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La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.
Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations
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Humanos , Criança , Pediatria , Asma/complicações , Rinite/complicações , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/terapia , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Rinite Alérgica/epidemiologia , Qualidade de VidaRESUMO
Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations.
La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.
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Asma , Pediatria , Rinite Alérgica Perene , Rinite Alérgica , Rinite , Humanos , Criança , Qualidade de Vida , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica Perene/terapia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Rinite Alérgica/epidemiologia , Asma/complicações , Rinite/complicaçõesRESUMO
OBJECTIVE: This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. DESIGN: Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. STUDY SAMPLE: About 231 adults with COM. RESULTS: Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01-1.05), higher education (aOR: 2.24; 95% CI: 1.03-4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02-3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05-4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28-3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. CONCLUSIONS: Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes.
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Otite Média Supurativa , Otite Média , Zumbido , Adulto , Humanos , Zumbido/etiologia , Zumbido/complicações , Estudos Transversais , Qualidade de Vida , Otite Média/complicações , Otite Média/diagnóstico , Otite Média Supurativa/complicações , Doença CrônicaRESUMO
The last third of gestation is a period of high energy and protein demand for the dam to support fetal growth and the following onset of lactation. Methionine is an essential amino acid that contributes to protein formation, fetal development, and milk synthesis; thus, is likely to have positive effects on the weight and size of the newborn and, afterward, milk yield and milk composition, which may improve growth patterns of the progeny. To test these hypotheses, we used 60 pregnant multiparous Alpine goats with similar live weights and gestational ages (~Day 100 of pregnancy; Mean ± SD; 1410 ± 14 days old and 50.4 ± 6.6 kg) and were separated into two groups: control and supplemented with the delivery. Treatments were T-MET (n = 30; received 1% herbal methionine Optimethione® dry matter based on from Day 100 of the pregnancy to delivery) or T-CTL (n = 30; served as the control and did not receive methionine). The methionine powder provided individual supplementation and was adjusted every week as the live weight and dry matter intake changed. At birth, the weight, body mass index (BMI), birth type, and sex of the kids were determined. Subsequently, the progeny was weighed weekly up to weaning. Two weeks after parturition, the milk composition was recorded weekly, and the milk yield was recorded monthly. The maternal live weight at the start (Mean ± SEM; T-CTL: 50.5 ± 1.1 vs. T-MET: 50.3 ± 1.3 kg) and end (T-CTL: 54.2 ± 1.3 vs. T-MET: 52.8 ± 1.4 kg) of the experiment did not differ statistically among treatments (p > 0.05); however, daily live weight changes tended to differ between groups (T-CTL: 73 ± 10 vs. T-MET: 51 ± 7 g day−1; p = 0.06). The birth weight (T-CTL: 3.1 ± 0.1 vs. T-MET: 3.5 ± 0.1 kg; p < 0.001), daily live weight change (T-CTL: 121 ± 6 vs. T-MET: 141 ± 6 g day−1; p < 0.01), and weaning weight (T-CTL: 8.3 ± 0.2 vs. T-MET: 9.3 ± 0.3 kg; p < 0.01) differed between treatments. The BMI at birth (T-CTL: 0.28 ± 0.01 vs. T-MET: 0.3 ± 0.01 units kg m−2; p < 0.01) and at weaning (T-CTL: 0.85 ± 0.1 kg vs. T-MET: 1.00 ± 0.06 units kg m−2; p < 0.05) differed between treatments. Milk components (protein, fat, lactose, and solids non-fat) and milk yield were similar between treatments (p > 0.05). It is concluded that the inclusion of methionine in the maternal goat diet during the last third of gestation increases the birth and growth variables of the progeny but without significant influence on the milk yield and composition.
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The objective of this study was to estimate the good-of-fitness and precision of parameters of the Gompertz-Laird, Logistic, Richards, and Von Bertalanffy growth models, using different data collection periods (DCP). Two hundred and sixty-two Mexican Creole chicks (116 females and 146 males), were individually weighed to form the following sets of data for each sex: DCP1 (weights recorded weekly from hatching to 63 d, and every 2 wk, from 63 to 133 d of age), DCP2 (weights recorded weekly from hatching to 133 d of age), DCP3 (weights recorded every third day, from hatching to 63 d, and every 14 d, from 63 to 133 d of age), and DCP4 (weights recorded every third day, from hatching to 63 d, and weekly, from 63 to 133 d of age). Data were analyzed using the NLIN procedure of SAS (Marquardt algorithm). For all growth models, the width of confidence interval (CI) of each parameter, was estimated (αâ¯=â¯0.05). The adjusted coefficient of determination (AR2), as well as the Akaike (AIC) and Bayesian information criteria (BIC) were used to select the best model. The higher the AR2, and the lower the width of CI, as well as the AIC and BIC values, the better the model. The Gompertz-Laird model, more frequently showed the highest AR2, and the lowest AIC and BIC values compared to the other models. Moreover, for all models, both sexes and all parameters, most confidence interval widths (all with the Gompertz-Laird model) were the lowest with DCP3 when compared to the other sets of data. In conclusion, the Gompertz-Laird model was the best provided that the chickens are weighed every third day from hatching until 63 d of age, and every 2 wk thereafter.
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Galinhas , Modelos Biológicos , Animais , Teorema de Bayes , Peso Corporal , Coleta de Dados , Feminino , MasculinoRESUMO
Tillandsia recurvata is an epiphyte that grows on the canopy of many trees in tropical and subtropical areas of America. The objective of this study was to evaluate the effect of partial or complete substitution of sorghum stubble with T. recurvata on liveweight change, metabolic profile, and complete blood count of goats fed increasing levels (0, 30, and 60%, dry matter basis) of T. recurvata. Thirty non-pregnant three-year-old, non-lactating, healthy mixed-breed goats, ten animals per treatment (T0, T30, and T60), were adapted to diets and facilities for 14 days (d-14). Blood samples were collected at d-15, 28, and 56. At the last phase of the trial (from days 67 on), control goats tended to gain more (p = 0.09) weight than their counterparts consuming T. recurvata. Plasma protein, glucose, triglycerides, calcium, and phosphorus concentrations did not differ among dietary treatments (p > 0.05). Dietary treatment influenced red blood cells (higher for T60; p < 0.01), white blood cells (higher for T30; p < 0.05), mean corpuscular volume (higher for T0; p < 0.001), and mean corpuscular hemoglobin concentration (higher for T0; p < 0.01), although not the rest of the blood variables (p > 0.05). The hematocrit percentage tended to be higher (p = 0.06) in T30 than T0 and T60. It was concluded that replacing sorghum stubble with T. recurvata did not modify the metabolic status and maintained live weight of goats. Nevertheless, the use of T. recurvata as feed for goats would improve the nutrition of these animals in the dry season compared to the current diet obtained from an arid rangeland, reducing production costs, and would alleviate the damage caused by this aggressive epiphyte to host trees.
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We tested whether the milk yield capacity of mixed-breed goats on a Chihuahuan desert rangeland in northern Mexico during the dry season affects milk composition, body weight gain, and weaning weight of their progeny. Milk yield and composition, and progeny postnatal growth performance, were recorded weekly. One week after kidding, mixed-breed goats (a mixture of Criollo × dairy breeds; n = 40) were allotted into medium (MP) or low (LP) milk yielding groups (20 goats per group). Mean 105-d total milk yield for MP and LP goats was 45.2 ± 12.5 and 20.7 ± 5.2 L, respectively. Milk lactose (4.3 vs. 4.2%) and solids-non-fat (SNF; 8.2 vs. 8.0) differed (p < 0.05) between MP and LP goats; milk protein content tended to differ (p = 0.08) between MP and LP goats with no difference for milk fat content (p > 0.05). Maternal body weight was positively associated with milk yield, milk lactose, and SNF content (p < 0.05 to p < 0.001). Goats giving birth to males produce more milk than goats giving birth to females, but milk fat percentage was higher in goats bearing females (p < 0.001). Milk yield and composition throughout lactation did not influence body weight gain (47.8 vs. 48.7 g/day for kids from MP and LP goats) and weaning weight (6.7 vs. 6.7 kg from MP and LP goats) of the offspring (p > 0.05). Birth weight and weaning weight of the progeny were positively related to maternal body weight (p ≤ 0.05). The postnatal growth of the kids was reduced, extending the time to reach market weight. Nevertheless, non-supplemented mixed-breed goats reared on semi-arid rangeland of northern Mexico have the potential for moderate milk production. Therefore, due to the limited nutrients ingested by grazing goats during the dry season, a nutritional supplement is necessary to keep up milk production and adequate growth of kids.
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We tested whether periconceptional nutrition with cladodes from the cactus, Opuntia ficus-indica, with or without protein-enrichment, improved the metabolomic profile and reproductive outcomes of adult female sheep. Sixty Rambouillet ewes of similar body weight were randomly allocated among three nutritional treatments that were fed during the breeding period (34 days): Control (Control; n = 20), Opuntia (Opuntia; n = 20) and protein-enriched Opuntia (E-Opuntia; n = 20). There were no effects of treatment on body weight but assessment of urine samples indicated that, for 76 metabolites, the Control and Opuntia groups differed completely (P < 0.05), whereas there was overlap between the Control and E-Opuntia groups. It appears that, in Opuntia-fed and Control-fed sheep, different functional groups are activated leading to changes in the metabolism of glucose, tyrosine, methane, and glycerolipids. Fertility and reproductive rate tended to be higher in the Opuntia (70% and 95%) and E-Opuntia (90% and 110%) groups than in the Control (55% and 65%), and an orthogonal contrast revealed the difference between Control and Opuntia to be significant for both reproductive variables (P < 0.05). We conclude that nutritional supplementation with Opuntia cladodes, with or without protein enrichment, increased fertility rate and reproductive rate of female sheep, without any accompanying increases in body weight. Our observations suggest that the reproductive responses to Opuntia do not simply reflect a response to good nutrition, but might be caused by specific metabolites/metabolomic pathways, perhaps by an activation of the metabolism of glucose, methane, tyrosine and glycerolipids. There are few reports relating these metabolomic compounds with the metabolism of the sheep, let alone with reproductive efficiency. The novelty of these discoveries suggests that we need further research into the mechanisms through which nutrition affects the reproductive system.
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Ração Animal , Fenômenos Fisiológicos da Nutrição Animal , Opuntia , Ovinos/fisiologia , Ração Animal/análise , Animais , Cruzamento , Suplementos Nutricionais/análise , Feminino , Fertilização , Masculino , Metaboloma , Estado Nutricional , Opuntia/química , Gravidez , Resultado da GravidezRESUMO
We tested whether maternal energy supplementation during the last third of gestation improves birth weight, neonatal wellbeing, and mother-young bonding. Thirty-six pregnant French Alpine goats were randomly allocated among three nutritional treatments for the last third of pregnancy: (i) Control, fed alfalfa (T-0; n = 12); (ii) alfalfa + 150 g/head daily energy concentrate (T-150; n = 12); (iii) alfalfa + 300 g/head daily energy concentrate (T-300; n = 12). At birth, we collected progeny data on birth weight, birth type, sex, rectal temperature, heart rate, respiratory rate, time to standing, time to udder connection, and time to first feeding. For the dams, we collected data on the duration of labor, time to clean the progeny, and time to allow first suckling. At birth, body weight, rectal temperature, heart rate, and the respiratory rate did not differ among treatments (p > 0.05). In the dams, labor duration was not affected by the treatments (p > 0.05). The T-150 dams were faster to clean the newborn and allow first suckling (p < 0.05). The T-150 progeny were faster to stand and the T-300 progeny were faster to connect to the udder (p < 0.05). We conclude that energy supplementation of the dam during the last third of gestation does not affect the birth weight of the progeny, but enhances the mother-young bonding.
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The high climatic variability of hot climates of the intertropical zone reduces cattle fertility. In dairy cows in temperates zones, the THI has been used to evaluate the temperature and relative humidity (RH) joint effect in reproduction, but its use is not recommended in all geographic zones; in hot climates, the maximum temperature (Tmax) can provide more convenient information than THI. The objective of this study was to determine the artificial insemination (AI) service seasons and their joint effect with the maximum temperature and relative humidity of the previous seven days, the service day, and posterior seven days to the AI in the tropical milking criollo (LT) heifer's gestation. Climatic data was used to define three seasons: hot-dry (HD), hot-humid (HH), and fresh-dry (FD), and 313 artificial insemination services from 176 heifers were analyzed over fourteen years. The seasons were determined by cluster analysis. Gestation at first service (GF) was analyzed with a logistic regression model and global gestation (GG) with a mixed linear generalized model. The Tmax of previous seven days insemination [Formula: see text] - 0.20 ± 0.09 (p ≤ 0.02) in HD (p ≤ 0.02) and RH of seven days posterior insemination [Formula: see text]= - 0.08 ± 0.04 (p ≤ 0.04) in HD (p ≤ 0.01) affected GF. No effect of the Tmax and RH on the service day was observed (p > 0.05). The highest GG probabilities were higher than 0.70 in HH and FD, making those seasons the most suitable for inseminating LT heifers.
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Bovinos/fisiologia , Umidade , Inseminação Artificial/veterinária , Temperatura , Animais , Feminino , Fertilidade , Modelos Logísticos , Leite , Modelos Biológicos , Gravidez , Reprodução , Estações do Ano , Clima TropicalRESUMO
Los antiinflamatorios no esteroideos son ampliamente recetados en niños. Constituyen la segunda causa de reacciones a medicamentos en pediatría después de los antibióticos betalactámicos; sin embargo, solo una parte de estas son reacciones de hipersensibilidad. La prevalencia de dichas reacciones a antiinflamatorios no esteroideos en niños es del 0,3 % y aumenta al 5 % en asmáticos.Los mecanismos fisiopatológicos involucrados (inhibición de la ciclooxigenasa, hipersensibilidad mediada por inmunoglobulina E, linfocitos T reactivos y/o afectación de la inmunidad innata) darán lugar a diferentes entidades clínicas con sintomatología dispar.La confusión con síntomas propios de procesos virales y la variabilidad clínica hacen del diagnóstico de certeza un verdadero desafío. Una historia clínica detallada, análisis de laboratorio, pruebas cutáneas y de provocación controlada permitirán definir estrategias para cada paciente en particular sin etiquetar como alérgico a un niño que no lo es ni exponer a riesgos innecesarios a quien está sensibilizado.
Nonsteroidal anti-inflammatory drugs are widely prescribed in children. They are the second cause of drug Ìs reactions in pediatrics after beta-lactam antibiotics, however only a part of them are hypersensitivity reactions. The prevalence of these reactions to nonsteroidal anti-inflammatory drugs in children is 0.3 %, increasing to 5 % in asthmatics.The different physiopathological mechanisms involved (inhibition of cyclooxygenase, immunoglobulin E-mediated hypersensitivity, reactive T lymphocytes and/or disturbance of innate immunity) will cause different clinical entities with diverse symptoms.The confusion between the common symptoms of a viral infection and a hypersensitivity reaction, and the variability of the clinical presentations make diagnosis a real challenge.A detailed clinical history, laboratory, skin and controlled provocation tests will provide strategies for each patient, without labeling a child who is not an allergic one, or taking unnecessary risks with those who are sensitized.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Anti-Inflamatórios não Esteroides , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Testes Cutâneos , Reações Cruzadas , Hipersensibilidade a Drogas/prevenção & controleRESUMO
Objective: Evaluate auditory results and communicative benefits in adult patients with single-sided deafness (SSD) treated with cochlear implantation.Study Design: Observational descriptive case series.Setting: Hospital Universitario Fundación Santa Fe de Bogotá.Patients: Ten patients with profound post-lingual SSD were treated with cochlear implantation between January 2011 and March 2016. Two patients were excluded because of incomplete follow-up.Interventions: Medical records included demographic information, pre and post-operative audiometric results, and binaural and monoaural speech discrimination tests in three sound-in-noise configurationswith the cochlear implant turned on and off, respectively. Subjective improvement was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Speech, Spatial, and Qualities of Hearing Scale (SSQ-B).Main Outcome Measures: Pre and post-operative audiometric and speech discrimination results, post-operative binaural and monoaural speech discrimination in noise results, and APHAB and SSQ-B questionnaire results.Results: Significant improvement in speech discrimination in a noisy environment was found when the noise and signal were presented from the front, and when the signal was presented to the implanted ear and the noise to the healthy ear. SSQ-B questionnaire showed improvement in all subscales, while APHAB showed improvement in all subscales except sound aversion.Conclusion: Patients with SSD showed improvement regarding communication skills and sound discrimination in a noisy environment.
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Implante Coclear , Implantes Cocleares/psicologia , Correção de Deficiência Auditiva/psicologia , Surdez/reabilitação , Perda Auditiva Unilateral/reabilitação , Idoso , Audiometria , Correção de Deficiência Auditiva/instrumentação , Surdez/psicologia , Feminino , Audição , Perda Auditiva Unilateral/psicologia , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Ruído , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Localização de Som , Percepção da Fala , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Two experiments (Australia and Mexico) tested whether feed intake (FI) and wool production (WP) are affected by pregnancy (PRG), litter size (LZ), or lamb sex (LS) in Merino-type ewes. In Experiment-1, ewes were either not pregnant (NPR; n = 6), or carrying 1 (PR1; n = 7) or 3 (PR3; n = 11) fetuses, were studied in individual pens. NPR ewes had lower (p < 0.02) FI throughout PRG and lactation (LAC), except around lambing (p < 0.001). Following lambing, FI increased in PRG ewes (p < 0.001) to double the values in NPR ewes. PRG reduced WP (p < 0.001); in PR3, WP was lower than for both PR1 and NPR (p < 0.001). WP decreased during LAC and was lower in ewes rearing lambs than in NPR ewes (p < 0.001). Experiment-2 used 48 pregnant ewes (28 bearing singles and 20 bearing twins). Dam and lamb live weights (LW) and body condition (BC) were recorded from birth to weaning at 60 d, and dam fleece weight (DFW) was measured at weaning (12 months growth). WP was higher in ewes bearing and rearing single lambs than in ewes bearing twins (p < 0.001). DFW was positively (p < 0.01) related to LZ, dam LW, and BC, but not to changes in dam LW during LAC, or to lamb weight at birth or weaning, or LW gain, or LS. In conclusion, FI was affected during PRG and by LZ during LAC, whereas WP was influenced by LZ, but not LS, only during pregnancy.
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OBJECTIVE: Evaluate the effects of i) dehulling of lupine seed on chemical composition and apparent metabolizable energy (AME) and ii) soybean meal substitution by dehulled lupine seed in broiler diets with enzymes on productive performance, size of digestive organs and welfare-related variables. METHODS: Experiment 1, chemical composition and AME were determined in whole and dehulled lupine seed. Experiment 2, two hundred eighty-eight one-day-old male Ross 308 broilers were used. The experimental diets were maize-soybean meal (MS), MS with enzymes (MSE) and maize-dehulled lupine seed with enzymes (MLE). Diets were assigned to the experimental units under a completely randomized design (eight replicates per diet). The body weight (BW) gain, feed intake, feed conversion, digestive organ weights, gait score, latency to lie down and valgus/varus angulation were evaluated. RESULTS: The dehulling process increased protein (25.0% to 31.1%), AME (5.9 to 8.8 MJ/kg) and amino acid contents. The BW gain of broilers fed the MLE diet was similar (p>0.05) to that of those fed the MS diet, but lower than that of those fed the MSE diet. Feed intake of broilers fed the MLE diet was higher (p<0.05) than that of those fed the MS diet and similar (p>0.05) to those fed the MSE diet. Feed conversion of broilers fed the MLE diet was 8.0% and 8.7% higher (p<0.05) than that of those fed the MS and MSE diets, respectively. Broilers fed the MLE diet had the highest (p<0.05) relative proventriculus and gizzard weights, but had poor welfare-related variables. CONCLUSION: It is possible to substitute soybean meal by dehulled lupine seed with enzymes in broiler diets, obtaining similar BW gains in broilers fed the MLE and MS diets; however, a higher feed intake is required. Additionally, the MLE diet reduced welfare-related variables.
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HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.