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The mechanisms involved in kidney disturbances during development, induced by vitamin D3 deficiency in female rats, that persist into adulthood were evaluated in this study. Female offspring from mothers fed normal (control group, n=8) or vitamin D-deficient (Vit.D-, n=10) diets were used. Three-month-old rats had their systolic blood pressure (SBP) measured and their blood and urine sampled to quantify vitamin D3 (Vit.D3), creatinine, Na+, Ca+2 and angiotensin II (ANGII) levels. The kidneys were then removed for nitric oxide (NO) quantification and immunohistochemical studies. Vit.D- pups showed higher SBP and plasma ANGII levels in adulthood (P<0.05) as well as decreased urine osmolality associated with increases in urinary volume (P<0.05). Decreased expression of JG12 (renal cortex and glomeruli) and synaptopodin (glomeruli) as well as reduced renal NO was also observed (P<0.05). These findings showed that renal disturbances in development in pups from Vit.D- mothers observed in adulthood may be related to the development of angiogenesis, NO and ANGII alterations.
Heavy weight gilts commonly show signs of oestrus during the late finishing phase, which results in a period of reduced feed intake and growth rate. Immunization against gonadotropin-releasing hormone (GnRH) (IM, immunocastration) was developed for finishing boars and recently extrapolated to females. Immunocastration acts by suppressing reproductive activity and improving the growth potential. The objective of this study was to evaluate the effects of IM on growth performance, reproductive activity and carcass characteristics of late finishing gilts. Seventy-two gilts (63.49 ± 0.39 kg) were either injected with saline (Intact) or immunized against GnRH (Immunized). The study consisted of three experimental periods: between the first to second immunization (V1 to V2, 15 to 19 weeks of age), from the second immunization to the beginning of daily boar exposure (DBE) (V2 to DBE, 19 to 21 weeks of age) and from the beginning of DBE to slaughter (S) (DBE to S, 21 to 25 weeks of age). Immunized gilts showed an overall increase (from 15 to 25 weeks) of 3.90 kg (P < 0.05) of live weight, 56 g (P < 0.05) of average daily gain (ADG) and 250 g (P < 0.001) of average daily feed intake (ADFI). Immunized gilts had a greater ADFI (+240 g, P < 0.05) and worse feed conversion ratio (+0.26, P < 0.05) from 19 (V2) to 21 weeks of age (before DBE). Furthermore, those females had higher feed intake (+410 g; P < 0.001) plus greater daily weight gain (+92 g; P < 0.05) from V2 to S, and from DBE to S (+470 g of ADFI, P < 0.001; +129 g of ADG, P < 0.01, respectively). Immunocastration had no effect on backfat thickness, lean meat percentage and weight, cold carcass yield or loin depth (P > 0.05). Immunized gilts showed 4.4% increased cold carcass weight (P < 0.01) and 10.6% greater gross flank weight (P < 0.001). Immunization against GnRH did not influence shoulder, collar, loin, belly or ham weights. Nor did it influence belly fat thickness, or meat, skin plus fat and bones yields of cold ham (P > 0.05). Immunocastration reduced ovarian and uterine weights by 82% (P < 0.001) and 93% (P < 0.001), respectively, and suppressed oestrus manifestation in all gilts in the immunized group (P < 0.001). These results indicate that immunization against GnRH is a promising tool for stimulating growth performance with no detrimental effects on carcass quality of heavy weight finishing gilts, by means of oestrus suppression.
To compare the accuracy of Mini-Mental State Examination (MMSE) and of the Montreal Cognitive Assessment (MoCA) in tracking mild cognitive impairment (MCI) and Alzheimer’s Disease (AD).
A Systematic review of the PubMed, Bireme, Science Direct, Cochrane Library, and PsycInfo databases was conducted. Using inclusion and exclusion criteria and staring with 1,629 articles, 34 articles were selected. The quality of the selected research was evaluated through the Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2).
More than 80% of the articles showed MoCA to be superior to MMSE in discriminating between individuals with mild cognitive impairment and no cognitive impairment. The area under the curve varied from 0.71 to 0.99 for MoCA, and 0.43 to 0.94 for MMSE, when evaluating the ability to discriminate MCI in the cognitively healthy elderly individuals, and 0.87 to 0.99 and 0.67 to 0.99, respectively, when evaluating the detection of AD. The AUC mean value for MoCA was significantly larger compared to the MMSE in discriminating MCI from control [0.883 (CI 95% 0.855-0.912) vs MMSE 0.780 (CI 95% 0.740-0.820) p < 0.001].
The screening tool MoCA is superior to MMSE in the identification of MCI, and both tests were found to be accurate in the detection of AD.
Sugarcane is an important forage source for dairy cows in tropical countries. However, it provides limited digestible fiber and energy intake, and fat supplementation can be a way to increase energy density and decrease dietary, non-fiber carbohydrates concentrations. We aimed to evaluate the performance, digestion and metabolism of dairy cows in early lactation fed different concentrations of soybean oil (SBO) in sugarcane-based diets. Fourteen primiparous (545±17.2 kg of BW) and eight multiparous (629±26.7 kg BW) Holstein dairy cows were used according to a randomized block design. After calving, diets were randomly assigned to cows within the two parity groups. Diets were formulated with increasing concentrations of SBO (g/kg dry matter (DM)): control (0), low (LSBO; 15.7), medium (MSBO; 44.3) and high (HSBO; 73.4). The study was performed from calving until 84 days in milk, divided into three periods of 28 days each. Dry matter intake (DMI) was affected quadratically in response to SBO addition with the greatest and lowest values of 19.0 and 16.0 kg/day for LSBO and HSBO diets, respectively. The digestibility of potentially digestible NDF was quadratically affected by SBO with the greatest value of 623 g/kg for LSBO diet. Both milk and energy-corrected milk (ECM) production were quadratically affected by SBO inclusion, with greatest ECM values of 27.9 and 27.3 for LSBO and MSBO, respectively. Soybean oil inclusion linearly decreased milk fat concentration by 13.2% from control to HSBO. The CLA t10,c12-18:2 was observed in milk fat only for MSBO and HSBO diets. Soybean oil inclusion did not affect plasma glucose or serum concentrations of total proteins, globulins, albumin, urea nitrogen, beta-hydroxybutyrate, non-esterified fatty acids or insulin. Serum concentrations of total cholesterol, triglycerides and low-density lipoprotein increased with SBO supplementation. Soybean oil inclusion in sugarcane-based diets for early lactation dairy cows from 15.7 to 44.3 g/kg DM can improve energy intake and performance; however, at 44.3 g/kg DM milk fat concentration and ECM decreased. Soybean oil inclusion at 73.4 g/kg DM adversely affected energy intake, fiber digestion and performance of early lactation dairy cows and is not recommended.
The present review will present the recent published results and discuss the main effects of nutrients, mainly fatty acids, on the expression of genes involved in lipid metabolism. In this sense, the review focuses in two phases: prenatal life and finishing phase, showing how nutrients can modulate gene expression affecting marbling and fatty acid profile in meat from ruminants. Adiposity in ruminants starts to be affected by nutrients during prenatal life when maternal nutrition affects the differentiation and proliferation of adipose cells enhancing the marbling potential. Therefore, several fetal programming studies were carried out in the last two decades in order to better understand how nutrients affect long-term expression of genes involved in adipogenesis and lipogenesis. In addition, during the finishing phase, marbling becomes largely dependent on starch digestion and glucose metabolism, being important to create alternatives to increase these metabolic processes, and modulates gene expression. Different lipid sources and their fatty acids may also influence the expression of genes responsible to encode enzymes involved in fat tissue deposition, influencing meat quality. In conclusion, the knowledge shows that gene expression is a metabolic factor affecting marbling and fatty acid profile in ruminant meat and diets and their nutrients have direct effect on how these genes are expressed.
Globally, the prevalence of tuberculosis (TB) disease is higher in males. This study examined the effect of sex and age on Mycobacterium tuberculosis (Mtb) infection. Demographic and exposure data were collected on household contacts of sputum smear-positive pulmonary TB patients in Brazil. Contacts with tuberculin skin test induration ⩾10 mm at baseline or 12 weeks were considered Mtb infected. The study enrolled 917 household contacts from 160 households; 508 (55.4%) were female, median age was 21.0 years (range 0.30–87.0) and 609 (66.4%) had Mtb infection. The proportion infected increased with age from 63.3% in girls <5 years to 75.4% in women ⩾40 years and from 44.9% in boys <5 years to 73.6% in men ⩾40 years. Multivariable modelling showed the odds of infection increased between age 5 and 14 years among female contacts (OR 1.5 per 5-year age increase; 95% CI 1.1–2.2; P = 0.02) and between ages 0–4 and 15–39 years among male contacts (OR 2.7, 95% CI 0.83–8.9 and 1.1, 95% CI 0.99–1.3 per 5-year age increase; P = 0.10, 0.07, respectively). The study suggests that the age at which Mtb infection increases most is different in females compared with males. Studies are needed to explore whether these findings are due to differences in host susceptibility, exposure outside the household or other factors.
Significant progress in nanoscience was achieved through the development of methods and instruments to better comprehend nanoscale properties. We present here a methodology and automated setup to measure layer-by-layer films capacitance in the air immediately after polyelectrolytes adsorption. It presents high accuracy (~0.01 pF) to check the capacitance stabilization during spontaneous drying process in the air, with sensitivity to show electrical signal alternation accordingly to the outermost polyelectrolyte layer. Besides, a linear trend in capacitance was observed similar to UV–vis measurements. This method allows analyzing films electrical properties, affording better choice of materials, thickness, and molecular architecture.
Sugar cane and maize silage samples were evaluated by the semi automated in vitro gas production technique. The associations between gas production and dry matter degradation (DMD) were analysed and high coefficients of determination were obtained for all the substrates. The results showed that particles losses could be influencing the DMD, including errors mostly when obtained before 6 hours of incubation. The gas alone could better predict the lag phase than the DMD before 6 hours of incubation.
Phosphorus and calcium deficiency in horses represents an important factor responsible for the low equine production in Brazil. The basic mechanisms of P and Ca metabolism differ substantially among species. Regulation of P and Ca metabolism is less well understood in horses than in others species. With the use of the isotopic dilution technique is possible to evaluate the metabolism for this mineral. The aim of the present experiment was to study the effect of different Ca levels in the diet on P and Ca metabolism in horses.
ESBL-producing Enterobacteriaceae and particularly Escherichia coli ST131 isolates producing CTX-M enzymes are commonly found colonizing the intestine of nursing home (NH) residents, but ST131 subclonal structure has been scarcely explored in this vulnerable population. Our goal was to perform a pilot study to assess the faecal carriage rate and epidemiological features of ESBL- and/or carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE, respectively) among NH residents. For this purpose, faecal samples from residents at 4 different NHs in the North of Portugal (representing 9·5% of the residents’ population, July 2014) were screened for ESBL-E and/or CPE by phenotypic and genotypic methods. Clonal structure and plasmid typing of ESBL-producing E. coli (ESBL-Ec) was performed by PCR and sequencing. Four ESBL-Ec isolates (2 CTX-M-15/2 CTX-M-14) were found in 20% of the samples, all belonging to the pandemic clonal lineage B2-ST131-O25b:H4. Two different clades were identified, the C2/H30-Rx-virotype C producing CTX-M-15 and an atypical B/H22-like-virotype D5 (producing CTX-M-14 and fluoroquinolone-resistant), firstly described in Portugal. This pilot study highlights the role of NH residents as a source of different ST131 clades, besides emphasizing the importance of E. coli B2-ST131 subtyping in different clinical settings, and understanding the transmission dynamics of the different variants.
We studied the ontogenetic growth of goat wethers (castrated male goats) of the Saanen and Swiss Alpine breeds based on a large range of intraspecific body mass (BM). The body parts and the chemical constituents of the empty body were described by the allometric function by using BM and the empty body mass (EBM) as the predictors for morphological traits and chemical composition, respectively. We fitted the allometric scaling function by applying the SAS NLMIXED procedure, but to evaluate assumptions regarding variances in morphological and compositional traits, we combined the scaling function with homoscedastic (MOD1), and the heteroscedastic exponential (MOD2) and power-of-the-mean (MOD3) variance functions. We also predicted the ontogenetic growth by using the traditional log-log transformation and back-transformed results into the arithmetic scale (MOD4). We obtained predictions from MOD4 in the arithmetic scale by a two-step process, and evaluated MOD1, MOD2 and MOD3 by a model selection framework, and compared MOD4 with MOD1, MOD2 and MOD3 based on goodness-of-fit measures. Based on information criteria for model selection, heterogeneous variance functions were more likely to describe 10 over 36 traits with a low level of model selection uncertainty. One trait was predicted by averaging the MOD1 and MOD2 variance functions; and nine traits were better described by averaging the MOD2 and MOD3 variance functions. The predictions for other 16 traits were averaged from MOD1, MOD2 and MOD3. However, MOD4 better described 11 traits according to the goodness-of-fit measures. Depending on the variable being analyzed, the body parts and the chemical amounts exhibited the three types of allometric behavior with respect to BM and EBM, that is, positive, negative and isometric ontogenetic growth. Reference BMs, that is, 20, 27, 35 and 45 kg, were used to compute the net protein and energy requirements based on the first derivative of the scaling function, and the results were presented in reference to the EBM and EBM0.75. Both the net protein and energy requirements scaled to EBM0.75 increased from 20 to 45 kg of BM.
American tegumentary leishmaniasis is caused by different species of Leishmania. This protozoan employs several mechanisms to subvert the microbicidal activity of macrophages and, given the limited efficacy of current therapies, the development of alternative treatments is essential. Animal venoms are known to exhibit a variety of pharmacological activities, including antiparasitic effects. Crotoxin (CTX) is the main component of Crotalus durissus terrificus venom, and it has several biological effects. Nevertheless, there is no report of CTX activity during macrophage – Leishmania interactions. Thus, the main objective of this study was to evaluate whether CTX has a role in macrophage M1 polarization during Leishmania infection murine macrophages, Leishmania amazonensis promastigotes and L. amazonensis-infected macrophages were challenged with CTX. MTT [3-(4,5dimethylthiazol-2-yl)-2,5-diphenyl tetrasodium bromide] toxicity assays were performed on murine macrophages, and no damage was observed in these cells. Promastigotes, however, were affected by treatment with CTX (IC50 = 22·86 µg mL−1) as were intracellular amastigotes. Macrophages treated with CTX also demonstrated increased reactive oxygen species production. After they were infected with Leishmania, macrophages exhibited an increase in nitric oxide production that converged into an M1 activation profile, as suggested by their elevated production of the cytokines interleukin-6 and tumour necrosis factor-α and changes in their morphology. CTX was able to reverse the L. amazonensis-mediated inhibition of macrophage immune responses and is capable of polarizing macrophages to the M1 profile, which is associated with a better prognosis for cutaneous leishmaniasis treatment.
An experiment was carried to evaluate the energy and protein requirements for the growth and maintenance of lambs of different sex classes. In all, 38 hair lambs (13.0±1.49 kg initial BW and 2 months old) were allocated in a factorial design with diet restriction levels (ad libitum, 30% and 60% feed restriction) and sex classes (castrated and non-castrated males). Four animals from each sex class were slaughtered at the beginning of the trial as a reference group to estimate the initial empty BW and body composition. The remaining lambs were weighed weekly to calculate BW gain (BWG), and when the animals fed ad libitum reached an average BW of 30 kg, all of the experimental animals were slaughtered. Before slaughter, fasted BW (FBW) was determined after 18 h without feed and water. Feed restriction induced reductions in body fat and energy concentration, whereas water restriction showed the opposite effect, and the protein concentration was not affected. The increase in BW promoted increases in body fat and energy content, and these increases were greater in castrated lambs, whereas the protein content was similar between classes tending to stabilize. The net energy required for gain (NEg) and the net protein required for gain (NPg) were not affected by sex class; therefore, an equation was generated for the combined results of both castrated and non-castrated lambs. The NEg varied from 1.13 to 2.01 MJ/day for lambs with BW of 15 and 30 kg and BWG of 200 g. The NPg varied from 24.57 to 16.33 g/day for lambs with BW of 15 and 30 kg and BWG of 200 g. The metabolizable energy efficiency for gain (kg) was 0.37, and the metabolizable protein efficiency for gain (kpg) was 0.28. The net energy required for maintenance (NEm) and the net requirement of protein for maintenance (NPm) did not differ between castrated and non-castrated lambs, with values of 0.241 MJ/kg FBW0.75 per day and 1.30 g/kg FBW0.75 per day, respectively. The metabolizable energy efficiency for maintenance (km) was 0.60, and the efficiency of metabolizable protein use for maintenance (kpm) was 0.57. Nutritional requirements for growth and maintenance did not differ between castrated and non-castrated lambs. This study emphasizes the importance of updating the tables of international committees and of including data obtained from studies with sheep breeds raised in tropical conditions, with the purpose of improving the productive efficiency of the animals
Plants’ ability to rebuild their tiller population is affected by weather changes and management strategies. The hypothesis of the present study was that frequency and severity of defoliation alter Mulato grass (Brachiaria ruziziensis × Brachiaria brizantha cv. Marandu) sward development, and the proportion of aerial and basal tillers, interfering with sward stability. The objective was to evaluate aerial, basal and total tiller population density and changes in tillering dynamics. Treatments corresponded to strategies of rotational grazing characterized by combinations between two pre-grazing (95% and maximum canopy light interception during regrowth; LI95% and LIMax) and two post-grazing conditions (15 and 20 cm stubble height). The experimental period comprised four seasons of the year: summer 2008 (February–March 2008); autumn–early spring (April to mid-November 2008); late spring (mid-November–December 2008); and summer 2009 (January–March 2009). Density of aerial tillers decreased from summer 2008 to late spring. Tiller death decreased from summer 2008 to autumn–early spring. Aerial and total tiller death increased from late spring to summer 2009, mainly for the LI95% treatment. No differences were observed in the tiller population stability index of aerial tillers for LI treatments or post-grazing heights. The balance between tiller appearance and death for basal tillers remained relatively stable from summer 2008 to late spring. For aerial tillers the balance decreased to negative values from summer 2008 to autumn–early spring for both LI treatments. For total tiller population, the balance decreased to negative values from summer 2008 to autumn–early spring. Results indicated a strong seasonal effect on Mulato grass tillering and growth. Tillering dynamics were affected primarily by grazing frequency, which changed the relative importance of basal and aerial tillers. The results suggested that basal tillering was the predominant perennation pathway.
The number of horses in northern Spanish mountains has increased in recent decades, but little is known about their grazing behaviour, performance and potential for foal meat production. This research aimed to study the diet selection, liveweight (LW) changes and parasitic status of dry and lactating mares, and foals’ LW gains, grazing on heathlands with different botanical composition. The experimental design consisted of three vegetation types: dominated by heather (Ericaceae) species (H), dominated by gorse (Ulex gallii; G) and co-dominated by gorse and heath-grasses (G-G), with four replicates per treatment (12 paddocks of 1.2 ha). The study lasted three grazing seasons (2010–12). Each year, 24 crossbred mature mares (310±52 kg LW) were used, managing one lactating mare with her foal plus one non-lactating mare per paddock from May to late summer or early autumn. In the case of H paddocks, animals had to be removed before (late August to early September) because of apparent loss of body condition. Animals were periodically weighed. Mares’ diet composition was estimated using alkane markers, analysing the discrepancies in alkane concentrations between dietary plant components and faeces. Faecal samples were also analysed for gastrointestinal nematodes ova. Chemical composition of the main plant components (i.e. heather, gorse and grasses) revealed a low nutritive value, averaging 79, 115 and 113 g CP/kg dry matter (DM), respectively, that could restrict livestock performance. Mares initially selected gorse and grasses (0.47 and 0.40, respectively, in 2010), increasing heather consumption over time (from 0.13 in 2010 to 0.29 in 2012) as gorse availability decreased. The performance of both mares and foals was lower in H compared with G and G-G paddocks (−216 v. 347 g/day for mares, P<0.01; 278 v. 576 g/day for foals, P<0.05), whereas LW changes were more favourable in dry mares than in lactating ones (241 v. 78 g/day; P<0.05). Small strongyle (Cyathostominae) egg counts in mares’ faeces increased across the grazing season with no differences between treatments. These results indicate that grazing by horses on gorse- and grass-gorse-dominated shrublands could be sustainable at least during part of the year (4 to 6 months). However, heather-dominated heathlands are not able to meet the nutritional needs of horses even for a short time (2 to 4 months). Nevertheless, the low nutritive quality of these vegetation communities, especially in autumn, requires animal access to other pastures with a higher nutritive value, or supplementary feeding, to enhance foals’ growth and maintain sustainable grazing systems with productive herds.
We performed two different approaches (broth enrichment step prior to culture (BEC) and PCR (BEPCR)) for detecting Streptococcus pneumoniae from nasopharyngeal specimens collected from 242 children aged <6 years attending one hospital (n = 140) and one childcare centre (n = 102) in a major urban area in Brazil. These specimens were collected immediately before the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent vaccine (PCV13) for routine use in Brazil. Results were compared with previous findings obtained with direct culture (DC) on a selective medium. Colonisation prevalence was 58·3% (n = 141), being higher among children attending the childcare centre (62·7% vs. 55%). The culture-based methods (DC and BEC) enabled the detection of S. pneumoniae in 119 (49·2%) and 115 (47·5%) children, respectively. The PCR-based method (BEPCR) was more sensitive and 137 (56·6%) carriers were identified. Twenty-six serogroups/serotypes were identified, predominantly 6B, 19F, 14, 6A, 15C and 23F. Multiple colonisation was observed in 13 (5·4%) children. The estimated serotypes coverage of available PCVs was 40·4% for the 10-valent (included in the Brazilian immunisation programme) and 55·8% for the 13-valent (only available in private clinics). The use of robust approaches to obtain a more realistic insight about the asymptomatic carrier status is of paramount importance to estimate and assess the impact of vaccine implementation. The combination between culture-based and molecular methods constitutes a suitable strategy.
Leishmaniasis are diseases caused by parasites of the genus Leishmania and transmitted to humans by the bite of infected insects of the subfamily Phlebotominae. Current drug therapy shows high toxicity and severe adverse effects. Recently, two oligopeptidases (OPBs) were identified in Leishmania amazonensis, namely oligopeptidase B (OPB) and oligopeptidase B2 (OPB2). These OPBs could be ideal targets, since both enzymes are expressed in all parasite lifecycle and were not identified in human. This work aimed to identify possible dual inhibitors of OPB and OPB2 from L. amazonensis. The three-dimensional structures of both enzymes were built by comparative modelling and used to perform a virtual screening of ZINC database by DOCK Blaster server. It is the first time that OPB models from L. amazonensis are used to virtual screening approach. Four hundred compounds were identified as possible inhibitors to each enzyme. The top scored compounds were submitted to refinement by AutoDock program. The best results suggest that compounds interact with important residues, as Tyr490, Glu612 and Arg655 (OPB numbers). The identified compounds showed better results than antipain and drugs currently used against leishmaniasis when ADMET in silico were performed. These compounds could be explored in order to find dual inhibitors of OPB and OPB2 from L. amazonensis.
We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Methods Eighty seven people with 1-3 brain metastases were enrolled on this Phase II trial of WBRT (30Gy/10)+simultaneous FSRT, (60Gy/10). Results Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to<27) ranged from 26-38% for KPS, 32-59% for FACT-Br and 0-16%for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (<6months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. Conclusions The effects on function and quality of life of this integrated treatment of WBRT+simultaneous FSRT were similar to other published series combining WBRT+SRS.
Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance.
As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients.
We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity.
It is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.
Background: Improved respiratory care of Duchenne muscular dystrophy (DMD) patients has unmasked cardiomyopathy as a major source of morbidity and mortality. There is currently no consensus regarding the management of DMD-associated cardiomyopathy (DMD-CM). The objective of this systematic review was to evaluate the efficacy of pharmacological therapies for prevention and management of DMD-CM, and determine the optimal timing to commence these interventions. Methods: A systematic search was conducted in October 2015 and updated in January 2016 using MEDLINE, EMBASE and CINAHL databases and 9 grey literature sources for studies evaluating the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB) or aldosterone antagonists (AA) in DMD patients. References of retrieved records were searched. Quality assessment was conducted using the Downs and Black Quality Assessment Checklist. PRISMA reporting guidelines were used. Results: The 11 included studies were of low methodological quality. However, the use of an ACEi, ARB, BB and AA tended to improve or preserve left ventricular systolic function and delay the progression of cardiomyopathy. Conclusions: While there is evidence supporting the use of heart failure medication in patients with DMD-CM, data regarding these interventions for delaying the onset of DMD-CM and when to initiate therapy is lacking.