Influence of the storage period on the nutritional and microbiological value of sun-dried brewer's grains / Influencia del período de almacenamiento sobre el valor nutricional y microbiológico de los granos de cervecería secados al sol / Influência do período de estocagem sobre o valor nutricional e microbiológico de grãos de cervejaria secos ao sol

Abstract Background: Brewer's grains, a by-product of the brewery industry, can be included in the diet of ruminants. However, its high humidity makes it difficult to store and preserve. Objective: To evaluate the efficiency of sun dehydration of wet brewer's grains (WBG) and the effect of storage period on its nutritional and microbiological quality. Methods: A completely randomized experimental design was used to evaluate WBG dehydration efficiency, with treatments corresponding to 0, 1, 2, 4, 6, 8, 10, 12, 14 and 16 hours of sun exposure. A second experiment was carried out using also a completely randomizeddesign to evaluated the effect of storage with the following treatments: 0, 10, 20, 30, 60, 90, 120, 150 and 180 days of storage of the dry by-product. Results: Dry matter (DM) content linearly increased with dehydration period. The chemical composition of the dried brewer's grains had no effect as a function of storage period. Indigestible protein (C fraction) increased linearly but did not compromise the cumulative gas production and the in vitro digestibility of DM and protein. Storage time had no effect on fungus population. The maximum aflatoxin value was 45.5 μg/kg, and remained within acceptable limits for bovine feed. Conclusion: Dehydration of WBG in the sun is efficient to guarantee conservation and makes it possible to store the by- product. The storage of the dry by-product for 180 days does not compromise its nutritional or microbiological quality.

Resumen Antecedentes: Los granos de cervecería son un subproducto de la industria cervecera que puede ser incluido en la dieta de rumiantes; sin embargo, su alta húmedad dificulta el almacenamiento y conservación de ese producto. Objetivo: Evaluar la eficiencia de la deshidratación al sol de los granos húmedos de cervecería (WBG) y el efecto del período de almacenamiento sobre su calidad nutricional y microbiológica. Métodos: Para evaluar la eficiencia de la deshidratación de los WBG se utilizó un diseño experimental completamente al azar, con tiempos de tratamiento de 0, 1, 2, 4, 6, 8, 10, 12, 14, y 16 horas de exposición al sol. En un segundo experimento, también con diseño experimental completamente al azar, se evaluó el efecto del almacenamiento comparando los siguientes tratamientos: 0, 10, 20, 30, 60, 90, 120, 150 y 180 días de almacenamiento del subproducto seco. Resultados: La materia seca (DM) del WBG presentó un efecto lineal creciente con el proceso de deshidratación. La composición química de los granos secos de cervecería no tuvo efecto en función de los tiempos de almacenamiento. La proteína no digestible (fracción C) aumentó linealmente; sin embargo, no comprometió la producción acumulativa de gas y la digestibilidad in vitro de la DM y de la proteína. El tiempo de almacenamiento no tuvo efecto sobre la población de hongos. El valor máximo de aflatoxina obtenido fue de 45,5 μg/kg y permaneció dentro de los limites aceptables para alimentación de bovinos. Conclusión: La deshidratación de WBG al sol es eficiente para garantizar la conservación del material y viabilizar su almacenamiento. El almacenamiento por 180 días de este subproducto seco no compromete su calidad nutricional y microbiológica.

Resumo Antecedentes: Os grãos de cervejaria são um subproduto que podem ser incluídos na dieta de ruminantes, no entanto sua forma úmida dificulta o armazenamento e a conservação desse produto. Objetivo: Avaliar a eficiência de desidratação ao sol dos grãos úmidos de cervejaria (WBG) e o efeito do período de armazenamento sobre a qualidade nutricional e microbiológica. Métodos: Para avaliar a desidratação do WBG, utilizou-se um delineamento experimental inteiramente casualizado, sendo os tratamentos os tempos de 0 e 1, 2, 4, 6, 8, 10, 12, 14 e 16 horas de exposição ao sol. Um segundo experimento foi realizado em delineamento inteiramente casualizado. Os tratamentos foram 0, 10, 20, 30, 60, 90, 120, 150 e 180 dias de armazenamento do subproduto seco. Resultados: A matéria seca (DM) do WBG apresentou efeito linear crescente com o processo de desidratação. A composição química dos grãos secos de cervejaria não apresentou efeito em função dos tempos de armazenagem. A proteína indigestível (Fração C) aumentou linearmente, no entanto não comprometeu a produção cumulativa de gás e a digestibilidade in vitro da DM e da proteína. A população de fungos não apresentou efeito com o tempo de armazenamento. O valor máximo de aflatoxina obtido foi de 45,5 μg/kg e permaneceu dentro dos limites aceitáveis para a alimentação de bovinos. Conclusão: A desidratação do WBG ao sol foi eficiente em garantir a conservação do material e viabilizar o seu armazenamento. A estocagem desse subproduto seco por 180 dias não comprometeu a sua qualidade nutricional e microbiológica.

Effects of Black Wattle (Acacia mearnsii) Condensed Tannins on Intake, Protozoa Population, Ruminal Fermentation, and Nutrient Digestibility in Jersey Steers.

The objective of this study was to evaluate the effect of inclusion of condensed tannins (CT) from black wattle (Acacia mearnsii) on feed intake, ruminal protozoa population, ruminal fermentation, and nutrient digestibility in Jersey steers. Five ruminally-cannulated steers were used in a 5x5 Latin square design, with five periods of 20 days each (14 days for diet adaptation and six days for sample collection per period). Treatments were composed of dietary inclusion levels of condensed tannins at 0, 5, 10, 15, and 20 g/kg of diet dry matter. Intakes of dry matter, organic matter, ether extract, crude protein, neutral detergent fiber, and total digestible nutrients were not affected by condensed tannins. The ruminal pH was reduced linearly with tannin levels. Ruminal ammonia nitrogen concentration was not affected by tannins. Tannins reduced the molar proportion of acetate and did not affect the ruminal protozoal population, which might be related to the low doses used. Digestibilities of dry matter, organic matter, and neutral detergent fiber were not altered; however, there was a linear reduction in crude protein digestibility. Based on these results, CT extracts from black wattle are not recommended for improving nutrient utilization in steers at the tested levels.

Efficacious Cefazolin Prophylactic Dose for Morbidly Obese Women Undergoing Bariatric Surgery Based on Evidence from Subcutaneous Microdialysis and Populational Pharmacokinetic Modeling.

PURPOSE: To determine the efficacious cefazolin prophylactic dose for bariatric surgery using free subcutaneous concentrations accessed by microdialysis after 2 g or 3 g i.v. bolus dosing to morbidly obese women and POPPK modeling. METHODS: A POPPK model with variable plasma and subcutaneous tissue protein binding was developed to simultaneously describe plasma and tissue data sets. The outcomes was predicted for common surgical site infection (SSI) bacteria over 3, 4, 5 and 6 h periods postdose, as probability of target attainment (PTA) using Monte Carlo simulation. RESULTS: CFZ 2 g warrant up to 5 h SSI prophylaxis for bacteria with MICs ≤1 mg/L such as Escherichia coli and Staphylococcus aureus. For species such as Klebsiella pneumoniae, which present MIC distribution frequency of 2 mg/L, the maintenance of PTA ≥ 90% occurs with a 3 g dose for surgeries lasting up to 5 h, and 2 g dose provide an adequate response up to 4 h (PTA of 89%). CONCLUSIONS: Effectiveness of CFZ 2 g is similar to 3 g against bacteria with a MIC up to 2 mg/L, especially if the surgery does not last for more than 4 h.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial.

INTRODUCTION: Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. OBJECTIVE: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. MATERIAL AND METHODS: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. RESULTS: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. CONCLUSION: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review.

PURPOSE: To review the use of cefazolin in prophylaxis of surgical wound infection (SSI) in bariatric surgery (BS). METHODS: A systematic review was performed from October to November, 2013 using the following databases: The Cochrane Library, Medline, LILACS, and EMBASE. The inclusion criteria were randomized clinical trials and observational studies that were evaluated by two independent reviewers. RESULTS: Nine hundred and sixty one titles were recovered after preliminary analysis (title and abstract), seven studies remained for final analysis. There were three clinical trials (one with SSI, and two with antibiotic levels as the outcome), and four were observational studies (three cohorts and one case-control, all had SSI as the outcome). After administration of 1g or 2 g, levels of cefazolin in serum and tissue were suboptimal according to two studies. Results from observational studies indicated that different antibiotics were used for prophylaxis of SSI in BS and that use of other drugs may be associated with higher rates of SSI. CONCLUSION: The use of cefazolin for surgical wound infection prophylaxis in bariatric surgery is recommended, however further studies are needed in order to refine parameters as initial dose, redose, moment of administration and lasting of prophylaxis.

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review

To review the use of cefazolin in prophylaxis of surgical wound infection (SSI) in bariatric surgery (BS). METHODS: A systematic review was performed from October to November, 2013 using the following databases: The Cochrane Library, Medline, LILACS, and EMBASE. The inclusion criteria were randomized clinical trials and observational studies that were evaluated by two independent reviewers. RESULTS: Nine hundred and sixty one titles were recovered after preliminary analysis (title and abstract), seven studies remained for final analysis. There were three clinical trials (one with SSI, and two with antibiotic levels as the outcome), and four were observational studies (three cohorts and one case-control, all had SSI as the outcome). After administration of 1g or 2 g, levels of cefazolin in serum and tissue were suboptimal according to two studies. Results from observational studies indicated that different antibiotics were used for prophylaxis of SSI in BS and that use of other drugs may be associated with higher rates of SSI. CONCLUSION: The use of cefazolin for surgical wound infection prophylaxis in bariatric surgery is recommended, however further studies are needed in order to refine parameters as initial dose, redose, moment of administration and lasting of prophylaxis.(AU)

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review

To review the use of cefazolin in prophylaxis of surgical wound infection (SSI) in bariatric surgery (BS). METHODS: A systematic review was performed from October to November, 2013 using the following databases: The Cochrane Library, Medline, LILACS, and EMBASE. The inclusion criteria were randomized clinical trials and observational studies that were evaluated by two independent reviewers. RESULTS: Nine hundred and sixty one titles were recovered after preliminary analysis (title and abstract), seven studies remained for final analysis. There were three clinical trials (one with SSI, and two with antibiotic levels as the outcome), and four were observational studies (three cohorts and one case-control, all had SSI as the outcome). After administration of 1g or 2 g, levels of cefazolin in serum and tissue were suboptimal according to two studies. Results from observational studies indicated that different antibiotics were used for prophylaxis of SSI in BS and that use of other drugs may be associated with higher rates of SSI. CONCLUSION: The use of cefazolin for surgical wound infection prophylaxis in bariatric surgery is recommended, however further studies are needed in order to refine parameters as initial dose, redose, moment of administration and lasting of prophylaxis.

Formação de jovens trabalhadores associados na produção da vida: questões para debate / Formation of young workers associated to produce life: issues for debate

Em formato de ensaio, o texto revela que, para enfrentar a crise estrutural do emprego e a precarização do trabalho, alguns jovens têm se organizado em torno do movimento por uma economia popular solidária. Com o propósito de refletir sobre a formação de jovens trabalhadores que se associam para garantir a reprodução ampliada da vida, são articulados alguns conceitos como juventude, associativismo, produção associada, cultura do trabalho e autogestão. A partir de informações extraídas do grupo de discussão E-solidária, são feitas referências às organizações econômicas associativas, criadas e dirigidas por jovens, cuja racionalidade econômica, ao contrário do “empreendedorismo”, se diferencia da lógica da economia capitalista. Enfatiza-se que problematizar o trabalho significa problematizar as atuais e as futuras relações entre escola e sociedade; ressignificar o trabalho dos jovens é ressignificar o sentido da escola como instituição social e, ao mesmo tempo, a maneira com que ela é percebida, hoje, pelos próprios jovens, que estão experimentando trabalhar de forma associativa e autogestionária.

This essay reveals that to face the structural crisis of employment and of work conditions, youths have participated in the movement for a solidary popular economy. In order to discuss about education for these young people that have associated themselves to guarantee an enlarged reproduction of life, we haveconsidered in an articulated way some concepts as follows: youth, associativity, associated production, culture of work and self-management. Along the article, references are made to associative economical organizations, established and driven by youths, whose economical rationality, unlike the so-called "empreendedorismo", differs from the logic of capitalist economy. It is emphasized that in order to problematize work one has to problematize the current and future relations between school and society; and, also, to re-signify work for youth is, simultaneously, re-signifying the meaning of school as social institution as well as the way it is perceived by the very youths who are struggling to work in an associative and self-managed form.

Formação de jovens trabalhadores associados na produção da vida: questões para debate / Formation of young workers associated to produce life: issues for debate

Em formato de ensaio, o texto revela que, para enfrentar a crise estrutural do emprego e a precarização do trabalho, alguns jovens têm se organizado em torno do movimento por uma economia popular solidária. Com o propósito de refletir sobre a formação de jovens trabalhadores que se associam para garantir a reprodução ampliada da vida, são articulados alguns conceitos como juventude, associativismo, produção associada, cultura do trabalho e autogestão. A partir de informações extraídas do grupo de discussão E-solidária, são feitas referências às organizações econômicas associativas, criadas e dirigidas por jovens, cuja racionalidade econômica, ao contrário do “empreendedorismo”, se diferencia da lógica da economia capitalista. Enfatiza-se que problematizar o trabalho significa problematizar as atuais e as futuras relações entre escola e sociedade; ressignificar o trabalho dos jovens é ressignificar o sentido da escola como instituição social e, ao mesmo tempo, a maneira com que ela é percebida, hoje, pelos próprios jovens, que estão experimentando trabalhar de forma associativa e autogestionária.(AU)

This essay reveals that to face the structural crisis of employment and of work conditions, youths have participated in the movement for a solidary popular economy. In order to discuss about education for these young people that have associated themselves to guarantee an enlarged reproduction of life, we haveconsidered in an articulated way some concepts as follows: youth, associativity, associated production, culture of work and self-management. Along the article, references are made to associative economical organizations, established and driven by youths, whose economical rationality, unlike the so-called "empreendedorismo", differs from the logic of capitalist economy. It is emphasized that in order to problematize work one has to problematize the current and future relations between school and society; and, also, to re-signify work for youth is, simultaneously, re-signifying the meaning of school as social institution as well as the way it is perceived by the very youths who are struggling to work in an associative and self-managed form.(AU)

Factors associated with healthcare services utilization and pharmacological treatment in individuals with diabetes diagnosis: lessons from a nationwide program for diabetes mellitus detection in Brazil.

The Brazilian Nationwide Population Screening Program for Diabetes, conducted in 2001, diagnosed 346,168 new cases. Although unexpected, approximately 65,000 previously diabetic individuals participated. We describe their characteristics compared to new cases, based on data obtained by a follow-up study of a subsample of 4991 positively screened from a representative sample of 90,106 individuals. Two groups were analyzed regarding factors associated with adherence to treatment, healthcare services utilization, and compliance to pharmacological treatment: 497 with newly diagnosed diabetes and 257 individuals with previous diabetes diagnosis who were not under treatment at the screening program. For this group, healthcare service utilization was lower when compared with the new cases (OR = 0.06; 95% CI: 0.03-0.12). Diabetes status (OR = 0.23; 95% CI: 0.14-0.37), a healthy behavior score (OR = 0.53, 95% CI: 0.34-0.83), and glucose levels at screening (altered, OR = 5.01; 95% CI: 2.38-10.6 and likely and very likely DM OR = 11.2; 95% CI: 6.85-18.4) were independently associated with pharmacological treatment.

Método da escavação em terapia ocupacional: um dispositivo dinâmico a três polos? / Method of excavation in occupational therapy: a dynamic, three-pole device?

