Surgical gowns as a safety barrier under non-standard environmental conditions.

In this prospective study, we aimed to investigate whether surgical gowns become contaminated during surgery. Samples from the gowns of five surgeons during 19 surgeries were collected using sterile swabs in circular standard delimited areas on both wrists and the mid-chest at three time-points: immediately before surgical incision (t=0), 30 min (t=30), and 60 min (t=60) later. Additionally, at t=0 and t=60, three settle plates of plate count agar were positioned at 1.5 m from the ground and remained open for 20 min. The operating room temperature and relative humidity were monitored. The swabs were cultivated and incubated, and colony-forming units per gram (CFU/g) counts were measured. The CFU/g counts for bacteria or fungi did not differ among the three sampling sites. The surgeons' lateral dominance in manual dexterity did not influence the gowns' contamination. There were significant variations in the temperature and relative humidity over time, but not in the CFU/g counts. In conclusion, during the first hour of surgery, surgical gowns did not become a source of contamination and are an effective barrier against bacterial and fungal contamination even under non-standard surgical environmental conditions.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR SYSTEMIC TREATMENT OF HEPATOCELLULAR CARCINOMA.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

Incidence and Risk Factors of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C Treated with Direct-Acting Antivirals.

BACKGROUND: Conflicting data regarding the incidence of hepatocellular carcinoma (HCC) after cure of HCV infection with direct-acting antivirals (DAAs) remains. We investigated the incidence and risk factors to HCC after treatment with DAAs followed up for five years. METHODS: A total of 1075 HCV patients ≥ 18 years were treated with DAAs from 2015 to 2019 and followed until 2022. Ultrasonography was performed before DAAs and each 6 months thereafter. RESULTS: Of the total, 51/1075 (4.7%) developed HCC in the median of 40 (IQR 25-58) months: 26/51 (51%) male, median age 60 (IQR 54-66) years, alpha-fetoprotein (AFP) 12.2 (IQR 6.1-18.8) ng/mL, 47/51 (92.1%) cirrhotic 78.7%, 8/51 (15.7%) without sustained virological response (SVR). Seventeen percent had non-characterized nodules before DAAs. Cumulative HCC incidence was 5.9% in 5 years. Overall incidence was 1.46/100 patient-years (PY) (95% CI = 1.09-1.91), being 2.31/100 PY (95% CI = 1.70-3.06), 0.45/100 PY (95% CI = 0.09-1.32) and 0.20/100 PY (95% CI 0.01-1.01) in METAVIR F4, F3 and F2, respectively, and the main risks to HCC were non-characterized nodule, cirrhosis, high AFP values and non-SVR. CONCLUSION: HCV cure reduced risk for HCC, but it still occurred particularly in cirrhotic patients. Some risk factors can be identified to predict early HCC diagnosis.

Atualização das Recomendações da Sociedade Brasileira de Hepatologia para o Tratamento Sistêmico do Carcinoma Hepatocelular / Brazilian society of hepatology updated recommendations for systemic treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study.

BACKGROUND & AIMS: Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. METHODS: Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered. RESULTS: Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection. CONCLUSIONS: This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.

PERFIL EPIDEMIOLÓGICO DE PACIENTES COM HEPATITE C CRÔNICA TRATADOS COM ANTIVIRAIS DE AÇÃO DIRETA EM UM CENTRO DE REFERÊNCIA NO ESTADO DO RIO DE JANEIRO / EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH DIRECT ACTION ANTIVIRALS IN A REFERENCE CENTER IN THE STATE OF RIO DE JANEIRO

Segundo o Ministério da Saúde, o número de casos notificados e confirmados de hepatite C no período entre 1999 e 2020 foi de 262.815 casos no Brasil. Em 2016, a OMS estabeleceu como objetivo global que as hepatites não fossem mais um problema de saúde pública em 2030. A partir de 2015, os agentes antivirais de ação direta (DAA) começaram a ser utilizados nessa terapêutica. O tratamento atual da hepatite C com os novos DAA revolucionou o cenário mundial com taxas de cura de até 98%. O objetivo desse artigo é apresentar e discutir o tratamento realizado com DAA em pacientes com hepatite C crônica em um centro de referência no Estado do Rio de Janeiro no período entre novembro de 2015 e julho de 2019. Trata-se de um estudo observacional, prospectivo e descritivo de pacientes com hepatite C crônica tratados com DAA no ambulatório de hepatologia de um hospital de referência. No presente estudo pode ser concluído que a maioria dos pacientes evoluiu para a cura após o tratamento. Foi possível concluir também que os esforços idealizados pela OMS para que o vírus da hepatite C seja erradicado estão ocorrendo de forma positiva e que com as novas DAAs é possível ter um número satisfatoriamente alto de RVS, evitando, assim, desfechos desfavoráveis, como por exemplo, o surgimento de carcinoma hepatocelular.

