1
|
Mizubuti GB, Ho AMH, Silva LMD, Phelan R. Perioperative management of patients on glucagon-like peptide-1 receptor agonists. Curr Opin Anaesthesiol 2024; 37:323-333. [PMID: 38390914 DOI: 10.1097/aco.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW To summarize the mechanism of action, clinical outcomes, and perioperative implications of glucagon-like peptide-1 receptor agonists (GLP-1-RAs). Specifically, this review focuses on the available literature surrounding complications (primarily, bronchoaspiration) and current recommendations, as well as knowledge gaps and future research directions on the perioperative management of GLP-1-RAs. RECENT FINDINGS GLP-1-RAs are known to delay gastric emptying. Accordingly, recent case reports and retrospective observational studies, while anecdotal, suggest that the perioperative use of GLP-1-RAs may increase the risk of bronchoaspiration despite fasting intervals that comply with (and often exceed) current guidelines. As a result, guidelines and safety bulletins have been published by several Anesthesiology Societies. SUMMARY While rapidly emerging evidence suggests that perioperative GLP-1-RAs use is associated with delayed gastric emptying and increased risk of bronchoaspiration (particularly in patients undergoing general anesthesia and/or deep sedation), high-quality studies are needed to provide definitive answers with respect to the safety and duration of preoperative drug cessation, and optimal fasting intervals according to the specific GLP-1-RA agent, the dose/duration of administration, and patient-specific factors. Meanwhile, clinicians must be aware of the potential risks associated with the perioperative use of GLP-1-RAs and follow the recommendations put forth by their respective Anesthesiology Societies.
Collapse
Affiliation(s)
- Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Leopoldo Muniz da Silva
- Department of Anesthesiology, São Luiz Hospital - Rede D'Or - CMA, Rua Alceu de Campos Rodrigues, São Paulo, SP, Brazil
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| |
Collapse
|
2
|
Borghi M, da Silva LM, Bispo L, Longui CA. A genetic study of a Brazilian cohort of patients with X-linked hypophosphatemia reveals no correlation between genotype and phenotype. Front Pediatr 2023; 11:1215952. [PMID: 37794959 PMCID: PMC10546205 DOI: 10.3389/fped.2023.1215952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Aim X-linked hypophosphatemia (XLH) is the most common inherited form of rickets, and it is caused by pathogenic inactivating variants of the phosphate-regulating endopeptidase homolog X-linked (PHEX) gene. The main purpose of this study is to identify the presence of a genotype-phenotype correlation in a cohort of XLH patients. Methods This is a retrospective study including patients diagnosed with hypophosphatemic rickets, confirmed by clinical, radiological, and laboratory findings. Medical records were reviewed for phenotypic analyses. Genomic DNA was extracted from the peripheral blood lymphocytes, and PHEX sequencing was performed by exomic NGS sequencing. The Wilcoxon rank-sum test and the two-tailed Fisher's exact test were employed for the statistical analyses of this study. Results A total of 41 patients were included in this study, and 63.41% (26/41) of the patients were female. The mutation analyses identified 29.27% missense variants and 29.72% nonsense variants, most of them were considered deleterious (66.41%). Six novel deleterious variants in the PHEX gene were detected in seven patients. The median concentrations of pretreatment serum calcium, phosphorus, and parathyroid hormone (PTH) were not significantly different among patients with different genotypes. An orthopedic surgery due to bone deformity was required in 57.69%. Conclusions Our analysis did not identify any specific genotype as a predictor. No significant genotype-phenotype correlation was found, suggesting that the recognition of subjacent pathogenic mutation in the PHEX gene may have limited prognostic value. Despite this finding, genetic testing may be useful for identifying affected individuals early and providing appropriate treatment.
Collapse
Affiliation(s)
- Mauro Borghi
- School of Medical Sciences Santa Casa SP and Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Hospital São Luiz—Rede D´Or—CMA, Departament of Anesthesiology, São Paulo, Brazil
| | | | - Luciana Bispo
- Laboratório Mendelics, Department of Genetic, São Paulo, Brazil
| | - Carlos A. Longui
- School of Medical Sciences Santa Casa SP and Pediatric Endocrinology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Silveira SQ, Nersessian RSF, Abib ADCV, Santos LB, Bellicieri FN, Botelho KK, Lima HDO, Queiroz RMD, Anjos GSD, Fernandes HDS, Mizubuti GB, Vieira JE, da Silva LM. Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit. Braz J Anesthesiol 2023:S0104-0014(23)00081-7. [PMID: 37562650 DOI: 10.1016/j.bjane.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU). METHODS This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency. RESULTS A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04-0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status. CONCLUSION Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.
Collapse
Affiliation(s)
- Saullo Queiroz Silveira
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Rafael Sousa Fava Nersessian
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Arthur de Campos Vieira Abib
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Leonardo Barbosa Santos
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil; Rede D'Or, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | - Fernando Nardy Bellicieri
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Karen Kato Botelho
- São Luiz Hospital (ITAIM), Rede D'Or, Departamento de Enfermagem, São Paulo, SP, Brazil
| | | | - Renata Mazzoni de Queiroz
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Gabriel Silva Dos Anjos
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | | | - Glenio B Mizubuti
- Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, Canada
| | - Joaquim Edson Vieira
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Cirurgia, Anestesiologia, São Paulo, SP, Brazil
| | - Leopoldo Muniz da Silva
- Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil; Rede D'Or, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
4
|
Silveira SQ, da Silva LM, de Campos Vieira Abib A, de Moura DTH, de Moura EGH, Santos LB, Ho AMH, Nersessian RSF, Lima FLM, Silva MV, Mizubuti GB. Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth 2023; 87:111091. [PMID: 36870274 DOI: 10.1016/j.jclinane.2023.111091] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
STUDY OBJECTIVE Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist used for management of type 2 diabetes and/or obesity. To test the hypothesis that perioperative semaglutide use is associated with delayed gastric emptying and increased residual gastric content (RGC) despite adequate preoperative fasting, we compared the RGC of patients who had and had not taken semaglutide prior to elective esophagogastroduodenoscopy. The primary outcome was the presence of increased RGC. DESIGN Single-center retrospective electronic chart review. SETTING Tertiary hospital. PATIENTS Patients undergoing esophagogastroduodenoscopy under deep sedation/general anesthesia between July/2021-March/2022. INTERVENTIONS Patients were divided into two (SG = semaglutide, NSG = non-semaglutide) groups, according to whether they had received semaglutide within 30 days prior to the esophagogastroduodenoscopy. MEASUREMENTS Increased RGC was defined as any amount of solid content, or > 0.8 mL/Kg (measured from the aspiration/suction canister) of fluid content. MAIN RESULTS Of the 886 esophagogastroduodenoscopies performed, 404 (33 in the SG and 371 in the NSG) were included in the final analysis. Increased RGC was observed in 27 (6.7%) patients, being 8 (24.2%) in the SG and 19 (5.1%) in the NSG (p < 0.001). Semaglutide use [5.15 (95%CI 1.92-12.92)] and the presence of preoperative digestive symptoms (nausea/vomiting, dyspepsia, abdominal distension) [3.56 (95%CI 2.2-5.78)] were associated with increased RGC in the propensity weighted analysis. Conversely, a protective [0.25 (95%CI 0.16-0.39)] effect against increased RGC was observed in patients undergoing esophagogastroduodenoscopy combined with colonoscopy. In the SG, the mean time of preoperative semaglutide interruption in patients with and without increased RGC was 10.5 ± 5.5 and 10.2 ± 5.6 days, respectively (p = 0.54). There was no relationship between semaglutide use and the amount/volume of RGC found on esophagogastroduodenoscopy (p = 0.99). Only one case (in the SG) of pulmonary aspiration was reported. CONCLUSIONS Semaglutide was associated with increased RGC in patients undergoing elective esophagogastroduodenoscopy. Digestive symptoms prior to esophagogastroduodenoscopy were also predictive of increased RGC.
Collapse
Affiliation(s)
- Saullo Queiroz Silveira
- Department of Anesthesiology, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Leopoldo Muniz da Silva
- Department of Anesthesiology, São Luiz Hospital - ITAIM / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | | | | | | | | | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Rafael Souza Fava Nersessian
- Department of Anesthesiology, São Luiz Hospital - ITAIM / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Filipe Lugon Moulin Lima
- Department of Anesthesiology, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Marcela Viana Silva
- Department of Endoscopy, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
| |
Collapse
|
5
|
Silveira SQ, da Silva LM, Gomes RF, de Campos Vieira Abib A, Vieira JE, Ho AMH, de Oliveira Lima H, Bellicieri FN, Camire D, Nersessian RSF, Mizubuti GB. An evaluation of the accuracy and self-reported confidence of clinicians in using the ASA-PS Classification System. J Clin Anesth 2022; 79:110794. [DOI: 10.1016/j.jclinane.2022.110794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
|
6
|
de Oliveira Lima H, da Silva LM, de Campos Vieira Abib A, Tavares LR, Santos DWDCL, de Araújo ACLF, Moreira LP, Silveira SQ, de Melo Silva Torres V, Simões D, Arellano R, Ho AMH, Mizubuti GB. Coronavirus disease-related in-hospital mortality: a cohort study in a private healthcare network in Brazil. Sci Rep 2022; 12:6371. [PMID: 35430625 PMCID: PMC9012947 DOI: 10.1038/s41598-022-10343-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
COVID-19-related in-hospital mortality has been reported at 30.7–47.3% in Brazil, however studies assessing exclusively private hospitals are lacking. This is important because of significant differences existing between the Brazilian private and public healthcare systems. We aimed to determine the COVID-19-related in-hospital mortality and associated risk factors in a Brazilian private network from March/2020 to March/2021. Data were extracted from institutional database and analyzed using Cox regression model. Length of hospitalization and death-related factors were modeled based on available independent variables. In total, 38,937 COVID-19 patients were hospitalized of whom 3058 (7.8%) died. Admission to the intensive care unit occurred in 62.5% of cases, and 11.5% and 3.8% required mechanical ventilation (MV) and renal replacement therapy (RRT), respectively. In the adjusted model, age ≥ 61 years-old, comorbidities, and the need for MV and/or RRT were significantly associated with increased mortality (p < 0.05). Obesity and hypertension were associated with the need for MV and RRT (p < 0.05).
Collapse
|
7
|
Domingues FS, Gayoso MV, Sikandar S, da Silva LM, Fonseca RG, de Barros GAM. Analgesic efficacy of a portable, disposable, and self-applied transcutaneous electrical nerve stimulation device during migraine attacks: A real-life randomized controlled trial. Pain Pract 2021; 21:850-858. [PMID: 34013542 DOI: 10.1111/papr.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/17/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the analgesic efficacy of a portable, disposable, and home self-applied transcutaneous electrical nerve stimulation (TENS) device during migraine attacks. BACKGROUND TENS has been used as a noninvasive treatment for migraine, but there are no reports on the outcomes following use of this treatment option for use at home during migraine attacks. DESIGN AND METHODS A double-blind, randomized controlled trial was conducted over 3 months, with monthly assessments. Active placebos (sham group) were in place and were allocated at a 1:1 ratio. Adult patients who had been diagnosed with migraine by a specialist were included. Pain intensity levels and functional disability were measured before and after the 20-min self-applied TENS intervention during the migraine attacks. RESULTS Seventy-four participants were randomly allocated to the sham and intervention groups. Although both groups of subjects reported lower pain scores, the intervention group showed a statistically significant reduction in pain scores compared to the sham group. CONCLUSION In our controlled trial, the use of a self-applied, TENS device is safe and effective in relieving pain associated with migraine attacks. Participants in the intervention group showed a statistically significant improvement in pain and functional disability scores. TENS has been used as a noninvasive treatment for migraine, but there are no reports on the outcomes following use of this treatment option for use at home during migraine attacks. This double-blind, randomized controlled trial had 2 groups: active-placebo and intervention. Seventy-four participants were randomly allocated. Participants in the intervention group showed a statistically significant improvement in pain and functional disability scores.
Collapse
Affiliation(s)
- Flávia S Domingues
- Surgical Specialties and Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Maisa V Gayoso
- Surgical Specialties and Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Shafaq Sikandar
- Barts and The London School of Medicine & Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Ronaldo G Fonseca
- Neurology Department, Medical School, Sao Paulo State University (UNESP, Botucatu, Brazil
| | - Guilherme A M de Barros
- Surgical Specialties and Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Botucatu, Brazil
| |
Collapse
|
8
|
da Silva LM, Lima HDO, Ferrer R, Ho AMH, Silveira SQ, Abib ADCV, Bellicieri FN, Camire D, Mittermayer O, Botelho KK, Pla Gil AM, Mizubuti GB. Comparison of strategies for adherence to venous thromboembolism prophylaxis in high-risk surgical patients: a before and after intervention study. BMJ Open Qual 2021; 10:bmjoq-2021-001583. [PMID: 34663589 PMCID: PMC8524289 DOI: 10.1136/bmjoq-2021-001583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major cause of perioperative morbimortality. Despite significant efforts to advance evidence-based practice, prevention rates remain inadequate in many centres. OBJECTIVE To evaluate the effectiveness of different strategies aimed at improving adherence to adequate VTE prophylaxis in surgical patients at high risk of VTE. METHOD Before and after intervention study conducted at a tertiary hospital. Adherence to adequate VTE prophylaxis was compared according to three strategies consecutively implemented from January 2019 to December 2020. A dedicated hospitalist physician alone (strategy A) or in conjunction with a nurse (strategy B) overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team approach (strategy C) focused on promoting adequate VTE prophylaxis across multiple stages of care-from the operating room (ie, preoperative team-based checklist) to collaboration with clinical pharmacists in the postoperative period-was implemented. RESULTS We analysed 2074 surgical patients: 783 from January to June 2019 (strategy A), 669 from July 2019 to May 2020 (strategy B), and 622 from June to December 2020 (strategy C). VTE prophylaxis adherence rates for strategies (A), (B) and (C) were (median (25th-75th percentile)) 43.29% (31.82-51.69), 50% (42.57-55.80) and 92.31% (91.38-93.51), respectively (p<0.001; C>A=B). There was a significant reduction in non-compliance on all analysed criteria (risk stratification (A (25.5%), B (22%), C (6%)), medical documentation (A (68%), B (55.2%) C (9%)) and medical prescription (A (51.85%), B (48%), C (6.10%)) after implementation of strategy C (p<0.05). Additionally, a significant increase in compliance with adequate dosage, dosing interval and scheduling of the prophylactic regimen was observed. CONCLUSION Perioperative VTE prophylaxis strategies that relied exclusively on physicians and/or nurses were associated with suboptimal execution and prevention. A multidisciplinary team-based approach that covers multiple stages of patient care significantly increased adherence to adequate VTE prophylaxis in surgical patients at high risk of developing perioperative VTE.
Collapse
Affiliation(s)
| | | | - Ricardo Ferrer
- Nursing, São Luiz Hospital-ITAIM/Rede D'Or-CMA, São Paulo, Brazil
| | - Anthony M-H Ho
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | | | - Daenis Camire
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Otto Mittermayer
- Anesthesiology, São Luiz Hospital-ITAIM/Rede D'Or-CMA Anaesthesia Team, São Paulo, Brazil
| | | | - Andre Mortari Pla Gil
- Anesthesiology, São Luiz Hospital-ITAIM/Rede D'Or-CMA Anaesthesia Team, São Paulo, Brazil
| | - Glenio B Mizubuti
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
9
|
Silveira SQ, da Silva LM, Ho AMH, Kakuda CM, Santos DWDCL, Nersessian RSF, Abib ADCV, de Sousa MP, Mizubuti GB. Orotracheal intubation incorporating aerosol-mitigating strategies by anaesthesiologists, intensivists and emergency physicians: a simulation study. BMJ Simul Technol Enhanc Learn 2021; 7:385-389. [PMID: 35515722 PMCID: PMC7844924 DOI: 10.1136/bmjstel-2020-000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/15/2022]
Abstract
Background Orotracheal intubation (OTI) can result in aerosolisation leading to an increased risk of infection for healthcare providers, a key concern during the COVID-19 pandemic. Objective This study aimed to evaluate the OTI time and success rate of two aerosol-mitigating strategies under direct laryngoscopy and videolaryngoscopy performed by anaesthesiologists, intensive care physicians and emergency physicians who were voluntarily recruited for OTI in an airway simulation model. Methodology The outcomes were successful OTI, degree of airway visualisation and time required for OTI. Not using a stylet during OTI reduced the success rate among non-anaesthesiologists and increased the time required for intubation, regardless of the laryngoscopy device used. Results Success rates were similar among physicians from different specialties during OTI using videolaryngoscopy with a stylet. The time required for successful OTI by intensive care and emergency physicians using videolaryngoscopy with a stylet was longer compared with anaesthesiologists using the same technique. Videolaryngoscopy increased the time required for OTI among intensive care physicians compared with direct laryngoscopy. The aerosol-mitigating strategy under direct laryngoscopy with stylet did not increase the time required for intubation, nor did it interfere with OTI success, regardless of the specialty of the performing physician. Conclusions The use of a stylet within the endotracheal tube, especially for non-anaesthesiologists, had an impact on OTI success rates and decreased procedural time.
Collapse
Affiliation(s)
| | | | - Anthony M-H Ho
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Cláudio Muller Kakuda
- Department of Anesthesia, São Luiz Hospital–Jabaquara/Rede D’Or–CMA, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
10
|
de Sá Oliveira RR, Módolo MP, Mizubuti GB, Ho AMH, de Barros GAM, Muniz da Silva L, Braz LG, Módolo NSP, Day AG, Phelan R, Navarro E Lima LH, Ganem EM. Total Spinal Anesthesia Failure: Have You Assessed the Sensory Anesthesia in Sacral Dermatomes? Anesth Analg 2017; 124:1674-1677. [PMID: 28431427 DOI: 10.1213/ane.0000000000001966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Intrathecal local anesthetic maldistribution is a well-known cause of spinal anesthesia failure (SAF). This could potentially result in sensory blockade restricted to the sacral dermatomes. We sought to determine the overall incidence of SAF and the role of sacral dermatomes in differentiating between total and partial failures. Of the 3111 spinals prospectively examined, 194 (6.2%) were classified as failures. Of the 72 presumed total failures based on the initial assessment, evaluation of the sacral dermatomes revealed sensory blockade in 32 (44%; 95% confidence interval, 32.7%-56.6%). Sacral dermatome assessment after SAF may be important in safely guiding subsequent anesthetic management.
Collapse
Affiliation(s)
- Ronaldo Rodrigo de Sá Oliveira
- From the *Department of Anesthesiology, Botucatu Medical School- Universidade. Estadual Paulista, Botucatu, São Paulo, Brazil; †Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada; ‡Department of Anesthesiology, São Luis Hospital, São Paulo, São Paulo, Brazil; §Department of Critical Care Medicine, Kingston General Hospital Research Institute, Kingston, Ontario, Canada; and ‖Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Mansano AM, Módolo NSP, Silva LMD, Ganem EM, Braz LG, Knabe ADC, Freitas FMD. Bedside tests to predict laryngoscopic difficulty in pediatric patients. Int J Pediatr Otorhinolaryngol 2016; 83:63-8. [PMID: 26968055 DOI: 10.1016/j.ijporl.2016.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric airway management is a priority during anesthesia, critical care and emergency medicine. The purpose of this study is to validate bedside tests that predict airway management difficulty in anesthetized children. METHODS Children under 12 years of age were recruited in a cross-sectional study to assess the value of some anthropometric measures as predictors of laryngoscopic difficulty. The patients were divided into three groups by age. Weight, height, neck circumference, BMI (body mass index), inter incisors distance thyromental distance, sternomental distance, frontal plane to chin distance (FPCD) and the Mallampati index were determined and were correlated with the CML (Cormack & Lehane classification). RESULTS The incidence of difficult laryngoscopy (CML 3 or 4) was 3.58%. Factors that were significantly associated with laryngoscopic difficulty included short inter incisors distance, high FPCD, thyromental distance, sternomental distance and the Mallampati index. The FPCD/weight index exhibited a higher area under the ROC curve than any other variable considered. CONCLUSIONS This study confirms that the FPCD and the FPCD/weight ratio are the most consistent predictors of laryngoscopic difficulty in pediatric patients. For patients over 6 months of age, the IID also correlated with laryngoscopic difficulty. For children who were capable of obeying simple orders, the Mallampati test correlated better with laryngoscopic difficulty than did the Mallampati test with phonation. Our results strongly suggest that skilled professionals should perform airway management in children, especially in patients with a high FPCD or a high FPCD/weight ratio.
Collapse
Affiliation(s)
| | | | | | - Eliana Maria Ganem
- Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil.
| | - Leandro Gobbo Braz
- Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil.
| | | | | |
Collapse
|
12
|
Calistro Neto JP, Torres RDC, Gonçalves GM, Silva LMD, Domingues MAC, Módolo NSP, Barros GAMD. Parecoxib reduces renal injury in an ischemia/reperfusion model in rats. Acta Cir Bras 2015; 30:270-6. [PMID: 25923260 DOI: 10.1590/s0102-865020150040000006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/18/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effect of parecoxib (an NSAID) on renal function by measuring plasma NGAL (serum neutrophil gelatinase-associated lipocalin) levels in an induced-ischemia rat model. METHODS Forty male Wistar rats were randomly assigned to one of four groups: Ischemia (I), Ischemia/parecoxib (IP), No-ischemia (NI), and No-ischemia/parecoxib (NIP). Body weight, mean arterial pressure, heart rate, body temperature, NGAL levels, and renal histology were compared across groups. RESULTS The Ischemia (I) group, which did not receive parecoxib, showed the highest NGAL levels (p=0.001), while the IP group, which received the medication, had NGAL levels similar to those of the non-ischemic (NI and NIP) groups. CONCLUSION Parecoxib resulted in renal protection in this experimental model.
Collapse
|
13
|
Silva LMD, Kakuda CM, Abib ADCV, Fugiwara FY, Lara GFLE, Mazzotta RC, Thon RS, Petri LB, Soares Júnior JBDA, Oliveira DRD, Batista BC. Fatores associados à dor pós-operatória na recuperação pós-anestésica em pacientes submetidos à gastroplastia laparoscópica. Rev dor 2013. [DOI: 10.1590/s1806-00132013000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
14
|
Medeiros TP, Vianna PTG, da Silva LM, de Carvalho LR, Wady GE, Braz LG, Castiglia YMM. Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac. Health (London) 2013. [DOI: 10.4236/health.2013.511a1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Mansano AM, Vianna PTG, Fabris VE, Silva LMD, Braz LG, Castiglia YMM. Prevention of renal ischemia/reperfusion injury in rats using acetylcysteine after anesthesia with isoflurane. Acta Cir Bras 2012; 27:340-5. [DOI: 10.1590/s0102-86502012000400010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/20/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate the effect of N-acetylcysteine, as a renoprotective agent, when administered early after anesthesia induction, against ischemia/reperfusion injury in rats anesthetized with isoflurane. METHODS: Eighteen male Wistar rats weighing > 300g were anesthetized with isoflurane. The internal jugular vein and the left carotid artery were dissected and cannulated. The animals were randomly divided into GAcetyl, receiving intravenous N-acetylcysteine, 300mg/kg, and GIsot, isotonic saline. After 30 minutes, right nephrectomy was performed and the left renal artery was clamped during 45 minutes. The animals were sacrificed after 48 hours and blood samples were taken after anesthetic induction and upon sacrificing of the animals to evaluate blood creatinine. The kidneys were sent for histological analysis. RESULTS: The variation in serum creatinine was 2.33mg/dL ± 2.21 in GAcetyl and 4.38mg/dL ± 2.13 in GIsot (p=0.074). Two animals presented intense tubular necrosis in GAcetyl, compared to 5 in GIsot. Only GAcetyl presented animals free of tubular necrosis (two) and tubular degeneration (one). CONCLUSION: After renal ischemia/reperfusion, the rats which were given N-acetylcysteine presented less variation in serum creatinine and milder kidney injuries than the control group.
Collapse
|
16
|
Guedes Jr FS, Cruz DSD, Rodrigues MMP, Silva LMD, Amorim RL, Vianna PTG, Castiglia YMM. Renal histology and immunohistochemistry after acute hemorrhage in rats under sevoflurane and ketoprofen effect. Acta Cir Bras 2012; 27:37-42. [DOI: 10.1590/s0102-86502012000100007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 11/21/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To investigate the influence of intravenous nonselective cyclooxygenase inhibitor, ketoprofen (keto), on kidney histological changes and kidney cytokines, tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1), levels after hemorrhage of 30% of volemia (three times 10%, intervals of 10 min) in rats. METHODS: Under sevoflurane (sevo) anesthesia, sevo and sevo+keto groups (10 rats each) were instrumented for Ringer solution (5mL/kg/h) administration and mean arterial pressure (MAP) evaluation, plus keto (1.5mg/kg) administration in sevo+keto group in the beginning of anesthesia. Rectal temperature was continuously measured. The baseline data of temperature and MAP were collected at the first hemorrhage (T1), the third hemorrhage (T2) and 30min after T2 (T3). Bilateral nephrectomy was achieved for histology and immunohistochemistry. RESULTS: In both groups, temperature and MAP diminished from initial values. Hypothermia was greater in sevo group (p=0.0002). Tubular necrosis was more frequent in sevo group (p=0.02). The studied cytokines were equally present in the kidneys of both groups. CONCLUSION: Ketoprofen was more protective to the rat kidney in condition of anesthesia with sevoflurane and hypovolemia, but it seems that TNF-α and IL-1 were not involved in that protection.
Collapse
|
17
|
Curtis FG, Vianna PTG, Viero RM, Fiorio PM, Silva LMD, Braz JRC, Oliveira C, Castiglia YMM. Dexmedetomidine and S(+)-ketamine in ischemia and reperfusion injury in the rat kidney. Acta Cir Bras 2011; 26:202-6. [DOI: 10.1590/s0102-86502011000300008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/17/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To investigate blood creatinine and renal histology in rats anesthetized with S(+)-ketamine (keta) or dexmedetomidine (dex) and submitted to kidney ischemia/reperfusion injury (IRI). METHODS: Under intraperitoneal (ip) S(+)-ketamine, 20 male Wistar rats were divided into two groups (n=10): maintenance with iv S(+)-ketamine or dex (keta and dex groups), and submitted to right (R) nephrectomy and left (L) renal artery clamping for 45 min. Blood creatinine was measured before ischemia (T1) and 48h after reperfusion (T2), when L nephrectomy was performed. Histological analysis was performed in all kidneys. RESULTS: Blood creatinine was significantly higher at T2 in both groups, but dex group results were lower than those of keta group. Histological changes: between groups, R kidneys did not differ; there were significant high scores for vascular dilation: keta L kidneys; for vascular congestion, tubular dilation, and necrosis: L kidneys from both groups; for tubular degeneration: keta R kidneys. CONCLUSION: S(+)-ketamine plus IRI were aggressive to rat kidneys, according to histological changes, and dexmedetomidine may have not totally protected the kidneys from these injuries, despite the better results of blood creatinine.
Collapse
|
18
|
da Silva LM, Vianna PTG, Módolo NSP, Braz LG, Castiglia YMM. Enzyme biomarkers of renal tubular injury in arterial surgery patients. Ren Fail 2011; 33:6-10. [PMID: 21219198 DOI: 10.3109/0886022x.2010.536443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to verify whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function in patients submitted to anesthesia for arterial surgery. METHODS Prospective observational study. One hundred and forty-four patients submitted to anesthesia for arterial surgery enrolled consecutively and divided into four groups: G1--diabetes and hypertension; G2--diabetes; G3--hypertension; and G4--without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr), alkaline phosphatase (AP), γ-glutamyltransferase (γGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2). RESULTS Values of γGT, γGT/Ucr, and AP × γGT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m(2)) presented increased γGT/Ucr and AP × γGT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m(2)) presented increased γGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltaγGT, deltaγGT/Ucr, deltaAP/Ucr, and deltaAP × γGT/Ucr. CONCLUSIONS Diabetes, hypertension, and preoperative renal function seem to interfere in tubular enzymuria immediately after surgery in arteriopathic patients. However, when these markers do not increase in postoperative period, renal dysfunction cannot be discarded.
Collapse
Affiliation(s)
- Leopoldo Muniz da Silva
- Department of Anaesthesiology, Botucatu School of Medicine - UNESP, São Paulo State University, Botucatu, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
19
|
Leite F, da Silva LM, Biancolin SE, Dias A, Castiglia YMM. Patient perceptions about anesthesia and anesthesiologists before and after surgical procedures. SAO PAULO MED J 2011; 129:224-9. [PMID: 21971897 PMCID: PMC10896022 DOI: 10.1590/s1516-31802011000400005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 09/17/2010] [Accepted: 04/14/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Anesthesiologist-patient relationships are established preoperatively and intraoperatively. These are opportunities for providing correct information about anesthesia/anesthesiologists, thereby improving outcomes. The aim here was to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions. DESIGN AND SETTING Prospective cross-sectional study using data obtained in 2007-2008, at a tertiary university hospital. METHODS 518 patients aged 16 years or over were interviewed before and after anesthesia exposure. A questionnaire was used to determine patient characteristics and perceptions of anesthesia/anesthesiologists. RESULTS The patients were 16-89 years of age and 59.8% had attended elementary school. 79.1% said that anesthesiologists were specialized physicians. Anesthesiologists' roles were associated with loss of consciousness (35.5% pre-anesthesia; 43.5% post-anesthesia), pain relief (29.7% pre-anesthesia, 31.7% post-anesthesia), vital sign monitoring (17.6% pre-anesthesia, 35% post-anesthesia; P < 0.05); and drug administration (10.8% pre-anesthesia, 43.9% post-anesthesia; P < 0.05). The level of confidence in the physician was rated high (82.2% and 89.8% pre- and post-anesthesia, respectively; P < 0.05) or intermediate (5.8% and 6.6% pre- and post-anesthesia, respectively; P < 0.05). The care provided by anesthesiologists was classified as: elucidating (52.8%), encouraging (52.6%), neutral (10.2%) and careless (0.8%). CONCLUSION Patients' perceptions of anesthesiologists' roles were fairly good, but improvements in this relationship still need to be pursued, to achieve better outcomes. Anesthetic care was important in providing information, confidence and reassurance among patients, regarding their perceptions. Anesthesiologists should not miss opportunities to provide excellent professional care for patients, thereby improving anesthesia outcomes and their image.
Collapse
Affiliation(s)
- Fernanda Leite
- Postgraduate Student of Anesthesiology, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Leopoldo Muniz da Silva
- Postgraduate Student of Anesthesiology, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Sckarlet Ernandes Biancolin
- Undergraduate Student, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Adriano Dias
- PhD. Epidemiologist and Assistant Professor, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| | - Yara Marcondes Machado Castiglia
- MD, PhD. Titular Professor, Department of Anesthesiology, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.
| |
Collapse
|
20
|
Silva AAMD, Silva LMD, Barbieri MA, Bettiol H, Carvalho LMD, Ribeiro VS, Goldani MZ. The epidemiologic paradox of low birth weight in Brazil. Rev Saude Publica 2010; 44:767-75. [PMID: 20835496 DOI: 10.1590/s0034-89102010005000033] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.
Collapse
|
21
|
Abstract
OBJECTIVE Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc.), stress during induction, hypoxemia, airway obstruction, noisy environment, anesthesia duration, child's personality, premedication and type of anesthesia. The purpose of this paper is to discuss the possible causes of postoperative agitation in children, providing a foundation for better methods of identifying and preventing this problem. SOURCES MEDLINE and PubMed were searched using the following words: emergence, agitation, incidence, etiology, diagnosis, treatment, children, pediatric, anesthesia. SUMMARY OF THE FINDINGS This study includes a review of potential agitation trigger factors and a proposal for a standardized diagnostic score system, in addition to measures to improve prevention and treatment. CONCLUSION No single factor can identified as the cause of postoperative agitation, which should therefore be considered a syndrome made up of biological, pharmacological, psychological and social components, and which anesthesiologists and pediatric intensive care specialists should be prepared to identify, prevent and intervene appropriately as necessary.
Collapse
Affiliation(s)
- Leopoldo Muniz da Silva
- Departamento de Anestesiologia, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | | | | |
Collapse
|
22
|
Nascimento MDDSB, Bezerra GFDB, Bandeira Neto AP, Silva LMD, Bezerra JDM, Viana GMDC. Estudo comparativo de anticorpos IgG e IgE antileishmania como marcadores de infecção e doença em indivíduos de área endêmica de leishmaniose visceral, em São Luis, MA. Rev Soc Bras Med Trop 2006; 39:38-42. [PMID: 16501764 DOI: 10.1590/s0037-86822006000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo comparativo de anticorpos IgG e IgE antileishmania como marcadores de infecção e doença em área endêmica de leishmaniose visceral na ilha de São Luis, MA no período de maio de 1999 a maio de 2000. A casuística foi composta de 1.016 menores de 16 anos. Destes, foram randomizados 85 para dosagem de IgE antileishmania pelo ELISA. A prevalência de soropositividade por IgG foi de 17,1% (174 menores) e 0,4% da população evoluiu para leishmaniose visceral doença. A positividade para IgE antileishmania, foi de 43,5% dos 85 indivíduos estudados. Dos 7 casos de calazar no passado analisados, observou-se que todos apresentavam positividade para IgG e 4 (57,14%) permaneciam positivos para IgE, mesmo 7 anos após a cura. Os 3 menores com leishmaniose visceral doença, apresentaram positividade para IgG e IgE antileishmania. A detecção de IgE antileishmania demonstrou ser marcador de infecção para Leishmania chagasi em área endêmica, não sendo entretanto, marcador de doença.
Collapse
|
23
|
Nascimento MDDSB, Souza EC, da Silva LM, Leal PDC, Cantanhede KDL, Bezerra GFDB, Viana GMDC. [Prevalence of infection by Leishmania chagasi using ELISA (rK39 and CRUDE) and the Montenegro skin test in an endemic leishmaniasis area of Maranhão, Brazil]. CAD SAUDE PUBLICA 2006; 21:1801-7. [PMID: 16410865 DOI: 10.1590/s0102-311x2005000600028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A prospective study was undertaken in 1,520 children less than 15 years of age in São José de Ribamar, Maranhão, Brazil, from June 1994 to January 1995, to evaluate the prevalence and characteristics (socioeconomic, environmental, and behavioral) associated with infection by Leishmania chagasi. Montenegro skin test (MST) and enzyme-linked immunosorbent assay (ELISA-rK39 and CRUDE) test were used to detect infection. The statistical analysis used the chi2 test with Yates correction and a p value less than 0.05 was considered statistically significant. Prevalence of infection was 61.7% as measured by MST, 19.4% according to ELISA (rK39), and 19.7% by ELISA (CRUDE). Association was detected between leishmaniasis in the family, water supply, application of insecticide, and infection by L. chagasi using MST. No association with infection by L. chagasi was detected using ELISA rK39 or CRUDE. More effective control measures are needed to reduce prevalence and to detect asymptomatic cases in this high percentage of infected children.
Collapse
|