Cutaneous mycobacteriosis in a captive Amazonian manatee Trichechus inunguis.

An adult male Amazonian manatee Trichechus inunguis under human care presented with 3 circular cutaneous lesions on the dorsal aspect of the rostrum and between the nostrils (plenum). Initially these lesions were superficial, hypopigmented, without warmth and non-painful. Microbiological cultures of skin swabs isolated Candida sp. and Pseudomonas aeruginosa, and topical treatment with antiseptic, antifungal, anti-inflammatory and antibiotic medication was instituted. This treatment strategy did not lead to any clinical improvement, and after 6 mo, the lesions progressed to a confluent abscess (5.0 × 3.0 cm) with increased temperature and obvious discomfort on palpation. An impression smear of a cutaneous biopsy was submitted for Ziehl-Neelsen staining and after detection of acid-fast bacilli, the cutaneous biopsy and a swab from the lesion were sent for histopathology, culture and sensitivity testing. After 5 d of incubation and through PCR-restriction analysis of the isolates, Mycobacterium fortuitum and M. abscessus were identified. Sensitivity testing indicated that the isolates were susceptible to ciprofloxacin and clarithromycin, and after draining of the lesion and administration of systemic antibiotic treatment, there was rapid clinical improvement. This report describes non-healing lesions in an aquatic animal and illustrates the importance of evaluating the presence of non-tuberculous mycobacteria, opportunistic pathogens which are ubiquitous in the aquatic environment, in protracted, non-responsive cases. We also highlight the importance of a correct diagnosis and treatment approach, and we review concerns that these bacteria are zoonotic agents and are frequently resistant to conventional antibiotics.

Behavioral responses of Magellanic Penguins (Spheniscus magellanicus) (Foster) to saltwater versus freshwater.

The most common penguin species found along the coast of Brazil is the Magellanic Penguin (Spheniscus magellanicus). These penguins spend most of their time foraging for food in the oceans. This information is vital to the maintenance of this species in captivity. The goal of this study was to evaluate the behavioral response of a group of Magellanic Penguins (S. magellanicus) in two different conditions of water--fresh and salt. The work was divided into two phases. First, animals were kept in enclosures with access to freshwater. Then they were housed with access to saltwater. Behaviors were recorded by scan sampling per interval of time, totaling 7,200 records for each animal. The results show that the use of saltwater for this group of animals kept in captivity was more effective for increasing the time the animals spent in the water, increasing foraging behavior, stimulating swimming, and providing display of typical behaviors of the species, showing that access to a saltwater environment is an important tool in trying to provide well-being for this species in captivity.

Reducing bumblefoot lesions in a group of captive Magellanic penguins (Spheniscus magellanicus) with the use of environmental enrichment / A redução do bumblefoot com a utilização de enriquecimento ambiental para um grupo de pinguim-de-Magalhães (Spheniscus magellanicus) mantido em cativeiro

Captive penguins are prone to pododermatitis (bumblefoot) lesions due to sedentary habits, changes in normal activity patterns, prolonged time on hard and abrasive surfaces, and less time swimming in the water. Environmental enrichment allows the use of creative and ingenious techniques that aim to keep the captive animals occupied by increasing the range and the diversity of behavioral opportunities always respecting the ethological needs of the species. The main goal of this work was to use environmental enrichment techniques to reduce pododermatitis in a group of captive penguins. Five captive Magellanic penguins (Spheniscus magellanicus) that were showing bumblefoot lesions were followed during this project. To monitor the lesions, all animals were physically restraint 3 times a week over a period of 12 weeks. Environmental enrichment was introduced daily in the water with the goal of enhancing their time in the water for one extra hour daily. The results demonstrate that in a twelve weeks period, four animals showed significant reduction of the lesions in both feet and in two animals the lesions were completely healed. With these results we can conclude that aquatic environmental enrichment allowed this group of penguins to spend more time in the water, favoring the reduction of the bumblefoot lesions.

Os pinguins cativos estão predispostos a pododermatite (bumblefoot) devido ao sedentarismo, mudanças dos padrões normais de atividade, tempo prolongado de permanência em pisos duros e abrasivos, diminuição da natação e tempo na água. O enriquecimento ambiental permite a utilização de técnicas imaginativas e engenhosas que visam manter os animais cativos ocupados e com uma maior diversidade de oportunidades comportamentais, sempre respeitando as necessidades etológicas da espécie. O objetivo deste trabalho foi utilizar técnicas de enriquecimento ambiental para reduzir as lesões de pododermatite em um grupo de pingüins. Cinco indivíduos da espécie Pinguim-de-Magalhães (Spheniscus magellanicus) foram monitorados durante este projeto. Todos os animais foram contidos fisicamente 3 vezes por semana para a realização do acompanhamento do tamanho das lesões, durante 12 semanas. Enriquecimento ambiental foi introduzido diariamente na água, objetivando aumentar em uma hora o tempo em que os animais passavam na água. Os resultados mostraram que, ao longo das 12 semanas, 4 animais apresentaram redução significativa das lesões em ambas as patas, sendo que em dois animais as lesões desapareceram. Com isto, podemos concluir que o enriquecimento ambiental aquático para este grupo de pingüins permitiu um maior tempo de permanência dos animais na água favorecendo a redução das lesões de bumblefoot.

