Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy.

OBJECTIVE: To compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. STUDY DESIGN: Prospective, randomized, blinded, clinical trial. ANIMALS: A total of 29 female dogs with mammary tumors. METHODS: Premedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 µg kg-1 loading dose (LD) and 1 µg kg-1 hour-1; lidocaine 2 mg kg-1 LD and 3 mg kg-1 hour-1; ketamine 1 mg kg-1 LD and 0.6 mg kg-1 hour-1; n = 14] or FLK (fentanyl 5 µg kg-1 LD and 9 µg kg-1 hour-1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe'Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann-Whitney test. RESULTS: More dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe'Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. CONCLUSIONS AND CLINICAL RELEVANCE: Based on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

Determinação da acurácia do monitor oscilométrico Delta Life DL 1000 na mensuração da pressão arterial em cães anestesiados de diferentes faixas de peso / Evaluation of the accuracy of the Delta Life DL 1000 oscillometric monitor for blood pressure measurement in anesthetized dogs of different weight ranges

Background: Arterial blood pressure is one of the most commonly variables monitored during anesthetic procedures in veterinary patients. The most reliable method for measuring arterial blood pressure in dogs and cats is the direct (invasive) method. However, the oscillometric method is less complex and more practical for clinical routine in small animals. Nevertheless, oscillometric monitors present great variability in accuracy. The present study aimed to determine the accuracy of the Delta Life DL 1000 oscillometric monitor for measurement of systolic, mean and diastolic blood pressures (SAP, MAP and DAP, respectively) in anesthetized dogs of different weight ranges. Materials, Methods & Results: This study was approved by the Institutional Ethics Committee of Animal Use. Fifteen female dogs of different breeds, weighing 11.6 ± 10.0 kg and with a mean age of 48 ± 51 months were used. All animals were scheduled for elective surgery under general anesthesia in the Institution Veterinary Hospital. Dogs were anesthetized with morphine, propofol and isoflurane and had a 20 or 22 gauge catheter introduced into the dorsal pedal artery for continuous, invasive monitoring of SAP, MAP and DAP. A blood pressure cuff was positioned over the middle third of the radius and connected to Delta Life DL 1000 monitor. Oscillometric readings of SAP, MAP and DAP were registered every 5 minutes, and invasive values were simultaneously recorded. Values obtained with both methods were compared (invasive versus oscillometric) by use of the Bland Altman method to determine the bias, standard deviation of bias and 95% limits of agreement. The percentages of errors between the methods within 10 mmHg and within...

Perfil dos casos de abandono do tratamento da tuberculose em um município prioritário mineiro / Cases profile of tuberculosis treatment abandonment in prioritized a Minas Gerais municipality

Introdução: tuberculose é uma doença milenar que ainda constitui um grande problema de saúde pública. É legítima a necessidade de consideração das implicações sociais e epidemiológicas que a TB possui, para o alcance da sua prevenção e controle, e mesmo diante dos esforços já instituídos, o abandono do tratamento tem se tornado cada vez mais frequente. Objetivo: Descrever o perfil dos casos de s abandono do tratamento da tuberculose em um município prioritário mineiro, no período de 2008 a 2017, compreendendo fatores sociodemográficos, clínicos e comportamentais dos indivíduos e do tratamento. Material e Métodos: Trata-se de um estudo do tipo ecológico do tipo série temporal, realizado mediante consulta de dados secundários disponíveis no sistema de Informações de Agravos e Notificação (SINAN). Os dados obtidos foram armazenados e consolidados para cálculo de frequência absoluta e relativa e representados nas tabelas. Resultados: Foram registrados 554 casos de abandono do tratamento de tuberculose, com predomínio do sexo masculino, faixa etária de 30 a 49 anos, pretos, com nível de escolaridade fundamental incompleto, apresentando tuberculose em forma pulmonar, HIV negativos, etilistas e usuários de droga. Entre os casos de abandono há preeminência do HIV negativo, baixa realização de testagem HIV, não realização de tratamento diretamente observado, sendo o serviço de referência especializada como a unidade de acompanhamento da condição de saúde. Conclusão: O perfil encontrado é consoante com os indivíduos de maiores taxas de incidência da doença, bem como com os mais elevados índices de mortalidade pela tuberculose em todo o território nacional. onível de escolaridade do indivíduo apresentou-se como uma característica importante no seguimento do tratamento, assim como a realização do tratamento observado.

Introduction: Tuberculosis is a millenary disease that is still a major public health problem. It is legitimate to consider the social and epidemiological implications of TB in order to achieve its prevention and control. Even with the efforts already made, the abandonment of tuberculosis treatment has become increasingly frequent. Objective: To describe the profile of cases of abandonment of tuberculosis treatment in a prioritized municipality of Minas Gerais state from 2008 to 2017, including sociodemographic, clinical and behavioral factors of individuals and treatment. Material and Methods:This is an ecological study of a time series type, based on secondary data available in the Information system on Diseases of Compulsory Declaration. The obtained data were stored and consolidated for absolute and relative frequency calculation and represented in the tables. Results: A total of 554 cases of abandonment of tuberculosis treatment were registered, with a predominance of males, aged between 30 and 49 years, blacks with incomplete primary education, presenting pulmonary tuberculosis, HIV negative, alcohol users and drug users. Among the cases of abandonment there is a prominence of HIV negative, low HIV testing, not directly observed treatment, and the referral specialized service as the unit for monitoring the health condition. Conclusion: The profile found is consistent with the individuals with the highest incidence rates of the disease, as well as with the highest tuberculosis mortality rates in the country. The level of schooling of the individual was presented as an important characteristic in the follow-up of the treatment, as well as the accomplishment of the observed treatment.

Evaluation of the accuracy and precision of the GE Dash 4000 oscillometric monitor for blood pressure measurement in anesthetized female dogs / Determinação da acurácia do monitor oscilométrico GE Dash 4000 na mensuração da pressão arterial em cadelas anestesiadas

Background: Indirect measurement of arterial blood pressure, such as the oscillometric method, is the most commonly used in clinical practice of dogs and cats. This method measures blood pressure values that are estimates of direct (invasive) arterial blood pressure values. Oscillometric devices are easy to use even for non-experienced personnel. However, there is considerable variation in accuracy and precision of blood pressure values measured by different oscillometric monitors. The present study aimed to determine the accuracy and precision of the GE Dash 4000 oscillometric monitor for arterial blood pressure measurement in anesthetized female dogs.Materials, Methods & Results:Sixteen healthy adult female dogs received 0.3 mg/kg morphine as premedication and were anesthetized with propofol and isoflurane. A 22-gauge catheter was introduced into the dorsal pedal artery and connected to a rigid tubular system and a pressure transducer filled with heparinized solution to allow direct (invasive) measurement of systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP). A blood pressure cuff was positioned proximal to the carpus and connected to the oscillometric device (GE-DASH 4000 monitor) in order to obtain indirect measurements of SAP, MAP and DAP. Cuff width was 40% of limb circumference. During anesthesia, invasive arterial blood pressure values were measured and recorded simultaneously with the oscillometric method. The Bland Altman method was used to evaluate agreement between the methods by calculating the bias (invasive - oscillometric) and limits of agreement. Percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg were calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods.[...](AU)

Evaluation of the accuracy and precision of the GE Dash 4000 oscillometric monitor for blood pressure measurement in anesthetized female dogs / Determinação da acurácia do monitor oscilométrico GE Dash 4000 na mensuração da pressão arterial em cadelas anestesiadas

Background: Indirect measurement of arterial blood pressure, such as the oscillometric method, is the most commonly used in clinical practice of dogs and cats. This method measures blood pressure values that are estimates of direct (invasive) arterial blood pressure values. Oscillometric devices are easy to use even for non-experienced personnel. However, there is considerable variation in accuracy and precision of blood pressure values measured by different oscillometric monitors. The present study aimed to determine the accuracy and precision of the GE Dash 4000 oscillometric monitor for arterial blood pressure measurement in anesthetized female dogs.Materials, Methods & Results:Sixteen healthy adult female dogs received 0.3 mg/kg morphine as premedication and were anesthetized with propofol and isoflurane. A 22-gauge catheter was introduced into the dorsal pedal artery and connected to a rigid tubular system and a pressure transducer filled with heparinized solution to allow direct (invasive) measurement of systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP). A blood pressure cuff was positioned proximal to the carpus and connected to the oscillometric device (GE-DASH 4000 monitor) in order to obtain indirect measurements of SAP, MAP and DAP. Cuff width was 40% of limb circumference. During anesthesia, invasive arterial blood pressure values were measured and recorded simultaneously with the oscillometric method. The Bland Altman method was used to evaluate agreement between the methods by calculating the bias (invasive - oscillometric) and limits of agreement. Percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg were calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods.[...]

Neutralization of toxicological activities of medically-relevant Bothrops snake venoms and relevant toxins by two polyvalent bothropic antivenoms produced in Peru and Brazil.

Snakebite envenoming is a neglected public pathology, affecting especially rural communities or isolated areas of tropical and subtropical Latin American countries. The parenteral administration of antivenom is the mainstay and the only validated treatment of snake bite envenoming. Here, we assess the efficacy of polyspecific anti-Bothrops serum (α-BS) produced in the Instituto Nacional de Salud (INS, Peru) and at the Fundação Ezequiel Dias (FUNED, Brazil), to neutralize the main toxic activities induced by five medically-relevant venoms of: Bothrops atrox, B. barnetti, and B. pictus from Peru, and the Brazilian B. jararaca and B. leucurus, all of them inhabiting different geographical locations. Protein electrophoretic patterns of these venoms showed significant differences in composition, number and intensity of bands. Another goal was to evaluate the efficacy and safety of lyophilized α-BS developed at INS to neutralize the detrimental effects of these venoms using in vivo and in vitro assays. The availability of lyophilized α-BS has relevant significance in its distribution to distant rural communities where the access to antivenom in health facilities is more difficult. Despite the fact that different antigen mixtures were used for immunization during antivenom production, our data showed high toxin-neutralizing activity of α-BS raised against Bothrops venoms. Moreover, the antivenom cross-reacted even against venoms not included in the immunization mixture. Furthermore, we have evaluated the efficacy of both α-BS to neutralize key toxic compounds belonging to the predominant protein families of Bothrops snakes. Most significantly, both α-BS cross-specifically neutralized the main toxicological activities e.g. lethality and hemorrhage induced by these venoms. Thus, our data indicate that both α-BS are equally effective to treat snake bite victims inflicted by Bothrops snakes particularly B. atrox, responsible for the largest numbers of human envenomations in the Amazon regions of some South American countries including Peru and Brazil.

Estado atual do emprego de triglicerídios de cadeia média em nutriçäo enteral e parenteral / Present situation of the use of medium chain triglycerides in enteral and parenteral feeding

Os triglicérides de cadeia média (TCM) já vêm sendo utilizados desde há muito como oferta nutricional suplementar por via oral. Nesta situaçäo sua indicaçäo clínica está bem estabelecida. Nos últimos dez anos, avanços na técnica de solubilizaçäo das gorduras (TCM) tornaram possível a utilizaçäo deste tipo de gordura, de metabolismo rápido, por via venosa. Os primeiros informes da literatura sugerem resultados favoráveis, quando soluçöes endovenosas de TCM säo aplicadas em voluntários normais e em pacientes em pós-operatório. No entanto, näo existem ainda disponíveis informaçöes claras quanto a indicaçöes específicas e ocorrência de efeitos colaterais indesejáveis em situaçäo metabólica crítica. Tendo estes fatos em mente, torna-se de alto interesse a realizaçäo de novos experimentos com o emprego de TCM parenteralmente, para que o acúmulo de dados venha possibilitar consolidaçäo das primeiras impressöes auspiciosas ao uso das emulsöes lipídicas de TCM/TCL associada a esquemas de nutriçäo parenteral e adequar esta nova alternativa energética no armazenamento do suporte nutricional endovenoso