A rare case of primary hepatic poorly differentiated leiomyosarcoma in a goat.

A 12-year-old Saanen goat presented with a history of hyporexia and sudden recumbency. Euthanasia was indicated due to suspicion of hepatic neoplasia associated with senility. Necropsy revealed generalized oedema and increased liver size and weight (33 × 38 × 17 cm and 10.6 kg, respectively), with a firm, multilobular mass. Fusiform to polygonal neoplastic cells, with marked pleomorphism, anisocytosis and anisokaryosis, were seen on histopathological examination of the hepatic mass. The neoplastic cells were immunohistochemically positive for alpha-smooth muscle actin and vimentin but immunonegative for pancytokeratin. The Ki-67 index was 18.8%. A poorly differentiated leiomyosarcoma was diagnosed on the basis of the gross, histopathological and immunohistochemical findings and should be included in the differential diagnosis of liver disease in goats.

Augmentation mammoplasty and autologous fat transplantation: an alternative for the treatment of hypomastia and mild pectus excavatum - Case report / Mamoplastia de aumento e transplante de gordura autóloga: uma alternativa para o tratamento da hipomastia e pectus excavatum leve - Relato de caso

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Pectus excavatum (PE) é uma deformidade torácica congênita, caracterizada como uma depressão profunda no esterno. O transplante autólogo de gordura tem sido utilizado para fins estéticos, principalmente na face, e recentemente ganhou relevância nas cirurgias torácica e das mamas. O objetivo do presente estudo é apresentar um caso de PE leve associado a hipomastia. Uma paciente de 24 anos compareceu à consulta para mamoplastia de aumento por hipomastia, mas o exame clínico também revelou um PE leve associado que não foi percebido pela paciente. O planejamento cirúrgico incluiu a mamoplastia de aumento e a transferência de gordura autóloga. Foi utilizado um implante mamário de silicone de 260ml, e uma quantidade total de 250ml de gordura foi injetada na região esternal e no contorno medial inferior das mamas. Não houve complicações durante o período de acompanhamento de 12 meses. A associação de mamoplastia de aumento e transplante de gordura no tratamento da deformidade de PE revelou-se uma opção minimamente invasiva, boa, segura e com alta satisfação da paciente.

Seguimiento de dilatación del tracto urinario neonatal diagnosticada en la evaluación de infección del tracto urinario / Follow-up of Neonatal Urinary Tract Dilatation Diagnosed in the Evaluation of Urinary Tract Infection

Objetivo: Mostrar las características y seguimiento de la dilatación del tracto urinario en recién nacidos con infección del tracto urinario. Métodos: Estudio observacional, descriptivo, realizado desde 1992 hasta 2019, en neonatos ingresados con infección del tracto urinario. A todos se les realizó ultrasonido renal y uretrocistografía miccional. Se analizaron las características clínicas y de radioimagen de presentación en el seguimiento de la dilatación del tracto urinario. Resultados: Se estudiaron 403 pacientes. La mediana de seguimiento fue de 13 meses. El ultrasonido renal resultó positivo para dilatación del tracto urinario en 148 (36,7 por ciento). Predominaron los grados de dilatación ligera (5-10 mm.) sobre grados moderados y severos. En 38 casos (9,4 por ciento) la dilatación del tracto urinario se asoció a reflujo vésico-ureteral. La condición más común fue la dilatación transitoria con una mediana de desaparición de la dilatación 5 meses. Hubo asociación estadística significativa de la desaparición de la dilatación del tracto urinario con el grado de esta y entre aquellos casos calificados de transitoria con los otros portadores de alguna anomalía del tracto urinario que también tuvieron desaparición de la dilatación en algún momento de su evolución. Conclusiones: Cerca de una tercera parte de los neonatos con infección del tracto urinario tuvieron dilatación del tracto urinario en ultrasonido renal, con predominio de grado ligero, como probable expresión de una anomalía del tracto urinario subyacente. Con frecuencia ocurre resolución de la dilatación del tracto urinario en aquellos casos no asociados con anomalía del tracto urinario, habitualmente dentro del primer año de vida(AU)

OBjective: To show the characteristics and follow-up of urinary tract dilatation in neonates with urinary tract infection. Methods: Observational, descriptive study performed from 1992 to 2019, in neonates admitted with urinary tract infection. All underwent renal ultrasound and voiding urethrocystography. The clinical and radioimaging features of presentation were analyzed in the follow-up of urinary tract dilatation, Results: 403 patients were studied. The median follow-up was 13 months. Renal ultrasound was positive for urinary tract dilatation in 148 (36.7 percent). Mild degrees of dilatation (5-10 mm) predominated over moderate and severe degrees. In 38 cases (9.4 percent) urinary tract dilatation was associated with vesico-ureteral reflux. The most common condition was transient dilatation with a median disappearance of dilatation 5 months. There was significant statistical association of the disappearance of urinary tract dilatation with the degree of dilatation and between those cases qualified as transient with the other carriers of some urinary tract anomaly who also had disappearance of dilatation at some point in their evolution. Conclusions: About one third of neonates with urinary tract infection had dilatation of the urinary tract on renal ultrasound, predominantly of mild degree, probably expression of an underlying anomaly. Resolution of dilatation frequently occurs in those cases not associated with urinary tract anomaly, usually within the first year of life(AU)

Intramedullary Metastatic Endometrial Adenocarcinoma in a Goat.

A 7-year-old female goat developed progressive ataxia, which progressed to sternal recumbency. Clinical examination revealed a slight elevation in the sacral spine (S1-S2), tetraparesis, perineal hypoaesthesia and absent tail and anal reflexes. Due to unresponsiveness to treatment with corticosteroids, the goat was euthanized. At necropsy, a 4.0 × 5.7 × 2.5 cm tumour mass was found in the uterine body and right uterine horn. In the cauda equina (L6‒S2), a 3 cm tumour associated with a 2 cm ventral intraosseous sacral haematoma was also found. The tumours were characterized by neoplastic proliferation of columnar epithelial cells with a predominant tubular pattern. Neoplastic cells with glandular cytoplasm stained with acid Alcian blue and periodic acid‒Schiff. Other metastases were found in the lungs, right ovary, dura mater and nerve roots of the medullary cone. Neoplastic cells were immunolabelled for cytokeratin but were negative for vimentin, and the tumour was diagnosed as metastatic endometrial tubular adenocarcinoma. To our knowledge, this is the first report of intramedullary metastasis to the spinal cord of this tumour in any species except humans.

Hydrolytic enzyme production from açai palm (Euterpe precatoria) endophytic fungi and characterization of the amylolytic and cellulolytic extracts.

Enzymes are biocatalysts that are widely used in different industries and generate billions of dollars annually. With the advancement of biotechnology, new enzymatic sources are being evaluated, especially microbial ones, in order to find efficient producers. Endophytic fungi are promising sources of biomolecules; however, Amazonian species are still poorly studied as to their enzymatic production potential. In this sense, the production of hydrolases (amylases, lipases, cellulases and pectinases) was evaluated in endophytic fungi isolated from the leaves, roots and stems of açai palms (Euterpe precatoria). A qualitative test was carried out to detect the enzymatic synthesis in each isolate, and the most promising ones were cultivated using submerged fermentation. The enzyme extracts were quantified to determine those with the greatest activity. Cellulolytic and amylolytic extracts showed the highest enzymatic activities and were partially characterized. Among 50 isolates, 82.9% produced pectinase, 58.5% produced cellulase, 31.7% produced amylase, and 12.2% produced lipase. Penicillium sp. L3 was the best producer of amylase and Colletotrichum sp. S1 was the best producer of cellulase in liquid medium cultivation. The amylolytic extract showed the highest enzymatic activity at pH 8.0 and 45 °C, and the cellulolytic extract at pH 5.0 and 35 °C. The cellulase and amylase produced by the endophytes had their molecular masses estimated between 38 and 76 kDa. These results indicate that endophytic fungi from the açai palm can be used as a new source of hydrolytic enzymes, which can be applied in numerous biotechnological processes.

Degradation of Staphylococcus aureus Biofilm Using Hydrolytic Enzymes Produced by Amazonian Endophytic Fungi.

Microbial biofilms can cause serious health problems, since, due to their persistent character, they often function as spreaders of contaminants. Hydrolytic enzymes have a number of industrial applications and have been indicated as an alternative to the traditional chemical methods that are used to eradicate microbial biofilms. In this study, we evaluated the ability of enzymatic extracts produced by endophytic fungi isolated from the Amazonian species Myrcia guianensis to remove Staphylococcus aureus biofilms. After culture in liquid medium, the fungal hydrolytic extracts showed amylase (3.77 U/mL), lipase (3.84 U/mL), protease (3.63 U/mL), and xylanase (2.91 U/mL) activity. A 24 h mature S. aureus ATCC6538 biofilm was exposed to each enzyme extract with standardized enzyme activities for 10, 30, and 60 min. The optical density at 630 nm was used to calculate the growth rate (GR%) and the residual biofilm rate (RBR%). The most promising solutions were used in combination, based on a 24 factorial design for 0, 10, 20, and 30 min of exposure. Lipase and protease solutions, when applied separately, were the most effective, and promoted the complete removal of S. aureus biofilms in t10 (lipase) and t30 and t60 (lipase and protease). Of the combined treatments using 1.0 U/mL protease and 0.4 U/mL lipase, total biofilm degradation was observed for all exposure times. Thus, the hydrolases produced by the Amazonian endophytic fungi evaluated here are highlighted as an interesting tool in the fight against microbial biofilms.

Immunohistochemical expression of HER - 2 and Ki - 67 in granulosa cell tumor in bitches.

Granulosa cell tumour, an ovarian neoplasm of stromal origin, is an important tumour related to oestrogenic dominance syndrome and cystic endometrial hyperplasia-pyometra complex. In order to analyse ovarian tumour´s malignant potential, immunohistochemical markers can be used, such as anti-HER2 and anti-Ki-67. The aim of this study was to evaluate the expression of immunohistochemical markers HER-2 and Ki-67 in granulosa cell tumour from bitches´ ovaries. In HER-2 immunomarker analysis using the HercepTest® method, most tumours were classified as 2+ (moderate labelling). Concerning Ki-67 immunomarker, only one case was described as having a high proliferative index. An association was found between immunostained cell percentage by anti-HER-2 antibodies and high pleomorphism, represented by the pattern of follicular/trabecular tumour arrangement. There was no correlation between anti-Ki-67 and anti-HER-2 antibody immunostaining intensities, probably due to only one case with a high Ki-67 index. With an effective protocol for HER-2 and Ki-67 immunohistochemical identification in granulosa cell tumours in bitches, it was possible to characterize this neoplasm proliferation profile.

Leucocituria significativa como indicador de probable infección del tracto urinario sin cultivo positivo / Significant leukocyturia as an indicator of probable urinary tract infection without positive culture

Introducción: La presencia de leucocituria nos orienta hacia la probabilidad de infección del tracto urinario en niños. Objetivo: Determinar si la leucocituria significativa es un marcador de infección urinaria aun sin cultivo de orina positivo. Métodos: Estudio descriptivo y retrospectivo en pacientes egresados de los Servicios de Neonatología y Nefrología del Hospital Pediátrico Universitario Juan Manuel Márquez, entre enero 2018-diciembre 2019, que incluyó 124 niños de 2 años de edad; un grupo con infección del tracto urinario confirmada (clínica, leucocituria mayor 10 000 leucocitos/ml y con urocultivos positivos) y otro sospechada (clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin cultivo de orina positivo). Se compararon variables clínicas, de laboratorio y de radioimagen. Resultados: En 78,6 por ciento de los niños se aisló Escherichia coli. La fiebre fue un hallazgo clínico frecuente. El reactante de fase aguda con mayor variación fue la velocidad de sedimentación globular (71,0 por ciento), presentaron alteraciones del ultrasonido (79,8 por ciento) y uretrocistografía miccional (50,0 por ciento). No hubo diferencias estadísticamente significativas al comparar las variables clínicas, de laboratorio y de radioimagen entre el grupo de pacientes con infección del tracto urinario confirmada por urocultivo positivo y el grupo sospechado por la clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin urocultivo positivo. Conclusiones: En los niños con manifestaciones clínicas de infección, con presencia de una leucocituria significativa (más 100 000 leucocitos/ml), aunque no cuenten con un resultado positivo del urocultivo, se les debe proporcionar la atención médica establecida para un paciente con infección del tracto urinario(AU)

Introduction: The presence of leukocyturia guides towards the probability of urinary tract infection in children. Objective: Determine whether significant leukocyturia is a marker of urinary tract infection even without positive urine culture. Methods: Descriptive and retrospective study in patients discharged from the Neonatology and Nephrology Services of Juan Manuel Márquez University Pediatric Hospital, from January 2018 to December 2019, which included 124 children of 2 years of age; one group with confirmed urinary tract infection (clinical, leukocyturia of more than 10 000 leukocytes/ml and with positive urine cultures) and another group of suspected ones (clinical, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture). Clinical, laboratory and radioimaging variables were compared. Results: Escherichia coli was isolated in 78.6 percent of the children. Fever was a common clinical finding. The reactant acute phase with the greatest variation was the erythrocyte sedimentation rate (71.0 percent), there were ultrasound alterations (79.8 percent) and voiding urethrocystography (50.0 percent). There were no statistically significant differences when comparing clinical, laboratory and radioimaging variables between the group of patients with urine tract infection confirmed by positive urine culture and the group suspected by the clinic findings, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture. Conclusions: In children with clinical manifestations of infection, with the presence of significant leukocyturia (more than 100 000 leukocytes/ml), even if they do not have a positive urine culture result, they should be provided with the medical care established for a patient with urinary tract infection(AU)

Histopathological study of canine sebaceous tumors and their association with PCNA expression by immunohistochemistry / Estudo histopatológico de tumores sebáceos caninos e sua associação com a expressão de PCNA por imuno-histoquímica

Sebaceous tumors are common in dogs. These tumors include both benign and malignant lesions. Immunohistochemical evaluation of these tumors can aggregate information regarding the origin and degree of malignancy of the lesions. Focusing on this matter, sixty-one samples including normal skin and sebaceous tumors were selected from dogs of various breeds and ages, with no predilection for sex, from the archive of Veterinary Pathology Service of Federal Fluminense University, Niterói/RJ, Brazil. The samples underwent to histological processing, routine staining and immunohistochemistry with anti-PCNA (proliferating cell nuclear antigen). Descriptive statistical analysis was performed, the Wilcoxon-Mann-Whitney test was used to compare the distribution of anti-PCNA labelling in different groups of variables. In case there were more than two groups, the Analysis of Variance (ANOVA) test was performed. The mean age of the affected animals was 10.56 years. The most affected breeds were Caniches and Cocker Spaniels, as well as mixed breed animals. There was immunostaining of PCNA in both benign and malignant tumors, as well as in hyperplasic lesions with varying intensity. Most of the tumors were neoplasms which represented 67.27% of the total sample; within these, 75.00% were benign. The most frequent neoplasm was sebaceous adenoma (37.74%). Results indicated no statistical difference in the distribution of anti-PCNA labelling between the groups of sex, age, reproductive status, localization, size of tumor, and histopathological diagnosis. Although there are not many studies analyzing anti-PCNA labelling in sebaceous tumors, several of them pointed out to the predictive value in other neoplasms. With this matter in mind, we intended to evaluate the expression of anti-PCNA in canine sebaceous tumor and a possible association with the malignancy of the lesions.

Tumores sebáceos são comuns em cães. Tais tumores incluem lesões benignas e malignas. A avaliação imunohistoquímica desses tumores pode agregar informações sobre a origem e o grau de malignidade das lesões. Para este fim, sessenta e uma amostras, incluindo pele normal e tumores sebáceos foram selecionadas de cães de várias raças e idades, sem predileção por sexo, do arquivo do Serviço de Patologia Veterinária da Universidade Federal Fluminense, Niterói/RJ, Brasil. As amostras passaram por processamento histológico, coloração de rotina e imuno-histoquímica com anti-PCNA (proliferating cell nuclear antigen). Foram realizadas análises estatísticas descritivas além dos testes de Wilcoxon-Mann-Whitney para comparar a distribuição da marcação de anti-PCNA entre grupos de variáveis. Para variáveis com mais de dois grupos, aplicou-se a Análise de Variância (ANOVA). A idade média dos animais afetados foi de 10.56 anos. As raças mais afetadas foram Caniches e Cocker Spaniel, e ainda animais sem raça definida. Houve imunomarcação de PCNA em tumores benignos, malignos, e ainda em lesões hiperplásicas com intensidade variada. A maioria dos tumores eram neoplásicos representando 67.92% do total; destes, 75.00% eram benignos. O adenoma sebáceo foi a neoplasia mais frequente (37.74%). Não foram encontradas diferenças significativas nas distribuições de anti-PCNA entre os grupos das variáveis sexo, idade, status reprodutivo, localização e tamanho do tumor e diagnóstico histopatológico. Embora não haja estudos com anti-PCNA em tumores sebáceos caninos, numerosas publicações apontam seu valor preditivo em outras neoplasias. Com isso, a finalidade deste estudo foi avaliar a expressão de anti-PCNA em tumores sebáceos caninos e sua possível associação com a malignidade das lesões.

Pregnancy loss due to amnionitis in anglo-arabian mare-Case report.

The amnion is a layer of the foetal membrane that has mechanical protection function and allows expansion and growth. The diseases that affect amnion have rarely been reported in horses. Amnionitis and funiculitis have been implicated as components of abortions as observed in abortions caused by the mare reproductive loss syndrome. Here, we report an abortion at 240-day gestation of a 7-year-old Anglo-Arabian mare with a history of previous stillbirth. Blood samples from both mare and foetus were collected for serological testing. Fragments from the placenta were taken for macroscopic and histopathological examinations. The results of these tests ruled out leptospirosis and concluded that the cause of the abortion was non-infectious chronic amnionitis. Moreover, the decreased vascularization in the placenta was consistent with placental insufficiency. This case highlights the importance of monthly ultrasound monitoring in equine pregnancy in order to diagnose placental insufficiency. The study also confirmed the efficiency of the histopathological examination for the definitive diagnosis of placental inflammation and for the study of foetal vascularization to rule out placental insufficiency in equine reproduction.

Infección por el virus SARS-CoV-2 y sus consecuencias en embarazadas y recién nacidos / Infection by SARS-CoV-2 virus and its consequences in pregnant women and newborns

Introducción: La infección por el virus SARS-COV-2 que produce la enfermedad COVID-19, es considerada una zoonosis que ha generado la pandemia actual, que extiende sus efectos a la población de gestantes y recién nacidos. Objetivo: Actualizar el conocimiento disponible sobre las consecuencias de la infección por el virus SARS-CoV-2 en embarazadas y recién nacidos. Métodos: En la base de datos PubMed y en la plataforma Google Scholar se identificaron artículos publicados sobre el tema hasta el 31 de mayo de 2020, referidos a informes de serie de casos y datos de laboratorio. Resultados: Los neonatos nacidos de madres infectadas por el virus SARS-CoV-2 no poseen un cuadro clínico y de laboratorio específico. La exposición de la madre al virus en el tercer trimestre del embarazo puede ser un indicador de complicaciones graves para el futuro bebé. No se ha demostrado la transmisión vertical y existe contradicción con el uso de la lactancia materna. Consideraciones finales: La exposición intrauterina al virus SARS-CoV-2 según investigaciones no representa una amenaza grave para el desarrollo de la función de la respuesta inmune celular y humoral en recién nacido. pero sí se afirma que la infección materna, sobre todo en el tercer trimestre del embarazo, puede ser un indicador importante de complicaciones graves en el recién nacido(AU)

Introduction: The infection by SARS-CoV-2 that produces COVID-19 disease is considered a zoonoses. This has generated the current pandemic that expands its effects to the expectant mothers and newborns population. Objective: To update the available knowledge on the infection by SARS-CoV-2 virus and its consequences in pregnant women and newborns. Methods: There were identified articles in PubMed database and Google Scholar platform on the topic above mentioned and series of cases reports and laboratory data that were published until May 31st, 2020. Results: Newborns of mothers infected with SARS-CoV-2 have no specific kind of clinical or laboratory profile, and the mother´s exposure to the virus in the first quarter of pregnancy can be an important indicator of severe complications in the future baby. It has not been proven vertical transmission and there is contradiction with the use of breastfeeding. Final considerations: According to some researches, intrauterine exposure to SARS-CoV-2 virus does not represent a serious threat to the development of the cellular and humoral immune response´s function in newborns; but it does confirm that maternal infection, mainly in the first quarter of pregnancy, can be an important indicator of severe complications in the newborn(AU)

Epidemiology and Estimated Cost of Surgery for Chronic Subdural Hematoma Conducted by the Unified Health System in Brazil (2008­2016)

Introduction Chronic subdural hematoma (CSH) is one of the most frequent forms of intracranial hemorrhage. It is a collection of encapsulated, well-delimited fluid and/or coagulated blood in several clotting stages located between the dura mater and the arachnoid mater. Objective To describe the epidemiological aspects of CSH described in the database of the Brazilian Unified Health System (SUS, in the Portuguese acronym) regarding admission numbers, hospitalization expenses, health care professional expenses, mortality rate, and death numbers by region from 2008 to the first half of 2016. Methods The present work was performed between August and September 2016 with a review about the epidemiological aspects of CSH in Brazil according to the Informatics Department of the Unified Health System (DATASUS) database, encompassing the period from January 2008 to June 2016, and to scientific papers from the past 10 years which were electronically published at the PubMed, Scielo, and LILACS databases. Results From 2008 to the first half of 2016, the total values were the following: hospital admission authorizations (HAAs). 33,878; hospital expenses, BRL 65,909,429.22; health care professional expenses, BRL 25,158,683.21; deaths, 2,758; and mortality rates ranging from 6.47 to 12.63%. Conclusion In spite of the high clinical relevance of CSH, epidemiological studies about this condition are limited. As such, the present paper is an updated approach on CSH, focusing on its epidemiological aspects according to the DATASUS database.

Expression of interleukins 6 and 10 and population of inflammatory cells in the equine endometrium: diagnostic implications.

