INTOXICAÇÃO DE CÃES POR VENENOS DE ANUROS: PREVALÊNCIA, DANOS AOS ANIMAIS E PROTOCOLOS CLÍNICOS

Individuals of the Bufonidae family are commonly associated with cases of poisoning in dogs after contact with the venom secreted in glands present in the tegument, reinforcing the importance of effective treatments after this interaction. In this paper, we present a review of cases of poisoning in dogs by anuran venom, relating the main symptoms in dogs and the clinical protocols used. We performed a search for articles reporting cases of anuran poisoning in dogs in the Google Scholar, Scielo, and PubMed repositories. We used keywords in Portuguese and English. A total of 430 articles were found and only 17 of which were in accordance with the research proposal. The records found were for Brazil, Australia, and the United States. The species of anurans reported in the literature were exclusively those of the genus Rhinella. The greatest number of cases registered in Brazil occurred in an urban environment. The main symptoms described after intoxication in dogs were excessive salivation, convulsion, and vomiting. Deaths were also found during the search. The main protocols for treatment after poisoning were washing the dog's oral cavity, and administration of atropine, diazepam, and fluid therapy. It was observed that the size of the dogs influences the severity after intoxication, with small dogs being more susceptible to lethal conditions. Due to the low number of records, we suggest that the number of cases on this topic is possibly underestimated. In this study, we showed that the protocols used for the care of intoxicated dogs are not performed in a standard way, changing according to the clinical picture presented.Indivíduos da família Bufonidae são comumente associados a casos de intoxicação de cães após contato com o veneno secretado nas glândulas presentes no tegumento, reforçando a importância de tratamentos efetivos após esta interação. Neste trabalho apresentamos uma revisão sobre casos de intoxicação de cães por venenos de anuros, relacionando os principais sintomas nos cães e os protocolos clínicos utilizados. Realizamos uma busca por artigos que relatem casos de intoxicação de cães por anuros nos repositórios Google Scholar, Scielo e PubMed. Utilizamos palavras-chave nos idiomas português e inglês. Um total de 430 artigos foram encontrados, sendo apenas 17 de acordo com a proposta da pesquisa. Os registros encontrados foram para o Brasil, Austrália e Estados Unidos. As espécies de anuros reportadas na literatura foram exclusivamente as do gênero Rhinella. O maior número dos casos registrados no Brasil ocorreu em ambiente urbano. Os principais sintomas descritos após intoxicação de cães foram salivação em excesso, convulsão e vômito. Óbitos também foram encontrados durante a busca. Principais protocolos para o tratamento após envenenamento foram lavagem da cavidade oral do cão, e administração de atropina, diazepam e fluidoterapia. Foi observado que há influência do tamanho dos cães na severidade após intoxicação, sendo os de pequeno porte mais suscetíveis a quadros letais. Sugerimos, por conta do baixo número de registros, que possivelmente a quantidade de casos acerca desta temática seja subestimado. Neste estudo evidenciamos que os protocolos utilizados para o cuidado dos cães intoxicados não são realizados de forma padrão, alterando de acordo com o quadro clínico apresentado

Age‐related white matter hyperintensities and overactive bladder: a systematic review

© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Introduction: Age-related white matter hyperintensities (ARWMHs) on brain magnetic resonance imaging have been associated with lower urinary tract symptoms/dysfunction (LUTS/LUTD), namely overactive bladder (OAB) and detrusor overactivity. We aimed to systematically review existing data on the association between ARWMH and LUTS and which clinical tools have been used for this assessment. Materials and methods: We searched PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov (from 1980 to November 2021) and considered original studies reporting data on ARWMH and LUTS/LUTD in patients of both sexes aged 50 or above. The primary outcome was OAB. We calculated the unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the outcomes of interest using random-effects models. Results: Fourteen studies were included. LUTS assessment was heterogeneous and mainly based on the use of nonvalidated questionnaires. Urodynamics assessment was reported in five studies. ARWMHs were graded using visual scales in eight studies. Patients with moderate-to-severe ARWMHs were more likely to present with OAB and urgency urinary incontinence (UUI; OR = 1.61; 95% CI: 1.05-2.49, p = 0.03), I2 = 21.3%) when compared to patients with similar age and absent or mild ARWMH. Discussion and conclusions: High-quality data on the association between ARWMH and OAB is scarce. Patients with moderate to severe ARWMH showed higher levels of OAB symptoms, including UUI, when compared to patients with absent or mild ARWMH. The use of standardized tools to assess both ARWMH and OAB in these patients should be encouraged in future research.info:eu-repo/semantics/publishedVersio

The role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta analysis

© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).Objectives: To review the optimal diagnostic cut-off of ultrasonographic optic nerve sheath diameter (ONSD) in the diagnosis of increased intracranial pressure (IICP). Methods: A systematic search was conducted of available studies assessing the use of ONSD ultrasonography in patients with suspected IICP. Meta-analysis of diagnostic accuracy of ultrasonographic ONSD was performed using a bivariate model of random effects to summarize pooled sensitivity and specificity. A summary receiver operating characteristics (SROC) curve was plotted. Accuracy measures associated with ONSD cut-off and predefined covariates were investigated with meta-regression. Results: We included 38 studies, comprising a total of 2824 patients. A total of 21 studies used invasive techniques as a reference standard estimation of IICP and meta-analysis revealed a pooled sensitivity of 0.90 (95% CI 0.85-0.93) and specificity of 0.87 (95% CI 0.80-0.91). Optimal ONSD cut-off values ranged between 4.1 mm and 7.2 mm. Meta-regression analysis showed that ONSD cut-off values of 5.6 to 6.3 mm were associated with higher pooled specificity compared to cut-off values of 4.9 to 5.5 mm (0.93, 95% CI 0.85-0.97 vs. 0.78, 95% CI 0.65-0.87; p = 0.036). Conclusions: Ultrasonography of ONSD shows a high diagnostic accuracy for IICP, with high pooled sensitivity and specificity. Additionally, larger cut-off values seem to significantly increase specificity without compromising sensitivity, which support their use as optimal ONSD cut-off. The overall high sensitivity of ultrasonographic ONSD suggests its usefulness as a screening tool for IIC, which may provide an estimate of when invasive methods are warranted. Clinical relevance: ONSD ultrasonography is a fast and cost-effective method with a high diagnostic accuracy to detect IICP. The optimum ONSD cut-off hasn't been established before, but we suggest the 5.6 to 6.3 mm range as the best for the diagnosis of IICP.DB has received funding from the Portuguese Foundation for Science and Technology [Fundação para a Ciência e Tecnologia – reference 2022.10667.BD] and Santa Casa da Misericórdia de Lisboa [Prémio João Lobo Antunes 2022].info:eu-repo/semantics/publishedVersio

Planning of stroke care and urgent prehospital care across Europe : Results of the ESO/ESMINT/EAN/SAFE Survey

Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SA is co-PI of the RACECAT trial. VC received grants and speaker fees from BI. UF is consultant for Stryker, Medtronic and CSL Behring; Research grant from the Swiss National Science Foundation, Swiss Heart Foundation and Medtronic. DAS, TG, FF, AK, IZ, MG and VF have no disclosures. Funding Information: The authors are grateful to all ?ESO/ESMINT/EAN/SAFE Survey on Stroke Care in Europe? collaborators. We are also in debt to Bo Norrving, Didier Leys, Kennedy Lees and Turgut Tatlisumak for their useful comments regarding the questionnaire, data collection methodology and policy implications of this paper. Publisher Copyright: © European Stroke Organisation 2019.Introduction: Adequate planning and implementation of stroke systems of care is key to guarantee a rapid healthcare response and delivery of specific reperfusion therapies among candidates. We assessed the availability of stroke care plans in Europe, and evaluated their impact on rates of reperfusion therapies for stroke. Patients: Based on the European Stroke Organisation (ESO), the European Society of Minimally Invasive Neurological Therapy (ESMINT), the European Academy of Neurology (EAN), and the Stroke Alliance for Europe (SAFE) survey, we analysed specific prespecified items in the questionnaire regarding availability and adequacy of stroke care plans, organised prehospital care and their potential impact on rates of delivery of reperfusion therapies for stroke at the country level. Results: Of 44 participating European countries, 37 have stroke care plans that operate at national and/or regional levels. Most stroke care plans take responsibility for the organisation/implementation of stroke systems of care (86%), quality of care assessment (77%), and act as a liaison between emergency medical systems and stroke physicians (79%). As for stroke systems of care, the focus is mainly on prehospital and in-hospital acute stroke care (Code Stroke systems available in 37/44 countries). Preferred urgent transport is via non-medicalised ambulances (70%). Presence of stroke care plans, stroke registry data, transport of urgent stroke patients via non-medicalised ambulances, and drip-and-ship routing of acute patients showed higher reperfusion treatment rates. Discussion: Availability of stroke care plans, still absent in some European countries, as well as some features of the stroke systems of care are associated with higher reperfusion treatment rates. Conclusion: Stroke is not yet a priority everywhere in Europe, which is a barrier to the spread of reperfusion therapies for stroke.publishersversionPeer reviewe

Avaliação das infrações sanitárias cometidas em farmácias magistrais no município de São Luís-MA

Introdução: Os estabelecimentos magistrais ressurgiram no Brasil no final da década de 80. Naquela época o país presenciava um cenário de forte restrição às importações e controle de preços pelo governo. Muitas indústrias deixaram de produzir inúmeros medicamentos abrindo espaço para o ressurgimento desta atividade. Objetivos: Identificar as principais infrações sanitárias cometidas pelas farmácias magistrais no município de São Luís, e verificar o registro de reincidência específica. Métodos: Estudo com base em análise documental realizado através do levantamento das ações de fiscalização da Vigilância Sanitária Estadual. Resultados: Durante o ano de 2006 a Vigilância Sanitária, autuou 3 (três) estabelecimentos farmacêuticos de manipulação de medicamentos no município de São Luís, correspondendo a 21,4% das farmácias magistrais. Em 2007, verificou-se que 4 (quatro) farmácias magistrais infringiram as regras pertinentes a esse setor, um representativo de 25%. Em 2008, 22%, ou seja, 4 (quatro) das 18 (dezoito) farmácias magistrais em funcionamento cometeram violações a legislação em vigor. Em 2009 não foi observada nenhuma infração sanitária. Quanto à ocorrência de reincidência específica, não há registro nos anos pesquisados. As infrações referentes a este período somaram um total de 12 transgressões a diversas legislações nacionais. Conclusões: As ações da Vigilância Sanitária são meios eficazes de prevenir riscos ao consumidor, sendo necessário, portanto, manter tais medidas, orientando os farmacêuticos e proprietários das farmácias magistrais para o cumprimento das legislações pertinentes, como forma de preservar um bem maior: a saúde.Palavras-chaves: Infração sanitária. Farmácia Magistral. Legislação.AbstractIntroduction: Compounding pharmacies reappeared in Brazil at the end of the eighties. At that time the country underwent strong limitation scenario on imports and price controls by the government. Several factories stopped producing many medicines, which in turn made possible the reemerging of the compounding activity. Objective: To identify the major health violations committed by compounding pharmacies in São Luís and verify the report of specific violation reoccurrence. Methods: The study was based on documental analysis through a survey of data from the inspection activities of the State Sanitary Surveillance. Results: During 2006, the Sanitary Surveillance notified three compounding pharmacies in São Luís corresponding to 21.4% of all compounding pharmacies. In 2007, four (25%) compounding pharmacies disobeyed rules applied to these establishments. In 2008, four (22%) of eighteen pharmacies in operation committed law violations. In 2009 we observed no sanitary infraction. During the four years of research we did not observed any specific violation recurrences. The Overall quantity of infractions committed during the four years accounted for 12 different law violations of many national laws. Conclusion: The actions of the Sanitary Surveillance are effective in preventing risks to consumers. Instructions for pharmacists and compounding pharmacies owners about the necessary of complying all pertinent laws are important, in order to preserve the most important thing, that is health.Keywords: Sanitary infraction. Compounding pharmacies. laws

Endovascular Treatment for Acute Basilar Artery Occlusion: A Fragility Index Meta-Analysis

Introduction: High-quality evidence regarding the use of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO) has been provided by recently completed randomized controlled clinical trials (RCTs). Methods: We conducted a systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of EVT in addition to best medical treatment (BMT) versus BMT alone for BAO. The random-effects model was used, while the fragility index (FI) was calculated for dichotomous outcomes of interest. Results: Four RCTs were included comprising a total of 988 patients with acute BAO (mean age: 65.6 years, 70% men, median NIHSS: 24, 39% pretreatment with intravenous thrombolysis). EVT was related to higher likelihood of good functional outcome (RR: 1.54; 95% CI: 1.16–2.05; I2 = 60%), functional independence (RR: 1.83; 95% CI: 1.08–3.08; I2 = 79%) and reduced disability at 3 months (adjusted common OR: 1.96; 95% CI: 1.26–3.05; I2 = 59%) compared to BMT alone. Despite that EVT was associated with a higher risk for symptomatic intracranial hemorrhage (RR: 7.78; 95% CI: 2.36–25.61; I2 = 0%) and any intracranial hemorrhage (RR: 2.85; 95% CI: 1.50–5.44; I2 = 16%), mortality at 3 months was lower among patients that received EVT plus BMT versus BMT alone (RR: 0.76; 95% CI: 0.65–0.89; I2 = 0%). However, sufficient robustness was not evident in any of the reported associations (FI < 10) including the overall effect regarding the primary outcome. The former associations were predominantly driven by RCTs with recruitment limited in China. Conclusions: EVT combined with BMT is associated with a higher likelihood of achieving good functional outcomes and a lower risk of death at 3 months compared to BMT alone, despite the higher risk of sICH. An individual-patient data meta-analysis is warranted to uncover and adjust for potential sources of heterogeneity and to provide further insight

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Acute stroke treatment; Health care resources; Intravenous thrombolysisTractament de l'ictus agut; Recursos sanitaris; Trombòlisi intravenosaTratamiento del ictus agudo; Recursos sanitarios; Trombólisis intravenosaINTRODUCTION: Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. METHODS: A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. RESULTS: We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3-3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1-1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4-176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2-91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7-47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5-25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4-9.1) and 1.9% received endovascular treatment (95% CI 1.3-2.5), highest country rates were 20.6% and 5.6%. CONCLUSION: We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe

Cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after a second ChAdOx1 nCoV-19 dose.

© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.Cerebral venous thrombosis (CVT) is the most common and severe manifestation of vaccine-induced immune thrombotic thrombocytopenia (VITT), which is a rare side effect of the SARS-CoV-2 vaccine ChAdOx1 nCoV-19 (Vaxzevria, AstraZeneca/Oxford). The absolute risk of VITT and VITT-related CVT is estimated at 20 and 8 per million first doses of ChAdOx1 nCoV-19, respectively. So far, no definite VITT cases occurring after a second ChAdOx1 nCoV-19 vaccine dose have been reported, raising the question of whether VITT only occurs after a first dose. Two pharmacovigilance studies reported cases of thrombosis with thrombocytopenia after a second ChAdOx1 nCoV-19 dose, but because of lack of clinical data, none of these could be classified as VITT. Knowledge on whether VITT can occur after a second ChAdOx1 nCoV-19 dose is relevant for clinicians and policymakers, especially in low- and middle-income countries, which are currently the main users of adenovirus-based vaccines. We used data from the “CVT after SARS-CoV-2 vaccination” registry to identify VITT-related CVT cases occurring after a second ChAdOx1 nCoV-19 dose. Details of this registry have been published. Briefly, this ongoing study collects data on patients with CVT with symptom onset ≤28 days from SARS-CoV-2 vaccination, regardless of the type and dose of vaccine. The study is endorsed by the European Academy of Neurology and the European Stroke Organization. Investigators are instructed to report consecutive cases from their hospitals. The ethical review board of the Academic Medical Centre issued a waiver of formal approval for this observational study. Each center obtained local permission to carry out the study and acquired informed consent for the use of pseudonymized care data according to national law. We used the case definition criteria of the United Kingdom expert hematology panel to classify cases as definite, probable, possible, or unlikely VITT after ChAdOx1 nCoV-19 administration among CVT cases reported until 1 December 2021.This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw, grant number 10430072110005) (J.M.C.) and the Dr. C. J. Vaillant Foundation (J.M.C.).info:eu-repo/semantics/publishedVersio

Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs