The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery.

BACKGROUND: The Modified Early Warning Score (MEWS) was proposed for early identification of patients deterioration. The purpose of this study was to determine if MEWS calculation can help the anaesthesist select the correct level of care to avoid inappropriate admission to the ICU and to enhance the use of the High Dependency Unit (HDU) after emergency surgical procedures. METHODS: Emergency surgical patients admitted before MEWS application (Jan 2008-Mar 2009) were included in the control group, whereas emergency surgical patients after MEWS introduction constituted the intervention group (Apr 2009-Jan 2010). Admission diagnosis was included into three groups for data analysis: acute abdomen (intestinal occlusion, bowel perforation, intestinal ischemia), non-complicated surgery (hernia recurrence, cholecystitis, appendicitis), and blunt abdominal trauma. In intervention group, MEWS was calculated by the anaesthesists on duty before and after surgical procedure. Patients with a MEWS of 3 or 4 were transferred to the HDU, whereas a MEWS score of 5 or more was considered criteria for ICU admission. RESULTS: A total of 1082 patients were enrolled in this study. The control group was made up of 604 patients, whereas the MEWS group included 478 patients. Baseline and clinical status were comparable between groups. After MEWS introduction, HDU admissions significantly increased from 14% to 21% (P=0.0008), with a significant decrease of ICU admissions (from 11% to 5%; P=0.0010). Mortality rate analysis did not differ between groups. CONCLUSION: This study suggests that the use of a simple and reproducible score system may help in reducing ICU admissions after emergency surgery.

Environmental exposure to organophosphate pesticides: assessment of endocrine disruption and hepatotoxicity in pregnant women.

In utero exposure is the first point of contact with environmental xenobiotics that may affect the maternal-placental-fetal balance. Considering that maternal pathophysiological changes affect intrauterine development, this pilot study was conducted to address how environmental exposure to organophosphate pesticides (OPs) during pregnancy may contribute to maternal endocrine disruption and disturbed hepatic function. A prospective study was carried out with pregnant women (n=97) living in a rural area of the Rio Negro province where OPs are intensively applied throughout 6 months of the year. Blood samples were obtained and biomarkers of OPs exposure (cholinesterases and ß-glucuronidase), cortisol (CT) and progesterone (PG) levels, as well as glycemia, were determined. Parameters of liver injury were assayed by measuring aspartate aminotransferase (AST) and alanine aminotransferase (ALT); liver function was assayed by measuring albumin. Biomonitoring carried out during the pre-spraying period (PreS) and spraying period (SP) showed that the population studied was exposed to OPs, proven by the fact that plasma (PCh) and erythrocyte cholinesterase (AChE) decreased very significantly (p<0.01) during SP. CT values increased very significantly (p<0.01) in the first trimester of pregnancy during SP with respect to PreS. Individual values above the upper limit of the CT and PG reference range were found both in PreS and SP. This finding could be associated with changes in hormone metabolism pathways produced by OPs exposure. During the second trimester of pregnancy there were increases in ALT values and the AST/ALT ratio in SP, suggesting subclinical hepatotoxicity. In SP, glycemia was unchanged while albuminemia increased. Although anthropometric newborn parameters and pregnancy alterations were within normal values for the general population, the increase in CT in the maternal compartment may lead to impaired newborn health later in life.

Evaluation of the adherence to a new potassium chloride storage and handling hospital protocol: an observational study.

The study aim to deal with problem of manage potassium chloride concentrate solution after the introduction of a new protocol on correct use (storage and handling) of these drugs in a high specialization-teaching hospital. The study, conducted from January 2009 to March 2009, was divided in two part: observation of the compliance of concentrated electrolytes solutions storage in 14 wards and prospective observational study on the compliance to the new protocol in the steps of prescription, preparation and administration of these drugs. 49 preparations and administrations of electrolytes solutions were observed. Medical prescriptions were made in a dedicated schedule in 40.8% (20/49), in therapy sheet in 36.7% (18/49), in 14.3% (7/49) the prescription was verbal and after written. Patient identified data was present in 85.7% of cases, solvent type in 61.2%, prescription date in 69.4%, prescription hour in 10.2%, signature of prescriptor in 77.6%, administration speed in 57.1%, administration date in 71.4%, administration hour in 32.7%. Data show a scarce knowledge of the protocol by the physicians or a difficulty in using an additional schedule respect to the existent. Lack of the prescriptor's signature was an important problem such as the absence of speed, date and hour of administration.

Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor.

BACKGROUND: Vitamin D is involved in immune regulation in humans. Vitamin D serum deficiency is reported to be common in hospitalized patients, especially among Intensive Care Unit (ICU) patients. Our aim was to evaluate the relationship between vitamin D levels in septic patients and outcome. METHODS: A total of 170 patients were studied, of which 92 were severe sepsis/septic shock patients, and 72 were major trauma patients, as an age-matched control group. Exclusion criteria were: age <18 years (y), malnutrition state, pregnancy, breast feeding, chemotherapy, immunotherapy, pathologies affecting bone and calcium metabolism, vitamin D metabolism derangement for therapy, hematological and solid malignancies, and HIV. Vitamin D levels were measured by radioimmunoassay at admission. RESULTS: Median vitamin D levels at admission to ICU were 10.1 ng/mL in the sepsis group and 18.4 ng/mL in the trauma group (P<0.0001). In univariate analysis, mortality rate in septic patients was significantly correlated with age, gender, SAPS II, vitamin D level at admission, duration of mechanical ventilation, and ICU/hospital length of stay, however, the multivariate logistic regression model confirmed significance only for age. CONCLUSION: In our cohort, septic patients showed a significantly lower vitamin D level than trauma patients in comparison to age cohort patients with the same demographic/clinical characteristics, but no clear relationship between vitamin D level and outcome was found. Further studies with larger samples are needed to clarify the prognostic role of vitamin D and nutraceutical interventions in critically ill patients.

Ausência de mutagenicidade e antimutagenicidade do extrato obtido das flores do ipê roxo [Tabebuia impetiginosa (Mart. ex DC.) Standl.] / Absence of mutagenicity and antimutagenicity of the extract obtained from the flowers of "ipê roxo" Tabebuia impetiginosa (Mart. ex DC.) Standl

A Tabebuia impetiginosa, conhecida popularmente como ipê-roxo, é uma planta nativa das florestas tropicais chuvosas da América do Sul e Central. Componentes químicos obtidos da casca têm mostrado efeito terapêutico, como antiinflamatório, antifúngico e antibacteriano. Porém, pela falta de dados na literatura, pouco se sabe sobre os efeitos do extrato das flores. Assim, o objetivo do presente trabalho foi avaliar o potencial mutagênico e antimutagênico do extrato obtido das flores da T. impetiginosa, em três diferentes concentrações (100, 300 e 500 mg kg-1 p.c.) pelo teste do micronúcleo. Para o teste de mutagenicidade, a doxorrubicina (DXR, 90 mg kg-1 p.c.) foi utilizada como indutor de danos no DNA e para o teste de antimutagenicidade, os tratamentos com o extrato foram realizados simultaneamente com este agente químico. O sangue periférico dos animais foi coletado 24 horas após os tratamentos. A comparação da frequência de eritrócitos policromáticos (PCEs) em 400 eritrócitos/animal entre os diferentes grupos não demonstrou qualquer citotoxicidade do extrato. Em relação às frequências de micronúcleos em PCEs (PCEMNs), não foram observadas diferenças significativas entre os grupos tratados com as diferentes concentrações de extrato e o controle negativo. Da mesma forma, todos os grupos de animais que receberam os tratamentos simultâneo do extrato (100, 300 ou 500 mg kg-1 p.c.) com a DXR, apresentaram valores de PCEMNs muito próximos quando comparados com os dados observados no grupo de animais que recebeu somente a DXR. Esses resultados apresentados indicam ausência de efeito mutagênico e antimutagênico do extrato obtido das flores da T. impetiginosa em sistema teste in vivo.

T. impetiginosa, known as "ipê-roxo", is a plant native to tropical rain forests of Central and South Americas. Chemical compounds obtained from its bark have shown anti-inflammatory, antifungal and antibacterial therapeutic effect. However, due to the lack of data in the literature, little is known about the effects of its flower extract. Thus, the aim of this study was to evaluate the mutagenic and antimutagenic potential of the extract obtained from T. impetiginosa flowers at three different concentrations (100, 300 and 500 mg kg-1 p.c.) by the micronucleus test. For the mutagenicity test, doxorubicin (DXR, 90 mg kg-1 p.c.) was used as DNA-damage inducer, while for the antimutagenicity test, treatments with the extract were performed simultaneously with this chemical agent. The peripheral blood of animals was collected 24 hours after the treatments. The frequency of polychromatic erythrocytes (PCEs) in 400 erythrocytes/animal was compared among the different groups and showed no extract cytotoxicity. As regards the frequency of micronuclei in PCEs (PCEMNs), there were no significant differences between the groups treated with different concentrations of extract and the negative control. Similarly, all groups of animals that received the simultaneous extract treatments (100, 300 or 500 mg kg-1 p.c.) with DXR showed very similar values of PCEMNs when compared with the data observed for the group of animals that received DXR alone. These results indicate no mutagenic and antimutagenic effect of the extract obtained from T. impetiginosa flowers in the testing system in vivo.

Low-dose dopamine in kidney transplantation.

BACKGROUND: The use of low-dose dopamine (LDD; 0.5-2.5 mug/kg/min) in kidney transplant recipients seeks to increase urine output, prevent arterial vasospasm, and reduce the incidence of acute tubular necrosis. The aim of this study was to evaluate the effect of LDD in the early postoperative period (12 hours) among kidney transplant recipients. METHODS: We studied all kidney transplant recipients admitted to the Intensive Care Unit (ICU) in the early postoperative period from January 2004 to December 2008. A total of 105 patients were retrospectively assigned to two groups: group A (n = 57) was treated with LDD and group B (n = 48), not treated with LDD. All patients otherwise received the same therapy. Blood sample analysis and kidney function were recorded at 0, 6, and 12 hours after admission. For each patient, we collected the following data: donor and transplant kidney features, recipient demographics, intraoperative events, hemodynamic and kidney function parameters in the ICU, and outcomes. Patients were followed for 6 months after ICU discharge. RESULTS: Hourly diuresis and kidney function parameters showed no significant difference between the groups. Significant differences between group A and group B were observed in heart rate (92.63 +/- 14.18 vs 82.87 +/- 13.5, respectively), hours of ICU length of stay (29.0 +/- 17.42 vs 20.43 +/- 7.35, respectively), and 6-month mortality rate (8.8% vs 0%, respectively; P < .05). CONCLUSION: LDD prescription in kidney transplantation neither improved kidney function during the postoperative period nor short-term outcomes, but was associated with an increased heart rate, ICU length of stay and 6-month mortality.

Role of oxidative stress as physiopathologic factor in the preterm infant.

Oxidative stress usually occurs when the production of damaging free radicals (ROS) and other oxidative molecules exceeds the capacity of the body's antioxidant defenses. This process is supposed to begin after the delivery, but it can even affect the fetus when maternal pregnancy diseases (i.e.: pre-eclampsia, eclampsia, maternal infections) occur and in the case of preterm delivery. Most living organisms have developed well integrated antioxidant defenses to prevent the potential negative role of the ROS, in order to scavenge them and to control their concentration. These mechanisms are deficient in preterm newborn. Many illnesses in preterm infants, including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), brain injury such as hypoxic/ischemic encephalopathy, and intraventricular hemorrhage (IVH) are thought to be related to the action of ROS. This presumably occurs due to the fact that the antioxidant system of preterm infants is at the same time highly stressed and incompletely developed. Unfortunately, the clinical trials which tried to prevent oxidative stress using antioxidant agents failed their objective and therefore they cannot be considered as an effective therapy. The objective of this review is to clarify the role of oxidative stress in the development of the previous severe diseases in preterm infants, and its possible correlation with hyperbilirubemia.