According to the Ministry of Health, the number of notified and confirmed cases of hepatitis C in the period between 1999 and 2020 was 262,815 cases in Brazil. In 2016, the WHO established as a global goal that hepatitis was no longer a public health problem in 2030. As of 2015, direct action antiviral agents (DAA) began to be used in this therapy. The current treatment of hepatitis C with the new DAA has revolutionized the world scenario with cure rates of up to 98%. The aim of this article is to present and discuss the treatment performed with DAA in patients with chronic hepatitis C in a reference center in the state of Rio de Janeiro between November 2015 and July 2019. This is an observational, prospective and descriptive study of patients with chronic hepatitis C treated with DAA in the hepatology clinic of a reference hospital. In the present study, it can be concluded that most patients evolved to cure after treatment. It was also possible to conclude that the efforts idealized by the WHO to eradicate the hepatitis C virus are occurring in a positive way and that with the new DAAs it is possible to have a satisfactorily high number of SVR, thus avoiding unfavorable outcomes, such as the appearance of hepatocellular carcinoma.

Mutational profile of skin lesions in hepatocellular carcinoma patients under tyrosine kinase inhibition: a repercussion of a wide-spectrum activity.

BACKGROUND/AIM: Dermatological adverse events (DAE) in hepatocellular carcinoma (HCC) patients treated with sorafenib predicts better outcome. Some turn into skin lesions (SL) requiring pathology examination. We describe incidence, characteristics and molecular profile of SL in HCC patients treated with sorafenib. MATERIALS AND METHODS: SL were prospectively collected in 311 HCC patients who started sorafenib. SL from sorafenib cohort were compared to those from a control patient group selected to match SL type and demographics. HRAS, KRAS and BRAF mutations were analyzed by CAST-PCR, mutated p53 and MAPK pathway activation by immunohistochemistry and immune infiltration by hematoxylin-eosin staining. RESULTS: Eighty-eight out of 311 patients developed DAE and 7.4% SL required histological assessment. Most frequent lesions were keratoacanthomas (n = 4), squamous-cell carcinomas (SCC)(n = 5), basal-cell carcinomas (BCC)(n = 3) and seborrheic keratosis (n = 5). HRAS and KRAS mutations were detected in 4 SL, while no mutations showed in control SL. Nuclear pERK immunostaining was identified in 33.3% of cases versus 5.3% of controls. Most SL (90%) from patients with DAE were proliferative with intense immune infiltration (73%). CONCLUSIONS: The onset of SL and their molecular profile did not impact negatively on patient's prognosis, but intense proliferation of SL may reflect compensatory activation of MAPK pathway and warrants their close monitoring.

Assessing the impact of COVID-19 on liver cancer management (CERO-19).

BACKGROUND & AIMS: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. METHODS: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). CONCLUSIONS: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. LAY SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.

The gynecological examination in Pantaneiro mares.

Gynecological examination is essential to assess the reproductive tract of mares and can provide important information about the uterine environment. It includes physical, vaginal, and rectal examination, ultrasound, cytology, culture, and endometrial biopsy. The present study aimed to perform gynecological examination and fertility to assess the fertility prognosis of Pantaneiro mares that have not been reproductively active and to determine their reproductive ability. Eight mares underwent ultrasound and gynecological examination and artificial insemination. Ultrasound revealed changes only in one mare. Histopathological findings were mild, such as periglandular and perivascular inflammatory cell infiltrates, fibrotic areas, glandular dilation, glandular island formation, and edema due to the phase of the estrous cycle. One animal was classified in category I and the others in category IIA. Cytological changes were found in only one mare. Endometrial culture from five mares resulted in isolation of Pseudomonas sp., Bacillus sp., Escherichia coli and Candida sp. Only four mares resulted pregnant through artificial insemination, using the same stallion with fresh semen, which has been proving fertility. Thus, mares with better uterine conditions will not always become pregnant and those with mild changes will not always be barren.

International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis.

BACKGROUND & AIMS: Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma (HCC) under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population. METHODS: We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events (AEs), treatment duration, and outcome of patients undergoing dialysis were recorded. RESULTS: As of March 2018, 6156 HCC patients were treated in 44 centres and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5 years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were Barcelona Clinic Liver Cancer-C. The median time to first dose modification, treatment duration and overall survival rate were 2.4 months (interquartile ranges [IQR], 0.8-3.8), 10.8 months (IQR, 4.5-16.9), and 17.5 months (95% CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of Eastern Cooperative Oncology Group-Performance Status and diarrhoea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumour progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE. CONCLUSIONS: The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in HCC patients undergoing dialysis.

Risk of recurrence of hepatocellular carcinoma in patients treated with interferon-free antivirals. / Riesgo de recurrencia del carcinoma hepatocelular en pacientes tratados con antivirales libres de interferón.

Eradication of the hepatitis C virus (HCV) with interferon-free therapies (DAAs) has modified the course of the disease, as the rate of patients with compensated cirrhosis who achieve a sustained virological response exceeds 95%. However, the impact on development of hepatocellular carcinoma (HCC) is currently in dispute. This argument could be divided into different key points: the impact of DAA on rate of HCC recurrence, the temporal link between starting DAAs and HCC recurrence, and finally, the aggressive pattern of HCC. Therefore, the aim of this review is to analyse the available results in this population of patients from a clinical perspective where the risks and benefits of HCV eradication with DAA therapies are evaluated in patients with complete response of HCC.

Salmonellosis in calves without intestinal lesions / Salmonelose em bezerros sem manifestações intestinais

Salmonellosis is a known cause of enteric disorders in calves. However, cases in the septicemic form may not present enteric lesions, which may lead the veterinary practitioner to not suspect salmonellosis, compromising the diagnosis. The current study describes the epidemiological, clinical, pathological and immunohistochemical aspects of septicemic salmonellosis in calves without enteric lesions. The protocols involving bovine material submitted to the Pathology Laboratory (LAP) of the "Faculdade de Medicina Veterinária e Zootecnia" (FAMEZ) of the "Universidade Federal do Mato Grosso do Sul" (UFMS) from January 1995 to July 2018 were studied. Cases confirmed or suggestive of septicemic salmonellosis in calves without enteric manifestations were selected. Fragments of the liver, lung, and spleen embedded in paraffin were submitted to immunohistochemistry (IHC). Only cases in which there was positive marking on the IHC or culture isolation of Salmonella were included in this study. Of a total of 5,550 cattle examined in the period, ten presented septicemic salmonellosis without enteric lesions. Clinical signs included mucosal pallor, apathy, hyperthermia, and dyspnea. Only three calves presented diarrhea, and two were found dead before clinical changes were observed. The most common necropsy findings were hepatosplenomegaly; yellow, orange or brown discolored livers; pale mucous membranes; inflated and sometimes red lungs; fibrin or fluid within body cavities; and gallbladder filled with inspissated bile. Jaundice was observed in three calves that had a concomitant infection with Anaplasma sp. Microscopically, paratyphoid hepatic nodules and interstitial pneumonia were the most frequent manifestations, followed by thrombosis and bacterial colonies in the spleen, lung, liver, and brain. A strong positive marking was observed in IHC, predominantly in the lung and to a lesser extent in the liver. Polymerase chain reaction (PCR) indicated the Dublin serotype as the causative agent in the samples of the four calves submitted to this procedure. In calves, the septicemic form was the major cause of death due to salmonellosis. Septicemic salmonellosis was usually not accompanied by diarrhea. The clinical signs of septicemia are nonspecific and of little assistance in the diagnosis. IHC has been shown to be efficient in the detection of the agent, mainly in the lung and especially in situations where it is not possible to perform bacterial culture.(AU)

