Reversao do flutter atrial por estimulaçao atrial transesofágica: análise da eficácia de drogas antiarrítmicas na potencializaçao do método

No estudo foram incluídos 62 pacientes e 81 episódios de f1utter atrial (FA). Os episódios foram divididos em 2 grupos: no 1° grupo (30 episódios) a técnica da estimulaçao transesofágica (EAT) foi realizada como primeira alternativa terapêutica em pacientes sem uso prévio de drogas antiarrítmicas. No 2° grupo (51 episódios), a técnica foi realizada após o uso prévio de drogas do grupo I (quinidina) ou grupo III (amiodarona), em dosagem de 800 mg/dia, até que fosse obtida a diminuiçao da freqüência atrial. Utilizou-se catéter eletrodo bipolar convencional e estimulador transesofágico IMC - Biomédica. O protocolo de reversao iniciou-se com largura de pulso (LP) de 20 ms e carga de 15 mA. Os estímulos foram liberados primeiramente com freqüências baixas, passando a freqüências mais altas nos casos em que nao houve reversao ao ritmo sinusal (RS). Os demais fatores avaliados durante o estudo foram: tamanho de átrio esquerdo (AE), alteraçao do ritmo do FA durante o protocolo, freqüência atrial, freqüência de estímulo e morfologia de onda P em RS pós-reversao. Como resultado global, obteve-se 45,2% de sucesso de reversao a RS. Analisando os grupos, observou-se que houve maior sucesso no grupo que fez uso prévio de drogas antiarrítmicas (62,7%), em relaçao ao grupo que nao usou drogas (20%). Observou-se também que o AE normal e as alteraçoes do ritmo do FA durante os estímulos podem ser fatores preditivos do sucesso da técnica. Os casos de onda P normal em RS foram os que melhor responderam à técnica. Freqüências atriais mais lentas obtiveram maior sucesso de reversao e a freqüência de estímulos necessária à reversao foi semelhante nos dois grupos do estudo

Radioterapia em paciente com neoplasia pulmonar e marcapasso ipsilateral

Durante anos, o tratamento com radioterapia de portadores de dispositivos eletrônicos implantáveis foi considerado perigoso. Se a zona a ser irradiada envolvesse o lado em que o dispositivo estivesse localizado, a estratégia envolvia inclusive mudanças no local do implante. Passaram-se os anos e tanto os dispositivos como a radioterapia evoluíram, e o que antes era regra para a segurança do binômio marcapasso-radioterapia hoje pode ser exceçao. Relatamos o caso de um paciente portador de neoplasia maligna de lobo superior de pulmao direito, em posiçao ipsilateral ao marcapasso implantado previamente

Schistosomus reflexus in a Dog and a Cat

Background: Schistosomus reflexus (SR) is a congenital anomaly, that the animal presents exposed abdominal and thoracic organs. The alterations includes limbs malformation, abnormal spinal column, liver and diaphragm hypoplasia, genitourinary and gastrointestinal changes, on this way, the fetus can not survive. The aim of this study was to report the first SR case in dog and cat in Brazil, and describe anatomical, pathological and radiographic changes.Case: The puppy had ventral midline defect in the abdominal and thoracic wall extending from the sternum to the pubis with viscera exposition, including the heart, lung, liver, stomach, intestine, spleen, kidneys, moreover right army was abnormal, however no spinal column was present. It was performed radiography to evaluate bone abnormalities, and was diagnosed agenesis of carpal, metacarpal and phalange bones. The kitten had ventral midline defect measuring 4 x 2 cm, in the abdominal wall and exposition of liver, stomach, intestine and spleen, as well as tibiotarsal joint arthrogryposis on both lags. It was performed fetus radiography and no spinal column change was diagnosed.Discussion: Schistosomus reflexus is a congenital abnormality common in ruminants. Although it was few reported in dogs and cats. The two cases in this study are the firsts reposts in Brazil in these especies. In our case, the dog had exposition of abdominal and thoracic organs and died one hour after born, similar to this, another author reported a case where the thoracic and abdominal evisceration and the puppy died ten minutes after born. However, in another case with abdominal evisceration only, the puppy survived for eight days. Probably it happened because respiratore function was not compromised. The kitten had abdominal opening only, in turn, other authors reported a case whose abdominal viscera exposition was by pelvic fissure, and another case, what presented thoracic and abdominal evisceration, like our dog case. Some authors affirm that this defect causes fetal dystocia on ruminants, because of the vertebral column abnormality, what promote passage difficult at born moment. On the other hand, dogs did not present these kind of changes and dystocia was not related to this pathology on cases in dogs and cats, however most of these authors performed cesarean because the female did not get normal born. As well as, on two cases in kitten were reported vertebral column abnormalities, what can be related to dystocia. Even no animal of our study present any vertebral column abnormality, other bone changes were found, like carpal, metacarpal and phalange agenesis on army of the dog and tibiotarsal joint arthrogryposis on both lags of the cat fetus. The others report in dogs did not found vertebral column or bone changes, but in cats it was observed vertebral column abnormalities and other changes, like arthrogryposis on four limbs, skull flattening, mandibular brachignathism, reduced ossification of the cranial vault bones, palatoschisis and unfused eyelids. SR etiology is not clearly known, it may be related with genetic, mechanic, endocrine, metabolic, nutrition and infectious factors. The moment of embryonic development, where these factors influence the changes is related with abnormality grade. Although, Chromosomic abnormalities, like chromatid and chromosome breaks, non-homologous pairing of chromosomes was shown. In this study the bitch did not present any metabolic, endocrine or nutritional change, on other hand the queen was submitted to exogenous hormonal treatment to avoid pregnancy, what may be related to SR development. SR is a rare abnormality in dog and cat, fetus radiographic, anatomical and pathological findings confirmed to being this congenital defect, and this are the first reports in Brazil in these species

Epidermoid Polycystic Ovaries and Uterine Hypoplasia in a Cow

 Background: Ovarian cysts originate from mature follicles that do not ovulate within the predicted time according to the oestrous cycle. Dermoid cysts are structures lined by keratinized stratified squamous epithelium, without adjacent epidermal structures, filled by keratinic debris and amorphous proteinaceus material. They are small, located below the cortex, near the hilus. There is controversy regarding the teratogenicity of the dermoid cyst. Some authors use the nomenclature of benign cystic ovarian teratoma, others, reports that although the fibrous wall and histological features are similar to teratomas, it is not associated with this germ cell-derived neoplasia.Case: Ovaries and uterus were received from a female, adult bovine, Nelore, from a slaughterhouse. The left ovary measured 6.5x5.0x3.9 cm and weighed 80 g; the right ovary measured 5.7x3.7x3.0 cm and weighed 60 g. Grossly, the ovaries were similar, presenting floating consistency, multilobulated and pointed aspect, and at the cut surface, there was extravasation of mucopurulent content of whitish colour. Regarding to the uterus, macroscopically, the uterine horns were infantile and decrease in the diameter. Fragments of the tissues were collected and fixed in 10% buffered formalin for histopathological examination and the staining of the slides was done with hematoxylin and eosin. Microscopically, in the ovaries, it was observed rare vestigial elements of ovary identifying an atresic follicle. Polycystic formation with cysts exhibiting partial or total coating of a keratinized squamous epithelium was also observed. In the lumen abundant keratinous material was present. The uterine microscopy revealed compact endometrium with areas variably infiltrated by lymphocytes, plasmocytes and occasional neutrophils. Areas devoid of endometrial glands were observed, in addition to other areas with reduced quantity and size. Also, the myoepithelial layer was thin and enlargement of the endometrial vascular space was noted.Discussion: Only one study was found reporting three cases of unilateral dermoid cyst in bovine ovary, also from slaughterhouse. Dermoid cysts appear most often in Zebu cattle. Clinically, these cysts do not necessarily result in infertility and do not interfere in the ovarian functions, due to this, the ovaries are not referred for histopathology examination, which difficult its classification. However, in this study the histological examination showed the absence of follicular development, which characterizes infertility, including endocrine dysfunction. Macroscopically ovarian dermoid cysts are similar to abscesses. It has a viscous or milky content inside and, at the cut surface, usually the content project to the surface. Histologically, there are dilated cysts containing material in the lumen at various stages of keratinization conferring a lamellar aspect and a keratinized stratified squamous epithelium. In this study, we observed pseudostratified epithelial lining containing cilia in addition to lumen keratin content, without follicles or adnexal structures, corroborating the findings in the literature. Also, it was observed uterine hypoplasia, which occurs due to failure of the development of the paramesonephric ducts during embryonic development. Ovarian dermoid cysts associated with uterine hypoplasia are infrequent in animals and, clinically, may not present changes in fertility and ovarian function

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

A viagem científica de Neiva e Penna: roteiro para os estudos das doenças do sertão The scientific journey taken by Neiva and Penna: a blueprint for studies of diseases from the Brazilian hinterland

Analisa o relatório de Arthur Neiva e Belisario Penna , focalizando a contribuição dos autores ao estudo de uma das doenças endêmicas por eles encontrada ao longo de todo o trajeto percorrido, de longa data conhecida popularmente por 'mal de engasgo'. Observaram e descreveram com minúcia os sintomas apresentados pelos doentes e a associação frequente do mal de engasgo com outro mal endêmico conhecido por 'vexame' ou 'vexame do coração', que consistia em crises de palpitações. Os estudos epidemiológicos e clínicos de Neiva e Penna sobre o mal de engasgo muito contribuíram para o conhecimento dessa afecção e representaram um incentivo para todos os pesquisadores que se dedicaram ao seu estudo, especialmente quanto a sua relação com a doença de Chagas.<br>Analyze the report by Neiva and Penna, focusing on the contribution these authors made to the study of one of the endemic diseases encountered throughout their journey, which had been long known under the popular name of mal de engasgo (choking disease). They recorded their observations and detailed descriptions of the patients' symptoms and the association frequently encountered between mal de engasgo and another endemic disease, known as vexame or vexame do coração, characterized by bouts of palpitations. Neiva and Penna's epidemiological and clinical observations of mal de engasgo were crucial for all the researchers interested in the disease, especially its relationship with Chagas disease