Bloqueio do plexo braquial em jumento - relato de caso / Brachial plexus block in donkey - case report

A anestesia locorregional reduz o requerimento de agentes inalatórios e diminui as respostas autonômicas a estímulos cirúrgicos nocivos. Objetiva-se descrever um bloqueio anestésico do plexo braquial guiado por neuroestimulador em jumento, submetido à amputação do membro anterior direito. Foi realizada medicação pré-anestésica com detomidina 0,01mg.kg-1, indução com diazepam 0,05mg.kg-1 e cetamina 2mg.kg-1, todos pela via intravenosa (IV), e a manutenção da anestesia com isoflurano. O plexo braquial foi bloqueado por acesso subescapular, sendo usado neuroestimulador. Utilizou-se 1mg.kg-1 de bupivacaína 0,5% sem vasoconstritor, associada a 1mg.kg-1 de lidocaína 2% sem vasoconstrictor. Os valores de FC e ƒ durante o procedimento cirúrgico variaram de 62 a 78bpm e de 24 a 32rpm, respectivamente. Foram coletadas quatro amostras de sangue para dosagem de cortisol. Este, antes da aplicação da medicação pré-anestésica, foi de 6,4µg/dL e, 30 minutos após a MPA, foi de 2,8µg/dL. A recuperação anestésica foi rápida e sem complicações. O bloqueio do plexo braquial guiado por neuroestimulador mostrou-se eficaz em jumentos, fornecendo analgesia e anestesia satisfatória.(AU)

Locoregional anesthesia reduces the requirement for inhaled agents and reduces the autonomic responses to noxious surgical stimuli. The aim of this study was to describe an anesthetic block of the brachial plexus guided by a neurostimulator in a donkey submitted to right limb amputation. Preanesthetic medication was performed with detomidine 0.01mg.kg-1 induction with diazepam 0.05mg.kg-1 and ketamine 2mg.kg-1 all intravenously, and maintenance of anesthesia with isoflurane. The brachial plexus was blocked by subscapular access, using a neurostimulator. For this purpose, 1mg.kg -1 of bupivacaine 0.5%, without vasoconstrictor, and 1mg.kg- 1 of lidocaine 2%, without vasoconstrictor were used. The values of HR and ƒ during the surgical procedure ranged from 62 to 78bpm, and 24 to 32bpm, respectively. Four blood samples were collected for cortisol dosing. This, prior to the application of the pre-anesthetic medication was 6.4µg/dL and 30 minutes was 2.8µg/dL. Anesthesia recovery was rapid and uncomplicated. Neurostimulator-guided brachial plexus blockade proved to be effective in donkeys, providing satisfactory analgesia and anesthesia.(AU)

Innate lymphoid cells: models of plasticity for immune homeostasis and rapid responsiveness in protection.

Innate lymphoid cells (ILCs) have stormed onto the immune landscape as "newly discovered" cell types. These tissue-resident sentinels are enriched at mucosal surfaces and engage in complex cross talk with elements of the adaptive immune system and microenvironment to orchestrate immune homeostasis. Many parallels exist between innate cells and T cells leading to the initial partitioning of ILCs into rather rigid subsets that reflect their "adaptive-like" effector cytokines profiles. ILCs themselves, however, have unique attributes that are only just beginning to be elucidated. These features result in complementarity with, rather than complete duplication of, functions of the adaptive immune system. Key transcription factors determine the pathway of differentiation of progenitors towards an ILC1, ILC2, or ILC3 subset. Once formed, flexibility in the responses of these subsets to stimuli unexpectedly allows transdifferentation between the different subsets and the acquisition of altered phenotypes and function. This provides a mechanism for rapid innate immune responsiveness. Here, we discuss the models of differentiation for maintenance and activation of tissue-resident ILCs in maintaining immune homeostasis and protection.

Transtracheal puncture: a forgotten procedure.

Transtracheal puncture has long been known as a safe, low-cost procedure. However, with the advent of bronchoscopy, it has largely been forgotten. Two researchers have suggested the use of α-amylase activity to diagnose salivary aspiration, but the normal values of this enzyme in tracheobronchial secretions are unknown. We aimed to define the normal values of α-amylase activity in tracheobronchial secretions and verify the rate of major complications of transtracheal puncture. From October 2009 to June 2011, we prospectively evaluated 118 patients without clinical or radiological signs of salivary aspiration who underwent transtracheal puncture before bronchoscopy. The patients were sedated with a solution of lidocaine and diazepam until they reached a Ramsay sedation score of 2 or 3. We then cleaned the cervical region and anesthetized the superficial planes with lidocaine. Next, we injected 10 mL of 2% lidocaine into the tracheobronchial tree. Finally, we injected 10 mL of normal saline into the tracheobronchial tree and immediately aspirated the saline with maximum vacuum pressure to collect samples for measurement of the α-amylase level. The α-amylase level mean ± SE, median, and range were 1914 ± 240, 1056, and 24-10,000 IU/L, respectively. No major complications (peripheral desaturation, subcutaneous emphysema, cardiac arrhythmia, or hemoptysis) occurred among 118 patients who underwent this procedure. Transtracheal aspiration is a safe, low-cost procedure. We herein define for the first time the normal α-amylase levels in the tracheobronchial secretions of humans.

A unique role for p53 in the regulation of M2 macrophage polarization.

P53 is critically important in preventing oncogenesis but its role in inflammation in general and in the function of inflammatory macrophages in particular is not clear. Here, we show that bone marrow-derived macrophages exhibit endogenous p53 activity, which is increased when macrophages are polarized to the M2 (alternatively activated macrophage) subtype. This leads to reduced expression of M2 genes. Nutlin-3a, which destabilizes the p53/MDM2 (mouse double minute 2 homolog) complex, promotes p53 activation and further downregulates M2 gene expression. In contrast, increased expression of M2 genes was apparent in M2-polarized macrophages from p53-deficient and p53 mutant mice. Furthermore, we show, in mice, that p53 also regulates M2 polarization in peritoneal macrophages from interleukin-4-challenged animals and that nutlin-3a retards the development of tolerance to Escherichia coli lipopolysaccharide. P53 acts via transcriptional repression of expression of c-Myc (v-myc avian myelocytomatosis viral oncogene homolog) gene by directly associating with its promoter. These data establish a role for the p53/MDM2/c-MYC axis as a physiological 'brake' to the M2 polarization process. This work reveals a hitherto unknown role for p53 in macrophages, provides further insight into the complexities of macrophage plasticity and raises the possibility that p53-activating drugs, many of which are currently being trialled clinically, may have unforeseen effects on macrophage function.

Spatio-temporal dynamics of dengue 2009 outbreak in Córdoba City, Argentina.

During 2009 the biggest dengue epidemic to date occurred in Argentina, affecting almost half the country. We studied the spatio-temporal dynamics of the outbreak in the second most populated city of the country, Córdoba city. Confirmed cases and the results of an Aedes aegypti monitoring during the outbreak were geolocated. The imported cases began in January, and the autochthonous in March. Thirty-three percent of the 130 confirmed cases were imported, and occurred mainly at the center of the city. The autochthonous cases were more frequent in the outskirts, specially in the NE and SE. Aedes aegypti infestation showed no difference between neighborhoods with or without autochthonous cases, neither between neighborhoods with autochthonous vs. imported cases. The neighborhoods with imported cases presented higher population densities. The majority of autochthonous cases occurred at ages between 25 and 44 years old. Cases formed a spatio-temporal cluster of up to 20 days and 12km. According to a mathematical model that estimates the required number of days needed for transmission according to daily temperature, the number of cases begun to fall when more than 15.5 days were needed. This may be a coarse estimation of mean mosquito survival in the area, provided that the study area is close to the global distribution limit of the vector, and that cases prevalence was very low.

Winter biology of Aedes albifasciatus (Diptera: Culicidae) from Córdoba, Argentina.

Host-seeking females of Aedes albifasciatus (Macquart) were collected from April to September 1997, kept under seminatural conditions, and offered sugar solution and blood. Daily survival of females ranged from 0.91 to 0.96, with blood fed females living longer than sugar fed females. Overall, 43% of engorged females completed a gonotrophic cycle, and 15% of them refed and completed a second gonotrophic cycle. The life expectancy of females emerging at the end of summer was longer than those that emerged during winter. Immature developmental time and the developmental threshold were estimated by regression. Embryo development was recorded during autumn, winter, and spring, with a duration of 5-9 d. The developmental threshold for eggs was estimated to be 2.28 degrees C. Egg mortality varied from 0.51 to 0.74. The development time for larva and pupa was between 16 and 29 d and was significantly correlated with temperature. The developmental threshold for larvae and pupae was estimated to be 4.75 degrees C. A greater proportion of females than males emerged when temperatures averaged < or = 18 degrees C. Larval and pupal mortality was high at temperatures below the developmental threshold. Aedes albifasciatus females remained gonotrophically active and immature development continued during winter in Córdoba (10 degrees C isotherm).

Colorectal cancer screening.

Colorectal cancer (CRC) is the third most common cancer in the world, and mortality has remained the same for the past 50 years, despite advances in diagnosis and treatment. Because significant numbers of patients present with advanced or incurable stages, patients with pre-malignant lesions (adenomatous polyps) that occur as result of genetic inheritance or age should be screened, and patients with long-standing inflammatory bowel disease should undergo surveillance. There are different risk groups for CRC, as well as different screening strategies. It remains to be determined which screening protocol is the most cost-effective for each risk catagory. The objective of screening is to reduce morbidity and mortality in a target population. The purpose of this review is to analyze the results of the published CRC screening studies, with regard to the measured reduction of morbidity and mortality, due to CRC in the studied populations, following various screening procedures. The main screening techniques, used in combination or alone, include fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy. Evidence from the published literature on screening methods for specific risk groups is scanty and frequently does not arise from controlled studies. Nevertheless, data from these studies, combined with recent advances in molecular genetics, certainly lead the way to greater efficacy and lower cost of CRC screening.

Relative abundance and gonotrophic status of Aedes albifasciatus (Diptera: Culicidae) during the autumn-winter period in Córdoba Province, Argentina.

Variations in the abundance of larvae and females of Aedes albifasciatus (Macquart) were monitored biweekly during the autumn-winter periods of 1996 and 1997 on the southern edge of the Mar Chiquita Lake in Córdoba Province. The degree of development of the primary ovarian follicles also was determined in host-seeking females. Abundance of the larvae and the females were noticeably different during the 2 yr of the study and matched changes in the pattern of precipitation. Although most females had ovarian follicles in Christophers stages Ib-IIa, 14% and 4% in 1996 and 1997, respectively, were in stages III-V (i.e., exhibited gonotrophic discordance). Females appeared to continue taking blood meals and laying eggs even during the autumn-winter period.

Monitoring the abundance of Aedes (Ochlerotatus) albifasciatus (Macquart 1838) (Diptera: Culicidae) to the south of Mar Chiquita Lake, central Argentina, with the aid of remote sensing.

Surges in the size of adult populations of the flood-water mosquito Aedes albifasciatus can produce important economical losses because of the way this species irritates livestock. Although this species is also the main vector of west equine encephalitis in Argentina, little is known about the factors affecting its population dynamics, as it is difficult to obtain data on its abundance over a large area. However, the results of intensive study of the mosquito in a few sites might reasonably be extrapolated to a regional scale by the use of remotely sensed data. The adult, larval and pupal stages of Ae. albifasciatus were sampled at five field sites to the south of Mar Chiquita Lake, either once a month (during the dry, cold season) or once a fortnight (during the warm, rainy season), between August 1992 and April 1993. The measured abundance of adults or pre-adults and a meteorological coefficient useful for the estimation of larval abundance each showed significant correlation with various statistics derived from normalized-difference, vegetation indices (NDVI) calculated from satellite (NOAA-AVHRR) imagery. A linear discriminant analysis, using data on NDVI, rainfall and temperature, accurately identified periods with and without pre-adults. The satellite imagery was also useful in the estimation of larval abundance and consequently could be used to predict adult abundance 7 days in advance. Even though the satellite data employed have poor spatial resolution, their high temporal resolution makes them very useful in studies of the population dynamics of mosquitoes in general, at least once the relevant variables and their relationships with mosquito breeding and survival have been identified.

Daily pattern of flight activity of Aedes albifasciatus in central Argentina.

Aedes albifasciatus is an important common mosquito in Central Argentina. It is a confirmed vector of the Western Equine Encephalitis and is responsible for loss of milk production in dairy cattle during peak populations. This paper reports the flight activity pattern of Ae. albifasciatus for different seasons, in the southern coast of the Mar Chiquita Lake (central Argentina). Data were collected by sampling two sites between 1992 and 1993 with CDC traps and human-bait captures. Adult mosquito population density, estimated by CDC trapping and human-bait, were highly correlated. However, when compared to other species, the proportion of Ae. albifasciatus was higher in human-bait collections. Adult female populations were active only when temperature were higher than 6 degrees C. Two daily biting peaks were observed (dusk and dawn) during the spring, summer and autumn, and only one peak during winter (around 15:00 pm). Adult abundance was significantly correlated (R2 = 0.71; p < 0.01) with temperature and illumination.

New records for mosquito species (Diptera: Culicidae) in Argentina.

The geographical distributions for Aedes fluviatilis, Culex acharistus, Culex apicinus, Culex coronator, Culex dolosus, Culex quinquefasciatus, Culex saltanensis, Psorophora paulli, Psorophora varinervis, and Uranotaenia apicalis are extended. New records for 6 provinces of Argentina are given.

Critical study of lactic dehydrogenase isoenzymes by electrophoresis in the diagnosis of cardiac patients.

Com o objetivo de estudar os padroes de perfis das isoenzimas do LD por fracionamento eletroforetico, os autores relacionaram um grupo normal controle e um grupo de pacientes na fase aguda do infarto do miocardio e com sindrome intermediaria.Para cada patologia foram determinados os padroes de liberacao do LD e HBD a fim de correlaciona-los com a curva de liberacao enzimatica do LD1. A inversao do LD (LD1 > LD2) foi estudada no seu "real significado" com dado diagnostico laboratorial, quando correlacionada a interpretacao clinica (foram usados valores referencia, segundo Galen, para este proposito). Seu valor preditivo pode ser de grande valia para o clinico, porem, o uso deste dado isoladamente pode levar a conclusoes erroneas em pacientes infartados agudos e com sindrome intermediaria. A correlacao entre LD 1 e o HBD foi positiva e se discute sua aplicabilidade sao calculados com base em valores referencia tanto para pacientes na fase aguda do infarto do miocardio, quanto da sindrome intermediaria

Test of Continental Drift by Comparison of Radiometric Ages: A pre-drift reconstruction shows matching geologic age provinces in West Africa and Northern Brazil.

1) The distribution of age values obtained by potassium-argon determinations and whole-rock rubidium-strontium determinations appears to be almost identical for West African rocks of the pervasive Eburnean Orogenic Cycle and basement rocks at opposite locations in South America. 2) There is also a close correlation, with respect to potassium-argon age determinations on micas, rubidium-strontium determinations on total-rock samples, and the extent to which these two sets of values differ, between rocks of the Pan-African Orogenic Cycle and rocks of the Caririan Orogenic Cycle in Brazil, where these two groups of rocks lie opposite each other in the two continents. 3) When Africa and South America are "fitted together," the sharply defined boundary between the Eburnean and the Pan-African age provinces in West Africa strikes directly toward the corresponding age boundary in northeast Brazil. 4) The transition from the 550-million-year Pan-African age province to the 2000-million-year age province in the Congo Craton in Cameroun-Gabon is matched in the rocks near the corresponding part of the east coast of Brazil. However the geological and age data are insufficient to do more than suggest the possibility of another age-boundary correlation here. 5) The evidence reported here supports the hypothesis of continental drift.