Mini invasive hemodynamic monitoring: from arterial pressure to cardiac output

To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient\u27s outcome. The interest to lesser and lesser invasive techniques is high. Therefore, the alternative techniques have been recently developed.Cardiac Output can be monitored continuously by different devices that analyze the arterial waveform to track changes in stroke volume (SV) and CO. The analysis of the arterial pressure wave to determine cardiac output is classified as Pulse Contour analysis or Pulse Pressure Analysis. Starting from a similar principle three main devices are now available on the market, with different algorithms and features:• PiCCO System (Pulsion Medical System, Munich, Germany)• LiDCOTM plus System (LidCO, Cambridge, UK)• Flotrac technology and Vigileo Monitor (Edwards Lifesciences, Irvine, CA, USA).The algorithm used by all these devices has been also implemented even with the analysis of the variation of stroke volume (SVV) and of the pulse pressure (PPV). SVV and PPV represent the variation of stroke volume and of the pulse pressure during the respiratory cycle. In sedated ventilated patients these indexes have proven to predict the response to a fluid challenge. A high variation (>10-12%) identifies with good sensitivity and specificity responders and not responders

Efficacy and safety of travoprost 0.004%/timolol 0.5% fixed combination as transition therapy in patients previously on prostaglandin analog monotherapy

Vital Paulino Costa1, Hamilton Moreira2, Mauricio Della Paolera3, Maria Rosa Bet de Moraes Silva41Universidade Estadual de Campinas – UNICAMP, São Paulo, 2Universidade Federal do Paraná, Curitiba, 3Santa Casa de Misericórdia de São Paulo, São Paulo, 4Faculdade de Medicina de Botucatu, UNESP, BrazilPurpose: To assess the safety and efficacy of transitioning patients whose intraocular pressure (IOP) had been insufficiently controlled on prostaglandin analog (PGA) monotherapy to treatment with travoprost 0.004%/timolol 0.5% fixed combination with benzalkonium chloride (TTFC).Methods: This prospective, multicenter, open-label, historical controlled, single-arm study transitioned patients who had primary open-angle glaucoma, pigment dispersion glaucoma, or ocular hypertension and who required further IOP reduction from PGA monotherapy to once-daily treatment with TTFC for 12 weeks. IOP and safety (adverse events, corrected distance visual acuity, and slit-lamp biomicroscopy) were assessed at baseline, week 4, and week 12. A solicited ocular symptom survey was administered at baseline and at week 12. Patients and investigators reported their medication preference at week 12.Results: Of 65 patients enrolled, 43 had received prior travoprost therapy and 22 had received prior nontravoprost therapy (n = 18, bimatoprost; n = 4, latanoprost). In the total population, mean IOP was significantly reduced from baseline (P = 0.000009), showing a 16.8% reduction after 12 weeks of TTFC therapy. In the study subgroups, mean IOP was significantly reduced from baseline to week 12 (P = 0.0001) in the prior travoprost cohort (19.0% reduction) and in the prior nontravoprost cohort (13.1% reduction). Seven mild, ocular, treatment-related adverse events were reported. Of the ten ocular symptom questions, eight had numerically lower percentages with TTFC compared with prior PGA monotherapy and two had numerically higher percentages with TTFC (dry eye symptoms and ocular stinging/burning). At week 12, TTFC was preferred over prior therapy for 84.2% of patients (48 of 57) by the patients themselves, and for 94.7% of patients (54 of 57) by their physicians.Conclusion: When TTFC replaced PGA monotherapy in patients whose IOP had been uncontrolled, the outcome was a significant reduction in IOP and an acceptable safety and tolerability profile. Most patients and investigators preferred TTFC to prior PGA monotherapy.Keywords: fixed combination, glaucoma, intraocular pressure, prostaglandin analog, timolol, travopros

Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia

INTRODUCTION: Total hip replacement is one of the most commonly performed major orthopaedic operations. Goal-directed therapy (GDT) using haemodynamic monitoring has previously demonstrated outcome benefits in high-risk surgical patients under general anaesthesia. GDT has never been formally assessed during regional anaesthesia. METHODS: Patients undergoing total hip replacement while under regional anaesthesia were randomised to either the control group (CTRL) or the protocol group (GDT). Patients in the GDT group, in addition to standard monitoring, were connected to the FloTrac sensor/Vigileo monitor haemodynamic monitoring system, and a GDT protocol was used to maximise the stroke volume and target the oxygen delivery index to > 600 mL/minute/m2. RESULTS: Patients randomised to the GDT group were given a greater volume of intravenous fluids during the intraoperative period (means ± standard deviation (SD): 6,032 ± 1,388 mL vs. 2,635 ± 346 mL; P < 0.0001), and more of the GDT patients received dobutamine (0 of 20 CTRL patients vs. 11 of 20 GDT patients; P < 0.0003). The GDT patients also received more blood transfused during the intraoperative period (means ± SD: 595 ± 316 mL vs. 0 ± 0 mL; P < 0.0001), although the CTRL group received greater volumes of blood replacement postoperatively (CTRL patients 658 ± 68 mL vs. GDT patients 198 ± 292 mL; P < 0.001). Overall blood consumption (intraoperatively and postoperatively) was not different between the two groups. There were an increased number of complications in the CTRL group (20 of 20 CTRL patients (100%) vs. 16 of 20 GDT patients (80%); P = 0.05). These outcomes were predominantly due to a difference in minor complications (20 of 20 CTRL patients (100%) vs. 15 of 20 GDT patients (75%); P = 0.047). CONCLUSIONS: GDT applied during regional anaesthesia in patients undergoing elective total hip replacement changes intraoperative fluid management and may improve patient outcomes by decreasing postoperative complications. Larger trials are required to confirm our findings

Severe reperfusion lung injury after double lung transplantation

AIM: To demonstrate the effects of combined inhaled nitric oxide and surfactant replacement as treatment for acute respiratory distress syndrome. This treatment has not previously been documented for reperfusion injury after double lung transplantation. METHOD: A 24-year-old female with cystic fibrosis underwent double lung transplantation. During implantation of the second lung a marked increase in pulmonary artery pressure associated with systemic hypotension, hypoxemia and low cardiac output were observed. Notwithstanding the patient received support from cardiovascular drugs and pulmonary vasodilators cardiopulmonary by-pass was necessary. In the intensive care unit the patient received the same drug support, inhaled nitric oxide and two bronchoscopic applications of bovine surfactant. RESULTS: A rapid improvement in PaO(2)/FiO(2) within 2–3 hours of administration of surfactant was seen. The patient is well at follow-up 1 year post-transplant. CONCLUSION: There is a potential role for a combined therapy with inhaled nitric oxide and surfactant replacement in reperfusion injury after lung transplantation

Carotene and provitamin A content of vegetables sold in Viçosa, MG, Brazil, during spring and winter

This study investigated the &#945;- and &#946;-carotene content and provitamin A value of four leafy vegetables sold at local and street markets in Viçosa, MG, Brazil, in the spring and winter of 2002. Carotenoids were analyzed by high-performance liquid chromatography. &#945;-Carotene was detected in all samples sold during spring, but was only present in a few samples of smooth and curly lettuce and kale in winter. &#946;-Carotene was found in marked quantities in all leafy vegetables analyzed. Duncan's test (&#945; = 5%) showed significantly higher &#945;-carotene content in curly lettuce and vitamin A value in large-leaved watercress in the spring. Mean &#946;-carotene content and vitamin A value were 7544, 8751, 2584, 2792, 8193, and 5338 &#956;g/100 g and 666, 760, 227, 238, 698, and 460 &#956;g RAE/100 g in large-leaved and hydroponic watercress, smooth and curly lettuce, kale and spinach, respectively. All leafy vegetables analyzed represent important sources of provitamin A and supply an important part of the daily requirements of children and adults.Investigou-se o conteúdo de &#945; e &#946;-caroteno e avaliou-se o valor pro-vitamínico A de quatro hortaliças folhosas comercializadas em mercados locais e feira- livre de Viçosa, MG durante a primavera e o inverno de 2002. Os carotenóides foram analisados por Cromatografia Líquida de Alta Eficiência (CLAE). O &#945;-caroteno foi detectado em todas as amostras analisadas na primavera, porém no inverno, somente algumas amostras de alface crespa e lisa, e couve apresentaram tal carotenóide. O &#946;-caroteno foi encontrado, em quantidades apreciáveis, em todas as hortaliças folhosas analisadas. O teste de Duncan (&#945;=5%) detectou que o conteúdo de &#945;-caroteno em alface crespa e o valor de vitamina A em agrião de folha larga foram estatisticamente superiores na primavera. Os teores médios de &#946;-caroteno e de valor de vitamina A para agrião de folha larga e hidropônico, alface crespa e lisa, couve e espinafre foram: 7544; 8751; 2584; 2792; 8193; 5338 &#956;g/100g e 666; 760; 227; 238; 698; 460 &#956;g RAE/100g, respectivamente. Todas as hortaliças folhosas analisadas constituem importantes fontes de provitamina A e suprem grande parte das recomendações diárias de crianças e adultos

ESTUDO DE MERCADO DE BISCOITO TIPO COOKIE INTEGRAL ADICIONADO DE GOMA DE LINHAÇA DOURADA

O interesse por produtos mais saudáveis está se tornando cada vez maior entre os consumidores. Este fato tem levado pesquisadores e a indústria de alimentos a procurarem maneiras de desenvolverem alimentos que atendam às exigências dos consumidores, como por exemplo, produtos com acrescidos de nutrientes que proporcionem benefícios à saúde e ao estado nutricional. Realizou-se uma pesquisa de mercado com 68 alunos e funcionários do Centro de Ciências Agrárias e Engenharias da Universidade Federal do Espírito Santo, para verificar a aceitabilidade de um cookie integral com goma de linhaça. Este, por sua vez, seria um produto rico em fibras, ômega 3 e reduzido em gordura, visto que a goma de linhaça seria usada em substituição ao ovo. Observou-se que o consumo de linhaça e produtos integrais é feito por grande parte dos entrevistados, 56% e 78% respectivamente. Em relação à aquisição, 69% dos entrevistados talvez compraria, e 31% definitivamente compraria este produt

Continuous right ventricular end diastolic volume and right ventricular ejection fraction during liver transplantation: A multicenter study

Cardiac preload is traditionally considered to be represented by its filling pressures, but more recently, estimations of end diastolic volume of the left or right ventricle have been shown to better reflect preload. One method of determining volumes is the evaluation of the continuous right ventricular end diastolic volume index (cRVEDVI) on the basis of the cardiac output thermodilution technique. Because preload and myocardial contractility are the main factors determining cardiac output during liver transplantation (LTx), accurate determination of preload is important. Thus, monitoring of cRVEDVI and cRVEF should help with fluid management and with the assessment of the need for inotropic and vasoactive agents. In this multicenter study, we looked for possible relationships between the stroke volume index (SVI) and cRVEDVI, cRVEF, and filling pressures at 4 predefined steps in 244 patients undergoing LTx. Univariate and multivariate autoregression models (across phases of the surgical procedure) were fitted to assess the possible association between SVI and cRVEDVI, pulmonary artery occlusion pressure (PAOP), and central venous pressure (CVP) after adjustment for cRVEF (categorized as 40%). SVI was strongly associated with both cRVEDVI and cRVEF. The model showing the best fit to the data was that including cRVEDVI. Even after adjustment for cRVEF, there was a statistically significant (P < 0.05) relationship between SVI and cRVEDVI with a regression coefficient (slope of the regression line) of 0.25; this meant that an increase in cRVEDVI of 1 mL m(-2) resulted in an increase in SVI of 0.25 mL m(-2). The correlations between SVI and CVP and PAOP were less strong. We conclude that cRVEDVI reflected preload better than CVP and PAOP

