A retrospective cohort study to screen linezolid-induced thrombocytopenia in adult patients hospitalized in the Midwestern Region of Brazil

ABSTRACT Background: Thrombocytopenia (TP) is the major event associated with linezolid (LZD) therapy. We investigated the incidence and risk factors for thrombocytopenia in hospitalized adults who received LZD (1200 mg/day) between 2015 and 2017. HIV-positive, death during follow-up and those with a baseline platelet count ≤100 × 103/mm3 were excluded. Method: TP was defined as a decrease in platelet count of ≥20% from the baseline level at the initiation of linezolid therapy and a final count of <100 × 103/mm3. The odds ratios (OR) for thrombocytopenia were obtained using multivariate stepwise logistic regression analysis. Main results: A total of 66 patients were included (mean age [SD] 62 [18], male gender [%], 37 [56]). LZD-associated TP was identified in 12 patients (18.2%). For TP, the adjusted OR [95% CI] of the platelet count ≤200 × 103/mm3, serum creatinine and renal impairment at baseline were 5.66 [1.15-27.9], 4.57 [1.26-16.5] and 9.41 [1.09-80.54], respectively. Male gender and dosage per weight per day (DPWD) >20 mg/kg/day were not risk factors. Conclusion: The results showed that the incidence of linezolid-induced thrombocytopenia was lower in patients with normal renal function and higher in those with platelet counts ≤200 × 103/mm3 or serum creatinine >1.5 mg/dL at the start of the treatment.

Overview of artemisinin effectiveness during outset years of its implementation in the western Brazilian Amazon

BACKGROUND The elimination of malaria depends on the blocking of transmission and of an effective treatment. In Brazil, artemisinin therapy was introduced in 1991, and here we present a performance overview during implementation outset years. METHODS It is a retrospective cohort (1991 to 2002) of patients treated in a tertiary centre of Manaus, with positive microscopic diagnosis of Plasmodium falciparum malaria, under treatment with using injectable or rectal artemisinin derivatives, and followed over 35-days to evaluate parasite clearance, death and recurrence. FINDINGS This cohort outcome resulted 97.6% (1554/1593) of patients who completed the 35-day follow-up, 0.6% (10/1593) of death and 1.8% (29/1593) of follow-up loss. All patients that died and those that presented parasitaemia recurrence had pure P. falciparum infections and received monotherapy. Considering patients who completed 35-day treatment, 98.2% (1527/1554) presented asexual parasitaemia clearance until D4 and 1.8% (27/1554) between D5-D10. It is important to highlight that had no correlation between the five treatment schemes and the sexual parasite clearance. Finally, it is noteworthy that we were able to observe also gametocytes carriage during all follow-up (D0-D35). MAIN CONCLUSIONS Artemisinin derivatives remained effective in the treatment of falciparum malaria during first 12-years of use in north area of Brazil.

Clinical and laboratorial features of oral candidiasis in HIV-positive patients

Abstract INTRODUCTION We describe the clinical and laboratorial features of oral candidiasis in 66 HIV-positive patients. METHODS: Polymerase chain reaction-based techniques were performed for differentiation of Candida spp. isolated from patients at a public teaching hospital in Midwest Brazil. RESULTS: Oral lesions, mainly pseudomembranous, were significantly related to higher levels of immunosuppression. Of 45 Candida isolates, 66.7% were C. albicans. Most of the isolates were susceptible to the antifungal drugs tested. CONCLUSIONS: Oral lesions were associated with higher immunosuppression levels. Lower susceptibility to antifungals by non-albicans isolates supports the importance of surveillance studies using susceptibility tests to aid in the treatment.

Variability in the clinical distributions of Candida species and the emergence of azole-resistant non-Candida albicans species in public hospitals in the Midwest region of Brazil

Abstract INTRODUCTION Incidence and antifungal susceptibility of Candida spp. from two teaching public hospitals are described. METHODS The minimum inhibitory concentrations of fluconazole, voriconazole, itraconazole, and amphotericin B were determined using Clinical Laboratory Standard Institute broth microdilution and genomic differentiation using PCR. RESULTS Of 221 Candida isolates, 50.2% were obtained from intensive care unit patients; 71.5% were recovered from urine and 9.1% from bloodstream samples. Candida parapsilosis sensu stricto was the most common candidemia agent. CONCLUSIONS We observed variations in Candida species distribution in hospitals in the same geographic region and documented the emergence of non-C. albicans species resistant to azoles.

Osteología del miembro torácico de la corzuela parda Mazama gouazoubira (g. Fischer, 1814) (Cetartiodactyla: Cervidae) / Osteology of the thoracic limb of south american gray brocket Mazama gouazoubira (Fischer, 1814) (Cetartiodactyla: Cervidae)

El objetivo del estudio fue describir las características anatómicas y establecer hipótesis morfo-funcionales del esqueleto del miembro torácico de Mazama gouazoubira. Para ello, se utilizaron los miembros torácicos de cuatro adultos jóvenes. Los huesos se prepararon mediante ebullición y fueron blanqueados en una solución de peróxido de hidrógeno para obtener descripciones comparativas, mediciones osteométricas y radiografías digitales. En comparación con los rumiantes domésticos, la escápula resultó ser ancha y plana, con el acromion pequeño, el proceso coracoides muy pequeño y sin tuberosidad de la espina. El húmero se observó alargado con la diáfisis redondeada en una sección transversal y con proyecciones no articulares lisas. La ulna se unió al radio hasta la epífisis distal y juntos formaron un espacio interóseo proximal alargado y estrecho, sin surco vascular. El esqueleto de la mano presentó los metacarpianos III y IV bien desarrollados y fusionados, mientras que los metacarpianos II y V resultaron rudimentarios con disposición telemetacarpiana, filogenéticamente típico de cérvidos del Nuevo Mundo. Se encontraron cuatro dedos con tres falanges en cada uno, de los cuales, dos corresponden a los principales (III y IV) que llegan al suelo y dos son rudimentarios (II y V). Las radiografías nos permitieron visualizar los patrones de tensiones trabeculares normales y la osteometría permitió establecer relaciones con fines comparativos. Se reconocieron las adaptaciones esqueléticas del miembro torácico para favorecer la locomoción cursorial saltatoria.

This study aimed to describe anatomical features of the forelimb skeleton of Mazama gouazoubira in order to establish morphofunctional activity. Forelimbs of four young adult specimens were used to this end. The bones were prepared by boiling and cleared in a solution of hydrogen peroxide for comparative descriptions, osteometrics measurements and digital radiographs. Compared to domestic ruminants, the scapula proved to be wide and flat, with a small acromion, reduced coracoid process and lacking of spine tuberosity. The humerus had an elongated shaft with a rounded cross-section and discrete non-articular projections. The ulna accompanied the radio to the distal epiphysis and formed a long and narrow, proximally placed interosseous space without a vascular groove. The skeleton of the hand presented the rudimentary metacarpals II and V and the well-developed III and IV fused metacarpals, which is a typical telemetacarpal arrangement of close phylogenetically deer species from the New World. There were four fingers, each one with three phalanges; two main (III and IV) touching the ground and two rudimentary (II and V). Radiographs allowed visualizing patterns of normal trabecular tensions and osteometrics enabled to establish ratios for comparative purposes. Adaptations of skeletal forelimb to favor cursorial saltatory locomotion were typically identified.

Morfologia da laringe em Cerdocyon thous (Linnaeus, 1766) / Laryngeal morphology in Cerdocyon thous (Linnaeus, 1766)

Cerdocyon thous (cachorro-do-mato) é o canídeo silvestre mais comum em território sul-americano. Objetivou-se com o presente trabalho descrever a morfologia macroscópica, microscópica e comparada da laringe nesta espécie. Para tal, as laringes de dezesseis espécimes (quatro machos e doze fêmeas) foram analisadas quanto à topografia, forma, morfometria, musculatura intrínseca e histologia. A laringe dispôs-se ventralmente ao áxis e foi constituída por uma cartilagem tireoide e outra cricoide (hialinas), uma epiglótica (elástica) e um par de ariteoides (mistas). Um par de cartilagens sesamoides foi identificado entre os processos corniculados e a lâmina da cricoide. A morfometria revelou que a tireoide é a maior cartilagem. Não houve sinais definitivos de dimorfismo sexual na laringe de C. thous. O epitélio predominante foi do tipo pavimentoso estratificado o qual sofreu transição para pseudoestratificado cilíndrico ciliado ao nível do terço caudal da tireoide e rostral da cricoide. A laringe de C. thous mostrou semelhança com a do cão doméstico, ainda que o formato das cartilagens tenha apresentado diferenças.

Cerdocyon thous (crab-eating fox) is the most common wild canid in South American territory. The aim of this paper was to describe macroscopic, microscopic and comparative morphology of the larynx of this species. Analyses of larynges of sixteen specimens (four males and twelve females) revealed the topography, conformation, morphometrics, intrinsic muscles and histological characteristics. The larynx was positioned ventral to the axis and comprised one cricoid and one thyroid cartilage (hyaline), one epiglottis (elastic) and a pair of arytenoids (mixed). A pair of sesamoid cartilages was identified between the corniculate processes and the cricoid lamina. Morphometry revealed that thyroid cartilage was the largest. There were no conclusive signs of sexual dimorphism in the larynx of this species. Squamous stratified epithelium predominated and underwent transition to ciliated pseudo-stratified at the level of caudal thyroid and rostral cricoid portions. By comparison, larynx of C. thous showed similarity with the domestic dog, although the shape of cartilages has shown some variation.

Origens e ramificações do plexo braquial no cachorro-do-mato Cerdocyon thous (Linnaeus, 1766) / Origins and ramifications of brachial plexus in the crab-eating-fox Cerdocyon thous (Linnaeus, 1766)

Este estudo teve o objetivo de descrever a origem e ramificação dos nervos de vinte plexos braquiais de cachorro-do-mato (Cerdocyon thous). Dez animais da espécie, obtidos post mortem por atropelamento em rodovias, foram utilizados para o estudo, de acordo com a autorização do IBAMA/SISBIO nº33667-1. Depois de coletados, os cadáveres foram fixados em solução de formaldeído a 50% e conservados por pelo menos 14 dias em solução de formaldeído a 10% antes das dissecções. Após remoção da pele, incisões na musculatura peitoral e afastamento dos membros, acessou-se o espaço axilar e os nervos do plexo tiveram seu trajeto dissecados individualmente até sua inserção muscular. Para melhorar a visualização dos ramos ventrais cervicais e torácicos que originavam cada nervo, removeram-se a musculatura que encobria os forames intervertebrais, os processos transversos e os corpos vertebrais ventralmente, expondo inclusive a medula espinhal. Registros fotográficos e desenhos esquemáticos documentaram a origem e ramificação dos nervos. Os vinte plexos braquiais foram resultantes das conexões entre os ramos ventrais dos três últimos nervos espinhais cervicais (C6, C7 e C8) e do primeiro torácico (T1). Estes ramos derivaram os nervos supra-escapular, subescapular, axilar, musculocutâneo, radial, mediano, ulnar para a musculatura intrínseca e os nervos braquiocefálico, toracodorsal, torácico lateral, torácico longo, peitoral cranial e peitoral caudal para a musculatura extrínseca do membro torácico. Constatou-se que os ramos ventrais de C7 foram os que mais contribuíram na formação de nervos (61,5%), seguido de C8 (55,4%), de T1 (41,2%) e de C6 (30,8%). O teste t de comparação entre as médias, ao nível de significância de 5%, não demonstrou diferenças na origem do plexo quando comparados os antímeros e os sexos. Do total dos 260 nervos dissecados, 68,8% foram originados pela combinação de dois ou três ramos, enquanto apenas 31,2% tiveram formação por um único ramo. A combinação entre C8 e T1 foi a que mais formou nervos para o plexo (23,8%) nesta espécie. Quando comparadas a origem, ramificação e área de inervação do plexo braquial do C. thous com outras espécies domésticas e silvestres, verificou-se maior semelhança com o cão doméstico. Os resultados deste estudo podem embasar o diagnóstico de disfunções neuromusculares, as técnicas de bloqueios anestésicos e análises morfofuncionais comparativas envolvendo esta espécie.

This study aimed to describe the origin and branching of nerves from twenty brachial plexuses of crab-eating foxes (Cerdocyon thous). Ten animals of the species, obtained post mortem from being run over on highways, were used for the study, in accordance with the authorization from IBAMA / SISBIO No. 33667-1. Once collected, the cadavers were fixed in 50% formaldehyde and kept for at least 14 days in a solution of 10% formaldehyde before dissections. After removal of skin, incisions in breast muscles and reflection of thoracic limbs allowed access to axillary space and the nerves could have trajects dissected individually to each muscle insertion. To improve visualization of the cervical and thoracic ventral roots that originated every single nerve, muscles that covered the intervertebral foramina, transverse processes and vertebral bodies were removed ventrally and the spinal cord exposed. Schematic drawings and photographic records documented the origin and branching of nerves. The twenty plexuses were resulted from connections between the ventral branches of the last three cervical spinal nerves (C6, C7 and C8) and first thoracic (T1). These branches derived the nerves suprascapular, subscapular, axillary, musculocutaneous, radial, median and ulnar to the intrinsic muscles and brachiocephalic, thoracodorsal, lateral thoracic, long thoracic, cranial and caudal pectoral nerves to the extrinsic muscles of the thoracic limb. It was found that the ventral rami of C7 were the main contributors in the formation of nerves (61.5%), followed by C8 (55.4%), T1 (41.2%) and C6 (30.8%). The t-test comparison between means at a significance level of 5% showed no differences in the origin of plexus when compared antimeres and sexes. Of the total of 260 dissected nerves, 68.8% originated by the combination of two or three roots, while only 31.2% were formed by a single root. The combination between C8 and T1 was the most frequent origin of nerves to the plexus (23.8%) in this species. Comparing the origin, branching and innervation area of the brachial plexus in C. thous with other domestic and wild species, there was a greater similarity with the domestic dog. These results may give the anatomical basis to diagnosis of neuromuscular disorders, anesthetic blocks techniques and comparative morphofunctional analyzes involving this species.

Topografia da intumescência lombar e do cone medular em Lycalopex gymnocercus (G. Fischer, 1814) / Topography of the lumbar intumescense and medullary conus in Lycalopex gymnocercus (G. Fischer, 1814) P

Objetivou-se com este estudo descrever a topografia da intumescência lombar e do cone medular da medula espinhal do graxaim-do-campo (Lycalopex gymnocercus) a fim de estabelecer uma base anatômica para procedimentos de anestesia epidural nesta espécie, bem como fornecer dados para estudos comparativos em neuroanatomia animal. Para tal, foram utilizados cinco espécimes, quatro machos e uma fêmea, recolhidos mortos em rodovias da mesorregião sudoeste do Rio Grande do Sul, Brasil, e então fixados e conservados em solução de formaldeído. As macrodissecções e exames radiográficos digitais permitiram observar que a intumescência lombar mediu, em média, 31,40 ± 5,09 mm e ocupou o espaço sobre as vértebras L4 e L5 (80%; n =4) e entre L5 e L6 (20%; n = 1), sendo relativamente pequena se comparada a outras espécies carnívoras. O cone medular revelou dimensões alongadas típicas de canídeos de menor porte. Seu comprimento médio foi 68,28 ± 8,36mm e sua esqueletopia demonstrou base sobre a vértebra L5 e ápice sobre a S3 em quatro indivíduos; em um único espécime a base situou-se sobre L6 e o ápice sobre Cd1. O comprimento do cone medular teve forte correlação positiva com o comprimento rostrossacral (r = 0,8324). Os achados sugerem que a introdução da agulha para fins de anestesia epidural no Lycalopex gymnocercus seja mais segura no espaço sacrocaudal.

