Hepatic Lipidosis in Banded Armadillos (Euphractus sexcinctus) Bred in Captivity

Background: Wild animals bred in captivity may develop steatosis due to unbalanced dietary intake and obesity caused by sedentary behaviour. In some rural areas, six-banded armadillos are raised in captivity inside some metal barrels, with restricted space, and are often overfeed. After getting fattening, armadillos they are slaughtered and used as food. Theunfavorable conditions may somehow contribute to likely underlie the development of many diseases, among them we can including hepatic steatosis. The present report aims to describe the pathological fndings of hepatic lipidosis in banded armadillos (Euphractus sexcinctus), bred in captivity.Case: The animals were three female adult six-banded armadillos (Euphractus sexcinctus), caught in the native forest of the city of Natal, Rio Grande do Norte, Brazil and raised in domestic environment in a small enclosure and fed with human food leftovers. After eight months kept in these conditions armadillos had severe obesity and then were donated to the city zoo, where they were quarantined and presented clinical symptoms of anorexia for two weeks, weight loss and exhaustion. After being found dead during daily inspection carried out by the veterinarian zoo, the six-banded armadillos were sent to the Animal Pathology Laboratory of Federal Rural University of the Semi-Arid (UFERSA) for pathological examination.The animals presented with a history of anorexia were extremely obese and the autopsy detected had extensive deposits of fat in the carcass and liver. Histopathologically, the liver cells hepatocytes showed marked intracytoplasmic vacuolization and with peripheral displacement of the nucleus to the periphery, with and positive staining for lipids using scarlet Sudan III. To our knowledge, this is the frst report of hepatic lipidosis in banded.Discussion: Hepatic lipidosis can be categorized into normal liver and mild, moderate, or severe fatty liver. In severe cases, it is estimated that 80% of the hepatocytes are affected. Therefore, we classifed the hepatic lipidosis of the three studied female six-banded armadillos as severe, since the lipids were deposited diffusely. Based on the severity of the lesions and absence of other fndings, we concluded here that hepatic lipidosis contributed to the cause of the six-banded armadil los death. The weight of the animals in this report may be associated with innapropriate enclosure dimensions and a diet based on human food leftovers. Such diet was reportedly composed of rice, beens, spaghetti, and bread, which are food with high levels of carbohydrate. The armadillos of the Euphractus sexcinctus species usually weigh between 3 and 6 kg and hence, the animals of this report showed twice the normal weight. The occurrence of hepatic lipidosis associated with anorexia triggered by a stressful event such as a change of environment and diet armadillos observed in the present study is in agreement with literature data pointing anorexia in obese animals as a major predisposing factors for the occurrence of hepatic lipidosis by promoting energy restriction, peripheral lipolysis and large intake of fatty acids to the liver.Keywords: Euphractus sexcinctus, armadillos, anatomopathology, liver, lipidosis

Preliminary observation of the use of sodium bicarbonate solution as an adjunct in the treatment of coronavirus 2019 disease (COVID-19): prognosis improvement in patients requiring intensive care / Observação preliminar do uso de solução de bicarbonato de sódio como coadjuvante no tratamento da doença coronavírus 2019 (COVID-19): melhora do prognóstico na necessidade de terapia intensiva

Introduction: This study aimed to evaluate the use of sodium bicarbonate solution as an adjunct in the treatment of critically ill patients in an intensive care unit (ICU). Methods: A group of 76 patients were followed up, of which 44 received treatment with a sodium bicarbonate (NaHCO3) solution along with the conventional treatment, and 32 patients used only the conventional treatment. Results: In patients treated, there was an improvement in radiological findings, a decrease in opacity and bilateral consolidations, as well as reduced length of stay in the ICU, and mortality. Conclusion: The use of NaHCO3 solution as an adjunct in the treatment of COVID-19 improved prognosis compared to conventional treatment. 

Redução da dispnéia relacionado ao uso da solução de bicarbonato de sódio em indígenas infectados com SARS-CoV-2 no estado do Acre, Amazônia Brasileira / Dyspnea reduction related to the use of the sodium bicarbonate solution in SARS-CoV-2 infected indigenous in the state of Acre, Brazilian Amazon

INTRODUÇÃO: Em 17 de março de 2020, o estado do Acre registrou os três primeiros casos confirmados na capital Rio Branco, sendo decretado o lockdown (20 de março) como medida para evitar a disseminação do SARS-CoV-2 em municípios e aldeias indígenas. Os 3 primeiros casos notificados no alto rio Juruá no dia 4 de abril, mobilizaram toda a equipe do DSEI para o enfrentamento do COVID-19. METODOLOGIA: Dentre os sintomas que mais levam o paciente a deixar a aldeia e procurar atendimento médico em hospitais de campanha está o desconforto respiratório ou dispneia. Relatamos aqui a redução da dispneia pelo uso de nebulização com solução de bicarbonato de sódio a 3% (NaHCO3 3%), em pacientes indígenas no Estado do Acre, Amazônia Ocidental. Por conveniência, foram selecionados 20 pacientes indígenas, positivos para SARS-CoV-2, que apresentavam a dispneia,  casos moderados, independentemente do sexo e idade, foram analisados. Esses pacientes foram divididos em dois grupos, um tratado com a solução e o outro controle não tratado. RESULTADOS: O grupo de tratamento nebulizou com 10ml de solução de NaHCO3 a 3% por 20 minutos, a cada 6h, por 7 dias consecutivos. A saturação periférica de oxigênio (SpO2%) foi medida por oxímetro de pulso, antes e após cada nebulização. Para a análise dos dados paramétricos, utilizou o teste de comparação com a média entre os grupos e o teste t pareado para comparar as médias dos dependentes. Para dados não paramétricos, o teste dos postos sinalizados de Wilcoxon foi usado a um nível de significância de 0,05. Verificou-se que os dez participantes do grupo tratado com a solução relataram melhora da dispneia e aumento da SpO2% nos dias 2, 3 e 4, após nebulizações com a solução. CONCLUSÃO: Espera-se, com estes resultados, ampliar o estudo para um número maior de participantes, em diferentes condições clínicas e comorbidades, grupos etários, indígenas e não indígenas.  

Epidemiology of American cutaneous leishmaniasis (ACL) in Xapuri municipality, Acre state, Brazil: study in human population, domestic dogs and vectors

Introdução. A leishmaniose tegumentar americana (LTA) é uma endemia de importância em saúde pública na Amazônia Brasileira, onde possui diferentes perfis de transmissão com a participação de diversas espécies de vetores e de protozoários do gênero Leishmania. O Estado do Acre apresenta altos índices de LTA e, no ano de 2015, apresentou o mais alto coeficiente de detecção de casos (137,7/100.000 hab.) da doença no Brasil. Objetivo. Analisar aspectos epidemiológicos da LTA no município de Xapuri, Estado do Acre, Brasil, envolvendo população humana, cães domésticos, vetores e identificação de Leishmania. Materiais e Métodos. Para a avaliação epidemiológica, foram analisadas fichas de notificação dos casos humanos no período de 2008 a 2014 obtidas do sistema de vigilância epidemiológica do município. Foram analisadas as variáveis: sexo, grupo etário, escolaridade, forma clínica, diagnóstico, tratamento e evolução clínica. Os dados foram submetidos à análise descritiva e teste estatístico do qui-quadrado de Pearson utilizando o pacote estatístico STATA. Também foram obtidas amostras de material de pacientes (escarificação das lesões fixadas em lâminas) atendidos no centro médico do município, durante o período de novembro de 2014 a janeiro de 2016. As amostras foram submetidas à análise molecular para diagnóstico de Leishmania spp. O inquérito canino foi realizado em áreas urbanas e rurais; nestas, predominantemente, em seringais, onde a doença foi reportada em humanos. Após avaliação clínica dos animais para busca de lesões e sinais característicos de leishmanioses, foram coletadas amostras de sangue venoso por punção jugular ou cefálica, e quando havia lesões sugestivas da doença, foram anestesiados e submetidos à biopsia para colheita do fragmento de lesão. Amostras destes fragmentos foram submetidas a técnicas parasitológicas, inoculação em meio de cultura Neal, Novy e Nicolle, exame direto e técnicas moleculares para detecção do parasita. A identificação de Leishmania spp. foi realizada por técnicas moleculares. Os flebotomíneos foram coletados em ambiente domiciliar e florestal de dois seringais (Floresta e Cachoeira) e na área urbana, com armadilhas luminosas tipo CDC, instaladas mensalmente, no período de agosto de 2013 a julho de 2015. Neste período, apenas no seringal Cachoeira, também foram feitas coletas utilizando armadilhas de Shannon nas cores branca e preta, e de janeiro a maio de 2016, coletas em trocos de árvores com aspiradores manuais. Uma amostra de fêmeas coletadas pelas diferentes técnicas foi dissecada viii para investigação da presença de flagelados. Para a análise do comportamento da fauna flebotomínea foram utilizados índices ecológicos como de Shannon, Pielou e Abundância das Espécies Padronizado, média geométrica de Williams e análise dos componentes principais. Para estimar a atratividade dos flebotomíneos pelas cores branca e preta foi utilizado o teste de Mann-Whitney (p<0,05). Análises morfométricas utilizando o teste de Gabriel (teste F, p <0,05) foram feitas para distinguir alguns táxons. Para as análises moleculares dos parasitas foi empregada a técnica de Nested-PCR SSU rRNA utilizando os iniciadores S4/S12 e S17/S18 e sequenciamento. Resultados. No estudo de casos humanos, constatou-se que a doença ocorre predominantemente em populações rurais e isoladas do município, em indivíduos de ambos os sexos, com as incidências mais elevadas em crianças e adolescentes. Em 33 dos 45 pacientes com clínica positiva para LTA foram detectadas a presença de DNA de Leishmania spp. Nos cães domésticos, verificou-se alta taxa de infecção (20,0 por cento ) por Leishmania (Viannia) sp. Nos estudos de flebotomíneos, foram coletados 21.197 espécimes (14.210 fêmeas e 7.107 machos) com armadilhas CDC, e 6.309 (864 machos e 5.445 fêmeas) com armadilhas de Shannon. As frequências, abundâncias e densidades mais elevadas foram dos gêneros Nyssomyia, Psychodopygus e Trichophoromyia, coletados em ambientes silvestres, peri e intradomiciliares. Em ambiente rural foram coletados 99,9 por cento dos espécimes e no urbano apenas 0,1 por cento . Nyssomyia shawi predominou no Seringal Cachoeira, e Trichophoromyia spp. (Th. auraensis/Th. ruifreitasi) no Seringal Floresta. Espécies do gênero Psychodopygus predominaram no período chuvoso, enquanto as de Nyssomyia, no período seco. Infecções por Leishmania spp. foram detectadas em Brumptomyia sp., Nyssomyia antunesi, Ny. shawi, Lutzomyia sherlocki, Psathyromyia aragaoi, Psychodopygus carrerai carrerai, Ps. davisi, Ps. hirsutus hisutus, Ps. llanosmartinsi, Ps. lainsoni, Thrichophoromyia ubiquitalis e Trichophoromyia spp. Por meio de análises morfológicas e morfométricas das fêmeas de Trichophoromyia sugeriu-se a distinção de Th. octavioi de Trichophoromyia spp. (Th. auraensis/Th. ruifreitasi) e descreveu-se, Psathyromyia elizabethdorvalae sp. n. Conclusões. A LTA em Xapuri apresenta um perfil de transmissão silvestre e outro domiciliar. As populações humanas e caninas que frequentam ambientes florestais estão expostas a uma alta diversidade de vetores e de agentes etiológicos, o que aumenta o risco de infecção de LTA. As informações aqui apresentadas podem nortear as medidas de controle, planejamento das ações e definição de prioridades dos órgãos de vigilância epidemiológica do Estado do Acre, visando o diagnóstico precoce e tratamento adequado dos casos de leishmanioses da população humana de XapuriIntroduction. American cutaneous leishmaniasis (ACL) is an endemic disease that deserves the attention of public health in the Brazilian Amazon, where it has various transmission profiles with the participation of several species of vectors and protozoa of the genus Leishmania. The state of Acre registers high rates of ACL, having in 2015 the highest coefficient of detection of cases (137.7 / 100,000 inhab.) in Brazil. Objective. To analyze the epidemiological aspects of LTA in the municipality of Xapuri, State of Acre, Brazil, involving the human population, domestic dogs, vectors and the identification of Leishmania ssp. Materials and Methods. For the epidemiological evaluation, records of the human cases notified between 2008 and 2014 obtained from the epidemiological surveillance system of the municipality, were analyzed. The following variables were selected for analysis: sex, age group, schooling, clinical form, diagnosis, treatment and clinical evolution. The data were submitted to descriptive analysis and the Pearson chi-squared statistical test using the statistical package STATA. Samples of patient material (scarification of lesions fixed on slides) were also obtained from the medical center of the city during the period from November 2014 to January 2016. These samples were submitted to molecular analysis for the diagnosis of Leishmania spp. The canine survey was carried out in both urban and rural areas, in the latter rubber plantations where the disease had been reported in humans predominated. After a clinical evaluation to search for lesions and characteristic signs of leishmaniasis, samples of venous blood were collected by jugular or cephalic puncture, and when the animals presented lesions suggestive of cutaneous leishmaniasis, they were anesthetized and submitted to biopsy to harvest the lesion fragment. Samples of these fragments were submitted to parasitological techniques, inoculation in Neal, Novy and Nicolle culture medium, direct examination and molecular techniques to detect Leishmania spp. The samples were submitted to molecular analysis for the diagnosis of Leishmania spp. The phlebotomine survey was carried out in forest and the domiciliary environment of the city and in two rubber plantation areas (Seringal Cachoeira and Seringal Floresta), monthly using CDC light traps, from August 2013 to July 2015. In this period, only in the Seringal Cachoeira were collections also made using black and white Shannon traps. Collections in tree trunks and among tree roots with manual aspirators were also undertaken from January to May 2016. xi Samples of females collected by different techniques were dissected to investigate the presence of flagellates. For the analysis of the behavior of the phlebotomine fauna, ecological indexes such as Shannon, Pielou, and Standardized Species Abundance, Williams geometric mean and main component analysis were used. The Mann-Whitney test (p <0.05) was used to estimate the attractiveness of the black and white colors to sandflies. Morphometric analyses using the Gabriel test (test F, p <0.05) were made to distinguish between some taxa. For the molecular analyses of the parasites the Nested-PCR SSU rRNA technique was used using primers S4 / S12 and S17 / S18 and sequencing. Results. In the study of human cases, it was found that the disease occurs in rural and isolated populations and in individuals of both sexes, especially in children and adolescents. In 33 of the 45 patients with positive ACL, the presence of Leishmania spp DNA was detected. The domestic dogs have shown a high infection rate (20.0 per cent ) attributed to Leishmania (Viannia) sp. In the sandfly studies, 21,197 specimens (14,210 females and 7,107 males) were collected in CDC traps, and 6,309 (864 males and 5,445 females) were collected in Shannon traps. The highest frequencies, abundances and densities were of the genera Nyssomyia, Psychodopygus and Trichophoromyia collected in wild, peri and intradomiciliary environments. Nyssomyia shawi predominated in the Seringal Cachoeira, and the Trichophoromyia spp. (Th. auraensis/Th. ruifreitasi) in the Seringal Floresta. Species of the genus Psychodopygus predominated in the rainy season while those of Nyssomyia in the dry period. Natural infections by Leishmania spp were detected in Brumptomyia sp., Nyssomyia antunesi, Ny. shawi, Lutzomyia sherlocki, Psathyromyia aragaoi, Psychodopygus carrerai carrerai, Ps. davisi, Ps. hirsutus hirsutus, Ps. llanosmartinsi, Ps. lainsoni, Trichophoromyia ubiquitalis and Trichophoromyia sp. Morphological and morphometric analyses of Trichophoromyia females were suggested to distinguish Th. octavioi from Trichophoromyia spp (Th. auraensis/Th. ruifreitasi), Pa. elizabethdorvalae being described for the first time. Conclusions. ACL in Xapuri presents one profile of wild transmission and another of domiciliar transmission. Both populations, human and canine, because they live in forest environments are exposed to a high diversity of vectors and etiological agents, which increases the risk of ACL infection. The information presented here may guide the measures of control, planning of actions and definition of priorities taken by the organs of surveillance and epidemiology of the State of Acre, aiming at the early diagnosis and appropriate treatment of the human cases in Xapur

Spatial and temporal distribution of American cutaneous leishmaniasis in Acre state, Brazil

Abstract Background Acre has reported the highest incidence of American cutaneous leishmaniasis (ACL) in Brazil in recent years. The present study seeks to identify high and low risk agglomerations of ACL in space and space-time during the period from 2007 to 2013 in Acre, and also to characterize the occurrence of the disease in time and according to sociodemographic variables. Methods This is an ecological study, the study population of which consisted of autochthonous ACL cases notified in the municipalities of Acre by an epidemiological surveillance system. Scan statistics of SaTScan™ software were used to identify spatial and space-time clusters. In addition, the cases were characterized by sex, age, home situation (in a rural or urban area), and temporal tendency. Results Acre reported an incidence rate of 12.4 cases per 10 000 inhabitant-years in the study period, with the rates varied greatly (standard deviation of 21.8) among their 22 municipalities. One agglomeration of high risk and three of low risk were detected in space and space-time. Four of the five micro-regions of Acre presented a stationary temporal tendency. The profile of transmission varied according to the micro-region. Generally speaking, the disease occurred more often among young people, those of male gender, and those living in rural areas. Conclusions Acre has stood out within the Brazilian national context due to its high rates of ACL incidence in the central region of the Acre Valley. The high rates in the micro-region of Brasiléia are related to the disease’s intra/peridomiciliary occurrence, and it would seem that the municipality of Sena Madureira is approaching a transmission pattern similar to that of Brasiléia. In other micro-regions, the profile of the disease’s transmission is mainly related to the forest/sylvatic cycle of ACL

APOIO EMOCIONAL A CUIDADORES DE IDOSOS: vivência de voluntários do projeto escuta solidária

Esse trabalho objetivou relatar a vivência de voluntários em ações do Projeto Escuta Solidária voltadas aos cuidadores de idosos acamados. Os voluntários realizavam ligações telefônicas que possibilitaram o estreitamento de vínculo com cuidadores, permitindo o desenvolvimento de habilidades como o acolhimento, a escuta qualificada e o reconhecimento das necessidades do cuidador. A experiência perpassou o conhecimento científico, promovendo aos voluntários percepção de gratidão e engrandecimento na execução das ações