RESUMO
OBJECTIVES: To analyze the mechanism of acid-base disorders in liver transplant recipients and to examine the relationship between these disorders and the fluids administered during surgery. METHODS: This prospective study in a university-affiliated hospital intensive care unit (ICU) included 52 patients admitted to the ICU from December 2009 to January 2011. We examined the contributions of inorganic ion differences, lactate, unmeasured anions, phosphate, and albumin to metabolic acidosis. In addition to laboratory variables, we collected demographic and clinical data. RESULTS: Metabolic acidosis (standard base excess ≤ -2.0 mmol/L) was identified in 37 (71.2%) patients during the immediate postoperative period. The inorganic ion difference was the main determinant of acidosis, accounting for -6.17 mEq/L of acidifying effect. The acidemia was attenuated mainly by the alkalinizing effect of albumin reduction, which contributed +6.03 mEq/L. There was an inverse proportional relationship between the quantity of saline solution used during surgery and the inorganic ion difference during the immediate postoperative period. CONCLUSIONS: Hyperchloremia is the primary contributor to metabolic acidosis in liver transplant recipients. Possibly the use of chloride-rich solutions increases the incidence of this disorder.
Assuntos
Equilíbrio Ácido-Base , Acidose/etiologia , Substitutos Sanguíneos/efeitos adversos , Hidratação/efeitos adversos , Transplante de Fígado/efeitos adversos , Acidose/sangue , Acidose/fisiopatologia , Adulto , Albuminas/efeitos adversos , Alcalose/sangue , Alcalose/etiologia , Alcalose/fisiopatologia , Biomarcadores/sangue , Cloretos/sangue , Feminino , Gelatina/efeitos adversos , Hospitais Universitários , Humanos , Concentração de Íons de Hidrogênio , Derivados de Hidroxietil Amido/efeitos adversos , Unidades de Terapia Intensiva , Soluções Isotônicas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lactato de Ringer , Cloreto de Sódio/efeitos adversos , Resultado do TratamentoRESUMO
Leptospiras excretadas pela urina podem sobreviver por longos períodos em águas de superfície e solos, na dependência do pH e teor de umidade e de matéria orgânica. Investigou-se a influência do meio ambiente na transmissão da leptospirose em dois rebanhos exclusivos de ovinos (A e C) e dois de ovinos consorciados com bovinos (F e H) da região de Sorocaba, SP, no período de dezembro de 2007 a setembro de 2008. Foram examinadas amostras de soro pela reação de soroaglutinação microscópica; de urina, água e solo pelo cultivo para leptospiras e urina de ovinos pela PCR. Condições edafoclimáticas, pH das águas de superfície e solo, granulometria e permeabilidade do solo foram analisadas. Todos os rebanhos apresentaram pelo menos um animal sororeagente para Leptospira spp. Apenas a PCR de um pool de urina de ovinos (H) foi positiva. Leptospira spp. foi isolada do lago de F. O pH das águas de superfície variou entre 6,0-7,0; e nos solos entre 4,5 e 6,8. Os índices de matéria orgânica em A, C e H variaram de 24 a 35 g/dm3, e 63 g/dm3 em F. A composição do solo de A e F mostrou-se franco-argiloarenosa, C argilosa e H franco-siltosa; como texturas mistas são capazes de manter a umidade, principalmente devido a argila. Diante da presença de animais sororeatores e portanto da circulação de Leptospira spp. nos rebanhos, conclui-se que o ciclo de transmissão é dependente da interação sinérgica e antagônica de muitas variáveis; onde o pastejo num habitat com alto teor de umidade parece ser limitante.
Leptospires excreted by urine are able to survive for long periods in surface water and soil depending on the pH, humidity and organic matter presence. This paper reported the influence of environment conditions on the transmission of leptospirosis in two sheep-only farms (A and C) and two cattle-sheep farms (F and H) from December 2007 to September 2008. Serum samples were examined by microscopic agglutination test; urine, surface water and soil samples were cultured for leptospires, and ovine urine pools were analyzed by PCR. Regional edaphoclimatic conditions, pH of surface water and soil, granulometry and permeability of soil were analyzed. All herds presented at least one reactor to Leptospira spp. Only the PCR of an ovine urine pool of herd H was positive and Leptospira spp. was isolated from the F lake. The pH of water samples ranged from 6.0 to 7.0; while in soil it was around from 4.5 to 6.8. Soil organic matter were 24 to 35 g/dm3 in A, C e H, and 63 g/dm3 in F. Soil samples of A and F showed loamy-clay texture; C had clay soil, and H loamy-silt soil; as mixed compositions are able to maintain the humidity, mainly where clay is present. As the presence of reactors in all herds indicated the contact with Leptospira spp., it was concluded that the cycle of transmission is dependent on the synergistic and antagonistic interaction of many variables; but the close contact of animals grazing in a high humidity habitat seems to be limiting.
Assuntos
Animais , Bovinos , Ovinos/microbiologia , Leptospirose/etiologia , Leptospirose/veterinária , Microbiologia do Solo , Doenças Transmissíveis/veterináriaRESUMO
ABSTRACT Leptospires excreted by urine are able to survive for long periods in surface water and soil depending on the pH, humidity and organic matter presence. This paper reported the influence of environment conditions on the transmission of leptospirosis in two sheep-only farms (A and C) and two cattle-sheep farms (F and H) from December 2007 to September 2008. Serum samples were examined by microscopic agglutination test; urine, surface water and soil samples were cultured for leptospires, and ovine urine pools were analyzed by PCR. Regional edaphoclimatic conditions, pH of surface water and soil, granulometry and permeability of soil were analyzed. All herds presented at least one reactor to Leptospira spp. Only the PCR of an ovine urine pool of herd H was positive and Leptospira spp. was isolated from the F lake. The pH of water samples ranged from 6.0 to 7.0; while in soil it was around from 4.5 to 6.8. Soil organic matter were 24 to 35 g/dm3 in A, C e H, and 63 g/dm3 in F. Soil samples of A and F showed loamy-clay texture; C had clay soil, and H loamy-silt soil; as mixed compositions are able to maintain the humidity, mainly where clay is present. As the presence of reactors in all herds indicated the contact with Leptospira spp., it was concluded that the cycle of transmission is dependent on the synergistic and antagonistic interaction of many variables; but the close contact of animals grazing in a high humidity habitat seems to be limiting.
RESUMO Leptospiras excretadas pela urina podem sobreviver por longos períodos em águas de superfície e solos, na dependência do pH e teor de umidade e de matéria orgânica. Investigou-se a influência do meio ambiente na transmissão da leptospirose em dois rebanhos exclusivos de ovinos (A e C) e dois de ovinos consorciados com bovinos (F e H) da região de Sorocaba, SP, no período de dezembro de 2007 a setembro de 2008. Foram examinadas amostras de soro pela reação de soroaglutinação microscópica; de urina, água e solo pelo cultivo para leptospiras e urina de ovinos pela PCR. Condições edafoclimáticas, pH das águas de superfície e solo, granulometria e permeabilidade do solo foram analisadas. Todos os rebanhos apresentaram pelo menos um animal sororeagente para Leptospira spp. Apenas a PCR de um pool de urina de ovinos (H) foi positiva. Leptospira spp. foi isolada do lago de F. O pH das águas de superfície variou entre 6,0-7,0; e nos solos entre 4,5 e 6,8. Os índices de matéria orgânica em A, C e H variaram de 24 a 35 g/dm3, e 63 g/dm3 em F. A composição do solo de A e F mostrou-se franco-argiloarenosa, C argilosa e H franco-siltosa; como texturas mistas são capazes de manter a umidade, principalmente devido a argila. Diante da presença de animais sororeatores e portanto da circulação de Leptospira spp. nos rebanhos, conclui-se que o ciclo de transmissão é dependente da interação sinérgica e antagônica de muitas variáveis; onde o pastejo num habitat com alto teor de umidade parece ser limitante.
RESUMO
The interest in experimental use of coronary arteries of swine as a stage towards their application in human hearts justifies the need for obtaining a detailed anatomical understanding of those arteries, particularly to evaluate similarities and differences. However, we did not find any citations about anatomical indicators of coronary dominance among swine in the literature. Many authors have used the crux cordis and the origin of the posterior interventricular branch as references for defining three types of pattern in human hearts: right, balanced and left dominance. We used 30 hearts fixed in 10% formalin from male and female Landrace swine aged five to six months, weighing 80 to 110 kg. The branch corresponding to the subsinuosal interventricular sulcus came from the right coronary artery (96.7%) or from both coronary arteries (3.3%). The subsinuosal interventricular branch presented at least one small branch that went beyond the crux cordis. The apical area presented predominance of the paraconal interventricular (left anterior descending) branch in 43.3%, the subsinuosal interventricular branch in 23.3% and presence of both arteries in 33.3%. The left coronary artery emitted 54.5% of the ventricular branches and the right coronary artery 46.5%. Taking the crux cordis and the subsinuosal interventricular branch as references, the arterial pattern in swine hearts is right dominance. The diversity of the apical pattern and the balance in the distribution of ventricular branches do not allow this to be used as an approach in isolation. The similarities between human and swine hearts also apply to the coronary artery pattern.
Assuntos
Vasos Coronários/anatomia & histologia , Sus scrofa/anatomia & histologia , Animais , Circulação Coronária , Vasos Coronários/fisiologia , Feminino , Humanos , Masculino , Especificidade da EspécieRESUMO
INTRODUCTION: Tetanus is still a significant health hazard in developing countries, with high associated mortality. OBJECTIVE: Describe the management of patients with severe tetanus in intensive care units (ICUs), in two different periods. SETTING: ICUs of two general hospitals. DESIGN: Concurrent cohort study. METHODS: Follow-up of all patients hospitalized with the diagnosis of severe tetanus in the ICUs from October 1981 to March 2001. We collected data prospectively, regarding the site of injury, clinical features, frequent clinical and infectious complications, concomitant illnesses, and mortality. The patients were divided into two groups according to the treatment protocol used; before 1993 and after 1993. RESULTS: There were 126 patients in group 1 (93 males) with a mean age of 39.0 +/- 18.8 years. There were 110 patients in group 2 (95 males) with a mean age of 48.4+/-17.8 years. Incubation period, onset period, and symptomatic period were higher in group 2 ( P < or = 0.02). The duration of neuromuscular junction blockade, benzodiazepine administration, mechanical ventilation, and ICU stay were longer in group 2, P < 0.001. Infectious complications were more frequent in group 2 ( P < 0.001). The mortality rate in group 1 was 36.5% and in group 2, 18.0% ( P = 0.002). Mortality was directly associated with symptomatic period, acute renal failure cardiac arrest and hypotension, and inversely associated with onset period in the multivariate analyses. CONCLUSIONS: The reduced mortality in severe accidental tetanus patients in group 2 is probably related to advances in ICU management, despite the higher incidence of infectious complications, which are probably related to the longer ICU stay.
Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Tétano/mortalidade , Acidentes , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Tétano/complicações , Tétano/diagnóstico , Tétano/fisiopatologia , Ferimentos e Lesões/complicaçõesRESUMO
In recent years, the productivity of cotton in Brazil has been progressively decreasing, often the result of the reniform nematode Rotylenchulus reniformis. This species can reduce crop productivity by up to 40%. Nematodes can be controlled by nematicides but, because of expense and toxicity, application of nematicides to large crop areas may be undesirable. In this work, a methodology using geostatistics for quantifying the risk of nematicide application to small crop areas is proposed. This risk, in economic terms, can be compared to nematicide cost to develop an optimal strategy for Precision Farming. Soil (300 cm(3)) was sampled in a regular network from a R. reniformis-infested area that was a cotton monoculture for 20 years. The number of nematodes in each sample was counted. The nematode number per volume of soil was characterized using geostatistics, and 100 conditional simulations were conducted. Based on the simulations, risk maps were plotted showing the areas where nematicide should be applied in a Precision Farming context. The methodology developed can be applied to farming in countries that are highly dependent on agriculture, with useful economic implications.
RESUMO
We report the case of a 42-year-old female with a second recurrence of cardiac myxoma. Her first diagnosis was at the age of 24 years, when cardiac tumors were withdrawn from her right ventricle and left atrium. Her first recurrence was at the age of 36 years, when tumors were removed from the left and right atria, and the right ventricle. Six years later, the patient was admitted to the Hospital das Clínicas de Porto Alegre complaining of sudden dyspnea, dry cough, and pain in the right hypochondrium, which bore no relation to breathing. The transesophageal echocardiography showed a small tumor in the interatrial septum, close to the superior vena cava, and 2 larger tumors in the right ventricle, 1 close to the outflow tract and the other almost completely obstructing the right branch of the pulmonary artery. The patient was referred to surgery, in which myxomas were removed from the right atrium and ventricle with extension to the right pulmonary artery. The postoperative period was uneventful.
Assuntos
Neoplasias Cardíacas/patologia , Mixoma/patologia , Recidiva Local de Neoplasia/patologia , Embolia Pulmonar/complicações , Doença Aguda , Adulto , Feminino , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/cirurgiaRESUMO
Liming is essential in modern agriculture to increase yield and fertilizer efficiency. Generally the addition of lime causes changes in soil chemical attributes. The objective of this study was to verify the trend of such changes in the surface horizons of an Oxisol and an Ultisol of the São Paulo State, Brazil. The attributes studied were: sum of bases, pH in water and KCl N, Al3+, H+, cation exchange capacity (CEC) at pH 7.0 and at soil pH, anion exchange capacity (AEC), extractable phosphate and sulphate, P-adsorption and available Fe, Mn, Zn and Cu. The results indicated that liming increased soil pH, sum of bases, CEC at soil pH and extratable P; decreased the relationship, img src="http:/img/fbpe/sa/v54n12/54n12a1fo1.gif" alt="54n12a1fo1.GIF (252 bytes)" align="top">, Al3+, AEC and extractable SO42-; and caused no change in CEC at pH 7.0, P-adsorption and available micronutrients.
A calagem é essencial na agricultura moderna para aumentar a produtividade das culturas e a eficiência do uso de adubos. A adição de calcário normalmente altera atributos químicos do solo. O objetivo do presente estudo foi verificar algumas dessas alterações no horizonte superficial de um latossolo vermelho-escuro argiloso e um podzólico vermelho-amarelo textura média/argilosa. Os atributos estudados foram: soma de bases, pH em H2O e KCl N, Al3+, H+, capacidade de troca catiônica (CTC) a pH 7,0 e ao pH do solo, capacidade de troca aniônica (CTA), fosfato e sulfato extraíveis, índice de adsorção de P e disponibilidade de Fe, Mn, Zn e Cu. Com os dados obtidos pôde-se concluir que a calagem aumentou o pH, a soma de bases, a CTC a pH do solo e o teor de fósforo extraível; diminuiu o teor de alumínio, a relação img src="http:/img/fbpe/sa/v54n12/54n12a1fo1.gif" alt="54n12a1fo1.GIF (252 bytes)" align="top">, a CTA e o teor de SO42- e não alterou a CTC a pH 7,0, a adsorção de P e o teor de micronutrientes.
RESUMO
Liming is essential in modern agriculture to increase yield and fertilizer efficiency. Generally the addition of lime causes changes in soil chemical attributes. The objective of this study was to verify the trend of such changes in the surface horizons of an Oxisol and an Ultisol of the São Paulo State, Brazil. The attributes studied were: sum of bases, pH in water and KCl N, Al3+, H+, cation exchange capacity (CEC) at pH 7.0 and at soil pH, anion exchange capacity (AEC), extractable phosphate and sulphate, P-adsorption and available Fe, Mn, Zn and Cu. The results indicated that liming increased soil pH, sum of bases, CEC at soil pH and extratable P; decreased the relationship, img src="http:/img/fbpe/sa/v54n12/54n12a1fo1.gif" alt="54n12a1fo1.GIF (252 bytes)" align="top">, Al3+, AEC and extractable SO42-; and caused no change in CEC at pH 7.0, P-adsorption and available micronutrients.
A calagem é essencial na agricultura moderna para aumentar a produtividade das culturas e a eficiência do uso de adubos. A adição de calcário normalmente altera atributos químicos do solo. O objetivo do presente estudo foi verificar algumas dessas alterações no horizonte superficial de um latossolo vermelho-escuro argiloso e um podzólico vermelho-amarelo textura média/argilosa. Os atributos estudados foram: soma de bases, pH em H2O e KCl N, Al3+, H+, capacidade de troca catiônica (CTC) a pH 7,0 e ao pH do solo, capacidade de troca aniônica (CTA), fosfato e sulfato extraíveis, índice de adsorção de P e disponibilidade de Fe, Mn, Zn e Cu. Com os dados obtidos pôde-se concluir que a calagem aumentou o pH, a soma de bases, a CTC a pH do solo e o teor de fósforo extraível; diminuiu o teor de alumínio, a relação img src="http:/img/fbpe/sa/v54n12/54n12a1fo1.gif" alt="54n12a1fo1.GIF (252 bytes)" align="top">, a CTA e o teor de SO42- e não alterou a CTC a pH 7,0, a adsorção de P e o teor de micronutrientes.