Aplicação do método QuEChERS na análise de resíduos de medicamentos veterinários em carne bovina.

A presença de resíduos de medicamentos veterinários nos alimentos pode comprometer a segurança alimentar, principalmente se os níveis estiverem acima dos limites máximos permitidos pela legislação, podendo provocar sérios problemas comerciais, econômicos, ambientais e de saúde pública. Portanto, a análise de traços de carrapaticidas em alimentos, destacando-se a carne, toma-se necessária, requerendo o desenvolvimento de métodos, os quais sejam rápidos, sensíveis e seletivos. O objetivo do presente estudo foi desenvolver um método analítico, utilizando o método QuEChERS modificado seguido pela cromatografia gasosa acoplada a espéctrometria de massas (GC/MS), para determinação de resíduos de clorfenvinfos, fipronil e cipermetrina, os quais são utilizados como carrapaticidas no rebanho bovino, analisando a matriz carne bovina. No método proposto para a extração dos analitos da matriz carne bovina, 2 g de amostra,. isenta dos princípios ativos estudados, foram fortificada com concentrações conhecidas dos analitos e, em seguida, homogeneizada com 4 mL de acetonitrila, 1,6 g de sulfato de magnésio anidro e 0,4 g de cloreto de sódio. A mistura foi centrifugada a 3000 rpm por 1 minuto e 1 mL da fase superior foi transferida para eppendorf de volume 1,5 mL, contendo 0,08 g de C18; 0,08 g de PSA e 0,150 g"de sulfato de magnésio anidro, sendo posteriormente submetida a uma segunda çentrifugação a 6000 rpm por 1 minuto. Uma alíquota de 0,5 mL da fase superior foi transferida para frasco específico do amostrador automático e. analisada por GC/MS, para separação, identificação e quantificação dos analitos. As análises foram realizadas em cromatógrafo a gás, marca Shimadzu, equipado com detector de nnassas, coluna capilar de sílica fundida, temperaturas do injetor, fonte de íons e interface de 250 °C, temperatura da coluna: 120 °C -4 °C mino} -190 °C -32 °C mino} -270 °C (4 min). Aplicando a técnica de extração proposta na análise de carrapaticidas em carne, obtiveram.-se valores aceitáveis de recuperação, variando de 98 -129 % estando dentro da faixa de aceite estabelecida pelo EPA (Environmental Protection Agency), que varia entre 70 e 130%. O método QuEChERS-GC/MS mostrou-se apropriado para análise de resíduos de clorfenvinfos, fipronil e cipermetrina, apresentando vantagens como rapidez, consumo de pequeno volume de solventes e geração de poucos resíduos

Validação de metodologia analítica para determinação de contaminantes em carne bovina.

Nos últimos anos é crescente a preocupação de órgãos responsáveis pela saúde pública e de produtores, com problemas relacionados à presença de resíduos de medicamentos veterinários em alimentos de origem animal. Para obtenção de níveis confiáveis de segurança alimentar tem se buscado o desenvolvimento de metodologias analíticas capazes de efetuar a identificação e quantificação de antimicrobianos, Anti-helmínticos, antiparasitários, hormônios, promotores de crescimento, entre outros, principalmente em amostras de carne, leite e ovos, os quais podem facilmente ser contaminados a partir da aplicação de tais drogas na criação animal. Portanto, a análise de traços de contaminantes em alimentos, destacando-se a carne bovina, torna-se necessária, requerendo o desenvolvimento de métodos, que sejam rápidos, sensíveis e seletivos. A validação de métodos analíticos é de extrema importância para garantir que os resultados gerados sejam de boa qualidade e confiáveis. Este estudo teve como objetivo validar uma metodologia analítica, método QuEChERS, seguido pela cromatografia gasosa acoplada à espectrometria de massas (GC/MS), na determinação de resíduos de clorfenvinfos, fipronil e cipermetrina, os quais são utilizados como acaricidas no rebanho bovino, analisando a matriz carne bovina. Na validação foram considerados os parâmetros: especificidade, linearidade, exatidão (recuperação), precisão (DPR), limites de detecção (LOD) e quantificação (LOQ). O método desenvolvido mostrou-se específico, ou seja, não co-extrai componentes da matriz no mesmo tempo de retenção dos analitos estudados; linear, avaliando as concentrações 0,010; 0,025; 0,050; 0,100; 0,200 e 0,500 mg kg-1 e com coeficientes de correlação superiores a 0,99. Considerando a exatidão e precisão, valores aceitáveis de recuperação foram obtidos, variando de 98 a 130%, com DPR entre 0,4 e 25%, que está dentro da faixa de aceite estabelecida pelo EPA (70 ? 130% ± 30%). Os valores de limites de detecção e quantificação foram baixos, inferiores aos limites máximos de resíduos (LMRs) estabelecidos pela União Européia e pelo Codex Alimentarius. O método validado, método QuEChERS-GC/MS, apresentou-se específico, linear, exato, preciso e com valores de limites de detecção e quantificação inferiores ao estabelecido pela legislação, mostrando-se apropriado para análise de resíduos de clorfenvinfos, fipronil e cipermetrina, em carne bovina

Análise de resíduos de acaricidas em gordura bovina aplicando o método QuEChERS-GC/MS.

A presença de resíduos de medicamentos veterinários nos alimentos pode comprometer a segurança alimentar, principalmente se os níveis estiverem acima dos limites máximos de resíduos (LMRs) permitidos pela legislação, podendo provocar sérios problemas comerciais, econômicos, ambientais e de saúde pública. Este estudo teve como objetivo aplicar e validar uma metodologia analítica limpa, método QuEChERS, seguido pela cromatografia gasosa acoplada à espectrometria de massas (GC/MS), a qual atende aos princípios da química verde, na determinação de resíduos dos pesticidas clorfenvinfos, fipronil e cipermetrina, os quais são utilizados como acaricidas no rebanho bovino, avaliando a matriz gordura bovina. Transferiu-se 1 g de gordura para um tubo Falcon, adicionando-se quantidades conhecidas dos padrões dos acaricidas em estudo e deixando-os em interação com a amostra por 40 minutos. Em seguida, acrescentou-se 5 mL de hexano e agitou-se por 1 minuto em vórtex; adicionando-se 10 mL de água, 10 mL de acetonitrila (MeCN), 4,0 g de sulfato de magnésio (MgSO ) e 0,5 g de cloreto de sódio (NaCl), agitando por 1 minuto em vórtex. Centrifugou-se a mistura a 3000 rpm por 1 minuto e a fase superior, correspondente ao solvente orgânico hexano, foi coletada e descartada. Da fase seguinte, correspondente ao solvente orgânico MeCN, transferiu-se uma alíquota de 1,0 mL para um tubo eppendorf, contendo 50 mg do adsorvente amina primária e secundária (PSA) e 150 mg de MgSO . Agitou-se manualmente e centrifugou-se a 5000 rpm por 1 minuto (SPE dispersiva). Da fase superior formada, 0,5 mL foi transferido para um frasco do amostrador automático, para análise por GC/MS. Na análise cromatográfica, utilizou-se gás de arraste hélio, temperaturas do injetor, interface e fonte de íons de 250 ºC e programação de temperatura do forno iniciando em 100 ºC, aumentando em 12 ºC min até 190 ºC e aumentando em 32 ºC min até 270 ºC, permanecendo nessa temperatura por 4 minutos. Para assegurar a confiabilidade dos dados obtidos nas análises no GC/MS, realizou-se a validação do método, sendo considerados os parâmetros: especificidade, linearidade, exatidão (recuperação), precisão (DPR) e limites de detecção (LOD) e quantificação (LOQ). O método desenvolvido mostrou-se específico; linear, avaliando as concentrações de 0,1; 0,2; 0,5; 0,7 e 1,0 mg kg , com coeficientes de correlação superiores a 0,95. Valores aceitáveis de recuperação foram obtidos, variando de 70 a 123%, com DPR entre 0,5 e 25%, estando dentro da faixa de aceite estabelecida pelo EPA (70 ? 130% ± 30%), com limites de detecção e quantificação inferiores aos LMRs estabelecidos pela União Européia e pelo Codex Alimentarius, exceto para clorfenvinfos. O método QuEChERS mostrou-se apropriado para análise de resíduos de clorfenvinfos, fipronil e cipermetrina em gordura bovina apresentando vantagens como rapidez, baixo custo e reduzido consumo de solventes orgânicos

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks