AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery: Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Individual writing group members are noted in the Acknowledgements section.

INTRODUCTION AND HYPOTHESIS: Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery. METHODS: A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members. RESULTS: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs. CONCLUSIONS: The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.

Presence of complete or incomplete septa in human jugular foramens / Presencia de septos completos o incompletos en forámenes yugulares humanos

SUMMARY: The objective of this study was to determine the occurrence of anatomical variants in the exocranial surface of the jugular foramen, specifically, the presence of single or double and complete or incomplete septation. A cross-sectional anatomical study was performed using 96 Brazilian dry human skulls (53 male and 43 female). One examiner determined the number (single or double) and type (i.e. complete or incomplete) of osseous septation at the outer surface of jugular foramens. Data went through statistical analysis on GraphPad Prism 6.01. Our results shown that Male individuals where more likely to present normal jugular foramens (male = 71.69%, female = 34.88%; p = 0.003). However, one incomplete septation occurred more often on the right side of female individuals (1 incomplete septation, male = 16.98%; 1 incomplete septation, female = 34.88%; p = 0.044). Similarly, one complete septation (i.e. the presence of two fully divided jugular compartments) also occurred more often on the right side of female individuals (1 complete septation, male = 9.43%; 1 complete septation, female = 25.58%; p = 0.038). Anatomical variants of the jugular foramen regarding single or double complete or incomplete septations were more likely to be found on the right side of female individuals, whose also presented a higher rate of jugular foramens with any type of septation than regular non-altered jugular foramens.

RESUMEN: El objetivo de la presente investigación fue determinar la presencia de variaciones anatómicas en la superficie exocraneal del foramen yugular, especificamente, la presencia de septos únicos o dobles, completos o incompletos. El estudio fue realizado en 96 cráneos secos (53 masculinos y 43 femeninos) de indivíduos Brasileños. Se determinaron septos óseos completos o incompletos y número de ellos. Los resultados obtenidos fueron tratados estadísticamente con el programa GraphPad Prism 6.01. Los sujetos de sexo masculino fueron más propensos a presentar forámenes yugulares normales (sexo masculino: 71,69%; sexo femenino: 34,88%, p= 0,003). Sin embargo, se observaron septos incompletos con mayor frecuencia en el lado derecho y en el sexo femenino (sexo masculino: 16,98%; sexo femenino: 34,88%, p=0,044). Adicionalmente, una septación completa (presencia de dos compartimientos yugulares, divididos completamente), se presentaron más frecuentemente en el lado derecho de indivíduos femeninos (sexo masculino: 9,43%; sexo femenino: 25,58%, p= 0,038). Las variantes anatómicas del foramen yugular, en relación a septos simples o dobles, completos o incompletos, se encontraron con mayor frecuencia en el lado derecho de las mujeres, las que presentaron un alto rango de forámenes yugulares con algún tipo de septos respecto a los forámenes yugulares regulares no alterados.

¿Es más efectivo el tratamiento combinado de electroestimulación transcutánea del nervio tibial y electroestimulación vaginal que el tratamiento en monoterapia de electroestimulación del nervio tibial para la vejiga hiperactiva? Un ensayo controlado aleatorizado / Is the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation more effective for overactive bladder treatment? A randomized controlled trial

INTRODUCCIÓN Y OBJETIVOS: La vejiga hiperactiva (VH) es un trastorno frecuente que aumenta con la edad y afecta a la calidad de vida de los pacientes. Las guías recomiendan los programas de modificación de la conducta como tratamiento de primera línea, aunque la fisioterapia también se ha utilizado con éxito, seguridad y bajo coste. La fisioterapia clínica está utilizando la electroestimulación transcutánea del nervio tibial (ETNT) y la electroestimulación vaginal (EV). Este estudio tuvo como objetivo evaluar si la combinación de EV con ETNT es más exitosa que la monoterapia con ETNT para el tratamiento de las mujeres con VH. PACIENTES Y MÉTODOS: En total, 106 mujeres mayores de 18 años diagnosticadas con VH o incontinencia urinaria mixta con síntomas típicos de VH se dividieron aleatoriamente en 2 grupos: grupo 1: ETNT (n = 52); grupo 2: ETNT + EV (n = 54). El diario miccional de 3 días, la fuerza muscular del suelo pélvico (escala de Ortiz), el cuestionario de salud de King y el cuestionario de VH se evaluaron antes y después del tratamiento. La variable principal fue la frecuencia urinaria y una reducción de ≥ 3 micciones/día se consideró como clínicamente relevante. Se usaron modelos lineales mixtos para la comparación de los 2 grupos. RESULTADOS: Inicialmente, los grupos fueron similares en edad, índice de masa corporal, número de embarazos, tiempo de aparición de VH y prevalencia de síntomas de VH. Después del tratamiento se observó una reducción en la frecuencia urinaria de 1,5 micciones en el grupo 2; a pesar de ser estadísticamente significativa, esta no fue clínicamente relevante. CONCLUSIONES: La combinación de EV con ETNT no hizo que el tratamiento para la VH fuese más efectivo que la monoterapia con ETNT

INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is a prevalent disorder that increases with age and impairs patients' quality of life. Guidelines recommend behavior modifications as the first-line treatment; however, physiotherapy has also been used with success, safety, and low cost. Transcutaneous tibial nerve electrical stimulation (TTNS) and vaginal electrical stimulation (VS) are being used in clinical physiotherapy practice. This study aimed to verify whether the addition of VS to TTNS is more beneficial than TTNS alone for women with OAB. PATIENTS AND METHODS: In all, 106 women aged >18 years diagnosed with OAB or mixed urinary incontinence with prevalent OAB symptoms were randomly divided into 2 groups: Group 1: TTNS (n = 52); Group 2: TTNS + VS (n = 54). The 3 day voiding diary, pelvic floor muscle strength (Ortiz Scale), King's Health Questionnaire, and Overactive Bladder Questionnaire were assessed before and after treatment. Urinary frequency was considered the primary outcome, and a reduction of ≥ 3 micturitions/day was considered clinically relevant. Mixed linear models were used to compare the 2 groups. RESULTS: Initially, the groups were similar in age, body mass index, number of pregnancies, time of OAB onset, and prevalence of OAB symptoms. After treatment, a reduction in urinary frequency of 1.5 micturitions was observed in Group 2, which was not clinically relevant despite being statistically significant. CONCLUSIONS: The addition of VS to TTNS for the treatment of OAB was not more effective than TTNS as a single therapy

Is the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation more effective for overactive bladder treatment? A randomized controlled trial. / ¿Es más efectivo el tratamiento combinado de electroestimulación transcutánea del nervio tibial y electroestimulación vaginal que el tratamiento en monoterapia de electroestimulación del nervio tibial para la vejiga hiperactiva? Un ensayo controlado aleatorizado.

INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is a prevalent disorder that increases with age and impairs patients' quality of life. Guidelines recommend behavior modifications as the first-line treatment; however, physiotherapy has also been used with success, safety, and low cost. Transcutaneous tibial nerve electrical stimulation (TTNS) and vaginal electrical stimulation (VS) are being used in clinical physiotherapy practice. This study aimed to verify whether the addition of VS to TTNS is more beneficial than TTNS alone for women with OAB. PATIENTS AND METHODS: In all, 106 women aged >18 years diagnosed with OAB or mixed urinary incontinence with prevalent OAB symptoms were randomly divided into 2 groups: Group 1: TTNS (n = 52); Group 2: TTNS + VS (n = 54). The 3 day voiding diary, pelvic floor muscle strength (Ortiz Scale), King's Health Questionnaire, and Overactive Bladder Questionnaire were assessed before and after treatment. Urinary frequency was considered the primary outcome, and a reduction of ≥ 3 micturitions/day was considered clinically relevant. Mixed linear models were used to compare the 2groups. RESULTS: Initially, the groups were similar in age, body mass index, number of pregnancies, time of OAB onset, and prevalence of OAB symptoms. After treatment, a reduction in urinary frequency of 1.5 micturitions was observed in Group 2, which was not clinically relevant despite being statistically significant. CONCLUSIONS: The addition of VS to TTNS for the treatment of OAB was not more effective than TTNS as a single therapy.

Gait characteristics during inadvertent obstacle contacts in young, middle-aged and older adults.

BACKGROUND: When stepping over obstacles, analyses have focused on the successful trials to understand adaptive gait. However, examination of the inadvertent trips that occasionally occur in the laboratory can provide a rich source of information regarding the gait characteristics underlying trip-related falls. RESEARCH QUESTION: What gait variables during obstacle crossing are associated with inadvertent obstacle contacts, and are these variables different across the lifespan? METHODS: Three age groups included: young adults (20-35 years, N = 20), middle-aged adults (50-64 years, N = 15), and older adults (65-79 years, N = 19). A stationary, visible obstacle (26 cm tall) was placed in the middle of a walkway. Foot trajectories and head angles were compared between contact and non-contact trials. RESULTS: Twelve participants contacted the obstacle: seven young adults (3.5% of young adult trials), two middle-aged adults (1.3%), and three older adults (1.6%). Young and middle-aged adults contacted primarily with the trail limb, while older adults contacted primarily with the lead limb. Contacts occurred for different reasons: Most young adult contact trials had appropriate foot placement, but inadequate elevation; middle-aged and older adults demonstrated inappropriate foot placement before the obstacle, leading to foot contact during the swing phase. SIGNIFICANCE: Lower contact rates in the middle-aged and older adults indicates that the cautious strategies adopted during obstacle crossing are effective. Higher contact rates in young adults may indicate trial-and-error exploratory behavior. Inappropriate foot placement in the middle-aged and older adults may indicate impaired ability to gather obstacle position information during the approach phase.

Reconstruction Of The Burnt Nose Using A Carved Flap In Four Cases.

