Cardiac output (CO) is an important haemodynamic parameter to monitor in patients during surgery. However, the majority of the techniques for measuring CO have a limited application in veterinary ...practice due to their invasive approach and associated complexity and risks. Transoesophageal echocardiography (TEE) is a technique used to monitor cardiac function in human patients during surgical procedures and allows CO to be measured non-invasively. This prospective clinical study aimed to compare the transoesophageal echocardiography using a transgastric view of the left ventricular outflow tract (LVOT) and the thermodilution (TD) technique for the assessment of CO during mean arterial pressure of 65-80 mmHg (normotension) and <65 mmHg (hypotension) in dogs undergoing elective surgery. Eight dogs were pre-medicated with acepromazine (0.05 mg/kg, IM), tramadol (4 mg/kg, IM) and atropine (0.03 mg/kg, IM), followed by anaesthetic induction with propofol (3-5 mg/kg IV) and maintenance with isoflurane associated with a continuous infusion rate of fentanyl (bolus of 3 μg/kg followed by 0.3 μg/kg/min). The CO was measured by TEE (CO
) and TD (CO
) at the end of expiration during normotension and hypotension (induced by isoflurane).
There was a strong positive correlation between CO
and CO
(r = 0.925; P < 0.0001). The bias between CO
and CO
was 0.14 ± 0.29 L/min (limits of agreement, -0.44 to 0.72 L/min). The percentage error of CO measured by the two methods was 12.32%. In addition, a strong positive correlation was found between CO
and CO
during normotension (r = 0.995; P < 0.0001) and hypotension (r = 0.78; P = 0.0223).
The results of this study indicated that the transgastric view of the LVOT by TEE was a minimally invasive alternative to clinically monitoring CO in dogs during anaesthesia. However, during hypotension, the CO obtained by TEE was less reliable, although still acceptable.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To test the effectiveness and safety of tramadol plus metamizole combined or not with a non-steroidal anti-inflammatory drug (NSAID) for treating moderate to severe chronic neoplastic pain in dogs, ...and its impact on quality of life (QL).
Prospective, uncontrolled, open-label, clinical study.
Sixty nine client-owned dogs with multiple forms of cancer and visual analog scale (VAS) pain score ≥40 after receiving NSAIDs for at least 7 days.
The MN group received metamizole + NSAID, MNT group received metamizole + NSAID + tramadol and MT group received metamizole + tramadol. Pain was scored by the 0 to 100 mm VAS (0 = no pain, 100 = worst pain) and analgesic therapy was considered effective if 25 mm differences in VAS scores were observed between day 0 and the follow ups. The QL was evaluated according to a 0 to 36 scoring method for dogs (0 = worst, 36 = best) and side effects were recorded. Data were registered at day 0 (baseline) and at the first and second follow ups (7 and 14 days after day 0, respectively).
The MN group had less analgesia at day 7 (25%) and day 14 (42%) than MNT (59%, p = 0.0274; 76%, p = 0.0251, respectively) and MT groups (69%, p = 0.0151; 81%, p = 0.0341, respectively). The QL scores were lower in the MN group at the first (score 23) and second follow up (score 26) than in MNT (27, p = 0.0847; 30, p = 0.0002) and MT (28, p = 0.0384; 31, p = 0.0001) groups. Side effects were more commonly observed in the MN group (87%) than in MNT (24%, p < 0.0001) and MT groups (25%, p = 0.0003) at the first follow up.
Tramadol plus metamizole combined or not with NSAID were well tolerated and clinically effective to treat moderate to severe pain in dogs with cancer and improved QL.
The aim of this paper was to compare the incidence of anesthetic complications in diabetic and nondiabetic dogs subjected to phacoemulsification. In total, 30 male and female dogs of different breeds ...were used. The dogs were distributed into two groups: diabetic (DG) (n=15) and control (CG) (n=15). The animals were premedicated with acepromazine (0.03mg/kg) and meperidine (4mg/kg), intramuscularly. After 20 minutes, anesthesia was induced with propofol (2 to 5mg/kg) and maintained with isoflurane. The animals were monitored and the heart rate, respiratory rate, peripheral oxyhemoglobin saturation, end tidal carbon dioxide tension, inspired and expired isoflurane fraction, and invasive arterial pressure were recorded at 10 minute intervals during the surgical procedure. Arterial hemogasometry was performed after anesthetic induction (T0) and at the end of the surgical procedure. Diabetic patients (DG 10±2 years) were older than non-diabetic group (CG 6±2 years). The expired isoflurane fraction after induction was 30% higher in the control group (CG 1.3±0.3%, DG 1.0±0.2%) (p<0.01). The most common anesthetic complication was hypotension. In total, 80% of the diabetic animals (n=12) exhibited mean arterial pressure (MAP) lower than 60mmHg (54±9.6mmHg) after anesthetic induction, and 83% of the hypotensive dogs (n=10) required vasoactive drugs to treat hypotension. Regarding hemodynamic changes, diabetic patients subjected to general anesthesia were more likely to exhibit hypotension which may be due to the response of older animals to the drugs used; however, this change deserves further investigation.
