Padronização da dose de heparina sódica utilizada na cirurgia de revascularização do miocárdio sem circulação extracorpórea Standardization of the sodium heparin dose used in off-pump myocardial revascularization surgery

OBJETIVO: Propor uma metodologia de anticoagulação com heparina sódica monitorizada pelo Tempo de Coagulação Ativada (TCA) nos pacientes submetidos à cirurgia de revascularização miocárdica (RM) sem circulação extracorpórea (CEC), que promova uma anticoagulação segura (TCA >200 segundos), utilizando uma dose inicial de 1mg heparina sódica/kg de peso. MÉTODO: Quarenta pacientes (30 homens e 10 mulheres), entre 41 e 85 anos, foram submetidos à cirurgia de RM sem CEC, utilizando uma dose inicial de 1mg heparina sódica/kg de peso. Dez minutos após a administração da droga, quando TCA > 200 segundos, iniciava-se a confecção das anastomoses coronarianas. Caso contrário, administrava-se 0,5mg/kg de heparina suplementar. Durante a cirurgia, a cada 30 minutos, novos valores de TCA foram obtidos. Concluídas as anastomoses coronarianas, a heparina foi revertida na proporção de 1:1 utilizando cloridrato de protamina. RESULTADOS: O valor médio de TCA dez minutos pós-heparinização foi de 372,2(+/-104,31) segundos, sem variação estatisticamente significante entre os sexos ou grupos etários (p>0,05). Os valores de TCA, 30 e 60 minutos pós-heparinização, mantiveram-se acima de 200 segundos. Aos 30 minutos, verificou-se diferença estatisticamente significante dos valores do TCA entre os sexos e diferentes idades (pOBJECTIVE: To evaluate a methodology of anticoagulation during off pump coronary artery bypass surgery (CABS) that promotes safe anticoagulation during the procedure (Activated Coagulation Time >200 seconds), using an initial dose of 1 mg of sodium heparin/kg weight. METHOD: 40 patients (30 men and 10 women), ages ranging from 41 to 85 years, were submitted to off pump CABS, using an initial sodium heparin dose of 1mg/kg of weight. Ten minutes after that drug was administered, if the ACT was > 200 seconds, we initiated the revascularization procedure. If not, we administered an additional of 0.5mg/kg heparin. During the surgery, the ACT was measured at 30 intervals. After revascularization, heparin reversal was achieved with a dose of protamine chloride equal do the total heparin dose infused during the procedure (1:1). RESULTS: The mean ACT at 10 minutes after heparinization was 372.2 (+/-104.31) seconds, without significant statistical difference between gender and age groups (p>0.05). The ACT values at 30 and 60 minutes remained greater than 200 seconds in all patients. The ACT at 30 minutes showed a significant statistical difference between age groups and gender (p 200s) even after 60 minutes of heparinization, independently of age and gender

Serum Fluorescent Advanced Glycation End (F-AGE) products in gestational diabetes patients

ABSTRACT Objectives Advanced glycation end products (AGEs) are involved in the pathogenesis and complications of diabetes mellitus (DM). Gestational DM (GDM) is characterized by increased glycemia and oxidative stress, which are factors associated with high serum AGE concentrations. The aim of this study was to evaluate the utility of a serum fluorescence AGE (F-AGE) method as a screening tool for gestational diabetes. Subjects and methods Serum samples from 225 GDM patients and 217 healthy pregnant women (healthy controls) were diluted 50-fold in phosphate-buffered saline, and the AGEs were estimated by fluorometric analysis (λEx 350 nm/ λEm 440 nm). Results No significant (P > 0.05) differences in AGE concentrations, expressed in Arbitrary Units (UA/mL × 104), were observed in the women with GDM or in the healthy controls. Furthermore, F-AGE concentrations did not change significantly during the pregnancy (12-32 weeks of gestation). Only the GDM group had a positive correlation (r = 0.421; P < 0.001) between F-AGEs and serum creatinine concentrations. Conclusion It was not possible to distinguish women with gestational diabetes from the healthy controls on the basis of serum F-AGE concentrations

Cirurgia de revascularização coronariana esquerda sem CEC e sem manuseio da aorta em pacientes acima de 75 anos: análise das mortalidades imediata e a médio prazo e das complicações neurológicas no pós-operatório imediato

INTRODUÇÃO: A circulação extracorpórea (CEC) e o manuseio da aorta ascendente (MAA) estão associados a alta incidência de acidente vascular cerebral (AVC) na cirurgia de revascularização do miocárdio (RM) em pacientes idosos. Esta complicação deve-se, sobretudo, ao MAA, por ocasião do pinçamento e despinçamento, quer para isolamento do coração do circuito de CEC, quer para realização das anastomoses dos enxertos na aorta ascendente. OBJETIVOS: Verificar mortalidades imediata e a médio prazo e a ocorrência de AVC no pós-operatório imediato (POI) em pacientes acima de 75 anos submetidos a cirurgia de revascularização do sistema coronariano esquerdo (SCE), sem CEC e sem MAA. MÉTODO: De janeiro de 2000 a abril de 2002, 40 pacientes acima de 75 anos (média 79,1 anos) foram submetidos a cirurgia de revascularização do SCE, com enxerto de artéria torácica interna esquerda (ATIE) para a artéria descendente anterior (DA), e enxerto(s) de veia safena magna oriundo(s) da ATIE para outro(s) ramo(s) da coronária esquerda (enxerto composto), sem CEC e sem MAA. Houve predominância do sexo masculino (67,5%). Foram realizados 89 enxertos (média 2,22 pontes por paciente), sendo 40 (44,94%) de ATIE e 49 (55,06%) de veia safena. A ocorrência de AVC foi avaliada por exames clínico e neurológico. RESULTADOS: Não foi observada ocorrência de AVC no grupo estudado. Não houve óbitos no POI. CONCLUSÃO: A cirurgia de revascularização do SCE em pacientes acima de 75 anos sem CEC e sem MAA pode ser realizada sistematicamente de modo a evitar a ocorrência de AVC, com baixa mortalidade

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine