Maxillomandibular Deformity in a Canine with Fibrous Osteodystrophy Secondary to Chronic Kidney Disease

Background: Cases of renal fibrous osteodystrophy are usually associated with nutritional causes, which of renal causes are considered uncommon in dogs. This disorder is characterized by the intense proliferation of fibrous connective tissue in bones, impairing bone stiffness. The aim of this study was to report a case of fibrous osteodystrophy secondary to chronic kidney disease in a canine with a "rubber jaw" facial deformity.Case: A 4-year-old male unneutered mongrel dog weighing 5.2 kg had a history of apathy, progressive weight loss and vomiting for one month, and polyuria and polydipsia for more than three months. In addition, the owner complained about the deformed appearance in the muzzle region of the animal, which was evidenced flexibility of the same, with a displacement of the mandible and maxilla on physical examination, similar to the "rubber jaw". Blood tests revealed macrocytic anemia, elevated total plasma proteins, and lymphopenia-associated neutrophilia, as well as hyperphosphatemia (24 mg/dL), uremia (283.6 mg/dL) and increased creatinine (8.6 mg/dL), ALT (143.2 UI/L) and alkaline phosphatase (3222.2 UI/L), while calcium (8.8 mg/dL) and albumin (1.9 g/dL) were decreased. A serological test for visceral leishmaniasis was also performed, which was negative. Abdominal ultrasound imaging revealed kidneys with alterations in tissue architecture, increased thickness and complete loss of cortico-medullary relationship, while the parathyroid gland was enlarged and spindle-shaped. Cranial radiography showed marked radiopacity of the bilateral maxillary bones, with destruction of the nasal, turbinate and frontal bones, as well as loosening of the teeth and destruction of the mandibular bone matrix, characterizing an aspect of “rubber jaw”. Based on the history, history and evidence of azotemia, hyperphosphatemia and loss of facial bone density, the diagnosis of fibrous osteodystrophy secondary to chronic kidney disease associated with hyperparathyroidism was concluded.Discussion: The clinical and laboratory findings reported in the present study were similar to those described in dogs with renal fibrous osteodystrophy associated with hyperparathyroidism. In the presence of azotemia, the patient was in stage 4 of chronic kidney disease which, despite investigating the infectious etiology, which was negative, remained unknown. Along with chronic kidney disease, the observation of hyperphosphatemia associated with hypokalemia contributed to the clinical investigation, whose pathophysiological mechanisms of this disorder were discussed in this study. The organic alterations observed in the patient's imaging examination coincided with the pathophysiological processes of renal fibrous osteodystrophy. The findings of renal and parathyroid alterations on ultrasound, as well as the damage to the bone matrix, maxillomandibular deformity and loss of bone support evidenced on cranial radiography, led to the conclusion of the diagnosis of renal fibrous osteodystrophy secondary to hyperparathyroidism. Despite the recommended symptomatic therapy, the patient died within 24 hours of hospitalization, and it was not possible to perform a necropsy. This report is highlighted by the occurrence of bone deformity at the maxillary and mandibular level, as a result of renal dysfunction in a young canine, alerting to the importance of complementary exams for proper diagnosis

Epidermal Renewal after Treatment of Primary Canine Hypothyroidism using Levothyroxine

Background: Primary canine hypothyroidism, an endocrine disorder that causes imbalances in the hypothalamus-pituitarythyroid axis, is a common cause of endocrine dermatoses, which frequently presents with opaque dry brittle hair. Tissue changes are also visible, such as myxedema, hyperkeratosis, epidermal atrophy, alopecia, and others. This paper describes the skin changes caused by primary hypothyroidism in a female dog before and after treatment with levothyroxine.Case: This case study involved a 7-year-old Dalmatian bitch with a history of weight gain and changes such as rough dry brittle hair. For about a year, the dog also had also presented symmetrical erythematous and alopecia skin lesions in the regions of the hind limbs, lower back and tail, progressive lethargy and fatigue after exercise. A hemogram showed mild normocytic and normochromic regenerative anemia, as well as mild leukopenia and neutropenia. Biochemical tests revealed increased levels of creatinine, total cholesterol, and triglycerides. Skin biopsy revealed the presence of comedones in the epidermis and acanthosis and trichilemmal keratinization. Hormonal tests revealed high TSH and low free T4 and total T4 levels. A cervical ultrasound scan showed changes in the thyroid glands, with hypoechoic parenchyma, in addition to increased size of the right lobe, suggesting thyroiditis. Based on these exams, the patient was diagnosed with primary hypothyroidism, and treatment with levothyroxine was instituted.Discussion: Around 90% of dogs with hypothyroidism show a decrease in total T4 and about 65-75% of them show an increase in TSH levels. In endocrinopathy, there is a decrease in the expression of T3 receptors in the keratinocytes and genes responsible for epidermal renewal. Also, molecules that affect epidermal differentiation bind to intracellular receptors belonging to the steroid/thyroid hormone superfamily. In this study, however, the application of the minimum levothyroxine dose restored the normal epidermal pattern for the species and the remaining parameters returned to normal. The hormone T3 acts in the differentiation of keratinocytes, a fact that, although not yet proven, is believed to be indirect and mediated by the epidermal growth factor or by the expression of the genes responsible for the renewal of the epidermis. Besides, some effects on the epidermis caused by deficiency of thyroid hormones may be due to secondary vitamin A deficiency, which is necessary for epithelial differentiation and binding epidermal growth factor (EGF) to the cell. Still, there is a theory that sex hormones also affect the differentiation of the epidermis, as studies show that deficiency causes effects similar to those caused by hypothyroidism. Some studies indicate the investigation of the relationship between secondary vitamin D deficiency and the increased cellularity of the epidermis of the spayed hypothyroid female rats. Additionally, the mechanism of the formation of hyperkeratosis in hypothyroidism is not yet elucidated. T3 is known to regulate keratingene expression and perhaps also epidermal maturation, epithelial cycle, and normal keratin synthesis. The single treatment with levothyroxine in the female dog was effective in promoting the restoration of gene expression to T3 in keratinocytes.Keywords: dermatopathies, endocrinopathies, hypothyroidism, levothyroxine, synthetic hormone

Pulmonary Adenocarcinoma in Dogs: Surgical Treatment with Real-Time Video-thermometry

Introdução :  Uma neoplasia pulmonar é uma proliferação anormal de células no tecido pulmonar, podendo ser classificada como primária, secundária ou metastática e multissistêmica. No entanto, uma neoplasia primária é rara em canídeos. Além disso, as neoplasias podem ser classificadas de acordo com seu comportamento biológico como malignas ou benignas. Os tumores malignos são mais prevalentes. O diagnóstico pode ser difícil devido a sintomas inespecíficos, tendo em vista que alguns pacientes afetados não apresentam nenhum sintoma; assim, um real da doença pode permanecer sem diagnóstico em certas ocasiões.Portanto, objetivamos relatar um caso de sucesso inédito de cirurgia de lobectomia pulmonar em cães com auxílio de videotermometria infravermelha, que mostrada como imagens em tempo real durante o procedimento cirúrgico.Caso : Um cão macho de 10 anos, mestiço com Cocker Spaniel, foi atendido com história de letargia, embotamento, perda progressiva de peso, tosse e dificuldade respiratória. Avaliação à gravidade dos sinais clínicos e ao exame clínico fisiológico normal, foram solicitados exames complementares, como radiografia da região cervical e torácica, tomografia computadorizada de sangue e toracoabdominal (TCT). Os resultados dos exames obtiveram a presença de massa nodular no lobo pulmonar direito caudal que ocasionava desvio lateral para hemitórax esquerdo da silhueta cardíaca. A paciente foi submetida a um procedimento cirúrgico com abordagem pela região torácica, na altura do sétimo espaço intercostal, sendo realizada lobectomia total. Durante todo o procedimento cirúrgico,A videotermometria em tempo real por meio da estação MART (Atividade Metabólica em Tempo Real FLIR SC325®) foi utilizada para determinar a viabilidade dos tecidos adjacentes por meio de diferenças de temperatura medidas em graus Celsius. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão.Discussão :Os adenocarcinomas consistem em estruturas glandulares papilares, acinares, sólidas ou mistas. Podem originar-se das vias aéreas, glândulas brônquicas ou região broncoalveolar e, freqüentemente, apresentam crescimento invasivo apresentando formato rudimentar e irregular. Os sinais clínicos são inespecíficos, incluindo intolerância a exercícios, tosse não produtiva, sinais respiratórios crônicos como taquipneia ou dispneia, apetite reduzido, perda de peso, letargia, dor à palpação torácica, hemotórax, pneumotórax e derrame pleural. O diagnóstico é concluído por meio de exames de diagnóstico por imagem, sendo a radiografia de tórax o mais importante, seguida da ressonância magnética e da tomografia computadorizada. Além disso, o exame histopatológico é essencial para determinar um diagnóstico definitivo. O tratamento de escolha para os nódulos de adenocarcinoma é a excisão cirúrgica da massa tumoral. Contudo, o tipo de abordagem cirúrgica é determinado por diferentes fatores, como tamanho, localização e envolvimento de estruturas adjacentes. A ablação de massas pulmonares pode ser realizada por meio de lobectomias parciais ou totais. No entanto, a lobectomia parcial é mais frequentemente realizada em massas não neoplásicas ou para obtenção de material para biópsia, enquanto a lobectomia total é recomendada para a remoção de uma neoplasia maligna.O prognóstico é sempre cauteloso, tendo um desfecho mais favorável nas massas de menor diâmetro sem o envolvimento de estruturas adjacentes

Heavy Metal Poisoning in a Cockatiel (Nymphicus hollandicus)

Background: In recent decades the demand for unconventional pets has been relatively increasing, a situation that increasingly causes veterinarians to encounter these animals in medical and surgical practice. Of these animals, the birds stand out. Animals of the order Psittaciform are known as very curious and active creatures that have the tendency to chew objectsin their environment. Among the several occurrences that lead this animal to attend the veterinary clinic, we highlight the poisoning by heavy metals, especially lead poisoning (Pb) and zinc (Zn). The objective of this work was to report a case of heavy metal intoxication in cockatiel (Nymphicus hollandicus).Case: A cockatiel was taken to the veterinarian with a history of apathy, motor incoordination, exacerbated water consumption and regurgitation. Complete anamnesis was instrumental in directing suspected heavy metal intoxication. Radiopaque particles were visualized through radiographic examination, suggesting heavy metal intoxication. The diagnosis wasconcluded through complementary examinations since the clinical symptoms are nonspecific. The treatment was intended to provide emergency intervention, avoid further absorption, use of antidotes, provide supportive measures and provide guidance to the owner. It can be concluded that the diagnosis and treatment were successful.Discussion: Metal poisoning can kill birds. The veterinarian should always seek the literature in order to perform the best support and treatment. For this, detailed history and detailed medical history must be taken into account, since the time of ingestion and the type of metal interfere with the therapeutic conduct. The use of imaging tests such as x-rays andultrasound are essential to assist the clinician, especially in cases where the tutor does not know whether or not the animal has ingested an object. In the radiographic examination, the heavy metal has the characteristic of having high radiopacity, which was evidenced in the case in question. Radiographic positions should be considered in order to avoid false negatives. In the literature, the treatment of chelation therapy is prioritized to remove the circulating heavy metal and thus act on the cause of the problem. In the case in question calcium EDTA was used intramuscularly, which showed clinical improvement in the animal after the second application. Calcium EDTA binds to metals and facilitates their transport and excretion. The use of fluid therapy is necessary as a supportive treatment to prevent kidney damage, since heavy metals are highlyharmful to nephrons. Especially in cases where the animal stops feeding and ingesting water. The use of antibiotics is essential because in many cases the animal, in addition to not feeding, becomes prone to infections due to metal toxicity, therefore, prophylactic use is essential for a better prognosis. In the case in question, the use of enrofloxacin was effective,as reported in the literature. It is recommended that the diagnosis of serum lead and zinc dosage should be made, however, due to the difficulties of obtaining the samples, and since other metals may also cause intoxication, in the case in question the treatment was started without these results. According to the results obtained in this work, the treatment described in the literature is effective and can be performed immediately to save animal life without subsequent sequelae.Keywords: bird, lead, zinc, calcium EDTA

