Detecção do DNA do herpesvírus eqüino 1 pela reação em cadeia pela polimerase em cavalos inoculados com a estirpe brasileira A4/72

Sete cavalos adultos de status sanitário convencional foram inoculados por via intranasal com a estirpe brasileira A4/72 do herpesvírus eqüino tipo 1 (EHV-1). Nos primeiros dez dias após a inoculação viral, todos os cavalos apresentaram manifestações de infecção respiratória leve e restrita às vias aéreas anteriores. Apesar de possuírem títulos de anticorpos neutralizantes antes da inoculação, alguns cavalos apresentaram soroconversão após o desafio viral. O EHV-1 não foi isolado a partir das secreções nasais e leucócitos sanguíneos periféricos (PBL) de nenhum animal. Entretanto, o DNA viral foi detectado pela reação em cadeia pela polimerase (PCR) nos PBL entre o terceiro e o oitavo dias pós-inoculação (d.p.i.) em todos os animais, indicando a ocorrência de viremia. Além disso, a prova de PCR detectou o vírus nas amostras do lavado broncoalveolar a partir do nono d.p.i. na maioria dos animais. Com base nos resultados obtidos, foi possível concluir que a PCR é uma técnica com alta sensibilidade e especificidade para o diagnóstico do EHV-1, capaz de detectar a presença do DNA viral mesmo quando não ocorre a constatação do agente pelos métodos tradicionaisSeven conventional adult horses were inoculated intranasally with a Brazilian A4/72 strain of equid herpesvirus-1 (EHV-1). In the first ten days after the inoculation, they showed signs of a mild, self-limiting upper respiratory tract infection. In spite of the presence of neutralizing antibodies before the trial, seroconversion was observed in some horses. The virus was not isolated from nasal swabs and peripheral blood leukocytes (PBL) of any of the horses. However, the EHV-1 was detected through the polymerase chain reaction (PCR) from PBL of all horses in the experiment within the third to the eighth day after the inoculation that illustrated the viremia. In addition, the PCR assay also detected the virus in bronchoalveolar lavage fluid samples starting on the ninth day after the experimental infection in most of horses. For that reason, as a diagnostic tool, the PCR assay showed higher sensitivity and specificity than the conventional laboratorial methods in detection of EHV-

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)