Tratamento de ferida em Coendou prehensilis (Rodentia: Erethizontidae) com laserterapia e ozonioterapia: relato de caso / Wound treatment of Coendou prehensilis (Rodentia: Erethizontidae) with laser and ozone therapy: case report

O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.(AU)

The use of therapy with laser beam and ozone in wounds has a high beneficial potential for patients, since it contributes to the management of pain, has an anti-inflammatory action and accelerates the cicatricial process. Due to this casuistry importance, the case report aims to present alternative therapy use for wound healing on a Coendou prehensilis. Thus, a female of C. prehensilis weighing 4kg, was sent to veterinary care. At first there was a hygiene process and debridement for necrotic edge removal. Furthermore, injected clindamycin (10mg/kg) was administered intramuscularly (IM), once a day (SID), tramadol (4mg/kg, IM, SID), flunixin (0.3mg/kg, SID), administered subcutaneously (SC) and iron dextran (25mg/kg, IM, SID). In spite of the established therapy, tissue necrotic growth was observed, which lead the wound treatment as healing by second intention, initiating an alternative therapy with laser beam and ozone. As a result, the healing was satisfactory due to the elected techniques, without signs of pain and infection. The adjuvant treatment with physiotherapy had advantageous effect and could be applied to wound healing in wild mammal animals.(AU)

Skeletogenesis of the pectoral girdle and forelimbs in embryos of Caiman yacare (Daudin, 1802) (Crocodylia, Alligatoridae)

Embryos of Caiman yacare were collected and subjected to the bone clearing and staining protocol in orderto analyze the ontogenetic patterns of ossification of the pectoral girdle and forelimb skeleton. The osseousstructure of the girdle and forelimbs of C. yacare begins to ossify starting at 30 days of incubation, withthe presence of dye retention in the scapula, coracoids, humerus, radius and ulna bones. During embryonicdevelopment, the autopodio of C. yacare has four bones in the carpus, the radial, ulnar, pisiform and carpaldistal 4+5 bone. Their ossification begins at 39 days of incubation with the radial, followed by the ulnar, and at54 days, the pisiform and the distal carpal 4 + 5. Each mesopodio has 5 metacarpi and are present 15 phalanges,two in digits I and V, three in digits II and IV, and four in digit III (phalangeal formula 2:3:4:3:2). Ossificationof the metacarpi starts at 27 days of incubation, following the sequence MCII=MCIII=MCIV>MCI>MCV.The first phalanges begin the process of ossification on day 36, continuing up to the last day of incubation.The sequence of ossification of the proximal phalanges is PPI=PPII=PPIII>PPIV=PPV, that of the medialphalanges is MPII>MPpIII>MPdIII>MPIV, and that of the distal phalanges is DPI>DPII>DPIII>DPV>DPIV.The ontogenetic pattern of the bones of the forepaw of C. yacare generally differs from that of other reptiles,although there are some similarities.

Proposta de Sistema de Informação para Atenção Farmacêutica baseado no Método Dáder / Proposal of an Information System for Pharmaceutical Care based on Dader Method

A característica principal do Acompanhamento Farmacoterapêutico, um dos macrocomponentes da Atenção Farmacêutica, é a documentação sistemática de informações para solução dos Problemas Relacionados aos Medicamentos (PRM). Essa documentação é feita, com frequência, de forma não automatizada e com o preenchimento de fichas manuais catalogadas em arquivos, o que dificulta a sua organização e torna o processo de recuperação dos dados exaustivo e complicado, limitando a sua aplicação no cotidiano. Uma maneira de minimizar estes problemas é utilizar um sistema de informação para dinamizar esse processo, facilitar o acesso aos dados da terapia e melhorar a comunicação entre o médico e a equipe de saúde responsável pelo paciente. Este artigo apresenta, portanto, o desenvolvimento de um sistema para Atenção Farmacêutica baseado no método Dáder, denominado Farmatools. Esse sistema tem como objetivo informatizar o método Dáder, facilitando o acompanhamento farmacoterapêutico, otimizando o tempo de visita e melhorando a recuperação de informação e a comunicação entre os profissionais de saúde. O Farmatools visa melhorar o acesso à informação, diminuindo a inacessibilidade e a perda das informações.

These registrations are often not automated, but done by filling manual forms, that are cataloged. Over time, with the increase in attendances, there is an increase in the number of forms (amount of paper), making the recovery data process extensive and complicated, thereby, its application in daily life. One way to minimize these problems is to use an information system to improve the process and facilitate the data access recorded during the visits, improving communication with the doctor and the health care team responsible for the patient. This paper presents Farmatools, anelectronic system for pharmaceutical care based on Dader Method. The system aims to automate the Dader method, facilitating the pharmaceutical monitoring, reducing visit time, improving the information retrieval, as well as the communication between health professionals. Furthermore, Farmatools avoid the pharmaceutical paper records of patients accumulation, the inaccessibility of them and the loss of information.