Dysautonomia in a Bitch with Hypothyroidism

Background: Thyroid hormones have important effects on the cardiovascular system, of which the main ones are the increase in the heart response to the autonomic sympathetic nervous system. Heart rate variability is a non-invasive method of assessing autonomic heart modulation, thus being an important form of evaluation in patients with thyroid dysfunctions. This study aimed to report electrocardiographic and heart rate variability data of a dog with hypothyroidism that presented a parasympathetic dysfunction.Case: A 7-year-old female Dalmatian dog was admitted for clinical evaluation in Fortaleza, Brazil. According to the owner, she had been apathetic for a year, had gained weight, always had a sad expression, and her hair was generally brittle and opaque. On physical examination, skin lesions were observed at the end of the spine, extending to the tail region, with the latter showing total alopecia. Low T4 levels confirmed the diagnosis of primary hypothyroidism. Then, a 24-h Holter monitoring was performed, which showed that the animal had sinus arrhythmia associated with moments of second-degree sinoatrial block and rare moments of sinus tachycardia. In addition, moments of premature multifocal ventricular extrasystoles and 1st-degree atrioventricular block were observed. Based on the Holter results, heart rate variability (HRV) was calculated. Regarding the HRV in the frequency domain, 32.16 was obtained in the low frequency (LF) band, 67.84 in the high frequency (HF) band, and the LF / HF ratio was 0.46, with a total power of 5205. As for the HRV in the time domain, RMSSD was 117, pNN50 was 62.64 and SDNN was 384. This showed an increase in the parasympathetic activity of the heart and, due to this increased activity, a second-degree sinoatrial block occurred, which is a sinus function disturbance resulting from the exacerbated parasympathetic activity.Discussion: Beta-adrenergic receptors have their expression and activity altered by thyroid hormones. The sympathetic stimulation on the heart through the activation of these receptors originates a positive inotropic, lusitropic, dromotropic and chronotropic effect. Therefore, in the absence of thyroid hormones, there is a decrease in this stimulation, thus allowing a preponderant parasympathetic tone. In the present report, the increase in the parasympathetic tonus, observed in hypothyroidism, resulted in a reduction in the frequency of sinus firing, slowing of intranodal and sinoatrial conduction, and shortening of the effective refractory period, a combination of factors that led to decreased HR observed in the Holter monitoring. Previous studies have shown that thyroid hormones increase sympathetic activity, mainly in the heart, since they do not act by increasing the production or release of catecholamines, but rather increasing catecholamine response on the heart, due to a positive regulation of Ca2+-ATPase channels of the sarcoplasmic reticulum and beta1-adrenergic receptors. Thus, the observed result was already expected, because in hypothyroidism there is a decrease in these hormones that increase the sympathetic activity on the heart and so, the parasympathetic tone was very evident. The study of heart rate variability allows the simple assessment of the autonomic nervous system imbalance, and may be extremely important in the follow-up of diseases that affect this balance, such as hypothyroidism. Hence, more studies are required to verify the effect of such diseases on heart rate variability, aiming to define associations between the diseases and the alterations, as well as to define parameters of normality for such examinations

Mieloma múltiplo em uma cadela de 10 anos

Background: The malignant neoplasms, in general, constitute one of the main causes of death in dogs and cats. The multiple myeloma is a neoplasm characterized by the monoclonal proliferation of plasma cells in the bone marrow, causing several systemic symptoms and it is rare in pets, representing less than 1% of the malignant neoplasms in these animals. It usually occurs in older dogs. Thus, the purpose of this report was to describe a case of multiple myeloma in a 10-year-old poodle dog, occurred in the Veterinary Hospital Unit of the State University of Ceará.Case: A 10-year-old Poodle bitch was admitted in the Veterinary Hospital Unit of the State University of Ceará presenting lump erythematosus, alopecic, soft and ulcers in the region of the digits of the left front leg, pain and lameness. The blood count evidenced normocytic and normochromic anemia, presence of rouleaux, lymphopenia and monocytopenia, and the biochemical exams have demonstrated an elevated value of alanine aminotransferase (ALT). The cytology of the nodule indicated probable diagnosis of plasma cell neoplasm and radiographic examination showed the presence of bone lysis, and therefore the patient underwent amputation of the affected limb surgery. A biopsy of the nodule indicated neoplastic proliferation, with an arrange compatible to plasmacytoma of cleaved type. A follow-up consultation was realized 30 days after surgery, and 2 new nodules appeared in the superior lip region and close to the surgery site. A new blood count indicated anemia with presence of rouleaux, thrombocytopenia, leucopenia, lymphopenia and monocytopenia, and the biochemical results showed a discrete diminution of aspartate aminotransferase(AST) and a considerable increase on the alkaline phosphatase levels. The cytology of the new nodules indicated plasmacytoma, and was realized a myelogram, that showed dysplastic marrow plasma cells, with more than 20% of plasma cells.Discussion: In the present case, the patient’s lump grew rapidly with bleeding and ulcer formation. The animal presented bone involvement, which characterizes the most suggestive sign of multiple myeloma. Justified by the stimulating factor of osteoclasts, promoting bone lysis, which can cause pathological fractures and pain. The amputation was a partial treatment to attenuates the discomfort and pain presented by the patient. The appearance of new nodules stimulated a more detailed investigation for multiple myeloma. The enzyme AST presented a discrete diminution, and ALT initially was higher than normal, but then returned to normal values. So, the elevated activity of alkaline phosphatase directed the suspects to multiple myeloma, since the activity of AST and ALT was normal, the alkaline phosphatase level was ligated to bone diseases. The rouleaux was constant at the hemograms, this is justified by the excess of immunoglobulins produced in marrow. Based on the chart presented by the patient, the bone marrow was punctured for myelogram. The symptoms displayed by the animal along with the cytological analysis, histopathological, hematological, biochemical and with myelogram indicated diagnosis of multiple myeloma. Other exams could be investigated, for example, detection of Bence Jones proteinuria, serum calcium dosage and inmunoelectroforesis for determination of the type of immunoglobulin produced by the plasma cells in the bone marrow. The definitive diagnostic was established approximately three months after the first consult, emphasizing the importance of a multiple myeloma differential diagnostic in case of plasma cell neoplasm

Hermafroditismo verdadeiro na espécie canina

Background: Hermaphroditism or intersex is a general term that includes various congenital anomalies of the genital system which is used to define animals with ambiguous sexual characteristics. It occurs in domestic animals, more commonly in pigs and goats, and rarely in horses, dogs, sheep, and cattle. The prevalence of hermaphroditism varies a lot among breeds and species and is higher in groups with a high degree of consanguinity. Therefore, the objective of this report is to describe a case of canine hermaphroditism in a dog with male phenotype, as well as the anatomical and hormonal findings, and classification of the hermaphroditism exhibited by the animal studied.Case: A 1-year-old, mongrel, 5 kg dog was referred to the UHV-UECE due to the presence of a slit on the lower quadrant of the abdomen, caudal to the umbilical scar. At examination, the animal exhibited normal rectal temperature, no alterations of palpable lymph nodes, and a satisfactory body condition score. The pubic area had 2 testicles, each one in a different scrotum, 1 to the right and 1 to the left of the slit. A prepuce with no apparent function was present cranially to the slit, closer to the umbilical scar. At the other extremity of the slit, on the pubic region, there was a flaccid structure similar to a penis (micropenis) with no penile bone and no function. The slit was open until the area ventral to the anus, where the urethra was detected. The animal exhibited a behavior of territory demarcation with urine typically seen in male dogs. Orchiectomy and slit correction surgery were performed. Pre-surgical exams included: complete blood count and hormonal doses of estradiol, testosterone, and progesterone. Abdominal ultrasound was performed to assess presence of sexual glands and gonads. The hormonal exam revealed: estradiol 56.39 pg/mL; testosterone 127.9 ng/mL; progesterone 0.892 ng/mL. A uterus was not detected on ultrasound examination. Ovaries were seen on their typical anatomical position; they were symmetrical and had normal sizes. There was a normal size prostate in the pelvic area, exhibiting normal texture and echogenicity. No other abnormalities were seen and the owner opted for no further surgical intervention.Discussion: Testosterone predominance explains the male behavior and appearance, demonstrating that the testis were prevalent over the ovaries. The occurrence of XX males has been reported. The genetic cause is the absence of the SRY chromosome, which has a fundamental role on activation of the SOX gene, which is responsible for sex determination. Clinically, a true hermaphrodite can exhibit different degrees of genital ambiguity; they can be diagnosed during puberty with the emergence of heterosexual characteristics, or as an adult, with infertility or gonadal neoplasia. True hermaphrodites are individuals with testicular and ovarian tissues, either combined in one gonad (ovotestis) or present as two separate gonads. The presence of ovaries and testicles can be confirmed by histology, which was not performed in this study. However, ultrasound findings (prostate and ovaries), and the presence of normal testis and external genitalia without a defined penis or vulva are in accordance with the description of a true hermaphrodite

Osteogênese Imperfeita em cão jovem da raça pinscher

Background: Osteogenesis imperfecta is a severe genetic disease rarely described in veterinary medicine. This multisystemic condition is caused by a defect in the production and metabolization of collagen, which implicates in bone fragility. This disease has been described in cattle, sheep, domestic felines, mouse and dogs of different breeds, including collie, golden retriever, beagle, dachshund and chow chow. Animals affected by this condition present multiple fractures without previous occurrence of trauma. Therefore, this report aimed to describe a case of osteogenesis imperfecta type III in a miniature pinscher dog.Case: A 1-year-old male miniature pinscher dog, was admitted for clinical evaluation in Fortaleza, Brazil, with a history of spontaneous fractures without known causes. This animal was maintained indoors, fed on dry feed and presented recurrent events of claudication and pain. In the physical examination, the individual walked solely with the forelimbs, avoiding the use of the hind limbs and presented pain behavior. Bulging of the skull was observed laterally, which promoted a triangular appearance of head and face. Fontanelles were soft, and the eyes presented blueish sclera and corneal opacity. Teeth were small, translucid, fragile and deformed. Radiography images revealed bulging of the calvaria and persistent fontanelles with open cranial sutures. In addition, cranial convolutions were less clear, which was compatible with hydrocephalus. Dental roots were narrow, short and presented partial pulp obliteration. The radiographic contrast of the dentin was low with a reduction of periapical radiolucency. Bone radiopacity was low in the bones of the abdomen and pelvis, in addition to femur. Metaphysis of the right tibia was enlarged and angular. Multiple fractures were identified in the pelvis with the formation of opaque bony calluses and bone marrow sclerosis. Physiological parameters and blood test results were unaltered. After the diagnosis of osteogenesis imperfecta type III, treatment was performed with meloxicam 0.1 mg/kg, SID, VO) and tramadol (2 mg/kg, TID, VO) until pain was controlled. When the patient was stable, the treatment was halted until the next event of fractures followed by pain.Discussion: Type I collagen is considered the most abundant protein in connective tissue, accounting for 95% of the various types of collagen found in bone tissue. In osteogenesis imperfecta, there is a shortage in coding of type I collagen, which prevents this protein from exerting its structural functions properly. In addition, it is subjected to intra and extracellular degradation, affecting cell migration and differentiation and, concomitantly, cell-matrix interaction. Hence, these changes are considered the main pathophysiological factors of osteogenesis imperfecta. There is a wide range of phenotypic presentations in individuals with osteogenesis imperfecta. However, there is a pattern of fractures and features that aid clinically and radiologically in the characterization of the disease and form the basis for case identification and diagnosis. In this case, the diagnosis was concluded primarily considering significant clinical signs, such as: repetitive fractures, triangular face, bulging of the skull, bluish sclera and corneal opacity. Radiographic examinations were used to confirm the diagnosis and to aid in treating the fractures. Although the genetic test provides a better understanding of the disease, it was not performed in this case, as it is routinely unavailable in many treatment centers. In conclusion, we described a case of osteogenesis imperfecta in a miniature pinscher dog

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Hipertensão arterial felina: Abordagem clínica

A hipertensão arterial felina é uma doença que acomete principalmente felinos geriátricos.Trata-se de uma patologia de extrema importância por ter a capacidade de lesionar órgãos nobres e essenciais a vida, como o coração, o cérebro, o rim e os olhos.As lesões , freqüentemente, são irreversíveis. As causas de hipertensão sistêmica podem ser primárias ou secundárias. Entretanto, a forma secundária é a que ocorre com maior freqüência. Faz-se importante, a prevenção, ou, que a doença seja descoberta em um estágio inicial, para uma abordagem correta imediata. Porém, a hipertensão ainda é pouco diagnosticada, sendo, muitas vezes, descoberta tardiamente.  A terapêutica visa a diminuição da sintomatologia cardiovascular e dos órgãos alvo atingidos a fim de evitar a progressão da doença, elevando, por conseguinte, a qualidade de vida do animal.Feline Hypertension is a disease that affects mainly geriatric .This is a condition of extreme importance cats to have the ability to injure vital organs and essential to life, such as heart, brain, kidney and eyes.The injuries, often they are irreversible. The systemic hypertension causes may be primary or secondary. However, the secondary form is the one that occurs most frequently. It will be important, prevention, or that the disease is discovered at an early stage, to an immediate right approach. However, hypertension is still underdiagnosed and is often discovered late. Therapy aims at the reduction of cardiovascular symptoms and target organs affected in order to prevent the progression of the disease, increasing therefore the quality of life of the animal