Presentation and management of cerebral proliferative angiopathy: a systematic review and meta-analysis on treatment outcomes.

Cerebral Proliferative Angiopathy (CPA) is a rare brain vascular malformation, similar to Arteriovenous Malformations (AVM) but lacking of early venous drainage. Presentation and treatment outcomes were investigated, examining for morbidity, mortality and complications. A meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase and Web Of Science were searched with keywords such as "cerebral proliferative angiopathy" and "management". We pooled and meta-analyzed outcomes on documented CPA cases. 11,079 studies were pooled as a result of manual citation searching, 50 studies were included, adding up to 115 CPA cases. The majority of patients were females (1.38:1), with a mean age of presentation of 26.9 (19.4) years. Headache (46%) and seizures (34%) were the most common presenting symptoms. 37% of patients presented with focal neurologic deficit. Patients managed conservatively from the surgical standpoint (i.e. nonoperative management) did not undergo homogenous treatment strategies, and major complications were at 47% (95% CI: 17%, 76%), with a 1% mortality (95% CI: 0%, 6%). Surgical and embolization interventions presented the highest proportion of major complications, 66% (95% CI: 33%, 99%) and 73% (95% CI: 42%, 100%), respectively. The embolization subgroup led in mortality, with 3% (95% CI: 0%, 10%). No death was documented in patients undergoing surgery. CPA has a similar presentation to brain arteriovenous malformations, but its treatment outcomes are potentially worse. This difference is not attributable to heterogeneity in assigning patient treatment strategies. This highlights the need for more accurate diagnostic methods.

Beneficial Effect of Exogenously Applied Calcium Pyruvate in Alleviating Water Deficit in Sugarcane as Assessed by Chlorophyll a Fluorescence Technique.

The growing demand for food production has led to an increase in agricultural areas, including many with low and irregular rainfall, stressing the importance of studies aimed at mitigating the harmful effects of water stress. From this perspective, the objective of this study was to evaluate calcium pyruvate as an attenuator of water deficit on chlorophyll a fluorescence of five sugarcane genotypes. The experiment was conducted in a plant nursery where three management strategies (E1-full irrigation, E2-water deficit with the application of 30 mM calcium pyruvate, and E3-water deficit without the application of calcium pyruvate) and five sugarcane genotypes (RB863129, RB92579, RB962962, RB021754, and RB041443) were tested, distributed in randomized blocks, in a 3 × 5 factorial design with three replications. There is dissimilarity in the fluorescence parameters and photosynthetic pigments of the RB863129 genotype in relation to those of the RB041443, RB96262, RB021754, and RB92579 genotypes. Foliar application of calcium pyruvate alleviates the effects of water deficit on the fluorescence parameters of chlorophyll a and photosynthetic pigments in sugarcane, without interaction with the genotypes. However, subsequent validation tests will be necessary to test and validate the adoption of this technology under field conditions.

The effect of sodium-glucose cotransporter 2 inhibitors in patients with chronic kidney disease with or without type 2 diabetes mellitus on cardiovascular and renal outcomes: A systematic review and meta-analysis.

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have shown a favorable effect on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM). However, their efficacy in patients with chronic kidney disease (CKD) with or without T2DM has not yet been analyzed. OBJECTIVE: To assess the cardiovascular and renal effects of SGLT-2 inhibitors in patients with CKD with and without T2DM, including all CKD patients in the current literature. METHODS: We searched MEDLINE, EMBASE, CENTRAL and Scopus for randomized controlled trials of SGLT-2 inhibitors that evaluated cardiovascular and kidney outcomes in patients with CKD, or trials in which these patients were a subgroup. We defined 2 primary outcomes: a composite of cardiovascular death or hospitalization for heart failure, and a composite renal outcome. For each outcome, we obtained overall hazard ratios with 95% confidence intervals by using a random effects model. RESULTS: We included 14 randomized controlled trials. SGLT-2 inhibitors decreased the hazard for the primary cardiovascular outcome (HR 0.76; [95% CI 0.72-0.79]) and the primary renal outcome (HR 0.69; [95% CI 0.61-0.79]) in patients with CKD with or without T2DM. We did not find significant differences in the subgroup analyses according to diabetes status, baseline eGFR values or the type of SGLT-2 inhibitor used. CONCLUSION: In patients with CKD, treatment with SGLT-2 inhibitors in addition to standard therapy conferred protection against cardiovascular and renal outcomes. Further research on patients with non-diabetic CKD should be done to confirm the utility of these medications in this population. (PROSPERO ID: CRD42021275012).

Promedio de presión arterial en 24 horas y cambios ecocardiográficos tempranos / 24 hour blood pressure monitoring and early echocardiographic findings

Resumen Introducción: la hipertensión arterial es uno de los factores principales de morbimortalidad cardiovascular, con una prevalencia en aumento, por lo cual se considera como uno de los factores principales prevenibles y tratables de mortalidad1. En Colombia no se cuenta con datos que correlacionen cambios ecocardiográficos con los valores obtenidos en el monitoreo ambulatorio de presión arterial en 24 horas. Objetivo: evaluar las posibles relaciones entre la presión arterial sistólica y diastólica promedio en 24 horas con los desenlaces: grosor relativo de pared (GRP), volumen auricular izquierdo indexado, fracción de eyección ventricular izquierda (FEVI) y masa ventricular indexada. Materiales y métodos: estudio observacional, descriptivo, de corte transversal, en pacientes colombianos con datos ecocardiográficos y resultados de MAPA del servicio de cardiología del Hospital de San José, entre junio de 2018 y diciembre de 2019. Resultados: se incluyeron 70 pacientes; se encontró posible relación entre la presión arterial sistólica promedio en 24 horas y el volumen auricular izquierdo indexado (p = 0.004), la presión arterial diastólica promedio en 24 horas y el grosor relativo de pared (p = 0.032). Conclusión: en este estudio se encontró una posible asociación entre volumen auricular izquierdo y presión arterial sistólica promedio en 24 h, GRP y presión arterial diastólica promedio en 24 h. Se hacen necesarios más estudios para confirmar estos hallazgos.

Abstract Introduction: Arterial hypertension is one of the main factor associated with cardiovascular morbidity and mortality with increasing prevalence, so it is considered as a key factor to treat to decrease cardiovascular disease. There is no data in Colombia that correlates echocardiographic parameters with meassures of blood pressure obtained by a 24 h ambulatory blood pressure monitoring. Objective: To evaluate possible relations between 24 hour blood pressure monitoring and relative wall thickness, left atrial volume index, left ventricular ejection fraction and ventricular mass index. Materials and methods: A cross sectional, observational, descriptive trial in Colombian patients between june 2018 to dicember 2019 with echocardiographic and 24 h blood pressure monitoring data from the cardiology deparment of the Hospital de San José. Results: 70 patients were included. a possible relation was found between 24 h systolic blood pressure monitoring and 24 h diastolic pressure monitoring with left atrial volume index (p = 0.004) and relative wall thickness (p = 0.032) respectively. Conclusion: A possible association was found between 24 h systolic blood pressure monitoring and 24 h diastolic blood pressure monitoring with left atrial volume index and relative wall thickness respectively. It is necessary to conduct more studies to confirm this finding.

Extended-spectrum ß-lactamases and virulence factors in uropathogenic Escherichia coli in nursing homes in Lima, Peru. / Β-lactamasas de espectro extendido y factores de virulencia en Escherichia coli uropatógenas en asilos de ancianos en Lima, Perú.

Nursing homes are institutions with high prevalence of urinary tract infections caused by ESBL-producing E. coli with several virulence factors. The aim of this study was to determine the frequency of the bla CTX-M gene and eight virulence genes in 35 ESBL-producing uropathogenic E. coli from six nursing homes in Peru during 2018. Of the E. coli samples, 57.1% (20/35) were carriers of the bla CTX-M gene. Furthermore, we obtained frequencies of 46% (15/35) and 37% (13/35) for hly-alpha and cnf-1, respectively; we also found high presence of the iucC (63%, 22/35), aer (94%, 33/35) and chuA genes (94%, 33/34) as well as a frequency of 46% (16/35) and 91% (32/34) for the pap GII and nanA genes, respectively. The bla CTX-M gene is predominant and a high frequency of exotoxins gives it a competitive advantage for spreading into the bloodstream.

Los asilos de ancianos son instituciones con una alta prevalencia de infecciones del tracto urinario ocasionado por Escherichia coli productoras de ß-lactamasas de espectro extendido (BLEE), con diversos factores de virulencia. El objetivo del estudio fue determinar la frecuencia del gen bla CTX-M y de ocho genes de virulencia en 35 E. coli uropatógenas productoras de BLEE provenientes de seis asilos en Perú, durante el 2018. El 57,1% (20/35) de las E. coli fueron portadores del gen bla CTX-M. Además, se obtuvo una frecuencia del 46% (15/35) y 37% (13/35) de hly-alfa y cnf-1, respectivamente; elevada presencia de los genes iucC (63%, 22/35), aer (94%, 33/35) y chuA (94%, 33/34) y una frecuencia del 46% (16/35) y del 91% (32/34) de los genes pap GII y nanA, respectivamente. Existe predominancia en la distribución del gen bla CTX-M, además de una alta frecuencia de exotoxinas que le confieren una ventaja competitiva para diseminarse hacia el torrente sanguíneo.

ß-lactamasas de espectro extendido y factores de virulencia en Escherichia coli uropatógenas en asilos de ancianos en Lima, Perú / ß-lactamases and virulence factors in uropathogenic Escherichia coli in nursing homes in Lima, Peru

RESUMEN Los asilos de ancianos son instituciones con una alta prevalencia de infecciones del tracto urinario ocasionado por Escherichia coli productoras de ß-lactamasas de espectro extendido (BLEE), con diversos factores de virulencia. El objetivo del estudio fue determinar la frecuencia del gen bla CTX-M y de ocho genes de virulencia en 35 E. coli uropatógenas productoras de BLEE provenientes de seis asilos en Perú, durante el 2018. El 57,1% (20/35) de las E. coli fueron portadores del gen bla CTX-M. Además, se obtuvo una frecuencia del 46% (15/35) y 37% (13/35) de hly-alfa y cnf-1, respectivamente; elevada presencia de los genes iucC (63%, 22/35), aer (94%, 33/35) y chuA (94%, 33/34) y una frecuencia del 46% (16/35) y del 91% (32/34) de los genes pap GII y nanA, respectivamente. Existe predominancia en la distribución del gen bla CTX-M, además de una alta frecuencia de exotoxinas que le confieren una ventaja competitiva para diseminarse hacia el torrente sanguíneo.

ABSTRACT Nursing homes are institutions with high prevalence of urinary tract infections caused by ESBL-producing E. coli with several virulence factors. The aim of this study was to determine the frequency of the bla CTX-M gene and eight virulence genes in 35 ESBL-producing uropathogenic E. coli from six nursing homes in Peru during 2018. Of the E. coli samples, 57.1% (20/35) were carriers of the bla CTX-M gene. Furthermore, we obtained frequencies of 46% (15/35) and 37% (13/35) for hly-alpha and cnf-1, respectively; we also found high presence of the iucC (63%, 22/35), aer (94%, 33/35) and chuA genes (94%, 33/34) as well as a frequency of 46% (16/35) and 91% (32/34) for the pap GII and nanA genes, respectively. The bla CTX-M gene is predominant and a high frequency of exotoxins gives it a competitive advantage for spreading into the bloodstream.

Chemical Characterization, Antioxidant, Cytotoxic and Microbiological Activities of the Essential Oil of Leaf of Tithonia Diversifolia (Hemsl) A. Gray (Asteraceae).

The present study aimed to evaluate the chemical composition, antioxidant potential, and the cytotoxic and antimicrobial activity of the essential oil of the plant species Tithonia diversifolia (Hemsl) A. Gray. The essential oil obtained was used to identify the chemical compounds present through the techniques of GC-MS and NMR. The antioxidant potential was calculated by the sequestration method of 2,2-diphenyl-1-picrylhydrazyl. For cytotoxic activity, the larval mortality of Artemia salina was evaluated. The main chemical constituents identified are αpinene (9.9%), Limonene (5.40%), (Z)-ß-ocimene (4.02%), p-cymen-8-ol (3.0%), Piperitone (11.72%), (E)-nerolidol (3.78%) and Spathulenol (10.8%). In the evaluation of the antimicrobial activity, bacterial strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were used. The results showed that the bacterium E. coli were more susceptible to the presence of the essential oil, presenting minimal inhibitory concentration at the concentrations that were exposed. The essential oil presented antioxidant activity of 54.6% at the concentration of 5 mg·mL-1 and provided a CI50 of 4.30. It was observed that the essential oil of this species was highly toxic against A. salina lavas, as its cytotoxic activity showed an LC50 of 3.11. Thus, it is concluded that T. diversifolia oils are effective in inhibiting bacterial growth and reducing oxidative stress.

IMPLEMENTATION OF ENHANCED RECOVERY AFTER COLORECTAL SURGERY (ERAS) PROTOCOL: INITIAL RESULTS OF THE FIRST BRAZILIAN EXPERIENCE.

BACKGROUND: Guidelines for enhanced recovery after surgery have their bases in colonic surgery, through the first protocols published in 2012. Since then, this practice has spread throughout the world, mainly due to improvements in surgical outcomes associated with resource savings. AIM: To analyze the first prospective results after the implementation of the guidelines. METHODS: Were retrospectively analyzed 48 patients operated in the institution prior to the standardization. This group was then compared with a series of 25 patients operated consecutively after the guidelines were implemented. RESULTS: With a 68.6% compliance rate, hospital length of stay (p=0.002), use of abdominal drains (p<0.001) and mechanical bowel preparation (p<0.001) were reduced. Mortality rates, anastomotic fistula, abdominal abscesses and reoperations were also reduced, but without statistical significance. CONCLUSION: Enhanced recovery after surgery protocols benefit patients care, resulting in better outcomes and possibly resource savings. Even with some limitations, its implementation is feasible in the Brazilian Public Health System.

Implementation of enhanced recovery after colorectal surgery (eras) protocol: initial results of the first brazilian experience / Implementação do protocolo de recuperação otimizada após cirurgia colorretal (eras): resultados iniciais da primeira experiência brasileira

ABSTRACT Background: Guidelines for enhanced recovery after surgery have their bases in colonic surgery, through the first protocols published in 2012. Since then, this practice has spread throughout the world, mainly due to improvements in surgical outcomes associated with resource savings. Aim: To analyze the first prospective results after the implementation of the guidelines. Methods: Were retrospectively analyzed 48 patients operated in the institution prior to the standardization. This group was then compared with a series of 25 patients operated consecutively after the guidelines were implemented. Results: With a 68.6% compliance rate, hospital length of stay (p=0.002), use of abdominal drains (p<0.001) and mechanical bowel preparation (p<0.001) were reduced. Mortality rates, anastomotic fistula, abdominal abscesses and reoperations were also reduced, but without statistical significance. Conclusion: Enhanced recovery after surgery protocols benefit patients care, resulting in better outcomes and possibly resource savings. Even with some limitations, its implementation is feasible in the Brazilian Public Health System.

RESUMO Racional: Os protocolos de recuperação otimizada após as operações têm as suas bases na cirurgia colônica, através das primeiras diretrizes publicadas em 2012. Desde então, tal prática difundiu-se pelo mundo, principalmente em virtude de melhorias nos resultados cirúrgicos associadas à economia de recursos. Objetivo: Apresentar os primeiros resultados prospectivos após a implementação das novas medidas. Métodos: Foram analisados de forma retrospectiva 48 pacientes operados na instituição previamente à aplicação do protocolo. Esse grupo foi então comparado com uma série de 25 pacientes operados de forma consecutiva após a implementação das diretrizes. Resultados: Com taxa de adesão de 68.6% às medidas propostas, observou-se redução do tempo de internação hospitalar (p=0.002), do uso de drenos abdominais (p<0.001) e do preparo mecânico do cólon (p<0.001). As taxas de mortalidade, de fístula da anastomose, de abscessos abdominais e de reoperações também foram reduzidas, porém sem significância estatística. Conclusão: A adesão às medidas recomendadas no protocolo é benéfica para pacientes e equipe de assistência, acarretando em melhores resultados e possível economia de recursos. Mesmo com algumas limitações, a sua implementação é factível no Sistema Único de Saúde Brasileiro.

Anesthesia for lower extremity vascular bypass with peripheral nerve block / Anestesia para bypass vascular em membro inferior com bloqueio de nervos periféricos

Abstract Vascular bypass is a surgical procedure widely used to treat peripheral vascular disease. The intraoperative anesthetic technique and the most appropriate postoperative analgesia for these high-risk patients remain controversial. We present the case of a patient undergoing femoropopliteal-distal bypass in our service, presenting with relevant comorbidities to the choice of anesthetic technique. This patient had several determining factors of difficult airway, especially thoracic kyphoscoliosis, which prevented him from being properly positioned for airway management, and chronic lung disease. This patient was also taken antiplatelet drugs, which is a contraindication for neuraxial block. So, we chose the anesthetic technique of peripheral nerve block, specifically the blockade of femoral and sciatic nerves.

Resumo A cirurgia para bypass vascular é um procedimento amplamente usado para o tratamento da insuficiência vascular periférica. A técnica anestésica para o intraoperatório e para analgesia pós-operatória mais apropriada para esses pacientes de alto risco ainda permanece controversa. Apresentaremos o caso de um paciente submetido a bypass femoropoplíteo distal no nosso serviço, que apresentava comorbidades relevantes para a escolha da técnica anestésica. Esse paciente apresentava fatores determinantes de via aérea difícil, principalmente cifoescoliose da coluna torácica, que o impedia de ser posicionado adequadamente para o manejo da via aérea, além de ser portador de patologia pulmonar crônica. Também fazia uso de antiplaquetários que contraindicavam o bloqueio de neuroeixo. Por isso, optou-se como técnica anestésica pelo bloqueio de nervos periféricos, especificamente o bloqueio dos nervos femoral e isquiático.

[Anesthesia for lower extremity vascular bypass with peripheral nerve block]. / Anestesia para bypass vascular em membro inferior com bloqueio de nervos periféricos.

Vascular bypass is a surgical procedure widely used to treat peripheral vascular disease. The intraoperative anesthetic technique and the most appropriate postoperative analgesia for these high-risk patients remain controversial. We present the case of a patient undergoing femoropopliteal-distal bypass in our service, presenting with relevant comorbidities to the choice of anesthetic technique. This patient had several determining factors of difficult airway, especially thoracic kyphoscoliosis, which prevented him from being properly positioned for airway management, and chronic lung disease. This patient was also taken antiplatelet drugs, which is a contraindication for neuraxial block. So, we chose the anesthetic technique of peripheral nerve block, specifically the blockade of femoral and sciatic nerves.

Comportamento de milho híbrido para silagem em diferentes condições de sucessão de culturas no município de Umuarama - PR / Hybrid maize for silage in different crop succession conditions in the city of Umuarama - PR / Comportamiento de maíz híbrido para ensilaje en diferentes condiciones de sucesión de cultivos en el municipio Umuarama - PR

O objetivo do trabalho foi avaliar o comportamento do milho híbrido para silagem em diferentes condições de sucessão de culturas no município de Umuarama ­ PR. O experimento foi realizado em duas diferentes áreas da fazenda experimental da Universidade Paranaense ­ UNIPAR, no referido município. Na área 1 cultivou-se o milho em sucessão à cana-de-açúcar e na área 2, em sucessão à pastagem do gênero Brachiaria. O experimento foi conduzido no período de dezembro/2014 a abril/2015. Utilizou-se o milho híbrido 2B688 PW, cujos tratos culturais foram realizados conforme a necessidade da cultura. Após 78 dias da semeadura, foram amostradas, aleatoriamente, 19 parcelas de 8m² em cada área, onde se avaliou altura de plantas e de inserção de espiga, comprimento e diâmetro de espiga. Não foram verificadas diferenças significativas entre os tratamentos para todas as variáveis analisadas, evidenciando que a cultura do milho apresentou as mesmas respostas quando cultivada em sucessão à cana ou à pastagem de Brachiaria.(AU)

The purpose of this study was to evaluate the behavior of hybrid maize for silage in different crop succession conditions in the city of Umuarama ­ PR in two different areas. The experiment was performed at the experimental farm at Universidade Paranaense - UNIPAR in the aforementioned city. In area 1, maize was grown after sugarcane, while in area 2 it was grown after pasture with Brachiaria. The experiment was carried out from December/2014 to April/2015. Hybrid maize 2B688 PW was used, with cultural traits performed according to the crop needs. Seventy-eight days after sowing, 19 plots measuring 8 m2 each were randomly chosen and analyzed, assessing plant height and spike insertion, as well as length and spike diameter. There were no significant differences between treatments for all variables analyzed, therefore, it can be concluded that maize crop presented the same responses when grown in succession to sugarcane or to Brachiaria pasture.(AU)

El objetivo de este estudio ha sido evaluar el comportamiento del maíz híbrido para ensilaje en diferentes condiciones de sucesión de culturas en la ciudad de Umuarama - PR. El experimento se llevó a cabo en dos áreas diferentes de la granja experimental de la Universidad Paranaense - Unipar, en el referido municipio. En el área 1 se ha cultivado maíz en sucesión a la caña de azúcar y en el área 2, en sucesión al pasto del género Brachiaria. El experimento se llevó a cabo en el periodo de diciembre/2014 a abril/2015. Se utilizó el maíz híbrido 2B688 PW, cuyas prácticas culturales se realizaron como las necesidades de los cultivos. Después de 78 días de la siembra, se tomaron muestras al azar, 19 parcelas de 8m² en cada área, que evaluó altura de las plantas y la inserción de mazorca, longitud y diámetro de mazorca. No se encontraron diferencias significativas entre los tratamientos para todas las variables, mostrando que el maíz presentó las mismas respuestas cuando cultivado en sucesión a la caña o al pasto de Brachiaria.(AU)

Comportamento de milho híbrido para silagem em diferentes condições de sucessão de culturas no município de Umuarama - PR / Hybrid maize for silage in different crop succession conditions in the city of Umuarama - PR / Comportamiento de maíz híbrido para ensilaje en diferentes condiciones de sucesión de cultivos en el municipio Umuarama - PR

O objetivo do trabalho foi avaliar o comportamento do milho híbrido para silagem em diferentes condições de sucessão de culturas no município de Umuarama ­ PR. O experimento foi realizado em duas diferentes áreas da fazenda experimental da Universidade Paranaense ­ UNIPAR, no referido município. Na área 1 cultivou-se o milho em sucessão à cana-de-açúcar e na área 2, em sucessão à pastagem do gênero Brachiaria. O experimento foi conduzido no período de dezembro/2014 a abril/2015. Utilizou-se o milho híbrido 2B688 PW, cujos tratos culturais foram realizados conforme a necessidade da cultura. Após 78 dias da semeadura, foram amostradas, aleatoriamente, 19 parcelas de 8m² em cada área, onde se avaliou altura de plantas e de inserção de espiga, comprimento e diâmetro de espiga. Não foram verificadas diferenças significativas entre os tratamentos para todas as variáveis analisadas, evidenciando que a cultura do milho apresentou as mesmas respostas quando cultivada em sucessão à cana ou à pastagem de Brachiaria.

The purpose of this study was to evaluate the behavior of hybrid maize for silage in different crop succession conditions in the city of Umuarama ­ PR in two different areas. The experiment was performed at the experimental farm at Universidade Paranaense - UNIPAR in the aforementioned city. In area 1, maize was grown after sugarcane, while in area 2 it was grown after pasture with Brachiaria. The experiment was carried out from December/2014 to April/2015. Hybrid maize 2B688 PW was used, with cultural traits performed according to the crop needs. Seventy-eight days after sowing, 19 plots measuring 8 m2 each were randomly chosen and analyzed, assessing plant height and spike insertion, as well as length and spike diameter. There were no significant differences between treatments for all variables analyzed, therefore, it can be concluded that maize crop presented the same responses when grown in succession to sugarcane or to Brachiaria pasture.

El objetivo de este estudio ha sido evaluar el comportamiento del maíz híbrido para ensilaje en diferentes condiciones de sucesión de culturas en la ciudad de Umuarama - PR. El experimento se llevó a cabo en dos áreas diferentes de la granja experimental de la Universidad Paranaense - Unipar, en el referido municipio. En el área 1 se ha cultivado maíz en sucesión a la caña de azúcar y en el área 2, en sucesión al pasto del género Brachiaria. El experimento se llevó a cabo en el periodo de diciembre/2014 a abril/2015. Se utilizó el maíz híbrido 2B688 PW, cuyas prácticas culturales se realizaron como las necesidades de los cultivos. Después de 78 días de la siembra, se tomaron muestras al azar, 19 parcelas de 8m² en cada área, que evaluó altura de las plantas y la inserción de mazorca, longitud y diámetro de mazorca. No se encontraron diferencias significativas entre los tratamientos para todas las variables, mostrando que el maíz presentó las mismas respuestas cuando cultivado en sucesión a la caña o al pasto de Brachiaria.

Quantitative structure-sorption relationships of pesticides used in the sugarcane industry in the northern coastal area of Paraíba State, Brazil.

Sorption coefficients (K(oc)) are useful in the prediction of whether a pesticide will remain dissolved in solution or will become adsorbed onto soil particles after its application. Measuring this process experimentally is difficult, expensive and time-consuming. Hence, much effort has been directed toward estimating K(oc) through statistical modelling. In this study, we investigated the physicochemical properties of pesticides employed by a local sugarcane company, in the northern coastal plain of Paraíba state in Brazil, by using several molecular descriptors, among them, GRid INdependent Descriptors (GRIND). Quantitative assessment of the structure-property relationship (QSPR) model indicated that size, shape, octanol-water coefficient, solubility and the balance between hydrophilic and lipophilic regions, are all relevant to K(oc) values.

Transumbilical sleeve gastrectomy with an accessory lateral port: surgical results in 237 patients and 1-year follow-up.

BACKGROUND: The transumbilical approach has recently been shown to be safe for several surgical procedures. Case series of sleeve gastrectomy (SG) with a transumbilical approach (TUSG) has been reported with various techniques. The objective of this report is to present the technique, surgical results, and 1-year follow-up results of simplified TUSG using rigid instruments. METHODS: All of the patients who had undergone SG since July 2010 were offered a transumbilical approach. The operative technique involves a transumbilical incision and the introduction of a SILS® or GelPoint® multiport and a 5-mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. Gastric transection was made 4-5 cm proximal to the pylorus, calibrated with a 36-Fr bougie. Selected hemostasis to the staple line was achieved with metallic clips. RESULTS: A total of 237 patients underwent TUSG. Patient body mass index ranged from 30 to 46 kg/m(2). The mean operative time was 49.5 ± 14.9 min. Six patients presented with early complications, including hemoperitoneum in three cases, antral leak in one case, intestinal perforation in one case, and portal vein thrombosis in one case. Conversion to the multitrocar technique was required in one patient. There were no mortalities. The mean length of hospital stay was 2.2 ± 1 days. The cosmetic result was satisfactory for all of the patients. CONCLUSIONS: TUSG is a safe and feasible procedure using the described technique. The insertion of a 5-mm assistance trocar simplifies the procedure, allowing the use of rigid instruments.

Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.

BACKGROUND: The treatment of pain in obese patients is always a challenge. These patients have low pain thresholds, and the use of opioids can be especially harmful. Intraoperative nervous fiber section and the high temperatures of electrical scalpels probably contribute to the generation of postoperative neuropathic pain. We hypothesized that an antineuropathic pain drug like pregabalin could be helpful to optimize postoperative analgesia by reducing the requirement for opioids and their associated side effects. METHODS: Eighty adults undergoing laparoscopic sleeve gastrectomy were randomly assigned to orally receive either placebo capsules (control) or pregabalin (150 mg) 2 h before surgery. Postoperative morphine consumption during the first 24 postoperative hours was registered. Visual analog pain scores (VAS) were assessed at 1, 2, 4, 6, 8, 12, 16, and 24 h after surgery. Both the incidence of adverse reactions and patient satisfaction were also assessed. RESULTS: Over a 24-h period, the morphine consumption in the pregabalin group was 11.51 ± 7.93 mg, whereas in the control group, it was 23.07 ± 9.57 mg (p < 0.0001). VAS scores were significantly lower in the pregabalin group. Postoperative nausea and vomiting and the consumption of antiemetics were reduced in the pregabalin group. CONCLUSIONS: A single preoperative oral dose of 150 mg pregabalin is useful for reducing morphine consumption after a sleeve gastrectomy, and it guarantees effective and safe analgesia with a low incidence of adverse effects.

Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso / Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

JUSTIFICATIVA E OBJETIVOS: Embora a tetralogia de Fallot seja a mais comum das cardiopatias congênitas cianóticas, as publicações nacionais, relacionando essa doença com a prática anestésica são escassas. O objetivo deste relato é apresentar um caso de analgesia de parto em paciente portadora de tetralogia de Fallot não corrigida e diagnosticada durante a gestação. RELATO DO CASO: Paciente com 26 anos, 56 kg, 1,56 m, idade gestacional 32 semanas e 5 dias, com diagnóstico de tetralogia de Fallot realizado durante a gestação. Internou em trabalho de parto. A conduta obstétrica foi a de parto via baixa, sendo realizada analgesia através de bloqueio peridural com bupivacaína a 0,125 por cento e fentanil (100 æg) e colocação de cateter peridural. Após 1h30 minutos do início da analgesia, ocorreu o nascimento. O peso do recém-nascido foi 1485 g e o índice de Apgar 6 e 8 no primeiro e no quinto minutos, respectivamente. A paciente permaneceu estável e sem alterações hemodinâmicas e/ou eletrocardiográficas. CONCLUSÕES: A escolha da técnica anestésica é de fundamental importância no manuseio das pacientes com tetralogia de Fallot não corrigidas. Condições favoráveis do colo e boa dinâmica uterina, particularmente naquelas pacientes sem história de síncope, tornam-se imprescindíveis para uma boa indicação da analgesia de parto.

[Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report.]. / Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso.

BACKGROUND AND OBJECTIVES: Although tetralogy of Fallot is the most common cyanotic congenital heart disease, national publications correlating this condition with anesthetic practice are scarce. This report aimed at presenting a case of labor epidural analgesia in a patient with uncorrected tetralogy of Fallot diagnosed during gestation. CASE REPORT: Patient 26 years old, 1.54 m, 56 kg, 32 weeks and 5 days of gestational age, who had been diagnosed with tetralogy of Fallot during gestation. Patient was admitted in labour. After obstetric evaluation and decision for natural birth, epidural analgesia was performed with 0.125% bupivacaine associated to 100microg fentanyl through a catheter. Patient gave birth 1 hour and 30 minutes after the procedure. The newborn weighed 1485 grams and had an Apgar score of 6 and 8 at one and five minutes, respectively. Patient remained stable, with no hemodynamic or ECG changes. CONCLUSIONS: Selecting the appropriate anesthetic technique is extremely important when managing patients with uncorrected tetralogy of Fallot. Favorable uterine dynamics and cervical conditions, particularly in patients with no history of syncope, are critical findings for adequate labour analgesia indication.

Respuesta inflamatoria sistémica y complicaciones en pacientes gastrectomizados / Systemic inflammatory response syndrome and complications in gastrectomized patients

El Síndrome de Respuesta Inflamatoria Sístematica (SRIS) es una condición clínica que surge frente a una agresión no específica, caracterizada por dos o más de los siguentes elementos: 1) fiebre o hipotermia; 2) taquicardia; 3) taquipnea y 4) leucocitosis. Para evaluar su significado en cirugía gastrointestinal mayor revisamos los pacientes gastrectomizados en el Servicio de Cirugía de nuestro hospital, entre los años 1996 y 1998, dividiéndolos en dos grupos: Complicados y No Complicados. Se evaluaron retrospectivamente 41 pacientes. Del total se descartan 3 por datos incompletos. Se analizaron 38 pacientes, con un promedio de edad de 61,4 años (SEM 0.38). Diecinueve pacientes presentaron algún tipo de complicación postoperatoria inmediata. En estos pacientes, la duración promedio del SRIS fue de 4,63 días (SEM 0,8) versus 1,52 días (SEM 0,26). Promedio en pacientes no complicados (p<0.0004). El diagnóstico de las complicaciones se hizo en promedio a los 6,47 días (SEM 0,225). El Valor Predictivo Positivo (VPP) de SRIS mayor de 3 días de duración para complicaciones fue 91,6 por ciento y su Valor Predictivo Negativo 69 por ciento. Expresado de otra forma, el riesgo relativo de tener una complicación con SRIS >3 días fue 2,98 (intervalo de confianza 1,63 <5,44, x2 corregido según Mantel-Haenszel 11,86, p <0,0005). Nuestros datos sugieren que la duración del SRIS postoperatorio puede tener un rol predictor de complicaciones en pacientes gastrectomizados

Vagotomía troncal posterior y seromiotomía anterior por videolaparoscopía para el tratamiento quirúrgico de la úlcera duodenal / Posterior truncal vagotomy and anterior seromyotomy by videolaparoscopy for the surgical treatment of duodenal ulcer

La cirugía aún tiene un rol que jugar en pacientes seleccionados en el tratamiento de la úlcera duodenal UD no complicada. El desarrollo de la cirugía laparoscópica ha incluido la vagotomía troncal posterior VTP y seromiotomía anterior SMA, con excelentes resultados preliminares. El objetivo de este trabajo prospectivo fue evaluar la factibilidad y efectividad de la VTP y SMA laparoscópica, en términos de morbimortalidad, secuelas e índice de recidivas. Se efectúan 18 vagotomías, con un seguimiento de 18 meses. Todos los pacientes cicatrizaron su úlcera al mes y se encontraban en Visick 1 y 2. La morbilidad fue mínima y no hay mortalidad en esta serie. La VTP y SMA laparoscópica, aparece como una promisoria alternativa en el tratamiento quirúrgico de la UD, cuyos resultados definitivos están susceptibles a evaluar a largo plazo