Neonatal severity indicators in dogs / Indicadores de severidade neonatal em cães

Despite the increasing interest for canine neonatology many aspects of canine neonatology are still not completely studied and perinatal mortality rates are high. The identification of newborn puppies at high risk at birth/hospitalization is the main goal in advancing veterinary neonatology, as well as the improvement of newborn assessment protocols. The identification of at risk puppies should rely on objective indicators of severity, allowing a differentiated clinical assistance according to neonatal conditions and allowing canine perinatal mortality reduce. This paper presents and discuss the neonatal severity indicators presently useful in the dog, as demonstrated by the specific scientific literature. Among them, some can be used only at birth, others only during the subsequent neonatal period and some useful at both times. Despite the availability of some useful severity indicators, the development of severity score systems are considered necessary also in dogs as in humans.

Laparoscopic bowel resection of deep infiltrating endometriosis: comparative outcomes of a public teaching hospital and a referral private hospital

Purpose To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. Methods The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. Results One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p 0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p 0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p 0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). Conclusion Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.(AU)

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

BackgroundCryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.MethodsThis cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.ResultsFifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O).ConclusionsWe strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)

The Glasgow Prognostic Score. An useful tool to predict survival in patients with advanced esophageal squamous cell carcinoma

To evaluate the usefulness of the Glasgow Prognostic Score (GPS) in patients with esophageal carcinoma (EC). A total of 50 patients with EC were analyzed for GPS, nutritional and clinicopathologic parameters. Patients with CRP ≤ 1.0mg/L and albumin ≥ 3.5mg/L were considered as GPS=0. Patients with only CRP increased or albumin decreased were classified as GPS=1 and patients with CRP > 1.0mg/L and albumin < 3.5mg/L were considered as GPS=2.RESULTS: GPS of 0, 1 and 2 were observed in seven, 23 and 20 patients, respectively. A significant inverse relationship was observed between GPS scores and the survival rate. The survival rate was greatest in patients with GPS=0 and significantly higher than those from patients with GPS=1 and GPS=2. Minimum 12-month survival was observed in 71% patients with GPS=0 and in 30% patients with GPS=1. None of the patients with GPS=2 survived for 12 months. A significant relationship between CRP or albumin individually and the survival rate was observed. No significant relationship among nutritional, clinic pathological parameters and survival was found. Glasgow Prognostic Score is an useful tool to predict survival in patients with esophageal carcinoma.(AU)

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.

Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies

PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.(AU)

Avaliação da associação vincristina-ivermectina no tratamento do tumor venéreo transmissível canino

O tumor venéreo transmissível (TVT) é uma doença neoplásica de células redondas que afeta principalmente o sistema genital de cães. A vincristina é considerada a droga de primeira escolha no tratamento, no entanto, nos últimos anos, vários casos de resistência foram relatados, bem como múltiplos efeitos colaterais causados por essa droga. Portanto, o uso de novos medicamentos ou novas combinações tem sido estudado, como a associação de vincristina e ivermectina (que é um fármaco que funciona como um inibidor da glicoproteína-P), buscando reduzir os efeitos colaterais da vincristina. O objetivo deste estudo foi avaliar a eficiência da combinação de vincristina e ivermectina no tratamento de cães naturalmente infectados com TVT. Também avaliamos a duração do tratamento, o número de aplicações de quimioterapia e os efeitos colaterais causados por este protocolo quimioterápico. Quarenta e um cães naturalmente infectados pelo TVT foram tratados no HOSPMEV-UFBA durante um período de 19 meses. Dentro destes quarenta e um, realizamos um estudo experimental com vinte animais. Foram alocados dez cães em dois grupos, aleatoriamente: o grupo controle (G-Vin) (n = 10) foi tratado apenas com vincristina a cada sete dias na dose de 0,5 mg / m² IV, e o grupo experimental (G-Iv/Vin) (n = 10) foi tratado com vincristina em a mesma dosagem e intervalo, juntamente com ivermectina SC, em torno de 24-48 horas antes da administração de vincristina, a cada quinze dias. Todos os cães foram acompanhados semanalmente por exame clínico, hemograma completo e análise citológica até o desaparecimento do tumor. No G-Vin 3 (3/10) dos cães apresentavam tumor do tipo linfocitoide, 2 (2/10) apresentavam tumor do tipo misto e 5 (5/10) apresentavam tumor do tipo plasmocitoides; no G-Iv/Vin 1 (1/10) apresentou tumor tipo linfocitoide, 3 (3/10) do tipo misto e 6 (6/10) do tipo plasmocitóide. Não houve diferença entre o tempo do tratamento entre os dois grupos (p = 0,48) e as doses necessárias de vincristina para remissão total do tumor (p = 0,80). No entanto, em cães do G-Vin, houve uma queda significativa nos valores de leucócitos totais quando comparados antes e após o tratamento, o que não ocorreu com os cães do G-Iv/Vin. Concluímos que existem benefícios terapêuticos da associação da ivermectina à vincristina para o tratamento do TVT, uma vez que houve redução da citotoxicidade do protocolo com a associação dos dois fármacos, não comprometendo o sucesso do tratamento. Sugerimos novos estudos, com maior número de animais, avaliar diferença estatística entre os grupos.

The transmissible venereal tumor (TVT) is a round cells neoplastic disease that mostly affects the genital system of dogs. Vincristine is considered the first-line drug in the treatment, however in recent years, several cases of resistance have been reported, as well as multiple side-effects caused by this drug. Therefore, the use of new medications or new combinations have been studied, such as the association of vincristine and ivermectin (which is a drug that works as a P-glycoprotein inhibitor), seeking to reduce vincristine side-effects. The aim of this study was to evaluate the efficiency of the combination of vincristine and ivermectin in the treatment of dogs naturally infected with TVT. We also assessed, the treatment length, the number of chemotherapy applications and the side effects caused by this chemotherapy protocol. Forty-one dogs naturally infected by TVT were treated at HOSPMEV-UFBA during a 19-month period. Within these forty-one, we conducted an experimental study with twenty animals. We allocated ten dogs in two groups, randomly: the control group (G-Vin) (n=10) was treated only with vincristine every seven days at a dose of 0.5 mg / m² IV, whether the experimental group (G-Iv/Vin) (n=10) was treated with vincristine at the same dosage and interval along with ivermectin IM, around 24-48 hours prior to vincristine administration, every fifteen days. All dogs were followed weekly by clinical examination, complete blood count and cytological analysis until tumor disappearance. In the G-Vin 3 (3/10) dogs presented lymphocyte type tumor, 2 (2/10) presented mixed type tumor and 5 (5/10) presented plasmacytoid type tumor; in the G-Iv/Vin 1 (1/10) presented lymphocyte type tumor, 3 (3/10) of the mixed type and 6 (6/10) of the plasmacytoid type. There was no difference between treatment length between the two groups (p = 0.48) and the required doses of vincristine to total tumor remission (p = 0.80). However, in dogs from the G-Vin, there was a significant drop in total leukocyte values when comparing before and after the treatment, which did not occur with the dogs from the G-Iv/Vin. We concluded that there are therapeutic benefits of associating ivermectin with vincristine for TVT treatment, since there was a reduction of the cytotoxicity of the protocol with the association of the two drugs, not jeopardizing the success of the treatment. We suggest further studies, with a greater number of animals, evaluate statistical difference between groups.

On-farm broiler welfare assessment and associated training

Around the world, people who care for animals as stock keepers, stockmen, farmers, producers are placed in a position where they can greatly influence the quality of life of the animals they manage. This is particularly true in broiler chickens, where large numbers of animals can be cared for by comparatively small numbers of people. There is an international progression to start to assess poultry welfare on farm by looking at the animals themselves using (Animal Based Measures ABMs) rather than by looking exclusively at the resources provided (space, light heat, litter material - Resource Based Measures RBM's). In general, the areas being assessed are: Are the animals properly fed and supplied with water? Are the animals properly housed? Are the animals healthy? Can the animals express a range of behaviours and emotional states? Different types of organisations are starting to use ABM's - Government inspection bodies - for example state veterinary staff, Research institutes - wishing to use standardized assessment methods for research, Animal Welfare NGO's, Farm assurance companies and Legislators. The WelfareQualityNetwork® (WQN) http://www.welfarequality.net/everyone has described ABM's which address twelve health and welfare criteria and has tested them on a large number of farms across Europe. Some examples from this assessment scheme are described.(AU)

On-farm broiler welfare assessment and associated training

Around the world, people who care for animals as stock keepers, stockmen, farmers, producers are placed in a position where they can greatly influence the quality of life of the animals they manage. This is particularly true in broiler chickens, where large numbers of animals can be cared for by comparatively small numbers of people. There is an international progression to start to assess poultry welfare on farm by looking at the animals themselves using (Animal Based Measures ABMs) rather than by looking exclusively at the resources provided (space, light heat, litter material - Resource Based Measures RBM's). In general, the areas being assessed are: Are the animals properly fed and supplied with water? Are the animals properly housed? Are the animals healthy? Can the animals express a range of behaviours and emotional states? Different types of organisations are starting to use ABM's - Government inspection bodies - for example state veterinary staff, Research institutes - wishing to use standardized assessment methods for research, Animal Welfare NGO's, Farm assurance companies and Legislators. The WelfareQualityNetwork® (WQN) http://www.welfarequality.net/everyone has described ABM's which address twelve health and welfare criteria and has tested them on a large number of farms across Europe. Some examples from this assessment scheme are described.