Plasma proteome signature of canine acute haemorrhagic diarrhoea syndrome (AHDS).

Acute haemorrhagic diarrhoea is a common complaint in dogs. In addition to causes like intestinal parasites, dietary indiscretion, intestinal foreign bodies, canine parvovirus infection, or hypoadrenocorticism, acute haemorrhagic diarrhoea syndrome (AHDS) is an important and sometimes life-threatening differential diagnosis. There is some evidence supporting the link between Clostridium perfringens toxins and AHDS. These toxins may be partially responsible for the epithelial cell injury, but the pathogenesis of AHDS is still not fully understood. Recent studies have suggested that severe damage to the intestinal mucosa and associated barrier dysfunction can trigger chronic gastrointestinal illnesses. Besides bloodwork and classical markers for AHDS such as protein loss and intestinal bacterial dysbiosis, we focused mainly on the plasma-proteome to identify systemic pathological alterations during this disease and searched for potential biomarkers to improve the diagnosis. To accomplish the goals, we used liquid chromatography-mass spectrometry. We compared the proteomic profiles of 20 dogs with AHDS to 20 age-, breed-, and sex-matched control dogs. All dogs were examined, and several blood work parameters were determined and compared, including plasma biochemistry and cell counts. We identified and quantified (relative quantification) 207 plasmatic proteins, from which dozens showed significantly altered levels in AHDS. Serpina3, Lipopolysaccharide-binding protein, several Ig-like domain-containing proteins, Glyceraldehyde-3-phosphate dehydrogenase and Serum amyloid A were more abundant in plasma from AHDS affected dogs. In contrast, other proteins such as Paraoxonase, Selenoprotein, Amine oxidases, and Apolipoprotein C-IV were significantly less abundant. Many of the identified and quantified proteins are known to be associated with inflammation. Other proteins like Serpina3 and RPLP1 have a relevant role in oncogenesis. Some proteins and their roles have not yet been described in dogs with diarrhoea. Our study opens new avenues that could contribute to the understanding of the aetiology and pathophysiology of AHDS.

Pseudoaneurysm Infection Ballooning Out of Control Following Sequential Cardiac Catheterizations: A Case Report.

A femoral artery pseudoaneurysm (PSA) is a potential complication of vascular access procedures, such as cardiac catheterizations, that can have serious consequences if left untreated. Although the incidence of PSA formation has decreased due to the advent of improved surgical techniques, this case demonstrates that such complications should be considered in a clinical setting. This report presents a case of right femoral PSA, pacemaker infection, and high-grade methicillin-resistant Staphylococcus aureus (MRSA) bacteremia status post multiple cardiac catheterizations. Treatment included open repair of his femoral artery PSA, antibiotics tailored to culture sensitivities, and pacemaker removal. The potential complications, diagnosis, management, and alternative treatment options for PSAs are discussed in order to encourage clinical awareness of a rare complication.

COVID-19 outcomes in people living with HIV: Peering through the waves

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Problematizações éticas, estéticas e políticas à branquitude como categoria de análise para psicologia social / Problematizaciones éticas, estéticas y políticas de la blanquitud como categoría de análisis para la psicología social / Ethical, aesthetic and political problematizations regarding whiteness as a category of analysis for social psychology

Resumo Desafiadas a pensar como a branquitude se coloca como categoria de análise para a psicologia social, duas pesquisadoras brancas tomam como pergunta disparadora de pesquisa: De que forma a branquitude se constitui como modo de subjetivação? A fim deslocar quaisquer supostas neutralidade e universalidade, ainda presentes no campo da psicologia social, o objetivo do estudo foi o de produzir efeitos de visibilidade nos processos de subjetivação racistas contemporâneos. O percurso cartográfico foi movimentado pelo recurso à produção de narrativas poéticas, a partir de vivências desde um lugar racializado das pesquisadoras. Esta estratégia metodológica buscou problematizar a branquitude engendrada às tecnologias de subjetivação. Ao final, o estudo destaca a universalidade, a invisibilidade e os pactos narcísicos entre as dimensões do racismo, que sinalizam a urgência de refletirmos acerca destas posições para a invenção de práticas antirracistas a comporem o porvir da psicologia.

Resumen Desafiado a pensar sobre cómo la blanquitud es una categoría de análisis para la psicología social, un par de investigadoras blancas formulan la siguiente pregunta de investigación: ¿Cómo se constituye la blanquitud como modo de subjetivación? Para desplazar cualquier supuesta neutralidad y universalidad, aún presente en el campo de la psicología social, el objetivo del estudio fue producir efectos de visibilidad en los procesos de subjetivación racistas contemporáneos. El recorrido cartográfico fue impulsado por el uso de la producción de narrativas poéticas, basadas en las experiencias de los investigadores desde un lugar racializado. Esta estrategia metodológica buscó problematizar la blanquitud engendrada por las tecnologías de subjetivación. Al final, el estudio destaca la universalidad, la invisibilidad y los pactos narcisistas entre las dimensiones del racismo, que señalan la urgencia de reflexionar sobre estas posiciones para la invención de prácticas antirracistas que formen el futuro de la psicología.

