Meningoencephalitis of unknown origin in dogs

Background: Meningoencephalitis of unknown origin (MUO) is a critical cause of neurological disorders in dogs, mainly affecting small young individuals. Its symptomatology is varied and depends on the affected neuroanatomic region. The ante mortem diagnosis of this condition is uncertain, being achieved by discarding other conditions and often occurring definitively only by performing a necropsy. Thus, this study aims to report 2 cases of meningoencephalitis, one necrotizing and the other granulomatous in dogs. Cases: Case 1. A 3-year-old, Shih Tzu bitch with a body weight of 4 kg, showing proprioceptive ataxia, behavior of walking in circles, and evolving rapidly to non-ambulatory paresis, was treated. The neurological examination showed a posture of decerebrate stiffness and absence of withdrawal reflex and proprioception, suggesting brainstem injury. Laboratory tests showed mild neutrophilia and lymphopenia, while the rapid test for distemper was non-reactive. The cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, and the PCR tests of the CSF, blood, and urine for the detection of infectious diseases were negative, as well as the culture. With no improvement in clinical condition and exams showing a progressive degenerative condition unresponsive to available treatments, the tutor opted for euthanasia of the patient. The subsequently requested necropsy confirmed the diagnosis of granulomatous meningoencephalitis. Case 2. This case refers to a 1-year-and-5-month-old male Maltese breed weighing 4.8 kg. This animal presented walking in circles behavior and loss of vision for a week, with signs worsening rapidly. In the neurological evaluation, the patient presented sensitivity in the middle ear, difficulty opening the mouth, hearing deficit in the right ear, blindness in the right eye, a proprioceptive deficit in the right anterior limb, and head pressing. Laboratory tests showed nonregenerative anemia and mild lymphopenia. After 1 day of hospitalization, the patient showed worsening clinical condition, with obstruction, absence of facial and auricular sensitivity, and nasal stimulus. In addition, onset of generalized seizures was observed; therefore, CSF was analyzed, which did not present significant alterations except for detecting reactive lymphocytes. The bacteriological culture of CSF resulted in no bacterial growth. In addition, the same neurological PCR panel performed for the previous patient was negative. After 5 days of intensive care, the patient presented a cardiorespiratory arrest and died. The subsequently requested necropsy confirmed the diagnosis of necrotizing meningoencephalitis. Discussion: The 2 reported cases confirm that MUO should be considered during the differential diagnoses of patients with neurological alterations. It is known that small-breed dogs are predisposed to these diseases. Laboratory tests and medical imaging are crucial for clinical guidance, helping to discard other neurological pathologies, especially those due to bacterial, fungal, and/or viral agents. However, definitive diagnosis of MUO can only be performed through necropsy and histopathological analysis. For the reported cases, CSF analysis, neurological PCR panel for detecting possible infectious agents, and bacterial culture were essential to rule out other possible causes of meningoencephalitis. Unfortunately, MUO includes progressive neurological disorders causing the patient's death.

Reanimação neonatal de cães e gatos ao nascimento / Neonatal resuscitation of dogs and cats at birth

Ao nascimento, a assistência neonatal é essencial, visto que filhotes podem apresentar depressão clínica, bradicardia, apneia persistente ou desconforto respiratório devido à hipóxia, decorrente de uma asfixia prolongada no útero ou durante o parto, necessitando de intervenção imediata. A equipe de recepção ao neonato precisa estar treinada para os procedimentos de reanimação neonatal, que devem ser realizados com enfoque em prover calor ao recém-nascido e no suporte ventilatório e circulatório, mantendo as vias aéreas patentes e uma adequada perfusão tecidual. O conhecimento das características fisiológicas neonatais e das etapas a serem seguidas no protocolo de reanimação, são cruciais para o sucesso da intervenção e maior sobrevivência neonatal.(AU)

At birth, neonatal assistance is essential, since puppies may experience clinical depression, bradycardia, persistent apnea or respiratory discomfort due to hypoxia, resulting from prolonged asphyxia in the uterus or during delivery, requiring immediate intervention. The team needs to be trained in neonatal resuscitation procedures, which must be performed with a focus on providing heat to the newborn and on ventilatory and circulatory support, maintaining patent airways and adequate tissue perfusion. Knowledge of the neonatal physiological characteristics and the steps to be followed in the resuscitation protocol are crucial for the success of the intervention and greater neonatal survival.(AU)

Circus Animal Welfare: analysis through a fivedomain approach

This study aims to review the current available literature regarding circus animals from the perspective of the five domains proposed for evaluating animal welfare to identify the critical points in the use of these animals and understand how circus spectacles affect their mental state and health. Exhibiting animals in circuses continues to be a popular practice today in some countries such as Germany, Spain, or Australia. However, animals' biological needs are not always prioritized due to the inadequate diets, reduced housing spaces, deficient social interaction, and handling that predisposes them to develop stereotypies and alter mental states due to chronic stress. Animal circuses are considered a controversial practice that can decrease the welfare of animals. Understanding the possible negative consequences on animal welfare (mental state and physical health) could contribute to planning strategies to improve the quality of life of wildlife animals exhibited in circuses worldwide.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Correlation between renal ultrasonography and serum cystatin C in acute kidney disease of critically ill dogs / Correlação entre a ultrassonografia e a determinação da cistatina C sérica em cães admitidos em unidade de terapia

Acute kidney injury (AKI) is defined as the rapid decline in kidney function. Its development is related to critical clinical statuses, such as sepsis, complicated post-surgical recovery, and infectious diseases. Serum cystatin C (CysC) has the best correlation with the glomerular filtration rate. Ultrasonography stands out because it is highly accessible and can be done at the bedside. Twenty-eight dogs admitted to the intensive care unit with serum creatinine values <1.6 mg/dL and at-risk factors of AKI development were selected. CysC measurements and ultrasound assessments were performed daily for 72 hours. Using CysC dosage, 22/28 animals (78.6%) were considered to have AKI, and 17/22 had ultrasound compatible with AKI changes, demonstrating moderate agreement with CysC dosage. Increased cortical renal echogenicity is the most prevalent alteration in critically ill patients and is correlated with serum increases in CysC and is associated with renal structural damage.

A injúria renal aguda (IRA) é definida como o declínio rápido da função renal. Seu desenvolvimento está relacionado a quadros clínicos críticos, como sepse, pós-operatório complicado e doenças infecciosas. A cistatina C sérica (CisC) tem melhor correlação com taxa de filtração glomerular. A ultrassonografia se destaca por ser altamente acessível e pode ser realizada à beira do leito. Foram selecionados 28 cães, internados em unidade de terapia intensiva, com valores de creatinina sérica <1,6mg/dL e fatores de risco para o desenvolvimento de IRA. Medições de CisC e avaliações ultrassonográficas foram realizadas diariamente por 72 horas. Utilizando-se a dosagem de CisC, 22/28 animais (78,6%) foram considerados portadores de IRA e 17/22 apresentaram ultrassom compatível com alterações de IRA, demonstrando concordância moderada com a dosagem de CisC. O aumento da ecogenicidade cortical renal é a alteração mais prevalente em pacientes críticos, está correlacionado com aumentos séricos de CisC e associado a dano estrutural renal.

Complete avulsion of the hoof capsule and subsequent testicular degeneration in a criollo stallion

Background: Complete avulsion of the hoof in horses, also known as exungulation, is not a commonly reported injury and usually leads to euthanasia due to the great amount of tissue loss, intense pain, secondary complications, expensive and lengthy treatment. It can involve deep structures and cause different complications leading to chronic lameness. In stallions affected by such injury, the reproductive tract and performance may also be affected. The aim of this study was to report a case of complete avulsion of the right front hoof in a Criollo stallion and subsequent bilateral testicular degeneration. Case: A 10-year-old Criollo stallion was referred to the Veterinary Clinical Hospital of the Federal University of Pelotas (HCV- UFPel) with a complete avulsion of the left front hoof. At admission, the stallion had clinical parameters compatible with intense pain and blood loss. Evaluation of the wound demonstrated that the distal end of the third phalanx (P3) was exposed but no fracture was detected on radiological evaluation. No other structure was apparently affected. Initially, anti-inflammatory (phenylbutazone) and opioid (morphine) was given for pain control and supportive fluid therapy was started to restore hydration. Antibiotic (Sulfamethoxazole with trimethoprim) was administered for 10 days. Continued therapy with phenylbutazone, pentoxifylline, omeprazole and supplementation with methionine, biotin and zinc was also given. Local treatment was carried out by cleaning the wound, applying an antimicrobial ointment and dressing it with a bandage. Wound management was adapted according to the evolution and healing process. The stallion was kept in stall rest during its hospitalization time. In the second month after the injury, accumulation of liquid in the scrotum was observed. Clinical and ultrasound evaluation lead to a presumptive diagnosis of testicular degeneration. The stallion was discharged after three months when the wound was almost healed and the hoof had started to grow. Six month later, a follow up by the referring vet showed that the hoof was almost completely grown and the x-ray assessment demonstrated a dorsal rotation and resorption of the distal end of the third phalanx. Discussion: The stallion of this report had a complete avulsion of the hoof capsule caused by trauma. Conservative treatment was established including wound cleaning and dressing to avoid contamination, control of pain and inflammation, antimicrobial care and supplementation to support hoof growth. Time period for wound healing and hoof growth was in agreement with other cases described previously. Bone sequestrum of the distal end of the third phalanx, and detachment of a fragment were observed in this case, followed by bone resorption. The stallion was closely monitored to prevent laminitis in the contralateral limb and no alterations were detected during the treatment period. Testicular degeneration was observed, probably caused as a consequence of hoof avulsion and due to a long period of stall rest. Degenerative alterations in testicles interfere with thermoregulation and spermatogenesis, affecting semen quality and reproductive performance. Rotation of the third phalanx was also observed six months later caused by the hoof loss. In conclusion, the patient of this report had a complete regrowth of the hoof capsule although a long intensive treatment was necessary to achieve this result. As a consequence, testicles degeneration may happen impairing its function as a stallion.(AU)

Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects

The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.(AU)

Determination of the reference interval of the C-reactive protein/albumin ratio and its efficiency, CRP and albumin as prognostic markers in dogs / Determinação do intervalo de referência e da eficiência da relação proteína C-reativa/albumina, PCR e albumina como marcadores prognósticos em cães

The objective of this research was to creates a reference interval for C-reactive protein (CRP)/albumin ratio (CAR) in the canine species and to analyze the potential of CRP, albumin and the relationship between both, to serve as indicators of disease severity, length of hospital stay (LoS) and mortality in this species. For this, an outcome study was conducted in a Veterinary Teaching Hospital in southern Brazil. One hundred ninety dogs were included randomly, without distinction of gender, age, or breed, from June 2013 to November 2016. Plasma was collected from them and analyzed for assessment of CRP and albumin. The reference range stipulated for CAR in dogs was 0.36-0.60, as determined by the confidence interval of mean resamplings (in percentiles). The frequencies mean, and standard deviations of the variables, correlation analysis, and comparative analysis (Kruskal-Wallis in α = 5%) were calculated. Elevation (above reference) of CAR was determined to be proportional to the severity of the underlying disease, and CRP means were reasonable. Besides, hypoalbuminemia was indicative of systemic disease, but not of severity. Thus, CAR was a better marker of disease severity than were CRP and albumin, analyzed separately. Concerning LoS, there was a positive correlation with CAR (p<0.01) in patients, and the same was not observed with CRP and albumin. Concerning mortality, hypoalbuminemia was the only marker valid in animals with a critical illness (p=0.04). In conclusion, CAR is a better marker of disease severity and LoS in dogs than are CRP and albumin analyzed separately.(AU)

O objetivo desta pesquisa foi determinar um intervalo de referência para a relação proteína C reativa (PCR)/albumina (R:PCR/ALB) na espécie canina e analisar o potencial de PCR, albumina e a relação entre ambas como indicadores de gravidade de doença, tempo de internação (TI) e mortalidade nesta espécie. Para isso, um estudo foi realizado em um Hospital Veterinário Escola no sul do Brasil. Cento e noventa cães foram incluídos aleatoriamente, sem distinção de sexo, idade ou raça, de junho de 2013 a novembro de 2016. O plasma foi coletado e analisado para avaliação da PCR e albumina. O intervalo de referência estipulado para o R:PCR/ALB em cães foi de 0,36-0,60, conforme determinado pelo intervalo de confiança da média das reamostragens (em percentis). Foram calculadas as frequências, médias e desvios-padrões das variáveis, análises de correlação e análises comparativas (Kruskal-Wallis em α = 5%). Notou-se elevação (acima da referência) da R:PCR/ALB proporcional à gravidade da doença de base, sendo normais as médias da PCR. Adicionalmente, a hipoalbuminemia foi indicadora de doença sistêmica, mas, não de gravidade. Dessa forma, a R:PCR/ALB foi melhor indicadora de gravidade de doença do que a PCR e albumina, analisadas separadamente. Em relação ao TI, houve correlação positiva com a R:PCR/ALB (p<0,01) em doentes, não sendo observado o mesmo com a PCR e albumina. Em relação à mortalidade, a hipoalbuminemia foi a única marcadora válida em animais com doenças críticas (p=0,04). Conclui-se, portanto, que a R:PCR/ALB é melhor marcadora de gravidade de doença e TI em cães do que a PCR e albumina analisadas separadamente.(AU)

Determination of the reference interval of the C-reactive protein/albumin ratio and its efficiency, CRP and albumin as prognostic markers in dogs / Determinação do intervalo de referência e da eficiência da relação proteína C-reativa/albumina, PCR e albumina como marcadores prognósticos em cães

The objective of this research was to creates a reference interval for C-reactive protein (CRP)/albumin ratio (CAR) in the canine species and to analyze the potential of CRP, albumin and the relationship between both, to serve as indicators of disease severity, length of hospital stay (LoS) and mortality in this species. For this, an outcome study was conducted in a Veterinary Teaching Hospital in southern Brazil. One hundred ninety dogs were included randomly, without distinction of gender, age, or breed, from June 2013 to November 2016. Plasma was collected from them and analyzed for assessment of CRP and albumin. The reference range stipulated for CAR in dogs was 0.36-0.60, as determined by the confidence interval of mean resamplings (in percentiles). The frequencies mean, and standard deviations of the variables, correlation analysis, and comparative analysis (Kruskal-Wallis in α = 5%) were calculated. Elevation (above reference) of CAR was determined to be proportional to the severity of the underlying disease, and CRP means were reasonable. Besides, hypoalbuminemia was indicative of systemic disease, but not of severity. Thus, CAR was a better marker of disease severity than were CRP and albumin, analyzed separately. Concerning LoS, there was a positive correlation with CAR (p<0.01) in patients, and the same was not observed with CRP and albumin. Concerning mortality, hypoalbuminemia was the only marker valid in animals with a critical illness (p=0.04). In conclusion, CAR is a better marker of disease severity and LoS in dogs than are CRP and albumin analyzed separately.(AU)

O objetivo desta pesquisa foi determinar um intervalo de referência para a relação proteína C reativa (PCR)/albumina (R:PCR/ALB) na espécie canina e analisar o potencial de PCR, albumina e a relação entre ambas como indicadores de gravidade de doença, tempo de internação (TI) e mortalidade nesta espécie. Para isso, um estudo foi realizado em um Hospital Veterinário Escola no sul do Brasil. Cento e noventa cães foram incluídos aleatoriamente, sem distinção de sexo, idade ou raça, de junho de 2013 a novembro de 2016. O plasma foi coletado e analisado para avaliação da PCR e albumina. O intervalo de referência estipulado para o R:PCR/ALB em cães foi de 0,36-0,60, conforme determinado pelo intervalo de confiança da média das reamostragens (em percentis). Foram calculadas as frequências, médias e desvios-padrões das variáveis, análises de correlação e análises comparativas (Kruskal-Wallis em α = 5%). Notou-se elevação (acima da referência) da R:PCR/ALB proporcional à gravidade da doença de base, sendo normais as médias da PCR. Adicionalmente, a hipoalbuminemia foi indicadora de doença sistêmica, mas, não de gravidade. Dessa forma, a R:PCR/ALB foi melhor indicadora de gravidade de doença do que a PCR e albumina, analisadas separadamente. Em relação ao TI, houve correlação positiva com a R:PCR/ALB (p<0,01) em doentes, não sendo observado o mesmo com a PCR e albumina. Em relação à mortalidade, a hipoalbuminemia foi a única marcadora válida em animais com doenças críticas (p=0,04). Conclui-se, portanto, que a R:PCR/ALB é melhor marcadora de gravidade de doença e TI em cães do que a PCR e albumina analisadas separadamente.(AU)

Evaluating Journal Impact Factor: a systematic survey of the pros and cons, and overview of alternative measures

Journal Impact Factor (JIF) has several intrinsic flaws, which highlight its inability to adequately measure citation distributions or indicate journal quality. Despite these flaws, JIF is still widely used within the academic community, resulting in the propagation of potentially misleading information. A critical review of the usefulness of JIF is needed including an overview of the literature to identify viable alternative metrics. The objectives of this study are: (1) to assess the usefulness of JIF by compiling and comparing its advantages and disadvantages; (2) to record the differential uses of JIF within research environments; and (3) to summarize and compare viable alternative measures to JIF. Methods: Three separate literature search strategies using MEDLINE and Web of Science were completed to address the three study objectives. Each search was completed in accordance with PRISMA guidelines. Results were compiled in tabular format and analyzed based on reporting frequency. Results: For objective (1), 84 studies were included in qualitative analysis. It was found that the recorded advantages of JIF were outweighed by disadvantages (18 disadvantages vs. 9 advantages). For objective (2), 653 records were included in a qualitative analysis. JIF was found to be most commonly used in journal ranking (n = 653, 100%) and calculation of scientific research productivity (n = 367, 56.2%). For objective (3), 65 works were included in qualitative analysis. These articles revealed 45 alternatives, which includes 18 alternatives that improve on highly reported disadvantages of JIF. Conclusion: JIF has many disadvantages and is applied beyond its original intent, leading to inaccurate information. Several metrics have been identified to improve on certain disadvantages of JIF. Integrated Impact Indicator (I3) shows great promise as an alternative to JIF. However, further scientometric analysis is needed to assess its properties.(AU)

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

Main agents and contamination prevention in animal feed industry: review / Principais agentes envolvidos e formas de prevenção da contaminação na indústria de alimentação animal: revisão / Principales agentes involucrados y formas de prevención de la contaminación en la industria de alimentos para animales: revisión

The main physical, biological and chemical agents involved in cross-contamination are of known origin, generally harmful and toxic, which ends up making the individual have direct or indirect contact with the nutrients used in the manufacturing of animal feed. The knowledge of the causes, as well as their different forms of prevention and corrective actions, allow us to minimize losses in animal yield and possible extra costs in production due to the need to prevent the spread of pests and diseases to human health. Failure in monitoring the Good Manufacturing Practices (GMP), Standard Operating Procedures (SOPs), and Hazard Analysis and Critical Control Points (HACCP) systems due to lack of trained personnel or bad structural conditions of the industry are the main causes of cross-contamination. In this sense, diagnosing risks and controlling critical points in the production process are essential tools. Thus, this review aims at emphasizing the main forms of cross-contamination in the animal feed industry and the care that must be taken at the factory to minimize cross-contamination.(AU)

Os principais agentes físicos, biológicos e químicos envolvidos na contaminação cruzada são de origem conhecida, geralmente nociva e tóxica, que acabam fazendo com o diretor contato indireto com os nutrientes utilizados na fabricação de alimentos para animais. O conhecimento das causas, formas diferenciadas de prevenção e ações corretivas, permite minimizar as perdas no desempenho animal e, possíveis custos extras de produção, pela necessidade de evitar a propagação de pragas e danos à saúde humana. Falhas no monitoramento das Boas Práticas de Fabricação (BPF), Procedimentos Operacionais Padrão (POPs) e do sistema de Análise de Perigos e Pontos Críticos de Controle (HACCP) por falta de pessoal treinado ou más condições estruturais na indústria do contexto físico são as principais causas da ocorrência de contaminação cruzada. Nesse sentido, diagnosticar riscos e controlar pontos críticos no processo de produção são ferramentas indispensáveis. Dessa forma, o presente artigo de revisão visa destacar as principais formas de contaminação cruzada na indústria de ração animal e os cuidados que devem ser tomados na fábrica para minimizar a contaminação cruzada.(AU)

Los principales agentes físicos, biológicos y químicos involucrados en la contaminación cruzada son de origen conocida, generalmente nociva y tóxica, que terminan haciendo contacto directo o indirecto con los nutrientes utilizados en la fabricación de alimentos para animales. El conocimiento de las causas, las formas diferenciadas de prevención y las acciones correctivas, permiten minimizar las pérdidas en el rendimiento de los animales y, posibles costos extras de producción, por la necesidad de prevenir la propagación de plagas y daños a la salud humana. Fallas en el monitoreo de las Buenas Prácticas de Fabricación (BPF), Procedimientos de Operación Estándar (POE) y del sistema de Análisis de Peligros y Puntos de Control Críticos (HACCP) por falta de personal capacitado, o malas condiciones estructurales en la industria del contexto físico, son las principales causas de la ocurrencia de contaminación cruzada. En ese aspecto, diagnosticar los riesgos y controlar los puntos críticos en el proceso de producción son herramientas indispensables. Así, el presente artículo de revisión pretende evidenciar las principales formas de contaminación cruzada en la industria de alimentación animal y los cuidados que deben ser tomados en la fábrica para minimizar la contaminación cruzada.(AU)

Main agents and contamination prevention in animal feed industry: review / Principais agentes envolvidos e formas de prevenção da contaminação na indústria de alimentação animal: revisão / Principales agentes involucrados y formas de prevención de la contaminación en la industria de alimentos para animales: revisión

The main physical, biological and chemical agents involved in cross-contamination are of known origin, generally harmful and toxic, which ends up making the individual have direct or indirect contact with the nutrients used in the manufacturing of animal feed. The knowledge of the causes, as well as their different forms of prevention and corrective actions, allow us to minimize losses in animal yield and possible extra costs in production due to the need to prevent the spread of pests and diseases to human health. Failure in monitoring the Good Manufacturing Practices (GMP), Standard Operating Procedures (SOPs), and Hazard Analysis and Critical Control Points (HACCP) systems due to lack of trained personnel or bad structural conditions of the industry are the main causes of cross-contamination. In this sense, diagnosing risks and controlling critical points in the production process are essential tools. Thus, this review aims at emphasizing the main forms of cross-contamination in the animal feed industry and the care that must be taken at the factory to minimize cross-contamination.(AU)

Os principais agentes físicos, biológicos e químicos envolvidos na contaminação cruzada são de origem conhecida, geralmente nociva e tóxica, que acabam fazendo com o diretor contato indireto com os nutrientes utilizados na fabricação de alimentos para animais. O conhecimento das causas, formas diferenciadas de prevenção e ações corretivas, permite minimizar as perdas no desempenho animal e, possíveis custos extras de produção, pela necessidade de evitar a propagação de pragas e danos à saúde humana. Falhas no monitoramento das Boas Práticas de Fabricação (BPF), Procedimentos Operacionais Padrão (POPs) e do sistema de Análise de Perigos e Pontos Críticos de Controle (HACCP) por falta de pessoal treinado ou más condições estruturais na indústria do contexto físico são as principais causas da ocorrência de contaminação cruzada. Nesse sentido, diagnosticar riscos e controlar pontos críticos no processo de produção são ferramentas indispensáveis. Dessa forma, o presente artigo de revisão visa destacar as principais formas de contaminação cruzada na indústria de ração animal e os cuidados que devem ser tomados na fábrica para minimizar a contaminação cruzada.(AU)

Los principales agentes físicos, biológicos y químicos involucrados en la contaminación cruzada son de origen conocida, generalmente nociva y tóxica, que terminan haciendo contacto directo o indirecto con los nutrientes utilizados en la fabricación de alimentos para animales. El conocimiento de las causas, las formas diferenciadas de prevención y las acciones correctivas, permiten minimizar las pérdidas en el rendimiento de los animales y, posibles costos extras de producción, por la necesidad de prevenir la propagación de plagas y daños a la salud humana. Fallas en el monitoreo de las Buenas Prácticas de Fabricación (BPF), Procedimientos de Operación Estándar (POE) y del sistema de Análisis de Peligros y Puntos de Control Críticos (HACCP) por falta de personal capacitado, o malas condiciones estructurales en la industria del contexto físico, son las principales causas de la ocurrencia de contaminación cruzada. En ese aspecto, diagnosticar los riesgos y controlar los puntos críticos en el proceso de producción son herramientas indispensables. Así, el presente artículo de revisión pretende evidenciar las principales formas de contaminación cruzada en la industria de alimentación animal y los cuidados que deben ser tomados en la fábrica para minimizar la contaminación cruzada.(AU)

The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan

Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of...(AU)

The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan

Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of...

Early parenteral nutrition in enterectomized dogs / Nutrição parenteral precoce em cães submetidos à enterectomia

The aim of this study was to explore the role of early central parenteral nutrition support with and without lipid emulsion in enterectomized dogs undergoing small bowel partial resection. Enterectomized dogs often cannot be fed properly via an oral or enteral route immediately post-surgery. After enterectomy, the animals received parenteral nutrition or crystalloid solution until they were able to voluntarily take in an oral diet. All dogs were recruited at the University of Sao Paulo veterinary teaching hospital. Eighteen dogs with intussusception, a foreign intestinal body, linear foreign intestinal body, or intussusception associated with a foreign intestinal body underwent enterectomy surgery and were randomly assigned to receive one of three treatments: crystalloid solution (CS group), parenteral nutrition with a mix of glucose and amino acids (GA group) or parenteral nutrition with a mix of glucose, amino acids and lipids (GAL group). A serum chemistry panel and complete blood count were collected prior to surgery and at the end of the study. Albumin increased in the GA and GAL group (p=0.042 and p=0.038 respectively) after hospitalization, but no significant differences were identified among the groups. Body weight decreased by 4.9% (p=0.042) in the CS group, but there were no significant changes in the GAL and GA groups. There was a significant decrease in the recovery scores in the GA and GAL groups during hospitalization (p=0.039 in both groups). Early parenteral nutrition was beneficial for patient recovery in post-surgical small bowel partial resection, indicating better quality, and no major complications or side effects were observed during the hospitalization period in the studied dogs.(AU)

O objetivo desse estudo era estudar os efeitos da nutrição parenteral central precoce com e sem emulsão lipídica em cães submetidos à ressecção parcial do intestino delgado. Os cães enterectomizados frequentemente não conseguem ser adequadamente alimentados por via oral ou enteral no pós-cirúrgico imediato. Após a enterectomia, os animais receberam nutrição parenteral ou solução cristaloide até o momento em que fossem capazes de alimentar-se voluntariamente por via oral. Todos os animais foram selecionados no hospital veterinário da Universidade de São Paulo. Dezoito cães diagnosticados com intussuscepção, corpo estranho intestinal, corpo estranho linear ou intussuscepção associada com corpo estranho intestinal foram submetidos à enterectomia e aleatoriamente alocados para receber um dos três tratamentos: solução cristaloide (grupo CS), nutrição parenteral com mistura de glicose e aminoácidos (grupo GA) ou nutrição parental com mistura de glicose e lipídios (grupo GAL). Hemograma e bioquímica sérica foram coletados antes da cirurgia e no final do estudo. Houve aumento de albumina no grupo GA e GAL (p=0,042 e p=0,038 respectivamente) após a hospitalização, mas não houve diferença significativa entre grupos. O peso corpóreo diminuiu cerca de 4,9% (p=0,042) no grupo CS mas não houve alterações significativas no grupo GAL e GA. Houve uma diminuição significativa no escore de recuperação no grupo GA e GAL durante a hospitalização (p=0,039 em ambos os grupos). A nutrição parenteral precoce mostrou-se benéfica para a recuperação no pós-operatório dos cães submetidos à ressecção parcial do intestino delgado, sinalizando uma melhora na qualidade da recuperação e ausência de grandes complicações ou efeitos colaterais durante o período de hospitalização dos animais estudados.(AU)

Early parenteral nutrition in enterectomized dogs / Nutrição parenteral precoce em cães submetidos à enterectomia

The aim of this study was to explore the role of early central parenteral nutrition support with and without lipid emulsion in enterectomized dogs undergoing small bowel partial resection. Enterectomized dogs often cannot be fed properly via an oral or enteral route immediately post-surgery. After enterectomy, the animals received parenteral nutrition or crystalloid solution until they were able to voluntarily take in an oral diet. All dogs were recruited at the University of Sao Paulo veterinary teaching hospital. Eighteen dogs with intussusception, a foreign intestinal body, linear foreign intestinal body, or intussusception associated with a foreign intestinal body underwent enterectomy surgery and were randomly assigned to receive one of three treatments: crystalloid solution (CS group), parenteral nutrition with a mix of glucose and amino acids (GA group) or parenteral nutrition with a mix of glucose, amino acids and lipids (GAL group). A serum chemistry panel and complete blood count were collected prior to surgery and at the end of the study. Albumin increased in the GA and GAL group (p=0.042 and p=0.038 respectively) after hospitalization, but no significant differences were identified among the groups. Body weight decreased by 4.9% (p=0.042) in the CS group, but there were no significant changes in the GAL and GA groups. There was a significant decrease in the recovery scores in the GA and GAL groups during hospitalization (p=0.039 in both groups). Early parenteral nutrition was beneficial for patient recovery in post-surgical small bowel partial resection, indicating better quality, and no major complications or side effects were observed during the hospitalization period in the studied dogs.(AU)

O objetivo desse estudo era estudar os efeitos da nutrição parenteral central precoce com e sem emulsão lipídica em cães submetidos à ressecção parcial do intestino delgado. Os cães enterectomizados frequentemente não conseguem ser adequadamente alimentados por via oral ou enteral no pós-cirúrgico imediato. Após a enterectomia, os animais receberam nutrição parenteral ou solução cristaloide até o momento em que fossem capazes de alimentar-se voluntariamente por via oral. Todos os animais foram selecionados no hospital veterinário da Universidade de São Paulo. Dezoito cães diagnosticados com intussuscepção, corpo estranho intestinal, corpo estranho linear ou intussuscepção associada com corpo estranho intestinal foram submetidos à enterectomia e aleatoriamente alocados para receber um dos três tratamentos: solução cristaloide (grupo CS), nutrição parenteral com mistura de glicose e aminoácidos (grupo GA) ou nutrição parental com mistura de glicose e lipídios (grupo GAL). Hemograma e bioquímica sérica foram coletados antes da cirurgia e no final do estudo. Houve aumento de albumina no grupo GA e GAL (p=0,042 e p=0,038 respectivamente) após a hospitalização, mas não houve diferença significativa entre grupos. O peso corpóreo diminuiu cerca de 4,9% (p=0,042) no grupo CS mas não houve alterações significativas no grupo GAL e GA. Houve uma diminuição significativa no escore de recuperação no grupo GA e GAL durante a hospitalização (p=0,039 em ambos os grupos). A nutrição parenteral precoce mostrou-se benéfica para a recuperação no pós-operatório dos cães submetidos à ressecção parcial do intestino delgado, sinalizando uma melhora na qualidade da recuperação e ausência de grandes complicações ou efeitos colaterais durante o período de hospitalização dos animais estudados.(AU)

