OBSERVAÇÕES ETNOVETERINARIA E PRÁTICAS USADAS EM COMUNIDADES RURAIS NO ESTADO DO ACRE, AMAZÔNIA OCIDENTAL, BRASIL

This study aimed to identify, register and analyze the ethnoveterinary knowledge of medicinal plants employed in rural communities of the State of Acre-Brazil. Sixty families were interviewed; the personal data and specific questions about the use of medicinal plants for the treatment of diseases that affect the animals were obtained. The results indicated 43 species of medicinal plants, distributed in 28 botanical families, highlighting Lamiaceae (1.6%), Asteraceae (11.6%), Euphorbiaceae (7%) and Myrtaceae (7%). The use-value of species per informant (UVIS /UVS) shows Mentha spicata (hortelã) (17/0.28), – Mormodica charantia (melão de são Caetano) (17/0.28), Arrabidaea chica (crajiru) (14/0.23). - Carica papaya (mamão macho) (13/0.22), Chenopodium ambrosioides (mastruz) (11/0.18) – Jatropha curcas (pinhão branco) (9/0.15), Melissa officinalis (cidreira) (9/0.15), and Cymbopogon citratus (lemongrass) (9/0.15) as the most cited plants. The values of the informant consensus factor (ICF) show that the digestive category presented the highest values (0,84), followed by integument (0,83), anti-inflammatory (0,80), diverse (0,72) and respiratory (0,70). As for the parts of the plant, fresh leaves (54%) were the most cited. Regarding the preparation mode, infusion tea (74%) was the most cited. This work will serve as a database for future research in the area of study.Keywords: Ethnoveterinary; Medicinal Plants; Amazon Region – State of Acre – Brazil.A utilização de plantas medicinais por comunidades ribeirinhas da Amazônia é um hábito comum, no entanto o conhecimento etnoveterinário ainda é desconhecido em algumas regiões da Amazônia. Assim a proposta deste estudo foi identificar documentar e analisar o conhecimento etnoveterinário de espécies vegetais de uso medicinal em comunidades rurais do estado do Acre-Brasil. Foram entrevistadas 60 famílias, contendo perguntas com os dados pessoais dos entrevistados e perguntas específicas sobre a utilização de plantas medicinais para o tratamento de doenças que acometem os animais. Os resultados indicaram 43 espécies de plantas de uso medicinal, distribuídas em 28 famílias botânicas, destacando-sea Lamiaceae (33%), Asteraceae (20%), Fabaceae (12,5%) e Myrtacecae (12,5%). O valor de uso de uma espécie por informante (UVIS /UVS) mostra o hortelã –Mentha spicata (17/0.28), melão de são Caetano – Mormodica charnatia (17/0.28), crajirú –Arrabidaea chica (14/0.23), mamão macho-Carica papaya (13/0.22), mastruz –Chenopodium ambrosioides (11/0.18), pião branco – Jatrophacurcas (9/0.15), cidreira- Melissa officinalis (9/0.15) e o capim santo- Cymbopongon citratus ( 9/0.15) como as plantas de maior indicação. Os valores dos fatores do informante consenso (IFC) mostram que a categoria digestivo apresentou os maiores valores (0,84), seguido do tegumentar (0,83), anti inflamatório (0,80), diversos (0,72) e respiratório (0,70). Quanto a parte usada da planta folha fresca (54%) foi a mais citada. Com relação a forma de preparo   foi encontrado com maior prevalência o chá por infusão (74%). Este trabalho servirá como base de dados para futuras pesquisas na área de estudo.Palavras chaves: Fitoterapia, Plantas Medicinais, Amazônia Brasileira, Animais domésticos

Acupuntura no tratamento da dor e interprofissionalidade: revisão integrativa / Acupuncture in pain management and interprofessionalism: integrative review

Objetivo: O objetivo desse estudo é analisar evidências científicas na literatura sobre o efeito da acupuntura no tratamento da dor, com enfoque na interprofissionalidade. Métodos: Revisão de literatura, incluindo seis artigos indexados em três bases de dados, usando palavras-chaves controladas. Resultados: Os estudos analisados mostraram eficácia da acupuntura no tratamento de dores como cefaleia, dor lombar na gravidez e outras, além da eficiência do trabalho interprofissional no uso de Práticas Integrativas. Conclusão: A acupuntura contribuiu na amenização de dores, mostrando ser uma prática integrativa que, aliada a interprofissionalidade, contribui para a promoção de saúde de forma simples

