Furuncular myiasis caused by Dermatobia hominis in five cats and efficacy of topical fluralaner for its treatment.

BACKGROUND: Dermatobia hominis (D. hominis) is a botfly that causes furuncular myiasis in several species of domestic and wild animals. However, reports of feline infestation by larvae of this dipteran are rare. OBJECTIVE: To report the natural occurrence of furuncular myiasis caused by D. hominis in five cats and the efficacy of topical fluralaner for its treatment. ANIMALS: Five adult mixed-breed cats (four males, one female) were diagnosed and treated, all living in the state of Rio de Janeiro, Brazil. RESULTS: The cats were treated with topical fluralaner. After this treatment, the larvae were dead after 24 h in three cats and after 48 h in two. There was spontaneous expulsion of larvae in two cats, and it was necessary to perform manual expression for removal of dead larvae in the other three cats. CONCLUSIONS AND CLINICAL IMPORTANCE: Dermatobia hominis can cause furuncular myiasis in cats, although this appears to be less common than in other animal species. Topical fluralaner proved to be effective in the treatment of this parasitic disease.

Efficacy of oral sarolaner against Lynxacarus radovskyi in naturally infested cats.

BACKGROUND: Lynxacarus radovskyi is a fur mite of cats. Several classes of ectoparasiticides have shown success for treatment, including an isoxazoline. OBJECTIVES: To evaluate the efficacy of a single oral dose of sarolaner for the treatment of L. radovskyi mites in naturally infested cats. ANIMALS: Fourteen adult cats (six males and eight females), naturally infested with L. radovskyi. METHODS AND MATERIALS: Animals were randomized according to sex and average pretreatment mite count. The cats were assigned to two groups of seven cats each. The treated group received one 10 mg sarolaner tablet, corresponding to a dose of 2-4 mg/kg body weight, and the control group received no treatment. From each cat, three trichograms consisting of approximately 50 hairs each were collected from the dorsal neck, lateral thigh and perineum/tail region (total of nine samples per cat). The severity of infestation was scored on a scale of 0 (no parasites) to 4 (>50 mites) at baseline and days 7, 15, 30, 45 and 60 post-treatment. Efficacy was compared between the treatment and control groups using the arithmetic mean reduction of the mite score; results were analysed using the Kruskal-Wallis test followed by the Student-Newtman-Keuls test, with significance set at P < 5%. RESULTS: The efficacy of oral sarolaner was >95% at Day 30 post-treatment. Statistical differences were first observed between the means of the control and treated groups 15 days post-treatment. CONCLUSION: A single oral dose of sarolaner effectively eliminated L. radovskyi in most cats.

Management of high risk T1 gastric adenocarcinoma following endoscopic resection.

Endoscopic submucosal dissection has revolutionized the treatment of early gastric cancer. However, cases that do not meet the curability criteria have a higher risk of lymph node metastasis and salvage surgery is still considered the next treatment approach to increase the chance of cure. Nevertheless, not all high-risk resections entail the same level of risk, emphasizing the utmost importance of individualized stratification for further treatment. In this review, we aim to examine the current evidence concerning the management following a high-risk non-curative resection, highlighting the existing approaches, while also presenting upcoming strategies that attempt to improve patient outcomes, minimize adverse events, and provide a tailored management.

Pharmacological Treatment of Functional Dyspepsia: An Old Story Revisited or a New Story to Be Told? A Clinical Review.

Dyspepsia incorporates a set of symptoms originating from the gastroduodenal region, frequently encountered in the adult population in the Western world. Most patients with symptoms compatible with dyspepsia eventually end up, in the absence of a potential organic cause, being diagnosed with functional dyspepsia. Many have been the new insights in the pathophysiology behind functional dyspeptic symptoms, namely, hypersensitivity to acid, duodenal eosinophilia, and altered gastric emptying, among others. Since these discoveries, new therapies have been proposed. Even so, an established mechanism for functional dyspepsia is not yet a reality, which makes its treatment a clinical challenge. In this paper, we review some of the possible approaches to treatment, both well established and some new therapeutic targets. Recommendations about dose and time of use are also made.

A dispepsia engloba um conjunto de sintomas provenientes do trato gastroduodenal, frequentes na população adulta ocidental. A maioria dos doentes com sintomas compatíveis com dispepsia, acaba eventualmente, na ausência de causa orgânica, por ser diagnosticado com dispepsia funcional. Novos conhecimentos sobre a fisiopatologia responsável pelos sintomas de dispepsia têm sido adquiridos, nomeadamente a hipersensibilidade ao ácido, eosinofilia duodenal e as alterações do esvaziamento gástrico, entre outros. Estas novas descobertas vieram proporcionar novos possíveis alvos terapêuticos. Ainda assim, um mecanismo exato ainda não é conhecido, o que torna o tratamento da dispepsia funcional tantas vezes um desafio clínico. Neste trabalho, algumas abordagens das possíveis terapêuticas são revisitadas, tanto aquelas que já são uma prática usual, bem como novos alvos terapêuticos. Recomendações sobre dose e duração do tratamento são também elaboradas.

Gastric cancer detection by non-blood-based liquid biopsies: A systematic review looking into the last decade of research.

Gastric cancer (GC) screening is arguable in most Western countries. Liquid biopsies are a great promise to answer the unmet need for less invasive diagnostic biomarkers in GC. Thus, we aimed at systematically reviewing the current knowledge on liquid biopsy-based biomarkers in GC screening. A systematic search on PubMed/MEDLINE and Scopus databases was performed on published articles reporting the use of non-blood specimen (saliva, gastric juice [GJ], urine and stool) on GC diagnosis. 3208 records were retrieved by June 2022. After removal of duplicate records, 2379 abstracts were screened, and 84 full texts included in this systematic review. More than 90% of studies were reported on Asian populations. Overall, 9 studies explored stool-, 12 saliva-, and 29 urine-derived biomarkers for GC detection. Additionally, 37 studies, representing the majority, analyzed GJ, focusing on nucleic acid molecules. Several miRNAs and lncRNA molecules have been associated with GC risk, particularly miR-21 (area under the curve [AUC] = 0.97, 95% CI: 0.94-1.00). Considering salivary biomarkers, the best described model in validation sets included the soybean agglutinin and Vicia villosa agglutinin lectins (AUC = 0.89, 95% CI: 0.80-0.99). Most studies in urine carried out metabolomic approaches, with two discriminatory models presenting AUC values superior to 0.97. This systematic review emphasizes the potential role of non-blood-based biomarkers, although further validation, particularly in Western countries, is mandatory, namely for non-invasive screening and/or monitoring, as well as the use of GJ as a tool to enhance upper gastrointestinal endoscopy accuracy.

COVID-19 threatens the progress of humanised childbirth: a qualitative study of giving birth during the pandemic in Brazil.

The stressful nature of the early months of the COVID-19 pandemic severely impacted the quality of maternity care. The purpose of this study was to understand and explore the labour and delivery experiences for women who were diagnosed with COVID-19 in Brazil during this time. Between July and October 2020, we conducted 28 semi-structured interviews with postpartum women who tested positive for COVID-19 prior to delivering at a tertiary hospital in Fortaleza, Brazil. Interview transcripts were coded, and we carried out a thematic analysis using three domains of the World Health Organization's model of intrapartum care for a positive childbirth experience as a framework. During labour and delivery, women experienced varying levels of respect, with many women reporting feeling mistreated by their healthcare team because of their COVID-19 diagnosis. Due to COVID-19 hospital protocols that denied companions or visitors, women reported feeling unsupported and isolated, especially during the mandatory quarantine. Women also experienced varying levels of effective communication, with some women citing they felt the staff were often fearful, and either avoidant or disrespectful. A minority of women reported that the staff appeared to be respectful and receptive to their needs. Our findings provide preliminary evidence that the strain of the COVID-19 pandemic on health professionals potentially results in ineffective communication and mistreatment during labour and delivery. Embedding respectful and humanised childbirth principles into emergency maternal healthcare protocols may improve the childbirth experience for women with COVID-19, as well as for women during future public health emergencies.

Real-time assessment of H. pylori during the endoscopic assessment of individuals with gastric intestinal metaplasia: a possible way to reduce the burden of care.

OBJECTIVES: The management of individuals with gastric intestinal metaplasia (GIM) includes biopsies for its staging and to diagnose Helicobacter pylori (Hp ). Advanced-stage GIM can be estimated by endoscopy through EGGIM, and a new device permits the real-time assessment of ammonia for the identification of Hp infection. The aim of this study was to assess the simultaneous use of EGGIM and real-time assessment of ammonia to avoid biopsies and reduce the burden of care in clinical practice. METHODS: A multicentre study involving 101 consecutively enrolled patients [52% male; 65(18-85) years]. During endoscopy, gastric juice was aspirated and analysed; EGGIM was determined in real-time. Targeted biopsies were performed and histopathological assessment was used as gold standard. RESULTS: Advanced-stage GIM were detected in 14.9% of patients and Hp infection in 18.8%. EGGIM showed for advanced-stage GIM a sensitivity, specificity and NPV of 86.7%, 84.9% and 97.3%, whilst real-time assessment of ammonia, 83.3%, 78.2% and 95.4%, respectively. Gastric juice was insufficient in 5 (5.0%). Overall, 64 (67%) patients were correctly diagnosed by EGGIM and real-time assessment of ammonia. If the 47 (49%) patients negative to both assessments would have avoided biopsies, only 4 (4.2%) would have been missed: two with advanced-stage GIM and two with Hp infection. CONCLUSION: The combination of endoscopic assessment and real-time analysis of Hp allows the exclusion of advanced-stage GIM or Hp infection without the need of biopsies in a significant proportion of individuals. This may allow in specific situations to abstain from biopsies reducing the burden of care.

Nitrofurantoin-Induced Exfoliative Dermatitis: A Case Report.

Exfoliative dermatitis (ED) is a rare and life-threatening dermatological emergency caused by a wide range of cutaneous or systemic conditions, such as inflammatory dermatosis, drug reactions, and malignancies. We report a case of a 77-year-old man who developed ED five days after starting nitrofurantoin. The drug was withdrawn, and the patient was treated with topical corticosteroid and supportive care, after which there was a full recovery within a week. This report describes an uncommon entity with a guarded prognosis that requires proper diagnosis and management.

Diabetic foot infection caused by bacteria of the Burkholderia cepacia complex: report of an unusual case and a scoping literature review.

Burkholderia cepacia complex (BCC) is group of widespread gram-negative bacillus organized in over 20 phylogenetically distinct bacterial species. According to previous studies, BCC species pathogens are widely reported in patients with cystic fibrosis (CF), but not in individuals with diabetes mellitus (DM). In this case report, a 42-year-old male patient with DM and a foot infection caused by BCC is presented. The patient was hospitalized after antibiotic treatment failure and improved after two surgical debridement procedures and a high-dose extended infusion (EI) of meropenem. The team of vascular surgeons and the infectious disease specialists worked fervently to solve the case. Finally, a scoping review was conducted to map BCC infections in patients with DM.

Efficacy of Oral Sarolaner for the Treatment of Feline Otodectic Mange.

Otodectes cynotis is a mite with a cosmopolitan distribution that is the primary agent for the development of otitis externa in feline species. The aim of this study was to evaluate the efficacy of the oral administration of sarolaner for the treatment of feline otodectic mange. We used 20 adult cats of both sexes that were naturally infested with O. cynotis. The mite infestation scoring was performed by video-otoscopy before treatment. The cats were randomized according to the infestation score and divided into two groups (treated and control). The treated group underwent oral administration of sarolaner in a single dose of 2-4 mg/kg. The evaluations were performed by video-otoscopy to evaluate the reduction of infestation score 2, 4, 6, 24 and 48 h and 7, 14, 21 and 28 days after medication. At the end of the study, the cats were sedated to enable the recovery of live and dead mites to determine efficacy. No adverse effects or laboratory changes were observed in these cats. Sarolaner showed 100% efficacy 48 h after treatment. Based on the results, a single oral dose of sarolaner was effective in controlling otodectic mange in naturally infested cats.

Efficacy and residual effect of Illicium verum (star anise) and Pelargonium graveolens (rose geranium) essential oil on cat fleas Ctenocephalides felis felis.

The essential oils (EOs) of Illicium verum and Pelargonium graveolens were evaluated for lethality, inhibition of development and residual efficacy against the flea Ctenocephalides felis felis. Their chemical composition was characterized by means of gas chromatography with a flame ionization and mass spectrometry detection. Mortality at different immature stages and among adult fleas was measured through in vitro filter paper tests at different concentrations of EOs. The chemical characterization of I. verum volatile oil showed that E-anethole (79.96%) was the major constituent, while the major compounds in P. graveolens were citronellol (29.67%) and geraniol (14.85%). Insecticidal activity against both immature and adult flea stages were observed. The EO of I. verum had insecticidal activity for approximately 18 days, while the EO activity of P. graveolens lasted for 13 days. The pulicidal activity of I. verum remained above 70% for up to 9 days, while the activity of P. graveolens was 41.7% for up to 2 days. Essential oils, especially that of I. verum, showed insecticidal activity for flea control at different life cycle stages and have potential for the development of ectoparasiticides (biopesticides) for veterinary use.

Kikuchi-Fujimoto Syndrome: A Rare Entity to Consider.

INTRODUCTION: Kikuchi-Fujimoto disease (KFD) is a rare, benign, necrotizing lymphadenitis of unknown aetiology with good prognosis. It is characterized by cervical lymphadenopathy, nocturnal diaphoresis and fever. Surgical excision of the adenopathy, histopathological study and immunophenotyping are crucial for diagnosis. PATIENTS AND METHODS: This paper describes five patients with three different histological subtypes of KFD, including an atypical presentation masquerading as pyelonephritis and two other cases where physicians mistakenly started chemotherapy. In one other case cytomegalovirus was identified as the responsible aetiological agent, while in the remaining patient, KFD evolved into an autoimmune condition. DISCUSSION: KFD, although rare, may mimic infectious, autoimmune and neoplastic diseases. It also poses a risk for the subsequent development of an autoimmune disorder. LEARNING POINTS: Kikuchi-Fujimoto disease (KFD), although rare, should be included in the differential diagnosis of patients with cervical lymphadenopathy and fever of unknown origin.Early recognition of KFD may minimize the use of unnecessary aggressive examinations and therapies.The course of KFD in most patients is self-limiting, but there is a risk of progression to an autoimmune syndrome.

Práticas de assistência ao parto e nascimento na perspetiva de gestantes com COVID-19 / Perspectives of pregnant women with COVID-19 on childbirth care practices / Prácticas de asistencia al parto y nacimiento desde la perspectiva de gestantes con COVID-19

Resumo Enquandramento: A pandemia de COVID-19 agravou as práticas de cuidar das mulheres no momento do parto. Objetivo: Compreender a perceção das grávidas com COVID-19 acerca da aplicabilidade das boas práticas de assistência ao parto e nascimento. Metodologia: Estudo exploratório e descritivo, com abordagem mista, realizado com 23 gestantes com COVID-19, num hospital público brasileiro. Resultados: O corpus geral consistia em 23 textos, com aproveitamento de 249 Segmentos de Texto (ST). O conteúdo analisado foi categorizado em cinco classes: COVID-19 no contexto da saúde do RN, com 56 STs (22,49%); Parto humanizado e COVID-19, com 51 STs (20,48%); A incerteza dos riscos maternos e fetais, com 39 STs (15,66%); Experiência do parto na pandemia por COVID-19, com 67 STs (26,91%); e Conhecimento sobre sintomas e prevenção contra a COVID-19, com 36 STs (14,46%). Conclusão: Foram encontradas gestantes com pouco conhecimento sobre a política e o seu direito à autonomia no trabalho de parto e pós-parto, evidenciando diversas práticas inadequadas durante a pandemia.

Abstract Background: The COVID-19 pandemic has aggravated childbirth care practices. Objective: To understand the perception of pregnant women with COVID-19 on the applicability of best childbirth care practices. Methodology: Exploratory and descriptive study, with a mixed methods approach, carried out with 23 pregnant women with COVID-19 in a Brazilian public hospital. Results: The general corpus comprised 23 texts with 249 Text Segments (TS). The analyzed content was categorized into five classes: COVID-19 in the context of NB health, with 56 TS (22.49%); Humanized childbirth and COVID-19, with 51 TS (20.48%); The uncertainty of maternal and fetal risks, with 39 TS (15.66%); Childbirth experience in the COVID-19 pandemic, with 67 TS (26.91%); and Knowledge about symptoms and prevention against COVID-19, with 36 TS (14.46%). Conclusion: Pregnant women have little knowledge about the policy and their right to autonomy in labor and postpartum, evidencing inadequate practices during the pandemic.

Resumen Marco contextual: La pandemia de COVID-19 ha empeorado las prácticas asistenciales de las mujeres en el momento del parto. Objetivo: Comprender la percepción de las mujeres embarazadas con COVID-19 sobre la aplicabilidad de las buenas prácticas en la atención al parto. Metodología: Estudio exploratorio y descriptivo, con enfoque mixto, realizado con 23 gestantes con COVID-19 en un hospital público brasileño. Resultados: El corpus general constó de 23 textos, y se utilizaron 249 segmentos de texto (ST). El contenido analizado se clasificó en cinco clases: COVID-19 en el contexto sanitario del RN, con 56 ST (22,49%); parto humanizado y COVID-19, con 51 ST (20,48%); la incertidumbre de los riesgos maternos y fetales, con 39 ST (15,66%); experiencia del parto en la pandemia por COVID-19, con 67 ST (26,91%), y conocimientos sobre los síntomas y la prevención de la COVID-19, con 36 ST (14,46%). Conclusión: Se observó que las gestantes tenían pocos conocimientos sobre la política y su derecho a la autonomía en el parto y el posparto, lo que puso de manifiesto varias prácticas inadecuadas durante la pandemia.

[Ocratoxin A in human plasma and coffee from Costa Rica by ELISA]. / Determinación de ocratoxina A en plasma humano y en café de Costa Rica por un método de ELISA.

Costa Rica is not an exception in the prevalence of ochratoxin A in human plasma, in this research the presence of the micotoxin was found in 95% of the 149 samples studied. The presence of ocratoxina A also was studied in 110 samples of toasted and grounded coffee from the most important 12 coffee factories of the country and from 7 supermarkets. With the exception of one negative sample the rest of them have concentrations of micotoxin below 4000 ng/kg. An association between the coffee consumption and the presence of ochratoxin A in plasma was attempted to be found as well as in the consumption of beer, but there were any statistically significant difference in the average level of mycotoxin between the coffee consumers and non coffee consumers neither between beer consumers and no beer consumers.

Diabetic foot infection caused by bacteria of the Burkholderia cepacia complex: report of an unusual case and a scoping literature review

ABSTRACT Burkholderia cepacia complex (BCC) is group of widespread gram-negative bacillus organized in over 20 phylogenetically distinct bacterial species. According to previous studies, BCC species pathogens are widely reported in patients with cystic fibrosis (CF), but not in individuals with diabetes mellitus (DM). In this case report, a 42-year-old male patient with DM and a foot infection caused by BCC is presented. The patient was hospitalized after antibiotic treatment failure and improved after two surgical debridement procedures and a high-dose extended infusion (EI) of meropenem. The team of vascular surgeons and the infectious disease specialists worked fervently to solve the case. Finally, a scoping review was conducted to map BCC infections in patients with DM.

Serratia marcescens harboring SME-4 in Brazil: A silent threat.

The intrinsic polymyxin resistance displayed by Serratia marcescens makes the acquisition of carbapenemase encoding genes a worrisome event. This study report a SME-4-producing S. marcescens isolate causing septic shock in Brazil. The insertion of novel resistance determinants and their consequent spread in our territory is noteworthy.

Efficacy and residual effect of Illicium verum (star anise) and Pelargonium graveolens (rose geranium) essential oil on cat fleas Ctenocephalides felis felis / Eficácia e efeito residual dos óleos essenciais de Illicium verum (anis-estrelado) e Pelargonium graveolens (gerânio rosa) em pulgas de gato Ctenocephalides felis felis

Abstract The essential oils (EOs) of Illicium verum and Pelargonium graveolens were evaluated for lethality, inhibition of development and residual efficacy against the flea Ctenocephalides felis felis. Their chemical composition was characterized by means of gas chromatography with a flame ionization and mass spectrometry detection. Mortality at different immature stages and among adult fleas was measured through in vitro filter paper tests at different concentrations of EOs. The chemical characterization of I. verum volatile oil showed that E-anethole (79.96%) was the major constituent, while the major compounds in P. graveolens were citronellol (29.67%) and geraniol (14.85%). Insecticidal activity against both immature and adult flea stages were observed. The EO of I. verum had insecticidal activity for approximately 18 days, while the EO activity of P. graveolens lasted for 13 days. The pulicidal activity of I. verum remained above 70% for up to 9 days, while the activity of P. graveolens was 41.7% for up to 2 days. Essential oils, especially that of I. verum, showed insecticidal activity for flea control at different life cycle stages and have potential for the development of ectoparasiticides (biopesticides) for veterinary use.

Resumo Os óleos essenciais (OE) de Illicium verum e Pelargonium graveolens foram avaliados quanto à letalidade, inibição do desenvolvimento e eficácia residual contra a pulga Ctenocephalides felis felis. Sua composição química foi caracterizada por meio de cromatografia gasosa com detector de ionização de chama e espectrometria de massas. A mortalidade entre os diferentes estágios imaturos e pulgas adultas foi avaliada por meio de testes in vitro em papel filtro, contendo diferentes concentrações de OEs. A caracterização química do óleo volátil de I. verum mostrou que o E-anetol (79,96%) foi o constituinte majoritário, enquanto os principais compostos de P. graveolens foram citronelol (29,67%) e geraniol (14,85%). Foi observada atividade inseticida contra os estágios imaturos e adulto da pulga. O OE de I. verum teve atividade inseticida por aproximadamente 18 dias, enquanto o de P. graveolens durou 13 dias. A atividade pulicida de I. verum permaneceu acima de 70% até o 9º dia, enquanto a atividade de P. graveolens foi de 41,7% até o 2º dia. Os óleos essenciais, principalmente de I. verum, apresentam atividade inseticida para o controle de pulgas em diferentes estágios do ciclo de vida e têm potencial para o desenvolvimento de ectoparasiticidas (biopesticidas) de uso veterinário.