Projeto Carroceiro FZEA-USP

The Cart Horse Project, created and organized by professor Renata Gebara Sampaio Dória (DVM, MSc, PhD), started its activities in 2011. Since then, it has been contributing to several families from Pirassununga and nearby cities that cannot afford veterinary care to their animals. The project aims to provide substantial knowledge and awareness on zoonosis, public health, handling and animal welfare and health of the owners of traction horses used as a worker for these families. Besides promoting health and welfare of these animals, as well as raising awareness on the owners, the project also benefits the Veterinary Medicine students of Faculty of Animal Husbandry and Food Engineering of University of São Paulo (FZEA-USP) in order to develop and improve their clinical and surgical abilities on equine medicine, complementing their professional education.O projeto Carroceiro, coordenado e idealizado pela Profa. Dra. Renata Gebara Sampaio Dória, iniciou suas atividades no ano de 2011 e, desde então, vem contribuindo com muitas famílias de Pirassununga e região que utilizam equídeos para tração e não possuem condições financeiras para fornecer a seus animais uma assistência médica veterinária. O trabalho objetiva a conscientização dos proprietários dos equídeos utilizados em carroças (carroceiros) sobre: zoonoses, saúde pública, manejo, bem-estar e promoção da saúde desses animais, que são utilizados para tração como fonte de subsistência por muitas famílias. Além de promover a saúde e bem-estar dos animais, bem como a conscientização dos carroceiros, o projeto auxilia os estudantes de Medicina Veterinária da Faculdade de Zootecnia e Engenharia de Alimentos da Universidade de São Paulo (FZEA-USP) a desenvolver e aprimorar suas habilidades clínico-cirúrgicas no tratamento de equídeos, complementando a formação profissional

Influence of recumbency upon pulmonary shunt occurrence in inhalation-anaesthetized sheep

O presente estudo teve por objetivo determinar o impacto de diferentes decúbitos durante a anestesia inalatória de ovinos, priorizando o estudo das alterações ventilatórias e de shunt pulmonar. Para esse fim, sete ovelhas foram submetidas a anestesia inalatória com sevofluorano e mantidas em ventilação mecânica controlada por pressão (12 cmH2O), com ƒ fixada em 10 mpm e pressão positiva ao final da expiração em 0 cm H2O (ZEEP). Imediatamente após indução anestésica, os animais foram submetidos a três diferentes tratamentos, a saber: decúbitos dorsal, lateral esquerdo ou lateral direito. A ordem dos tratamentos foi determinada de forma aleatória, sendo que todos os animais foram submetidos a todos os tratamentos, com duração de 120 minutos cada. O intervalo entre os procedimentos foi de 48 horas. Todos os parâmetros foram adaptados do projeto inicial após estudo-piloto, o mesmo ocorrendo com a adequação do intervalo, o qual não influenciou nos resultados do estudo-piloto. Foram coletadas amostras de sangue arterial e venoso para análises de gases sanguíneos e eletrólitos, imediatamente após indução anestésica, decorridos 60 minutos da indução e após 120 minutos da indução. Os valores obtidos foram utilizados para calcular a fração de shunt pulmonar (V/Q), conteúdo arterial de oxigênio (CaO2), conteúdo venoso central de oxigênio (CcvO2), conteúdo capilar de oxigênio (Cc\'O2), pressão alveolar de oxigênio (PAO2), volume minuto (VM), volume corrente (VCe), gradiente alvéolo-arterial de oxigênio [P(A-a)O2] e gradiente de dióxido de carbono expirado e arterial [(a-ET)CO2]. Os resultados mostraram que V/Q diminuiu expressivamente de 0 a 120 minutos em todos os grupos (dorsal: 69,3% para 27,3%; lateral esquerdo: 59,1% para 25,0%; lateral direito: 67,2% para 32,4%). Os valores de CaO2, CcvO2, CcO2, PAO2, e P(A-a)O2 foram significativamente mais elevados em todos os grupos, a partir de 60 minutos após a indução, e mantendo-se posteriormente (p <0.05). Níveis mais elevados de CaO2 foram observados nos animais do grupo lateral esquerdo, no minuto 0 (9,9 ± 1,43 mL.dL-1) em comparação com o decúbito dorsal (8,9 ± 1,4 mL.dL-1) (p=0.0177). Não foram observadas diferenças entre tratamentos para CcvO2, CcO2 e PAO2. O grupo lateral esquerdo apresentou menores valores de P(A-a)O2 em 0 min (p = 0,0117) e 60 min em relação ao direito (p = 0,0282). Não foram encontradas diferenças nem VT e VM em todos os tratamentos e entre os momentos, e o mesmo foi observado para os valores de P(a-ET)CO2. A PaO2 apresentou valores mais elevados aos 60 e 120 minutos, em todos os grupos, quando comparada ao minuto 0 (p <0,001). Por outro lado, o grupo dorsal apresentou PaCO2 estável durante todo o período de anestesia, sendo diferente dos demais aos 120 minutos. Conclui-se que o decúbito exerce pouca influência na formação de shunt pulmonar.The present study analyzed the impact of different decubitus in sheep during inhalation anaesthesia, prioritizing ventilatory changes and pulmonary shunt. For this purpose, 7 female sheep were submitted to sevoflurane inhalation anesthesia, maintained on pressure-controlled ventilation (12 cmH2O), respiratory rate (ƒ) fixed on 10 mpm and a zero end-expiratory pressure (ZEEP). Immediately after anesthetic induction, the animals undergone three different treatments, namely: dorsal, left lateral or right lateral recumbency positions. Treatments order were determined randomly, being all animals subjected to all treatments, with duration of 120 minutes each. Interval between procedures was 48 hours. Arterial and central venous blood samples were collected for blood gas and electrolytes analysis immediately after anesthetic induction, after 60 minutes of induction and after 120 minutes of induction. Obtained values were used to calculate the pulmonary shunt fraction (V/Q), arterial oxygen content (CaO2), central venous oxygen content (CcvO2), pulmonary end-capillary oxygen content (Cc\'O2), alveolar oxygen partial pressure (PAO2), minute volume (VM), tidal volume (VT), alveolar-arterial oxygen gradient [P(A-a)O2] and arterial-end-tidal carbon dioxide gradient [(a-ET)CO2]. Results showed that V/Q greatly decreased from 0 to 120 min in all the groups (dorsal: 69.3% to 27.3%; left lateral: 59.1% to 25.0%; right lateral: 67.2% to 32.4%). CaO2, CcvO2, CcO2, PAO2, P(A-a)O2 values were significantly higher in all the groups, from 60 min after induction, and maintaining them further (p <0.05). Higher CaO2 levels in animals from the left lateral recumbency group were observed at 0 min (9.9±1.43 mL.dL-1) compared to the dorsal recumbency group (8.9±1.4 mL.dL-1) (p=0.0177). No differences between treatments were observed for CcvO2, CcO2 and PAO2. The left recumbency group showed lower P(A-a)O2 values at 0 min (p=0.0117) and 60 min compared to the right one (p=0.0282). No differences were found in VT and VM in all treatments and between time points, and the same was observed for P(a-ET)CO2 values. FiO2, HR and FE\'Sevo showed no statistical difference at different time points. PaO2 showed higher values at 60 and 120 min for all the groups, when compared to the 0 minute (p<0.001). PaCO2 followed the same pattern, but only for the right and left recumbency groups. Conversely, the dorsal recumbency group showed stable PaCO2 throughout the anaesthesia period, thus, being different from the others at 120 min. In conclusion, recumbency has little influence on pulmonary shunt occurrence

