Surgical approach in correction of a crack in the gnathotheca of a black swan (Cygnus atratus, Latham, 1790): first case report / Abordagem cirúrgica em correção de fissura na gnatoteca em um cisne-negro (Cygnus atratus, Latham, 1790): primeiro relato de caso

The black swan (Cygnus atratus, LATHAM, 1790) is a bird kept as an ornamental in zoos. Because of their long beaks they tend to have a reserved prognosis in musculoskeletal disorders such as beak trauma, secondary to skull bone fractures, presenting irreversible lesions. The aim of this report is present a clinical surgical innovation in the repair of a black swan's gnathotheca fissure with the application of non-conventional materials used. It was observed that one of the swans kept in a zoo display area had difficulty feeding, with associated weight loss. It was observed tissue loss and a lacerative lesion in the caudal sublingual region of its beak. The lesion was corrected by a separate simple suture in the cranial region of the beak and with a x-clamping using steel surgical wire and the application of dental resin in the distal region to perform a sustentation bridge in the beak end-gap. After 12 days, the animal was able to feed again and remained perfectly adapted to the restoration, reestablishing the anatomical and physiological function of its beak.

O cisne-negro (Cygnus atratus, Latham, 1790) é uma ave mantida como ornamental em zoológicos. Por apresentar bicos longos, tende a ter prognóstico reservado em afecções musculoesqueléticas, como traumas de bico secundários e fraturas de ossos do crânio, com lesões irreversíveis. O objetivo deste relato é apresentar uma inovação clínica cirúrgica no reparo de fissura na gnatoteca de um cisne-negro, com a utilização de materiais não convencionais. Observou-se que um dos cisnes mantidos em uma área de exibição de um zoológico apresentava dificuldade para se alimentar, com perda de peso associada. Constatou-se perda tecidual e lesão lacerativa na região sublingual caudal de seu bico. A lesão foi corrigida por meio de sutura simples separada na região cranial do bico e posterior sutura em x com fio cirúrgico de aço, finalizando com aplicação de resina odontológica na região distal para realização de ponte de sustentação do bico. Após 12 dias, o animal conseguiu se alimentar novamente e se manteve perfeitamente adaptado à restauração, restabelecendo a função anatômica e fisiológica de seu bico.

Prevalence and risk factors associated with anti-Leptospira spp agglutinins in cattle from dairy farmers in Ji-Paraná, RO, Brazil / Prevalência e fatores associados ao risco da presença de aglutininas anti-Leptospira spp em bovinos de agricultores familiares da bacia leiteira do município de Ji-Paraná - RO, Brasil

Leptospirosis affects several animal species, including man. This study aimed to evaluate the prevalence of Leptospira spp. and to identify factors associated with the risk of Leptospira spp. in dairy cattle in the municipality of Ji-Paraná, RO, Brazil, sampled by rural sector, from September 2012 to November 2013. Blood samples from 627 dairy cows were randomly collected from 63 farms belonging to six rural sectors. Leptospirosis was diagnosed by the microscopic serum agglutination technique. Of the 627 animals tested, 255 had anti-Leptospira antibodies (40.48%, 95% CI: 36.64-44.31) and 57 of the 63 studied dairy farms (90.5%, 95% CI: 83.23-97.72) had at least one reactive animal. The results indicate that serovar Hardjo had the highest (12.38%. 95% CI: 10.03-15.18) followed by serovars Shermani, Wolffi, Hebdomadis and Canicola occurrence in dairy cows. Additionally, infection was also associated with abortion occurrences in cows of 36 farms (57.14%) and the presence of dogs roaming free with access to pasture, water and cattle in 47 farms (74.60%). Therefore, free-roaming animals are considered a predisposing factor, highlighting the need for adopting prophylactic measures while raising the awareness from rural producers about the importance and the economic losses that leptospirosis may cause.

A leptospirose acomete diversas espécies animais, inclusive o homem. Este estudo teve como objetivo avaliar a prevalência de anticorpos contra Leptospira spp., bem como identificar fatores associados ao risco da infecção por Leptospira spp. em bovinos de leite do município de Ji-Paraná - RO, amostrados por setor rural, de setembro de 2012 a novembro de 2013. Amostras de sangue foram coletadas sistematicamente de 627 fêmeas leiteiras, oriundas de 63 propriedades pertencentes a seis setores rurais. O diagnóstico da leptospirose foi realizado por meio da soroaglutinação microscópica. Constatou-se que 255 animais possuíam anticorpos anti-Leptospira (40,48%, IC95%: 36,64-44,31). Das 63 propriedades estudadas, 57 (90,5%, IC95%: 83,23-97,72) apresentavam pelo menos um animal reagente. Observou-se maior ocorrência do sorovar Hardjo nas fêmeas bovinas (12,38%, IC95%: 10,03-15,18), seguido dos sorovares Shermani, Wolffi, Hebdomadis e Canicola. Observaram-se, como fatores associados à infecção por sorovar, a ocorrência de aborto em fêmeas de 36 propriedades estudadas (57,14%), bem como a existência de cães criados livres em 47 propriedades (74,60%) e com acesso ao pasto, à água e aos bovinos, o que reforça a necessidade de adoção de medidas profiláticas e a conscientização dos produtores rurais sobre a importância e os prejuízos que podem ser causados pela leptospirose.

Microbial ecology and predicted metabolic pathways in various oral environments from patients with acute endodontic infections.

AIM: To assess in a cross-sectional clinical study the effect of antibiotics on the diversity, structure and metabolic pathways of bacterial communities in various oral environments in patients with acute primary infections. METHODOLOGY: Samples of saliva (SA), supragingival biofilm (SB) and from the pulp cavity (PC) were collected from teeth with acute primary infections and then grouped according to previous use of antibiotics (NoAtb = no antibiotics [n = 6]; Atb = antibiotics [n = 6]). DNA sequencing was conducted using MiSeq (Illumina, San Diego, CA, USA). The V1-V3 hyper-variable region of the 16S rRNA gene was amplified. A custom Mothur pipeline was used for 16S rRNA processing. Subsequent analyses of the sequence dataset were performed in R (using vegan, phyloseq and ggplot2 packages) or QIIME. RESULTS: Twelve patients aged from 22 to 56 years were recruited. Participants in the Atb group had taken the beta-lactamics amoxicillin (5/6) or cephalexin (1/6) for 2-3 days. A total of 332 bacterial taxa (OTUs) were identified, belonging to 120 genera, 60 families and nine phyla. Firmicutes (41%) and Bacteroidetes (38%) were the most abundant phyla in all samples. Taxa clustered significantly by oral site (PCoA analysis; P < 0.05, ANOSIM). Use of antibiotics had little effect on this clustering. However, SA, SB and PC had different degrees of richness, diversity and evenness. The greatest diversity was observed in SB samples and the least diversity was observed in PC samples. Metabolic prediction identified 163 pathways and previous use of antibiotics had a major effect on the estimated functional clustering in SA and PC samples. CONCLUSION: The ecological niche had a strong influence on the bacterial content of samples from various oral sites. Previous exposure to antibiotics may exert an effect on the phylogenetic composition of SA. Metabolic pathways appear to be modulated by antimicrobial agents in SA and PC samples. The dynamics of host/microbial interactions in the apical region and the functional ecology of the infected pulp cavity should be revisited.

Prevotella strains and lactamic resistance gene distribution in different oral environments of children with pulp necrosis.

AIM: To determine the presence of Prevotella species, the cfxA/cfxA2, blaZ and blaTEM genes associated with resistance to lactamic agents in different oral niches of children with pulp necrosis. METHODOLOGY: Children with pulp necrosis in primary teeth had samples of saliva, supragingival, pulp chamber and root canal biofilms collected and tested for Prevotella species (P. intermedia, P. nigrescens, P. tannerae) and for beta-lactam resistance genes (cfxA/cfxA2, blaZ and blaTEM). The presence of bacterial DNA was examined through PCR, with a specific primer directed to the 16S rRNA gene. Specific primers were used to detect the Prevotella species and beta-lactam resistance genes. The chi-square test was used to analyse associations between the presence of bacteria and clinical variables. The Cochran's Q test was used to assess whether the proportion of gene detection is the same between different sites. RESULTS: Thirty-two teeth were sampled from 27 patients with a mean age of 5.5 years (±1.76). The total detection rate of Prevotella strains was 29.1%, 25%, 21.8% and 32.29% in saliva, supragingival, pulp chamber and root canal samples, respectively. P. nigrescens was the most commonly detected species in all oral niches. The previous use of antibiotics was associated with detection of P. nigrescens in saliva (P = 0.03). Pain was associated with the presence of P. nigrescens (P = 0.04) and P. tannerae (P = 0.01) in pulp chamber biofilm. blaTEM was detected in the four oral niches, being more frequent (23.8%) in supragingival biofilm (Cochran's Q test, P = 0.04). The presence of P. intermedia in SB and PC was associated with the detection of blaTEM in saliva (P = 0.04). The cfxA/cfxA2 and blaZ genes were not detected in any of the four oral niches. CONCLUSIONS: The oral cavity of children with pulp necrosis had a variable distribution of Prevotella strains in different niches. Saliva, supragingival biofilm, pulp chamber and root canals of primary teeth with necrotic pulps can harbour resistance genes to beta-lactams agents.

Desenvolvimento reprodutivo de tourinhos Gir selecionados para produção de leite / Reproductive development of Gyr young bulls selected for milk production

O estudo visou identificar tourinhos Gir precoces e não precoces quanto à puberdade e avaliar diferenças durante seu desenvolvimento reprodutivo. Peso vivo e perímetro escrotal foram mensurados mensalmente junto com a coleta e a avaliação física e morfológica do sêmen de 16 animais, dos 13 aos 23 meses de idade. Animais precoces foram mais leves na pré-puberdade e apresentaram menores idades à puberdade e à maturidade sexual - 17,0 e 18,7 meses -, respectivamente, - em relação aos não precoces - 19,2 e 20,5 meses, respectivamente. A motilidade aumentou na pré-puberdade dois meses mais cedo nos animais precoces - 1,75 por cento a 18,4 por cento dos 14 aos 17 meses - em relação aos não precoces - 2,5 por cento a 12,4 por cento dos 15 aos 18 meses de idade. Registrou-se aumento mais cedo da concentração espermática em animais precoces, a qual foi maior - 660 milhões/mL - aos 23 meses em relação aos animais não precoces -66.7 milhões/mL. As diferenças observadas no desenvolvimento dos dois grupos foram favoráveis aos animais precoces e indicam que a seleção para a maturidade sexual precoce é indicada para a antecipação da fase reprodutiva de touros Gir.(AU)

This study aimed to identify precocious and non-precocious Gyr young bulls according to puberty and evaluate differences during their reproductive development. Live weight and scrotal circumference were measured monthly with collection and evaluation of semen samples from 16 animals, from 13 to 23 months of age. Precocious animals were lighter at the pre-puberty period and younger at puberty and sexual maturity, 17.0 and 18.7 months, respectively, regarding non-precocious, 19.2 and 20.5 months, respectively. Sperm motility increased during pre-puberty two months earlier for precocious animals, 1.75 percent to 18.4 percent from 14 to 17 months, regarding non-precocious, 2.5 percent to 12.4 percent from 16 to 18 months. Sperm concentration increase occurred earlier in precocious animals, and was higher, 669 million/mL, at 23 months of age in relation to non-precocious animals, 66.7 million/mL. The differences in reproductive development of both groups were favorable for precocious animals and indicate that the selection for precocious sexual maturity is advised to anticipate the reproductive phase of Gyr bulls.(AU)

Desenvolvimento reprodutivo de tourinhos Gir selecionados para produção de leite / Reproductive development of Gyr young bulls selected for milk production

O estudo visou identificar tourinhos Gir precoces e não precoces quanto à puberdade e avaliar diferenças durante seu desenvolvimento reprodutivo. Peso vivo e perímetro escrotal foram mensurados mensalmente junto com a coleta e a avaliação física e morfológica do sêmen de 16 animais, dos 13 aos 23 meses de idade. Animais precoces foram mais leves na pré-puberdade e apresentaram menores idades à puberdade e à maturidade sexual - 17,0 e 18,7 meses -, respectivamente, - em relação aos não precoces - 19,2 e 20,5 meses, respectivamente. A motilidade aumentou na pré-puberdade dois meses mais cedo nos animais precoces - 1,75 por cento a 18,4 por cento dos 14 aos 17 meses - em relação aos não precoces - 2,5 por cento a 12,4 por cento dos 15 aos 18 meses de idade. Registrou-se aumento mais cedo da concentração espermática em animais precoces, a qual foi maior - 660 milhões/mL - aos 23 meses em relação aos animais não precoces -66.7 milhões/mL. As diferenças observadas no desenvolvimento dos dois grupos foram favoráveis aos animais precoces e indicam que a seleção para a maturidade sexual precoce é indicada para a antecipação da fase reprodutiva de touros Gir.

This study aimed to identify precocious and non-precocious Gyr young bulls according to puberty and evaluate differences during their reproductive development. Live weight and scrotal circumference were measured monthly with collection and evaluation of semen samples from 16 animals, from 13 to 23 months of age. Precocious animals were lighter at the pre-puberty period and younger at puberty and sexual maturity, 17.0 and 18.7 months, respectively, regarding non-precocious, 19.2 and 20.5 months, respectively. Sperm motility increased during pre-puberty two months earlier for precocious animals, 1.75 percent to 18.4 percent from 14 to 17 months, regarding non-precocious, 2.5 percent to 12.4 percent from 16 to 18 months. Sperm concentration increase occurred earlier in precocious animals, and was higher, 669 million/mL, at 23 months of age in relation to non-precocious animals, 66.7 million/mL. The differences in reproductive development of both groups were favorable for precocious animals and indicate that the selection for precocious sexual maturity is advised to anticipate the reproductive phase of Gyr bulls.

Efeitos do diluidor na viabilidade espermática pós-criopreservação em tourinhos da raça Gir Leiteiro aos 25 meses de idade, pré-selecionados pela classificação andrológica por pontos / Effects of the extender in the semen post - thaw viability in young dairy Gyr bulls (Bos taurus indicus), pre - selected by breeding soundness evaluation

Procedeu-se à criopreservação do sêmen de oito tourinhos Gir Leiteiro, com idade média de 25 meses, pré-selecionados para elevada pontuação (média 84,4±5,6) na classificação andrológica por pontos (CAP), em dois diferentes diluidores: um à base de lactose-gema-glicerol e outro à base de lecitina de soja. As curvas de resfriamento e congelação foram padronizadas com o auxílio da máquina CRYOGEN®. Os parâmetros pós-congelação avaliados no sêmen submetido aos dois diluidores - motilidade, vigor, defeitos maiores, menores e totais, defeitos de acrossoma, cauda dobrada, reação ao teste hiposmótico (Thos) e células normais - foram comparados aos do sêmen fresco, exceto para Thos e entre eles. O sêmen de todos os animais foi congelado com êxito no diluidor lactose-gema-glicerol. Houve diferença (P<0,05) em todas as variáveis analisadas no sêmen fresco e pós-congelado, exceto para defeitos maiores. Entre diluidores, houve diferença (P<0,05) para motilidade, vigor, cauda dobrada e Thos. Estes resultados indicam que a seleção pelo CAP médio >80 é um bom índice para selecionar touros com maior taxa de espermatozoides viáveis pós-congelação.(AU)

Semen cryopreservation from eight young dairy Gyr bulls was performed using two different semen extenders. Bulls aging 25 months old and pre-selected for a high average score (84.4±5.6 in a 0-100 scale) in Zebu breeding soundness evaluation (BSE) composed the experimental group. Extenders were based on lactosis-egg yolk-glycerol and soya lecithin. Chilling and freezing curves were standardized by CRYOGEN® machine. Post-thaw features evaluated in semen frost in both extenders - motility, vigor, major, minor and total deffects, morphological alteration in acrossome, bent tail, reative cells to hyposmotic sweeling test (Thos), and normal cells - were compared to the ones in the fresh ejaculate (except Thos) and among them. It was possible to freeze semen from all animals in the lactosis-egg yolk-glycerol extender. There were difference (P<0.05) in all analyzed features between fresh and cryopreserved semen, except for major deffects. Between extenders, there were differences (P<0.05) in motility, vigor, bent tail, and Thos. All bulls had successfull semen freezability. These results sustain that pre-selection for high BSE values (average >80 points) is a good index to identify bulls with good post semen - thaw features. However, the choice of the extender is critical for obtaining acceptable results.(AU)

Efeitos do diluidor na viabilidade espermática pós-criopreservação em tourinhos da raça Gir Leiteiro aos 25 meses de idade, pré-selecionados pela classificação andrológica por pontos / Effects of the extender in the semen post - thaw viability in young dairy Gyr bulls (Bos taurus indicus), pre - selected by breeding soundness evaluation

Procedeu-se à criopreservação do sêmen de oito tourinhos Gir Leiteiro, com idade média de 25 meses, pré-selecionados para elevada pontuação (média 84,4±5,6) na classificação andrológica por pontos (CAP), em dois diferentes diluidores: um à base de lactose-gema-glicerol e outro à base de lecitina de soja. As curvas de resfriamento e congelação foram padronizadas com o auxílio da máquina CRYOGEN®. Os parâmetros pós-congelação avaliados no sêmen submetido aos dois diluidores - motilidade, vigor, defeitos maiores, menores e totais, defeitos de acrossoma, cauda dobrada, reação ao teste hiposmótico (Thos) e células normais - foram comparados aos do sêmen fresco, exceto para Thos e entre eles. O sêmen de todos os animais foi congelado com êxito no diluidor lactose-gema-glicerol. Houve diferença (P<0,05) em todas as variáveis analisadas no sêmen fresco e pós-congelado, exceto para defeitos maiores. Entre diluidores, houve diferença (P<0,05) para motilidade, vigor, cauda dobrada e Thos. Estes resultados indicam que a seleção pelo CAP médio >80 é um bom índice para selecionar touros com maior taxa de espermatozoides viáveis pós-congelação.

Semen cryopreservation from eight young dairy Gyr bulls was performed using two different semen extenders. Bulls aging 25 months old and pre-selected for a high average score (84.4±5.6 in a 0-100 scale) in Zebu breeding soundness evaluation (BSE) composed the experimental group. Extenders were based on lactosis-egg yolk-glycerol and soya lecithin. Chilling and freezing curves were standardized by CRYOGEN® machine. Post-thaw features evaluated in semen frost in both extenders - motility, vigor, major, minor and total deffects, morphological alteration in acrossome, bent tail, reative cells to hyposmotic sweeling test (Thos), and normal cells - were compared to the ones in the fresh ejaculate (except Thos) and among them. It was possible to freeze semen from all animals in the lactosis-egg yolk-glycerol extender. There were difference (P<0.05) in all analyzed features between fresh and cryopreserved semen, except for major deffects. Between extenders, there were differences (P<0.05) in motility, vigor, bent tail, and Thos. All bulls had successfull semen freezability. These results sustain that pre-selection for high BSE values (average >80 points) is a good index to identify bulls with good post semen - thaw features. However, the choice of the extender is critical for obtaining acceptable results.

The potential protective effect of low potassium dextran against lipid peroxidation in a rat lung transplantation model.

The overproduction of reactive oxygen species plays an important role in the cascade of events during lung ischemia-reperfusion leading to graft failure. An evaluation of the peripheral markers of oxidative stress and antioxidant enzyme activities was carried out after reperfusion in a rat lung transplant model. The decrease in lipid peroxidation immediately after transplantation ( P < 0.05) may suggest an adaptative response and/or a protective effect of low potassium dextran against lipid peroxidation through natural scavenging mechanisms.

Familial osteopetrosis in Agouti paca: report of nine cases / Osteopetrose familiar em Agouti paca: relato de nove casos

Nine cases of familial osteopetrosis were studied in Agouti paca rodents maintained in captivity. Animals were distributed in three groups depending on the severity of their skeletal lesions. Based upon clinical, radiological, and microscopic findings, it was concluded that one animal had level I lesions, three animals had level II lesions, and five animals had level III osteopetrosis and osteonecrosis. Throughout the entire axial and appendicular skeleton, there was an increased amount of both trabecular and cortical bone tissue. All analyzed bones showed thickened cortex and reduced medullary canals. Bone trabeculae were thick and confluent. Cortex showed a narrowing of Haversian canals. Numerous cementing lines resulted in typical mosaic patterns. Osteocytes were pycnotic. Osteonecrosis was characterized by the disappearance of osteocytes and bone matrix decomposition.(AU)

Descreveram-se nove casos de osteopetrose familiar em Agouti paca mantidas em cativeiro. Os animais foram distribuídos em três grupos de acordo com a gravidade das lesões do esqueleto. Com base nos exames clínico, radiológico e microscópico, foi concluído que um animal apresentou lesões de nível I, três animais tiveram lesões de nível II e cinco animais tiveram osteopetrose de nível III. Por todo o esqueleto axial e apendicular, a quantidade de osso trabecular e osteônico estava aumentada. Todos os ossos analisados mostraram córtex espesso e canais medulares reduzidos. As trabéculas ósseas eram espessas e confluentes. No córtex, verificou-se um estreitamento de canais de Havers. Numerosas linhas de cimentação resultaram em um padrão de mosaico típico. Osteócitos estavam picnóticos e a osteonecrose foi caracterizada pela morte dos osteócitos, com desintegração da matriz óssea.(AU)

Familial osteopetrosis in Agouti paca: report of nine cases / Osteopetrose familiar em Agouti paca: relato de nove casos

Nine cases of familial osteopetrosis were studied in Agouti paca rodents maintained in captivity. Animals were distributed in three groups depending on the severity of their skeletal lesions. Based upon clinical, radiological, and microscopic findings, it was concluded that one animal had level I lesions, three animals had level II lesions, and five animals had level III osteopetrosis and osteonecrosis. Throughout the entire axial and appendicular skeleton, there was an increased amount of both trabecular and cortical bone tissue. All analyzed bones showed thickened cortex and reduced medullary canals. Bone trabeculae were thick and confluent. Cortex showed a narrowing of Haversian canals. Numerous cementing lines resulted in typical mosaic patterns. Osteocytes were pycnotic. Osteonecrosis was characterized by the disappearance of osteocytes and bone matrix decomposition.

Descreveram-se nove casos de osteopetrose familiar em Agouti paca mantidas em cativeiro. Os animais foram distribuídos em três grupos de acordo com a gravidade das lesões do esqueleto. Com base nos exames clínico, radiológico e microscópico, foi concluído que um animal apresentou lesões de nível I, três animais tiveram lesões de nível II e cinco animais tiveram osteopetrose de nível III. Por todo o esqueleto axial e apendicular, a quantidade de osso trabecular e osteônico estava aumentada. Todos os ossos analisados mostraram córtex espesso e canais medulares reduzidos. As trabéculas ósseas eram espessas e confluentes. No córtex, verificou-se um estreitamento de canais de Havers. Numerosas linhas de cimentação resultaram em um padrão de mosaico típico. Osteócitos estavam picnóticos e a osteonecrose foi caracterizada pela morte dos osteócitos, com desintegração da matriz óssea.

Bos indicus or Bos taurus mitochondrial DNA - comparison of productive and reproductive breeding values in a Guzerat dairy herd.

The observation of bovine mitochondrial DNA (mtDNA) polymorphisms allows the separation of American zebu cattle, according to its maternal lineage ancestry, into two groups: one with Bos indicus mtDNA and other with Bos taurus mtDNA. The aim of the present study was to determine the productive and reproductive differences between these two groups, in a Guzerat dairy herd. The genotyping of a sample of 56 animals allowed the categorization of most of the 3835 animals in the pedigree file. The production file included 3528 calving and 3198 lactation records from 729 cows, born during the years 1947 to 2007. The traits considered were: lactation milk yield (LMY); days in milk (DIM); age at first calving (AFC), and calving interval (CI). Heritabilities and breeding values were estimated using an animal model. The regression of the average breeding values per year of birth indicated the genetic trends of the herd. The heritability coefficients estimated for LMY, DIM, AFC, and CI were 0.42, 0.43, 0.20, and 0.10, respectively. The genetic trends were similar for both groups, pointing to an improvement in the productive and a worsening in the reproductive traits. The two groups differed significantly regarding the average estimated breeding values for LMY, DIM and AFC, in the starting period, until 1970, but no differences were observed in the more recent years, after 1970. The segregation between the groups existed in the starting period, probably because the Bos taurus contributions to the herd had occurred more recently at that moment. The conclusion is that mtDNA has no significant effect on these traits.

Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery.

BACKGROUND: Pain is a sensory and emotional experience that is influenced by physiologic, sensory, affective, cognitive, socio-cultural, and behavioral factors. Consistent with the perspective to improve the postoperative pain control, the present study has the purpose of assessing the effect of presurgical clinical factors, psychological and demographic characteristics as predictors for reporting moderate to intense acute postoperative pain. METHODS: A prospective cohort study was performed with 346 inpatients undergoing abdominal elective surgery (ASA physical status I-III, age range 18-60 years). The measuring instruments were Pain Visual Analog Scale, the State-Trait Anxiety Inventory, and the Montgomery-Asberg Depression Rating Scale. Multivariate conditional regression modeling was used to determine independent predictors for moderate to intense acute postoperative pain. RESULTS: Moderate to intense acute postoperative pain was associated with status ASA III (odds ratio (OR) = 1.99), age (OR = 4.72), preoperative moderate to intense pain (OR = 2.96), chronic pain (OR = 1.75), high trait-anxiety and depressive mood moderate to intense (OR = 1.74 and OR = 2.00, respectively). Patients undergoing surgery to treat cancer presented lower risk for reporting moderate to intense pain OR = 0.39, as well as those that received the epidural analgesia and multimodal analgesia with systemic opioid (OR = 0.09 and OR = 0.16, respectively). CONCLUSIONS: The identification of predictive factors for intense acute postoperative pain may be useful for designing specific preventive interventions to relieve patient suffering. Especially because few of these variables are accessible for medical intervention, which would improve the clinical outcomes and quality of life of patients at risk of moderate to intense acute postoperative pain.

Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy.

In a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n=56) or placebo (n=56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time.

Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery.

This study compared the analgesic efficacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double-blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml(-1)), or ropivacaine (2 mg.ml(-1)) with sufentanil (RS group, 1 microg.ml(-1)), using a patient-controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side-effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic efficacy was significantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p = 0.009). There was no significant difference during the other periods. Pruritus, nausea and vomiting were significantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml(-1)). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a significant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical benefit from the addition of sufentanil.

Risk factors for postoperative anxiety in adults.

We identified risk factors for postoperative anxiety and quantified their effect on 712 adults between 18 and 60 years of age (ASA I-III physical status) undergoing elective surgery under general anaesthesia, neural blockade or both. The measuring instruments were a structured questionnaire, a pain visual analogue scale, the McGill Pain Questionnaire, the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale, a Self-Reporting Questionnaire-20, and a Self-Perception of Future Questionnaire. Multivariate conditional regression modelling taking into account the hierarchical relationship between risk factors revealed that postoperative anxiety was associated with ASA status III (OR = 1.48), history of smoking (1.62), moderate to intense postoperative pain (OR = 2.62) and high pain rating index (OR = 2.35), minor psychiatric disorders (OR = 1.87), pre-operative state-anxiety (OR = 2.65), and negative future perception (OR = 2.20). Neural block anaesthesia (OR = 0.72), systemic multimodal analgesia (OR = 0.62) and neuroaxial opioids with or without local anaesthesia (OR = 0.63) were found to be protective factors against postoperative anxiety.

Risk factors for preoperative anxiety in adults.

BACKGROUND: Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults. METHODS: A cross-sectional study was performed with 592 inpatients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State-Trait Anxiety Inventory; the Montgomery-Asberg Depression Rating Scale, the WHO Self-Reporting Questionnaire-20, and the future self-perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors. RESULTS: High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR= 2.30), moderate to intense depressive symptoms (3.22), high trait-anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR= 0.61) was associated with lower risk for preoperative state-anxiety. CONCLUSIONS: History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait-anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state-anxiety. Previous surgery reduced the risk for preoperative anxiety.

Ethical issues in a Brazilian hospital.

PURPOSE: The objective of this paper is to discuss ethical issues such as data protection, confidentiality, and patient freedom taking two ongoing studies as examples. METHODS: The two studies are being carried out at a public hospital in southern Brazil. Study 1 evaluates inadequate use of drugs (mainly vancomycin) and aims at reviewing criteria for drug use control. It includes records of 100 patients whose prescriptions are dispensed at the hospital's pharmacy. A major ethical concern in this study was to ensure data confidentiality. Study 2 evaluates treatment adherence by hypertension patients with a focus on hydrochlorothiazide. Here, in addition to data protection, a major ethical concern was the ability of patients to understand the informed consent form and therefore freely enter or refuse to enter the study. Both projects were approved by the Institutional Review Board at Hospital de Clínicas de Porto Alegre. RESULTS: In both studies, data confidentiality is ensured by the removal of all personal information from the forms used for data analysis. In Study 2, readability of the informed consent was considered adequate by the IRB for the population served by the clinic, and one-third of the patients who were contacted agreed to participate in the study. CONCLUSIONS: To obtain reliable results, basic ethical principles must be observed throughout the planning and execution of research projects, whether data are obtained from medical records or from actual interaction with patients. Thus, monitoring by an Institutional Review Board or equivalent is of paramount importance.

Interaction between repeated restraint stress and concomitant midazolam administration on sweet food ingestion in rats

Emotional changes can influence feeding behavior. Previous studies have shown that chronically stressed animals present increased ingestion of sweet food, an effect reversed by a single dose of diazepam administered before testing the animals. The aim of the present study was to evaluate the response of animals chronically treated with midazolam and/or submitted to repeated restraint stress upon the ingestion of sweet food. Male adult Wistar rats were divided into two groups: controls and exposed to restraint 1 h/day, 5 days/week for 40 days. Both groups were subdivided into two other groups treated or not with midazolam (0.06 mg/ml in their drinking water during the 40-day treatment). The animals were placed in a lighted area in the presence of 10 pellets of sweet food (Froot loops(r)). The number of ingested pellets was measured during a period of 3 min, in the presence or absence of fasting. The group chronically treated with midazolam alone presented increased ingestion when compared to control animals (control group: 2.0 +/- 0.44 pellets and midazolam group: 3.60 +/- 0.57 pellets). The group submitted to restraint stress presented an increased ingestion compared to controls (control group: 2.0 +/- 0.44 pellets and stressed group: 4.18 +/- 0.58 pellets). Chronically administered midazolam reduced the ingestion in stressed animals (stressed/water group: 4.18 +/- 0.58 pellets; stressed/midazolam group: 3.2 +/- 0.49 pellets). Thus, repeated stress increases appetite for sweet food independently of hunger and chronic administration of midazolam can decrease this behavioral effect

Interaction between repeated restraint stress and concomitant midazolam administration on sweet food ingestion in rats.

Emotional changes can influence feeding behavior. Previous studies have shown that chronically stressed animals present increased ingestion of sweet food, an effect reversed by a single dose of diazepam administered before testing the animals. The aim of the present study was to evaluate the response of animals chronically treated with midazolam and/or submitted to repeated restraint stress upon the ingestion of sweet food. Male adult Wistar rats were divided into two groups: controls and exposed to restraint 1 h/day, 5 days/week for 40 days. Both groups were subdivided into two other groups treated or not with midazolam (0.06 mg/ml in their drinking water during the 40-day treatment). The animals were placed in a lighted area in the presence of 10 pellets of sweet food (Froot loops). The number of ingested pellets was measured during a period of 3 min, in the presence or absence of fasting. The group chronically treated with midazolam alone presented increased ingestion when compared to control animals (control group: 2.0 +/- 0.44 pellets and midazolam group: 3.60 +/- 0.57 pellets). The group submitted to restraint stress presented an increased ingestion compared to controls (control group: 2.0 +/- 0.44 pellets and stressed group: 4.18 +/- 0.58 pellets). Chronically administered midazolam reduced the ingestion in stressed animals (stressed/water group: 4.18 +/- 0.58 pellets; stressed/midazolam group: 3.2 +/- 0.49 pellets). Thus, repeated stress increases appetite for sweet food independently of hunger and chronic administration of midazolam can decrease this behavioral effect.