Cytogenetic study of chronic ethanol consumption in rats.

Ethanol was supplied in the drinking water of Wistar rats at a concentration of 20% v/v for up to 30 days. The animals treated with ethanol demonstrated a nonsignificant increase in chromosomal aberration frequency when compared with control animals. The mitotic index values obtained indicated no significant differences between ethanol treatment and control groups. The final weights of control rats were significantly greater than those of the ethanol-treated group. Chronic administration of ethanol showed no clastogenic or cytotoxic effect. After chronic ethanol consumption, the cytochromes P450 activity increases, thus possibly preventing the ethanol that has entered the circulation from reaching excessive levels, leading to metabolic adaptation and/or tolerance.

Comparative study of the effects of vitamin C and bleomycin on smokers' and non-smokers' lymphocytes in clastogenicity assays.

Free radicals are products of metabolic reactions and of external factors that can injure different biological molecules. However, different antioxidant agents can prevent the action of these reactive species and the damage they cause. Vitamin C (VC) is an important micronutrient found in the diet, which presents defense mechanisms against the free radicals that challenge the cells of the organism. The objective of the present study was to investigate the effect of VC as a modulator of the damage induced in DNA by bleomycin (BLM) in lymphocytes from smokers and non-smokers. The difference in response to the mutagenic potential of BLM between smokers and non-smokers was also investigated. Peripheral blood lymphocyte cultures were treated simultaneously with BLM (20 microg/ml) and/or VC (100, 200, and 400 microg/ml) in the G2 phase of the cell cycle. The results obtained did not demonstrate a statistically significant difference in the response to the antitumor agent BLM between smokers and non-smokers. The data also showed that VC had no significant modulating effect on the frequency of chromosome aberrations induced by BLM in the cells of smokers and non-smokers under the experimental conditions used.

[Collection of autologous blood during pregnancy and fetal safety. Computer analysis of fetal heart rate]. / Predonazione di sangue autologo in corso di gravidanza e sicurezza fetale. Analisi computerizzata dell'attività cardiaca fetale.

BACKGROUND: This study aims at objectively evaluating the impact on the fetus of a sudden maternal blood withdrawal, through a computer analysis of the various aspects of the cardiotocographic pattern before and after one autologous blood unit predonation from near term pregnant women. METHODS: For the collection of cardiotocographic data, a Sonicaid Team fetal monitor was used; it is a monitoring system which uses Doppler ultrasound impulses and autocorrelates the received Doppler signals with varied signals of frequency, connected to Sonicaid System 8000, a program for "objective" cardiotocographic analysis according to the so-called Dawes-Redman criteria. RESULTS: From the statistic comparison of Non Stress Tests preceeding and following predonation, some statistically significant differences have sometimes emerged on the level of specific parameters. CONCLUSIONS: In particular, the general variation of fetal heart frequency and fetal reactivity resulted higher after predonation, even though they were within absolute normality, justifying the suspicion that the stress of autologous predonation practice might produce some indefinite disturbance to fetal activity/rest rhythm.

Protective effects of the amino acid glutamine and of ascorbic acid against chromosomal damage induced by doxorubicin in mammalian cells.

The interaction of antioxidants can provide an essential protection against the damaging effects of free radicals. Beneficial interactions include radioprotection, protection against acute toxicity of chemicals, and antimutagenic and anticarcinogenic activity. The present study was undertaken to evaluate the protective effect of the amino acid glutamine (GLN) and ascorbic acid (AA) on the frequency of chromosomal aberrations induced by the antineoplastic agent doxorubicin (DXR). These micronutrients were tested separately and simultaneously in Wistar rat bone marrow and Chinese hamster ovary (CHO) cells. The treatments with GLN and/or AA significantly decreased the frequency of DXR-induced clastogenic damage in both test systems.