CAROTENOS PROVITAMÍNICOS A EM HORTALIÇAS PREPARADAS EM UNIDADES PRODUTORAS DE REFEIÇÕES COMERCIAIS

This study investigated the content of a and b-carotene and the provitamin A value of five vegetables, raw and/or cooked served at three Commercial Meal Production Units in Viçosa, MG, Brazil. Pumpkin and green bean were analyzed in the cooked form, tomato and green pepper were analyzed in the raw form and carrot, in both forms. The carotenoids were analysed by High Performance Liquid Chromatography (HPLC). The a-carotene wasn’t quantified in pumpkin, green pepper and green bean (values below the detection limit of the method); and it wasn’t found in tomato. Raw shredded carrot was the vegetable with the greatest content of a-carotene (123.74 mg/100 g of insoluble solids). b-carotene was detected in all the vegetables analyzed, being cooked stick carrot the vegetable with the greatest content of this component (223.14 mg/100 g of insoluble solids) and cooked sliced green bean showed the lowest content (5.60 mg/100 g of insoluble solids). It wasn’t found statistical differences (a=5%) on the contents of a and b-carotene in pumpkin, carrot, green pepper and green bean prepared in different forms at the studied restaurants. On the other hand, the content of b-carotene in sliced tomato was significantly higher than in cube tomato, at three studied restaurants, showing that this is the kind of slicing that better preserves this carotenoid. Regarding to the vitamin A value, there was a similar behavior between these results and those found to b-carotene, since this is the main provitamin A carotenoid found in vegetables.Investigou-se o teor de a e b-caroteno e avaliou-se o valor provitamínico A de cinco hortaliças, servidas cruas e/ou submetidas à cocção, em três Unidades Produtoras de Refeições (UPR) Comerciais, localizadas em Viçosa, MG. Abóbora-moranga e vagem foram analisadas na forma cozida, tomate e pimentão na forma crua, e cenoura, em ambas as formas. Os carotenoides foram analisados por Cromatografia a Líquido de Alta Eficiência (CLAE). O a-caroteno não foi encontrado em tomate e não foi quantificado em abóbora-moranga, pimentão e vagem (teores abaixo do limite de detecção do método). Cenoura crua ralada foi a hortaliça que apresentou o maior teor de a-caroteno (123,74 mg/100 g, base sólidos insolúveis). O b-caroteno foi detectado em todas as hortaliças analisadas, sendo a cenoura cozida em forma de bastão a hortaliça mais rica nesse componente (223,14 mg/100 g, base sólidos insolúveis) e a vagem cozida em rodela a hortaliça com teor mais reduzido (5,60 mg/100 g, base sólidos insolúveis). Não houve diferença estatisticamente significativa (a=5%) nos teores de a e b-caroteno para abóbora-moranga, cenoura, pimentão e vagem preparados em diferentes formas nos restaurantes estudados. Por outro lado, o teor de b-caroteno em tomate fatiado em rodelas foi significativamente superior àquele encontrado em tomates fatiados na forma de cubos nos três restaurantes estudados, mostrando que esse tipo de fatiamento preserva melhor esse carotenoide. Com relação ao valor de vitamina A obteve-se perfil similar aos resultados encontrados para b-caroteno, uma vez que esse foi o principal carotenoide provitamínico A encontrado nas hortaliças

