Dissertations / Theses on the topic 'Blood gas analysi'

East African meso- and mega-herbivores have been a key part of the Earth’s ecosystem for millions of years, but are now at risk of disappearing. To ensure their conservation, operations that involve veterinary immobilization are becoming essential for wild populations. However, capture morbidity remains high, with both short- and longer-term physiological alterations that can result in acute or delayed death. In large-sized herbivores, the size and unique anatomy and physiology contribute to the high susceptibility to capture stress, drugs adverse effects and alterations due to recumbency. On top of this, the limited knowledge in the species-specific physiological response to immobilization and, as a result, the obliged practice of extrapolating drug doses and protocols from similar species, enhances the risk of complications. Improvement in capture methods and drug protocols are advocated, and as such, in order to develop targeted strategies, it is essential to gain a better understanding of the species-specific physiological impact of capture. The general objective of this thesis is to advance the knowledge of the physiological mechanism of capture morbidity, and evaluate strategies for the prevention, detection and treatment of complications arising from opioid-based immobilization of selected species of East African megaherbivores, the giraffe (Giraffa camelopardalis ssp. tippelskirchi and reticulata) and the black rhinoceros (Diceros bicornis ssp. michaeli), and in a large mesoherbivore, the African buffalo (Syncerus caffer). A key factor of this study was the collection of data through an opportunistic approach, whereas the research design was shaped for each of the study species based on targeted needs, thus different specific objectives were pursued for each species. In free-ranging Masai giraffes that were immobilized for a translocation, a combination of etorphine and azaperone was evaluated for physiological and handling safety. Early opioid antagonization – a common procedure performed to reduce etorphine’s respiratory depression – was performed at low doses to assess if it would result in smoother restraint and transport. The protocol produced safe inductions, but variable opioid-related excitement occurred and accounted for metabolic derangement. On the other hand, early antagonization with low dose naltrexone allowed calm restraints, a stable physiological function during the recumbency, and enabled smooth recoveries and loading into the chariot with resulting uneventful transport. No delayed complications or resedation were observed during a two-week post-capture boma monitoring. Although the protocol allowed safe immobilization and transport, the study highlighted that further research on techniques that reduce induction-induced excitement, which poses severe health risks in giraffe capture, is advocated. Building up on the study performed in Masai giraffe, the physiological mechanism of capture morbidity occurring in both vehicle and helicopter darted reticulated giraffes, immobilized with an etorphine-azaperone combination, was investigated in order to detect the predisposing factors for homeostatic alterations and to define and guide prevention strategies. Trends over time in blood gases, selected biochemistry variables and cardio-respiratory function were analyzed following early opioid antagonization, and the use of a non-invasive nasal capnometer was investigated. In the helicopter darted giraffes, severe metabolic alterations were observed as a result of an intense startle response, whereas in vehicle darted giraffes, these were moderate and mainly a result of etorphine-induced excitement. Intense excitement occurred when lower doses of etorphine were administered, whereas higher doses resulted in respiratory depression, severe respiratory acidosis and hypoxemia. Early antagonization produced an improvement over time of gas exchanges, but not of the acid-base status, and resulted in poor immobilization quality. Nasal capnometry proved to be a useful non-invasive monitoring tool for field ventilatory function in giraffes. The severe alterations observed suggest that advances in giraffe immobilization should focus on reducing both opioid-respiratory depression and excitement, and onto providing adequate sedation and analgesia during field immobilizations. In Eastern black rhinoceroses, two intra-anesthetic treatments, butorphanol and oxygen, or doxapram, butorphanol and oxygen - which are routinely administered to improve gas exchanges, but which efficacy has not been investigated yet in the species - were evaluated. The mechanism of physiological alterations resulting from capture was investigated, and nasal capnometry was evaluated for its accuracy in monitoring carbon dioxide. Hypoxemia and severe lactic acidosis, proportional to more intense pre-dart chase, occurred. After the administration of doxapram and butorphanol, the initial hypoxemia and acidosis improved, presumably as a result of increase in ventilation mediated by doxapram; whereas the same values worsened when butorphanol only was administered. This might suggest that, different to other rhinoceroses, increased oxygen consumption is not the primary mechanism of hypoxemia in black rhinoceros. Nasal capnometry was efficient in monitoring carbon dioxide trends, but not accurate in predicting absolute values. Although intra-anesthetic treatment with doxapram partially improved gas exchanges, and post-capture complications did not occur for at least nine months, the severe metabolic and respiratory alterations observed highlight the need of advances in black rhinoceros capture methods that focus on preventing the origin of physiological alterations. The physiological safety of two immobilization protocols, etorphine-azaperone and etorphine- medetomidine-azaperone combinations, was compared in free-ranging African buffalos. The aim was to evaluate if medetomidine’s sparing effect would have allowed to safely decrease etorphine doses, and its adverse respiratory effects, without increasing the risk of excitement or poor immobilization quality. The addition of a low dose of medetomidine allowed to decrease etorphine dose by 30 %, and resulted in quicker and smoother inductions, and significantly improved immobilization quality. Medetomidine reduced the occurrence of tachycardia and respiratory acidosis, but not of hypoxemia. Etorphine-medetomidine-azaperone combination is recommended for buffalo immobilization as it provides greater physiological and handling safety, and can help to reduce the onset of capture stress. The new knowledge acquired within the different studies of this thesis has allowed to detect and evaluate species-specific strategies for the prevention (through knowledge of factors influencing capture morbidity, and improved immobilization protocols), detection (through clinical monitoring) or treatment (intra-anesthetic drugs) of capture and drug complications in large-sized herbivores. Species- specific and intra-specific variation of physiological response to capture stress and drugs were individuated, and hence a species-specific approach needs to be endorsed when capturing large-sized herbivores. Furthermore, based on the new information gained in this thesis, further studies can now specifically focus towards targeting solutions for the specific detected physiological alterations. The advances on immobilization methods resulting from this thesis represents a first step towards the improvement of the safety of immobilization of giraffes, black rhinoceroses and buffalos, and by reducing the risk of occurrence of delayed morbidity, it also contributes to the conservation of these East African large-sized herbivores.

Orientador: Luiz Claudio Nogueira Mendes
Banca: Lina Maria Wehrle Gomide
Banca:fernando Christiano Gabriel Morelli
Resumo: A urolitíase apresenta alta incidência em ovinos confinados, etiologia multifatorial e pode causar prejuízo econômico. O objetivo com o presente estudo foi determinar a capacidade da acidificação urinária utilizando cloreto de amônio em ovinos. Foram utilizados 25 ovinos, machos, com idade de três meses, confinados e divididos aleatoriamente em três grupos: Grupo GC (Controle) (n=5) não recebeu Cloreto de Amônio; Grupo G200 (n=10) (200 mg/kg/PV) de Cloreto de Amônio por 56 dias consecutivos; Grupo G500 (n=10) (500 mg/Kg/PV) de Cloreto de Amônio por 56 dias consecutivos, administrados diariamente por via oral. Os Momentos (M) de colheita de amostras e avaliação clínica foram realizados com intervalo de sete dias, sendo M1 (imediatamente antes do Cloreto de Amônio), M2 (sete dias após) até M9, totalizando 70 dias de confinamento. Foram realizados hemogasometria, concentração sérica de ureia e creatinina e avaliação ultrassonográfica do trato urinário. Na urinálise, houve uma maior incidência de cristais de fosfato amônio magnesiano no início do estudo, com migração para formação de cristais de urato, principalmente no G500, devido à acidificação urinária. Não houve alterações hemogasométricas, na bioquímica sérica, no líquido ruminal ou alterações ultrassonográficas. A acidificação urinária foi obtida e mantida a partir do M7 durante a administração do Cloreto de Amônio no grupo G500, não ocorrendo nos outros grupos de estudo.
Abstract:Urolithiasis has high incidence in confined sheep, multifactorial and may cause economic injury. Our aim was to determine the capacity of urinary acidification using ammonium chloride in sheep. Twenty-five male sheep, aged three months, confined and randomly divided into three groups were used: CG Group (n = 5) did not receive Ammonium Chloride; G200 Group (n=10) (200 mg / kg / LW) of Ammonium Chloride for 56 consecutive days; G500 Group (n=10) (500 mg / kg / LW) of Ammonium Chloride for 56 consecutive days, administered daily orally. Sampling times and clinical evaluation were performed at seven days, with M1 (immediately before Ammonium Chloride), M2 (seven days after) until M9, totaling 70 days of feedlot. Hemogasometry, serum urea and creatinine concentration and ultrasound evaluation of the urinary tract were performed. In the urinalysis, there was a higher incidence of ammonium magnesium phosphate crystals at the beginning of the study, presenting a migration to the formation of urate crystals, mainly in the G500 due to urinary acidification. There were no hemogasometric, serum biochemistry, ruminal fluid or ultrasonographic changes. Urinary acidification was obtained and maintained after M7 during the administration of Ammonium Chloride in the G500 group, not occurring in the other study groups
Mestre

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
This study evaluated the clinical, hematological, biochemical and blood gas responses and the oxidative stress in sheep submitted to hiperacute anemia and subsequently underwent to homologous transfusion with whole blood, either fresh, or stored for 15 or 35 days. Eighteen adult Santa Inez crossbred sheep, males and females, were used, weighing on average 52kg. The animals were submitted to a single phlebotomy to remove 40% of blood volume and equally divided into three experimental groups: G0 - animals receiving fresh blood; G15 receiving blood stored for 15 days; and G35 - receiving blood stored for 35 days. The animals were submitted to clinical examination and blood collection 24 h after induction of anemia (T0), 30 minutes after transfusion (T30), six, twelve, twenty-four, forty-eight, seventy-two and ninety-six hours post-transfusion (T6, T12, T24, T48, T72 and T96, respectively), and eight and sixteen days post-transfusion (T8d and T16d, respectively). The blood bags stored for 35 days showed an increase in K, pCO2, pO2, lactate, plasma hemoglobin and decreased plasma pH, sodium and leukocytes. The sheep transfused from all groups had increased GV, red cell count and total hemoglobin in the T30. The animals of the G35 had higher plasma hemoglobin in T12, a significant decrease in blood pH indicating a mild metabolic acidosis on T96. With respect to oxidative stress, was observed a decreased on catalase values of the G35 at T30, T6, T12 and T24, suggesting the occurrence of hemolysis witch was supported by the concomitant increase in the total bilirubin values at the same periods. Animals that received blood stored for 35 days showed higher alteration on hematological, blood gas, biochemical and oxidative stress parameters
O presente trabalho objetivou avaliar as respostas clínicas, hematológicas, bioquímicas, hemogasométricas e o estresse oxidativo de ovinos induzidos à anemia superaguda e transfundidos com sangue total fresco ou armazenado por dois diferentes períodos (15 e 35 dias). Foram utilizados 18 ovinos, machos e fêmeas, com idade entre 3 e 4 anos, pesando em media 52kg. Os animais foram submetidos a uma única flebotomia para retirada de 40% do volume sanguíneo e divididos em três grupos experimentais, sendo o G0 composto por animais que receberam sangue fresco, G15 e G35 animais que receberam sangue armazenado em bolsas CPDA-1 por 15 e 35 dias, respectivamente. Foi realizado exame clínico e coleta de amostras de sangue 24 horas pós-indução da anemia (T0), 30 minutos pós-transfusão (T30), seis, 12, 24, 48, 72 e 96 horas após à transfusão (T6, T12, T24, T48, T72, T96, respectivamente) e oito e dezesseis dias após à transfusão (T8d e T16d, respectivamente). O sangue armazenado por 35 dias apresentou aumento do potássio, pCO2, pO2, lactato, hemoglobina plasmática e diminuição do pH, sódio e leucócitos. Ovinos transfundidos no T30 apresentaram aumento significativo do VG, hemácias e hemoglobina total. Os animais do G35 apresentaram maiores valores de hemoglobina plasmática no T12 e diminuição do pH sanguíneo, caracterizando leve acidemia metabólica no T96. Com relação ao estresse oxidativo o G35 apresentou redução da catalase no T30, T6, T12 e T24, indicando a ocorrência de hemólise, o que foi corroborado pelo aumento concomitante da bilirrubina. Os animais que receberam sangue armazenado por 35 dias apresentaram maiores alterações hematológicas, hemogasométricas, bioquímicas e oxidativas

Einleitung: Alpakas gehören zu einer Tiergruppe, die in den vergangenen Jahren im Patientengut der Tierärzte immer häufiger anzutreffen ist. Daher ist es von großer Bedeutung, sich mit der Physiologie und Pathologie dieser Tierart zu beschäftigen. Die Versorgung der Neonaten spielt dabei eine große Rolle. Da Alpakacrias, wenn überhaupt, dann erst sehr spät, klinische Anzeichen einer Erkrankung zeigen, ist es für den Untersucher von großem Nutzen, einen Einblick in den Blutgas- und Säure-Basen-Haushalt, sowie Kenntnis von den hämatologischen und blutchemischen Parametern des Neonaten zu erhalten. Des Weiteren bietet die Blutuntersuchung ein wichtiges Hilfsmittel zur Überprüfung der Versorgung mit kolostralen Antikörpern. Ziele der Untersuchungen: Ein Ziel der Untersuchungen war die Erstellung von bisher nicht vorhandenen Referenzwerten für die venöse Blutgasanalyse, die Hämatologie und für einige blutchemische Parameter bei gesunden, lebensfrischen Alpakacrias innerhalb der ersten drei Lebenstage. Des Weiteren sollte in diesem Zusammenhang die Eignung eines mobil einsetzbaren Blutgasanalysegerätes (epoc®, Fa. Alere GmbH, Köln) für die Tierart Alpaka eruiert werden. Hierfür wurden Doppelbestimmungen der Proben mit einem etablierten stationären Blutgasanalysegerät (ABL90 FLEX®, Fa. Radiometer, Kopenhagen) durchgeführt. Tiere, Material und Methoden: In die Studie wurden 20 gesunde neugeborene Alpakacrias integriert. Die Fohlen stammten vornehmlich aus Stuten, die zur Geburtsüberwachung in die Klinik eingestallt wurden, bei anderen handelte es sich um solche, die innerhalb der ersten Lebensstunden wegen vermeintlich verzögerter Tränkeaufnahme vorgestellt worden waren, was sich aber nicht bestätigte. Alle Alpakafohlen wurden nach dem Gießener Vorsorgeschema II für neonatale Equiden klinisch untersucht. Anschließend erfolgte 3-8 Stunden p. n., 24 Stunden p. n. und 72 Stunden p. n. je eine Blutprobenentnahme. Der erste Analysezeitpunkt wurde bewusst nicht unmittelbar post natum gewählt, da die Etablierung einer stabilen Prägungsphase zwischen Muttertier und Cria nach der ersten Tränkeaufnahme abgewartet werden sollte. Die Blutentnahme erfolgte nach Reinigung und Desinfektion aus der ungestauten V. jugularis externa im Bereich des sechsten Halswirbels. Die Blutgasanalyse wurde innerhalb von 15 Minuten mit den zuvor genannten Blutgasautomaten durchgeführt. Die hämatologischen Parameter wurden mit dem pocH-100 iV (Fa. Sysmex Deutschland GmbH, Norderstedt) bestimmt, die blutchemischen Untersuchungen erfolgten mit dem FUJI DRI CHEM 3500 (Fa. Sysmex Deutschland GmbH, Norderstedt). Insgesamt wurden 55 Blutproben entnommen und analysiert. Pro Analysegerät (epoc®, ABL90 FLEX®, pocH-100 iV, FUJI DRI-CHEM 3500) wurden je 55 Messungen durchgeführt. Die statistische Auswertung erfolgte mit dem Programm IBM SPSS Statistics 22.0. Die Normalverteilung wurde mittels Shapiro-Wilk-Test überprüft. Für den Gerätevergleich (epoc®/ABL90 FLEX®) fand der Wilcoxon-Test Anwendung. Der Vergleich der Zeitpunkte erfolgte über den Friedman-Test für verbundene Stichproben. Des Weiteren wurden für die einzelnen Parameter der Median und die Perzentile, bzw. der Mittelwert und die Standardabweichung bestimmt. Die grafische Darstellung erfolgte mit Boxplots und Bland-Altman-Plots. Ergebnisse: Im Gerätevergleich konnte insgesamt auf eine gute Übereinstimmung der Messwerte geschlossen werden. Signifikante und gleichzeitig klinisch relevante Unterschiede gab es lediglich bei der Bestimmung der Sauerstoffsättigung und des Hämatokrits, was auf unterschiedliche Mess- und Berechnungsmethoden bei den Geräten zurückzuführen ist. So liegen die Hämatokritwerte beim epoc® deutlich unter denen vom ABL90 FLEX®. In diesem Zusammenhang wichtig für die Interpretation der Ergebnisse ist, dass für jedes Messgerät die individuellen Referenzbereiche berücksichtigt werden müssen. Die venöse Blutgasanalyse ergab für gesunde Crias zu Beginn des ersten Lebenstages einen pH-Wert von 7,34 – 7,40, einen Sauerstoffpartialdruck (pO2) von 21,6 – 29,2 mmHg, einen Kohlendioxidpartialdruck (pCO2) von 37,3 – 46,0 mmHg, eine Sauerstoffsättigung (sO2) von 30,5 – 48,0 %, ein aktuelles Bikarbonat (HCO3-) von 21,3 – 25,1 mmol/l, eine Standardbasenabweichung (SBE) von -3,3 – 0,2 mmol/l und einen Laktatgehalt von 1,6 – 3,4 mmol/l. Der pH Wert ähnelte im Verlauf dabei dem von Kälbern und Lämmern gleichen Alters, der pO2 war insgesamt etwas niedrig, aber konstant und ähnelte über den Messzeitraum dem von Kälbern. Es wurden bei den Crias im Vergleich zu Fohlen, Kälbern und Lämmern niedrigere pCO2-Werte festgestellt. Die Sauerstoffsättigung ähnelte der von Equidenfohlen, über den Messzeitraum fällt die Konzentration im Mittel geringfügig ab, bei den anderen Vergleichstierarten steigt sie an. Die Glukosekonzentrationen waren postnatal höher als bei anderen Haustierneonaten (3-8 h p.n.: 4,4 – 8,2; 24 h p.n.: 7,3 – 12,8; 72 h p.n.: 7,3 – 16,2 mmol/l). Laktat kann nicht, wie es beim Equidenfohlen postuliert wird, als Indikator für den Gesundheitszustand eines Alpaka-Crias genutzt werden. Hämatologisch sind die spezielle Form und die hohe Anzahl der Alpakaerythrozyten, die hohe Zahl an Leukozyten und Thrombozyten (speziell bei den Crias), sowie die hohe MCHC zu nennen. Schlussfolgerungen: Es konnten teilweise bisher fehlende Daten zur venösen Blutgasanalyse für die Beurteilung der Stoffwechsellage neugeborener Alpakacrias etabliert werden. Das mobile Blutgasgerät epoc® stellt eine für die Anwendung geeignete Alternative dar.

This thesis critically examines dominant conceptualizations of safety crimes – offences by corporations that seriously injure and kill workers – within the Alberta oil and gas industry. Using critical discourse analysis, and relying on and Foucaultian and Marxist literatures, the thesis critically examines the extent to which government fatality reports, workplace safety education campaigns and court decisions characterize safety crimes primarily as ‘accidents’ caused by ‘careless’ workers. Two main discourses were found: first, workers were responsibilized, effectively blamed for their own injury and death in the workplace while employers were characterized as largely good and law-abiding; second, serious injury and death was (re)conventionalized as the regrettable but largely unintentional and unavoidable side effect of capitalist production. In the process, the underlying causes of safety crimes, including weak and under-enforced laws and a socio-economic context that prioritizes profits over worker safety, remain untouched.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A composição mineral da dieta influencia as características da urina de gatos, estando envolvida no desenvolvimento e prevenção de urolitíases. O excesso de bases (EB) do alimento possui alta correlação com o pH urinário de gatos. Este pode ser calculado a partir da determinação da composição de macroelementos ou de aminoácidos sulfurados contidos na dieta. Em um primeiro estudo comparou-se fórmulas publicadas para estimar o EB do alimento e o pH urinário de gatos, avaliando a influência do enxofre e dos aminoácidos sulfurados sobre os cálculos, e verificou a relação entre o EB do alimento e parâmetros hemogasométricos. Em outro estudo foram avaliados os efeitos da adição de sais aniônicos acidificantes e de sais catiônicos alcalinizantes em dietas para felinos, com o objetivo de se validar as equações de estimação do pH urinário desenvolvidas no estudo anterior, demonstrar a eficácia desses sais, bem como verificar possíveis perturbações no equilíbrio ácido-básico dos animais decorrentes destas modificações na composição da dieta. Os gatos permaneceram em gaiolas metabólicas durante sete dias de adaptação à dieta, seguidos por três dias de coleta total de urina. Durante a coleta, a urina produzida em cada período de 24 horas teve aferida seu volume, densidade e pH. O equilíbrio ácido-básico foi estudado pela hemogasometria de sangue venoso. Amostras de sangue foram coletadas às 8:00hs (antes do fornecimento do alimento) e 6 horas depois do fornecimento, após 10 dias de adaptação ao alimento. No primeiro estudo o pH urinário variou entre 5,83±0,09 e 7,74±0,13. O EBS entre –185 e 309 mEq/kg MS e EBaa entre -49 e 377 mEq/kg MS. A diferença média de -115 mEq/kg entre EBS e EBaa foi observada. O pH urinário apresentou alta correlação com o EBS (r=0,95; p<0.0001) e EBaa (r=0,86; p<0.0001)...
Food mineral composition influences the characteristics of cat’s urine and is involved in the development and prevention of urolithiasis. Food base excess (BE) has a high correlation with cat urinary pH. BE can be calculated utilizing only macroelements or using sulfur amino acids (methionine and cistine) instead of total sulfur. In the first chapter compared published formulas to estimate food BE and urinary pH of cats, evaluated the influence of total sulfur and sulfur amino acids on BE calculations, and verified the relationship between food BE with cat blood gases analysis. In other chapter, effects of acidifying and alkalizing additives on cats food were evaluated, so that: 1. the urinary pH prediction equations developed on chapter 2 could be validated, 2. mineral salt efficacy could be demonstrated, 3. potential acid base alterations caused by the additives used on the cat’s food could be verified. Cats were housed in metabolic cages and fed during a seven days adaptation phase followed by three days of total urine collection. Urine was collected in plastic bottles conserved in ice under the cage funnel. Each 24-h of produced urine were pooled by cat and analyzed for density, volume and pH. Cat’s acidbasic status was studied by blood gas analysis of venous blood. Blood samples were collected at 8:00h (pre feeding) and 6 hours after meal, after 10-days of food adaptation. In the first chapter pH of cats varied in the interval of 5.83±0.13 (mean±SD) and 7.74±0.12. Food BEs varied between –185 and 309 mmol/kg DM, and food BEaa between -49 and 377 mmol/kg DM. A mean difference of -115 mmol/kg between EB1 and EB2 was observed Urine pH has high correlations with food BEs (r=0.95; p<0.0001) and BEaa (r=0.86; p<0.0001). In the second chapter Alkalizing additives: urinary pH of cats varied in the interval of 5,60±0,07 a 6,15±0,06 (p<0,0005)... (Complete abstract click electronic access below)

A monitorização após o parto é necessária a manutenção da vida nos bezerros clonados. É imperativo que os protocolos e procedimentos, bem como a avaliação clínica dos sistemas cardiovascular e respiratório sejam aprimorados para a sobrevida dos clones. As avaliações que permitam averiguar a capacidade de oxigenação dos pulmões são de crucial importância na assistência ao neonato, sendo que para essa finalidade tem-se recomendado a utilização da hemogasometria. O estudo foi dividido em quatro capítulos, sendo o 1 º Capítulo: Comparação das diferenças da adaptação neonatal de bezerros da raça Nelore(n=10) e de bezerros da raça Holandesa(n=10) nas trocas gasosas e nos parâmetros hemodinâmicos obtidos por meio do cateter de Swan-Ganz, o 2 º Capítulo: Avaliação da hemodinâmica e da hemogasometria de bezerros clonados(n=3), e o 3º Capítulo: Relato da utilização da ventilação mecânica não invasiva - modo CPAP- no tratamento de hipóxia neonatal em 10 bezerros e o 4º Capítulo: Avaliação hemodinâmica e hemogasométrica de bezerros neonatos com distúrbios respiratórios submetidos a ventilação mecânica não invasiva com mascara facial modo ventilatório CPAP (n=12). O objetivo deste trabalho será padronizar a utilização de ventiladores em bezerros neonatos dando o suporte respiratório necessário, avaliando hemodinâmicas da pressão da artéria pulmonar, freqüência cardíaca, débito cardíaco por meio da utilização do cateter de Swan-Ganz, a hemogasometria de sangue arterial para avaliação dos distúrbios respiratórios e obtenção dos valores de normalidade dos parâmetros, além de conhecer a adaptação neonatal das raças Nelore e holandesa. Foram determinadas média pressão artéria pulmonar, pressão artéria pulmonar ocluída, pressão ventrículo direito, pressão átrio direito, temperatura, pH, pCO2, pO2, HCO3, BE, SO2. Os animais foram ventilados modo CPAP- ventilação mecânica não invasiva com mascara facial com pressão positiva no final da expiração(PEEP).
Monitoring after calving is required for the maintenance of life in cloned calves. It is imperative that protocols and procedures, as well as the clinical assessment of cardiovascular and respiratory systems are improved for the survival of clones. Evaluations in order to verify the oxygenation capacity of lungs are crucial in neonatal care, and for this purpose has recommended the use of blood gas analysis. The study was divided into four chapters, the 1st chapter: Comparison of differences in neonatal adaptation of Nellore calves (n = 10) and Holstein calves (n = 10) in gas exchange and hemodynamic parameters obtained by through the Swan-Ganz, the 2nd Chapter: hemodynamic evaluation and blood gas analysis of cloned calves (n = 3), and the 3rd Chapter: Reporting the use of noninvasive mechanical ventilation - CPAP- in the treatment of neonatal hypoxic 10 calves and Chapter 4: hemodynamic evaluation and hemogasometric of newborn calves with respiratory disorders underwent noninvasive ventilation with face mask ventilation mode CPAP (n = 12). The purpose of this study is to standardize the use of mechanical ventilators in newborn calves giving the required respiratory support, evaluating hemodynamic pulmonary artery pressure, heart rate, cardiac output by using of the Swan-Ganz catheter, arterial blood gas analysis to evaluation of respiratory disorders and obtaining the parameters normal values, and know the neonatal adaptation of Nellore and Hostein Frisian races. They were determined means of pulmonary artery pressure, pulmonary artery wedge pressure, right ventricular pressure, right atrial pressure, temperature, pH, pCO2, pO2, HCO 3, BE, SO 2. The animals were ventilated CPAP- noninvasive ventilation mode with face mask with positive pressure at the end of expiration (PEEP)

Com o avanço de novas biotécnicas da reprodução (TE, FIV e Clonagem), exige-se o controle mais acurado da gestação e do parto, em razão dos problemas obstétricos decorrentes do nascimento de produtos com crescimento exacerbado ou com menor vitalidade por disfunções placentárias. Desta forma, a redução da mortalidade neonatal justifica-se por acompanhar o aprimoramento na área, visando ao bem-estar materno e neonatal, como também aos interesses do mercado pecuário. As distocias podem comprometer o fluxo sangüíneo materno-fetal e a ocitocina utilizada como agente ecbólico nas atonias uterinas pode aumentar o estresse do parto. Os objetivos deste estudo foram: identificar alterações do escore Apgar de vitalidade neonatal, temperatura corpórea, hemogasometria arterial, glicemia e cortisol ao nascimento e 1 hora pós-parto de neonatos nascidos em distintas condições obstétricas e verificar modificações da pressão arterial (PA), freqüência cardíaca, eletrocardiograma, glicemia e cortisol de vacas no pré-parto, intra-parto, pós-parto imediato e após 1 hora. Foram utilizadas 30 fêmeas bovinas e 30 bezerros da raça Holandesa subdivididos em: Grupo Eutocia (G EUT; n=10); Grupo Distocia com extração fetal forçada moderada a intensa (G DIST; n=10) e Grupo Atonia ou hipotonia uterina com infusão de Ocitocina (50UI) (G OCT; n=10). As vacas apresentaram hiperglicemia de estresse apenas 1 hora pós-parto no G EUT e G OCT, no entanto, já no intra-parto no G DIST. A distocia também elevou os níveis de cortisol no pós-parto imediato. Houve acréscimo significativo da PA no intra-parto do G DIST, decorrente de contrações uterinas e abdominais mais intensas. Os traçados eletrocardiográficos denotaram ritmo sinusal normal em todos os períodos. Os resultados demonstram adaptação hemodinâmica materna frente às alterações do parto, mesmo com infusão exógena de ocitocina. Os neonatos do G DIST ao nascimento apresentaram menor vitalidade (escore Apgar) e maior estresse (nível de cortisol) em relação aos demais grupos. Os bezerros apresentaram normotermia, a despeito da redução da temperatura corpórea 1 hora pós-parto, e mantiveram-se normoglicêmicos. Ainda, os valores de base-excess, HCO3- e pO2 eram baixos, enquanto os níveis de Anion-gap e pCO2, elevados. No entanto, apenas no G DIST observou-se acidose mista (metabólica e respiratória) evidente (pH<7,20), indicando maior grau de sofrimento fetal e redução do suprimento sangüíneo durante o parto. Os bezerros do G OCT apresentaram pCO2 superior e pO2 inferior aos demais grupos ao nascimento. A infusão de ocitocina pode promover padrões de contração uterina diferenciados, comprometendo ainda mais a oxigenação fetal. A ocitocina alterou momentaneamente as variáveis hemodinâmicas maternas com possível efeito bradicárdico e hipotensor intra-parto, promovendo menor adaptabilidade respiratória neonatal e, portanto, impondo assistência mais criteriosa ao nascimento. Todos os bezerros apresentaram reduzidos valores de hematócrito e hemoglobina, em decorrência da eritropoiese imatura e intensa metabolização de eritrócitos fetais. Após 60 minutos de vida, os bezerros apresentaram recuperação satisfatória do desequilíbrio ácido-base e capacidade evidente de termorregulação e manutenção glicêmica. A condição obstétrica ao nascimento é crítica para o desempenho clínico do neonato, comprometendo sua vitalidade inicial e influenciando a circulação materno-fetal nos casos de distocias. As alterações circulatórias maternas ocasionadas pela ocitocina são consideradas momentâneas, reversíveis e não comprometeram o êxito neonatal.
The novel reproductive biotechnologies (ET, IVF and Cloning) require more accurate control of pregnancy and parturition, due to obstetrical problems as a result of the large offspring syndrome or reduced calf vitality associated with placental anomalies. Hence, the reduction in neonatal mortality is justifiable as research in this area progresses, aiming maternal and neonatal well-being and livestock economic concernment. Dystocia may compromise dam-fetal blood flow and induces severe hypoxia at birth. Oxytocin employed as ecbolic treatment for uterine inertia can enhance calving stress. Therefore, the aims of this study were to identify abnormalities in neonatal Apgar score, body temperature, arterial blood gas analysis, glucose and cortisol assay at birth and after 1 hour of calving under distinct obstetrical conditions and to verify the changes on blood pressure (BP), heart rate, electrocardiogram record, glucose and cortisol assay of cows during the first stage of labor, intra-partum, immediately after calving and 1 hour later. Thirty Holstein cows and 30 Holstein calves were grouped according to the obstetrical condition into: Eutocia Group (EUT G; n=10); Dystocia Group with mild to severe obstetric assistance (DIST G; n=10) and Uterine Inertia Group treated with oxytocin (50UI) (OCT G; n=10). EUT G and OCT G cows showed stress-induced hyperglycemia 1 hour after calving. On the other hand, DIST G presented hyperglycemia yet during intra-partum. Dystocia also increased cortisol levels shortly after calving. During labor, DIST G presented significantly higher BP, due to uterine and abdominal strengthened contractions. Electrocardiogram recordings denoted normal sinus rhythm at all time points. DIST G neonates presented lower vitality (Apgar score) and higher stress (cortisol level) at birth compared to other groups. Calves were normothermic, despite the significative decrease in body temperature after 1 hour of birth, and remained normoglycemic. Moreover, base-excess, HCO3- and pO2 results were low, while Anion-gap and pCO2 were high, comparing to standard values. However, mixed acidosis (metabolic and respiratory; pH<7,2) was only noticeable in DIST G, suggesting higher fetal distress during calving and reduced blood supply (oxygenation). In addition, OCT G calves presented increased pCO2 and decreased pO2 at birth. Oxytocin infusion may cause a distinct pattern of uterine contraction, compromising neonatal hypoxia even more. The oxytocin infusion altered transitorily the maternal hemodynamic variables with a possible bradicardiac effect and intrapartum hypotension, causing lower neonatal respiratory adaptability, demanding more intensive care at birth. All newborns showed low hematocrit and hemoglobin concentration due to immature erythropoiesis and intense fetal erythrocyte metabolism. The present results indicate full maternal adaptation to labors requirement. Calves showed stark acid-base recovery during the critical period of adaptation to ex utero life, with also evident thermoregulation and glucose maintenance 1 hour after birth. The obstetrical condition presented at birth was determinant to neonatal clinical demeanor. Dystocia mainly compromised blood flow and oxygen supply and ultimately interfered with newborn vitality. Ponctual maternal circulatory alterations caused by oxytocin infusion were reversible and did not compromise neonatal outcome.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A composição de macroelementos da dieta influencia o equilíbrio ácido básico e as características da urina de cães, contribuindo tanto para o desenvolvimento como prevenção de urolitíases. O experimento 1 teve por objetivo comparar fórmulas para estimar o excesso de bases (EB) do alimento, avaliando a influência do enxofre e dos aminoácidos sulfurados sobre estes cálculos e o equilíbrio ácido-basico de cães. O segundo e terceiro estudo objetivaram avaliar, respectivamente, os efeitos da adição de sal catiônico (citrato de potássio em duas doses, 150mEq/kg e 300mEq/kg de dieta) e compostos aniônicos (hexametafosfato de sódio, metionina e sulfato de amônio, em duas doses cada um, -150mEq/kg e -300mEq/kg) em dietas para cães. Os cães permaneceram em gaiolas metabólicas durante cinco dias de adaptação à dieta, seguidos por três dias de coleta de urina total. Durante a coleta, a urina produzida em cada período de 24 horas teve seu volume, densidade e pH aferidos. O equilíbrio ácido-básico foi estudado por hemogasometria de sangue venoso, em amostras coletadas às 8:00hs (antes do fornecimento do alimento) e 15hs (6 horas após alimentação). O primeiro experimento incluiu nove alimentos comerciais e nove cães, em um delineamento quadrado latino 9x9. O pH urinário variou entre 6,47±0,23 a 7,77±0,16, o EB entre 75 e 765 mEq/kg MS. Foi observada diferença média de -57 mEq/kg entre o EB calculado com enxofre (EBs) e o EB calculado com aminoácidos sulfurados, sendo o primeiro melhor estimativa do EB do alimento. O pH urinário apresentou alta correlação com o EBS (r=0,98; p<0,001). No segundo experimento houve aumento linear do pH urinário mediante adição de citrato de potássio (p<0,05), elevando-se o pH urinário de 5,97±0,19 (controle) a 7,11±0,11 (300mEq citrato de potássio/kg; p<0,001). No terceiro experimento foi verificada redução do pH urinário...
Food mineral composition influences the acid-basic balance and characteristics of dogs’ urine, contributing for both development and prevention of urolithiasis. The first experiment compared formulas to estimate food base excess (BE), evaluating the influence of total sulfur and sulfur amino acids on these calculations and acid-basic balance of dogs. The second and third experiments evaluated, respectively, the effects of addition of a cationic salt (potassium citrate in two doses, 150mEq/kg and 300mEq/kg of diet) and anionic compounds (sodium hexametaphosphate, methionine and ammonium sulphate, also in two doses, - 150mEq/kg and -300mEq/kg) in diets for dogs. Dogs were kept in metabolic cages for five days of adaptation phase to the diet, followed by three days of total urine collection. During collection, each 24 hours of produced urine were analyzed for density, volume and pH. Acid-basic balance was appraised by blood gas analysis of venous blood, in samples collected at 8:00h (before food consumption) and 15:00h (6 hours after meal). First experiment included nine commercial diets and nine dogs, in a Latin Square 9x9 design. The urinary pH varied between 6.47±0.23 to 7.77±0.16, BE between 75 and 765mEq/kg. A mean difference of -57mEq/kg was observed between BE calculations with sulfur (BEs) and BE calculations with sulfur amino acids, being the first formula a better tool to estimate food BE. The urinary pH presented high correlation with BEs (r=0.98; p<0.001). In second experiment was verified a linear increase of urinary pH by addition of potassium citrate (p<0.05), increasing the urinary pH from 5.97±0.19 (control) to 7.11±0.11 (300mEq potassium citrate/kg; p<0.001). In third experiment a reduction of urinary pH from 6.81±0.10 (control) to 5.45±0.23 (-300mEq/kg of ammonium sulphate; p<0.0001) was observed. Ammonium sulphate and methionine were effective in acidifying urine... (Complete abstract click electronic access below)

Orientador: Paulo Sérgio Patto dos Santos
Banca: Newton Nunes
Banca: Valéria Nobre Leal de Souza Oliva
Resumo: Objetivou-se avaliar os efeitos hemogasométricos, cardiorrespiratórios, qualidade da recuperação, alterações na motilidade gastrointestinal e cortisol plasmático de equinos submetidos à orquiectomia e anestesiados com isofluorano associado à infusão continua de butorfanol. Foram utilizados doze equinos adultos, distribuídos em dois grupos dois grupos, butorfanol (GB) e controle (GC). Os animais foram pré-medicados com xilazina, induzidos com quetamina associada ao midazolam e mantidos com isofluorano. Ao GB foi administrado butorfanol (0, 025 mg/kg IV) em bolus seguido de por infusão continua do fármaco (13µg/kg/h). As observações das variáveis foram feitas no momento basal e a cada 15 minutos por 75 minutos. Foi constatada redução na FC no M45 e M75 no GC e no M45 e M60 no GB comparados ao M0. A PAS, no GC, aumentou no M30 e M45 comparado ao M0. Já a PAD e PAM aumentaram em ambos os grupos quando comparadas ao valor basal. Houve redução da motilidade gastrointestinal por 60 minutos no GB. Foi observada elevação do cortisol plasmático em M60 e T30 em relação ao M0 em ambos os grupos. Os resultados obtidos permitiram concluir que a infusão contínua de butorfanol em equinos anestesiados pelo isofluorano promove discreta redução na motilidade gastrointestinal
Abstract: The aim of this study was to evaluate the blood gases, cardiorespiratory effects, quality of recovery, changes in intestinal motility and plasma cotisol in isoflurane-anesthetized horses associated to continuous rate infusion of butorphanol and submitted to orchiectomy. Twelve adult horses distributed into two groups (BG) and control group (CG). The animals were premedicated with xylazine, induced with ketamine combined with midazolam and maintained with isoflurane. In the BG, butorphanol (0.025 mg-1 kg-1 IV) was administered followed by continuous rate infusion (13µg-1kg-1hour) of the opiod. Observations of the variables were carried out at baseline and every 15 minutes during 75 minutes. Reduction in HR was observed in M45 and M75 in the CG and M45 and M60 in BG compared to M0. The SAP increased in the CG at M30 and M45 compared to M0 whereas DAP and MAP increased in both groups compared to baseline. PaO2 and RT decreased over time in both groups. There was a reduction of gastrointestinal motility by 60 minutes in GB. And plasma cortisol was higher in M60 and T30 than M0 in both groups. The results allow conclude that the continuous rate infusion of butorphanol in horses anesthetized with isoflurane a modest intestinal motility reduction
Mestre

O presente trabalho foi realizado com o objetivo de verificar alterações do estado ácido-básico metabólico de equinos antes e após atividade física de intensidade máxima (corrida) através do exame hemogasométrico. Avaliou-se, ainda, a confiabilidade deste exame para o sangue armazenado a 4ºC durante doze horas. Duas amostras de sangue venoso foram coletadas de quinze animais clinicamente sadios, sendo a primeira coleta realizada com o animal em repouso e a segunda após o término da prova, e as mesmas foram divididas em dois grupos: Grupo I (GI) – pré-corrida e Grupo II (GII) – pós-corrida. As amostras de sete animais foram avaliadas imediatamente após a coleta, enquanto as amostras de oito animais foram mantidas sob-refrigeração a 4ºC (dentro do refrigerador) durante doze horas antes de serem analisadas. O sangue foi analisado para verificar os valores de pH, pCO2, TCO2, HCO3, BE, pO2, sO2 e Lactato. Os resultados grupos foram comparados através da análise de variância. O Teste T de Student foi utilizado para uma comparação das médias das avaliações das amostras analisadas imediatamente ou doze horas após a coleta. Foram observadas diferenças estatísticas para todas as variáveis analisadas pré e pós-exercício, verificando-se valores significativamente menores para pH, pCO2, BE, HCO3 e TCO2, e valores significativamente maiores para sO2, pO2 e lactato nas amostras coletadas após a corrida em relação aos valores obtidos para as mesmas variáveis com os animais em repouso. Verificou-se, também, diferença significativa entre os resultados obtidos imediatamente após a coleta em relação àqueles encontrados nas amostras refrigeradas para todas as variáveis analisadas, tanto com os animais em repouso como após o exercício, exceto para a pCO2 após o exercício. Esses resultados indicam que o exercício físico, bem como o armazenamento das amostras de sangue, promovem alterações nos parâmetros avaliados no presente trabalho.
This study was carried out to verify changes in the metabolic acid-base status of equines before and after physical activity of maximum intensity (race) using blood gas analysis. We also evaluated the reliability of this test for the blood stored at 4 ° C for twelve hours. Two venous blood samples were collected from fifteen clinically healthy animals, the first collection with the animal at rest and the second after the race, and then divided into two groups: Group I (GI) - pre-race and group II (GII) - post-race. Samples of seven animals were evaluated immediately after collection, while samples from eight animals were kept under refrigeration at 4ºC (in a refrigerator) for twelve hours before being analyzed. The blood was analyzed to check pH, pCO2, TCO2, HCO3, BE, pO2, sO2 and lactate values. The results of the groups were compared by analysis of variance. Student's t test was used for comparison of the means of the evaluations of the samples analyzed immediately or twelve hours after collection. Statistical differences were observed for all variables analyzed before and after exercise, showing significantly lower values for pH, pCO2, BE, HCO3 and TCO2, and significantly higher values for sO2, pO2 and lactate in the samples collected after the race compared to the values obtained for the same variables with the animals at rest. There was also a significant difference between the results obtained immediately after collection compared to those found in the refrigerated samples for all analyzed variables, both with the animals at rest and after exercise, except for pCO2 after exercise. These results indicate that exercise and storage of blood samples promote changes in the parameters evaluated in this study.

Orientador: Aulus Cavalieri Carciofi
Banca: José Jurandir Fagliari
Banca: Arquivaldo Reche Júnior
Resumo: A composição mineral da dieta influencia as características da urina de gatos, estando envolvida no desenvolvimento e prevenção de urolitíases. O excesso de bases (EB) do alimento possui alta correlação com o pH urinário de gatos. Este pode ser calculado a partir da determinação da composição de macroelementos ou de aminoácidos sulfurados contidos na dieta. Em um primeiro estudo comparou-se fórmulas publicadas para estimar o EB do alimento e o pH urinário de gatos, avaliando a influência do enxofre e dos aminoácidos sulfurados sobre os cálculos, e verificou a relação entre o EB do alimento e parâmetros hemogasométricos. Em outro estudo foram avaliados os efeitos da adição de sais aniônicos acidificantes e de sais catiônicos alcalinizantes em dietas para felinos, com o objetivo de se validar as equações de estimação do pH urinário desenvolvidas no estudo anterior, demonstrar a eficácia desses sais, bem como verificar possíveis perturbações no equilíbrio ácido-básico dos animais decorrentes destas modificações na composição da dieta. Os gatos permaneceram em gaiolas metabólicas durante sete dias de adaptação à dieta, seguidos por três dias de coleta total de urina. Durante a coleta, a urina produzida em cada período de 24 horas teve aferida seu volume, densidade e pH. O equilíbrio ácido-básico foi estudado pela hemogasometria de sangue venoso. Amostras de sangue foram coletadas às 8:00hs (antes do fornecimento do alimento) e 6 horas depois do fornecimento, após 10 dias de adaptação ao alimento. No primeiro estudo o pH urinário variou entre 5,83±0,09 e 7,74±0,13. O EBS entre -185 e 309 mEq/kg MS e EBaa entre -49 e 377 mEq/kg MS. A diferença média de -115 mEq/kg entre EBS e EBaa foi observada. O pH urinário apresentou alta correlação com o EBS (r=0,95; p<0.0001) e EBaa (r=0,86; p<0.0001)... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Food mineral composition influences the characteristics of cat's urine and is involved in the development and prevention of urolithiasis. Food base excess (BE) has a high correlation with cat urinary pH. BE can be calculated utilizing only macroelements or using sulfur amino acids (methionine and cistine) instead of total sulfur. In the first chapter compared published formulas to estimate food BE and urinary pH of cats, evaluated the influence of total sulfur and sulfur amino acids on BE calculations, and verified the relationship between food BE with cat blood gases analysis. In other chapter, effects of acidifying and alkalizing additives on cats food were evaluated, so that: 1. the urinary pH prediction equations developed on chapter 2 could be validated, 2. mineral salt efficacy could be demonstrated, 3. potential acid base alterations caused by the additives used on the cat's food could be verified. Cats were housed in metabolic cages and fed during a seven days adaptation phase followed by three days of total urine collection. Urine was collected in plastic bottles conserved in ice under the cage funnel. Each 24-h of produced urine were pooled by cat and analyzed for density, volume and pH. Cat's acidbasic status was studied by blood gas analysis of venous blood. Blood samples were collected at 8:00h (pre feeding) and 6 hours after meal, after 10-days of food adaptation. In the first chapter pH of cats varied in the interval of 5.83±0.13 (mean±SD) and 7.74±0.12. Food BEs varied between -185 and 309 mmol/kg DM, and food BEaa between -49 and 377 mmol/kg DM. A mean difference of -115 mmol/kg between EB1 and EB2 was observed Urine pH has high correlations with food BEs (r=0.95; p<0.0001) and BEaa (r=0.86; p<0.0001). In the second chapter Alkalizing additives: urinary pH of cats varied in the interval of 5,60±0,07 a 6,15±0,06 (p<0,0005)... (Complete abstract click electronic access below)
Mestre

Orientador: Aulus Cavalieri Carciofi
Banca: Aureo Evangelista Santana
Banca: Márcia Mery Kogika
Resumo: A composição de macroelementos da dieta influencia o equilíbrio ácido básico e as características da urina de cães, contribuindo tanto para o desenvolvimento como prevenção de urolitíases. O experimento 1 teve por objetivo comparar fórmulas para estimar o excesso de bases (EB) do alimento, avaliando a influência do enxofre e dos aminoácidos sulfurados sobre estes cálculos e o equilíbrio ácido-basico de cães. O segundo e terceiro estudo objetivaram avaliar, respectivamente, os efeitos da adição de sal catiônico (citrato de potássio em duas doses, 150mEq/kg e 300mEq/kg de dieta) e compostos aniônicos (hexametafosfato de sódio, metionina e sulfato de amônio, em duas doses cada um, -150mEq/kg e -300mEq/kg) em dietas para cães. Os cães permaneceram em gaiolas metabólicas durante cinco dias de adaptação à dieta, seguidos por três dias de coleta de urina total. Durante a coleta, a urina produzida em cada período de 24 horas teve seu volume, densidade e pH aferidos. O equilíbrio ácido-básico foi estudado por hemogasometria de sangue venoso, em amostras coletadas às 8:00hs (antes do fornecimento do alimento) e 15hs (6 horas após alimentação). O primeiro experimento incluiu nove alimentos comerciais e nove cães, em um delineamento quadrado latino 9x9. O pH urinário variou entre 6,47±0,23 a 7,77±0,16, o EB entre 75 e 765 mEq/kg MS. Foi observada diferença média de -57 mEq/kg entre o EB calculado com enxofre (EBs) e o EB calculado com aminoácidos sulfurados, sendo o primeiro melhor estimativa do EB do alimento. O pH urinário apresentou alta correlação com o EBS (r=0,98; p<0,001). No segundo experimento houve aumento linear do pH urinário mediante adição de citrato de potássio (p<0,05), elevando-se o pH urinário de 5,97±0,19 (controle) a 7,11±0,11 (300mEq citrato de potássio/kg; p<0,001). No terceiro experimento foi verificada redução do pH urinário... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Food mineral composition influences the acid-basic balance and characteristics of dogs' urine, contributing for both development and prevention of urolithiasis. The first experiment compared formulas to estimate food base excess (BE), evaluating the influence of total sulfur and sulfur amino acids on these calculations and acid-basic balance of dogs. The second and third experiments evaluated, respectively, the effects of addition of a cationic salt (potassium citrate in two doses, 150mEq/kg and 300mEq/kg of diet) and anionic compounds (sodium hexametaphosphate, methionine and ammonium sulphate, also in two doses, - 150mEq/kg and -300mEq/kg) in diets for dogs. Dogs were kept in metabolic cages for five days of adaptation phase to the diet, followed by three days of total urine collection. During collection, each 24 hours of produced urine were analyzed for density, volume and pH. Acid-basic balance was appraised by blood gas analysis of venous blood, in samples collected at 8:00h (before food consumption) and 15:00h (6 hours after meal). First experiment included nine commercial diets and nine dogs, in a Latin Square 9x9 design. The urinary pH varied between 6.47±0.23 to 7.77±0.16, BE between 75 and 765mEq/kg. A mean difference of -57mEq/kg was observed between BE calculations with sulfur (BEs) and BE calculations with sulfur amino acids, being the first formula a better tool to estimate food BE. The urinary pH presented high correlation with BEs (r=0.98; p<0.001). In second experiment was verified a linear increase of urinary pH by addition of potassium citrate (p<0.05), increasing the urinary pH from 5.97±0.19 (control) to 7.11±0.11 (300mEq potassium citrate/kg; p<0.001). In third experiment a reduction of urinary pH from 6.81±0.10 (control) to 5.45±0.23 (-300mEq/kg of ammonium sulphate; p<0.0001) was observed. Ammonium sulphate and methionine were effective in acidifying urine... (Complete abstract click electronic access below)
Mestre

Base teórica: A Síndrome Hepatopulmonar (SHP) caracteriza-se por uma tríade clínica que inclui doença hepática, anormalidades em trocas gasosas e presença de dilatações vasculares pulmonares, sendo a obstrução prolongada do ducto biliar utilizada em modelos experimentais de cirrose biliar secundária que leva a reações inflamatórias agudas, podendo, ainda, ocasionar alterações sistêmicas. Animais com cirrose induzida experimentalmente por ligadura de ducto biliar (LDB) apresentam aumento do estresse oxidativo no tecido hepático, mas a inter-relação com o tecido pulmonar ainda não está bem esclarecida. O estresse oxidativo desempenha papel central na patogênese e na progressão de doenças crônicas, e o uso de antioxidantes tem sido proposto como agente terapêutico para compensar danos sistêmicos e hepáticos. Em estudos em que a utilização da melatonina foi comparada com a utilização de outros antioxidantes conhecidos como as vitaminas C e E, tal componente mostrou-se mais eficiente na redução do estresse oxidativo/nitrosativo, demonstrando que a melatonina atua como potente antioxidante. Objetivo: A presente tese teve como objetivo investigar o efeito do antioxidante Melatonina sobre o tecido pulmonar no modelo experimental de Síndrome Hepatopulmonar por ligadura de ducto biliar. Métodos: O trabalho está dividido em três partes: Parte I- Artigo de revisão intitulado “Hepatopulmonary Syndrome: Oxidative Stress and Physical Exercise,” enviado para publicação no periódico European Medical Journal; Parte II- Artigo original intitulado “Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de síndrome hepatopulmonar”, enviado para o periódico Jornal de Pneumologia; Parte III- Artigo original intitulado “Efeitos da melatonina sobre o tecido hepático e pulmonar em animais com síndrome hepatopulmonar por ligadura do ducto biliar”, a ser enviado para o periódico Digestive Diseases and Sciences. Foi utilizado o modelo de cirrose biliar secundária, induzida pelo modelo de ligadura de ducto biliar (LDB), com ratos machos Wistar, pesando ± 300 gramas, divididos em quatro grupos: CO (controle), CO+MLT, SHP e SHP+MLT. Os animais foram tratados com MLT a partir do 15° dia e com LDB até o 28° dia. No 29° dia, mediante administração de fármacos anestésicos, foram coletados sangue, fígado, pulmão e fêmur. Resultados: Nos artigos II e III, ao se avaliar as transaminases, observou-se aumento significativo nas enzimas ALT, AST e FA no grupo SHP quando comparadas aos grupos controles, o que determina a presença de doença hepática. Posteriormente à administração da 7 melatonina, houve diminuição significativa do grupo SHP+MLT quando comparado ao grupo SHP na avaliação da lipoperoxidação, atividade das enzimas Catalase (CAT), superóxido dismutase (SOD) e glutationa Peroxidade (GPx), bem como na de Nitritos/Nitratos (NO2/NO3) e no sistema inflamatório, quando da avaliação da expressão da Óxido Nítrico Sintase Induzível (iNOS) e da região p65 do fator de transcrição nuclear-kB (NF-kB). Também houve diferença na gasometria arterial e na histologia do tecido pulmonar pelas técnicas de Hematoxilina e Eosina e Picrosírius, especialmente no diâmetro dos vasos pulmonares. Ao avaliar o dano ao DNA pelo Ensaio Cometa, foi observado aumento do índice e da frequência de dano no grupo SHP, com redução após o uso da MLT. Conclusão: Os resultados sugerem efeito protetor da melatonina no tecido hepático e pulmonar, no modelo de Síndrome Hepatopulmonar por ligadura de ducto biliar.
Background: Hepatopulmonary syndrome (HPS) is clinically characterized by a combination of liver disease, gas exchange abnormalities, and pulmonary vascular dilation. Prolonged biliary duct obstruction was used in experimental models of secondary biliary cirrhosis leading to acute inflammatory reactions and possibly to systemic changes. Animals with cirrhosis experimentally induced by biliary duct ligation (BDL) showed increased oxidative stress in liver tissue, but the lung tissue has not been investigated yet. Oxidative stress has a key role in the pathogenesis and progression of chronic diseases, and antioxidants have been proposed as therapeutic agents to compensate for systemic and liver damages. In studies comparing melatonin with other known antioxidants such as vitamins C and E, melatonin was found to be more efficient in reducing oxidative/nitrosative stress, showing that it is a potent antioxidant. Objective: The present doctoral dissertation aimed to investigate the effect of the antioxidant melatonin on lung and liver tissues in an experimental model of BDL-induced HPS. Methods: This dissertation is divided into three parts: Part I consists of the review article entitled “Hepatopulmonary Syndrome: Oxidative Stress and Physical Exercise,” which was submitted to the European Medical Journal; Part II consists of the original article entitled “Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de síndrome hepatopulmonar”, which was submitted to Jornal de Pneumologia; and Part III consists of the original article entitled “Effects of melatonin on liver and lung tissues of animals with bile duct ligation-induced hepatopulmonary syndrome”, which will be submitted to Digestive Diseases and Sciences. A model of secondary BDL-induced biliary cirrhosis was used in male Wistar rats weighing ± 300 g and divided into four groups: control group (CG), CG+MLT, HPS, and HPS+MLT. Animals were treated with MLT or vehicle from day 15 to day 28 after BDL. On day 29, blood, liver, lung, and femur samples were collected after the administration of anesthetic drugs. Results: As for transminases, papers II e III found that there was a significant increase in enzymes ALT, AST e FA in the HPS group compared with the control groups, which indicates the presence of liver disease. The administration of melatonin led to a significant decrease in the HPS group compared with the control groups with regard to the following variables: lipid peroxidation; catalase, superoxide dismutase, and glutathione peroxidase activity; nitrite/nitrate ratio; and inducible nitric oxide synthase and p65 region of nuclear factor kappa B. There were also differences in blood gas analysis and histology of lung tissues as assessed by hematoxylin and eosin (HE) and picrosirius red staining, especially in the diameter of pulmonary vessels. The comet assay revealed an increase the index and frequency of DNA damage in the HPS group compared with the control groups, but these parameters were reduced with the use of melatonin in the HPS+MLT group. Conclusion: Results suggest that melatonin has a protective effect in liver and lung tissues using a BLD-induce HPS model.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Objetivou-se avaliar os efeitos hemogasométricos, cardiorrespiratórios, qualidade da recuperação, alterações na motilidade gastrointestinal e cortisol plasmático de equinos submetidos à orquiectomia e anestesiados com isofluorano associado à infusão continua de butorfanol. Foram utilizados doze equinos adultos, distribuídos em dois grupos dois grupos, butorfanol (GB) e controle (GC). Os animais foram pré-medicados com xilazina, induzidos com quetamina associada ao midazolam e mantidos com isofluorano. Ao GB foi administrado butorfanol (0, 025 mg/kg IV) em bolus seguido de por infusão continua do fármaco (13µg/kg/h). As observações das variáveis foram feitas no momento basal e a cada 15 minutos por 75 minutos. Foi constatada redução na FC no M45 e M75 no GC e no M45 e M60 no GB comparados ao M0. A PAS, no GC, aumentou no M30 e M45 comparado ao M0. Já a PAD e PAM aumentaram em ambos os grupos quando comparadas ao valor basal. Houve redução da motilidade gastrointestinal por 60 minutos no GB. Foi observada elevação do cortisol plasmático em M60 e T30 em relação ao M0 em ambos os grupos. Os resultados obtidos permitiram concluir que a infusão contínua de butorfanol em equinos anestesiados pelo isofluorano promove discreta redução na motilidade gastrointestinal
The aim of this study was to evaluate the blood gases, cardiorespiratory effects, quality of recovery, changes in intestinal motility and plasma cotisol in isoflurane-anesthetized horses associated to continuous rate infusion of butorphanol and submitted to orchiectomy. Twelve adult horses distributed into two groups (BG) and control group (CG). The animals were premedicated with xylazine, induced with ketamine combined with midazolam and maintained with isoflurane. In the BG, butorphanol (0.025 mg-1 kg-1 IV) was administered followed by continuous rate infusion (13µg-1kg-1hour) of the opiod. Observations of the variables were carried out at baseline and every 15 minutes during 75 minutes. Reduction in HR was observed in M45 and M75 in the CG and M45 and M60 in BG compared to M0. The SAP increased in the CG at M30 and M45 compared to M0 whereas DAP and MAP increased in both groups compared to baseline. PaO2 and RT decreased over time in both groups. There was a reduction of gastrointestinal motility by 60 minutes in GB. And plasma cortisol was higher in M60 and T30 than M0 in both groups. The results allow conclude that the continuous rate infusion of butorphanol in horses anesthetized with isoflurane a modest intestinal motility reduction

Obstruções uretrais em felinos geralmente são secundárias à doença do trato urinário inferior felino (DTUIF), afecção comum em gatos. A doença pode ser auto-limitante, mas a obstrução uretral leva à parada da função renal, gerando uma série de distúrbios no organismo, que necessitam tratamento imediato. A maioria dos estudos sobre as alterações decorrentes da obstrução foi feito em animais em estado crítico ou experimentalmente. O objetivo do presente estudo foi descrever as principais alterações observadas em gatos obstruídos atendidos na rotina clínica e correlacioná-las. Foram avaliados 32 gatos machos com obstrução uretral e sem tratamento prévio. A avaliação constou de exame clínico, hemograma, bioquímica sérica (uréia, creatinina, proteína total, ALT, AST, fosfatase alcalina, sódio, potássio, cálcio, fósforo, magnésio, glicemia e lactato), gasometria venosa, exame e cultura de urina e eletrocardiograma (ECG). Os animais foram agrupados conforme o tempo de obstrução (mais e menos de 36 horas). As alterações mais comuns no histórico foram disúria (100% dos animais), disorexia (84,4%), apatia (71,8%), vocalização (68,7%) e oligodipsia (68,7%); no exame físico, desidratação (71,8%), taquipnéia (53,1%) e hipotermia (53,1%). As alterações laboratoriais mais freqüentes foram hipermagnesemia (100%), acidose metabólica (89,6%), hiperglicemia (88,9%), hiperazotemia (84,4%) e hiperpotassemia (80,6%). Vinte por cento dos gatos tinham infecção urinária. Alterações no ECG foram evidenciadas em 39,3% dos casos, sendo a parada atrial com ritmo sinoventricular a mais freqüente. Não houve relação entre as alterações no ECG e os níveis de potássio sérico. A análise dos grupos sugere agravamento da hiperazotemia, hiperpotassemia, hipermagnesemia e do estado geral com a evolução do processo. Nas correlações, a temperatura e a freqüência cardíaca apresentaram relação direta com pH sanguíneo, excesso de base e bicarbonato, e relação inversa com uréia, creatinina, potássio e fósforo. A uréia e creatinina se correlacionaram inversamente com sódio, pH sanguíneo, excesso de base e bicarbonato, e diretamente com potássio e fósforo. O estado geral correlacionou-se com a temperatura, uréia, creatinina, potássio, pH sanguíneo, excesso de base e bicarbonato.
Urethral obstruction is a frequent complication in cats with feline lower urinary tract disease (FLUTD), considered a common disease in cats. Most cases are self-limiting, but the urethral obstruction causes renal failure and metabolic alterations which needs immediate treatment. Previous reports selected cats that were critically ill or had a experimental induction of the disease. The goal of this study was to describe the clinical signs, laboratory and electrocardiographyc abnormalities in cats with urethral obstruction and to correlate these results. Thirty-two male cats with natural urethral obstruction and without previous therapy were studied. Complete blood count, serum chemistry profile (urea, creatinine, plasma protein, alanine transferase, aspartate transferase, alkaline phosphatase, sodium, potassium, calcium, phosphorus, magnesium, glucose and lactate), venous blood gas, urinalysis, urine culture and electrocardiogram (ECG) were performed. Two groups of 16 cats were composed (animals under and over 36 hours of obstruction). The most frequent abnormalities described were dysuria (100%), anorexia (84,4%), lethargy (71,8%), vocalization (68,7%), hypodipsia (68,7%), and dehydration (71,8%), tachypnea (53,1%) and hypothermia (53,1%) in physical evaluation. The laboratorial abnormalities most frequently observed were hypermagnesemia (100%), metabolic acidosis (89,6%), hyperglicemia (88,9%), azotemia (84,4%) and hyperkalemia (80,6%). Twenty per cent of cats had urinary infections. Abnormalities in ECG, such as atrial standstill with sinoventricular rhythm, were seen in 39,3% of cases, and there were no correlation with hyperkalemia. The analyses of the groups suggest worsening of azotemia, hyperkalemia, hypermagnesemia and lethargy with evolution of obstruction. Temperature and heart rate were positively correlated with blood pH, base excess and bicarbonate, and inversely correlated with urea, creatinine, potassium and phosphorus. Lethargy was correlated with temperature, blood pH, base excess and bicarbonate.

Blodgassprutor beställs för att undersöka en patients syra-bas-status, laktatkoncentration och elektrolytkoncentration. Några orsaker till balansrubbningar kan vara trauma, syrebrist, infektion, intoxikation eller svält. År 2018 installerades ett nytt rörtransportsystem på Västerviks sjukhus och syftet med studien var att undersöka om det är möjligt att transportera blodgassprutor i det nya rörsystemet utan att provresultat påverkas. Analyser som studerades var pH (power of hydrogen), syretryck, koldioxidtryck, syrgasmättnad, natriumjoner, kaliumjoner, fria kalciumjoner, standardbikarbonat, basöverskott och laktat. Studien omfattade 27 arteriella dubbelprover där det ena provet transporterades i rörtransportsystemet och det andra transporterades manuellt till laboratoriet. Proverna analyserades på instrumentet ABL 800 Flex, inom 30 minuter efter provtagning, med analysmetoderna potentiometri, amperometri och spektrofotometri. Resultaten jämfördes i korrelationsdiagram med en regressionslinje för att påvisa samband mellan proverna. Korrelationsdiagrammen visade positiv linjär korrelation hos samtliga analyser och ett samband kunde påvisas (r = 0,930-0,998). Om resultatet från proverna som transporterats manuellt ökade, ökade även resultatet från proverna som transporterats i rörpost och tvärtom. Ett stapeldiagram skapades för att visualisera skillnader i medelvärde som visade en liten skillnad på basöverskott som ökade efter transport i rörpostsystemet. Ett tvåsidigt parat t-test utfördes för att påvisa om någon signifikant skillnad förelåg mellan analysresultaten. T-testet visade en statistisk signifikant skillnad på syretrycket (p = 0,04), syrgasmättnaden (p = 0,04), basöverskott (p = 0,001) och standardbikarbonat (p = 0,006), då medelvärdet ökade efter transport i rörpost. Medelvärdet för halten natriumjoner minskade efter transport i rörpostsystemet vilket innebar att hemolys inte förekom. Slutsatsen var att det finns en signifikant skillnad mellan blodgassprutor transporterade i rörpostsystem och blodgassprutor transporterade manuellt på vissa analyser, men skillnaden har ingen klinisk betydelse.
Blood gas syringe are ordered to examine the patient´s acid-base status, lactate concentration and electrolyte concentration. Some causes for imbalance could be trauma, lack of oxygen, infection, poisoning or starvation. In 2018, a new pneumatic tube transport system was installed at Västervik´s hostpital and the purpose of this study was to investigate if it is possible to transport samples for blood gas analyses with the new pneumatic tube transport system without affecting the test results. The analyses which were investigated were pH (power of hydrogen), oxygen tension, carbon dioxide tension, saturation, sodium ions, potassium ions, free calcium ions, standard bicarbonate, base excess and lactate. The study included 27 arterial double samples, one samples was transported in the pneumatic tube transport system and the other was manually transported to the laboratory. The samples were analysed within 30 minutes after the sampling, on the ABL 800 Flex instrument, using the methods potentiometry, amperometry and spectrophotometry. The results were compared using a correlation diagram with a regression line to study the relationship between the parameters. The correlation diagram shown a positive linear correlation and a relationship could be demonstrated for all the parameters (r = 0,929-0,998). If the results from the samples transported manually increased, the results also increased from the samples transported in the pneumatic tube transport system and vice versa. A bar chart was created to visualize differences in the mean values. A difference could be seen in base excess and the mean value increased after transport in the pneumatic tube transport. A two-sided paired t-test was performed to demonstrate any significant difference between the parameters. The t-test demonstrated a significant difference in the oxygen tension (p = 0,04), oxygen saturation (p = 0,04), base excess (p = 0,001) and the standard bicarbonate (p = 0,006) and statistically the values was higher after transport with the pneumatic tube transport system. The mean value for sodium ions decreased after transport in the pneumatic tube transport system and that indicate that hemolysis did not occur. The conclusion of the study was that there is a significant difference between blood gas syringes transported with pneumatic tube transport system and blood gas syringes transported manually, but the differences are not clinically relevant.

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Sem bolsa
Objetivou-se avaliar o consumo de água durante a ordenha sobre a hemogasometria e parâmetros metabólicos de vacas leiteiras em diferentes estágios de lactação. Foram utilizados 40 animais de terceira lactação, mantidos em sistema semi-intensivo de criação e distribuídos ao acaso nos tratamentos, permanecendo 10 animais em cada um. Os fatores experimentais foram representados pelos os dias em lactação (DEL), com animais entre 60-120 (DEL60-120) ou acima de 150 (DEL>150), e pelo fornecimento de água durante a ordenha (AOD), formando-se os seguintes grupos experimentais: CA: DEL60-120, sem AOD; CB: DEL>150vacas, sem AOD; TA: DEL60-120, com AOD; TB: DEL>150vacas, com AOD. A água foi ofertada durante as duas ordenhas diárias através bebedouros móveis posicionados em frente às vacas dos grupos TA e TB, e de bebedouros vazios para as vacas do CA e CB, registrando-se o consumo (sim ou não) dos animais suplementados. Foram coletadas amostras de leite e sangue nos dias 0, 7, 14, 21 e 28, para determinação dos teores de gordura, proteína bruta, lactose, sólidos totais e ureia no leite e análises bioquímicas e hemogasométricas. A pressão parcial de oxigênio (pCO2) diferiu entre os tratamentos CA e TA em todo o período experimental. Os valores fisiológicos da pCO2 para bovinos variaram de 35 a 44 mmHg, observando-se que as amostras do TB ficaram ligeiramente abaixo dos parâmetros fisiológicos. Os valores de tCO2 estavam dentro dos padrões fisiológicos. Não foram observadas alterações nas variáveis ligadas ao equilíbrio eletrolítico do sangue. Os resultados de BE, pO2, sO2, Na, K não diferiram entre os tratamentos. Os níveis de ureia não diferiram entre CA e TA, mas diferiram entre CB e TB. Os parâmetros qualitativos do leite não foram alterados pelos tratamentos. A suplementação de água durante a ordenha não influenciou o equilíbrio eletrolítico em vacas leiteiras em diferentes estágios de lactação. A redução da pCO2 observada no grupo TA não foi suficiente para alterar o equilíbrio eletrolítico sanguíneo.
This study aimed to evaluate the water consumption during milking on blood gas analysis and metabolic parameters of dairy cows at different stages of lactation. 40 third lactation animals were kept in semi-intensive system and randomly assigned to the treatments, remaining 10 animals in each. The experimental factors were represented by the days in milk (DIM) with animals between 60-120 (DIM 60-120) or above 150 (DIM > 150), and providing water during milking (WDM). The groups remained as: CA: DIM 60-120 without WDM; CB: DIM > 150 without WDM; TA: DIM 60-120 with WDM; TB: DIM > 150 with WDM. The water was supplied during the two daily milkings through mobile drinkers positioned in front of the cows of the TA and TB groups, and empty water drinkers for cows CA and CB, recording the consumption (yes or no). Milk and blood samples were collected on days 0, 7, 14, 21 and 28 to determine the levels of fat, protein, lactose, total solids and urea in milk and biochemical and blood gas analysis. The oxygen partial pressure (pCO2) differed between CA and TA treatments throughout the experimental period. The physiological pCO2 values for cattle ranged 35 to 44 mmHg, observing that samples TB were slightly below physiological parameters. The tCO2 values were within the physiological patterns. No changes were observed in the variables related to the electrolyte balance of the blood. The results of BE, pO2 and Be, SO2, Na, K did not differ between treatments. Urea levels did not differ between CA and TA, but differed between CB and TB. The qualitative milk parameters were not affected by treatments. Supplementation of water for milking did not affect the electrolyte balance in dairy cows in different stages of lactation. The reduction of pCO2 seen in the TA group was not enough to alter blood electrolyte balance.

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Mestrado Profissional em Enfermagem Assistencial
Este estudo tem como objeto o efeito do oxigênio pré-aspiração em pacientes entubados em choque séptico em UTI. A questão de pesquisa é se há diferenças nos valores oximétricos após a aspiração endotraqueal na ausência da replemento de oxigênio em pacientes em choque séptico entubados sem injúria pulmonar? A hipótese é que não há diferenças nos valores oximétricos após a aspiração endotraqueal comparados entre a vigência ou não do replemento de oxigênio em pacientes em choque séptico entubados sem injúria pulmonar. Objetivo geral: confrontar a efetividade da recomendação preconizada pelo guidelines AARC quando à replementação de oxigênio pré-aspiração endotraqual aos pacientes em choque séptico entubados. O objetivos especifícos: comparar as variáveis oximétricas e hemodinâmicas mensuradas após a vigência ou ausência da replementação pré-aspiração em pacientes em choque séptico entubados e criar um protocolo operacional padrão com as recomendações oriundas dos resultados desse ensaio. Método: ensaio clínico crossover randomizado, 2X2, um-braço, duplo-cego de equivalência com pacientes em choque sepse sob ventilação mecânica internados em Unidade de Terapia Intensiva (UTI) de um hospital universitário de grande porte no município do Rio de Janeiro. A amostra consecutiva constituída de 22 pacientes por randomização simples A sequência AB foi inicialmente replementada com O2 e o grupo BA iniciou sem a referida maximização. Foram realizados pré e pós-teste com a coleta de sangue para análise dos gases arteriais. Após washout ocorreu a inversão entre grupos AB para BA. A comparação das diferenças das médias foi realizada através do teste t-student para amostras independentes homocedásticos e o seu similiar não-paramétricos Mann- whitney quando a amostra não era normal, ambos bicaudais com nível de significância adotado de 5% e intervalo de confiança de 95%. Para as variáveis dicotômicas foi utilizado o teste exato de Fisher e análise da estatística clínica foram empregados o Risco Relativo (RR), Aumento do Risco Absoluto(ARA), Redução do Risco Absoluto (RRA) todos com IC95% Resultados: a amostra foi predominantemente idosa, feminina, de baixa escolaridade e renda salarial. A análise da estatística inferencial evidenciou que os paciente se apresentavam hiperoxigenados com FiO2 acima do que era considerado como ideal para idade repercutindo num efeito mais preponderante na PaO2 que apresentou significância estatística com p < 0,05. Contudo, o ARA para hipoxemia foi insignificante clínica e estatísticamente com p <0,05, contudo, foi evidenciado para hiperoxemia. Para as demais variáveis não houve significância estatística e nem clínicas. Conclusão: O emprego da aspiração endotraqueal sem replementação não confere prejuízo ao paciente em relação às variáveis oximétricas e hemodinâmicas e, é preterível em relação a replementação de oxigênio. Produto: A criação do procedimento operacional padrão foi a forma de documentar uma prática que já vem sendo utilizada a pelo menos 11 anos, a partir de 2002, sem intercorrência registradas para os pacientes críticos em UTI
Introduction: This paper studied the effect of oxygen before aspiration in intubated patients in septic shock in the ICU . The research question is whether there are differences in oximetry values after endotracheal suction in the absence of oxygen increase in septic shock patients intubated without lung injury? The hypothesis is that no difference in oximetry values after endotracheal suctioning compared between the presence or absence of oxygen increase in septic shock patients intubated without lung injury. Overall Objective: To compare the effectiveness of the recommendations laid out when the AARC guidelines increase oxygen endotraqual intubated patients in septic shock before aspiration. Specific aim to compare oximetric and hemodynamic variables measured after the expiration or absence of increase before aspiration in intubated patients in septic shock and create a standard operating protocol with the recommendations arising from the results of this test. Method: a randomized crossover trial, 2X2, one - arm , double-blind equivalence in patients with septic shock, mechanical ventilation admitted to the Intensive Unit (ICU) of a university Therapy large hospital in the city of Rio de Janeiro. A consecutive sample of 22 patients. Inclusion criteria were: suspected and/or confirmed septic shock , mechanical ventilation > 12 hours , fraction of inspired oxygen (FiO2) ideal < 95 %, positive end expiratory pressure (PEEP) < 16 mm / Hg. Exclusion criteria: weaning process , surgical with chronic obstructive pulmonary disease ( COPD ) Gold IV , pregnant or postpartum women, under 18 years, and thrombocytopenic (less than 50.000.000/mm3 ) devoid of arterial catheter. A simple randomization was performed by a sequence of numbers generated in a spreadsheet. The AB sequence was initially increase with O2 and BA group started without such maximization. Post- test with blood sampling for analysis of arterial blood gases were performed before and . After washout reversal between AB to BA groups occurred. The determination of carryover was performed by adding the values in both sequences being missing for all variables of primary and secondary outcomes . Comparison of means was performed using the Student t test for independent samples homoscedastic because the variances were equal and its equal non- parametric Mann - Whitney when the sample was not normal, both with two-tailed significance level of 5 % and range 95% confidence. For dichotomous variables, the Fisher exact test and analysis of clinical statistics were used were used the relative risk (RR), Absolute Risk Increase (ARA), Absolute Risk Reduction (ARR) all with 95% CI. Results: The sample was predominantly elderly , female , low education and wage income . The inferential statistical analysis showed that the patient had hyperoxygenation with FiO2 above what was considered to be ideal for age reflecting a more prominent effect on PaO2 that was statistically significant with p < 0,05 for ARA does not cause hypoxemia , however was shown to hyperoxemia. The momentary increase in FiO2 causes a false negative rate of improvement that LPA may be a confounding factor for prognosis patient. For the other variables there was statistics nor clinical significance. Conclusion: The use of endotracheal suctioning without increase confers no injury to the patient regarding oximetric and hemodynamic variables and is beneficial regarding increase oxygen . Product: A creation of standard operating protocol is a way of documenting a practice that is already being used in at least 11 years , since 2002 , registered uneventful for critical patients in ICU

UVOD: Anestezija je povezana sa promenama ventilacije, koje počinju sa prvim datim lekom, a mogu da traju i danima posle hirurške intervencije. Hipoksemija je najočiglednija posledica ove promene. U anesteziološkoj praksi i perioperativnom tretmanu bolesnika kiseonička terapija zauzima značajno mesto. Još uvek ne postoje jasne, na dokazima zasnovane, smernice za upotrebu kiseoničke terapije u postoperativnom periodu. Razlog verovatno leži u činjenici da veliki broj faktora može da utiče na ishod lečenja hirurškog bolesnika i zato je teško ispitati njihove pojedinačne uticaje. Kiseonička terapija tretira ili prevenira nastanak hipoksije obezbeđujući inspiratornu koncentraciju kiseonika veću od iste u vazduhu. Kod najvećeg broja pacijenata u postoperativnom periodu ne postoji potreba za strogom kontrolom inspiratorne koncentracije kiseonika, a administracija kiseoničke terapije sprovodi se primenom uređaja niskog protoka i varijabilne performanse, kao što su nazalna kanila i kiseonička maska za lice. Brojna istraživanja poslednjih decenija pokušala su da daju odgovor na pitanja da li postoji stvarna razlika u primeni ova dva uređaja, posebno u svetlu razvoja hipoksemije u postoperativnom periodu. Prednosti primene nazalne kanile su bolje prihvatanje od strane bolesnika u poređenju sa maskom, obično zbog manje izraženog osećaja klaustrofobije pri upotrebi nazalne kanile. Nazalna kanila, ne zahteva uklanjanje prilikom nege usne duplje ili per os unosa što obezbeđuje kontinuitet u isporuci kiseonika. Nedostaci nazalne kanile vezani su za otežanu primenu kod bolesnika sa nazogastričnom sondom ili otežanim disanjem na nos. Pri protocima većim od 4 litre u mnuti može izazvati nelagodnost na nosnoj sluznici bolesnika. Literaturni podaci, ukazuju da se primenom kiseoničke maske ipak postižu veće inspiratorne koncentracije kiseonika, te da se epizode desaturacije i hipoksemije znatno ređe javljaju. Međutim, postoje i istraživanja koja ukazuju na mogućnost ponovnog udisanja vazduha iz mrtvog prostora maske, pri nižim protocima što može uticati na parcijalni pritisak ugljen-dioksida u arterijskoj krvi. CILJEVI: Ciljevi istraživanja su da se ispitata učestalost javljanja hipoksemije unutar 48 sati od ekstubacije kod bolesnika u jedinici intezivne terapije, zatima da se ispita pojava desaturacije, da se utvrditi učestalost potrebe za primenom neinvazivne mehaničke ventilacije pozitivnim pritiskom kod bolesnika u jedinici intezivne terapije kod kojih se primenjuje kiseonička terapija putem nazalne kanile, odnosno kiseoničke maske. Takođe, cilj je i da se ispita da li postoji povezanost preoperativnih karakteristika bolesnika sa eventualnim izborom jednog od dva uređaja za primenu kiseoničke terapije u ranom postoperativnom periodu. METODOLOGIJA: Na Klinici za anesteziju i intenzivnu terapiju Kliničkog centra Vojvodine sprovedeno je prospektivno istraživanje kojim je obuhvaćeno 160 pacijenata nakon elektivnih hrurških procedura, koji su nakon operativnog zahvata praćeni u jedinici intenzivne terapije. Pacijenti su randomizovani u dve grupe (grupa M – kiseonička maska i grupa N – nazalna kanila) u odnosu na uređaj kojim je sprovođena postoperativna kiseonička terapija. Za sve pacijente uključene u studiju evidentirana je pol, starost, telesna masa, telesna visina, izračunat indeks telesne mase. Evidentiran je i ASA status, kao i NYHA status. U istraživanje nisu uključeni pacijenti sa plućnim komorbiditetima. Iz istraživanja su isključeni svi oni bolesnici kod kojih je došlo do respiratornih komplikacija u perioperativnom periodu, kao i onih kod kojih je bila prisutna hemodinamska nestabilnost. Postoperativno svi pacijenti su sedirani, na mehaničkoj ventilaciji smešteni u jedinicu intenzivne terapije. Nakon prevođenja na spontano disanje i ekstubacije započinjana je primena kiseonika putem kiseoničke maske za lice (6 l/min) odnosno nazalne kanile (4 l/min). Sprovođen je kontinuirani monitoring vitalnih parametara, saturacije hemoglobina kiseonikom, kao i novo ugljen-dioksida na kraju ekspirijuma. Kod svih pacijenata u četiri vremena rađene su gasne analize arterijske krvi. Svi praćeni parametri poređeni su između dve ispitivane grupe pacijenata. Za statističku obradu podataka korišćen je programski paket Statistical Package for Social Sciences - SPSS 21. Numerička obeležja su prikazana putem srednjih vrednosti (aritmetička sredina) i mera varijabiliteta (opseg vrednosti, standardna devijacija), a atributivna obeležja korišćenjem frekvencija i procenata. Komparacija vrednosti numeričkih obeležja između dve grupe vršena je primenom Studentovog t- testa, odnosno neparametrijskog Mann- Whitney testa. Testiranje razlike frekvencija atributivnih obeležja vršeno je primenom χ2 testa. U cilju ispitivanja povezanosti dva ili više obeležja, odnosno generisanja adekvatnih statističkih modela, korišćena je multivarijantna regresiona analiza. Statistički značajnim se smatraju vrednosti nivoa značajnosti p<0.05. REZULTATI: U odnosu na preoperativne karakteristike ispitivanih pacijenata nije nađena statistički značajna razlika u distribuciji pacijenata u dve ispitivane grupe u odnosu na pol (2 test; 2=0,378;p=0,539), starost (T test; t=1,958; p=0,053), APACHE II skor na prijemu (Mann-Whitney test; U=1220,500; p=0,837), indeks telesne mase (T test; t=1,380; p=0,171), pušačkim navikama (2 test; 2=0,644;p=0,422), vrednostima preoperativnog hemoglobina (T test; t=0,442; p=0,660), saturacije hemoglobina kiseonikom (T test; t=0,883; p=0,380). Razlike nije bilo ni u pogledu trajanja mehaničke ventilacije (Mann-Whitney test; U=1114,500; p=0,345). Hipoksemija (parcijalni pritisak kiseonika u arterijskoj krvi manji od 65 mmHg) nije registrovana ni kod jednog od pacijenata u obe ispitivane grupe. Vrednsti SpO2 < 92%, registrovane su kod ukupno 24 pacijenta u svim analiziranim vremenima (24%). Najveći broj pacijenata kod kojih je registrovana niska vrednost detektovan je u prvom satu nakon ekstubacije kada je vrednost manja od 92% registrovana kod 5 pacijenata (5%) i to kod 3 pacijenta u grupi M (6%) i 2 pacijenta u grupi N (4%). Između vizita 2. i 3. vrednosti satutracije manje od 92% registrovana je kod 19 pacijenata (19%), kod 8 pacijenata u grupi M (16%) i kod 11 pacijenata u grupi N (22%). U periodu između vizita 3. i 4. vrednosti saturacije niže od 92% registrovane su kod 19 (19%) pacijenata i to kod 10 pacijenata u grupi M (20%) i kod 9 pacijenata u grupi N (18%). Statistički značajna razlika zabeležena je u sve tri vizite (vizita 2, 3, 4) u vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi. Tako su pacijenti u grupi kod kojih je primenjivana maska imali statistički značajno veće vrednosti parcijalnog pritiska kiseonika. Istovremeno pacijenti kod kojih je kiseonička terapija primenjivana putem maske imali su značajno veće vrednosti saturacije hemoglobina kiseonikom i ova razlika je bila statistički značajna u svim posmatranim vizitama. U prvih 48 sati nakon operacije neinvazivna mehanička ventilacija primenjena je kod 80 pacijenata. Kod svih pacijenata indikacija za primenu je bila pojava desaturacije. U odnosu na distribuciju pacijenata po ispitivanim grupama nije bilo statistički značajne razlike u broju pacijenata koji su zahtevali neinvazivnu mehaničku ventilaciju (2 test; 2=2,250; p=0,134). Pacijenti u grupi N proveli su više minuta (srednja vrednost 56,85 +/- 19,80 minuta) na neinvazivnoj ventilaciji od pacijenata u grupi M (srednja vrednost 33,14 +/- 10,65 minuta), a ova razlika je statistički značajna (T test; t=2,923; p=0,009). Na osnovu multivarijantne regresione analize, pacijenti koji su kiseoničku terapiju primali putem nazalne kanile, sa porastom indeksa telesne mase imali su niže vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi (r2=0,392). ZAKLJUČCI: Kiseonička maska za lice i nazalna kanila obezbeđuju adekvatnu primenu kiseoničke terapije u smislu prevencije nastanka hipoksemije u ranom postoperativnom periodu. Primenom kiseoničke maske za lice ostvaruju se više vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi. Epizode desaturacije češće se javljaju kod pacijenata kod kojih se u ranom postoperativnom periodu primenjuje kiseonička terapija putem nazalne kanile. Pacijenti kod kojih se primenjuje kiseonička terapija putem maske ostvaruju veće vrednosti saturacije hemoglobina kiseonikom. Pacijenti kod kojih je kiseonička terapija u ranom postoperativnom periodu primenjivana putem nazalne kanile zahtevali su dužu primenu neinvazivne mehaničke ventilacije pluća. Kod pacijenata sa većim vrednostima indeksa telesne mase, za primenu kiseoničke terapije u ranom postoperativnom periodu, kiseonička maska za lice će obezbediti bolju oksigenaciju.
INTRODUCTION: Anesthesiology is associated with vicissitudes in ventilation, which start with application of first medicine and last for days following surgical intervention. Hypoxemia is a most common side effect of vicissitudes in ventilation. Oxygen therapy is important in anesthesiology and post-operative treatment of a patient. There are no clear evidence-based guidelines for application of oxygen therapy in post-operative period. Numerous factors influence patient’s treatment outcome and it is difficult to examine each factor’s independent impact. Oxygen therapy treats or prevents occurrence of hypoxemia by providing inspiratory concentration of oxygen greater than the amount found in air. Most patients in post-operative period don’t require vigilant control of inspiratory concentration of oxygen, and administration of oxygen therapy is implemented with a low flow device with variable performances such as nasal cannula and oxygen face mask. Various research attempts where made in the last decades to discover an evident difference between these two devices, especially in cases where hypoxemia occurred in post-operative period. One advantage to using nasal cannula over oxygen face mask is that its better perceived by a patient as it reduces feeling of claustrophobia. Nasal cannula doesn’t need to be removed during oral cavity care or “per os” intake which ensures continuous oxygen delivery. The drawback to using nasal cannula is that its challenging to insert it in a patient with nasogastric tube or difficult nasal breathing. Also, patient can experience nasal discomfort if the oxygen flow is bigger than four litters per minute. Literature data shows that application of oxygen trough the face mask achieves greater inspiratory concentrations of oxygen, and reduces the occurrence of desaturation and hypoxemia. Still, there is research which points out to the possibility of breathing in from dead space in the mask, in lower flows, which can partially affect pressure of carbon dioxide in artery blood. AIM: Aim of the research is to examine frequency of hypoxemia and non-invasive mechanical ventilation in patients treated with oxygen therapy via nasal cannula or oxygen face mask during the first 48 hours following patient extubating in intensive care unit. Also, aim is to examine correlation between patients’ pre-operative characteristics and the choice of one of the two devices for oxygen therapy in early postoperative period. METHODOLOGY: Clinic for Anesthesiology and Intensive Therapy at the Clinical Center of Vojvodina conducted this research on 160 patients who underwent elective surgical procedures and received post-operative care in Intensive Care Unit. Patients were randomly assigned to two groups (Group M with oxygen face mask and Group N with nasal cannula) relative to device which was used for post-operative oxygen therapy. Information recorded for all the patients included in the study constituted their gender, age, weight, hight, and body max index. ASA status, as well as NYHA status were also recorded. Research excluded any patient who experienced respiratory complications in post-operative period as well as those who experienced hemodynamic instability. Postoperatively all patients were sedated and on mechanical ventilation therapy in intensive care unit. After transition to spontaneous breathing and extubating, oxygen therapy was applied using oxygen mask (6 l/min) or nasal cannula (4 l/min). Vital parameters were continuously monitored as well as hemoglobin oxygen saturation, and carbon dioxide at the end of the expirium. Gas analysis of artery blood was carried out four times for all participants in the study. All parameters were compared between two examined patient groups. Statistical analysis was carried out using Statistical Package for Social Sciences - SPSS 21. Numerical features are depicted using arithmetic mean and variability rate, and attributive features are depicted with frequency and percentages. Comparison of the values of numerical characteristics between the two groups was performed using Student's t-test, that is, a non-parametric Mann-Whitney test. The frequency difference in attributive characteristics was tested using χ2 test. To generate adequate statistical model, multivariate regression analysis was applied to examine the link between two or more of features. Significant values are determined if level of significance is p<0.05. RESULTS: Preoperative characteristics of the patient showed no significant differences between the two study groups. Characteristics were recorded with respect to gender (2 test; 2 = 0.378; p = 0.539), age (t-test; t = 1,958, p = 0,053 ), APACHE II score on admission (Mann-Whitney test; U = 1220.500; p = 0.837), body mass index (t-test; t = 1.380, p = 0.171), smoking habits (2 test; 2 = 0.644; p = 0.422), the values of the preoperative hemoglobin (t-test; t = 0.442, p = 0.660), and hemoglobin oxygen saturation (t-test; t = 0.883, p = 0.380). Difference was discovered in regards to duration of mechanical ventilation (Mann-Whitney test; U = 1114.500; p = 0.345). Hypoxemia (partial oxygen pressure in the arterial blood of less than 65 mmHg) was not registered in any of the patients in both study groups. Value SpO2< 92%, was registered in 24 patients during every round (24%). Patients who registered value lower than 92% experienced it in the first hour post extubation. This was observed in 5 patients in total (5%) where 3 patients from group M (6%) and 2 from group N (4%). Between 2nd and 3rd rounds, saturation values lower than 92% were recorded in 19 patients (19%): 8 from group M (16%) and 11 from group N (22%). In the period between the 3rd and 4th rounds the value of saturation lower than 92% was detected in 19 (19%) patients: 10 from group M (20%) and 9 from group N (18%). Statistically significant difference was noted in all three rounds (rounds 2, 3, 4) in the values of the partial oxygen pressure in arterial blood. Thus, patients from the group treated with an oxygen face mask had significantly higher values of partial oxygen pressure. In addition patients treated by oxygen face mask had significantly higher levels of oxygen saturated hemoglobin, and this difference was statistically significant in all observed rounds. In the first 48 hours after surgery noninvasive mechanical ventilation was performed in 80 patients. Common indication for oxygen therapy in all patients was desaturation. There were no statistically significant differences in the number of patients who required non-invasive mechanical ventilation in either of the groups (2 test; 2 = 2.250; p = 0.134). Patients in group N received several minutes more (mean value of 56.85 +/- 19.80 minutes) of the non-invasive ventilation than patients in the group M (mean value of 33.14 +/- 10.65 minutes), and this difference was statistically significant (t-test; t = 2,923, p = 0,009). Based on the multivariate regression analysis, the patients who received oxygen therapy via nasal cannula, with the increase in body mass index had lower values of partial oxygen pressure in arterial blood (r2 = 0.392). CONCLUSION: Both face mask and nasal cannula ensure adequate application of oxygen therapy to prevent hypoxemia in the early postoperative period. Oxygen face mask achieves higher value of partial oxygen pressure in arterial blood. Episodes of desaturation more frequently occur in patients who receive oxygen therapy with nasal cannula in early postoperative period. Patients who receive oxygen therapy via oxygen face mask achieve higher hemoglobin oxygen saturation values. Patients who undergo oxygen therapy in the early postoperative period using nasal cannula require longer application of non-invasive mechanical ventilation. Patients with higher body mass index receive better oxygenation in the early postoperative period if facial mask is the device of choice.

Određivanje koncentracije etanola u telesnim tečnostima, pre svega u krvi, neophodan je uslov da bi se ustanovio uticaj alkoholemije na psihomotorne sposobnosti. Poznavanje stabilnosti lekova, droga i metabolita u biološkim uzorcima je od ključne važnosti kada se ukaže potreba za ponovljenom analizom i evaluacijom rezultata u sudskom postupku. Osnovni ciljevi ovog rada su da se uz pomoć HS-GC metode (hedspejs gasna hromatografija) ustanovi da li postoji statistički značajna promena koncentracije etanola u uzorcima krvi dobijenih od živih osoba i u biološkim uzorcima uzorcima sa autopsijskog materijala. Na osnovu rezultata potrebno je bilo utvrditi u kojem tipu uzorka uzetog sa lešnog materijala postoji najmanja promena koncentracije tokom perioda čuvanja uzorka. Istraživanje je bilo otvoreno, randomizirano i prospektivnog tipa. Biološki uzorci krvi krvi živih osoba i lešnog materijala (krv, mokraća i staklasto telo) uzimani su metodom slučajnog izbora, u rasponu alkoholemije od 0,1 mg/ml do 5 mg/ml. Nakon inicijalne dvostruke analize, jedan biološki uzorak čuvan je u trajanju od 180 dana, dok je drugi otvaran i analiziran nakon 60, 120 i 180 dana. Ukupan broj analiza alkoholemije u krvi živih osoba iznosio je 500. Ukupan broj analiza koncentracije etanola u krvi, mokraći i staklastom telu sa leševa iznosio je 360. Etanol je u uzorcima krvi živih osoba, kao i u biološkim uzorcima sa autopsijskog materijala određivan metodom HS GC. Tokom čuvanja bioloških uzoraka u periodu od šest meseci ustanovljeno je da je došlo do značajnog smanjenja koncentracije etanola u svim analiziranim uzorcima, nezavisno od njegovog porekla. Promena koncentracije etanola tokom čuvanja u zavisnosti je od tkivne vrste uzorka, inicijalne alkoholemije, dužine čuvanja, integriteta vijala i čepova, temperature, odnosa tečne i gasne faze, prisustva konzervansa i potencijalnog intermitentnog otvaranja radi analiza.
Determination of ethanol concentration in body fluids, especially blood, is a necessary objective to establish the influence of alcohol on psychomotor skills. Knowing the stability of medicines, drugs and metabolites in biological samples is of crucial importance when there is a need for repeated analysis and result evaluation in court. The main objectives of this work were to determine whether there was a statistically significant change in ethanol concentration in blood samples obtained from living subjects and from autopsy material, by using HS-GC method (headspace gas chromatography). Based on the results it was necessary to determine which type of sample collected from autopsy showed the lowest change in concentration during the storage period. The study was open, randomized and prospective. Biological samples of living person's blood and autopsy biological samples (blood, urine and the vitreous humor) were taken at random, in the level range between 0.1 mg/ml and 5 mg/ml. After an initial duplicate analysis, one biological sample was stored for a period of 180 days, while the other was opened and analyzed after 60, 120 and 180 days. Total number of analysis of living person's blood samples was 500. The total number of analysis of autopsy biological samples was 360. All concentrations were determined by HS-GC method. During the storage, results showed that there has been a significant decrease in the concentration of ethanol in all of the analyzed samples, regardless of its origin. The level of this change was dependent on the type of tissue sample, initial alcohol concentration, duration of storage, integrity of the vials and stoppers, temperature, ratio of liquid and gas phases, presence of preservatives and intermittent opening for analysis.

An arterialblood gas analysis which is conducted in critical care areas contributes to the assessment of a patient's ventilatory status and acid -base balance. The purpose of this research was to determine the relationship of time delays and temperature on the result of a blood gas analysis. The objective was to either accept or refute the null hypothesis, that there is no relationship between temperature and time delays and an arterial blood gas result Fifteen subjects were randomly selected. The researcher drew three samples of arterial blood from each subject. Ethical principles were observed. An inferential non-parametric statistic was used. The chi-squared test was used to test the hypothesis and the Friedman and the Wilcoxon signed ranks test were used to test the differences between the means. The results revealed that there was a relationship between time delays, temperature and the arterial blood gas result. The null hypothesis was rejected.
Health Stusies
M.A. (Health Studies)

Blood gas analysis is an important part of a doctor’s diagnosis; it primarily consists of the partial pressure of oxygen, partial pressure of carbon dioxide and the pH. It provides the medical practitioners with insight into the patient’s respiratory health, the metabolic activity in the body and the health of the renal system. The emphasis of the thesis is based on the development of the colorimetric technique to measure the pH and pCO2 and the design and implementation of the colorimetric algorithm in hardware. The colorimetric algorithm is implemented using floating point arithmetic architectures for high accuracy with an emphasis on low power consumption and area.

Background Point-of-care blood gas analysis is considered a standard of care in modern air ambulance operations by many professional organisations for clinical assessment and monitoring of patients. Instances where point-of-care blood gas analysis has identified clinically significant abnormalities which then led to clinical intervention are well documented and have been quantified previously in the air ambulance environment. However, results obtained from point-of-care blood gas analysis are not always required for patient care, nor do they always result in any clinical action on the part of the medical crew. Our question therefore related to the data for a Johannesburg based jet air ambulance service. Methods By means of retrospective case reviews over a one year period, we reviewed the overall frequency of utilisation of point-of-care blood gas analysis on patient transportations within a Johannesburg based jet air ambulance service. We established how often point-of-care blood gas analysis yielded abnormal findings, and how frequently abnormalities detected by point-of-care blood gas analysis resulted in clinical interventions. Results Point-of-care blood gas analysis was undertaken in 266 of 334 patients transported (79.6%). Abnormal findings were noted in 203 of the 338 blood gas analyses undertaken (60.1%). Patient age (p=0.001) and intubation status (p=0.01) were significant influences on number of analyses performed, while flight time was not significant (p=0.07). Clinical intervention followed in 65.5% of instances where abnormalities on blood gas analysis were noted and in 87.6% where clinical corrective intervention was assessed as being possible under prevailing conditions. Of all patients transported, some form of clinical intervention was undertaken following 39.3% of all blood gas analyses undertaken. This therapeutic yield evidenced is equivalent to 2.54 samples analysed per corrective clinical action evidenced. A costing analysis further revealed that this testing is relatively inexpensive per positive finding yielded and subsequent clinical actions. Conclusions Abnormalities detected and subsequent clinical intervention using point-of-care blood gas analysis in this patient population was significant with a clinical yield of 39.3%. Since the costs are also not very high this modality is rightfully considered a minimum standard of care in air ambulance operations. These findings also support the notion that such testing should be carried out routinely on all patients irrespective of clinician interpretation of indication or need

碩士
國立臺灣科技大學
工業管理系
105
Blood is a vitally important fluid of the human body, and the management of its supply and demand is an important research issue in contemporary health care systems. Because blood substitute has not yet been well developed, most of the healthcare systems rely on voluntary donations to ensure sufficient blood supplies. However, blood demand and supply can be highly stochastic and irregular because the donation pattern and transfusion need may be affected by various factors including time, weather, and other events (such as disasters). Blood products are also perishable, and an inappropriate inventory management can result in shortage or wastage of blood products. Thus, a model which is capable of accurately predicting blood supply and demand has long been valued in the blood inventory management research. In this study, a forecasting model which can precisely predict the amount of blood donation was developed. In particular, we integrated the data of donation histories of whole-blood donors collected from Taipei Blood Center and the weather information form the Central Weather Bureau, and combined the generalized additive model (GAM) with the time series model to construct a two-step prediction model. A bootstrap method was also implemented on the residuals produced by the two-step model to construct the prediction intervals which can later be used to detect the anomaly donation patterns. The results of this research could have considerable implications in blood inventory management to help achieving better allocation of resources for Blood Centers.

Einleitung: Alpakas gehören zu einer Tiergruppe, die in den vergangenen Jahren im Patientengut der Tierärzte immer häufiger anzutreffen ist. Daher ist es von großer Bedeutung, sich mit der Physiologie und Pathologie dieser Tierart zu beschäftigen. Die Versorgung der Neonaten spielt dabei eine große Rolle. Da Alpakacrias, wenn überhaupt, dann erst sehr spät, klinische Anzeichen einer Erkrankung zeigen, ist es für den Untersucher von großem Nutzen, einen Einblick in den Blutgas- und Säure-Basen-Haushalt, sowie Kenntnis von den hämatologischen und blutchemischen Parametern des Neonaten zu erhalten. Des Weiteren bietet die Blutuntersuchung ein wichtiges Hilfsmittel zur Überprüfung der Versorgung mit kolostralen Antikörpern. Ziele der Untersuchungen: Ein Ziel der Untersuchungen war die Erstellung von bisher nicht vorhandenen Referenzwerten für die venöse Blutgasanalyse, die Hämatologie und für einige blutchemische Parameter bei gesunden, lebensfrischen Alpakacrias innerhalb der ersten drei Lebenstage. Des Weiteren sollte in diesem Zusammenhang die Eignung eines mobil einsetzbaren Blutgasanalysegerätes (epoc®, Fa. Alere GmbH, Köln) für die Tierart Alpaka eruiert werden. Hierfür wurden Doppelbestimmungen der Proben mit einem etablierten stationären Blutgasanalysegerät (ABL90 FLEX®, Fa. Radiometer, Kopenhagen) durchgeführt. Tiere, Material und Methoden: In die Studie wurden 20 gesunde neugeborene Alpakacrias integriert. Die Fohlen stammten vornehmlich aus Stuten, die zur Geburtsüberwachung in die Klinik eingestallt wurden, bei anderen handelte es sich um solche, die innerhalb der ersten Lebensstunden wegen vermeintlich verzögerter Tränkeaufnahme vorgestellt worden waren, was sich aber nicht bestätigte. Alle Alpakafohlen wurden nach dem Gießener Vorsorgeschema II für neonatale Equiden klinisch untersucht. Anschließend erfolgte 3-8 Stunden p. n., 24 Stunden p. n. und 72 Stunden p. n. je eine Blutprobenentnahme. Der erste Analysezeitpunkt wurde bewusst nicht unmittelbar post natum gewählt, da die Etablierung einer stabilen Prägungsphase zwischen Muttertier und Cria nach der ersten Tränkeaufnahme abgewartet werden sollte. Die Blutentnahme erfolgte nach Reinigung und Desinfektion aus der ungestauten V. jugularis externa im Bereich des sechsten Halswirbels. Die Blutgasanalyse wurde innerhalb von 15 Minuten mit den zuvor genannten Blutgasautomaten durchgeführt. Die hämatologischen Parameter wurden mit dem pocH-100 iV (Fa. Sysmex Deutschland GmbH, Norderstedt) bestimmt, die blutchemischen Untersuchungen erfolgten mit dem FUJI DRI CHEM 3500 (Fa. Sysmex Deutschland GmbH, Norderstedt). Insgesamt wurden 55 Blutproben entnommen und analysiert. Pro Analysegerät (epoc®, ABL90 FLEX®, pocH-100 iV, FUJI DRI-CHEM 3500) wurden je 55 Messungen durchgeführt. Die statistische Auswertung erfolgte mit dem Programm IBM SPSS Statistics 22.0. Die Normalverteilung wurde mittels Shapiro-Wilk-Test überprüft. Für den Gerätevergleich (epoc®/ABL90 FLEX®) fand der Wilcoxon-Test Anwendung. Der Vergleich der Zeitpunkte erfolgte über den Friedman-Test für verbundene Stichproben. Des Weiteren wurden für die einzelnen Parameter der Median und die Perzentile, bzw. der Mittelwert und die Standardabweichung bestimmt. Die grafische Darstellung erfolgte mit Boxplots und Bland-Altman-Plots. Ergebnisse: Im Gerätevergleich konnte insgesamt auf eine gute Übereinstimmung der Messwerte geschlossen werden. Signifikante und gleichzeitig klinisch relevante Unterschiede gab es lediglich bei der Bestimmung der Sauerstoffsättigung und des Hämatokrits, was auf unterschiedliche Mess- und Berechnungsmethoden bei den Geräten zurückzuführen ist. So liegen die Hämatokritwerte beim epoc® deutlich unter denen vom ABL90 FLEX®. In diesem Zusammenhang wichtig für die Interpretation der Ergebnisse ist, dass für jedes Messgerät die individuellen Referenzbereiche berücksichtigt werden müssen. Die venöse Blutgasanalyse ergab für gesunde Crias zu Beginn des ersten Lebenstages einen pH-Wert von 7,34 – 7,40, einen Sauerstoffpartialdruck (pO2) von 21,6 – 29,2 mmHg, einen Kohlendioxidpartialdruck (pCO2) von 37,3 – 46,0 mmHg, eine Sauerstoffsättigung (sO2) von 30,5 – 48,0 %, ein aktuelles Bikarbonat (HCO3-) von 21,3 – 25,1 mmol/l, eine Standardbasenabweichung (SBE) von -3,3 – 0,2 mmol/l und einen Laktatgehalt von 1,6 – 3,4 mmol/l. Der pH Wert ähnelte im Verlauf dabei dem von Kälbern und Lämmern gleichen Alters, der pO2 war insgesamt etwas niedrig, aber konstant und ähnelte über den Messzeitraum dem von Kälbern. Es wurden bei den Crias im Vergleich zu Fohlen, Kälbern und Lämmern niedrigere pCO2-Werte festgestellt. Die Sauerstoffsättigung ähnelte der von Equidenfohlen, über den Messzeitraum fällt die Konzentration im Mittel geringfügig ab, bei den anderen Vergleichstierarten steigt sie an. Die Glukosekonzentrationen waren postnatal höher als bei anderen Haustierneonaten (3-8 h p.n.: 4,4 – 8,2; 24 h p.n.: 7,3 – 12,8; 72 h p.n.: 7,3 – 16,2 mmol/l). Laktat kann nicht, wie es beim Equidenfohlen postuliert wird, als Indikator für den Gesundheitszustand eines Alpaka-Crias genutzt werden. Hämatologisch sind die spezielle Form und die hohe Anzahl der Alpakaerythrozyten, die hohe Zahl an Leukozyten und Thrombozyten (speziell bei den Crias), sowie die hohe MCHC zu nennen. Schlussfolgerungen: Es konnten teilweise bisher fehlende Daten zur venösen Blutgasanalyse für die Beurteilung der Stoffwechsellage neugeborener Alpakacrias etabliert werden. Das mobile Blutgasgerät epoc® stellt eine für die Anwendung geeignete Alternative dar.

Dissertação de Mestrado em Química Forense apresentada à Faculdade de Ciências e Tecnologia
O desenvolvimento do presente estudo tornou-se pertinente devido ao consumo indevido de opióides e ao número de mortes por overdoses associadas ao seu consumo, tanto em Portugal como no resto do mundo. Por outro lado, sendo o recurso a matrizes biológicas postmortem alternativas ao sangue, uma área de crescente interesse em toxicologia forense estudámos a viabilidade do uso do líquido pericárdico na determinação das substâncias selecionadas.Assim, o objetivo deste trabalho foi o desenvolvimento, otimização e validação de uma metodologia analítica para a determinação qualitativa e quantitativa de alguns opióides em sangue e líquido pericárdico.Os opióides estudados foram: morfina, codeína, 6-acetilmorfina, 6-acetilcodeína, oxicodona, oximorfona e o fentanil.O estudo incluiu a otimização do procedimento analítico e do método cromatográfico. Otimizámos a extração em fase sólida (SPE), a derivatização com e sem recurso a hidroxilamina aquosa a 1% e o tempo de derivatização induzida por micro-ondas com o reagente químico MSTFA (n-metil-n-(trimetilsilil) trifluoroacetamida)+5% TMCS (trimetilclorosilano).O método mais eficiente e seletivo correspondeu ao seguinte procedimento: precipitação com acetonitrilo de volumes de 250 μL de amostras de sangue e de líquido pericárdico, derivatização das substâncias de interesse usando 1% hidroxilamina aquosa em PBS (1:2, v/v) promovida por irradiação de micro-ondas, durante 30 segundos com uma potência de 900 W a 50%. Procedeu-se à extração dos analitos de interesse por SPE. Após evaporação dos eluatos (sob corrente de azoto a 40 ᵒC) os extratos foram derivatizados com MSTFA+5% TMCS sob ação de micro-ondas durante 100 segundos com uma potência de 900 W a 100%. Seguidamente os extratos derivatizados foram injetados (2 μL, splitless) diretamente no sistema de cromatografia de gases associado à espectrometria de massas (GC-MS-EI) com monitorização dos iões selecionados (modo SIM) e com o forno à temperatura inicial de 50 ᵒC.Após a otimização, o método foi validado seguindo as normas da Scientific Working Group for Forensic Toxicology (SWGTOX) de forma a garantir que o método é adequado para os fins a que se destina e assim atestar a sua fiabilidade na interpretação dos resultados analíticos. O método apresentou linearidade no intervalo 5-1000 ng/mL com coeficientes de determinação superiores a 0.99 para todos os analitos. Os limites de deteção (LOD) variaram entre 3 e 4 ng/mL, dependendo da substância e/ou da matriz analisada e os limites de quantificação (LOQ) foram de 5 ng/mL para todas as substâncias. Em relação às precisões (intra-dia e intermédia) todos os níveis de concentração apresentaram valores de CV <20% e a exatidão situou-se dentro do intervalo ±20%.Verificou-se ainda que as substâncias apresentaram estabilidade sob as seguintes condições: nos extratos deixados no amostrador em condições ambientais por pelo menos 24 h; nas amostras de sangue e líquido pericárdico deixadas na bancada de trabalho durante 4 h e nas amostras de líquido pericárdico durante 3 ciclos de congelação e descongelação ao longo de pelo menos 4 semanas.Por fim, a metodologia analítica foi aplicada a amostras reais disponibilizadas pelo Serviço de Química e Toxicologia Forenses da Delegação do Centro do Instituto Nacional de Medicina Legal e Ciências Forenses, I.P..De acordo com a revisão bibliográfica efetuada, este foi o primeiro método desenvolvido para a deteção e quantificação simultânea deste grupo de substâncias em sangue e líquido pericárdico com recurso à derivatização promovida por micro-ondas com os reagentes químicos hidroxilamina e MSTFA+5% TMCS.
The development of the present study became pertinent due to the misuse of opioids and the number of overdose deaths associated with its use, both in Portugal and in the rest of the world. On the other hand, being the use of alternative biological matrices to postmortem blood, an area of growing interest in forensic toxicology, we studied the feasibility of using pericardial fluid in the determination of the selected substances.Thus, the objective of this work was the development, optimization and validation of an analytical methodology for the qualitative and quantitative determination of some opioids in blood and pericardial fluid.The opioids studied were: morphine, codeine, 6-acetylmorphine, 6-acetylcodeine, oxycodone, oxymorphone and fentanyl.The study included the optimization of the analytical procedure and the chromatographic method. We have optimized solid phase extraction (SPE), derivatization with and without 1% aqueous hydroxylamine and microwave derivatization time with the chemical reagent MSTFA (n-methyl-n-(trimethylsilyl) trifluoroacetamide)+5% TMCS (trimethylchlorosilane).The most efficient and selective method was as follows: precipitation with acetonitrile of 250 μL volumes of blood and pericardial fluid samples, derivatization of the substances of interest using 1% aqueous hydroxylamine in PBS (1:2, v/v) with microwave action for 30 seconds with a power of 900 W at 50%. The samples were cooled and then the analytes of interest were extracted by SPE. After evaporation of the eluates (under nitrogen stream at 40 °C) the extracts were derivatized with MSTFA+5% TMCS under microwave action for 100 seconds with a power of 900 W at 100%. Then the derivatized extracts were injected (2 μL, splitless) directly into a gas chromatography mass spectrometry system (GC-MS-EI) with selective ion monitoring mode (SIM mode) and with the oven at the initial temperature of 50 °C.After optimization, the method was validated following the standards of the Scientific Working Group for Forensic Toxicology (SWGTOX) to ensure that the method is suitable for its intended purpose and thus attest to its reliability in interpreting the analytical results. The method presented linearity in the range 5-1000 ng/mL with coefficients of determination above 0.99 for all analytes. The limits of detection (LOD) ranged from 3 to 4 ng/mL, depending on the substance and/or matrix analysed and the limits of quantitation (LOQ) were 5 ng/mL for all substances. Regarding the precision (intra-day and intermediate) all concentration levels presented CV values <20% and the bias was within ±20%. It was also verified that the substances presented stability under the following conditions: in the extracts left in the autosampler under environmentalconditions for at least 24 h; blood and pericardial fluid samples on the workbench for 4 h; pericardial fluid samples for 3 freeze-thaw cycles for at least 4 weeks.Finally, the analytical methodology was applied to real samples provided by the Serviço de Química e Toxicologia Forenses da Delegação do Centro do Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (Forensic Chemistry and Toxicology department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences, I.P.).According to the literature review, this was the first method developed for the simultaneous detection and quantification of this group of substances in blood and pericardial fluid using microwave induced derivatization with the chemical reagent’s hydroxylamine and MSTFA+5% TMCS.

Une morbidité et une mortalité néonatales élevées limitent l’efficacité du clonage somatique chez les bovins. Des malformations myoarthrosquelettiques, des anomalies ombilicales, des problèmes respiratoires et de la faiblesse ont été fréquemment observés chez les veaux clonés nouveaux-nés. Cette étude rétrospective porte sur 31 veaux clonés. Ses objectifs étaient de décrire les problèmes respiratoires rencontrés, leur évolution au cours du temps, les traitements instaurés pour soutenir la fonction respiratoire et la réponse aux traitements. Vingt-deux veaux ont souffert de problèmes respiratoires. La tachypnée, l’hypoxémie et l’hypercapnie sont les signes cliniques les plus fréquemment observés. L’analyse des gaz sanguins a été un outil essentiel dans le diagnostic et le suivi de la fonction respiratoire. La radiographie a permis une évaluation globale du poumon. L’oxygénothérapie intranasale et la ventilation mécanique ont permis de limiter la mortalité due à une insuffisance respiratoire à 18% (4/22). Cette étude a permis d’émettre des hypothèses quant à l’origine des problèmes respiratoires chez les veaux clonés. Plus d’une maladie semblent affecter les veaux clonés. La déficience en surfactant, l’hypertension pulmonaire persistante et le retard de résorption du fluide pulmonaire figurent parmi les entités pathologiques les plus probables.
High morbidity and mortality decrease the efficiency of somatic cell nuclear transfer. The main abnormalities observed in neonatal cloned calves are skeletal malformations, enlarged umbilical vessels, respiratory problems and weakness. This retrospective study involved 31 cloned calves. The objectives of this study were to describe the respiratory problems suffered by cloned calves during neonatal period, to assess their evolution, and to determine the possible causes. Secondary objectives were to describe the techniques used to assess and support respiratory function and the calves’ response. Respiratory problems affected 22 calves. Tachypnea, hypoxemia and hypercapnia were the most frequently observed signs. Arterial blood gas analyses and chest radiographs were precious to identify and assess respiratory problems. Intranasal oxygen and mechanical ventilation were efficient to limit mortality due to respiratory failure to 18% (4/22). It is plausible that more than one disease affect cloned calves. Delayed resorption of pulmonary fluid, persistent pulmonary hypertension and surfactant deficiency, or a combination of these factors, are among the most probable pathological entities.