Additional effects using progestins in mares on levels of thyroid hormones and steroids in neonates.

The risk of pregnancy loss in mares leads to the use of exogenous hormones to help pregnancy maintenance. The objective was to evaluate the proportion of thyroid hormones and steroids in neonates, in the following postpartum period, born to mares fed with synthetic progesterone and to verify the existence of a correlation between the level of progesterone between mother and neonate. Twenty-seven mares and their foals were used. The animals were divided into 5 experimental groups: group 1 (control, without hormonal supplementation), group 2 (random samples fed to 120 days of pregnancy with long-term progesterone), group 3 (mares fed with short-term progesterone as of 280.º day of pregnancy), group 4 (mares fed with long-term progesterone as of 280.º day of pregnancy) and group 5 (mares fed with synthetic hormone [altrenogest] as of 280.º day of pregnancy). The animal's blood collection took place immediately after parturition for the hormonal measurement. The hormones measured in neonates were total T3, free T4, TSH, progesterone and cortisone. In mares, only levels of progesterone. The groups of neonates showed no difference on levels of total T3, free T4, TSH and progesterone. There was no difference on levels of progesterone in mares among the groups. Neonates from groups 4 and 5 had higher and lower cortisone levels, respectively. No neonate showed clinical change. There was also no correlation between levels of progesterone in mares and foals. Thus, hormonal supplementation with long-term progesterone as of 280 days of pregnancy leds to an increase in the neonate's cortisone levels, in the meantime, supplementation with altrenogest as of 280 days of pregnancy caused a decrease on cortisone levels in foals, despite clinical signs have not been observed on these animals.

Volatile fingerprinting, sensory characterization, and consumer acceptance of pure and blended arabica coffee leaf teas.

Coffee leaves contain several bioactive compounds and have been traditionally consumed as a medicinal infusion in the East for centuries. Coffee production generates large amounts of leaves as by-products, which are often wasted in most producing countries because of the low acceptability in the West. Nevertheless, processing and blending coffee leaves may increase aroma and flavor complexity. This study evaluated the volatile and sensory profiles and consumer acceptance of coffee leaf teas compared to two among the most consumed teas (black and maté teas) in Rio de Janeiro. Infusions were made with one experimental and one commercial coffee leaf tea (CLT), two black teas (BT), and one toasted maté tea (TMT) for volatile (GC-MS/MS) and sensory profiles. As an attempt to improve coffee leaf tea acceptance, CLT were also blended (50%) with BT or TMT. Acceptance, Check All That Apply (CATA), and Projective Mapping sensory tests were performed with untrained assessors aged 18-49 (n = 100). Volatile data were standardized by centering and normalization. Sensory data were treated by ANOVA/Fisher test, PCA, and AHCMFA, considering differences at p < 0.05. Ninety-two volatile compounds distributed in 12 classes were identified in different samples. CLT, BT, and TMT infusions shared 19 compounds, including 9 potential impact compounds for aroma and flavor: α-ionone, ß-ionone, hexanal, nonanal, decanal, benzaldehyde, trans-linalool oxide, linalool, and dihydroactinidiolide. The most cited flavor attributes for CLT infusions were herbs/green leaf, woody and refreshing. For TMT and BT, herbs/green leaf, woody, burnt, and fermented were the most cited. These attributes agreed with the volatile profiles. CLT shared 22 compounds with TMT and 28 with BT. Considering pure infusions, TMT presented the highest mean acceptance scores (6.7), followed by Com. and Exp. CLT (6.1 and 5.8, on a 9-point-hedonic scale, respectively). Blending with TMT increased mean acceptance of Exp. CLT (6.4), while blending with BT, downgraded the mean acceptance of Com. CLT (5.3). In Projective Mapping, CLT was considered to have a higher sensory resemblance with TMT than BT. If produced adequately, CLT was shown to have good market potential to support sustainable coffee production and promote health.

A cross-sectional study of clinical, dermoscopic, histopathological, and molecular patterns of scalp melanoma in patients with or without androgenetic alopecia.

Scalp melanoma (SM) has a worse prognosis than melanoma in other locations likely because of late diagnosis due to hair coverage, difficulties in interpreting dermoscopy findings, and its unique molecular profile. We aimed to describe the clinical, histopathological, molecular, and dermoscopic patterns of SM and its relation to androgenetic alopecia/elastosis at the tumor site. Through a retrospective cross-sectional study, we identified all SM diagnosed at the A.C.Camargo Cancer Center between 2008 and 2018. In all, 48 SM were analyzed: 45.8% of which exhibited moderate/severe androgenetic alopecia and 54.1% exhibited elastosis. Androgenetic alopecia/elastosis at the site of the SM was associated with older age (p < 0.001), chronic sun damage (p < 0.001), lentigo maligna subtype (p = 0.029), and photodamaged dermoscopic pattern (p < 0.001). Additionally, 41 cases were evaluated with a 14-gene panel: 53.7% displayed mutations and 46.3% were wild-type. BRAF mutations were most common (77%), with BRAF V600K being more frequent (50%) than BRAF V600E (31.2%). The NF1 gene was evaluated in 40 samples, of which 20% exhibited mutations. SM presents differently in areas covered by hair compared to in areas with androgenetic alopecia. Patients without alopecia may have higher Breslow thickness due to late diagnosis because of hair concealment. The high frequency of detrimental mutations can also explain the poor prognosis of SM.

Comparison of hematological parameters between single and twin pregnancies in Dorper ewes during gestation, lambing, and postpartum / Comparação dos parâmetros hematológicos entre ovelhas Dorper de gestação simples e gemelar durante a prenhez, parto e pós-parto

ABSTRACT: The hematopoietic system changes during the pregnancy to carry fetal development and maternal needs. This study compared the hematological parameters between ewes with single and twin pregnancies during gestation, delivery, and postpartum. The experiment was conducted on 60 healthy pregnant Dorper ewes that were divided into two experimental groups: Group 1 (G1), with single pregnancies (n=30), and Group 2 (G2), with twin pregnancies (n=30). Blood samples were collected from all ewes at different times: immediately before fixed-time artificial insemination (AI); on day 30, 90, 120, 130, and 140 of pregnancy; immediately after delivery; and at 24h and 48h postpartum. Statistical analysis compared the two groups at different times (P<0.05). Mild, normocytic, and hypochromic anemia was detected in all ewes from AI time and throughout pregnancy from both groups, but did not prove to be of clinical relevance. In the peripartum stage (from the 140th day of pregnancy to 48h postpartum), the ewes with twin pregnancies (G2) exhibited higher erythrogram values and neutrophil:lymphocyte ratio than did ewes with single pregnancies (G1). This indicated a greater hematopoietic adaptation in the body during the development of two fetuses. Except for the eosinophil numbers, all leukogram parameters were influenced by pregnancy in a similar way in both groups, and was characterized mainly by leukocytosis with neutrophilia during peripartum due to the high presence of endogenous cortisol at delivery. Thus, these findings showed that pregnancy was a stressful physiological event that increased the leukocyte count with a slight alteration in the erythrogram of Dorper ewes.

RESUMO: O sistema hematopoiético sofre mudanças durante a gestação para atender o desenvolvimento fetal e as necessidades maternas. Este estudo comparou os parâmetros hematológicos entre ovelhas com gestação simples e gemelar durante a prenhez, parto e pós-parto. O estudo foi realizado em 60 ovelhas Dorper prenhes, saudáveis, divididas em dois grupos experimentais: Grupo 1 (G1) com gestação simples (n = 30); e Grupo 2 (G2) com gestação gemelar (n = 30). Amostras de sangue foram colhidos de todas as ovelhas em diferentes momentos: imediatamente antes da inseminação artificial em tempo fixo (IA); nos dias 30, 90, 120, 130 e 140 de gestação; imediatamente após o parto; e às 24h e 48h pós-parto. A análise estatística comparou os dois grupos nos diferentes momentos (P < 0,05). Anemia leve, normocítica e hipocrômica foi detectada desde a IA e ao longo da gestação, nas ovelhas de ambos os grupos, mas não houve relevância clínica. Na fase periparto (do 140º dia de gestação às 48h pós-parto), as ovelhas com gestação gemelar (G2) mostraram valores do eritrograma e proporção neutrófilos: linfócitos mais elevados do que as ovelhas com gestação simples (G1). Isso indicou maior adaptação hematopoiética da ovelha para o desenvolvimento de dois fetos. Com exceção do número de eosinófilos, todos os parâmetros do leucograma foram influenciados pela gestação de forma semelhante em ambos os grupos, e foi caracterizada principalmente por leucocitose com neutrofilia no periparto devido ao alto nível de cortisol endógeno no parto. Assim, os achados mostraram que a gestação foi um evento fisiológico estressante que aumentou a contagem de leucócitos com leve alteração no eritrograma de ovelhas Dorper.

Evaluation of Bacterial Nanocellulose Membranes Loaded or Not with Nisin as a Complementary Treatment in Surgical Dehorning Wounds in Bovines.

Treatments of postsurgical dehorning in cattle usually includes topical application of healing agents in wounds. The Bacterial Nanocellulose (BNC) may come to a complementary treatment for these wounds. Two new complementary treatments with BNC and BNC loaded with nisin were evaluated for wound healing in surgical dehorning in bovine. Hence, two groups of experiments were run, and 12 animals were used in each group. All animals, in right and left horns, received antisepsis treatment. For the first group, the left horn was the control, and on the right one the BNC was applied. For the second group, BNC was applied on the left horn (control) and on the right ones BNC+nisin was applied. In both experiments, wounds were evaluated macroscopically by photographic images and microscopically by histology. For macroscopic evaluations, a significant difference was observed over time, but only in the comparison within the same groups. Microscopic analyzes did not showed significant differences in any type of comparison. In conclusion, there was a clinical improvement in the wound healing response with the application of BNC. However, there was no significant difference between BNC compared to the nisin loaded in BNC. For the first time it was applied a BNC in surgical dehorning wounds in bovines and evaluated the efficacy of treatment in a real animal handling situation.

Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial.

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

Primary cutaneous melanoma of the scalp: Patterns of clinical, histological and epidemiological characteristics in Brazil.

BACKGROUND/OBJECTIVES: Scalp melanoma is a subgroup of melanomas on the head and neck, historically associated with worst prognosis. Knowledge of the usual presentation of scalp melanoma can help to understand the reasons for the poor outcomes of treatment. This is the first publication to describe the clinical, histopathological and epidemiological profile of patients with scalp melanoma in a Latin American population. METHODS: A cross-sectional study was performed of all primary cutaneous melanoma seen by the A.C.Camargo Cancer Center between 2008 and 2018, using an electronic health records to access clinical and pathology data. RESULTS: When compared to trunk and limbs, increasing age is expected for patients with scalp melanoma (10.865; CI (95%) = [8.303; 13.427]). Regarding risk of invasion, scalp melanomas have a higher chance to be invasive than in situ (OR = 1.783; CI (95%) = [1.196; 2.657]) and present with higher Breslow thickness (OR = 3.005; CI (95%) = [2.507; 3.601]). Scalp site was significantly associated with male sex (OR = 3.750; CI (95%) = [2.533; 5.554]), perineural invasion (OR = 13.739; CI (95%) = [5.919; 31.895]), ulceration (OR = 2.311; CI (95%) = [1.488; 3.588]), and mitosis (OR = 2.366; CI (95%) = [1.701; 3.292]), when compared to trunk and limbs melanoma. CONCLUSION: In the present study, head and neck melanomas represented 14.9% of all melanomas, a frequency slightly lower than that described in the literature and the mean age of melanoma on the scalp found was lower than that reported in the literature. These results could be explained by the demographic characteristics of Brazil, which has a population with a lower life expectancy compared to the European and North American population. Scalp melanomas occurred in older men, were diagnosed with greater Breslow thickness and were associated with the presence of perineural invasion, mitosis and ulceration.

Socio-Economic and Racial profile of Medical Students from a Public University in Rio de Janeiro, Brazil / Perfil Socioeconômico e Racial de Estudantes de Medicina em uma Universidade Pública do Rio de Janeiro

Abstract: Introduction: There are still many economic and racial barriers for black and indigenous peoples regarding access to a university degree in Brazil. Although Brazil is mistakenly considered a racial democracy, black people, indigenous peoples and those of low social status are the most affected by such difficulties regarding access to the university. Medical schools are traditionally attended by white, wealthy and upper-middle-class groups, although 54% of Brazilians consider themselves to be African descendants. To deal with this scenario, since 2013, 50% of all vacancies in public universities have been reserved for low social classes, indigenous peoples and African descendants. Our objective was to describe the socioeconomic and racial profile of those attending a public medical school in the state of Rio de Janeiro during a five-year period, analyzing the associations between the Brazilian segregationist structure and inclusion policies. Method: A census study was carried out, including all groups that entered the medical school at a public university in the state of Rio de Janeiro between 2013 and 2017. We applied a self-administered questionnaire that addressed social, ethnic, economic and university admission aspects. The data were analyzed by a simple description of the frequencies and by bivariate analysis. Results: The results show that the majority profile is white, with an annual income higher than US$ 8,640, coming from a private school, with financial support from the family, both parents with higher education and no gender difference. As for the inclusion of non-white people into the course, the current quota system has not significantly increased their presence. Conclusion: We conclude that racial inclusion policies subordinated to economic ones seem to be a barrier to the entry of non-whites to medical school, contributing to racial inequality.

Resumo: Introdução: O Brasil continua sendo um país onde persistem muitas barreiras socioeconômicas e raciais para acesso à formação médica. Ainda que o Brasil seja equivocadamente considerado uma democracia racial, pessoas negras, povos indígenas e aqueles de baixo status social são os mais afetados por tais dificuldades de acesso à universidade. As faculdades de Medicina são tradicionalmente ocupadas por grupos brancos, ricos e de classe média alta, embora 54% dos brasileiros se considerem afro-brasileiros. Para lidar com esse cenário, há, desde 2013, a reserva de 50% de todas as vagas em universidades públicas para baixa classe social, povos indígenas e pessoas negras. Nosso objetivo foi descrever o perfil socioeconômico e racial dos ingressantes de uma faculdade de Medicina da Região Sudeste ao longo de cinco anos, analisando as relações entre a estrutura segregacionista brasileira e as políticas de inclusão. Método: Um estudo censitário foi realizado abrangendo todos os grupos que entraram entre 2013 e 2017 na Faculdade de Medicina de uma universidade do Estado do Rio de Janeiro. Optamos por aplicar um questionário autoadministrado que aborda aspectos sociais, raciais, econômicos e de admissão em universidades. Os dados foram analisados por uma descrição simples das frequências e por análise bivariada. Resultados: Constatou-se que o perfil majoritário é branco, com renda anual superior a US$ 8.640, proveniente de escola particular, com apoio financeiro da família, ambos os pais com ensino superior e sem diferença de gênero. Quanto à inserção de pessoas não brancas no curso, o atual sistema de cotas não aumentou significativamente a presença dessas pessoas. Conclusão: Políticas de inclusão racial subordinadas à econômica parecem ser uma barreira à entrada de não brancos na Faculdade de Medicina, o que contribui para a desigualdade racial.

Melanoacanthoma: a potential pitfall of reflectance confocal microscopy.

Melanoacanthoma is a rare variant of seborrheic keratosis, which is notable for dark pigmentation and fast radial growth, making it difficult to distinguish from melanoma. Histologically, it is characterized by proliferation of keratinocytes and dendritic melanocytes. The authors report a scalp lesion, fast growing, suspected by dermoscopy and confocal microscopy examination, with dendritic cells distributed throughout the lesion. Based on these findings, it was not possible to classify this lesion as clearly benign, so it was excised. Histopathologic evaluation and immunostain were consistent with melanoacanthoma.

Melanoacanthoma: a potential pitfall of reflectance confocal microscopy

Abstract Melanoacanthoma is a rare variant of seborrheic keratosis, which is notable for dark pigmentation and fast radial growth, making it difficult to distinguish from melanoma. Histologically, it is characterized by proliferation of keratinocytes and dendritic melanocytes. The authors report a scalp lesion, fast growing, suspected by dermoscopy and confocal microscopy examination, with dendritic cells distributed throughout the lesion. Based on these findings, it was not possible to classify this lesion as clearly benign, so it was excised. Histopathologic evaluation and immunostain were consistent with melanoacanthoma.

Evaluation of the social, clinical and laboratorial profile of patients diagnosed with leprosy in a reference center in São Paulo.

BACKGROUND: Leprosy is the main infectious cause of disability. It is said to be eradicated in São Paulo since 2005, but diagnosis is still late. OBJECTIVES: To investigate the social, clinical and laboratorial profile of leprosy patients diagnosed between 01/2007 and 12/2011, in a reference center in São Paulo. METHODS: Retrospective descriptive study. Data of all new leprosy cases diagnosed between 01/2007 and 12/2011 were raised in São Paulo. RESULTS: 103 men and 71 women were diagnosed, most of them were multibacillary. Mean age at diagnosis was 49 yrs; 2,2% were children; 70% had incomplete primary education; 50% were referred without diagnostic suspicion of leprosy. Mean time since first symptoms/signs and diagnosis was 2 years; 64% of patients had some degree of disability, and 26% had grade 2. 23 cases were diagnosed only after being summoned, and 80% of these had no disability. Agreement between the Ridley and Jopling and the WHO classification was 75% (kappa index = 0.44). Serology for IgM anti-PGL1 (87 patients) showed a mean value of 0.25, and an association between MB classification and test positivity (p <0.001). CONCLUSIONS: Leprosy diagnosis in São Paulo is late. The disease mainly affected the socially disadvantaged and economically active population. Failure to detect the disease (41% in the last 10 years) could be due to the lack of suspicion and to decentralization. For the classification of patients with advanced leprosy, both the WHO and R&J classifications proved to be helpful tools.

Evaluation of the social, clinical and laboratorial profile of patients diagnosed with leprosy in a reference center in São Paulo

BACKGROUND: Leprosy is the main infectious cause of disability. It is said to be eradicated in São Paulo since 2005, but diagnosis is still late. OBJECTIVES: To investigate the social, clinical and laboratorial profile of leprosy patients diagnosed between 01/2007 and 12/2011, in a reference center in São Paulo. METHODS: Retrospective descriptive study. Data of all new leprosy cases diagnosed between 01/2007 and 12/2011 were raised in São Paulo. RESULTS: 103 men and 71 women were diagnosed, most of them were multibacillary. Mean age at diagnosis was 49 yrs; 2,2% were children; 70% had incomplete primary education; 50% were referred without diagnostic suspicion of leprosy. Mean time since first symptoms/signs and diagnosis was 2 years; 64% of patients had some degree of disability, and 26% had grade 2. 23 cases were diagnosed only after being summoned, and 80% of these had no disability. Agreement between the Ridley and Jopling and the WHO classification was 75% (kappa index = 0.44). Serology for IgM anti-PGL1 (87 patients) showed a mean value of 0.25, and an association between MB classification and test positivity (p <0.001). CONCLUSIONS: Leprosy diagnosis in São Paulo is late. The disease mainly affected the socially disadvantaged and economically active population. Failure to detect the disease (41% in the last 10 years) could be due to the lack of suspicion and to decentralization. For the classification of patients with advanced leprosy, both the WHO and R&J classifications proved to be helpful tools. .

Cowden Syndrome: report of a case and brief review of literature.

We present the case of a female patient with facial cutaneous lesions, a cobblestone-like pattern of the oral mucosa, and verruciform lesions on the hand since her youth. She reported a history of breast cancer, endometrial cancer, melanoma and multiple benign tumors and cysts. PTEN gene analysis was performed and confirmed Cowden Syndrome, a rare genodermatosis with an autosomal dominant pattern of inheritance, characterized by multiple hamartomas. The phosphatase and tensin homolog (PTEN) gene negatively regulates cell proliferation and cell cycle progression. Loss of PTEN function contributes to an increased risk of cancer. We emphasize the importance of early detection and accurate management of Cowden Syndrome.

Cowden Syndrome: report of a case and brief review of literature / Sindrome de Cowden: Relato de caso e uma breve revisao da literatura

We present the case of a female patient with facial cutaneous lesions, a cobblestone-like pattern of the oral mucosa, and verruciform lesions on the hand since her youth. She reported a history of breast cancer, endometrial cancer, melanoma and multiple benign tumors and cysts. PTEN gene analysis was performed and confirmed Cowden Syndrome, a rare genodermatosis with an autosomal dominant pattern of inheritance, characterized by multiple hamartomas. The phosphatase and tensin homolog (PTEN) gene negatively regulates cell proliferation and cell cycle progression. Loss of PTEN function contributes to an increased risk of cancer. We emphasize the importance of early detection and accurate management of Cowden Syndrome.

Apresentamos o caso de uma paciente com lesões cutâneas faciais, mucosa oral com aparência de paralelepípedo, e lesões de aspecto verrucoso na mão desde a sua juventude. Ela relatou uma história de câncer de mama, câncer de endométrio, melanoma e múltiplos tumores benignos e cistos. A análise genética PTEN foi realizada e confirmou a Síndrome de Cowden, uma genodermatose rara, com um padrão de herança autossômica dominante, caracterizada por múltiplos hamartomas. O gene homólogo de fosfatase e angiotensina (PTEN) regula negativamente a proliferação celular e a progressão do ciclo celular. A perda da função PTEN contribui para um aumento do risco de câncer. Ressaltamos a importância da detecção precoce e tratamento preciso da Síndrome de Cowden.

Rhodococcus equi Parte 1: epidemiologia, manifestações clínicas, diagnóstico e tratamento / Rhodococcus equi Part 1: epidemiology, clinical manifestations, diagnosis and treatment

A rodococose é uma doença de distribuição mundial causada pelo Rhodococcus equi, responsável por taxas elevadas de mortalidade e grandes perdas econômicas relacionadas à pneumonia grave em potros com menos de seis meses de idade. Essa revisão inclui a etiologia, epidemiologia e patogenia da doença com atenção especial à proteína de superfície VapA, seu principal determinante de virulência. As principais manifestações clínicas são apresentadas, bem como os métodos diagnósticos e as suas aplicações, incluindo as novas estratégias em desenvolvimento. Da mesma maneira, as medidas terapêuticas mais utilizadas são também discutidas, abordando principalmente o uso de antibióticos capazes de penetrar nas formações abscedantes.

Rodococosis is a disease that has a worldwide distribution caused by Rhodococcus equi. In foals under six months high mortality and great econimic losses are related to this bacterial pneumonia. This review includes the ethiology, epidemiology and pathogenesis of the disease with focus on the role of VapA, a surface protein, as the major determinant of virulence. The clinical manifestations are reviewed and diagnostic methods and their applications are commented, including new strategies that are still being developed. Likewise, the most common clinical therapies are discussed specially those using antibiotics that are known to penetrate in abcesses.

Rhodococcus equi Parte 2: imunologia e profilaxia / Rhodococcus equi Part 2: immunology and profilaxy

Rhodococcus equi é um patógeno ubíquo e habitante da flora intestinal dos equinos de importância na neonatologia equina. Todos os potros são expostos à doença ao nascimento, porém alguns a desenvolvem e outros não. Este artigo revisa características da resposta imune, tanto em adultos competentes quanto em potros suscetíveis ao patógeno. A resposta imune humoral é abordada, incluindo uma discussão sobre o uso do plasma hiperimune como ferramenta profilática. O papel dos mecanismos de imunidade inata na suscetibilidade de alguns potros ao R. equi é também abordado. Da mesma maneira, os componentes envolvidos na resposta cito-mediada são revisados, com atenção particular às pesquisas direcionadas ao desenvolvimento de uma vacina efetiva para ser utilizada em potros.

Rhodococcus equi is an important pathogen in equine neonatology that is ubiquitous and a normal intestinal inhabitant of equines. All foals are exposed at birth, however, some foals develop disease and others do not. This article reviews concepts of the equine immune response, both in the immune adult and susceptible neonate, with respect to this pathogen. Humoral immune responses are addressed, with a discussion on the use of hyperimmune plasma as a prophylactic tool. The role that innate immune mechanisms play in the susceptibility of some foals to R. equi infection is also highlighted. Likewise, cell-mediated immune components are reviewed, with particular attention directed towards research to develop an effective vaccine for foals.

Corticoterapia no choque séptico e sepse grave / Corticotherapy in severe sepsis and septic shock

JUSTIFICATIVA E OBJETIVOS: A sepse é uma causa importante de internação e a principal causa de morte em unidades de terapia intensiva (UTI). Atualmente existem várias orientações terapêuticas e dúvidas quanto ao emprego dos corticoides na sepse grave e no choque séptico. O objetivo deste estudo foi confrontar os diversos pontos de vista, bem como aperfeiçoar a qualidade e segurança do tratamento da sepse grave e choque séptico. CONTEÚDO: Realizou-se uma pesquisa em estudos publicados entre 1993 e 2009, nos bancos de dados Pubmed, Cochrane Librarye Embase LILACS, através das palavras-chave: "sepsis", "septic shock","steroids" e "corticosteroids", além de livros das áreas de Medicina Intensiva. As altas taxas de morbimortalidade associadas à sepse grave e ao choque séptico geram grande preocupação frente a essas condições clínicas. Enquanto alguns estudos demonstraram benefícios na sobrevida de pacientes que fizeram uso de corticoides por tempo prolongado e em baixa dose, uma importante metanálise na qual se utilizou o corticoide durante cinco dias, mostrou ineficácia dessa terapia com relação à mortalidade, pois não houve evidência de sua redução, apenas acelerando o tempo de reversão do choque. Apesar dos avanços da Medicina, a taxa de sua incidência é crescente devido ao grande número de pessoas com fatores de risco. Desta forma, a utilização adequada dos recursos corticoterápicos pode ser fundamental para o sucesso do tratamento. CONCLUSÃO: O uso de corticoides no choque séptico é indicado em baixas doses, por período prolongado.

BACKGROUND AND OBJECTIVES: Sepsis is a major cause of hospitalization and the leading cause of death in intensive care units. Currently there are several treatment guidelines and questions regarding the use of corticosteroids in severe sepsis and septic shock. The aim of this study was to compare the various views, and optimize the quality and safety of treatment of severe sepsis and septic shock. CONTENTS: Review of studies published between 1993 and 2009 in the databases Pubmed, Cochrane and Embase Library, LILACS, through the keywords: "sepsis", "septic shock", "steroids" and "corticosteroids" as well as books in the areas of Intensive Care Medicine. The high rates of morbidity and mortality associated with severe sepsis and septic shock cause high concern before these clinical conditions. While some studies show benefits in survival of patients who used corticosteroids for long term and low dose, an important metaanalysis in which we used the corticosteroids for five days, show edthat inefficiency therapy regarding mortality, because there was no evidence of reduction, only speeding time to reversal of shock . Despite medical advances, the rate of its incidence is increasing due tothe large number of people with risk factors. In this way, the use of resources corticotherapy can be the key resource to the success of treatment. CONCLUSION: The use of corticosteroids in septic shock is indicatedin low doses, for prolonged periods.

Ureia como marcador de diluição em amostras de lavado traqueobrônquico de potros com rodococose / Urea as a dilution mark in tracheobronchial wash samples of foals with rodhococosis

No estudo das infecções e dos mecanismos inflamatórios do trato respiratório posterior, a diluição desconhecida de amostras de lavados traqueobrônquicos leva a um grave problema na interpretação das concentrações de várias substâncias. Foi investigada a amplitude da diluição em uma situação clínica verdadeira, com o objetivo de determinar a validez do uso da dosagem da ureia em lavados traqueobrônquicos para correção da diluição. As amostras do estudo consistiram em lavados traqueobrônquicos obtidos de sete potros com infecção por Rhodococcus equi. Foi realizada a contagem celular total e diferencial e comprado com o quadro clínico e a recuperação bacteriana de todas as amostras. Os fatores de diluição dos lavados variaram entre 14,3 e 130 (média 59,7). O uso da ureia como marcador de diluição melhorou a exatidão na determinação da concentração total de células nos lavados. Estes resultados sugerem que a prática de mensurar substâncias em lavado traqueobrônquico sem correção da diluição possa induzir a falsas conclusões.

In the study of infection and inflammatory mechanisms of the lower respiratory tract, the unknown dilution of tracheobronchial wash samples is a serious problem for interpretation of the measured concentrations of various substances. The range of dilution in a true clinical situation was investigated with the goal to determine the validity of using urea dosage in tracheobronchial wash to correct the dilution. The study samples consisted of tracheobronchial wash specimens from 7 foals with Rhodococcus equi infection. Total and differential cell counts were made and compared with clinical status and bacterial recuperation of all samples. The dilution factors of the nasal lavage specimens varied between 14.3 and 130 (median 59.7). The use of urea as a dilution mark improves the accuracy of quantifying total cell concentration in washes. These findings suggest that the most common current practice of meansuring substances in tracheobronchial wash, without correction for the dilution, may induce to false conclusions.