Abstract Challenged to think about how whiteness is a category of analysis for social psychology, two white researchers take the following research question as the trigger: How whiteness is constituted as a mode of subjectivation? In order to displace any supposed neutrality and universality, still present in the field of social psychology, the aim of the study was to produce visibility effects in contemporary racist subjectivation processes. The cartographic journey was driven by the use of the production of poetic narratives, based on the researchers' experiences from a racialized place. This methodological strategy sought to problematize the whiteness engendered by subjectivation technologies. In the end, the study highlights the universality, invisibility, and narcissistic pacts between the dimensions of racism, which signal the urgency of reflecting on these positions for the invention of anti-racist practices to form the future of psychology.

Factores atribuibles a enfermedades cardiovasculares en población mayor del Reasentamiento Campo Alegre, Tierralta, Córdoba

RESUMEN Fundamento: las enfermedades cardiovasculares constituyen la principal causa de muerte en todo el mundo, cada año mueren más personas por alguna de estas enfermedades que por cualquier otra causa. Objetivo: identificar los factores de riesgo para el desarrollo de enfermedades cardiovasculares en el reasentamiento Campo Alegre, Tierra Alta, Córdoba durante el 2020-2021. Métodos: se realizó un estudio descriptivo en el que se incluyeron a los adultos mayores de 60 años residentes en el reasentamiento. Las variables estudiadas fueron: edad, sexo, estado civil, estrato socioeconómico, nivel educativo, estado de trabajo, ingresos en el hogar o personales, antecedentes de salud, condiciones y estilos de vida saludable relacionados con la hipertensión arterial, la diabetes mellitus tipo 2, la actividad física, alimentación saludable y ración de comida diaria, control de peso, farmacodependencia, control médico e hipercolesterolemia. Se les realizó una encuesta enfocada en conocer los riesgos expuestos ante una enfermedad cardiovascular. Los datos fueron almacenados en Excel y analizados en SPSS Statistics 26. Resultados: se obtuvieron edades mínimas (60 años) y máximas (76 años y más). Se logró evidenciar que la hipertensión arterial prevalecía en la población para ambos sexos, el nivel educativo está relacionado con el nivel educativo de la población, se encontró un mayor número de casos en la población sin estudios. Conclusiones: la frecuencia de los factores de riesgo para enfermedades cardiovasculares presentes en la población, alerta sobre la necesidad de desarrollar planes de promoción y prevención de salud de las enfermedades presentes en esta zona del municipio de Tierralta, Córdoba ya que se ha evidenciado que esto conlleva a consecuencias en la calidad de vida de la población adulta mayor.

ABSTRACT Background: cardiovascular diseases are the leading cause of death worldwide, each year more people die from one of these diseases than from any other cause. Objective: to identify the risk factors for the development of cardiovascular diseases in the Campo Alegre resettlement, Tierra Alta, Córdoba during 2020-2021. Methods: a descriptive study was carried out in which adults over 60 years of age residing in the resettlement were included. The variables studied were: age and sex, marital status, socioeconomic status, educational level, work status, household or personal income, health history and healthy lifestyle conditions such as high blood pressure, type 2 diabetes mellitus, physical activity , healthy eating and daily food ration, weight control, drug dependence, medical control and hypercholesterolemia. They were given a survey focused on knowing the risks exposed to cardiovascular disease. The data was stored in Excel and analyzed in SPSS Statistics 26. Results: minimum ages (60 years) and maximum ages (76 years and over) were obtained. It was possible to show that arterial hypertension prevailed in the population for both sexes, the educational level is related to the educational level of the population, a greater number of cases was found in the population without studies. Conclusions: the frequency of risk factors for cardiovascular diseases present in the population warns about the need to develop health promotion and disease prevention plans in this area of ​​the municipality of Tierralta, Córdoba, since it has been shown that this entails to consequences in the quality of life of the elderly population.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry.

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

Do automotive window films affect drivers' safety by decreasing vision sensitivity? A Cross-sectional study / Películas automotivas e perda de acuidade visual? Estudo transversal

ABSTRACT Objective: To measure visual acuity in high contrast and low contrast sensitivities in different grades of visible light transmission films in three different positions (front, lateral and rear windows). Methods: Forty-four healthy volunteers between 30-75 y-o, with BCVA better than 0,5, were tested in the 5 following vehicles with different grades of visible light transmission films. Vehicle 1: 75% in the front and 70% in the lateral and rear windows; Vehicle 2: 70% in the front and lateral windows and 28% in the rear; Vehicle 3: 70% in the front, 28% in the lateral and 15% rear; Vehicle 4: 35% in all 3 windows; Vehicle 5: 50% in the front, 20% in the lateral and 15% in the rear. Descriptive statistics were used and the average of the 3 measurements of VA was considered. Wilcoxon Test was applied to compare the average visual acuity in each vehicle and position. P value<0.05 was considered statistically significant. Results: According to the Brazilian Traffic Regulations for driving in categories C/D/E, when low contrast was tested in the front window, all visible light transmissions were borderline, in the lateral window they were all outside the limit, while in the rear window for both low and high contrast, all visible light transmissions tested were outside the limit and also borderline for driving in categories A/B, with the exception of the vehicle with visible light transmission of 35%. Conclusion: Visual acuity is affected, especially in the rear window, by the use of automotive films. The study is an alert that window films is a possible cause of accidents and may contribute to the revision of traffic regulations worldwide.

RESUMO Objetivo: Medir a acuidade visual em alto e baixo contraste nas diversas graduações de transparência de filmes em três janelas de veículos: frontal, lateral e traseira. Métodos: Foram avaliados 44 voluntários saudáveis entre 30 e 75 anos, com acuidade visual melhor corrigida acima de 0,5, em cinco veículos, sendo: veículo 1, com 75% de transparência frontal e 70% na lateral e traseira; veículo 2, com 70% na frontal e na lateral e 28% na traseira; veículo 3, com 70% na frontal, 28% na lateral e 15% na traseira; veículo 4, com 35% nas três janelas; e veículo 5, com 50% na frontal, 20% na lateral e 15% na traseira. Foi realizada estatística descritiva utilizando a média de três medidas consecutivas, com teste de Wilcoxon para comparar a média de acuidade visual em cada janela, e foi considerado estatisticamente significativo quando valor de p<0,05. Resultados: Todas as transparências testadas nos vidros reduziram a acuidade visual em situação de baixo contraste para níveis limítrofes na janela frontal e níveis ilegais na lateral para conduzir veículos nas categorias C/D/E. Na janela traseira, tanto em alto quanto em baixo contraste, todas as transparências mostraram redução da acuidade visual para níveis ilegais para categorias C/D/E e limítrofes para as categorias A/B, exceto na transparência de 35%. Conclusão: A acuidade visual é reduzida pelo uso dos filmes automotivos, especialmente na janela traseira. Condutores de veículos com filmes devem ser alertados pelo risco aumentado de acidentes. Esse dado científico propõe revisões nas regulações de tráfego mundiais.

Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg).

OBJECTIVES: Longer-acting gonadotropin-releasing hormone analogs (GnRHa) have been widely used for central precocious puberty (CPP) treatment. However, the follow-up of patients after this treatment are still scarce. Our aim was to describe anthropometric, metabolic, and reproductive follow-up of CPP patients after treatment with leuprorelin acetate 3-month depot (11.25 mg). METHODS: Twenty-two female patients with idiopathic CPP were treated with leuprorelin acetate 3-month depot (11.25 mg). Their medical records were retrospectively evaluated regarding clinical, hormonal, and imaging aspects before, during, and after GnRHa treatment until adult height (AH). RESULTS: At the diagnosis of CPP, the mean chronological age (CA) was 8.2 ± 1.13 year, and mean bone age (BA) was 10.4 ± 1.4 year. Mean height SDS at the start and the end of GnRHa treatment was 1.6 ± 0.8 and 1.3 ± 0.9, respectively. The mean duration of GnRHa treatment was 2.8 ± 0.8 year. Mean predicted adult heights (PAH) at the start and the end of GnRH treatment was 153.2 ± 8.6 and 164.4 ± 7.3 cm, respectively (p<0.05). The mean AH was 163.2 ± 6.2 cm (mean SDS: 0.1 ± 1). All patients were within their target height (TH) range. There was a decrease in the percentage of overweight and obesity from the diagnosis until AH (39-19% p>0.05). At the AH, the insulin resistance and high LDL levels were identified in 3/17 patients (17.6%) and 2/21 patients (9.5%), respectively. The mean CA of menarche was 12.2 ± 0.5 years. At the AH, PCOS was diagnosed in one patient (4.8%). CONCLUSIONS: Long-term anthropometric, metabolic, and reproductive follow-up of patients with CPP treated with longer-acting GnRHa revealed effectivity, safety, and favorable outcomes.

Genotype-Phenotype Correlations in Central Precocious Puberty Caused by MKRN3 Mutations.

CONTEXT: Loss-of-function mutations of makorin RING finger protein 3 (MKRN3) are the most common monogenic cause of familial central precocious puberty (CPP). OBJECTIVE: To describe the clinical and hormonal features of a large cohort of patients with CPP due to MKRN3 mutations and compare the characteristics of different types of genetic defects. METHODS: Multiethnic cohort of 716 patients with familial or idiopathic CPP screened for MKRN3 mutations using Sanger sequencing. A group of 156 Brazilian girls with idiopathic CPP (ICPP) was used as control group. RESULTS: Seventy-one patients (45 girls and 26 boys from 36 families) had 18 different loss-of-function MKRN3 mutations. Eight mutations were classified as severe (70% of patients). Among the 71 patients, first pubertal signs occurred at 6.2 ±â€…1.2 years in girls and 7.1 ±â€…1.5 years in boys. Girls with MKRN3 mutations had a shorter delay between puberty onset and first evaluation and higher follicle-stimulating hormone levels than ICPP. Patients with severe MKRN3 mutations had a greater bone age advancement than patients with missense mutations (2.3 ±â€…1.6 vs 1.6 ±â€…1.4 years, P = .048), and had higher basal luteinizing hormone levels (2.2 ±â€…1.8 vs 1.1 ±â€…1.1 UI/L, P = .018) at the time of presentation. Computational protein modeling revealed that 60% of the missense mutations were predicted to cause protein destabilization. CONCLUSION: Inherited premature activation of the reproductive axis caused by loss-of-function mutations of MKRN3 is clinically indistinct from ICPP. However, the type of genetic defect may affect bone age maturation and gonadotropin levels.

Clostridioides (Clostridium) difficile-associated diarrhea in equine in Minas Gerais, Brazil: clinical and microbiological characterization of six cases / Diarreia por Clostridioides (Clostridium) difficile em equinos em Minas Gerais, Brasil: caracterização clínica e microbiológica de seis casos

ABSTRACT: Clostridioides (Clostridium) difficile is the main causative agent of antimicrobial-related diarrhea in humans and a major pathogen-associated enteric disorder in foals and adult horses. Moreover, studies have suggested that animals are a possible reservoir of toxigenic C. difficile strains for humans. Despite this known importance, the epidemiology of C. difficile infection (CDI) in equine is still largely unknown. Therefore, this study described six cases of equine CDI occurring in Minas Gerais, Brazil, including the characterization of the isolates. All but one equine included in this research developed CDI after antimicrobial therapy, three of which occurred during hospitalization. Coinfection with Salmonella Heidelberg and S. Infantis was detected in three cases, making the antimicrobial treatment challenging. All animals recovered after metronidazole administration. All C. difficile isolates were susceptible to metronidazole and vancomycin, while three were resistant to moxifloxacin and two were resistant to clindamycin. The isolates were classified as RT126 (n = 4), RT078 (n = 1), and RT014/020 (n = 1), all previously reported infecting humans and animals worldwide.

RESUMO: Clostridioides (Clostridium) difficile é o principal agente envolvido em diarreias associadas ao uso de antimicrobianos em seres humanos e um enteropatógeno de grande relevância em quadros de diarreia em potros e equinos adultos. Em adição, estudos tem sugerido que animais são possíveis reservatórios de estirpes toxigênicas de C. difficile para humanos. Apesar da importância na saúde animal e humana, a epidemiologia da infecção por C. difficile (ICD) é ainda pouco conhecida. Dessa forma, o presente estudo tem como objetivo caracterizar seis casos de diarreia por C. difficile ocorridos em Minas Gerais, Brasil. Com exceção de um animal, todos os equinos incluídos no presente estudo desenvolveram ICD após antibioticoterapia, três dos quais durante a hospitalização. Coinfecção por Salmonella Heidelberg e S. Infantis foi detectada em três casos, tornando o tratamento antimicrobiano desafiador. Todos os animais recuperaram após administração de metronidazol. Os isolados obtidos no presente estudo foram sensíveis a metronidazol e vancomicina, porém três estirpes foram resistentes a moxifloxacina e duas a clindamicina. Os isolados foram classificados como ribotipos 126 (n=4), 078 (n=1) e 014/020 (n=1), todos previamente relatados em seres humanos com ICD no Brasil e em outros países.

Perfil epidemiológico de agravos urológicos em homens cisgêneros em município da Bahia, Brasil / Epidemiological profile of urological disorders in cisgendered men in the municipality of Bahia, Brazil / Perfil epidemiológico de los trastornos urológicos en hombres cisgénero en el municipio de Bahía, Brasil

Objetivo: caracterizar o perfil epidemiológico de agravos urológicos em homens cisgêneros em uma unidade de urologia, nefrologia e transplante na Bahia, Brasil. Método: Estudo descritivo, quantitativo, transversal, realizado a partir da base de dados oriundos de 160 prontuários de atendimento em um hospital público, filantrópico, especializado, localizado em um município da Bahia, Brasil no ano de 2016. Os dados foram analisados no software Statistic Package Science for Social (SPSS). Resultados: Dos 160 homens atendidos na unidade de referência, na faixa etária ≥ 60 anos, casados, raçacor parda, escolaridade não informada, zona urbana e aposentados. Dos agravos urológicos identificados, 12 tipos de agravos foram identificados sendo os mais frequentes: câncer de próstata e hiperplasia prostática. As características clínicas foram: os hábitos de vida tiveram quantitativo expressivo de informações não fornecidas. Entretanto, daqueles informados, destacaram: ser tabagista e etilista. As doenças de base não foram informadas. Daquelas apontadas, destacaram a Hipertensão. O modo de identificação da doença, a maioria não informou, mas destacou-se a apresentação de sintomas. Os exames realizados foram os laboratoriais e o PSA. Sobre os tratamentos, o medicamentoso e cirúrgico foram os mais frequentes. Quatro usuários foram a óbito. Conclusão: O perfil de atendimentos de homens com agravos urológicos no serviço de referência, predominou os idosos, da raça negra (pretos e pardos) e o câncer de próstata como principal agravo urológico.

Objective: to characterize the epidemiological profile of urological disorders in cisgendered men in a urology, nephrology and transplant unit in Bahia, Brazil. Method: Descriptive, quantitative, crosssectional study, carried out from a database of 160 medical records in a public, philanthropic, specialized hospital, located in a municipality in Bahia, Brazil in 2016. The data were analyzed using the software Statistic Package Science for Social (SPSS). Results: Of the 160 men seen at the referral unit, aged ≥ 60 years, married, mixed race, uneducated schooling, urban area and retirees. Of the urological disorders identified, 12 types of disorders were identified, the most frequent being: prostate cancer and prostatic hyperplasia. The clinical characteristics were: life habits had a significant amount of information not provided. However, of those informed, they highlighted: being a smoker and alcoholic. The underlying diseases were not reported. Of those pointed out, they highlighted Hypertension. The mode of identification of the disease, most did not report, but the presentation of symptoms stood out. The tests performed were laboratory tests and PSA. Regarding treatments, medication and surgery were the most frequent. Four users died. Conclusion: The profile of visits by men with urological disorders at the reference service, predominated the elderly, blacks (blacks and browns) and prostate cancer as the main urological condition.

Objetivo: Objetivo: caracterizar el perfil epidemiológico de los trastornos urológicos en hombres cisgénero en una unidad de urología, nefrología y trasplante de Bahía, Brasil. Método: Estudio descriptivo, cuantitativo, transversal, realizado a partir de una base de datos de 160 historias clínicas de un hospital público, filantrópico, especializado, ubicado en un municipio de Bahía, Brasil en 2016. Los datos fueron analizados mediante el software Ciencia del paquete estadístico para las redes sociales (SPSS). Resultados: De los 160 hombres atendidos en la unidad de derivación, de ≥ 60 años, casados, mestizos, sin educación, zona urbana y jubilados. De los trastornos urológicos identificados, se identificaron 12 tipos de trastornos, siendo los más frecuentes: cáncer de próstata e hiperplasia prostática. Las características clínicas fueron: los hábitos de vida tenían una cantidad significativa de información no aportada. Sin embargo, de los informados destacaron: ser fumador y alcohólico. No se informaron las enfermedades subyacentes. De los señalados, destacaron Hipertensión. El modo de identificación de la enfermedad, la mayoría no informó, pero se destacó la presentación de los síntomas. Las pruebas realizadas fueron pruebas de laboratorio y PSA. En cuanto a los tratamientos, la medicación y la cirugía fueron las más frecuentes. Murieron cuatro usuarios. Conclusión: En el perfil de visitas de hombres con alteraciones urológicas al servicio de referencia, predominó el anciano, la raza negra (negros y pardos) y el cáncer de próstata como principal afección urológica.

Mast cells in the kidney biopsies of pediatric patients with lupus nephritis.

INTRODUCTION: Mast cells may be involved in inflammation and contribute to the onset of fibrosis in lupus nephritis (LN). OBJECTIVE: This study aimed to correlate the presence of mast cells in kidney biopsy specimens of pediatric patients with LN with activity (AI) and chronicity (CI) indices and assess how effectively mast cells may be used as a prognostic factor. METHOD: The study included 40 patients aged 6-18 years diagnosed with LN at the Renal Disease Service of the Federal University of Triângulo Mineiro between 1996 and 2015. Workup and epidemiological data were evaluated vis-à-vis AI, CI, and mast cell counts (MCC). RESULTS: Significant positive correlations were found between mast cell counts (MCC) and AI (p = 0.003; r: 0.66) and MCC and CI (p = 0.048; r: 0.48). The ROC curve showed that mast cells were highly sensitive and specific in the differentiation of patients with an AI > 12 from individuals with an AI ≤ 12. Serum creatinine levels were higher in individuals with class IV LN than in patients with class V disease [1.50 (0.40-20.90) vs. 0.70 (0.62-0.90), p = 0.04]. Blood urea nitrogen had a positive significant correlation with MCC (p = 0.002; r: 0.75). A trend toward a negative correlation was observed between MCC and serum albumin (p = 0.06; r: -0.5459). Kidney biopsies of patients with nephrotic syndrome had higher MCC [2.12 (0.41-5.140) vs. 0.53 (0.0-3.94), p = 0.07]. CONCLUSION: Inflammatory cell infiltration and morphological differences between cell types in the inflammatory infiltrate are relevant factors in the assessment of the LN. Mast cell analysis and AI/CI assessment may be relevant prognostic indicators for pediatric patients with LN.

Outcomes of Patients with Central Precocious Puberty Due to Loss-of-Function Mutations in the MKRN3 Gene after Treatment with Gonadotropin-Releasing Hormone Analog.

INTRODUCTION: Loss-of-function mutation of MKRN3 represents the most frequent genetic cause of familial central precocious puberty (CPP). The outcomes of gonadotropin-releasing hormone analog (GnRHa) treatment in CPP patients with MKRN3 defects are unknown. OBJECTIVE: To describe the clinical and hormonal features of patients with CPP with or without MKRN3 mutations after GnRHa treatment. Anthropometric, metabolic and reproductive parameters were evaluated. PATIENTS AND METHODS: Twenty-nine female patients with CPP due to loss-of-function mutations in the MKRN3 and 43 female patients with idiopathic CPP were included. Their medical records were retrospectively evaluated for clinical, laboratory, and imaging study, before, during, and after GnRHa treatment. All patients with idiopathic CPP and 11 patients with CPP due to MKRN3 defects reached final height (FH). RESULTS: At the diagnosis, there were no significant differences between clinical and laboratory features of patients with CPP with or without MKRN3 mutations. A high prevalence of overweight and obesity was observed in patients with CPP with or without MKRN3 mutations (47.3 and 50%, respectively), followed by a significant reduction after GnRHa treatment. No significant differences in the values of mean FH and target height were found between the 2 CPP groups after GnRHa treatment. Menarche occurred at the expected age in patients with or without CPP due to MKRN3 mutations (11.5 ± 1.3 and 12 ± 0.6 years, respectively). The prevalence of polycystic ovarian syndrome was 9.1% in patients with CPP due to MKRN3 mutations and 5.9% in those with idiopathic CPP. CONCLUSION: Anthropometric, metabolic, and reproductive outcomes after GnRHa treatment were comparable in CPP patients, with or without MKRN3 mutations, suggesting the absence of deleterious effects of MKRN3 defects in young female adults' life.

Desfecho perinatal no crescimento intrauterino restrito seletivo em gestações gemelares monocoriônicas acompanhadas de forma expectante / Perinatal outcome in selective intrauterine growth restriction in monochorionic twin pregnancies followed expectantly

Objetivo: Avaliar a morbimortalidade perinatal de gestações gemelares monocoriônicas afetadas por Crescimento Intrauterino Restrito Seletivo (CIUR-s), de acordo com o padrão de fluxo ao Doppler na artéria umbilical do gêmeo menor. Métodos: Esse estudo de coorte retrospectiva tem como objetivo avaliar o desfecho perinatal de gestações gemelares monocoriônicas afetadas por CIUR-s e conduzidas de forma expectante, analisando os resultados de acordo com o padrão Doppler da artéria umbilical do gêmeo menor (Tipo I: persistentemente positivo / Tipo II: persistentemente ausente ou reverso / Tipo III: intermitentemente ausente ou reverso), desde o período pré-natal até a alta hospitalar. Setenta e cinco gestações gemelares monocoriônicas diamnióticas com CIUR-s foram incluídas nesse estudo, no qual definimos restrição seletiva de crescimento como peso fetal estimado (PFE) abaixo do terceiro percentil para a idade gestacional ou ou pela presença de pelo menos dois dos quatro parâmetros contributivos: PFE abaixo do décimo percentil, circunferência abdominal abaixo do percentil 10, índice de pulsatilidade da artéria umbilical do gêmeo menor acima do percentil 95 ou discordância entre os pesos fetais estimados de 25% ou mais. Os desfechos perinatais incluíram morte perinatal, lesão neurológica, retinopatia da prematuridade (ROP), displasia broncopulmonar (DBP), enterocolite necrosante (ECN) e sepse. Resultados: A taxa de mortalidade foi de 1,33% nessa coorte. A taxa de morbidade geral foi de 28,66%, com menor incidência em gestações gemelares do Tipo I. Conclusão: Esse estudo mostra que o CIUR-s Tipo I apresenta menor morbidade do que os Tipos II e III em conduta expectante.

Objective: To evaluate perinatal morbidity and mortality of monochorionic twin pregnancies affected by Selective Intrauterine Growth Restriction (sIUGR), according to the Doppler flow pattern in the umbilical artery of the smaller twin. Methods: This retrospective cohort study aims to assess the perinatal outcome of monochorionic twin pregnancies affected by this disorder and conducted expectantly, analyzing the results according to the umbilical artery Doppler pattern of the smaller twin (Type I: persistently forward / Type II: persistently absent or reversed / Type III: intermittently absent or reversed, from prenatal period to hospital discharge. Seventy five monochorionic diamniotic twin pregnancies with sIUGR were included in this study, in which we defined selective growth restriction as estimated fetal weight (EFW) of one twin less than the third centile or in the presence of at least two out of four contributory parameters: EFW less than the 10th percentile when associated with AC of one twin less than the 10th centile, EFW discordance of 25% or more, and umbilical artery (UA) pulsatility index (PI) of the smaller twin above the 95th centile. Perinatal outcomes included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and sepsis. Results: The mortality rate was 1.33% in this cohort. Overall morbidity rate was 28.66%, with lower incidence in Type I twin pregnancies. Conclusion: This study shows that sIUGR Type I has lower morbidity than Types II and III in expectant management.

Rationale and Study Design for an Individualized Perioperative Open Lung Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV).

OBJECTIVE: The aim of this clinical trial is to examine whether it is possible to reduce postoperative complications using an individualized perioperative ventilatory strategy versus using a standard lung-protective ventilation strategy in patients scheduled for thoracic surgery requiring one-lung ventilation. DESIGN: International, multicenter, prospective, randomized controlled clinical trial. SETTING: A network of university hospitals. PARTICIPANTS: The study comprises 1,380 patients scheduled for thoracic surgery. INTERVENTIONS: The individualized group will receive intraoperative recruitment maneuvers followed by individualized positive end-expiratory pressure (open lung approach) during the intraoperative period plus postoperative ventilatory support with high-flow nasal cannula, whereas the control group will be managed with conventional lung-protective ventilation. MEASUREMENTS AND MAIN RESULTS: Individual and total number of postoperative complications, including atelectasis, pneumothorax, pleural effusion, pneumonia, acute lung injury; unplanned readmission and reintubation; length of stay and death in the critical care unit and in the hospital will be analyzed for both groups. The authors hypothesize that the intraoperative application of an open lung approach followed by an individual indication of high-flow nasal cannula in the postoperative period will reduce pulmonary complications and length of hospital stay in high-risk surgical patients.

Premature Pubarche due to Exogenous Testosterone Gel or Intense Diaper Rash Prevention Cream Use: A Case Series.

BACKGROUND/AIMS: Premature pubarche is associated with conditions such as virilizing congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous exposure to androgen products. We describe the clinical and hormonal features of a series of children who were referred to endocrine evaluation due to premature pubarche. METHODS: This is a retrospective case series study of 14 children with premature pubarche and/or virilization. Five were unintentionally exposed to testosterone gel (parental use). Nine patients were intensely exposed to diaper rash prevention creams. Clinical and laboratory data were revised. RESULTS: Moderate to severe virilization was detected in the 5 patients (2 boys and 3 girls) who were exposed to testosterone gel. These patients had pubic hair development associated with clitoromegaly (3/3), penile enlargement (2/2), and accelerated growth (5/5). Testosterone levels were elevated in 4/5 patients associated with normal prepubertal gonadotropin levels and adrenal androgen precursors. The 9 children who were intensely exposed to diaper rash prevention creams had mild pubarche (intermediate hair) without any other clinical manifestation of pubertal development. Three of them exhibited pubic hair thinning after cream withdrawal. CONCLUSION: Unintentional topical androgen exposure or the intense use of diaper rash prevention cream should be ruled out in children with precocious pubarche and/or virilization signs to avoid misdiagnosis and expendable investigation.

DLK1 Is a Novel Link Between Reproduction and Metabolism.

BACKGROUND: Delta-like homolog 1 (DLK1), also called preadipocyte factor 1, prevents adipocyte differentiation and has been considered a molecular gatekeeper of adipogenesis. A DLK1 complex genomic defect was identified in five women from a single family with central precocious puberty (CPP) and increased body fat percentage. METHODS: We studied 60 female patients with a diagnosis of CPP or history of precocious menarche. Thirty-one of them reported a family history of precocious puberty. DLK1 DNA sequencing was performed in all patients. Serum DLK1 concentrations were measured using an ELISA assay in selected cases. Metabolic and reproductive profiles of adult women with CPP caused by DLK1 defects were compared with those of 20 women with idiopathic CPP. RESULTS: We identified three frameshift mutations of DLK1 (p.Gly199Alafs*11, p.Val271Cysfs*14, and p.Pro160Leufs*50) in five women from three families with CPP. Segregation analysis was consistent with the maternal imprinting of DLK1. Serum DLK1 concentrations were undetectable in three affected women. Metabolic abnormalities, such as overweight/obesity, early-onset glucose intolerance/type 2 diabetes mellitus, and hyperlipidemia, were more prevalent in women with the DLK1 mutation than in the idiopathic CPP group. Notably, the human metabolic alterations were similar to the previously described dlk1-null mice phenotype. Two sisters who carried the p.Gly199Alafs*11 mutation also exhibited polycystic ovary syndrome and infertility. CONCLUSIONS: Loss-of-function mutations of DLK1 are a definitive cause of familial CPP. The high prevalence of metabolic alterations in adult women who experienced CPP due to DLK1 defects suggests that this antiadipogenic factor represents a link between reproduction and metabolism.

Outbreak of multidrug resistant Salmonella Typhimurium in calves at a veterinary hospital in Brazil / Surto de Salmonella Typhimurium multirresistante em bezerros em um hospital veterinário do Brasil

ABSTRACT: The present study aimed to describe and characterize a nosocomial outbreak caused by a multidrug resistant Salmonella Typhimurium in hospitalized calves at a veterinary medical teaching hospital from Brazil. Sixty-three (96.9%) calves showed lethargy, hyperthermia and profuse diarrhea and despite treatment, 26 (41.2%) animals died. Five animals were necropsied and stool samples of six calves were collected. The isolated strains were subjected to antimicrobial susceptibility test by disc-difusion method and were fingerprinted by ERIC-PCR. Macroscopic lesions suggestive of salmonellosis, such as fibrinonecrotic enteritis and hepatosplenomegaly were observed. Salmonellosis was confirmed by isolation of S. Typhimurium from stool samples and organs from seven affected animals. Six out of seven isolates of S. Typhimurium, exhibited 100% of similarity at ERIC-PCR, suggesting occurrence of nosocomial transmission of S. Typhimurium among the hospitalized calves. All but one S. Typhimurium isolated were resistant to marbofloxacin, enrofloxacin, florfenicol, oxytetracycline and trimethoprim/sulfamethoxazole, antimicrobial agents largely used for humans and animal treatment. This is the first study of a nosocomial outbreak of multidrug resistant S. Typhimurium in a veterinary hospital in Brazil and highlighted the need for preventive measures to reduce the risks for inpatients and humans in contact with animals.

RESUMO: O objetivo do presente estudo é descrever e caracterizar um surto nosocomial provocado por S. Typhimurium multirresistente em bezerros hospitalizados em um hospital escola de medicina veteriária localizado no Brasil. Sessenta e três (96,9%) bezerros apresentaram letargia, hipertermia e diarreia profusa e, apesar do tratamento, vinte e seis animais (41,2%) morreram. Cinco animais foram necropsiados e amostras fecais de seis bezerros foram coletadas. As estirpes isoladas foram submetidas a testes de susceptibilidade a antimicrobianos pelo método de disco-difusão e foram genotipadas pelo ERIC-PCR. Lesões macroscópicas sugestivas de salmonelose, como enterite fibrinonecrótica e hepatoesplenomegalia, foram observadas. Salmonelose foi confirmada pelo isolamento de S. Typhimurium em amostras fecais e órgãos de sete animais. Dos sete isolados, seis apresentaram 100% de similaridade ao ERIC-PCR, sugerindo ocorrẽncia de transmissão nosocomial de S. Typhimurium entre os bezerros hospitalizados. Com excessão de uma estirpe, todas foram resistentes a marbofloxacina, enrofloxacina, florfenicol, oxitetraciclina e trimetoprima/sulfametoxazol, agentes antimicrobianos amplamente utilizados para o tratamento humano e animal. Esse é o primeiro estudo que demonstra um surto nosocomial de estirpes de S. Typhimurium resistentes a múltiplas drogas em um hospital veterinário no Brasil, enfatizando a necessidade de medidas preventivas que reduzam os riscos aos animais hospitalizados e a pessoas que entrarem em contato com esses animais.

Salmonella Typhimurium - associated meningoencephalomyelitis in a foal / Meningoencefalomielite por Salmonella Typhimurium em potro

ABSTRACT: A 10-day old foal presented with a history of acute recumbency and generalized weakness, that progressed to seizure episodes and death. Post mortem examination revealed necrotizing and purulent omphalophlebitis and fibrinopurulent meningoencephalomyelitis. Salmonella Typhimurium was isolated from the central nervous system and determined to be the cause of the meningoencephalomyelitis. Due to the lack of evidence of gastrointestinal disease, the umbilical cord was considered the most likely portal of entry of the bacteria. The isolated S. Typhimurium was resistant to ampicillin and cephalotin, and partially resistant to enrofloxacin. These drugs are commonly used in the treatment of salmonellosis. This is the first report of S. Typhimurium affecting the brain and spinal cord of a foal. Salmonellosis should be considered a differential diagnosis in foals with neurologic signs, even in the absence of enterocolitis.

RESUMO: Um potro de 10 dias de idade foi admitido com histórico de decúbito e fraqueza generalizada aguda, com progressão para episódios de convulsão e morte. A avaliação post mortem demonstrou onfalite necropurulenta e meningoencefalomielite fibrinopurulenta. Salmonella Typhimurium foi isolada do material purulento coletado do sistema nervoso central. A ausência de diarreia e lesões entéricas associadas à presença de onfalite sugerem que o umbigo foi possivelmente a porta de entrada do agente. O isolado de S. Typhimurium apresentou resistência a cefalotina e ampicilina e resistência intermediária a enrofloxacina, drogas utilizadas para o tratamento de salmonelose. Este é o primeiro relato de S. Typhimurium levando a alterações encefálicas e medulares em potro. A salmonelose deve ser considerada, portanto, como diagnóstico diferencial em potros neonatos com alterações neurológicas, mesmo na ausência de enterocolite.