Patterns and Risk Factors for Rehospitalizations Within the First 90 Days Following Discharge After Heart Transplantation.

BACKGROUND: Heart transplantation (HT) recipients are at risk for urgent rehospitalizations following discharge. However, data on prevalence, risk factors and clinical outcomes associated with post-HT rehospitalization are limited. METHODS: This study aims to describe patterns of urgent rehospitalizations in HT recipients at a cardiology reference center in Brazil. Rehospitalizations and deaths occurring within the first 90 days following hospital discharge were identified. Regression models were used to identify variables associated with urgent rehospitalizations. RESULTS: A total of 239 patients were included. Of those, 118 (49.4%) presented with a rehospitalization within 90 days following hospital discharge and 5 (2.01%) died. Most patients who were rehospitalized had one new hospital admission (86.0%). The main cause of urgent rehospitalization was infection (55.0%). In the multivariate analysis, elevated C-reactive protein at discharge and the occurrence of intracranial bleeding at index hospitalization were associated with an increased risk of readmission. Longer duration of index hospitalization and use of lower doses of azathioprine were associated with a lower risk of rehospitalization. CONCLUSION: Around half of HT recipients were rehospitalized within the first 90 days after hospital discharge. Understanding factors associated with post-HT rehospitalization may help the implementation of strategies to avoid patient morbidity and hospital costs.

Acute myeloid leukemia with neutrophilic differentiation in a 12-year-old African lion (Panthera leo).

OBJECTIVE: To describe the clinical presentation, progression, and diagnosis of acute myeloid leukemia (AML) with neutrophilic differentiation in an African lion (Panthera leo). ANIMAL: A 12-year-old male African lion kept at a zoological institution in Colombia. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The lion presented for anorexia, pale mucous membranes, and a hind limb lameness of acute onset. Feline leukemia virus testing was negative, and repeated blood samples revealed severe anemia, intermittent thrombocytopenia, lymphopenia, and neutrophilia. Coinfection with Anaplasma and Mycoplasma spp and chronic kidney disease were diagnosed based on clinicopathological findings. TREATMENT AND OUTCOME: The lion received symptomatic treatment, doxycycline, and methylprednisolone or prednisolone. Euthanasia was elected due to clinical deterioration and unresponsive anemia, despite the resolution of Anaplasma and Mycoplasma spp infections. AML with neutrophilic differentiation was diagnosed based on bone marrow cytology, histopathology, and immunohistochemistry. CLINICAL RELEVANCE: AML is a rare, aggressive hematopoietic disorder in domestic cats, although it has not yet been reported in nondomestic cats. This is the first description of the clinicopathological, histological, and immunohistochemical features of AML with neutrophilic differentiation in an FeLV-negative African lion that lacked circulating blasts.

Facial nerve monitoring in parotid gland surgery: Design and feasibility assessment of a potential standardized technique.

Background: Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve, it surely offers some advantages over the traditional approach. Different from thyroid surgery, where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but-most importantly-the function of the recurrent laryngeal nerve, in parotid gland surgery, a formal guideline to follow while dissecting the facial nerve has yet to be described. Methods: A five-year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring. The operative findings regarding the neuromonitoring process, particularly in regard to the amplitude of two main branches, were revised. A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered. Results: Fifty-five patients were operated on using the Nim 3 Nerve Monitoring System (Medtronic); 31 were female patients, and 47 patients had benign lesions. Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation. There were only three articles discussing the term loss of signal during parotid gland surgery. Conclusion: Today, no sufficient attention has been given to the facial nerve monitoring process during parotidectomy. This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.

Sex-related head size and shape dimorphism in Mapaná snakes (Bothrops asper) kept in captivity / Dimorfismo sexual en la forma y tamaño de la cabeza de serpientes Mapaná (Bothrops asper) mantenidas en cautiverio / Dimorfismo sexual no tamanho e na forma da cabeça de serpente de Mapana (Bothrops asper) mantidos sob condições de cativeiro

Background: sexual size dimorphism in snakes is generally well documented, however, sexual shape dimorphism has been poorly studied. As snakes are considered gape-limited predators, identifying patterns of sexual size and head shape dimorphism can help elucidate the life history of these organisms. Objective: to detect differences between sexes regarding head size and shape dimorphism of Mapaná snakes (Bothrops asper) maintained in captivity under the same diet in order to determine if it has a plastic or genetic origin. Methods: geometric morphometrics were used to quantify the head size and shape of male and female Mapaná snakes. Results: our results suggest that head shape is sexually dimorphic, being relatively wider in females compared to males. In both sexes head shape also varied with snout-vent length (SVL), growing wider as body size increases. Head size was also sexually dimorphic, with female head being larger than that of males of the same body length. Head size also increased with SVL. However, female head size increased disproportionally faster when compared to males. Conclusions: evidence of sexual differences in head size and shape of Mapaná snakes raised under the same diet was found. These findings suggest that sexual head size and shape dimorphism is not a plastic response given that both sexes were maintained under similar conditions,which suggests a strong genetic basis. Sexual shape dimorphism is also being mediated by stronger phenotypic changes of females while males seem to have a more constrained phenotypic head development.

Antecedentes: el dimorfismo sexual en el tamaño de las serpientes está bien documentado, sin embargo el dimorfismo sexual en la forma ha sido pobremente estudiado. Dado que la dieta de las serpientes está limitada por el ancho de su hocico, identificar patrones de dimorfismo sexual en la forma y tamaño de la cabeza es útil para comprender mejor su historia de vida. Objetivo: detectar evidencias de dimorfismo sexual en el tamaño y forma de la cabeza de serpientes Mapaná (Bothrops asper) mantenidas bajo la misma dieta para determinar si su origen es genético o plástico. Métodos: se utilizó morfometría geométrica para cuantificar el tamaño y la forma de la cabeza de machos y hembras. Resultados: los resultados sugieren que la forma de la cabeza es sexualmente dimórfica, siendo más ancha en las hembras. En ambos sexos, la forma de la cabeza varió positivamente con la longitud hocico-cola (SVL). El tamaño de la cabeza también fue sexualmente dimórfico, siendo más grande en las hembras que en machos de la misma talla. El tamaño de la cabeza también aumentó con la SVL; sin embargo, este aumento fue desproporcionalmente más rápido en las hembras. Conclusiones: se encontraron evidencias de dimorfismo sexual en el tamaño y la forma de la cabeza de serpientes Mapaná alimentadas con la misma dieta. Los hallazgos sugieren que este dimorfismo sexual es de origen genético y no es una respuesta plástica, debido a que ambos sexos fueron mantenidos bajo condiciones homogéneas.Este dimorfismo es además mediado por un ambio fenotípico más fuerte en las hembras, mientras que los machos parecen tener un desarrollo fenotípico más canalizado.

Antecedentes: o dimorfismo sexual no tamanho das serpentes está bem documentado, no entanto o dimorfismo sexual na forma tem sido pobremente estudado. Dado que a dieta das serpentes é limitada pela largura de seu focinho, identificar padrões de dimorfismo sexual no tamanho e forma da cabeça é útil para compreender melhor a sua história de vida. Objetivo: investigar as evidências de dimorfismo sexual no tamanho e forma da cabeça da serpente Jararaca (Bothrops asper), mantidas em condições homogêneas para ambos os sexos com o intuito de esclarecer se a origem deste dimorfismo é plástica ou genética. Métodos: neste estudo utilizamos morfometria geométrica para quantificar o tamanho e o formato da cabeça de machos e fêmeas. Resultados: nossos resultados sugerem que a forma da cabeça é sexualmente dimórfica, sendo mais larga nas fêmeas. Este formato teve uma variação positiva com o comprimento rostro-cauda, este efeito foi observado em ambos os sexos. O tamanho da cabeça também é sexualmente dimórfico, sendo maior nas fêmeas do que nos machos do mesmo tamanho. O tamanho da cabeça também aumentou com o tamanho, no entanto, esse aumento foi desproporcionalmente mais rápido nas fêmeas. Conclusões: neste estudo foram encontradas evidências de dimorfismo sexual no tamanho e na forma da cabeça das serpentes Jararaca alimentadas com a mesma dieta. Sugerimos que este dimorfismo sexual é de origem genética, e não é uma resposta plástica, e é mediado por uma mudança fenotípica mais forte nas fêmeas, enquanto os machos parecem ter um desenvolvimento fenotípico mais canalizado.

Osteomyelitis and periosteal reaction in a red brocket deer (Mazama americana) / Osteomielitis y reacción perióstica en un venado soche (Mazama americana) / Osteomelite e reação periosteal em um veado (Mazama americana)

Anamnesis and treatment approach: a female red brocket deer (Mazama americana, Erxleben 1777) presented a post-traumatic abscess in the left-carpometacarpal joint. The deer was treated with enrofloxacin (5 mg/kg) and ivermectin (0.2 mg/kg) with no response. The animal underwent two surgical procedures to remove purulent material and perform adequate antisepsis as well as several antimicrobial therapies, with satisfactory results in a period of 68 days. Clinical and laboratory findings: according to the radiological and laboratory tests the animal developed a metacarpal bone osteomyelitis with periosteal reaction due to a beta-hemolytic Streptococcus abscess. Conclusion: to our knowledge, this is the first report of medical procedures in this species. The most relevant findings and treatment schedule are discussed.

Anamnesis y aproximación terapéutica: una hembra de venado soche (Mazama americana), que presentó un absceso postraumático en la articulación carpo-metacarpiana del miembro anterior izquierdo fue tratada con enrofloxacina (5 mg/kg) e ivermectina (0,2 mg/kg), sin responder al tratamiento. Se sometió a dos procedimientos quirúrgicos con el fin de extraer el material purulento y realizar una antisepsia adecuada, además de varias terapias antibióticas, con resultados satisfactorios en un término de 68 días. Hallazgos clínicos y de laboratorio: de acuerdo a los resultados radiológicos y de laboratorio el animal desarrolló osteomielitis con reacción perióstica metacarpiana, debido a un absceso por Streptococcus beta-hemolítico. Conclusión: este es el primer reporte sobre procedimientos médicos en esta especie, se discuten los hallazgos clínicos y el esquema de tratamiento más relevante.

História e tratamento: uma fêmea de veado (Mazama americana) apresentou um abscesso póstraumático na articulação do carpo-metacarpo do membro esquerdo. Foi tratada com enrofloxacino (5 mg/kg) e ivermectina (0,2 mg/kg), sem responder ao tratamento. Logo foi submetida a dois procedimentos cirúrgicos para remover o pus e fazer limpeza com antisséptico apropriado, além de várias terapias antibióticas, com resultados satisfatórios em um período de 68 dias. Resultados clínicos e laboratoriais: de acordo com os resultados dos exames radiológicos e de laboratório, o animal desenvolveu osteomielite no metacarpo com reação periosteal devido a um abscesso por Streptococcus beta-hemolítico. Conclusão: este é o primeiro relatório sobre procedimentos médicos nesta espécie, discutimos os achados clínicos e o sistema de tratamento adequado.

Failure of right ventricular adaptation in children with tetralogy of Fallot.

BACKGROUND: The left ventricle (LV) adapts to chronic hypoxia by expressing protective angiogenic, metabolic, and antioxidant genes to improve O2 delivery and energy production, and to minimize reoxygenation injury. The ability of the right ventricle (RV) to adapt to hypoxia in children with tetralogy of Fallot (TOF) is unknown. METHODS AND RESULTS: Gene expression using real-time polymerase chain reaction was measured in RV myocardium obtained during surgical repair of TOF from 23 patients: 13 cyanotic and 10 acyanotic. Results were compared between the 2 groups and correlated with age at surgery, severity of cyanosis, and early postoperative course. The cyanotic patients were younger at surgery compared with acyanotic (5+/-3 versus 9+/-4 months; P=0.01), had higher hematocrit (43+/-4 versus 38+/-3 grams/dL; P=0.004), and lower O2 saturations (84+/-4% versus 98+/-2%; (P<0.001). Cyanotic patients had a significantly lower expression of vascular endothelial growth factor (VEGF), glycolytic enzymes, and glutathione peroxidase (GPX) (P<0.05), and a higher expression of collagen (P<0.01) compared with acyanotic patients. Gene expression correlated inversely with severity of cyanosis ie, preoperative hematocrit (P<0.01) and positively with preoperative saturation (P<0.05). The relationship between gene expression and cyanosis was independent of age at surgery. Ca2+ handling genes did not correlate with the severity of hypoxia. Lower angiogenic, glycolytic, and antioxidant gene expression correlated with increasing postoperative lactate (P<0.05). CONCLUSIONS: The RV fails to up regulate adaptive pathways in response to increasing hypoxia in children with TOF. The implications of an early maladaptive response of the RV on long-term RV function require further investigation.