Techniques for reconstructing nasal defects in burns are very limited because the surrounding scar tissue makes it difficult to use local flaps. The authors report their experience using the Converse scalping flap harvested from scarred skin, placed as a mass on the nasal area, then secondarily carved to shape the nose and covered by a skin graft. This is a retrospective study of 4 patients, 3 men and 1 woman, with an average age of 45 years, who were operated on between 1994 and 2013 using this technique for postburn nasal reconstruction. Patients had 45% burns on average. The flap was weaned from its donor site at the third week and the frontalis donor area grafted. Several months later, the flap was sculpted from the outside to the inside in the three dimensions, removing the scarred epidermal areas to restore the aesthetic units of the nose, which were grafted using a full thickness skin graft. The final aesthetic result of the nasal reconstruction was evaluated by the patient and the surgical team. The four nasal reconstructions were carried out to completion. Three were rated as 'very good' (75%) and one was rated as 'good' (25%). The Converse flap modification, referred to as the "carved flap", to reconstruct the burned nose is a reliable technique, possible on a scarred forehead with no additional donor site morbidity.

Les techniques de reconstruction nasale après brûlure sont limitées. En effet, la peau cicatricielle environnante rend difficile l'utilisation de lambeaux locaux. Les auteurs rapportent leur expérience avec le lambeau scalpant de Converse prélevé en peau cicatricielle, placé en bloc sur la région nasale puis secondairement sculpté pour donner sa forme au nez et greffé. Il s'agit d'une étude rétrospective sur quatre cas, 3 hommes et 1 femme, d'un âge moyen de 45 ans, opéré entre 1994 et 2013, en utilisant cette technique de reconstruction nasale après brûlure. Les patients étaient brûlés en moyenne à 45% de la surface corporelle. Le lambeau a été sevré du site donneur à trois semaines et la perte de substance au niveau du front a été greffée. Plusieurs mois plus tard, le lambeau a été sculpté de dehors en dedans dans les trois dimensions, la peau cicatricielle a été désépidermisée sur l'unité esthétique du nez qui a été greffée en peau totale. Le résultat esthétique final de cette reconstruction nasale a été évaluée à la fois par le patient et par l'équipe chirurgicale. Les quatre reconstructions nasales ont été menées à terme. Elles ont été cotées comme très bon résultat dans 75% des cas et comme bon résultat dans 25% des cas. Ce lambeau de Converse modifié, appelé « lambeau sculpté ¼, est une technique fiable pour reconstruire un nez, possible sur un front cicatriciel et sans morbidité additionnelle au site donneur.

In vitro activity of antimicrobial-impregnated catheters against biofilms formed by KPC-producing Klebsiella pneumoniae.

AIM: To evaluate the activity and effectiveness of impregnated central venous catheters (CVC) against Klebsiella pneumoniae biofilms. METHODS AND RESULTS: The antimicrobial activity and durability of impregnated-CVCs were evaluated over time and the size of zones of inhibition (ZI) was measured. Biofilm formation was observed by quantitative culture and also by scanning electron microscopy. The catheters impregnated with chlorhexidine/silver sulfadiazine (CHX/SS) reduced bacteria counts by 0·3 log and were most effective (P < 0·01) against Klebsiella pneumoniae biofilms N-acetylcysteine/levofloxacin (NAC/LEV) catheters. It was observed that the catheter impregnated with NAC/LEV had initially the largest average ZI size being statistically significant (P < 0·01). The NAC/LEV combination remained active until day 30, whereas the combination of CHX/SS was completely inactivated from day 15 on. CONCLUSIONS: The NAC/LEV combination showed greater durability on the catheters, but it was the CHX/SS combination that had the greater initial efficacy in bacterial inhibition. It was also observed that NAC/LEV-impregnated catheters do not prevent the emergence of resistant subpopulations inside the inhibition halos during antimicrobial susceptibility tests. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results highlighted that the in vitro efficacy of antimicrobial-impregnated CVCs is limited by time and that their colonization occurred earlier than expected. Our data also demonstrated that NAC/LEV remained active until day 30 of evaluation and CHX/SS combination was completely inactivated from day 15 on. Our findings suggested that implantable devices should be carefully used by medical community.

A systematic review on outcome reporting in randomised controlled trials on surgical interventions for female stress urinary incontinence: a call to develop a core outcome set.

BACKGROUND: Several meta-analyses have identified methodological limitations in female stress urinary incontinence (SUI) trials, precluding the synthesis of primary studies and high-quality evidence. OBJECTIVES: Evaluation of outcome measure selection and outcome reporting in randomised controlled trials (RCTs) on surgery for SUI. SEARCH STRATEGY: Systematic review of RCTs identified from bibliographical databases, including Medline, Cochrane, and EMBASE. SELECTION CRITERIA: Randomised controlled trials evaluating the efficacy and safety of surgical interventions for the management of female SUI. DATA COLLECTION AND ANALYSIS: Two researchers independently assessed the included studies and documented outcomes. MAIN RESULTS: Overall, 108 studies were identified that included 422 reported outcomes and 119 outcome measures. The three most common outcomes were cure rates (87 studies), quality of life (85 studies), and overactive bladder (78 studies). The median methodological quality rating was 3 (range 0-3) and the outcome reporting quality rating was 3 (range 0-5). Multinomial logistic regression analysis revealed that the methodological quality and use of validated questionnaire were significant predictors of the quality of outcome reporting (ß = 0.538, P < 0.001; ß = 0.218, P = 0.011, respectively). CONCLUSIONS: Outcome reporting in SUI trials is highly variable. Until a core outcome set is developed and implemented, we propose an interim use of three commonly reported outcomes in each domain (treatment success rate - complete cure, partial improvement, or failure of response; urodynamic evaluation outcomes - overactive bladder (OAB), voiding dysfunction, and urodynamic stress incontinence; patient-reported outcomes - quality of life, sexual dysfunction, and patient satisfaction) with the use of validated questionnaires for patient-reported outcomes and subjective success rates. Complications should be also explicitly and comprehensively reported using validated outcome measures. TWEETABLE ABSTRACT: There is significant variation in outcome reporting in SUI trials. Our systematic review findings aim to form the basis for the development of a core outcome set.

Changes in the control of obstacle crossing in middle age become evident as gait task difficulty increases.

BACKGROUND: Age-associated physiological changes result in modified gait, such as slower speed, for older adults. Identifying the onset of age-related gait changes will provide insight into the role of aging on locomotor control. It is expected that a more challenging gait task (obstacle crossing) puts more demands on physiological systems, and may reveal gait modifications in a middle-aged group that are not evident in an easier gait task (level walking). RESEARCH QUESTION: To identify the effect of advancing age on gait as a function of increasing locomotor challenge during an obstacle crossing task. METHODS: Three age groups (young, middle-aged, and older adults) stepped over an obstacle placed in a 15 m walkway. Task challenge ranged from low to high in four conditions: unobstructed gait, 3, 10, and 26 cm obstacles. Gait measures were calculated during the approach and crossing steps. RESULTS: Significant interactions were observed for gait speed (age by height by step, p < 0.01), foot placement variability (age by step, p < 0.01) and foot clearance (age by height, p = 0.05). Relative to young adults, older adults walked slower in all conditions and had higher foot clearances for the 10 and 26 cm obstacles. Middle-aged adults walked with speeds and foot clearances that were not different from young adults in the lower gait challenge conditions, and changed to values that were not different from older adults in the highest gait challenge conditions. Foot placement variability was greater for the middle-aged and older groups, but only in the last two steps before the obstacle. SIGNIFICANCE: Multiple gait changes were observed as early as middle-age, and changes in speed and foot clearance became more evident as task difficulty increased. The increased gait challenge placed more demands on the neuromuscular system, revealing age-related gait modifications that were not evident in the level walking gait task.

Biosseguridade para sistemas de produção de peixes em tanque-rede em função da colmatação agravada por Limnoperna fortunei / Biosecurity for fishfarming cage systems due to the highly clogged screen aggravated by Limnoperna fortunei

Este trabalho avaliou a colmatação por Limnoperna fortunei em diferentes materiais para confecção de telas de arame, a dinâmica da colmatação pelo molusco e a relação custo-benefício dos materiais usados em tanques-rede. Utilizaram-se amostras de telas de simples torção de malha 19mm, de cinco tipos diferentes de revestimentos, colocadas na barragem de Salto Caxias, no Rio Iguaçu, estado do Paraná, entre julho de 2012 e julho de 2014. A cada seis meses, foi verificado o ganho de peso das telas em razão da colmatação, além da contagem do número de mexilhões aderidos. Após as coletas dos dados, foi realizado o teste estatístico de Kruskal-Wallis para se avaliar o ganho de peso das telas devido à colmatação. Realizou-se também uma pesquisa com 21 empresas para se obter o preço comercializado de telas para confecção de tanques-rede e se avaliar a expectativa de durabilidade dos materiais. Verificou-se que os diferentes materiais avaliados para as telas influenciam na colmatação e aderência do mexilhão-dourado; além disso, constatou-se que a tela mais eficiente quanto ao custo/ano é a de arame galvanizado plastificado e, para baixa colmatação, a de arame Bezinal.(AU)

This research evaluated degree of clogging by Limnoperna fortunei in different materials for wire mesh fabrication, the dynamics of mollusk sealing and the cost-benefit ratio of these materials used in tank-nets. Samples of single-twist screens of 19 mm mesh were used, from five different types of coatings were placed in the Salto Caxias dam on the Iguaçu River in the Paraná state, between July 2012 and July 2014. Every six months, it was verified the weight gain of the screens due to clogging and counting of the number of mussels adhered. After the data collection was performed Kruskal-Wallis statistical test to evaluate the weight gain of the screens due to clogging. In addition, a survey was carried out with 21 companies to obtain the commercialized price of screens for the production of net tanks and to evaluate the expected durability of the materials. The different materials evaluated for the screens influenced the sealing and adhesion of the golden mussel. In addition, the most cost-per-year screen is that of plastic-coated galvanized wire and for low clogging it is the Bezinal wire.(AU)

A phase 2a randomized controlled study to evaluate the pharmacokinetic, safety, tolerability and clinical effect of topically applied Umeclidinium in subjects with primary axillary hyperhidrosis.

BACKGROUND: Hyperhidrosis is a common medical condition which can have a significant impact on quality of life. Umeclidinium (UMEC) is a long-acting muscarinic antagonist (LAMA) developed as a dermal formulation. OBJECTIVES: This 2-week, double-blind, randomized, vehicle-controlled study evaluated systemic exposure, safety and tolerability of topically administered UMEC in subjects with primary axillary hyperhidrosis. Clinical effect was a secondary objective, measured by gravimetry and the hyperhidrosis disease severity scale (HDSS). Vehicle was included to evaluate safety. METHODS: Twenty-three subjects were randomized to either 1.85% UMEC (N = 18) or vehicle (N = 5) once daily. RESULTS: Measurable plasma concentrations were observed in 78% of subjects after the treatment. Nine subjects (50%) on UMEC and two subjects (40%) on vehicle reported AEs, most commonly application site reactions. At Day 15, seven subjects (41%) in UMEC and two subjects (40%) in vehicle had at least a 50% reduction in sweat production. Eight subjects (47%) in UMEC and one subject (20%) in vehicle had at least a two-point reduction in HDSS. No comparisons of treatment arms were planned prospectively. CONCLUSIONS: The measurable exposure, acceptable safety and preliminary clinical activity observed in this proof-of-concept study suggest the potential clinical utility of topical UMEC in subjects with axillary hyperhidrosis.

Burns caused by electronic vaping devices (e-cigarettes): A new classification proposal based on mechanisms.

Introduction With more than 10 million of daily users, e-cigarettes encountered a great success. But in the past few years, the number of medical reports of injuries caused by the explosion of e-cigarettes has significantly increased. This article aims at reporting our series and reviewing the literature to propose a new classification based on the mechanisms of injuries related to e-cigarettes that can guide non-specialists and specialists in the management of these patients. Method We performed a retrospective review of our institutional burn database from June 2016 to July 2017 for injuries caused by or in the context of using an e-cigarette. The patients' demographics (age, gender), burn injury mechanisms, depth, localization, surface and interventions were described. Results Ten patients suffered from burns related to the use of e-cigarettes. The burns were located at the thigh (80%) and the hand (50%) with a mean surface of 3% of TBSA. Four different mechanisms could be described: Type A: thermal burns with flames due to the phenomenon of "thermal runaway", Type B: blasts lesions secondary to the explosion, Type C: chemical alkali burns caused by spreading of the electrolyte solution and Type D: thermal burns without flames due to overheating. These different mechanisms suggest specific surgical and non-surgical management. Conclusion Management of injuries sustained from e-cigarettes' explosions should be approached from the standpoint of mechanisms. Different mechanisms could be associated and should be considered in specific management.

Avaliação do tratamento antirrábico humano pós-exposição, associado a acidentes com cães / Evaluation the human anti-rabies treatment associated with accidents with dogs

O estudo da profilaxia da raiva humana contribui para orientação quanto ao uso de vacinas e soros antirrábicos, servindo de base para a definição de estratégias de prevenção, controle e avaliação da doença. Objetivou-se avaliar o atendimento antirrábico humano pós-exposição e possíveis incompatibilidades com o protocolo do Ministério da Saúde, em agressões por cães, no município de Belo Horizonte. Analisaram-se as fichas de atendimento antirrábico do SINAN para comparação dos tratamentos prescritos com as Normas de Profilaxia antirrábica do Ministério da Saúde. As características dos atendimentos foram: quanto à exposição, 93,0% decorrentes de mordedura; quanto à localização da agressão, 35,5% ocorreram nos membros inferiores; quanto ao ferimento, 62,0% foram lesões únicas; quanto ao tipo de ferimento, 65,8% foram superficiais; quanto à condição do animal, 85,0% ocorreram por animais sadios; em 83,4% dos casos os animais eram observáveis; quanto ao tratamento, observação e vacina (57,3%). O tratamento foi inadequado em 32,7% das condutas. O número de tratamentos instituídos foi muito elevado, 75,7% dos casos. De todos os atendimentos 21,2% das indicações foram consideradas excessivas e 11,5% insuficientes. O sistema de vigilância apresenta falhas e existe a necessidade de corrigi-las para que as informações referentes à finalização dos casos sejam conclusivas.(AU)

The study of prophylaxis of human rabies contributes to guidance on the use of vaccines and anti-rabies serums, providing the basis for the definition of strategies for prevention, control and evaluation of the disease. This study aimed to evaluate the service to early post-exposure human anti-rabies and possible incompatibilities with the Ministry of Health protocol attacks by dogs in the city of Belo Horizonte. The anti-rabies care records of SINAN were analyzed for comparison of treatments prescribed in the Prophylaxis of Rabies Standards of the Ministry of Health. The characteristics of the calls were about the exposure, 93.0% resulting from biting; the location of the assault, 35.5% occurred in the lower limbs; the injury, only 62.0% were injuries; the type of injury, 65.8% were superficial; the condition of the animal, 85.0% occurred in healthy animals; 83.4% of the cases the animals were observed; as treatment, observation and vaccine (57.3%). The treatment was inadequate in 32.7%. The number of established treatments was very high, 75.7% of cases. In all 21.2% of indications consultations were considered excessive and 11.5% insufficient. The surveillance system is faulty and there is a need to correct them so that the information regarding the completion of cases are conclusive.(AU)

Mastitis in the transition period: identification of potential blood markers / Mastite no período de transição: identificação de potenciais marcadores no sangue

This study identified potential blood markers associated with mastitis in dairy cows under different dry therapies during the transition period, using a logistic regression model. Thirty-four Holstein dairy cows were divided into three groups: untreated controls (13 cows, 42 quarters); animals that received an antimicrobial at drying-off (10 cows, 40 quarters); and animals that were administered an internal teat sealant at drying-off (11 cow, 44 quarters). Blood and quarter milk samples were collected 60 days before the expected day of calving, on the day of calving, and three, seven, 15, 21, and 30 days after calving. Milk samples were submitted for bacteriological analysis and somatic cell count. Blood samples were collected for analyses of the following: the erythrogram and leucogram; plasm fibrinogen concentration; hepatic and renal functions; metabolic profile; serum calcium and phosphorous levels; total serum protein and albumin concentrations. The concentration of total serum proteins was associated with a high somatic cell count. Similarly, the concentrations of total serum proteins and triglycerides were associated to milk bacteriological positive samples during the transition period. Thus, the occurrence of mastitis in dairy cows during the transition period was greater in animals that showed higher concentrations of serum total proteins and triglycerides, in contrast to the use of dry cow therapy.(AU)

O presente estudo identificou potenciais marcadores sanguíneos associados tanto à mastite, durante o período de transição em vacas leiteiras submetidas à antimicrobianoterapia, quanto à utilização do selante interno de teto na secagem por modelo de regressão logística. Trinta e quatro vacas da raça Holandesa foram divididas em três grupos experimentais, a saber: 13 animais (42 quartos mamários) que não receberam tratamento na secagem; 10 animais (40 quartos mamários) tratados por via intramamária com uma bisnaga do antimicrobiano para vaca seca à base de cefalônio anidro após a última ordenha em cada quarto mamário; e 11 animais (44 quartos mamários) que receberam, por via intramamária, uma bisnaga de selante à base de subnitrato de bismuto após a última ordenha em cada quarto mamário. As amostras de leite e sangue foram coletadas 60 dias antes da data prevista do parto, na secagem, e no dia do parto e após três, sete, 15 e 21 dias após o parto. As amostras de leite foram utilizadas para o exame microbiológico e a determinação da contagem de células somáticas. As amostras de sangue foram utilizadas para determinação do eritrograma, leucograma, fibrinogênio plasmático, funções hepáticas e renais, perfil metabólico, proteína total e albuminas séricas e concentração sérica de cálcio e fósforo. A concentração total de proteínas séricas foi associada à alta contagem de células somáticas. Similarmente, a concentração total de proteínas séricas e triglicérides foi associada ao isolamento de patógenos causadores de mastite nas amostras de leite durante o período de transição. Desse modo, conclui-se que vacas leiteiras com concentrações séricas maiores de proteína total e triglicérides têm maior chance de apresentar mastite durante o período de transição; em contraste, o uso da antimicrobianoterapia de vaca seca reduz esse risco.(AU)

Adulterants interference on Fourier Transform Infrared analysis of raw milk / Interferência de adulterantes na análise do leite cru por espectroscopia pela transformada de Fourier

O objetivo deste trabalho foi analisar as leituras de composição do leite cru por meio de espectrofotometria FTIR, utilizando-se curva de regressão PLS, bem como as contagens de células somáticas e bacteriana total por citometria de fluxo, após adição de amido e sacarose. O leite cru foi adulterado com três concentrações de amido e sacarose (0,1%, 0,5% e 1%), colocado em frascos contendo bronopol ou azidiol, os quais foram armazenados em duas temperaturas (7±2°C e 25±2°C ). As análises foram realizadas após zero, três, 24, 48, 72 e 168 horas de armazenamento. O modelo de regressão linear múltipla foi utilizado para análise estatística. A adição de amido e sacarose resultou em mudança significativa (P<0,05) para todas as variáveis dependentes. O leite adulterado com amido resultou em aumento nas leituras de gordura, proteína, lactose, sólidos totais (ST), sólidos não gordurosos (SNG), CCS e CBT e em diminuição das leituras de caseína, do nitrogênio ureico do leite (NUL) e do ponto de congelamento. O leite adulterado com sacarose resultou no aumento das leituras da lactose, ST, SNG e NUL, enquanto as leituras de proteína, caseína, ponto de congelamento e CCS diminuíram. Este trabalho evidencia a importância do monitoramento de adulterantes reconstituintes no leite por afetarem os resultados analíticos da qualidade do leite, obtidos por métodos eletrônicos.(AU)

Factor analysis as a tool to estimate association among individual proteins and other milk components with casein micelle size and cheese yield / Análise fatorial como ferramenta para estimar a associação entre proteínas individuais e outros componentes do leite com o tamanho das micelas de caseína e massa seca de queijo

The present study attempted to identify individual milk proteins and other milk components that are associated with casein micelle size (CMS) and dry matter cheese yield (DMCY) using factor analysis. Here, we used 140 bulk tank milk samples from different farms. Milk composition was determined using a Fourier transform infrared equipament. The individual milk proteins were (αS-casein, ß-casein, κ-casein, ß-lactoglobulin and α-lactoalbumin) measured by their electrophoretic profile. The CMS was estimated by photon correlation spectroscopy, and the DMCY was determined using reduced laboratory-scale cheese production. Factor analysis partitioned the milk components into three groups that, taken together, explain 68.3% of the total variance. The first factor was defined as "CMS", while the second as "DMCY" factor, based on their high loadings. The CMS was positively correlated with protein, casein, non-fat solids and αS-casein and negatively associated with κ-casein and ß-lactoglubulin. DMCY was positively correlated with fat, protein, casein, total solids and negatively correlated with αs-casein. These results indicate that the variation of individual milk proteins may be an important aspect correlated to milk quality and cheese production.(AU)

O objetivo do presente estudo foi avaliar a associação das frações proteicas individuais e de outros componentes do leite com o tamanho das micelas de caseína (TMC) e a produção de matéria seca de queijo (MSQ) utilizando-se análise fatorial. Foram coletadas 140 amostras de leite de tanque provenientes de diferentes fazendas. A determinação da composição do leite foi determinada por espectroscopia no infravermelho com transformação de Fourier. As proteínas individuais (αS-caseína, ß-caseína, κ-caseína, ß-lactoglobulina e α-lactalbumina) foram quantificadas pelo perfil eletroforético. O tamanho médio das micelas de caseína foi analisado pelo princípio de espectroscopia de correlação de fótons e pela produção MSQ a partir do modelo de coagulação do leite em escala reduzida. A análise fatorial delimitou as variáveis em três fatores, que, juntos, responderam por 68,3% da variação total dos dados. No primeiro fator foram observadas as associações mais fortes com o TMC, enquanto no segundo fator as correlações foram mais significativas com a MSQ. O TMC foi associado positivamente com o conteúdo de proteína, caseína, sólidos desengordurados e αS-caseína, e negativamente com κ-caseína e ß-lactoglubulina. MSQ foi associada positivamente com o teor gordura, proteína e caseína total, sólidos totais, e negativamente com o teor de αs-caseína. Esses resultados indicam que a variação quantitativa das proteínas do leite pode ser determinante da qualidade do leite na produção de queijo.(AU)

Marker of coxsackievirus-B4 infection in saliva of patients with type 1 diabetes.

BACKGROUND: Coxsackieviruses B (CV-B) are enteroviruses that have been reported to play a role in the pathogenesis of type 1 diabetes. Enteroviral RNA was detected in the gut mucosa of patients. The mucosal immunity is an interconnected network; therefore, the response to enteroviruses possibly present in the gastrointestinal mucosa can be reflected by specific antibodies in the saliva. In the present study, the anti-CV-B neutralizing activity of saliva samples from patients with type 1 diabetes was investigated. METHODS: Saliva samples were collected from patients and controls of 3 countries, and plasma was obtained from some of them. The anti-CV-B activity of clinical samples was determined by neutralization of the cytopathic effect induced by challenging viruses in vitro and expressed as titre value. RESULTS: Overall prevalence and levels of anti-CV-B4 activity of saliva were higher in patients (n = 181) than in controls (n = 135; P = .0002; titre values ≥ 16: odds ratio = 4.22 95% CI: 1.90-9.38 P = .0002). It has been shown that IgA1 played a role in this activity. There was no correlation between the saliva and the plasma anti-CV-B4 neutralizing activity. The neutralizing activity of saliva against CV-B1, CV-B2, CV-B3, and CV-B5 existed rarely, if at all. Increased levels of anti-CV-B4 activity were observed all along a 4 year follow-up period in patients but not in matched controls (P = .01). CONCLUSION: There is an anti-CV-B4 activity in saliva of patients with type 1 diabetes that may be a useful marker to study the role of CV-B in the pathogenesis of the disease.

In-MOFs based on amide functionalised flexible linkers.

Two new amide functionalised metal-organic frameworks, In(OH)CSA and In(OH)PDG, were synthesized using two flexible linkers, N-(4-carboxyphenyl)succinamic acid (CSA) and N,N'-(1,4-phenylenedicarbonyl)diglycine (PDG), respectively. Both structures consist of corner-sharing {InO4(OH)2} octahedra in the form of trans indium hydroxide chains, which are interconnected by the dicarboxylate linkers to form stacked 2-dimensional layers. The different symmetries and configurations of the flexible and rigid features on the linkers results in different supramolecular interactions dominating between linkers, resulting in different shaped pores and functional group orientation. In(OH)CSA lacks hydrogen bonding between linkers, which results in close packing between the layers and very small solvent accessible pores running perpendicular to the plane of the layers. In(OH)PDG exhibits strong intra- and interlayer hydrogen bonding, which prevents the layers from close packing and results in larger cylindrical pores running parallel to the indium hydroxide chains, producing a total accessible volume of 25% of the unit cell volume.

Immunological implications of bovine leukemia virus infection.

This study examined neutrophil and monocyte functions and the blood lymphocyte profile of naturally BLV-infected cows with or without persistent lymphocytosis (PL). The percentage of neutrophils and monocytes that phagocytosed Staphylococcus aureus was lower in BLV-infected dairy cows, particularly those with PL. The relative percentage of CD44+ monocytes and neutrophils and CD11b expression by neutrophils was also lower in BLV-infected dairy cows with PL. A correlation between the percentage of CD11b+ neutrophils and that produced reactive oxygen species (ROS) was found. Furthermore, the percentage of CD44+ monocytes was positively correlated with the percentage of monocytes that phagocytosed S. aureus and the same phenomenon was observed for neutrophils. In BLV-infected dairy cows, particularly those with PL, inhibition of monocyte and neutrophil apoptosis was observed. Additionally, the percentage of neutrophils producing ROS was lower in BLV-infected cows with PL, in contrast to higher intensity of intracellular production of ROS by monocytes. The result from the lymphocyte immunophenotyping of BLV-infected cows with PL was an increase in B cells, mainly B CD5+ CD11b+, due to the apoptosis inhibition. In conclusion, this study provides novel insight into the implications of BLV infection for cattle, which can include the dysfunction of blood monocytes and neutrophils.

Climate conditions associated with the occurrence of antimicrobial and macrocyclic lactone residues in bulk tank milk / Condições climáticas associadas à ocorrência de resíduos de antimicrobianos e lactonas macrocíclicas em amostras de leite de tanque

The present study aimed to identify the climate condition parameters that are associated with the occurrence of antimicrobial and macrocyclic lactone residues in bulk tank milk using a multivariate principal components analysis (PCA). A total of 132 raw milk samples were collected at dairy farms in Minas Gerais State in Brazil and analyzed for 35 analytes, comprising macrocyclic lactones and antibacterials, using liquid chromatography coupled with mass spectrometry in tandem mode spectrometry. Of the 132 samples, 34 (25.76%) bulk tank milk samples were positive for at least one analyte. PCA showed that antimicrobial residues in bulk tank milk occurred less frequently on days with a higher average temperature, maximum temperature and temperature-humidity index. In contrast, relative humidity was inversely associated with antimicrobial residues in raw milk. The PCA showed that daily milk production was also related to macrocyclic lactone residues, while rainfall showed an inverse association. Thus, some climate conditions, such as average temperature, maximum temperature and temperature-humidity index, can predict the moments with lower risk of occurrence of antimicrobial residues in bulk tank milk, in contrast to relative humidity. Furthermore, the risk of macrocyclic lactone residues in bulk tank milk was higher in months with less rainfall.(AU)

O presente trabalho objetivou identificar fatores climáticos associados à ocorrência de resíduos de antimicrobianos e lactonas macrocíclicas em amostras de leite de tanque por análise multivariada de componentes principais (ACP). Para o presente trabalho, 132 amostras de leite cru foram coletadas em fazendas leiteiras localizadas no estado de Minas Gerais (Brasil) e analisadas por cromatografia líquida de alta eficiência e espectrometria de massas in tandem para detecção de 35 analitos, incluindo antimicrobianos e lactonas macrocíclicas. Das 132 amostras de leite analisadas, detectou-se pelo menos um analito em 34 (25,76%) amostras. A ACP demonstrou que a presença de resíduos de antimicrobianos no leite de tanque ocorreu menos frequentemente nos dias com maior temperatura média, temperatura máxima e índice de temperatura e umidade. Por outro lado, a umidade relativa foi inversamente associada à presença de resíduos antimicrobianos no leite. A ACP demonstrou associação entre a presença de resíduos de lactonas macrocíclicas no leite e a produção diária de leite, e a presença de resíduos de lactonas macrocíclicas ocorreu menos frequentemente nos meses com maiores índices pluviométricos. Dessa forma, conclui-se que alguns índices climáticos, como temperatura média, temperatura máxima e índice de temperatura e umidade, podem predizer períodos com maior risco de ocorrência de resíduos de antimicrobianos, em contraste com a umidade relativa. Além disso, o risco de resíduos de lactonas macrocíclicas no leite de tanque foi maior nos meses com menores índices pluviométricos.(AU)