Riquetsioses do grupo das febres exantemáticas em canídeos domésticos em Portugal: revisão bibliográfica e estudo retrospectivo

Dissertação de Mestrado Integrado em Medicina VeterináriaAs riquétsias do grupo das febres exantemáticas estão amplamente distribuídas, em focos endémicos, por várias regiões geográficas do Mundo e são importantes causas de morbilidade e mortalidade no Homem e nos animais domésticos. Em Portugal, Rickettsia conorii é o principal agente deste grupo e causa febre botonosa em humanos. Esta foi a única riquétsia identificada por métodos de biologia molecular em cães portugueses doentes. O vector de R. conorii no país é o ixodídeo Rhipicephalus sanguineus. Os cães, os principais hospedeiros deste ixodídeo, podem servir como sentinelas e dar alguma indicação sobre a prevalência da infecção. Apesar da elevada seroprevalência desta riquétsia em canídeos, existem poucos estudos que relacionam a infecção por este agente com doença nestes animais. O mesmo animal pode ser infectado concomitantemente por vários agentes transmitidos por vectores e muitas vezes os quadros clínicos das diferentes doenças são inespecíficos e semelhantes. Por isso, deve ser feito diagnóstico diferencial entre várias patologias e neste âmbito, as técnicas laboratoriais assumem maior importância que o diagnóstico clínico. Foi realizado um estudo restrospectivo sobre uma amostra de 91 animais apresentados a consulta no Hospital Veterinário do Restelo, entre Maio de 2007 e Fevereiro de 2008, com sintomas suspeitos de doença transmitida por ixodídeos e aos quais foram pesquisados anticorpos anti-R. conorii. Alguns dos casos clínicos incluídos neste estudo decorreram fora do período de estágio pelo que houve conhecimento dos mesmos pelo acesso a base de dados do hospital. A técnica de Imunofluorescência Indirecta (IFI) foi utilizada para pesquisa de anticorpos contra R. conorii (n=91), E. canis (n=90), L. infantum (n=56) e B. canis (n=26). Na amostra, a seroprevalência de R. conorii foi de 73%, superior a de qualquer um dos outros agentes. Foram encontradas possíveis co-infecções de vários agentes em 38 dos 66 animais que possuiam anticorpos contra a riquétsia em questão. A associação de sinais clínicos com resultados de IFI positivos para R. conorii foi realizada em seis animais. Foram detectados vários sinais e sintomas como piréxia, uveíte, petéquias e hematomas, dor de origem inespecífica, rigidez muscular e esplenomegália. Anemia, trombocitopénia e hipoproteinémia foram as alterações hematológicas verificadas. Nesta amostra, a maioria dos cães de rua e dos animais com história de parasitismo por ixodídeos, possuia anticorpos contra agentes transmitidos por ixodídeos, nomeadamente R. conorii.ABSTRACT Rickettsia of the Spotted Fever group are widely distributed, in endemic focii, throughout the world and are important causes of morbidity and mortality in man and domestic animals worldwide. In Portugal, Rickettsia conorii is the main organism of this group, causing boutounneuse fever in humans. Also, this was the only rickettsia identified by molecular biology methods in sick portuguese dogs. In Portugal, the arthropod that transmits this rickettsia is the tick Rhipicephalus sanguineus. Dogs, the main hosts of this tick, may serve as sentinels and elucidate about the prevalence of infection. Despite the high prevalence of this rickettsia in these animals, there are few studies that link infection by this agent and clinical signs in canines. The same animal can be infected by several vector-borne agents simultaneously which can cause overllaping and unspecific clinical signs. Therefore, some differential diagnosis should be included and, for this concern, the laboratorial techniques assume an important role to achieve the definitive diagnosis. Between May 2007 and February 2008, several animals were assisted in Hospital Veterinário do Restelo for tick-borne diasease symptoms. Of these, 91 were included in this retrospective study. Some of the animals came to the hospital out of the externship period therefore, knowledge of the cases was taken accessing the hospital data base. An indirect fluorescent-antibody test (IFA) was performed to search for antibodies against R. conorii in (n=91), E. canis (n=90), L. infantum (n=56) and B. canis (n=26). In this sample, the R. conorii seroprevalence was 73%, higher than the seroprevalence for the other agents. Possible co-infections were found in 38 of the 66 canines that had antibodies against the rickettsia in question. The association between clinical signs in dogs and positive IFA results for R. conorii was done in 6 animals. In these canines, symptoms such as fever, uveitis, petequial hemorrhages, bruises, unspecific pain, tremors, muscle stiffness and splenomegaly were detected. Anemia, thrombocytopenia and hypoproteinemia were the hematologic changes found. In this sample, the majority of the stray dogs and animals with a history of parasitism by ticks featured antibodies against tick-borne agents, especially R. conorii

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Perfil imuno-histoquímico e variáveis clinicopatológicas no câncer de mama

OBJETIVO: Descrever as principais características em mulheres com câncer de mama, de acordo com o perfil imuno-histoquímico. MÉTODOS: A população foi composta a partir de coorte hospitalar formada por mulheres com diagnóstico de câncer de mama efetuado entre 2003 e 2005 (n = 601) e atendidas em centro de referência em assistência oncológica de Juiz de Fora-MG. Foram selecionadas apenas 397 mulheres que possuíam imunohistoquímica completa. Para definição dos grupos segundo perfil imuno-histoquímico, optou-se por classificação baseada na avaliação dos receptores de estrógeno e de progesterona, índice de proliferação celular Ki67 e superexpressão de HER2. De acordo com os diferentes fenótipos, foram definidos cinco subtipos: luminal A, luminal B-HER2 negativo, luminal B-HER2 positivo, triplo negativo e HER2 superexpresso. RESULTADOS: A maioria dos pacientes tinha pele branca (80,7%) e era pós-menopausada (64,9%), com idade média de 57,4 anos (±13,5). Ao diagnóstico, 57,5% delas tinha tumor de tamanho > 2,0 cm, e 41,7% exibiam comprometimento linfonodal. Os subtipos mais frequentes foram luminal B-HER2 negativo (41,8%) e triplo negativo (24,2%). No subtipo luminal A, 72,1% das pacientes eram pós-menopausadas, enquanto que os maiores percentuais na pré-menopausa foram observados nos subtipos luminal B-HER2 positivo e triplo negativo (45,2% e 44,2%, respectivamente). Verificou-se maior frequência de tumores > 2,0 cm e com linfonodos comprometidos nos subtipos triplo negativo e HER2 positivo. CONCLUSÃO: Esta pesquisa possibilitou avaliar a distribuição das principais características clinicopatológicas e relacionadas aos serviços de saúde em coorte de mulheres brasileiras com câncer de mama, segundo os subtipos tumorais imuno-histoquímicos

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)