Description of Clinical and Surgical Aspects of Four Cases of Lip Commissure to Eyelid Transposition for Repair of Eyelid Coloboma in Cats

Background: Eyelid coloboma or eyelid agenesis is the most common congenital disease in cats. It can affect both the upper and the lower lids and is commonly bilateral. This congenital defect has been reported in several breeds, such as Persian and Domestic Short-Haired Cat. Generally, this defect results in inversion of the colobomatous eyelid, which can cause trichiasis and inflammatory keratitis and corneal ulceration. The only effective treatment is blepharoplasty. This paper describes the clinical and surgical aspects of four patients treated by lip commissure to eyelid transposition for the repair of eyelid coloboma using the technique described in 2010. Results of this procedure have never been reported in Brazil. Cases: Seven eyes of four cats presenting eyelid coloboma affecting up to two thirds of the eyelid were evaluated in this study. Two of the four cats were males and two were females; their average age was 3 years. All patients were admitted at the same institution, and the main issues were purulent discharge and impaired vision. Diagnosis was based on physical and ophthalmic examination. Non-ulcerative keratitis was present in all cases. Corneal ulcer was diagnosed in three patients by the fluorescein dye test. In two cats, a corneo-conjunctival dermoid was found at the temporal-dorsal region of one eye, and measured approximately 0.3 mm; and the other two exhibited microphthalmia in one eye. No abnormalities were seen in the anterior chamber, lens, and vitreous. One of the cats exhibited retinal detachment, and one exhibited testicular agenesis, both of the abnormalities diagnosed by ultrasound. Complete blood count and biochemical tests were performed in all patients before general anesthesia for the corrective procedure. Before surgery, eyes with ulcerative and non-ulcerative keratitis were treated with topical antibiotics and lacrimommimetics. In the 7 eyes, lip commissure to eyelid transposition technique was used for correction of the colobomatous defect. The procedure consisted of a mucocutaneous flap that simulates a natural eyelid. Corneo-conjunctival dermoids were also removed at the same time by superfcial keratectomy. In the postoperative period, all patients received oral non-steroidal antiinflammatory drug and an antibiotic, as well as cleansing of the surgical wound. All patients exhibited improvement of corneal abnormalities following one week of the procedure. However, three cats had suture dehiscence on the lip commissure, which healed by secondary intention after a week. Two weeks after surgery, superfcial necrosis was observed at the tip of the edge of the transplanted flap, in all cats. In order to promote healing, the necrotic edges were debrided at the time of sutures removal, 10 to 15 days after surgeries; at this time, both lip commissure and eyelid wound had already healed. Facial distortion was presente owing to skin overlapping on the site of the flap. All patients had their ability to blink restored, and there was absence of trichiasis on the flap. However, three cats had thichiasis caused by retraction of the pre-existing eyelid at the medial canthus. Discussion: Good functional and esthetic results were achieved, similarly to those previously described, which allows us to consider that this technique is appropriate for eyelid reconstruction in eyelid coloboma or agenesis cases. Nevertheless, this procedure can have some complications, such as suture dehiscence, facial deformity, superfcial necrosis of the edges of the flap, and trichiasis of the pre-existing eyelid of the medial canthus. To overcome these issues, authors suggest removal of the skin under the flap to decrease facial distortion, and removal of the whole pre-existing eyelid, in order to avoid trichiasis caused by retraction of this tissue. Keywords: blepharoplasty, congenital defect, eyelid, feline

Aplicação de um modelo de aprendizado de máquina em estudo de eficiência energética de edificações: foco para sistemas construtivos leves

A utilização de técnicas de aprendizado de máquina em estudos de desempenho termoenergético de edificações surge como uma alternativa aos métodos convencionais, que demandam uma maior complexidade de dados. Esta pesquisa tem por objetivo aplicar uma técnica de aprendizado de máquina em estudo de eficiência energética de uma edificação executada em sistema construtivo leve. Sendo assim, foi feita a implementação de um algoritmo referente a um modelo otimizado de árvore de classificação e regressão (CART) para aplicação em um conjunto de dados. Tal conjunto contempla 2048 simulações paramétricas de uma habitação em sistema construtivo leve para o clima da cidade de São Paulo, cujos indicadores de saída são a carga térmica anual de aquecimento e a carga térmica anual de refrigeração. A partir da divisão dos dados em conjuntos de treinamento e teste e da aplicação de técnicas de Grid Search e k-fold Cross Validation para otimização de hiperparâmetros, foram obtidos resultados médios de 1,11\% de erro para cargas de aquecimento e 1,52\% de erro para a predição de cargas de refrigeração. Posteriormente, foi feita uma análise de sensibilidade revelando a propriedade de transmitância térmica das paredes como parâmetro de maior influência na predição de carga de aquecimento e a condição de contato do solo com o piso como parâmetro de maior influência na predição de carga de refrigeração. Por fim, foram geradas as árvores de decisão para análise visual de estratégias que podem ser adotadas para a obtenção de melhores níveis de desempenho termoenergético. Obteve-se assim, um diagnóstico de eficiência energética mais simplificado na interpretação de seus resultados, favorecendo maior difusão da tecnologia em sistemas leves

Description of Clinical and Surgical Aspects of Four Cases of Lip Commissure to Eyelid Transposition for Repair of Eyelid Coloboma in Cats

Background: Eyelid coloboma or eyelid agenesis is the most common congenital disease in cats. It can affect both the upper and the lower lids and is commonly bilateral. This congenital defect has been reported in several breeds, such as Persian and Domestic Short-Haired Cat. Generally, this defect results in inversion of the colobomatous eyelid, which can cause trichiasis and inflammatory keratitis and corneal ulceration. The only effective treatment is blepharoplasty. This paper describes the clinical and surgical aspects of four patients treated by lip commissure to eyelid transposition for the repair of eyelid coloboma using the technique described in 2010. Results of this procedure have never been reported in Brazil. Cases: Seven eyes of four cats presenting eyelid coloboma affecting up to two thirds of the eyelid were evaluated in this study. Two of the four cats were males and two were females; their average age was 3 years. All patients were admitted at the same institution, and the main issues were purulent discharge and impaired vision. Diagnosis was based on physical and ophthalmic examination. Non-ulcerative keratitis was present in all cases. Corneal ulcer was diagnosed in three patients by the fluorescein dye test. In two cats, a corneo-conjunctival dermoid was found at the temporal-dorsal region of one eye, and measured approximately 0.3 mm; and the other two exhibited microphthalmia in one eye. No abnormalities were seen in the anterior chamber, lens, and vitreous. One of the cats exhibited retinal detachment, and one exhibited testicular agenesis, both of the abnormalities diagnosed by ultrasound. Complete blood count and biochemical tests were performed in all patients before general anesthesia for the corrective procedure. Before surgery, eyes with ulcerative and non-ulcerative keratitis were treated with topical antibiotics and lacrimommimetics. In the 7 eyes, lip commissure to eyelid transposition technique was used for correction of the colobomatous defect. The procedure consisted of a mucocutaneous flap that simulates a natural eyelid. Corneo-conjunctival dermoids were also removed at the same time by superfcial keratectomy. In the postoperative period, all patients received oral non-steroidal antiinflammatory drug and an antibiotic, as well as cleansing of the surgical wound. All patients exhibited improvement of corneal abnormalities following one week of the procedure. However, three cats had suture dehiscence on the lip commissure, which healed by secondary intention after a week. Two weeks after surgery, superfcial necrosis was observed at the tip of the edge of the transplanted flap, in all cats. In order to promote healing, the necrotic edges were debrided at the time of sutures removal, 10 to 15 days after surgeries; at this time, both lip commissure and eyelid wound had already healed. Facial distortion was presente owing to skin overlapping on the site of the flap. All patients had their ability to blink restored, and there was absence of trichiasis on the flap. However, three cats had thichiasis caused by retraction of the pre-existing eyelid at the medial canthus. Discussion: Good functional and esthetic results were achieved, similarly to those previously described, which allows us to consider that this technique is appropriate for eyelid reconstruction in eyelid coloboma or agenesis cases. Nevertheless, this procedure can have some complications, such as suture dehiscence, facial deformity, superfcial necrosis of the edges of the flap, and trichiasis of the pre-existing eyelid of the medial canthus. To overcome these issues, authors suggest removal of the skin under the flap to decrease facial distortion, and removal of the whole pre-existing eyelid, in order to avoid trichiasis caused by retraction of this tissue. Keywords: blepharoplasty, congenital defect, eyelid, feline

Production of the First Effective Hyperimmune Equine Serum Antivenom against Africanized Bees

Victims of massive bee attacks become extremely ill, presenting symptoms ranging from dizziness and headache to acute renal failure and multiple organ failure that can lead to death. Previous attempts to develop specific antivenom to treat these victims have been unsuccessful. We herein report a F(ab)'(2)-based antivenom raised in horse as a potential new treatment for victims of multiple bee stings. The final product contains high specific IgG titers and is effective in neutralizing toxic effects, such as hemolysis, cytotoxicity and myotoxicity. The assessment of neutralization was revised and hemolysis, the primary toxic effect of these stings, was fully neutralized in vivo for the first time.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Acute kidney injury and intra-abdominal hypertension in burn patients in intensive care

<p></p><p>ABSTRACT Objective: To evaluate the frequency of intra-abdominal hypertension in major burn patients and its association with the occurrence of acute kidney injury. Methods: This was a prospective cohort study of a population of burn patients hospitalized in a specialized intensive care unit. A convenience sample was taken of adult patients hospitalized in the period from 1 August 2015 to 31 October 2016. Clinical and burn data were collected, and serial intra-abdominal pressure measurements taken. The significance level used was 5%. Results: A total of 46 patients were analyzed. Of these, 38 patients developed intra-abdominal hypertension (82.6%). The median increase in intra-abdominal pressure was 15.0mmHg (interquartile range: 12.0 to 19.0). Thirty-two patients (69.9%) developed acute kidney injury. The median time to development of acute kidney injury was 3 days (interquartile range: 1 - 7). The individual analysis of risk factors for acute kidney injury indicated an association with intra-abdominal hypertension (p = 0.041), use of glycopeptides (p = 0.001), use of vasopressors (p = 0.001) and use of mechanical ventilation (p = 0.006). Acute kidney injury was demonstrated to have an association with increased 30-day mortality (log-rank, p = 0.009). Conclusion: Intra-abdominal hypertension occurred in most patients, predominantly in grades I and II. The identified risk factors for the occurrence of acute kidney injury were intra-abdominal hypertension and use of glycopeptides, vasopressors and mechanical ventilation. Acute kidney injury was associated with increased 30-day mortality.</p><p></p

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance.

ObjectivesTo analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic.Patients and methodsThis was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018.ResultsDuring the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (PConclusionsIn our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship

Hemolysis and neutralization of Africanized honeybee (AHB) venom.

<p><b>A</b>, Minimum concentration of AHB venom <i>in </i><i>vitro</i> able to cause 100% hemolysis was established in 312.5 µg/mL; <b>B</b>, Using this established venom concentration the least amount of antivenom needed to completely neutralize the hemolysis was 50-fold times higher than the venom protein content. Values represent average of three experiments.</p

Cytotoxicity of AHB venom and neutralization by antivenom.

<p>Cytotoxicity of HBV against CHO cells, highlighting the minimal amount able to cause 100% of cells death - 108.24 mg/mL (<b>A</b>); Neutralization of minimal cytotoxic dose by diluted antivenom - 1:58 (<b>B</b>). Values represent average of three experiments.</p

Inhibition of hyaluronidase <i>in</i><i>vitro</i> and myotoxic activity of AHB venom <i>in</i><i>vivo</i>.

<p><b>A</b>, The activity of hyaluronidase is shown for the whole venom as well for the dialyzed venom using the same protein content. The inhibition of this enzyme by antivenom was completely achieved. Values represent an average of three experiments. <b>B</b>, The myotoxic activity was measured by creatine kinase release and expressed the amount of enzyme that will catalyze 1 μmol of substrate per minute under specified conditions. The specific antivenom was able to completely neutralize this activity <i>in </i><i>vivo</i>. Values represent the average of three experiments. Statistical analysis – ANOVA. CK – Creatine kinase; AV – antivenom; AHBV – Africanized bee venom. </p