Uso da ultrassonografia para avaliação do volume gástrico após ingestão de diferentes volumes de solução isotônica

ResumoJustificativa e objetivosAs diretrizes recentes de jejum pré‐operatório permitem a ingestão de líquidos até 2 horas antes da cirurgia. O objetivo do presente estudo foi, por meio de ultrassonografia gástrica, avaliar o volume gástrico de voluntários após jejum noturno e comparar com o volume gástrico duas horas após a ingestão de 200 e 500ml de solução isotônica.MétodoForam submetidos à ultrassonografia gástrica 80 voluntários em três momentos: após jejum de 8h; 2horas após a ingestão de 200ml de solução isotônica, seguida do primeiro exame; e, em outro dia, 2horas após a ingestão de 500ml da mesma solução, após jejum noturno. A avaliação foi quantitativa (área do antro e volume gástricos e relação volume gástrico/peso dos participantes) e qualitativa, pela ausência ou presença de conteúdo gástrico nas posições de decúbito lateral direito e supina. Foi considerado significante p<0,05.ResultadosNão houve diferença nas variáveis quantitativas nos três momentos estudados (p>0,05). Cinco voluntários (6,25%) apresentaram um volume/peso superior a 1,5ml.kg‐1 em jejum e 2h após a ingestão de 200ml e seis (7,5%) após 500ml. Qualitativamente, a presença de líquido gástrico ocorreu em mais voluntários após a ingestão de líquidos, principalmente de 500ml (18,7%), embora sem significância estatística.ConclusãoO volume gástrico pela ultrassonografia não apresenta diferença significativa tanto qualitativa quanto quantitativa, 2horas após a ingestão de 200ml ou de 500ml de solução isotônica em comparação com o jejum, embora conteúdo líquido gástrico tenha sido identificado em mais voluntários, principalmente após a ingestão de 500ml de solução isotônica.AbstractBackground and objectivesThe current preoperative fasting guidelines allow fluid intake up to 2hours before surgery. The aim of this study was to evaluate the gastric volume of volunteers after an overnight fast and compare it with the gastric volume 2hours after ingestion of 200 and 500mL of isotonic solution, using gastric ultrasound.MethodEighty volunteers underwent gastric ultrasound at three times: after 8h of fasting; 2hours after ingestion of 200mL isotonic saline, followed by the first scan; and on another day, 2hours after ingestion of 500mL of the same solution after an overnight fast. The evaluation was quantitative (antrum area and gastric volume, and the ratio of participants’ gastric volume/weight) and qualitative (absence or presence of gastric contents on right lateral decubitus and supine positions. A p‐value<0.05 was considered significant).ResultsThere was no difference in quantitative variables at measurement times (p>0.05). Five volunteers (6.25%) had a volume/weight over 1.5mL.kg−1 at fasting and 2hours after ingestion of 200mL and 6 (7.5%) after 500mL. Qualitatively, the presence of gastric fluid occurred in more volunteers after fluid ingestion, especially 500mL (18.7%), although not statistically significant.ConclusionUltrasound assessment of gastric volume showed no significant difference, both qualitative and quantitative, 2h after ingestion of 200mL or 500mL of isotonic solution compared to fasting, although gastric fluid content has been identified in more volunteers, especially after ingestion of 500mL isotonic solution

How to avoid discontinuation of antihypertensive treatment. The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic >110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the "uncomplicated" group and 67% in the "complicated" group (p<0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment

The HLA-DRB1 Alleles Effects on Multiple Sclerosis:a Systematic Review

Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that affects sensitive and motor functions. Many population studies were made with the intent of knowing better the most affected groups and the disease manifestations. These review analyses some of those studies, evaluating risk factors, especially genetic relations of Human Leukocyte Antigen DRB1 (HLADRB1) gens, for developing clinical disease.Method: We have analyzed 57 articles, published between 2009 and 2014, with the key words “multiple sclerosisâ€, “genetic association studies†and “HLA-DRB1 chainsâ€, through the Scopus database. Only 18 articles were eligible for our study; they were read entirely and included in the fial analysis.Results: Most studies imply genetic and environmental factors for the incidence of MS, its age of starting and prognosis. Previous studies have shown that many gens are related in MS pathogenesis and that interactions between them are important in determining clinicalmanifestations.Limitations: Different results were observed when different populations were targeted in the studies.Conclusion: There is an important relation between HLA-DRB1 and MS in diverse population groups. Complementary studies are needed to know better the importance of environmental factors and its interaction with gens in the development of MS

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Swimmer's shoulder in young athlete: Rehabilitation with emphasis on manual therapy and stabilization of shoulder complex

Universidade Federal de São Paulo, Escola Paulista Med, Ctr Traumatol Esporte CETE, Dept Ortopedia & Traumatol, BR-04039060 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fisioterapia, BR-04039060 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Ctr Traumatol Esporte CETE, Dept Ortopedia & Traumatol, BR-04039060 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fisioterapia, BR-04039060 São Paulo, BrazilWeb of Scienc

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic &gt;110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30;

Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution

Background and objectives: The current preoperative fasting guidelines allow fluid intake up to 2 h before surgery. The aim of this study was to evaluate the gastric volume of volunteers after an overnight fast and compare it with the gastric volume 2 h after ingestion of 200 and 500 mL of isotonic solution, by means of ultrasound assessment. Method: Eighty volunteers underwent gastric ultrasound at three times: after 8 h of fasting; 2 h after ingestion of 200 mL isotonic saline, followed by the first scan; and on another day, 2 h after ingestion of 500 mL of the same solution after an overnight fast. The evaluation was quantitative (antrum area and gastric volume, and the ratio of participants’ gastric volume/weight) and qualitative (absence or presence of gastric contents on right lateral decubitus and supine positions. A p-value  0.05). Five volunteers (6.25%) had a volume/weight over 1.5 mL kg−1 at fasting and 2 h after ingestion of 200 mL and 6 (7.5%) after 500 mL. Qualitatively, the presence of gastric fluid occurred in more volunteers after fluid ingestion, especially 500 mL (18.7%), although not statistically significant. Conclusion: Ultrasound assessment of gastric volume showed no significant difference, both qualitative and quantitative, 2 h after ingestion of 200 mL or 500 mL of isotonic solution compared to fasting, although gastric fluid content has been identified in more volunteers, especially after ingestion of 500 mL isotonic solution. Resumo: Justificativa e objetivos: As diretrizes recentes de jejum pré-operatório permitem a ingestão de líquidos até 2 horas antes da cirurgia. O objetivo do presente estudo foi, por meio de ultrassonografia gástrica, avaliar o volume gástrico de voluntários após jejum noturno e comparar com o volume gástrico duas horas após a ingestão de 200 e 500 ml de solução isotônica. Método: Foram submetidos à ultrassonografia gástrica 80 voluntários em três momentos: após jejum de 8 horas; 2 horas após a ingestão de 200 ml de solução isotônica, seguida do primeiro exame; e, em outro dia, 2 horas após a ingestão de 500 ml da mesma solução, após jejum noturno. A avaliação foi quantitativa (área do antro e volume gástricos e relação volume gástrico/peso dos participantes) e qualitativa, pela ausência ou presença de conteúdo gástrico nas posições de decúbito lateral direito e supina. Foi considerado significante p  0,05). Cinco voluntários (6,25%) apresentaram um volume/peso superior a 1,5 ml.kg−1 em jejum e 2 horas após a ingestão de 200 ml e seis (7,5%) após 500 ml. Qualitativamente, a presença de líquido gástrico ocorreu em mais voluntários após a ingestão de líquidos, principalmente de 500 ml (18,7%), embora sem significância estatística. Conclusão: O volume gástrico pela ultrassonografia não apresenta diferença significativa tanto qualitativa quanto quantitativa, 2 horas após a ingestão de 200 ml ou de 500 ml de solução isotônica em comparação com o jejum, embora conteúdo líquido gástrico tenha sido identificado em mais voluntários, principalmente após a ingestão de 500 ml de solução isotônica. Keywords: Bronchoaspiration, Gastric ultrasound, Preoperative fasting, Palavras-chave: Broncoaspiração, Ultrassonografia gástrica, Jejum pré-operatóri

Bactérias isoladas de abscessos em pequenos ruminantes inspecionados na região semiárida do Brasil

Loss in the supply chain of small ruminants owing to condemnations of carcasses in the abattoirs and slaughterhouses is common in northeastern Brazil. This study aims to identify bacterial agents, including Mycobacterium spp., in the abscesses found in the postmortem analysis of the carcasses of sheep and goats bred in northeastern Brazil. Our analysis involved 679 goats and 1,838 sheep carcasses. Abscess samples were extracted and inoculated on blood agar and Lowenstein Jensen with pyruvate or glycerol for bacterial isolation. We then performed polymerase chain reaction of the hps 65 gene; samples positive for Mycobacterium spp. were subjected to DNA sequencing. Relative frequencies of abscesses in goats and sheep were 5.44 and 3.26%, respectively. Microbiological analysis revealed 87.7% bacterial growth in the inoculated samples. Among these, Corynebacterium pseudotuberculosis represented 67.7% of the isolates. We observed 1.9% mycobacteria growth in the abscess samples inoculated on Lowenstein-Jensen medium. PCR of DNA extracted from abscesses samples showed amplification of 0.9% of samples. After sequencing, Mycobacterium spp. isolate was identified as M. novocastrense. C. pseudotuberculosis was the main agent responsible for the formation of abscesses in the examined animals, and we did not identify any species of the M. tuberculosis complex in the examined small ruminants.Perdas na cadeia produtiva dos pequenos ruminantes pela condenação de carcaças e vísceras são comuns nos matadouros/frigoríficos da região nordeste do Brasil. Este estudo objetivou identificar agentes bacterianos, inclusive Mycobacterium spp., no conteúdo de abscessos encontrados no exame post mortem de caprinos e ovinos criados em regiões do nordeste do Brasil. Foram inspecionados no exame post mortem 679 caprinos e 1.838 ovinos. Para o isolamento bacteriano as amostras foram cultivadas em meio Agar Sangue e Lowenstein Jensen contendo piruvato ou glicerol. Além do cultivo, foi realizada identificação molecular para Mycobacterium spp. pela técnica de Reação em Cadeia de Polimerase (PCR) em que foram utilizados primers que amplificam fragmentos de parte do gene hsp65. As amostras positivas para micobactérias foram submetidas ao sequenciamento de DNA. As frequências relativas de abscessos em caprinos e ovinos foram de 5,44% (37/679) e 3,26% (60/1.838), respectivamente. No exame microbiológico, utilizando o meio Ágar Sague, observou-se crescimento bacteriano em 87,7% (93/106) das amostras cultivadas. Destes, o Corynebacterium pseudotuberculosis representou 67,7% (63/93) dos isolados. Do cultivo em meio Lowenstein Jensen foram isolados micobactérias em 1,9% (2/106) das amostras de abscessos e, na PCR com DNA extraído direto das amostras de abscessos, observou-se amplificação em 0,9% (1/106) das amostras. No sequenciamento o isolado de Mycobacterium spp. foi confirmado como M. Novocastrense. C. pseudotuberculosis foi o principal agente responsável pela formação de abscessos nos animais avaliados e não foi identificada nenhuma espécie do complexo M. tuberculosis nos pequenos ruminantes inspecionados

Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution

Abstract Background and objectives: The current preoperative fasting guidelines allow fluid intake up to 2 h before surgery. The aim of this study was to evaluate the gastric volume of volunteers after an overnight fast and compare it with the gastric volume 2 h after ingestion of 200 and 500 mL of isotonic solution, by means of ultrasound assessment. Method: Eighty volunteers underwent gastric ultrasound at three times: after 8 h of fasting; 2 h after ingestion of 200 mL isotonic saline, followed by the first scan; and on another day, 2 h after ingestion of 500 mL of the same solution after an overnight fast. The evaluation was quantitative (antrum area and gastric volume, and the ratio of participants’ gastric volume/weight) and qualitative (absence or presence of gastric contents on right lateral decubitus and supine positions. A p-value 0.05). Five volunteers (6.25%) had a volume/weight over 1.5 mL kg-1 at fasting and 2 h after ingestion of 200 mL and 6 (7.5%) after 500 mL. Qualitatively, the presence of gastric fluid occurred in more volunteers after fluid ingestion, especially 500 mL (18.7%), although not statistically significant. Conclusion: Ultrasound assessment of gastric volume showed no significant difference, both qualitative and quantitative, 2 h after ingestion of 200 mL or 500 mL of isotonic solution compared to fasting, although gastric fluid content has been identified in more volunteers, especially after ingestion of 500 mL isotonic solution

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic &gt;110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the "uncomplicated" group and 67% in the "complicated" group (p<0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment