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The chronic kidney disease (CKD) and diabetes mellitus (DM) are considered a serious public health problem. The objective was investigating the association of DM with the anthropometric measures, biochemical profile and dietary intake in patients with CKD. Is a cross-sectional study done in 2017, with 51 patients previously diagnosed with CKD. We collect socio-demographic, lifestyle variables, anthropometric measurements, biochemical profile and dietary intake. We using the Kolmogorov–Smirnov test, followed by Pearson's χ2 test and Student's t test. Data were analysed using several multivariable logistic regression models, including the socio-demographic, anthropometric, dietary intake and biochemical variable. Variables with P ≤ 0⋅20 in the univariate analyses were selected and kept in the block in the simple and multiple logistic regression analysis, to determine the differences between the categories and the factors associated with the presence of DM or not, remaining in the model final, only the significant variables (P ≤ 0⋅05). Each variable was adjusted for all other variables included in the univariate analysis. The strength of the association was assessed by the odds ratio and 95% confidence intervals (CI). The multivariate logistic regression analysis evidenced that the increase of 1 cm in waist circumference and 1 mg/dl in VLDL-c values increases the chance of DM, respectively, by 8⋅4% (OR 1⋅076; P 0⋅05) and 8⋅8% (OR 1⋅102; P 0⋅01). In contrast, an increase of 1 mg/dl in total cholesterol decreases the chance of developing DM by 3⋅1% (OR 0⋅965; P 0⋅01), that is, it becomes a protective factor. The present study identified the associations between overweight, dietary intake and biochemical tests.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Chagas disease (CD) is a neglected disease and endemic in Brazil. In the Brazilian Northeast Region, it affects millions of people. Therefore, it is necessary to identify the spatiotemporal trends of CD mortality in the Northeast of Brazil. This ecological study was designed, in which the unit of analysis was the municipality of the Brazilian northeast. The data source was the Information System of Mortality. It was calculated relative risk from socioeconomic characteristics. Mortality rates were smoothed by the Local Empirical Bayes method. Spatial dependency was analysed by the Global and Local Moran Index. Scan spatial statistics were also used. A total of 11 287 deaths by CD were notified in the study. An expressive parcel of this number was observed among 70-year-olds or more (n = 4381; 38.8%), no schooling (n = 4381; 38.8%), mixed-race (n = 4381; 62.3%), male (n = 6875; 60.9%). It was observed positive spatial autocorrelation, mostly in municipalities of the state of Bahia, Piauí (with high-high clusters), and Maranhão (with low-low clusters). The spatial scan statistics has presented a risk of mortality in 24 purely spatial clusters (P < 0.05). The study has identified the spatial pattern of CD mortality mostly in Bahia and Piauí, highlighting priority areas in planning and control strategies of the health services.
The farrowing process is one of the most energy-demanding activities for the modern hyperprolific sow. This study evaluated the effects of supply of energy on the expected date of farrowing on the farrowing kinetics and piglets’ performance during the first 24 h after birth. A total of 80 sows were used. The sows and their respective litters were considered as the experimental unit. On the expected day of farrowing, the sows were allocated to one of the following groups: sows that did not have access to feed from farrowing induction until the end of the farrowing process (CON, n = 40); sows fed 500 g of energetic supplement, which consisted of 250 g of the basal lactation diet plus 250 g of cane sugar, 18 h after farrowing induction (SUP, n = 40). The farrowing duration, farrowing assistance, birth interval, number of total born, stillborn and mummified piglets were recorded for each sow. Piglets were weighed individually at birth and 24 h later. The interval from birth to first suckle was evaluated individually for each piglet in 16 randomly selected litters (eight litters per treatment group). Blood glucose concentrations of six sows were measured shortly after expulsion of the first piglet. Farrowing duration, farrowing assistance and stillborn rate tended to be greater (P = 0.06, P = 0.09 and P = 0.07, respectively) in sows from the CON group compared to sows from the SUP group. However, there was no difference (P > 0.05) between the groups for birth interval. Colostrum intake was greater (P < 0.05) for piglets from the SUP group compared to piglets from the CON group. Additionally, BW gain of the piglets suckling the SUP group was greater (P < 0.05) than those suckling the CON group at 24 h after birth. The blood glucose concentrations during the expulsive stage of farrowing were greater (P < 0.05) in the SUP group than for sows from the CON group. In conclusion, supplying modern hyperprolific sows energy on the expected day of farrowing is a valuable nutritional intervention to improve the farrowing kinetics and piglets’ performance in early life.
The rate of passage (ROP) in the gastrointestinal tract (GIT) influences the exposure time of food to the digestion and absorption processes. Consequently, ROP affects the efficiency of nutrient utilization and energy from the diet. This study aimed to determine the physiological parameters that characterize the digestive response, such as first appearance time (FAT), ROP, mean retention time (MRT) and transit time (TT) in adult Japanese quail (Coturnix coturnix japonica), and to evaluate the effects of sex, apparent metabolizable energy corrected for nitrogen balance (AMEn) content in the diet and different types of markers on these parameters. In the first trial, we investigated the effects of sex and AMEn level (high- and low-energy diet) on the FAT parameter. Thirty-two male and 32 female Japanese quail were randomly allocated to 8 battery cages and assigned to 4 treatments in a 2 × 2 factorial design with 4 replicates of 4 birds for each treatment. To determine the FAT, ferric oxide (1%) was added to the diet, and the excreta of the quail was monitored until the first appearance of the marker. The results indicated significant differences (P < 0.05) in the FAT between males (100 min) and females (56 min), regardless of the AMEn content. In the second trial, thirty-two 32-week-old female Japanese quail in the laying phase were assigned to four treatments in a 2 × 2 factorial design, in which the main independent variables were type of marker (Cr or Ti) and AMEn level (high- and low-energy diets). In order to determine ROP (ET1%), MRT and TT (ET100%), the markers (0.5%: Cr2O3 and 0.5%: TiO2) were added to the diets, and the excreta were collected for 750 min. The excretion times for 1% (ET1%), 25% (ET25%), 50% (ET50%), 75% (ET75%) and 100% (ET100%) were estimated using cumulative excretion curves. No effect was detected for the AMEn level (P > 0.05); however, the effect of different marker types was significant (P < 0.05). This difference increased with time and ET100% was estimated to occur at 59 min. The ROP was estimated to be 68 min. The TT was estimated to be 540 min using Cr and 599 min using Ti, with an average MRT value of 0930 h. Taken together, our findings support the hypothesis that Japanese quail digestion through the GIT can be dynamic and differ based on sex or marker type.
Spontaneous abortion is considered a public health problem having several causes, including infections. Among the infectious agents, bacteria of the vaginal microbiota and Ureaplasma parvum have been associated with abortion, but their participation needs to be further elucidated. This study aims to evaluate the influence of Mollicutes on the development of spontaneous abortion. Women who underwent spontaneous abortion and those with normal birth (control) were studied. Samples of cervical mucus (CM) and placental tissue were collected to identify Mollicutes using the quantitative polymerase chain reaction methodology. Eighty-nine women who had a miscarriage and 20 women with normal pregnancies were studied. The presence of Mollicutes in placental tissue increased the chance of developing miscarriage sevenfold. The prevalence of U. parvum in women who experienced spontaneous abortion was 66.3% in placental tissue. A positive association was observed between the detection of U. parvum in samples of placental tissue and abortion. There was a significant increase in microbial load in placental tissue for M. hominis, U. urealyticum and U. parvum compared to the control group. Detection of U. parvum in CM in pregnant women can ascend to the region of the placental tissue and trigger a spontaneous abortion.
The description of the growth of the Japanese quails is necessary to characterize the genetic potential of these birds raised in different countries. Thus, the aim of this study was to describe the genetic potential of Japanese quails by conducting a meta-analysis considering studies conducted in different countries. Only data about the subspecies Coturnix coturnix japonica were considered; studies regarding Coturnix coturnix coturnix were not examined. The criteria investigated were BW (W), age (t), year of publication and location of the study. Each set of genetic material within a publication was coded as one study. The Gompertz function was used to interpret the growth of laying quails; thus, each study was represented by Gompertz parameters. The W and t data were applied to estimate the values of Gompertz growth parameters, including BW at maturity (Wm), BW at birth (Wi), maturity rate (B) and inflection point (IP). The age at which the maximum growth rate was achieved (t*) was calculated considering the parameters Wm, Wi and B. To estimate these parameters, random regression was used to randomize the parameter Wm. The parameters estimated for each assay were used in exploratory, grouping, and principal component analyses. The values of Wi ranged from 4.1 to 11.6 g. The values of B ranged from 0.0393 to 0.1039/day, and consequently, the values of t* and IP ranged from 14 to 31 days and 9.21 to 31.03 g, respectively. These results show that there is considerable variability in the growth potential of Japanese quails. To better understand this variation, two groups were examined: Brazil and other countries, according to the grouping of Wi, Wm, B and t*; parameter B was the variable that presented the highest specificity, indicating that both groups modified the maturity rate. For the principal component analysis, the year of publication showed a relationship with the growth parameters but only for studies performed in Brazil. For studies carried out in other countries, the changes in growth parameters were not related to the year of publication. In Brazilian studies, there was a decrease in the maturity rate, but the weight at maturity was higher. Therefore, it appears that different strategies of genetic selection were adopted in Brazil compared to other countries.
An understanding of the processes involved in grazing behaviour is a prerequisite for the design of efficient grassland management systems. The purpose of managing the grazing process is to identify sward structures that can maximize animal forage daily intake and optimize grazing time. Our aim was to evaluate the effect of different grazing management strategies on foraging behaviour and herbage intake by sheep grazing Italian ryegrass under rotational stocking. The experiment was carried out in 2015 in southern Brazil. The experimental design was a randomized complete block with two grazing management strategies and four replicates. The grazing management treatments were a traditional rotational stocking (RT), with pre- and post-grazing sward heights of 25 and 5 cm, respectively, and a ‘Rotatinuous’ stocking (RN) with pre- and post-grazing sward heights of 18 and 11 cm, respectively. Male sheep with an average live weight of 32 ± 2.3 kg were used. As intended, the pre- and post-grazing sward heights were according to the treatments. The pre-grazing leaf/stem ratio of the Italian ryegrass pasture did not differ between treatments (P > 0.05) (~2.87), but the post-grazing leaf/stem ratio was greater (P < 0.001) in the RN than in the RT treatment (1.59 and 0.76, respectively). The percentage of the non-grazed area was greater (P < 0.01) in post-grazing for RN compared with RT treatment, with an average of 29.7% and 3.49%, respectively. Herbage nutritive value was greater for the RN than for the RT treatment, with greater CP and lower ADF and NDF contents. The total time spent grazing, ruminating and resting did not differ between treatments (P > 0.05), with averages of 439, 167 and 85 min, respectively. The bite rate, feeding stations per min and steps per min by sheep were greater (P < 0.05) in the RN than in the RT treatment. The grazing time per hour and the bite rate were greater (P < 0.05) in the afternoon than in the morning in both treatments. The daily herbage intake by sheep grazing Italian ryegrass was greater (P < 0.05) in the RN than in the RT treatment (843.7 and 707.8 g organic matter/sheep, respectively). Our study supports the idea that even though the grazing time was not affected by the grazing management strategies when the animal behaviour responses drive management targets, such as in ‘Rotatinuous’ stocking, the sheep herbage intake is maximized, and the grazing time is optimized.
This study presents two years of characterization of a warm temperate rhodolith bed in order to analyse how certain environmental changes influence the community ecology. The biomass of rhodoliths and associated species were analysed during this period and in situ experiments were conducted to evaluate the primary production, calcification and respiration of the dominant species of rhodoliths and epiphytes. The highest total biomass of rhodoliths occurred during austral winter. Lithothamnion crispatum was the most abundant rhodolith species in austral summer. Epiphytic macroalgae occurred only in January 2015, with Padina gymnospora being the most abundant. Considering associated fauna, the biomass of Mollusca increased from February 2015 to February 2016. Population densities of key reef fish species inside and around the rhodolith beds showed significant variations in time. The densities of grouper (carnivores/piscivores) increased in time, especially from 2015 to 2016. On the other hand, grunts (macroinvertebrate feeders) had a modest decrease over time (from 2014 to 2016). Other parameters such as primary production and calcification of L. crispatum were higher under enhanced irradiance, yet decreased in the presence of P. gymnospora. Community structure and physiological responses can be explained by the interaction of abiotic and biotic factors, which are driven by environmental changes over time. Biomass changes can indicate that herbivores play a role in limiting the growth of epiphytes, and this is beneficial to the rhodoliths because it decreases competition for environmental resources with fleshy algae.
Sleep disturbance is recognized as an essential aspect of affective illness.
Multiple lines of evidence suggest that a change in sleep pattern may indicate an imminent mood change. In fact, the impaired sleep can be seen as a sign as well as a cause of manic episodes. Thus, sleep can be a predictor of mania or a marker of response and therapeutic target.
This retrospective study explores the role of insomnia in patients with Affective Bipolar Disorder presenting with current mania or hypomanic episode, based on ICD-10 criteria. It was randomly selected a sample of 61 adults admitted at Psychiatry Department of Hospital de São João between 2005-2007. It was assessed the presence of insomnia before and during the treatment and compared with the duration of the hospitalization, the number of attendances to the Emergency Department and hospitalizations one year after.
Given the importance of insomnia in bipolar illness, appropriate evaluation and management of sleep can be helpful in preventing relapses in this disorder. Therefore sleep improvement in mania may be clinically useful as therapeutic target.
Choking phobia is a condition characterized by intense fear of choking accompanied by avoidance of swallowing solid food, drinking and taking pills in the absence of anatomical or physiological abnormalities. Patients may present a significant weight loss, about which they usually feel uncomfortable.
Fear respondents are elicited by the phobic stimuli and the patient learns to emit avoidance or escape behaviors as an attempt to reduce a hypothetical risk of choking. These escape and avoidance behaviors are characterized by a quantitative and qualitative restriction of food intake, as well as concerns about food texture, size of bite, and topographical changes in the eating response. Patients start to eat slowly, thus leading to social dysfunction.
The authors propose to describe a case report, treatment and the results for this condition.
R. is a 34 year old married male. Phobic symptoms started in 2005, after experiencing a choking incident with bone of fish. He progressively began limiting his intake of various food items by avoiding items he considered to be dangerous. Over the time he completely banished certain kinds of food from his diet and started to ingest all the aliments passed over a strainer. He refrained from eating at social events were he could not control the production of meals. This situation has implications in his marital life with constant conflicts.
In spite of the insistence of the relatives he postponed around 3 years the search of medical treatment for this situation.
He began pharmacological and psychotherapeutic treatment.
In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.
To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.
Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.
The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.
Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.
Schizophrenic patients show a marked deficit of attention to the normal population.
In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.
Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.
Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).
The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.
Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.
Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.
Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.
14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.
Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.
Studying inpatient clinical population's features allows a better understanding of readmissions. Factors associated with higher levels of readmission may give clues concerning better treatment planning and follow-up.
To detect psychosocial and clinic factors associated with readmissions in an inpatient general psychiatric population.
107 patients consecutively admitted to an inpatient unit were characterized in terms of psychosocial, clinical, treatment and discharge plan features. Readmission was defined as the number of previous admittances in the last two years.
Patients characteristics: Average age 44 (SD: 16); 58% female; 10 (SD:5) years of education; average disease duration of 128 (SD:115) months. Main diagnosis: 30,8% schizophrenia; 14% bipolar I disorder; 13,1% major depression; 11,2% recurrent major depression; 5,6% cluster B personality; 3,8% bipolar II disorder and 2,9% schizoaffective disorder. From more to less frequent diagnosis implicated in readmissions were schizophrenia, schizoaffective disorder, recurrent major depression, bipolar I, bipolar II and major depression episode. Readmissions were not associated with inpatient treatment or disease duration, nor toxics or axis II diagnosis. Nonetheless, beginning a depot antipsychotic medication was related to an increase in previous admissions.
These are preliminary results of a small sample, but they point towards the usefulness of a systematic evaluation of inpatient populations, mainly in what concerns complex clinical situations like major pathology readmissions.
Factitious disorders (FD) are characterized by intentional production of either physical, psychological or mixed symptoms that mimic various clinical syndromes, with no apparent advantage for the individual concerned other than allowing him to assume the sick role. Large body of work has been accumulated on FD, but the majority of published data deal with the physical variant of the disease, with comparable few reports on psychiatric FD. Although there are many different presentations for psychiatric FD, the factitious psychosis subset justifies particular attention. Factitious psychosis may be prodromic of a genuine chronic psychosis, usually in the context of a personality disorder. Published data shows Munchausen psychosis, a severe subset of FD psychosis, with a prevalence of 0.25% of all inpatient admissions and global FD psychosis attaining 4.1% of all diagnosed psychoses, generally with a poor prognosis.
The scantiness of studies on the subject of psychiatric FD and factitious psychosis in particular, despite its significant prevalence, coupled with the fact that its recognition embarks on a radically different approach compared with the physical variant, stresses the need for case reporting.
We present four clinical cases with discussion of the underlying pathology and outcome, and a systematic review of the literature of FD psychosis case reports. This is followed by further discussion addressing the recognition of factitious psychosis, its etiological contributing factors, management, effects on staff and diagnostic criteria.
There is a need to address vulnerable carers in schizophrenia and severe mental illness, although research has not yet defined feasible risk assessment routines. Caregiver needs must be sought and targeted instead of blindly delivering previously defined programs. In Portugal, where psychoeducational family work has been scarcely implemented/evaluated, the Families of Psychotic Patients(FAPS) Project is now running in Lisbon. It consists of a prospective study of caregivers, which will be followed in time by a group intervention study for a defined sub-sample.
Caregivers' assessments (baseline) include the Involvement Evaluation Questionnaire, the GHQ, the Social Network Questionnaire and a schedule including questions on intervention needs/adherence). Patients are given the BPRS, WHO-DAS II and GAF. We present preliminary data concerning baseline assessments of a first cohort of the prospective survey (n=70). A convenience sample of primary caregivers to patients with schizophrenia, schizo-affective or delusional disorders (ICD-10) was considered.
Key-relatives (age 59.4±13.1 yrs) were mostly female (87%). Burden was evident (especially IEQ worrying 18.9±5.4). 31,4 % scored GHQ+, while needs for family work were not invariably expressed, in discrepancy with interviewers's expectations.
Caregiver burden and psychological distress do not imply adherence to family interventions (either in relative groups or behaviour family therapy format). Moreover, some of the most distressed carers seem to be the hardest to recruit.
These considerations must be checked at follow-up with the whole sample and warrant further research. Apparently, one should tailor family intervention programs to each family according to prior detailed assessments.