Comparison of Hemodynamic Effects of Dobutamine and Ephedrine Infusions in Isoflurane-Anesthetized Horses.

The objective of this study was to compare the hemodynamic effects of dobutamine and ephedrine during the management of anesthesia-related hypotension in healthy horses. Thirteen horses underwent general anesthesia with isoflurane and were randomly divided into two different groups, one of which received a dobutamine constant rate infusion (CRI) (1 µg/kg bwt/min) and the other received an ephedrine CRI (20 µg/kg bwt/min) when hypotension (<60 mmHg) was identified, following up to 15 min after the blood pressure reached 70 mmHg. All horses were equipped with a pulmonary artery catheter and a peripheral artery catheter, and multiparameter monitoring commenced as soon as they were under mechanical ventilation. Hemodynamic parameters were recorded, while tissue perfusion markers (peripheral oxygen saturation, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, arterial pH, arterial plasma bicarbonate concentration, arterial oxygen saturation, mixed venous oxygen saturation, mixed venous oxygen content, arterial oxygen content, arteriovenous oxygen difference, oxygen delivery index, oxygen consumption index, and oxygen extraction ratio), serum lactate concentration, and troponin I concentrations were analyzed before the start of infusions (T0), when the blood pressure reached 70 mmHg (T1), and 15 min after T1 (T2). The time to restore the arterial pressure was similar in both groups (p > 0.05); however, the heart rate was higher in the ephedrine group (p = 0.0098), and sinus bradyarrhythmia occurred in the dobutamine group. Furthermore, both experimental protocols increased cardiac output (p = 0.0012), cardiac index (p = 0.0013), systemic vascular resistance (p = 0.008), systemic vascular resistance index (p < 0.001), and ameliorated perfusion markers. In the dobutamine group, the pulmonary artery wedge pressure (p < 0.001) and systolic index (p = 0.003) were elevated, while the arteriovenous oxygen difference was reduced in the ephedrine group (p = 0.02). Troponin I was used as a myocardial injury indicator, and did not differ between moments or between groups (p > 0.05). We concluded that both drugs were effective and safe to treat anesthetic hypotension under the conditions of this study.

Predictors of short-term mortality in HIV-infected patients admitted to intensive care unit / Fatores preditores de mortalidade de curto prazo em pacientes infectados com HIV admitidos em unidade de terapia intensiva

INTRODUCTIONn: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. OBJECTIVE: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. METHODS: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. RESULTS: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% between 2003 and 2012. Among the risk factors for mortality were low albumin, high APACHE, low CD4+ T lymphocyte count, and not using antiretroviral therapy. CONCLUSION: Despite the availability of diagnosis and treatment for HIV-infected individuals, the number of new cases of advanced Aids diagnosed in high-complexity services such as ICU is high, as well as the non-use of combination antiretroviral therapy. It is necessary to strengthen anti-HIV screening to detect and treat more cases in the early stages.

INTRODUÇÃO: Historicamente, as complicações da infecção pelo HIV estavam relacionadas às internações em Unidade de Terapia Intensiva (UTI). Apesar dos avanços terapêuticos, os fatores prognósticos em pacientes com HIV/AIDS têm variado, incluindo diagnóstico tardio e não adesão ao tratamento antirretroviral. OBJETIVO: Avaliar os fatores preditores de mortalidade a curto prazo em pacientes infectados pelo HIV internados em UTI, bem como suas características sociodemográficas e clínicas. MÉTODOS: Estudo de coorte retrospectivo incluindo pacientes internados na UTI de um hospital universitário entre 2003 a 2012. Os dados foram coletados dos prontuários médicos após a aprovação pelo Comitê de Ética em Pesquisa com Seres Humanos. RESULTADOS: 148 pacientes infectados pelo HIV foram identificados e 131 eram elegíveis. Entre os pacientes incluídos, 42,75% possuíam diagnósticos recente de HIV e 5,34% não possuíam informação sobre o momento do diagnóstico. Os principais motivos de admissão na UTI foram insuficiência respiratória e sepse, enquanto a mortalidade foi 70,23% entre 2003 e 2012. Entre os fatores de risco para mortalidade identificou-se albumina baixa, APACHE alto, baixa contagem de linfócitos T CD4+ e não uso de terapia antirretroviral. CONCLUSÃO: Apesar da disponibilidade de diagnóstico e tratamento para indivíduos infectados pelo HIV, é elevado o número de casos novos em estágio avançado de Aids diagnosticados em serviços de alta complexidade, como UTI, e o não uso de terapia antirretroviral combinada. É necessário fortalecer a triagem anti-HIV, bem como aumentar a repetição da testagem anti-HIV para detectar e tratar mais casos em estágios iniciais.

Efeito da reabilitação cardiopulmonar e metabólica em pacientes que apresentaram dessaturação da oxihemoglobina induzida pelo exercício após alta hospitalar pela COVID-19: série de casos / Effect of cardiopulmonary and metabolic rehabilitation in patients with exercise-induced oxyhemoglobin desaturation after hospital discharge from COVID-19: case series

INTRODUÇÃO: A dessaturação da oxihemoglobina induzida pelo exercício em pacientes pós-COVID-19 parece estar associada à redução da difusão e dos volumes pulmonares, à maior dispneia e baixa capacidade funcional, sendo relacionada à maior mortalidade e pior prognóstico. A reabilitação cardiopulmonar e metabólica (RCPM) é relevante, pois visa restaurar a funcionalidade, tolerância ao esforço e a qualidade de vida (QV). OBJETIVO: Verificar os efeitos da RCPM em pacientes que apresentaram dessaturação da oxihemoglobina induzida pelo exercício após alta hospitalar pela COVID-19 e ainda observar a diferença entre os treinamentos contínuo de moderada intensidade (TCMI) e o intervalado de alta intensidade (TIAI) na tolerância ao esforço, nos sintomas e na QV. MÉTODOS: Trata-se do relato de uma série de 4 casos que foram hospitalizados por COVID-19 e que após alta hospitalar apresentaram dessaturação da oxihemoglobina induzida pelo esforço durante o teste do degrau de 6 minutos (TD6). Os pacientes foram avaliados por meio de espirometria de repouso, mensuração da força da musculatura inspiratória, TD6, teste da caminhada de 6 minutos (TC6), teste de repetições máximas do quadríceps e bíceps braquial e responderam ao questionário SF-36 de QV. Submetidos a um protocolo de treinamento contendo treino da musculatura inspiratória e treino resistido para grandes grupos musculares, adicionalmente, 2 pacientes fizeram TCMI (com 60-80% da frequência cárdica de reserva (FCR)) e 2 TIAI (com 40% da FCR na fase off, durante 4 minutos e 80 a 100%, na fase on, durante 2 minutos) em esteira por 30 minutos e, por fim, após 3 meses foram reavaliados. RESULTADOS: Observouse aumento da tolerância ao esforço, da força muscular inspiratória e periférica, além da melhora da QV e redução dos sintomas em todos os pacientes após a RCPM, porém houve incrementos maiores nos pacientes submetidos ao TIAI comparados ao TCMI na distância percorrida em metros (caso 1- 156 (23% de incremento); caso 3 - 168 (40%)) versus (caso 2 e 4 - 60 metros, com incrementos de 9% e 14%, respectivamente) e maior número de degraus (caso 1- 28 (23% de aumento); caso 3- 37 (34%)) versus (caso 2 ­ 2 (2% incremento); caso 4 - 15 (21%)). CONCLUSÃO: A RCPM apresentou efeitos positivos, com incremento da capacidade funcional e melhora da QV, além da redução dos sintomas durante o esforço, particularmente nos pacientes submetidos ao TIAI.

INTRODUCTION: Exercise-induced oxyhemoglobin desaturation in post-COVID-19 patients appears to be associated with reduced diffusion and lung volumes, greater dyspnea and low functional capacity, being related to higher mortality and worse prognosis. Cardiopulmonary and metabolic rehabilitation (CPMR) is relevant, as it aims to restore functionality, exercise tolerance and quality of life (QoL). OBJECTIVE: To verify the effects of CPMR in patients who presented exercise-induced oxyhemoglobin desaturation after hospital discharge due to COVID-19 and also to observe the difference between moderate-intensity continuous training (MICT) and high intensity interval training (HIIT) on effort tolerance, symptoms and QoL. METHODS: This is the report of a series of 4 cases who were hospitalized for COVID-19 and who, after hospital discharge, presented exertion-induced oxyhemoglobin desaturation during the 6-minute step test (6MST). Patients were assessed using spirometry at rest, measurement of inspiratory muscle strength, 6MST, 6-minute walk test (6MWT), quadriceps and biceps brachii maximum repetitions test, and answered the SF-36 QoL questionnaire. Submitted to a training protocol containing training of the inspiratory muscles and resistance training for large muscle groups, additionally, 2 patients underwent CMIT (with 60-80% of heart rate reserve) and 2 HIIT (with 40% of HR reserve in the off, for 4 minutes and 80 to 100%, in the on phase, for 2 minutes) on a treadmill for 30 minutes, finally, after 3 months, they were reassessed. RESULTS: There was an increase in effort tolerance, inspiratory and peripheral muscle strength, in addition to an improvement in QoL and a reduction in symptoms in all patients after CPMR, but there were greater increments in patients submitted to HIIT compared to CMIT in the distance covered in meters (case 1 - 156 (23% increment); case 3 - 168 (40%)) versus (case 2 and 4 - 60 meters, with increments of 9% and 14%, respectively) and greater number of steps (case 1 - 28 (23% increase); case 3- 37 (34%)) versus (case 2 ­ 2 (2% increment); case 4 - 15 (21%)). CONCLUSION: CPMR had positive effects, with an increase in functional capacity and improvement in QoL, in addition to a reduction in symptoms during exertion, particularly in patients undergoing HIIT.

Effects of a stepwise alveolar recruitment maneuver on lung volume distribution in dogs assessed by computed tomography.

Background: Pulmonary atelectasis is a commonly occurs during anesthesia. In these cases, mechanical ventilation (MV) associated with alveolar recruitment maneuvers (ARMs) and positive end-expiratory pressure (PEEP) is indicated to reverse the condition, ensure adequate gas exchange and improve oxygenation. ARMs can trigger volutrauma, barotrauma, and atelectrauma. Therefore, computed tomography (CT) is the gold-standard method for monitoring lung aeration after ARM. Objective: To evaluate lung volume distribution after stepwise ARMs using computed tomography (CT). Methods: Twelve dogs weighing 24.0 ± 6.0 kg, aged 3 ± 1 years, of both sexes and different breeds, underwent orchiectomy or ovariohysterectomy. The animals were anesthetized and ventilated in volume-controlled mode. ARMs were then initiated by positive end-expiratory pressure (PEEP) titration (5, 10, 15, and 20 cmH2O). CT scans, cardiovascular parameters, and ventilatory mechanics were evaluated at all time points. Data were assessed for normality using the Shapiro-Wilk test and a two-way analysis of variance, followed by a post-hoc Bonferroni test to identify differences between time points. Statistical significance was attributed to a value of p of <0.05. Results: CT demonstrated that the ARMs increased ventilation throughout the lung, including the dependent regions, with volumes that increased and decreased proportionally with PEEP titration. When they reached PEEP 10 and 5 cmH2O descending (d), they remained significantly higher than those in PEEP 0 cmH2O (baseline). Static compliance improved about 40% at PEEP 10d and PEEP 5d compared to baseline. There was an increase in heart rate (HR) from PEEP 15 increasing (i) (74.5%) to PEEP 10d (54.8%) compared to baseline. Mean arterial blood pressure (MABP) decreased approximately 9% from PEEP 15i to PEEP 15d compared to baseline. Conclusion: Lung attenuation and regional and global volumes assessed by CT showed that maximum pulmonary aeration distribution followed by PEEP titration occurred at PEEP 20 cmH2O, maintaining the lungs normoaerated and without hyperaeration.

The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.

Background: Electrical impedance tomography (EIT) has been an essential tool for assessing pulmonary ventilation in several situations, such as the alveolar recruitment maneuver (ARM) in PEEP titration to maintain the lungs open after atelectasis reversion. In the same way as in humans and dogs, in horses, this tool has been widely used to assess pulmonary aeration undergoing anesthesia, mechanical ventilation, recruitment maneuver, standing horses, or specific procedures. Objectives: The present study aimed to evaluate the distribution of regional ventilation during ARM based on lung monitoring assessment by EIT, with a focus on better recruitment associated with less or no overdistention. Methods: Fourteen horses of 306 ± 21 kg undergoing isoflurane anesthesia in dorsal recumbency were used. The animals were mechanically ventilated with a tidal volume of 14 ml kg-1 and a respiratory rate of 7-9. An alveolar recruitment maneuver was instituted, increasing the PEEP by five cmH2O every 5 min until 32 cmH2O and decreasing it by five cmH2O every 5 min to 7 cmH2O. At each step of PEEP, arterial blood samples were collected for blood gas analysis, EIT images, hemodynamic, and respiratory mechanics. Results: Associated with the CoV-DV increase, there was a significant decrease in the DSS during the ARM and a significant increase in the NSS when PEEP was applied above 12 cmH2O compared to baseline. The ComplROI showed a significant increase in the dependent area and a significant decrease in the non-dependent area during ARM, and both were compared to their baseline values. The driving pressure decreased significantly during the ARM, and Cst, PaO2, and PaO2/FiO2 ratio increased significantly. The VD/VT decreased significantly at DEPEEP17 and DEPEEP12. There was an HR increase at INPEEP27, INPEEP 32, and DEPEEP17 (p < 0.0001; p < 0.0001; and p < 0.05, respectively), those values being above the normal reference range for the species. The SAP, MAP, DAP, CI, and DO2I significantly decreased INPEEP32 (p < 0.05). Conclusion: The ARM by PEEP titration applied in the present study showed better ventilation distribution associated with better aeration in the dependent lung areas, with minimal overdistention between PEEP 17 and 12 cmH2O decreasing step. Those changes were also followed by improvements in static and regional compliance associated with increased oxygenation and pulmonary ventilation. ARM promoted a transitory decrease in arterial blood pressure and depression in CI with a concomitant drop in oxygen delivery, which should be best investigated before its routine use in clinical cases.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block in dogs undergoing ovariectomy.

Background: In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluate the analgesic efficacy of TAP block, guided by ultrasound in female dogs submitted to ovariectomy. Methods: Therefore, 32 animals randomly assigned in two groups (n = 16) were used. Groups consisted of TAP block control (TBC) which received water injection (0.2 ml kg-1 point), and TAP block bupivacaine (TBB) which received bupivacaine (0.2 ml kg-1 point at 0.25%); both groups were submitted to four-point approach. Animals were pre-medicated with acepromazine (0.03 mg kg-1) and meperidine (2 mg kg-1) IM, propofol was used as anesthetic induction (3-5 mg kg-1) IV, and isoflurane was used to maintain. To standardize groups, the animals received a continuous infusion of remifentanil (0.2µg kg-1 min) and rocuronium (0.6 mg kg-1) IV in the intraoperative period. Variables measured were the heart and respiratory rates, blood pressure, temperature, peripheral oxyhemoglobin saturation, exhaled carbon dioxide concentration, exhaled isoflurane concentration, serum cortisol, analgesia, and sedation. Before the pre-anesthetic medication (Baseline) and 1, 2, 4, 6, and 8 h after extubation, pain and sedation were assessed using a numeric rating scale (NRS), Glasgow composite measure pain scale (GCMPS-SF), and sedation scale. Moreover, serum cortisol was measured at different moments. Results: The results show that in the intraoperative period, there was no significant difference between groups. After surgery, in TBC, 13 out of 16 animals required analgesic rescue, whereas, in TBB, this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed a significant difference when compared to the baseline time in the traction of the first ovary (p < 0.0001), 2 h (p = 0.0441), and 8 h (p = 0.0384) after extubation. In TBB, cortisol showed a significant increase only in the traction of the first ovary and 2 h after extubation (p < 0.0001). Conclusion: The technique using ultrasound-guided TAP block in two points approach by hemiabdomen with 0.2 ml kg-1 bupivacaine 0.25% was effective in providing post-operative analgesia in dogs undergoing ovariectomy.

Integra Project: strengthening social participation in the agenda of health policies, services, and technologies. / Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde.

The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde / Integra Project: strengthening social participation in the agenda of health policies, services, and technologies

Resumo A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Abstract The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

Assessment of Regional Ventilation During Recruitment Maneuver by Electrical Impedance Tomography in Dogs.

BACKGROUND: During protective mechanical ventilation, electrical impedance tomography (EIT) is used to monitor alveolar recruitment maneuvers as well as the distribution of regional ventilation. This technique can infer atelectasis and lung overdistention during mechanical ventilation in anesthetized patients or in the ICU. Changes in lung tissue stretching are evaluated by monitoring the electrical impedance of lung tissue with each respiratory cycle. OBJECTIVE: This study aimed to evaluate the distribution of regional ventilation during recruitment maneuvers based on the variables obtained in pulmonary electrical impedance tomography during protective mechanical ventilation, focusing on better lung recruitment associated with less or no overdistention. METHODS: Prospective clinical study using seven adult client-owned healthy dogs, weighing 25 ± 6 kg, undergoing elective ovariohysterectomy or orchiectomy. The animals were anesthetized and ventilated in volume-controlled mode (7 ml.kg-1) with stepwise PEEP increases from 0 to 20 cmH2O in steps of 5 cmH2O every 5 min and then a stepwise decrease. EIT, respiratory mechanics, oxygenation, and hemodynamic variables were recorded for each PEEP step. RESULTS: The results show that the regional compliance of the dependent lung significantly increased in the PEEP 10 cmH2O decrease step when compared with baseline (p < 0.027), and for the nondependent lung, there was a decrease in compliance at PEEP 20 cmH2O (p = 0.039) compared with baseline. A higher level of PEEP was associated with a significant increase in silent space of the nondependent regions from the PEEP 10 cmH2O increase step (p = 0.048) until the PEEP 15 cmH2O (0.019) decrease step with the highest values at PEEP 20 cmH20 (p = 0.016), returning to baseline values thereafter. Silent space of the dependent regions did not show any significant changes. Drive pressure decreased significantly in the PEEP 10 and 5 cmH2O decrease steps (p = 0.032) accompanied by increased respiratory static compliance in the same PEEP step (p = 0.035 and 0.018, respectively). CONCLUSIONS: The regional ventilation distribution assessed by EIT showed that the best PEEP value for recruitment maintenance, capable of decreasing areas of pulmonary atelectasis in dependent regions promoting less overinflation in nondependent areas, was from 10 to 5 cmH2O decreased steps.

Myofascial Pain Syndrome, myofascial trigger points and trigger points in veterinary medicine: a review / Revisão: Síndrome Dolorosa Miofascial, pontos gatilhos miofascial e pontos gatilhos na medicina veterinária

Myofascial Pain Syndrome (MPS) a is a painful condition related to myofascial trigger points (TP) in skeletal muscle. The aim of this study was to perform a literature review on the etiology, pathophysiology, diagnosis and treatment of MPS in veterinary medicine. The research sites used for this purpose were: Scientific Electronic Library, PubMed and Medline. The inclusion criteria for the papers were: must be written in English; published between 1990 and 2018; include the following keywords: myofascial pain syndrome veterinary/dog/canine/cat/feline/horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Through the review, it was observed that veterinary clinical studies are scarce, and the articles found lack information such as MPS description, incidence and specific treatment techniques in dogs and horses, and no studies in cats were found.(AU)

Síndrome Dolorosa Miofascial (SDM) é uma condição dolorosa relacionada aos pontos gatilhos miofasciais (PG) no músculo esquelético. Este trabalho tem como objetivo realizar uma revisão bibliográfica sobre a etiologia, fisiopatogenia, diagnóstico e tratamento na medicina veterinária. Foram utilizados sites de pesquisas Scientific Electronic Library, Pubmed e Medline. Os critérios de inclusão estabelecidos foram: ser escrito em inglês; no período de 1990 a 2018; ter as palavras chaves para busca: myofascial pain syndrome veterinary/dog/canine/cat/feline/ horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Após a revisão observa-se que faltam estudos clínicos em medicina veterinária, sendo que os artigos encontrados se limitam à descrição, incidência e técnicas pontuais em cães e equinos, não sendo encontradas referencias em felinos.(AU)

Science, Technology and Pharmaceutical Policy on the agenda: contributions from the society to the 16th National Conference on Health. / Ciência, Tecnologia e Assistência Farmacêutica em pauta: contribuições da sociedade para a 16ª Conferência Nacional de Saúde.

The Plenary of the National Health Council (CNS) approved the Resolution 568/2017, convening the 16th National Health Conference to be held in 2019 and decided to promote thematic activities in eight areas, including Pharmaceutical Policy and Science and Technology. CNS partnership with FIOCRUZ and the National School of Pharmacists proposed the 8th National Symposium on Science and Technology and Pharmaceutical Policy, preceded by ten regional preparatory meetings for the symposium throughout the country. The purpose of this article is to present and analyze the results of the first stage of meetings. A participatory methodology was developed for the meetings that included the presentation of problem situations reported in the form of "cases" built by real narratives, fictitious or adapted from reality. Debates in groups and proposals construction, compilation and weighting, with general discussion completed the meetings. The set of 150 proposals from the 5 meetings was read individually by each of the members of the analysis team and pre-categorized. The 5 meetings had a total of 238 participants. Four categories were defined: Health as a right; Consolidation of SUS principles; Adequate and sufficient financing for SUS; Participatory democracy.

O Pleno do Conselho Nacional de Saúde (CNS) aprovou a Resolução nº 568/2017 que convoca a 16ª Conferência Nacional de Saúde, a ser realizada no ano de 2019 e deliberou pela realização de atividades temáticas, em oito áreas, incluindo Assistência Farmacêutica e Ciência e Tecnologia. Uma parceria do CNS com a Fiocruz e a Escola Nacional dos Farmacêuticos propôs a realização do 8º Simpósio Nacional de Ciência e Tecnologia e Assistência Farmacêutica, antecedido por dez encontros regionais preparatórios para o simpósio em todo o país. O objetivo deste artigo é apresentar e analisar os resultados dessa primeira etapa de encontros. Foi desenvolvida uma metodologia participativa para os encontros que inclui a apresentação de situações-problema em forma de "casos" com narrativas reais, fictícias ou adaptadas da realidade. Debates em grupos e construção de propostas, compilação e ponderação, com discussão geral completaram os encontros. As 150 propostas oriundas de cinco encontros foram lidas por cada membro da equipe de análise e pré-categorizado. Esses encontros reuniram 238 participantes. Quatro categorias foram definidas: Saúde como direito; Consolidação dos princípios do SUS; Financiamento adequado e suficiente para o SUS; Democracia participativa.

Postoperative pain and short-term complications after two elective sterilization techniques: ovariohysterectomy or ovariectomy in cats.

BACKGROUND: Surgical sterilization of cats is one of the most commonly performed procedures in veterinary practice and it can be accomplished by two different techniques: ovariohysterectomy (OVH) or ovariectomy (OVE). Although there is an apparent preference for OVH in United States and Canada, OVE seems to be the standard of care in many European countries due to its advantages, such as a smaller surgical incision and potentially less complications associated with surgical manipulation of the uterus. The aim of this randomized, blind, prospective study was to compare postoperative pain and short-term complications in cats undergoing ovariohysterectomy or ovariectomy. METHODS: Twenty female cats were randomly assigned into two groups (OVH, n = 10 and OVE, n = 10). Pain was assessed prior to surgery (baseline) and 1, 2, 4, 8 12 and 24 h after the procedure using pain and sedation scales, physiologic parameters and blood glucose levels. Short-term complications were evaluated in the early postoperative period and reassessed at day 7 and day 10. RESULTS: Changes in cardiovascular parameters were not clinically relevant, however cats in OVH group had higher heart rates at T1 h compared with baseline (p = 0.0184). Blood glucose levels in OVH group were also higher at T1 h compared with baseline (p = 0.0135) and with OVE group (p = 0.0218). Surgical time was higher in OVH group (p = 0.0115). Even though no significant differences in pain scores were observed between groups or time points, cats in OVH group had greater need for rescue analgesia compared with OVE (2/10 and 0/10, respectively). Complications were not observed in any cat during surgery, at days 7 and 10 postoperatively or at discharge. CONCLUSIONS: Both surgical techniques promoted similar intensity of postoperative pain in cats and there were no short-term complications throughout the study's evaluation period. Therefore, both techniques may be indicated for surgical sterilization of cats, according to the surgeon's preference and expertise. Cats that underwent ovariectomy did not require rescue analgesia and surgical time was shorter in that group.

Serratia marcescens harboring SME-4 in Brazil: A silent threat.

The intrinsic polymyxin resistance displayed by Serratia marcescens makes the acquisition of carbapenemase encoding genes a worrisome event. This study report a SME-4-producing S. marcescens isolate causing septic shock in Brazil. The insertion of novel resistance determinants and their consequent spread in our territory is noteworthy.

Small Animal Massage Therapy: A Brief Review and Relevant Observations.

Massage therapy is becoming increasingly popular in human and animal physiotherapy and rehabilitation. Wider application of the technique led to research efforts aimed at providing scientific support to anecdotal beneficial effects, particularly pain relief. Recent studies have shown that massage therapy alters dopamine and serotonin levels, decreases noradrenaline levels, and modulates the immune system. Psychological effects such as reduction of stress and anxiety, with improvement of depressive patients, have been reported in humans. This article set out to review the major aspects of massage therapy based on recent publications on the topic, and to extrapolate concepts and practical aspects described in human physiotherapy to the veterinary patient, particularly the applicability of different techniques in Small Animal Medicine. Indications of massage therapy in small animals include pain relief, orthopedic rehabilitation, Canine Sports Medicine, intensive care, and management of nonspecific edema. Techniques described in this article were originally intended for use in humans and scientific data supporting anecdotal, beneficial effects in domestic animals are still lacking; this fruitful area for research is therefore open to veterinary professionals.

Recognition and behavioral assessment of acute pain in cats: literature review / Reconhecimento e avaliação comportamental da dor aguda em gatos: revisão de literatura

Although pain is considered the 4th vital sign and one of the most frequently observed clinical signs in domestic animals' clinical practice, its treatment is still inadequate despite significant improvement in the last few years. Acute post-operative pain has aroused great interest due to its potential risk of developing into chronic pain, and if not treated properly, it might worsen the recovery and the patient's quality of life. Cats are one of the least studied species of domestic animals regarding pain recognition and control. Some of the difficulties lie in pain assessment and perception. The consensus published in February 2016 about behavioral signs of pain in cats considered some signs to be reliable and sensitive for the assessment of pain in this species in many different clinical conditions, however it still states that more studies will be necessary in order to evaluate its clinical validity and applicability, especially considering the various pain intensities. As an attempt to quantify pain intensity in cats, several types of traditional subjective scales and others that facilitate pain assessment by combining the observation of spontaneous behavioral signals of pain and qualitative response to palpation of surgical wound are used as tools. It is necessary to use specific scales for each type of pain and for each specific animal species so to minimize the subjectivity and the partiality of the observers, reducing bias and improving efficacy, thus leading to a better patient care.(AU)

Embora a dor seja considerada o quarto sinal vital e uma das manifestações mais comumente encontradas na prática médica veterinária dos animais domésticos, seu tratamento ainda é inadequado. A dor aguda pós-operatória tem suscitado grande interesse por seu potencial risco de cronificação caso não adequadamente tratada, podendo piorar a recuperação e a qualidade de vida do paciente. O gato é uma das espécies domésticas menos estudadas no que diz respeito ao reconhecimento e controle da dor, e algumas das dificuldades residem na avaliação e na percepção da dor. O consenso sobre os sinais comportamentais da dor nesta espécie publicado em fevereiro de 2016 considerou alguns sinais como confiáveis e sensíveis para a avaliação da dor em gatos, em toda uma gama de diferentes condições clínicas, porém afirma a necessidade da realização de estudos que analisem a sua validade e aplicabilidade clínica, especialmente em relação a diferentes intensidades de dor. Na tentativa de se quantificar a dor são utilizados vários tipos de escalas subjetivas tradicionais e outras que facilitam a avaliação da efetividade da analgesia, a partir da observação de sinais comportamentais espontâneos indicativos de dor, combinada a uma resposta qualitativa à palpação da ferida cirúrgica. Faz-se necessária a utilização de escalas específicas para o tipo de dor (aguda ou crônica) e para a espécie, de modo a minimizar a subjetividade e a parcialidade dos observadores e possibilitando uma melhor assistência ao paciente.(AU)

[Obtaining drugs for hypertension and diabetes through the Brazilian People's Pharmacy Program: results of the National Health Survey, 2013]. / Obtenção de medicamentos para hipertensão e diabetes no Programa Farmácia Popular do Brasil: resultados da Pesquisa Nacional de Saúde, 2013.

OBJECTIVE: to describe the proportion of hypertensive and diabetic patients who reported getting medicines to control these diseases via the Brazilian People's Pharmacy Program, according to sociodemographic factors. METHODS: this was a population-based descriptive study using 2013 National Health Survey data on individuals aged over 18 years. RESULTS: around one third of hypertensive individuals (35.9%; 95%CI 34.1-37.7) and more than half of those with diabetes (57.4%; 95%CI 54.2-60.2%) had got at least one kind of medication via the Program, there being some differences between the country's regions. Among patients with diabetes, higher rates of getting medication were found in black people (69.4%; 95%CI 60.8-77.9) and those with less schooling (0-8 years) (63.9%; 95%CI 60.2-67.7), with no significant differences between age groups or sex. CONCLUSION: obtaining at least one kind of medication to treat hypertension and diabetes via the Program was high, especially among the underprivileged.

Obtenção de medicamentos para hipertensão e diabetes no Programa Farmácia Popular do Brasil: resultados da Pesquisa Nacional de Saúde, 2013 / Obtaining drugs for hypertension and diabetes through the Brazilian People's Pharmacy Program: results of the National Health Survey, 2013 / Obtención de medicamentos para hipertensión y diabetes en el programa Farmacia Popular de Brasil: resultados de la Encuesta Nacional de Salud, 2013

OBJETIVO: descrever a proporção de hipertensos e diabéticos que referiram obter medicamentos para controle dessas doenças no Programa Farmácia Popular do Brasil (PFPB), segundo características sociodemográficas. MÉTODOS: estudo descritivo de base populacional, com indivíduos adultos (18 anos ou mais), sobre dados da Pesquisa Nacional de Saúde (PNS) 2013. RESULTADOS: cerca de um terço dos indivíduos hipertensos (35,9% - IC95% 34,1;37,7) e mais da metade dos diabéticos (57,4% - IC95% 54,2;60,2) obtiveram pelo menos um medicamento no PFPB, com algumas diferenças entre as grandes regiões brasileiras; para os diabéticos, foram encontradas maiores proporções de obtenção de medicamentos pelo PFPB por indivíduos de cor preta (69,4% - IC95% 60,8;77,9) e com menor nível de escolaridade (≤8 anos de estudo) (63,9% - IC95% 60,2;67,7), sem diferenças significativas entre os grupos etários e sexos. CONCLUSÃO: a obtenção de pelo menos um medicamento para tratamento da hipertensão e diabetes pelo PFPB foi elevada, especialmente nos segmentos menos favorecidos socioeconomicamente.

OBJECTIVE: to describe the proportion of hypertensive and diabetic patients who reported getting medicines to control these diseases via the Brazilian People's Pharmacy Program, according to sociodemographic factors. METHODS: this was a population-based descriptive study using 2013 National Health Survey data on individuals aged over 18 years. RESULTS: around one third of hypertensive individuals (35.9%; 95%CI 34.1-37.7) and more than half of those with diabetes (57.4%; 95%CI 54.2-60.2%) had got at least one kind of medication via the Program, there being some differences between the country's regions. Among patients with diabetes, higher rates of getting medication were found in black people (69.4%; 95%CI 60.8-77.9) and those with less schooling (0-8 years) (63.9%; 95%CI 60.2-67.7), with no significant differences between age groups or sex. CONCLUSION: obtaining at least one kind of medication to treat hypertension and diabetes via the Program was high, especially among the underprivileged.

