Prevalence, risk factors, causative organism and antibiotic susceptibility of catheter associated urinary tract infections

Background: The most common nosocomial infection is catheter-associated urinary tract infection (CAUTI), with a 3-7% daily risk of developing CAUTI in acute care settings. This study's goal was to identify the prevalence, risk factors, causative organism of CAUTI and understanding the organism's current antimicrobial agent sensitivity profile. Methods: Total 120 patients participated in a prospective and observational study conducted at Adichunchanagiri Hospital, Karnataka. Reviewing and evaluating patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided data needed for the study. Microsoft Excel was used to enter the data and version 28 of SPSS to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: It was discovered that 12.5% of HAI cases were linked to catheter use. The most prevalent microbial agent in the current investigation was E. coli (41.7%). According to the current study, women are more likely than men to get UTIs. An underlying medical condition was found to have a strong correlation with UTIs in the current investigation. For CAUTI, drug resistance to cefotaxime and tigecycline was noted. Conclusions: The study suggested that gender, age extremes, use of antibiotics, length of stay in intensive care unit, diabetes mellitus, immunosuppressive medication, and indwelling urinary devices are the major risk factors for CAUTI. E. coli was the most common microbiological agent in the current study. Therefore, to assist doctors in the treatment and management of CAUTIs, ongoing surveillance of antimicrobial resistance patterns is required.

A rare case of giant mucinous cystadenocarcinoma of the right ovary with metastatic deposits and Brenner tumor in the left ovary

Ovarian cancer is the second most common gynecological malignancy. Mucinous tumor accounts for 3% of ovarian tumors and is a challenging task for a surgical pathologist. Association of Brenner tumor, a subtype of epithelial malignancy is a rare entity reported in the literature. Herein, we report a unique case of a 57-years old post-menopausal woman who presented with progressive abdominal distention for 3 years and constipation for 1 year. Clinically, it was suspected as a case of complex ovarian cyst and the patient underwent staging laparotomy. Intraoperatively, a giant mucinous cystadenocarcinoma of the right ovary with deposits in the pouch of Douglas, omentum, umbilical, and the sub-umbilical region was found along with a benign Brenner tumor of the left ovary.

Assessment of medication adherence, quality of life and risk factors among patients with tuberculosis in a South Indian tertiary care hospital: a cross-sectional study

Background:The main objective of the current study was to assess the level of medication adherence, quality of life, risk factors for better treatment outcomes and to improve patient quality of life by giving TB education. Methods:A prospective observational study was conducted on 278 patients (139 tubercular patientsand 139 health volunteers).A data collection form of various socio-demographic factors, lifestyle factors, and co-morbid conditions for tuberculosis were collected. The quality of life(QOL) was assessed by interviewing the subjects using WHO-QOL BREF questionnaire. Morisky –8 item medication Adherence Questionnaire was used for assessing adherence.Results:In a total of 139 TB patients, high adherence (60.06%), medium adherence (20.86%) and low adherence (10.07%) are reported. WHOQOL-BREF mean domain scores were physical health (54.10±12.33), psychologicalhealth (51.73±16.24),social health (62.04±15.35) and environmental health (57.14±16.90) respectively. In present study male (67.63%) are higher than females (32.37%). Risk factors observed in study were statistically significant and discussed inpresent study.Conclusions:This study showed that the MMAS-8 had good reliability and validity for measuring adherence levels in rural TB patients. There was a high level of adherence to anti-TB treatment was seen in study area. WHO-QOL BREF questionnaire had good reliability and validity for measuring quality of life and Improved quality of life observed in patients with high adherence to anti tubercular drugs. Risk factors such as age, education, locality, food habits, income, smoking and alcoholism are independently associated with Tuberculosis

Evaluation of Antifibrin, Antioxidant and Antimicrobial Activities of Betel Leaves (Piper betel L.)

Piper betel L. belongs to the family Piperaceae. It has been an important medicinal agent since ages in various traditional and folk systems of medicine. Leaves obtained from the local market were shade dried and powdered. Different solvents were used based on polarity to extract phytochemicals from this powder using a Soxhlet extractor and separated using rotary vacuum evaporator. Thin layer chromatography was run using different solvent systems in different ratios for identifying essential compounds of Piper betel and for standardizing the ratios at which better resolution of compounds taken place. Antimicrobial activities were tested on twelve bacterial and three fungal species. Also, anti fibrin activity was tested on erythrocytes by using the extracts obtained by the plant. The zone of inhibitions formed due to the anti microbial activity were measured and found that mixtures of ethyl acetate and ethanol were effective. The percentage of clot lysis was found to be appreciable for ethyl acetate extract of the Piper leaves.

Efeito da suplementação parenteral extra de cobre e zinco sobre a resposta imunológica de vacas Nelore / Effects of parenteral over-supplementation of cooper and zinc on immune response of Nellore cows

O objetivo deste estudo foi avaliar o efeito da suplementação mineral injetável extra de cobre (Cu) e zinco (Zn) sobre a resposta imunológica de vacas Nelore no período pré-parto. Foram avaliadas 60 vacas prenhes, as quais foram divididas em dois tratamentos, por meio da distribuição aleatória em delineamento inteiramente ao acaso. Aos 75 dias antes do parto, as vacas do tratamento testemunha (T) receberam soro fisiológico como placebo e os animais suplementados (S) receberam mineral injetável via subcutânea (75mg de cobre e 250mg de zinco, em dose única). Foram realizadas três coletas de sangue, duas antes da data prevista para o parto (75 e 10 dias) e uma 30 dias após o parto. Os teores de Cu, Zn, ceruloplasmina, imunoglobulinas G (IgG) e M (IgM) foram analisados durante as três coletas. A atividade fagocitária foi avaliada aos 30 dias pós-parto. Os dados foram examinados mediante análise de variância, com o uso do pacote estatístico do SAS, e os dados individuais da atividade fagocitária pelo PROC GLM. Os dados de Cu, Zn, IgG e IgM foram analisados como medidas repetidas no tempo de coleta por meio do PROC MIXED, com o nível de significância de 5%. Os teores de Cu, Zn, IgM, IgG, ceruloplasmina e a atividade fagocitária das vacas não sofreram influência dos tratamentos (P>0,05). O fornecimento de Cu e Zn injetável, nas doses utilizadas, aos 75 dias antes do parto para vacas Nelore, em dietas suficientes, não alterou os teores de Cu, Zn, ceruloplasmina e a resposta imunológica até 30 dias após o parto.(AU)

The aim of this study was to evaluate the effect of extra injectable mineral supplementation of copper (Cu) and zinc (Zn) on the immune response of Nellore cows in pre-partum period. Sixty pregnant cows were randomly distributed in a completely randomized design in two treatments. In the control treatment (T), cows received saline as placebo, and supplemented treatment (S) received mineral injection (75mg copper and 250mg of zinc, single dose) subcutaneously, 75 days prior to parturition. Blood was sampled three times, two before the expected date of parturition (75 and 10 days) and another at 30 days postpartum. Analyses were performed for Cu, Zn, ceruloplasmin, immunoglobulin G (IgG) and M (IgM) in the three periods and the phagocytic activity in the last period (30 days postpartum). The experimental data were subjected to analysis of variance using the statistical package SAS, being that the individual data phagocytic activity were analyzed by PROC GLM, and the Cu, Zn, IgG and IgM were analyzed as repeated measures in the time, using the PROC MIXED, with the significance level of 5%. The Cu, Zn, IgM, IgG, ceruloplasmin and the phagocytic activity of the cows were not affected by treatments (P>0.05). The supply of injectable Cu and Zn, at the doses used, 75 days before parturition to Nellore cows in sufficient diets, did not alter the serum contents of Cu, Zn, ceruloplasmin and the immune response up to 30 days after parturition.(AU)

Eficiência de óleos essenciais na qualidade sanitária e fisiológica em sementes de feijão-fava (Phaseolus lunatus L. ) / Efficiency of essential oils in the sanitary and physiological quality of lima bean seeds (Phaseolus lunatus L. )

RESUMO A espécie Phaseolus lunatus L., conhecida popularmente como feijão-fava constitui uma das alternativas de renda e alimentação para a população da região Nordeste do Brasil. Um dos problemas enfrentados são as doenças que provocam grandes perdas na produção de sementes. O presente trabalho objetivou avaliar a eficiência dos óleos essenciais de copaíba, cravo-da-índia e manjericão na redução da incidência de fungos associados às sementes de feijão-fava, e sua interferência na qualidade fisiológica. Os tratamentos foram constituídos por óleos essenciais de copaíba, cravo-da-índia e manjericão nas concentrações de 0; 1; 1,5 e 2 mL. L-1 e fungicida (Captan®). Foram utilizadas 200 sementes por tratamento. Para análise da qualidade sanitária das sementes foi adotado o método de incubação em placas de Petri contendo dupla camada de papel-filtro umedecida com ADE, sob temperatura de 20 ±2 ºC, por 7 dias. A qualidade fisiológica das sementes foi determinada com base nos testes de germinação, emergência e vigor das sementes. Para o teste germinação foi empregado método de rolo de papel germitest e na emergência osemeio foi realizado em bandejas plásticas contendo areia lavada esterilizada, em condição de casa de vegetação, e após 9 dias da instalação foi determinado o vigor com base nos resultados de índice de velocidade de germinação e emergência; comprimento da parte aérea, raiz primária e plântula; e teor de massa seca da partes aérea, raízes e plântulas de feijão-fava. O delineamento experimental foi interiamente casualizados, em esquama de fatorial simples (3x4)+1 (óleos essenciais x concentrações + fungicida), com quatro repetições de 50 sementes. Os óleos essenciais de copaíba e manjericão reduziram consideravelmente o percentual de incidência dos fungos associados as sementes de feijão-fava. O óleo essencial de cravo-da-índia na concetração de 2 mL. L-1, reduziu a qualidade fisiológica das sementes de feijão-fava.

ABSTRACT The Phaseolus lunatus L. species, popularly known as lima bean, is one of the alternative sources of income and food for the population of Northeast Brazil. One of the problems is the diseases that cause great losses in seed production. This study evaluated the effectiveness of essential oils of copaiba, clove, and basil in reducing the incidence of fungi associated with lima bean seeds, as well as the effect on their physiological quality. The treatments consisted of essential oils of copaiba, clove, and basil at concentrations of 0; 1; 1.5; and 2 mL. L-1 and fungicide (Captan®). A total of 200 seeds were used per treatment. To analyze the sanitary quality of the seeds, the method used was incubation in petri dishes containing a double layer of filter paper moistened with distilled sterilized water at a temperature of 20 ± 2°C, for seven days. The physiological quality of the seeds was determined by testing their germination, emergence, and vigor. For the germination test, the method used was a roll of Germitest paper. For the emergence, the seeds were sown in plastic trays containing washed sterilized sand in greenhouse conditions. After nine days, the vigor was determined based on the results of germination and emergence speed rates; length of the aerial part, primary root, and seedling; and dry matter content of the aerial part, roots, and seedlings of the lima beans. The experimental design was completely randomized in a simple factorial arrangement (3x4)+1 (essential oils x concentrations + fungicide) with four replications of 50 seeds. The essential oils of copaiba and basil considerably reduced the percentage of incidence of the fungi associated with lima bean seeds. The essential clove oil at 2 mL. L-1 reduced the physiological quality of the lima bean seeds.

Determination of diflubenzuron residues in milk and cattle tissues / Determinação de resíduos de diflubenzuron em leite e tecidos bovinos

Diflubenzuron (DFB) is used to control ectoparasitic infestation by inhibiting larvae development in the manure and feces of treated animals. It is also currently been used to control tick infestations. In this study, milk and tissues from cattle treated orally with DFB for a 77-120 day period with a commercial product containing the compound were analyzed for the presence of residues. DFB residues were determined by using extraction with acetonitrile, cleanup with C18 SPE and chromatographic analysis by HPLC with UV detection (254nm). DFB was not detected in any of the analysed samples (<0.006mg kg-1 for fat, <0.014mg kg-1 for muscle, <0.015mg kg-1 for kidney, <0.016mg kg-1 for liver and <0.0006mg kg-1 for milk). In this manner, the use of this compound, according to the manufacturer's suggested doses may result in cattle milk, liver, kidneys, fat and muscles being considered safe regarding the presence of DFB residues.

O diflubenzuron (DFB) é um inibidor de desenvolvimento de insetos que inibe a síntese de quitina com atividade ovicida e larvicida e está sendo utilizado na pecuária para o controle do carrapato. Leite e tecidos provenientes de bovinos tratados por um período de 77 a 120 dias com um produto comercial contendo DFB foram analisados quanto à presença de resíduos. Os resíduos de DFB foram determinados utilizando-se extração com acetonitrila, limpeza por SPE C18 e cromatografia líquida de alta eficiência com detecção por UV (254nm). DFB não foi detectado em nenhuma das amostras analisadas (<0.006mg kg-1 para gordura, <0,014mg kg-1 para músculo, <0,015mg kg-1 para rim, <0,016mg kg-1 para fígado e <0.0006mg kg-1 para leite). Dessa forma, a utilização do princípio ativo conforme recomendado pelo fabricante e em níveis suficientes para se obter o efeito larvicida desejado deve resultar em leite, fígado, rins, gordura e músculos que podem ser considerados seguros para o consumo em termos da presença DFB.

Cytogenetic studies of Brazilian pediatric myelodysplastic syndrome cases: challenges and difficulties in a large and emerging country

Myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukemia (JMML) are rare hematopoietic stem cell diseases affecting children. Cytogenetics plays an important role in the diagnosis of these diseases. We report here the experience of the Cytogenetic Subcommittee of the Brazilian Cooperative Group on Pediatric Myelodysplastic Syndromes (BCG-MDS-PED). We analyzed 168 cytogenetic studies performed in 23 different cytogenetic centers; 84 of these studies were performed in patients with confirmed MDS (primary MDS, secondary MDS, JMML, and acute myeloid leukemia/MDS+Down syndrome). Clonal abnormalities were found in 36.9% of the MDS cases and cytogenetic studies were important for the detection of constitutional diseases and for differential diagnosis with other myeloid neoplasms. These data show the importance of the Cooperative Group for continuing education in order to avoid a late or wrong diagnosis.

Caracterização morfológica dos órgãos internos de reprodução de Spartocera dentiventris (Berg, 1884) (Hemiptera: Coreidae) em diferentes idades / Reproductive organs of Spartocera dentiventris (Berg, 1884) (Hemiptera: Coreidae) at different ages

Nesse estudo foi descrita, mensurada e ilustrada, a genitália interna de machos e fêmeas de Spartocera dentiventris considerando distintas idades. As alterações mais evidentes no sistema reprodutivo foram observadas na largura e no comprimento dos ovários que permitem a distinção entre os estágios imaturo e reprodutivo. As medidas dos órgãos de reprodução de machos não apresentam diferenças significativas nas diferentes idades.

In this work, the internal reproductive organs of Spartocera dentiventris males and females with different ages are described, measured and illustrated. The most significant changes in the reproductive organs were found in the length and width of ovaries, which permit the distinction between immature and reproductive stages. No significant difference was found among the measurements of the reproductive structures of males at the different ages.

Structure and composition of bacterial and fungal community in soil under soybean monoculture in the Brazilian cerrado

Soybean is the most important oilseed cultivated in the world and Brazil is the second major producer. Expansion of soybean cultivation has direct and indirect impacts on natural habitats of high conservation value, such as the Brazilian savannas (Cerrado). In addition to deforestation, land conversion includes the use of fertilizers and pesticides and can lead to changes in the soil microbial communities. This study evaluated the soil bacterial and fungal communities and the microbial biomass C in a native Cerrado and in a similar no-tillage soybean monoculture area using PCR-DGGE and sequencing of bands. Compared to the native area, microbial biomass C was lower in the soybean area and cluster analysis indicated that the structure of soil microbial communities differed. 16S and 18S rDNA dendrograms analysis did not show differences between row and inter-row samples, but microbial biomass C values were higher in inter-rows during soybean fructification and harvest. The study pointed to different responses and alterations in bacterial and fungal communities due to soil cover changes (fallow x growth period) and crop development. These changes might be related to differences in the pattern of root exudates affecting the soil microbial community. Among the bands chosen for sequencing there was a predominance of actinobacteria, y-proteobacteria and ascomycetous divisions. Even under no-tillage management methods, the soil microbial community was affected due to changes in the soil cover and crop development, hence warning of the impacts caused by changes in land use.

Enzymatic characteristics of quercetinases from some indigenous Aspergillus flavus strains.

Five indigenous Aspergillus flavus strains MTCC-2206, 1884, 1883, 1783 and 2456 were screened for the secretion of quercetinase. Fungal strains MTCC-2206, 1884, 1883, and 1783 were found to secrete the quercetinase in the range of 0.24-0.36 enzyme unit/mL of the culture medium, while MTCC-2456 secreted only 0.04 enzyme unit/mL. The enzymatic characteristics of quercetinase were determined. The Km values using quercetin as the substrate were 12.5 microM, 14.0 microM, 12.5 microM and 13.0 microM for the quercetinase produced by MTCC-2206, 1884, 1883 and 1783, respectively. The pH optima for the above enzymes were 6.5, 6.5, 6.0 and 6.0 and temperature optima were 45, 40, 45 and 50 degrees C, respectively. The partial purification from only one strain MTCC-2206 was achieved (nearly 3-fold purification).

Estudo comparativo da cinética de degradação ruminal de forragens tropicais em bovinos e ovinos / Comparative study of ruminal degradation kinetics of tropical forages in cattle and sheep

Estimaram-se os parâmetros da cinética de degradação ruminal in situ da fibra em detergente neutro (DgFDN) da cana-de-açúcar e das silagens de capim-elefante, de milho e de sorgo em diferentes tempos de incubação, tamanhos de partícula (1 e 2mm) e espécies (ovinos e bovinos). A DgFDN foi obtida nos tempos de incubação: 3, 6, 12, 24, 36, 48, 72, 96, 120, 144 e 240 horas. A avaliação dos tamanhos de partículas e das espécies na degradabilidade foi realizada pelo teste de identidade de modelos de regressão não linear e interpretada pela análise de fatores. As taxas de degradação da FDN (k d) também foram estimadas, matematicamente, utilizando-se apenas de dois tempos de incubação in situ (tempos 6 e 24h ou 6 e 36h). Os valores de k d estimados em 2 tempos ou 11 tempos de incubação foram comparados pelo teste t com arranjo em pares. Os valores de k d estimados com dois tempos de incubação, quando comparados com os valores obtidos em vários tempos de incubação mostraram-se similares (P>0,05). Em estudos da cinética de degradação ruminal in situ da FDN, ovinos não devem ser considerados modelos experimentais para bovinos, mas o tamanho de partícula do alimento incubado, de 1 ou 2mm, tem pouca influência nos parâmetros de degradação ruminal.

The neutral detergent fiber degradability (NDFd) of sugar-cane, and elephantgrass, corn, and sorghum silages were predicted by in situ method, with different time points, sample grind sizes (1 and 2mm) and animal species (sheep and cattle). The feedstuffs were incubated at 3, 6, 12, 24, 36, 48, 72, 96, 120, 144, 240 hours. The effects of sample grind sizes and of the species in NDFd were analyzed through the test of identity of non-linear regression models and interpreted by factor analysis. The rates of degradation of NDF (k d) were also estimated for two times of incubation in situ (times 6 and 24h or 6 and 36h), and they were compared to the k d values estimated at the in situ trial, through the t statistical test. The k d values estimated by different time points and predicted by in situ incubation times were similar (P>0.05). There is little interference of particle size in degradation parameters, and the NDF degradation in situ trials in sheep can not be used as an experimental model for cattle.

Purification of a peroxidase from Solanum melongena fruit juice.

Solanum melongena fruit juice contains peroxidase activity of the order of 0.125 IU/mL. A method for the 11-fold purification of the enzyme was developed. The Km values of the peroxidase for the substrates guaiacol and hydrogen peroxide were 6.5 mM and 0.33 mM, respectively. The pH and temperature optima were 5.5 and 84 degrees C, respectively using guaiacol as the substrate. Sodium azide and phenyl hydrazine inhibited the enzyme competitively.

Seasonal abundance and mortality of Oebalus poecilus (Dallas) (Hemiptera: Pentatomidae) in a hibernation refuge

Oebalus poecilus (Dallas) é praga importante do arroz irrigado no Rio Grande do Sul, Brasil. Este inseto hiberna durante os meses mais frios em refúgios como o folhedo de bambu. Este estudo objetivou elucidar a hibernação de O. poecilus e determinar as causas de mortalidade durante este período. O estudo foi realizado em um bambuzal com cerca de 140 m2, situado em área orizícola, em Eldorado do Sul (30° 02’ S e 51° 23’ W), RS. De junho/2000 à abril/2002, foram realizadas 63 amostragens de folhedo, em intervalos semanais ou quinzenais e o número de percevejos registrado em laboratório. A entrada no refúgio de hibernação (folhedo de bambu) iniciou na primeira semana de março, completando-se no início de maio. O. poecilus abandonou o refúgio da metade de outubro até o final de dezembro. O parasitismo por mosca (taquinídeos) e o fungo Beauveria bassiana (Bals.) Vuill. foram os principais fatores de mortalidade.

A situação social do idoso no Brasil: uma breve consideração / The social situation of elderly in Brazil: a brief consideration

O envelhecimento é uma questão explorada por pesquisadores, epidemiologistas e estatísticos por meio de investigações científicas encontradas na literatura nacional e internacional, que revelam a projeção notória desta população de idosos. No panorama mundial bem como nos países em desenvolvimento, a população idosa aumenta significativamente e o contraponto desta realidade aponta que o suporte para essa nova condição não evolui com a mesma velocidade. Diante disto, a preocupação com esse novo perfil populacional vem gerando, nos últimos anos, inúmeras discussões e a realização de diversos estudos com o objetivo de fornecerem dados que subsidiem o desenvolvimento de políticas e programas adequados para essa parcela da população. Isto devido ao fato que a referida população requer cuidados específicos e direcionados às peculiaridades advindas com o processo do envelhecimento sem segregá-los da sociedade. Assim sendo, esse artigo tem como objetivo discutir sobre a situação social do idoso no Brasil, considerando os aspectos demográficos, epidemiológicos e os aspectos psicossociais com destaque para a aposentadoria, a importância da família e as relações interpessoais.

Characterization of the imaginal reproductive diapause of Oebalus poecilus (Dallas) (Hemiptera: Pentatomidae)

The state of development of the internal reproductive organs of male and female Oebalus poecilus (Dallas) as well as the body fat amount in the abdominal cavity during hibernation, of individuals sampled in bamboo litter in Eldorado do Sul (30º02'S and 51º23'W), RS, Brazil was investigated. Females and males showed the abdominal cavity filled with body fat in the beginning of the hibernation phase. The decrease in fat reserve level occurred from August on for males and from October on for females. Ovaries and testis doubled in length and tripled in width from immature to the reproductive phase. Male sexual maturation occurred in the hibernation sites while for females it occurred later on outside of the sites. Reproductive organ immaturity and abdominal body fat hypertrophy characterized the diapause of O. poecilus.

Secretion of ligninperoxidase by Penicillium citrinum, Fusarium oxysporum and Aspergillus terreus.

Secretion of ligninperoxidase [E.C.1.11.1.7] by Penicillium citrinum, Fusarium oxysporum and Aspergillus terreus in liquid culture growth medium has been demonstrated. Enzymatic characteristics like Km, pH and temperature optima using veratryl alcohol as the organic substrate of ligninperoxidases from above sources have been determined. Km values using veratryl alcohol as substrate for enzymes from P. citrinum, F. oxysporum and A. terreus were 69, 64 and 60 microM respectively. Km values using H2O2 as the variable substrate were 64, 72 and 80 microM.The pH optima were 4.0, 2.3 and 2.0 respectively. The values of temperature optima were 30 degrees, 25 degrees and 22 degrees C for the enzymes from P. citrinum, F. oxysporum and A. terreus respectively.

Bupivacaína a 0,5% hiperbárica na raquianestesia subaracnóidea / Hyperbaric bupivacaine at 0,5% in spinal anesthesia

Estudaram-se 40 pacientes submetidos a diferentes procedimentos cirúrgicos sob anestesia raquídea subaracnóidea com 15 mg de bupivacaína 0,5% hiperbárica, injetada em L3-4 após punçäo com agulha 7 em decúbito lateral. O tempo médio de latência (T2) foi de 3 min 33s. A duraçäo média do bloqueio anestésico foi de 88 min nas cirurgias intra-abdominais e 97 min nas ortopédicas. O bloqueio motor completo de membros inferiores atingiu a 72,5% dos pacientes. A analgesia pós operatória situou-se em torno de 232 min. Em seis casos houve necessidade de administrar anestesia geral, pois os bloqueios cessaram aos 90 min. A atropina foi utilizada em cinco casos e em outros 9, o metaraminol. As alteraçöes hemodinâmicas tiveram pequena freqüência e fácil controle