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OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

https://doi.org/10.6061/clinics/2021/e3547

Comparative analyses of three swallow species (Aves, Passeriformes, Hirundinidae): Insights on karyotype evolution and genomic organization
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Barcellos, Suziane Alves

; Kretschmer, Rafael

; Souza, Marcelo Santos de

; Costa, Alice Lemos

; Degrandi, Tiago Marafiga

; Lopes, Cassiane Furlan

; Ferguson-Smith, Malcolm A.

; Pereira, Jorge

; Oliveira, Edivaldo Herculano Correa de

; Gunski, Ricardo José

; Garnero, Analía del Valle

Genetics and Molecular Biology

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2020, Volume 43 N. 1 elocation e20190232

Abstract: En | Text: En | PDF: En

Abstract Despite the richness of species in the Hirudinidae family, little is known about the genome organization of swallows. The Progne tapera species presents genetic and morphological difference when compared to other members of the same genus. Hence, the aims of this study were to analyze the chromosomal evolution of three species Progne tapera, Progne chalybea and Pygochelidon cyanoleuca - by comparative chromosome painting using two sets of probes, Gallus gallus and Zenaida auriculata, in order to determine chromosome homologies and the relationship between these species. All karyotypes exhibited 76 chromosomes with similar morphology, except for the 5th, 6th and 7th chromosome pairs in P. cyanoleuca. Additionally, comparative chromosome painting demonstrated the same hybridization pattern in the two Progne, which was similar to the putative avian ancestral karyotype, except for the centric fission in the first pair, as found in other Passeriformes. Thus, these data display a close relationship between the Progne species. Although P. cyanoleuca demonstrated the same fission in the first pair of the ancestral syntenic (GGA1), it also showed an additional chromosomal rearrangement for this species, namely a fusion with a microchromosome in the seventh pair.

https://doi.org/10.1590/1678-4685-gmb-2019-0232 756 downloads

The distribution of 45S rDNA sites in bird chromosomes suggests multiple evolutionary histories
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Degrandi, Tiago Marafiga

; Gunski, Ricardo José

; Garnero, Analía del Valle

; Oliveira, Edivaldo Herculano Correa de

; Kretschmer, Rafael

; Souza, Marcelo Santos de

; Barcellos, Suziane Alves

; Hass, Iris

Genetics and Molecular Biology

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2020, Volume 43 N. 2 elocation e20180331

Abstract: En | Text: En | PDF: En

Abstract The distribution of 45S rDNA cluster in avian karyotypes varies in different aspects, such as position, number of bearer chromosomes, and bearers being macro- or microchromosomes. The present study investigated the patterns of variation in the 45S rDNA-bearer chromosomes of birds in order to understand the evolutionary dynamics of the cluster configuration and its contribution to the evolution of bird karyotypes. A total of 73 bird species were analyzed, including both published data and species for which rDNA-FISH was conducted for the first time. In most birds, the 45S rDNA clusters were located in a single pair of microchromosomes. Hence, the location of 45S rDNA in macrochromosomes, observed only in Neognathae species, seems to be a derived state, probably the result of chromosomal fusion between microchromosomes and distinct macrochromosomes. Additionally, the 45S rDNA was observed in multiple microchromosomes in different branches of the bird phylogeny, suggesting recurrence of dispersion processeses, such as duplications and translocations. Overall, this study indicated that the redistribution of the 45S rDNA sites in bird chromosomes followed different evolutionary trajectories with respect to each lineage of the class Aves.

https://doi.org/10.1590/1678-4685-gmb-2018-0331 929 downloads

Novel insights into chromosome evolution of Charadriiformes: extensive genomic reshuffling in the wattled jacana (Jacana jacana, Charadriiformes, Jacanidae)
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Kretschmer, Rafael

; Souza, Marcelo Santos de

; Barcellos, Suziane Alves

; Degrandi, Tiago Marafiga

; Pereira, Jorge C.

; O’Brien, Patricia C.M.

; Ferguson-Smith, Malcolm A.

; Gunski, Ricardo José

; Garnero, Analía del Valle

; Oliveira, Edivaldo Herculano Correa de

; Freitas, Thales Renato Ochotorena de

Genetics and Molecular Biology

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2020, Volume 43 N. 1 elocation e20190236

Abstract: En | Text: En | PDF: En

Abstract The order Charadriiformes comprises three major clades: Lari and Scolopaci as sister group to Charadrii. Until now, only three Charadriiformes species have been studied by chromosome painting: Larus argentatus (Lari), Burhinus oedicnemus and Vanellus chilensis (Charadrii). Hence, there is a lack of information concerning the third clade, Scolapaci. Based on this, and to gain a better understanding of karyotype evolution in the order Charadriiformes, we applied conventional and molecular cytogenetic approaches in a species belonging to clade Scolopaci - the wattled jacana (Jacana jacana) - using Gallus gallus and Zenaida auriculata chromosome-specific probes. Cross-species evaluation of J. jacana chromosomes shows extensive genomic reshuffling within macrochromosomes during evolution, with multiple fission and fusion events, although the diploid number remains at high level (2n=82). Interestingly, this species does not have the GGA7-8 fusion, which was found in two representatives of Charadrii clade, reinforcing the idea that this fusion may be exclusive to the Charadrii clade. In addition, it is shown that the chromosome evolution in Charadriiformes is complex and resulted in species with typical and atypical karyotypes. The karyotypic features of Scolopaci are very different from those of Charadrii and Lari, indicating that after divergence, each suborder has undergone different chromosome rearrangements.

https://doi.org/10.1590/1678-4685-gmb-2019-0236 797 downloads

Culicidae fauna (Diptera: Culicidae) survey in urban, ecotonal and forested areas, from the Moreno municipality - Pernambuco State, Brazil.
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Silva, Cláudio Júlio da

; Pereira, Sônia Valéria

; Apolinário, Edivaldo José

; Santos, Gilvan Leite dos

; Melo-Santos, Maria Alice Varjal

; Silva, Alexandre Freitas da

; Wallau, Gabriel Luz

; Oliveira, Cláudia Maria Fontes de

Revista da Sociedade Brasileira de Medicina Tropical

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aug 2018, Volume 51 N. 4 Pages 523 - 527

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Mosquitoes are vectors of several pathogens in tropical regions. However, information on Culicidae in the northeast region of Brazil is scarce despite many municipalities having environmental conditions favorable for these insects. METHODS: We collected mosquitoes monthly for one year from urban, ecotonal, and ecological reserve areas in Moreno, Brazil, by using CDC Miniature light traps, aspiration, ovitraps, and liquid suction. RESULTS: We collected 1,401 insects in the Culicidae family. Fifteen species of seven genera of Culicidae were identified and five specimens were identified only at the genus level. CONCLUSIONS: There is a wide diversity of mosquito species in the sampled areas, some of which are important for human health.

https://doi.org/10.1590/0037-8682-0249-2017 872 downloads

Maize kernel size and texture: production parameters, quality of eggs of the laying hens and electricity intake
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Vieira Filho, Javer Alves

; Garcia, Edivaldo Antônio

; Seraphim, Odivaldo José

; Murakami, Elise Saori Floriano

; Molino, Andréa de Britto

; Santos, Graciene Conceição dos

Acta Scientiarum. Animal Sciences

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sep 2015, Volume 37 N. 3 Pages 301 - 306

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O objetivo foi avaliar como os fatores granulometria e textura do milho podem alterar os parâmetros de desempenho produtivo de poedeiras comerciais, bem como o consumo de energia elétrica para moagem dos grãos. Foram utilizadas 384 poedeiras da linhagem Isa Brown com 36 semanas de idade, alojadas em aviário de produção convencional com taxa de lotação de 562,5 cm2 ave-1. Os tratamentos foram distribuídos em delineamento inteiramente ao acaso em esquema fatorial 2 x 3 (texturas de milho: duro e dentado e graus de moagem: fino, médio e grosso), com oito repetições de oito aves por parcela. Os dados foram avaliados com o auxílio do pacote estatístico SISVAR com médias comparadas pelo teste de Tukey a 5% de probabilidade. Foi constatada diferença para o fator textura, em que a textura dura apresentou aumento nas variáveis: consumo de ração e peso dos ovos. As características de qualidade dos ovos demonstraram diferença significativa apenas quanto à cor da gema. Maiores granulometrias consumiram menos energia elétrica durante a moagem. A cultivar de milho duro teve consumo de energia elétrica 31,66% menor comparativamente à cultivar dentado.

The influence of maize corn size and texture on the performance parameters of laying hens and power consumption required for grinding maize corn were evaluated. The experiment was carried out on 384 Isa Brown hens, 36 weeks old, penned in a conventional aviary with 562.5 cm2 bird-1 stocking rate. The treatments were distributed in a completely randomized 2 x 3 factorial design (maize textures: flint and dent; and milling degree: fine, medium and coarse) with eight replicates of eight birds per plot. Data were evaluated with SISVAR and means were compared by Tukey's test at 5% probability. Difference was reported for the variable texture and flint increased the variables feed intake and egg weight. Significant difference in the characteristics of egg quality occurred only for the colorof the yolk. Larger corn sizes consumed less electricity during grinding. The maize flint cultivar had a lower 31.7% power consumption when compared to that of the dent cultivar.

https://doi.org/10.4025/actascianimsci.v37i3.25561 2656 downloads

Avaliação de embriões ovinos provenientes de oócitos submetidos a estresse calórico durante a maturação in vitro
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Santos Junior, Edivaldo Rosas dos

; Chaves, Ricardo Macêdo

; Silva, José Carlos Ferreira da

; Moura, Marcelo Tigre

; Bartolomeu, Cláudio Coutinho

; Gonçalves, Paulo Bayard Dias

; Lima, Paulo Fernandes de

; Oliveira, Marcos Antônio Lemos de

Ciência Animal Brasileira

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sep 2013, Volume 14 N. 3 Pages 360 - 365

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Neste trabalho foi avaliado o efeito do estresse calórico durante a maturação de oócitos sobre a produção in vitro de embriões ovinos. Os ovários foram obtidos em abatedouro e os oócitos colhidos de folículos de 2 a 6 mm de diâmetro. Após seleção, os oócitos, em 10 replicações, foram colocados para maturação in vitro (MIV) durante 24 horas. Os oócitos submetidos ao estresse térmico de 41º C durante 3, 6, 12, 18 e 24 horas foram posteriormente transferidos para completar a MIV a 39 ºC, mesma temperatura utilizada para maturação dos oócitos do grupo controle. O desenvolvimento dos embriões foi determinado nos dias 3, 4, 5 e 8 pós-fecundação. A avaliação da qualidade dos embriões foi efetuada através da contagem total de células coradas pelo DAPI e da determinação do número de blastômeros positivos para apoptose através do teste de TUNEL. Observou-se que o estresse térmico diminuiu (P < 0,05) a capacidade de maturação dos oócitos de acordo com o tempo de exposição à temperatura de 41º C. No grupo de oócitos incubados a 39° C, 70,70% maturou, enquanto que nos grupos expostos ao estresse térmico, apenas 45,28%, 35,17%, 12,30%, 9,74% e 4,60% maturaram, respectivamente, após 3, 6, 12, 18 e 24 horas de incubação. A duração de exposição dos oócitos ao estresse calórico foi inversamente proporcional (P < 0,05) à capacidade de desenvolvimento embrionário e diretamente proporcional (P < 0,05) ao número de blastocistos positivos para apoptose. Todavia, o efeito deletério do estresse térmico sobre a clivagem e os embriões nos estádios de 8 a 16 células e de mórula foi crescente (P > 0,05) somente até 18 horas de incubação. Os resultados permitem concluir que o estresse calórico durante a maturação in vitro de oócitos reduz a quantidade e a qualidade dos embriões ovinos produzidos in vitro determinadas pela alta incidência de apoptose.

The aim of this work was to evaluate the effect of heat stress during oocyte maturation on ovine in vitro embryo production. Ovaries were collected at abattoirs and oocytes retrieved from follicles ranging from 2 and 6 mm in diameter. After selection, all oocytes, in 10 replicates, were placed in in vitro maturation (IVM) during 24 hours. The oocytes were submitted to heat stress at 41º C during 3, 6, 12, 18 and 24 hours and were further transferred to 39º C in order to complete IVM, which was the temperature of maturation of control oocytes. Embryonic development was determined on days 3, 4, 5, and 8 post-fertilization. Embryo evaluation was performed as total cell count by DAPI staining and determination of positive blastomere for apoptosis by the TUNEL assay. We observed that heat stress diminishes (P < 0.05) oocyte maturation capacity in accordance with exposure time at 41º C. In the group of oocytes incubated at 39 ºC, 70.70% matured, while in the groups exposed to heat stress at 41º C, only 45.28%, 35.17%, 12.30%, 9.74% and 4.60% matured after 3, 6, 12, 18 and 24 hours of incubation, respectively. The duration of exposure to heat stress was inversely proportional (P < 0.05) to embryonic developmental capacity and directly proportional (P < 0.05) to the number of blastocysts positive to apoptosis. However, the cleavage rate and embryonic development from 8 to 16 cells and morulae stages were affected by heat stress (P > 0.05) only up to 18 hours of incubation. The results allow the conclusion that heat stress during oocyte in vitro maturation reduces the quantity and quality of ovine embryos produced in vitro determined by the high incidence of apoptosis.

https://doi.org/10.5216/cab.v14i3.17170 1529 downloads

Influência das estações seca e chuvosa na capacidade de desenvolvimento de oócitos e produção in vitro de embriões da espécie caprina
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Chaves, Ricardo de Macêdo

; Santos Junior, Edivaldo Rosas dos

; Neves, Jairo Pereira

; Moura, Marcelo Tigre

; Silva, José Carlos Ferreira da

; Lima, Paulo Fernandes de

; Oliveira, Marcos Antônio Lemos de

Ciência Animal Brasileira

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mar 2013, Volume 14 N. 1 Pages 135 - 142

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivou-se com este estudo determinar a influência das estações seca e chuvosa na maturação de oócitos e produção in vitro (PIV) de embriões na espécie caprina. Os ovários das cabras nas estações seca (outubro a março) e chuvosa (abril a setembro) foram colhidos em abatedouro e transportados ao Laboratório de Biotécnicas da Reprodução da UFRPE. Os complexos cumulus oophorus (CCOs) foram colhidos pela técnica de "slicing" dos folículos entre 2 a 6 mm de diâmetro e selecionados com base na classificação morfológica. Foram realizadas 12 repetições, nas quais os CCOs foram submetidos à maturação, fertilização e cultivo in vitro dos embriões. A média e desvio padrão da taxa de clivagem foi determinada no dia 3 (D-3) e dos embriões que se desenvolveram aos estádios de 8-16 células, mórula e blastocisto foi determinada nos dias 4 (D-4), 5 (D-5) e 8 (D-8) após a fecundação, respectivamente. A quantidade de blastômeros foi determinada com o corante DAPI e os blastômeros positivos para apoptose por meio do teste de TUNEL. A produção de embriões no D-3 e mórulas foram inferiores ao obtido no período chuvoso (P < 0,05). Não apresentaram diferenças (P > 0,05) quanto às fases de maturação, fertilização, cultivo no D-4 e blastocisto. Os embriões produzidos na estação seca apresentaram maior incidência de apoptose (P < 0,05). Nas condições descritas neste estudo, os resultados permitem concluir que as fases iniciais do desenvolvimento embrionário sofrem maior impacto negativo durante a estação seca em protocolos de PIV na espécie caprina.

This study aimed to determine the influence of dry and rainy seasons on oocyte maturation and in vitro production (IVP) of embryos in goats. The ovaries of does in dry (October to March) and rainy season (April-September) were collected at a slaughterhouse and transported to the Laboratory of Biotechnical Reproduction of UFRPE. The cumulus oophorus complexes (COCs) were collected by the technique of slicing of the follicles from 2 to 6 mm in diameter, and selected based on morphologic classification. We used 12 replicates, in which the COCs were submitted to maturation, fertilization and in vitro culture. The cleavage rate was determined on day 3 (D-3) and embryos that developed to 8-16 cells (D-4), morulae (D-5) and blastocyst (D-8) stages after fertilization. The number of blastomeres was assessed with DAPI staining, and the determination of apoptotic blastomeres was performed by TUNEL assay. In the dry season, D-3 embryos and morulae development was lower than that obtained in the rainy season (P<0.05). However, no differences (P>0.05) were observed on oocyte maturation, fertilization, D-4 embryo yield and blastocyst development. Embryos produced during the dry season had a higher incidence of apoptosis on D- 3 and at the morulae stage (P<0.05). Under the conditions described in this study, the results suggest that the early stages of embryonic development suffer greater negative impact during the dry season in IVP protocols in goats.

https://doi.org/10.5216/cab.v14i1.9375 1596 downloads

Miíases humanas por Cochliomyia Hominivorax (Coquerel, 1858) (Diptera, Calliphoridae) em hospitais públicos na cidade do Recife, Pernambuco, Brasil
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Nascimento, Edleuza Maria Ferreira do

; Oliveira, Jaqueline Bianque de

; Paes, Maria José

; Lobo, Andrea de Paula

; Silva, Ana Lúcia Andrade da

; Santos Júnior, Edivaldo Rosas dos

; Leal, Jefferson Luis Figueiredo

; Moya-Borja, Gonzalo Efraim

Entomología y Vectores

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mar 2005, Volume 12 N. 1 Pages 37 - 51

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A ocorrência de miíases humanas causadas pelas larvas de Cochliomyia hominivorax foi registrada pela primeira vez em Recife, Estado de Pernambuco, Brasil. No período de novembro de 1999 a outubro de 2002 foram registrados, em três hospitais da rede pública, 24 casos de miíases em pacientes de ambos os sexos, com idade variando de 08 a 93 anos. As miíases diagnosticadas foram classificadas em cutâneas, orais, anais, auriculares e oculares, sendo os membros inferiores acometidos com maior freqüência (10/24) (41,7%). Em todos os casos, as miíases se desenvolveram em lesões pré-existentes, resultantes de: escoriações de natureza variada (10/24) (41,7%); lesões de origem não identificada (05/24) (20,8%); doenças do sistema circulatório (03/24) (12,5%); neoplasias (02/24) (8,3%); conjuntivite, otite, dermatite e ferida cirúrgica (01/24) (4,2%). Os fatores predisponentes às míiases foram debilidade física e mental, desidratação, higiene corporal inadequada, diabetes, desnutrição, elefantíase, esquizofrenia, alcoolismo, anemia, infestação por piolhos e, fundamentalmente, feridas acidentais.

The occurence of human myiasis caused by larvae of Cochliomyia hominivorax was registered for the first time in Recife, State of Pernambuco, Brazil. From November, 1999 to October, 2002 were registered, in three public hospitals 24 cases of myiasis in human beings, of both sexes, with age varying from 08 to 93 years old. The wounds infested with screwworms observed in these patients were classified as cutaneous, oral, anal, aureal and ocular myiasis. The inferior members were more frequently attacked (10/24) (41.7%) than the other anatomic areas. In all of the cases, the myiasis were established in pre-existent lesions, and the factors that predispose to this disease were: excoriations of varied nature (10/24) (41.7%); no identified lesions (05/24) (20.8%); diseases of the circulatory system (03/24) (12.5%); tumors (02/24) (8.3%); conjunctivitis, auricular infections, dermatitis and surgical wound (01/24) (4.2%). The factors that predispose to be infested by C. hominivoraxwere the physical and mental weakness, dehydration, inadequate corporal hygiene, diabetes, malnutrition, elephantiasis, schizophrenia, alcoholism, anemia, lice infestation and fundamentally accidental wounds.

13283 downloads

10.

Reconstructive surgery of the aortic valve
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Mendonça, José Teles de

; Carvalho, Marcos Ramos

; Costa, Rika Kakuda da

; Barroso, Roberto Cardoso

; Santos, José Edivaldo dos

; Tavares Filho, Sérgio Costa

Brazilian Journal of Cardiovascular Surgery

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dec 2003, Volume 18 N. 4 Pages 364 - 369

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Por falta de um substituto valvar ideal e motivados pelos bons resultados obtidos com a plástica da valva mitral, passamos, a partir de 1990, a encarar, com determinação, também a cirurgia reconstrutiva da valva aórtica. O objetivo deste trabalho é apresentar nossa experiência com este tipo de procedimento. MÉTODO: De janeiro de 1990 a dezembro de 2001, foram realizadas 136 plásticas da valva aórtica. Setenta e cinco (55,1%) pacientes eram mulheres e a idade variou de 4 a 70 anos (x = 23,3 ± 1,16 anos). Todos eram portadores de disfunção valvar de origem reumática, sendo a insuficiência o tipo mais freqüente (108 pacientes-79,4%), seguida pela dupla lesão (16 pacientes - 11,7%) e pela estenose (12 pacientes - 8,8%).Os procedimentos empregados na reconstrução foram: anuloplastia subcomissural em 74 (54,4%) pacientes; comissurotomia em 38 (27,9%); ampliação de cúspide com pericárdio bovino em 17 (12,5%); substituição de uma cúspide em 2 (1,4%); suspensão de cúspide por plicatura em 37 (27,2%) e remodelação do seio de Valsalva em 27 (19,8%). A operação foi realizada apenas na valva aórtica em 57 (41,9%) pacientes e associada em 79 (troca de valva mitral em 12; plástica mitral em 65; revascularização do miocárdio em 1 e comissurotomia pulmonar em 1). RESULTADOS: Três (2,2%) pacientes faleceram na internação e 22 (16,2%) necessitaram de reoperação durante o seguimento (x - 57,7 ± 3,5 meses). CONCLUSÕES: A cirurgia reconstrutiva da valva aórtica é um procedimento seguro, pode ser realizado em um número significativo de pacientes e os resultados são promissores.

OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1%) of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years). Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%), followed by double aortic lesion in 16 (11.7%) patients and stenosis in 12 (8.8%). The surgical techniques used were: subcommissural annuloplasty in 74 (54.4%) patients, commissurotomy in 38 (27.9%), cusp extension with pericardium in 17 (12.5%), substitution of one cusp in 2 (1.4%), cusp suspension by annuloplasty in 37 (27.2%) and Valsalva sinus remodeling in 27 (19.8%). The surgery exclusively involved the aortic valve in 57 (41.9%) patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1). RESULTS: Hospital mortality was 2.2% and 22 (16.2%) patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months). CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

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11.

