Primeiro relato da mutação nt230(del4) no gene MDR1 em Pastores Alemães no sul do Brasil

The P-glycoprotein (P-gp) is a transmembrane protein encoded by the MDR1 gene that functions as a biological barrier by extruding toxins and xenobiotics out of cells. The MDR1 gene can carry a mutation called nt230(del4), which is a deletion of four base pairs resulting in the formation of a non-functional protein that may predispose to severe toxicosis, as observed in dogs with sensitivity to ivermectin. Several breeds have been described as carriers of the mutation, including German Shepherds (GS). However, the presence of the mutant allele in this breed has not been described in Brazil. This study aimed to determine the genotypic and allelic frequency of the nt230(del4) mutation in the MDR1 gene in GS from Southern Brazil. Blood samples were collected from 79 GS in the state of Rio Grande do Sul and genotype for the MDR1 gene was performed. Seventy-eight (98.7%) dogs were dominant homozygous genotype (wild) and one (1.3%) was heterozygous. This study showed that there is a low frequency (0.6%) of the mutant allele while the frequency of the wild allele is high (99.4%) in this specific population. This is the first report of the presence of the nt230(del4) mutation in the MDR1 gene in GS in Brazil. This information is important for breeders to prevent dissemination of the mutant allele in the national breeding population and international exchange of animals for breeding; for owners and veterinarians to be aware when dispensing and administering medications for GS dogs in Brazil.A Glicoproteína-P é uma proteína transmembrana codificada pelo gene MDR1 que atua como uma barreira fisiológica através da extrusão de toxinas e xenobióticos para fora das células. O gene MDR1 pode carregar uma mutação chamada nt230(del4) que é uma deleção de quatro pares de bases, resultando na formação de uma proteína não-funcional que pode predispor à toxicoses graves, como as observadas em cães sensíveis à ivermectina. Diversas raças de cães foram descritas como portadoras da mutação nt230(del4), incluindo Pastores Alemães (PA). Entretanto, a presença do alelo mutante nessa raça não foi descrita em cães no Brasil. O objetivo desse estudo foi determinar a frequência genotípica e alélica da mutação nt230(del4) em PA no sul do Brasil. Amostras de sangue foram coletadas de 79 PA no estado do Rio Grande do Sul e o genótipo dos cães para o gene MDR1 realizado. Setenta e oito (98.7%) cães foram homozigotos dominantes (selvagem) e um (1.3%) tinha genótipo heterozigoto. A frequência do alelo mutante foi baixa (0.6%), enquanto a frequência do alelo selvagem foi alta (99.4%) nesta população. Este é o primeiro relato da presença desta mutação nt230(del4) no gene MDR1 em PA no Brasil. Esta informação é importante para criadores a fim de prevenir a disseminação do alelo mutante na população de criadores da raça no Brasil e programas internacionais de troca de animais para criação, para tutores e veterinários estarem conscientes quando prescreverem e administrarem medicações para cães PA no Brasil

Resultados de la Nursing Outcomes Classification/NOC para pacientes con trastorno obsesivo-compulsivo

Objetivo: Analisar a aplicação de resultados e indicadores de enfermagem selecionados na Nursing Outcomes Classification (NOC) para avaliar pacientes com Transtorno Obsessivo-Compulsivo (TOC) em acompanhamento ambulatorial. Método: Pesquisa de resultados. Primeiro, realizou-se consenso entre enfermeiros especialistas em saúde mental (SM) e em processo de enfermagem para seleção de resultados e indicadores da NOC, seguido da elaboração das suas definições conceituais e operacionais. Depois, construiu-se um instrumento com estes, que foi testado em grupo piloto de seis pacientes atendidos em ambulatório de SM. O instrumento foi aplicado aos pacientes com TOC submetidos a Terapia Cognitivo-Comportamental em Grupo (TCCG). Estudo aprovado pelo Comitê de Ética em Pesquisa da instituição. Resultados: Foram selecionados quatro resultados e 17 indicadores NOC. Observou-se modificação significativa dos escores de nove indicadores após a TCCG. Conclusão: O estudo apontou viabilidade de avaliação dos sintomas de pacientes com TOC através dos resultados e indicadores da NOC em cenário ambulatorial.Objective: To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessivecompulsive disorder (OCD) in outpatient follow-up. Method: Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution. Results: Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT. Conclusion: The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.Objetivo: Evaluar la aplicación de resultados e indicadores de enfermería seleccionados en la Nursing Outcomes Classification (NOC) para examinar a los pacientes con Trastorno ObsesivoCompulsivo (TOC) en seguimiento ambulatorio. Método: Investigación de resultados. Primeramente, se realizó un acuerdo entre enfermeros expertos en salud mental (SM) y en proceso de enfermería para seleccionar los resultados e indicadores de la NOC, seguido de la elaboración de sus definiciones conceptuales y operativas. Después, se construyó un instrumento con las informaciones recolectadas, y lo aplicaron a un grupo piloto con seis pacientes, que recibían atención en el ambulatorio de SM. Se aplicó el instrumento a los pacientes con TOC, sometidos a Terapia Cognitivo-Conductual en Grupo (TCCG). Estudio aprobado por el Comité de Ética en Investigación de la institución. Resultados: Se seleccionaron cuatro resultados y 17 indicadores NOC. Se observó una modificación significativa de los puntajes de nueve indicadores después de la TCCG. Conclusión: El estudio apuntó la viabilidad de evaluación de los síntomas de pacientes con TOC por medio de los resultados e indicadores de la NOC en el ámbito ambulatori

Effects of detomidine constant rate infusion on blood glucose and lactate in sevoflurane anesthetized horses

Background: The drugs that promote sedation, analgesia, and anesthesia, as inhalatory agents, phenothiazines, benzodiazepines, alpha-2 adrenergic agonists, and opioids, can promote different kinds of side effects. The concept of a balanced anesthesia in equine was developed in order to minimize adverse effects inherent to anesthesia, creating a combination of lower doses of these drugs in comparison with the doses of each one used alone. Alpha-2-adrenoceptor agonists such as xylazine, detomidine, and others, are drugs used for standing sedation, analgesia, and reduction of volatile anesthetic requirement in the equine as well as an agent used to maintenance of arterial blood pressure during anesthesia. Alpha-2 agonists works stimulating receptors of autonomic neurons inducing reduction of heart rate, cardiac output and vascular resistance, hypertension, behavioral changes, and inhibition of insulin secretion. This reduction in insulin levels increases blood glucose concentration in horses due to its lower utilization in insulin-dependent tissues, as muscular and adipose tissues. Muscular tissue is capable to maintain a constant lactate production even in a well oxygenated environment in order to maintain its cellular activity, especially in cases when glucose is not available. To evaluate the effect on blood glucose and lactate, horses were submitted to one hour of detomidine constant rate infusion during sevofl urane inhalatory anesthesia with controlled ventilation, in order to assess blood concentration of glucose and lactate Materials, Methods & Results: Four adult horses were studied. Detomidine 20 µg.kg-1 was used as premedication followed by an association of ketamine and diazepam intravenously as anesthetic induction. After intubation, sevofl urane was vaporized at approximately 2.3 V%. Mechanical ventilation was established. After stabilization, an intravenous continuous rate infusion (CRI) of detomidine 5 µg.kg.h-1 was started. Venous blood samples were collected before premedication, prior to detomidine continuous infusion, 20, 40, and 60 min after beginning of infusion, in order to determination of glucose and lactate serum concentrations. After 60 min of detomidine infusion, the horses were allowed to recovery. There was statistical signifi cant hyperglycemia in the horses under CRI of detomidine. There was no signifi cant increase in blood lactate, despite of the hyperlactatemia in some animals. Discussion: Detomidine CRI of 5 µg.kg.h-1 does increase blood glucose levels over normal values but not to levels that could be toxic to tissues, mainly CNS. With low levels of serum insulin, body tissues, mainly muscular and adipose tissues, are unable to capture this available blood glucose and these cells depend on lactate metabolism. The lactate serum concentrations below normal range observed in studied horses suggest that all lactate produced by the tissues is being utilized in the energetic metabolism. In according to many authors, lactate is produced and utilized for mitochondrias as energetic source even in fully oxygenated tissues, which seems to be what happened in this experiment. The present study helps to understand energetic metabolism in horses under general inhaled anesthesia with detomidine CRI, a selective alpha-2-adrenoceptor agonist. In order to better evaluate energetic metabolism during inhaled anesthesia under detomidine infl uence, other studies are suggested, as prolonged anesthesia duration to evaluate a longer adrenergic stimulus induced by detomidine. Besides, other investigations with detomidine CRI in horses submitted to surgical procedures could provide different responses in energetic metabolism

COMPLICAÇÕES E MANEJO DO ACRETISMO PLACENTÁRIO: UMA REVISÃO INTEGRATIVA

Introduction: Placental accreta is a severe and complex obstetric condition that is becoming more common due to the increase in cesarean sections and other uterine interventions. This condition occurs when the placenta adheres abnormally to the uterine muscle, varying in severity as placenta accreta, increta, and percreta. It can cause serious complications, such as heavy bleeding and the need for a hysterectomy. Early diagnosis, made by ultrasound and magnetic resonance imaging, is crucial for proper management. The increased incidence is linked to risk factors such as previous cesarean sections, multiparity, advanced maternal age, and a history of uterine curettage. Methodology: Ten relevant scientific articles were selected, published in Portuguese, English and Spanish, found in databases such as PubMed, SciELO and Google Scholar, using terms such as "placental accreta", "diagnosis", "clinical management" and "complications". Original studies, systematic reviews, and case reports on the diagnosis, management, and complications of placental accreta were included, excluding studies with non-human populations, non-full-text articles, and publications prior to 2010. Results: The integrative review resulted in the selection of ten relevant scientific articles that address the management and complications of placental accreta. The main topics include diagnosis, clinical management and treatment, with emphasis on medical management and the multidisciplinary team. The most frequent complications identified were postpartum hemorrhage, need for hysterectomy, and damage to other organs. The introduction of multidisciplinary teams and new surgical techniques has been shown to be effective in reducing maternal morbidity. Conclusions: The creation of specialized teams has been shown to be effective in reducing maternal morbidity in severe cases. Major complications, such as postpartum hemorrhage and the need for hysterectomy, can be better managed with proper planning and timely interventions. Diagnostic tools, such as ultrasound and magnetic resonance imaging, are essential for early detection. The implementation of protocols and new surgical techniques has also shown promise. However, there is a need for further studies with larger samples to consolidate the evidence and improve management strategies for this complex condition.Introduction: Placental accreta is a severe and complex obstetric condition that is becoming more common due to the increase in cesarean sections and other uterine interventions. This condition occurs when the placenta adheres abnormally to the uterine muscle, varying in severity as placenta accreta, increta, and percreta. It can cause serious complications, such as heavy bleeding and the need for a hysterectomy. Early diagnosis, made by ultrasound and magnetic resonance imaging, is crucial for proper management. The increased incidence is linked to risk factors such as previous cesarean sections, multiparity, advanced maternal age, and a history of uterine curettage. Methodology: Ten relevant scientific articles were selected, published in Portuguese, English and Spanish, found in databases such as PubMed, SciELO and Google Scholar, using terms such as "placental accreta", "diagnosis", "clinical management" and "complications". Original studies, systematic reviews, and case reports on the diagnosis, management, and complications of placental accreta were included, excluding studies with non-human populations, non-full-text articles, and publications prior to 2010. Results: The integrative review resulted in the selection of ten relevant scientific articles that address the management and complications of placental accreta. The main topics include diagnosis, clinical management and treatment, with emphasis on medical management and the multidisciplinary team. The most frequent complications identified were postpartum hemorrhage, need for hysterectomy, and damage to other organs. The introduction of multidisciplinary teams and new surgical techniques has been shown to be effective in reducing maternal morbidity. Conclusions: The creation of specialized teams has been shown to be effective in reducing maternal morbidity in severe cases. Major complications, such as postpartum hemorrhage and the need for hysterectomy, can be better managed with proper planning and timely interventions. Diagnostic tools, such as ultrasound and magnetic resonance imaging, are essential for early detection. The implementation of protocols and new surgical techniques has also shown promise. However, there is a need for further studies with larger samples to consolidate the evidence and improve management strategies for this complex condition.Introdução: O acretismo placentário é uma condição obstétrica grave e complexa que está se tornando mais comum devido ao aumento das cesarianas e outras intervenções uterinas. Esta condição ocorre quando a placenta adere anormalmente ao músculo uterino, variando em gravidade como placenta acreta, increta e percreta. Ela pode causar complicações sérias, como hemorragias intensas e a necessidade de histerectomia. O diagnóstico precoce, feito por ultrassonografia e ressonância magnética, é crucial para um manejo adequado. O aumento da incidência está ligado a fatores de risco como cesarianas anteriores, multiparidade, idade materna avançada e histórico de curetagem uterina. Metodologia: Foram selecionados dez artigos científicos relevantes, publicados em português, inglês e espanhol, encontrados em bases de dados como PubMed, SciELO e Google Scholar, usando termos como "acretismo placentário", "diagnóstico", "manejo clínico" e "complicações". Incluíram-se estudos originais, revisões sistemáticas e relatos de casos sobre o diagnóstico, manejo e complicações do acretismo placentário, excluindo estudos com populações não humanas, artigos sem texto completo e publicações anteriores a 2010. Resultados: A revisão integrativa resultou na seleção de dez artigos científicos relevantes que abordam o manejo e as complicações do acretismo placentário. Os principais temas incluem diagnóstico, manejo clínico e tratamento, com ênfase na conduta médica e da equipe multiprofissional. As complicações mais frequentes identificadas foram hemorragia pós-parto, necessidade de histerectomia e lesões a outros órgãos. A introdução de equipes multidisciplinares e novas técnicas cirúrgicas mostrou-se eficaz na redução da morbidade materna. Conclusões: A criação de equipes especializadas mostrou-se eficaz na redução da morbidade materna em casos graves. As principais complicações, como hemorragia pós-parto e necessidade de histerectomia, podem ser melhor gerenciadas com planejamento adequado e intervenções oportunas. Ferramentas diagnósticas, como ultrassonografia e ressonância magnética, são essenciais para a detecção precoce. A implementação de protocolos e novas técnicas cirúrgicas também se mostrou promissora. No entanto, há necessidade de mais estudos com amostras maiores para consolidar as evidências e aprimorar as estratégias de manejo dessa condição complexa

Frequência genotípica e alélica da mutação nt230(del4) no gene mdr1 em cães da raça pastor alemão

A glicoproteína P é uma proteína transmembrana que funciona como uma bomba de efluxo para diversas substâncias no organismo. É codificada pelo gene MDR1 (Multi Drug Resistance) e pode apresentar uma mutação conhecida como nt230(del4). Esse polimorfismo é uma deleção de quatro pares de bases resultando na formação de uma proteína com menos de 10% da sua sequência original de aminoácidos, o que gera uma proteína afuncional. Várias raças de cães foram descritas como portadoras da mutação, principalmente, cães da raça Collie. Esta mutação foi encontrada também em cães da raça Pastor Alemão, entretanto há poucos estudos nesta raça. O presente estudo objetivou determinar a frequência genotípica e alélica da mutação nt230(del4) em cães da raça pastor alemão. Foram coletadas amostras sanguíneas de 80 cães pastores alemães residentes no Estado do Rio Grande do Sul. Os cães possuíam diferentes origens sendo provenientes não somente de outros estados do Brasil, mas também de outros países. Dos 80 cães, 78 (97,5%) apresentaram genótipo homozigoto dominante (selvagem), 1 (1,25%) apresentou genótipo heterozigoto e 1 (1,25%) genótipo homozigoto recessivo. O alelo mutante apresentou uma frequência baixa (1,88%) enquanto o selvagem apresentou uma frequência alta (98,1%). Dentro das cidades do Estado do Rio Grande do Sul onde foram coletados os animais (Porto Alegre, Canoas, Viamão, Gravataí, Novo Hamburgo, Torres e Dom Pedro de Alcântara), os cães da raça Pastor Alemão carregam o alelo da mutação nt230(del4) no gene MDR1The P-glycoprotein is a transmembrane protein which acts as an efflux pump for many substances in the body. It is encoded by the MDR1 (Muti Drug Resistance) gene and may have a mutation known as nt230 (del4). This polymorphism is a deletion of four base pairs, resulting in the formation of a protein with less than 10% of its original amino acid sequence, which results in a nonfunctional protein. Several breeds were described as carriers of the mutation, mainly Collie breed dogs. This mutation was also found in German shepherd dogs, but there are few studies in this breed. This study aimed to determine the genotypic and allelic frequency of mutation nt230 (del4) in German Shepherd dogs. Blood samples were collected from 80 German Shepherds dogs living in the state of Rio Grande do Sul. The dogs were originated from different states of Brazil but also from other countries. In the dogs studied, 78 (97.5%) were dominant homozygous genotype (wild); 1 (1.25%) had heterozygous genotype and 1 (1.25%) recessive homozygous genotype. The mutant allele had a low frequency (1.88%) while the wild showed high frequency (98.1%).Within the cities of Rio Grande do Sul State where the animals were collected (Porto Alegre, Canoas, Viamão, Gravataí, Novo Hamburgo, Torres and Dom Pedro de Alcantara), the German Shepherd dogs carry the allele mutation nt230(del4 ) on the MDR1gene