Acute kidney injury in cats and dogs: A proportional meta-analysis of case series studies.

INTRODUCTION: Risk of mortality in the setting of acute kidney injury (AKI) in cats and dogs remains unclear. OBJECTIVES: To evaluate the incidence of mortality in cats and dogs with AKI based on etiology (i.e. infectious versus non-infectious; receiving dialysis versus conservative treatment). MATERIALS AND METHODS: Ovid Medline, EMBASE, and LILACS were searched up to July 2016. Articles were deemed eligible if they were case series studies evaluating the incidence of all-cause mortality in cats and dogs with AKI, regardless of etiology or the nature of treatment. RESULTS: Eighteen case series involving 1,201animalsproved eligible. The pooled proportions for overall mortality were: cats53.1% [95% CI 0.475, 0.586; I2 = 11,9%, p = 0.3352]; dogs 45.0% [95% CI 0.33, 0.58; I2 = 91.5%, P < 0.0001]. A non-significant increase in overall mortality risk was found among dialysed animals relative to those managed with conservative treatment, independent of animal type and the etiology of their AKI. The pooled proportions for overall mortality according to etiology, regardless of treatment type, were: AKI due infectious etiology for cats and dogs, 19.2% [95% CI 0.134, 0.258; I2 = 37.7%, P = 0.0982]; AKI due non-infectious etiology for cats and dogs, 59.9% [95% CI 0.532, 0.663; I2 = 51.0%, P = 0.0211]. CONCLUSION: Our findings suggest higher rates of overall mortality in cats and dogs with AKI due to non-infectious etiologies relative to infectious etiologies, and showed non-significant differences in terms of higher rates associated with dialysis compared to conservative management. Further investigations regarding optimal time to initiate dialysis and the development of clinical models to prognosticate the course of disease and guide optimal treatment initiation for less severe cases of AKI in cats and dogs is warranted.

Citotoxicidade e ação anti-inflamatória in vitro dos extratos glicólicos de Morus nigra (amora), Ziziphus joazeiro (juá) e Vitis vinifera (uva) / Cytotoxicity and anti-inflammatory action in vitro of the glycolic extracts of Morus nigra (black mulberry), Ziziphus joazeiro (juá) and Vitis vinifera (grape)

As plantas medicinais e seus extratos têm sido utilizados na medicina tradicional para fins terapêuticos e como uma atrativa fonte de pesquisa em diversas vertentes ciêntíficas, dentre elas, a atividade anti-inflamatória. O objetivo deste estudo foi analisar a citotoxicidade e ação anti-inflamatória in vitro dos extratos glicólicos das plantas medicinais Morus nigra (amora), Ziziphus joazeiro (juá) e Vitis vinifera (uva) em macrófagos de camundongo RAW 264.7. A citotoxicidade dos extratos foi analisada pelo teste de viabilidade celular MTT em dois períodos de tratamento, 5 min e 24 h. A ação anti-inflamatória dos extratos foi avaliada em macrófagos RAW 264.7 estimulados pelo lipopolissacarídeo (LPS) por meio da quantificação das citocinas pró-inflamatórias fator de necrose tumoral (TNF-α) e interleucina-6 (IL-6) pelo teste imunoenzimático (ELISA), e da quantificação do óxido nítrico pela reação de Griess. Os valores obtidos foram submetidos à análise estatística ANOVA ou Kruskal-Wallis com comparação múltipla de Tukey ou Dunn, com nível de significância de 5%. Concentrações não citotóxicas foram observadas após exposição por 5 min e 24 h, respectivamente, para os extratos de M. nigra (≤ 50 mg/mL e ≤ 1,56 mg/mL), Z. joazeiro (≤ 6,25 mg/mL e ≤ 3,12 mg/mL) e V. vinifera (≤ 25 mg/mL e ≤ 3,12 mg/mL). Em relação à resposta anti-inflamatória, 0,78 e 1,56 mg/mL do extrato de M. nigra e 3,12 mg/mL de V. vinifera apresentaram inibição significativa na produção da citocina TNF-α, e o extrato de Z. joazeiro suprimiu de modo significativo a expressão da citocina TNF-α (3,12 mg/mL) e do óxido nítrico (1,56 e 3,12 mg/mL). O presente trabalho demonstrou que os extratos glicólicos de M. nigra, Z. joazeiro e V. vinifera apresentaram concentrações não citotóxicas em ambos os tempos de tratamento e exerceram efeito anti-inflamatório em macrófagos de camundongo RAW 264.7(AU)

Medicinal plants and theirs extracts have been used in traditional medicine for therapeutic purposes and as a source of research in several scientific aspects, e.g. the anti-inflammatory activity. This study aimed to analyze the in vitro cytotoxicity and anti-inflammatory action of the glycolic extracts of the medicinal plants Morus nigra (black mulberry), Ziziphus joazeiro (juá) and Vitis vinifera (grape) in mouse macrophages cells RAW 264.7. The cytotoxicity of the extracts was analyzed by MTT cell viability assay in two periods, 5 min and 24 h. The anti-inflammatory action of the extracts was evaluated in lipopolysaccharide (LPS) stimulated RAW 264.7 cells by quantifying the pro-inflammatory cytokines tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay (ELISA) and nitric oxide by Griess reagent. The values obtained were submitted to statistical tests ANOVA or Kruskal-Wallis with post-test Tukey or Dunn multiple comparisons with the significance level of 5%. After exposure for 5 min and 24 h, respectively, noncytotoxic concentrations were observed for M. nigra (≤ 50 mg/mL and ≤ 1.56 mg/mL), Z. joazeiro (≤ 6.25 mg/mL and ≤ 3.12 mg/mL) and V. vinifera (≤ 25 mg/mL and ≤ 3.12 mg/mL) extracts. Concerning the anti-inflammatory response, 0.78 and 1.56 mg/mL of M. nigra extract and 3.12 mg/mL of V. vinifera extract showed significant inhibition of TNF-α cytokine production. Z. joazeiro extract suppressed significantly the TNF-α cytokine (3.12 mg/mL) and the nitric oxide (1.56 and 3.12 mg/mL) expression. In conclusion, the glycolic extracts of M. nigra, Z. joazeiro, and V. vinifera presented non-cytotoxic concentrations in both treatment periods and showed an antiinflammatory effect in RAW 264.7 cells(AU)

Efficacy and safety of blood transfusion in obstetric patients: systematic review of the literature.

OBJECTIVES: To evaluate the efficacy of blood transfusion compared to no intervention in obstetric patients. MATERIAL AND METHODS: A systematic review was performed with Cochrane Database of Clinical Trials, PubMed, EMBASE and LILACS databases searched as of September, 2016. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data, using the GRADE approach. RESULTS: Five studies within a total of 6,297 met the inclusion criteria, with women generally aged 20-40 years. Three included studies allocated women to receive blood transfusion or no intervention. Two other studies allocated women with either restricted or full blood supplies. The major issue regarding risk of bias was the extent of concealment of randomization and blinding. There was no statistically significant difference between blood transfusion versus no transfusion or restricted blood supply on mortality (relative risk 0.82 [95% confidential interval 0.32 to 2.09], p = 0.68; two studies; I2 = not applicable). CONCLUSIONS: Very low-quality evidence suggests no significant difference between blood transfusion and no intervention in obstetric patients, underlining the need for more robust clinical trials evaluating this area.

Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials.

STUDY OBJECTIVE: To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting. DESIGN: A systematic review. SETTING: A hospital-affiliated university. MEASUREMENTS: The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10), MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the GRADE approach to rate overall certainty of the evidence. RESULTS: In total we included 58 studies with a total of 6105 participants. The methodological quality was difficult to assess as it was poorly reported in 35 included studies (three or more domains were rated as unclear risk of bias). Two trials of sevoflurane showed a statistically significant reduction in death within 180 to 365days of surgery (on-pump) (RR 4.10, 95% CI 1.42 to 11.79; p=0.009; I2=not applicable; high quality of evidence). There was also a statistically significant difference favouring sevoflurane compared to propofol on both inotropic (RR 2.11, 95% CI 1.53 to 2.90; p<0.00001; I2=0%) and vasoconstrictor support needed (RR 1.51, 95% CI 1.04 to 2.22; p=0.03; I2=0%) after coronary artery bypass grafting on-pump. Two trials of sevoflurane (MD -0.22, 95% CI -0.41 to -0.03; p=0.02; I2=0%) and two further trials of desflurane (MD -0.33, 95% CI -0.45 to -0.20; p<0.00001; I2=82%) showed a statistically significant difference on cardiac index during and after coronary artery bypass grafting on-pump, respectively. CONCLUSIONS: There is high quality evidence that sevoflurane reduces death within 180 to 365days of surgery and, inotropic and vasoconstrictor support compared to propofol for patients undergoing coronary artery bypass grafting. There is also some evidence showing that the cardiac index is minimally influenced by administration of sevoflurane and desflurane compared to propofol.

Meperidine: opioid not indicated for analgesia / Meperidina: opioide não indicado para analgesia

BACKGROUND AND OBJECTIVES: Pain evaluation and the choice of the analgesic best providing its control are extremely important for patients’ quality of life. This study aimed at describing the characteristics which make meperidine unfeasible for pain management, at calling the attention to the incidence of its prescriptions and to the need of a multidisciplinary educative action aiming at decreasing its use, in addition to presenting two opioids as options for analgesia. CONTENTS: National or international scientific and governmental publications between the years 1997 and 2013 used in this study report that meperidine is not indicated for pain management, primarily due to its short action time, presence of neurotoxic metabolite (normeperidine) and possibility of rapidly developing tolerance. CONCLUSION: According to analyzed data, meperidine was the most widely used opioid for analgesic or was among the most prescribed analgesics. This fact shows the real need for an educative multidisciplinary action to promote awareness of meperidine risks and to decrease its prescription. According to searched literature, morphine and methadone have longer action time and higher analgesic potency, with metabolites which are less toxic and noxious for patients as compared to meperidine. .

JUSTIFICATIVA E OBJETIVOS: A avaliação da dor e a escolha do analgésico que mais bem provenha o seu controle são de extrema importância para a qualidade de vida do paciente. O objetivo deste estudo foi elucidar as características que inviabilizam a administração da meperidina para o tratamento da dor, atentar para a incidência de sua prescrição e a necessidade de uma ação educativa multidisciplinar visando à redução do seu uso e apresentar dois opioides como opções de escolha para a analgesia. CONTEÚDO: As publicações científicas e governamentais de âmbito nacional ou internacional entre os anos de 1997 e 2013 utilizadas neste artigo relatam que a meperidina não é indicada para o tratamento da dor devido, principalmente, ao seu curto tempo de ação, presença de metabólito neurotóxico (normeperidina), e a possibilidade de desenvolver tolerância rapidamente. CONCLUSÃO: Segundo os dados das pesquisas analisadas, a meperidina foi o opioide mais utilizado para analgesia ou estava entre os analgésicos mais prescritos. Esse fato relata a real necessidade de uma ação multidisciplinar educativa em prol da conscientização sobre os riscos presentes no tratamento com a meperidina e da diminuição da sua prescrição. De acordo com a literatura consultada, a morfina e a metadona apresentam maior tempo de ação e potência analgésica com metabólitos menos tóxicos e prejudiciais ao paciente que a meperidina. .