Apresentação clínica, achados histológicos e prognóstico em cadelas com neoplasias mamárias mistas

The aim of this study was to describe the clinical and morphological characteristics of mixed mammary neoplasms and verify what characteristics affect the prognosis of female dogs with carcinomas in mixed tumors and carcinosarcomas. This was a retrospective study of 67 female dogs that underwent mastectomies and were diagnosed with benign mixed tumors (n=13), carcinomas in mixed tumors (n=44) and carcinosarcomas (n=10). Data regarding the clinical and histological aspects of the neoplasms were collected and the relation with specific survival times, and hazard ratios (HR) in 24 months was calculated. In univariate analysis, the diagnosis of carcinosarcoma (HR 8.26, p=0.006), carcinomatous areas with micropapillary or solid patterns (HR 17.49; p=0. 001) and lymph node metastasis (HR 7.07;p=0.020) were associated with specific survival. In multivariable analysis, only micropapillary or solid pattern (HR=16.34; p=0.007) remained independent factor associated with lower specific survival. Micropapillary or solid carcinomatous patterns were associated with shorter specific survival time (p=0.002) among animals with carcinomas in mixed tumors. Among the carcinosarcomas, lymph node metastasis (p=0.010) was associated with a shorter specific survival time. In conclusion, carcinomas in mixed tumors and carcinosarcomas vary in prognosis depending on the carcinomatous proliferation patterns and spread of the disease.O objetivo deste estudo foi descrever as características clínicas e morfológicas das neoplasias mamárias mistas e verificar quais características interferem no prognóstico de cadelas com carcinomas em tumores mistos e carcinossarcomas. Este foi um estudo retrospectivo de 67 cadelas, que foram submetidas a mastectomias e diagnosticadas com tumores mistos benignos (n = 13), carcinomas em tumores mistos (n = 44) e carcinossarcomas (n = 10). Foram coletados dados sobre os aspectos clínicos e histológicos das neoplasias e a relação com o tempo de sobrevida específica e a razão de risco (OR) em 24 meses foram calculadas. Na análise univariada, o diagnóstico de carcinossarcoma (HR 8,26; p=0,006), as áreas carcinomatosas com padrão micropapilar e sólido (HR 17,49; p= 0,001) e metástase linfonodal (HR 7,07; p=0,020) foram associadas à menor sobrevida específica. Na análise multivariável, apenas o padrão micropapilar ou sólido (HR=16,34; p=0,007) permaneceu como fator independente associado à sobrevida. Proliferações carcinomatosas micropapilares ou sólidas (p = 0,002) foram associadas a tempos de sobrevida específica mais curtos entre os animais com carcinomas em tumor misto. Entre os pacientes com carcinossarcoma, metástases em linfonodos (p = 0,010) foram associadas a um menor tempo de sobrevida específica. Em conclusão, os resultados mostraram que os carcinomas em tumores mistos e os carcinossarcomas podem ter prognóstico variável, dependendo do padrão de proliferação carcinomatosa e da disseminação linfática da doença

Controle da dor no paciente oncológico

O câncer é a maior causa de morbidade e mortalidade em animais de companhia idosos, além de causar a chamada dor crônica. Grande parte dos pacientes humanos com câncer relatar dor, e muitos morrem sem receber o tratamento adequado. Não há uma estatística sobre animais, mas pelas semelhanças do sistema nocioceptivo, pode-se deduzir que grande parte dos animais com câncer sofre com dor. A dor fisiológica ajuda a proteger o local da ferida e, na medida em que causa uma reação de proteção do local, impede uma maior lesão tecidual. Estados dolorosos prolongados induzem alterações que aumentam os efeitos deletérios da dor crônica, sem a função de proteção, introduzindo então o conceito de dor patológica. A dor pode ainda ser classificada em aguda ou crônica, nocioceptiva ou neuropática. A classificação é importante para que se possa implementar o tratamento mais adequado e eficiente a cada caso. A avaliação das diversas alterações fisiológicas e comportamentais pode ser utilizada para reconhecer que um animal sente dor. Além disso, existem escalas e questionários, como a escala HHHHHMM (VILLALOBOS, 2011) e a escala para avaliação da qualidade de vida validada para cães com sinais de dor secundária ao câncer (YAZBEK, 2005), que podem ajudar no reconhecimento da dor, bem como na avaliação da eficácia do tratamento. A dor pode ser tratada com diversos fármacos, como anti-inflamatórios e opioides. Anticonvulsivantes, antidepressivos e tranquilizantes também podem atuar como adjuvantes no controle da dor. Em casos mais complicados, pode-se fazer uso de bloqueios neurológicos e cirurgias para o controle da dor. E há ainda outras terapias alternativas, como os nutracêuticos e a acupuntura, que podem contribuir para o controle da dor e melhora da qualidade de vida do paciente oncológico.Cancer is the major cause of death on elderly animals, besides it causes chronic pain. Most human patients with cancer report pain, and many die without receiving adequate treatment. There are no statistics on animals, but by the similarities on the nocioceptive system, one can deduce that most animals with cancer suffer with pain. The physiological pain helps to protect the wound site and prevents further tissue injury. Prolonged painful states induce changes that increase the deleterious effects of chronic pain, without the protection function, then introducing the concept of pathological pain. The pain can be further classified as acute or chronic, neuropathic or nocioceptive. The classification becomes important so that it helps to implement the most efficient and appropriate treatment for each case. The evaluation of the different physiological and behavioral changes can be used to recognize that an animal feels pain. In addition, there are scales and questionnaires, as the HHHHHMM scale (VILLALOBOS, 2011) and the health-related quality of life scale for dogs with signs of of pain secondary to cancer (YAZBEK, 2005), which may help in the recognition of pain as well as evaluating the effectiveness of treatment. The pain can be treated with several drugs such as anti-inflammatory and opioids. Anticonvulsants, antidepressants and tranquilizers can act as adjuvants in pain management. In more complicated cases, one can make use of neurological locks and surgery for pain control. There are other alternative therapies such as nutraceuticals and acupuncture, which may contribute to pain control and improved quality of life of cancer patients

Genetic relatedness, virulence factors and antimicrobial resistance of C. difficile strains from hospitalized patients in a multicentric study in Brazil

Background: Clostridium (Clostridioides) difficile infection (CDI) is recognized worldwide as a public health concern, related mainly with hypervirulent strains. In Brazil there are few studies about molecular epidemiology of C. difficile, for this reason, we aimed to characterize C. difficile isolates from a large cohort study of three different Brazilian states to identify virulence and resistance genes, specifically genes related to metronidazole and vancomycin resistance. Methods: All 153 fecal samples were submitted to C. difficile culture in CM0601 broth. Identification of suspected colonies was confirmed by matrix-assisted laser desorption/ionization (MALDI-TOF/MS, Brucker Daltonics, Germany). The tcdA and tcdB toxin were searched by PCR. The sequence type (ST) was determinate by multilocus sequencing typing (MLST) and susceptibility profile was performed by agar dilution method. Results: Among the 16 isolates, we identified fourteen different STs, five belonging to Clade 1, one to Clade 2 and eight news STs with high similarity levels. Resistance (ermB, tetM, VanW and nimB) and virulence genes (cwp84, cwp66, cwp2, fbpA and secA) were found in toxigenic strains. Conclusion: Differently from other studies, we found high levels of resistance to vancomycin. These results suggest that the main circulating strains in Brazil belong to Clade 1 and have high pathogenicity and resistance profile