Surgical removal of periocular neoformation in Peixe -Kinguiu (Carassius Auratus) submitted to anesthesia with propofol in combination with morphine: case report / Remoção cirúrgica de neoformação periocular em peixe-kinguiu (Carassius Auratus) submetido à anestesia com propofol em associação com morfina: relato de caso

Different anesthetic agents are commonly used during procedures performed in aquaculture to minimize stress and maximize fish welfare during handling. A Kinguio fish was treated with a history of a mass near the left eye. In the clinical evaluation, a pedunculated neoformation was found in the periocular region. The fish was submitted to anesthesia for surgical removal of the mass, which was later referred to histopathological evaluation, revealing myxoma. The anesthesia protocol used 1% propofol at a concentration of 5 mg/liter of water and morphine at a dose of 5 mg/kg, intramuscularly. Immediately after the end of the procedure, the fish was returned to the aquarium and its anesthetic recovery was observed. The objective of this report is to describe a surgical procedure in kinguio fish and to determine the efficacy of propofol associated with morphine in this species. As a result, complete immobilization of the fish was obtained with propofol, reaching the fourth stage of anesthesia and the administration of morphine suggested being able to provide effective and long-lasting analgesia. It is concluded that despite the positive results obtained, anesthesia in fish still needs to be extensively investigated to refine analgesia protocols during procedures that cause pain and stress.

Diferentes agentes anestésicos são usados durante procedimentos realizados na aquicultura para minimizar o estresse e maximizar o bem-estar dos peixes durante o processo de manejo. Um peixe kinguiu foi atendido com histórico de presença de uma massa próxima ao olho esquerdo. Na avaliação clínica, constatou-se uma neoformação pedunculada na região periocular. O peixe foi submetido à anestesia para remoção cirúrgica da massa, que posteriormente foi encaminhada para avaliação histopatológica, a qual revelou mixoma. Como protocolo de anestesia, utilizou-se propofol 1% diluído em água, na concentração de 5mg/litro, e morfina, na dose de 5mg/kg, na concentração de 10mg/mL, intramuscular. Imediatamente após o procedimento, o peixe foi devolvido ao aquário para observação da recuperação anestésica. O objetivo deste relato é descrever um procedimento cirúrgico em peixe kinguio e determinar a eficácia do propofol associado à morfina nessa espécie. Como resultados, obteve-se a imobilização completa do peixe com o uso do propofol, atingindo o quarto estágio da anestesia, e a administração da morfina sugeriu ser capaz de proporcionar analgesia eficaz e duradoura. Conclui-se que, apesar dos resultados positivos obtidos, a anestesia em peixes precisa ainda ser bastante investigada para refinar os protocolos de analgesia durante os procedimentos que causam dor e estresse.

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients.

Atherosclerosis is a major complication of chronic renal failure. Microinflammation is involved in atherogenesis and is associated with uremia and dialysis. The role of dialysate water contamination in inducing inflammation has been debated. Our aim was to study inflammatory markers in patients on chronic dialysis, before and 3 to 6 months after switching the water purification system from deionization to reverse osmosis. Patients had demographic, clinical and nutritional information collected and blood drawn for determination of albumin, ferritin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-alpha in both situations. Acceptable levels of water purity were less than 200 colony-forming units of bacteria and less than 1 ng/ml of endotoxin. Sixteen patients died. They had higher median CRP (26.6 vs 11.2 mg/dl, P = 0.007) and lower median albumin levels (3.1 vs 3.9 g/l, P < 0.05) compared to the 31 survivors. Eight patients were excluded because of obvious inflammatory conditions. From the 23 remaining patients (mean age +/- SD: 51.3 +/- 13.9 years), 18 had a decrease in CRP after the water treatment system was changed. Overall, median CRP was lower with reverse osmosis than with deionization (13.2 vs 4.5 mg/l, P = 0.022, N = 23). There was no difference in albumin, cytokines, subjective global evaluation, or clinical and biochemical parameters. In conclusion, uremic patients presented a clinically significant reduction in CRP levels when dialysate water purification system switched from deionization to reverse osmosis. It is possible that better water treatments induce less inflammation and eventually less atherosclerosis in hemodialysis patients.

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients

Atherosclerosis is a major complication of chronic renal failure. Microinflammation is involved in atherogenesis and is associated with uremia and dialysis. The role of dialysate water contamination in inducing inflammation has been debated. Our aim was to study inflammatory markers in patients on chronic dialysis, before and 3 to 6 months after switching the water purification system from deionization to reverse osmosis. Patients had demographic, clinical and nutritional information collected and blood drawn for determination of albumin, ferritin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-alpha in both situations. Acceptable levels of water purity were less than 200 colony-forming units of bacteria and less than 1 ng/ml of endotoxin. Sixteen patients died. They had higher median CRP (26.6 vs 11.2 mg/dl, P = 0.007) and lower median albumin levels (3.1 vs 3.9 g/l, P < 0.05) compared to the 31 survivors. Eight patients were excluded because of obvious inflammatory conditions. From the 23 remaining patients (mean age ± SD: 51.3 ± 13.9 years), 18 had a decrease in CRP after the water treatment system was changed. Overall, median CRP was lower with reverse osmosis than with deionization (13.2 vs 4.5 mg/l, P = 0.022, N = 23). There was no difference in albumin, cytokines, subjective global evaluation, or clinical and biochemical parameters. In conclusion, uremic patients presented a clinically significant reduction in CRP levels when dialysate water purification system switched from deionization to reverse osmosis. It is possible that better water treatments induce less inflammation and eventually less atherosclerosis in hemodialysis patients.