Feline Comorbidities: Balancing hyperthyroidism and concurrent chronic kidney disease.

PRACTICAL RELEVANCE: Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times. Hyperthyroidism may mask the presence of CKD, and vice versa, by various mechanisms that are described in this review. Hyperthyroidism treatment options should be carefully considered when CKD has also been diagnosed. CLINICAL CHALLENGES: Although it can be difficult to diagnose hyperthyroidism and CKD simultaneously, given that one condition may mask the other, it is important to consider the presence of both diseases when examining an older cat presenting with vomiting, weight loss, polyuria/ polydipsia, anorexia or sarcopenia. The concurrent presence of hyperthyroidism and CKD requires careful monitoring of glomerular filtration rate biomarkers, and adequate and prompt support of kidney function when normal thyroid function is re-established. Iatrogenic hypothyroidism is a recognised complication of all of the treatment options for hyperthyroidism, and increases the risk of azotaemia. Therapy with levothyroxine is recommended for cats that are hypothyroid and azotaemic. EVIDENCE BASE: The information in this review draws on current literature and guidelines related to the pathophysiology, diagnosis and treatment recommendations for feline hyperthyroidism and CKD.

Evolution of Rabies Virus Isolates: Virulence Signatures and Effects of Modulation by Neutralizing Antibodies.

Lyssavirus rabies (RABV) is an RNA virus and, therefore, is subject to mutations due to low RNA polymerase replication fidelity, forming a population structure known as a viral quasispecies, which is the core of RNA viruses' adaptive strategy. Under new microenvironmental conditions, the fittest populations are selected, and the study of this process on the molecular level can help determine molecular signatures related to virulence. Our aim was to survey gene signatures on nucleoprotein and glycoprotein genes that might be involved in virulence modulation during the in vitro evolution of RABV lineages after serial passages in a neuronal cell system with or without the presence of neutralizing antibodies based on replicative fitness, in vivo neurotropism and protein structure and dynamics. The experiments revealed that amino acids at positions 186 and 188 of the glycoprotein are virulence factors of Lyssavirus rabies, and site 186 specifically might allow the attachment to heparan as a secondary cell receptor, while polymorphism at position 333 might allow the selection of escape mutants under suboptimal neutralizing antibodies titers.

Long-term effect of neutering on plasma luteinising hormone concentration in cats.

OBJECTIVES: The objectives of this study were to validate a commercially available luteinising hormone (LH) cat ELISA, to determine whether the increases in plasma LH concentration that occur after neutering are maintained throughout cats' lives and if other factors such as calendar seasons in both intact and neutered cats, and neutering age in neutered cats, influence plasma LH concentrations. METHODS: Stored plasma samples from client-owned cats were used for the measurement of LH concentrations. Clinical data, including age, sex, age at neutering and medical history, were reviewed. Two populations were included in this study: (1) a senior and geriatric cat population (⩾9 years old), including 18 intact and 18 neutered cats matched for age, sex and month of sample collection; and (2) an adult cat population (2-8 years old), including 45 neutered cats. LH concentrations were measured using a commercially available feline ELISA. RESULTS: Senior and geriatric neutered cats had higher plasma LH concentrations than age-matched intact cats (P <0.001). Calendar season did not influence plasma LH concentrations in the adult (P = 0.727) or senior/geriatric (P = 0.745) cats included in this study. No influence of age at neutering was observed on plasma LH concentrations (P = 0.296). CONCLUSIONS AND RELEVANCE: Neutering causes a significant long-term increase in LH concentrations in cats and further studies are required to determine the consequences on feline health.

Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke - A Pilot Study.

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.

Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions.

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P <0.0001), systolic arterial blood pressure (-10.33 ± 18.44 vs 5.21 ± 15.23 mmHg, P = 0.02) and vaporiser settings (-0.2 ± 0.2 vs 0.1 ± 0.4, P = 0.023) were significantly different between groups. The control group had higher postoperative pain scores (median [interquartile range]) at 2 h (3 [1.75-4.00] vs 1 [0-2], P = 0.008) and 4 h (4 [2-6] vs 2 [1-2], P = 0.006) after the dental extractions. Maxillary and inferior alveolar nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks.

A experiência da co-residência para idosas em família intergeracional / The experience of co-residence elderly women in intergenerational family

As transformações causadas pelo envelhecimento populacional, além de promover desenvolvimento, investimento, distribuição de renda, flexibilidade da mão-de-obra, estimula a convivência com a família, principalmente as relações intergeracionais, igualdade social e de gênero e das diversas formas de gestão econômica, social e política. O Brasil vem envelhecendo de forma rápida e intensa, apesar disso, pouco se conhece a situação dos idosos convivendo com suas famílias, ou seja, o número e a condição dos idosos que moram com seus filhos, genros, noras e netos. Com o objetivo de identificar a experiência dos idosos que co-residem com filhos (genros/noras) e netos. Utilizamos o método de pesquisa qualitativa de caráter descritivo. A população estudada foi composta por 13 idosas, residentes em Maringá-Pr, onde os idosos representam 8,9% da população. Todos os preceitos éticos preconizados pela Resolução 196/96, Ministério da Saúde, foram cumpridos. As entrevistas foram realizadas de junho a agosto de 2007. Para a coleta das informações foi utilizado entrevista semi-estruturada, e os dados obtidos foram analisados utilizando-se a metodologia do Discurso do Sujeito Coletivo. O resultado deste estudo nos mostra que as idosas co-residem com a família em virtude de sua viuvez/solidão e de necessidades econômicas, de moradia, emocional e de ajuda, demonstrada pelos filhos. Elas prestam ajuda à seus filhos e netos e são o ponto de apoio da família, quando em necessidade ou situação de risco. A convivência em família é considerada boa e muito boa, as idosas relatam que se sentem bem e felizes como cuidadoras e protetoras da família, já que a co-residência lhes possibilitou um tipo de vida, permeada por atividades compartilhada com os membros da família, onde elas se sentem amadas, respeitadas, valorizadas e cuidadas. Relatam autonomia financeira, com fonte de renda advinda de aposentadoria, benefícios previdenciários e atividades de trabalhos informais. Utilizam sua renda para despesas pessoais e/ou como ajuda nas despesas da família e tem consciência do poder que exercem sobre a família. Cuidam da saúde, principalmente para manterem-se independentes fisicamente. Chefiam e são chefiadas em seus lares e não trocariam a convivência com seus filhos, genros, noras e netos, pela solidão. Em sua maioria elas não referem violência física, mas algumas relatam violência verbal. Concluímos que co-residir em família, é uma forma de cuidado mutuo, no qual há interação, troca de experiência, ajuda e apoio entre as gerações.

The changes because of population aging over there to promote research, investment, income distribute, labor flexibility, and encourage living with family, specially generation relationship, social and gender equality and kind of economical, social and politic management .The Brazilian population was getting old intense and quickly, nevertheless, little get know about the situation of elderly who live theirs family, in other words, the number and condition of elderly who live theirs sons, sons-in-law, daughters-in-law and grandchildren. With the goal to identify the elderly experiences that live with their sons (sons-in-law/daughters-inlaw) and grandchildren, we use the qualitative research method of descriptive character. The population was study was composing to 13 elderly women residents in Maringá-Pr, where the elderly represent 8, 9% this population. All ethical precepts established for to Resolution 196/96, Health Department, were fulfilling. The interviews was realized July to August 2007. To collection the information was use semi-structured interview and the piece of information to get were analyzed through of the methodology of Collective Subject Discourse. The results this paper was that these elderly women co-reside with theirs family because are widow, solitary, economical, residence and emotional necessities, to prove for sons. Also auxiliary theirs sons and grandchildren and are support point of the family when risk situation. The live together in family is considered very well and the elderly women relate that to feel yourself and happy with career of and protector her family, since the co-residence possibility to her a life involved to activities whit family members where they feel loved, respected, valued and cared. They relate financial autonomy, with pension source of income, Social Security benefits and informal work. Use their income to personal expense and/or with family expense, and are aware of power about family. They take care of health to maintain themselves physically independents. They lead and are leading in their homes and wouldn't change the live together with sons, sons-in-law, daughters-inlaw and grandchildren however solitude. Although didn't reveal physical violence, they sad about verbal violence. We concluded that co-resided in family is mutual care form, since participate activity the everyday family with change experience, help and support between generations.

Las transformaciones ocasionadas por el envejecimiento poblacional además de promover el desarrollo, inversión, distribución de renta, flexibilidad de mano de obra, estimula la convivencia con la familia principalmente las relaciones intergeneracionales, igualdad social y de género y en las diversas formas de gestión económica, social y política. La población brasileña está envejeciendo de manera rápida e intensa, a pesar de esto, poco se conoce sobre la situación de los ancianos que co-residen con sus familias, o sea, el numero y las condiciones de personas grandes que viven con sus hijos, yernos, nueras y nietos. Con el objetivo de identificar la experiencia de los ancianos que conviven con sus hijos (yernos/nueras) y nietos. Utilizamos el método de investigación cualitativa de carácter descriptivo. La población investigada fue compuesta por 13 ancianas, residentes en la ciudad de Maringa- PR, en donde los ancianos representando 8,9% de la población. Todos los preceptos éticos determinados por la Resolución 196/96, Ministerio de la Salud, fueran cumplidos. Las encuestas fueran realizadas de Junio hasta Agosto de 2007. Para la colecta de las informaciones fue utilizada entrevista semiestructurada y los datos obtenidos fueran analizados utilizándose la metodología del Discurso del Sujeto Colectivo. El resultado de este estudio demuestra que estas señoras mayores conviven con su familia en virtud de su viudez/soledad y de necesidades económicas y de morada, emocional y de ayuda, demuéstrala por los hijos. Prestan ayuda a sus hijos y nietos y son el punto de apoyo de la familia cuando en necesidad o situación de riesgo. La convivencia en familia es considerada muy buena y las ancianas describen que siéntense muy bien y felices como las cuidadoras y protectoras de la familia, ya que la convivencia posibilitó a ellas una forma de vida llena de actividades compartidas con los miembros de la familia, en la cual siéntense amadas, respetadas, valorizadas y cuidadas. Las ancianas relatan autonomía financiera y tienen como fuente de renta la jubilación, beneficios de la previdencia social y actividades de trabajos informales. Utilizan su renta para los gastos personales y/o ayuda en los gastos de la familia, y tienen conciencia del poder que ejercen sobre la familia. Cuidan de la salud, principalmente para que se mantengan independientes físicamente. Lideran y son lideradas en sus hogares y no cambiarían la convivencia con sus hijos, yernos, nueras y nietos por la soledad. En su mayoría no relatan violencia física, todavía, con relatos de violencia verbal. Concluimos que co-residir en familia es una manera de cuidado mutuo, en el cual ocurre interacción, cambio de experiencias, ayuda y apoyo entre las generaciones.

Nutrição enteral como alternativa em síndrome do intestino curto / Enteral nutrition as an alternative in short bowel syndrome / Nutrición enteral como una alternativa en el síndrome de intestino corto

Este trabalho avaliou a eficácia da terapia nutricional (TN) adjuvante em portadores de síndrome do intestino curto (SIC) em regime de NPT domiciliar por 2 a 4,5 anos. A interrupção da terapia deu-se por sepse por cateter em dois pacientes, trombose venosa profunda em dois e embolia pulmonar em um. A dieta enteral foi introduzida após um a seis meses de suspensão de NPT. A via de acesso da TN enteral foi nasotenral (um paciente), gastronomia (três) e oral (um). A dieta enteral utilizada foi polimérica isomolar com fibras (três pacientes) e sem fibras (dois). A técnica de infusão foi cíclica noturna e/ou diurna em sistema fechado com bomba de infusão (50 a 83 ml/h) ou oral fracionada. Os resultados permitiram concluir que a TN enteral adjuvante nesta população permitiu prover as necessidades calóricas sem NPT, com manutenção de peso corpóreo, constituindo-se alternativa viável no manuseio nutricional de SIC.

This study evaluated the efficacy of nutritional therapy (NT) adjuvant in patients with short bowel syndrome (SBS) on a home TPN for 2 to 4.5 years. Discontinuation of therapy was given by catheter sepsis in two patients, deep vein thrombosis and pulmonary embolism in two in one. Enteral feeding was introduced after a six-month suspension of NPT. The route of enteral access was nasotenral TN (one patient), food (three) and oral (a). Enteral nutrition was used isomolar polymeric fibers (three patients) and no fiber (two). The infusion technique was cyclical and nighttime or daytime in a closed system using an infusion pump (50-83 ml / h) or divided oral doses. The results showed that NT enteral adjuvant allowed this population to provide the caloric needs without TPN, with maintenance of body weight, becoming a viable alternative in the nutritional management of SBS.

Este estudio evaluó la eficacia de la terapia nutricional (NT) adyuvante en pacientes con síndrome de intestino corto (SIC) en un TPN en casa por 2 a 4,5 años. La interrupción del tratamiento fue dado por sepsis por catéter en dos pacientes, la trombosis venosa profunda y embolismo pulmonar en dos en uno. La alimentación enteral se introdujo después de una suspensión de seis meses del TNP. La ruta de acceso enteral fue nasotenral TN (un paciente), alimentos (tres) y oral (a). La nutrición enteral se utilizó isomolar fibras poliméricas (tres pacientes) y sin fibra (dos). La técnica de infusión era cíclico y la noche o de día en un sistema cerrado mediante una bomba de infusión (50 a 83 ml / h) o divide las dosis orales. Los resultados mostraron que adyuvante NT enteral permite a esta población para cubrir las necesidades de calorías sin RPT, con el mantenimiento del peso corporal, convirtiéndose en una alternativa viable en el manejo nutricional de SBS.