Solid lipid nanoparticles as anti-inflammatory drug delivery system in a human inflammatory bowel disease whole-blood model.

Standard treatment for inflammatory bowel diseases (IBD) necessitates frequent intake of anti-inflammatory and/or immunosuppressive drugs, leading to significant adverse events. To evaluate the role solid lipid nanoparticles (SLN) play as drug delivery system in enhancing anti-inflammatory activity for drugs such as dexamethasone and butyrate in a human inflammatory bowel diseases whole-blood model. ELISA assay and the peripheral blood mononuclear cell (PBMC) cytokine mRNA expression levels were evaluated by quantitative SYBR Green real-time RT-PCR to determine the IL-1beta, TNF-alpha, IFN-gamma and IL-10 secretion in inflammatory bowel diseases patients' PBMC culture supernatants. There was a significant decrease in IL-1beta (p<0.01) and TNF-alpha (p<0.001) secretion, whilst IL-10 (p<0.05) secretion significantly increased after cholesteryl butyrate administration, compared to that of butyrate alone at the highest concentration tested (100 microM), at 24h exposure. There was a significant decrease in IL-1beta (p<0.01), TNF-alpha (p<0.001) and IL-10 (p<0.001) secretion after dexamethasone loaded SLN administration, compared to dexamethasone alone at the highest concentration tested (250 nM) at 24h exposure. No IFN-gamma was detected under any conditions and no cytotoxic effects observed even at the highest concentration tested. The incorporation of butyrate and dexamethasone into SLN has a significant positive anti-inflammatory effect in the human inflammatory bowel disease whole-blood model.

Hepatitis C virus-infected patients report communication problems with physicians.

We examined the prevalence and nature of perceived problems in the interaction between physicians and patients diagnosed with hepatitis C virus (HCV) infection. This cross-sectional study included 322 outpatients diagnosed with chronic HCV infection and treated at a tertiary referral hospital's hepatology clinic. Patients were asked to provide demographic information and to complete a semistructured interview, the Sickness Impact Profile (SIP) and Hospital Anxiety Depression (HAD) scale. A team of two blinded coders analyzed the interviews. A total of 131 (41%) study patients reported communication difficulties with physicians involved in their care. The main difficulties were the poor communication skills of physicians (91 [28%]), physician incompetence regarding the diagnosis and treatment of HCV infection (74 [23%]), feelings of being misdiagnosed, misled, or abandoned (51 [16%]), or being stigmatized by their physician (29 [9%]). Patients were twice as likely to report difficulties with subspecialists as compared with generalists. Nonresponse with antiviral therapy correlated with perceived physician conflict even after adjusting for treatment in relation to the time of interview, whereas previous or ongoing substance abuse and mode of acquisition did not. In a multivariate model, patients' psychosocial problems were the best predictors of communication difficulties. In conclusion, a substantial number of patients with HCV infection report difficulties when interacting with physicians, which may be due to coexisting emotional or social problems. However, perceived stigmatization by physicians and a sense of abandonment reflect the need for further educational efforts. These should target both specialists and primary care providers to inform them about the psychosocial challenges facing these patients.

"They treated me like a leper". Stigmatization and the quality of life of patients with hepatitis C.

OBJECTIVE: Hepatitis C virus is the most prevalent chronic blood-borne infection in the United States, typically acquired through contaminated blood products or needle sharing. We hypothesized that patients with chronic hepatitis C infection experience stigmatization independent of mode of acquisition and that it negatively affects quality of life. DESIGN: Cross-sectional observation study. SETTING: Specialty clinic in a tertiary referral hospital. PATIENTS: Two hundred and ninety outpatients diagnosed with chronic hepatitis C infection and seen in a hepatology clinic. Thirty participants were excluded because of missing data. MEASUREMENTS AND MAIN RESULTS: Patients were asked to complete a demographic profile, a semistructured interview, the Sickness Impact Profile, and the Hospital Anxiety Depression Scale. A team of two blinded coders analyzed the interviews. A total of 147 of the 257 study patients experienced stigmatization that they attributed to the disease. Women were more likely to report perceived stigmatization than men (P <.05). Age, education, professional status, and mode of infection did not influence the likelihood of stigmatization. Stigmatization was associated with higher anxiety (P <.01) and depression (P <.01), worsened quality of life (P <.01), loss of control (P <.01), and difficulty coping (P <.01). Individuals who experienced stigmatization also mentioned problems in their health care (P <.01) and work environment (P <.01) as well as with family members (P <.01). CONCLUSION: Stigmatization is a very common emotionally burdensome experience for patients with hepatitis C, which can erode social support. As it penetrates even into the health care environment, physicians and other care providers should be aware of the existence and impact of such negative stereotyping.

Anxiety and Depression as Predictors of Recurrence in Geriatric Depression: A Preliminary Report.

The authors studied elderly patients with major depression (MDD) who recovered after nortriptyline treatment to determine the relationship of affective symptoms at completion of continuation treatment to eventual MDD recurrence. Independent objective measures of depressive and anxiety symptoms were obtained before and after nortriptyline tapering. Univariate log-rank analysis demonstrated a trend for total post-discontinuation anxiety scores to predict time-to-recurrence in 12 subjects with complete data sets. Items assessing excessive worry and psychic tension (subjective anxiety) were significant predictors. No relationship was found between continuation-phase anxiety or depressive symptoms either immediately preceding or after discontinuation and course.