Ant Community Evolution According to Aging in Brazilian Cocoa Tree Plantations

Agriculture is frequently held accountable for the depletion of biotic diversity, although a few agroforestry systems support the conservation of a number of organisms. Cocoa farming is noteworthy as an example of an agricultural activity that benefits or maintains species richness. However, the mechanism by which the biodiversity persists throughout the entire process of plant development remains obscure. In Southeastern Bahia, Brazil, cacao tree plantations support the conservation of a large amount of organisms native to the Atlantic Forest, between them the ants. This study aims at recording the relationship between cocoa tree development and ant community structure. The experiment was carried out in a series of six cocoa tree plantations aged one, three, four, eight, fifteen and 33 years, distributed across the experimental grounds of the Cocoa Research Center at Ilhéus. 1,500 ant samples were collected using the sampling techniques: hand collection, honey and sardine baits, entomological blanket and “pitfall”. Highest values for diversity and richness were reported in the 15-years-old cocoa plantation. No significant correlations between diversity, richness or plant age were reported. Considering the faunistic composition, a statistical similarity was observed between the plantations close in age to one another. Plant aging did not exert any influence on the diversity gradient and richness in the succession process of the ant community. In young plantations, there are low differences between the ants found on the ground and the ones found on the young cocoa trees. In older plantations, the ant community divides in two distinct assemblages on the ground and on the trees. The variations observed in the ant community along the plant development were likely caused by the structural organization of the dominant species mosaic

Bovine Respiratory Disease (BRD) Complex as a Signal for Bovine Viral Diarrhea Virus (BVDV) Presence in the Herd

Background: Infections are caused by Bovine Viral Diarrhea Virus and still continue to be a worldwide plague in cattle industry. It is responsible for sudden death syndromes in adult cattle with high mortality rates, abortions, acute gastrointestinal and respiratory diseases. The BVDV infection occurs in early pregnancy (40-142 days), in immunosuppressed females or cows results in 100% of persistently infected (PI) calves that are seronegative and asymptomatic at birth. Evidences suggests that BVDV contributes to BRD complex potentiating secondary infections caused by Mannheimia haemolytica e Pasteurella multocida due to its immunosuppressive action. However, the farmers have often associated the respiratory syndrome with other infectious agents. This paper reports the attendance of dairy calves manifesting clinical signs of bronchopneumonia, which led to the screening of the persistently infected animals to control of the BVDV infection in the herd.Materials, Methods & Results: During the technical assistance, ten calves manifesting bronchopneumonia were selected to trans-tracheal lavage (TL) in order to identify possible infectious agents. Reverse transcription polymerase chain reaction (RT-PCR) detected the presence of BVDV in two heifers. Pasteurella multocida was the unique bacterial agent isolated from TL (5/10, 50%). These data motivated the technical team and producers to investigate the PI screening by direct enzyme-linked immunosorbent assay from biopsies of the ear edge. The screening of PI’s detected 29 positive within of 2,342 animals tested (1.23%). The re-test of positive was performed only in 24 animals due to the cull of five bovine with severe bronchopneumonia and diarrhea, confirming 18 persistently infected calves (18/24; 75%). Finally, in all PI’s live dams were tested. It was observed four positive adult animals. One grand dam was live and tested, but it had negative result for direct enzyme-linked immunosorbent test. The rate of PI’s considering the whole herd was 0.81% (22/3,700 animals).Discussion: The involvement of BVDV in the etiology of bronchopneumonia was confirmed by detection of the virus in trans-tracheal lavages in two calves by RT-PCR. The susceptibility for Pasteurella multocida infection could be promoted by BVDV prime-infection, considering that immunossupressive nature of BVDV is a critical factor in the interaction with others viruses and bacteria. At this time, we are aware about any report about the detection of BVDV in trans-tracheal lavages. These findings culminated with the screening of PI animals in the herd, detecting rates of 0.81%. The intensive vaccination and colostrum management of this farm could protected the herd against BVDV, however others facts facilitated the introduction of the virus in the herd. This research was conduced in a high-production dairy farm with around 3,700 animals raised in an open herd, in which some of cows with high genetic potential were transferred for embryo collection in the state of Paraná, Brazil; resulting in the addition of the calves to the herd by others routes. Moreover, the farm used for many years vaccine containing only BVDV-1, which may have favored the entry and spread of BVDV-2 or BVDV-3 in the herd. This research showed the presence of BVDV in trans-tracheal lavage of heifers with bronchopneumonia by RT-PCR. This fact points to the need of BRD control programs that include detection of PI animals