Comparing continuous lumbar plexus block, continuous epidural block and continuous lumbar plexus block with a parasacral sciatic nerve block on post-operative analgesia after hip arthroplasty

Study Objective: To compare post-operative analgesia obtained by continuous lumbar epidural block (CLEB) versus continuous lumbar plexus block (CLPB) versus CLPB associated with a single shot parasacral sciatic nerve block (CLEBS) after total hip arthroplasty (THA). Study design: Randomized clinical trial. Setting: Operating room, postoperative care unit, orthopedic surgical ward. Methods: 78 ASA I-III patients undergoing elective THA were randomly assigned to receive CLEB (n=24, 15-20 ml of 5 mg/ml ropivacaine, sufentanil 10 mg, clonidine 1 mg/ml), CLPB (n=22, 3mg/kg of 5 mg/ml of ropivacaine, max. 40 ml, clonidine 1 mg/ml, sufentanil 10 mg) or CLPBS (n=23, CLPB as described above; sciatic nerve: 20 ml of ropivacaine 5 mg/ml, clonidine 1 mg/ml). All patients received continuous infusion of 2 mg/ml of ropivacaine, 8 ml/h for 48 hours. Primary outcome was pain intensity assessment (VAS and VS). Secondary outcomes were postoperative total opioid consumption, hemodynamic stability, motor blockade, blood loss, intraoperative sufentanil and propofol consumption, patient satisfaction and complications. Results: VAS was lower in the CLEB group than in the CLPB and CLPBS groups respectively for 6 and 12 hours postoperatively (post-surgery p<0.001, 2h p<0.001, 6h p<0.001, 12h p<0.03)(Table 2). Moreover, CLPSB patients reported lower VAS than CLPB patients from the end of the surgery till the 12th follow up hour (Table 2). VS was lower in the CLEB group from the end of surgery to 6h postoperatively (Table 3). The CLPB group showed higher morphine consumption than the CLPSB and CLEB groups over 12 h postoperatively (p=0.05); thereafter, no statistically significant diferences were observed between groups at the end of follow up (48h) (p=0.4) (Table 4). onclusion: In conclusion, continuous lumbar plexus block in association with single shot sciatic nerve block is a valid alternative to epidural technique in managing postoperative analgesia after THA, with an improved risk-benefit balanc

Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences

Background: Gabapentin and pregabalin inhibit Ca2+ currents via high-voltage-activated channels containing the α2δ-1 subunit, reducing neurotransmitter release and attenuating the postsynaptic excitability. They are antiepileptic drugs successfully used also for the chronic pain treatment. A large number of clinical trials indicate that gabapentin and pregabalin could be effective as postoperative analgesics. This systematic-narrative review aims to analyse the most recent evidences regarding the effect of gabapentinoids on postoperative pain treatment. Methods: Medline, The Cochrane Library, EMBASE and CINHAL were searched for recent (2006-2009) randomized clinical trials (RCTs) of gabapentin-pregabalin for postoperative pain relief in adults. Quality of RCTs was evaluated according to Jadad method. Visual analogue scale (VAS), opioid consumption and side-effects (nausea, vomiting, dizziness and sedation) were considered the most important outcomes. Results: An overall of 22 gabapentin (1640 patients), 8 pregabalin (707 patients) RCTs and seven meta-analysis were involved in this review. Gabapentin provided better post-operative analgesia and rescue analgesics sparing than placebo in 6 of the 10 RCTs that administered only pre-emptive analgesia. Fourteen RCTs suggested that gabapentin did not reduce PONV when compared with placebo, clonidine or lornoxicam. Pregabalin provided better post-operative analgesia and rescue analgesics sparing than placebo in two of the three RCTs that evaluated the effects of pregabalin alone vs placebo. Four studies reported no pregabalin effects on preventing the PONV. Conclusion: Gabapentin and pregabalin reduce pain and opioid consumption after surgery in confront with placebo, but comparisons with other standard post-operative regimens are not sufficient. Gabapentin and pregabalin seem not to have any influence on the prevention of PONV

International Student Athletes Research Project

This essay was created for Megen Boyett\u27s English 102 course

The comparing of ultrasound-guided techniques:sciatic block with continous lumbar plexus block or continous femoral nerve block for aneshtesia and analgesia of total knee replacement