Nonspecific interstitial pneumonitis mimicking Pneumocystis carinii pneumonia.

Bronchoalveolar lavage (BAL) and transbronchial biopsies from 351 human immunodeficiency virus (HIV)-positive patients with presumed Pneumocystis pneumonia were analyzed to determine the spectrum and frequency of interstitial lung disease mimicking Pneumocystis pneumonia. Among 67 patients without Pneumocystis, nonspecific interstitial pneumonitis (NSIP) was the most common histologic diagnosis (n = 16). Tissue sections from patients with NSIP were tested by in situ hybridization for Epstein-Barr virus, cytomegalovirus (CMV), and HIV; sections were also tested with the polymerase chain reaction (PCR) for HIV env and gag protein DNA. In patients with NSIP, Epstein-Barr virus and CMV could not be detected by in situ hybridization; HIV nucleic acid was amplifiable with PCR in 10 of 15 formalin-fixed, paraffin-embedded tissue sections. Symptoms, physical findings, and blood gas values were similar in patients with NSIP and matched controls with Pneumocystis. Patients with NSIP presented earlier in the course of HIV, with higher weight, serum albumin levels, and CD4+ T-lymphocyte counts (492 +/- 828 cells/mm3 versus 57 +/- 60 cells/mm3), and more normal lactate dehydrogenase (LDH) levels (280 +/- 113 IU/L versus 432 +/- 141 IU/L; means +/- SD). Seven to 10 d later, improvement in blood gas values was of similar magnitude for the two groups. Only one other unequivocal, treatable infection was diagnosed only with transbronchial biopsy. These results indicate that NSIP may be the most common diagnosis mimicking Pneumocystis pneumonia in acquired immune deficiency syndrome (AIDS), and that NSIP may improve during empiric therapy.

Beta-Lactam-beta-lactamase-inhibitor combinations are active in experimental endocarditis caused by beta-lactamase-producing oxacillin-resistant staphylococci.

Optimal therapeutic strategies for serious infections caused by borderline and heterotypic oxacillin-resistant Staphylococcus aureus (BORSA and ORSA) strains have not been fully characterized. Recent evidence suggests that the dominant penicillin-binding protein of ORSA strains (PBP 2a) shows good affinity for ampicillin and that these strains commonly produce beta-lactamase. Therefore, we compared the in vivo efficacy of the combination of ampicillin plus sulbactam with that of vancomycin against ORSA strains. Also, the moderate resistance of BORSA strains appears to be attributable mainly to the hyperproduction of beta-lactamase. Therefore, we also studied the in vivo efficacy of ampicillin plus sulbactam against such organisms. Experimental aortic endocarditis was induced in rabbits by the following three strains: beta-lactamase-producing BORSA strain VP-986, beta-lactamase-producing ORSA strain 67-0, and its beta-lactamase-negative clone. In animals with BORSA endocarditis, ampicillin plus sulbactam and oxacillin were highly effective in reducing mean intravegetation bacterial densities, with each being significantly better than either ampicillin alone or no therapy. In animals with endocarditis caused by the beta-lactamase-producing ORSA strain, ampicillin plus sulbactam was significantly better at reducing mean vegetation bacterial densities than the other regimens. For endocarditis caused by the beta-lactamase-negative ORSA clone, ampicillin was better than vancomycin in reducing mean intravegetation bacterial densities. These data show that infections caused by beta-lactamase-producing BORSA strains respond therapeutically in a manner similar to that of infections caused by oxacillin-susceptible strains, with both oxacillin and ampicillin plus sulbactam being highly efficacious. Moreover, high-dose ampicillin treatment strategies were effective in the therapy of ORSA endocarditis; this efficacy is presumably related to the relatively high affinity profile of this compound (compare with that of oxacillin) for the functionally dominant ORSA PBP 2a.

Development of beta-lactam resistance and increased quinolone MICs during therapy of experimental Pseudomonas aeruginosa endocarditis.

The in vivo efficacies of pefloxacin, a new fluoroquinolone, and amikacin-ceftazidime were compared in 50 rabbits with experimental aortic endocarditis caused by Pseudomonas aeruginosa. Animals were randomly chosen to receive 4 or 10 days of no therapy (controls), pefloxacin (40 mg/kg [body weight] per day, intramuscularly [i.m.]), or amikacin (30 or 80 mg/kg per day, i.m.)-ceftazidime (150 mg/kg per day, i.m.). Pefloxacin and both amikacin regimens significantly reduced vegetation bacterial densities compared with controls at days 4 and 10 of treatment (P less than 0.0005). By day 10 of therapy, between 33 and 40% of vegetations from amikacin-ceftazidime recipients contained ceftazidime-resistant bacteria (MICs, greater than 25 micrograms/ml); nitrocefin agar overlay confirmed that these ceftazidime-resistant variants were constitutive overproducers of beta-lactamase. At therapy days 4 and 10, approximately 30% of vegetations sampled from pefloxacin recipients contained bacteria for which pefloxacin MICs were four- to eightfold higher than the MIC for the parental strain used to initially induce endocarditis (MIC, 0.19 microgram/ml). These variants also exhibited increases in ciprofloxacin and ticarcillin MICs, as well as pleotropic resistance to chloramphenicol (but not to amikacin, ceftazidime, or tetracycline). Amikacin-ceftazidime, as well as pefloxacin, was effective in this model of aortic pseudomonal endocarditis. However, in vivo development of ceftazidime resistance and step-ups in pefloxacin MICs among intravegetation isolates were associated with inability to completely eradicate P. aeruginosa from aortic vegetations.

LY146032 compared with penicillin G in experimental aortic valve endocarditis caused by group G streptococci.

Rabbits with group G streptococcal aortic endocarditis received no therapy (controls); repeated doses of procaine penicillin G, 300 mg/kg (body weight) per day, administered intramuscularly; or LY146032, a new peptolide antibiotic, 20 mg/kg per day, administered intravenously. Penicillin G and LY146032 reduced mean intravegetation group G streptococcal densities significantly below those observed in controls at both day 3 and day 6 of therapy. Penicillin G effected a more rapid clearance of intravegetation streptococci than LY146032 by day 3, but not by day 6, of therapy.

Bactericidal interactions of a beta-lactam and beta-lactamase inhibitors in experimental Pseudomonas aeruginosa endocarditis caused by a constitutive overproducer of type Id beta-lactamase.

We investigated the in vitro and in vivo effects of a combination of a beta-lactam (ceftazidime) and a beta-lactamase inhibitor (dicloxacillin) to synergistically kill a ceftazidime-resistant variant, Pseudomonas aeruginosa PA-48, which overproduces type Id cephalosporinase constitutively. In vitro, dicloxacillin plus ceftazidime exerted bactericidal synergy at approximately 10(5) CFU/ml of inoculum (but not at approximately 10(7)-CFU inoculum), whereas other beta-lactamase inhibitors (sulbactam, clavulanic acid) showed no enhanced killing of PA-48 when combined with ceftazidime at clinically achievable levels for each agent. Dicloxacillin was a potent competitive inhibitor of the extracted Id cephalosporinase from strain PA-48 in short-term comixture studies (less than 10 min [Ki = 2 nM]); in contrast, longer-term comixture studies (90 min) indicated that dicloxacillin functions as a competitive substrate for the enzyme. Growth of PA-48 cells in the presence of dicloxacillin (12.5 to 100 micrograms/ml) had no significant effect on the production rates or functional activity of the Id enzyme. In experimental aortic valve endocarditis due to the ceftazidime-resistant variant (PA-48), rabbits received either no therapy, ceftazidime (25 mg/kg intramuscularly, every 4 h), or ceftazidime plus dicloxacillin (200 mg/kg intramuscularly, every 4 h). The combination regimen reduced mean bacterial densities of PA-48 within cardiac vegetations significantly below those in the other groups at both days 3 and 6 of treatment (P less than 0.005). However, mean vegetation bacterial densities remained greater than 6 log10 CFU/g in the combined treatment group. This modest in vivo synergistic effect (as compared to striking in vitro synergy at approximately 10(5)-CFU inoculum) most likely reflects the high densities of PA-48 achieved in vivo within cardiac vegetations (greater than 8 log10 CFU/g).

Efficacy of ciprofloxacin in experimental aortic valve endocarditis caused by a multiply beta-lactam-resistant variant of Pseudomonas aeruginosa stably derepressed for beta-lactamase production.

The emergence of multi-beta-lactam resistance is a limiting factor in treating invasive Pseudomonas infections with newer cephalosporins. The in vivo efficacy of ciprofloxacin, a new carboxy-quinolone, was evaluated in experimental aortic valve endocarditis caused by a strain of Pseudomonas aeruginosa which is stably derepressed for beta-lactamase production and is resistant to ceftazidime and multiple other beta-lactam agents. A total of 51 catheterized rabbits with aortic catheters in place were infected with this strain and then received no therapy (controls), ceftazidime (75 mg/kg per day), or ciprofloxacin (80 mg/kg per day). Ciprofloxacin sterilized all blood cultures and significantly lowered vegetation densities of P. aeruginosa by day 2 of treatment versus controls (P less than 0.0005) and animals receiving ceftazidime (P less than 0.0005). This beneficial effect of ciprofloxacin was also noted on therapy days 6 and 11. Ciprofloxacin rendered most vegetations (85%) culture negative over the 11-day treatment period and achieved bacteriologic cure in 73% of animals (P less than 0.0005 versus other therapy groups). Ciprofloxacin prevented bacteriologic relapse at 6 days posttherapy. No ciprofloxacin resistance was detected among Pseudomonas isolates from cardiac vegetations. Ciprofloxacin warrants further evaluation in vivo versus multi-drug-resistant gram-negative bacillary infections.