A salmonelose é uma causa conhecida de distúrbios entéricos em bezerros. Porém, casos na forma septicêmica podem não apresentar manifestação entérica, o que leva o médico veterinário a não suspeitar de salmonelose, comprometendo o diagnóstico. Este estudo descreve os aspectos epidemiológicos, clínicos, patológicos e imuno-histoquímicos da salmonelose septicêmica em bezerros sem lesões entéricas. O estudo foi realizado a partir dos protocolos referentes a materiais de bovinos enviados para diagnóstico ao Laboratório de Anatomia Patológica (LAP) da Faculdade de Medicina Veterinária e Zootecnia (FAMEZ) da Universidade Federal de Mato Grosso do Sul (UFMS) de janeiro de 1995 a julho de 2018. Foram selecionados os casos de bezerros confirmados ou sugestivos de salmonelose septicêmica sem lesões entéricas. Fragmentos de fígado, pulmão e baço embebidos em parafina foram submetidos ao exame de imuno-histoquímica (IHQ). Somente foram incluídos neste estudo casos em que houve marcação positiva na IHQ ou isolamento da bactéria em cultura. De um total de 5.550 bovinos examinados no período, dez apresentaram salmonelose septicêmica sem lesão entérica. Os sinais clínicos incluíram palidez de mucosas, apatia, hipertermia e dispneia. Apenas três bezerros apresentaram diarreia e dois foram encontrados mortos sem terem sido observadas alterações clínicas. Os achados mais frequentes de necropsia foram hepatoesplenomegalia, fígado amarelado, alaranjado ou acastanhado, palidez de mucosas, pulmões inflados e, por vezes, vermelhos, fibrina ou líquido nas cavidades do organismo e vesícula biliar repleta de bile grumosa. Icterícia foi observada em três bezerros que apresentavam infecção concomitante por Anaplasma sp. Microscopicamente, os nódulos paratifoides hepáticos e pneumonia intersticial foram as manifestações mais encontradas, seguidas por trombose e colônias bacterianas no baço, pulmão, fígado e encéfalo. Na IHQ, marcação fortemente positiva foi observada, predominantemente, no pulmão e, em menor intensidade, no fígado. A técnica de reação em cadeia de polimerase (PCR) tipificou o sorotipo Dublin como agente etiológico nas amostras dos quatro bezerros submetidos a este procedimento. Em bezerros, a forma septicêmica foi a principal responsável pelas mortes por salmonelose. Na maioria das vezes essa forma não estava acompanhada por diarreia. Os sinais clínicos da forma septicêmica são inespecíficos e de pouco auxílio no direcionamento do diagnóstico. A IHQ mostrou-se eficiente na detecção do agente principalmente no pulmão e especialmente nas situações em que não é possível a realização da cultura bacteriana.(AU)

Hepatocellular Carcinoma Recurrence in HCV Patients Treated with Direct Antiviral Agents.

The risk of hepatocellular carcinoma recurrence is universal regardless of the treatment modality applied, and secondary prevention is still an unmet issue even though the elimination of hepatitis C (HCV) with direct antiviral agents (DAAs) was expected to be one of the new options. Unfortunately, the impact of DAAs on hepatocellular carcinoma (HCC) development (de novo and recurrence) is still controversial. Since the first publication on the subject in 2016, almost all groups worldwide have carried out research in this field with hundreds of publications now available. This revision is focused on the impact of DAAs on HCC recurrence and aims to discuss the potential underlying mechanisms and host factors pointing out the time association phenomenon between DAA treatment and HCC recurrence. Moreover, we comment on the methodological issues that could affect the different interpretations of the published results. In conclusion, this is an area of research with potential in the understanding of the impact of factors not previously considered, and may also help change hepatocarcinogenesis tenets, such as the belief that the elimination of HCV should be used as a second prevention treatment.

Survival and tolerance to sorafenib in Child-Pugh B patients with hepatocellular carcinoma: a prospective study.

Sorafenib has been widely used to treat unresectable hepatocellular carcinoma (HCC) but most studies have been done in Child-Pugh A (CP-A) patients with well-preserved liver function. We evaluated the overall survival (OS) and tolerance to sorafenib in a large cohort of Child-Pugh B (CP-B) HCC patients as compared to CP-A HCC patients. We prospectively studied 130 patients with advanced HCC who started sorafenib between January 2011 and December 2015. Patients were classified as CP-A (n = 65) or CP-B (n = 65). The average OS for all 130 patients was 10 months. CP-A patients had a median survival rate significantly longer than CP-B patients: 12 months vs. 6 months. The OS found in our group of CP-B patients was 6.5 months, which is higher than that found in most studies done so far. When stratified, our CP-B patients had better OS than ever reported. The dose of the drug was interrupted due to adverse events (AEs) in 38 (29%) of the patients, of whom 20 (30%) were CP-A patients and 18 (28%) were CP-B patients. This real-life cohort of CP-B HCC patients treated with sorafenib had a higher survival than that described in the literature, with a satisfactory safety profile. Despite the high prevalence of severe AEs in CP-B patients, there were fewer treatment interruptions in this group, indicating that Child-Pugh B patients can tolerate treatment and may benefit from sorafenib.

Propolis extract in tshe diet of weaned piglets / Extrato de própolis na dieta de leitões desmamados

ABSTRACT: This study was conducted to assess the use of propolis ethanolic extract as an alternative to performance-enhancing antibiotics for piglets. Seventy piglets weaned at 21 days of age, with initial weights of 7.3±0.4kg and final weights of 24.9±1.2kg, were randomly assigned to five diets: positive control (diet with 200ppm antibiotic); negative control (diet without growth promoter); and diets with 100, 500, and 1,000ppm of brown propolis ethanolic extract, with seven replicates of two piglets each. The duration of the experimental period was 35 days. The diets did not influence (P>0.05) daily feed intake, daily weight gain, final weight, and feed conversion of animals. The bacteriological profile of the nasal swab presented a predominance of gram-positive bacteria commonly associated with the mucous membranes in all samples. Rectal swabs did not present atypical bacterial isolates. The use of ethanolic propolis extract in diets did not alter the performance of weaned piglets, nor did it affect the bacteriological profile, fecal score, or the occurrence of diarrhea in piglets.

RESUMO: Esta pesquisa foi realizada com o objetivo de investigar a utilização de extrato etanóico de própolis como alternativa aos antibióticos melhoradores de desempenho para leitões. Foram avaliados 70 leitões desmamados aos 21 dias de idade, com pesos iniciais de 7,3±0,4kg e final de 24,9±1,2kg. Estes foram distribuídos em delineamento de blocos ao acaso, com cinco dietas: controle positivo - dieta com 200ppm de antibiótico; controle negativo - dieta sem promotor de crescimento; dietas com 100, 500 e 1.000ppm de extrato etanóico de própolis marrom, com sete repetições de dois leitões cada. A duração do período experimental foi de 35 dias. As dietas não influenciaram (P>0,05) no consumo de ração diária, ganho de peso diário, peso final e a conversão alimentar dos animais. O perfil bacteriológico da swab nasal apresentou predomínio de bactérias Gram positivas comumente associadas às membranas das mucosas em todas as coletas realizadas. As swabs retais não apresentaram isolamento atípico. A utilização do extrato etanóico de própolis nas dietas não altera o desempenho de leitões desmamados, bem como não afeta o perfil bacteriológico, escore fecal e a ocorrência de diarreia dos leitões.

Photoinactivation effect of eosin methylene blue and chlorophyllin sodium-copper against Staphylococcus aureus and Escherichia coli.

The use of eosin methylene blue according to Giemsa as photosensitizer is presented for the first time in this paper. The present study evaluated the potential application of chlorophyllin sodium copper salt (CuChlNa) and eosin methylene blue according to Giemsa (EMB) as antimicrobial photosensitizers (aPS) for photodynamic inactivation (PDI) of Staphylococcus aureus (gram-positive) and Escherichia coli (gram-negative) bacteria. The experiments were performed using S. aureus stain ATCC 25923 and E. coli ATCC 25922 in which five aPS concentrations (0.0, 1.0, 2.5, 5.0, 10.0, and 20.0 µM for S. aureus and 0.0, 5.0, 10.0, 20.0, 40.0, and 50.0 µM for E. coli) were prepared and added in 2 mL of a saline solution containing the bacterial inoculum. After aPS incubation, the samples were divided into two groups, one kept in the dark and another submitted to the illumination. Then, the bacterial inactivation was determined 18 h after the incubation at 37 °C by counting the colony-forming units (CFU). The results revealed that both EMB and CuChlNa can be used as aPS for the photoinactivation of S. aureus, while only EMB was able to photoinactivate E. coli. Nevertheless, a more complex experimental setup was needed for photoinactivation of E. coli. The data showed that EMB and CuChlNa presented similar photoinactivation effects on S. aureus, in which bacterial growth was completely inhibited at photosensitizer (PS) concentrations over 5 µM, when samples were previously incubated for 30 min and irradiated by a light dose of 30 J cm-2 as a result of an illumination of 1 h at 8.3 mW cm-2 by using a red light at 625 nm with a 1 cm beam diameter and output power of 6.5 mW. In the case of E. coli, bacterial growth was completely inhibited only when combining a PS incubation period of 120 min with concentrations over 20 µM.

Atividade antibacteriana in vitro da própolis marrom / In vitro biological activity of brown propolis

Objetivou-se avaliar a atividade antibacteriana in vitro da própolis marrom, por meio da determinação da Concentração Inibitória Mínima (CIM). O extrato alcoólico de própolis foi obtido de 35 g de própolis bruta macerada em 65 mL de álcool de cereais. As concentrações do extrato de própolis usadas foram: 75mg/mL; 56,4mg/mL; 37,5mg/mL; 18,9mg/mL; 9,3mg/mL; 4,5mg/mL e 2,25mg/mL. Foram utilizados 32 isolados de bactérias Gram-positivas: Rhodococcus equi, Staphylococcus aureus, Staphylococcus hyicus, Staphylococcus spp. e Streptococcus spp., e 32 isolados de bactérias Gram-negativas: Enterobacter agglomerans, Escherichia coli, Klebsiella pneumoniae, Klebsiella sp., Pseudomonas aeruginosa, Pseudomonas spp., Salmonella spp. e Serratia rubidaea, provenientes de processos clínicos infecciosos de animais domésticos, obtidas e armazenadas no Laboratório de Bacteriologia da FAMEZ/UFMS. O extrato de própolis marrom apresentou atividade antimicrobiana com CIM variando de 2,25 a 18,9mg/mL para as bactérias Gram-positivas e 4,5 a 18,9mg/mL para as bactérias Gram-negativas, sendo as bactérias provenientes de bovinos e caninos as mais resistentes. Conclui-se que a própolis marrom tem ação bactericida, em função da espécie da bactéria e da procedência animal.

The aim of this study was to evaluate the in vitro antibacterial activity of brown propolis, by determining the minimum inhibitory concentration (MIC). The alcoholic extract of propolis was obtained from 35g of crude propolis macerated in 65mL of cereals alcohol. Dilutions of propolis extracts used were: 75mg/mL; 56.4mg/mL; 37.5mg/mL; 18.9mg/mL; 9.3mg/mL; 4.5mg/mL, and 2.25mg/mL. Thirty-two Gram-positive bacteria isolates were used: Rhodococcus equi, Staphylococcus aureus, Staphylococcus hyicus, Staphylococcus spp. and Streptococcus spp.; and the thirty-two Gram-negative bacteria isolated were: Enterobacter agglomerans, Escherichia coli, Klebsiella pneumoniae, Klebsiella sp., Pseudomonas aeruginosa, Pseudomonas sp., Salmonella sp., and Serratia rubidaea, obtained from infectious clinical processes of domestic animals, and stored in the Laboratory of Bacteriology of FAMEZ/UFMS. The brown propolis extract showed antibacterial activity with MIC ranging from 2.25 to 18.9mg/ml for Gram-positive bacteria and 4.5 to 18.9mg/ml for Gram-negative bacteria, and bacteria from cattle and dogs were more resistant. It was concluded that brown propolis has antibacterial action, but the effect depends on the species of the bacterium and its origin.

Estimativas de perdas econômicas causadas por reação granulomatosa local após uso de vacina oleosa contra febre aftosa em bovinos de Mato Grosso do Sul / Estimates of economic losses caused by local granulomatous reaction after use of an oily vaccine against FMD in cattle of Mato Grosso do Sul

Lesões exacerbadas à vacina contra a febre aftosa foram observadas em 1.815 de um total de 5.000 bovinos abatidos em frigorífico com inspeção federal. Essas lesões resultaram na condenação de parte das carcaças de acordo com o Regulamento da Inspeção Industrial e Sanitária de Produtos de Origem Animal. Os bovinos haviam sido vacinados em maio de 2012 e abatidos em setembro do mesmo ano e divididos em Lotes 1 e 2 constituídos respectivamente por 1.500 e 315 bovinos. As lesões de reação vacinal eram caracterizadas por nódulos protuberantes, circunscritos, bem delimitados, firmes e de tamanhos variáveis, distribuídos multifocalmente na musculatura do aspecto lateral do pescoço; ao corte apresentavam exsudato purulento. Amostras da lesão de 28 bovinos foram avaliadas histologicamente e os principais achados foram piogranulomas com espaços claros circulares de tamanhos variados no centro, circundados por intenso infiltrado de neutrófilos íntegros e necróticos, circundados por macrófagos epitelioides com citoplasma vacuolizado, ocasionais células gigantes multinucleadas e, mais externamente, por abundante tecido conjuntivo em meio observavam-se linfócitos e plasmócitos. Culturas bacterianas realizadas em amostras do exsudato da lesão de seis bovinos resultaram negativas. Quando as carcaças afetadas foram submetidas ao toalete foi retirado em média 1,8 e 2,0 kg de músculo da área afetada, respectivamente dos Lotes 1 e 2. O prejuízo econômico da propriedade de origem dos bovinos afetados foi de R$ 20.424,00, considerando o preço pago pela arroba do boi no mês e ano da ocorrência. Esses valores à época seriam suficientes para adquirir 29,17 bezerros desmamados para engorda. Se considerarmos 5.000 bovinos vacinados forem considerados como população sob risco o coeficiente de morbidade seria de 0,36%. Os resultados deste estudo demonstram que perdas por reação vacinal, mesmo quando não provocam sinais clínicos marcantes, podem ocasionar importantes prejuízos econômicos...

Lesions caused by excessive reaction to foot and mouth vaccine were observed in 1,815 out of 5,000 cattle slaughtered in a slaughterhouse under federal meat inspection. Such lesions resulted in condemnation of the affect parts of the carcasses in accordance with the Brazilian Federal Meat Inspection Regulations. The affected cattle had been vaccinated on May 2012 and then slaughtered in September of the same year. They were allotted to two groups with 1,500 (Groups 1) and 315 cattle (Group 2). Post vaccination lesions were characterized as salient, firm variable sized nodules multifocally distributed in the musculature of the lateral neck. Pus oozed at the cut surface of these nodules. Samples of 28 cattle were submitted for histopathological examination; main findings were pyogranulomas with central variable-sized clear spaces surrounded by marked infiltrate of viable and dead neutrophils, which were surrounded by epithelioid macrophages with vacuolated cytoplasm and occasional multinucleated giant cell. This inflammatory reaction was walled by abundant connective tissue infiltrated by lymphocytes and plasma cells. Samples of the lesion of six cattle were submitted to bacteriological culture with negative results. When affected carcasses went through dressing, there was an average of 1.8 and 2.0 kg of muscle tissue cut off from the carcasses respectively of Group 1 and 2. Economic losses in the farm of origin of the affected cattle was R$ 20,424.00, considering the price paid by kg of cattle for slaughter at the time of the occurrence. This amount at that time was enough to buy 29.17 weaned calves for fattening. If one considers theses 5,000 cattle vaccinated on the farm as the population at risk, the morbidity rate would be 0.36%. These results indicate that the losses due to vaccine reaction, even with no overt clinical signs, may cause important economic losses...

Doenças de ovinos diagnosticadas no Laboratório de Anatomia Patológica Animal da Universidade Federal de Mato Grosso do Sul (1996-2010) / Sheep diseases diagnosed at the Laboratory of Animal Pathology, Federal University of Mato Grosso do Sul, Brazil (1996-2010)

Nas últimas décadas a pecuária ovina cresceu significativamente no Brasil. Concomitantemente, grupos de pesquisas e laboratórios de diagnósticos realizam estudos retrospectivos com a finalidade de fornecer subsídios técnico-científicos para os médicos veterinários. Desta forma, realizou-se um estudo de prevalência nos arquivos do Laboratório de Anatomia Patológica Animal (LAP) da Universidade Federal de Mato Grosso do Sul (UFMS) no período de Janeiro de 1996 a Dezembro de 2010. O Laboratório de Bacteriologia da UFMS e o Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul forneceram apoio diagnóstico nos casos de mannheimiose pulmonar e scrapie, respectivamente. Os laudos da espécie ovina foram revisados e agrupados em conclusivos e inconclusivos, dos quais foram excluídos os casos experimentais e de outros estados e países. Os casos conclusivos foram classificados de acordo com a etiologia da doença. Os exames da espécie ovina somaram 331 laudos (3,97 %) de um total de 8.333 casos diagnosticados no período. Destes, foram excluídos sessenta e quatro (19,3%) casos experimentais e materiais oriundos de outros estados ou países. Dos 267 casos remanescentes, 87 (32,6%) foram inconclusivos e 180 (67,4%) considerados conclusivos, sendo 60 (33,3%) doenças infecciosas e parasitárias; 45 (25%) intoxicações e toxi-infecções; 41 (22,8%) "lesões sem causa definida"; 22 (12,2%) doenças metabólicas e nutricionais; 10 (5,6%) foram classificadas como "outros distúrbios" e 2 (1,1%) neoplasmas. A hemoncose, intoxicação por Brachiaria spp., pleuropneumonias, broncopneumonias, pneumonias fibrinonecrosante ou fibrinossupurativa sem causa definida e a intoxicação por cobre foram as doenças mais prevalentes no período estudado. Dois casos de scrapie foram diagnosticados no período.

Sheep farming has increased significantly in Brazil during the last decades. Concurrently, research groups and diagnostic laboratories compile data and perform retrospective studies to provide important insight for professionals. A prevalence study from January 1996 to December 2010 was carried out in the archives of Laboratório de Anatomia Patológica Animal (LAP), Universidade Federal de Mato Grosso do Sul (UFMS). Laboratório de Bacteriologia, UFMS, and Setor de Patologia Veterinária at Universidade Federal do Rio Grande do Sul helped on the diagnostic of pulmonary mannheimiosis and scrapie respectively. The reports for sheep were reviewed and grouped into conclusive and inconclusive ones. The conclusive cases were classified according to the etiology of the disease. In the period, 331 exams (3.97%) were done. Sixty-four experimental cases and materials from other states or countries (19.3%) were excluded. Remaining cases (267), eighty-seven (32.6%) were inconclusive and 180 (67.4%) were considered conclusive reports, were classified according to the etiology: 60 (33.3%) infectious and parasitary diseases; 45 (25%) were poisonings and toxi-infections; 41 (22.8%) were summarized as "injuries without apparent cause"; 22 (12.2%) cases of metabolic and nutritional diseases; 10 (5.6%) were classified as "other disorders" and 2 (1.1%) case of neoplasms. Haemonchosis, fibrinonecrotic or fibrinopurulent pleuropneumonia, bronchopneumonia and pneumonia, poisonings by Brachiaria spp. and copper poisoning were the most prevalent diseases in sheep. Two cases of scrapie have been diagnosed in this period.

Effects of platelet-rich plasma gel on skin healing in surgical wound in horses.

PURPOSE: To establish a low-cost method to prepare platelet-rich plasma (PRP) and evaluates the potential of platelet derived factors to enhance wound healing in the surgical wounds in equine. METHODS: To obtain a PRP gel, calcium gluconate and autologous thrombin were added to platelet-rich plasma. For the tests six saddle horses were used and two surgical incisions were made in each animal. Wounds were treated with PRP gel or untreated. Sequential wound biopsies collected at Treatment 1: at days 5 and 30 and Treatment 2: at days 15 and 45 post wounding permitted comparison of differentiation markers and wound repair. RESULTS: The optimal platelets enrichment over 4.0 time's baseline values was obtained using 300 g for 10 min on the first centrifugation and 640 g for 10 min on the second centrifugation. CONCLUSION: Wounds treated with PRP gel exhibit more rapid epithelial differentiation and enhanced organization of dermal collagen compared to controls in equine.