Evaluation of the analgesic effects of diclofenac as a premedication drug in dogs undergoing ovariohysterectomy

Pre-emptive analgesia consists of administering drugs such as opioids and nonsteroid anti-inflammatory drugs. This study aims to evaluate the intraoperative antinociceptive effects of diclofenac administered alone in premedication or combined with morphine along with its potential influence on recovery of dogs undergoing ovariohysterectomy. A total of 34 dogs (ASA I or II) admitted for ovariohysterectomy were randomly allocated into three groups according to the drugs given in premedication: Diclofenac (D) (n = 11), Morphine (M) (n = 13) and Diclofenac-Morphine (DM) (n = 10) groups. Induction and maintenance of anesthesia were standardized in all dogs. To assess intraoperative nociception, the heart rate (HR) and mean arterial pressure (MAP) were recorded during the surgery and at predefined time points: St (steady-state), Cut (cutaneous incision), P1 (first ovarian manipulation), P2 (second ovarian manipulation) and Cerv (cervical manipulation). The dynamic variation of HR (ΔHR) and MAP (ΔMAP) over 2 min was calculated at each time point. After extubation, early quality of recovery was assessed. Compared to St, a significant increase in HR and MAP at P1, P2 and Cerv was shown in all groups. MAP in the M group was lower at St than in the other groups. The dynamic variation of HR (ΔHR) and MAP (ΔMAP) was significantly less important at P2 and Cerv compared to P1 only in the DM group. Also, a better quality of recovery was shown in the D group compared to the M and DM groups. Diclofenac may be considered a suitable premedication drug and a part of a multimodal anesthetic approach in dogs.

Calcium-alkali syndrome as a rare cause of severe hypercalcemia requiring dialysis in early twin gestation

Hypercalcemia is rare in women of child-bearing age, and most cases are due to primary hyperparathyroidism. A 28-year-old woman, 14 weeks pregnant with dichorionic diamniotic twins, presented to hospital with vomiting, muscle cramps, and weakness. She had been taking calcium carbonate for gastric reflux and nausea from 5 weeks of gestation. Investigations revealed severe hypercalcemia, metabolic alkalosis, and renal injury. She was transferred to intensive care, receiving fluid resuscitation and subcutaneous calcitonin followed by dialysis. Investigations revealed suppressed PTH and PTH-related peptide, negative malignancy screening and low vitamin D level. Calcium and renal function quickly normalized and with cessation of calcium carbonate remained normal throughout the rest of pregnancy. Reports of calcium-alkali syndrome causing severe hypercalcemia are scarce, with most cases occurring later in gestation. This case represents a dramatic presentation requiring renal replacement therapy early in twin gestation.

Investigation of flagellates in sandfly guts by microscopic observation

Background

The identification of natural Leishmania infection, observing the location of flagellates in the gut and development stages of promastigotes, helps to incriminate a certain species as vector and to assess the infection risk in host populations, thus contributing with leishmaniasis surveillance.

Objectives

To document with photos, videos and description of the dissection process of sandfly females for observation in their digestive tract of Leishmania infections of Leishmania and Viannia subgenera (suprapillary and peripillary distribution, respectively), to produce a manual to assist in leishmaniasis surveillance actions.

Methods

For the documentation of suprapillary infection, Lutzomyia longipalpis females fed on hamsters infected with Leishmania (L.) infantum and for peripillary infection, Pintomyia fischeri and Nyssomyia neivai fed on hamsters infected with L (V.) braziliensis were used. The dissection of the females was performed at intervals of 12 hours after infectious repast, until completing 120 hours, to observe the different phases of the parasite's evolutionary cycle in the gut.

Results

A manual was produced with description and photos of the entire process, from field sandfly collection, transportation, laboratory maintenance and dissection, as well as the complete cycle of the parasite's evolution inside the vector. Videos were also produce.

Conclusions

This project sought to contribute with the leishmaniasis surveillance as regards the sandfly natural infection investigation by Leishmania to assess the transmission risk of parasites. Although the identification of the Leishmania species depends on molecular techniques, this initial screening may reduce its costs.

Key messages

This study enabled the elaboration of a support manual for technicians from the Entomology laboratory networks. This study enabled with information to identify infected sandflies and thus colaborate with the leishmaniasis epidemiological surveillance programs.

An original knee arthrodesis technique combining external fixator with Steinman pins direct fixation

INTRODUCTION

Knee arthrodesis may be the last possible option for infected total knee arthroplasty (TKA) patients and in revision cases involving severe bone loss and/or extensor mechanism damages. Success in these situations depends on achieving good fixation assembly stability. We report bone fusion results using a fixation technique combining cross-pinning by two Steinman pins with a single-frame external fixator. Remission of infection at long-term follow-up was an additional criteria assessed for those cases initially treated for sepsis.

HYPOTHESIS

This fixation modality improves fusion rates.

PATIENTS AND METHODS

In six of this series of eight patients (mean age: 59 years), surgery was performed in a context of infection: five cases of infected TKA, and one case of septic arthritis. In the other two cases, arthrodesis was respectively indicated for a severe post-traumatic stiffness compounded by extensor system rupture and for a fracture combined to a complete mechanical implant loosening. In three of the six infection cases, arthrodesis was performed as a single-stage procedure. All patients were operated on using the same technique: primary arthrodesis site stabilization by frontal cross-pinning with two Steinman pins, followed by installation of a sagittal external fixator frame. Results were assessed at a mean 8 year follow-up.

RESULTS

All the arthrodeses showed fusion at a mean 3.5 months (range: 2.5 to 6 months) postoperative delay without reintervention. Weight-bearing was resumed at 2 to 3 months. The external fixator was removed at a mean 5.2 months. No recurrence of infection was observed over a mean follow-up of 8.2 years (range: 1 to 15 years). Three complications occurred: one hematoma, managed surgically; one supracondylar fracture treated orthopedically; and one osteitis, managed by surgical curettage.

DISCUSSION

This knee arthrodesis technique proved effective, with no failures in this short series, especially in cases of primary infection. It is a reproducible means of osteosynthesis, with little subsequent morbidity. Fixation in two orthogonal planes seemed to provide the stability required to achieve bone fusion. This assembly avoids internal fixation, which is never risk-free in a context of primary sepsis.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon

OBJECTIVE

This study aims at examining the patterns of 'substance' use in Lebanon among an 'at risk' population, the university students.

METHOD

A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered.

RESULTS

The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%.

CONCLUSION

University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.