EFICÁCIA DE COLOIDES VS CRISTALOIDES NA REPOSIÇÃO VOLÉMICA A NÍVEL HEPÁTICO EM PACIENTES HEMORRÁGICOS

Apesar dos avanços na sua abordagem terapêutica, a hemorragia severa continua a ser a principal causa de morbilidade e mortalidade em animais vítimas de trauma ou sujeitos a intervenção cirúrgica. A causa das lesões decorrentes, ou da morte consequente, deve-se ao deficit de volume de fluidos intravasculares e subsequente desenvolvimento do estado hipovolémico.O controlo da hipovolémia passa pela resolução da hemorragia e pela correção do deficit de volume intravascular causado e envolve, obrigatoriamente, o recurso à administração de fluidos intravenosos. A escolha do tipo de fluido mais adequado para a terapia intravenosa (IV), em cada ocorrência, é uma tarefa que exige reflexão e ponderação. O objetivo deste trabalho consistiu na avaliação do tipo de fluido mais adequado e eficiente para efetuar a reposição volémica em pacientes hemorrágicos, em particular no respeitante a qual deles acarreta menor comprometimento da função hepática. As lesões histopatológicas avaliadas nos diferentes grupos deste estudo não revelaram diferenças estatisticamente significativas entre os 3 grupos, o que validou a possibilidade de se usar qualquer um dos fluidos testados. Contudo, foi notória uma maior intensidade da gravidade das lesões no grupo 2. Assim, foi possível concluir que o uso do hidroxietilamido 130/0,4, em detrimento do lactato de Ringer em situações de hipovolémia, contribui para a preservação da integridade histológica e fisiológica hepática.COMPETE - FCOMP-01-0124-FEDER-009525; FCT/CI&DETS (PEst- OE/CED/UI4016/2011

Detection of apoptotic events, using different methods, in renal tissues after acute haemorrhage.

Apoptosis plays an important role in cellular damage caused by acute renal hypoperfusion. The aim of this study was to detect apoptotic events in an animal model of acute haemorrhage, followed by volume replacement with different intravenous solution

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Small intestine apoptosis evaluation after haemorrhage followed by volume replacement with colloid and crystalloid solution in a pig model

Apoptosis plays a key role in intestinal injury, as response to ischemia. Furthermore, reperfusion exacerbates abnormal intestinal apoptosis. In this study, the apoptotic index (AI) in the small intestine after haemorrhage and volume replacement with Ringer´s solution was evaluated, in a pig modelFEDER-COMPETE Program, FCT, project COMPETE: FCOMP-01-0124-FEDER-00952

Evaluation of small intestine apoptosis after haemorrhage followed by volume replacement – a preliminary study

FEDER funds trough the COMPETE Program, and by national funds from Portuguese Foundation for Science and Technology, under the project COMPETE: FCOMP-01-0124-FEDER-009525Apoptosis plays a key role in intestinal injury, as response to ischemia. Furthermore, reperfusion exacerbates abnormal intestinal apoptosis. In this study, the apoptotic index (AI) in the small intestine after haemorrhage and volume replacement with Ringer´s solution was evaluated, in a pig modelProject COMPETE: FCOMP-01-0124-FEDER-00952

Detection of apoptotic events, using different methods, in renal tissues after acute haemorrhage

Introduction: Apoptosis plays an important role in cellular damage caused by acute renal hypoperfusion. The aim of this study was to detect apoptotic events in an animal model of acute haemorrhage, followed by volume replacement with different intravenous solutions. Materials and Methods: Renal samples were collected from animals submitted to passive arterial blood bleeding and reperfusion with a crystalloid (RL) (G1) and with a synthetic colloid (HES 130/0.4) (G2). All procedures were carried out under personal and project licenses approved by the Ethical Committee of the national regulatory office. Immunohistochemistry was performed, using cytochrome c antibody to detect mitochondrial activity and in situ TUNEL method to evaluate endonucleosomic cleavage of DNA by TdT. An immunofluorescence method, the M30 Cytodeath, was also used to detect early apoptotic events. Results: In all groups, apoptosis was detected in the epithelial tubular cells of the proximal and distal convoluted tubules, in the loop of Henle and in the collecting tubules. However, the percentage of apoptotic cells and the intensity of reaction was significantly higher in G2. Conclusions: Apoptosis plays an important role in the cellular damage in renal tubules following acute haemorrhage and volume replacement. The type of solution used for volume replacement may influence the extent of renal damage resulting from this clinical situation. In the present study, the use of RL was related with decreased cytosolic cytochrome c and a lower apoptotic index in the tubular renal cells