Dissulfiram na manutenção da abstinência do álcool: Avaliação do conhecimento num grupo de pessoas em internamento / Disulfiram in alcohol abstinence maintenance: Evaluation of knowledge in an inpatient group / Disulfiram en el mantenimiento de la abstinencia de alcohol: Evaluación del conocimiento en un grupo de pacientes hospitalizados

Resumo Contexto: O uso do dissulfiram no tratamento da Perturbação de Uso de Álcool (PUA) é uma estratégia importante na manutenção da abstinência. As sessões de psicoeducação, realizadas pelos enfermeiros, têm a finalidade de preparar o utente/família para a toma segura do dissulfiram, monitorizando os seus efeitos. Objetivo: Avaliar o conhecimento de pessoas com PUA internadas sobre os cuidados a ter com a alimentação e produtos de higiene durante a toma de dissulfiram identificando as necessidades de intervenções de enfermagem psicoeducativas. Métodos: Estudo transversal e descritivo. Na colheita de dados utilizou-se um questionário sociodemográfico e um instrumento desenvolvido pelos autores com questões de avaliação do conhecimento acerca dos cuidados a ter durante a toma de dissulfiram indicando os aspetos sobre os quais devem incidir as sessões de psicoeducação. Resultados: Amostra constituída por 31 participantes com uma média de idades de 49 anos (DP=8,87). Destaca-se o conhecimento não demonstrado, sobre o consumo de pickles, maionese e mostarda (48,4%), de doces confecionados com álcool (38,8%), a utilização de xaropes e elixires com álcool (41,9%) e de aftershave, perfumes ou tónicos com álcool (35,5%). 12,9% dos participantes não reconhece os sintomas, toracalgia, tonturas, taquicardia e cefaleias, como reações adversas aquando da junção de álcool com dissulfiram. Conclusões: Uma percentagem significativa da amostra não sabe quais os cuidados a ter com a alimentação e com a seleção dos produtos de higiene pelo que é necessário realizar intervenções psicoeducativas, tendo os enfermeiros especialistas em saúde mental um papel fundamental.

Abstract Background: The use of disulfiram in the treatment of Alcohol Use Disorder (AUD) is an important strategy to the maintenance of abstinence. The psychoeducation sessions conducted by nurses are intended to prepare the patient / family for the safe use of disulfiram and to monitor its effects. Aim: To evaluate the knowledge of hospitalized people with AUD about the care to be taken with food and hygiene products during the taking of disulfiram and to identify the need for psychoeducational nursing interventions. Methods: Cross-sectional and descriptive. Data were collected using a form with sociodemographic data and an instrument developed by the authors with questions about knowledge about the care to be taken during the taking of disulfiram and identify the aspects on which psychoeducation sessions should focus. Results: Sample consisting of 31 participants with an average age of 49 years (SD = 8.87). It stands out the knowledge not demonstrated, about the consumption of pickles, mayonnaise and mustard (48.4%), of sweets made with alcohol (38.8%), the use of syrups and elixirs with alcohol (41.9%) and aftershave, perfum or tonics with alcohol (35.5%). 12.9% of the participants do not recognize the symptoms, chest pain, dizziness, tachycardia and headache, as adverse reactions when the addition of alcohol with disulfiram. Conclusions: A significant percentage of the sample does not know what precautions to take with food and of hygiene products selection, so it is necessary to carry out psychoeducational interventions, having the nurse specialists in mental health a fundamental role.

Resumen Contexto: El uso de disulfiram en el tratamiento del Trastorno por Uso de Alcohol (TUA) es una estrategia importante para el mantenimiento de la abstinencia. Las sesiones psicoeducativas realizadas por enfermeras están destinadas a preparar al paciente / familia para el uso seguro de disulfiram y controlar sus efectos. Objetivo(s): Evaluar el conocimiento de personas hospitalizadas con TUA sobre el cuidado que se debe tener con los cuidados alimentarios, productos higiénicos durante la toma de disulfiram, identificando la necesidad de intervenciones psicoeducativas de enfermería. Métodos: Estudio transversal y descriptivo. Los datos se recopilaron mediante un formulario sociodemográfico, y un instrumento desarrollado por los autores con preguntas de evaluación del conocimiento sobre el cuidado a tener durante la toma de disulfiram, indicando aspectos en los que deben centrarse las sesiones de psicoeducación. Resultados: Muestra compuesta por 31 participantes con edad promedio de 49 años (DE = 8,87). Destaca conocimiento insuficientes sobre el consumo de encurtidos, mayonesa y mostaza (48.4%), dulces hechos con alcohol (38.8%), el uso de jarabes y elixires con alcohol (41.9%) y después del afeitado, perfume o tónicos con alcohol (35.5%). El 12,9% de los participantes descalifican los síntomas, dolor de pecho, mareos, taquicardia y dolor de cabeza, como reacciones adversas cuando se agrega alcohol con disulfiram. Conclusiones: Un porcentaje significativo de la muestra no sabe qué precauciones tomar con los alimentos y selección de productos higiénicos, siendo necesario efeto intervenciones psicoeducativas, con enfermeros especializadas en salud mental que desempeñan un papel fundamental.

Determination of urokinase-type plasminogen activator serum levels in healthy and oncologic cats.

The urokinase plasminogen activator system (uPAS) has been poorly investigated in veterinary oncology. The aim of this study was to determine uPA serum concentrations in healthy and oncologic cats to understand the potential value of uPA as a cancer biomarker. Serum samples were collected from 19 healthy cats and 18 cats with spontaneous malignant neoplasms and uPA was measured through a specific enzyme-linked immunosorbent assay kit. The differences between uPA values and their relation with intrinsic factors and clinicopathological parameters were analyzed using an analysis of variance (ANOVA) and independent t-test. The average serum concentration of uPA in cancerous cats (0.54 ± 0.22 ng/mL) differed from that of healthy cats (1.10 ± 1.16 ng/mL) but was not significantly influenced by cats' clinicopathological parameters or by the presence of metastases. This study describes, for the first time, the serum concentrations of uPA in cats and proposes directions for future studies to uncover the relevance of uPAS in feline carcinogenesis.

Le système activateur de plasminogène de type urokinase (uPAS) a été peu étudié en oncologie vétérinaire. L'objectif de la présente étude était de déterminer les concentrations sériques d'uPA chez des chats en santé et oncologiques afin de comprendre la valeur potentielle d'uPA comme marqueur de cancer. Des échantillons de sérum furent prélevés de 19 chats en santé et de 18 chats avec des néoplasmes malins spontanés et l'uPA fut mesuré à l'aide d'une trousse immuno-enzymatique. Les différences entre les valeurs d'uPA et leur relation avec des facteurs intrinsèques et des paramètres clinico-pathologiques furent analysées par analyse de variance (ANOVA) et test de t indépendant. La concentration moyenne d'uPA chez les chats avec cancer (0,54 ± 0,22 ng/mL) différait de celle des chats en santé (1,10 ± 1,16 ng/mL) mais n'était pas influencée de manière significative par les paramètres clinico-pathologiques des chats ou la présence de métastases. Cette étude décrit, pour la première fois, les concentrations sériques d'uPA chez les chats et propose des orientations pour des études ultérieures afin de révéler la pertinence d'uPAS dans la carcinogénèse chez les chats.(Traduit par Docteur Serge Messier).

Serum levels of urokinase-type plasminogen activator in healthy dogs and oncologic canine patients.

AIM: Urokinase plasminogen activator (uPA) has been scarcely studied in veterinary oncology. The aim of this study was to determine the uPA serum concentrations in healthy and oncologic canine patients and to investigate its potential value as a tumor biomarker. MATERIALS AND METHODS: Serum uPA concentrations of healthy and oncologic canine patients were measured by enzyme-linked immunosorbent assay. Their relationships with the dogs' health status and tumor characteristics were analyzed through ANOVA and independent t-test. RESULTS: There were no significant differences between mean serum values (±standard deviation) of healthy dogs (0.19±0.13 ng/ml) and oncologic canine patients (0.22±0.33 ng/ml), or between dogs with benign or malignant tumors, and with or without metastases, although the latter tended to show higher uPA serum levels. CONCLUSION: This is the first study describing the uPA serum levels in dogs. Although its results do not support uPA as a tumor biomarker, higher uPA levels in dogs with metastatic neoplasms may reflect the role of the enzyme in tumor progression.

Use of planar kV vs. CBCT in evaluation of setup errors in oesophagus carcinoma radiotherapy.

AIM: The aim of this study is to evaluate differences in terms of the setup errors observed using kV planar image compared to CBCT for oesophageal cancer patients. BACKGROUND: Planar kV images are quick to acquire but only allow the observation of bony structures. CBCT allows the evaluation of soft tissues, which includes the oesophagus (and tumour) and OAR, giving a more accurate verification of the positioning. MATERIALS AND METHODS: All patients were imaged with both techniques between January 2012 and March 2014 were included in the study (16 patients, 212 kV images and 116 CBCT images). Differences between the setup errors observed on the two images modalities were studied. A correlation study between TNM staging, tumour location and immobilization systems with setup errors was also done. Finally, the calculation of systematic and random errors allowed to determine the CTV-PTV margin. RESULTS: A significant discrepancy (p < 0.05) between the setup errors observed with kV and CBCT was observed in the lateral direction. No statistical correlation was found between setup errors and tumour location, immobilization system or TNM staging. The CTV-PTV margin was smaller with CBCT in the vertical (0.6 cm vs. 0.9 cm) and longitudinal (0.7 cm vs. 1 cm) directions and smaller with kV for the lateral directions (0.8 cm vs. 0.9 cm). CONCLUSIONS: The chosen modality influences the setup error observed which will influence the correction applied. Allowing a better observation of the volumes of interest, CBCT should be the modality of choice in this pathology. The CTV-PTV margins could be shrunk if CBCT is used.

Coagulase-Positive Staphylococcus: Prevalence and Antimicrobial Resistance.

Staphylococcus pseudintermedius is the most prevalent coagulase-positive Staphylococcus inhabitant of the skin and mucosa of dogs and cats, causing skin and soft tissue infections in these animals. In this study, coagulase-positive Staphylococcus species were isolated from companion animals, veterinary professionals, and objects from a clinical veterinary environment by using two particular culture media, Baird-Parker RPF agar and CHROMagar Staph aureus. Different morphology features of colonies on the media allowed the identification of the species, which was confirmed by performing a multiplex polymerase chain reaction (PCR). Among 23 animals, 15 (65.2%) harbored coagulase-positive Staphylococcus, being 12 Staphylococcus pseudintermedius carriers. Four out of 12 were methicillin-resistant S. pseudintermedius (MRSP). All veterinary professionals had coagulase-positive Staphylococcus (CoPS) species on their hands and two out of nine objects sampled harbored MRSP. The antimicrobial-resistance pattern was achieved for all isolates, revealing the presence of many multidrug-resistant CoPS, particularly S. pseudintermedius . The combined analysis of the antimicrobial-resistance patterns shown by the isolates led to the hypothesis that there is a possible crosscontamination and dissemination of S. aureus and S. pseudintermedius species between the three types of carriers sampled in this study that could facilitate the spread of the methicillin-resistance phenotype.

Prevalence of antimicrobial resistance in enteric Escherichia coli from domestic pets and assessment of associated risk markers using a generalized linear mixed model.

Antimicrobial resistance (AMR) is a growing global public health problem, which is caused by the use of antimicrobials in both human and animal medical practice. The objectives of the present cross-sectional study were as follows: (1) to determine the prevalence of resistance in Escherichia coli isolated from the feces of pets from the Porto region of Portugal against 19 antimicrobial agents and (2) to assess the individual, clinical and environmental characteristics associated with each pet as risk markers for the AMR of the E. coli isolates. From September 2009 to May 2012, rectal swabs were collected from pets selected using a systematic random procedure from the ordinary population of animals attending the Veterinary Hospital of Porto University. A total of 78 dogs and 22 cats were sampled with the objective of isolating E. coli. The animals' owners, who allowed the collection of fecal samples from their pets, answered a questionnaire to collect information about the markers that could influence the AMR of the enteric E. coli. Chromocult tryptone bile X-glucuronide agar was used for E. coli isolation, and the disk diffusion method was used to determine the antimicrobial susceptibility. The data were analyzed using a multilevel, univariable and multivariable generalized linear mixed model (GLMM). Several (49.7%) of the 396 isolates obtained in this study were multidrug-resistant. The E. coli isolates exhibited resistance to the antimicrobial agent's ampicillin (51.3%), cephalothin (46.7%), tetracycline (45.2%) and streptomycin (43.4%). Previous quinolone treatment was the main risk marker for the presence of AMR for 12 (ampicillin, cephalothin, ceftazidime, cefotaxime, nalidixic acid, ciprofloxacin, gentamicin, tetracycline, streptomycin, chloramphenicol, trimethoprim-sulfamethoxazole and aztreonam) of the 15 antimicrobials assessed. Coprophagic habits were also positively associated with an increased risk of AMR for six drugs, ampicillin, amoxicillin-clavulanic acid, cephamycin, ciprofloxacin, streptomycin, and trimethoprim-sulfamethoxazole. In summary, pets with a record of one or more previous quinolone treatments and exhibiting coprophagic habits were at an increased risk of harboring multidrug-resistant E. coli strains in their feces compared to pets without these characteristics. AMR is a serious global problem, and assessing the risk markers for the presence of drug-resistant bacteria in pets, a very close source of resistance determinants to humans, is essential for the implementation of safe handling procedures for companion animals and for the prudent selection of antimicrobial compounds in veterinary practice.

Toxic potential of paracetamol to freshwater organisms: a headache to environmental regulators?

Paracetamol is one of the most prescribed drugs globally, due to its antipyretic and analgesic properties. However, it is highly toxic at elevated doses, with involvement of an already described oxidative stress pathway. Despite this, the number of ecotoxicological studies on potential effects of paracetamol in wild organisms is still scarce. The present article presents a comprehensive series of standardized assays for the assessment of paracetamol effects in freshwater organisms. The results show that paracetamol toxicity is widely variable among species, even when these species are phylogenetically related. Furthermore, comparisons between data from the literature and our results reinforce this conclusion, providing evidence of the inadequacy of standardized toxicity testing guidelines for pharmaceutical compounds in wild organisms. Paracetamol toxicity can be modulated by unpredictable physiological conditions that might compromise extrapolations and comparisons of responsiveness among species. The ecological relevance of data obtained from classical tests for this compound is further discussed.

Biochemical and standard toxic effects of acetaminophen on the macrophyte species Lemna minor and Lemna gibba.

Acetaminophen is globally one of the most prescribed drugs due to its antipyretic and analgesic properties. However, it is highly toxic when the dosage surpasses the detoxification capability of an exposed organism, with involvement of an already described oxidative stress pathway. To address the issue of the ecotoxicity of acetaminophen, we performed acute exposures of two aquatic plant species, Lemna gibba and Lemna minor, to this compound. The selected biomarkers were number of fronds, biomass, chlorophyll content, lipid peroxidation (TBARS assay), and proline content. Our results showed marked differences between the two species. Acetaminophen caused a significant decrease in the number of fronds (EC50 = 446.6 mg/L), and the establishment of a dose-dependent peroxidative damage in L. minor, but not in L. gibba. No effects were reported in both species for the indicative parameters chlorophyll content and total biomass. However, the proline content in L. gibba was substantially reduced. The overall conclusions point to the occurrence of an oxidative stress scenario more prominent for L. minor. However, the mechanisms that allowed L. gibba to cope with acetaminophen exposure were distinct from those reported for L. minor, with the likely involvement of proline as antioxidant.

Spread of multidrug-resistant Enterococcus faecalis within the household setting.

Advances in veterinary medicine have resulted in the survival of many animals with severe illness or infectious diseases. In addition, increased usage of antimicrobial agents for veterinary purposes has contributed to the worldwide problem of increasing antimicrobial resistance. The objective of this study was to contribute to better understand the potential and implications for the spread of antimicrobial-resistant enterococci between pets receiving antimicrobial treatments and their owners. Three household aggregates (HA A, B, and C) were selected for this study. Information was collected on individual and clinical parameters of both humans and animals that cohabit. For this study, samples of feces, oral secretions, skin and fur of pets, as well as owners' feces and hands and exposed household surfaces and objects were also collected. All enterococci isolates were analyzed for antimicrobial susceptibility. Based on the antimicrobial resistance patterns and origin of isolates, ERIC-PCR analysis was performed on selected isolates to evaluate phylogenetic relationships. In all three HA, Enterococcus faecalis clonal spread was detected between pets and the respective owners, confirming the in-home interanimal species dissemination. Additionally, fecal enterococci colonization of other body parts of the same animal and dissemination of those same enterococci to household surfaces and objects were also observed. Our results demonstrate that enterococcal clones were found in pets in multiple body sites, their human cohabitants, and shared domestic objects.

Common phenotypic and genotypic antimicrobial resistance patterns found in a case study of multiresistant E. coli from cohabitant pets, humans, and household surfaces.

The objective of the study described in this article was to characterize the antimicrobial resistance profiles among E. coli strains isolated from cohabitant pets and humans, evaluating the concurrent colonization of pets, owners, and home surfaces by bacteria carrying the same antimicrobial-resistant genes. The authors also intended to assess whether household surfaces and objects could contribute to the within-household antimicrobial-resistant gene diffusion between human and animal cohabitants. A total of 124 E. coli strains were isolated displaying 24 different phenotypic patterns with a remarkable percentage of multiresistant ones. The same resistance patterns were isolated from the dog's urine, mouth, the laundry floor, the refrigerator door, and the dog's food bowl. Some other multiresistant phenotypes, as long as resistant genes, were found repeatedly in different inhabitants and surfaces of the house. Direct, close contact between all the cohabitants and the touch of contaminated household surfaces and objects could be an explanation for these observations.

Identification of prognostic factors in canine mammary malignant tumours: a multivariable survival study.

BACKGROUND: Although several histopathological and clinical features of canine mammary gland tumours have been widely studied from a prognostic standpoint, considerable variations in tumour individual biologic behaviour difficult the definition of accurate prognostic factors. It has been suggested that the malignant behaviour of tumours is the end result of several alterations in cellular physiology that culminate in tumour growth and spread. Accordingly, the aim of this study was to determine, using a multivariable model, the independent prognostic value of several immunohistochemically detected tumour-associated molecules, such as MMP-9 and uPA in stromal cells and Ki-67, TIMP-2 and VEGF in cancer cells. RESULTS: Eighty-five female dogs affected by spontaneous malignant mammary neoplasias were followed up for a 2-year post-operative period. In univariate analysis, tumour characteristics such as size, mode of growth, regional lymph node metastases, tumour cell MIB-1 LI and MMP-9 and uPA expressions in tumour-adjacent fibroblasts, were associated with both survival and disease-free intervals. Histological type and grade were related with overall survival while VEGF and TIMP-2 were not significantly associated with none of the outcome parameters. In multivariable analysis, only a MIB-1 labelling index higher than 40% and a stromal expression of MMP-9 higher than 50% retained significant relationships with poor overall and disease-free survival. CONCLUSIONS: The results of this study indicate that MMP-9 and Ki-67 are independent prognostic markers of canine malignant mammary tumours. Furthermore, the high stromal expressions of uPA and MMP-9 in aggressive tumours suggest that these molecules are potential therapeutic targets in the post-operative treatment of canine mammary cancer.