Caseous Stomatitis Caused by Pseudomonas aeruginosa in Boa constrictor amarali

Background: Pseudomonas aeruginosa is a bacterium that belongs to the microbiota of snakes, but it may also be an opportunistic pathogen and contaminate humans through fecal contact, bites, and injuries. In snakes, this microorganism may present high pathogenicity at certain conditions and have been associated with high morbidity and mortality. Reports of infection of Boa constrictor by this pathogen are rare. Thus, this study aimed to describe the P. aeruginosa oral infection in a snake specimen (Boa constrictor amarali), approaching the isolation and identification of the infectious agents involved, the antimicrobial sensitivity and resistance, and the therapeutic protocol adopted.Case: A free-living adult female specimen of Boa constrictor amarali (Amaral's boa), with no described previous history was rescued in an urban area by the Environmental Police. Clinical evaluations showed structures of caseous aspect in the oral cavity, with hyperemia spots in the mucosa. Samples of these lesions were sent for mycological examination, and fungal forms were not found. Samples were collected for isolation and culture. The antimicrobial susceptibility of the isolated microorganisms was determined by the modified Kirby-Bauer disk diffusion method. P. aeruginosa was isolated and showed susceptibility to amikacin, gentamicin, and polymyxin-B; intermediate susceptibility to azithromycin, and ciprofloxacin; and resistance to cephalexin, ceftiofur, chloramphenicol, and enrofloxacin. The treatment consisted of cleaning of the oral cavity, local infiltration of lidocaine for debridement of the caseous area that were later cauterized with iodine. Systemic antibiotic therapy was used, with intramuscular administration of amikacin (5 mg/kg) for the first dose and (2.5 mg/kg) for the other doses with intervals of 72 h, and oral administration of metronidazole (20 mg/kg) with intervals of 48 h, both during 21 days. Daily subcutaneous fluid therapy was performed as support treatment, using Lactated Ringer's solution (25 mg/kg) and Vitamin C (10 mg/kg) with intervals of 24 h, being the cure observed at the end of treatment.Discussion: This paper presents the pathological findings of the Pseudomonas aeruginosa oral infection in a B. constrictor amarali. This bacterium is an opportunistic pathogen that is commonly found  in snakes, thus, humans in contact with these animals may be contaminated with this pathogen. However, oral cavity lesions associated with P. aeruginosa had not yet been related to Boa constrictor amarali, which is a non-venomous species. Few bacteria associated with reptile diseases are primary causative agents. Clinical bacterial infections generally tend to be secondary to viral infections. Predisposing factors for the development of bacterial diseases in these reptiles include immunodepression, malnutrition, poor adaptation to captivity, and the maintenance of these animals at temperatures and humidities outside their thermal comfort range. In the present study, the P. aeruginosa behaved as an opportunistic pathogen, resulting in clinical manifestations with caseous lesions in the oral cavity, probably due to an imbalance of the microbiota caused by stress or immunodepression. The antibiogram allowed the adoption of a correct therapeutic protocol based on the susceptibility of the pathogen, resulting in remission of lesions and clinical signs after 21 days of treatment

Dermatopathy Caused by Enterobacter aerogenes and Pseudomonas aeruginosa in Boa constrictor amarali

Background: Bacterial diseases are the main cause of the high mortality rates of snakes, especially those caused by gramnegative agents. However, studies on dermatopathy caused by these bacterial agents in snakes are scarce; and no reports have been found on Enterobacter aerogenes as causative agent of dermatopathy in snake species. Thus, the objective of this study was to describe the clinical signs, and lesion evolution of a dermatopathy in a male snake (Boa constrictor amarali) specimen of approximately seven years old; and to describe the isolation and identification of the Enterobacter aerogenes and Pseudomonas aeruginosa agents involved in the cause of this disease.Case: The Boa constrictor amarali evaluated presented blackened cutaneous lesions in the dorsal, snout-vent and tail regions; and well-defined subcutaneous nodules of 2.0-3.0 cm diameter, with soft consistency, reddish color, cutaneous flaccidity, and areas of scale ulceration in the dorsolateral region. The clinical evaluation of the animal showed dehydration signs and pale mucous membranes. The blackened lesions were subjected to mycological analysis - after procedure of deep scale scraping - which showed presence of septate hyphae. The nodule was punctured for microbiological and biochemical analysis. The sample was collected with a sterilized alginate cotton tip swab, and was stored in a plastic tube containing a semi-solid Stuart transport medium, for microbiological analysis. Then, this sample was incubated in a bacteriological oven at 37°C for 24 h. Typical colonies of Pseudomonas and Enterobacter grew on MacConkey agar medium; these bacteria were identified by the colony morphology and their typical odor. The colonies grown in MacConkey agar were also identified through biochemical tests in the mediums: Phenol red, Lysine, Phenylalanine, Citrate, Urea and SIM (Sulfide, Indole, Motility). The results of these tests were able to confirm and identify the P. aeruginosa and E. aerogenes species. The animal died within 36 h, before the identification of the causative agents of the disease, thus, no pharmacological interference was possible.Discussion: Immunodepression, malnutrition, and temperatures and humidity outside the animal thermal comfort zone, are predisposing factors for the development of bacterial diseases in reptiles. Little information about pathogen agents affecting Boa constrictor specimens in their native area is available; however, captive snakes are subject to a wide variety of diseases - most of which caused or intensified by the captivity conditions. Among the bacteria involved in reptile diseases, few are primary causative agents. In general, clinical bacterial infections tend to be secondary to viral infections. The bacterial agents found in this study are commonly described in scientific literature with location in the oral cavity, differently from the results found in this study. Moreover, the bacterium E. aerogenes has not yet been described in other studies as a causative agent of dermatopathy. Reptiles are considered reservoirs of important zoonotic microorganisms, such as P. aeruginosa, which can be transmitted by fecal contact, bites and wounds. However, the little information on P. aeruginosa in captive reptiles indicates the need for further studies to establish its zoonotic potential. A most adequate management conditions for the snake species could have decreased the severity of the lesions. The occurrence of P. aeruginosa and E. aerogenes found in this work may alert professionals for future clinical suspicions and adequate therapeutic management

Hepatic Lipidosis Due to Obesity in a Free-Living Snake (Boa constrictor amarali)

Background: Liver performs several important functions to the maintenance of physiological mechanisms. Some liver diseases may directly affect anatomical and physiological aspects of this organ, and may lead to a permanent liver injury. In snakes, the most common causes of liver disease are infections, however, approaches on non-infectious liver diseases are scarce. Therefore, the objective of this study was to describe macroscopically and microscopically liver alterations in a Boa constrictor amarali snake.Case: A adult male boa (Boa constrictor amarali) snake of 110 cm of length and weight of 3.270 kg from free-living conditions, and without previous history was rescued in an urban area and taken by the Environmental Police to the Laboratory for Teaching and Research in Wild Animals (LAPAS) of the Federal University of Uberlândia’s (UFU) Veterinary Hospital, in Uberlândia MG, Brazil. The animal died and a significant amount of adipose tissue was found throughout the extension of the coelomic cavity at necropsy, limiting the visualization of its internal organs. Fragments of altered organs were collected and packed in a universal collector containing a 10% buffered formalin solution. These samples were sent to the Animal Pathology Laboratory (LPA) of the UFU. Macroscopically, the stomach presented a reddish mucosa, and mucous contents. The liver was pale, with a yellowish color and a friable consistency. Microscopically, dilated hepatic sinusoids filled with red blood cells were observed; the hepatocytes were enlarged, and its cytoplasm were filled with vacuoles ofvaried sizes that did not stain (severe diffuse lipidosis). It was also found occurrence of multifocal areas with loss of tissue architecture, and hepatocytes in karyolysis, charactering necrosis; and a discrete amount of multifocal mononuclear inflammatory infiltrate (multifocal hepatitis).Discussion: Obesity is connected to the occurrence of hepatic steatosis, since snakes are ectothermic animals that depend on environmental factors to maintain their metabolic rates. Obesity is a common problem in reptiles kept in captivity because they usually have constantly available food and little space to move. However, this was also observed in this study in a free-living animal found in an urbanized environment. Urbanization provides greater availability of food, and the animal does not need to go long distances to find a pray; this causes greater gain of body weight. Reptiles subjected to hot environments lose weight rapidly due to their relatively high metabolic rates. However, when subjected to low temperatures, they have a decrease in metabolism, compromising absorption, digestion, and liver metabolism, which causes fat accumulation. The animal under study is sedentary and it is a marked characteristic of this species; this strengthen the hypothesis that the animal moved little to feed because it was in an environment with high availability of prey. The animal presented accumulation of fat throughout the coelomic cavity, causing the rate of accumulation of triglycerides in the hepatocytes to exceed its metabolic degradation rate, resulting in steatosis. The early diagnosis of hepatic alterations favors the appropriatetreatment, allowing the prevention of irreversible damage to this organ, and avoid the animal’s death.Keywords: ectotherm, hepatocellular lipidosis, snakes, amaral’s boa, hepatic steatosis

Classification of schizophrenic traits in transcriptions of audio spectra from patient literature: artificial intelligence models enhanced by geometric properties

Schizophrenia is a severe mental illness that affects approximately 1% of the global population and presents significant challenges for patients, families, and healthcare professionals. Characterized by symptoms such as delusions, hallucinations, disorganized speech or behavior, and cognitive impairment, this condition has an early onset and chronic trajectory, making it a debilitating challenge. Schizophrenia also imposes a substantial burden on society, exacerbated by the stigma associated with mental disorders. Technological advancements, such as computerized semantic, linguistic, and acoustic analyses, are revolutionizing the understanding and assessment of communication alterations, a significant aspect in various severe mental illnesses. Early and accurate diagnosis is crucial for improving prognosis and implementing appropriate treatments. In this context, the advancement of Artificial Intelligence (AI) has provided new perspectives for the treatment of schizophrenia, with machine learning techniques and natural language processing allowing a more detailed analysis of clinical, neurological, and behavioral data sets. The present article aims to present a proposal for computational models for the identification of schizophrenic traits in texts.  The database used in this article was created with 139 excerpts of patients' speeches reported in the book “Memories of My Nervous Disease” by German judge Daniel Paul Schreber, classifying them into three categories: 1 - schizophrenic, 2 - with schizophrenic traits and 3 - without any relation to the disorder. Of these speeches, 104 were used for training the models and the others 35 for validation.Three classification models were implemented using features based on geometric properties of graphs (number of vertices, number of cycles, girth, vertex of maximum degree, maximum clique size) and text entropy. Promising results were observed in the classification, with the Decision Tree-based model [1] achieving 100% accuracy, the KNN- k-Nearest Neighbor model observed with 62.8% accuracy, and the 'centrality-based' model with 59% precision. The high precision rates, observed when geometric properties are incorporated into Artificial Intelligence Models, suggest that the models can be improved to the point of capturing the language deviation traits that are indicative of schizophrenic disorders. In summary, this study paves the way for significant advances in the use of geometric properties in the field of psychiatry, offering a new data-based approach to the understanding and therapy of schizophrenia

Quais são as novas evidências para o manejo das dislipidemias? Uma revisão integrativa

As dislipidemias se encontram difundidas amplamente na população brasileira, com uma prevalência de 24,8% e de até 75% em indivíduos obesos. O presente estudo de revisão buscou avaliar novos avanços para a abordagem terapêutica das dislipidemias, documentados por meio de estudos clínicos e randomizados. Trata-se de uma pesquisa de revisão integrativa realizada por meio da base de dados PubMed, que levou em consideração os seguintes critérios de inclusão: ensaios clínicos e testes controlados e randomizados; artigos publicados no último ano; que possuíam texto completo disponível e que abordassem acerca do manejo das dislipidemias. Ficou constatado que a terapia conjunta de pitavastatina e ezetimiba reduz, de forma significativa, os níveis de LDL-colesterol quando comparado com a monoterapia com pitavastatina, sem aumentar o número de eventos adversos gerais. Outra medida eficaz, ao se combinar a ezetimiba com a atorvastatina, houve uma maior eficácia na redução do nível de LDL-colesterol quando comparado com a monoterapia com atorvastatina. Além disso, observa-se o impacto positivo da suplementação de produto rico em polifenóis para a redução de lipídios no sangue, possibilitando um efeito protetor contra a aterosclerose, da mesma forma que a suplementação oral combinada de hidroxitirosol e punicalagina, a qual reduziu, de forma significativa, os níveis plasmáticos de LDL-colesterol e de triglicerídeos. Por fim, o uso do recaticimabe também pode ser aplicado como terapia adjuvante à estatina em indivíduos com hipercolesterolemia, reduzindo o nível de LDL-colesterol e tornando-se uma nova opção de tratamento segura e eficaz para o manejo de tal dislipidemia

Novas evidências na abordagem terapêutica das infecções do trato urinário (ITUs) em mulheres

No mundo, as infecções do trato urinário (ITUs) acometem em torno de 150 milhões de pessoas a cada ano. Ademais, as ITUs representam uma importante causa de morbidade em aproximadamente 10 a 20% das mulheres com idade entre 25 e 80 anos, acometendo em uma proporção de 8 mulheres para cada homem. O presente estudo de revisão buscou avaliar novas evidências na abordagem terapêutica das ITUs em mulheres, documentadas por meio de estudos clínicos e randomizados. Trata-se de uma pesquisa de revisão integrativa realizada por meio da base de dados PubMed, que levou em consideração os seguintes critérios de inclusão: ensaios clínicos e testes controlados e aleatórios; artigos publicados no último ano; que possuíam texto completo disponível e que abordassem acerca da terapêutica das ITUs em mulheres. Ficou constatado que a fosfomicina figura como opção de tratamento antibiótico oral adicional para casos de ITU na população feminina. Além disso, a diminuição potencial do impacto ecológico que a fosfomicina pode exercer sobre casos de ITU MDR é alvo para novos estudos. Já em relação às terapias não antibióticas, o hipurato de metenamina, produtos do cranberry, como as proantocianidinas de cranberry, sozinho ou combinado com antibióticos, além da uva ursi (UU) e do estrogênio vaginal são terapêuticas que mostraram benefícios nos casos de ITU ou ITU recorrente, mas que continuam sendo alvo para estudos potenciais futuros

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI