Clinical, Cytological, Histopathological and Immunohistochemical Features of a T-Zone Lymphoma in a Mixed-Breed Dog

Background: Non-Hodgkin lymphoma are a group of lymphoid neoplasms originated from the proliferation of precursors or mature, T, B and/ or NK lymphocytes. T-Zone lymphoma (TZL) is characterized as an indolent lymphoma due to its slow progression and poor chemotherapy´s response. Dogs affected by this neoplasm may live for many years without clinical signs and are often underdiagnosed. The aim of the present article is report a TZL case in a nine-year old male mixed breed dog, submitted to clinical follow-up and chemotherapy. Case: A nine-year old male mixed-breed dog was presented due to the observation of an increased left mandibular lymph node. The previous cytological examination was suggestive of reactive hyperplasia and histopathological examination, by incisional biopsy, compatible with lymphocytic low-grade lymphoma. Physical examination revealed enlarged and firm left mandibular lymph node and adequate physical condition.A cytological examination was performed in the mandibular and  both popliteal lymph nodes and revealed many small lymphocytes with hyperchromatic chromatin, rarely evident nucleolus and whose cytoplasm often projected in the form of a “hind-mirror” or “comet tail”, compatible with lymphocytic lymphoma (low grade) and suggestive of TZL, in the both lymph nodes. The histopathological and immunohistochemical examination, of the mandibular lymph node, were chosen to confirm the diagnosis. At histopathology it was observed 40% of the sample contained a monotonous cell population, composed by small lymphocytes, with some presenting “hand-mirror” morphology. Two mitotic figures were evidenced per field of high magnification (40x), inferring a low-grade disease. Immunohistochemical analysis revealed neoplastic proliferation with immunolabeling of CD3 lymphocytes and positivity for Ki-67, but negative for CD20, CD79a, CD45, MUM-1 and PAX-5. Although there is no consensus about requirements and treatment´s efficacy, it has been chosen to treat the dog with chlorambucil, because of the elevated Ki-67 value (48%). The patient obtained a free-progression interval higher than 820 days, from the earlier investigations of lymphadenopathy, with excellent quality of life and no side effects related to the use of chlorambucil. Discussion: Although TZL is a common subtype of lymphoproliferative disease in dog, it is still underdiagnosed. The TZL diagnosis can be suggested by cytology, from the disclosures in neoplastic cells of a cytoplasmic projections, recognized as a “hand-mirror” or “comet tail”, corroborated with the present case, however the histopathology is confirmatory. Immunohistochemistry in which the neoplasm cells showed a positive immunolabeling for CD3 and negative for CD79a, CD20, CD45, MUM1 and PAX5, as evidenced in this report, confirming the T-cell origin. According to the literature, lymphomas composed by small clear cells and cytoplasm projecting by cytology, immunolabeling CD3 and CD25 positive and CD45 negative are, together, findings that confirmed TZL. The biological behaviour of indolent lymphoma is still largely unknown, however the prognosis of dogs, with indolent lymphoma of T or B cells, seems to be favourable.  Studies showed different days of median overall survival, such as 760 days and 4.4 years. In the present case, the dog showed 820 days, confirming the good prognosis and an indolent behavoiur. Aggressive chemotherapy protocols are not necessary for such cases and the treatment with chlorambucil, without the association of prednisolone, has been well tolerated by the patient, which showed no side effects until the moment

Solitary Osseous Plasmacytoma of a Lumbar Vertebrae with Systemic Involvement in a Dog

Background: Myeloma-related disorders are characterized by proliferation of neoplastic plasma cell or immature immunoglobulin secreting B-lymphocytes, and include multiple myeloma, M-macroglobulinemia and extra-medullary plasmacytoma (cutaneous or extra-cutaneous). Solitary osseous plasmacytoma (SOP) is considered an unique entity among extra-medullary extra-cutaneous plasmacytoma. It is an unusual neoplasia in dogs, predominantly found in middle-aged to older animals, with a higher incidence in bones of axial skeleton. Dogs with vertebral SOP present neurological signs related to spinal cord compression, but progression to multiple myeloma is related to a poor outcome. As in humans, progression to multiple myeloma occurs in most cases, although it may take months or years from its initial presentation. SOP´s biological behaviour, incidence and prognostic are rarely documented. Chemotherapy with melphalan and prednisolone represent the most used protocol for multiple myeloma. However, in SOP, the combination of chemotherapy with local approaches is controversial before the evidence of systemic disease. This paper aims at reporting a case of SOP in a lumbar vertebrae of a dog, with systemic involvement. Case: A 11-year old male mixed breed dog was attended presenting muscle weakness, lethargy, anorexia, adipsia and intense pain manifestation. The dog also presented multiple skin nodules, previously diagnosed as a plasmacytoma, through cytology. The dog´s poor clinical condition and aggressive temper, associated with suspicious of an advanced myeloma-related disorder, resulted in the decision for humanized euthanasia. At necropsy, a pale, friable and hemorrhagic mass was identified on the L3 lumbar vertebrae, associated with an osteolytic bone lesion and spinal cord compression. Histopathological analyses revealed proliferation of plasma cells, with pale perinuclear halo, moderate cellular pleomorphism, 10 binucleated cells and 10 mitotic figures per 10 high power fields, compatible with extramedullary plasmacytoma of the mature type, in the lumbar vertebrae (SOP). It was also seen myeloma-related lesions in the skin and subcutaneous, prostate, heart, superficial mandibular and axillary lymph nodesDiscussion: Solitary osseous plasmacytoma is a myeloma-related disorder rarely reported in dogs. Its biological behaviour is poorly characterized, however progression for multiple myeloma is common in humans and dogs, and it is related to a poor outcome. As the present report, systemic progression of SOP has been previously described and although an overt bone marrow infiltration was not detected, such possibility can not be excluded, once multiple myeloma distribution in the bone marrow is often multifocal. Although chemotherapy is the treatment of choice for multiple myeloma, its indication for SOP is conditioned to the evidence of systemic disease. It might delay tumour progression, but its early implementation may favor the selection of resistant neoplastic clones, making it ineffective when progression to multiple myeloma occurs. In humans radiotherapy is the treatment of choice for SOP, however it may be indicated in association to surgery. A retrospective study showed a higher survival rate in patients with SOP in the axial skeleton, which received surgical treatment combined with radiotherapy, if compared to those treated with surgery or radiotherapy alone. Decision for euthanasia was made based on the suspicious of advanced myeloma-related disorder, patient´s medical condition and aggressive temper, which limited diagnostic investigation and treatment

Atuação da enfermagem em casos de violência sexual contra a mulher

Identificar na literatura pesquisas científicas sobre estratégias utilizadas pela equipe de enfermagem frente aos casos de violência sexual contra as mulheres. Trata-se de uma revisão integrativa da literatura, utilizando seis etapas, a partir dos pressupostos propostos por Ganong (1987), sendo elas: estabelecimento do problema de análise, seleção da amostra, categorização dos estudos, avaliação dos estudos incluídos na pesquisa, apresentação dos resultados e discussão e exposição da investigação, os artigos foram pesquisados nas bases de dados internacionais, PubMed, Medline, Scopus e Embase,  a partir de uma chave de busca utilizando-se os descritores  “enfermagem”, “violência contra a mulher” e “delitos sexuais”, em português e seus correspondentes em inglês. Foram encontrados no total 345 artigos, sendo 97 artigos duplicados, resultando em 248 para leitura, após a análise de cada um constatou-se que 10 artigos cumpriam com os critérios estabelecidos, dessa forma analisou-se três categorias: a) Dificuldades da equipe de enfermagem acerca do assunto violência sexual feminina; b) Assistência às vítimas e suas implicações e c) Novas modalidades da Enfermagem. A violência sexual contra a mulher, é um problema de saúde pública, os profissionais de enfermagem desenvolvem um papel importante na assistência, principalmente na atuação da criação de vínculo e apoio psicológico. Em relação às dificuldades destaca-se a sobrecarga emocional do enfermeiro. Salienta-se a importância da produção de mais estudos acerca da temática, assim como a adição nas grades curriculares dos cursos da equipe multidisciplinar

Enterolitíase em equinos da raça crioula

Enteroliths are intestinal mineral calculi predominantly composed of struvite. In horses this material accumulates concentrically around a core, causing total or partial obstruction of the higher and lower colon, and can lead to death by rupture. The enterolithiasis has worldwide distribution, and occurs frequently in Rio Grande do Sul, especially in Crioulo Horses. The aim of this work is to report a sequence of cases of Crioulo Horses with enterolithiasis, linking risk factors through historical analysis, clinical presentation and management employed by the breeding farms. Case: Between the years 2012 and 2015, 16 Crioulo Horses with colic syndrome caused by enteroliths were treated at the Hospital de Clínicas Veterinária of Universidade Federal de Pelotas (UFPel), RS, Brazil and Clínica Hípica, in Porto Alegre, RS. The group was formed predominantly by males, weighted 430 kg in average and the average age was eight years old. All horses underwent general and specific clinical examination, laboratory tests and surgical procedure to remove the enterolith. After discharge, there was an epidemiological questionnaire seeking information about the history, food and environmental management that could be related to the development of enterolithiasis. In relationship to the history of previous episodes of colic, the results were: 4 horses (25%) had no previous episodes of colic, while 12 horses (75%) had experienced previous colic. Regarding the horses’ bedding, 70% use sawdust and 30% rice husk, and about behavior, ten (62.5%) of the 16 horses attended had no stereotypies. Related to food and water supply, it was observed that nine horses (56.25%) had alfalfa as the only roughage source in the diet, and all animals (100%) were fed commercial food and water ad libitum. According to the number of hours the patients remained stabled, the rearing system was classified as intensive (over 12 h/stable/day), extensive (0 h, at the field) or semi-extensive (up to 12 h/stable/day). The frequencies observed were: intensive (9 animals - 56.25%), semi-intensive (6 animals - 37.5%) and extensive (1 animal - 6.25%). The average time of stabling was 17.2 h/day. Discussion: The alfalfa consumption as the only forage observed in our study is the main risk factor described for the formation of enteroliths. This is because in digestion, alfalfa tends to alkalize the intestinal pH, hindering the metabolism of some minerals and thus forming the enterolith. Another important risk factor observed in this work is the intensive rearing, with long periods of stabling. This explains why confinement leads to decreased intestinal motility, due to reduced or absent grazing. Furthermore, reduced physical activity is another contributing factor to the reduction of motility, because the exercise influence the intestinal peristalsis. The rearing of horses intensively is usual with the Crioulo, especially in training and morphological preparation. Based on this case study, we can’t say that there is a racial predisposition to enterolithiasis of the Crioulo Horse, since it would require more studies on the physiology and a standard feeding of these horses. However, we can attribute the considerable volume of enteroliths observed in Crioulo Horses in Rio Grande do Sul to the increase in the number of referrals to the reference hospitals, feeding alfalfa as the only roughage source in the diet and to intensive management of the farms, with long periods of daily stabling

Hospitalizações por Diabetes Mellitus no Sistema Único de Saúde: um panorama da última década / Diabetes Mellitus Hospitalizations in the Brazilian National Health System: an overview of the last decade

O diabetes mellitus é uma doença crônica não transmissível que assola grande parte da população mundial e que vem aumentando cada vez mais sua incidência no Brasil e no mundo. A maior parte dos casos podem ser manejados na Atenção Básica, melhorando a qualidade de vida e diminuindo a mortalidade dos doentes. Foi realizado um estudo por meio dos dados do DATASUS que avalia a flutuação do número de internações por diabetes no Sistema Único de Saúde. O estudo mostra que apesar do aumento crescente do número de casos as internações não aumentaram, o que se concluiu que deve-se ao aumento da eficácia das estratégias da Atenção Básica.

Uma visão educativa: relatos das experiencias vivenciadas pelos alunos do curso de química licenciatura durante suas caminhadas escolares / An educative vision: reports of experiences experienced by students in the chemistry degree course during their school walk

O presente trabalho procede de pesquisas desenvolvidas no decorrer da disciplina de práticas curriculares na dimensão escolar que tem como foco principal a temática: a escola. A pesquisa consistiu em relatos dos alunos do curso de química licenciatura da Universidade Estadual do Maranhão-UEMA, onde os mesmos apresentam suas experiências vivenciadas ao longo da suas caminhadas escolares, desde do ensino dos anos iniciais até sua chegada a academia. Nas oportunidades os relatos retratam a importancia do ambiente escolar para sua formação como cidadão quanto para sua escolha a cursar uma universidade. Percebe-se pelos relatos dos discentes que a escola ainda é um ambiente responsável em estimular os alunos, contribuindo assim para o crescimento daquele individuo, adquirindo cada vez mais sua identidade em resumo sua cidadania. Em contra partida esse mesmo ambiente quando não cumpre com sua funçao pode simplesmente contribuir para uma desmotivação. Alguns discentes revelam ainda situações vividas que contribuiram para descontentamentos deste ambiente. Os relatos foram registrados atraves de um portfólio, ferramenta ultilizada durante a ministração da disciplina. Os resultados das pesquisas apontaram que a escola é essencial e fundamental para a construção de um individuo e a inserção do mesmo a sociedade

Aneurysm in the Distal Portion of the Extern Jugular Vein in a Horse

Background: Aneurysm is a vascular disease that causes the partial rupture of arteries and veins and subsequent blood leakage due to the weakening of the vessels elastic middle layer. Venous aneurysms in horses are rare, but the arterial aneurysms are commonly reported. The aim of this paper is to report a rare occurrence of jugular external aneurysm in a horse and propose the inclusion this disease as a differential diagnosis, both because it is rare in this specie and invariably fatal. The medical examination showed a firm well-defined mass, painless, nonpulsatile on palpation and with no changed in the local temperature.Case: The horse was referred to the Veterinarian Hospital of the Federal University of Pelotas (UFPel, RS-Brazil. It was a male, Crioulo breed, 10 years old, used as stallion. The owner reported a swelling in the pectoral region that occurred after a trauma episode that had gradually grown for two years. The patient was clinically stable, and would undergo surgery extirpation for aesthetic matters. Clinical examination showed the swelling was circumscribed and centralized and it presented about 20 centimeters in diameter. The ultrasound of the pectoral area showed an anechoic structure with hyperechoic spots inside limited by an hyperechoic layer similar to a fibrous capsule. Presumptive diagnostics were of: hematoma, subcutaneous abscess, neoplasia, and possible vascular involvement. The use of conventional ultrasound was not enough to set the diagnosis, and the patient was referred to surgical exploration, where the procedures of isolation and anastomosis were performed, however rupture occurred and the patient died. Necropsy revealed sacculation of the ventral region of the neck next to the entrance of the thorax, and the involvement of the external right jugular vein, being the adjacent muscle tissue not involved. Histopathological evaluation showed intense proliferation of sub-endothelial fibrous tissue which infiltrated the tunica media and adventitia and a mild inflammatory infiltrate of lymphocytes and histiocytes, which was diagnosed as an aneurysm of the right external jugular vein.Discussion: The reported patient had a venous aneurysm located superficially, which may have contributed to the absence of symptoms. The ultrasound is a diagnostic method available to most veterinarians nowadays, mainly in the countryside. However, when it is used in the diagnosis of an aneurysm it displays a dilatation with anechoic content, which is com­mon to several other skin diseases. A similar ultrasound image was observed in the case reported, but the diagnosis was difficult because the aneurysm presented intense proliferation of fibrous tissue infiltrated in the media and adventitia of the vascular wall, similar to a capsule of fibrous tissue, which lead to the presumptive diagnostics of hematoma, abscess and neoplasia, with possible vascular involvement. The options for the treatment of the aneurysms consider the location, size and extent of them and it determines the choice between clinical observation and surgery. In veterinary medicine it is difficult to keep the animals still and in the case of a horse, any movement can lead to the spontaneous rupture of the aneurism. Considering the risk of spontaneous rupture and hemorrhage, the surgical resolution, even if risky, emerges as the most suitable treatment. Venous aneurysms although rare, need to be included as a differential diagnosis in skin diseases along with increased volume, as hematomas, abscesses and tumors. The prognosis, however, is poor because of the surgical limitations and risks of imminent rupture in the clinical treatment.Keywords: venous aneurysm, differential diagnosis, equine