Endometritis consists of an acute or chronic inflammatory process involving the endometrium and together with endometrosis constitute the main causes of infertility in mares. The aim of this study was to associate the histopathological findings with the immunohistochemical markers interleukins 6 (IL-6) and 10 (IL-10) to evaluate the inflammatory changes and progression of uterine tissue lesions of mares in the diestrus phase and their diagnostic implications. Twelve crossbred cyclic mares were used for endometrial biopsy collection. Samples were collected in the diestrus period (6 ± 1 day after ovulation) without previous artificial insemination. In the histopathological analysis the samples were classified according to the type and intensity of inflammation, alterations regarding endometrial fibrosis and biopsy categories (I, IIA, IIB and III). In the immunohistochemical analysis, the markers of IL-6 and IL-10 were evaluated by scores (0, 2, 4, 6) according to the intensity of the immunostaining and inflammatory cells (CD-3, CD-20, CD-68 and MPO antibodies) and were counted according to the number of cells immunostained in brown, in ten random fields. An association (p ≤ 0.05) occurred between low score (2) for IL-6 in the endometrial glandular area and moderate fibrotic nets; and between high scores (4 and 6) for IL-10 in sub-epithelial connective tissue and moderate periglandular fibrosis. In conclusion, immunohistochemical analysis demonstrated an association between interleukins and inflammatory cells with endometrial lesions. In addition, this research may be useful in the future to evaluate the progress of the inflammatory process, contributing to the adequate optimization of the reproductive management of the mares.

Convivência com filhos com transtorno do espectro autista: desvelando sentidos do ser-aí-mãe / Conviviendo con niños con el trastorno del espectro autista: desvellando los sentidos del ser-ahí-madre / Living with children with autistic spectrum disorder: unveiling the meanings of the being-there-mother

Objetivo desvelar sentidos de mães na convivência com filhos acometidos pelo transtorno de espectro autista (TEA). Método pesquisa qualitativa, ancorada na fenomenologia heideggeriana, com dados coletados por meio de entrevista fenomenológica com 14 mulheres/mães, entre janeiro e março de 2016. Resultados as mães significaram que a convivência trazia aprendizado, mudanças como ser humano e busca por saber tudo a respeito de autismo; e não conseguir trabalhar, por ter de cuidar do filho, sentir-se excluída e sobrecarregada. Conclusão o alcance do movimento existencial do ser-aí-mãe na convivência com o filho acometido pelo TEA permitiu compreender as mudanças, exigências e cobranças que cabiam à mulher que, de modo inautêntico, ocupava-se com a rotina de cuidados ao filho. Preocupando-se em oferecer o melhor de si, sentia-se distante do cuidado consigo e com suas relações sociais e familiares. Do mesmo modo, pela fragilidade da rede de apoio social, tornava-se vulnerável biopsicosocioespiritualmente.

Objetivo desvelar los sentidos de las madres que conviven con niños acometidos por el trastorno del espectro autista (TEA). Método investigación cualitativa, basada en la fenomenología Heideggeriana, con datos colectados por medio de una entrevista fenomenológica con 14 mujeres/madres, de enero a marzo de 2016. Resultados madres significaron que convivencia traía aprendizaje, cambios en los modos de cuidar del niño, sentimientos de exclusión y sobrecarga. Conclusión el alcance del movimiento existencial del ser-ahí-madre en la convivencia con el hijo acometido por el TEA permitió comprender los cambios, exigencias y demandas sobre la mujer que, de manera inauténtica, se ocupaba con la rutina de cuidados a su hijo. Se preocupando en ofrecer su mejor, sentíase distante del cuidado con ella misma y de sus relaciones sociales y familiares. De la misma manera, debido a la fragilidad de su red de apoyo social, se volvía biopsicosocioespiritualmente vulnerable.

Objective to unveil the human experiences of mothers who coexist with children affected by the autism spectrum disorder (ASD). Method A qualitative research based on Heideggerian phenomenology, with data collected through a phenomenological interview among 14 women/mothers, from January to March 2016. Results the mothers expressed that the coexistence led to learning, changes as human beings, and the search to know everything about autism; as well as not being able to work due to the care the child requires, feeling excluded and overloaded. Conclusion the reach of the existential movement of the being-there-mother in the coexistence with the son affected by ASD allowed to understand changes, demands, and burdens on women who, inauthentically, were engaged in the routine of care of their children. Getting worried with the fact they should offer all they could, they felt distant from the care with themselves and from their social and family relations. Similarly, due to the fragility of their social support network, they became bio-psycho-social-spiritually vulnerable.

Iatrogenic Takotsubo Cardiomyopathy Secondary to Norepinephrine by Continuous Infusion for Shock.

Takotsubo cardiomyopathy is a condition characterized by transient left ventricular systolic and diastolic dysfunction, with a possible direct causal role of catecholamine in its pathophysiology. We present a case of a woman with shock and adrenal insufficiency in whom Takotsubo cardiomyopathy developed after treatment with norepinephrine. This case confirms the direct causal role of catecholamine in the pathophysiology of Takotsubo cardiomyopathy. An 82-year-old woman presented with asthenia, anorexia, nausea and abdominal pain. The patient had been on chronic corticosteroid therapy until 3 months before, when she underwent abdominal surgery and corticosteroids were stopped. She now presented with acute kidney injury, hyponatremia and hyperkalemia and shock. A norepinephrine continuous infusion was administered to maintain a mean arterial pressure over 65 mmHg. An echocardiogram showed severe hypokinesis in the apical segments and hyperdynamic basal segments, with an ejection fraction of 25%. Plasma cortisol level was 4.5 µg/dL (reference range 5-25). Corticosteroid therapy was begun and norepinephrine was tapered and stopped. A new echocardiogram showed normalization of cardiac wall motion and an ejection fraction of 70%. This case highlights the importance of the correction of the cause of shock, as well as the risks associated with the use of norepinephrine if hypotension is severe or if it persists despite fluid administration, as usually recommended. It also confirms the direct causal role of catecholamine in the pathophysiology of Takotsubo cardiomyopathy. To the best of our knowledge, this is the first report of stress-induced cardiomyopathy secondary to norepinephrine by continuous infusion for shock. LEARNING POINTS: Takotsubo cardiomyopathy is a condition characterized by transient left ventricular dysfunction of the apex and midventricle in the absence of attributable coronary artery disease.In patients with shock and adrenal insufficiency, who can be erroneously interpreted as septic shock, Takotsubo cardiomyopathy can develop after treatment with norepinephrine.In the management of shock, there are risks associated with recommending the use of norepinephrine if hypotension is severe or if it persists despite fluid administration, when the cause of shock is other than septic shock and is not corrected.There is a direct causal role of catecholamine in the pathophysiology of Takotsubo cardiomyopathy.

Infección del tracto urinario causada por Enterobacteriaceae y su relación con reflujo vésico-ureteral en recién nacidos / Urinary tract infection caused by Enterobacteriaceae and its relationship with vesicoureteral reflux

Resumen: Introducción: La primera infección del tracto urinario puede ser un marcador de una anomalía del tracto urinario, principalmente de reflujo vésico-ureteral. El objetivo de este trabajo fue determinar la asociación entre microorganismos de la familia Enterobacteriaceae con la presencia y grado de reflujo vésico-ureteral en pacientes neonatales quienes debutaron con infección del tracto urinario. Métodos: Se realizó un estudio retrospectivo, observacional y analítico de recién nacidos con infección del tracto urinario, quienes ingresaron en el Servicio de Neonatología del Hospital Pediátrico Universitario ''Juan Manuel Márquez'', La Habana, Cuba, desde 1992 hasta 2013, y en quienes el microorganismo causal era de la familia Enterobacteriaceae. Se realizaron estudios por imagen y se analizó la asociación entre la presencia y grado de reflujo vésico-ureteral con el microorganismo causal de la infección del tracto urinario. Resultados: Se estudiaron 450 recién nacidos. Los aislamientos bacterianos en los urocultivos correspondieron a E. coli en 316 casos (70.2%). La prevalencia de reflujo vésico-ureteral resultó del 18.2%. Se comprobó que el microorganismo causal -otras bacterias diferentes a E. coli correspondientes a la familia Enterobacteriaceae- se asoció significativamente con el riesgo (OR 2.02; p < 0.01) y el grado de reflujo vésico-ureteral (para los de más alto grado, p < 0.01). Conclusiones: E. coli es el agente causal más frecuente de la infección del tracto urinario neonatal. Sin embargo, existe una asociación entre la presencia de un microorganismo de la familia Enterobacteriaceae diferente a E. coli y el reflujo vésico-ureteral, principalmente los de mayor grado.

Abstract: Background: The first urinary tract infection can be a marker of a urinary tract anomaly, mainly vesicoureteral reflux. The aim of this work was to determine the association between isolated enterobacteria with the presence and grade of vesicoureteral reflux in neonatal patients with their first urinary tract infection. Methods: A retrospective, observational and analytic study of newborns, who were admitted to the Neonatal Department, University Pediatric Hospital ''Juan Manuel Márquez,'' in Havana, Cuba, from 1992 to 2013 was conducted. The causal microorganism of urinary tract infection was from the Enterobacteriaceae family. They were evaluated by radio imaging. The association between the presence and grade of vesicoureteral reflux with the causal microorganism of the urinary tract infection was analyzed. Results: Newborn infants with urinary tract infection (450) were studied. Bacterial isolations in the urine cultures corresponded to E. coli in 316 cases (70.2%). The prevalence of vesicoureteral reflux was 18.2%. The presence of bacteria corresponding to the Enterobacteriaceae family (other than E. coli) had significant risk association with vesicoureteral reflux (OR: 2.02; p < 0.01) and vesicoureteral reflux classification (for higher grades, p < 0.01). Conclusions: E. coli is the most frequent causal microorganism in neonatal urinary tract infection. However, an association between the isolation of a microorganism of the Enterobacteriaceae family different to E. coli with the presence of vesicoureteral reflux and mainly with higher grades of vesicoureteral reflux exists.

[Urinary tract infection caused by Enterobacteriaceae and its relationship with vesicoureteral reflux]. / Infección del tracto urinario causada por Enterobacteriaceae y su relación con reflujo vésico-ureteral en recién nacidos.

BACKGROUND: The first urinary tract infection can be a marker of a urinary tract anomaly, mainly vesicoureteral reflux. The aim of this work was to determine the association between isolated enterobacteria with the presence and grade of vesicoureteral reflux in neonatal patients with their first urinary tract infection. METHODS: A retrospective, observational and analytic study of newborns, who were admitted to the Neonatal Department, University Pediatric Hospital "Juan Manuel Márquez," in Havana, Cuba, from 1992 to 2013 was conducted. The causal microorganism of urinary tract infection was from the Enterobacteriaceae family. They were evaluated by radio imaging. The association between the presence and grade of vesicoureteral reflux with the causal microorganism of the urinary tract infection was analyzed. RESULTS: Newborn infants with urinary tract infection (450) were studied. Bacterial isolations in the urine cultures corresponded to E. coli in 316 cases (70.2%). The prevalence of vesicoureteral reflux was 18.2%. The presence of bacteria corresponding to the Enterobacteriaceae family (other than E. coli) had significant risk association with vesicoureteral reflux (OR: 2.02; p < 0.01) and vesicoureteral reflux classification (for higher grades, p < 0.01). CONCLUSIONS: E. coli is the most frequent causal microorganism in neonatal urinary tract infection. However, an association between the isolation of a microorganism of the Enterobacteriaceae family different to E. coli with the presence of vesicoureteral reflux and mainly with higher grades of vesicoureteral reflux exists.

Sialadenitis submandibular supurada aguda neonatal. Reportes de la literatura, periodo 1950-2015 / Neonatal acute suppurative submandibular sialadenitis. Literature reports from 1950-2015

Resumen: Introducción: La infección de la glándula salivar submandibular es poco común, por lo que la sialadenitis submandibular supurativa aguda neonatal no coincidente con parotiditis se considera una entidad de rara presentación. El objetivo de esta revisión fue verificar si ha habido cambios en los aspectos clínicos y microbiológicos de esta infección desde sus primeras descripciones. Métodos: Se realizó una revisión de la literatura internacional en distintas fuentes de información desde los primeros reportes y hasta abril del 2016, para tratar de recopilar todos los casos publicados con esta infección hasta la fecha actual. Resultados: El total de pacientes reportados en esta revisión fue de 39 neonatos en 30 artículos. Las publicaciones provinieron fundamentalmente de los Estados Unidos y Europa, mientras que en América Latina solo ha sido declarado un caso en Cuba. Se describen distintos aspectos clínicos de presentación y evolución de esta infección en los pacientes reportados. Conclusiones: La sialadenitis submandibular supurada aguda neonatal es una infección poco común que presenta características clínicas similares a través de los años. Como característica microbiológica, esta infección es habitualmente ocasionada por Staphylococcus aureus aunque en los últimos 16 años involucra algunos Staphylococcus aureus resistentes a meticilina. Por lo general, evoluciona de manera favorable con tratamiento temprano y apropiado.

Abstract: Background: Submandibular salivary gland infections are uncommon. For this reason, neonatal acute suppurative submandibular sialadenitis non-coincident with parotitis is considered as a rare entity. The aim of this work was to verify if there have been changes in the clinical and microbiological aspects of this infection from its first descriptions. Methods: A review of the international literature from different sources was performed from the earliest reports until April, 2016, in order to collect all the cases reported with this infection up to the present date. Results: We found 39 neonate patients reported in 30 articles for this review. Most articles came from the United States of America and Europe, whereas in Latin America there was only one case declared in Cuba. Some of the clinical aspects of the presentation and evolution of this infection in the reported patients are described. Conclusions: Neonatal acute suppurative submandibular sialadenitis is an uncommon infection that presents similar clinical features through the years. As microbiological feature, this infection is usually caused by Staphylococcus aureus, although some methicillin-resistant Staphylococcus aureus have been implicated during the last 16 years. In general, it presents a satisfactory evolution with an early and appropriate antibiotic treatment.