Regolamentazione ed efficienza alias proporzionalità ed (in)efficacia. Una riflessione critica in tema di politiche di accantonamento e modelli di business delle banche dell’area euro

L'esposizione al rischio di credito delle banche di minori dimensioni è analizzata in una prospettiva critica. Lo studio mette in luce che il credito cooperativo esibisce una specifica capacità valutativa riconducibile alla prossimità territoriale

Complete Avulsion of the Hoof Capsule and Subsequent Testicular Degeneration in a Criollo Stallion

Background: Complete avulsion of the hoof in horses, also known as exungulation, is not a commonly reported injury and usually leads to euthanasia due to the great amount of tissue loss, intense pain, secondary complications, expensive and lengthy treatment. It can involve deep structures and cause different complications leading to chronic lameness. In stallions affected by such injury, the reproductive tract and performance may also be affected. The aim of this study was to report a case of complete avulsion of the right front hoof in a Criollo stallion and subsequent bilateral testicular degeneration.Case: A 10-year-old Criollo stallion was referred to the Veterinary Clinical Hospital of the Federal University of Pelotas (HCV- UFPel) with a complete avulsion of the left front hoof. At admission, the stallion had clinical parameters compatible with intense pain and blood loss. Evaluation of the wound demonstrated that the distal end of the third phalanx (P3) was exposed but no fracture was detected on radiological evaluation. No other structure was apparently affected. Initially, anti-inflammatory (phenylbutazone) and opioid (morphine) was given for pain control and supportive fluid therapy was started to restore hydration. Antibiotic (Sulfamethoxazole with trimethoprim) were administered for 10 days. Continued therapy with phenylbutazone, pentoxifylline, omeprazole and supplementation with methionine, biotin and zinc was also given. Local treatment was carried out by cleaning the wound, applying an antimicrobial ointment and dressing it with a bandage. Wound management was adapted according to the evolution and healing process. The stallion was kept in stall rest during its hospitalization time. In the second month after the injury, accumulation of liquid in the scrotum was observed. Clinical and ultrasound evaluation lead to a presumptive diagnosis of testicular degeneration. The stallion was discharged after three months when the wound was almost healed and the hoof had started to grow. Six month later, a follow up by the referring vet showed that the hoof was almost completely grown and the x-ray assessment demonstrated a cranial rotation and resorption of the distal end of the third phalanx.Discussion: The stallion of this report had a complete avulsion of the hoof capsule caused by trauma. Conservative treatment was established including wound cleaning and dressing to avoid contamination, control of pain and inflammation, antimicrobial care and supplementation to support hoof growth. Time period for wound healing and hoof growth was in agreement with other cases described previously. Bone sequestrum of the distal end of the third phalanx, and detachment of a fragment were observed in this case, followed by bone resorption. The stallion was closely monitored to prevent laminitis in the contralateral limb and no alterations were detected during the treatment period. Testicular degeneration was observed, probably caused as a consequence of hoof avulsion and due to a long period of stall rest. Degenerative alterations in testicles interfere with thermoregulation and spermatogenesis, affecting semen quality and reproductive performance. Rotation of the third phalanx was also observed six months later caused by the hoof loss. In conclusion, the patient of this report had a complete regrowth of the hoof capsule although a long intensive treatment was necessary to achieve this result. As a consequence, testicles degeneration may happen impairing its function as a stallion.Keywords: exungulation,hoof trauma, degenerative changes

CD34 Expression in the Stromal Cells of Alveolar Adenoma

The alveolar adenoma of the lung is a rare benign tumor characterized by a proliferation of both the alveolar epithelial cells and the mesenchymal septal cells. Immunohistochemically, the epithelial cells stain for cytokeratin (CK) AE1AE3, CK7, thyroid transcription factor 1 (TTF1), and surfactant apoprotein confirming the derivation by the type 2 pneumocytes. The stromal cells are negative for these markers but they show focally smooth muscle and muscle-specific actin positivity. We describe two cases that showed immunohistochemically a CD34 positivity of the mesenchymal septal cells. This aspect has been previously described in a two cases report, but not emphasized by the authors as a distinctive feature of the lesion. We consider this CD34 positivity as a marker of immaturity or stemness of the lesional septal spindle cells, that could be responsible of the different phenotypic and morphological profile of the interstitial cells, that could be, therefore, considered neoplastic and not reactive

Changes in Cholesterol, Triglycerides and Body Composition in Pregnant Mares

Background: Mares are very different from other species during pregnancy, and studies on the physiological changes of this period are important. During late pregnancy, the distribution of weight and body fat are often used as indicators of adequate nutrition. This is a physiological period that results in an increase in metabolic demand. There is a tendency for the Criollo breed to have a higher body condition score that becomes more evident during pregnancy, a period when mares tend to gain more weight. The current study monitored serum cholesterol and triglyceride levels in pregnant mares during late gestation to determine a possible correlation with the distribution of fat or body weight.Materials, Methods & Results: Four body parameters of thirty-four Criollo-type mares in late gestation were evaluated: body weight measured with a weight scale, body weight using a commercial weight tape, total body fat and fat thickness and the serum levels of total cholesterol and triglycerides. The fat thickness was measured in an ultrasound device and the prediction of total body fat was calculated using an equation. According to the days prior foaling, biometric monitoring and blood collection were carried out in five periods: F-90 (± 90 days prior to foaling) n = 33; F-60 (± 60 days prior to foaling) n = 33; F-30 (± 30 days prior to foaling) n = 31; F-15 (± 15 days prior to foaling) n = 29 and Foaling (at day of foaling) n = 14. Mares were monitored daily and accompanied foaling was also performed, ensuring collection at the right time. Comparisons of means were performed between variables in addition to the Pearson correlation test. Statistical significance was established at P 0.05). A strong positive correlation was observed between the average weights (P 0.068). There was a strong positive correlation between weights (P 0.191). There was also no correlation with the body composition (P > 0.068).Discussion: The absence of difference between the periods in relation to the weight measures and the correlations existing in these measures is related to the period in which they were collected, since the maximum relative weight of the foal is reached in ten months, causing the mare's weight stability. Interestingly, an unexplained increase in total cholesterol levels was found on the day of foaling. As the same change in triglycerides was not observed and there was no change in the diet or feeding behavior of the mares, the effects of the diet can be excluded in this case, which requires further studies to explain this result. Our hypothesis is that this increase is linked to hormones that tend to change in this pre-delivery period and that have their metabolism strongly linked to cholesterol levels. Levels of body fat and mare weight can therefore be correlated in the late gestation, allowing for their use as indicators of adequate nutritional and energy reserves

Delayed sudden radial artery rupture after left transradial coronary catheterization a case report

Local complications at the radial access site are not frequent, hence its large diffusion as the preferred access route for endovascular procedures. However, in a time of fast widespreading, better comprehension of all potential complications becomes critical to facilitate their early recognition and the most appropriate treatment. In this case report, we present for the first time a case of sudden massive bleeding at the left wrist, due to spontaneous gross rupture of the left radial artery bleeding 15 days after an endovascular procedure through a left radial arterial access. The patient had been readmitted to the hospital after evidence of local infection at the left wrist with loss of substance. The radial artery was patent with no evidence of pseudoaneurysm. After sudden radial artery rupture, with massive bleeding and suspicion that the local infection could have reached the arterial wall, surgical hemostasis with artery ligation was obtained. Healing of the large wound was then efficiently speeded up using a negative pressure wound therapy. This is the first case of macroscopic radial artery rupture associated with local wrist infection after arterial catheterization. After prompt surgical hemostasis, negative pressure wound therapy was very helpful in favoring healing of the large and deep wound

Gestation in a Mare with Facial Deviation (Wry Nose)

Background: Wry nose is a congenital deformity that causes respiratory obstruction and decreased oxygenation rate. Gestation in a wry nose mare may be considered a risk to the neonate since it depends on the maternal environment for development. Compromised oxygenation during pregnancy can lead to fetal distress and cause consequences on fetal development. However, depending on the degree of the impairment, the fetus may still be able to adapt. The aim of the present study was to report the gestation in a mare with facial deviation until term and to assess blood gases in the mare and neonate, and to evaluate the histomorphometry of the placenta.Case: A Criollo breed mare presenting facial deviation (Wry Nose) was donated to Equine Medicine Research Group (ClinEq) of the Federal University of Pelotas (UFPel) due to the presence of the physical deformity. When the mare was five years old, it was inseminated and had a pregnancy confirmed. At the fifth month of gestation, evaluation of fetal aorta diameter, fetal orbital diameter and combined thickness of the uterus and placenta (CTUP) started to be performed monthly to assess gestation health. The assessment of the fetal orbit and aorta diameter revealed a linear increase of both variables with the progress of gestation indicating a normal fetal development.  CTUP remained in the normal reference range, presenting no alterations during the gestational length. The mare foaled at 324 days of gestation a coat showing no congenital deformities. The foaling was monitored until the complete passage of fetal membranes. A complete clinical and hematological evaluation of the foal was carried out after birth. The foal showed normal adaptive behavior, clinical and hematological parameters during the first hours of life, although presenting physical signs of immaturity. Venous blood samples were collected from the mare at 315 days of gestation, immediately after foaling and 24 h post-partum for lactate and blood gas analysis.  Mild changes were observed in the mare’s blood gas analysis at foaling that were compensated within 24 h post-partum. Venous blood samples were collected from the umbilical cord and from the foal after birth, at 12 and 24 h post-partum to measure blood gases and lactate. The newborn foal presented respiratory acidosis immediately after birth, which was metabolically compensated at 24 h post-partum. Both mare’s and foal’s lactate evaluation were within the normal reference ranges. After expulsion of the placenta, samples from the gravid horn, uterine body and non-gravid horn were collected for histological and histomorphometric evaluation. In the histological evaluation, avillous areas were detected in the gravid horn and uterine body and mild hypoplasia was found in the uterine body. Placental histomorphometry revealed larger total microcotiledonary and capillary areas on the non-gravid horn when compared to the remaining areas of the placenta (gravid horn and uterine body). No abnormalities on the placental vasculature were detected.  Discussion: To date, there are no reports of a pregnancy in a mare with facial deviation in the literature. This report showed that the wry nose mare gave birth to a viable foal showing no congenital abnormalities, which suggests that wry nose animals can be bred normally. The mare presented a healthy pregnancy, with mild changes in the blood gas analysis at foaling that were compensated at 24 h postpartum. Similarly, despite the foal showed physical signs of immaturity and respiratory acidosis at birth, these changes were compensated in the later assessments. Furthermore, no abnormalities on the placental vasculature were detected

Occurrence of Gasterophilus spp. in Weanling Foals in Southern Brazil

Background: The occurrence of gastrointestinal myiasis caused by Gasterophilus spp. larvae (Diptera: Oestridae) in adult horses has been widely characterized, however data on natural infestation in young foals have been lacking. This observation may be related to the absence of conclusive diagnosis in these individuals, most likely due to logistical or financial constraints. Gastric ulceration is a problem and a significant cause of morbidity in foals, particularly during the weaning stage; therefore, gasterophilosis should be included in the differential diagnosis. The primary purpose of this study was to determine the prevalence of gasterophilosis in 4- to 6-month-old weanling foals.Material, Methods & Results: Seventy-one healthy weanling foals were enrolled in the study. Physical assessment blood sampling and was completed in all foals before the commencement of the experiment. Gastroscopy examinations were performed under sedation (Detomidine 0.01 - 0.02 mg/kg) with a flexible endoscope inserted through nasogastric via. The lumen of the stomach was examined in order to search for botflies’ larvae. Following gastroscopy, foals were classified into 2 groups based on the presence of Gasterophilus spp. larvae in their stomachs: 1) Infected and 2) Not Infected. Infected foals received a single dose of commercial trichlorfon and albendazole equine oral gel and were stalled for 24 h. The passed feces were thoroughly examined, searching for elimination of larvae. A Total of 64% of the foals (n=45/71) harbored Gasterophilus spp. larvae in the stomach. Mild hyperemia in the gastric mucosa was observed in the attachment sites of the parasites. Physical assessment and hematological parameters’ data were analyzed with Shapiro-Wilk normality test. Comparison between groups for clinical signs, hematological parameters and Gasterophilus spp. infection rates were evaluated using the Kruskal-Wallis test or Student's t-test. Statistical significance was set at P < 0.05. There were no statistically significant variations in physical and hematological parameters between foals that were affected and those that were not infected. The larvae found in the feces were subjected to morphological examination, which confirmed the diagnosis of Gasterophilus intestinalis.Discussion: No systemic clinical indications compatible with Gasterophilus infestation were seen, as described in previous studies of horses infected with the parasite. No botfly eggs were observed in the hair of evaluated foals. During gastroscopy, mild hyperemic lesions in the gastric mucosa were observed in the larvae fixation sites. Although no changes in clinical or hematological parameters were noted, the confirmation of parasite presence is a cause for concern due to horses' tolerance for low infestation levels and poor diagnosis. Additionally, the presence of this myiasis in foals may be a significant stressor during the weaning period and should be included in the differential diagnosis of recurring abdominal pain. Furthermore, infected foals might be a reservoir for the parasite and, contribute to the elimination and spread of the larvae in the environment. Thus, inclusion of young horses in deworming protocols targeted to botfly larvae is needed. This is the first report of Gasterophilus intestinalis myiasis in foals in Brazil. Further research is necessary to fully understand the epidemiology and prevalence of this condition in young horses in Brazil, based on the findings of this study. Keywords: Gasterophilus intestinalis, cavity myiasis, gastroscopy, Oestridae

Educational strategies to promote adherence to treatment in patients with cardiovascular disease

INTRODUCTION: Educational material is a key strategy for primary health care promotion. PURPOSE: To design and validate educational material adapted to the population and aimed to increase knowledge about adherence to the treatment of arterial hypertension and diabetes mellitus. METHODOLOGY: Methodological study for the design of educational material for people with diabetes mellitus and high blood pressure. For the design, content validity tests were carried out, with the participation of six experts in health education and six patients with chronic diseases. Validation was performed pursuant to the attraction, understanding, engagement, and acceptance criteria. RESULTS: The validation confirmed that all items and criteria were above the minimal expected range. CONCLUSION: The design and validation of educational material provide elements that improve the education of patients about their pathologies and their adherence to treatment.info:eu-repo/semantics/publishedVersio

Fast-track ruling in/out SARS-CoV-2 infection with rapid 0/1.5 h molecular test in patients with acute coronary syndromes

AIMS: Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS: We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65 ± 12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS: In this fast-track protocol, the time to perform nasopharyngeal swab was 11 ± 11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ± 20 min; time to detect viral nucleic acid was 68 ± 16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ± 26 min. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION: This study demonstrates that 0-1.5 h fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection