Cloacoplasty in a 40-Day-Old Monk Parakeet with Cloacal Prolapse

Background: The monk parakeet (Myiopsitta monachus) is also known as the quaker parrot and belongs to the order Psittaciformes in the family Psittacidae. The cloaca is a posterior orifice common to reproductive, digestive and urinary systems and the cloacal prolapse is the displacement or inversion of its anatomic position. Nowadays, the non-conventional pet market in Brazil is rapidly growing, which demands more skills and competences from an avian veterinarian. This study case has as its main objective to present a 40-day-old monk parakeet (Myiopsitta monachus) with cloacal prolapse, treated using the cloacoplasty technique. It is important to mention that the occurrence of cloacal prolapse in this species and in such an early age is uncommon.Case: The patient presented 1 day before the physical examination an increased volume in the cloacal region and hematochezia, and diagnosed as cloacal prolapse. For the treatment, wounds were washed using physiological saline solution, ice and sugar were applied in order to reduce the edema, and mineral oil was used for repositioning the cloacal mucosa. Finally, local anesthesia was applied and 2 isolated contralateral sutures were done with the objective of reducing the sphincter’s diameter, without compromising the flow of urine and feces.  The monk parakeet was treated with antibiotic Avitrin®)  [oxytetracycline hydrochloride - 8.1 mg/mL] and a vermifuge [mebendazole 50 mg/mL]. A sample of feces was also obtained and sent to the Laboratory of Avian Pathology Diagnosis. The patient was discharged after 7 days of the treatment, obtaining a favorable result with no further complications.Discussion: The results of the coproparasitological examination were negative for the samples analyzed; nevertheless, the possibility of a false negative result cannot be totally dismissed. Cloacal prolapse may be related to cases of hypersexual disorder or overexertion to defecate due to intestinal parasites, posture, polyps, enteritis, neoplasm or cloacal hyperplasia. Besides that, endoparasitism is common in captive birds. For the correct treatment, proceed with a cloacoplasty, in which 1 or 2 simple sutures are made separated laterally in both sides, promoting the narrowing of the orifice. The surgeries such as the cloacoplasty are currently being defended, but in most cases as an adjuvant therapy. Cloacal prolapse in birds is a disease considered as an intestinal emergency. The techniques presented in this work demand sedation or anesthesia for the patient, which were not authorized by the tutor due to the high risk involved. However, due to the characteristic of domestication and docile behavior of the bird, it was possible to perform the 2 sutures with a local anesthetic block only. Cloacal prolapse is relatively common in adult psittacine birds, but uncommon in monk parakeets and young birds.  The treatment performed was effective for the monk-parakeet presented in this study case. The authors, however, would like to strongly reinforce the need to identify the cause of cloacal prolapse in order to properly treat it. The importance of correctly identifying the anatomy of a psittacine bird as well as applying precisely the suture techniques are the most important conclusions obtained, making both the identification of the problem and its solution through surgical intervention a simpler and successful process.Keywords: birds, endoparasites, suture, wild

Carcinoma de células escamosas corneal em um cão - uso da Mitomicina C 0.02% como adjuvante no tratamento

Background: Although Squamous Cell Carcinoma (SCC) is most commonly seen in the epidermis, this malignant neoplasm can manifest in various other tissues. A wide range of factors may be related to the development of SCC in the cornea, with continuous exposure to ultraviolet radiation and chronic friction to the ocular surface being the most accepted theories. In addition to surgical procedures, the use of mitomycin C in the topical treatment of corneal SCC has shown good results in therapeutic management. Thus, the objective of the current work is to report the satisfactory response observed in the use of mitomycin C in a case of SCC in the cornea of a dog.Case: A 9-year-old male Pug dog was attended by the Veterinary Ophthalmology and Microsurgery Sector (SOMVET) of the University Veterinary Hospital (HVU) of the Federal University of Santa Maria (UFSM) with Squamous Cell Carcinoma (SCC) in the cornea of the left eye, which had recurred after a previous surgical intervention. Secretion and discomfort in the left eye were noted during clinical examination. In addition, both eyes presented pigmentary keratitis in the medial corner. Surgical excision of the neoplasm was performed using the surgical technique of anterior lamellar keratectomy.In the immediate postoperative period, topical therapy was started with eye drops based on mitomycin C at 0.02%, for a period of 28 consecutive days. The use of this chemotherapy drug in the topical form was intended to minimize the chances of recurrence of the clinical condition, since the patient is predisposed to this alteration. In addition, supportive therapy was implemented to improve patient comfort, consisting of the use of tobramycin-based eye drops (6 times a day, for 14 days), atropine 1% eye drops (BID, for 3 days), lubricating eye drops based on sodium hyaluronate (3 times a day, for continuous use), and immunomodulatory eye drops based on tacrolimus 0.02% (twice a day, for continuous use). The patient was evaluated 7, 14, 21, and 28 days after surgery, when good results were observed. One year after treatment, the dog was still showing no signs of recurrence of the treated clinical condition.Discussion: It is known that chronic friction on the surface of the cornea predisposes to the diagnosis of corneal SCC. Accordingly, in the clinical examination of the patient in this report, the presence of bilateral pigmentary keratitis was observed, an alteration that leads to a framework of chronic aggression to the cornea. Surgical treatment is recommended to remove the tumor mass in the ocular region. However, in cases of corneal SCC, the literature highlights that recurrence after surgical excision is a common factor. As the patient in this study arrived at the clinic with a history of recurrence, topical therapy with mitomycin C associated with surgical treatment was instituted. This chemotherapy drug has shown encouraging results in the treatment of some neoplasms, especially SCC. Its use in this case supported previous findings, pointing to a satisfactory result in which the patient had no recurrences after one year of follow-up. In addition, the concentration and frequency used of the active ingredient did not lead to adverse effects in the short or medium term. Keywords: corneal, dry keratitis, chronic, chemotherapy. Título: Carcinoma de células escamosas corneal em um cão - uso da MitomicinaC 0.02% como adjuvante no tratamento Descritores: corneal, ceratoconjuntivite seca, crônico, quimioterápico.Background: Although Squamous Cell Carcinoma (SCC) is most commonly seen in the epidermis, this malignant neoplasm can manifest in various other tissues. A wide range of factors may be related to the development of SCC in the cornea, with continuous exposure to ultraviolet radiation and chronic friction to the ocular surface being the most accepted theories. In addition to surgical procedures, the use of mitomycin C in the topical treatment of corneal SCC has shown good results in therapeutic management. Thus, the objective of the current work is to report the satisfactory response observed in the use of mitomycin C in a case of SCC in the cornea of a dog. Case: This study addresses the case of a 9-year-old male Pug dog who was attended by the Veterinary Ophthalmology and Microsurgery Sector (SOMVET) of the University Veterinary Hospital (HVU) of the Federal University of Santa Maria (UFSM). The patient presented with Squamous Cell Carcinoma (SCC) in the cornea of the left eye, which had recurred after a previous surgical intervention. Secretion and discomfort in the left eye were noted during clinical examination. In addition, both eyes presented pigmentary keratitis in the medial corner. Surgical excision of the neoplasm was performed using the surgical technique of anterior lamellar keratectomy. In the immediate postoperative period, topical therapy was started with eye drops based on mitomycin C at 0.02%, for a period of 28 consecutive days. The use of this chemotherapy drug in the topical form was intended to minimize the chances of recurrence of the clinical condition, since the patient is predisposed to this alteration. In addition, supportive therapy was implemented to improve patient comfort, consisting of the use of tobramycin-based eye drops (6 times a day, for 14 days), atropine 1% eye drops (BID, for 3 days), lubricating eye drops based on sodium hyaluronate (3 times a day, for continuous use), and immunomodulatory eye drops based on tacrolimus 0.02% (twice a day, for continuous use). The patient was evaluated 7, 14, 21, and 28 days after surgery, when good results were observed. One year after treatment, the dog was still showing no signs of recurrence of the treated clinical condition. Discussion: It is known that chronic friction on the surface of the cornea predisposes to the diagnosis of corneal SCC. Accordingly, in the clinical examination of the patient in this report, the presence of bilateral pigmentary keratitis was observed, an alteration that leads to a framework of chronic aggression to the cornea. Surgical treatment is recommended to remove the tumor mass in the ocular region. However, in cases of corneal SCC, the literature highlights that recurrence after surgical excision is a common factor. As the patient in this study arrived at the clinic with a history of recurrence, topical therapy with mitomycin C associated with surgical treatment was instituted. This chemotherapy drug has shown encouraging results in the treatment of some neoplasms, especially SCC. Its use in this case supported previous findings, pointing to a satisfactory result in which the patient had no recurrences after one year of follow-up. In addition, the concentration and frequency used of the active ingredient did not lead to adverse effects in the short or medium term

Intrastromal Fluconazole - Effectiveness in the Surgery of Stromal Abscess in a Horse

Background: Due to its ocular microflora, the equine species is predisposed to develop mycotic ulcers which, when not properly treated, can lead to the formation of a stromal abscess. A stromal abscess occurs through the introduction of microorganisms into the corneal stroma. During re-epithelialization, the foreign body is encapsulated, thus creating a barrier that protects bacteria or fungi from treatment with antimicrobial medication. This framework can end up resulting in blindness due to chronic iridocyclitis, putting the animal's vision at risk. The current work aims to report a case of corrective surgery for stromal abscess in a mare with the administration of intraoperative intrastromal fluconazole, in order to corroborate the effectiveness of the technique.  Case: A 9-year-old mare was evaluated, with the complaint that her right eye was closed and “yellowish” and that she had already been treated with intramuscular injectable anti-inflammatory drugs based on flunexin meglumine (Banamine® - 50 mg) for 15 days, referring to a possible ulcer in the right eye.  Ophthalmic screening resulted in a negative direct reflex and no threat response in the right eye. Examination of the conjunctiva showed congestion and chemosis. Examination of the cornea of the right eye was negative for Fluorescein and Green Lissamine tests, and opacity and corneal neovascularization were noted. The final diagnosis was a corneal abscess of probable fungal origin secondary to a keratomycosis. After the consultation, complementary blood and biochemical tests were performed, which showed normal results for the species in question, and treatment was started with eye drops based on atropine 1% (Fagra® - 20 mL), ciprofloxacin antimicrobial eye drops (Ciprovet Colirio® - 5 mL), and antifungal eye drops based on ketoconazole 1% (manipulated), in addition to an intramuscular injectable anti-inflammatory based on flunexin meglumine (Banamine® - 50 mg - 1.1 mg/kg SID) and an intramuscular injectable analgesic based on sodium dipyrone (Febrax® - 0.5 g - 15 mL/animal SID) until the day of surgery, which was booked for 3 days later. The surgical intervention was then instituted by the technique of anterior lamellar keratectomy followed by intrastromal hydration with fluconazole and the forming of a bipedicled flap, in order to remove the necrotic tissue and antigenic stimulation factors, while the conjunctival flap aimed to improve blood supply and protect the injured area, thus favoring local healing. For better postoperative quality for the animal, continuation of the same treatment as prior to surgery was prescribed for a period of 15 days. The return of the animal for the removal of the flap was scheduled for 45 days after surgery, however, due to the COVID-19 pandemic, there was a delay of 135 days. When the animal returned the flap was still stable. A second surgery was instituted for the removal of the flap, during which it was possible to affirm that the cornea had recovered total integrity and partial transparency with only a leukoma in the previous location of the abscess.Discussion: The technique of anterior lamellar keratectomy together with the use of a conjunctiva flap for the treatment of stromal abscess in horses is a known technique that is used routinely, although some cases report the formation of a second infection in the same space. However, there are few reports on the use of intrastromal hydration with antifungal medication adjuvant to the surgical technique, which, as shown in this report, proved to be effective since even with the issue of a delay in removing the conjunctival flap, the eye remained whole and there was no second infection. The use of this technique can therefore be indicated for the treatment of stromal abscess in horses, given the safety that the application of intrastromal antifungal provides.Keywords: azole, abscess, stromal, keratectomy, ophthalmology, equine, mare.Descritores: azol, abscesso, estroma, ceratectomia, oftalmologia, equino, égua.

Flape de rotação em padrão axial caudal lateral superficial após remoção de adenocarcinoma de glândula perianal em cão: Superficial lateral caudal axial pattern flap after removal perianal gland adenocarcinoma in dog

A cirurgia reconstrutiva tem sido frequentemente utilizada, principalmente para o fechamento de defeitos secundários à remoção de neoplasias. As neoplasias de glândula perianal geralmente acometem cães machos, inteiros e de meia idade à idosos. Dentre os tumores desta glândula, os adenocarcinomas são menos frequentes quando comparados aos adenomas e exigem excisão cirúrgica com margem de segurança, tornando o defeito secundário maior e, muitas vezes, sendo necessário a utilização de técnicas reconstrutivas para o seu fechamento. O presente trabalho objetiva descrever o caso de um canino que apresentava um nódulo em região perianal, na base da cauda, e o uso da cirurgia reconstrutiva para o fechamento do defeito oriundo da excisão cirúrgica nessa região. Foi atendido no Hospital Veterinário, um canino, macho, sem raça definida (SRD), de 12 anos de idade, apresentando um nódulo na região perianal, na base da cauda, há cerca de três meses que, segundo exame histopatológico após a remoção, tratava-se de um adenocarcinoma de glândula perianal. Para a remoção cirúrgica do tumor, foi necessária a utilização de reconstrução com flape de rotação de padrão axial caudal lateral superficial, resultando no fechamento completo do defeito cirúrgico, retorno funcional da área afetada, perfusão adequada, bons resultados estéticos, ausência de grandes complicações e permitindo a remoção da neoplasia com ampla margem de segurança, confirmando o sucesso da técnica escolhida

Osteossíntese de úmero em um gato-maracajá (Leopardus Wiedii) / Humeral osteosynthesis in a margay (Leopardus Wiedii)

Os felídeos selvagens são os mamíferos mais admirados pelo ser humano, mas a maior causa do declínio desses animais na natureza é a destruição e a fragmentação dos seus habitats. A espécie Leopardus wiedii, de nome popular gato-maracajá, está listada como Quase Ameaçada pela Lista Vermelha de Espécies Ameaçadas da IUCN. Em felídeos selvagens, as correções de fraturas oriundas de traumatismos são uma das intervenções cirúrgicas mais comuns. Logo, o objetivo desse trabalho é apresentar um gato maracajá com fratura de úmero, do qual optou-se pelo tratamento cirúrgico com dois pinos de Steinmann intramedulares. Ressalta-se a eficácia do método escolhido, que foi avaliado aos 30, 45 e 60 dias do pós-operatório e alta clínica da paciente aos 60 dias, com ganho de 700 gramas de massa corporal

Aspectos morfológicos da glândula molar em leão (Panthera leo)/ Morphological aspects of the molar gland in lion (Panthera leo)

O conhecimento morfológico das glândulas salivares é importante nas espécies silvestres e domésticas. As glândulas salivares dos felinos são mandibulares, parótida, sublingual, zigomática e molar. As glândulas molares são um total de duas no leão (Panthera leo), com secreção predominante mucosa. Dessa forma, o objetivo desse trabalho foi descrever anatomicamente a glândula molar. O presente trabalho foi realizado no laboratório de anatomia na Universidade Federal de Santa Maria. Foi dissecada uma cabeça de uma leoa (Panthera leo) de vinte e três anos que pertencia a um criadouro de Santa Maria/RS. Fixou-se e realizou-se a dissecação das glândulas molares de ambos os lados da face, com rebatimento da pele, do músculo platisma e remoção do músculo subcutâneo. A forma, posição e a relação das glândulas foram observadas. Com a fita métrica foram realizadas medidas da extremidade do nariz até o ponto mais alto da crista nucal (Medida A), desta até o ponto médio entre os ângulos mediais dos olhos (Medida B), e de uma linha reta transversal partindo do processo angular da mandíbula até o dorso da cabeça (Medida C). Mediram-se também com auxílio de um parquímetro o comprimento, a largura e a profundidade das glândulas. Logo, a glândula molar apresentou uma forma retangular alongada, com medidas proporcionais em relação ao tamanho da cabeça, de 1/6 a 1/7 do comprimento, e de 1/16 a 1/23 da largura

Toracotomia com esofagotomia para remoção de corpo estranho esofágico em um cão

Na rotina clínica de pequenos animais, a ocorrência de corpos estranhos (CE) no trato digestório é rotineira, principalmente em cães e gatos com hábitos alimentares não controlados e filhotes. Nos cães, a principal ocorrência trata-se de ossos e em gatos, materiais lineares. A remoção cirúrgica, usualmente, é o método eficaz no tratamento dos CE esofágicos, sendo a endoscopia a técnica de eleição, porém, em alguns casos, é preconizada a realização de toracotomia com esofagotomia, pois apresenta os melhores resultados na resolução cirúrgica. O objetivo deste trabalho é relatar o caso de um canino, de dois anos de idade, da raça Labrador, que foi atendido pelo Setor de Oftalmologia e Microcirurgia do Hospital Veterinário Universitário da Universidade Federal de Santa Maria (HVU-UFSM) e que apresentava obstrução esofágica por corpo estranho. Após o diagnóstico e com os resultados dos exames complementares favoráveis, o paciente foi submetido à toracotomia com esofagotomia para a remoção do CE. No transoperatório foram utilizadas medicações analgésicas, anti-inflamatórias e antibióticas, sendo: dipirona 25 mg/kg, TID, cloridrato de tramadol 4 mg/kg, TID, meloxicam 0,1 mg/kg SID e cefalotina 30 mg/kg BID, todas pela via intravenosa. No terceiro dia pós-cirurgia o paciente recebeu alta sem complicações. As mesmas medicações foram prescritas para administração em domicílio, substituindo a via de administração para a via oral e o antibiótico para cefalexina 30mg/kg. A abordagem cirúrgica escolhida para o tratamento foi indicada pelo tamanho e localização do CE no esôfago. Assim, conclui-se que a utilização desta técnica proporciona a remoção com a visualização da viabilidade das camadas esofágicas e demonstra resultados excelentes com retorno as atividades de rotineiras

Rede de atenção às urgências e emergências e a produção viva de mapas de cuidado: Relatório técnico-científico final

Objetivo: analisar o processo de implementação e conformação dos modos de produção do cuidado da política de Rede de Atenção às Urgências e Emergências (RUE), em duas regiões de saúde: Campinas (SP) e Passo Fundo (RS). Procura, ainda, identificar analisadores da produção micropolítica presentes no processo de pactuação e implementação da RUE nessas regiões; analisar as possíveis mudanças no processo de gestão a partir da implementação das RUE; e caracterizar as transformações ocorridas nos modos de produção do cuidado em saúde a partir da implementação das RUE. Metodologia: a pesquisa tem caráter qualitativo, com abordagem micropolítica, e caracteriza-se como estudo de caso e foi desenvolvida através de revisão de literatura, análise de documentos oficiais, coleta de depoimentos de gestores municipais e estaduais, entrevistas narrativas com usuários, e entrevistas em profundidade com gerentes de serviços. No total, foram entrevistados 61 sujeitos. A análise teve como referência a ‘Abordagem do Ciclo de Políticas’. A pesquisa foi desenvolvida por pesquisadores dos programas de Pós-Graduação em Saúde Coletiva da Escola Paulista de Medicina – Universidade Federal de São Paulo (Unifesp-EPM) e da Imed-Faculdade Meridional de Passo Fundo (RS), com apoio de gestores regionais e municipais de saúde e dos Conselhos de Secretários Municipais de Saúde (COSEMS) dos estados de São Paulo e do Rio Grande do Sul. Resultados: Os principais resultados apontam para uma política pública de caráter plural e multifacetado, formulada a partir de diversas influências sociais, econômicas, políticas e teóricas, que expressa como intencionalidade a ampliação do acesso e o cuidado integral em situações de urgência e emergência em saúde. No contexto da prática, apesar da ênfase aos aspectos organizativos e ao financiamento, é observada a política ‘em cena’ onde podem ser identificadas ações de gestão e de produção de cuidado induzidas pela política, mantidas apesar da política e produzidas para além da política da RUE. A relação entre a política oficial e a ação micropolítica dos gestores, tornou-a uma produção singular no campo da governança regional; a necessidade de autonomia dos usuários e a dimensão do cuidado familiar apontam para caminhos na construção da integralidade; há evidências de produções vivas induzidas pela política que qualificam o cuidado, embora iniquidades sejam mantidas ou produzidas; e, a necessidade de articulação entre os componentes em rede, embora evocada, traduz-se em conexões frágeis e não regulares. Considerações Finais: A compreensão dos complexos processos que envolvem as políticas públicas de saúde, os interesses e poderes que as atravessam, tem potencial para fortalecer os atores implicados com a luta pela promoção da equidade em saúde e pela justiça social.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)428431/2018-

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The LHCb upgrade I

The LHCb upgrade represents a major change of the experiment. The detectors have been almost completely renewed to allow running at an instantaneous luminosity five times larger than that of the previous running periods. Readout of all detectors into an all-software trigger is central to the new design, facilitating the reconstruction of events at the maximum LHC interaction rate, and their selection in real time. The experiment's tracking system has been completely upgraded with a new pixel vertex detector, a silicon tracker upstream of the dipole magnet and three scintillating fibre tracking stations downstream of the magnet. The whole photon detection system of the RICH detectors has been renewed and the readout electronics of the calorimeter and muon systems have been fully overhauled. The first stage of the all-software trigger is implemented on a GPU farm. The output of the trigger provides a combination of totally reconstructed physics objects, such as tracks and vertices, ready for final analysis, and of entire events which need further offline reprocessing. This scheme required a complete revision of the computing model and rewriting of the experiment's software