RESUMO: O objetivo do presente estudo foi comparar a incidência de complicações anestésicas em cães diabéticos e não diabéticos submetidos a cirurgia de facoemulsificação. Foram utilizados 30 cães, machos ou fêmeas de diversas raças. Os cães foram distribuídos em dois grupos: diabético (GD) (n=15) e controle (GC) (n=15). Os animais foram pré-tratados com acepromazina (0,03mg/kg) e meperidina (4mg/kg), pela via intramuscular. Após 20 minutos, a indução foi realizada com propofol (2 a 5mg/kg) e a manutenção da anestesia com isofluorano. Os animais foram monitorados e as variáveis de frequência cardíaca, frequência respiratória, saturação oxihemoglobina periférica, concentração dióxido de carbono no final da expiração, fração inspirada e expirada de isofluorano e pressão arterial invasiva, foram registradas em intervalos de 10 minutos durante o procedimento cirúrgico. A hemogasometria arterial foi realizada após a indução (T0) e ao final do procedimento cirúrgico (T40). A idade dos animais do grupo diabético (10±2 anos) foi superior em relação aos animais do grupo controle (6±2 anos) (p<0,0001). A concentração expirada de isofluorano após a indução foi 30% superior nos animais do grupo controle (GC 1,3±0,3%, GD 1,0±0,2%) (p<0,01). A complicação anestésica mais comum foi a hipotensão arterial, 80% dos animais diabéticos (n=12) apresentaram pressão arterial média inferior a 60mmHg (54±9.6 mmHg) após indução anestésica; 83% dos cães hipotensos (n=10) necessitaram de fármacos vasoativos para tratamento da hipotensão. Com relação às alterações hemodinâmicas, os pacientes diabéticos submetidos à anestesia geral foram mais propensos à hipotensão arterial que pode ser decorrente da resposta dos animais mais velhos aos fármacos empregados; entretanto essa alteração merece maior investigação.
Summary
Approximately 3500 children with sickle cell disease (SCD) are born in Brazil each year, but the burden of SCD morbidity is not fully characterised. A large, multi‐centre cohort was ...established to characterise clinical outcomes in the Brazilian SCD population and create the infrastructure to perform genotype‐phenotype association studies. Eligible patients were randomly selected from participating sites and recruited at routine visits. A biorepository of blood samples was created and comprehensive demographic and clinical outcome data were entered in a centralized electronic database. Peripheral blood genome‐wide single nucleotide polymorphism (SNP) genotyping was performed using a customized Transfusion Medicine (TM) Array. A total of 2795 participants at six Brazilian sites were enrolled between 2013 and 2015. The cohort included slight predominance of children <18 years (55·9%) and females (53·0%). Haemoglobin (Hb) SS was the most common SCD genotype (70·7%), followed by HbSC (23%), Sβ0 (3·0%) and Sβ+ (2·9%). SNP data from the TM Array were analysed to evaluate the genetic ancestry of the cohort and revealed significant admixture among the population. Demographics and clinical complications, stratified by age and SCD genotype, are summarized and future studies in this cohort are discussed.
This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever ≥38.0°C. Exclusions are noted. After a commissioned evidence-based review by ...the Agency for Healthcare Research and Quality, an additional extensive and ongoing review of the literature, and supplemental data from published, peer-reviewed studies provided by active investigators, 21 key action statements were derived. For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine the strength of recommendations. When appropriate, parents' values and preferences should be incorporated as part of shared decision-making. For diagnostic testing, the committee has attempted to develop numbers needed to test, and for antimicrobial administration, the committee provided numbers needed to treat. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or ...neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
According to numbers reported by the Hospital in 2015, hemodynamics area makes 3.646 procedures in 2176 patients of which 1767 correspond with coronary diagnoses and 625 coronary surgeries. ...Currently, the Institution has a risk policy which is related to application of methodology and tools for risk analyzing deleting or mitigating; in this way are diminished adverse events which may arise in different process and to put patient's health at risk. This paper presents application results of FMEA methodology for diagnostic procedure and endovascular therapeutic in an ambulatory patient of Cardio Infantil foundation. FMEA Methodology proposes 9 step which were applied to selected procedure. Each step of methodology allowed to identify failure mode and effects, causes and to interpret the results which were obtained through qualification criteria and to do plan improvement plan for failures of high criticality index. After to do the actions of improvement plan is necessary to qualify, again, proposed criteria, in this way is possible to determine impact of implanted actions. The conclusions obtained reflect that this methodology should be incorporated in different management system at Cardio Infantil foundation, mainly, those related to ISO 90001:2015 recent update, which to include approach based on risks as one of fundamental principles.
The Zika virus (ZIKV) epidemic in Brazil occurred in regions where dengue viruses (DENV) are historically endemic. We investigated the differences in adverse pregnancy/infant outcomes in two cohorts ...comprising 114 pregnant women with PCR-confirmed ZIKV infection in Rio de Janeiro, Southeastern Brazil (
= 50) and Manaus, in the north region of the country (
= 64). Prior exposure to DENV was evaluated through plaque reduction neutralizing antibody assays (PRNT 80) and DENV IgG serologies. Potential associations between pregnancy outcomes and Zika attack rates in the two cities were explored. Overall, 31 women (27%) had adverse pregnancy/infant outcomes, 27 in Rio (54%) and 4 in Manaus (6%),
< 0.001. This included 4 pregnancy losses (13%) and 27 infants with abnormalities at birth (24%). A total of 93 women (82%) had evidence of prior DENV exposure, 45 in Rio (90%) and 48 in Manaus (75%). Zika attack rates differed; the rate in Rio was 10.28 cases/10,000 and in Manaus, 0.6 cases/10,000,
< 0.001. Only Zika attack rates (Odds Ratio: 17.6, 95% Confidence Interval 5.6-55.9,
< 0.001) and infection in the first trimester of pregnancy (OR: 4.26, 95% CI 1.4-12.9,
= 0.011) were associated with adverse pregnancy and infant outcomes. Pre-existing immunity to DENV was not associated with outcomes (normal or abnormal) in patients with ZIKV infection during pregnancy.
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