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.

Multi-resistant diarrheagenic Escherichia coli identified by FTIR and machine learning: a feasible strategy to improve the group classification.

The identification of multidrug-resistant strains from E. coli species responsible for diarrhea in calves still faces many laboratory limitations and is necessary for adequately monitoring the microorganism spread and control. Then, there is a need to develop a screening tool for bacterial strain identification in microbiology laboratories, which must show easy implementation, fast response, and accurate results. The use of FTIR spectroscopy to identify microorganisms has been successfully demonstrated in the literature, including many bacterial strains; here, we explored the FTIR potential for multi-resistant E. coli identification. First, we applied principal component analysis to observe the group formation tendency; the first results showed no clustering tendency with a messy sample score distribution; then, we improved these results by adequately selecting the main principal components which most contribute to group separation. Finally, using machine learning algorithms, a predicting model showed 75% overall accuracy, demonstrating the method's viability as a screaming test for microorganism identification.

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.

Outbreaks of Brachiaria ruziziensis and Brachiaria brizantha intoxications in Brazilian experienced cattle.

Brachiaria species are some of the most used forage species for raising Brazilian cattle because of their great nutritional value and adaptability to the tropical climate. However, cases of animal intoxication have been described. Animal species, age, genetic resistance, and previous adaptation to the forage can influence the susceptibility to intoxication. Cattle (young or adults), other adult ruminants and animals adapted to consumption (experienced flocks) are considered more resistant. The main clinical presentation is that of hepatogenous photosensitization. Brachiaria brizantha and Brachiaria ruziziensis are considered less toxic. The aim of this study is to describe three outbreaks of intoxication by B. brizantha and B. ruziziensis in experienced cattle, as well as to compare the concentrations of protodioscin in paddocks with and without clinical cases. It was observed that the two forage species are toxic to all age groups of cattle adapted to their consumption, and the concentrations of protodioscin present in the plant cannot be used as the only criterion for determining the occurrence of intoxication.

Molecular and phenotypic characterization of Escherichia coli from calves in an important meat-producing region in Brazil.

INTRODUCTION: Escherichia coli strains that lead to enteritis are considered an important cause of diarrhea in calves. For correct identification, these microorganisms must be differentiated from non-pathogenic members of the intestinal microbiota. The aim of the present work was to characterize E. coli isolates in calves regarding the presence of virulence genes that cause enteritis and evaluate the sensitivity of the isolates to different antimicrobials. METHODOLOGY: One hundred forty-nine samples from beef cattle and 27 samples from dairy cattle were evaluated. All samples were submitted to microbiological identification and the disk diffusion antibiogram test. The polymerase chain reaction method was used to detect virulence genes. RESULTS: A hundred seventy-six samples were biochemically identified as E. coli and antibiograms were determined. The samples were then submitted to PCR; 35 were positive for the eae gene (19.88%), 135 (76.70%) for the stx1 gene, 62 (35.22%) for the stx2 gene, 159 (90.34%) for the sta gene and 35 (19.88%) for the ltII gene. No samples were positive for the cnf gene. Based on these results, the E. coli isolates were classified into pathotypes: enteropathogenic (n = 3), enterohemorrhagic (n = 32), Shiga toxin-producing (n = 122) and enterotoxigenic (n = 163). The antimicrobial sensitivity tests revealed that 77.2% of the isolates were resistant to three or more pharmacological groups, characterizing these isolates as multidrug resistant. CONCLUSIONS: Enterotoxigenic E. coli was the predominant pathotype. Moreover, the prevalence of multidrug-resistant isolates was very high, accounting for the vast majority of isolates.

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.

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.

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.

Antimicrobial Potential of Essential Oils from Cerrado Plants against Multidrug-Resistant Foodborne Microorganisms.

Foodborne pathogens are a real public health concern in an escalating antimicrobial resistance scenario. Natural products represent a promising source of bioactive molecules, and essential oils have attracted much attention due to their myriad of biological properties, including antibacterial activities. In this context, essential oils obtained from the leaves of Chromolaena squalida, Campomanesia sessiliflora, Myrsine guianensis, Matayba guianensis, Siparuna guianensis, Ocotea minarum and Endlicheria paniculata-species from the Cerrado biome of Midwest Brazil-were extracted and evaluated for their antibacterial activity against a panel of four standard and three clinical multidrug-resistant bacterial strains. All tested oils showed moderate to good activity against at least four bacterial strains, including Salmonella Typhi and oxacillin-resistant Staphylococcus. The essential oils from C. squalida, C. sessiliflora, My. guianensis and Ma. guianensis showed strong inhibition of clinical Staphylococcus strains, which cause bovine mastitis and are related to milk-borne diseases. Their chemical profiles were investigated by gas chromatography coupled to mass spectrometry (GC/MS), which revealed a predominance of mono- and sesquiterpene hydrocarbons, some of which with well-known antimicrobial properties. The essential oil from Cerrado plants proved active against resistant Gram-positive and Gram-negative bacteria, revealing their potentialities for the development of new alternative agents to prevent the spreading of resistant bacterial contamination.

Phytase and xylanase in diets with nutritional adjustments and their effects on serum biochemistry, morphometry and intestinal health of broilers.

To examine the association between phytase and xylanase in diets with nutritional adjustments on intestinal morphometry, serum biochemistry and microbiology of broilers, 250 broilers were evaluated in a completely randomized design with five treatments and five replicates. The following treatments were tested: positive control diet - without phytase or xylanase; negative control diet - with an energy reduction of 100 kcal/kg, without phytase or xylanase; and three diets containing xylanase and phytase and energy reductions of 50, 100 and 150 Kcal/kg. For all energy-reduced diets, the nutritional matrix of phytase with phosphorus (0.15%), calcium (0.165%) and sodium (0.035%) was considered. An effect of the association between enzyme inclusion and metabolizable energy reduction in the diets was observed only by contrast analysis, for villus height. Intestinal health was not changed. Only the serum phosphorus concentration was altered by the treatments at the different evaluated ages. The association of phytase (500 FTU/kg) with xylanase (16000 BXU/kg) in diets with reductions of up to 150 Kcal/kg metabolizable energy, 0.15% digestible P, 0.165% Ca and 0.035% Na does not alter the intestinal morphometry, serum biochemistry or microbiology of broilers.

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.

Outbreak investigation of septicemic salmonellosis in calves.

INTRODUCTION: An early and accurate diagnosis of septicemic salmonellosis is critical for implementing timely and proper treatment, prevention, and control measures. METHODOLOGY: Here, we report a study on three outbreaks of septicemic salmonellosis in calves from Midwestern Brazil. RESULTS: the morbidity, mortality and lethality rates were of 10.55%, 2.79%, and 26.4%, respectively. Higher susceptibility was detected in Bos taurus than in Bos indicus cattle. Clinical manifestations consisted of apathy, hyperthermia, difficulty breathing and panting, and pallor of the mucous membranes. Chronic cases had necrosis of the tail tip and ears. Gross findings included enlarged liver, non-collapsed edematous lungs and diphtheritic enteritis. Significant histopathological changes included paratyphoid nodules in the liver and acute interstitial pneumonia. Salmonella enterica subsp. enterica serotype Dublin was detected by culture and by PCR from the blood of live calves, and from the spleen, liver, bile, mesenteric lymph node and lung samples of necropsied calves. CONCLUSIONS: We suggest that in clinical cases of septicemic salmonellosis, blood samples are better than fecal samples for detection of the agent, being a sound test to identify animal carriers in the herd.

SALMONELLA SPP. INFECTION IN PSITTACIDAE AT A WILDLIFE REHABILITATION CENTER IN THE STATE OF MATO GROSSO DO SUL, BRAZIL.

The growing interest in wild birds as pets and the increasingly complex interspecific relationships due to human activities in wild environments underscore the need for better knowledge about the health of these animals. Salmonella stands out among the infectious agents of considerable importance to both animal and human health. The importance of these enterobacteria to the health of humans and livestock animals has long been known. In wild birds in countries such as Brazil, however, little is known regarding the frequency of infection and the main serotypes of occurrence. In the present study, the frequency of infection and the main serotypes of Salmonella spp. were investigated in 258 birds at a wild animal rehabilitation center using conventional microbiological methods and molecular diagnostic techniques. Four birds infected with Salmonella enterica were identified using PCR. The birds were of the species Brotogeris chiriri, Ara ararauna, and Eupsittula aurea. Sequencing of DNA revealed identity with the Javiana, Newport, and Arizonae serotypes. These results are of considerable importance to the implementation of management and control measures directed at human and animal health.

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

La erradicación del virus de la hepatitis C (VHC) con esquemas libres de interferón (AAD) ha modificado la evolución de la enfermedad ya que más del 95% de los pacientes con cirrosis compensada logran la respuesta virológica sostenida. Sin embargo, el impacto de la erradicación del VHC sobre el desarrollo del carcinoma hepatocelular (CHC) es controvertido. Dicha controversia podría dividirse en diversos aspectos fundamentales: el impacto del AAD en la tasa de recurrencia del CHC, la asociación temporal entre el inicio de AAD y el desarrollo de la recurrencia del CHC y finalmente la agresividad de los CHC. Es por ello que esta revisión tiene por objetivo analizar los resultados disponibles en esta población de pacientes desde una perspectiva clínica donde se valoran los riesgos/beneficios de erradicar el VHC con AAD en el contexto de pacientes con CHC en respuesta completa

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

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)