Avaliação da protamina na neutralização da heparina após circulação extracorpórea
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BARROSO, Roberto Cardoso

; MENDONÇA, José Teles de

; CARVALHO, Marcos Ramos

; COSTA, Rika Kakuda

; SANTOS, José Edivaldo dos

Brazilian Journal of Cardiovascular Surgery

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mar 2002, Volume 17 N. 1 Pages 54 - 60

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A protamina é o antídoto universalmente usado para neutralizar a heparina no final da circulação extracorpórea; porém não existe até o momento consenso sobre uma dose ideal necessária. OBJETIVO: Avaliar a efetividade da neutralização da heparina, com doses variadas de protamina após circulação extracorpórea, com três protocolos diferentes. CASUÍSTICA E MÉTODOS: Foram randomizados prospectivamente 45 pacientes, no período de abril a agosto de 2000, e divididos em três protocolos: I, II e III, com 15 pacientes cada. O protocolo I avalia a neutralização da heparina, com dose de protamina calculada pela dose inicial de heparina. O protocolo II avalia a neutralização da dose total de heparina usada durante a circulação extracorpórea. O protocolo III avalia a neutralização da dose total de heparina mais um reforço de 30% dessa dose, administrada em veia periférica durante 4 horas. RESULTADOS: No protocolo I, 60% dos pacientes tiveram necessidade de reforço da dose de protamina e 20% apresentaram complicações hemorrágicas, necessitando de reoperação. Desses 20%, um paciente foi a óbito e outro apresentou acidente vascular cerebral; 53% dos pacientes do protocolo II tiveram necessidade de reforço da dose de protamina. Os pacientes dos protocolos II e III não apresentaram complicações hemorrágicas nem reoperações. CONCLUSÕES: 1- A dose de protamina para neutralizar a heparina na proporção menor que 1:1 não é suficiente. Os pacientes necessitam de doses de reforço, apresentam mais complicações hemorrágicas e maior necessidade de transfusões. 2 - A neutralização da heparina com dose de protamina na proporção de 1:1 não é totalmente eficaz; 53% dos pacientes necessitaram de doses complementares nas primeiras horas do pós-operatório. 3 - Uma dose adicional de 30% da dose de protamina na proporção de 1:1 em infusão contínua nas primeiras horas do pós-operatório reduz a perda sangüínea e a necessidade de transfusões.

INTRODUCTION: The protamine is the antidote universally used to neutralize the heparin at the end of the cardiopulmonary bypass; however there isn't a consensus about the ideal necessary dosage so far. OBJECTIVE: To evaluate the effectiveness of the neutralization of heparin, with variable dosages of protamine after cardiopulmonary bypass, using three different protocols. MATERIAL AND METHODS: From April to August 2000, 45 patients were randomized prospectively, and divided into three Protocols: I, II e III with 15 patients each. The protocol I evaluates the neutralization of heparin, with dosage of protamine calculated by the initial dosage of heparin. The protocol II evaluates the neutralization of the full dosage of heparin used during cardiopulmonary bypass.The protocol III evaluates the neutrlization of the full dosage of heparin, plus a reinforcement of 30% of this dosage, administered in peripheral vein during four hours. RESULTS: In the protocol I, 60% of the patients had necessity of reinforcement of the dosage of protamine and 20% showed hemorrhagics complications, requiring reoperation. From these 20%, one patient passed away and another had cerebrovascular accident; 53% of the patients of the protocol II had necessity of reinforcement of the dosage of protamine. The patients from protocols II and III didn't have neither hemorrhagics complications nor necessity of reoperation. CONCLUSIONS: 1- The dosage of protamine to neutralize heparin in the proportion less than 1:1, isn't sufficient. The patients that need of doses of reinforcement, have more hemorrhagics complications and greater necessity of blood transfusions. 2 - The neutralization of heparin, with dosage of protamine in the proportion of 1:1 isn't totaly effective; 53% of the pacients needed complementary doses in the frist hours affter surgery. 3 - An additional dose of 30% in the dosage of protame in the proportion of 1:1 in continual infuse in the frist hours after surgery, decreases the loss of blood and the necessity of transfusions.

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