Avaliação diagnóstica na síndrome disfunção cognitiva canina / Diagnostic Evaluation of Canine Cognitive Dysfunction Syndrome

O objetivo do presente estudo foi avaliar o questionário observacional e os testes de reatividade como forma de triagem e diagnóstico da disfunção cognitiva em cães idosos. Foram estudados 10 cães acima de sete anos, que apresentavam queixas comportamentais. Foi utilizado questionário que abordava questões comportamentais, como desorientação, atividade, interação socioambiental, alterações no padrão do sono e casa-sujidade. As respostas foram convertidas em pontuações, cujo somatório classificou o cão com disfunção cognitiva canina (DCC), ou borderline (BL), ou sem alterações comportamentais (SAC). Logo depois, foram realizados, em todos os cães, os seguintes testes cognitivos: open field, curiosidade, interação com humano e com espelho. Pela avaliação do questionário, foi determinado que dois cães tinham DCC, três eram BL, cinco eram SAC. Os cães classificados com DCC tinham idade superior aos demais e apresentaram alterações em todos os testes de reatividade, enquanto os cães BL apresentaram alterações em dois testes de reatividade e os SAC não apresentaram alterações. Conclui-se que, com o aumento da expectativa de vida canina, o questionário observacional foi um instrumento de triagem para a identificação dos cães classificados com DCC, BL e SAC, e os testes de reatividade como um método inovador para identificar o verdadeiro estado cognitivo dos pacientes idosos.(AU)

The objective was to evaluate the observational questionnaire and the reactivity tests as a way of screening and diagnosis of cognitive dysfunction in elderly dogs. Ten dogs over seven years of age, with behavioral complaints, were studied. A questionnaire was used that addressed behavioral issues such as disorientation, activity, socioenvironmental interaction, changes in sleep pattern, and house-dirtiness. Responses were converted into scores, which summed the dog with canine cognitive dysfunction (DCC), or Borderline (BL) or without behavioral changes (SAC). Soon after, the following cognitive tests were performed on all dogs: open field, curiosity, interaction with human and with mirror. Through questionnaire evaluation, two dogs had CHD, three were BL, and five were SAC. The dogs classified with DCC were older than the others and presented alterations in all reactivity tests, while the BL dogs presented changes in two reactivity tests and CAD showed no alterations. With the increase in canine life expectancy, the observational questionnaire was a screening instrument for the identification of dogs classified with DCC, BL and SAC and the reactivity tests as an innovative method to identify the true cognitive status of the dogs elderly patients.(AU)

Criterios Médicos de elegibilidad para el uso de anticonceptivos de la OMS / Medical eligibility criteria for the use of WHO contraceptives

Introducción: Los "Criterios Médicos de Elegibilidad para el Uso de Anticonceptivos" de la Organización Mundial de la Salud (OMS) son una guía para la correcta elección y uso de los métodos anticonceptivos en variadas condiciones de salud. En este documento revisaremos las principales modificaciones en su quinta y última edición publicada en inglés el año 2015. Desarrollo: Las modificaciones de la quinta edición son fundamentalmente la adición de nuevos métodos y la modificación de la categoría de recomendación para algunas condiciones de salud. Se agregan el acetato de medroxiprogesterona de depósito vía subcutánea, el anillo vaginal de progesterona, el implante anticonceptivo subcutáneo sinoimplant(II)® y el método anticonceptivo de emergencia acetato de ulipristal. Se modifican las recomendaciones para las mujeres en lactancia, permitiendo el uso de algunos métodos de progestágeno solo desde el posparto inmediato, salvo el acetato de medroxiprogesterona de depósito por entregar una dosis elevada del esteroide y el dispositivo intrauterino (DIU) con levonorgestrel, el cual sigue las normas de los DIU con cobre. También hay modificación en las recomendaciones en cuanto al uso de anticonceptivos combinados en el puerperio, con más restricciones para mujeres sin lactancia. Por último, sobre el uso de terapia antiretroviral, cambian algunas categorías y se amplía el listado de fármacos detallados. Conclusión: Es necesario que los profesionales de salud conozcan estas modificaciones para poder entregar una atención de calidad a las usuarias de anticoncepción.

Introduction: The "Medical Eligibility Criteria for Contraceptive Use" published by the World Health Organization (WHO) is a guide for the correct choice and use of the contraceptive methods in many different health conditions. In this document we will review the main changes made in the fifth and last edition of this guide published in English in 2015. Development: The modifications of this last edition are the addition of new contraceptive methods and the modification of the category of the recommendation for some health conditions. It adds the medroxiprogesterone acetate subcutaneous injection, the progesterone vaginal ring, the subcutaneous contraceptive implant sinoimplant(II)® and ulipristal acetate as emergency contraception. There are modifications of the recommendations for breastfeeding women, allowing the use of some progestin only methods since the immediate postpartum, with the exception of medroxiprogesterone acetate because it delivers a high dose of the steroid and the levonorgestrel intrauterine device that follows the same recommendations as the copper intrauterine device. There are also modifications in the recommendations for the use of combined contraceptives in the first 42 days postpartum, with more restrictions for non-breastfeeding women. Finally, on the use of antiretroviral therapy drugs, there were changes of some categories and a detailed categorization for each drug. Conclusion: It is necessary for health care providers to know these changes in order to deliver a quality care to contraception users.

Potencial cicatricial da Bixa orellana L. em feridas cutâneas: estudo em modelo experimental / Therapeutic potential of Bixa orellana L. in skin wounds: a study in the rat model of open wound healing

O uso de fitoterápicos é uma alternativa de baixo custo e de fácil acesso para o tratamento de feridas cutâneas. Objetivou-se avaliar a ação do extrato oleoso de urucum na cicatrização de feridas cutâneas abertas. Inicialmente, identificaram-se os principais ácidos graxos do óleo de urucum. Foi realizado ensaio citotóxico para determinar as concentrações a serem utilizadas no ensaio in vivo. No experimento, feridas cutâneas em ratos Wistar foram diariamente tratadas com: extrato de urucum 0,1% (U 0,1%), extrato de urucum 0,01% (U 0,01%), vaselina (V) e solução fisiológica (SF), por até 21 dias. Aos quatro, sete, 14 e 21 dias, foi avaliada clinicamente a presença de exsudato, crosta e epitelização. Determinaram-se as áreas da lesão, e amostras de pele, fígado e rins foram coletadas para avalição histológica. Aos 21dias, amostras de pele foram coletadas para análise tensiométrica. Clinicamente, todos os grupos de tratamento apresentaram evolução cicatricial fisiológica. Os grupos U 0,1% e U 0,01% apresentaram maior presença de epitelização aos sete dias e maior retração cicatricial aos quatro dias. Na histologia, U 0,1% e U 0,01% apresentaram aos quatro e sete dias maior quantidade de fibrina e inflamação que V e SF, e, nos demais momentos, não houve diferenças entre os grupos. Quanto à fase cicatricial, aos quatro dias todos os grupos encontravam-se na fase inflamatória, aos sete dias U 0,1% e U 0,01% permaneciam na fase inflamatória, diferindo de SF e V, que se caracterizavam na fase proliferativa. Aos 14 dias, os grupos apresentavam-se em transição de fase proliferativa para maturação e, aos 21dias, estavam todos na fase de maturação. Os grupos tratados com urucum expressaram menor resistência à tensão que V e SF. Concluiu-se com este estudo que o extrato oleoso de urucum acelera o processo cicatricial nos primeiros dias, mas proporciona uma cicatriz de baixa qualidade.

Phytotherapies are a low cost, easily accessible alternative to traditional medicines in wound healing management. The purpose of this study was to assess the oil extract of Bixa orellana L. as a healing agent in the rat model of open wound healing. Initially, the oil was obtained and characterized through gas chromatography. Furthermore, the cytotoxic potential of the oil was verified in cell cultures to determine the doses used in animal experiments. Wounds were surgically produced in Wistar rats, these were treated with the oil extract at 0.1% (U 0.1%), 0.01% (U 0.01%), petrol jelly (V) and saline (SF) for up to 21 days. At four, seven and 14 days of treatment the wounds were assessed clinically regarding the presence of exudate, crust and epithelialization. The wound area was also determined and skin, kidney and liver tissues were harvested for histopathology. At 21 days of treatment the skins were also harvested for tension resistance assessment. Clinically, all groups evolved similarly, however, those treated with U 0.1% and U 0.01% had a greater amount of epithelialized wounds by day seven, and grater shrinkage by day four. Histopathologicaly, the skin samples of oil treated wounds had more lesions in the inflammatory phase at seven days, when compared to the controls, which were majorly in the proliferation phase. By 14 days no difference was observed among groups, which were all in the transition from the proliferation to the maturation phase. By day 21, all wounds were in the maturation phase. Oil treated wounds also had more fibrin in the first two assessment dates, when compared to the controls. Tension resistance of the oil treated wounds was, however, inferior to that of the controls. This study shows that B. orellana L. oil will hasten the onset of the healing process and its initial phases, but will ultimately produce a scar of poorer quality.

Cardiopatías congénitas: diagnóstico prenatal y seguimiento / Congenital heart disease: prenatal diagnosis and follow-up

Objetivo: Valorar la capacidad diagnóstica y el seguimiento de las cardiopatías congénitas con diagnóstico prenatal realizadas en el Centro de Referencia Perinatal Oriente (CERPO). Método: Se analizan todas las cardiopatías congénitas con diagnóstico prenatal que ingresaron al CERPO entre abril 2003 y diciembre de 2011. Se realiza seguimiento postnatal, se evalúa la concordancia entre el diagnóstico pre y postnatal, y se compara el pronóstico con la experiencia previamente reportada en la literatura. Resultados: Se detectaron 568 cardiopatías congénitas, el 53 por ciento correspondían a pacientes referidas desde otras regiones del país. En relación a la edad materna y paterna el 28 por ciento y el 35 por ciento tenían 35 años o más, respectivamente. De las 568 cardiopatías congénitas controladas, el 75 por ciento fueron pesquisadas con la ecocardiografía por visión de 4 cámaras y el 25 por ciento por visión de tractos de salida. La concordancia entre la ecocardiografía prenatal y postnatal fue de 87 por ciento Los diagnósticos más frecuentes correspondieron a comunicación interventricular, síndrome de hipoplasia ventricular izquierdo, arritmias y canal aurículoventricular. Se detectaron 60 cromosomopatías, 8 síndromes genéticos y 145 malformaciones extracardiacas asociadas. Se pudo realizar seguimiento de sobrevida al año en 390 pacientes, la sobrevida global en este grupo (excluidas las aneuploidías incompatibles con la vida) alcanzó un 44 por ciento. Conclusión: Existe una alta tasa de diagnóstico prenatal de cardiopatías congénitas a nivel terciario, con un 87 por ciento de concordancia entre ecocardiografía pre y postnatal. La sobrevida global de pacientes con cardiopatías congénitas fue de 44 por ciento al año de seguimiento. Por las características territoriales de nuestro país debiera contarse con más centros de referencia perinatal, al menos en las zonas norte y sur del país.

Objective: To evaluate the diagnostic and follow-up congenital heart disease with prenatal diagnosis performed in the Centro de Referencia Perinatal Oriente (CERPO). Method: We analyzed all the congenital heart disease with prenatal diagnosis admitted to CERPO between April 2003 and December 2011. Postnatal follow-up is performed, evaluating the correlation between pre and postnatal diagnosis and prognosis compared with the experience previously reported in the literature. Results: We detected 568 congenital heart diseases of which 53 percent were patients referred from other regions of the country. In relation to maternal and paternal age, 28 percent and 35 percent were 35 years or older, respectively. From 568 controlled congenital heart diseases, 75 percent could be researched to ultrasound echocardiography 4-chamber view and 25 percent per-view outflow tracts. The correlation between prenatal and postnatal echocardiography in this series was 87 percent. The most frequent diagnosis was interventricular communication, hypoplastic left heart syndrome, arrhythmias and atrioventricular canal. In this series we detected 60 chromosomal, 8 genetic syndromes and 145 extracardiac malformations. Follow-up could be performed one year survival in 390 patients, overall survival in this group (excluding aneuploidies with life incompatibility) reached 44 percent. Conclusion: There is a high rate of prenatal diagnosis of congenital heart disease at the tertiary level, with 87 percent concordance between pre-and postnatal echocardiography. Overall survival of patients with congenital heart disease is 44 percent at one year. For the territorial characteristics of our country should be counted more perinatal referral centers, at least in the north and south.

Frecuencia y factores asociados a daño hepático inducido por medicamentos en tratamiento antituberculosis / Frequency and factors associated with DILI in antituberculosis treatment

Introduction: Potentially hepatotoxic drugs are used in tuberculosis treatment. The incidence range of drug-induced liver injury (DILI) varies from 0.6 to 33 percent. Adverse reactions can be asymptomatic; therefore periodical liver tests are required. Multiple risk factors are described, such as age and HIV infection, among others. Objective: To determine risk factors associated to DILI and secondary lethality in patients receiving anti-tuberculosis drugs. Materials and Methods: The database from the Servicio de Salud Metropolitano Central de Chile was used. 1,249 patients were analyzed from 2003 to 2008 to determine DILI’s frequency and time of appearance. Multivariate binominal regression was used to study possible risks associated to hepatotoxicity. Results: 2,8 percent of our patients presented DILI (n = 35), three of them died from this cause (8.5 percent). Association between DILI and HIV infection and extrapulmonary tuberculosis was observed (p < 0.01). DILI was present in 50 percent of our patients before the 23rd day. Conclusions: We propose a more exhaustive control of the liver function in patients with DILI risk factors, including HIV carriers and extrapulmonary tuberculosis.

Introducción: El tratamiento antituberculosis incluye drogas hepatotóxicas, estimándose una incidencia de daño hepático inducido por medicamentos (DHIM) entre 0,6 y 33 por ciento. Puede ser asintomático, debiendo evaluarse periódicamente con perfil hepático. Se han descrito múltiples factores de riesgo, como mayor edad e infección por VIH, entre otros. Objetivo: Determinar factores asociados al desarrollo de DHIM y letalidad secundaria a tratamiento antituberculosis. Materiales y Métodos: Base de datos del Programa de Tratamiento antituberculosis del Servicio de Salud Metropolitano Central de Chile. Se analizaron 1.249 pacientes entre 2003 y 2008. Se determinó frecuencia y tiempo de aparición de DHIM. Se estudiaron posibles factores asociados a hepatotoxicidad mediante regresión binomial. Resultados: se diagnosticó DHIM en 2,8 por ciento de los pacientes (n = 35), falleciendo 3 de ellos por esta causa (8,5 por ciento). Se observó asociación entre DHIM con ser portador de VIH (+) y tuberculosis extrapulmonar (p < 0,01). Aparición de DHIM antes del día 23 en 50 por ciento de los casos. Conclusión: Sugerimos un control más exhaustivo del perfil hepático en pacientes con factores de riesgo, entre los cuales deben considerarse los portadores de VIH y tuberculosis extrapulmonar.