Neutropenia: ocorrência e manejo em mulheres com câncer de mama em quimioterapia

OBJETIVOS: identificar a prevalência e descrever o manejo de neutropenia ao longo do tratamento quimioterápico, entre mulheres com câncer de mama. MÉTODOS: estudo observacional, ciclos de quimioterapia. Registraram-se 116 eventos neutropênicos e 63,3% das pacientes apresentaram neutropenia em algum momento do tratamento, sendo que 46,5% desses foram de grau II. O manejo utilizado foi a suspensão temporária entre os ciclos e a média de atrasos foi de 6, prospectivo, longitudinal, onde foi realizada a avaliação das toxicidades hematológicas, a cada ciclo de quimioterapia, neoadjuvante ou adjuvante. RESULTADOS: foram incluídas 79 mulheres submetidas a 572 ciclos de quimioterapia. Registraram-se 116 eventos neutropênicos e 63,3% das pacientes apresentaram neutropenia em algum momento do tratamento, sendo que 46,5% desses foram de grau II. O manejo utilizado foi a suspensão temporária entre os ciclos e a média de atrasos foi de 6.OBJECTIVES: to identify the prevalence, and describe the management of, neutropenia throughout the chemotherapy treatment among women with breast cancer. METHODS: observational study, cycles of chemotherapy. 116 neutropenic events were recorded, and 63.3% of the patients presented neutropenia at some point of their treatment, 46.5% of these presenting grade II. The management used was temporary suspension between the cycles and the mean number of delays was 6 days. The study was prospective and longitudinal, where the evaluation of the hematological toxicities was undertaken at each cycle of chemotherapy, whether neoadjuvant or adjuvant. RESULTS: 79 women were included, who received 572 cycles. However, the reasons for the suspensions were the lack of a space in the chemotherapy center, followed by neutropenia. CONCLUSION: neutropenia is one of the most common and serious adverse events observed during the chemotherapy. Nursing must invest in research regarding this adverse event and in management strategies for organizing the public health system, so as to offer quality care.OBJETIVOS: identificar la prevalencia y describir el manejo de la neutropenia a lo largo del tratamiento quimioterapéutico entre mujeres con cáncer de mama. MÉTODOS: estudio observacional, ciclos de quimioterapia. Se registraron 116 eventos neutropénicos y 63,3% de las pacientes presentaron neutropenia en algún momento del tratamiento, siendo que 46,5% de estos fueron de grado II. El manejo utilizado fue la suspensión temporaria entre los ciclos y el promedio de atrasos fue de 6 días. Estudio prospectivo, longitudinal en donde fue realizada la evaluación de las toxicidades hematológicas, a cada ciclo de quimioterapia, neoadyuvante o adyuvante. RESULTADOS: fueron incluidas 79 mujeres sometidas a 572 ciclos. Sin embargo, los motivos de las suspensiones fueron la falta de cupo en la central de quimioterapia seguido por la neutropenia. CONCLUSIÓN: la neutropenia es uno de los eventos adversos más comunes y graves observados durante la quimioterapia. La enfermería debe realizar inversiones para investigar este evento adverso y para proponer estrategias de gestión para organizar el sistema público de salud, ofreciendo así una asistencia de calidad

Renal Dysplasia in a Maltese dog

Background: Renal dysplasia (RD) is a common cause of renal failure in young dogs. It is defined as a disorganization in renal parenchymal development, with abnormal differentiation. In all domestic animal species, RD may be hereditary or acquired. The affected animals show clinical signs of early chronic kidney disease, usually between 3 months to 3 years of age. The alterations include persistent metanephric ducts surrounded by primitive mesenchyme, glomeruli and fetal tubules, and abnormal interstitial fibrous tissue. We aimed to report the case of a 1-year-old canine with renal dysplasia.Case: A 1-year-old male Maltese dog experiencing polyuria, polydipsia, recurrent episodic vomiting, bloody diarrhea, weight loss, apathy, and anorexia was referred to a private clinic in the municipality of Itabuna-Bahia. Physical examination revealed hypochromic mucosa, dehydration estimated at 8%, rectal temperature of 37.5º C, halitosis, and a body score of 3 out of 9. Laboratory abnormalities included hematocrit of 18%, with hypochromic normocytic aregenerative anemia, azotemia (urea - 530 mg/dL, creatinine - 10.5 mg/dL), hyperglobulinemia (4.7 g/dL), low urinary density (1005), proteinuria (300 mg/dL), and urinary pH - 7.0. Ultrasonography revealed bilateral small kidneys with loss of cortico-medullary definition, cystic formations of different sizes on the renal surface, and hyperechoic areas in the parenchyma; these alterations were suggestive of bilateral chronic nephropathy. Considering the clinical, hematological, biochemical, and ultrasonographic presentation associated with the age of the patient, renal dysplasia was suspected. The patient's clinical condition progressed to loss of consciousness and convulsions, followed by death. Necropsy revealed pale, hypotrophic kidneys with firm consistency, irregular capsular surface containing multiple cortical cysts of different sizes, and altered cortico-medullar proportion. . Kidney fragments were sent to the Laboratory of Histopathology of the State University of Santa Cruz.  Histopathological analysis revealed a marked alteration of renal architecture with glomeruli and immature tubules (adenomatous aspect), persistent primitive mesenchyme, and remnants of the metanephric ducts, as well as tubular dilatation associated with marked interstitial fibrosis, discrete lymphohistiocytic interstitial nephritis, and multifocal areas of mineralization.Discussion: The clinical changes observed in the present case occurred as a consequence of chronic kidney failure caused by RD and included anorexia, apathy, vomiting, bloody diarrhea, polyuria, polydipsia, and dehydration. These alterations were also found in other reported cases. The macroscopic findings were similar to those described in the literature and are characteristic of chronic kidney disease: small, firm, pale-colored kidneys. Microscopic changes of renal dysplasia include persistent metanephric ducts surrounded by primitive mesenchyme, glomeruli and fetal tubules, and abnormal interstitial fibrous tissue. In the histopathological renal evaluation in the present report, morphological alterations compatible with the described alterations in the literature were observed, thus allowing the diagnosis of renal dysplasia. Renal dysplasia can affect young dogs of different breeds, causing clinical manifestations of chronic kidney disease. In view of this, this disease should be included as a differential diagnosis in patients under 3 years old who present signs of chronic nephropathy.

Three Cases of Exclusively Extragenital Canine Transmissible Venereal Tumor (cTVT)

Background: Canine Transmissible Venereal Tumor (cTVT) is a neoplasia that affects mainly the genital organs of dogs, but can rich extragenital sites as well. It´s a tumor characterized microscopically by the presence of vacuolized round cells. Transmission occurs by implantation of these cells in non-affected tissues and the treatment is based on vincristine chemotherapy.Cases: Case 1. A 5-year-old intact male Poodle, presenting an increase volume of nasal plane came for veterinary care at a private veterinary clinic. The animal had bilateral bloody nasal secretion and dyspnea. The external genitalia had no alterations. The cytological evaluation confirmed cTVT. Treatment with vincristine sulfate weekly showed a rapid responsewith improvement of the respiratory condition, total remission of the mass and absence of neoplastic cells in cytology. Case 2. A 5-year-old mixed-breed canine bitch, weighing 6.7 kg, was brought to the State University of Santa Cruz Veterinary Hospital (UESC-VH), showing an increase volume in the nasal plan region, with complaints about sneezing, nasal bleeding,respiratory distress with approximately 4 months of evolution. The owner informed that the mother of these female dog, that lived in the same environment, died a month before the beginning of clinical signs of the bitch of this case, and showed a reddish vaginal mass with intense bleeding. Intranasal exfoliative cytology showed moderately cellular sample compatible with cTVT. The treatment with vincristine sulphate for 6 weeks, showed completely remission of all clinical signs. Case 3. A 3-year-old mixed-breed male dog was brought to the UESC-VH with a reddish, friable mass located in the left eye. The citology confirmed the clinical suspicion of cTVT. After six weekly sessions of chemotherapy with vincristine sulfate, the tumor regressed and a new cytological evaluation was performed, without visible of tumor cells. By the end of the treatment, the dog was diagnosed with phitisis bulbi, and one year later, due to recurrent ulcerative keratitis, the enucleation was performed and the histopathological examination of the eye did not identify the presence of tumor cells.Discussion: Two of the dogs cited in this report had freely streets access, without supervision of the owners, and they are likely to have contracted cTVT on one of those occasions. The animal’s care style acts as a risk factor for the development of neoplasia. Regarding the third animal, the close contact with another female dog, who had compatible vaginal cTVTclinical signs was probably the factor that determined the transmission. None of the animals cited in this report had lesions on their external genitalia. The extragenital presentation may be attributed to the social behavior of licking and sniffing the genitalia of carrier animals, which may lead to the natural implantation of the viable cells of the cTVT into the ocular and nasal mucosa. About the clinical signs manifested, in the cases of involvement of the nasal structures, the main signs described in literature are bloody nasal secretion, sneezing, dyspnea and increased nasal plane volume, and are similar to those observed in the animals cited in this report. In the case of ocular cTVT, the increase volume with impairment and deformity of all ocular structures, as well as pain and pruritus corroborate with the clinical findings observed in the literature. The cytopathological test was the diagnostic tool used in all cases cited in this report and the cytopathological findings corroborates with those described in the literature. Vincristine sulfate is the drug of choice for the treatment of cTVT cases, and in the dogs of this report, this drug was successfully used leading to complete remission of lesions and clinical signs, as observed in other studies.Keywords: nasal mucosa, ocular mucosa, venereal disease, round cells

Molecular diagnosis of Ehrlichia canis infection in dogs with uveitis

Canine monocytic ehrlichiosis (CME) is an infectious disease caused by a gram-negative bacterium Ehrlichia canis that has a high global prevalence that leads to high rates of morbidity and mortality in dogs. Among the clinical changes, ophthalmic diseases can lead to permanent blindness and it can be an important clinical sign. The objective of this study was to perform nested polymerase chain reaction (PCR) to diagnose E. canis infection in dogs with bilateral uveitis from the Veterinary Hospital of the Santa Cruz State University. Blood samples were collected and DNA for the molecular diagnosis was extracted from 66 adult dogs of both genders and mixed breeds diagnosed with bilateral uveitis. Thirty-five (53%) dogs showed positive results and presented with iridocyclitis, posterior uveitis, panuveitis, or uveitis with secondary glaucoma. This study demonstrates that nested PCR is an important tool for the differential diagnosis of dogs with bilateral uveitis, as it provides evidence of the infectious agent in the animal

Uso de jogos e redes sociais como estratégias de promoção de saúde para crianças e adolescentes: um relato de experiência de extensão universitária

The pandemic caused by the new coronavirus has had consequences in many areas. With the suspension of face-to-face classes, students and educators have been encouraged to develop better technological aptitude to optimize the use of distance communication media. Thus, academic institutions have prioritized the use of digital media to enable and supervise studies and projects. Therefore, the extension project entitled "Healthy Eating and Physical Activity Practice as a Health Prevention Strategy for Children and Adolescents", which aims to encourage the adoption of good eating habits and physical exercise in health promotion for public school students, has adapted the materials applied in previous face-to-face versions to the digital format. This paper aims to share the experience report of the conversion and innovation of the original proposal. Survey questionnaires were made on Google Forms; video recordings posted on YouTube; and posts on the social network Instagram. However, the big innovation was the creation of games on the Wordwall platform. As a result, there was a closer relationship between extensionists and the children, despite the distance in person, with a high degree of improvement in digital communication abilities. The extensionists went further into the technological universe, always reflecting on the children's performance. In this way, this process proved to be a true exercise for professional practice from a virtual perspective, generating more qualified, updated, and empathetic citizens.A pandemia provocada pelo novo coronavírus trouxe consequências para diversas áreas. Com a suspensão das aulas presenciais, alunos e educadores foram instados a desenvolver melhor aptidão tecnológica para otimizar o uso de meios de comunicação a distância. Assim, instituições de Ensino Superior aperfeiçoaram o uso de mídias digitais para fomentar e supervisionar estudos e projetos. Dessa forma, o projeto de extensão intitulado “Alimentação Saudável e Prática de Atividade Física como estratégia de Prevenção em Saúde de crianças e adolescentes”, que visa a incentivar a adoção de bons hábitos alimentares e do exercício físico na promoção da saúde de estudantes da rede pública, adaptou para o formato digital os materiais aplicados em versões presenciais anteriores. Este trabalho objetiva compartilhar o relato de experiência da conversão e inovação da proposta original. Foram feitos questionários de sondagem no Google Forms; gravação de vídeos postados no YouTube; e postagens na rede social Instagram. Entretanto, a grande inovação foi a criação de games na plataforma Wordwall. Como resultados, destaca-se o estreitamento dos vínculos entre extensionistas e o público-alvo, a despeito do distanciamento presencial, com elevado grau de aperfeiçoamento de habilidades de comunicação digital. Os extensionistas se aprofundaram mais no universo tecnológico, refletindo sempre no aproveitamento das crianças. Desse modo, esse processo mostrou-se um verdadeiro exercício para a prática profissional numa perspectiva virtual, formando cidadãos mais qualificados, atualizados e empáticos. Destaca-se o uso dos jogos e redes sociais como grandes aliados no processo de ensino-aprendizagem que poderão ser incorporados à ação presencial da extensão universitária

Babesia spp. and Ehrlichia chaffeensis infection in Dogs from Southeastern Bahia, Brazil

Background: Tickborne diseases are frequent in tropical countries such as Brazil. Protozoa of the Babesia genus and bacteria of the Ehrlichia genus spread throughout the country with high prevalences in urban and rural areas, causing clinical or subclinical diseases in dogs. This study aimed to investigate the prevalence of infection from Babesia spp. and Ehrlichia chaffeensis in the dog population in the municipality of Ituberá, Bahia, Brazil, and to verify the risk factors associated with the infections.Materials, Methods & Results: A cross-sectional study was conducted, consisting of the following procedures: clinical examination and blood samples collection from 380 dogs and application of a structure questionnaire to dog owners to collect epidemiological data. All dogs were evaluated for the presence of ticks and clinical signs associated with the infections. Blood samples were collected and tested for Babesia spp. through capillary blood smears, indirect immunofluorescence assays (IFAT), and polymerase chain reaction (PCR); all the samples were also tested for E. chaffeensis through nested PCR. Intra-erythrocyte piroplasms were visualized in the blood smears of two animals (2/380; 0.5%) in the cytology exams. Anti-B. canis antibodies were detected in 140/380 (36.8%) dogs, at 1:40 dilution. By PCR, 147/380 (38.7%) dogs tested positive for infection by Babesia sp., but no animal was infected by E. chaffeensis. Only 115/380 dogs (30.3%) were infested by ticks. In total, 223/380 dogs (58.7%) were found infected by Babesia spp. No clinical signs were it found to be significant for the infection. The infected (Ht = 40%) and uninfected dogs’ (Ht = 39%) hematocrit averages were not found to significantly differ (P = 0.47). No hematological changes were found to be significant for the disease. The evaluated variables sex, habitat (urban or rural), exposure to other dogs, age, and infestation by ticks were not found to be risk factors. The condition of semirestriction of 175/223 (78.4%) dogs was found as a risk factor for the infection (P = 0.01; OR = 1.75; IC 95% = 1.10-2.78).Discussion: The low detection from blood smears was inferior to the lowest prevalences found in Brazil. On the other hand, the high seroprevalence rate by IFAT observed in this study was found in other Brazilian states.  The low infection prevalence in the cytologic analysis associated with high seroprevalence are characteristics of chronic or subclinical infections. The high seroprevalence rates may also indicate chronicity and/or subclinical disease when associated with low parasitemia and may also be indicated by the low title variation observed. In this study, some dogs that tested positive for Babesia by serology tested negative in the PCR, which suggests a previously exposure to this pathogen and maintenance of detectable levels of antibodies, or that they were subclinical or chronic carriers of the infection. The equal hematocrit averages of dogs either carrying or not the disease suggests that the infected animals, especially the seemingly healthy dogs, are subclinical or chronic carriers, either asymptomatic or otherwise, that are adapted to the disease, which may contribute to the agent remaining in this population. The fact that no clinical sign of hematological change was significant for the infection may demonstrate the low pathogenicity of this agent in the evaluated population. The semi-restricted condition of the dogs as a risk factor is probably due to the increased exposure of these animals to canine babesiosis vectors during their movement through different neighborhood areas and villages in the municipality. The combination of diagnostic methods is important to identify the infection and determine its prevalence in epidemiological studies. Also, PCR was fundamental in this study, to identify the infection in asymptomatic dogs

Atuação do Programa de Extensão “Centro Colaborador de Alimentação e Nutrição Escolar – CECANE-UNIRIO” durante a pandemia pela Covid-19

A pandemia do novo coronavírus levou a necessidade de adaptações na execução do Programa Nacional de Alimentação Escolar (PNAE). Nesse sentido, o Fundo Nacional de Desenvolvimento para Educação (FNDE) por meio de leis e normativas, autorizou a distribuição de kits de gêneros alimentícios de modo a assegurar a Segurança Alimentar e Nutricional (SAN) e o Direito Humano à Alimentação Adequada (DHAA) ao alunado. Dessa forma, considerando os desafios impostos pela Covid-19, o presente artigo tem como objetivo mostrar as modificações para o cumprimento do PNAE e as ações do CECANE-UNIRIO durante este período. As atividades de formação para atores sociais, assim como a assessoria e o monitoramento às Entidades Executoras (EEx) ocorreram de maneira remota, da mesma maneira que outras atividades nas quais o programa de extensão esteve envolvido para além do plano de trabalho. De modo geral, as atividades desenvolvidas disseminaram conhecimento para a comunidade como um todo

Telessaúde Covid: caracterização sociodemográfica, clínico-epidemiológica e indicadores do telemonitoramento em Viçosa-MG

Em 2020, a Universidade Federal de Viçosa e a Gestão Municipal implementaram o projeto de extensão Telessaúde Covid para o enfrentamento da pandemia. O objetivo é fazer uma análise descritiva dos quatorze meses de atuação do projeto. Realizou-se análise descritiva da caracterização sociodemográfica, clínico-epidemiológica e indicadores do serviço. Foram atendidos 6.898 pacientes, predominando o gênero feminino e adultos jovens. Os sinais e sintomas mais frequentes foram cefaleia, tosse, coriza, dor de garganta, dor muscular e febre. O RT-PCR foi o teste realizado pela maioria e 31,6% dos pacientes foram positivos. O serviço concluiu o encerramento de 91,5% dos atendimentos. O Telessaúde Covid foi relevante para o contingenciamento da Covid-19, com número expressivo de atendimentos, e contemplou a missão social da universidade pública, transformando o modelo assistencial e reorientando o processo de formação e ação profissional de estudantes e profissionais de saúde