Placement of a subcutaneous ureteral bypass for the treatment of ureteral obstruction in cats : a retrospective study

Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de ClínicaA obstrução ureteral em gatos é uma condição multifatorial e potencialmente fatal com tendência crescente, sendo a causa mais comum a obstrução intraluminal secundária a ureterolitíase. A manifestação pode ser rápida ou insidiosa, e após o diagnóstico, a intervenção imediata é essencial para aliviar a pressão no bacinete renal e evitar uma redução da função renal e lesões renais irreversíveis. O diagnóstico é determinado com base na avaliação dos sinais clínicos, análises sanguíneas, particularmente as concentrações séricas da creatinina e BUN, e exames imagiológicas, tipicamente ultrassonografia e radiografia. Para o tratamento, a abordagem médica deve ser tentada por um curto período de tempo para estabilizar o paciente e procurar resolução. No caso de insucesso da terapêutica médica, a implantação de um bypass subcutâneo ureteral (SUB) surge como uma terapia promissorapelo seu potencial na resolução de obstruções ureterais que não teriam outra resolução. O presente estudo, descreve os resultados e as complicações da colocação do dispositivo SUB em gatos, para o tratamento de obstruções ureterais, no Hospital Veterinário do Porto. Foram analisados de forma detalhada os registos médicos de 5 gatos com ureterolitíase obstrutiva, submetidos à colocação do dispositivo SUB. Os resultados indicam que este procedimento proporciona alívio imediato do bacinete renal, com consequente resolução da lesão renal aguda pós-renal desencadeada pela ureterolitíase obstrutiva. No entanto verificaram-se as seguintes complicações: infeção urinária por bactérias com resistência a múltiplos antibióticos, resultando na morte de dois pacientes. Outras complicações incluíram hipotermia, obstipação, anemia, hematúria e disúriaABSTRACT - Placement of a subcutaneous ureteral bypass for the treatment of ureteral obstruction in cats: a retrospective study - Benign ureteral obstruction in cats is a multifactorial and life-threatening condition with an increasing tendency, with the most common cause being an intraluminal obstruction, secondary to ureterolithiasis. The manifestation can be rapid or insidious, and upon diagnosis, immediate intervention is essential to relieve the pressure on the renal pelvis and prevent a decline in renal function and irreversible renal lesions. The diagnosis is determined based on the evaluation of the clinical signs, blood analysis, particularly serum creatinine and BUN concentrations, and imaging modalities, typically ultrasonography and radiography. For treatment, medical management must be attempted for a short period of time in order to stabilize the patient and seek resolution. However, in case of failure of medical therapy, the implantation of a subcutaneous ureteral bypass emerges as a promising therapy due to its potential in resolving ureteral obstructions that would not have any resolution. The present study describes the outcomes and complications of placing the SUB device in cats for the treatment of ureteral obstructions at the Veterinary Hospital of Porto. The medical records of 5 cats with obstructive ureterolithiasis undergoing SUB device placement were thoroughly analyzed. The results indicate that this procedure provides immediate relief of the renal pelvis, leading to the resolution of post-renal acute kidney injury triggered by obstructive ureterolithiasis. However, the following complications were observed: urinary tract infection caused by bacteria resistant to multiple antibiotics, resulting in the death of two patients. Other complications included hypothermia, constipation, anemia, hematuria, and dysuriaN/

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research