Peritoneal Response to Abdominal Surgery: The Role of Equine Abdominal Adhesions and Current Prophylactic Strategies

Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch – case report

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy

Associação da ceftriaxona intraperitoneal, gentamicina intravenosa e do metronidazol oral no tratamento de abscesso abdominal e peritonite em equino: relato de um caso

O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical respons

Educação Popular e Universidade: vivências a partir da extensão, pesquisa e ensino

Este livro é um apanhado histórico, mas atual. É uma reunião de relatos, textos, reflexões, processos, partilhas, que versam sobre nosso sonho de construir uma educação libertadora, um mundo de liberdade. Ainda há muito que ser construído e o caminho é árduo, não temos dúvida. A verdadeira práxis revolucionária não se nutre de seres apenas caminhantes, mas de seres que se envolvem com o caminhar, que são capazes de mudar, mudando a si mesmos também. Somos indivíduos sociais e pintamos o quadro da vida em múltiplas linguagens. É por isso que este livro também carrega diferentes apostas acadêmico-estético-políticas. Por meio de fotografias, poesias, relatos, ensaios e reflexões teóricas, olhares que abordaram com muito carinho e rigor o universo do PET Educação Popular. Foi escrito por várias mãos que constituíram a trajetória do grupo nas diversidades humanas (relações de sexo/gênero), étnico-raciais (negros, indígenas, imigrantes, nordestinos, pobres em geral) e de classes sociais. Combate-se assim, nas ações concretas, as desigualdades sociais, de sexo/gênero, étnico-racial etc, o patriarcado, machismo, LGBTQIA+fobia, o racismo e o capitalismo, a falta de democracia, de liberdade, que outrora iluminaram a modernidade do Capital.Ministério da Educação (MEC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Avaliação da reatividade peritoneal e das concentrações plasmáticas e peritoneais da ceftriaxona após administração intraperitoneal por cateter Tenckhoff em equinos

A peritonite em equinos permanece como enfermidade de alta ocorrência e letalidade, sendo necessárias estratégias terapêuticas mais efetivas e inovadoras que resultem no aumento da taxa de sobrevida dos animais acometidos. O objetivo deste estudo foi avaliar por estudo clínico randomizado a evolução da concentração da ceftriaxona no líquido peritoneal após administração pela via intraperitoneal (IP) e intravenosa, a utilização do cateter Tenckhoff, e da via intraperitoneal em equinos. Foram utilizados dez equinos jovens, divididos em dois grupos de 5 animais. Ambos os grupos foram submetidos a procedimento laparoscópico para implantação do cateter Tenckhoff. O grupo intraperitoneal (GIP) recebeu 25 mg/Kg de Ceftriaxona diluída em 1 litro de Solução Fisiológica à 0,9% (SF) por via IP a cada 24 horas, durante 5 dias. Para os animais do grupo intravenoso (GIV) foi administrado 25 mg/Kg de ceftriaxona por via intravenosa e 1 litro de SF via intraperitoneal a cada 24 horas, durante 5 dias. Os animais foram acompanhados clínica e laboratorialmente, através: de hemograma, fibrinogênio e concentração plasmática do fármaco; avaliação macroscópica, físicoquímica, citológica e concentração do fármaco no líquido peritoneal; avaliação ultrassonográfica e laparoscópica a fim de se avaliar alterações relacionadas à permanência do cateter ou ainda à aplicação intraperitoneal da ceftriaxona. A utilização intraperitoneal do fármaco não desencadeou processo inflamatório local ou sistêmico e resultou em concentrações peritoneais acima da concentração inibitória mínima por períodos superiores à 24 horas. O cateter Tenckhoff mostrou-se como uma via adequada para administração de soluções intraperitoneais e não foram observadas complicações decorrentes de sua utilização, amplificando-se as possibilidades de utilização da via intraperitoneal.Peritonitis persists with high incidence and mortality in horses, requiring more innovative and effective therapeutic strategies. The aim of this randomized clinical trial study was to evaluate ceftriaxone peritoneal fluid concentration after intraperitoneal (IP) and intravenous administration, Tenckhoff’s catheter use, and intraperitoneal route in horses. Ten adult horses were divided into two groups of five animals. Both groups underwent laparoscopy for Tenckhoff’s catheter insertion. The intraperitoneal group (GIP) received 25 mg/kg of ceftriaxone diluted in 1 liter of 0.9% saline solution (SS) intraperitoneally every 24 hours for 5 days. For the intravenous group (GIV) was administered 25 mg/kg of ceftriaxone intravenously and 1 liter of SS every 24 hours for 5 days. Both groups were followed clinically and biochemically through: complete blood count, fibrinogen and plasmatic drug concentration; macroscopic, physical chemistry, cytological and drug concentration in peritoneal fluid ; sonographic and laparoscopic evaluation in order to assess the catheter permanence effects and the aggression potential of the drug to peritoneum. Intraperitoneal use of the drug did not induce local or systemic inflammation and resulted in concentrations above minimum inhibitory concentration for longer than 24 hours. The Tenckhoff catheter proved to be an appropriate route for intraperitoneal solutions administration and no complications from its use was observed, amplifying the possibilities for intraperitoneal route using.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Avaliação da reatividade peritoneal de equinos submetidos à enterotomia de cólon menor e tratados com heparina pela via subcutânea

As afecções do cólon menor são causas frequentes de síndrome cólica, sendo a enterotomia rotineiramente empregada para a remoção de fecalitos, enterólitos e corpos estranhos. O trauma cirúrgico resulta em inflamação difusa e ocorrência de peritonite asséptica devido à manipulação e ao acesso cirúrgico. Objetivou-se estudar a reatividade peritoneal após a realização de enterotomia e abrasão do cólon menor em equinos tratados ou não com heparina sistêmica. Foram utilizados dez equinos com idade média de 9 ± 3,87anos e 358 ± 30,28 Kg de massa corporal, divididos em dois grupos de cinco animais, sendo um grupo o controle (GC) e o outro tratado (GT). Ambos os grupos foram submetidos à laparotomia e enterotomia de cólon menor através da via paralombar direita em posição quadrupedal e receberam flunixin meglumine, gentamicina e associação de penicilinas. Ao GT, acrescentou-se heparina (150 UI/Kg SC, BID, 5 dias). Os animais foram avaliados quanto ao exame físico; hemograma; fibrinogênio; coagulograma; proteínas de fase aguda, séricas e peritoneais; características macroscópicas, físico-químicas e citológicas do líquido peritoneal; concentrações peritoneais do ativador e inibidor do plasminogênio tecidual e dímero D. Para tanto, pradonizaram-se os seguintes momentos de avaliação: M0-prévio à enterotomia; M1-12 horas; M2 - 1dia, M3- 2dias, M4- 4dias e M5- 6 dias; M6- 10 dias e M7- 14 dias após a enterotomia. Observou-se que a heparina resultou em anemia e diminuição da contagem de plaquetas, aumento do tempo de tromboplastina parcial ativada e aumento nas concentrações séricas e peritoneais das proteínas de fase aguda, entretanto diminuiu a formação de dímeros D, sugerindo diminuição da formação de coágulos de fibrina. Após 15 dias da enterotomia, realizou-se o exame laparoscópico, que não demonstrou diferença na deposição de fibrina entre os grupos, entretanto...Small colon affections are frequent causes of abdominal pain, and enterotomy is routinely employed for removal of fecalith, enteroliths and foreign bodies. Surgical trauma results in diffuse inflammation and aseptic peritonitis occurrence due to handling and surgical access. The aim of this study was to evaluate peritoneal reactivity after small colon enterotomy and abrasion in horses treated or not with systemic heparin. Were used ten horses with a mean age of 9 ± 3.87 years and 358 ± 30,28 body weight, divided into two groups of five animals: one control group (CG) and the other treated (TG). Both groups underwent laparotomy and small colon enterotomy via right paralumbar flank in standing position and received flunixin meglumine, gentamicin and penicillin association. TG received also heparin (150 IU / kg SC BID, 5 days). Animals were evaluated for physiological parameters, hemogram, fibrinogen, coagulation markers, serum and peritoneal acute phase proteins, peritoneal fluid macroscopic, physico-chemical and cytological characteristics, peritoneal concentrations of tissue plasminogen activator and inhibitor and d-dimer. Assessments were performed prior to enterotomy-M0, M1-12 hours after enterotomy; M2 - 1 day, M3 - 2days; M4 - 4days; M5 - 6 days; M6-10 days and M7 - 14 days after the enterotomy. Heparin resulted in anemia and decreased platelet counts, increased in partial thromboplastin activated time and increased serum and peritoneal acute phase proteins, however, resulted in decreased formation of fibrin clots and d dimer formation. After 15 days of enterotomy, laparoscopic examination showed no difference in fibrin deposition between the groups, and a slight diffuse peritoneal reactivity higher to treated group. So, heparin showed as negative effect the development of anemia, significant decrease in platelet count and acting as a proinflammatory agent, however shown to reduce fibrin deposition and formation ..