ABSTRACT Little is known about the toxicity of concomitantly occurring mycotoxins in pig diets. This study was conducted to evaluate, through meta-analysis, the individual and the combined effects of mycotoxins on pig performance. The meta-analysis followed three sequential analyses (graphical, correlation, and variance-covariance) based on a database composed of 85 published papers, 1,012 treatments and 13,196 animals. Contamination of diets with individual mycotoxins reduced (p < 0.05) feed intake by 14 % and weight gain by 17 %, while combined mycotoxins reduced the same responses by 42 % and 45 %, respectively, in comparison with the non-challenged group. The correlation (p < 0.05) between reduction in weight gain (ΔG) and reduction in feed intake (ΔFI) was 0.67 in individual challenges and 0.93 in combined challenges. The estimated ΔG was –6 % in individual challenges and –7 % in combined challenges when ΔFI was zero, suggesting an increase in the maintenance requirements of challenged animals. Most of ΔG (58 % in individual challenges and 84 % in combined challenges) was attributed to the changes in feed efficiency. The association of mycotoxins enhances individual toxic effects and the ΔFI is important in explaining the deleterious effects on the growth of challenged pigs.

O trabalho foi realizado para avaliar as características de carcaça e carne de suínos machos castrados e imunocastrados alimentados com dietas contendo diferentes níveis nutricionais. O delineamento experimental foi inteiramente casualizado com quatro tratamentos principais (T1-suínos machos castrados alimentados com dieta basal; T2-machos imunocastrados alimentados com dieta basal; T3-machos imunocastrados alimentados com dieta basal+3% aminoácidos e energia; T4-machos imunocastrados alimentados com dieta basal+5% aminoácidos e energia) e dois tratamentos secundários com ou sem ractopamina dentro de cada tratamento principal. Os suínos machos castrados apresentaram peso de abate 3,3% inferior (P<0,05), peso de carcaça fria 1,4% superior (P<0,05) e peso de carré 13% superior (P<0,05) em relação aos machos imunocastrados. Suínos machos imunocastrados suplementados com 5% a mais de aminoácidos e energia apresentaram costela 19% mais (P<0,05) pesada e valores superiores (P<0,05) na coloração b* (amarelo-azul) na carne aos 45min e às 24h pós-abate em relação aos machos castrados alimentados com a dieta basal. A suplementação com 5% de aminoácidos e energia aumenta o peso e rendimento de costela e altera o valor da coloração b* (amarelo-azul) na carne aos 45min e às 24h pós-abate de suínos machos imunocastrados.

The study was carried out to evaluate the carcass characteristics and meat of surgically castrated and immunocastrated pigs fed with different nutritional levels. The animals were distribuited in a completely randomized experimental design with four main treatments (T1-surgically castrated pigs fed with basal diet; T2-immunocastrated pigs fed with basal diet; T3-immunocastrated pigs fed with basal diet+3% amino acids and energy; T4-immunocastrated pigs fed with basal diet+5% amino acids and energy) and two secondary treatments with or without ractopamine within each main treatment. The surgically castrated pigs had slaughter weight 3.3% lower (P<0.05), cold carcass weight 1.4% higher (P<0.05) and loin chop weight 13% higher (P<0.05) compared to immunocastred pigs. The immunocastrated pigs supplemented with 5% more amino acids and energy had rib 19% more heavier (P<0.05) and higher values (P<0.05) in the color b* (yellow-blue) in the meat to 45min and 24h post-slaughter compared with surgically castrated pigs fed with basal diet. Supplementation with 5% amino acids and energy increases weight and yield of rib and changes the value of color b* (yellow-blue) in the meat to 45min and 24h post-slaughter male pigs immunocastrated.

OBJETIVO: Avaliar a incidência e os fatores preditores de disfunção neurológica maior pós-operatória e a evolução clínica precoce em uma coorte não selecionada. MÉTODO: Um total de 1760 pacientes consecutivos submetidos a CRM isolada, no Hospital São Lucas da PUCRS, entre janeiro de 1997 e fevereiro de 2004, foram incluídos. Dados demográficos, informações do procedimento e desfechos perioperatórios foram coletados usando-se o protocolo do registro de dados da Unidade de Pós-Operatório de Cirurgia Cardíaca do nosso hospital. As variáveis consideradas estatisticamente significativas foram aquelas com p <0,05 e intervalo de confiança de 95%. RESULTADOS: Na nossa amostra, 52 (3%) pacientes evoluíram com disfunção neurológica maior (AVC). Na análise univariada, idade avançada, maior prevalência de doença pulmonar obstrutiva crônica (DPOC), doença cerebrovascular (DCV) prévia, média de fibrinogênio elevada, desenvolvimento de choque ou hipotensão grave, presença de taquicardia supraventricular (fibrilação atrial ou flutter), ocorrência de síndrome da resposta inflamatória sistêmica (SIRS) e ventilação mecânica prolongada estiveram associados ao desenvolvimento de AVC. Na análise multivariada, a história prévia de DCV e DPOC demonstraram ser preditores independentes para a ocorrência de disfunção neurológica maior. Ventilação mecânica prolongada também apresentou associação independente com o desfecho. Além disso, a ocorrência de AVC aumentou significativamente o tempo de internação hospitalar e a mortalidade intra-hospitalar. CONCLUSÃO: A disfunção neurológica permanece sendo relevante causa de morbidade hospitalar, no pós-operatório de CRM com circulação extracorpórea.

OBJECTIVE: The aim of this study was to evaluate the incidence and to identify possible predictors of major postoperative neurologic dysfunction (defined as stroke) and to evaluate early clinical outcome in a non-selected cohort. METHOD: A total of 1760 consecutive patients who underwent isolated CABG in the San Lucas Hospital -PUCRS, between January 1997 and February 2004, were enrolled. Demographic and laboratory data, informations regarding the procedure and perioperative endpoints were collected prospectively using a standard protocol of data register of the cardiac postoperative unit of our hospital. We considered statistically significant those variables with a p value no greater than 0.05 with a confidence interval of 95%. RESULTS: In this study, 52 (3%) patients presented with major neurologic dysfunction. On the univariable analysis advanced age, higher prevalence of obstructive pulmonary disease, previous cerebrovascular disease, higher mean value of fibrinogen, occurrence of shock or severe hypotension, presence of supraventricular tachycardia (atrial fibrillation or flutter), occurrence of the systemic inflammatory syndrome and prolonged mechanical ventilation were associated with stroke. On the multivariable analysis previous history of cerebrovascular disease and obstructive pulmonary disease presented as independent predictors for the occurrence of major neurologic dysfunction. Prolonged mechanical ventilation was also independently associated with the endpoint. Furthermore, the occurrence of stroke raised significantly the duration of hospital stay and in-hospital mortality. CONCLUSION: Neurological dysfunction is still a significant cause of morbidity after CABG.

OBJETIVO: Estimar o custo anual do manejo da doença arterial coronária (DAC) em valores do SUS e convênios. MÉTODOS: Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internações e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM). Valores de eventos cardiovasculares foram obtidos de internações em hospital público e privado com estas classificações diagnósticas em 2002. O preço dos fármacos utilizado foi o de menor custo no mercado. RESULTADOS: Os 147 pacientes (65±12 anos, 63% homens, 69% hipertensos, 35% diabéticos e 59% com IAM prévio) tiveram acompanhamento médio de 24±8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00) representou 80% e 55% dos custos ambulatoriais, e 41% e 17% dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, p<0,01). CONCLUSÃO: O custo médio anual do manejo da DAC foi elevado, sendo o tratamento farmacológico o principal determinante dos custos públicos. Essas estimativas podem subsidiar análises econômicas nesta área, sendo úteis para nortear políticas de saúde pública.

OBJECTIVE: To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil. METHODS: Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS: The 147 patients (65±12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24±8 months. The average estimated annual cost per patient was R$ 2,733.00, for the public sector, and R$ 6,788.00, for private and fee-for-service plans. Expenses with medications (R$ 1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R$ 4,626.00 vs. R$ 1,312.00, in SUS, and R$ 13,453.00 vs. R$ 1,789.00, for HMOs, p<0.01) on the results. CONCLUSION: The average annual cost of CAD management was high, being the pharmacological treatment the main determinant of public costs. Such estimates may subsidize economical analyses in this area, and foster related healthcare policies.

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3±12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.