Malformação arteriovenosa uterina: um relato de caso / Uterine arteriovenous malformation: a case report

O presente estudo tem como objetivo relatar o caso de uma paciente com malformação arteriovenosa uterina, efetivamente tratada com embolização seletiva e com fertilidade preservada. A malformação arteriovenosa uterina é uma alteração vascular rara até então pouco descrita na literatura. A paciente do sexo feminino apresentou quadro de sangramento uterino anormal, com início 30 dias após um abortamento, sem realização de curetagem, de uma gestação resultante de fertilização in vitro. Foram, então, realizados exames de imagem, que levaram ao diagnóstico de malformação arteriovenosa uterina. O tratamento de escolha foi a embolização arterial seletiva, com resolução do caso. Após sete meses, nova fertilização in vitro foi realizada, encontrando-se na 36a semana de gestação. São necessários mais estudos sobre essa malformação a fim de que sejam estabelecidos os métodos mais eficazes para o manejo de casos futuros, especialmente quando há desejo de gestar.

The present study aims to report the case of a patient with uterine arteriovenous malformation, effectively treated with selective embolization and with preserved fertility. Uterine arteriovenous malformation is a rare vascular disorder that has so far been rarely described in the literature. Female patient presented with abnormal uterine bleeding, starting 30 days after an abortion without subsequent curettage, of a pregnancy resulting from in vitro fertilization. Imaging tests were then performed that led to the diagnosis of uterine arteriovenous malformation. The treatment of choice was selective arterial embolization, with successful results. After seven months, a new in vitro fertilization was performed, being in the 36th week of pregnancy. Further studies on this pathology are needed in order to establish the most effective methods for the management of future cases, especially when there is a desire to become pregnant.

Características relacionadas à ocorrência de infecção puerperal em mulheres submetidas ao parto cesáreo / Characteristics related to the occurrence of puerperal infection in women submitted to cesarrel delivery

Objetivo: Este artigo de revisão sistemática tem como objetivo analisar as principais características relacionadas à infeção puerperal em mulheres submetidas ao parto cesáreo. Fonte dos dados: Foi realizada busca nas bases de dados on-line Biblioteca Virtual de Saúde (BVS) e PubMed. Seleção dos estudos: Selecionaram-se artigos publicados nos últimos 11 anos (2010-2021), totalizando 12 artigos analisados. Coleta de dados: Realizou-se a busca dos artigos a partir dos descritores infecção puerperal, mortalidade materna, cesárea, fatores de risco em inglês e português. Em seguida à adequação aos critérios de inclusão (artigos em inglês, português e espanhol, com publicação nos últimos 11 anos, realizados em humanos) e exclusão (artigos duplicados, revisão de literatura, estudos de caso e dissertações), a análise dos títulos e dos resumos dos artigos encontrados permitiu a exclusão daqueles que se afastavam do tema em estudo. Síntese dos dados: Dentre os fatores sociodemográficos, destacam-se mulheres nos extremos de idade, negras, residentes na zona rural, com baixo nível econômico e escolar, primíparas e tabagistas. Em relação aos fatores clínicos, obesidade, HIV, diabetes mellitus, doenças cardiovasculares, hipertensão arterial, pré-eclâmpsia e eclâmpsia, anemia e infecções geniturinárias apresentaram-se como fatores de risco para infecção puerperal. Fatores obstétricos também foram avaliados, identificando-se como variáveis importantes o parto cesáreo, rotura prematura de membranas, tempo de membrana rota, trabalho de parto maior que 12 horas, parto prematuro e trabalho de parto induzido, hemorragia pós-parto, transfusão prévia e mecônio em líquido amniótico. Por fim, as características assistenciais trazem o baixo número de consultas de pré-natal e número de toques vaginais antes e após a ruptura de membranas como variáveis de risco. Conclusão: Muitos dos fatores identificados são passíveis de controle, e a sua reversão contribui para a redução dos índices de infecção puerperal e, consequentemente, de mortalidade materna.(AU)

Objective: This systematic review article aims to analyze the main characteristics related to puerperal infection in women undergoing cesarean delivery. Source of data: A search was performed in the online databases Virtual Health Library (VHL) and Pub- Med. Selection of studies: Articles published in the last 11 years were selected, totaling 12 analyzed articles. Data collection: Articles were searched based on the keywords puerperal infection, maternal mortality, cesarean section, risk factors in English and Portuguese. Following the adaptation to the inclusion criteria (articles in English, Portuguese and Spanish, publication in the last 11 years, carried out in humans) and exclusion (duplicates, literature review, case studies and dissertations), the analysis of the titles and abstracts of the found articles allowed the exclusion of those who departed from the topic under study. Summary of the findings: Among the sociodemographic factors, women of extreme age, blacks, residents in the rural area, with low economic and educational status, primiparous women and smokers, stand out. Regarding clinical factors, obesity, HIV, Diabetes Mellitus, Cardiovascular Diseases, Hypertension, Pre-eclampsia and Eclampsia, Anemia and genitourinary infections were risk factors for puerperal infection. Obstetric factors were also evaluated, identifying as important variables cesarean delivery, premature rupture of membranes, ruptured membrane time, labor longer than 12 hours, premature labor and induced labor, postpartum hemorrhage, previous transfusion and meconium in amniotic fluid. Finally, the care characteristics bring the low number of prenatal consultations, the number of vaginal touches before and after rupture of membranes as risk variables. Conclusion: Many of the identified factors are possible to control and their reversion contributes to the reduction of puerperal infection rates and consequently maternal mortality.(AU)

Using PacBio sequencing to investigate the effects of treatment with lactic acid bacteria or antibiotics on cow endometritis

BACKGROUND: Endometritis is the most common disease of dairy cows and traditionally treated with antibiotics. Lactic acid bacteria can inhibit the growth of pathogens and also have potential for treatment of endometritis. Using PacBio single-molecule real-time sequencing technology, we sequenced the fulllength l6S rRNA of the microbiota in uterine mucus samples from 31 cows with endometritis, treated with lactic acid bacteria (experimental [E] group) and antibiotics (control [C] group) separately. Microbiota profiles taken before and after treatment were compared. RESULTS: After both treatments, bacterial species richness was significantly higher than before, but there was no significant difference in bacterial diversity. Abundance of some bacteria increased after both lactic acid bacteria and antibiotic treatment: Lactobacillus helveticus, Lactococcus lactis, Lactococcus raffinolactis, Pseudomonas alcaligenes and Pseudomonas veronii. The bacterial species that significantly decreased in abundance varied depending on whether the cows had been treated with lactic acid bacteria or antibiotics. Abundance of Staphylococcus equorum and Treponema brennaborense increased after lactic acid bacteria treatment but decreased after antibiotic treatment. According to COG-based functional metagenomic predictions, 384 functional proteins were significantly differently expressed after treatment. E and C group protein expression pathways were significantly higher than before treatment (p < 0.05). CONCLUSIONS: In this study, we found that lactic acid bacteria could cure endometritis and restore a normal physiological state, while avoiding the disadvantages of antibiotic treatment, such as the reductions in abundance of beneficial microbiota. This suggests that lactic acid bacteria treatment has potential as an alternative to antibiotics in the treatment of endometritis in cattle.

Endometrite crônica e infertilidade / Chronic endometritis and infertility

A endometrite crônica (EC) é uma doença que, apesar de ainda pouco investigada, tem sido associada a resultados reprodutivos desfavoráveis. Estudos têm mostrado que a EC pode prejudicar a receptividade endometrial, levando a falhas de implantação e perdas gestacionais recorrentes. Os métodos padronizados para diagnóstico incluem histeroscopia, histologia para pesquisa de plasmócitos e cultura endometrial para identificação de agentes bacterianos. O tratamento com antibióticos para EC parece melhorar as taxas de gestação e nascidos vivos em pacientes com falhas de implantação e perdas gestacionais recorrentes sem causa conhecida. Esta publicação tem por objetivo fazer uma revisão da etiologia, fisiopatologia, diagnóstico e tratamento da EC, seu impacto no microambiente endometrial e sua associação com infertilidade. Esta revisão narrativa da literatura atualizada sintetiza os achados encontrados em bases de dados computadorizadas.(AU)

Chronic endometritis (CE) is a poorly investigated disease, which has been related to adverse reproductive outcomes. Published studies have shown that CE can impair endometrial receptivity, which is associated with implantation failure and recurrent pregnancy loss. The standard tools for diagnosis include hysteroscopy, histology to identification of plasma cells and endometrial culture for identification of bacterial pathogens. Effective antibiotic treatment for CE seems to improve the pregnancy and live birth rates in patients with implantation failure and unexplained recurrent pregnancy loss. This paper intends to provide an overview of etiology, pathophysiology, diagnosis and treatment of CE, its impact on endometrial microenvironment and its association with infertility. This narrative review of the current literature synthesizes the findings retrieved from searches in computerized databases.(AU)

Lesions of the sheep reproductive system found in a slaughterhouse in the state of Bahia, Brazil / Lesões do sistema reprodutor em ovelhas de abatedouros frigoríficos no estado da Bahia

The present study aimed to evaluate and diagnose pathologies of the reproductive system of slaughtered sheep in slaughterhouses in the state of Bahia since there are few data on the subject as well as it is important to note the diagnosis of these diseases to apply appropriate control and prophylaxis measures. The research was carried out in slaughterhouses in the state of Bahia according to the "Serviço de Inspeção Federal" and "Serviço de Inspeção Estadual" for sheep slaughter. From July 2018 to February 2019, visits and monitoring of 1,072 slaughtered sheep were carried out. The animals came from 22 municipalities in the state of Bahia, aged from six to 18 months. During slaughter, the sheep reproductive systems were sectioned for evisceration and lesion collection. Additionally, epidemiological surveys related to origin, age, and race were obtained. For bacteriological examination, collections were performed with sterile scalpel slides and swabs in Stuart medium sterile tubes and refrigerated in a thermal box. For histopathological analysis, fragments were fixed in 10% formaldehyde and routinely processed for histology, stained with Hematoxylin and Eosin (HE). A study of the sheep's main pathological changes in slaughterhouses in the state of Bahia was carried out, in which 1.072 genital systems were evaluated, and 211 alterations were identified. The most affected reproductive organs were the ovaries (65.3%), followed by the uterus (29.4%) and uterine tubes (5.3%). In the ovaries, the most frequent lesion was a follicular cyst (34.1%); in the fallopian tubes, the cysts represented 3.3% of the lesions, and in the womb, endometritis was observed in 9% of the animals. Other pathologies identified in the ovaries were: luteinized cyst (2.3%); cystic granulosa cell tumor (0.5%); benign lesion (0.5%); agenesis unilateral (0.5%), in addition to other changes of little clinical significance, such as corpus luteum cysts (11.8%) and paraovarian cysts (15.6%). In the fallopian tubes, hydrosalpinx was observed (1%), as well as adenoma (0.5%), agenesis (0.5%), and cysts (3.3%). Uterine lesions included hydrometra (2.3%); Cystic Endometrial Hyperplasia (CEH), abscess, and pyometra (1.4% each); adenomyosis, womb sera petechiae, and total segmental aplasia (1% each); two pregnant uterus, in early pregnancy, presented pyometra (0.9%), however, no change was observed in the fetuses; and uterine polyp (0.5%). Ectopic pregnancy with fetal maceration (0.5%) was observed; vaginitis occurred in 0.5% of the animals, and endometrial melanosis in 8.5%. The high incidence of follicular cysts and endometritis are characterized as diseases that reduce the reproductive efficiency in herds, causing infertility and economic losses in production.(AU)

