Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update.

PURPOSE: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil. METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence. RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease. CONCLUSION: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.

First report of spontaneous hepatic fibrosarcoma in a white-tufted marmoset (Callithrix jacchus) kept in captivity.

Reports of sarcomas in nonhuman primates are scarce and, specifically, primary hepatic sarcomas are rare, as in humans. This is the first report of an aggressive hepatic fibrosarcoma in a young adult Callithrix jacchus. The final postmortem diagnosis was obtained by means of immunohistochemical analysis, which confirmed the tumor histogenesis.

Mating- and oviposition-dependent changes of the spermatheca and colleterial glands in the pest termite Cryptotermes brevis (Blattaria, Isoptera, Kalotermitidae).

The spermatheca and colleterial glands of female insects are organs associated with the reproductive system, responsible for sperm storage and secretion of egg coverings, respectively. Here we compared the development, secretory activity, and chemical nature of the secretion in the spermatheca and colleterial glands of different-aged females of the drywood termite Cryptotermes brevis. We also provide the ultrastructure of these organs in alate females. These structures have been poorly investigated in termites when compared to other eusocial insects (Hymenoptera) and termite-related dictyopterans (mantises and cockroaches). The spermatheca of C. brevis comprises a cone-shaped structure, connected to the genital chamber by a short duct. The colleterial glands, in turn, are divided into anterior and posterior tubules, each showing a basal trunk, and join into a common duct. Histological and histochemical analyses showed that the secretion of proteins and polysaccharides by the spermatheca takes place before pairing, but increases as females mate and store sperm. Colleterial glands of alates showed non-synchronous secretory activity, but the synthesis of products increased in egg-laying queens, together with the epithelium height. Ultrastructure of the spermatheca and colleterial glands revealed epithelia composed of class III secretory cells. Richness of mitochondria and electron-dense secretion in the spermatheca indicates synthesis and transport of content. Presence and absence of colleterial gland secretion in different individuals may reflect variable maturation stages of the females and secretory cells. Assuming that termites are iteroparous, the development and secretion of the spermatheca and colleterial glands play a crucial role for C. brevis queens.

Factors associated with house-soiling in Italian cats.

OBJECTIVES: The aim of the present study was to identify factors associated with house-soiling in Italian cats. METHODS: A cross-sectional online survey collected information on respondents' and cats' details and litter management, and whether the cat showed house-soiling. Univariable and multivariable regression models were performed using house-soiling (present/absent) and the type of house-soiling (ie, urinary, faecal, concurrent urinary and faecal) as dummy variables. RESULTS: Data from 3106 cats were obtained. The number of dogs and other cats in the household, the cat's age, the number, type and location of the litter boxes, the type of litter, and the frequency of litter scooping and full replacement were retained in the final multivariable regression model for house-soiling (model P <0.001, Akaike information criterion [AIC] = 2454.30). Urinary tract diseases, the type and number of litter boxes and the number of dogs in the household were associated with urinary house-soiling (model P <0.001, AIC = 534.08), and gastroenteric/musculoskeletal diseases, number of litter boxes and litter box location were associated with faecal house-soiling (model P <0.001, AIC = 448.52). Healthy cats, the number of dogs in the household, the type of litter and litter full replacement frequency were retained in the final multivariable regression model for the concurrent expression of urinary and faecal house-soiling (model P <0.001, AIC = 411.47). CONCLUSIONS AND RELEVANCE: Meeting cats' preferences for litter and litter box type, location, behavioural needs and strict litter hygienic conditions is recommended. Cat owners need to be educated to prevent and manage house-soiling in their cats.

Functional Morphology and Development of the Colleterial Glands in Non- and Egg-Laying Females of the Pest Termite Coptotermes gestroi (Blattaria, Isoptera, Rhinotermitidae).

Colleterial glands of female insects are accessory glands responsible for producing secretions associated with egg-laying. Within Dictyoptera, they synthesize compounds of the ootheca. However, their morphology and role in termites are poorly understood. Here, we compared the morphology, development, and secretory activity of the colleterial glands between non- and egg-laying females of the pest termite Coptotermes gestroi under light and transmission electron microscopy. We also provide the first description of these glands for Rhinotermitidae. The glands are paired, divided into anterior and posterior units, which join in a common duct via basal trunks. They are highly developed within egg-laying females, especially the posterior gland, secreting glycoproteins to lubricate the genital chamber and/or stick the eggs together. Ultrastructure revealed glandular epithelia composed of bicellular units of Class 3, whose secretory activity varied between groups and units. Posterior gland of egg-laying females showed richness of mitochondria, rough endoplasmic reticulum, and secretory vesicles, including electron-dense secretory granules, indicating synthesis and transport of contents, especially proteins. The basal trunks were enfolded by muscles, supporting their role in conducting secretion. Morphophysiological modifications occur in the colleterial glands as females mature and lay eggs, and the mechanisms underlying the secretory cycle of the glands are discussed.

Ecological traits do not predict the uptake of microplastics by fishes in a Neotropical River.

Pollution by synthetic polymers is even more problematic to the environment when this material is fragmented into small portions, forming microplastics (MPs). We analyzed the contamination of ichthyofauna by MPs in an important river of the Atlantic Rainforest in regard to abundance, diversity of morphotypes, polymers, colors, and sizes of the synthetic particles in 20 species of fish. Fish were collected in November 2019 and in March 2020 in five sites along the Pomba River. Of the 101 fish analyzed, 49 (49%) presented MPs in at least one organ. Of the 20 species of fish collected 13 included individuals with at least one MP in their analyzed organs. The organs, trophic categories and feeding areas did not affect the general abundance of MPs types. Blue MPs were predominant, followed by the colors black, red, and white. MP fibers represented 91% of total MPs. Most MPs were between 2 and 3 mm in size. Polyethylene terephthalate (PET), polypropylene (PP), polyamide (PA), polyvinylidene chloride "Nylon" (PVDC), and high-density polyethylene (HDPE) were detected in the fishes. The exposure of the fish species to MPs was associated mainly with individual size and species-specific aspects, regardless of ecological traits. Considering that 55% of the fish species studied are consumed by humans, it is necessary to study the potential impact of MP ingestion on human health and to understand to what extent we may be consuming both plastic particles and contaminants that are adsorbed to MPs.

REAC Neurobiological Modulation as a Precision Medicine Treatment for Fibromyalgia.

Fibromyalgia syndrome (FS) is a disorder characterized by widespread musculoskeletal pain and psychopathological symptoms, often associated with central pain modulation failure and dysfunctional adaptive responses to environmental stress. The Radio Electric Asymmetric Conveyer (REAC) technology is a neuromodulation technology. The aim of this study was to evaluate the effects of some REAC treatments on psychomotor responses and quality of life in 37 patients with FS. Tests were conducted before and after a single session of Neuro Postural Optimization and after a cycle of 18 sessions of Neuro Psycho Physical Optimization (NPPO), using evaluation of the functional dysmetria (FD) phenomenon, Sitting and Standing (SS), Time Up and Go (TUG) tests for motor evaluation, Fibromyalgia Impact Questionnaire (FIQ) for quality of life. The data were statistically analyzed, and the results showed a statistically significant improvement in motor response and quality of life parameters, including pain, as well as reduced FD measures in all participants. The study concludes that the neurobiological balance established by the REAC therapeutic protocols NPO and NPPO improved the dysfunctional adaptive state caused by environmental and exposomal stress in FS patients, leading to an improvement in psychomotor responses and quality of life. The findings suggest that REAC treatments could be an effective approach for FS patients, reducing the excessive use of analgesic drugs and improving daily activities.

First Report on the Chemical Composition, Antioxidant Capacity, and Preliminary Toxicity to Artemia salina L. of Croton campinarensis Secco, A. Rosário & PE Berry (Euphorbiaceae) Essential Oil, and In Silico Study.

Croton campinarensis Secco, A. Rosário & PE Berry is an aromatic species recently discovered in the Amazon region. This study first reports the chemical profile, antioxidant capacity, and preliminary toxicity to A. salina Leach of the essential oil (EO) of this species. The phytochemical profile of the essential oil was analyzed by gas chromatography (GC/MS) and (GC-FID). The antioxidant capacity of the EO was measured by its inhibition of ABTS•+ and DPPH• radicals. Molecular modeling was used to evaluate the mode of interaction of the major compounds with acetylcholinesterase (AChE). The results indicate that the EO yield was 0.24%, and germacrene D (26.95%), bicyclogermacrene (17.08%), (E)-caryophyllene (17.06%), and δ-elemene (7.59%) were the major compounds of the EO sample. The EO showed a TEAC of 0.55 ± 0.04 mM·L-1 for the reduction of the ABTS•+ radical and 1.88 ± 0.08 mM·L-1 for the reduction of the DPPH• radical. Regarding preliminary toxicity, the EO was classified as toxic in the bioassay with A. salina (LC50 = 20.84 ± 4.84 µg·mL-1). Through molecular docking, it was found that the majority of the EO components were able to interact with the binding pocket of AChE, a molecular target related to toxicity evaluated in A. salina models; the main interactions were van der Waals and π-alkyl interactions.

Componente curricular de Urgência e Emergência nas graduações brasileiras em Enfermagem / Curricular component of Urgency and Emergency in Brazilian Nursing undergraduate courses

Objetivo: Caracterizar a oferta da disciplina de Urgência e Emergência nas matrizes curriculares dos cursos superiores de Enfermagem no Brasil. Métodos: Trata-se de estudo descritivo, documental, realizado no website do Ministério da Educação e em 691 matrizes curriculares de cursos de bacharelado em Enfermagem no Brasil. Resultados: Das matrizes curriculares, 97,2% pertenciam a cursos de ensino presencial; 83,6%, de instituições privadas, majoritariamente localizada na região sudeste (36,8%). Com relação à disciplina de Urgência e Emergência, esta apareceu em 97,2% das instituições como componente curricular obrigatório, em sua maioria, ofertada no sétimo período (31,2%) do curso, com carga horária média de 103,3 horas. Conclusão: As disciplinas de Urgência e Emergência nos cursos de graduação em Enfermagem foram, predominantemente, oriundas de instituições privadas, de componente obrigatório, ofertadas no sétimo semestre do curso. Descritores: Urgência. Emergência. Educação em Enfermagem. Bacharelado em Enfermagem. Medicina de Emergência.

Objective: To characterize the offer of the Urgency and Emergency discipline in the curricular matrices of Brazilian Nursing undergraduate courses. Methods: This is a descriptive, documentary study carried out on the Ministry of Education's website and in 691 curriculum matrices of bachelor's degree courses in Nursing in Brazil. Results: Of the curriculum matrices, 97.2% belonged to in-person teaching courses; 83.6% from private institutions, mostly located in the Southeast region (36.8%). Regarding the Urgency and Emergency discipline, it appeared in 97.2% ofthe institutions as a mandatory curricular component, mostly offered in the seventh period (31.2%) of the course, with an average workload of 103.3 hours. Conclusion: Urgency and Emergency disciplines in undergraduate Nursing courses were predominantly from private institutions, with a mandatory component, offered in the seventh semester of the course. Descriptors:Urgency. Emergency. Education in Nursing. Bachelor of Nursing. Emergency Medicine.

BILIARY FISTULAS ASSOCIATED WITH LIVER TRANSPLANTATION VERSUS OTHER ETIOLOGIES: WHAT IS THE SUCCESS RATE OF THE ENDOSCOPIC TREATMENT?

BACKGROUND: Biliary fistulas typically occur as surgical complications after laparoscopic cholecystectomy, liver transplantation, or partial liver resection. AIMS: This study aimed to evaluate the efficacy of the endoscopic treatment of biliary fistulae secondary to liver transplantation compared to that of other etiologies. METHODS: A retrospective study of 25 patients undergoing endoscopic retrograde cholangiopancreatography for biliary fistula from 2015 to 2021 was conducted at the Endoscospy Unit of Walter Cantídio University Hospital. Clinical characteristics and endoscopic success rates of the post-liver transplantation group were analyzed in comparison with those of other etiologies. RESULTS: The main causes of biliary fistula were liver transplantation (44%) and cholecystectomy complications (44%). The post-liver transplantation group had a significantly higher proportion of male sex (liver transplantation=81.8%, others=28.6%) and older age (liver transplantation=54.1 years, others=42.0 years) and a higher incidence of biliary stenosis (liver transplantation=90.9%, others=14.3%) than those of the group with other etiologies (p<0.05). The two groups received similar treatment types, among which sphincterotomy associated with biliary stent placement was most commonly used. Endoscopic therapeutic success rates showed no significant difference between the post-liver transplantation group (63.6%) and the group with other etiologies (71.4%). CONCLUSIONS: The endoscopic treatment of biliary fistulae secondary to liver transplantation presented a recovery rate similar to that of other etiologies despite the patients older age and the presence of biliary stenosis.

First Neotropical record of the association between brown sclerotium-forming fungi and termite eggs in a nest of Coptotermes gestroi (Blattaria, Isoptera, Rhinotermitidae).

Insects and fungi are abundant in many environments, in which facultative and/or obligate associations involving these groups have been established during evolution. In termites, mutualism with fungi is well reported for some termite lineages (e.g., Macrotermitinae). Within some subterranean termite species (Rhinotermitidae), egg-mimicking fungi, also referred to as "termite "balls", are often harbored inside the nest, mixed to the egg piles. Such interaction seems to be advantageous for both partners since the fungi are protected inside the nest while they may serve as an additional food source and also provide cellulases which may be incorporated into the termite digestive process. Although such mutualism has been reported for seven species of Reticulitermes and Coptotermes formosanus, all the samplings were restricted to temperate regions. Here, we provide the first Neotropical record of this termite-fungus association, and the first report for Coptotermes gestroi. The morphological characters of the "termite balls" observed in a C. gestroi nest resemble those already reported for Reticulitermes spp. and the congeneric species C. formosanus. They include a color ranging from light to dark brown, spherical shape, and a reduced diameter (0.23-0.34 mm). Our findings provide new insights into the geographical distribution of the association between termites and sclerotium-forming fungi. Future genetic analyses will be valuable aiming to identify the egg-mimicking fungi associated with C. gestroi and shed light on the evolution of this fascinating symbiosis.

Discussões sobre bioética, direito penal e pacientes testemunhas de Jeová / Discussions on bioethics, criminal law, and Jehovah's witness patients / Debates sobre bioética, derecho penal y pacientes testigos de Jehová

Resumo Este estudo tem como finalidade refletir sobre os aspectos bioéticos e jurídicos implicados na relação médico-paciente testemunha de Jeová. Para isso, o trabalho abordará, inicialmente, a relação médico-paciente diante dos impasses terapêuticos desse grupo de pacientes, estudando essa relação do ponto de vista histórico e elucidando os pontos acerca dos pacientes adeptos à religião. Em seguida, abordar-se-ão os princípios bioéticos envolvidos no cuidado do paciente testemunha de Jeová, discutindo cada princípio e sua incorporação ao atendimento desse grupo. Por fim, será discutida a abordagem jurídica à luz dos direitos fundamentais do paciente, caracterizando as normas constitucionais e penais que se aplicam ao cuidado dos profissionais de saúde a pacientes adeptos a essa religião.

Abstract This study aims to reflect on the bioethical and juridical aspects tied to the doctor-Jehovah's Witness patient relationship. To that end, the work will focus, initially, on the doctor-patient relationship faced with the therapeutic obstacles of this group of patients, studying the relationship from the historical standpoint and elucidating the topics about the patients of this religion. Then, we will focus on the bioethical principles involved in the care for Jehovah's Witness patients, discussing each principle and its incorporation to the care for this group. Finally, we will focus on the juridical approach in the light of the patient's fundamental rights, characterizing the constitutional and criminal norms that apply to the care of health professionals to patients of this religion.

Resumen Este estudio tiene como objetivo reflexionar sobre los aspectos bioéticos y legales involucrados en la relación médico-paciente de los testigos de Jehová. Para ello, se abordará inicialmente la relación médico-paciente ante los impasses terapéuticos de este grupo de pacientes desde la perspectiva histórica teniendo en cuenta a los pacientes practicantes de esta religión. Luego, se plantearán los principios bioéticos involucrados en el cuidado del paciente testigo de Jehová, discutiendo cada principio y su incorporación en la asistencia a este grupo. Por último, se discutirá el enfoque jurídico a la luz de los derechos fundamentales del paciente, caracterizando las normas constitucionales y penales que se aplican a la asistencia de los profesionales de la salud a los pacientes practicantes de esta religión.

Comparative reproductive biology of pre-, imaginal, and neotenic castes of the Asian termite Coptotermes gestroi (Blattaria, Isoptera, Rhinotermitidae).

The Asian subterranean termite Coptotermes gestroi is a worldwide structural pest, although its reproductive biology has been poorly investigated due to a cryptic habit and occurrence of polycalic nests. In this study, we investigated ovarian development and oogenesis in different-aged females of C. gestroi: fourth-instar nymphs, non-functional neotenics, alates, and functional queens. We show that the ovaries develop gradually according to their age and functionality, as younger individuals possess immature oocytes, whereas alates and functional queens always undergo vitellogenesis. Oocytes were classified into previtellogenic (stages I, II, and III) or vitellogenic (stages IV, V, and VI). Ovary development varied among non-functional neotenics, and a rapid differentiation and/or the presence of primary reproductives are believed to influence such a maturation. Immature oocyte stages were shared between fourth-instar nymphs and neotenics. These characteristics, together with other neotenic features (wing buds, body pigmentation, and eye color), should be evaluated in detail aiming to clarify which nymphal instars differentiate into secondary reproductives. Oogenesis was not uniform among alate females, and cross-sectional area of terminal oocytes was significantly smaller in alates when compared to functional queens, suggesting different degrees of maturation in swarming individuals. Functional queens always had mature terminal oocytes (stage VI). Ovariole number and oocyte maturation in C. gestroi relies on several factors and may therefore differ among individuals of the same caste. Future studies should take into account these reproductive features to evaluate how they impact colony development.

Aplicação de terapia por pressão negativa adaptada em lesão por queimadura no norte do Brasil: Relato de caso / Application of low cost negative pressure therapy in burn injury in northern Brazil: Case report

OBJETIVO: Relatar um caso clínico ocorrido em um Centro de Referência de Tratamento de Queimados, submetido a terapia por pressão negativa (TPN) adaptada com materiais hospitalares durante o período de internação, visando a cicatrização mais eficaz da lesão. RELATO DE CASO: Paciente de 47 anos de idade, sexo masculino, vítima de queimadura por descarga elétrica, apresentando lesão em pé direito, região submetida há 16 dias de tratamento por TPN adaptada, tendo como resultado a cicatrização da lesão sem necessidade de enxertia. CONSIDERAÇÕES FINAIS: A aplicação de TPN adaptada demonstrou ser um importante alicerce na cicatrização da lesão, permitindo como resultados a redução da planimetria da lesão, aumento do tecido de granulação, redução do esfacelo, além da aproximação das bordas.

OBJECTIVE: To report a clinical case that occurred in Reference Center for Burn Treatment, submitted to negative pressure therapy (NPT) adapted with hospital materials during the period of hospitalization, aiming at a more effective wound healing. CASE REPORT: 47-year-old male patient, victim of burns caused by electrical discharge, presenting a lesion in the right foot, region submitted to 16 days of treatment with adapted NPT, resulting in healing of the lesion without the need for grafting. FINAL CONSIDERATIONS: the application of adapted not proved to be an important foundation in the healing of the lesion, resulting in a reduction in the planimetry of the lesion, an increase in granulation tissue, a reduction in slough, in addition to approximation of the edges.

Spontaneous poisoning by Baccharis vulneraria Backer in cattle / Intoxicação espontânea por Baccharis vulneraria Backer em bovinos

Baccharis vulneraria Backer is a sub-shrub frequently found in southern Brazil, which leads to gastrointestinal tract intoxication. The objective of this study is to describe epidemiological, clinical and anatomopathological aspects of two cases of B. vulneraria poisoning in cattle. Two bovines from two different municipalities in the Itajaí Valley, Santa Catarina, Brazil were necropsied and performed the histopathological evaluation and botanical classification of the plant found in the pasture. Bovine 1 had dehydration, ruminal atony, diarrhea, congested mucous membranes and hypothermia for 20 hours, and died during clinical care. At necropsy, there was moderate multifocal detachment and reddening of the forestomachs mucosa. Bovine 2 presented anorexia, dry feces, ruminal atony, vocalization and muscle tremors for ten days, unresponsive to treatments, evolving to death. At necropsy were seen loosening of the mucosa with marked diffuse reddening and transmural edema. The microscopic exam revealed degeneration, necrosis, vesiculation, and detachment of the forestomachs' mucosa, associated with moderate multifocal neutrophilic infiltrate (Bovine 1); marked diffuse transmural necrosis, edema, hemorrhage, and marked fibrinous exudation (Bovine 2). A large amount of B. vulneraria was found in the pastures, with signs of consumption. In this report, a case of subacute evolution of B. vulneraria poisoning was observed, since the poisoning by this plant is usually acute. More knowledge about poisoning by this plant is necessary for the prevention and control, avoiding new mortality cases.

Baccharis vulneraria Backer é um subarbusto frequentemente encontrado no sul do Brasil, que leva a um quadro de intoxicação nocivo ao trato gastrointestinal. O objetivo deste trabalho é descrever aspectos epidemiológicos, clínicos e anatomopatológicos de dois casos de intoxicação por B. vulneraria em bovinos. Foram necropsiados dois bovinos de dois municípios do Vale do Itajaí, Santa Catarina, Brasil, com avaliação histopatológica dos órgãos e classificação botânica dos exemplares da planta localizada nos piquetes. No exame clínico do Bovino 1 foram constatados desidratação, atonia ruminal, diarreia, mucosas congestas e hipotermia durante 20 horas, com morte durante atendimento clínico. Na necropsia, havia desprendimento e avermelhamento multifocais moderados na mucosa dos proventrículos. Já o Bovino 2 teve manifestações clínicas de anorexia, fezes secas, atonia ruminal, vocalização e tremores musculares por 10 dias, não responsivas a tratamento, evoluindo para óbito. Na necropsia, havia desprendimento da mucosa dos proventrículos, com avermelhamento e edema transmural difusos acentuados. No exame histológico havia degeneração e necrose da mucosa proventricular, vacuolização e desprendimento do epitélio, infiltrado neutrofílico multifocal moderado (Bovino 1), e necrose transmural difusa acentuada, edema, hemorragia e exsudação fibrinosa acentuados (Bovino 2). Grande quantidade de B. vulneraria foi encontrada nas pastagens dos bovinos, com sinais de consumo. É relatado um caso de evolução subaguda de intoxicação por B. vulneraria, visto que a intoxicação por essa planta geralmente tem curso agudo. Conhecimentos acerca desta planta são necessários para prevenção e controle da intoxicação, evitando novos casos de mortalidade.

Spontaneous poisoning by Baccharis vulneraria Backer in cattle

ABSTRACT: Baccharis vulneraria Backer is a sub-shrub frequently found in southern Brazil, which leads to gastrointestinal tract intoxication. The objective of this study is to describe epidemiological, clinical and anatomopathological aspects of two cases of B. vulneraria poisoning in cattle. Two bovines from two different municipalities in the Itajaí Valley, Santa Catarina, Brazil were necropsied and performed the histopathological evaluation and botanical classification of the plant found in the pasture. Bovine 1 had dehydration, ruminal atony, diarrhea, congested mucous membranes and hypothermia for 20 hours, and died during clinical care. At necropsy, there was moderate multifocal detachment and reddening of the forestomachs mucosa. Bovine 2 presented anorexia, dry feces, ruminal atony, vocalization and muscle tremors for ten days, unresponsive to treatments, evolving to death. At necropsy were seen loosening of the mucosa with marked diffuse reddening and transmural edema. The microscopic exam revealed degeneration, necrosis, vesiculation, and detachment of the forestomachs mucosa, associated with moderate multifocal neutrophilic infiltrate (Bovine 1); marked diffuse transmural necrosis, edema, hemorrhage, and marked fibrinous exudation (Bovine 2). A large amount of B. vulneraria was found in the pastures, with signs of consumption. In this report, a case of subacute evolution of B. vulneraria poisoning was observed, since the poisoning by this plant is usually acute. More knowledge about poisoning by this plant is necessary for the prevention and control, avoiding new mortality cases.

RESUMO: Baccharis vulneraria Backer é um subarbusto frequentemente encontrado no sul do Brasil, que leva a um quadro de intoxicação nocivo ao trato gastrointestinal. O objetivo deste trabalho é descrever aspectos epidemiológicos, clínicos e anatomopatológicos de dois casos de intoxicação por B. vulneraria em bovinos. Foram necropsiados dois bovinos de dois municípios do Vale do Itajaí, Santa Catarina, Brasil, com avaliação histopatológica dos órgãos e classificação botânica dos exemplares da planta localizada nos piquetes. No exame clínico do Bovino 1 foram constatados desidratação, atonia ruminal, diarreia, mucosas congestas e hipotermia durante 20 horas, com morte durante atendimento clínico. Na necropsia, havia desprendimento e avermelhamento multifocais moderados na mucosa dos proventrículos. Já o Bovino 2 teve manifestações clínicas de anorexia, fezes secas, atonia ruminal, vocalização e tremores musculares por 10 dias, não responsivas a tratamento, evoluindo para óbito. Na necropsia, havia desprendimento da mucosa dos proventrículos, com avermelhamento e edema transmural difusos acentuados. No exame histológico havia degeneração e necrose da mucosa proventricular, vacuolização e desprendimento do epitélio, infiltrado neutrofílico multifocal moderado (Bovino 1), e necrose transmural difusa acentuada, edema, hemorragia e exsudação fibrinosa acentuados (Bovino 2). Grande quantidade de B. vulneraria foi encontrada nas pastagens dos bovinos, com sinais de consumo. É relatado um caso de evolução subaguda de intoxicação por B. vulneraria, visto que a intoxicação por essa planta geralmente tem curso agudo. Conhecimentos acerca desta planta são necessários para prevenção e controle da intoxicação, evitando novos casos de mortalidade.

Spontaneous poisoning by Baccharis vulneraria Backer in cattle / Intoxicação espontânea por Baccharis vulneraria Backer em bovinos

Baccharis vulneraria Backer is a sub-shrub frequently found in southern Brazil, which leads to gastrointestinal tract intoxication. The objective of this study is to describe epidemiological, clinical and anatomopathological aspects of two cases of B. vulneraria poisoning in cattle. Two bovines from two different municipalities in the Itajaí Valley, Santa Catarina, Brazil were necropsied and performed the histopathological evaluation and botanical classification of the plant found in the pasture. Bovine 1 had dehydration, ruminal atony, diarrhea, congested mucous membranes and hypothermia for 20 hours, and died during clinical care. At necropsy, there was moderate multifocal detachment and reddening of the forestomachs mucosa. Bovine 2 presented anorexia, dry feces, ruminal atony, vocalization and muscle tremors for ten days, unresponsive to treatments, evolving to death. At necropsy were seen loosening of the mucosa with marked diffuse reddening and transmural edema. The microscopic exam revealed degeneration, necrosis, vesiculation, and detachment of the forestomachs' mucosa, associated with moderate multifocal neutrophilic infiltrate (Bovine 1); marked diffuse transmural necrosis, edema, hemorrhage, and marked fibrinous exudation (Bovine 2). A large amount of B. vulneraria was found in the pastures, with signs of consumption. In this report, a case of subacute evolution of B. vulneraria poisoning was observed, since the poisoning by this plant is usually acute. More knowledge about poisoning by this plant is necessary for the prevention and control, avoiding new mortality cases.(AU)

Baccharis vulneraria Backer é um subarbusto frequentemente encontrado no sul do Brasil, que leva a um quadro de intoxicação nocivo ao trato gastrointestinal. O objetivo deste trabalho é descrever aspectos epidemiológicos, clínicos e anatomopatológicos de dois casos de intoxicação por B. vulneraria em bovinos. Foram necropsiados dois bovinos de dois municípios do Vale do Itajaí, Santa Catarina, Brasil, com avaliação histopatológica dos órgãos e classificação botânica dos exemplares da planta localizada nos piquetes. No exame clínico do Bovino 1 foram constatados desidratação, atonia ruminal, diarreia, mucosas congestas e hipotermia durante 20 horas, com morte durante atendimento clínico. Na necropsia, havia desprendimento e avermelhamento multifocais moderados na mucosa dos proventrículos. Já o Bovino 2 teve manifestações clínicas de anorexia, fezes secas, atonia ruminal, vocalização e tremores musculares por 10 dias, não responsivas a tratamento, evoluindo para óbito. Na necropsia, havia desprendimento da mucosa dos proventrículos, com avermelhamento e edema transmural difusos acentuados. No exame histológico havia degeneração e necrose da mucosa proventricular, vacuolização e desprendimento do epitélio, infiltrado neutrofílico multifocal moderado (Bovino 1), e necrose transmural difusa acentuada, edema, hemorragia e exsudação fibrinosa acentuados (Bovino 2). Grande quantidade de B. vulneraria foi encontrada nas pastagens dos bovinos, com sinais de consumo. É relatado um caso de evolução subaguda de intoxicação por B. vulneraria, visto que a intoxicação por essa planta geralmente tem curso agudo. Conhecimentos acerca desta planta são necessários para prevenção e controle da intoxicação, evitando novos casos de mortalidade.(AU)

Biliary fistulas associated with liver transplantation versus other etiologies: what is the success rate of the endoscopic treatment? / Fístulas biliares associadas com transplante hepático versus outras etiologias: qual a taxa de sucesso do tratamento endoscópico?

ABSTRACT - BACKGROUND: Biliary fistulas typically occur as surgical complications after laparoscopic cholecystectomy, liver transplantation, or partial liver resection. AIMS: This study aimed to evaluate the efficacy of the endoscopic treatment of biliary fistulae secondary to liver transplantation compared to that of other etiologies. METHODS: A retrospective study of 25 patients undergoing endoscopic retrograde cholangiopancreatography for biliary fistula from 2015 to 2021 was conducted at the Endoscospy Unit of Walter Cantídio University Hospital. Clinical characteristics and endoscopic success rates of the post-liver transplantation group were analyzed in comparison with those of other etiologies. RESULTS: The main causes of biliary fistula were liver transplantation (44%) and cholecystectomy complications (44%). The post-liver transplantation group had a significantly higher proportion of male sex (liver transplantation=81.8%, others=28.6%) and older age (liver transplantation=54.1 years, others=42.0 years) and a higher incidence of biliary stenosis (liver transplantation=90.9%, others=14.3%) than those of the group with other etiologies (p<0.05). The two groups received similar treatment types, among which sphincterotomy associated with biliary stent placement was most commonly used. Endoscopic therapeutic success rates showed no significant difference between the post-liver transplantation group (63.6%) and the group with other etiologies (71.4%). CONCLUSIONS: The endoscopic treatment of biliary fistulae secondary to liver transplantation presented a recovery rate similar to that of other etiologies despite the patients older age and the presence of biliary stenosis

RESUMO - RACIONAL: As fístulas biliares geralmente ocorrem como complicações cirúrgicas, especialmente após colecistectomia laparoscópica, transplante hepático ou ressecção hepática parcial. OBJETIVOS: Avaliar a eficácia do tratamento endoscópico das fístulas biliares secundária ao transplante hepático em comparação com outras etiologias. MÉTODOS: Estudo retrospectivo de 25 pacientes submetidos a Colangiopancreatografia Retrógada Endoscópica por fístula biliar entre 2015 e 2021 no Serviço de Endoscopia do Hospital Universitário Walter Cantídeo. As características clínicas e as taxas de sucesso endoscópico do grupo pós-transplante hepático foram analisadas em comparação com as de outras etiologias. RESULTADOS: As principais causas de fístula biliar foram pós-transplante hepático (44%) e complicações da pós-colecistectomia (44%). O grupo pós-transplante hepático apresentou proporção significativamente maior de sexo masculino (pós-transplante hepático=81,8%, outros=28,6%) e idade mais avançada (pós-transplante hepático=54,1 anos, outros=42,0 anos) e maior incidência de estenose biliar (pós-transplante hepático=90,9%, outros=14,3%) do que o grupo com outras etiologias (p<0,05). Os dois grupos receberam tipos de tratamento semelhantes, dentre os quais a esfincterotomia associada à aposição de prótese biliar foi a mais utilizada. As taxas de sucesso terapêutico endoscópico não mostraram diferença significativa entre o grupo pós-transplante hepático (63,6%) e o grupo com outras etiologias (71,4%). CONCLUSÕES: O tratamento endoscópico das fístulas biliares secundária ao transplante hepático apresentou taxa de recuperação semelhante à de outras etiologias, apesar da idade avançada dos pacientes e da presença de estenose biliar.

Consensus on the Treatment and Follow-Up for Metastatic Castration-Resistant Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS: A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS: Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION: There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.

Consensus on Treatment and Follow-Up for Biochemical Recurrence in Castration-Sensitive Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries.

PURPOSE: To present a summary of the treatment and follow-up recommendations for the biochemical recurrence in castration-sensitive prostate cancer (PCa) acquired through a questionnaire administered to 99 PCa experts from developing countries during the Prostate Cancer Consensus Conference for Developing Countries. METHODS: A total of 27 questions were identified as related to this topic from more than 300 questions. The clinician's responses were tallied and presented in a percentage format. Topics included the use of imaging for staging biochemical recurrence, treatment recommendations for three different clinical scenarios, the field of radiation recommended, and follow-up. Each question had 5-7 relevant response options, including "abstain" and/or "unqualified to answer," and investigated not only recommendations but also if a limitation in resources would change the recommendation. RESULTS: For most questions, a clear majority (> 50%) of clinicians agreed on a recommended treatment for imaging, treatment scenarios, and follow-up, although only a few topics reached a consensus > 75%. Limited resources did affect several areas of treatment, although in many cases, they reinforced more stringent criteria for treatment such as prostate-specific antigen values > 0.2 ng/mL and STAMPEDE inclusion criteria as a basis for recommending treatment. CONCLUSION: A majority of clinicians working in developing countries with limited resources use similar cutoff points and selection criteria to manage patients treated for biochemically recurrent castration-sensitive PCa.