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Distrofia muscular nutricional em ovinos na Paraíba Nutritional muscular dystrophy in sheep in Paraíba

Descreve-se um surto de distrofia muscular nutricional em ovinos no semi-árido Nordestino. Foram afetados animais de 3-4 meses de idade, da raça Dorper, pesando 30-40 kg. Os animais eram alimentados, à vontade, com leite, ração balanceada, capim Tifton e sal mineral. Dos 70 animais Dorper, 6 adoeceram e morreram em um período de 48 horas. Apresentaram temperatura, entre 40 e 41ºC, incoordenação com posterior paralisia e decúbito, depressão, prostração e diminuição dos reflexos pupilar e de ameaça, flacidez da língua e mandíbula, salivação, edema submandibular, dispnéia e aumento da freqüência cardíaca. A morte ocorreu após curso clínico de 6- 12 horas. Na necropsia de 3 animais, os músculos esqueléticos estavam de coloração pálida, o fígado estava aumentado de volume e de coloração amarelada, os gânglios parotídeos, submandibulares, retrofaríngeos, prescapulares e mediastínicos estavam aumentados de volume e avermelhados e os pulmões apresentavam áreas vermelhas. Na histologia havia necrose segmentar de todos os músculos examinados e congestão dos gânglios linfáticos e pulmão. Posteriormente mais três animais adoeceram, sendo tratado com oxitetraciclina e complexo vitamínico A,D e E. Desses 3 animais, 2 morreram e um sobreviveu. Na mesma fazenda havia e não adoeceram 20 ovinos da raça Santa Inês, da mesma idade que os animais afetados, que recebiam a mesma alimentação exceto o leite, e 900 ovinos de outras idades. A superalimentação em animais com rápido crescimento e o estresse causado pela restrição de água durantes 2 dias, para aumentar o consumo de leite, parecem ter sido fatores predisponentes para a ocorrência da doença. É possível, também, que algum dos minerais suplementados tenha antagonizado o Se presente na alimentação.An outbreak of nutritional muscular dystrophy is reported in the semiarid region of northeastern Brazil affecting 3-4 months old Dorper sheep. The animals, weighing 30-40 kg, were fed ad libitum with milk, concentrated ration, Tifton hay, and a mineral mixture. Six out of 70 lambs were affected and died in the first 48 hours after the onset of the outbreak. Clinical signs were fever of 40-41ºC, incoordination followed by paralysis and recumbence, depression, prostration with decreased pupillary and corneal reflexes, decreased tonus of the tongue and maxilla, salivation, submaxillar edema, and increased cardiac and respiratory rates. Death occurred after a clinical manifestation period of 6-12 hours. At necropsy of three animals, skeletal muscles were pale, the liver was yellowish and enlarged, the parotid, submaxillary, retropharyngeal, prescapular and mediastinal lymph nodes were enlarged with red surface, and red areas were observed on the lung surface. On histology, segmental muscular necrosis was observed in all skeletal muscles examined. The liver had centrilobular fatty degeneration, and congestion was observed in the lung and lymph nodes. From 48-96 hours after the begin of the outbreak, another 3 animals were affected. They were treated with Vitamin A, E and D complex; two of them died and one survived. On the same farm, a flock of 20 Santa Inês sheep of the same age as the affected animals, fed with the same food, but no milk, and another 900 sheep of different ages were not affected. The over nutrition of sheep with fast growing rates, and the stress caused by two days of water restriction to improve milk consumption had been predisposing factors for the occurrence of the disease. It is also possible that some of the minerals supplemented interfered with selenium availability

SQUAMOUS CELL CARCINOMA IN OVINES IN THE STATE OF ACRE

The squamous cells carcinoma (SCC), also known as epidermoid carcinoma, is a malign neoplasia of the squamous layer of the skin’s epidermis, very common in bovines of tropical countries such as Brazil, due to the chronic exposure of animals to ultraviolet radiation. The objective of this work was to describe SCC cases in sheep ( Ovis aries ), because it is known that this disease is rare in this species. A standard animal of approximately six years old was assisted in the municipality of Rio Branco, State of Acre, in Brazil, presenting cachectic state and multifocal tumors. Despite the rarity of this neoplasia in sheep, it is important to use preventive measures, such as: avoiding acquisition of depigmented animals, with absent or sparse fur coverage and, mainly avoiding prolonged exposure to ultraviolet lights, which could cause the appearance of this morbid disease

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit