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Abstract Background and objectives: Limited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal-hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal-hypotension and ephedrine requirement during cesarean delivery. Methods: One hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 µg.mL−1 (n = 40), epinephrine 5 µg.mL−1 (n = 40), phenylephrine 100 µg.mL−1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of intravenous ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. Results: There was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p< 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p= 0.001). Conclusion: There is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered an alternative agent for management of spinal hypotension.

En la actualidad se exige cada vez más, destinar importantes recursos a la preparación de los directivos para hacerlos más competentes en su trabajo y de esa manera, contribuir a lograr un mejor desempeño en la organización. Este trabajo se concibe en la Empresa Constructora Integral de Mayabeque, con el objetivo central de elaborar un procedimiento para evaluar el impacto de la capacitación de sus cuadros y reservas, basado en la Norma Cubana de Gestión del Capital Humano, que contribuya a elevar el desempeño de sus directivos y el de la organización. El procedimiento puede ser útil como herramienta para ser aplicada con sistematicidad, teniendo en cuenta los principios del proceso de capacitación, el cumplimiento de las premisas que se abordan en el trabajo, así como la secuencia de pasos, responsabilidades, el establecimiento de indicadores y la aplicación de instrumentos de medición; pero, por sobre todas las cosas, si se tiene en cuenta como mecanismo de retroalimentación y mejora continua del proceso de evaluación del impacto de la capacitación de los directivos./ Nowadays, it is becoming increasingly important the demand related to assign significant resources to the task of preparing managers to make them more competent in their work and in that way, to contribute to the improvement of performance within the organization. This work is conceived in the Empresa Constructora Integral de Mayabeque, with the main objective of elaborating a procedure to evaluate the impact of the training of managers and their substitutes, which contributes to increase the performance level of them and the organization itself; based on the Cuban Regulations regarding the Human Capital Management. The procedure could be useful if it is applied as a systematic tool, taking as a starting point the principles of the training process, the achievement of the premises treated in this work, as well as the sequence of steps, responsibilities, the establishment of indicators and the application of measuring instruments; but mainly, if it is considered as a mechanism of feedback and continuous improvement of the evaluative process of the impact of managers´training.

ABSTRACT Studies were conducted to determine the effects of different ensiling densities on fermentation, aerobic stability, and nutritive value of maize and sorghum silages. Maize and sorghum were harvested at dough (363 g/kg) and milk stages (275 g/kg), respectively. Herbages were chopped approximately 1.5 cm after harvest and then ensiled in mini silos at high and low-bulk densities for 8.5 weeks. Different bulk densities were achieved by ensiling different weights of herbage in the fixed-volume mini silos (1.5-L anaerobic jars, Weck, Germany). The obtained dry matter (DM) densities were 168 and 216 kg of DM/m3 for maize forage and 132 and 178 kg of DM/m3 for sorghum forage. Fermentation kinetics, the rate of aerobic deterioration upon aerobic exposure, and nutrient digestibility were followed during the periods of ensiling (on days 2, 4, 8, 15, and 60). In all cases, increased packing density resulted in silages with lower acetate content, ammonium N levels, and fermentation losses, but lactate content did not differ. Butyrate was detected in appreciable amounts only in sorghum silage. Propionate was not detected in any silage. Tightly packed silages remained stable upon exposure to air. Tight packing increases the digestibly of nutrients and improves the energy content of silages. These data show that high density limits air infiltration and reduces the oxidation loss during storage and feed-out. As a consequence, more dry matter is recovered and more energy is preserved.

ABSTRACT The current study was undertaken to investigate the ensilage characteristics in triticale lines treated by inoculants and their interaction on fermentation metabolites and rumen degradability. Costs were estimated for growing and feeding whole-crop triticale lines for animal production. Triticale hybrids were harvested at the dough stage of maturity (38% dry matter, DM). Plants were chopped approximately 2 cm after harvest and then treated with inoculants and were ensiled in 1.5-L mini laboratory silos. Two lactic acid bacterial inoculants with enzymes (LAB+enzymes I: Pediococcus acidilactici, Lactobacillus plantarum, and Streptococcus faecium with cellulase, hemicellulase, pentosanase, and amylase; LAB+enzyme II: P. acidilactici, L. plantarum, and amylase) were used as silage additives. Inoculants were applied at 1.5 × 105 cfu/g chopped fresh material. Silages with no additive served as the control. Four jars per treatment were sampled on day 60 after ensiling for chemical and microbiological analysis. At the end of the ensiling period (60 day), the silages were subjected to an aerobic stability test. The nutrient degradability of silages was determined in situ. Overall, there were no obvious interactions between triticale lines and the treatments for any of the parameters measured. The fermentation and nutritive value of silages were affected by treatments. LAB+enzymes increased the concentrations of lactic acid of the triticale silages and decreased the concentrations of butyric acid, total alcohols, and ammonia-N. Under aerobic conditions, LAB+enzyme treated silages had lower pH, CO2 production, and number of yeasts. Fibrous fractions were decreased with the application of LAB+enzymes. The 48 h in situ organic matter, DM, and neutral detergent fiber digestibility of the silages were enhanced by treatments. Addition LAB+enzymes to dough stage triticale silage reduces proteolysis; the inoculant possess antimicrobial properties and improves fermentation and nutritional value. The economic results are favorable financially for growing winter triticale as an animal feed in Mediterranean-type climates.

Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction., (Sociedad Argentina de Pediatría.)