Eficacia y seguridad de morfina y metadona como analgésicos en un protocolo anestésico balanceado en conejos

The efficacy of preventive analgesia and the cardiopulmonary effects of morphine or methadone in rabbits undergoing experimental skin surgery were evaluated and compared. Thirty-six rabbits were randomly assigned to three experimental groups: Control, Morphine, and Methadone. The rabbits received midazolam 1 mg/kg IM associated with: placebo (NaCl 0.9%) 0.05 ml/kg, methadone 0.5 mg/kg or morphine 0.5 mg/kg, depending on the experimental group. Anaesthesia was induced and maintained with isoflurane. Heart (HR) and respiratory (fR) rates, peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), and body temperature were assessed every 10 minutes. Electrocardiographic examination was performed after sedation, in the trans and immediate postoperative period. After procedure, the control group received tramadol 5 mg/kg IV. Postoperative analgesia was assessed using the visual analogue scale (VAS) and Von-Frey filament stimulation responses. All variables were compared between groups by ANOVA or Friedman. Methadone and morphine caused an increase in MAP (p=0.0112) and a decrease in HR (p=0.0001). fR and SpO2 were reduced in the methadone group (p=0.0100). The response to Von-Frey filaments (p=0.6824) and VAS (p=0.7661) were similar between treatments, however, the control group presented a higher proportion of analgesic rescue (33%) compared to morphine (19%) and methadone (12%). Electrocardiographic variables were similar between treatments (p>0.05). In conclusion, preventive treatment with morphine or methadone was effective in controlling trans and postoperative pain in rabbits, and its cardiovascular effects were limited; however, methadone caused marked respiratory depression.Se evaluó y comparó la eficacia de la analgesia preventiva y los efectos cardiopulmonares de morfina o metadona en conejos sometidos a cirugía cutánea experimental. Treinta y seis conejos fueron asignados al azar a tres grupos experimentales: Control, Morfina y Metadona. Los conejos recibieron midazolam 1 mg/kg vía IM asociado a: placebo (NaCl 0.9%) 0.05 ml/kg, metadona 0.5 mg/kg o morfina 0.5 mg/kg, según el grupo experimental. La anestesia fue inducida y mantenida con isoflurano. La frecuencia cardíaca (FC) y respiratoria (fR), la saturación periférica de oxígeno (SpO2), la presión arterial media (PAM) y la temperatura corporal se evaluaron cada 10 minutos. Se realizó examen electrocardiográfico después de la sedación, en el trans y posoperatorio inmediato. Después del procedimiento, el grupo control recibió tramadol 5 mg/kg vía IV. La analgesia posoperatoria fue evaluada mediante la escala analógica visual (VAS) y la respuesta a estímulos con filamentos de Von-Frey. Todas las variables se compararon entre los grupos mediante ANOVA o Friedman. Metadona y morfina causaron aumento de PAM (p=0.0112) y reducción de la fR (p=0.0001). La fR y la SpO2 se redujeron en el grupo de metadona (p=0.0100). La respuesta a los filamentos de Von-Frey (p=0.6824) y la VAS (p=0.7661) fueron similares entre tratamientos, sin embargo, el grupo control presentó una mayor proporción de rescate analgésico (33%) en comparación con la morfina (19%) y la metadona (12%). Las variables electrocardiográficas fueron similares entre tratamientos (p>0.05). En conclusión, el tratamiento preventivo con morfina o metadona resultó eficaz para controlar el dolor trans y posoperatorio en conejos y sus efectos cardiovasculares fueron limitados; sin embargo, la metadona ocasionó depresión respiratoria marcada

Pacientes oncológicos e seus familiares: um olhar educacional da enfermagem / Cancer patients and their families: an educational look at nursing

Este trabalho discute as ações de educação em saúde realizadas por enfermeiros e demais integrantes da equipe de enfermagem com pacientes oncológicos e seus familiares, abordando quais são as principais ações e instrumentos utilizados, a importância das mesmas para o tratamento do paciente e o papel do enfermeiro nesse contexto junto ao paciente e seus familiares. Para tal, realizou-se uma pesquisa bibliográfica envolvendo estudos publicados entre os anos de 2008 e 2017 na Biblioteca Virtual em Saúde, utilizando para tanto os descritores: educação em saúde, paciente oncológico e assistência de enfermagem. Foi realizada a leitura na íntegra dos artigos com textos completos em português que abordavam a temática proposta. Após análise dos textos, pode-se concluir que os meios utilizados para realização de educação em saúde com pacientes oncológicos e seus familiares são: o diálogo dentro da consulta de enfermagem, atividades lúdicas, confecção de materiais impressos, visitas domiciliares, atividades em grupo e acompanhamento via telefone. Relatos de pacientes e seus familiares citam como muito importante essas ações educativas realizadas pela equipe de enfermagem, uma vez que minimiza a ansiedade e medo, tira dúvidas existentes e auxilia na tomada de decisão sobre a melhor conduta terapêutica possível pra cada situação de adoecimento. No que concerne o papel do enfermeiro, percebeu-se que por ser o líder da equipe e também o profissional que está mais tempo presente nos cuidados com o paciente, este torna-se fundamental na condução das ações educativas, pois tem a capacidade de perceber as reais necessidades da sua clientela e atuar de forma personalizada e rápida na resolução dos problemas e dissolução de dúvidas que vão surgindo ao longo do tratamento. Portanto, que as ações de educação em saúde desenvolvidas com pacientes oncológicos e seus familiares, são imprescindível para que haja uma resposta positiva na condução do tratamento terapêutico, sempre respeitando as crenças e o desejo do paciente

Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study

Introduction: Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques. Methods: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications. Results: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein’s repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84). Conclusion: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Núcleos de Ensino da Unesp: artigos 2013: volume 2: metodologias de ensino e a apropriação de conhecimento pelos alunos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP