ANESTESIA POR INFUSÃO INTRAVENOSA CONTÍNUA EM Tapirus terrestris (ANTA BRASILEIRA), PELA ASSOCIAÇÃO DE DETOMIDINA OU XILAZINA, COM MIDAZOLAM E QUETAMINA

A manutenção da anta brasileira em cativeiro vem contribuindo para a sua preservação. Todavia, o manejo destes animais pode necessitar de contenção química, haja visto que a contenção mecânica é um método arriscado nesta espécie. Poucos estudos foram realizados em relação à anestesia desses animais. Este trabalho objetivou pesquisar dois protocolos anestésicos em antas. Foram realizados dois grupos experimentais com 6 animais adultos cada, sendo 5 deles utilizados em ambos os grupos. A MPA foi procedida pela administração intramuscular (IM) de 0,05 mg/kg de detomidina (DMQ) ou 1 mg/kg de xilazina (XMQ). A indução anestésica deu-se pela associação de 0,1 mg/kg de midazolam com 2 mg/kg de quetantina, pela via intravenosa (IV), em ambos os grupos, 15 minutos após a MPA. A anestesia foi mantida por 60 minutos, pela infusão IV contínua de uma solução de NaCl a 0,9 %, contendo 0,04 mg/ml de detomidina (DMQ) ou 1,72 mg/ml de xilazina (XMQ), com 0,1 mg/ml de midazolam e 4 mg/ml de quetamina, na taxa de 1 ml/kg/h. Os parâmetros aferidos foram as freqüências cardíaca e respiratória, temperatura retal, hemogasometria venosa (pressão de oxigênio (PvO2), saturação de oxigênio na hemoglobina, pressão de dióxido de carbono (PvCO2), concentração total de dióxido de carbono, pH e bicarbonato), eletrólitos (cálcio, sódio e potássio), hematócrito, hemoglobina, glicose e cortisol plasmáticos, resposta reflexa a estímulos oculares, interdigital e anal, qualidade de relaxamento muscular e a sensibilidade cutânea à dor. Ambos os protocolos produziram anestesia segura, com efeitos de magnitude semelhante, com mínima depressão cardiorrespiratória, elevação da glicemia, bom miorrelaxamento e ausência de sensibilidade cutânea à dor. No grupo em que utilizou-se detomidina houve menor elevação da concentração de cortisol plasmático, com conseqüente redução da resposta de estresse anestésico. A sedação dos animais após a anestesia, com α2 - agonistas melhorou a qualidade de recuperação anestésica

Anestesia por infusão intravenosa continua em Tapirus terrestris (Anta brasileira), pela associação de detomidina ou xilazina, com midazolam e quetamina

A manutenção da anta brasileira em cativeiro vem contribuindo para a sua preservação. Todavia, o manejo destes animais pode necessitar de contenção química, haja visto que a contenção mecânica é um método arriscado nesta espécie. Poucos estudos foram realizados em relação à anestesia desses animais. Este trabalho objetivou pesquisar dois protocolos anestésicos em antas. Foram realizados dois grupos experimentais com 6 animais adultos cada, sendo 5 deles utilizados em ambos os grupos. A MPA foi procedida pela administração intramuscular (IM) de 0,05 mg/kg de detomidina (DMQ) ou 1 mg/kg de xilazina (XMQ). A indução anestésica deu-se pela associação de 0,1 mg/kg de midazolam com 2 mg/kg de quetamina, pela via intravenosa (IV), em ambos os grupos, 15 minutos após a MPA. A anestesia foi mantida por 60 minutos, pela infusão N contínua de uma solução de NaCl a 0,9 %, contendo 0,04 mg/ml de detomidina (DMQ) ou 1,72 mg/ml de xilazina (XMQ), com 0,1 mg/ml de midazolam e 4 mg/ml de quetamina, na taxa de 1 ml/kg/h. Os parâmetros aferidos foram as freqüências cardíaca e respiratória, temperatura retal, hemogasometria venosa (pressão de oxigênio (PvO2), saturação de oxigênio na hemoglobina, pressão de dióxido de carbono (PvCO2), concentração total de dióxido de carbono, pH e bicarbonato), eletrólitos (cálcio, sódio e potássio), hematócrito, hemoglobina, glicose e cortisol plasmáticos, resposta reflexa a estímulos oculares, interdigital e anal, qualidade de relaxamento muscular e a sensibilidade cutânea à dor. Ambos os protocolos produziram anestesia segura, com efeitos de magnitude semelhante, com mínima depressão cardiorrespiratória, elevação da glicemia, bom miorrelaxamento e ausência de sensibilidade cutânea à dor. No grupo em que utilizou-se detomidina houve menor elevação da concentração de cortisol plasmático, com conseqüente redução da resposta de estresse anestésico. A sedação dos animais após a anestesia, com a2-agonistas melhorou a qualidade de recuperação anestésic

Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil.

Purpose: To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted.Methods: Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ≥1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education.Results: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was 99% of surveyed children.Conclusions: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Anestesia por infusão intravenosa continua em Tapirus terrestris (Anta brasileira), pela associação de detomidina ou xilazina, com midazolam e quetamina

A manutenção da anta brasileira em cativeiro vem contribuindo para a sua preservação. Todavia, o manejo destes animais pode necessitar de contenção química, haja visto que a contenção mecânica é um método arriscado nesta espécie. Poucos estudos foram realizados em relação à anestesia desses animais. Este trabalho objetivou pesquisar dois protocolos anestésicos em antas. Foram realizados dois grupos experimentais com 6 animais adultos cada, sendo 5 deles utilizados em ambos os grupos. A MPA foi procedida pela administração intramuscular (IM) de 0,05 mg/kg de detomidina (DMQ) ou 1 mg/kg de xilazina (XMQ). A indução anestésica deu-se pela associação de 0,1 mg/kg de midazolam com 2 mg/kg de quetamina, pela via intravenosa (IV), em ambos os grupos, 15 minutos após a MPA. A anestesia foi mantida por 60 minutos, pela infusão N contínua de uma solução de NaCl a 0,9 %, contendo 0,04 mg/ml de detomidina (DMQ) ou 1,72 mg/ml de xilazina (XMQ), com 0,1 mg/ml de midazolam e 4 mg/ml de quetamina, na taxa de 1 ml/kg/h. Os parâmetros aferidos foram as freqüências cardíaca e respiratória, temperatura retal, hemogasometria venosa (pressão de oxigênio (PvO2), saturação de oxigênio na hemoglobina, pressão de dióxido de carbono (PvCO2), concentração total de dióxido de carbono, pH e bicarbonato), eletrólitos (cálcio, sódio e potássio), hematócrito, hemoglobina, glicose e cortisol plasmáticos, resposta reflexa a estímulos oculares, interdigital e anal, qualidade de relaxamento muscular e a sensibilidade cutânea à dor. Ambos os protocolos produziram anestesia segura, com efeitos de magnitude semelhante, com mínima depressão cardiorrespiratória, elevação da glicemia, bom miorrelaxamento e ausência de sensibilidade cutânea à dor. No grupo em que utilizou-se detomidina houve menor elevação da concentração de cortisol plasmático, com conseqüente redução da resposta de estresse anestésico. A sedação dos animais após a anestesia, com a2-agonistas melhorou a qualidade de recuperação anestésic