Abstract: Background and Aims: This double blind prospective randomized clinical trial evaluated the efficacy and safety of continuous ultrasound-guided lumbar plexus block compared to continuous ultrasound-guided femoral nerve block, in the intra-operative and postoperative periods after total knee replacement. Methods: Forty ASA I-III patients were randomized to receive: continuous femoral block (n= 20, 30 ml of ropivacaine 5 mg/ml) or continuous lumbar plexus block (n= 20, 30 ml of ropivacaine 5 mg/ml) both in association with single injection sciatic nerve block. All patients received continuous infusion of 2 mg/ml of ropivacaine at 8 ml/h for 48 hours and intra- venous morphine for patient-controlled analgesia. Primary outcomes were intra-operative sufentanil consumption and verbal analogue scale (VAS) score at rest at 24h follow up. Results: Intra-operative sufentanil consumption was higher in the femoral block (FEM) group compared to the lumbar plexus block (PSOAS) group (FEM: 10.00 (10.00, 17.50) μg; PSOAS: 2.50 (0.00, 10.00) μg. p= 0.002). Obturator motor blockade occurred more frequently in the PSOAS group (70%) than in the FEM group (40%) (p=0.1); however, we found no differences in sensory blockade (p=0.6). VAS at rest was similar in the two groups at 24h postoperatively (FEM: 29.50 ± 14.74 mm; PSOAS: 25.60 ±17.42 mm. p=0.4), and throughout the follow-up period. No differences were detected in pain scores during physiotherapy. Conclusion: Continuous femoral and lumbar plexus blocks, both in association with sciatic nerve block, provided similar VAS scores at 24h, and throughout the follow-up period; intra-operative sufentanil consumption was, however, lower in the lumbar plexus block group

The Interplanetary Network Supplement to the BeppoSAX Gamma-Ray Burst Catalogs

Between 1996 July and 2002 April, one or more spacecraft of the interplanetary network detected 787 cosmic gamma-ray bursts that were also detected by the Gamma-Ray Burst Monitor and/or Wide-Field X-Ray Camera experiments aboard the BeppoSAX spacecraft. During this period, the network consisted of up to six spacecraft, and using triangulation, the localizations of 475 bursts were obtained. We present the localization data for these events.Comment: 89 pages, 3 figures. Submitted to the Astrophysical Journal Supplement Serie

Aspectos clínico-patológicos das poxviroses em bovinos no Distrito Federal (2015-2018)

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, Programa de Pós-Graduação em Saúde Animal, 2018.Foi realizado estudo retrospectivo de casos de poxviroses diagnosticadas e notificadas em bovinos, no Distrito Federal (DF), entre 2015 a 2018, pelo Serviço Oficial Veterinário da Secretaria de Agricultura, Abastecimento e Desenvolvimento Rural do DF. Na maioria dos casos, foram coletadas amostras de lesões orais, cutâneas (tetos, úbere) ou podais para diagnóstico molecular por PCR. Em aproximadamente 70% dos casos, também foram coletados fragmentos para histopatologia. De 2.467 bovinos avaliados clinicamente, de 385 propriedades, 93 apresentaram lesões sugestivas e/ou compatíveis com poxviroses. Desses, foram confirmados 52 casos de poxviroses: 27 por VACV, nove por PCPV, oito por BPSV, cinco por coinfecção PCPV e BPSV e três por parapoxvírus não identificado. As enfermidades foram observadas em propriedades com diferentes tipos de exploração (corte, leite ou mista) e em nove das 30 regiões administrativas (RAs) do DF. As lesões macroscópicas consistiram de pápulas, vesículas, úlceras, crostas e cicatrizes, e variaram de tipo, intensidade e local acometido, de acordo com o(s) vírus detectado(s). Foi observado apenas um episódio de comprometimento humano em um caso de infecção por BPSV. Os achados histopatológicos foram muito similares, independente do poxvírus envolvido e incluíram inflamação linfoplasmo-histiocítica e/ou neutrofílica multifocal superficial leve a moderada com acantose e hiperqueratose paraqueratótica, usualmente associada a crostas serocelulares e espongiose. Nos casos com úlceras, havia áreas focalmente extensas de necrose com infiltrado acentuado de neutrófilos no tecido conjuntivo adjacente. Em seis casos (dois de VACV, dois de PCPV e dois de coinfecção por PCPV/BPSV), foi observada pequena a moderada quantidade de corpúsculos de inclusão eosinofílicos de 4-8 μm no citoplasma dos queratinócitos. Os dados do presente estudo demonstram que há ampla circulação de diferentes poxvírus em bovinos de diferentes categorias e em várias RAs do DF.A retrospective study of poxviruses cases diagnosed and notified in cattle, in Distrito Federal (DF), Brazil, between 2015 and 2018, was conducted. In the most cases, samples of oral, cutaneous (teats, udder) or roof lesions were collected to molecular diagnosis by PCR. In approximately 70% of the cases, additional samples were collected to histopathology. Out of 2,467 cattle analysed of 385 farms, 93 presented lesions sugestive and/or compatible with poxviruses. Fifty-two cases of poxviruses were confirmed: 27 by VACV, 9 by PCPV, 8 by BPSV, 5 by PCPV and BPSV coinfection, and 3 by not identified parapoxvirus. The diseases were observed in farms with diferente types of exploration (beef, dairy, or mixed cattle) and in 9 of 30 administrative regions (RAs) of DF. Gross findings include papules, vesicles, ulcers, crusts, and scars, and varied of type, intensity and affected tissue according to the detected virus. Only one episode of human infection in a case of BPSV was observed. Histopathology findings were very similar in all poxviruses and consisted of mild to moderate multifocal infiltrate of lymphocytes, plasma cells, macrophages and/or neutrophils with acanthosis and parakeratotic hyperkeratosis, usually associated to crusts and spongiosis. In the ulcerated cases, there was focally extensive areas of necrosis with severe infiltrate of neutrophils in the adjacent connective tissue. Few to moderate amount of cytoplasmic eosinophilic inclusion bodies (4-8μm) were noted in six cases (two of VACV, two of PCPV and two of PCPV and BPSV coinfection). Data of the current study demonstrate that there is wide circulation of different poxvirus in cattle of different categories and in many RAs of DF

Necessidade de prévio processo administrativo como condição de procedibilidade para dar início a ação penal

Nosso trabalho tem o escopo de analisar a necessidade de prévio processo administrativo como condição de procedibilidade para a ação penal, dessa forma analisaremos qual o exato momento da consumação do crime contra a ordem tributária, haja vista que os crimes contra a ordem tributária são materiais dependem de um resultado finalístico, com o intuito de saber se o contribuinte cometeu ou não os delitos de sonegação fiscal capitulados na Lei. 8.137/90, bem como, em outras leis esparsas que tratam do mesmo assunto. Abordaremos em princípio os aspectos gerais do direito tributário, os elementos principais da norma geral e abstrata, noções gerais do direito penal, adentrando nos crimes contra a ordem tributária dentre os itens o mais relevante para nosso trabalho, ou seja, a necessidade de prévio processo administrativo como condição de procedibilidade para o início da ação penal, iremos tecer breve comentários nas formas de suspenção, exclusão e extinção do crédito tributário, formas que, em tese, beneficiam o contribuinte para não incorrer as penas dos delitos tributários, dentre outros assuntos relevantes relacionados a matéria em comento.Our work has the scope to examine the need for prior administrative process as procedibilidade condition for prosecution, thus analyze what the exact time of the consummation of the crime against the tax order, given that the crimes against the tax system are material dependent of a final result, in order to know if the taxpayer has committed the offense of tax evasion capitulated in Law. 8,137 / 90, and in other scattered laws dealing with the same subject. We will cover in principle the general aspects of tax law, the main elements of general and abstract rule, general notions of criminal law, entering in the crimes against the tax order among the items most relevant to our work, that is, the need for prior process administrative as procedibilidade condition for the start of criminal proceedings, we will weave brief comments in the forms of suspension, exclusion and termination of the tax credit, ways which, in theory, benefit the taxpayer not to incur the penalties of tax offenses, among other relevant issues related matter under discussion

Celebridades diplomatas: atuações da indústria do entretenimento no cenário político internacional

Em um campo tão diverso e em constante evolução como o das Relações Internacionais, é frequente o surgimento de novas concepções acerca de suas problemáticas, em especial no que tange a inclusão de novos tipos atores, temas na agenda internacional e formas de se exercer o poder no cenário político global. Muito embora grande parte da doutrina ainda afirme que este poder esteja vinculado apenas ao Estado e organizações internacionais, governamentais ou não, se observa a crescente participação da indústria do entretenimento no cenário internacional, uma vez que esta vem apresentando um volume cada vez maior de participação em iniciativas humanitárias, políticas e sociais, podendo assim representar um indício de que tais exercícios ou processos de tomada de decisões podem ser bastante vantajosos tanto para esta indústria, quanto para as organizações que promovem estas ações sociais de caráter internacional. Frente a esta participação global, pretende o presente estudo analisar se esta visibilidade das causas sociais através do entretenimento e da cultura da celebridade afeta a política internacional, fazendo da celebridade um verdadeiro ator de relações internacionais, já que através destes personagens faz com que a ação social saia do escopo local e tome ares de preocupação global.In such a diverse and constantly evolving field of research as the International Relations, the appearance of new conceptions about its problems are often perceived, especially regarding the inclusion of new types of actors, themes on the international agenda and ways to exercise power on the global political scenario. Although much of the doctrine still states that this power is linked only to the State and the international organizations, governmental or not, it has been observed the growing participation of the entertainment industry in the international scenario, since it has shown an increasing volume of participation in initiatives, such as humanitarian, political and social, which may represent a clue that these exercises or decision-making processes can be quite advantageous not only for the industry, but for the organizations that promote these social actions of international character. Faced with this global participation, this study intends to examine whether this visibility of social issues through entertainment and celebrity culture affects international politics, making one celebrity a real actor of international relations, since they make the action goes beyond the local scope and achives the global concern

A memória, o equívoco e a reparação: uma análise sobre memória e o filme “Desejo e Reparação”

Este artigo pretende, por meio da análise do filme “Desejo e reparação”, baseado na obra de Ian McEwan, estudar como, em uma narrativa fundamentada, as memórias exercem influência no destino dos personagens. O estudo tomará como base uma das personagens protagonistas da história para, então, por intermédio de conceitos de memória, equívoco e reparação, entender os desdobramentos da narrativa. Em conclusão, pretende-se definir se, através de uma reparação, o uso da memória como forma de se desculpa pode ser a única forma de redenção da personagem