Correlação dos achados bioquímicos na identificação de efusões exsudativas e transudativas em cães

A avaliação laboratorial de uma efusão é relevante para que, em conjunto com os sinais clínicos apresentados pelo paciente, possa ser firmado um possível diagnóstico e instituída ação terapêutica adequada. Assim sendo, a classificação de uma efusão em transudato ou exsudato torna-se um dos pontos críticos para a elucidação do diagnóstico e condução do caso clínico. Em medicina veterinária o método tradicional de classificação de uma efusão é baseado na contagem celular e na concentração de proteínas do fluido, contudo, diversos estudos evidenciam que tais parâmetros não são suficientes para a correta classificação de todas as efusões. Desta forma, o presente estudo foi conduzido com o objetivo de verificar a correlação de outros parâmetros bioquímicos com a diferenciação das efusões transudativas e exsudativas e para tal foram avaliadas as atividades de lactato desidrogenase (LDH) e fosfatase alcalina (FA), bem como a relação de suas atividades fluido/soro, a concentração de lactato, colesterol, proteínas e os gradientes de concentração soro/fluido destas mesmas substâncias e de albumina. Os resultados obtidos permitiram observar e concluir que, dentre os parâmetros avaliados não houve nenhum que apresentasse 100% de sensibilidade e especificidade, contudo, a atividade de LDH, a relação LDH fluido/soro, a concentração de lactato e o gradiente de concentração de lactato soro/fluido apresentam diferença estatisticamente significativa (p<0,05), alta correlação com a classificação de uma efusão exsudativa e transudativa. Assim sendo, estes parâmetros se mostraram mais eficazes na classificação de uma efusão quando comparado com a concentração total de proteínas do fluidoThe laboratorial evaluation of this fluid becomes relevant, jointly with clinical signs presented by patient; to become possible the diagnosis definition and institution of appropriate therapeutic. Thus, classification of effusion in exudate and transudate is one of major points to elucidation of diagnosis and conduction of clinical case. In veterinary medicine the traditional method of an effusion classification is based on cellular counting and protein concentration of the fluid, however, several studies evidence that such parameters are not enough for the correct classification of all kinds of effusions. Considering this, the present study aimed to verify the correlation of some biochemical parameters with the differentiation of transudatives and exudatives effusions. To perform this, the activities of lactate dehydrogenase (LDH) and alkaline phosphatase (FA) were appraised, as well as the relationship of their activities with fluid/serum; lactate, cholesterol and proteins concentration and fluid/serum gradients of concentration of these same substances and albumin. The results allowed to observe that, among the appraised parameters, the activity of LDH, relationship LDH and fluid/serum, lactate concentration and lactate serum/fluid gradient of concentration present statistically significant difference (p<0,05), as well as a high correlation with the classification of an exudative and transudative effusion. Therefore, these parameters were shown to be more effective in the classification of an effusion when compared with total proteins concentration in the fluidCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Correlação da atividade de lactato desidrogenase e concentração de lactato com a classificação de efusões em cães

As efusões são problemas clínicos frequentes e que ocorrem em consequência de uma enfermidade que culmine com diminuição da pressão coloidosmótica intravascular, elevação da pressão hidrostática local, aumento da permeabilidade vascular e/ou comprometimento da drenagem realizada pelos vasos linfáticos. Dessa maneira, a avaliação laboratorial desse fluido torna-se relevante para que, em conjunto com os sinais clínicos apresentados pelo paciente, possa ser firmado um possível diagnóstico e instituída ação terapêutica adequada. Assim sendo, a classificação de uma efusão em transudato ou exsudato torna-se um dos pontos críticos para a elucidação do diagnóstico e condução do caso clínico. em Medicina Veterinária, o método tradicional de classificação de uma efusão é baseado na contagem celular e na concentração de proteínas do fluido. Contudo, diversos estudos evidenciam que tais parâmetros não são suficientes para a correta classificação de todas as efusões. Assim, o presente estudo foi conduzido com o objetivo de verificar a correlação de outros parâmetros bioquímicos com a diferenciação das efusões transudativas e exsudativas e, para tal, foram avaliadas as atividades de lacatato desidrogenase (LDH) das efusões, a relação de sua atividade fluido/soro, concentração de lactato das efusões, o gradiente de concentração de lactato do soro para o fluido e a concentração de proteínas das efusões. Os resultados obtidos permitiram observar que a atividade de LDH, a relação LDH efusão/soro, a concentração de lactato e o gradiente de concentração de lactato soro/efusão apresentam diferença estatisticamente significativa (P<0,05), bem como alta correlação com a classificação de uma efusão exsudativa.The effusions are frequent clinical problems and can occur in consequence to an illness that culminates with decrease of the intravascular coloidosmotic pressure, increase of local hydrostatic pressure, increase of vascular permeability and/or compromising of the drainage accomplished by lymphatic vases. Therefore, the laboratorial evaluation of this fluid becomes relevant, jointly with clinical signs presented by patient; to become possible the diagnosis definition and institution of appropriate therapeutic. Thus, classification of effusion in exudate and transudate is one of major points to elucidation of diagnosis and conduction of clinical case. In veterinary medicine the traditional method of an effusion classification is based on cellular counting and protein concentration of the fluid, however, several studies evidence that such parameters are not enough for the correct classification of all kinds of effusions. Considering this, the present study aimed to verify the correlation of some biochemical parameters with the differentiation of transudatives and exudatives effusions. To perform this, the activities of lactate dehydrogenase (LDH) were appraised, as well as the relationship of their activities with fluid/serum; lactate and proteins concentration and fluid/serum gradients of concentration of these same substances. The results allowed to observe that the activity of LDH, relationship LDH and fluid/serum, lactate concentration and lactate fluid/serum gradient of concentration present statistically significant difference (P<0.05), as well as a high correlation with the classification of an exudative effusion

Physical-chemical analysis of the cerebrospinal fluid of healthy dogs submitted to different storage periods and temperatures

Disfunções envolvendo o sistema nervoso são de grande importância na Medicina Veterinária, pois tratam-se de enfermidades de elevada incidência e com poucos subsídios auxiliares no seu diagnóstico, prognóstico e na avaliação de terapias empregadas. Ainda hoje, o diagnóstico baseia-se, em grande parte, no histórico e no exame clínico neurológico. Dessa forma, a análise dos constituintes do fluido cefalorraquidiano torna-se uma das poucas alternativas de acesso clínico ao sistema nervoso central (SNC). Mesmo com a grande utilidade do exame físico-químico e citoscópico do liquor na neurologia veterinária, poucos são os estudos sobre a estabilidade dos seus constituintes sob estocagem. Dessa forma, o presente trabalho teve como finalidade verificar a influência da temperatura e do tempo de conservação nas características físico-químicas do liquor de cães hígidos. Para tanto, foram coletadas amostras de LCR, através da punção da cisterna cerebelo-medular de cães clinicamente sadios, as quais foram submetidas à análise da densidade específica, do pH, da glicorraquia, das proteínas totais e das atividades das enzimas creatina quinase (CK) e aspartato aminotransferase (AST), após conservá-las em diferentes temperaturas (25&deg;C, 4&deg;C e -4&deg;C) e por diferentes períodos de tempo (logo após a colheita, 24 horas, 48 horas, uma semana e um mês). Dentre os resultados obtidos, foi possível verificar, principalmente, que houve estabilidade dos parâmetros estudados por até um mês de estocagem nas amostras mantidas sob a temperaturas de congelamento de -4&deg;C.Disorders involving the nervous system have a great importance in veterinary medicine because they have a high incidence and few auxiliary tools for their diagnostic, prognostic and evaluation of the employed therapy. Today, the diagnostic is based, mainly, on the patient history and neurologic examination. Hence, evaluation of the cerebrospinal fluid elements is one of the few alternatives to clinically access the central nervous system (CNS). Even with the great usefullness of the physical-chemical and cytoscopy exams of the CSF in veterinary neurology, there are few studies concerning the stability of its elements under freezing storage. The present study was aimed at verifing the influence of temperature and period of conservation on physical-chemical characteristics of the CSF of healthy dogs. For that purpose, CSF samples were collected by puncture of the cisterna magna of dogs clinically healthy, and then were analysed for density, pH, glucorrhachia, total proteins and activity of the enzymes creatine kinase (CK) and aspartate aminotransferase (AST), after storage in different temperatures (25&deg;C, 4&deg;C and -4&deg;C) and periods (immediately after collection and after 24 hours, 48 hours, a week and a month). Regarding the obtained results it was possible to verify that the parameters studied were stable up to a month of storage, under freezing at -4&deg;C

Cerebrospinal fluid collection in dogs: modification of previous technique

Unlike the already described techniques, which are based on imaginary lines among extremities or bone projections, this research describes a collection technique modification of cerebrospinal fluid (CSF) in dogs, in the atlantooccipital space. The palpation of bone structures in this joint, plus the supported directioning of the needle, does make the collection easy, even by professionals which have no experience in this kind of procedure. The applied technique enabled the collection of adequate volumes of limpid and colorless CSF of 50 healthy dogs in the first attempt of collection. There was no contamination with blood during the procedure, what made possible the correct interpretation of laboratory parameters usually examined in CSF samples

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

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 &lt; 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)