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1.
Nutrients ; 13(10)2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34684627

RESUMO

Oral processing of food results in the formation of food boluses, which are then swallowed and reach the stomach for further digestion. The number, size and surface properties of the boluses will affect their processing and emptying from the stomach. Knowledge of these parameters, however, is incomplete due to limitations of the techniques used. In this work, non-invasive magnetic resonance imaging (MRI) was used for the first time to measure boluses in the stomach a few minutes after swallowing. Three groups of nine healthy participants were fed three different meals: chicken and roasted vegetables (Meal 1), bread and jam (Meal 2) and cheese and yogurt (Meal 3), and then, their stomach content was imaged. The median number of boluses within the stomach was 282, 106 and 9 for Meal 1, Meal 2 and Meal 3 (p < 0.0001) with an average volume of 0.47 mL, 2.4 mL and 13.6 mL, respectively (p < 0.0001). The cohesiveness as well as the meal composition seem to play a key role in the resulting boluses. These new in vivo data from undisturbed organ imaging can improve knowledge of the digestion process, which will, in turn, inform in vitro and in silico modelling of digestion, thus improving their in vitro/in vivo relevance.


Assuntos
Digestão , Conteúdo Gastrointestinal/diagnóstico por imagem , Refeições , Estômago/diagnóstico por imagem , Adulto , Animais , Pão , Queijo , Feminino , Esvaziamento Gástrico , Voluntários Saudáveis , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Período Pós-Prandial , Aves Domésticas , Estudos Retrospectivos , Verduras , Iogurte , Adulto Jovem
2.
Anesth Analg ; 133(3): 581-591, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34403386

RESUMO

Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion of clear liquids before general anesthesia, regional anesthesia, or procedural sedation and analgesia. Nonetheless, in children, fasting guidelines also have consequences as regards to child and parent satisfaction, hemodynamic stability, the ability to achieve vascular access, and perioperative energy balance. Despite the fact that current guidelines recommend a relatively short fasting time for clear fluids of 2 hours, the actual duration of fasting time can be significantly longer. This may be the result of deficiencies in communication regarding the duration of the ongoing fasting interval as the schedule changes in a busy operating room as well as to poor parent and patient adherence to the 2-hour guidelines. Prolonged fasting can result in children arriving in the operating room for an elective procedure being thirsty, hungry, and generally in an uncomfortable state. Furthermore, prolonged fasting may adversely affect hemodynamic stability and can result in parental dissatisfaction with the perioperative experience. In this PRO and CON presentation, the authors debate the premise that reducing the nominal minimum fasting time from 2 hours to 1 hour can reduce the incidence of prolonged fasting and provide significant benefits to children, with no increased risks.


Assuntos
Anestesia/normas , Ingestão de Líquidos , Procedimentos Cirúrgicos Eletivos/normas , Jejum , Esvaziamento Gástrico , Cuidados Pré-Operatórios/normas , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Adolescente , Fatores Etários , Anestesia/efeitos adversos , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Conteúdo Gastrointestinal , Humanos , Lactente , Recém-Nascido , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/efeitos adversos , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo
3.
Arq Gastroenterol ; 58(2): 180-184, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34378651

RESUMO

BACKGROUND: Bowel preparation with mannitol is a well-established method in Brazil. However, factors that interfere with the gastric emptying time period are yet to be known. Knowing these factors may favor the examination scheduling logistics and the individualized orientation for each patient. OBJECTIVE: Know the factors that can contribute to the gastric emptying time after intestinal preparation with express mannitol. METHODS: This is a prospective observational study to know factors that may contribute on the gastric emptying timing: predominant type of diet, comorbidities, medication usage, previous surgeries, number of evacuation per week, bearer of bowel obstipation, fecal type, diet type, number of evacuations after the home usage of bisacodyl before the ingestion of mannitol and number of evacuations after the ingestion of mannitol until reaching a proper bowel preparation. Before starting the colonoscopy exam, an upper digestive endoscopy exam was made to aspirate the gastric content. RESULTS: Sample was composed of 103 patients, 55 (53.4%) women, medium age 61 (±12.1) years, medium weight 75.3 (±14.1) kg, medium height 1.7 (±10) m and medium BMI of 26.6 (±3.9) kg/m2. Average gastric residual volume was 120.9 (0-900) mL. Gastric residual volume (GRV) below 100 mL (GRV ≤100 mL) occurred in 45 (43.6%) patients, 24 (53.3%) women, medium age of 61.0 years and medium BMI of 26.7 kg/m2. Gastric residual volume above 100 mL (GRV >100 mL) occurred on 58 (56.3%) patients, 29 (50%) women, medium age of 61.0 years and medium BMI of 26.2 kg/m2. Comparing both groups, average fasting time period after the ingestion of mannitol was significantly higher on the group with GRV ≤100 mL than group with GRV >100 mL, 123.1 (60-246) vs 95.3 (55-195) minutes, respectively. There was also statistical significance concerning the usage of ezetimibe 6 (13.7%) in the group with GRV ≤100 mL and statistical significance in the group with GRV >100 mL concerning the usage of paroxetine 3 (6.7%) and tadalafil 3 (6.7%) and surgical history of prostatectomy 3 (6.7%) and bridle withdrawal 3 (6.7%). CONCLUSION: We may conclude in this study that the usage of ezetimibe and fasting above 2 hours after the ingestion of mannitol decrease significantly the incidence of a GRV >100 mL. The usage of paroxetine, tadalafil and surgical history of prostatectomy or bridle withdrawal may contribute to increase de incidence of a GRV >100 mL.


Assuntos
Manitol , Estômago , Feminino , Esvaziamento Gástrico , Conteúdo Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Volume Residual
5.
Ying Yong Sheng Tai Xue Bao ; 32(6): 2035-2044, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34212609

RESUMO

Engraulis japonicus, an important fishery resource, is a key species in ecosystem trophodynamics studies. In this study, we examined stomach content of E. japonicusby stable isotope analyses, with samples collected from the East China Sea in 2008-2009 and 2020. The aim of this study was to demonstrate their diet composition, diel and ontogenetic changes in feeding habits and trophic level. Results of the stomach content analysis showed that E. japonicus mainly fed on planktonic crustaceans and small fish. The main prey species were Euphausia pacifica [index of relative importance (IRI)=87.6%; frequency(F)=57.6%], Paracalanus parvus (IRI=3.2%, F=15.3%), and Themisto gracilipes (IRI=2.1%, F=13.1%). Results of the stable isotope analysis showed that Copepoda were the main food source of E. japonicus, followed by Euphausiacea, and the contribution rate of Amphipoda was the least, which was less than 1%. There was significant diel change in diet composition. Feeding intensity was higher in the daytime than at night, with the highest in the dusk and the lowest at midnight. Ontogenetic change in feeding habit occurred when fork length reached 90 mm, over which the fish fed both zooplankton and small fishes. The δ13C of E. japonicus was between -21.66‰ and -18.14‰, with an average of (-19.92±0.86)‰. The δ15N of E. japonicus ranged from 4.07‰ to 10.78‰, with an average of (8.14±2.48)‰. Both δ13C and δ15N values were positively correlated with fork length. Trophic level of the fish was 3.4 with stomach content analysis and 2.7 with stable isotope analysis. The results would provide important reference for understanding nutritional status of pelagic small fish, and offer some basic data to establish ecopath model.


Assuntos
Ecossistema , Conteúdo Gastrointestinal , Animais , Isótopos de Carbono/análise , China , Comportamento Alimentar , Peixes , Cadeia Alimentar , Conteúdo Gastrointestinal/química , Isótopos de Nitrogênio/análise
6.
Mar Pollut Bull ; 170: 112679, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34218031

RESUMO

Here, characteristics of marine litter ingested by Pacific bluefin tuna (PBF, Thunnus orientalis) juveniles under captive conditions were investigated. Swimming speeds of PBF juveniles with pseud-ingested polystyrene chips were compared, and mortality due to polystyrene chip ingestion in cultured teleosts (red sea bream, greater amberjack, and white trevally) was examined in the laboratory. Marine litter ingested by the PBF juveniles included mainly microplastics. The body size of dead specimens with ingested marine litter was significantly smaller than that of other dead fish. We suggest that when the PBF juveniles ingested the marine litter, they died due to energy exhaustion within a few days. All the examined species ingested polystyrene chips, but no related mortality was confirmed. These results suggest that only the PBF could not vomit or excrete the ingested marine litter. This study indicates that the marine litter problem significantly affects the aquaculture industry, especially tuna aquaculture.


Assuntos
Plásticos , Atum , Animais , Aquicultura , Conteúdo Gastrointestinal , Natação
7.
J Forensic Sci ; 66(5): 2035-2040, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34235734

RESUMO

Aconitine is a natural toxic substance belonging to the family of aconitum alkaloids, which is used in small doses by Traditional Chinese practitioners. We present a case of accidental death due to acute aconitine poisoning. A 65-year-old Chinese man presented to a medical clinic with fever and shoulder pain. Soon after administration of intravenous ceftriaxone, a bottle of Chinese medicinal wine was administered. The man rapidly experienced headache, hearing loss and tinnitus, nausea, diarrhea, numbness of the lips, tongue, face, and the upper and lower extremities, cold sweat, fall of blood pressure, and discomfort of the entire body, and he died on the same day. Postmortem examination showed cyanosis of the nail beds, severe congestion in lungs and other organs, bilateral pleural effusions, and infiltration of basophils in the intestinal submucosa. No significant increase of IgE was found in the blood. Toxicological analysis detected aconitine in the medicinal wine, blood, and stomach contents by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Aconitine was quantified in cardiac blood as 16.4 ng/ml, and in stomach contents (63.8 ng/ml) and wine sample (10.1 ug/ml). The cause of death was aconitine poisoning. This case report highlights the danger of aconitine. LC-MS/MS has the advantages of high analytic speed, sensitivity, and accuracy. It would be desirable for the government to control the use of aconitine-containing herbal extracts.


Assuntos
Aconitina/envenenamento , Medicina Tradicional Chinesa/efeitos adversos , Idoso , Cromatografia Líquida , Conteúdo Gastrointestinal/química , Humanos , Masculino , Espectrometria de Massas em Tandem , Vinho
8.
PLoS One ; 16(7): e0253754, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288928

RESUMO

Subacute rumen acidosis (SARA) occurs when highly fermentable carbohydrates are introduced into the diet, decreasing pH and disturbing the microbial ecology of the rumen. Rumen amylolytic bacteria rapidly catabolize starch, fermentation acids accumulate in the rumen and reduce environmental pH. Historically, antibiotics (e.g., monensin, MON) have been used in the prevention and treatment of SARA. Biochanin A (BCA), an isoflavone produced by red clover (Trifolium pratense), mitigates changes associated with starch fermentation ex vivo. The objective of the study was to determine the effect of BCA on amylolytic bacteria and rumen pH during a SARA challenge. Twelve rumen fistulated steers were assigned to 1 of 4 treatments: HF CON (high fiber control), SARA CON, MON (200 mg d-1), or BCA (6 g d-1). The basal diet consisted of corn silage and dried distiller's grains ad libitum. The study consisted of a 2-wk adaptation, a 1-wk HF period, and an 8-d SARA challenge (d 1-4: 40% corn; d 5-8: 70% cracked corn). Samples for pH and enumeration were taken on the last day of each period (4 h). Amylolytic, cellulolytic, and amino acid/peptide-fermenting bacteria (APB) were enumerated. Enumeration data were normalized by log transformation and data were analyzed by repeated measures ANOVA using the MIXED procedure of SAS. The SARA challenge increased total amylolytics and APB, but decreased pH, cellulolytics, and in situ DMD of hay (P < 0.05). BCA treatment counteracted the pH, microbiological, and fermentative changes associated with SARA challenge (P < 0.05). Similar results were also observed with MON (P < 0.05). These results indicate that BCA may be an effective alternative to antibiotics for mitigating SARA in cattle production systems.


Assuntos
Acidose/tratamento farmacológico , Ração Animal , Doenças dos Bovinos/tratamento farmacológico , Bovinos/microbiologia , Fibras na Dieta , Conteúdo Gastrointestinal/microbiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Genisteína/uso terapêutico , Rúmen/microbiologia , Acidose/microbiologia , Animais , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Carga Bacteriana , Doenças dos Bovinos/microbiologia , Celulose/metabolismo , Desoxiglucose/farmacologia , Carboidratos da Dieta/metabolismo , Fibras na Dieta/metabolismo , Proteínas na Dieta/metabolismo , Fermentação , Genisteína/farmacologia , Concentração de Íons de Hidrogênio , Ionóforos/farmacologia , Masculino , Distribuição Aleatória , Silagem , Amido/metabolismo
9.
J Fish Biol ; 99(5): 1591-1601, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34310705

RESUMO

This work examined the diet of the porbeagle shark Lamna nasus in the south-west Atlantic Ocean (SWAO, Argentina, 52° S-56° S) by analysing the stomach content information obtained by scientific observers who sampled specimens captured as by-catch on-board commercial fishing vessels from 2010 to 2020. A total of 148 fishing sites were analysed, in which the estimated catch was composed mainly of hoki Macruronus magellanicus (56.00%) and southern blue whiting Micromesistius australis (33.13%). From 413 porbeagle sharks sampled (292 females and 121 males) ranging from 71 to 241 cm total length (LT ) (mean: 179.76 ± 26.74 cm), 310 (75.06%) contained food in the stomachs. The forage fish were mainly hoki M. magellanicus (23.53%) and southern blue whiting M. australis (19.05%), followed by the Patagonian sprat Sprattus fuegensis (4.48%) and nototheniids (1.4%). Cephalopods and crustaceans accounted for 10% of the diet. The estimated trophic level was 4.35. Generalized linear models revealed that the consumption of hoki M. magellanicus and southern blue whiting M. australis increased with the LT of the porbeagle shark. Moreover, smaller porbeagle sharks preyed upon both small and large teleost fish, whereas larger porbeagle sharks predated exclusively upon large fish. The diet of porbeagle shark involved interactions with fisheries as it fed upon the fish species that constituted the main catch in the analysed fishing sites, as well as the main catches of the austral trawl fisheries. The ecological role of porbeagle shark observed in the SWAO exposed implications for fisheries management from a multispecies perspective.


Assuntos
Pesqueiros , Tubarões , Animais , Dieta , Feminino , Conteúdo Gastrointestinal , Masculino , Estômago
10.
Sci Data ; 8(1): 150, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108483

RESUMO

European plethodontid salamanders (genus Speleomantes; formerly Hydromantes) are a group of eight strictly protected amphibian species which are sensitive to human-induced environmental changes. Long-term monitoring is highly recommended to evaluate their status and to assess potential threats. Here we used two low-impact methodologies to build up a large dataset on two mainland Speleomantes species (S. strinatii and S. ambrosii), which represents an update to two previously published datasets, but also includes several new populations. Specifically, we provide a set of 851 high quality images and a table gathering stomach contents recognized from 560 salamanders. This dataset offers the opportunity to analyse phenotypic traits and stomach contents of eight populations belonging to two Speleomantes species. Furthermore, the data collection performed over different periods allows to expand the potential analyses through a wide temporal scale, allowing long-term studies.


Assuntos
Espécies em Perigo de Extinção , Conteúdo Gastrointestinal , Urodelos , Animais , França , Itália , Fenótipo
12.
Arch Anim Nutr ; 75(3): 222-236, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34148447

RESUMO

Fermentable fibres are used in commercial dog food to promote intestinal health by providing substrates for better metabolic activity of the gut microbiota. Brazil is the world's largest producer of oranges, from which it is possible to obtain fibre with a relevant soluble fraction. The present study compared the effects of two inclusions of orange fibre (1% and 3%, on as fed basis) with a negative control (without addition of fibre source) and two positive controls, beet pulp (3%) and purified inulin (1%), totalling five extruded diets for dogs. The experiment followed a randomised block design with 4 blocks of 10 dogs, 2 dogs per food in each block, totalling 8 dogs per diet. The apparent total tract nutrient digestibility was determined by total faecal collection. Faecal pH and fermentation product content were also measured. The digesta mean retention time (DMRT) was evaluated using plastic markers. The inclusion of a 3% fibre source in diets with 3% orange fibre and beet pulp reduced DM, OM, and energy digestibility (p < 0.05). Diets with 3% orange fibre, beet pulp and 1% inulin presented lower crude protein digestibility than the control (p < 0.05). Dietary fibre digestibility was higher for orange fibre-supplemented diets than inulin (p < 0.05). Beet pulp and 3% orange fibre inclusions resulted in increased moisture content in the faeces of dogs (p < 0.05) but did not alter DMRT. Total short-chain fatty acids were higher than the control in the faeces of dogs fed both orange fibre levels and the beet pulp-supplemented diet (p < 0.05), and the inulin diet-fed dogs presented intermediate values. Butyrate was higher in the faeces of dogs fed the diets supplemented with 1% and 3% orange fibre (p < 0.05), and similar values to the control were observed for beet pulp- and inulin-fed animals. Thus, it was concluded that orange fibre presented higher apparent total tract dietary fibre digestibility than beet pulp and had a fermentation profile in the colon that promoted the generation of butyrate, an effect not observed for inulin and beet pulp.


Assuntos
Citrus sinensis/química , Fibras na Dieta/metabolismo , Digestão , Cães/fisiologia , Fezes/química , Fermentação , Conteúdo Gastrointestinal/química , Nutrientes/fisiologia , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Dieta/veterinária , Suplementos Nutricionais/análise , Feminino , Masculino , Distribuição Aleatória
13.
Braz J Biol ; 82: e232701, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076161

RESUMO

The present study objectified to evaluate the trophic relationships and the possible aggressive mimicry involving Carnegiella strigata, Carnegiella marthae and Gnathocharax steindachneri, in lowland forest streams. Samplings occurred in November 2002, March and August 2003 in Amanã Sustainable Development Reserve (ASDR). The total of 943 fish was caught, being 79.43% of C. marthae, 3.18% of C. strigata and 17.39% of G. steindachneri. Stomach contents, degree of stomach repletion, relative volume and frequency of occurrence of food items were evaluated. Thirteen food items were identified, and the presence of terrestrial and aquatic insects indicates the high dependence of these species and the flooded forest. Low feeding overlap was observed between Carnegiella strigata and C. marthae compared to Gnathocharax steindachneri. However, the overlap between the two Carnegiella species was relatively high, which could explain the low frequency of syntopic occurrence among these species, suggesting a possible case of competitive exclusion.


Assuntos
Characidae , Caraciformes , Animais , Peixes , Conteúdo Gastrointestinal , Lagos , Rios
14.
Braz J Biol ; 82: e237040, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105668

RESUMO

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin's niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.


Assuntos
Peixes-Gato , Animais , Comportamento Alimentar , Conteúdo Gastrointestinal , Hábitos , Humanos , Estações do Ano
15.
Carbohydr Polym ; 265: 118013, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33966820

RESUMO

This study reports the preparation of microspheres of pectin and magnetite nanoparticles coated by chitosan to encapsulate and deliver drugs. Magnetic-pectin microspheres were obtained by ionotropic gelation followed by polyelectrolyte complexation with chitosan. Characterization data show that magnetite changes the physicochemical and morphological properties of the microspheres compared to the non-magnetic samples. Using metamizole (Mtz) as a drug model, the magnetic microspheres showed appreciable encapsulation efficiency (85 %). Release experiments performed in simulated gastric (pH 1.2) and intestinal (pH 6.8) fluids suggested that the release process is pH-dependent. At pH 6.8, the Mtz release is favored achieving 75 % after 12 h. The application of an external magnetic field increased the release to 91 % at pH 6.8, indicating that the release also is magnetic-dependent. The results suggest that the magnetic microspheres based on pectin/chitosan biopolymers show the potential to be used as a multi-responsive drug delivery system.


Assuntos
Quitosana/química , Dipirona/química , Sistemas de Liberação de Medicamentos/métodos , Nanopartículas de Magnetita/química , Microesferas , Pectinas/química , Animais , Biopolímeros/química , Citrus sinensis/química , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Conteúdo Gastrointestinal/química , Géis/química , Humanos , Concentração de Íons de Hidrogênio , Campos Magnéticos , Espectroscopia de Infravermelho com Transformada de Fourier/métodos
16.
Anesthesiology ; 135(2): 284-291, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34019629

RESUMO

BACKGROUND: Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration. METHODS: Inclusion criteria were anesthesia malpractice claims in the American Society of Anesthesiologists Closed Claims Project that were associated with surgical, procedural, or obstetric anesthesia care with the year of the aspiration event 2000 to 2014. Claims involving pulmonary aspiration were identified and assessed for patient and process factors that may have contributed to the aspiration event and outcome. The standard of care was assessed for each claim. RESULTS: Aspiration of gastric contents accounted for 115 of the 2,496 (5%) claims in the American Society of Anesthesiologists Closed Claims Project that met inclusion criteria. Death directly related to pulmonary aspiration occurred in 66 of the 115 (57%) aspiration claims. Another 16 of the 115 (14%) claims documented permanent severe injury. Seventy of the 115 (61%) patients who aspirated had either gastrointestinal obstruction or another acute intraabdominal process. Anesthetic management was judged to be substandard in 62 of the 115 (59%) claims. CONCLUSIONS: Death and permanent severe injury were common outcomes of perioperative pulmonary aspiration of gastric contents in this series of closed anesthesia malpractice claims. The majority of the patients who aspirated had either gastrointestinal obstruction or acute intraabdominal processes. Anesthesia care was frequently judged to be substandard. These findings suggest that clinical practice modifications to preoperative assessment and anesthetic management of patients at risk for pulmonary aspiration may lead to improvement of their perioperative outcomes.


Assuntos
Anestesiologia/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Aspiração Respiratória/epidemiologia , Bases de Dados Factuais , Feminino , Conteúdo Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade
17.
J Wildl Dis ; 57(3): 601-611, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33979445

RESUMO

Marine birds are frequently found dead on beaches, either from natural or from anthropogenic causes. Complete necropsies of those carcasses can provide valuable information, particularly for pelagic species, such as Northern Fulmars (Fulmarus glacialis) and shearwaters, which come to land only to breed and for which information on diseases that may affect them is, therefore, sparse. Between 2000 and 2012, 315 carcasses of four species of Procellariiformes (173 Northern Fulmars, 89 Great Shearwaters [Ardenna gravis], 50 Sooty Shearwaters [Ardenna grisea], and three Cory's Shearwaters [Calonectris diomedea]) were collected on Sable Island, Nova Scotia, Canada, an isolated island near the edge of the continental shelf. A complete necropsy, including examination for the presence of ingested plastic, was performed on all carcasses. Most (70%) of these birds were immature. The cause of death was undetermined in 22% (n=70) of the birds: 36% (62/173) of the Northern Fulmars, 4% (4/89) of the Great Shearwaters, 6% (3/50) of the Sooty Shearwaters, and 33% (1/3) of the Cory's Shearwaters. Emaciation was considered the primary cause of death in 91% of the remaining 245 birds: 87% (97/111) of the Northern Fulmars, 92% (78/85) of the Great Shearwaters, 100% (47/47) of the Sooty Shearwaters, and 100% (2/2) of the Cory's Shearwaters. Notable primary causes of death other than emaciation included mycobacteriosis and neoplasia in Northern Fulmars and transmural parasitic proventriculitis in Great Shearwaters. For Northern Fulmars, nutritional condition (as determined semiquantitatively) was compared with other parameters. Birds in good nutritional condition had heavier body mass and flight muscle mass than those in poor nutritional condition (P<0.01). More adults were in poor nutritional condition than expected by chance (91%; χ2=8.23, P<0.01), whereas only 57% of immature birds were in poor condition. There was no relationship between nutritional condition and sex or mass of ingested plastic. Our study provides information on some previously unsuspected health threats in Procellariiformes.


Assuntos
Conteúdo Gastrointestinal , Mustelidae , Animais , Aves , Canadá , Monitoramento Ambiental , Nova Escócia/epidemiologia
18.
Br J Anaesth ; 127(2): 224-235, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34023055

RESUMO

BACKGROUND: Gastric emptying may be delayed in patients with diabetes mellitus (DM). However, the incidence of full stomach in fasting patients with DM and their risk of pulmonary aspiration under anaesthesia is not well understood. METHODS: A scoping review was undertaken to map the literature on aspiration risk in DM. A search was conducted in seven bibliographic databases, including MEDLINE and Embase, for original articles that studied aspiration risk, gastric emptying, or gastric content and volume. Selection and characterisation were performed by two independent reviewers using a predefined protocol registered externally. RESULTS: The search identified 5063 unique records, and 16 studies (totalling 775 patients with DM) were selected: nine studied gastric emptying and seven studied gastric content or volume. There were no studies reporting the incidence of aspiration in subjects with DM. All nine studies reported delayed emptying in patients with DM compared with healthy controls. Amongst the seven studies that compared gastric residual content/volume (GRV) in the perioperative period, five reported clinically negligible GRV in both patients with DM and controls, whereas two observed a higher incidence of 'full' stomach in patients with DM. CONCLUSIONS: The evidence concerning the aspiration risk for surgical patients with DM is based on a limited number of studies, mostly unblinded, reporting physiological data on gastric emptying and gastric volume as surrogate markers of aspiration risk. Data on fasting gastric content and volume in patients with DM are limited and contradictory; hence, the true risk of aspiration in fasting patients with DM is unknown.


Assuntos
Anestesia , Diabetes Mellitus/epidemiologia , Esvaziamento Gástrico/fisiologia , Conteúdo Gastrointestinal/diagnóstico por imagem , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Aspiração Respiratória/epidemiologia , Comorbidade , Diabetes Mellitus/fisiopatologia , Jejum , Humanos , Complicações Intraoperatórias/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Aspiração Respiratória/fisiopatologia , Ultrassonografia/métodos
19.
Br J Anaesth ; 127(2): 275-280, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34045064

RESUMO

BACKGROUND: Point-of-care ultrasonography can estimate gastric contents and volume to assess the risk of pulmonary aspiration; however, its use in infants has not been well validated. We aimed to develop a predictive model for estimating gastric fluid volume using ultrasonography in infants. METHODS: This prospective observational study enrolled 200 infants (≤12 months) undergoing general anaesthesia. After anaesthetic induction, while preserving spontaneous respiration, we measured gastric antral cross-sectional area using ultrasonography in both the supine and right lateral decubitus positions. We then suctioned the gastric content and measured its volume. The primary outcome was development of a gastric fluid volume prediction model with multiple regression analysis. Agreement between the predicted volume and the suctioned volume was evaluated using a Bland-Altman plot. RESULTS: Overall, 192 infants were included in the final analysis. Pearson correlation analysis showed that the gastric antral cross-sectional area in the supine (P<0.001; correlation coefficient: 0.667) and right lateral decubitus (P<0.001; correlation coefficient: 0.845) positions and qualitative antral grade (P<0.001; correlation coefficient: 0.581) correlated with suctioned volume. We developed a predictive model: predicted volume (ml)=-3.7+6.5 × (right lateral decubitus cross-sectional area [cm2])-3.9 (supine cross-sectional area [cm2])+1.7 × grade (P<0.01). When comparing the predicted volume and suctioned volume, the mean bias was 0.01 ml kg-1 and the limit of agreement was -0.58 to 0.62 ml kg-1. CONCLUSIONS: Gastric fluid volume can be estimated using a predictive model based on ultrasonography data in infants. CLINICAL TRIAL REGISTRATION: NCT03155776.


Assuntos
Anestesia Geral , Conteúdo Gastrointestinal/diagnóstico por imagem , Aspiração Respiratória/diagnóstico por imagem , Ultrassonografia/métodos , Feminino , Humanos , Lactente , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos
20.
Forensic Sci Int ; 324: 110825, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34000617

RESUMO

We report a case in which a tapentadol acute intoxication was suspected as the cause of death of a 39-year-old man: approximately two days after death, cardiac and femoral blood, as well as urine, bile, gastric content and chest hair, were collected during the autopsy. Tapentadol was detected before and after hydrolysis in femoral (530 ng/mL unconjugated and 1570 ng/mL conjugated) and cardiac (680 ng/mL unconjugated and 3440 ng/mL conjugated) blood, and additionally in bile (3200 ng/mL), urine (9300 ng/mL), chest hair (2850 pg/mg) and gastric content. LC-QTOF screening analysis confirmed the presence of five different tapentadol metabolites (tapentadol-O-glucuronide, tapentadol-O-sulfate, N-desmethyltapentadol, N-desmethyltapentadol-glucuronide and N-desmethyltapentadol-O-sulfate), in urine, bile, cardiac and femoral blood. Positivity of body hairs allowed us to conclude that the man had used tapentadol in the last weeks/months. Autopsy and toxicological results (also positive for clotiapine, diazepam and chlordesmethyldiazepam) suggested that tapentadol could have caused, even at low concentrations, a severe respiratory depression, which contributed to the death of the subject. This is one of the few cases in literature where tapentadol was detected in blood, together with its metabolites, and the only one in which the parent drug was identified in hairs.


Assuntos
Analgésicos Opioides/envenenamento , Tapentadol/envenenamento , Adulto , Analgésicos Opioides/análise , Benzodiazepinas/análise , Bile/química , Cromatografia Líquida , Diazepam/análise , Dibenzotiazepinas/análise , Cromatografia Gasosa-Espectrometria de Massas , Conteúdo Gastrointestinal/química , Cabelo/química , Humanos , Masculino , Nordazepam/análogos & derivados , Nordazepam/análise , Prisioneiros , Tapentadol/análise , Tranquilizantes/análise , Ácido Valproico/análise
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