Physics behind the implants used for high strain fractures: literature review / A física por trás dos implantes utilizados para fraturas de alto strain: revisão de literatura

Whenever bone fractures occur, external forces produce continuous interfragmentary motion and a stabilization method is necessary. It is known that the mechanical conditions at the fracture site influence bone callus formation during healing process. To achieve primary (direct) bone healing, absolute stability at the fracture site is necessary. Perren's concept of strain determines that relative deformation at the fracture gap depends on the original gap's conformation. Simple fractures (without comminution) are considered high strain fractures since a small force applied to the fracture site results in great movement with deleterious effects on the healing process. The purpose of this study is to review the available literature regarding factors that influence the mechanics of high strain fractures in veterinary medicine, its treatment methods and implants available. Each fracture configuration requires special attention and critical care in choosing the osteosynthesis method and the type of stability required for consolidation to occur within the expected time. One must know the strain theory to become an orthopedic surgeon.(AU)

Quando fraturas ósseas ocorrem, forças externas produzem movimentação interfragmentária continuamente e um método de estabilização se faz necessário. É sabido que as condições mecânicas no local de fratura influenciam a formação de calo durante o processo de cicatrização óssea e para que cicatrização óssea primária seja obtida é necessária estabilidade absoluta no foco de fratura. O conceito de strain de Perren determina que a deformação relativa no foco de fratura estabilizado depende do tamanho da lacuna de fratura original. Fraturas redutíveis (sem cominuição) são consideradas de alto strain, pois uma pequena força aplicada a linha de fratura resulta em grande movimentação com efeito deletério ao processo de consolidação. O presente trabalho revisa a literatura disponível a respeito de fatores que influenciam a mecânica de fraturas de alto strain em medicina veterinária, seus métodos de tratamento e a física por trás dos implantes disponíveis. Cada configuração de fratura requer atenção especial e cuidado crítico na escolha do método de osteossíntese e no tipo de estabilidade necessária para que a consolidação ocorra no tempo esperado. Conhecimento da teoria do strain é mandatório para a formação de cirurgiões ortopédicos.(AU)

Physics behind the implants used for high strain fractures: literature review / A física por trás dos implantes utilizados para fraturas de alto strain: revisão de literatura

Whenever bone fractures occur, external forces produce continuous interfragmentary motion and a stabilization method is necessary. It is known that the mechanical conditions at the fracture site influence bone callus formation during healing process. To achieve primary (direct) bone healing, absolute stability at the fracture site is necessary. Perren's concept of strain determines that relative deformation at the fracture gap depends on the original gap's conformation. Simple fractures (without comminution) are considered high strain fractures since a small force applied to the fracture site results in great movement with deleterious effects on the healing process. The purpose of this study is to review the available literature regarding factors that influence the mechanics of high strain fractures in veterinary medicine, its treatment methods and implants available. Each fracture configuration requires special attention and critical care in choosing the osteosynthesis method and the type of stability required for consolidation to occur within the expected time. One must know the strain theory to become an orthopedic surgeon.(AU)

Quando fraturas ósseas ocorrem, forças externas produzem movimentação interfragmentária continuamente e um método de estabilização se faz necessário. É sabido que as condições mecânicas no local de fratura influenciam a formação de calo durante o processo de cicatrização óssea e para que cicatrização óssea primária seja obtida é necessária estabilidade absoluta no foco de fratura. O conceito de strain de Perren determina que a deformação relativa no foco de fratura estabilizado depende do tamanho da lacuna de fratura original. Fraturas redutíveis (sem cominuição) são consideradas de alto strain, pois uma pequena força aplicada a linha de fratura resulta em grande movimentação com efeito deletério ao processo de consolidação. O presente trabalho revisa a literatura disponível a respeito de fatores que influenciam a mecânica de fraturas de alto strain em medicina veterinária, seus métodos de tratamento e a física por trás dos implantes disponíveis. Cada configuração de fratura requer atenção especial e cuidado crítico na escolha do método de osteossíntese e no tipo de estabilidade necessária para que a consolidação ocorra no tempo esperado. Conhecimento da teoria do strain é mandatório para a formação de cirurgiões ortopédicos.(AU)