The aim of this study was to describe the topography of the lumbar intumescence and medullary conus in the spinal cord of the pampas fox (Lycalopex gymnocercus), in order to establish anatomical basis for epidural anesthesia procedures in this species, as well as to give data for neuroanatomical comparative studies in animals. For this purpose, five specimens, four males and one female, collected dead from road kills at the southwest region of Rio Grande do Sul, Brazil, were embalmed and conserved in formaldehyde solution. Macrodissections and digital radiographs revealed that lumbar intumescence has an average length of 31.40 ± 5,09 mm, lies over L4 and L5 vertebrae and appears relatively shorter in comparison to other carnivore species. The medullary conus has an elongated dimension which seemed to be typical for smaller canids and an average length of 68.28 ± 8,36 mm. Its skeletopy exhibited a basis over L5 and an apices over S3 vertebrae in four specimens; in one individual the basis was over L6 and the apices over Cd1. The findings suggest that needle puncture for epidural anesthesia in Lycalopex gymnocercus is safer if done at the sacrocaudal space. Keywords: animal anatomy, epidural anesthesia, pampas fox, wild carnivores.

Topografia da intumescência lombar e do cone medular em Lycalopex gymnocercus (G. Fischer, 1814) / Topography of the lumbar intumescense and medullary conus in Lycalopexgymnocercus (G. Fischer, 1814)

Objetivou-se com este estudo descrever a topografia da intumescência lombar e do cone medular da medula espinhal dograxaim-do-campo (Lycalopex gymnocercus) a fim de estabelecer uma base anatômica para procedimentos de anestesia epiduralnesta espécie, bem como fornecer dados para estudos comparativos em neuroanatomia animal. Para tal, foram utilizados cincoespécimes, quatro machos e uma fêmea, recolhidos mortos em rodovias da mesorregião sudoeste do Rio Grande do Sul, Brasil,e então fixados e conservados em solução de formaldeído. As macrodissecções e exames radiográficos digitais permitiramobservar que a intumescência lombar mediu, em média, 31,40 ± 5,09 mm e ocupou o espaço sobre as vértebras L4 e L5 (80%;n =4) e entre L5 e L6 (20%; n = 1), sendo relativamente pequena se comparada a outras espécies carnívoras. O cone medularrevelou dimensões alongadas típicas de canídeos de menor porte. Seu comprimento médio foi 68,28 ± 8,36mm e sua esqueletopiademonstrou base sobre a vértebra L5 e ápice sobre a S3 em quatro indivíduos; em um único espécime a base situou-se sobreL6 e o ápice sobre Cd1. O comprimento do cone medular teve forte correlação positiva com o comprimento rostrossacral (r =0,8324). Os achados sugerem que a introdução da agulha para fins de anestesia epidural no Lycalopex gymnocercus seja maissegura no espaço sacrocaudal.

The aim of this study was to describe the topography of the lumbar intumescence and medullary conus in the spinal cord of thepampas fox (Lycalopex gymnocercus), in order to establish anatomical basis for epidural anesthesia procedures in this species,as well as to give data for neuroanatomical comparative studies in animals. For this purpose, five specimens, four males andone female, collected dead from road kills at the southwest region of Rio Grande do Sul, Brazil, were embalmed and conservedin formaldehyde solution. Macrodissections and digital radiographs revealed that lumbar intumescence has an average lengthof 31.40 ± 5,09 mm, lies over L4 and L5 vertebrae and appears relatively shorter in comparison to other carnivore species. Themedullary conus has an elongated dimension which seemed to be typical for smaller canids and an average length of 68.28 ± 8,36mm. Its skeletopy exhibited a basis over L5 and an apices over S3 vertebrae in four specimens; in one individual the basis wasover L6 and the apices over Cd1. The findings suggest that needle puncture for epidural anesthesia in Lycalopex gymnocercus issafer if done at the sacrocaudal space.