OBJETIVO: describir la proporción de hipertensos y diabéticos que reportaron conseguir medicamentos para controlar estas enfermedades en el Programa Farmacia Popular de Brasil (PFPB), de acuerdo con factores sociodemográficos. MÉTODOS: estudio descriptivo poblacional, con individuos adultos (18 años o más), con datos de la Encuesta Nacional de Salud (PNS) 2013. RESULTADOS: cerca de un tercio de los individuos hipertensos (35,9%; IC95% 34,1-37,7) y más de la mitad de los diabéticos (57,4%; IC95% 54,2-60,2) obtuvieron al menos un medicamento en el PFPB, con diferencias entre las regiones; entre los diabéticos se encontraron mayores proporciones de obtención de medicamentos por el PFPB en individuos negros (69,4%; IC95% 60,8-77,9) y menor nivel de educación (≤8 años de estudio) (63,9%; IC95% 60,2-67,7), sin diferencias significativas entre los grupos etario o sexo. CONCLUSIÓN: la obtención de al menos un medicamento para el tratamiento de hipertensión y diabetes por el PFPB fui significativo, especialmente en los sectores menos favorecidos socioeconómicamente.

Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil.

OBJECTIVES: The Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil's government announced the "Farmácia Popular" Program (FPP) as a new mechanism to improve the Brazilian population's access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies. The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time. METHODS: It was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps. RESULTS: A growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization. CONCLUSIONS: There has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.

Doses monitoring in radiology: calibration of air kerma-area product (PKA) meters / Monitoração de doses em radiologia: a calibração de medidores do produto kerma-área (PKA)

Objective The authors have sought to study the calibration of a clinical PKA meter (Diamentor E2) and a calibrator for clinical meters (PDC) in the Laboratory of Ionizing Radiation Metrology at Instituto de Energia e Ambiente - Universidade de São Paulo. Materials and Methods Different qualities of both incident and transmitted beams were utilized in conditions similar to a clinical setting, analyzing the influence from the reference dosimeter, from the distance between meters, from the filtration and from the average beam energy. Calibrations were performed directly against a standard 30 cm3 cylindrical chamber or a parallel-plate monitor chamber, and indirectly against the PDC meter. Results The lowest energy dependence was observed for transmitted beams. The cross calibration between the Diamentor E2 and the PDC meters, and the PDC presented the greatest propagation of uncertainties. Conclusion The calibration coefficient of the PDC meter showed to be more stable with voltage, while the Diamentor E2 calibration coefficient was more variable. On the other hand, the PDC meter presented greater uncertainty in readings (5.0%) than with the use of the monitor chamber (3.5%) as a reference. .

Programa farmácia popular no Brasil: uma análise sobre sua relação com o Complexo Econômico-Industrial da Saúde e os programas estratégicos do Governo Federal / Popular pharmacy program in Brazil: an analysis of their relationship with the Economic-Industrial Complex of Health and strategic programs of the Federal Government

No Brasil, o direito de acesso à saúde é um preceito constitucional garantido enquanto dever do Estado, com base em princípios que preveem que este seja universal, integral, igualitário e com controle social. Desta forma, a saúde deve ser compreendida enquanto política pública que articule ações que compreendam os diferentes níveis de complexidade de atenção e a intersetorialidade inerente a este setor.A assistência farmacêutica, prevista enquanto campo de atuação do SUS, está organizada com base em uma Política Nacional aprovada no âmbito do Conselho Nacional de Saúde. As diversas ações que garantam o acesso aos medicamentos essenciais, de forma qualificada e racional, devem ser vistas enquanto parte integrante da Política Nacional de Saúde. Nesta lógica, em 2004, foi criado o Programa Farmácia Popular do Brasil - PFPB. Em caráter complementar às demais ações executadas no campo da assistência farmacêutica, o Programa foi concebido enquanto uma alternativa de acesso aos medicamentos, buscando atender àqueles que pudessem despender de um pequeno valor pelo seu medicamento, permitindo desta forma que os usuários de medicamentos não tivessem interrompido seu tratamento em virtude de dificuldades de acesso. Em 2006, além das parcerias com Estados e Municípios, o Programa foi ampliado através de parcerias com farmácias e drogarias, chamado de “Aqui Tem Farmácia Popular”. Considerando a dimensão do Programa, este trabalho objetivou analisar o Programa Farmácia Popular do Brasil enquanto alternativa de acesso aos medicamentos e sua articulação com as demais ações estratégicas do MS, com base na Política Nacional de Medicamentos e na Política Nacional de Assistência Farmacêutica. Além disso, analisar a relação entre Programa Farmácia Popular do Brasil e o Complexo Econômico- Industrial da Saúde - CEIS, com base na dimensão da dispensação e investimentos feitos pelo Ministério da Saúde, em especial no fortalecimento da oferta de medicamentos genéricos. Ao considerarmos os resultados de capilaridade do Programa, ampliação do número de pessoas atendidas, os valores gastos pelo MS e estímulo aos medicamentos genéricos, é possível afirmar que estes apontam que o PFPB articula-se com o CEIS, na sua dimensão social e econômica, e com as demais ações estratégicas do Governo, fortalecendo o acesso os medicamentos.