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BACKGROUND: Post-operative nausea and vomiting (PONV) is one of the most important causes of patient discomfort after laparoscopic surgeries despite the use of a multimodal pharmacological approach. This study assessed whether the addition of aprepitant to a multimodal regimen would further decrease the incidence of PONV in high-risk patients. METHODS: Apfel-score three or four patients, scheduled for laparoscopic procedures to treat abdominal or pelvic cancer, were randomized to receive oral starch (control group) or 80 mg of oral aprepitant (treatment group) before induction of anaesthesia in a double-blind study. All patients received 4-8 mg of intravenous dexamethasone (at induction) and 4-8 mg of ondansetron (at the end) and a standardized total intravenous anaesthesia (TIVA) technique combined with neuraxial blockade. PONV was defined as any episode of nausea, vomiting or retching in the first 24 h after anaesthesia. RESULTS: Sixty-six patients completed the study. Vomiting occurred in 13/32 (40.6%) patients in the control group and in 1/34 (2.9%) patients in the treatment group (P = 0.0002, 95%CI: 18-54%) in the first 24 h after anaesthesia. Severe nausea occurred in two (6.3%) patients, and severe vomiting occurred in four (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 post-operative hours. CONCLUSION: Eighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements. This study was registered in the ClinicalTrials.gov (NCT 02357693) database.

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INTRODUCTION: Ascitis and undernutrition are frequent complications of cirrhosis, however ascitis volume and anthropometric assessment are not routinely documented or considered in prognostic evaluation. In a homogeneous cohort followed during two years these variables were scrutinized, aiming to ascertain relevance for longterm outcome. METHODS: Population (N = 25, all males with alcoholic cirrhosis) was recruited among patients hospitalized for uncomplicated ascitis. Exclusion criteria were refractory or tense ascitis, cancer, spontaneous bacterial peritonitis, bleeding varices and critical illness. Measurements included ultrasonographically estimated ascitis volume, dry body mass index/BMI , upper arm anthropometrics, hematologic counts and liver function tests. RESULTS: Population (age 48.3 ± 11.3 years, BMI 21.1 ± 3.5 kg/m², serum albumin 2.5 ± 0.8 g/dL) was mostly in the Child-Pugh C category (77.8%) but clinically stable. During the follow-up period of 22.6 ± 3.8 months, additional hospitalizations numbered 1.7 ± 1.0 and more than one quarter succumbed. Admission ascitis volume corresponded to 7.1 ± 3.6 L and dry BMI to 18.3 ± 3.5 kg/m². Child Pugh index was relevant for both mortality and rehospitalization. Nevertheless, similar matches for mortality were documented with ascitis volume and dry BMI, and arm circumference below the 5th percentile was highly significantly associated with rehospitalization. CONCLUSIONS: A greater association than hitherto acknowledged, between ascitis volume and anthropometric measurements from one side, and long-term rehospitalization and mortality from the other, was demonstrated in male stable alcoholic cirrhotics. Further studies with alcoholic and other modalities of cirrhosis including women are recommended.

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As perdas buco-maxilo faciais causam grande constrangimento e sofrimento aos seus portadores, especialmente aquelas passíveis de reabilitação somente através da prótese. Este trabalho relata o caso de um paciente, sexo feminino, leucoderma e com 66 anos de idade, atendido na Clínica de Prótese Buco-Maxilo Facial da Faculdade de Odontologia de Pernambuco da Universidade de Pernambuco (FOP/UPE), portador de uma mutilação na região óculo-palpebral que teve como fator etiológico um câncer da região orbitária, descrevendo-se a técnica e a importância da reabilitação protética facial nos aspectos estéticos e psicossociais.

The maxillofacial losses cause great constraint and sadness especially those with need of rehabilitation only through prosthesis. This work present a case of a patient, feminine, leucoderm and 66 years of age, seeking for treatment at Clinic of Maxillofacial Prosthetic of the Dental School of the University of Pernambuco (FOP/UPE). The patient had a mutilation in the oculo-palpebral region and the etiologic factor was a cancer on the orbital region. This case report aimed also to describe its technique and the importance of the facial prosthetic rehabilitation to aesthetic and psicossociais aspects.

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Sludge incinerated ash has been fired at different temperatures. This material was fired at 1050 degrees C for 3 h and until a peak of 1010 degrees C. After thermal treatment the ash was screened at 200 mesh.The ash was characterized by X-ray fluorescence and trace elements like Cr, Pb, Zn, Cu, and some oxides like quartz(SiO2), Al2O3, P2O5, Fe2O3 were found. Scanning electron microscopy(SEM) has shown one change of particle between 2 microm at 90 microm and apparent porosity, thermal analysis has shown loss of mass and residual decomposition in the TG, DTG and DTA curves.

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Sida cordifolia L. (Malvaceae), known as "malva branca", is a plant used in the popular medicine for the treatment stomatits, of asthma and nasal congestion. This work researched the acute toxicity of Sida cordifolia and its action on the central nervous system (CNS) because no data in the literature have been found about of pharmacological activity of this plant in the CNS. The hydroalcoholic extract of Sida cordifolia leaves (HESc) was used and the psychopharmacology approach began with the determination of LD(50), where a low toxicity was observed in mice. Depressive activity on CNS was demonstrated by several alterations in mice's behavior in the pharmacological screening. In the motility test, the HESc showed significant reduction of spontaneous activity at a dose of 1000 mg/kg (i.p.) at 30 and 60 min. The same form the HESc also decreased the ambulation and rearing in open-field test at 30, 60 and 120 min at a dose of 1000 mg/kg (i.p.).

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Tremorine-induced tremors model is used to evaluate antiparkinsonian drugs because rest tremor is a sign that distinguishes Parkinson's disease (PD) from other diseases. The effects of crude ethanolic extract (CEE) and total acetate fraction (TAF) of Plumbago scandens were investigated at several doses. These extracts at doses of 125 and 250 mg/kg i.p. failed to reduce tremors in tremorine-treated mice. TAF showed significant effects only at a dose of 500 mg/kg. Both CEE and TAF at doses of 1000 and 2000 mg/kg i.p. suppressed the tremors in a dose-dependent fashion for 60 min. Biperiden, an anticholinergic drug, was used as standard at a dose of 3 mg/kg i.p. This study suggests that P. scandens is a plant with possible therapeutic value for PD.

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Neuropharmacological studies were carried out with reticuline, a benzylisoquinoline alkaloid, isolated from Ocotea duckei Vattimo. It was found that reticuline (50-100 mg/kg i.p.) produced alteration of behaviour pattern, prolongation of pentobarbital-induced sleep, reduction in motor coordination and D-amphetamine-induced hypermotility and suppression of the conditioned avoidance response. These observations suggest that reticuline possesses potent central nervous system depressant action.

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