Obstructive Urolithiasis in Horse

Background: Obstructive urinary tract disease in horses is a rare and low prevalence pathology in the species, but potentially severe. It is an emergency condition that presents variable clinical signs and depends on the anatomical location of the obstruction. The bladder calculus are the most common followed by the urethra and less commonly seen are the kidney or ureteral. The main crystalloid component of uroliths in horses is calcium carbonate. The higher prevalence of urolithiasis in male horses is justified by some anatomical differences between genders. The urethra of males is narrower and longer than that of females. The tissue injury is the most important factor for the development of uroliths in horses. Desquamation of epithelial cells, presence of leukocyte and necrotic cell debris are relevant contributors to crystal growth. Urinary stasis favors nucleation by increasing the chance of contact between crystalloid material and urinary epithelium. Once crystal growth has begun, the urine alkalinity of the equines favors the crystallization and further deposition of other components, especially calcium carbonate. Typical clinical signs of urolithiasis include tenesmus, dysuria, strangury and polaquiuria. Hematuria is often present, mainly observed after exercise and at the end of urination. In addition signs of colic are quite frequent in the acute bladder and urethral urolithiasis due to bladder distension. Upper urinary tract surgery may be technically challenging due to limited structural exposure, especially in adult horses The prognosis for horses with urolithiasis depends on the location of the urolith and the degree of renal injury that occurred.Case: This report aims to describe a rare case of obstructive urolithiasis in a 8-year-old castrated male horse with 24 h evolution. The horse was expressing signs of abdominal pain and during the transretal examination through palpation, it was possible to notice great distension and turgidity of the bladder, in addition to a high pain sensitivity to the palpation of the kidneys. Was perform urethral catheterization, but it was unproductive. The diagnosis was made through perineal ultrasonography and treated surgically by perineal urethrotomy. The animal presented an excellent evolution after being discharged after 10 days of hospitalization and did not present any complication or recurrence of the disease after one year of the procedure.Discussion: Urolithiasis in horses has a prognosis dependent on the location of the urolith and the degree of renal damage. Cases of obstructive urolithiasis in horses are rare and require prompt and appropriate intervention. Therefore, a rapid and accurate diagnosis is directly related to the success of the treatment. In the present case, the animal had characteristic clinical signs of an acute abdomen. Transrectal palpation, for evaluation of the intestinal portions, was important to diagnose an excessively distended urinary vesicle with no intestinal changes. Transcutaneous ultrasonography of the perineum allowed visualization of the calculus, and then a case of perineal urolithiasis was diagnosed. The choice for perineal urethrotomy was performed because of the ease of palpation of the calculus through the skin below the anus and because it is a non-invasive technique. The urethra was sutured to guide the cicatricial process and the urethral catheter was maintained, reducing the risks of occlusion of the urethral lumen

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status