916 resultados para peripheral venous catheters


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Background: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice. © 2013 Elsevier Inc. All rights reserved.

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Background: The relationship between the immune response and red and white blood cell homeostasis is cited in literature, but no studies regarding the balance of these cell populations following maxillary bone-graft surgeries can be found. Aim: The aim of this study was to evaluate the possible impairments in the blood cell balance following fresh-frozen allogeneic bone-graft augmentation procedures in patients who needed maxillary reconstruction prior to implants. Material and Methods: From 33 patients elected to onlay bone grafting procedures, 20 were treated with fresh-frozen bone allografts and 13 with autologous bone grafts. Five blood samples were collected from each patient in a 6-month period (baseline: 14, 30, 90, and 180 days postsurgery), and the hematological parameters (erythrogram, leukogram, and platelets count) were accessed. Results: All evaluated parameters were within the reference values accepted as normal, and significant differences were found for the eosinophils count when comparing the treatments (30 days, p=.035) and when comparing different periods of evaluation (allograft-treated group, baseline×180 days, p≤.05 and 90×180 days, p≤.01; autograft-treated group, 30×90 days, p≤.05 and 30×180 days, p≤.05). Conclusions: Both autologous and fresh-frozen allogeneic bone grafts did not cause any impairment in the red and white blood cell balance, based on quantitative hemogram analysis, in patients subjected to maxillary reconstruction. © 2011 Wiley Periodicals, Inc.

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Venous leg ulcers (VLUs) represent the most advanced stage of chronic venous insufficiency. Despite the large body of knowledge available regarding the risk factors and aetiopathogeny of the condition, patients referred to public health care systems in developing countries often do not receive adequate diagnosis or early treatment, leading to clinical evolution and disease recurrence. This review collates updated information about the epidemiology, risk factors, aetiopathogeny, diagnosis, ulcer healing methods and determinant factors of the pernicious cycle of VLUs in developing countries, with a focus on the Brazilian setting.

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Cancer pain is an important clinical problem and may not respond satisfactorily to the current analgesic therapy. We have characterized a novel and potent analgesic peptide, crotalphine, from the venom of the South American rattlesnake Crotalus durissus terrificus. In the present work, the antinociceptive effect of crotalphine was evaluated in a rat model of cancer pain induced by intraplantar injection of Walker 256 carcinoma cells. Intraplantar injection of tumor cells caused the development of hyperalgesia and allodynia, detected on day 5 after tumor cell inoculation. Crotalphine (6 μg/kg), administered p.o., blocked both phenomena. The antinociceptive effect was detected 1 h after treatment and lasted for up to 48 h. Intraplantar injection of nor-binaltorphimine (50 g/paw), a selective antagonist of κ-opioid receptors, antagonized the antinociceptive effect of the peptide, whereas N,N-diallyl-Tyr-Aib-Phe-Leu (ICI 174,864, 10 μg/paw), a selective antagonist of δ-opioid receptors, partially reversed this effect. On the other hand, D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr amide (CTOP, 20 g/paw), an antagonist of μ-opioid receptors, did not modify crotalphine-induced antinociception. These data indicate that crotalphine induces a potent and long lasting opioid-mediated antinociception in cancer pain. © 2013 Elsevier Inc.

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Infected dogs are urban reservoirs of Leishmania chagasi, which is a causative agent of visceral leishmaniasis (VL). Dogs exhibit immune suppression during the course of this disease, and lymphocyte apoptosis is involved in this process. To investigate apoptosis and the expression levels of FAS-FAS-associated death domain protein (CD95 or APO-1), FASL-FAS ligand protein (CD178), and TRAIL-TNF-related apoptosis-inducing ligand (CD253) receptors in peripheral blood mononuclear cells and spleen leukocytes from 38 symptomatic dogs with moderate VL and 25 healthy dogs were evaluated by flow cytometry. The apoptosis rate of blood and splenic CD4+ and CD8+ cells was higher in infected dogs than in healthy dogs. The expression levels of FAS and FASL in blood and splenic CD4+ cells were lower in infected dogs than in healthy dogs. FAS expression in CD8+ cells was higher in infected dogs than in healthy dogs; in contrast, FASL expression was lower in infected dogs. The expression of the TRAIL receptor increased only in splenic CD8+ cells from infected dogs. The FAS and FAS-L blocking antibodies confirmed the importance of these receptors in apoptosis. Our results enhance the current understanding of the immune response in dogs infected with L. chagasi, facilitating the future development of therapeutic interventions to reduce lymphocyte depletion. © 2013 Elsevier B.V.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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In the present investigation we mapped the primary visual area of the South American diurnal rodent, Dasyprocta aguti, by standardized electrophysiological mapping techniques. In particular, we performed a series of mapping experiments of the visual streak in the primary visual cortex. We found that the representation of the visual streak in V1 is greatly expanded, the nasal 10 degrees of the visual streak representation occupies ten times more cortical area than equivalent areas in the central or temporal representation. Comparison of these data with those on the density of ganglion cells in the retina at corresponding locations in the visual field reveal a significant mismatch between these two variables. The nasal representation is greatly expanded along the horizontal meridian in V1 as compared to the central and temporal regions whereas the density of ganglion cells decreases with progression along the visual streak from central region towards the nasal or temporal visual field. A review of the available data reveals that all lateral-eyed mammals exhibit a similar mismatch between the retinal and cortical representation of the visual field, and this mismatches is greater in those species with well defined visual streaks such as rabbit and agouti.

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A doença de Alzheimer (DA) é uma doença neurodegenerativa que provoca morte neuronal e consequente perda progressiva das funções cognitivas, reduzindo as capacidades de trabalho, interferindo na relação social e no comportamento do paciente. Entre as doenças causadoras de demência, a DA é a mais incidente que as de cunho vascular, numa proporção de 4:1, respectivamente. Além das terapias farmacológicas, os métodos diagnósticos auxiliam na identificação precoce da doença auxiliando o tratamento prévio, assim diminuído a progressão da doença. Atualmente estudos citogenéticos vêm demonstrando alterações cromossômicas em portadoras da DA e podem auxiliar no diagnósticos da doença. O objetivo desse trabalho foi verificar o potencial da análise cariotípica de linfócitos do sangue periférico como bioindicador diagnostico da doença de Alzheimer. Para a realização deste trabalho, utilizamos dois grupos de mulheres com 65 anos ou mais, sendo um grupo com (10) portadoras de DA e outro grupo (10) normais. Cada indivíduo foi submetida ao questionário socioeconômico, teste de rastreio cognitivo (MEEM) e à coleta de sangue venoso para cultura de linfócitos e análise cromossômica. Nossos resultados demonstram que o grupo de mulheres portadoras da DA apresentaram elevada taxa de monossomia e trissomia em relação às mulheres normais. Através de estudo de anamnese via questionário, verificamos o estilo de vida de ambos os grupos. Quando comparado a relação das alterações cromossômicas com o nível cognitivo do grupo DA, nós evidenciamos uma tendência inversamente proporcional entre o número de monossomia/trissomia e o desempenho cognitivo. Outro aspecto de nossas análises foi o papel de cada cromossomo ligado à DA. Os cromossomos 1, 14 e 21 não apresentaram trissomia e na verificação da frequência de monossomia, cada cromossomo possui frequência abaixo de 3 % de aneuploidia, ou seja, os cromossomos estudados não possuem uma grande representatividade nas alterações cromossômicas encontradas no estudo.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Os tempos de reação manuais e sacádicos (TRMs e TRSs) são reduzidos quando um sinal de aviso precede o aparecimento do alvo. O decréscimo nos TRSs observados depois do desaparecimento do ponto de fixação tem sido chamado de efeito de intervalo. Teorias diferentes foram propostas para explicá-lo. De acordo com alguns autores, o desaparecimento também permite ao sistema sacádico gerar uma população separada de TRSs, as sacádicas expressas. No entanto, não há concordância sobre a influência do desaparecimento de um estímulo periférico no TRM. Em dois experimentos, testou-se os efeitos de um desaparecimento visual periférico empregado como um sinal preparatório para os TRMs a um alvo, após intervalos variáveis. Encontrou-se uma redução no TRM para intervalos curtos (200-300 ms) e longos (1300-2000 ms) após o desaparecimento periférico. A distribuição dos TRMs deslocou-se para latências curtas, formando por vezes populações separadas. Visto que os TRMs obtidos em intervalos longos foram afetados pela introdução de sessões capciosas, enquanto que os TRMs em intervalos curtos não o foram, propõe-se que dois mecanismos diferentes estão envolvidos no decréscimo dos TRMs: alerta e expectativa temporal. Nossos dados sustentam a hipótese de que o componente temporal envolvido com os estágios preparatórios das respostas motoras podem ser compartilhados pelos movimentos sacádicos e pelas respostas de apertar botões, permitindo a redução das latências motoras após o desaparecimento visual, dentro do paradigma do intervalo. Nossos dados corroboram o modelo de três componentes do efeito de intervalo. Em nosso ponto de vista, a questão da existência ou não do efeito de intervalo para respostas manuais é essencialmente conceitual.