O objetivo do presente trabalho foi avaliar e diagnosticar alterações do sistema reprodutor de ovelhas abatidas em abatedouros frigoríficos no estado da Bahia. A pesquisa foi realizada em abatedouros frigoríficos do estado da Bahia com Serviços de Inspeção Federal e Estadual no abate de ovinos. No período de julho de 2018 a fevereiro de 2019 foram realizadas visitas e acompanhamento do abate de 1.072 ovelhas. Os animais eram provenientes de 22 municípios do estado da Bahia, com idade entre 6 a 18 meses. Durante o abate, na evisceração foram seccionados os sistemas reprodutores das ovelhas para avaliação e coleta das lesões. Adicionalmente foram obtidos inquéritos epidemiológicos relacionados à procedência, idade e raça. Para o exame bacteriológico, as coletas foram realizadas com lâminas de bisturi estéreis e swabs em tubos estéreis com meio Stuart e refrigeradas em caixa térmica. Para análise histopatológica, os fragmentos foram fixados em formol a 10% e processados de forma rotineira para histologia e corados pela hematoxilina e eosina (HE). Entre 1.072 sistemas genitais avaliados, identificou-se 211 alterações. Os órgãos do sistema reprodutor mais acometidos foram os ovários (65,3%), útero (29,4%) e tubas uterinas (5,3%). Nos ovários, a lesão mais frequente foi o cisto folicular (34,1%); no útero a endometrite (9%) e nas tubas uterinas, os cistos representaram (3,3%). Outras lesões identificadas nos ovários foram: cisto luteinizado (2,3%); tumor de células da granulosa (0,5%); adenoma (0,5%); agenesia unilateral (0,5%), além de outras alterações de pouco significado clínico, como cistos paraovarianos (15,6%) e corpo lúteo cístico (11,8%). Nas tubas uterinas observou-se, além dos cistos tubo-ovarianos (3,3%), hidrossalpinge (1%), adenoma (0,5%) e agenesia (0,5%). As lesões uterinas foram endometrite (9%), hidrometra (2,3%); hiperplasia endometrial cística, abscesso e piometra (1,4% cada); adenomiose, petéquias na serosa do útero e aplasia segmentar (1% cada); dois úteros gravídicos, em início de gestação, apresentaram piometra (0,9%), porém os fetos não apresentaram alterações; e pólipo uterino (0,5%). Observou-se uma gestação ectópica com maceração fetal (0,5%); a vaginite ocorreu em 0,5%, e melanose endometrial em 8,5%. Destaca-se a elevada incidência de cistos foliculares e endometrite que são doenças que reduzem a eficiência reprodutiva dos rebanhos, provocando infertilidade e perdas econômicas na produção.(AU)

Acute endometritis induced by Escherichia coli in mares evaluated through color doppler ultrasonography / [Endometrite aguda induzida por Escherichia coli em éguas avaliadas por ultrassonografia com Doppler colorido]

The objectives of this study were to characterize the endometritis induced in mares using color Doppler ultrasonography and traditional exams. Experiment 1. Mares (n=20) were submitted to intrauterine inoculation with Escherichia coli. Uterine evaluation was performed at M0 and M1. Experiment 2. Animals were divided into two groups: control group (n=10), and treated group (n=10) using phytotherapeutic solution. In both groups, the uterine evaluation was performed at time T1, T2, and T3. Experiment 3: Uterine evaluation was compared after antibiotic therapy, phytotherapy, and M0. For statistical analysis, the Tukey test, t Student, and Anova test were applied. Experiment 1. The mean values of vascularization at M1 were significantly higher than those obtained at M0 (P<0.05). Bacterial growth was observed in all samples collected. Experiment 2. The mean value of vascularization at time T1 in both groups was significantly higher (P<0.05) compared to M2 and M3. Experiment 3. After antibiotic therapy, the vascularization of the body and uterine horns was not equivalent to the vascularization presented at M0. We can conclude that it was not possible to correlate results obtained by color Doppler ultrasonography with the traditional findings for the diagnosis of endometritis.(AU)

Os objetivos deste estudo foram caracterizar a endometrite induzida em éguas utilizando-se a ultrassonografia com Doppler colorido e exames tradicionais. Experimento 1: as éguas (n=20) foram submetidas à inoculação intrauterina com Escherichia coli. A avaliação uterina foi realizada em M0 e M1. Experimento 2: os animais foram divididos em dois grupos: grupo controle (n=10) e grupo tratado (n=10), sendo usada solução fitoterápica. Nos dois grupos, a avaliação uterina ocorreu nos momentos T1, T2 e T3. Experimento 3: a avaliação uterina foi comparada após antibioticoterapia, fitoterapia e M0. Para análise estatística, foram aplicados os testes de Tukey, t de Student e ANOVA. Experimento 1: os valores médios de vascularização em M1 foram significativamente maiores que os obtidos no M0 (P<0,05). Houve crescimento bacteriano em todas as amostras coletadas. Experimento 2: o valor médio da vascularização no tempo T1 nos dois grupos foi significativamente maior (P<0,05) do que o obtido em M2 e M3. Experimento 3: após antibioticoterapia, a vascularização do corpo e dos cornos uterinos não era equivalente à vascularização apresentada em M0. Pode-se concluir que não foi possível correlacionar os resultados obtidos pela ultrassonografia com Doppler colorido com os achados tradicionais para o diagnóstico de endometrite.(AU)

Endometritis granulomatosa por tuberculosis en mujer postmenopaúsica / Granulomatous tuberculosis endometritis in a posmenopausal woman

INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.

INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.

Establishment and evaluation of multiplex PCR for detection of main pathogenic bacteria of endometritis in Tibetan sheep / 生物工程学报

A multiplex PCR method was developed to detect the main pathogens of Qinghai Tibetan sheep endometritis. First, the genomes of five standard bacterial strains were extracted and specific primers were selected; the multiplex PCR method was established by using the genome of the standard strain as a template. The samples were collected by sterile cotton swab from Tibetan sheep uterus, and then placed in LB medium and numbered. After 48 h, the genomes of cultured bacteria were extracted and detected by single PCR method, then the positive samples were recorded. The positive samples detected by single PCR were selected for multiplex PCR detection and recorded again. The coincidence rate between these two methods was calculated to measure the accuracy of multiplex PCR. In order to identify the species of the pathogen, 30 positive samples verified by single and multiplex PCR were randomly selected for bacterial isolation and identification. In the 600 samples, the infected ratio of Streptococcus agalactiae (GBS) was 47.33%, Escherichia coli 34.83%, Staphylococcus aureus 6.5%, Salmonella and Trueperella pyogenes were negatively detected. Among the positive samples detected by multiplex PCR, the positive ratio of GBS was 45.50%, E. coli 33.50%, S. aureus 6.5%. Comparison of two detection results, Multiplex PCR detection coincidence rate is more than 95%. The isolated pathogens were identified as E. coli, GBS and S. aureus, which was consistent with the results of two methods. The multiplex PCR method was successfully established and the main pathogens of endometritis in Qinghai Tibetan sheep were GBS, E. coli and S. aureus.

Coxiella burnetii associated with BVDV (Bovine Viral Diarrhea Virus), BoHV (Bovine Herpesvirus), Leptospira spp, Neospora caninum, Toxoplasma gondii and Trypanosoma vivax in reproductive disorders in cattle / Coxiella burnetii associada ao BVDV (Vírus da Diarreia Viral Bovina), BoHV (Vírus do Herpes Bovino), Leptospira spp, Neospora caninum, Toxoplasma gondii e Trypanosoma vivax em distúrbios reprodutivos em bovinos

Abstract This is a cross-sectional study to assess the presence of antibodies in ruminants against selected pathogens associated with reproductive disorders in cattle in four Brazilian states, including the zoonotic agent Coxiella burnetii. The used tests were Virus Neutralization Assay for IBR and BVD, Microscopic Agglutination Test for Leptospira spp., Indirect Fluorescent Antibody Test (IFAT) for C. burnetii and Toxoplasma gondii, and Enzyme-Linked Immunosorbent Assay for Neospora caninum and Trypanosoma vivax. Seropositivity for C. burnetii was 13.7% with titers from 128 to 131,072; 57.8% for BoHV-1, with titers between 2 and 1,024; 47.1% for BVDV-1a, with titers from 10 to 5,120; 89.2% for N. caninum; 50% for T. vivax; and 52.0% for Leptospira spp., with titers between 100 to 800 (the following serovars were found: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona and Icterohaemorrhagiae); 19.6% for T. gondii with titer of 40. This is the first study that has identified C. burnetii in cattle associated with BoHV and BVDV, N. caninum, Leptospira spp., T. gondii and T. vivax. Thus, future studies should be conducted to investigate how widespread this pathogen is in Brazilian cattle herds.

Resumo Este é um estudo transversal para avaliar a presença de anticorpos em ruminantes contra patógenos selecionados e associados a distúrbios reprodutivos em bovinos de quatro estados brasileiros, incluindo o agente zoonótico Coxiella burnetii. Os testes utilizados foram Teste de Vírus-Neutralização para BoHV e BVDV, teste de Aglutinação Microscópica para Leptospira spp., Reação de Imunofluorescência Indireta for C. burnetii e Toxoplasma gondii, e Ensaio de Imunoabsorção Enzimática para Neospora caninum e Trypanosoma vivax. A soropositividade para C. burnetii foi de 13,7% com títulos de 128 a 131.072; 57,8% para BoHV-1, com títulos entre 2 a 1.024; 47,1% para BVDV-1a, com títulos de 10 a 5.120; 89,2% para N. caninum; 50% para T. vivax; e 52,0% para Leptospira spp., com títulos entre 100 a 800 (sorovares encontrados: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona e Icterohaemorrhagiae) 19,6% para T. gondii com título de 40. Este é o primeiro estudo que evidencia a participação de C. burnetii em bovinos associada ao Vírus da Rinotraqueíte bovina infecciosa e da diarreia viral bovina, N. caninum, Leptospira spp., T. gondii e T. vivax em bovinos. Desta forma, futuros estudos devem ser conduzidos a fim de investigar o quão disseminado se encontra este patógeno em rebanhos bovinos brasileiros.

Characteristic profiles of biofilm, enterotoxins and virulence of Staphylococcus aureus isolates from dairy cows in Xinjiang Province, China

As an important zoonotic pathogen, Staphylococcus aureus has led to serious mastitis and endometritis in infected dairy cows. In this study, a total of 164 strains of S. aureus were isolated from dairy cows in Xinjiang Province, China, and subjected to assays to determine drug susceptibility and biofilm (BF) formation ability. Enterotoxin-related genes were detected, and the transcription levels of genes related to BF formation were determined by using reverse transcription-quantitative polymerase chain reaction. Moreover, the pathogenicity of isolates with different BF formation abilities was determined by measuring their hemolysis activity, half lethal dose (LD₅₀) and organ bacterial load. The results showed that 86.0% of S. aureus isolates could form BF. Among them, 42.1% of the strains had weak BF formation ability, and most strains with a strong BF formation ability were ica gene carriers. The S. aureus isolates displayed multidrug resistance and their drug resistance was positively correlated with their BF formation ability. Moreover, 96.3% of the S. aureus isolates carried enterotoxin genes. Among them, the detection rates of the novel enterotoxin genes were higher than those of conventional enterotoxin genes. Furthermore, isolates with a strong BF formation ability had higher LD50 but lower hemolysis ability and organ bacterial load than those of the isolates with weak or no BF ability. However, isolates without BF ability produced more severe pathological changes than those of isolates with strong BF formation ability. These findings suggest that higher BF ability and presence of novel enterotoxin genes are important characteristics of S. aureus isolates from dairy cows in Xinjiang Province, China, and such isolates may pose potential threats to food safety.

Thick “Swiss Cheese” Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Prevalence of inflamatory processes in the reproductive tracts of crossbred dairy cows / Prevalência de processos inflamatórios no sistema reprodutivo de vacas leiteiras mestiças

This study evaluated the prevalence of cervicitis and endometritis and their interrelations in crossbred dairy cows that were more than 60 days in milk (DIM), and the efficiency of the cytology technique (cytobrush) and histology as diagnostic methods for these diseases. The reproductive tracts (n=149) derived from cows were collected from a slaughterhouse and grossly evaluated to determine uterine involution and the phase of the estrous cycle. Subsequently, cervical and uterine cytological evaluations were done to characterize the inflammatory response as cervicitis (with a neutrophilic count greater than 5%) or endometritis (with more than 6% neutrophils). Additionally, randomly obtained samples from the cervix and uterus were collected for histological evaluation. Cytological evaluation revealed that the frequency of cervicitis was 6% (9/149), and endometritis was diagnosed in 8.1% (12/149) of the samples; both inflammatory reactions were diagnosed 2.1% (3/149) in three of these. Histological evaluation revealed that of the cows diagnosed with cervicitis by cytology, 66.6% (6/9) had no inflammatory reaction in the cervical mucosa, and 33.3% (3/9) had mild inflammation in this region. Histological evaluation of the uterine horn revealed that of the 12 cows diagnosed with endometritis by cytology, 50% (6/12) of these had a histological diagnosis of mild and moderate inflammatory responses, 8.3% (1/12) of these demonstrated a severe inflammatory response, while no inflammatory reaction was identified in 41.7% (5/12) of the endometrial biopsies evaluated. In conclusion, the endometrial and cervical inflammatory response diagnosed by the cytobrush technique persisted in 12.1% of the cows. Comparatively, the frequency of the inflammatory responses at the cervix and uterus was reduced by histological analysis relative to cytological evaluation with the cytobrush technique.

O objetivo deste estudo foi determinar a prevalência de cervicite e endometrite citológicas e suas inter-relações em vacas leiteiras mestiças com mais de 60 dias pós-parto (DPP), bem como avaliar as técnicas de citologia (cytobrush) e histologia como métodos diagnósticos para estas doenças. Foram utilizados 149 tratos reprodutivos de vacas com mais de 60 DPP de abatedouro e avaliados macroscopicamente para determinar a involução uterina e a fase do ciclo estral. Posteriormente, realizou-se citologia cervical e uterina para o diagnóstico de inflamação utilizando como ponto de corte, contagem de polimorfonucleares (PMN) superior a 5% e 6%, respectivamente, para cervicite e endometrite citológica. Também foram coletadas amostras de cérvix e útero para histologia. Do total de vacas, identificaram-se 6% (9/149) com cervicite e 8,1% (12/149) com endometrite citológica, sendo três destes animais (2,1%) com ambas as inflamações. Histologicamente, dos animais com cervicite citológica, 66,6% (6/9) não apresentaram infiltrado inflamatório na mucosa cervical e 33,3% (3/9) apresentaram inflamação leve. A histologia uterina mostrou que de 12 vacas com endometrite citológica, 50% (6/12) apresentaram infiltrados inflamatórios leves a moderados, 8,3% (1/12) grave e 41,7% (5/12) não tinham Inflamação endometrial. Concluiu-se que a inflamação endometrial e cervical, por meio da técnica de citologia, persistiu em 12,1% das vacas com mais de 60 DPP. Quando se utiliza a histologia como método de diagnóstico, a detecção de inflamação cervical e uterina é inferior ao detectado pela técnica de citologia por meio do esfregaço endometrial (cytobrush).

Retenção de placenta e endometrite subclínica: prevalência e relação com o desempenho reprodutivo de vacas leiteiras mestiças / Retained placenta and subclinical endometritis: prevalence and relation with reproductive performance of crossbred dairy cows

Objetivou-se avaliar os efeitos do tipo de parto (eutócico vs. distócico) e do período do ano (chuvoso vs. seco) sobre a prevalência de retenção de placenta (RP) e de endometrite subclínica (ES), verificar a relação entre as duas patologias, e os efeitos dessas sobre a taxa de descarte, o período de serviço (PS) e número de IA/concepção. A RP foi avaliada no primeiro dia pós-parto (DPP). A citologia endometrial foi realizada entre 30 e 80 DPP, considerando positivos casos contendo acima de 5% de neutrófilos. Os dados foram analisados por regressão logística e análise de variância no programa Minitab (P<0,05). A prevalência de RP foi de 14,93% (69/462) e de ES de 27,49% (127/462). Foi detectada tendência de efeito (P=0,10) da RP sobre a prevalência da ES. Partos distócicos aumentaram a prevalência de RP e vacas que pariram nos meses chuvosos tiveram maior prevalência de ES (P<0,05). A RP elevou a taxa de descarte (P<0,05), a duração do período de serviço (P<0,05) e o número de IA por concepção (P<0,05), enquanto a ES não afetou essas variáveis (P>0,05). Conclui-se que a retenção de placenta tende a ser um fator de risco para endometrite subclínica, distocia predispõe à retenção de placenta e partos ocorridos no período chuvoso aumentam os casos de endometrite subclínica. Há um impacto negativo na eficiência reprodutiva de vacas leiteiras mestiças acometidas por retenção de placenta.(AU)

This study aimed to evaluate the effects of type of calving (eutocic vs. dystocic), season of the year (rainy vs. dry) on retained placenta (RP) and subclinical endometritis (SE) prevalence, to verify the relation between these diseases, as well as its effects on culling rate, days open and number of AI/conception. Retention of fetal membranes was recorded on first day postpartum. Endometrial cytology was performed between 30 and 80 days in milk (DIM) and positive cases were considered ≥5% neutrophils. Data were analysed by logistic regression and analysis of variance on Minitab program (P<0.05). The prevalence of RP was 14.93% (69/462) and of SE was 27.49% (127/462). A tendency of effect of RP on SE prevalence was detected (P=0.10). Dystocia increased RP prevalence (P<0.05). Cows that calved during rainy months had greater SE prevalence (P<0.05). RP increased culling rate (P<0.05), calving to conception interval (P<0.05) and number of AI/conception (P<0.05), although SE occurrence did not affect these variables (P>0.05). In conclusion, RP tended to be a risk factor for SE, dystocia is a predisposing factor for RP and calvings that happens during rainy period increases SE. There is a negative impact on reproductive efficiency of crossbred dairy cows that had retained placenta.(AU)

Cytological endometritis in dairy cows: diagnostic threshold, risk factors, and impact on reproductive performance

We determined the threshold proportion of polymorphonuclear leukocytes (PMNs) for a diagnosis of cytological endometritis (CEM), the risk factors for this condition, and its impact on reproductive performance in dairy cows. Uterine cytology was performed on 407 Holstein cows 4 weeks postpartum to determine the proportions of endometrial cells and PMNs. A receiver operator characteristics curve was used to determine the threshold above which the PMN proportion affected the likelihood of cows conceiving by 200 days postpartum. The optimal threshold was ≥ 14% PMN (sensitivity, 31.3%; specificity, 81.7%; p < 0.05). The farm identity, retained placenta (odds ratio [OR] = 1.87), and septicemic metritis (OR = 3.07) were risk factors for CEM (p < 0.05). Cows with CEM were less likely to resume cyclicity (OR = 0.58) and to conceive by 200 days postpartum (hazard ratio = 0.58). Cows with CEM tended (p < 0.1) to be less likely to become pregnant after their first insemination (OR = 0.65) and to require a greater number of inseminations per conception (2.3 vs. 2.2). In conclusion, a PMN threshold of 14% defined the presence of CEM at 4 weeks postpartum. The farm, retained placenta, and septicemic metritis were risk factors for CEM, which reduces subsequent reproductive performance.

The impact of HSF on endometrium

Summary Objective: We conducted the research in order to explore the impact of hydrosalpinx fluid (HSF) on endometrium. Method: HSF group: 261 patients with HSF scheduled to undergo laparoscopic surgery 3 to 7 days after menstruation in our center. Hysteroscopy would also be performed in order to observe the endometrial morphology during the surgery. Sixty (60) patients would be randomly selected for endometrial biopsy in order to detect the inflammatory cytokines TNF-a and IL-2 mRNA. Non-HSF group: 210 patients with no evidence of HSF due to chronic salpingitis or pelvic adhesion. IVF-ET treatment was performed after eliminating the factor of male infertility and hysteroscopy was conducted before the treatment. Fifty (50) patients underwent endometrial biopsy in order to detect TNF-a and IL-2 mRNA. Results: Hysteroscopy was performed in 261 patients with HSF and 210 patients without HSF. The incidence rate of endometritis manifestation among these two groups of patients was 37.2% (97/261) and 20.5% (43/210), respectively. The incidence rate of endometritis in the patients with HSF is significantly higher than in the patients without HSF (p<0.05). Sixty (60) patients from the HSF group and 50 patients from the non-HSF group were regrouped according to inflammatory and normal manifestation after the endometrial biopsy. There were 49 patients in the inflammatory manifestation group and 61 patients in the normal manifestation group. RT-PCR technology was adopted to detect the expression of inflammatory cytokines TNF-a and IL-2 mRNA in endometrial tissue. The level of TNF-a mRNA expression in endometrial tissues with inflammatory manifestation was higher than in normal endometrium (76.75±11.95 vs. 23.45±9.75, p<0.01). There are significant differences between them. The level of IL-2 mRNA expression in endometrial tissues with inflammatory manifestation was higher than that found in normal endometrium (80.56±13.35 vs. 35.12±8.35, p<0.01). There are significant differences between them. Conclusion: Chronic endometritis is related to HSF and may therefore affect endometrial receptivity.

Citocentrifugação e métodos convencionais na citologia uterina de éguas em estro e diestro / Cytocentrifugation and conventional methods in endometrial cytology of estrus and diestrus mares

A citologia uterina consiste em método prático e eficiente para o diagnóstico de afecções uterinas na égua, contribuindo para a conduta terapêutica e o prognóstico quanto à fertilidade das fêmeas. Assim, o objetivo deste trabalho foi comparar diferentes técnicas de coleta de material para citologia uterina em éguas, a fim de se verificarem possíveis diferenças qualitativas e quantitativas e a praticidade na execução das metodologias. Para tanto, 12 éguas multíparas foram submetidas ao exame citológico uterino, durante o estro e o diestro, por meio de escova ginecológica e lavado uterino de baixo volume. Com esse ensaio, observou-se que não houve diferença significativa (P>0,05) no resultado da citologia uterina entre as diferentes técnicas avaliadas. No entanto, quando comparadas as fases do ciclo estral, houve uma diferença significativa (P<0,05) quanto ao percentual médio de polimorfonucleares neutrófilos, sendo de 8,07±2,80 no estro e de 1,55±0,28 no diestro. Conclui-se, desse modo, que as técnicas estudadas apresentaram resultados igualmente eficazes para detecção de neutrófilos ao exame citológico do útero em ambas as fases avaliadas do ciclo estral, apesar de, na fase de estro, a detecção de maior percentual de neutrófilos possibilitar um diagnóstico e um prognóstico mais precoces de endometrite e, portanto, uma conduta terapêutica mais adequada.(AU)

The endometrial cytology consists in an efficient and practical method for the diagnosis of uterine disorders in mares, contributing for therapeutic conduct and prognostic evaluation regarding the females' fertility. Therefore, the aim of this study was to compare different techniques of material sampling for endometrial cytology in mares, in order to verify possible qualitative and quantitative differences in the practicality of implementation of this methodology. Twelve multiparous mares underwent an endometrial cytological exam, during estrus and diestrus, by means of a cytobrush and a low-volume uterine flush. With this test, no statistical difference was observed (P>0.05) regarding the result of endometrial cytology between the evaluated techniques. However, in comparison to the estrous cycle's phases, a significant difference was verified (P<0.05) on the average percentage of polymorphonuclear neutrophils: 8.07±2.80 in estrus and 1.55±0.28 in diestrus. Thus, we conclude that the studied techniques presented equally effective results for the detection of neutrophils in the cytological exam for both evaluated stages of the estrous cycle, whereas in estrus phase, the detection of a higher percentage of neutrophils allows a more precocious diagnostic and prognostic of endometritis and, therefore, a more adequate therapeutic approach.(AU)

Factores de riesgo para endometritis puerperal en pacientes que asisten para terminación del embarazo en el hospital Simón Bolivar entre enero 2007 a diciembre 2013 / Risk factors for puerperal endometritis in patients attending for termination of pregnancy at Simón Bolivar hospital between january 2007 to december 2013

La endometritis Posparto constituye la causa más frecuente de fiebre puerperal, y su incidencia aumenta con la presencia de ciertos factores de riesgo que se pueden encontrar en todos los niveles de atención de la gestante y su identificación, permitiría disminuir la morbimortalidad en los servicios de Ginecología y Obstetricia. OBJETIVO Determinar los factores de riesgo para endometritis puerperal en el servicio de Ginecología y Obstetricia del Hospital Simón Bolívar. MATERIALES Y MÉTODOS Se realizó un estudio observacional tipo analítico retrospectivo de casos y controles en el Hospital Simón Bolívar de la ciudad de Bogotá, en mujeres que asistieron durante el periodo comprendido entre Enero de 2007 a Diciembre de 2013 para terminación del embarazo durante el tercer trimestre. RESULTADOS Se analizaron un total 408 pacientes, 136 pacientes con endometritis postparto (casos) y 272 pacientes sin endometritis (controles), con una relación caso control de 1 caso por cada 2 controles. Al realizar el análisis de las variables a estudio como: paridad, ruptura de membranas, vía del parto, índice de masa corporal, revisión uterina, infección de vías urinarias y presencia de flujo vaginal, asociado a endometritis no mostraron resultados estadísticamente significativos. La asociación entre la edad de la madre, edad gestacional al momento del parto y preeclampsia evidenciaron un ligero aumento del riesgo para endometritis puerperal. CONCLUSIÓN Los principales factores de riesgo para endometritis puerperal encontrados entre las pacientes atendidas por servicio de Ginecología y Obstetricia del Hospital Simón Bolívar fueron gestantes de edad avanzada, pacientes con preeclampsia asociada y edad gestacional menor de 37 semanas al momento del parto. La vía de parto y la atención intraparto no tuvieron asociación ni aumento del riesgo de forma significativa.

Endometrial polyp surveillance in premenopausal breast cancer patients using tamoxifen

OBJECTIVE: To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use. METHODS: We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination. RESULTS: Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma. CONCLUSION: For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.

Histopathologic findings in uteri and ovaries collected from clinically healthy dogs at elective ovariohysterectomy: a cross-sectional study

Opinions on ovariohysterectomy (OHE) of bitches vary depending on region and country. In this descriptive, prospective cross-sectional study, uterine tracts and ovaries exhibiting gross pathologic findings (n = 76) were collected post-surgery from a reference population of 3,600 bitches (2.11% incidence) that underwent elective OHE during September to November 2013 and evaluated by histopathology examination. Data were evaluated by using descriptive statistics and chi-squared tests. Bitches were of crossbred background with average age 5 years (range 0.6–8.0 years) and most were nulliparous (69.7%) with no anamnesis of reproductive diseases (81.6%). Frequencies of proestrus, estrus, and diestrus were 42.1%, 6.6%, and 19.7%, respectively. The presence of mammary gland masses (5.3%) significantly correlated with histopathologic findings in ovaries and age of the bitch (p < 0.05). Predominant uterine histopathologies included cystic endometrial hyperplasia, periglandular fibrosis, lymphoplasmocytary endometritis, and adenomyosis (19.7%, 14.5%, 4.0%, and 2.6%, respectively). In ovaries, hyperplasia of rete ovarii, follicular cysts, oophoritis, adenoma of the rete ovarii, cysts of superficial structures, and granulosa cell tumors (10.5%, 10.5%, 7.9%, 4.0%, 2.6%, and 2.6%, respectively) were observed. The results reveal the presence of subclinical pathologies in healthy bitches, suggesting that OHE at an early age is beneficial for prevention of reproductive pathologies.

Efeito da suplementação com colina protegida sobre parâmetros bioquímicos, produção e reprodução de vacas leiteiras no periparto / Effect of protected choline supplementation on biochemical parameters, production, and reproduction of dairy cows in peripartum

Avaliou-se o efeito da suplementação com colina protegida sobre o perfil energético, as enzimas hepáticas e a reprodução de vacas leiteiras no periparto. Quinze vacas leiteiras foram divididas em dois grupos experimentais: oito receberam 80 gramas de colina protegida por 21 dias no pré-parto e por 40 dias no pós-parto e sete foram consideradas controle. Amostras de sangue foram coletadas nos dias 10, 20, 30 e 60 pós-parto para avaliação dos perfis energético e hepático. Aos 60 dias pós-parto, realizou-se exame ginecológico dos animais para avaliação da saúde reprodutiva. A suplementação com colina protegida não alterou os níveis de beta-hidroxibutirato (BHBA), ácidos graxos não esterificados (AGNE), frutosamina, fator de crescimento semelhante a glicose I (IGF-I), status oxidante total (TOS), aspartato aminotransferase (AST) e gamaglutamiltransferase (GGT) no pós-parto. Não houve diferença também quanto à produção de leite. Aos 60 dias pós-parto, vacas suplementadas com colina protegida apresentaram menor número de casos de endometrite que vacas do grupo controle. A suplementação de colina protegida não alterou o perfil bioquímico e a produção de leite, mas reduziu o número de casos de endometrite no pós-parto de vacas leiteiras.(AU)

The study aimed to evaluate the effect of supplementation with protected choline on the energy profile, liver enzymes and reproduction in dairy cows in peripartum. Fifteen cows were divided into two groups: 8 received 80 grams of protected choline for 21 days pre-partum and 40 days postpartum, and 7 were considered control. Blood samples were collected on days 10, 20, 30, and 60 postpartum to evaluate the energy and hepatic profiles. After 60 days postpartum a gynecological examination of animals for evaluation of reproductive health was done. The supplementation with choline protected did not alter the beta-hydroxybutyrate levels (BHBA), non-esterified fatty acids (NEFA), fructosamine, like growth factor glucose (IGF-I), total oxidant status (TOS), aspartate aminotransferase (AST) and glutamiltrasferase range (GGT) postpartum. There was no difference in milk production. After 60 days postpartum, cows fed protected choline had fewer cases of endometritis that cows in the control group. The protected choline supplementation did not alter the biochemical profile and milk production, but reduced the number of endometritis cases in postpartum dairy cows.(AU)