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BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.
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Anestesia , Anestesiologia , Humanos , Estudos Transversais , Salas Cirúrgicas , Escherichia coliRESUMO
ABSTRACT BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.
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BACKGROUND: Gastric cancer is an extremely rare condition to occur after bariatric surgery, and most of the reported cases are adenocarcinomas. Regarding gastrointestinal stromal tumors (GISTs), there are only two reported cases occurring after bariatric surgery (one after gastric banding and the other following Roux-en-Y gastric bypass (RYGB)). CASE PRESENTATION: A 48-year-old woman with previous history of obesity and type 2 diabetes, treated with a Roux-en-Y gastric bypass 2 years earlier, was referred to our center due to complains of diffuse abdominal pain and distension associated with asthenia. Magnetic resonance imaging showed a cystic-solid mass located in the right hypochondrium, measuring 19.5 × 13.5 × 16 cm, suggesting the diagnosis of a retroperitoneal tumor. Based on these findings, a laparotomy, evidencing that the larger cystic-solid tumor was originating from the excluded stomach post-RYGB. The gastrectomy of the excluded stomach was performed aside with a conventional cholecystectomy. Histopathology and immunohistochemistry confirmed to be a gastric GIST with epithelioid cells. Currently, 12 months after surgery, the patient presents no signs of recurrence. CONCLUSION: This is the second case of gastric GIST occurring after RYGB to be reported in the literature.
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INTRODUCTION: Some studies have reported the occurrence of microorganisms isolated from water. Considering these microorganisms, fungi are known to occur ubiquitously in the environment, including water, and some are pathogenic and may cause health problems, especially in immunocompromised individuals. The aim of this study was to identify fungi in hospital water samples and to correlate their presence with the concentration of free residual chlorine. METHODS: Water samples (100 mL) were collected from taps (n = 74) and water purifiers (n = 14) in different locations in a university hospital. Samples were filtered through a nitrocellulose membrane and placed on Sabouraud dextrose agar and incubated for 24 hours at 30°C. Fungi were identified according to established methods based on macroscopic and microscopic characteristics (filamentous) and physiological tests (yeasts). Free chlorine residual content was measured at the time of sample collection. RESULTS: Seventy species of fungi were identified in the water samples and about 56% of the water samples contained culturable fungi. Cladosporium oxysporum, Penicillium spinulosum, and Aspergillus fumigatus were the most common filamentous fungi. Aureobasidium pullulans and Candida parapsilosis were the most common yeasts. Chemical analyses revealed that free residual chlorine was present in 81.8% of the samples within recommended concentrations. Among samples from water purifiers, 92.9% showed low levels of free residual chlorine (<0.2 mg/L). There was no significant association between chlorine concentrations (either within or outside the recommended range) and the presence of filamentous fungi and yeasts. CONCLUSIONS: This study showed that hospital water can be a reservoir for fungi, some of which are potentially harmful to immunocompromised patients. Free residual chlorine was ineffective in some samples.
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Biodiversidade , Fungos/isolamento & purificação , Hospitais Universitários , Microbiologia da Água , Abastecimento de Água , Aspergillus fumigatus/isolamento & purificação , Aspergillus fumigatus/fisiologia , Aureobasidium/isolamento & purificação , Aureobasidium/fisiologia , Biofilmes/crescimento & desenvolvimento , Brasil , Candida parapsilosis/isolamento & purificação , Candida parapsilosis/fisiologia , Cloro/análise , Cladosporium/isolamento & purificação , Cladosporium/fisiologia , Fungos/classificação , Fungos/fisiologia , Humanos , Micoses/microbiologia , Penicillium/isolamento & purificação , Penicillium/fisiologia , Água/análise , Água/químicaRESUMO
OBJECTIVE: To assess the influence of bariatric surgery on transcription factor 7-like 2 (TCF7L2) expression and its association with body mass index (BMI) and Type 2 diabetes mellitus (T2DM). METHODS: Prospective study performed between 2016 and 2018, where 26 obese patients undergoing bariatric surgery were divided into two subgroups: diabetics and non-diabetics. The RNAs were extracted from peripheral blood samples that were obtained from each patient in two different moments: before surgery and after 12 months of follow-up. The relative expression of TCF7L2 was determined according to the delta-Ct method. RESULTS: The linear regression model of BMI x delta-Ct showed a positive correlation (p = 0.037). In the subgroups, an inversely proportional relationship was found between delta-Ct and BMI in the diabetic group and a directly proportional relationship in the non-diabetic group (p>0.05 in both). In the postoperative period, the regression model was similar to the preoperative, except when analyzing the subgroups, where diabetic patients showed a directly proportional relationship (p>0.05). The relative expression of TCF7L2 showed an average of 1.16 ± 0.91, CI-95% 0.79-1.53. There was an increase in relative expression of 48% in the non-diabetic group (p = 0.021), and a decrease of 27% in the T2DM group (p>0.05) in the postoperative. There was a positive correlation between a greater decrease in BMI and increased relative expression (p = 0.027). CONCLUSION: Our results showed that generally, the TCF7L2 expression increase with a decrease in BMI, however, for patients with T2DM, it exhibits an inverse pattern, which is normalized one year after bariatric surgery.
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Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/cirurgia , Obesidade/cirurgia , Proteína 2 Semelhante ao Fator 7 de Transcrição/genética , Redução de Peso , Adolescente , Adulto , Idoso , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Período Pós-Operatório , Estudos Prospectivos , Proteína 2 Semelhante ao Fator 7 de Transcrição/sangue , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: to compare the improvements in lipid profile in patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). METHODS: in a mixed cohort study, we evaluated 334 patients undergoing SG and 178 patients undergoing RYGB at the University Hospital of the Federal University of Pernambuco and at the Real Hospital Português de Beneficência, Recife, PE, Brazil. We measured serum levels of total cholesterol, LDL, HDL and triglycerides preoperatively and at three, six, 12 and 24 months follow-up. RESULTS: the SG group consisted of 58 men and 276 women. In the group submitted to RYGB, there were 64 men and 114 women. The mean age was 37.2±20.5 years in the SG group and 41.9±11.1 years in the RYGB group. The preoperative mean BMI was 39.4±2.6kg/m2 and 42.7±5.8kg/m2 for the SG and RYGB groups, respectively. In the preoperative period, 80% of the patients had at least one abnormality in the lipid profile. Two years after surgery, there was improvement in total cholesterol, LDL, HDL and triglycerides in the group submitted to RYGB. In the group submitted to SG, after two years there was improvement in total cholesterol, HDL and triglyceride levels. CONCLUSION: both techniques resulted in improvements in the lipid profile, but the RYGB was more effective.
OBJETIVO: comparar as melhorias no perfil lipídico de pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). METÓDOS: estudo de coorte misto, em que foram avaliados 334 pacientes submetidos à GV e 178 pacientes submetidos à DGYR no Hospital das Clínicas da Universidade Federal de Pernambuco e no Real Hospital Português de Beneficência, Recife, PE, Brasil. Foram realizadas dosagens séricas de colesterol total, LDL, HDL e triglicerídeos no pré-operatório e com três, seis, 12 e 24 meses de seguimento. RESULTADOS: o grupo submetido à GV foi composto por 58 homens e 276 mulheres. No grupo submetido à DGYR, foram analisados 64 homens e 114 mulheres. A média de idade foi de 37,2±20,5 anos no grupo da GV e de 41,9±11,1 anos no grupo da DGYR. O IMC médio pré-operatório foi de 39,4±2,6kg/m2 e 42,7±5,8kg/m2, para o grupo da GV e da DGYR, respectivamente. No pré-operatório, 80% dos pacientes tinha, no mínimo, uma anormalidade no perfil lipídico. Dois anos após a cirurgia houve melhora do colesterol total, LDL, HDL e triglicerídeos no grupo submetido à DGYR. No grupo submetido à GV, após dois anos houve melhora dos níveis de colesterol total, HDL e triglicerídeos, apenas. CONCLUSÃO: ambas as técnicas resultaram em melhorias no perfil lipídico, porém a DGYR foi mais efetiva.
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Dislipidemias/epidemiologia , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Lipídeos/sangue , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Seguimentos , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prevalência , Resultado do Tratamento , Triglicerídeos/sangue , Adulto JovemRESUMO
RESUMO Objetivo: comparar as melhorias no perfil lipídico de pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). Metódos: estudo de coorte misto, em que foram avaliados 334 pacientes submetidos à GV e 178 pacientes submetidos à DGYR no Hospital das Clínicas da Universidade Federal de Pernambuco e no Real Hospital Português de Beneficência, Recife, PE, Brasil. Foram realizadas dosagens séricas de colesterol total, LDL, HDL e triglicerídeos no pré-operatório e com três, seis, 12 e 24 meses de seguimento. Resultados: o grupo submetido à GV foi composto por 58 homens e 276 mulheres. No grupo submetido à DGYR, foram analisados 64 homens e 114 mulheres. A média de idade foi de 37,2±20,5 anos no grupo da GV e de 41,9±11,1 anos no grupo da DGYR. O IMC médio pré-operatório foi de 39,4±2,6kg/m2 e 42,7±5,8kg/m2, para o grupo da GV e da DGYR, respectivamente. No pré-operatório, 80% dos pacientes tinha, no mínimo, uma anormalidade no perfil lipídico. Dois anos após a cirurgia houve melhora do colesterol total, LDL, HDL e triglicerídeos no grupo submetido à DGYR. No grupo submetido à GV, após dois anos houve melhora dos níveis de colesterol total, HDL e triglicerídeos, apenas. Conclusão: ambas as técnicas resultaram em melhorias no perfil lipídico, porém a DGYR foi mais efetiva.
ABSTRACT Objective: to compare the improvements in lipid profile in patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods: in a mixed cohort study, we evaluated 334 patients undergoing SG and 178 patients undergoing RYGB at the University Hospital of the Federal University of Pernambuco and at the Real Hospital Português de Beneficência, Recife, PE, Brazil. We measured serum levels of total cholesterol, LDL, HDL and triglycerides preoperatively and at three, six, 12 and 24 months follow-up. Results: the SG group consisted of 58 men and 276 women. In the group submitted to RYGB, there were 64 men and 114 women. The mean age was 37.2±20.5 years in the SG group and 41.9±11.1 years in the RYGB group. The preoperative mean BMI was 39.4±2.6kg/m2 and 42.7±5.8kg/m2 for the SG and RYGB groups, respectively. In the preoperative period, 80% of the patients had at least one abnormality in the lipid profile. Two years after surgery, there was improvement in total cholesterol, LDL, HDL and triglycerides in the group submitted to RYGB. In the group submitted to SG, after two years there was improvement in total cholesterol, HDL and triglyceride levels. Conclusion: both techniques resulted in improvements in the lipid profile, but the RYGB was more effective.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Obesidade Mórbida/cirurgia , Derivação Gástrica/estatística & dados numéricos , Dislipidemias/epidemiologia , Gastrectomia/estatística & dados numéricos , Lipídeos/sangue , Período Pós-Operatório , Triglicerídeos/sangue , Brasil/epidemiologia , Índice de Massa Corporal , Prevalência , Seguimentos , Resultado do Tratamento , Gastrectomia/métodos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Pessoa de Meia-IdadeRESUMO
Brain injuries are often associated with the later development of epilepsy. Evidence suggests that morphological and functional changes occur in the remaining neural tissue during a silent (or latent) period in which no seizures are expressed. It is believed that this silent (reorganization) period may provide a therapeutic window for modifying the natural history of disease progression. Here we provide evidence that biperiden, a muscarinic anticholinergic agent, is able to alter disease progression in an animal model of epilepsy. We observed that biperiden was capable of slowing the manifestation of the first spontaneous epileptic seizure and effectively reduced the severity and number of recurrent, spontaneous epileptic seizures during the animals' lifespan. Biomolecular (microdialysis) and electrophysiological (extracellular field recordings) studies determined that biperiden was capable of elevating the threshold of hippocampal excitability, thereby making the hippocampal glutamatergic pathways less responsive to stimuli when high concentrations of potassium were used in vivo or in vitro. Notably, there was no hindrance of long-term memory or learning (a potential problem given the amnestic nature of biperiden). We conclude that biperiden has antiepileptogenic potential and may represent an opportunity for the prevention of post-traumatic epilepsy.
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Biperideno/uso terapêutico , Epilepsia/induzido quimicamente , Epilepsia/tratamento farmacológico , Agonistas Muscarínicos/toxicidade , Antagonistas Muscarínicos/uso terapêutico , Pilocarpina/toxicidade , Potenciais de Ação/efeitos dos fármacos , Animais , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/fisiopatologia , Doença Crônica , Citocinas/metabolismo , Modelos Animais de Doenças , Progressão da Doença , Epilepsia/patologia , Comportamento Exploratório/efeitos dos fármacos , Ácido Glutâmico/metabolismo , Hipocampo/efeitos dos fármacos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Ratos , Ratos Wistar , Ácido gama-Aminobutírico/metabolismoRESUMO
Rats with a neonatal ventral hippocampal lesion (NVHL) have been used to model certain features of schizophrenia because they display dopaminergic activity and behavioral alterations consistent with a dysfunctional prefrontal cortex after puberty. Microdialysis studies in normal rats demonstrated increased prefrontal dopamine release during the incentive phase of behavior in an experimental situation specifically designed to evidence this behavioral aspect: the so called "sensory-specific satiety" procedure. Our hypothesis is that if dopaminergic activity in the prefrontal cortex of NVHL rats differs from sham lesioned rats, the responsiveness to the aforementioned experimental situation should also be different. Extracellular medial prefrontal dopamine outflow increased in hungry control rats when they had access to food and decreased across satiety. It increased again when a new food was presented, even when the rats were satiated. NVHL rats also had increased dopamine prefrontal outflow in these conditions, but it remained high after the end of the consumption period. The food consumption behavior declined less rapidly and the reinstatement of food consumption, usually produced by new food, did not occur in NVHL rats, provided the lesions were large. These data were discussed in relation to several theoretical backgrounds developed about the incentive aspect of behavior and for understanding the pathophysiology of schizophrenia.
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Dopamina/metabolismo , Hipocampo/fisiopatologia , Córtex Pré-Frontal/metabolismo , Resposta de Saciedade/fisiologia , Animais , Animais Recém-Nascidos , Ingestão de Alimentos/fisiologia , Hipocampo/efeitos dos fármacos , Ácido Ibotênico/toxicidade , Microdiálise , Córtex Pré-Frontal/fisiopatologia , Ratos , Ratos Sprague-DawleyRESUMO
Excitation of the mesocorticolimbic pathway, originating from dopaminergic neurons in the ventral tegmental area (VTA), may be important for the development of exaggerated fear responding. Among the forebrain regions innervated by this pathway, the amygdala is an essential component of the neural circuitry of conditioned fear. The functional role of the dopaminergic pathway connecting the VTA to the basolateral amygdala (BLA) in fear and anxiety has received little attention. In vivo microdialysis was performed to measure dopamine levels in the BLA of Wistar rats that received the dopamine D(2) agonist quinpirole (1 µg/0.2 µl) into the VTA and were subjected to a fear conditioning test using a light as the conditioned stimulus (CS). The effects of intra-BLA injections of the D(1) antagonist SCH 23390 (1 and 2 µg/0.2 µl) and D(2) antagonist sulpiride (1 and 2 µg/0.2 µl) on fear-potentiated startle (FPS) to a light-CS were also assessed. Locomotor performance was evaluated by use of open-field and rotarod tests. Freezing and increased dopamine levels in the BLA in response to the CS were both inhibited by intra-VTA quinpirole. Whereas intra-BLA SCH 23390 did not affect FPS, intra-BLA sulpiride (2 µg) inhibited FPS. Sulpiride's ability to decrease FPS cannot be attributed to nonspecific effects because this drug did not affect motor performance. These findings indicate that the dopamine D(2) receptor pathway connecting the ventral tegmental area and the basolateral amygdala modulates fear and anxiety and may be a novel pharmacological target for the treatment of anxiety.