Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency

Biodistribuição do fitato de sódio marcado com tecnécio-99m em ratos esplenectomizados

O baço, como maior órgão linfóide do corpo humano, desempenha funções imunológicas relevantes, tais como depuração de bactérias da corrente sangüínea, produção de anticorpos e interação com a função hepática. A esplenectomia tem sido evitada sempre que possível, mas quando realizada pode provocar uma série de efeitos indesejáveis. O radiofármaco 99mTc-fitato é usado no diagnóstico de doenças, especialmente no fígado, através de exames de imagem, na dependência de sua biodistribuição. Algumas drogas e intervenções cirúrgicas podem interferir na biodistribuição de radiofármacos e inexistem na literatura dados sobre efeitos da esplenectomia no metabolismo do 99mTc-fitato. O objetivo do trabalho foi avaliar se a esplenectomia interfere na biodistribuição hepática do 99mTc-fitato e na função do fígado em ratos Wistar. Sob anestesia e técnica asséptica, os animais do grupo SP (n=6) foram esplenectomizados. No grupo C (controle; n=6) os animais não foram operados. Após 15 dias de observação, foi injetado de 0,1ml de 99mTc-fitato via plexo orbital (0,66MBq) em todos os animais. Após 30 minutos, foram retiradas amostras hepáticas para determinação do percentual de radioatividade/grama (% ATI/g), usando-se contador gama Wizard Perkin-Elmer. Realizou-se dosagem sérica de ALT, AST e LDH, e leucometria. Estatística pelo teste t, com significância de p>0,05. Observou-se diferença significativa (p=0,034) comparando-se o %ATI/g no fígado dos ratos esplenectomizados (0,990,2) com os controles (0,400,2). ALT, AST e LDH tiveram dosagens significativamente menores e houve leucocitose nos esplenectomizados (p=0,01), comparando-se com os controles. Concluiu-se que, em ratos, a esplenectomia provavelmente provocou alteração na captação de 99mTc-fitato pelo fígado, coincidindo com alterações na função hepática. A realização deste estudo teve caráter multidisciplinar, envolvendo pesquisadores de diversas áreas como Medicina Nuclear, Cirurgia, Análises Clínicas e Estatística. Este aspecto preencheu os requisitos da multidisciplinaridade do Programa de Pós-graduação em Ciências da Saúde

Ocorrência e tratamento de monogenoides em alevinos de pampo (Trachinotus carolinus) cultivados experimentalmente na região norte do estado de São Paulo

This work had as objective tests therapeutic treatments seeking the monogenea eradication in fingerlings Florida Pompano (Trachinotus carolinus) servants in cage net in the area of Ubatuba, State of São Paulo. The fingerlings presented an accentuated weigh loss and strong discoloration and through observation of scraped of gills under light microscope were identified a high amount of monogenea. Three treatments were tested in form of baths: T1 (fresh water for 5 minutes); T2 (formalin: 1: 1.000 for 20 minutes) and T3: (formalin: 1:4.000 for 30 minutes). The treatments were appraised through scraped of gills, mounted among you laminate and laminulas and observed to the light microscope. It was observed that in the tested conditions all of the treatments were efficient in the elimination of the monogenea without presenting lethality to the fish. The treatment is recommended T I (take a bath in fresh water for 5 minutes) for the facility in the application and for the absence of use of chemical products.

Avaliação da eficácia analgésica no pós-operatório de revascularização do miocárdio: ensaio clínico randomizado controlado

A analgesia pós-operatória eficaz é especialmente importante após cirurgias torácicas, pois, além de aliviar a dor, facilita a retomada de atividades normais, incluindo a deambulação, a respiração e a tosse. Dessa forma, os objetivos deste estudo são: avaliar a eficácia analgésica da associação entre anestesia geral e raquianestesia com morfina e ropivacaína mais esquema multimodal em relação à anestesia geral e esquema multimodal em cirurgia de revascularização do miocárdio; analisar a eficácia analgésica da injeção subcutânea de lidocaína e analgesia multimodal na remoção de tubos torácicos em cirurgia de revascularização do miocárdio. A metodologia consiste em ensaio clínico randomizado, controlado, envolvendo 58 pacientes, de ambos os sexos, com idade média de 59,8  8,9 anos, estado físico ASA II e III. Os participantes foram alocados em dois grupos, sendo o GI composto por indivíduos submetidos à anestesia geral combinada à raquianestesia com morfina 400μg e 6 ml (30mg) a 8 ml (40mg) de ropivacaína a 0,5% e analgesia multimodal; já o GII foi composto por indivíduos submetidos à anestesia geral associada à analgesia multimodal. Foi avaliada a dor, ao despertar, nas primeiras 24 horas, e ao realizar exercício respiratório, ao retirar drenos de torácicos e o tempo para extubação. A análise estatística foi realizada pelos testes do Qui-quadrado e Teste t de Student e o teste de Fisher. O resultado obtido foi o seguinte: o GI apresentou menor intensidade de dor ao despertar (p= 0,001), nas primeiras 24 horas (p= 0,001) e durante a realização dos exercícios respiratórios (p= 0,004). Houve maior necessidade de analgesia complementar no grupo GII, com maior consumo de morfina (p= 0,05), e os efeitos colaterais leves, como náuseas (p= 0,001), vômito (p= 0,002), prurido (p= 0,030), predominaram no GI. Não houve diferença estatisticamente significante entre os grupos (P= 0,47), em relação à intensidade de dor na remoção dos drenos. Após as observações feitas, o estudo sugere que a anestesia geral combinada à raquianestesia com morfina associada à ropivacaína oferece melhor efeito analgésico no pós-operatório de cirurgia cardíaca. Adicionalmente, o estudo sugere que o efeito analgésico da injeção subcutânea de lidocaína 1% associado à analgesia multimodal não é eficaz

Crescimento, desenvolvimento gonadal e composição muscular de matrinxãs (Brycon cephalus) submetidos à restrição alimentar e realimentação durante um ano

Neste trabalho, avaliou-se o efeito da restrição de ração alternada com realimentação no crescimento, desenvolvimento gonadal e composição muscular de matrinxãs (Brycon cephalus) adultos, de ambos os sexos, durante um ano (janeiro de 1998 a janeiro de 1999). Foram utilizados 135 peixes, separados em dois grupos: controle, alimentado diariamente até aparente saciação, e experimental, submetido ininterruptamente a ciclos de três dias de alimentação/2 dias de restrição de ração (40% de restrição ao mês). Foram realizadas 7 amostragens, nas quais foram utilizados 8 a 10 peixes por grupo. Após anestesia, os peixes foram pesados e as gônadas foram retiradas para determinação do IGS, sexo e fase do ciclo reprodutivo. Porções dos músculos branco e vermelho foram retiradas para determinação da porcentagem de lipídio total, proteína bruta, matéria seca e umidade. Os resultados mostraram que a estratégia alimentar utilizada não afetou o crescimento, o desenvolvimento gonadal e a composição muscular do matrinxã. A restrição de ração seguida por realimentação parece ter desencadeado mecanismos de ajuste metabólico para melhor utilização do alimento e aporte suficiente de energia para o crescimento, processo de maturação gonadal e composição corporal. É possível estabelecer formas de manejo alimentar mais econômicas para o matrinxã sem que processos fisiológicos importantes sejam afetados.

Metacromasia para identificação de basófilos sanguíneos em surubim híbrido: contribuição metodológica

Padua S.B. & Ishikawa M.M. [Metachromasia for blood basophils identification in hybrid surubim catfish: methodological contribution]. Metacromasia para identificacao de basofilos sanguineos em surubim hibrido: contribuicao metodologica. Revista Brasileira de Medicina Veterinaria, 33(3):147-150, 2011. Centro de Aquicultura da Unesp/Jaboticabal Rod. Paulo Donato Castellane, s/n Bairro Rural, Jaboticabal, 14884-900, SP. Brasil. E-mail: santiagopadua@live.comDifferent protocols of fixation and hydrolysis of blood smears of hybrid surubim catfish for metachromasia to marking blood basophils were evaluated. For this reason, methanol, acid-alcohol and formalin vapor were tested as fixatives. For hydrolysis of blood smears, HCl, citric acid and 2-Mercaptoethanol + Urea + NaCl solutions was evaluated. After procedures, the blood smears was stained with toluidine blue (0.025%) diluted in McIlvaine buffer (pH 4). The different protocols for fixation and hydrolysis of blood smears for metachromasia influenced the quality of the reaction. Hydrolysis with 2-Mercaptoethanol + Urea + NaCl solutions provided negative results when using methanol and acid-alcohol as fixatives. The fixation with acid-alcohol associated with citric acid hydrolysis provides highest quality reason.

Identificação morfológica de organismos semelhantes à anaplasmataceae em monócitos de surubim híbrido (Pseudoplatystoma reticulatum x P. corruscans) – relato de caso

The aim of this study was to report the occurrence of Anaplasmataceae-like organisms in monocytes from the hybrid surubim catfish. During the hematological evaluation of fish infected by Pseudomonas sp. in a fish farm located in the State of Mato Grosso do Sul we observed into the monocytes the presence of numerous pleomorphic inclusions of various sizes, rough in appearance which presented basophilic staining. These inclusions were similar to elementary bodies, initial bodies and morule of the bacteria from Anaplasmataceae family, often diagnosed in domestic mammals. This is the first report of its occurrence possibly belonging to the family of Anaplasmataceae in cultured fish in Brazil. Additional studies are necessary for molecular characterization of this bacteria, pathogenic potential, life cycle and impact on the intensive production of fish.

Benzocaine and eugenol as anesthetics for Brycon hilarii

A utilização de produtos anestésicos durante práticas de manejo é frequentemente empregada, porém doses corretas de diferentes fármacos e para espécies distintas ainda estão em fases de pesquisa. O objetivo do estudo foi determinar a melhor concentração de benzocaína e eugenol para juvenis de piraputanga (B. hilarii). Foram utilizados 104 juvenis de piraputanga com peso médio de 50,04 ± 20,80 g e comprimento total médio de 16,30 ± 12,32 cm adquiridos em uma piscicultura comercial localizada na região Oeste do Estado do Paraná. O trabalho foi conduzido no Laboratório de Aquicultura do Grupo de Estudos de Manejo na Aquicultura - GEMAq da Universidade Estadual do Oeste do Paraná (UNIOESTE). Os animais foram submetidos a cinco concentrações de benzocaína (50,0; 100,0; 150,0; 200,0 e 250,0 mg L-1) e sete concentrações de eugenol (50,0; 100,0; 150,0; 200,0; 250,0; 300,0 e 350 mg L-1), para a aferição dos tempos referentes à letargia. Para a recuperação, os animais foram mantidos em aquários livre do anestésico e observado o tempo em que retornaram às atividades normais. A melhor dose de benzocaína verificada foi de 100 mg L-1, enquanto a melhor dose de eugenol foi entre 100 e 150 mg L-1.

Biodistribuição do pertecnetato de sódio (Na99mTcO4) em ratos submetidos à ressecção extensa de intestino delgado

Massive resection of the small intestine results in short bowel syndrome with anti-absorptive effect and repercussions on the metabolism. Morphologic and functional evaluation may be necessary in order to control wrapped organs. Scintigraphy an examination with little invading and no biologic damage can be used. The purpose were to assess the biodistribution of sodium pertecnetate in organs of rats subjected to massive resection of the small intestine, the intestinal adaptation of the remnant intestinal mucosa and weight curve evaluation in the postoperative period. Twenty-one Wistar rats were randomly allocated into three groups (n = 7). The operated group named short bowel (SB) after anesthetized was subjected to massive resection of the small intestine; the control group (C), and sham group (SHAM). On the 30th postoperative day, 0.l mL of sodium pertechnetate was injected into the venous orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The percentage of radioactivity per gram of tissue (%ATI/g) was determined using Gama Counter WizardTM 1470, PerkinElmer to all samples. Biopsies of 3 cm remaining jejunum were removed to histological analyses. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. The study had the participation of some departments and laboratories, as Nucleus of Experimental Surgery, Department of Surgery, Laboratory of Radiobiology, Department of Pathology and Service of Nuclear Medicine, certifying the character of a multidisciplinary research. The results were no significant differences in %ATI/g of the sodium pertechnetate in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05. The biodistribution of sodium pertechnetate was not affected by massive intestinal resection in rats. An adaptive response by the intestinal mucosa probably contributed to the reversion of weight loss and the biodistribution of sodium pertechnetate was not affected by the surgery

Tecido hepático e corpo adiposo de rã-touro (Lithobates catesbeianus) submetido a diferentes fotoperíodos

The study was conducted to evaluate the liver tissue weight, body fat weight, the fatty somatic index and the liver somatic index of bullfrogs subjected to three photoperiod during the growing phase (initial 30 days) and finishing (60 days). The treatments were 16 h light and 8 h dark, 12 h of light and dark and 8 h light and 16 h dark. The experimental design was completely randomized design with three replications. We used 36 bullfrogs/m2 weighing from 22 to 28 g. The results were submitted to ANOVA and Tukey Test at 5% probability. Differences were found for the weight of body fat, liver tissue weight, liver somatic index and fatty somatic index the bullfrog to the treatments and the study periods and there is greater accumulation of energy to ninety days. The photoperiod did not influence body weight and fat weight of the liver tissue of bullfrog at the end of the fattening period and the difference fatty somatic index and liver somatic index were influenced by body weight of animals.

Influence of the season of year, stage of lactation and milking time on the chloride content in bovine milk

From January to October 1995, chloride content determinations were accomplished in 2,218 samples of milk collected from 67 quarters of 17 lactating cows, in initial, middle and final stages of lactation, in the morning and afternoon milking. The highest means of chloride contents were observed among the milk samples collected in the final stage of lactation (0,203 gC1/100ml), in the summer (0,212 gC1/100ml) and in the morning milking (0,189 g C1/100ml). The differences observed between the chloride contents in the samples obtained in the different stages of lactation and the seasons of the year were statistically significant (P<0.0001). The gratest occornce of chloride at rates superior to 0.22 gC1100ml was observed in the final stge of lactation (31.4%), summer (44.2%) and after the morning milking (27.8%). These results evidentiate the influence of physiological and external factors (stage of lactation and season of the year) on the concentration of chloride of milk.

Parâmetros eletrocardiográficos e valores séricos e urinários de sódio e potássio em cães tratados com furosemida

The serum and urine Na+ and K+ levels and their relationship with electrocardiography characteristics,were studied in 15 male adult mongrel dogs, treated twice-a-day,with 2, 4, 8mg/kg of live weight doses of furosemide and furosemide associated with KCl during 35 days. Urine samples were analyzed weekly in order to determine the Na+ and K+ concentrations and to evaluate the urinary excretion of both cations. Electrocardiography was performed simultaneously, using limb derivations, speed 50mm/sec and calibration of 1 cm corresponding to 1mV. Data showed decreased seric concentrations of Na+ and Ki, increase in Na+ fractional excretion between days 7 and 21 of the treatment, slower heart rate and longer PR, QRS and QT intervals in the ECG. Briefly 2mg/kg furosemide associated with KCl was the most suitable treatment since it induced lesser side effects.

Ostecondrose em bovinos confinados

This paper reports the occurrence of osteochondrosis in feedlot cattle submitted to a high-caloric diet. About 11.6% of the animals showed symptoms that included lameness, tarsal hyperflexion, muscle fasciculations, reluctance to move and delayed recumbency. Necropsy and radiologic examination showed typical lesion of osteochondrosis, including cartilage discontinuity and osseous injury. The diet, age and high grow rate of the animals were considered to he factors in the development of osteochondrosis.

Efeitos de diferentes frações inspiradas de oxigênio no índice biespectral em cães submetidos à infusão contínua de propofol

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