Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial.

OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. MEASUREMENTS AND MAIN RESULTS: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.

Effect of volatile anesthetics on myocardial infarction after coronary artery surgery: a post hoc analysis of a randomized trial

OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. Measurements and main Results: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.

Avaliação da deformação do preparo de superfície de implantes dentários submetidos a diferentes intensidades de torque / Deformation analysis of the surface preparation in dental implants submitted to different torque intensities

Introdução: o aprimoramento do processo de osseointegração faz com que os investimentos em pesquisa e o desenvolvimento de novos materiais e tratamentos de superfície sejam despendidos para promover a relação entre osso e implante. Uma das condições para o sucesso é a ausência de micromovimentos ou estabilidade primária da peça implantada, fato esse que leva alguns cirurgiões a aplicar torques excessivos sobre o implante, podendo resultar em danos ao tratamento aplicado à superfície externa do mesmo. Objetivo: o presente trabalho investigou possíveis níveis de deformação do preparo de superfície conforme diferentes valores de torque foram aplicados à dois sistemas de implantes para avaliar os possíveis danos causados. Metodologia: foram instalados 5 implantes do sistema Dérig e 5 implantes do sistema Straumann em um bloco de poliuretano, para posterior remoção com contra-torque e avaliação da superfície sob o Microscópio Eletrônico de Varredura (MEV). Resultados: nos resultados obtidos, no grupo de implantes Dérig não foi possível constatar evidências que comprovem que a elevação dos valores de torque aplicados aos implantes até 95 Ncm danifiquem ou alterem a estrutura do preparo de superfície externa dos implantes, contudo, no grupo Straumann, verificamos danos e alterações no preparo de superfície com torque progressivo a partir de 50 Ncm. Conclusão: possíveis alterações e danos ao preparo de superfície de implantes que apresentem rugosidade de superfície aumentada por jateamento podem ocorrer em torques acima de 50 Ncm empregados com o objetivo de aumentar sua estabilidade primária.

Introduction: improving the osseointegration process means that investments in research and development of new materials and surface treatments are expended to promote the relationship between bone and implant. One of the conditions for success is the absence of micromovements or primary stability of the implanted part. This fact causes some surgeons to apply excessive torque to the implant, which may result in damage to the treatment applied to the external surface of the implant. Objective: The present work investigated possible surface preparation deformation levels as different torque values were applied to two implant systems to evaluate the possible damage caused. Methodology: ive Dérig system implants and five Straumann system implants were installed in a polyurethane block for subsequent counter-torque removal and surface evaluation under the Scanning Electron Microscope (SEM). Results: Iin the obtained results, in the Dérig implant group it was not possible to verify evidences that the increase of the torque values applied to the implants up to 95 Ncm could damage or alter the structure of the external surface preparation of the implants, however, in the Straumann group we verified damage and changes in surface preparation with progressive torque from 50 Ncm. Conclusion: possible alterations and damages to the surface preparation of implants that present increased surface roughness by blasting can occur in torques above 50 Ncm employed in order to increase their primary stability.

MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of volatile anesthetics. Rationale and design

Objective: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless,small Randomized Controlled Trials have failed to demonstrate a survival advantage. Thus, whethervolatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable.Design: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio.Setting: Tertiary and University hospitals.

Estudo da variação neutropênica pelo sulfato de vincristina em cães com tvt tratados em um hospital veterinário do noroeste paulista / Neutropenic variation by vincristine sulfate in tvt dogs treated in a veterinary hospital in northwestern são paulo / Estudio de la variación neutropénica por sulfato de vincristina en perros con tvt tratados en el hospital veterinario del noroeste paulista

O presente estudo avaliou dados epidemiológicos de neutropenia induzida por sulfato vincristina em cães com Tumor Venéreo Transmissível (TVT), num Hospital Veterinário do Noroeste paulista. Para tanto, trata-se de um estudo do tipo retrospectivo de protocolos eletrônicos e formulários manuais de dados digitalizados de 51 casos de TVT. O atendimento ambulatorial e de internação desses animais foi realizado no período de setembro de 2006 a dezembro de 2009. Dentre os resultados, destaca-se que 51 animais foram diagnosticados com TVT, sendo 37 fêmeas (73%) e 14 (27%) machos; 46 animais (90,2%) foram tratados exclusivamente com sulfato de vincristina. Os cães Sem Raça Definida-SRD (n=28) foram os maiores acometidos com 54,9%; seguidos pelos Poodles com quatro cães (7,84%). Os animais com idade entre 37 e 84 meses obtiveram a maior porcentagem de acometimento pelo TVT com 20 casos (39,22%). Em doze animais (23,52%) foi observada neutropenia (valores entre 390 a 1927 cél/µL). Conclusão: a possível toxicidade medular induzida pela vincristina foi verificada pela descrição da neutropenia. Dessa forma, a identificação de quadros neutropênicos, por meio da realização de hemogramas semanais, é considerada obrigatória e de extrema relevância devido à prevalência de mielotoxicidade secundária à utilização deste quimioterápico.

The present study aims to assess epidemiological data on neutropenia induced by vincristine sulfate among dogs with Canine Transmissible Venereal Tumor (CTVT) at a veterinary hospital in the Northwestern region in the São Paulo State. Methodology: This is a retrospective study of electronic protocols and digitalized data from manually filled form from 51 CTVT cases. These animals were treated in an outpatient care clinic and hospitalization took place from September 2006 to December 2009. Results: 51 animals were diagnosed with CTVT; among these, 37 were female (73%) and 14 were male (27%). From these, 46 animals (90.2%) were treated exclusively with vincristine sulfate. Among them, mongrels (n=28) were the most common, with 54.9%, followed by Poodles, with 4 dogs (7.84%). Animals aged from 37 and 84 months were the largest age group, with 20 cases (39.22 %). Neutropenia (390 to 1927 cells/µL) was observed in 12 animals. Conclusion: possible vincristine-induced marrow toxicity was verified by the description of neutropenia. Thus, neutropenia identification through weekly blood count cells is considered extremely important and mandatory due to the prevalence of myelotoxicity following treatment with this chemotherapeutic drug.

Este estudio busca evaluar datos epidemiológicos de neutropenia inducida por sulfato vincristina en perros con Tumor Venéreo Transmisible (TVT), en un Hospital Veterinario del Noroeste Paulista. Es un estudio del tipo retrospectivo de protocolos electrónicos y formularios manuales de datos digitalizados de 51 casos de TVT. El atendimiento de ambulatorio y de internación de esos animales se realizó en el período de septiembre de 2006 a diciembre de 2009. Entre los resultados, se destaca que 51 animales fueron diagnosticados con TVT, siendo 37 hembras (73%) y 14 (27%) machos; 46 animales (90,2%) fueron tratados exclusivamente con sulfato de vincristina. Los perros Sin Raza Definida ? SRD (n=28) fueron los más acometidos con 54,9%; seguidos por los Poodles con cuatro perros (7,84%). Los animales con edad entre 37 y 84 meses obtuvieron mayor porcentaje de acometimiento por TVT, con 20 casos (39,22%). En doce animales (23,52%0 se ha observado neutropenia (valores entre 390 a 1927 cél/µL). Conclusión: la posible toxicidad medular inducida por vincristina se ha verificado por la descripción de la neutropenia. Así, la identificación de cuadros neutropénicos por medio de realización de hemogramas semanales, es considerada obligatoria y de extrema relevancia debido a la prevalencia de mielotoxicidad secundaria a la utilización de este quimioterápico.

Estudo da variação neutropênica pelo sulfato de vincristina em cães com tvt tratados em um hospital veterinário do Noroeste Paulista / Neutropenic variation by vincristine sulfate in tvt dogs treated in a veterinary hospital in northwestern São Paulo / Estudio de la variación neutropénica por sulfato de vincristina en perros con tvt tratados en el hospital veterinario del Noroeste Paulista

O presente estudo avaliou dados epidemiológicos de neutropenia induzida por sulfato vincristina em cães com Tumor Venéreo Transmissível (TVT), num Hospital Veterinário do Noroeste paulista. Para tanto, trata-se de um estudo do tipo retrospectivo de protocolos eletrônicos e formulários manuais de dados digitalizados de 51 casos de TVT. O atendimento ambulatorial e de internação desses animais foi realizado no período de setembro de 2006 a dezembro de 2009. Dentre os resultados, destaca-se que 51 animais foram diagnosticados com TVT, sendo 37 fêmeas (73%) e 14 (27%) machos; 46 animais (90,2%) foram tratados exclusivamente com sulfato de vincristina. Os cães Sem Raça Definida-SRD (n=28) foram os maiores acometidos com 54,9%; seguidos pelos Poodles com quatro cães (7,84%). Os animais com idade entre 37 e 84 meses obtiveram a maior porcentagem de acometimento pelo TVT com 20 casos (39,22%). Em doze animais (23,52%) foi observada neutropenia (valores entre 390 a 1927 cél/µL). Conclusão: a possível toxicidade medular induzida pela vincristina foi verificada pela descrição da neutropenia. Dessa forma, a identificação de quadros neutropênicos, por meio da realização de hemogramas semanais, é considerada obrigatória e de extrema relevância devido à prevalência de mielotoxicidade secundária à utilização deste quimioterápico...

The present study aims to assess epidemiological data on neutropenia induced by vincristine sulfate among dogs with Canine Transmissible Venereal Tumor (CTVT) at a veterinary hospital in the Northwestern region in the São Paulo State. Methodology: This is a retrospective study of electronic protocols and digitalized data from manually filled form from 51 CTVT cases. These animals were treated in an outpatient care clinic and hospitalization took place from September 2006 to December 2009. Results: 51 animals were diagnosed with CTVT; among these, 37 were female (73%) and 14 were male (27%). From these, 46 animals (90.2%) were treated exclusively with vincristine sulfate. Among them, mongrels (n=28) were the most common, with 54.9%, followed by Poodles, with 4 dogs (7.84%). Animals aged from 37 and 84 months were the largest age group, with 20 cases (39.22 %). Neutropenia (390 to 1927 cells/µL) was observed in 12 animals. Conclusion: possible vincristine-induced marrow toxicity was verified by the description of neutropenia. Thus, neutropenia identification through weekly blood count cells is considered extremely important and mandatory due to the prevalence of myelotoxicity following treatment with this chemotherapeutic drug...

Este estudio busca evaluar datos epidemiológicos de neutropenia inducida por sulfato vincristina en perros con Tumor Venéreo Transmisible (TVT), en un Hospital Veterinario del Noroeste Paulista. Es un estudio del tipo retrospectivo de protocolos electrónicos y formularios manuales de datos digitalizados de 51 casos de TVT. El atendimiento de ambulatorio y de internación de esos animales se realizó en el período de septiembre de 2006 a diciembre de 2009. Entre los resultados, se destaca que 51 animales fueron diagnosticados con TVT, siendo 37 hembras (73%) y 14 (27%) machos; 46 animales (90,2%) fueron tratados exclusivamente con sulfato de vincristina. Los perros Sin Raza Definida – SRD (n=28) fueron los más acometidos con 54,9%; seguidos por los Poodles con cuatro perros (7,84%). Los animales con edad entre 37 y 84 meses obtuvieron mayor porcentaje de acometimiento por TVT, con 20 casos (39,22%). En doce animales (23,52%0 se ha observado neutropenia (valores entre 390 a 1927 cél/µL). Conclusión: la posible toxicidad medular inducida por vincristina se há verificado por la descripción de la neutropenia. Así, la identificación de cuadros neutropénicos por medio de realización de hemogramas semanales, es considerada obligatoria y de extrema relevancia debido a la prevalencia de mielotoxicidad secundaria a la utilización de este quimioterápico...

Azatioprina na doença inflamatória intestinal seria um fator de risco para Strongyloides stercoralis? / Would azathioprine in inflammatory bowel disease be a risk factor for Strongyloides stercoralis infection?

A azatioprina é um dos mais comuns imunomoduladores utilizados no tratamento de Doença de Crohn e Retocolite Ulcerativa Idiopática, sendo que alguns pacientes desenvolvem imunossupressão. Por outro lado, o Strongyloides stercoralis está relacionado à infecção em pacientes imunocomprometidos. No presente estudo, pesquisa-se a prevalência do parasita nos pacientes portadores de Doença Inflamatória Intestinal em uso de azatioprina, através de exames parasitológicos de fezes. Analisa-se também a relação entre eosinofilia e a referida parasitose. No grupo tratado com azatioprina, 5,8% (4/69) dos pacientes estavam infectadospor Strongyloides stercoralis e apresentavam eosinofilia. Naquele tratado com outras drogas, somente 1,8% (1/55) apresentou a infecção e o número de eosinófilos dentro do referencial. Concluiu-se que a infecção pelo parasita é mais freqüente em pacientes da zona rural e que a eosnofilia pode ser um marcador indireto desta infecção.

Although azathioprine is one of the most common immunomodulatory drugs used in the treatment of Crohn's disease and ulcerative colitis, some patients can develop imunnosuppression. Strongyloides stercoralis infection may be associated with immunocompromised patients. In this study, our aim was to evaluate the prevalence of this infection in patients with Inflammatory bowel disease being treated with azathioprine, through parasitologic stool examination. The association between peripheral blood eosinophil counts and the infection was also studied. In the group treated with azathioprine, 5.8% (4/69) patients were infected by Strongyloides stercoralis and showed high level of eosinophil. In the other group, treated with different drug, only one patient (1.8%) revealed the infection and the number of eosinophil was normal. These observations demonstrated that the infection caused by this parasite was more frequent in patients from rural area. Besides, the high level of eosinophil could be an indirect marker for this infection.