Distribution of Bupivacaine Enantiomers and Lidocaine and Its Metabolite in the Placental Intervillous Space and in the Different Maternal and Fetal Compartments in Term Pregnant Women

The aim of this study is to determine the concentrations of lidocaine and its metabolite, monoethylglycine xylidide (MEGX), and of the enantiomers of bupivacaine in maternal and fetal compartments. Ten healthy pregnant women were submitted to epidural anesthesia. Drug concentrations were determined in the maternal vein, fetal umbilical artery and vein, and the placental intervillous space. The highest concentrations of the bupivacaine enantiomers lidocaine and of lidocaine and of its MEGX metabolite were detected in maternal plasma and in the placental intervillous space. The placental transfer was 33% for the (+)-(R)-bupivacaine enantiomer and 31% for the (-)-(S)-bupivacaine enantiomer. For lidocaine and its MEGX metabolite, respective placental transfers were 60% and 43%. Lidocaine concentration in the fetal umbilical vein was 1.46 times higher than in the fetal umbilical artery. The highest concentrations of lidocaine and its metabolite and of the enantiomers of bupivacaine were detected in the placental intervillous space. The higher lidocaine concentrations in the fetal umbilical vein than in the fetal umbilical artery suggest that there was tissue uptake of the drug or drug metabolization by the fetus.

Temporal distribution of trauma deaths: Quality of trauma care in a developing country

Background: Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care. Objective: The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas. Methods: We analyzed the National Health Minister`s System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001. Results. During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%). Conclusions: The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.

Reference distribution of the bioelectrical impedance vector in healthy term newborns

Bioelectrical impedance vector analysis (BIVA) is a new method that is used for the routine monitoring of the variation in body fluids and nutritional status with assumptions regarding body composition values. The aim of the present study was to determine bivariate tolerance intervals of the whole-body impedance vector and to describe phase angle (PA) values for healthy term newborns aged 7-28 d. This descriptive cross-sectional study was conducted on healthy term neonates born at a low-risk public maternity. General and anthropometric neonatal data and bioelectrical impedance data (800 mu A-50 kHz) were obtained. Bivariate vector analysis was conducted with the resistance-reactance (RXc) graph method. The BIVA software was used to construct the graphs. The study was conducted on 109 neonates (52.3% females) who were born at term, adequate for gestational age, exclusively breast-fed and aged 13 (SD 3.6) d. We constructed one standard, reference, RXc-score graph and RXc-tolerance ellipses (50, 75 and 95 %) that can be used with any analyser. Mean PA was 3.14 (SD 0.43)degrees (3.12 (SD 0.39)degrees for males and 3.17 (SD 0.48)degrees for females). Considering the overlapping of ellipses of males and females with the general distribution, a graph for newborns aged 7-28 d with the same reference tolerance ellipse was defined for boys and girls. The results differ from those reported in the literature probably, in part, due to the ethnic differences in body composition. BIVA and PA permit an assessment without the need to know body weight and the prediction error of conventional impedance formulas.

An integrated database on ticks and tick-borne zoonoses in the tropics and subtropics with special reference to developing and emerging countries

Tick-borne zoonoses (TBZ) are emerging diseases worldwide. A large amount of information (e.g. case reports, results of epidemiological surveillance, etc.) is dispersed through various reference sources (ISI and non-ISI journals, conference proceedings, technical reports, etc.). An integrated database-derived from the ICTTD-3 project (http://www.icttd.nl)-was developed in order to gather TBZ records in the (sub-)tropics, collected both by the authors and collaborators worldwide. A dedicated website (http://www.tickbornezoonoses.org) was created to promote collaboration and circulate information. Data collected are made freely available to researchers for analysis by spatial methods, integrating mapped ecological factors for predicting TBZ risk. The authors present the assembly process of the TBZ database: the compilation of an updated list of TBZ relevant for (sub-)tropics, the database design and its structure, the method of bibliographic search, the assessment of spatial precision of geo-referenced records. At the time of writing, 725 records extracted from 337 publications related to 59 countries in the (sub-)tropics, have been entered in the database. TBZ distribution maps were also produced. Imported cases have been also accounted for. The most important datasets with geo-referenced records were those on Spotted Fever Group rickettsiosis in Latin-America and Crimean-Congo Haemorrhagic Fever in Africa. The authors stress the need for international collaboration in data collection to update and improve the database. Supervision of data entered remains always necessary. Means to foster collaboration are discussed. The paper is also intended to describe the challenges encountered to assemble spatial data from various sources and to help develop similar data collections.

Effect of cantilever length and framework alloy on the stress distribution of mandibular-cantilevered implant-supported prostheses

The purpose of this in vitro study was to analyze the stress distribution on components of a mandibular-cantilevered implant-supported prosthesis with frameworks cast in cobalt-chromium (Co-Cr) or palladium-silver (Pd-Ag) alloys, according to the cantilever length. Frameworks were fabricated on (Co-Cr) and (Pd-Ag) alloys and screwed into standard abutments positioned on a master-cast containing five implant replicas. Two linear strain gauges were fixed on the mesial and distal aspects of each abutment to capture deformation. A vertical static load of 100 N was applied to the cantilever arm at the distances of 10, 15, and 20 mm from the center of the distal abutment and the absolute values of specific deformation were recorded. Different patterns of abutment deformation were observed according to the framework alloy. The Co-Cr alloy framework resulted in higher levels of abutment deformation than the silver-palladium alloy framework. Abutment deformation was higher with longer cantilever extensions. Physical properties of the alloys used for framework interfere with abutment deformations patterns. Excessively long cantilever extensions must be avoided. To cite this article:Jacques LB, Moura MS, Suedam V, Souza EAC, Rubo JH. Effect of cantilever length and framework alloy on the stress distribution of mandibular-cantilevered implant-supported prostheses.Clin. Oral Impl. Res. 20, 2009; 737-741.doi: 10.1111/j.1600-0501.2009.01712.x.

Effect of abutment`s height and framework alloy on the load distribution of mandibular cantilevered implant-supported prosthesis

In cantilevered implant-supported complete prosthesis, the abutments` different heights represent different lever arms to which the abutments are subjected resulting in deformation of the components, which in turn transmit the load to the adjacent bone. The purpose of this in vitro study was to quantitatively assess the deformation of abutments of different heights in mandibular cantilevered implant-supported complete prosthesis. A circular steel master cast with five perforations containing implant replicas (O3.75 mm) was used. Two groups were formed according to the types of alloy of the framework (CoCr or PdAg). Three frameworks were made for each group to be tested with 4, 5.5 and 7 mm abutments. A 100 N load was applied at a point 15 mm distal to the center of the terminal implant. Readings of the deformations generated on the mesial and distal aspects of the abutments were obtained with the use of strain gauges. Deformation caused by tension and compression was observed in all specimens with the terminal abutment taking most of the load. An increase in deformation was observed in the terminal abutment as the height was increased. The use of an alloy of higher elastic modulus (CoCr) also caused the abutment deformation to increase. Abutment`s height and framework alloy influence the deformation of abutments of mandibular cantilevered implant-supported prosthesis. To cite this article:Suedam V, Capello SouzaEA, Moura MS, Jacques LB, Rubo JH. Effect of abutment`s height and framework alloy on the load distribution of mandibular cantilevered implant-supported prosthesis. Clin. Oral Impl. Res. 20, 2009; 196-200.doi: 10.1111/j.1600-0501.2008.01609.x.