A placa de hidrocoloide para prevenção de lesão por pressão na prona é efetiva? Análise de uma coorte retrospectiva

The aim of this study was to evaluate the presence of pressure injuries and their association with the use of hydrocolloid plaque in patients admitted to the ICU-COVID, submitted to pronation. This is a retrospective cohort performed with patients admitted to two COVID-ICUs who pronated during hospitalization. Patients who did not have data regarding pronation or injury were excluded. Eighty patients were included, who performed an average of three pronations with an average stay of 19:48 hours. The hydrocolloid patch was used in 47.5% of the participants, with 43.8% applied in an extended area. Regarding the development of pressure injuries, 42.5% developed from one to six wounds on the prone, stage I or II (35.0%). A significant difference was observed between those who were female, had altered hemoglobin, presence of edema or fever in pronation (p<0.05). There was no significant difference between those who used or did not use a hydrocolloid patch. In logistic regression analyses, it was observed that, with each new pronation, patients have 1.3 times more chance of developing injury (p<0.05). The effectiveness of using a hydrocolloid patch in preventing pressure injuries in the prone position is still controversial. It is suggested that randomized controlled trials be carried out to verify its efficacy and cost-effectiveness.O objetivo deste estudo foi avaliar a presença de lesões por pressão e sua associação com o uso de placa hidrocoloide em pacientes internados em UTI-COVID, submetidos à pronação. Trata-se de uma coorte retrospectiva realizada com pacientes internados em duas UTI-COVID que fizeram pronação durante a internação. Excluiu-se pacientes que não tinham dados referentes à pronação ou lesão. Foram incluídos 80 pacientes, que realizaram em média três pronações com permanência média de 19:48 horas. A placa de hidrocoloide foi utilizada em 47,5% dos participantes, sendo 43,8% aplicada em área estendida. Em relação ao desenvolvimento de lesão por pressão, 42,5% desenvolveram de uma a seis feridas na prona, de estadiamento I ou II (35,0%). Observou-se diferença significante entre quem era do sexo feminino, tinha hemoglobina alterada, presença de edema ou febre na pronação (p<0,05). Não houve diferença significativa entre quem usou ou não placa de hidrocoloide. Nas análises de regressão logística, observou-se que, a cada nova pronação, os pacientes têm 1,3 vezes mais chance de desenvolver lesão (p<0,05). A efetividade do uso de placa de hidrocoloide na prevenção de lesão por pressão na posição prona ainda é controversa. Sugere-se a realização de ensaios randomizados controlados para verificar sua eficácia e custo-efetividade

A placa de hidrocoloide para prevenção de lesão por pressão na prona é efetiva? Análise de uma coorte retrospectiva

The aim of this study was to evaluate the presence of pressure injuries and their association with the use of hydrocolloid plaque in patients admitted to the ICU-COVID, submitted to pronation. This is a retrospective cohort performed with patients admitted to two COVID-ICUs who pronated during hospitalization. Patients who did not have data regarding pronation or injury were excluded. Eighty patients were included, who performed an average of three pronations with an average stay of 19:48 hours. The hydrocolloid patch was used in 47.5% of the participants, with 43.8% applied in an extended area. Regarding the development of pressure injuries, 42.5% developed from one to six wounds on the prone, stage I or II (35.0%). A significant difference was observed between those who were female, had altered hemoglobin, presence of edema or fever in pronation (p<0.05). There was no significant difference between those who used or did not use a hydrocolloid patch. In logistic regression analyses, it was observed that, with each new pronation, patients have 1.3 times more chance of developing injury (p<0.05). The effectiveness of using a hydrocolloid patch in preventing pressure injuries in the prone position is still controversial. It is suggested that randomized controlled trials be carried out to verify its efficacy and cost-effectiveness.O objetivo deste estudo foi avaliar a presença de lesões por pressão e sua associação com o uso de placa hidrocoloide em pacientes internados em UTI-COVID, submetidos à pronação. Trata-se de uma coorte retrospectiva realizada com pacientes internados em duas UTI-COVID que fizeram pronação durante a internação. Excluiu-se pacientes que não tinham dados referentes à pronação ou lesão. Foram incluídos 80 pacientes, que realizaram em média três pronações com permanência média de 19:48 horas. A placa de hidrocoloide foi utilizada em 47,5% dos participantes, sendo 43,8% aplicada em área estendida. Em relação ao desenvolvimento de lesão por pressão, 42,5% desenvolveram de uma a seis feridas na prona, de estadiamento I ou II (35,0%). Observou-se diferença significante entre quem era do sexo feminino, tinha hemoglobina alterada, presença de edema ou febre na pronação (p<0,05). Não houve diferença significativa entre quem usou ou não placa de hidrocoloide. Nas análises de regressão logística, observou-se que, a cada nova pronação, os pacientes têm 1,3 vezes mais chance de desenvolver lesão (p<0,05). A efetividade do uso de placa de hidrocoloide na prevenção de lesão por pressão na posição prona ainda é controversa. Sugere-se a realização de ensaios randomizados controlados para verificar sua eficácia e custo-efetividade

Disfunção metabólica e Síndrome dos Ovários Policísticos: uma abordagem integrada para o tratamento da infertilidade

Introdução A Síndrome dos Ovários Policísticos (SOP) é uma das endocrinopatias mais comuns em mulheres em idade reprodutiva, afetando aproximadamente 6-10% dessa população. Caracteriza-se por anormalidades menstruais, hiperandrogenismo e ovários policísticos e está associada a uma série de complicações metabólicas e infertilidade. Objetivo Este estudo destaca a importância da conscientização sobre a relação entre SOP, disfunções metabólicas e infertilidade, bem como da implementação de estratégias de manejo eficazes para melhorar os resultados reprodutivos e a qualidade de vida dessas pacientes. Métodos Realizou-se uma revisão sistemática da literatura utilizando bases de dados eletrônicas como PubMed, Scielo e Lilacs, cuja busca utilizou os descritores “SOP”, “sobrepeso”, “infertilidade” e “dislipidemia”. Os estudos foram selecionados com base em critérios de inclusão e exclusão pré-definidos. Resultados mulheres com SOP têm maior probabilidade de apresentar disfunção endócrina, incluindo resistência à insulina e hiperinsulinemia, que por sua vez estão associadas a um maior risco de desenvolvimento de sobrepeso, obesidade e diabetes mellitus tipo 2. A SOP está associada também a perfis lipídicos alterados, como níveis elevados de triglicerídeos e baixos níveis de colesterol HDL, aumentando o risco de dislipidemia e doenças cardiovasculares. Em relação à infertilidade, a síndrome é uma das principais causas de anovulação crônica, levando à dificuldade de concepção. Ademais, mulheres com SOP e sobrepeso ou obesidade apresentam sintomas clínicos, metabólicos e reprodutivos mais pronunciados. Conclusão O manejo clínico desta condição deve incluir estratégias para prevenir e controlar complicações, como modificações no estilo de vida e tratamento da resistência à insulina. A detecção precoce e o manejo adequado da infertilidade relacionada à SOP podem melhorar significativamente as chances de concepção e a qualidade de vida das pacientes afetadas

MIOCARDIOPATIA NÃO COMPACTA: TRÍADE POR INSUFICIÊNCIA CARDÍACA CONGÊNITA

Introduction: Non-compacted cardiomyopathy (NCM) is a disease that occurs in families, with a high risk of sudden death due to its involvement in the myocardial chamber, and is also one of the main pathologies with the development of heart failure. It is considered unclassified cardiomyopathy by the Health Organization (WHO). MNC is the result of a genetic alteration, which affects the process of myocardial compaction, with the presence of trabeculations and deep recesses that are responsible for communication with the ventricular cavity. Objectives: Refers to the study of non-compacted cardiomyopathy, focusing on diagnosis, treatment and classifications relating to the heart failure triad. Methodology: This is descriptive research of the narrative literature review type, which sought to highlight aspects of cardiomyopathies, with the main focus on non-compacted cardiomyopathy and the presentation of the triad due to congenital heart failure, as well as clinical manifestations and diagnosis. The research was carried out through online access to the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Latin American and Caribbean Literature in Health Sciences (LILACS) databases, in the month of June 2023. Results and Discussions: The prevalence of cardiomyopathy in children is higher than in adults, with up to 50% of cases occurring in families. Imaging exams are still the best way to identify the pathology, with the prescription of evaluating the myocardium and its cardiac chambers and being able to identify the difference from other heart diseases. Conclusion: Therefore, the presence of heart failure is a consequence of non-compaction cardiomyopathy. The therapeutic measure is the use of implantable cardiac defibrillators and in severe cases the patient undergoes heart transplantation, with medication being used depending on the clinical case. Furthermore, the diagnosis presents a great evolution through technological advances and improved resolution of cardiac images.  Introdução: A Cardiomiopatia não compactada (MNC) é uma doença de ocorrência familiar, tendo um alto risco a morte súbita devido seus acometimentos na câmara do miocárdio, sendo também uma das principais patologias com desenvolvimento de insuficiências cardíacas. É considerado como miocardiopatia não classificada pela Organização da Saúde (OMS). A MNC é resultante de uma alteração genética, que acomete no processo de compactação miocárdica, tendo a presença de trabeculações e recessos profundos que são responsáveis pela comunicação com a cavidade ventricular. Objetivos: Refere-se no estudo da Cardiomiopatia não compactada, tendo como foco o diagnóstico, tratamento e suas classificações referentes a tríade por insuficiência cardíaca. Metodologia: Trata-se de uma pesquisa descritiva do tipo revisão narrativa da literatura, que buscou evidenciar aspectos das cardiomiopatias, tendo o maior foco em cardiomiopatia não compactada e a apresentação da tríade por insuficiência cardíaca congênita bem como as manifestações clínicas e o diagnóstico. A pesquisa foi realizada através do acesso online nas bases de dados National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), no mês de junho de 2023. Resultados e Discussões: A prevalência da miocardiopatia, em crianças, encontra-se maior do que em adultos apresentando um percentual de até 50% dos casos por ocorrência famíliar. Os exames de imagem ainda são a melhor forma para a identificação da patologia, tendo a prescrição da avaliação do miocárdio e suas câmaras cardíacas podendo identificar a diferença das outras cardiopatias. Conclusão: Por conseguinte, a presença da insuficiência cardíaca é uma consequência da cardiomiopatia não compactada. Tendo como medida terapêutica a utilização de desfibriladores cardíacos implantáveis e em casos graves o paciente é submetido ao transplante cardíaco, podendo haver usos de medicações dependendo do caso clínico. Outrossim, o diagnóstico apresenta uma grande evolução mediante aos avanços tecnológicos e a melhora da resolução das imagens cardíacas

Perineal Hernia in Dogs: Which Technique Should We Use?

Background: Perineal hernia may be unilateral or bilateral and results from weakening and separation of the pelvic diaphragm muscles, favoring the abdominal viscera herniation into the perineal subcutaneous. The factors described as possible etiology of this affection are prostate hyperplasia, senile muscular atrophy, myopathy and hormonal imbalances. Several herniorrhaphy techniques are available in literature presenting different rates of success leaving the question whether there is any technique that is predominantly better than others are. This case report aims to describe five cases of perineal hernia treated with four different techniques performed by four experienced surgeons.Cases: Case 1. Semitendinous muscle transposition: A 8-year-old intact male Shitzu (6 kg) was referred for the evaluation of a swelling in the right perineal region. The mass was soft and regressed into de pelvic cavity during palpation. Abdominal ultrasound and radiography were taken, which reveled perineal hernia and a mild prostate enlargement. The patient was prepared for hernia repair with semitendinous muscle transposition and orchiectomy. Case 2. Internal obturator muscle transposition: A 9-year-old intact male mixed breed dog (18kg) presenting a two-week long unilateral (right-side) perineral hernia. Ultrasound exam revealed a cystic prostate and adipose tissue as the hernia content. After clinical and image examination the patient was submitted to surgical repair using the internal obturator muscle transposition technique and orchiectomy. Case 3. Internal obturator muscle transposition associated to correction of rectal sacculation: A 12-year-old intact male mixed breed presenting swelling on the right side of the perianal region. The owner reported a 4-day long aquesia, emesis and increased volume in perineum for 6 months. During the rectal palpation, resected fecal content was present and rectal sacculation was suspected. Enema, simple abdominal radiography, contrast radiography and ultrasonography were performed. The exams showed perineal hernia with bowel content and presence of rectal sacculation. The patient was submitted to surgery in order to correct the perineal hernia and rectal sacculation, and to performe orchiectomy. Case 4. Polypropylene mesh: A 13-year-old intact male dachshund dog (8.6 kg) was referred to clinical examination due to a 1-year-history complaint of a mass in the right perineal area. The owner also reported rectal prolapse and stranguria noted two days prior the consultation. Ultrasound and radiography showed bladder, prostate and bowel contained in hernia sac. The patient underwent to hernia repair with polypropylene mesh and castration. Case 5. Bovine pericardium preserved in 4% formaldehyde: A 7-year-old intact male mixed breed dog (14 kg) was presented to clinical evaluation with swelling lateral to the anus and dyschezia. Abdominal radiography and ultrasound revealed images suggestive of perineal hernia with urinary bladder, prostate and bowl content. The patient was referred to surgery.Discussion: Perineal herniations are commonly related to weakness of pelvic diaphragm muscles. However, the etiology involved in this process is undetermined. Success rate of perineal hernia repair techniques vary in literature. It can be speculated that local factors may influence these results, such as the surgeon ability to perform the technique or to recognize components that adversely affects the surgery. The results were considered satisfactory in all cases, which may answer the question: the better technique is the one we perform better

Piotórax crônico em cão por vagem de Acácia Imperial (Cassia fistula)

Background: Pyothorax is characterized by the accumulation of septic purulent fluid within the pleural space. Most of the times, it is the true identified infection way in only 2 to 22% of dog cases. Reports show that the most common cause is the migration of grass edges and plant materials, mainly in regions of California, USA. The current study reports an unusual case of a Cassia fistula pod (Brazilian Acácia Imperial), of around 10x3 cm long, causing chronic Pyothorax in a Border Collie female dog.Case: It was admitted in a Teaching Veterinary Hospital a 2-year-old female Border Collie, weighing 16.5 kg. The complaint was producing of severe cough, dyspnoea, hyporexia and loss of weight in the past three months. The animal could have been horse-kicked, as it is used to herding. In the physical examination, it was detected bilateral thick lung crepitations, more evident in the ventral skull area, dyspnoea, tachypnea, fever, splenomegaly and low body condition score (3/9). The laboratory tests revealed nonregenerative anemia and leukemoid reaction. The chest x-ray showed intense pulmonary opacification and free fluids in the pleural space along with a heterogenic cylindrical image of the mixed radiopacity. This image was then confirmed as the intrathoracic foreing body by the use of a computerized tomography. In this exam it was also possible to observe the damage of part of the middle and inferior right lung lobe. The cytology of the pleural effusion found mixed inflammation and coccoid bacteria, and the microbiological culture Streptococcus sp., and Escherichia coli. The dog underwent thoracotomy in order to remove the foreign body, which was later identified as being a Cassia fistula pod (Brazilian Acácia Imperial), of around 10x3 cm long. Due to the intense lung damage, a right pneumonectomy was required. After 30 days the animal was fully recovered.Discussion: The applied surgical procedure ended up being the most correct, due to the shape and place of the foreign body, and also due to the massive damage of the lobes on the right lung. In dogs, right pneumonectomy may cause respiratory acidosis and exercise intolerance, besides it can also show signs of hyperinflation in some pulmonary spots. However, such abnormalities were not perceived by the patient. There are a few reports concerning the right pneumonectomy applicability on veterinary routine, nevertheless, it is a perfect practicable intervention from the clinic-surgical perspective, according to this case’s reports. Initially, the possibility of a foreign body was not expected, once the history of a plausible trauma, caused by horse-kick, associated to the presence of thoracic effusion, influenced only to the Pyothorax’s etiology. But the continuity of the clinic condition and the cylindrical image in subsequent x-rays favored the suspect of an foreign body, which could be confirmed in the computerized tomography. However, the way the pod got into the animal’s thorax, adhering to the lung parenchyma, remained undetermined. Besides, there were not found clinic descriptions relating the Cassia fistula pod (Brazilian Acácia Imperial) as an etiological agent of intra-thoracic foreign body in dogs, making this report an unusual clinic case. The computerized tomography was primordial to the definite diagnostic and for choosing the type of surgical procedure to be applied. The right pneumonectomy associated to the removal of the foreign body promoted the success of the treatment without further post-operatory complications

Condrossarcoma mixoide em joelho de cão com ruptura do ligamento cruzado cranial - Relato de caso

RESUMO. O objetivo do presente relato é descrever um caso de condrossarcoma mixoide em um cão. Foi atendida uma cadela com nove anos de idade da raça Chow-Chow com queixa de claudicação do membro pélvico esquerdo. O paciente foi diagnosticado e encaminhado para tratamento cirúrgico de ruptura do ligamento cruzado cranial esquerdo. Durante a artrotomia para avaliação dos meniscos, observou-se superfície periarticular irregular e rugosa sem notório aumento de volume na região óssea distal do fêmur. Optou-se pela coleta de amostras para análise histopatológica, que revelou a presença do condrossarcoma mixoide. Após 15 dias foi realizada a amputação do membro pélvico esquerdo. Sete meses seguintes da cirurgia, o animal apresentou dificuldade respiratória e hiporexia. Foi realizada radiografia torácica, identificando sinais de metástase pulmonar. Introduziu-se uma sonda esofágica para fazer a alimentação enteral do paciente. Dias após, o animal apresentou piora do quadro clínico e a proprietária optou por não fazer tratamento quimioterápico e sim eutanásia. Apesar de o tratamento cirúrgico ter permitido ao paciente uma boa taxa de sobrevida, não foi suficiente para evitar o desenvolvimento de metástase, o que nos faz considerar que tratamentos adjuvantes como a quimioterapia podem ser necessários. Além disso, ressalta-se a importância de se observar o aspecto macroscópico dos tecidos durante cirurgias ósseas e articulares

Benznidazole alters the pattern of Cyclophosphamide-induced reactivation in experimental Trypanosoma cruzi-dependent lineage infection.

The factors involved in the reactivation of chronic Chagas disease infection are not clear enough and may be related to host immune unbalance and/or parasite genetic diversity. To evaluate the role of the Trypanosoma cruzi genetic background in the Chagas disease reactivation, we inoculated Cyclophosphamide-immunos upressed (CyI) Swiss mice with clonal stocks from T. cruzi I (Cuica cl1, P209 cl1, Gamba cl1, SP104 cl1), T. cruzi II (IVV cl4, MVB cl8) and T. cruzi (Bug2148 cl1, MN cl2) lineages. We used the parasitemia as the parameter for Chagas disease reactivation and observed that CyI animals infected with T. cruzi stocks showed no reactivation and those infected with T. cruzi II stocks showed only 5% of reactivation. In contrast, immunosuppressed mice infected with stocks from T. cruzi I lineage showed 77.5 and 51.25% reactivation of the infection when Cyclophosphamide treatment was performed 60 and 180 days after inoculation, respectively. Next, we evaluated the efficacy of the Benznidazole (Bz) pre-treatment in reducing or preventing the recurrence of the infection in these CyI animals. In general, the percentage of the parasite recurrence was not altered among the CyI mice that received the Bz pretreatment during the acute phase of the infection. Interestingly, when pre-Bz treatment was performed during the chronic phase, we observed two different patterns of response: (i) an increased protection among the animals inoculated with the SP104 cl1 (genotype 19) and Cuica cl1 (genotype 20) stocks; (ii) an increased percentage of parasitemia reactivation among mice inoculated with Gamba cl1 (genotype 19) and P209 cl1 (genotype 20) T. cruzi stocks. Our results corroborate our hypothesis by showing that the T. cruzi genetic background in combination with specific Bz treatment has an important role in the Chagas disease reactivation in immunosuppressed animals

Benznidazole alters the pattern of Cyclophosphamide-induced reactivation in experimental Trypanosoma cruzi-dependent lineage infection.

The factors involved in the reactivation of chronic Chagas disease infection are not clear enough and may be related to host immune unbalance and/or parasite genetic diversity. To evaluate the role of the Trypanosoma cruzi genetic background in the Chagas disease reactivation, we inoculated Cyclophosphamide-immunos upressed (CyI) Swiss mice with clonal stocks from T. cruzi I (Cuica cl1, P209 cl1, Gamba cl1, SP104 cl1), T. cruzi II (IVV cl4, MVB cl8) and T. cruzi (Bug2148 cl1, MN cl2) lineages. We used the parasitemia as the parameter for Chagas disease reactivation and observed that CyI animals infected with T. cruzi stocks showed no reactivation and those infected with T. cruzi II stocks showed only 5% of reactivation. In contrast, immunosuppressed mice infected with stocks from T. cruzi I lineage showed 77.5 and 51.25% reactivation of the infection when Cyclophosphamide treatment was performed 60 and 180 days after inoculation, respectively. Next, we evaluated the efficacy of the Benznidazole (Bz) pre-treatment in reducing or preventing the recurrence of the infection in these CyI animals. In general, the percentage of the parasite recurrence was not altered among the CyI mice that received the Bz pretreatment during the acute phase of the infection. Interestingly, when pre-Bz treatment was performed during the chronic phase, we observed two different patterns of response: (i) an increased protection among the animals inoculated with the SP104 cl1 (genotype 19) and Cuica cl1 (genotype 20) stocks; (ii) an increased percentage of parasitemia reactivation among mice inoculated with Gamba cl1 (genotype 19) and P209 cl1 (genotype 20) T. cruzi stocks. Our results corroborate our hypothesis by showing that the T. cruzi genetic background in combination with specific Bz treatment has an important role in the Chagas disease reactivation in immunosuppressed animals

Extensão universitária em ortopedia veterinária

The aim of this project is to collaborate in the development and theoretical-practical training of students and professionals, besides that to promote integration and implementation of acts with the population, through internships, promoting contact between professionals, students and owners. In this aspect, production of didactic materials, programs to prevent diseases and data gathering for presentations and publications were performed. In this study, orthopedic conditions of companion animals were characterized in order to inform general public, collect information for learning and for preventive veterinary medicine. With this purpose, a retrospective study of musculoskeletal system affections at the Veterinary Hospital "Governador Laudo Natel", Faculty of Agricultural and Veterinary Sciences, campus Jaboticabal, from May 2014 to June 2015 was conducted. During this period, 585 patient were selected. From those, 557 were dogs (95,21%) and 28 (4,79%) were cats. It was observed in both cases a higher prevalence of 0-4-year-old (45,4% and 92,8%, respectively) patients. It was found that the most prevalent orthopedic cases included fractures (33,69% in dogs and 92,86% in cats) and cranial cruciate ligament rupture (16,84% in dogs). Thus, the achievement of the extension project enabled the integration of several people, allowing further information and knowledge about veterinary orthopedics.O objetivo deste projeto é colaborar no desenvolvimento e capacitação teórico-prático de alunos e profissionais, além de promover uma integração e implementação de medidas junto à população, por meio de estágios, favorecendo, assim, o contato entre profissionais, alunos e proprietários. Neste aspecto, ocorreu a realização de programas de prevenção das doenças e coleta de dados para apresentação de trabalhos e publicações. Na presente apresentação buscou-se caracterizar as afecções ortopédicas em animais de companhia, visando obter informações que sirvam de instrumento para o aprendizado e medicina veterinária preventiva. Para isto, realizouse o estudo retrospectivo dos casos envolvendo alterações no sistema osteomuscular atendidos no Hospital Veterinário “Governador Laudo Natel”, da Faculdade de Ciências Agrárias e Veterinárias, Campus de Jaboticabal, ocorridos no período de maio de 2014 a junho de 2015. Neste intervalo foram selecionados 585 animais, sendo 557 cães (95,21%) e 28 gatos (4,79%), em ambos observouse uma prevalência maior de animais entre 0-4 anos (45,4% e 92,8%, respectivamente). Constatou-se que os casos ortopédicos de maior prevalência incluíam as fraturas (33,69% em caninos e 92,86% em felinos) e a ruptura do ligamento cruzado cranial do joelho (16,84% em caninos). Desta forma, a realização do Projeto de Extensão possibilitou a integração de diversas pessoas, permitindo a propagação de informações e conhecimento a respeito da ortopedia veterinária