Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts / Adhesión a la ventilación mecánica protectora en el síndrome de dificultad respiratoria aguda asociado a COVID-19 o asociado a otras etiologias: comparación entre dos cohortes prospectivas

Objective To compare adherence to protective mechanical ventilation (MV) parametersin patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. Design Multiple prospective cohort study. Setting: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). Patients: ARDS patients under MV. Interventions: None. Main variables of interest: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. Results Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. Conclusions Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients (AU)

Objetivo Comparar la adhesión a la ventilación mecánica (VM) protectora en pacientes con síndrome de dificultad respiratoria aguda (SDRA) causada por COVID-19 con pacientes con SDRA de otras etiologías. Diseño Estudio de cohorte prospectivo. Âmbito: Se evaluaron dos cohortes de pacientes con SDRA: 1.pacientes con COVID-19 ingresados en dos unidades de cuidados intensivos (UCI) brasileñas en 2020 y 2021 (C-ARDS, n=282); 2.pacientes con SDRA de otras etiologías ingresados en 37 UCI brasileñas en 2016 (NC-ARDS, n=120). Pacientes: Pacientes con SDRA bajo VM invasiva. Intervenciones: No. Variables de interés principals: Adhesión a la VM protectora (volumen tidal ≤8mL/kg; presión de meseta ≤30cmH2O; y presión de distensión [PD] ≤15cmH2O), adhesión a cada componente individual de la VM protectora, y la asociación entre la VM protectora y la mortalidad. Resultados La adhesión a la VM protectora fue mayor en la cohorte C-ARDS que en la NC-ARDS (65,8% vs. 50,0%, p=0,005), principalmente debido a mayor adhesión a la PD≤15cmH2O (75,0% vs. 62,4%, p=0,02). La regresión logística multivariable mostró que la cohorte C-ARDS se asoció de forma independiente con la adhesión a la VM protectora. Entre los componentes de la VM protectora, sólo la limitación de la PD se asoció de forma independiente con menor mortalidad en la UCI. Conclusión La mayor adhesión a la VM protectora en los pacientes con C-ARDS fue secundaria a la mayor adhesión a limitación da PD. Además, una menor PD se asoció de forma independiente a menor mortalidad en la UCI, lo que sugiere que limitar la exposición a altas PD puede mejorar la supervivencia en estos pacientes (AU)

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts.

OBJECTIVE: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN: Multiple prospective cohort study. SETTING: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS: ARDS patients under MV. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation.

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1ß) tissue levels, and positive immunostaining for TNF-α, IL-1ß, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Applicability of polyamide 12 intramedullary locked rods in the stabilization of induced humeral fracture in cockerels (white plymouth rock) - in vivo study / Aplicabilidade da haste intramedular bloqueada de poliamida 12 na estabilização de fratura umeral induzida em galos (Plymouth Rock Branca) - estudo in vivo

The aim of this study was to evaluate the use of polyamide 12 intramedullary rods in osteotomized humerus in cockerels (White Plymouth Rock) and analyze, by radiography and histopathology, bone consolidation and the formation of bone callus. Ten cockerels were subjected to transverse osteotomy of the right humeral diaphysis followed by the insertion of polyamide 12 locked rods, with two nails in each bone fragment. Radiographies obtained at the immediate pre and post-operative period, and every 7 days for 3 months revealed no perioperatory complications. Radiography revealed a radiopaque bone callus between the 4th and 5th week post-surgery. Histopathology detected an amphophylic material (polyamide 12 rod) in the intramedullary region and the proliferation of highly vascularized connective tissue between the rod and the cortical bone. This connective tissue was highly cellular with differentiation into osteoblasts. The collagen fibers varied from loose to dense and a differentiated bone matrix, containing osteocytes in gaps and the development of bone marrow, was also observed; indicating the formation of a bone callus without signs of implant rejection. The polyamide 12 intramedullary rod was effective in the stabilization of the fractures used in this experimental model, with no rejection reaction for at least 90 days.(AU)

O presente estudo teve como objetivo avaliar a implantação de hastes intramedulares de poliamida 12, em úmeros osteotomizados de galos (Plymouth Rock Branca), bem como avaliar a consolidação óssea, por meio da verificação da formação de calo ósseo, analisando exames radiográficos e histopatológicos. Os galos foram submetidos à osteotomia transversa da diáfise do úmero direito, sendo implantadas posteriormente as hastes de poliamida 12 bloqueada com dois parafusos em cada fragmento ósseo. Após o procedimento cirúrgico, foram realizadas radiografias nos momentos pré e pós-operatório imediato e, posteriormente, a cada sete dias, durante três meses, até a realização da eutanásia. Não houve complicações perioperatórias. Ao exame radiográfico, os animais apresentaram formação de calo ósseo radiopaco entre a quarta e quinta semanas de pós-operatório. Ao exame histopatológico, foi possível notar, em todos os animais, presença de material anfofílico (haste de poliamida 12) ocupando a região intramedular óssea, e entre a haste e as corticais ósseas, proliferação de tecido conjuntivo altamente vascularizado. Tal tecido apresentou-se altamente celular com diferenciação em osteoblastos. Notaram-se também fibras colágenas, variando de aspecto frouxo a denso, e observou-se formação de matriz óssea diferenciada com osteócitos em lacunas e formações de medula óssea, denotando formação de calo ósseo sem sinais de rejeição do implante. A haste intramedular de poliamida 12 foi eficaz para estabilização das fraturas utilizando-se esse modelo experimental, sem reação de rejeição pelo período de 90 dias.(AU)

Cardiopulmonary and sedative effects of intravenous or epidural methadone in conscious dogs.

Cardiopulmonary and sedative effects of intravenous or epidural methadone were compared. Six beagles were randomly assigned to group MIV (methadone 0.5 mg/kg IV + NaCl 0.9% epidurally) or MEP (methadone 0.5 mg/kg epidurally + NaCl 0.9% IV). Cardiopulmonary, blood gas and sedation were assessed at time (T) 0, 15, 30, 60, 120, 240 and 480 min after drug administration. Compared to T0, heart rate decreased at T15-T120 in MIV (p < .001) and T15-T240 in MEP (p < .05); mean arterial pressure was reduced at T15-T60 in MEP (p < .01); respiratory rate was higher at T15 and T30 in both groups (p < .05); pH was lower at T15-T120 in MIV (p < .01) and T15, T30 and T120 in MEP (p < .05); PaCO2 was higher at T15-T60 in MIV (p < .01) and T15, T30 and T120 in MEP (p < .01); sedation scores were higher at T15 and T30 in MIV and T15-T60 in MEP (p < .05). At T120 and T240, sedation score was higher in group MEP compared with group MIV (p < .01) In conclusion, cardiopulmonary and sedative effects of identical methadone doses are similar when administered IV or epidurally to conscious healthy dogs.

Avaliação da atividade larvicida do óleo essencial do Zingiber officinale Roscoe (gengibre) frente ao mosquito Aedes aegypti / Evaluation of the larvicidal effectof the essential oil of Zingiber officinale Roscoe (ginger) against the mosquito Aedes aegypti

RESUMO Este trabalho analisa o efeito larvicida do óleo Zingiber officinale Roscoe contra larvas em terceiro estágio do mosquito Aedes aegypti. Extraiu-se quantitativamente o óleo essencial por hidrodestilação e calculou-se a CL50 do óleo, a partir dos métodos de Reed-Muench e Pizzi, respectivamente. O óleo essencial obteve CL50 de 76,07 (±2,24) μg mL-1 e rendimento de 0,52% m/v. Os resultados indicam que o óleo essencial avaliado é composto por substâncias que propiciam efeito larvicida contra Aedes aegypti.

ABSTRACT This study analyzes the larvicidal effect of the oil of Zingiber officinale Roscoe against larvae in third stage of the mosquito Aedes aegypti (Linnaeus 1792). The essential oil was extracted quantitatively by hydrodistillation and we calculated the oil’s LC50 from Reed-Muench (1938) and Pizzi (1950) methods, respectively. The essential oil obtained LC50 of 76.07 (±2.24) ug mL-1, and yield of 0.52% m/v. The results indicate that the essential oil assessed has substances that provide larvicidal effect against Aedes aegypti.

Panniculitis-an unusual cutaneous manifestation of systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune systemic disease characterized by small vessel involvement that leads to tissue ischemia and fibroblast stimulation resulting in accumulation of collagen (fibrosis) in the skin and internal organs. Lipomembranous panniculitis is a peculiar type of fat necrosis and has been reported with clinical conditions, commonly with peripheral vascular diseases. We describe a case of a 43-year-old woman with SSc manifestations, who presented with black scaly skin plaques, associated with thickening of the subcutaneous fat tissue, on the lateral surface of her thighs, her calves, gluteal area and lower abdomen. Biopsy revealed lipomembranous panniculitis. Lipomembranous changes have been seen in connective tissue disorders such as lupus profundus, morphea, systemic sclerosis and panniculitis associated with dermatomyositis, but rarely in thighs, calves, gluteal area and lower abdomen.