Clinical, Laboratorial and Image Aspects of a Perforated Pyloric Ulcer Secondary to Nonsteroidal Anti-Inflammatory Use in a Cat

Background: Inappropriate use of drugs for veterinary patients represents a common problem at clinical practice. Nonsteroidal anti-inflammatories are one of these misused drugs and may lead to clinical status of challenging diagnosis. Adverse effects for patients submitted to its incorrect use may include simple cases such as pharmacological gastroenteritis to severe acute renal failure or perforated gastroenteric ulcers with no pathognomonic clinical signs. The objective of this report was to describe a case of a perforated pyloric ulcer secondary to prolonged use of meloxicam in a cat with its clinical, laboratorial and image aspects from the moment of suspicion until the diagnosis.Case: An 8-year-old female feline was attended at the Veterinary Hospital of the Dom Bosco Catholic University, with main complaint being a mammary nodule with recent ulceration. Tumor staging and pre-surgical blood analysis were performed previous to total unilateral mastectomy. Eleven days post-surgery the patient was brought for suture removal, but it was observed stupor, moderate dehydration (estimated 10%), 36.7ºC rectal temperature, heart rate at 100 beats/min, respiratory rate at 60 breaths/min, 40 mg/dL blood glucose, icterus and abdominal distension with tympany at percussion (fluid wave test was negative). Anamnesis revealed the possible use of meloxicam for 10 days. The first suspicion was sepsis, with enteric gas secondary to infection. Due to no classical signs of peritoneum effusion and possible severe enteric distension, abdominocentesis was not immediate performed. Complete blood count and serum biochemistry revealed a marked band leukocytosis associated with renal injury, supporting the first sepsis suspicion. Abdominal radiography revealed radiodensity of diffuse aspect at ventral topography but no evidence of marked enteric distension that would justify tympany. Abdominal ultrasound identified effusion predominantly hyperechogenic with hyperechogenic mesentery, indicative of peritonitis. A diagnostic abdominocentesis was performed revealing a dense yellow-green effusion with high suspicion of being gastroenteric liquid. Exploratory laparotomy was not authorized by the owner and the patient was submitted to euthanasia due to the bad prognosis. Macroscopic necropsy was performed and a perforated pyloric ulcer was identified along with an impregnated mesentery with a green-brown color (peritonitis), closing the diagnosis.Discussion: The importance of reiteration regarding veterinary prescription orientation, especially for feline patients, is evidenced. Along the indiscriminate over-the-counter sale of veterinary drugs, self-medication prior to veterinary consultation is usual even for ongoing assisted patients. Considering the unspecific clinical signs that patients with perforated gastroenteric ulcers may present, the diagnosis may be challenging when no complementary image exams are immediate available. The stuporous mental state inhibiting possible manifestation of abdominal discomfort, absence of positive fluid wave test and tympany at percussion which prohibited a secure abdominocentesis could have led to a delay in diagnosis, if not for image support. Considering the emergency status of these patients, early diagnosis is crucial, therefore clinicians should have precaution when approaching patients with possible perforated gastroenteric ulcers and trust clinical history, even when classical signs of abdominal effusion are not present

Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment

Background: Feline eosinophilic keratoconjunctivitis is a proliferative eye lesion of chronic aspect with usually unilateral presentation that may initiate as a superficial vascularization that evolves to a proliferative, granular, irregular lesion of whitish-pink aspect. With its association with an immune-mediated response, nonsteroidal anti-inflammatories do not appear to be efficient, although few studies describe its use. This case report describes a case of a feline eosinophilic keratoconjunctivitis with its clinical evolution since the use of nonsteroidal topical anti-inflammatory drug in an undiagnosed patient and the transition to a topical corticosteroid and cure after 14 days since diagnosis.Case: An 8-year-old female cat was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an eye injury with at least 36 days of evolution andunresponsive to treatment (topical tobramycin 0.3% every 12 h / ketorolac trometamol 0.5%/ every 12 h and ophthalmic lubricant/every 4 h). Since the patient had free access to the street, the owners suspected of trauma-induced lesion. At physical examination, it was observed a proliferative lesion at the peri-limbal superotemporal quadrant of the right cornea with approximately 0.4 cm diameter, with color varying of pale to pink, with irregular surface and low vascularity, the adjacent conjunctiva was also affected with similar multiple nodular lesions (0.1 cm). Fluorescein test was negative as well as FIV/FeLV immunochromatography testing. Feline herpesvirus investigation was not possible. The patient was anesthetized and a lesion specimen was acquired with a cotton swab scraping and a fine needle aspiration. Cytology showed predominance of eosinophils and mast cells, with rare corneal epithelial cells, with smear background containing mast cell granules and free eosinophils. Presumptive diagnosis was eosinophilic keratoconjunctivits. After 14 days of topical corticosteroid (prednisolone acetate 1% every 8 h) the patient showed complete remission of the lesions with no relapse in 48 days.Discussion: Misdiagnosis and consequently mistreatment seems a greater prejudice than the risks associated with sample collection of keratoconjunctival proliferative lesions. Due to the lack of cytobrush or cotton swab, apparently, the reported patient was not submitted to ophthalmic cytology due to reluctance of the staff regarding fine needle aspiration of the cornea lesion. Despite a greater risk of iatrogenic trauma with needle aspiration, with eye anatomy well defined, level size and movement amplitude respected, it is unlikely that severe complications could occur. In this case, the undiagnosed patient was submitted to unnecessary 15 days of topical antibiotic and nonsteroidal anti-inflammatory, and no improvement of the clinical signs was observed. Despite non-recommended, few clinical trials as well as case descriptions are available comparing nonsteroidal and corticosteroid treatment of the disease. Once with diagnosis and beginning of topical prednisolone acetate 1% exclusively, the patient showed continuous improvement until complete remission of clinical signs after 14 days. This report reinforces the recommendation of corticosteroid therapy for feline eosinophilic keratoconjunctivitis and the absence of efficacy of nonsteroidal drugs. It also highlights the importance of diagnosis before any medical treatment is considered

Microscopic and ultrastructural evaluation of the saphenous vein endothelium for CABG prepared by the no touch technique

OBJECTIVE: Saphenous vein grafts (SV) used in coronary artery bypass grafting have a limited life and vein occlusion may be the final adverse effect. Efforts to develop new techniques to harvest the saphenous vein may improve the viability of the graft. METHODS: Twenty patients were randomly divided into two groups with the objective of evaluating the vascular endothelium. The No Touch (NT) technique consists in removing the saphenous vein with perivascular tissue. The conventional technique consists in harvesting with in situ removal of the perivascular tissue. The standard saphenous vein harvesting procedure used bridged incisions. Characteristics of the vein were considered. Evaluation of the endothelium was achieved by electron microscopy and histologic analysis using hematoxylin eosin staining. The Picrosirius and Masson Trichrome methods were used to analyze subendothelial collagen. RESULTS: Electron microscopy demonstrated that the NT Group had larger non-denudated endothelial areas as well as a smaller number of degraded cells. Histological analysis showed the form and integrity of the saphenous vein layers. A larger amount of collagen fibers were identified in the NT Group. CONCLUSIONS: The NT technique better preserves the saphenous vein endothelium suggesting a more viable graft in the long term.OBJETIVO: O enxerto de veia safena (VS) utilizado em revascularização miocárdica possui uma vida útil, sendo o estágio final a oclusão do vaso. Esforços em adquirir novas técnicas de coleta da VS podem possibilitar uma viabilidade maior do enxerto. MÉTODOS: Vinte pacientes foram randomizados e divididos em dois grupos com o objetivo de avaliação do endotélio vascular. A técnica no touch (NT) consiste em retirar o segmento de VS com o tecido perivascular. A técnica convencional consiste em retirar a VS, com remoção in situ do tecido perivascular e conseqüente vasoespasmo. Houve um padrão de retirada das VS com incisões longitudinais escalonadas. Características da VS foram consideradas. A avaliação do endotélio das VS foi realizada usando microscópio eletrônico (ME) pelo método de varredura e de transmissão. Cortes histológicos das VS foram corados em Hematoxilina-Eosina (HE). O colágeno subendotelial foi analisado pelos métodos de Picro-Sirius e Tricrômio de Masson. RESULTADOS: A ME evidenciou que o Grupo NT possui maiores áreas endoteliais não desnudadas, além de um menor número de células degradadas. A coloração em HE nos permitiu verificar a forma e a integridade das camadas das VS. Há um predomínio maior de fibras colágenas coradas no Grupo NT. CONCLUSÕES: A técnica NT permite uma melhor preservação endotelial da VS, sugerindo um enxerto mais viável em longo prazo.Escola Paulista de Medicina Universidade Federal de São Paulo (UNIFESP)Escola Paulista de Medicina Universidade Federal de São Paulo (UNIFESP) Departamento de Patologia InvestigativaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Setor de Microscopia EletrônicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina setor de Transplante Cardíaco da Disciplina de Cirurgia CardiovascularUNIFESP, EPM, EPM EPM, Depto. de Patologia InvestigativaEPM, Escola Paulista de Medicina Setor de Microscopia EletrônicaEPM, Escola Paulista de Medicina setor de Transplante Cardíaco da Disciplina de Cirurgia CardiovascularSciEL

DESENVOLVIMENTO INICIAL DO AMENDOINZEIRO SOB DIFERENTES DENSIDADES DE MATOCOMPETIÇÃO COM Urochloa

Gramíneas e leguminosas competem nos sistemas produtivos, sendo que esta competição depende de suas habilidades específicas para a sua sobrevivência. O objetivo desse trabalho foi avaliar o desenvolvimento inicial de amendoinzeiro sob diferentes densidades de matocompetição com Urochloa. Foi realizado um experimento com delineamento inteiramente casualizado, em esquema fatorial 4 x 5. O primeiro fator foi composto por quatro tipos de gramíneas, ou seja, Urochloa brizantha cv. Paiaguás, Marandu, Piatã e Urochloa ruziziensis; o segundo, por cinco densidades de matocompetição e cinco repetições, totalizando 100 parcelas ou vasos. Após 30 dias da semeadura, foram determinados os seguintes parâmetros: ISPADA – índice spad do amendoim; CEA – condutância estomática do amendoim; DCA – diâmetro de caule do amendoim; APA e APG – altura de planta do amendoim e gramínea; MSPAA e MSPAG – massa seca da parte aérea do amendoim e gramínea; e MSRA e MSRG – massa seca de raiz do amendoim e gramínea. O amendoinzeiro responde de maneira negativa quando submetido a altas densidades de matocompetição com gramíneas do gênero Urochloa. A Urochloa ruziziensis apresentou uma maior matocompetição no desenvolvimento inicial do amendoinzeiro

O Largo da Banana e a presença negra em São Paulo

The Largo da Banana relates to the history of the black population in São Paulo. Acknowledged as one of São Paulo’s “cradle” of samba, samba musicians are its main spokespersons. Largo da Banana used to be located near the former Barra Funda Railway Station. From the first decades to around half the Twentieth century, informal laborers in the railway logistics used to gather together in that space. Within a precarious and unsteady daily life, they used to play samba and tiririca. In the fifties, the municipality built the Pacaembu Viaduct in that area, aiming to extend the homonym avenue beyond the railway road. In the sixties, samba musician Geraldo Filme wrote two songs in which he paid homage to Largo da Banana and regrettedits disappearance after the viaduct’s inauguration. In these and other of his songs, the artist recorded his perceptions on the life conditions of São Paulo’s blacks and samba musicians, their sociabilities, and also the urban changes he witnessed. Considering that his artistic work contributes to enlighten aspects of social reality, I analyze some of his songs to interpret the sociabilities at Largo da Banana, as well as the urban intervention in that location.O Largo da Banana está associado à história da população negra em São Paulo. Reconhecido como um dos “berços” do samba paulista, é sobretudo através dos próprios sambistas que essa história pode hoje ser conhecida. Localizado junto à antiga estação da Barra Funda, desde as primeiras décadas até meados do século passado, aquele espaço concentrou trabalhadores informais vinculados às atividades da ferrovia. Em meio a um cotidiano precário e instável, essa população realizava rodas de samba e de tiririca. Nos anos 1950, foi construído naquele local o Viaduto Pacaembu, que prolongava a avenida homônima para além davia férrea. A partir da década de 1960, o sambista negro Geraldo Filme compôs duas canções em que homenageava o Largo da Banana e lamentava seu desaparecimento após a inauguração do viaduto. Nessas e em outras composições, o artista registrou suas percepções sobre as condições de vida da população negra e sambista na cidade, suas sociabilidades, bem como sobre as transformações urbanas que testemunhou. Considerando que sua obra artística contribui para iluminar aspectos da realidade social, ela é adotada como fonte para analisar as formas de sociabilidade no Largo da Banana e a intervenção urbanística naquele local

Prevalence of pfmdr1, pfcrt, pfdhfr and pfdhps mutations associated with drug resistance, in Luanda, Angola

<p>Abstract</p> <p>Background</p> <p>Malaria is the infectious disease causing the highest morbidity and mortality in Angola and due to widespread chloroquine (CQ) resistance, the country has recently changed its first-line treatment recommendations for uncomplicated malaria, from CQ to artemisinin combination therapies (ACT) in adults, and sulphadoxine/pyrimethamine (S/P) in pregnant women. Loss of SP sensitivity is, however, progressing rapidly in Africa and, in this study, were investigated a number of molecular markers associated to CQ and S/P.</p> <p>Methods</p> <p>Blood samples were collected from 245 children with uncomplicated malaria, admitted at the Pediatric Hospital Dr. David Bernardino (HPDB), Angola, and the occurrence of mutations in <it>Plasmodium falciparum </it>was investigated in the <it>pfmdr1 </it>(N86Y) and <it>pfcrt </it>(K76T) genes, associated with CQ resistance, as well as in <it>pfdhfr </it>(C59R) and <it>pfdhps </it>(K540E), conferring SP resistance.</p> <p>Results</p> <p>The frequencies of <it>pfmdr1 </it>mutations in codon 86 were 28.6% N, 61.3% Y and 10.1% mixed infections (NY). The frequency of <it>pfcrt </it>mutations in codon 76 were 93.9% K, 5.7% T and 0.4% mixed infections (KT). For <it>pfdhfr </it>the results were in codon 59, 60.6% C, 20.6% R and 18.8% mixed infections (CR). Concerning <it>pfdhps</it>, 6.3% of the isolates were bearers of the mutation 540E and 5.4% mixed infections (K540E).</p> <p>Conclusion</p> <p>The results of this epidemiologic study showed high presence of CQ resistance markers while for SP a much lower prevalence was detected for the markers under study.</p

DESENVOLVIMENTO INICIAL DO AMENDOINZEIRO SOB DIFERENTES DENSIDADES DE MATOCOMPETIÇÃO COM Urochloa

Gramíneas e leguminosas competem nos sistemas produtivos, sendo que esta competição depende de suas habilidades específicas para a sua sobrevivência. O objetivo desse trabalho foi avaliar o desenvolvimento inicial de amendoinzeiro sob diferentes densidades de matocompetição com Urochloa. Foi realizado um experimento com delineamento inteiramente casualizado, em esquema fatorial 4 x 5. O primeiro fator foi composto por quatro tipos de gramíneas, ou seja, Urochloa brizantha cv. Paiaguás, Marandu, Piatã e Urochloa ruziziensis; o segundo, por cinco densidades de matocompetição e cinco repetições, totalizando 100 parcelas ou vasos. Após 30 dias da semeadura, foram determinados os seguintes parâmetros: ISPADA – índice spad do amendoim; CEA – condutância estomática do amendoim; DCA – diâmetro de caule do amendoim; APA e APG – altura de planta do amendoim e gramínea; MSPAA e MSPAG – massa seca da parte aérea do amendoim e gramínea; e MSRA e MSRG – massa seca de raiz do amendoim e gramínea. O amendoinzeiro responde de maneira negativa quando submetido a altas densidades de matocompetição com gramíneas do gênero Urochloa. A Urochloa ruziziensis apresentou uma maior matocompetição no desenvolvimento inicial do amendoinzeiro