74 resultados para Intermittent catheter
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional meta-analysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasi-RCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gram-negative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.
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Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of tunneled CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty infusing or withdrawing fluid from their paths. Alteplase dose was infused to fill the lumen of the occluded catheter and remained for 50 min. As there was no obstruction of the catheter, the procedure was repeated. Three hundred and thirty-nine CVC in 247 patients were evaluated and followed, totalling 67 244 CVC-days. One hundred fifty-seven patients had only one CVC, 88 patients had two CVC during the study, and two patients had three CVC. The median age was 58 (47–66) years, patients were predominantly men (54%), with diabetic nephropathy as the main cause of chronic kidney disease (44%), the internal jugular vein as the main site of implantation (82%), and duration of dialysis before CVC implantation of 119 (41.5 to 585.5) days. Eight hundred and fifteen occlusion episodes were diagnosed (12 episodes/1000 CVC-days), with primary success with alteplase in 596 episodes (77%) and secondary in 81 cases (10%). In 99 episodes (13%), success was not achieved after the second dose of alteplase. Two hundred and thirty CVC were removed during the study and the removal causes were arteriovenous fistula use in 88 patients (38.3%), infectious and mechanical complications in 89 (38.7%) and 21 (9.1%), respectively, and others (transplantation, transfer, or death) in 32 patients (13.9%). Adverse effects were also not observed. In the multivariate analysis, we identified the greatest number of days with CVC (OR = 1.02, CI = 1.01–1.04, P = 0.004), the presence of diabetes (OR = 1.560, CI = 1.351–1.894, P = 0.015), and exit site infection (ESI) (OR = 1.567 CI = 1347–1926, P = 0.023) as factors associated with obstruction. Thrombotic occlusion showed frequent mechanical complication in CVC of HD patients. We observed 12 episodes of obstruction per 1000 CVC-days, with a high success rate after alteplase use (87%). In the multivariate analysis, the time with CVC, the presence of diabetes, and ESI were identified as variables associated with thrombotic obstruction.
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This study aimed to determine the indole-3-butyric acid (IBA) requirement and proper concentration for Caesalpinia echinata rooting in a hydroponic system for plantlet production. The experiment was conducted in a greenhouse of the 'Faculdade de Ciencias Agrarias e Veterinarias', UNESP, in Jaboticabal, São Paulo state. The vegetal material consisted of 160 stem cuttings that were 11 to 12 cm in length with two pairs of leaves, prepared from young seedlings. The cutting bases were treated by slow immersion in 5% ethanol solution containing 0, 100, 200 and 400 mg L-1 of IBA during 14 hours and by fast immersion in 50% ethanol solution containing 0, 1000, 3000 and 5000 mg L-1 of IBA during 5 seconds. The cuttings were maintained in the hydroponic system for 90 days and, for additional 90 days in plastic bags containing substrate (Plantmax (R)) under intermittent mist. After 90 and 180 days of rooting, the percentage of cuttings that survived, the rooting percentage and the number and length of adventious root were evaluated. Cuttings should be treated with IBA at 100 mg L-1 for 14 hours and placed to root in a hydroponic system.
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Objective-To compare the pre-emptive analgesic effects of epidural ketamine or S(+)-ketamine on post-incisional hyperalgesia.Study Design-Prospective randomized study.Animals-Twenty-four mongrel dogs (1-5 years, weighing 11.9 +/- 1.8 kg).Methods-Dogs were anesthetized with propofol (5 mg/kg intravenously) and a lumbosacral epidural catheter was placed. Dogs were randomly allocated to 3 groups, each with 8 dogs. The control group (CG) was administered saline solution (0.3 mL/kg); the ketamine group (KG) ketamine (0.6 mg/kg); and the S(+)-ketamine group (SG) S(+)-ketamine (0.6 mg/kg). The final volume was adjusted to 0.3 mL/kg in all groups. Five minutes after the epidural injection a surgical incision was made in the common pad of the right hind limb and was immediately closed with simple interrupted nylon suture. Respiratory (RR) and heart (HR) rates, rectal temperature (7, sedation (S), lameness score, and mechanical nociceptive threshold by von Frey filaments were evaluated before the propofol anesthesia and at 15, 30, 45, 60, 75, and 90 minutes and then at 2, 4, 6, 8, 12, and 24 hours after epidural injection.Results-There were no differences in RR, HR, T, or S between groups. Motor blockade of the hind limbs was observed during 20 +/- 3.6 minutes in KG and during 30.6 +/- 7.5 minutes in SG (mean SD). Mechanical force applied to obtain an aversive response was higher from 45 minutes to 12 hours in KG and from 60 to 90 minutes in SG, when compared with CG.Conclusions-Pre-emptive epidural ketamine induced no alterations in RR and FIR, and reduced post-incisional hyperalgesia for a longer time than did S(+) ketamine.Clinical Relevance-Although anesthetic and analgesic potency of S(+) ketamine is twice that of ketamine, the racemic form is seemingly better for post-incisional hyperalgesia. (C) Copyright 2004 by the American College of Veterinary Surgeons.
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Estudos em animais de laboratório sugerem um efeito antiulcerogênico do extrato de Casearia sylvestris. Esse extrato ainda não foi estudado para a profilaxia e/ou o tratamento de úlceras gástricas em equinos. Para avaliar a influência do extrato de C. sylvestris na permeabilidade gástrica à sacarose, seis equinos adultos foram submetidos a modelo de indução de úlceras gástricas. Os animais foram submetidos ao teste de permeabilidade à sacarose antes e ao término do protocolo de restrição alimentar intermitente, para detecção de ulceração gástrica. Durante os sete dias da indução, os animais foram submetidos a tratamentos diários via sondagem nasogástrica com extrato de C. sylvestris (9mg kg-1 de peso corpóreo) ou veículo (ágar). Após intervalo de 32 dias em piquete, para permitir a cicatrização das úlceras induzidas, cada animal foi submetido novamente ao protocolo de indução de úlcera gástrica, e os tratamentos foram alternados. Dessa forma, cada animal foi submetido a ambos os tratamentos em períodos distintos. A concentração de sacarose na urina foi determinada para cada amostra obtida, por cromatografia líquida de alto desempenho e detecção amperométrica pulsátil. Não foram observadas alterações nos exames clínicos e hemogramas. O tratamento com o extrato de C. sylvestris evitou o aumento da concentração de sacarose urinária (P<0,05) quando comparado ao veículo, sugerindo um efeito antiulcerogênico gástrico em equinos. Estudos mais amplos incluindo gastroscopia são necessários para avaliar a possibilidade de usar o extrato para a profilaxia e/ou o tratamento das úlceras gástricas em equinos.
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ObjectiveTo compare cardiac output (CO) measured by Doppler echocardiography and thermodilution techniques in spontaneously breathing dogs during continuous infusion of propofol. To do so, CO was obtained using the thermodilution method (CO(TD)) and Doppler evaluation of pulmonary flow (CO(DP)) and aortic flow (CO(DA)).Study designProspective cohort study.AnimalsEight adult dogs weighing 8.3 +/- 2.0 kg.MethodsPropofol was used for induction (7.5 +/- 1.9 mg kg-1 IV) followed by a continuous rate infusion at 0.7 mg kg-1 minute-1. The animals were positioned in left lateral recumbency on an echocardiography table that allowed for positioning of the transducer at the 3rd and 5th intercostal spaces of the left hemithorax for Doppler evaluation of pulmonary and aortic valves, respectively. CO(DP) and CO(DA) were calculated from pulmonary and aortic velocity spectra, respectively. A pulmonary artery catheter was inserted via the jugular vein and positioned inside the lumen of the pulmonary artery in order to evaluate CO(TD). The first measurement of CO(TD), CO(DP) and CO(DA) was performed 30 minutes after beginning continuous infusion (T0) and then at 15-minute intervals (T15, T30, T45 and T60). Numeric data were submitted to two-way anova for repeated measurements, Pearson's correlation coefficient and Bland & Altman analysis. Data are presented as mean +/- SD.ResultsAt T0, CO(TD) was lower than CO(DA). CO(DA) was higher than CO(TD) and CO(DP) at T30, T45 and T60. The difference between the CO(TD) and CO(DP), when all data were included, was -0.04 +/- 0.22 L minute-1 and Pearson's correlation coefficient (r) was 0.86. The difference between the CO(TD) and CO(DA) was -0.87 +/- 0.54 L minute-1 and r = 0.69. For CO(TD) and CO(DP), the difference was -0.82 +/- 0.59 L minute-1 and r = 0.61.ConclusionDoppler evaluation of pulmonary flow was a clinically acceptable method for assessing the CO in propofol-anesthetized dogs.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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O trabalho teve como objetivo desenvolver um protótipo aplicador de líquidos na superfície do solo para cafezais localizados em regiões de topografia acidentada ou cultivados em sistema de plantio adensado. O protótipo do aplicador construído é um trator de rabiças acionado por um motor de dois tempos a gasolina, de 2,61 kW (3,5 cv), com duas rodas motrizes com bitola de 0,60 m e uma terceira roda direcional, equipado com sistema de pulverização dotado de depósito de 40 L, bomba centrífuga, filtros de linha, regulador de pressão, manômetro, mangueiras, válvulas e suporte de bicos. Para avaliar a eficiência do protótipo, foram instalados dois experimentos de campo em São Sebastião do Paraíso - MG (2003 e 2004), onde foram aplicados inseticidas sistêmicos para o controle da cigarra. Os métodos de aplicação avaliados foram: aplicação em faixa, filete, drench contínuo e drench intermitente. O protótipo aplicador de líquidos à superfície do solo atendeu aos objetivos propostos, visto que conseguiu realizar o controle químico de cigarras com destaque para a aplicação em drench contínuo. O protótipo, se equipado para aplicar simultaneamente nos dois lados da planta, apresentará capacidade de campo operacional semelhante à do equipamento tratorizado.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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This research investigated the pattern of antibody response by means of enzyme linked immunosorbent assay (Elisa) and indirect fluorescent antibody test (IFAT) through the course of experimental Trypanosoma evansi infection in dogs. Clinical and parasitological features were also studied. The average prepatent period was 11.2 days and parasitaemia showed an undulating course. Biometrical study of parasites revealed a mean total length of 21.68mm. The disease was characterized by intermittent fever closely related to the degree of parasitaemia and main clinical signs consisted of pallor of mucous membrane, edema, progressive emaciation and enlargement of palpable lymph nodes. Diagnostic antibody was detected within 12 to 15 days and 15 to 19 days of infection by IFAT and Elisa, respectively. High and persistent antibody levels were detected by both tests and appeared not to correlate with control of parasitaemia
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Chlamydophila psittaci (C. psittaci) has been detected in 460 avian species, among them the most frequent are the Psittaciformes, Columbiformes, Anseriformes and raptors. In Brazil, the main avian species recognized as healthy carriers belong to the order Psittaciformes and Columbiformes, but very few studies have been done in other bird families. Reports of the occurrence of this disease in the clinical form are rare in the Ramphastids; consequently, they are not commonly evaluated for this agent. The present study reports the investigation of C. psittaci in 25 captive ramphastids from a zoological park in São Paulo State, Brazil. Swabs samples from the cloaca were submitted to semi-nested polymerase chain reaction (semi-nested PCR) for direct detection of the microorganism. Additionally, blood samples obtained from these birds were submitted to the Complement Fixation Test (CFT) for detection of antibodies anti-C. psittaci. The presence of C. psittaci was not detected in the cloacal swab samples tested by the PCR. Nevertheless, 16% (4/25) of the bird's sera were positive by the CFT. Among the species with positive results, there are the saffron toucanet (Pteroglossus bailloni) and black-necked-aracari (Pteroglossus aracari), two species with no descriptions of the survey of C. psittaci published in the literature. Intermittent elimination of C. psittaci is a feature of chronically infected birds; however the absence of a positive-antigen sample did not guarantee that the bird is Chlamydophila-free. The serological results obtained show that the ramphastids tested were previously exposed to the pathogen and developed immune response, but showed no clinical signs of the disease and didn't eliminate regularly the organism in their feces in the moment of the sample collection.
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O presente trabalho objetivou avaliar o enraizamento de estacas de P. nitida, utilizando dois tipos de estacas (com 1 e 2 gemas) e 4 doses de ácido indolbutírico (AIB) (0; 1.000; 3.000 e 5.000 mgL-1) com imersão lenta (5 segundos), com a finalidade de utilizá-las como porta-enxerto do maracujazeiro-azedo. O delineamento experimental utilizado foi inteiramente casualizado, em esquema fatorial 4x2 (concentrações de AIB x número de gemas na estaca), com quatro repetições de 10 estacas, totalizando 320 estacas. As estacas foram dispostas em bandejas plásticas, contendo vermiculita expandida de textura média, e mantidas sob sistema de nebulização intermitente, por 25 dias. As doses de AIB testadas influenciaram na sobrevivência, enraizamento das estacas e número e comprimento de raízes; e o número de gemas não influenciou no enraizamento de estacas.