Dysautonomia in a Bitch with Hypothyroidism

Background: Thyroid hormones have important effects on the cardiovascular system, of which the main ones are the increase in the heart response to the autonomic sympathetic nervous system. Heart rate variability is a non-invasive method of assessing autonomic heart modulation, thus being an important form of evaluation in patients with thyroid dysfunctions. This study aimed to report electrocardiographic and heart rate variability data of a dog with hypothyroidism that presented a parasympathetic dysfunction.Case: A 7-year-old female Dalmatian dog was admitted for clinical evaluation in Fortaleza, Brazil. According to the owner, she had been apathetic for a year, had gained weight, always had a sad expression, and her hair was generally brittle and opaque. On physical examination, skin lesions were observed at the end of the spine, extending to the tail region, with the latter showing total alopecia. Low T4 levels confirmed the diagnosis of primary hypothyroidism. Then, a 24-h Holter monitoring was performed, which showed that the animal had sinus arrhythmia associated with moments of second-degree sinoatrial block and rare moments of sinus tachycardia. In addition, moments of premature multifocal ventricular extrasystoles and 1st-degree atrioventricular block were observed. Based on the Holter results, heart rate variability (HRV) was calculated. Regarding the HRV in the frequency domain, 32.16 was obtained in the low frequency (LF) band, 67.84 in the high frequency (HF) band, and the LF / HF ratio was 0.46, with a total power of 5205. As for the HRV in the time domain, RMSSD was 117, pNN50 was 62.64 and SDNN was 384. This showed an increase in the parasympathetic activity of the heart and, due to this increased activity, a second-degree sinoatrial block occurred, which is a sinus function disturbance resulting from the exacerbated parasympathetic activity.Discussion: Beta-adrenergic receptors have their expression and activity altered by thyroid hormones. The sympathetic stimulation on the heart through the activation of these receptors originates a positive inotropic, lusitropic, dromotropic and chronotropic effect. Therefore, in the absence of thyroid hormones, there is a decrease in this stimulation, thus allowing a preponderant parasympathetic tone. In the present report, the increase in the parasympathetic tonus, observed in hypothyroidism, resulted in a reduction in the frequency of sinus firing, slowing of intranodal and sinoatrial conduction, and shortening of the effective refractory period, a combination of factors that led to decreased HR observed in the Holter monitoring. Previous studies have shown that thyroid hormones increase sympathetic activity, mainly in the heart, since they do not act by increasing the production or release of catecholamines, but rather increasing catecholamine response on the heart, due to a positive regulation of Ca2+-ATPase channels of the sarcoplasmic reticulum and beta1-adrenergic receptors. Thus, the observed result was already expected, because in hypothyroidism there is a decrease in these hormones that increase the sympathetic activity on the heart and so, the parasympathetic tone was very evident. The study of heart rate variability allows the simple assessment of the autonomic nervous system imbalance, and may be extremely important in the follow-up of diseases that affect this balance, such as hypothyroidism. Hence, more studies are required to verify the effect of such diseases on heart rate variability, aiming to define associations between the diseases and the alterations, as well as to define parameters of normality for such examinations

Mieloma múltiplo em uma cadela de 10 anos

Background: The malignant neoplasms, in general, constitute one of the main causes of death in dogs and cats. The multiple myeloma is a neoplasm characterized by the monoclonal proliferation of plasma cells in the bone marrow, causing several systemic symptoms and it is rare in pets, representing less than 1% of the malignant neoplasms in these animals. It usually occurs in older dogs. Thus, the purpose of this report was to describe a case of multiple myeloma in a 10-year-old poodle dog, occurred in the Veterinary Hospital Unit of the State University of Ceará.Case: A 10-year-old Poodle bitch was admitted in the Veterinary Hospital Unit of the State University of Ceará presenting lump erythematosus, alopecic, soft and ulcers in the region of the digits of the left front leg, pain and lameness. The blood count evidenced normocytic and normochromic anemia, presence of rouleaux, lymphopenia and monocytopenia, and the biochemical exams have demonstrated an elevated value of alanine aminotransferase (ALT). The cytology of the nodule indicated probable diagnosis of plasma cell neoplasm and radiographic examination showed the presence of bone lysis, and therefore the patient underwent amputation of the affected limb surgery. A biopsy of the nodule indicated neoplastic proliferation, with an arrange compatible to plasmacytoma of cleaved type. A follow-up consultation was realized 30 days after surgery, and 2 new nodules appeared in the superior lip region and close to the surgery site. A new blood count indicated anemia with presence of rouleaux, thrombocytopenia, leucopenia, lymphopenia and monocytopenia, and the biochemical results showed a discrete diminution of aspartate aminotransferase(AST) and a considerable increase on the alkaline phosphatase levels. The cytology of the new nodules indicated plasmacytoma, and was realized a myelogram, that showed dysplastic marrow plasma cells, with more than 20% of plasma cells.Discussion: In the present case, the patient’s lump grew rapidly with bleeding and ulcer formation. The animal presented bone involvement, which characterizes the most suggestive sign of multiple myeloma. Justified by the stimulating factor of osteoclasts, promoting bone lysis, which can cause pathological fractures and pain. The amputation was a partial treatment to attenuates the discomfort and pain presented by the patient. The appearance of new nodules stimulated a more detailed investigation for multiple myeloma. The enzyme AST presented a discrete diminution, and ALT initially was higher than normal, but then returned to normal values. So, the elevated activity of alkaline phosphatase directed the suspects to multiple myeloma, since the activity of AST and ALT was normal, the alkaline phosphatase level was ligated to bone diseases. The rouleaux was constant at the hemograms, this is justified by the excess of immunoglobulins produced in marrow. Based on the chart presented by the patient, the bone marrow was punctured for myelogram. The symptoms displayed by the animal along with the cytological analysis, histopathological, hematological, biochemical and with myelogram indicated diagnosis of multiple myeloma. Other exams could be investigated, for example, detection of Bence Jones proteinuria, serum calcium dosage and inmunoelectroforesis for determination of the type of immunoglobulin produced by the plasma cells in the bone marrow. The definitive diagnostic was established approximately three months after the first consult, emphasizing the importance of a multiple myeloma differential diagnostic in case of plasma cell neoplasm

Minimum Dose of Levothyroxine Restored the Autonomic Balance on a Dalmatian Female Dog with Primary Hypothyroidism

Background: Hypothyroidism is an endocrine disease that leads to a reduction in the hormones thyroxine (T3) and triiodothyronine (T4), which therapy with levothyroxine restores the clinical signs related to the metabolic rate. Due to the influence of thyroid hormones on the heart, which is under the constant influence of the autonomic nervous system (ANS), dogs with hypothyroidism can develop bradycardia, arrhythmia, and dysautonomia.  Heart rate variability (HRV) assesses autonomic modulation by the Holter method, which is scarce in dogs. We aimed to report the cardiac and autonomic effects of the primary hypothyroidism untreated and treated with levothyroxine in a canine case by Holter monitoring.Case: A 7-year-old female Dalmatian, weighing 36 kg, was referred for clinical evaluation due to apathy, weight gain, low hair quality, and lethargy. On physical examination, alopecic lesions on the hind limbs and tail, as well as bradycardia with a heart rate (HR) of 40-50 beats per minute (bpm) were observed, in addition to a 3/6 mitral murmur and 2/6 tricuspid murmur. Given the suspicion of thyroid gland disorder, the blood hormonal measurement revealed an increase in thyroid-stimulating hormone (TSH; 0.65 ng/mL) and a decrease in free T4 (0.11 ng/mL) and total T4 (0.44 ng/mL), confirming primary hypothyroidism. Therapy was started with a minimum dose of levothyroxine (0.913 mg, every 12 h), which clinical signs were restored in five months of treatment, with weight loss, hair growth, and active behavior. To assess the impact of untreated and treated hypothyroidism on the patient’s ANS, a Holter monitoring exam was performed for 24 h before and after therapy. Before treatment, the average HR was 75 bpm, and the HR<50 bpm occurred during 05 h 20 min 36 s. Still, 320 pause events (>2.0s), 1st-degree atrioventricular blocks (AVB), six ventricular ectopias events, and 2nd-degree sinoatrial block (SAB) were also observed. The ANS parasympathetic tone was significantly stimulated, highlighting bradycardia, arrhythmia, and dysautonomia. After five months of treatment with levothyroxine, the average HR was 89 bpm, and the HR<50 bpm occurred during 02 h 06 min 13 s. No ventricular pauses, blocks, or ectopias were observed, showing the stimulation of sympathetic tonus, which restored HR and ANS balance. Still, it was observed that the minimum levothyroxine dose corrected cardiac changes by increasing the low frequency (LF), decreasing the high frequency (HF), and, consequently, increasing the LF/HF ratio, normalizing the frequency conditions in HRV.Discussion: In the frequency index, HF indicates the vagal activity, whereas LF indicates both systems with parasympathetic predominance. Before treatment, the dog had a low LF/HF ratio (0.46), indicating dysautonomia with parasympathetic stimulation. After therapy, the conditions of bradycardia and functional cardiac capacity were corrected, restoring ANS, due to the serum recovery of thyroid hormones. This study reported the cardiac and autonomic effects of primary hypothyroidism untreated and treated with levothyroxine on a dog, that had intense bradycardia and abnormal stimulation of the parasympathetic tone, associated with episodes of 1st-degree AVB, ventricular ectopias, and 2nd-degree SAB. After therapy with a minimum dose of levothyroxine, there was a decrease in parasympathetic activity and an increase in sympathetic stimulus, correcting cardiac changes, and restoring the balance of ANS. As it is a simple, non-invasive, and safe tool that helps the clinician to understand cardiac autonomic modulation, it is recommended to adopt the Holter monitoring exam in cases of hypothyroidism cases to assess sympathetic-vagal balance and check potential cardiac risks

Anatomical Description of the Forelimb Muscles of the Brown-Throated Sloth (Bradypus variegatus)

Background: Brown-throated sloths are mammals of the order Xenarthra, suborder Pilosa, family Bradypodidae. These folivorous and arboreal animals, which possess a peculiar type of arboreal quadrupedalism, move through the forest canopy by means of suspensory locomotion. On the ground, their extremely slow movements make them easy targets for road accidents, often leading to serious injury or even death. This paper describes the forelimb muscles of the brown-throated sloth (Bradypus variegatus), updating the literature on the subject to help veterinarians in clinical and surgical interventions on this species, and to provide data for comparative animal anatomy.Materials, Methods & Results: Five brown-throated sloths (Bradypus variegatus Schinz, 1825), two adults and three babies were dissected. The animals were donated by the Arruda Câmara Zoo and Botanical Park in João Pessoa, state of Paraíba, Brazil, where they were thawed and fixed in 10% formalin. The sloths’ forelimbs were dissected by lifting and folding over a skin flap to expose, identify and describe the underlying musculature. The dissection revealed the following muscles: supraspinatus, infraspinatus, deltoideus, teres major, subscapularis, coracobrachialis, brachialis, biceps brachii, triceps brachii, anconeus epitrochlearis, dorsoepitrochlearis, brachioradialis, supinator, pronator teres, pronator quadratus, extensor carpi radialis, extensor carpi ulnaris, extensor carpi obliquus, flexor carpi radialis, flexor carpi ulnaris, extensor digitorum communis, extensor digitorum lateralis, palmaris longus, flexor digitorum superficialis, flexor digitorum profundus, extensor indicis longus second finger, extensor indicis brevis second finger, extensor digitorum third finger, abductor digitorum second finger, abductor digitorum third finger, palmaris brevis, and interosseous muscles. Characteristics found in this species revealed differences in the muscular development of the upper forelimb, whose muscles are less developed than those of the lower forelimb, which are visibly more developed with greater muscle density. An interesting feature of this musculature is the presence of three flexor tendons, short and thick, originating from the flexor muscles, which give the hand of the brown-throated sloth a hook-like aspect.Discussion: Our observations indicate that some of the muscles are very similar to those of other animals of this order and also of domestic mammals. However, the most relevant characteristics resemble those of arboreal animals and humans, since the forearm and hand pronation and supination muscles are essential for their arboreal habits. Therefore, all the pronator and supinator muscles of the brown-throated sloth are well developed. Due to the functional adaptations of the species of the family Bradypodidae, the shoulder muscles, especially the deltoideus, are more developed, providing greater support to the shoulder joint, and their origin and insertion assist in faster and easier movements, albeit exerting less force. The group of flexor muscles in this species gives the forearm stronger and more concentrated action than the extensor muscles. This study enabled us not only to produce a more precise description of the muscles of the forelimb of this species but also to update the literature, since there are few relevant studies on the subject and the terms in the literature are outdated and no longer in use. Keywords: sloth, Bradypodidae, morp

Aspectos anatômicos e morfométricos do crânio de maracanã-pequena – Diopsittaca nobilis Linnaeus, 1758

As aves da ordem Psittaciformes estão entre as mais criadas como pet, o que consequentemente aumenta a procura por atendimento médico veterinário especializado em aves e, para tal, o estudo e conhecimento da anatomia destes animais se torna essencial.De outra forma, a morfologia craniana é fundamental naidentificação de espécie de animais com características morfológicas externas semelhantes. Buscou-se obter dados referentes ao crânio de Diopsittaca nobilis, para contribuir com o conhecimento anatômico desta espécie. O presente estudo foi realizado com 3 crânios de Diopsittaca nobilis, que foram preparados através de dissecação e maceração controlada com água. Apesar do processo natural de fusão, puderam ser identificados ossos e estruturas do crânio com suas particularidades. Realizou-se também mensurações dos crânios, onde a média da largura máxima do crânio foi de 28,70mm e do comprimento do crânio sem a ranfoteca foi de 36,16mm. Os dados obtidos contribuem para a melhor caracterização da espécie

Uso de benzodiazepínicos por idosos: Sonolência diurna excessiva, instabilidade postural e adequação da prescrição na Estratégia de Saúde da Família

Este estudo teve por objetivo investigar capacidade cognitiva, sonolência diurna excessiva, coordenação motora e instabilidade postural entre idosos usuários de benzodiazepínicos comparando-os com idosos não usuários e verificar adequação das prescrições deste psicotrópico por profissionais da Estratégia de Saúde da Família. Trata-se de um estudo comparativo entre idosos de três Unidades de Saúde de Montes Claros – MG. Dados coletados por pesquisadores calibrados utilizando instrumentos validados para uso no Brasil. Participaram 58 usuários e 232 não usuários deste psicotrópico. Registrou-se associação entre uso de benzodiazepínico e: sonolência diurna excessiva (p=0,039) e instabilidade postural (p=0,011). A prescrição mostrou-se inadequada quanto: período de uso, dosagem e tipo de benzodiazepínico prescrito. Os registros norteiam para a necessidade de ponderar os impactos do uso de benzodiazepínicos entre idosos, principalmente no que se refere à sonolência diurna excessiva e à instabilidade postural, bem como adequação dos profissionais da Estratégia de Saúde da Família quanto à prescrição deste fármaco.

Fatores associados às internações infantis por condições sensíveis à atenção primária no Brasil: estudo ecológico

Objetivo. Identificar a associação da estrutura das unidades básicas de saúde (UBS) e do processo de trabalho das equipes de atenção primária com determinantes sociais e taxas de internações por condições sensíveis à atenção primária (ICSAP) em menores de 5 anos no Brasil. Métodos. Estudo longitudinal ecológico, com dados secundários do Sistema de Informações Hospitalares e dos três ciclos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) (2012, 2014, 2017/2018). Foram analisadas 42 916 UBS. Foi realizada modelagem multinível com angulação fixa e intercepto aleatório. No primeiro nível, foram analisados o desfecho (taxas de ICSAP) e as variáveis explicativas (indicadores estruturais e processuais), agregados por UBS. No segundo nível, foram incluídos determinantes sociais municipais (representados por critério de estratificação que combina o porte do município com indicadores que influenciam a gestão de saúde). Utilizou-se o teste t com correção de Bonferroni para comparar as médias dos indicadores entre as regiões, e a regressão linear multinível para estimar os coeficientes de correlação. Resultados. A taxa de ICSAP em menores de 5 anos foi de 62,78/100 mil habitantes por área estimada de cobertura de UBS. Apresentaram associação direta com o desfecho: participação em um ou mais ciclos do PMAQ-AB; planejamento da equipe; horário especial; dependências para atenção infantil na unidade; e disponibilidade de vacinas. A variável equipamentos, materiais e insumos e a classificação como município de porte pequeno ou médio associaram-se inversamente às ICSAP. Conclusões. As ICSAP em menores de 5 anos podem ser potencialmente reduzidas pela melhoria dos indicadores estruturais e processuais das UBS e dos determinantes sociais municipais

Obtenção de oócitos em cadelas e gatas submetidas a ovariosalpingohisterectomia

A utilização de técnicas modernas para aplicação na área da reprodução cresce cada vez mais na medicina veterinária e com isso se fazem necessários estudos que avaliem a eficiência destas técnicas. Devido à localização cortical dos folículos dentro do ovário, a técnica mais adequada para obtenção dos oócitos caninos é o Slicing, o qual apresenta melhores resultados em relação a quantidade de oócitos coletados quando comparado com outras técnicas. Buscou-se com este estudo, verificar a qualidade dos oócitos coletados em ovários de cadelas e gatas com diferentes idades que foram submetidas à procedimento de Ovário Salpingo Histerectomia (OSH) no Hospital Veterinário da Universidade Federal de Campina Grande. Os oócitos foram classificados quanto a sua qualidade com relação a morfologia do complexo cumulus oophorus. A idade e a fase estral em que as cadelas e gatas se encontravam no momento da coleta não influenciou na qualidade e quantidade dos oócitos coletados

Lobation and bronchopulmonary segmentation of Callithrix jacchus (Linnaeus, 1758)

<div><p>Abstract The common marmoset (Callithrix jacchus) are small primates belonging to the family Cebidae, subfamily Callitrichinae and are the most well-known and common in adaptation to captivity. The scarcity of data in the literature on the anatomy of these marmosets and wild animals hinders the application of appropriate anesthetic and surgical procedures and therapeutics. In order to understand the anatomic variations in the lobation and bronchopulmonary segmentation the lungs were dissected from nine adult common marmoset (Callithrix jacchus) corpses, five males and four females. In the marmosets, the right lung presented cranial lobe, middle lobe, caudal lobe and accessory lobe while the left lung presented cranial and caudal lobes. The fissures were very pro-eminent in both the lungs. The main right bronchus emitted independent branches, one for each lobe, and it followed in a straight line in the caudal lobe as a continuation of this bronchus and the same was observed in the main left bronchus. The bronchopulmonary segmentation in the right lung ranged from one to five branches in the cranial lobe; the middle lobe had a single branch; the caudal lobe had three to five branches and the accessory lobe had three branches. In the left lung the cranial lobe bronchopulmonary segmentation ranged from one to five branches while in the caudal lobe it was three to four branches.</p></div