens infection in dogs from Colombia

Dirofilariasis is a mosquito-borne disease caused by Dirofilaria parasites, affecting both wild and domestic animals, including humans considered as accidental hosts. Dirofilaria repens is the principal causative agent of dirofilariasis in the Old World, with increasing reports of the parasite in countries where it has not been previously identified, due to several factors such as the expansion of mosquito vectors' geographical distribution. By utilizing newly designed primers for molecular detection and confirming through next-generation sequencing, here, we report the first plausible cases of D. repens in dogs from Colombia. Our results support the classification of this species as an emergent pathogen in the Americas. Finally, we encourage an increase in diagnostic and surveillance efforts to prevent and control the current and future dirofilariasis cases in this region.

Sow mortality in a pig production system in the midwestern USA: Reasons for removal and factors associated with increased mortality

BACKGROUND

Sow mortality has become a growing concern in the pig production industry over the past decade. Therefore, we aimed to describe sow mortality and associated factors in a production system in the midwestern USA.

METHODS

Mortality records from 2009 to 2018 for four farrow-to-wean farms were described. Environmental, farm- and individual-level factors associated with weekly mortality and individual risk of dying throughout a sow's lifetime were assessed.

RESULTS

Deaths occurred at a median of 116 days from last service, or 26 days postpartum. The median parity upon death was two. Overall, the main reasons for death were locomotion (27%) and reproduction (24%). A higher weekly number of deaths was associated with spring (incidence rate ratio [IRR] 1.27, compared to winter). Sows had a higher mortality when they were exposed to at least one porcine reproductive and respiratory syndrome (PRRS) outbreak during their lifetime (IRR 1.55) and when housed in groups (pens) during gestation (IRR 1.32). Conversely, they had  a lower mortality when housed in filtered farms (IRR 0.76), accounting for an interaction term between parity at removal and PRRS outbreak exposure.

LIMITATIONS

Issues with data completion and information accuracy were present, and prospective data collection throughout sows' lifetimes is still needed.

CONCLUSION

Efforts to reduce infectious diseases within the herd and manage environmental stressors should help reduce mortality.

279 Identification of Potential Biomarkers of Reproductive Development in Vaginal Gene Expression Associated with Serum Concentrations of Reproductive Hormones at key Periods in Gilt Development

Early puberty in gilts is associated with long-term reproductive performance. The ability to predict who will achieve early puberty is limited to intensive and invasive collection of serial blood samples to assess reproductive hormones, which is not practical for on-farm use. The objective of this pilot study was to characterize changes in gene expression in the vaginal epithelium related to reproduction during key periods in pubertal development. Pre-pubertal gilts (n =13) in 2 cohorts were followed from 70 d of age until first estrus or 213-215 d of age. Blood and vaginal epithelia were collected at five key timepoints during reproductive development (d70/77, d100/110, d130, d160 and first estrus or end of trial). Total RNA were isolated from vaginal epithelia and relative gene expression of two toll-like receptors (TLR-4 and TLR-5), tacykinin precursor-3 (TAC-3), insulin-like growth factor-1 (IGF-1), and estrogen receptor (ER)-alpha was quantified by real time RT-PCR, relative to the expression of RPLP0. Of the 13 gilts, 3 exhibited estrus early (d169 to 174), 3 were average (d194 to 195), 2 were late (d203 to 213), 3 were deemed anestrus and 2 had a silent estrus (one prior to d160 and one after d200). Statistical analysis of relative expression of each gene relative to 70 d was performed using the PCR package in RStudio (version 1.2.5025). Analysis of gene expression utilized Fisher’s exact t-test for genes TLR-4, TLR-5 and TAC-3, and ANOVA for genes ER-alpha, IGF-1. Expression of IGF-1 and TAC-3 were up-regulated 9-fold and 7-fold, at the start of boar exposure (d 160; P < 0.05). Expression of ER-alpha tended to be upregulated 3-fold at 100 d of age (P = 0.08). Expression of TLR-4 and TLR-5 was not detected for most samples until standing estrus. These transcripts may be putative biomarkers for early estrus detection.

173 Identification of Biological Markers to Detect Early Estrus in Pre-Pubertal Gilts

A proven predictor of reproductive success in swine breeding herds is age at puberty. Early puberty is associated with improved long-term reproductive performance. The objective of this study was to identify biomarkers of reproductive success at key periods in gilt reproductive development. Pre-pubertal gilts (n = 13) in 2 cohorts were followed from 70 d of age until first estrus or 213-215 d of age. Vaginal epithelia were collected using a swabbing technique at 5 key timepoints during reproductive development (70/77, 100/110, 130, 160 d of age, and first estrus or end of trial). Of the 13 gilts, 3 exhibited estrus early (d169 to 171), 2 were average (d 194 to 195), 2 were late (d 203 to 213), 3 were deemed anestrus and 2 had a silent estrus (one prior to d160 and 1 after d200). Total RNA were isolated and relative gene expression measured for RPLP0 (reference gene), TLR-4, TLR-5, IGF-1, ER-alpha and TAC-3 by quantitative real-time RT-PCR. Target genes were those involved with cellular protein function within the reproductive tract (IGF-1) and that prevent infection while allowing fertilization and implantation to occur (toll-like receptors 4 and 5). Gene ER-alpha is essential in the maturation of the female phenotype. Gene TAC-3 is critical for gonadal function. Comparison of relative expression of each gene of interest at different time points relative to 70 d was performed using the PCR package in RStudio (version 1.2.5025). Expression of IGF-1 and TAC-3 were up-regulated 9-fold and 7-fold, respectively, at the start of boar exposure (d 160; P < 0.05). Expression of ER-alpha tended to be upregulated 3-fold at 100 d of age (P = 0.08). Expression of TLR-4 and TLR-5 was not detected for most samples until standing estrus. These transcripts may be putative biomarkers for early estrus detection.

Identification of Multiple Blastocystis Subtypes in Domestic Animals From Colombia Using Amplicon-Based Next Generation Sequencing

Blastocystis is frequently reported in fecal samples from animals and humans worldwide, and a variety of subtypes (STs) have been observed in wild and domestic animals. In Colombia, few studies have focused on the transmission dynamics and epidemiological importance of Blastocystis in animals. In this study, we characterized the frequency and subtypes of Blastocystis in fecal samples of domestic animals including pigs, minipigs, cows, dogs, horses, goats, sheep, and llama from three departments of Colombia. Of the 118 fecal samples included in this study 81.4% (n = 96) were positive for Blastocystis using a PCR that amplifies a fragment of the small subunit ribosomal RNA (SSU rRNA) gene. PCR positive samples were sequenced by next generation amplicon sequencing (NGS) to determine subtypes. Eleven subtypes were detected, ten previously reported, ST5 (50.7%), ST10 (47.8%), ST25 (34.3%), ST26 (29.8%), ST21 (22.4%), ST23 (22.4%), ST1 (17.9%), ST14 (16.4%), ST24 (14.9%), ST3 (7.5%), and a novel subtype, named ST32 (3.0%). Mixed infection and/or intra -subtype variations were identified in most of the samples. Novel ST32 was observed in two samples from a goat and a cow. To support novel subtype designation, a MinION based sequencing strategy was used to generate the full-length of the SSU rRNA gene. Comparison of full-length nucleotide sequences with those from current valid subtypes supported the designation of ST32. This is the first study in Colombia using NGS to molecularly characterize subtypes of Blastocystis in farm animals. A great diversity of subtypes was observed in domestic animals including subtypes previously identified in humans. Additionally, subtype overlap between the different hosts examined in this study were observed. These findings highlight the presence of Blastocystis subtypes with zoonotic potential in farm animals indicating that farm animals could play a role in transmission to humans.

Comparison between five coprological methods for the diagnosis of Balantidium coli cysts in fecal samples from pigs

Background and Aim:

Balantidium coli is a protozoan that can infect humans and non-human primates, being the domestic pigs the animals most affected by this parasite. This study aimed to compare the performance of five coprological methods for diagnosis of Balantidium coli cysts in fecal samples from pigs.

Materials and Methods:

From September to December 2019, 558 fecal samples were collected from the rectum of backyard pigs in the Bucaramanga metropolitan area, Colombia. The average age of the sampled animals was 3-4 months. Fecal samples collected were tested using the following coprological techniques: Direct examination with Lugol’s iodine solution, buffered saline, centrifugation/flotation and McMaster techniques, and Ziehl–Neelsen method.

Results:

The results indicate that B. coli cysts were diagnosed most frequently through direct examination with Lugol’s iodine solution (52.7% of the samples) followed by direct examination with a buffered saline solution (37.6%). Moderate concordance (k=0.41; p<0.05) was determined between direct method with Lugol’s iodine and buffered saline solution, McMaster and buffered saline (k=0.35; p<0.05), and centrifugation/flotation and buffered saline (k=0.28; p<0.05) showed a fair degree of concordance. The rest of the comparisons were classified as poor. The flotation techniques (centrifugation/flotation and McMaster) did not show good recovery of cysts.

Conclusion:

It is concluded that the most efficient method for diagnosing this parasitosis was to an association between direct examination with Lugol’s iodine solution and buffered saline.

A survey for potentially zoonotic parasites in backyard pigs in the Bucaramanga metropolitan area, Northeast Colombia

Background and Aim:

Backyard pigs farming is a rearing system associated with poor hygienic and sanitary conditions of the pig, often causing public health and food safety problems. Therefore, this study was conducted to investigate the occurrence of potentially zoonotic parasites in population pig reared under backyard farming in the Bucaramanga metropolitan area, Northeast Colombia.

Materials and Methods:

From September to December 2019, a total of 558 fecal samples from 64 backyard pig farms were examined for the presence of enteric protozoan infection. The coprological diagnosis was done by direct examination using Lugol’s iodine solution, buffered saline solution, and Kinyoun technique. In addition, blood samples were collected from 200 pigs. Serum was collected and used for the detection of Trichinella spiralis and Taenia solium cysticercosis infections, using the enzyme-linked immunosorbent assay.

Results:

The overall prevalence of zoonotic protozoa in the Bucaramanga metropolitan area was 65.2%, reporting 52.7% prevalence for Balantidium coli, 33.7% for Entamoeba coli, and 5.7% for Cryptosporidium spp. Regarding the prevalence by municipalities, there was no statistical association (p>0.05), indicating that the prevalence was similar in the region under study. Pigs >7 months of age showed to be a risk factor for B. coli infection, indicating that the prevalence increases with the age, while pigs raised at >1000 masl and access to latrines, increased infection risk for E. coli and Cryptosporidium spp. infections. In the present study, T. spiralis infection was not detected in the analyzed sera, while T. solium cysticercosis infection was found to be 40.5%.

Conclusion:

The high prevalence of protozoan infections and porcine cysticercosis reported in this study could be due to poor facilities, and lack of hygiene in the facilities, and suggests the possible transmission of these parasite populations between pigs and humans, thus increasing the transmission of parasites zoonotic potential. Therefore, appropriate sanitary management practices and deworming programs should be adopted to reduce the prevalence of these infectious agents.

Current status of prevalence and risk factors associated with liver fluke Fasciola hepatica in cattle raised in different altitudinal regions of Colombia

Fasciola hepatica is a trematode parasite with a worldwide distribution that affects mammals, including humans, and is considered a major food safety and public health problem. A research was conducted in three hundred eighty-five livestock farms located in different altitudinal regions of Colombia between February 2017 and March 2018 with the aim to determine the coprological prevalence, seroprevalence (SP) and risk factors associated with liver fluke F. hepatica. A total of 5620 fecal sample were collected from cattle and processed using sedimentation technique. Additionally, 597 blood samples were collected and processed by an ELISA test. The coprological prevalence of F. hepatica in animals and herds was 6.4% and 38.4%, respectively. Regarding the prevalence by municipalities, there was statistical association (P < .05), indicating that the prevalence was higher in those municipalities above 2000 masl (meters above sea level). Regarding risk factors, cattle raised in municipalities at 2000 to 3000 masl showed about 4 (OR = 3.96 [CI95% 3.1-5]; P < .05) times higher probability for infection than those raised at lower altitude. Cattle from 2 to 3 year of age, showed almost 4 times (OR = 3.7[CI95% 2.5-5.4]; P < .05), increased infection risk. Females and dairy breeds showed almost 2 (OR = 1.9 [CI95% 1.3-2.6]; P < .05) and 10 times (OR = 10 [CI95% 7.8-12.8]; P < .05), respectively, increased infection risk. The presence of antibodies anti- F. hepatica (SP = 37.8%; [CI95% 35.8-39.7]; P < .05) in cattle of the region under study is confirmed, which suggests an endemic behavior of this parasitosis. The present study provides current information on the prevalence of F. hepatica in different altitudinal regions of Colombia, and these findings could be useful for designing new holistic control measures for the liver fluke F. hepatica infection.

Prevalence of Dirofilaria immitis in shelter dogs in Bucaramanga metropolitan area, Colombia

The heartworm Dirofilaria immitis is the causative agent of cardiopulmonary dirofilariosis in dogs and cats and also infects humans. The current knowledge about this parasite in South America is scarce compared to North America and Europe. Nevertheless, this parasite has been reported in some regions of Colombia. The objective of this study was to determine the prevalence and risk factors associated with D. immitis infection in shelter dogs from Bucaramanga metropolitan area. We performed a cross-sectional study using blood samples from shelter dogs. Microfilariae testing of whole blood included a blood smear and modified Knott's test. Antigen testing of serum was performed using the Anigen Rapid HW Ag Test Kit 2.0 ®. A descriptive analysis and univariable logistic regression analysis were applied. A total of 207 whole blood samples, from 7 shelters dogs in the Bucaramanga metropolitan area, were utilized. The overall prevalence of D. immitis observed in shelter dogs in the Bucaramanga metropolitan area by blood smears and modified Knott's test was 6.3% (13/ 207) and 0.5% (1/207) by immunochromatography test kit. Regarding the prevalence by municipalities, there was a statistical association (P < .05), indicating that the prevalence was higher in dogs in Girón municipality. Likewise, there was a statistical association (P < .05) between the prevalence with respect to heartworm knowledge and mosquito control. For prevalence by gender, age group, dog breed, and hair length, there was no statistical association (P > .05). For Girón municipality there was a 7.1 times (OR = 7.1; CI95% 0.8-59.2; P < .05) increased infection risk. This study provides current data and the first known report of the prevalence of D. immitis microfilaremia and antigenemia in shelter dogs in the Bucaramanga metropolitan area, and these results could be useful for designing new control measures for this infection. We observed that the prevalence of both microfilaremia and antigenemia was significantly lower in these sampled dogs compared to previous reports.

Prevalence and risk factors of gastrointestinal parasites in backyard pigs reared in the Bucaramanga Metropolitan Area, Colombia

Backyard pigs have been associated with poor sanitary conditions and the development of parasitic diseases, often causing public health and food safety problems. Therefore, the aim of this study was to determine the prevalence and risk factors for gastrointestinal parasites in backyard pigs. 279 animals were sampled from thirty-two backyard pig farms located in the Bucaramanga, Floridablanca, Giron and Piedecuesta municipalities, from Bucaramanga Metropolitan Area, Colombia. Fecal samples were taken directly from the rectum and processed by four coprological techniques. The overall prevalence of gastrointestinal parasites was 91%, being the highest values for Balantidium coli and Eimeria sp. Regarding the prevalence by municipalities, there was no statistical association (p ≥ 0.05) indicating that the prevalence was similar in the region under study. Floridablanca municipality, free-ranging pigs, access to latrines, and consumption of spring water showed to be a risk factor for nematodes, while Giron municipality, pigs > 7 months of age and access to latrines, increased infection risk for coccidian. We concluded that there is a high prevalence of gastrointestinal parasites in backyard pigs from the Bucaramanga Metropolitan Area, and that it could be controlled by improving management practices and farm facilities.

Prevalence and risk factors associated with liver fluke Fasciola hepatica in cattle and sheep in three municipalities in the Colombian Northeastern Mountains

Fasciola hepatica is a parasitic trematode of worldwide distribution, which affects cattle and a large number of mammals, including man. An investigation was carried out to the Colombian Northeastern Mountain between October 2017 and February 2018 with the aim to determine the prevalence and risk factors associated with Fasciola hepatica. Thirty-four farms whose owners agreed to participate in the study were included. Overall, 103 bovines and 97 sheep were examined. A fecal and blood sample was collected from each animal, and all the samples were identified and stored in a refrigerated box to be transported to the Parasitology laboratory for analysis. Fecal samples were processed with a coprological technique, and blood by ELISA test. A written epidemiological survey was applied on all farms. The results indicate 20.5% of coprological prevalence and 41.5% of seroprevalence (SP). Evidence of the parasite was demonstrated in the three municipalities; however, statistical differences were found (P < .05), with higher seropositivity in Duitama municipality (SP = 83.3%). Regarding risk factor, pure breeds of cattle showed 2.5 (SP = 56.1, OR = 2.5) times higher of infection than crossed breed. Cattle and sheep from 12 to 24 months of age, showed 2.5 (SP = 66.7%, OR = 2.5) and 5.9 times (SP = 44.2%, OR = 5.9), respectively, increased infection risk. The presence of snails on the farms had higher odds for testing F. hepatica-positive, therefore, showed to be an important risk factor. The presence of antibodies against F. hepatica in cattle and sheep from the region under study suggests it is endemic and should be controlled by control and prevention programs in the farms.

Point prevalence of gastrointestinal parasites in double purpose cattle of Rio de Oro and Aguachica municipalities, Cesar state, Colombia

Gastrointestinal parasites are one of the most important health problems in cattle worldwide, as they cause economic losses in the herds. Twenty - seven double purpose herds were visited to determine the prevalence of gastrointestinal parasites in cattle at the Rio de Oro and Aguachica municipalities. Overall, 862 fecal samples were collected in three age groups: <12months, 12-24months and >24months. Stool samples were taken directly from the rectum and refrigerated until processing. For parasite determination, fecal samples were processed using coprological techniques. The parasitic genera were identified by egg or infective larval morphology. The global prevalence of gastrointestinal parasites was 83.2%, being the highest values for Eimeria sp. (77.9%), Strongyloides sp. (10.8%) and Haemonchus sp. (8.5%). Regarding the prevalence by municipalities, there was no statistical association (P>0.05) indicating that the prevalence was similar in the two municipalities. Regarding the results for Eimeria sp., different degrees of positivity were observed, reflecting that there was statistical association (P<0.05) with respect to the age group, suggesting that adult animals may act as infection source for calves. Likewise, there was statistical association (P<0.05) between the prevalence for Strongyloides sp., Haemonchus sp. and Trichostrongylus sp. with respect to the age group. It is concluded that there is a high prevalence of gastrointestinal parasites in dual-purpose cattle in the municipalities under study, and that it could be controlled by improving the hygienic conditions of the herds, and informing the farmer about parasite control programs.

Prevalencia de <i>Cystoisospora suis</i> en granjas porcinas intensivas de la región central de Venezuela

It was carried out an investigation at the central region of Venezuela from January to June 2014 with the aim to determine the prevalence of coccidian Cystoisospora suis in intensive swine herds. For parasitic determination 572 litters were selected with signsof diarrhea. Likewise, 1.712 fecal samples were also collected in mature pigs. Stoolsamples were cultured in a 2.5% potassium dichromate solution and later processedby coprological technique. The results of this investigation indicated that C. suis was observed in 55 herds (82.1%) and 210 litters (36.7%) with the highest prevalence values in first two weeks of age (P < 0.05). Regarding to mature pigs, there was a significant correlation (rho = 0.35; P < 0.05) among oocysts excretion in piglets and sows, suggesting that sows may act as infection sources. Sows parity was statistically correlated with the prevalence values in litters as in lactating sows (P < 0.05). This might indicate that as parity increase, prevalence decreases in these groups. Probably these findings are associated with unknown immunologic mechanisms. It is concluding that C. suis is broadly distributed in Venezuela and it could be controlled by improving conditions sanitary herd, however, non elucidated immunologic mechanisms might be involved in the protozoa transmission cycle.

Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial

BACKGROUND

The purpose of this study was to compare gastrointestinal tolerance to two enteral feeding protocols in critically ill patients.

METHODS

A prospective, randomized controlled trial, that involved 96 consecutive patients expected to stay in the intensive care unit for > or =3 days and who had no contraindications to enteral feeding. The patients were randomized to either the current protocol (group I; gastric residual volume threshold, 150 mL, optional prokinetic) or proposed feeding protocol (group II; gastric residual volume threshold 250 mL, mandatory prokinetic). Gastrointestinal intolerance was recorded as episodes of high gastric residual volume, emesis, or diarrhea. The time to reach the goal rate of feeding and the percentage of nutritional requirements received during the study period were also recorded.

RESULTS

Nineteen of 36 patients (19/36 = 0.53) in group I had one or more episodes of high gastric residual volume, compared with 10 of 44 patients (10/44 = 0.23) in group II (p < .005). There was no statistical difference between the two protocols with regards to emesis, diarrhea, or the total episodes of intolerance. The patients in group II reached their goal rates on average in 15 hours and received 76% of their nutritional requirements, compared with 22 hours and 70% in group I; however, these differences were not statistically significant.

CONCLUSIONS

The incidence of enteral feeding intolerance was reduced by using a gastric residual volume of 250 mL along with the mandatory use of prokinetics. The study showed a trend of improved enteral nutrition provision and reduced the time to reach the goal rate in group II. These improvements support the adoption of the proposed feeding protocol for critically ill patients.

The C-reactive protein to prealbumin ratio correlates with the severity of multiple organ dysfunction

BACKGROUND

This study evaluates the correlation between a ratio of two hepatic proteins, C-reactive protein (CRP) and prealbumin (PALB), and the severity of organ dysfunction as measured by the multiple organ dysfunction score (MODS).

METHODS

A prospective cohort study was undertaken in critically ill patients (n = 70) by measuring the serum levels of CRP and PALB, the energy expenditure via indirect calorimetry, and severity of organ dysfunction by the MODS. All three variables were recorded for a period of 5 days from admission and then assessed for correlation to each other and to the length of stay and mortality in the intensive care unit.

RESULTS

The CRP/PALB ratio showed a statistically significant correlation at 48 hours (r = 0.45, P < .01) and 120 hours (r = 0.53, P < .01). This ratio showed higher degrees of correlation when applied to patients with a diagnosis of sepsis, multiple organ dysfunction, or single organ dysfunction, r = 0.71 and 0.56 at 48 and 120 hours, respectively. Receiver operating characteristics (ROC) curves show that a ratio of 2.07 correlated with a MODS of 16 with a sensitivity of 92% and a specificity of 71%.

CONCLUSIONS

This study demonstrates a strong correlation between the severity of organ dysfunction and the ratio of two hepatic proteins, CRP and PALB. There was no correlation between the degree of energy expenditure and the MODS, Acute Physiology and Chronic Health Evaluation II score, or the ratio of CRP/PALB. The use of inflammatory markers may be an easy, inexpensive method of assessing severity of illness in the critically ill.

Use of desmopressin acetate to reduce blood transfusion requirements during cardiac surgery in patients with acetylsalicylic-acid-induced platelet dysfunction

OBJECTIVE

To determine whether desmopressin acetate (DDAVP) has the ability to reduce blood loss in patients with a known bleeding tendency.

DESIGN

A randomized, double-blind, placebo controlled study.

SETTING

A university teaching hospital.

PATIENTS

Men under the age of 70 years who had taken acetylsalicylic acid within 7 days of scheduled coronary artery bypass surgery. Patients with an abnormal hematologic profile or a history of bleeding or who were receiving heparin or undergoing repeat coronary bypass surgery were excluded. Forty-four patients were randomized with restriction in blocks of 10; 20 received DDAVP and 24 received a placebo.

MAIN OUTCOME MEASURES

Blood loss and blood transfusion requirements.

RESULTS

Patients treated with DDAVP lost significantly (p < 0.01) less blood than those receiving a placebo (1543 mL versus 2376 mL respectively). Nineteen patients had a blood loss of more than 2000 mL; 15 of these were in the placebo group. Significantly (p < 0.02) fewer patients receiving DDAVP required blood transfusion (9 versus 18).

CONCLUSIONS

DDAVP reduces blood loss during cardiac bypass surgery in patients who have taken acetylsalicylic acid within 7 days before operation.

New and simple equations to estimate the energy and fat contents and energy density of humans in sickness and health

Two formulas were derived to estimate the energy content of the human body which use only body mass, total body water by 3H2O dilution space and body minerals assessed by anthropometry. The formulas were tested in a body composition database of 561 patients and 151 normal volunteers using established metabolizable energy values for protein, fat and glycogen. Total body protein was determined by in vivo neutron activation analysis (IVNAA), body water by dilution of tritium and body minerals from skeletal frame size. Body glycogen was assumed to be 14.6% of the mineral component. Body fat was obtained by difference, body mass less the sum of water, protein, minerals and glycogen. The standard deviation in the estimate of body energy content was 30 MJ or 4.1% of the energy content of reference man. Two formulas for body energy content were derived by regression with body mass, total body water and body minerals or height. Two formulas for energy density and formulas for percentage body fat were similarly derived.

Effect of body positions and splints in bioelectrical impedance analysis

The objective of this study was to evaluate body composition as measured by bioelectric impedance analysis using splints and body positions differing from the standard supine position. Forty-three patients, randomized into two groups of different body positions, and 101 healthy volunteers were prospectively studied. Resistance and reactance of body tissues were measured by bioelectric impedance analysis. Body composition is described by a three-compartment model composed of body fat, body cell mass, and extra cellular mass. The patients were measured in the standard supine position and then randomized into two groups. They were then remeasured with the appropriate splinting device or position change. Volunteers were measured in the standard supine position and all four alternative positions. There was a statistically significant difference demonstrated in whole body resistance, whole body reactance, body cell mass, and the ratio of extracellular mass to body cell mass in some body positions. The percentage of change with different body positions and splints, when compared with the standard supine position, was generally below 2%, a clinically insignificant difference. We conclude that the reliability of resistance and reactance as measured by bioelectric impedance analysis is clinically valid using any of the tested body positions and/or splints. The three-compartment model may be a useful concept to measure body composition changes in both healthy and sick persons.

Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery

Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. The PaO2/FIO2 was significantly (p less than .05) better from half an hour after extubation until 24 h postextubation in the nasal CPAP group, but was decreased for the remainder of the study in both groups. Incidence of atelectasis/consolidation was not different in both groups during the study period. We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.

Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients?

Sixty-five surgical ICU patients at high risk of developing acute erosive gastritis and bleeding received prophylactic antacid treatment to maintain a gastric pH of at least 5.0. A similar control group of 61 patients received no specific prophylaxis. All patients in both groups developed microscopic bleeding; however, microscopic bleeding did not influence outcome. In the control group, eight (13.1%) patients developed moderate visible bleeding, as compared to seven (10.8%) patients in the antacid group, an insignificant difference. A single patient in the control group developed severe GI bleeding due to acute erosive gastritis. Antacid prophylaxis did not prevent macroscopic bleeding and there was no correlation between the number of risk factors in individual patients and the rate of upper GI bleeding. We conclude that antacid is not required to prevent upper GI bleeding in high-risk critically ill patients.

Acute respiratory failure in severe blunt chest trauma

From 1973 through 1980 144 patients with chest trauma were treated. Concomitant acute respiratory failure was considered severe in 125 (83%). Morbidity and mortality were found to be related to the presence of shock, head injury Glasgow score 3-4, and size of the flail segment, but not by the extent of the thoracic or intrathoracic injuries. Mortality for the whole group and for the flail chest group were 8.3 and 9.5%, respectively. Treatment was analyzed in two historical periods: In the first, 1973 through 1976, controlled mandatory ventilation and tracheostomy were used in 83 and 70% of the cases, respectively. In the second period, 1977 through 1980, intermittent mandatory ventilation plus soft-cuff endotracheal tube were used in 77% of the cases. Ventilator time did not vary in these two periods but the lung oxygen transport was better in the group treated with intermittent mandatory ventilation.