A experiência docente e profissional em terapia ocupacional indica uma formação acadêmica limitada em relação aos seguintes aspectos: o ser terapeuta ocupacional e suas implicações técnicas e metodológicas; o compreender e o assimilar o perfil profissional e, ainda, o entender o papel da atividade humana como recurso terapêutico. Para contribuir com tais lacunas, desenvolveu-se o Método da Escavação, criado com base na prática clínica e acadêmica. Neste artigo, o método é apresentado e analisado considerando as relações teórico-metodológicas entre a prática clínica, a formação acadêmica em terapia ocupacional e a abordagem ergológica. A argumentação desenvolvida resultou de um estudo de caso realizado em pesquisa de doutorado. Os dados foram coletados em documentos, entrevistas semiestruturadas e observação do Grupo de Estudos sobre Atividade Humana (Geah) do Instituto Metodista de Porto Alegre (IPA). Concluiu-se que há convergências entre o Método da Escavação e o Dispositivo Dinâmico a Três Polos. A vivência do método permitiu a confrontação e o entrecruzamento de saberes e valores entre o polo da experiência e o polo conceitual que compõem a terapia ocupacional. Os discentes renormatizaram saberes e ressignificaram suas vidas cotidianas e experiências de trabalho, reafirmando o poder terapêutico e criador da atividade humana.

The experience of teaching and working in occupational therapy has indicated some educational gaps in the professional education in the field: the very nature of being occupational therapist and its technical and methodological implications; the understanding and identification of the workers with the field and, also, the role of human activity as a therapeutic resource. In order to give a contribution to resolve it, it has been developed the so called Excavation Method that was created on the basis of academic and clinical practice. In this article, the method is presented and analyzed considering the theoretical and methodological relations between practice (academic and clinical) and the ergologic approach. The argument is based on a case study undertaken in a PhD course. The field work was developed with a group called Study Group of Human Activity (Geah) of the Methodist Institute of Porto Alegre (IPA). The main conclusion is that the Excavation Method and the Tree Poles Dynamic Dispositive have strong relationship. The method allowed confrontation and interchanging of knowledge and values between those people situated in the pole of experience and those of the conceptual pole, in the field of occupational therapy. The students renormalized their knowledge and gave new meaning for their daily life and working experience confirming the therapeutic and creational power of human activity.

Diagnosis of the availability and use of drug information sources in drugstores and pharmacies in southern Brazil / Diagnóstico da disponibilidade e da utilização de fontes de informação sobre medicamentos em drogarias e farmácias no sul do Brasil

This research has aimed to estimate the use of drug information sources by pharmacists in drugstores and pharmacies in southern Brazil. It consisted of sending a questionnaire through regular mail, contacting the pharmacist via phone and visiting the drugstores. Four hundred and eight (68.6 percent) of the 595 enrolled establishments answered the questionnaire. The information at pharmacies and drugstores is searched mainly to orient the patient. At drugstores the professionals have an average of 2.3 books, whereas at pharmacies they rely on 6.1. In a pharmacy, the chance to find more than five books is 27 times higher than in a drugstore. The more often available books are pharmaceutical specialties compendiums. There is access to Internet in 87.5 percent of pharmacies and 59 percent of drugstores. The National Agency of Health Surveillance webpage is the most accessed website, and the call centers of Pharmaceutical Companies are the most searched information service. Lack of time is the main alleged difficulty for searching information. The pharmacists working in the studied establishments miss appropriate drug information sources. Taking into consideration how important information is in the pharmaceutical practice, there is a need to emphasize this subject through an educative process, during undergraduate studies and continued education.

A pesquisa teve como objetivo descrever a utilização de fontes de informação em drogarias e farmácias no sul do Brasil. A mesma consistiu do envio do questionário pelo correio, contato com farmacêuticos por telefone e visita aos estabelecimentos. A resposta foi obtida em 408 (68,6 por cento) dos 595 estabelecimentos amostrados. A informação nas farmácias e drogarias é buscada, principalmente, para orientar o paciente. O profissional tem, em média, 2,3 livros nas drogarias e 6,1 nas farmácias. Em uma farmácia, a chance de se encontrar mais de cinco livros corresponde a 27 vezes aquela em uma drogaria. Os bulários são os livros mais frequentemente disponíveis. Há acesso à Internet em 87,5 por cento das farmácias e em 59 por cento das drogarias, sendo a chance de uma farmácia ter este recurso, cinco vezes maior que aquela em uma drogaria. A página da Agência Nacional de Vigilância Sanitária é a mais acessada e o Serviço de Atendimento ao Consumidor das Companhias Farmacêuticas, o serviço de informação mais consultado. A falta de tempo é a principal limitação da busca de informação. O farmacêutico nos estabelecimentos pesquisados é carente de fontes adequadas de informação. Considerando a importância da informação na prática farmacêutica, é necessário enfatizar o tema utilizando um processo educativo no período de formação e em atividades de atualização.

Anemia grave en un paciente con infección por el virus de inmunodeficiencia humana / Severe anemia in a patient with human immunodeficiency virus infection

La anemia es relativamente frecuente en pacientes con infección avanzada por VIH. La aplasia pura de la serie roja (APSR) asociada a la infección por Parvovirus B19 (PVB19) se caracteriza por la ausencia de precursores eritroides en la médula ósea que produce anemia grave normocítica, normocrómica, con un bajo recuento de reticulocitos. Este artículo describe un paciente con infección por VIH con inmunosupresión grave y en fracaso virológico que desarrolló APSR asociada a PV B19.(AU)

Severe anemia is quite frequently seen in HIV infected patient with advanced disease. Pure red cell aplasia associated to Parvovirus B19 (PVB 19) infection is characterized by the absence of erythroid precursors in the bone marrow resulting in severe normocytic-normochromic anemia with a low reticulocyte count. This article reports a patient with advanced HIV and virological failure, who developed pure red cell aplasia associated to PVB19.(AU)

Anemia grave en un paciente con infección por el virus de inmunodeficiencia humana / Severe anemia in a patient with human immunodeficiency virus infection

La anemia es relativamente frecuente en pacientes con infección avanzada por VIH. La aplasia pura de la serie roja (APSR) asociada a la infección por Parvovirus B19 (PVB19) se caracteriza por la ausencia de precursores eritroides en la médula ósea que produce anemia grave normocítica, normocrómica, con un bajo recuento de reticulocitos. Este artículo describe un paciente con infección por VIH con inmunosupresión grave y en fracaso virológico que desarrolló APSR asociada a PV B19.

Severe anemia is quite frequently seen in HIV infected patient with advanced disease. Pure red cell aplasia associated to Parvovirus B19 (PVB 19) infection is characterized by the absence of erythroid precursors in the bone marrow resulting in severe normocytic-normochromic anemia with a low reticulocyte count. This article reports a patient with advanced HIV and virological failure, who developed pure red cell aplasia associated to PVB19.

Dipyrone use during pregnancy and adverse perinatal events.

OBJECTIVE: To evaluate the risk of adverse perinatal events among newborns exposed to dipyrone during gestation. DESIGN AND SETTING: The present study is a secondary analysis of Brazilian study of gestational diabetes (EBDG), a cohort of women attended at healthcare units of the Brazilian national health system (SUS) located in six Brazilian state capitals, between February 1991 and June 1995. SAMPLE: A total number of 5,564 women aged 20 years and over who were between their 21st and 28th week of pregnancy were followed up. METHODS: A structured questionnaire was used to obtain data on the pregnant women, their pregnancies, and their use of medications. Other data and the outcomes congenital abnormalities, intrauterine death, preterm birth, or low birth weight were obtained from the medical records. To estimate the odds ratios after adjustment for the potential confounding factors, logistic regression modeling was developed. MAIN OUTCOME MEASURES: Congenital abnormalities, intrauterine death, preterm birth, and low birth weight. RESULTS: Dipyrone use was reported by 555 pregnant women (11.5%). Their exposure to this medication did not present any association with the outcomes of congenital abnormalities (OR 1.11; 95% CI, 0.58-2.10), intrauterine death (OR 0.69; 95% CI, 0.33-1.43), preterm birth (OR 0.94; 95% CI, 0.73-1.20), or low birth weight (OR 0.88; 95% CI, 0.64-1.22), in the crude analysis. This absence of associations was maintained after performing logistic regression analysis. CONCLUSIONS: The data suggest that the exposure to dipyrone during pregnancy does not increase the risk of congenital abnormalities and other adverse events as outcomes from pregnancy.

Edema pulmonar após absorção sistêmica de fenilefrina tópica durante cirurgia oftalmológica em criança: relato de caso / Pulmonary edema after systemic absorption of topical phenylephrine during ophthalmologic surgery in a child: case report

JUSTIFICATIVA E OBJETIVOS: Soluções tópicas de fenilefrina são empregadas freqüentemente em cirurgia oftalmológica com o objetivo de promover descongestionamento capilar ou dilatação pupilar. Este artigo descreve um caso de hipertensão arterial grave seguida de edema pulmonar durante cirurgia para correção de estrabismo. A provável causa desta complicação foi a absorção sistêmica de fenilefrina administrada por via tópica ocular. O objetivo do relato é a discussão de meios de prevenção desta complicação, assim como do tratamento mais adequado. RELATO DO CASO: Paciente do sexo masculino, 12 anos, 50 kg, estado físico ASA I, admitido no centro cirúrgico para realização de correção de estrabismo convergente bilateral em regime ambulatorial. Foi submetido à anestesia geral venosa e a manutenção, realizada com infusão contínua de remifentanil e propofol. Após colocação do bléfaro, 6 gotas de fenilefrina a 10 por cento foram aplicadas por via tópica. Decorridos 5 minutos do início da cirurgia, o paciente desenvolveu hipertensão arterial e taquicardia, refratárias à elevação da dose administrada de remifentanil e propofol, bem como à administração de droperidol. O controle da pressão arterial e da freqüência cardíaca foi possível após o emprego do sevoflurano, mas houve diminuição da saturação de oxigênio e o aparecimento de crepitações pulmonares difusas por provável desenvolvimento de edema pulmonar agudo. A furosemida foi administrada e os anestésicos foram suspensos. O paciente apresentou melhora progressiva do quadro pulmonar, enquanto os valores de pressão arterial permaneciam dentro da normalidade. Recebeu alta da sala de recuperação pós-anestésica 6 horas após a cirurgia, quando se apresentava em ventilação espontânea em ar ambiente, com saturação de O2, ausculta pulmonar e pressão arterial normais. CONCLUSÕES: A administração de fenilefrina tópica deve ser realizada com cautela, antes do início da cirurgia e com o conhecimento do anestesiologista, para que medidas sejam empregadas com o objetivo de evitar absorção sistêmica em grande quantidade e, caso esta ocorra, as condutas preconizadas devem ser seguidas, ou seja, diminuição da pressão arterial sem causar depressão miocárdica, como no caso do emprego de beta-bloqueadores ou bloqueadores do canal de cálcio. Os vasodilatadores de ação direta ou alfa-bloqueadores são as opções diante de hipertensão arterial grave decorrente da absorção sistêmica de fenilefrina.

[Pulmonary edema after topic phenylephrine absorption during pediatric eye surgery: case report.]. / Edema pulmonar após absorção sistêmica de fenilefrina tópica durante cirurgia oftalmológica em criança: relato de caso.

BACKGROUND AND OBJECTIVES: Topic phenylephrine solutions are commonly used in eye procedures to promote capillary decongestion or pupil dilation. This article describes a case of severe hypertension followed by pulmonary edema during strabismus correction procedure. Possible cause of this complication might have been systemic absorption of phenylephrine eyedrops. Our objective is to discuss preventive means for such complication as well as the most adequate treatment. CASE REPORT: Male patient, 12 years old, 50 kg, physical status ASA I, admitted for outpatient bilateral convergent strabismus correction. Patient was submitted to intravenous general anesthesia, which was maintained with continuous remifentanil and propofol infusion. After blepharus adjustment, 6 drops of topic 10% phenylephrine were applied. Five minutes after beginning of surgery, patient has developed hypertension and tachycardia, refractory to increased remifentanil and propofol dose, as well as to droperidol. Blood pressure and heart rate could be controlled after sevoflurane administration, but there has been oxygen saturation decrease with diffuse pulmonary rales by possible development of acute pulmonary edema. Furosemide was administered and anesthetic solutions were withdrawn. Patient presented progressive pulmonary improvement while blood pressure remained within normal values. Patient was discharged from PACU six hours after surgery with spontaneous ventilation in room air, and normal O2 saturation, pulmonary auscultation and blood pressure. CONCLUSIONS: Topic phenylephrine should be cautiously administered before surgery and the anesthesiologist should be informed so that measures may be taken to prevent systemic absorption of large amounts. If there is absorption, preconized management should be followed, that is, decrease blood pressure without inducing myocardial depression, as it is the case with beta-blockers or calcium channel blockers. Direct action vasodilators, or alpha-blockers, are the options for severe hypertension induced by systemic phenylephrine absorption.