Aneurysm in the Distal Portion of the Extern Jugular Vein in a Horse

Background: Aneurysm is a vascular disease that causes the partial rupture of arteries and veins and subsequent blood leakage due to the weakening of the vessels elastic middle layer. Venous aneurysms in horses are rare, but the arterial aneurysms are commonly reported. The aim of this paper is to report a rare occurrence of jugular external aneurysm in a horse and propose the inclusion this disease as a differential diagnosis, both because it is rare in this specie and invariably fatal. The medical examination showed a firm well-defined mass, painless, nonpulsatile on palpation and with no changed in the local temperature.Case: The horse was referred to the Veterinarian Hospital of the Federal University of Pelotas (UFPel, RS-Brazil. It was a male, Crioulo breed, 10 years old, used as stallion. The owner reported a swelling in the pectoral region that occurred after a trauma episode that had gradually grown for two years. The patient was clinically stable, and would undergo surgery extirpation for aesthetic matters. Clinical examination showed the swelling was circumscribed and centralized and it presented about 20 centimeters in diameter. The ultrasound of the pectoral area showed an anechoic structure with hyperechoic spots inside limited by an hyperechoic layer similar to a fibrous capsule. Presumptive diagnostics were of: hematoma, subcutaneous abscess, neoplasia, and possible vascular involvement. The use of conventional ultrasound was not enough to set the diagnosis, and the patient was referred to surgical exploration, where the procedures of isolation and anastomosis were performed, however rupture occurred and the patient died. Necropsy revealed sacculation of the ventral region of the neck next to the entrance of the thorax, and the involvement of the external right jugular vein, being the adjacent muscle tissue not involved. Histopathological evaluation showed intense proliferation of sub-endothelial fibrous tissue which infiltrated the tunica media and adventitia and a mild inflammatory infiltrate of lymphocytes and histiocytes, which was diagnosed as an aneurysm of the right external jugular vein.Discussion: The reported patient had a venous aneurysm located superficially, which may have contributed to the absence of symptoms. The ultrasound is a diagnostic method available to most veterinarians nowadays, mainly in the countryside. However, when it is used in the diagnosis of an aneurysm it displays a dilatation with anechoic content, which is com­mon to several other skin diseases. A similar ultrasound image was observed in the case reported, but the diagnosis was difficult because the aneurysm presented intense proliferation of fibrous tissue infiltrated in the media and adventitia of the vascular wall, similar to a capsule of fibrous tissue, which lead to the presumptive diagnostics of hematoma, abscess and neoplasia, with possible vascular involvement. The options for the treatment of the aneurysms consider the location, size and extent of them and it determines the choice between clinical observation and surgery. In veterinary medicine it is difficult to keep the animals still and in the case of a horse, any movement can lead to the spontaneous rupture of the aneurism. Considering the risk of spontaneous rupture and hemorrhage, the surgical resolution, even if risky, emerges as the most suitable treatment. Venous aneurysms although rare, need to be included as a differential diagnosis in skin diseases along with increased volume, as hematomas, abscesses and tumors. The prognosis, however, is poor because of the surgical limitations and risks of imminent rupture in the clinical treatment.Keywords: venous aneurysm, differential diagnosis, equine

The Silences Framework: A Method for researching sensitive themes and marginalized health perspectives (English version)

Objective: To describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/HIV/AIDS coinfection . Method: The Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes 'sexual health' and 'ethnicity'. Following this study a conceptual a theory for research on sensitive issues and health care of marginalized populations was developed called 'Screaming Silences' which forms the foundation of The Silences Framework. Screaming Silences define research areas and experiences that are poorly studied, little understood or silenced. Results: The Silences Framework supports researchers in revealing "silences" in the subjects they study - as such results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of "sounds of silence", mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations. KEYWORDS: Inequalities in health. Methods. Nursing. Coinfection. Research. Tuberculosis. Acquired immunodeficiency syndrome

TELERREABILITAÇÃO E TELEMONITORAMENTO CARDIORRESPIRATÓRIO EM TEMPOS DE PANDEMIA DE COVID-19

Introduction: Covid-19 has represented a global challenge to health systems, expanding the increase of obits. Population control methods as the isolation and tracking of connected people has been applied all around the world. This disease appearing made very necessary the adoption and expansionism of Telehealth. Objective: Describe the COPD social isolated  patients telerehabilitation and cardiorespiratory telemonitoring effects. Method: Prospective, transversal search. Eight diagnosed COPD patients were evaluated. Ten digital meetings were realized. For evaluation, the Functional Independence Measure, SF-36, Airways 20, and Beck Depression Inventory II questionnaires were applied, in the beginning and end of the protocol. Results: There were positive results, considering that telemonitoring and telerehabilitation were an alternative for these patients to continue the treatment. The rehabilitation protocol sustained the individuals functionality, like the cases of anxious symptoms that after the program, fell from 25% to 12,5% of the patients.In 37,5% of the cases, the airways obstructive level was mild, and the number raised 50%. It was observed that their quality life score has increased.Conclusion: The telemonitoring and telerehabilitation proved to be very useful in the continuation of the CPOD therapy program, it has overcome functional  difficulties, airway obstruction, depression, and consequently, improves quality of life.Introducción: El COVID-19 ha representado un desafío global para los sistemas de salud, expandiéndose a un ritmo creciente de muertes. En todo el mundo se han utilizado métodos para controlar la propagación de la enfermedad, como el aislamiento social y la detección de los contactos de casos. Con la aparición del COVID-19 fue necesario ampliar las aplicaciones y la adopción de tecnologías telessaúde. Objetivo: Describir los efectos de la telerrehabilitación y telemonitorización cardiorrespiratoria en pacientes con EPOC en aislamiento social. Método: Investigación transversal, prospectiva. Evaluaron a ocho pacientes diagnosticados con COPD. Se realizaron 10 reuniones a través de plataformas digitales. Para la evaluación, se aplicaron los cuestionarios de Medida de Independencia Funcional, SF-36, Cuestionario de Airways 20 e Inventario de Depresión de Beck II, inicial y al final del protocolo. Resultados: Hubo resultados positivos, habiendo visto que la telemonitorización y la telerrehabilitación eran una alternativa para que estos pacientes mantuvieran el tratamiento. Así, el protocolo de rehabilitación mantuvo la funcionalidad de los individuos, en cuanto a la mejoría de los síntomas de ansiedad, 25% de los pacientes presentaron síntomas de depresión y después del programa de rehabilitación sólo 12,5% presentaron síntomas. El grado obstructivo de las áreas de vías 37,5% de los participantes presentaron un grado de afectación leve y después del programa 50%. Así, hubo un aumento en su puntaje de calidad de vida. Conclusión: Encontramos que la telemonitorización y la telerrehabilitación pueden ayudar en la continuidad del programa de rehabilitación.Introdução: A COVID-19 tem representado um desafio global aos sistemas de saúde, expandindo em velocidade crescente de óbitos. Métodos para controlar a propagação da doença como o isolamento social e o rastreio dos contactantes dos casos têm sido utilizados no mundo. Com o surgimento da COVID-19 foi necessário a expansão das aplicações e adoção de tecnologias de Telessaúde. Objetivo: Descrever os efeitos da telerreabilitação e do telemonitoramento cardiorrespiratório nos pacientes DPOC em isolamento social. Método: Pesquisa transversal, prospectiva. Foram avaliados 8 pacientes com diagnóstico de DPOC. Foram realizados 10 encontros através de plataforma digitais. Para avaliação foram aplicados os questionários de Medida de Independência Funcional, SF-36, Airways questionnaire 20 e Inventário de Depressão de Beck II, inicial e ao final do protocolo. Resultados: Houve resultados positivos, tendo visto que o telemonitoramento e a telerreabilitação foram uma alternativa para esses pacientes manterem o tratamento. E assim o protocolo de reabilitação manteve a funcionalidade dos indivíduos,  quanto à melhora de sintomas de ansiedade  25% dos pacientes tinham sintomas de depressão e após o programa de reabilitação somente 12,5% apresentou sintomas. O grau obstrutivo de vias áreas 37,5% dos participantes apresentaram grau de acometimento leve e após o programa 50%. De forma que houve aumento da pontuação da qualidade de vida dos mesmos. Conclusão: Verificamos que o telemonitoramento e telerreabilitação podem auxiliar na continuidade do programa de reabilitação fisioterapêutica dos pacientes com DPOC, superando as dificuldades de funcionalidade, obstrução de vias aéreas e depressão, melhorando assim a qualidade de vida

Desigualdades socioeconômicas e regionais na cobertura de exames citopatológicos do colo do útero

Objetivos: Identificar desigualdades socioeconômicas e regionais na cobertura de exames citopatológicos do colo do útero no Rio Grande do Sul.Métodos: Estudo ecológico utilizou dados dos sistemas de informação em saúde de 2011-2012 para estimar coberturas anuais de exames para todas as mulheres residentes e para as não beneficiárias de planos privados de saúde. Desigualdades na cobertura foram estimadas conforme o Índice de Vulnerabilidade Social Municipal, macrorregiões e regiões de saúde.Resultados: A prevalência de mulheres não beneficiarias de planos privados de saúde variou de 38,1% a 94,2% entre regiões de saúde. A cobertura estadual foi 17,3% para todas as residentes e 23,8% para as não beneficiárias de planos privados. As maiores coberturas ocorreram nos municípios em maior vulnerabilidade social e nas regiões com maior prevalência de planos privados.Conclusões: A prevalência de planos privados de saúde deve ser considerada em estudos da cobertura de serviços pelo Sistema Único de Saúde.Palavras-chave: Desigualdades em saúde. Prevenção de câncer de colo uterino. Cobertura de serviços públicos de saúde

Desafios para promoção da abordagem ecossistêmica à gestão de praias na América Latina e Caribe

The complexity of global changes and their effects on social-ecological systems motivate the development of more integrated and innovative management approaches to balance the society-nature relationship. With the challenge of meeting global demands and considering local impacts, Ecosystem-Based Management (EBM) emerges as an assessment and action strategy with the potential to qualify social-ecological interactions. In this sense, sandy beaches are an important and complex social-ecological system whose management has been historically characterized by a reductionist, immediatist, fragmented and technocratic approach - all challenges for EBM implementation. This article aims to discuss opportunities to incorporate EBM in beach management and the challenges to its implementation in Latin America and the Caribbean (LA&C). GBE can guide beach management processes towards achieving sustainability. Despite the challenges faced in LA&C, GBE implementation must be strengthened in the region to support beach sustainability through the promotion of transdisciplinarity and international cooperation.A complexidade das mudanças globais e seus efeitos nos sistemas socioecológicos motivam o desenvolvimento de abordagens de gestão mais integradas e inovadoras para equilibrar as relações sociedade-natureza. Com o desafio de suprir demandas globais e considerar impactos locais, a Gestão Baseada em Ecossistemas (GBE) aparece como uma estratégia de avaliação e ação com potencial de qualificar as interações socioecológicas. Nesse sentido, as praias arenosas surgem como um importante e complexo sistema socioecológico cuja gestão é historicamente realizada de forma reducionista, imediatista, fragmentada e tecnocrática, o que são desafios para a implementação da GBE. Dessa forma, esse artigo visou discutir as oportunidades de incorporar a GBE na gestão de praias e os desafios para sua implementação na América Latina e Caribe. Assim, observa-se que a GBE pode orientar a adequação dos processos da gestão de praias. Apesar dos desafios enfrentados na AL&C sua implementação é uma ferramenta a ser fortalecida na região por meio da transdisciplinaridade e cooperação internacional para promover a sustentabilidade das praias

Platelet-activating factor receptor (PAF-R)-dependent pathways control tumour growth and tumour response to chemotherapy

<p>Abstract</p> <p>Background</p> <p>Phagocytosis of apoptotic cells by macrophages induces a suppressor phenotype. Previous data from our group suggested that this occurs via Platelet-activating factor receptor (PAF-R)-mediated pathways. In the present study, we investigated the impact of apoptotic cell inoculation or induction by a chemotherapeutic agent (dacarbazine, DTIC) on tumour growth, microenvironmental parameters and survival, and the effect of treatment with a PAF-R antagonist (WEB2170). These studies were performed in murine tumours: Ehrlich Ascitis Tumour (EAT) and B16F10 melanoma.</p> <p>Methods</p> <p>Tumour growth was assessed by direct counting of EAT cells in the ascitis or by measuring the volume of the solid tumour. Parameters of the tumour microenvironment, such as the frequency of cells expressing cyclo-oxygenase-2 (COX-2), caspase-3 and galectin-3, and microvascular density, were determined by immunohistochemistry. Levels of vascular endothelium growth factor (VEGF) and prostaglandin E2 (PGE2) were determined by ELISA, and levels of nitric oxide (NO) by Griess reaction. PAF-R expression was analysed by immunohistochemistry and flow cytometry.</p> <p>Results</p> <p>Inoculation of apoptotic cells before EAT implantation stimulated tumour growth. This effect was reversed by <it>in vivo </it>pre-treatment with WEB2170. This treatment also reduced tumour growth and modified the microenvironment by reducing PGE2, VEGF and NO production. In B16F10 melanoma, WEB2170 alone or in association with DTIC significantly reduced tumour volume. Survival of the tumour-bearing mice was not affected by WEB2170 treatment but was significantly improved by the combination of DTIC with WEB2170. Tumour microenvironment elements were among the targets of the combination therapy since the relative frequency of COX-2 and galectin-3 positive cells and the microvascular density within the tumour mass were significantly reduced by treatment with WEB2170 or DTIC alone or in combination. Antibodies to PAF-R stained the cells from inside the tumour, but not the tumour cells grown <it>in vitro</it>. At the tissue level, a few cells (probably macrophages) stained positively with antibodies to PAF-R.</p> <p>Conclusions</p> <p>We suggest that PAF-R-dependent pathways are activated during experimental tumour growth, modifying the microenvironment and the phenotype of the tumour macrophages in such a way as to favour tumour growth. Combination therapy with a PAF-R antagonist and a chemotherapeutic drug may represent a new and promising strategy for the treatment of some tumours.</p

Estratégias de aquisição da casa própria: a trajetória de algumas famílias negras paulistanas nas décadas de 1920 a 1940

In Brazil, there is a cultural belief that property acquisition is the wisest attitude to ensure a safe and stable economy. For generations, the "dream of property ownership" has been cultivated as a horizon to be achieved. Confirming this tendency, since the 1920s, "casa propria" (home ownership) became a notion mobilized in the black press periodicals, circulating as a desirable aspiration and an orientation to the journals public. Between 1924 and 1937, two of the main newspapers of São Paulo black press, O Clarim da Alvorada and A Voz da Raça, carried out a campaign in favor of property ownership, spreading among paulista black families the importance of property acquisition. These campaigns are an important sign for the relevance of buying a property for black families at that time. In this paper, we seek to analyze it as an intergenerational social security strategy, through the presentation of three cases of black families that accomplished this goal between 1920s and 1940s. The black families testimonies reported here indicate precocity, specificities and strategies that represent new challenges for the formulation of property ownership problem, from a racial point of view.No Brasil, há uma crença cultural de que a atitude mais sábia para garantir uma economia doméstica segura e estável é a aquisição da casa própria. Por gerações, o “sonho da casa própria” tem sido cultivado como um horizonte a se atingir. Confirmando essa tendência, desde a década de 1920, a “casa própria” torna-se uma noção mobilizada nos periódicos da imprensa negra, circulando em diversos artigos como uma aspiração desejável e uma orientação ao público dos jornais. Entre 1924 e 1937, dois dos principais jornais da imprensa negra paulista, O Clarim da Alvorada e A Voz da Raça, realizaram uma campanha em favor da casa própria, difundindo entre as famílias negras paulistanas a ideia da importância da aquisição imobiliária. Essas campanhas constituem um indício importante da relevância da aquisição residencial para as famílias negras do período. Neste trabalho, procuramos analisar essa importância como estratégia de seguridade social intergeracional, por meio da apresentação de três casos de famílias negras que realizaram esse objetivo entre as décadas de 1920 e 1940. Os depoimentos das famílias negras aqui reportados indicamprecocidade, especificidades e estratégias que representam novos desafios para a reflexão sobre a formulação do problema da casa própria, a partir do ponto de vista racial