RESUMO Avaliamos retrospectivamente os registros de 49 pacientes com 42 aneurismas intracranianos de graus 4 e 5, tratados nas primeiras 72 horas após uma hemorragia subaracnóidea (HSA). Trinta e cinco pacientes (71%) apresentavam grau 4 e catorze (29%) grau 5. Quarenta e dois pacientes (85%) tinham um único aneurisma, seis (12%) tinham dois aneurismas, e um paciente (3%) tinha três aneurismas. Dos 49 pacientes, uma complicação técnica (2%) e uma complicação clínica (2%) ocorreram durante a cirurgia. Vinte e um pacientes (43%) recuperaram-se bem, incluindo sete que tiveram hematomas pós-operatórios que requereram a imediata evacuação do coágulo. Catorze pacientes (29%) tiveram hidrocefalia e submeteram-se à derivação ventrículo-peritoneal; doze pacientes submeteram-se à traqueostomia no pós-operatório, devido a coma e infecção pulmonar. Pacientes com aneurismas de graus 4 e 5, segundo a escala de Hunt & Hess podem submeter-se com sucesso à clipagem dos aneurismas após HSA. Entretanto, as taxas de morbidade e mortalidade ainda são altas, devido à condição clínica precária e à alta incidência de vasoespasmo durante o tratamento.

ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

Abstract: Aflatoxin B1 (AFB1), produced by Aspergillus flavus and Aspergillus parasiticus, is one of the major mycotoxins to affect animal health. AFB1 contamination of aquafeed is widespread, especially in countries with humid, tropical climates. The most applied method for protecting animals against aflatoxicosis is the use of clay minerals. Growth performance, immunosuppressive effects (bactericidal activity, lysozyme activity, albumin/globulin ratio, alternative complement pathway activity, and protein content), and pathology parameters were used to evaluate the response of yellow catfish (Pelteobagrus fulvidraco) to increasing concentrations of AFB1 and test the protective effect of dietary supplementation with a bentonite (dioctahedral montmorillonite) based AFB1 binder. Triplicate groups of yellow catfish with an average weight of 2.0 ± 0.1 g were fed diets containing 0, 200, 500, and 1,000 μg/kg of AFB1 alone, or diets containing 0, 200, 500, and 1,000 μg/kg of AFB1 along with 2 g/kg AFB1 binder, for 12 weeks. Results showed that diets containing increasing amounts of AFB1 had a significantly lower (P = 0.002) survival rate. There was a statistical significant reduction in weight gain, final body weight, and specific growth rate, and an increase in feed conversion ratio (FCR) influenced by the levels of AFB1 in the diet (P < 0.001 for all parameters), as well as increasing protection due to the presence of the binder (P = 0.046, P = 0.014, P = 0.038, and P = 0.485, respectively). The immunosuppressive nature of AFB1 in yellow catfish diets was confirmed through observation of lower bactericidal activity (P = 0.001), lower lysozyme activity (P = 0.006), reduced total protein (P = 0.002), and enhanced albumin/globulin ratio (P = 0.004). Fish fed diets contaminated with AFB1 and supplemented with the AFB1 binder showed better improvement in FCR (P = 0.019). These results indicate that AFB1 has a negative impact on yellow catfish growth and survival rate. The AFB1 binder protected fish from the toxic effects of AFB1.

Resumen: La aflatoxina B1 (AFB1), producida por Aspergillus flavus y Aspergillus parasiticus, es una de las principales micotoxinas que afectan la salud animal. La contaminación de alimentos acuícolas con AFB1 es común, especialmente en países con climas húmedos y tropicales. El método más usado para proteger a los animales contra la aflatoxicosis es el uso de arcillas. Para evaluar la respuesta del bagre amarillo (Pelteobagrus fulvidraco) a concentraciones crecientes de AFB1 y evaluar el efecto protector de una bentonita (montmorillonita dioctaédrica), se analizaron el crecimiento, efectos inmunosupresores (actividad bactericida, relación albúmina/globulina, actividad de la lisozima, actividad de la vía alternativa del complemento y contenido de proteínas) y parámetros patológicos. Grupos triplicados de P. fulvidraco, con un peso promedio de 2.0 ± 0.1 g, fueron alimentados durante 12 semanas con dietas que contenían 0, 200, 500 y 1,000 μg/kg de AFB1 pura, o dietas que contiendan 0, 200, 500 y 1,000 μg/kg de AFB1 junto con 2 g/kg de bentonita. Los resultados mostraron que las dietas con mayores cantidades de AFB1 tenían una tasa de supervivencia significativamente menor (P = 0.002). Hubo una reducción estadísticamente significativa del aumento de peso, el peso corporal final y la tasa de crecimiento específico y un aumento de la tasa de conversión alimenticia debido a los niveles de AFB1 en la dieta (P < 0.001 para todos los parámetros), así como mayor protección por la presencia de la bentonita (P = 0.046, P = 0.014, P = 0.038 y P = 0.485, respectivamente). La naturaleza inmunosupresora de AFB1 en las dietas del bagre amarillo se confirmó mediante la observación de una menor actividad bactericida (P = 0.001), una menor actividad de la lisozima (P = 0.006), una disminución de la proteína total (P = 0.002) y una mayor relación albúmina/globulina (P = 0.004). Los peces alimentados con dietas contaminadas con AFB1 y complementadas con la bentonita mostraron una mejora de la tasa de conversión alimenticia (P = 0.019). Estos resultados indican que la AFB1 tiene un impacto negativo en el crecimiento del bagre amarillo y la tasa de supervivencia. La bentonita protegió a los individuos de los efectos tóxicos de la AFB1.