The pharmacokinetics of transdermal flunixin in lactating dairy goats.

Flunixin is a nonsteroidal anti-inflammatory drug approved for use in cattle to manage pyrexia associated with bovine respiratory disease, mastitis, and endotoxemia. In the United States, no nonsteroidal anti-inflammatory drugs are approved for use in goats, but analgesics are needed for management of painful conditions to improve animal welfare. The objective of this study was to evaluate the pharmacokinetics of transdermal flunixin in dairy goats to determine a milk withdrawal interval (WDI) to avoid violative residue contamination in the food supply. Six adult lactating dairy goats received 3.3 mg/kg of transdermal flunixin before milk, interstitial fluid (ISF), and blood samples were collected at various time points for 360 h. The samples were analyzed using tandem mass spectrometry to detect flunixin as well as the flunixin marker metabolite, 5-hydroxyflunixin followed by a pharmacokinetic WDI calculation using the US Food and Drug Administration tolerance limit method to propose safe residue levels in goat milk. The mean flunixin apparent plasma half-life was 21.63 h. The apparent milk half-life for 5-hydroxyflunixin was 17.52 h. Our findings provide a milk WDI of 60 h using the US Food and Drug Administration tolerance of 0.002 µg/mL (established for bovine milk) and a more conservative WDI of 96 h using a limit of quantification of 0.001 µg/mL following the extralabel use of transdermal flunixin in dairy goats.

Concurrent Clostridial Enteritis and Oviductal Adenocarcinoma with Carcinomatosis in an Adult Alpaca (Vicugna pacos).

An adult alpaca (Vicugna pacos) with a history of colic and anorexia was euthanized because of failure to respond to treatment. Macroscopically, pale-tan, multifocal to coalescing, firm nodules and plaques markedly expanded the omentum, mesentery and the parietal and visceral peritoneum of multiple abdominal organs, especially the right oviduct and associated mesosalpinx. Abundant dark-red watery digesta were present in the duodenum and jejunum. Histological evaluation of the right oviduct, abdominal visceral nodules and plaques and mesenteric lymph nodes revealed transmural expansion and replacement by an epithelial malignant neoplasm, comprised of tubules and acini of ciliated columnar cells supported by abundant fibrous connective tissue. Both ovaries were histologically normal. On the basis of the ciliated morphology of the neoplastic cells, the focus on the proximal reproductive tract and the unremarkable ovaries, a reproductive tubal adenocarcinoma with carcinomatosis was diagnosed, with both the endometrium and oviduct considered as the tissues of origin. The prominent ciliated morphology of the neoplastic cells and the classification of human fallopian tube (oviduct) neoplasia lead us to propose oviductal adenocarcinoma with widespread carcinomatosis as the definitive diagnosis. The lamina propria of the small intestine was infiltrated segmentally by lymphocytes, plasma cells and neutrophils, and Clostridium perfringens with beta2 toxin production was identified by polymerase chain reaction in the small intestinal contents. To our knowledge, this is the first report of these two distinct diseases in an alpaca.

Coronary Sinus Phlebography in Cardiac Resynchronization Therapy Patients: Identifying and Solving Demanding Cases.

Cardiac resynchronization therapy (CRT) improves symptoms and reduces morbidity and mortality in select heart failure patients but remains challenging to deploy widely because of difficult or unsuccessful coronary sinus (CS) access in up to 10% to 15% of patients. This report describes the radiological and anatomical aspects for improving CS catheterization and left ventricular (LV) lead positioning, focusing on the radioscopic and anatomical aspects, based on phlebography, to identify demanding cases in patients with dilated cardiomyopathy referred for CRT implantation. Anatomical and radiological aspects were explored in the anteroposterior, 30° left anterior oblique, and 30° right anterior oblique (RAO) views. In total, 117 phlebographies were performed in 39 consecutive procedures (one reintervention). Access to the CS was successful 37 times (94.9%). The most difficult cases were complicated by issues related to the altered spatial orientation of the CS ostium toward the tricuspid annular plane (TAP), which was best perceived in the 30° RAO projection and occurred in 37% of patients. One of two catheterization failures that occurred was caused by anomalous coronary venous drainage into the left atrium. Final LV lead positioning was successful in 36 (92.3%) of 39 procedures. More severe heart failure and worse LV ejection fraction did not translate into greater difficulty in LV lead implantation. As such, understanding anatomical and radiological relationships is the key to successful LV lead positioning. RAO projection can be particularly useful in the assessment of demanding CRT implant cases, especially when the CS ostium pointed to the TAP.

Development and evaluation of a new recombinant protein vaccine (YidR) against Klebsiella pneumoniae infection.

Vaccination is a promising approach to prevent Klebsiella infection; however, the high heterogeneity of strains is a limiting factor. The best antigenic target for an anti-Klebsiella vaccine should be expressed by all or most of strains. We previously found YidR protein to be highly conserved among K. pneumoniae strains independently of antigen serotype. Therefore, in the present study, we developed a recombinant YidR protein vaccine and evaluated its protective efficacy against lethal challenge with K. pneumoniae in a mouse model. The yidR gene was cloned in Escherichia coli for recombinant expression. The lethal dose (LD100) of K. pneumoniae was determined and lethal challenge was carried out after immunization with recombinant purified YidR. After immunization, the concentration of total serum IgG was significantly higher in YidR-immunized mice than in non-immunized mice, indicating strong induction of antibodies. Mice were challenged with LD100 of K. pneumoniae, and significantly lower murine sepsis and higher body weight were observed in YidR-immunized mice compared to unvaccinated controls. Moreover, ∼90% of YidR-immunized mice survived beyond 10 days of observation, whereas none of the control mice survived past 48 h. The protective effect of YidR recombinant protein vaccine was demonstrated and YidR may be a promising vaccine candidate to prevent klebsiellosis.

ANTHELMINTIC EFFECTS OF DRIED GROUND BANANA PLANT LEAVES (MUSA SPP.) FED TO SHEEP ARTIFICIALLY INFECTED WITH HAEMONCHUS CONTORTUS AND TRICHOSTRONGYLUS COLUBRIFORMIS.

BACKGROUND: Helminths is a endoparasites that cause the major losses for profitable sheep production in Brazil. The increased development of resistant strains of endoparasites have enforced the search for sustainable alternatives. The aim of this paper was to provide information about endoparasites control with banana leaves in infected sheep as alternative control strategies and see its viability. MATERIALS AND METHODS: In this study, we performed two trials to investigate the anthelmintic properties of banana leaves on endoparasites in sheep. In Trial 1, twelve sheep were artificially infected with Trichostrongylus colubriformis; in Trial 2, eleven sheep were artificially infected with Haemonchus contortus. Clinical examinations, packed cell volume, total protein, faecal egg counts (FECs) and egg hatchability tests (EHTs) were performed. At the end of the trials, the sheep were humanely slaughtered, and total worm counts were performed. RESULTS: In Trial 1 and 2, no significant FEC decreases were note but significant diference in EHTs were observed. Total worm counts, clinical and haematological parameters did not reveal significant changes between the treatment and control groups. These results suggest that feeding dried ground banana plant leaves to sheep may reduce the viability of Trichostrongylus colubriformis eggs, and this anthelmintic activity is potentially exploitable as part of an integrated parasite management programme. CONCLUSION: However, further investigation is needed to establish the optimal dosage, develop a convenient delivery form and confirm the economic feasibility of using banana plantation byproducts as feed for ruminant species. Abbreviations: Coproculture test (CT)., Faecal egg count (FEC)., Egg hatchability test (EHT).

Microbiota of cow's milk; distinguishing healthy, sub-clinically and clinically diseased quarters.

The objective of this study was to use pyrosequencing of the 16S rRNA genes to describe the microbial diversity of bovine milk samples derived from clinically unaffected quarters across a range of somatic cell counts (SCC) values or from clinical mastitis, culture negative quarters. The obtained microbiota profiles were used to distinguish healthy, subclinically and clinically affected quarters. Two dairy farms were used for the collection of milk samples. A total of 177 samples were used. Fifty samples derived from healthy, culture negative quarters with a SCC of less than 20,000 cells/ml (group 1); 34 samples derived from healthy, culture negative quarters, with a SCC ranging from 21,000 to 50,000 cells/ml (group 2); 26 samples derived from healthy, culture negative quarters with a SCC greater than 50,000 cells/ml (group 3); 34 samples derived from healthy, culture positive quarters, with a SCC greater than 400,000 (group 4, subclinical); and 33 samples derived from clinical mastitis, culture negative quarters (group 5, clinical). Bacterial DNA was isolated from these samples and the 16S rRNA genes were individually amplified and pyrosequenced. All samples analyzed revealed great microbial diversity. Four bacterial genera were present in every sample obtained from healthy quarters (Faecalibacterium spp., unclassified Lachnospiraceae, Propionibacterium spp. and Aeribacillus spp.). Discriminant analysis models showed that samples derived from healthy quarters were easily discriminated based on their microbiota profiles from samples derived from clinical mastitis, culture negative quarters; that was also the case for samples obtained from different farms. Staphylococcus spp. and Streptococcus spp. were among the most prevalent genera in all groups while a general multivariable linear model revealed that Sphingobacterium and Streptococcus prevalences were associated with increased 10 log SCC. Conversely, Nocardiodes and Paenibacillus were negatively correlated, and a higher percentage of the genera was associated with a lower 10 log SCC.

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery / Plasma fresco congelado como fator de risco para a disfunção renal no pós-operatório de cirurgia cardiovascular

OBJECTIVE: Kidney dysfunction is a major complication in the postoperative cardiac surgery setting. Operative risk factors for its development are cardiopulmonary bypass, anemia, antifibrinolytic drugs and blood transfusion. The objective of this study was to identify the risk factors for developing kidney dysfunction in patients undergoing cardiac surgery. METHODS: Ninety-seven patients were studied and 84 were analyzed. The sample was stratified into two groups. A serum creatinine higher than 30% compared to the preoperative period was considered for the kidney dysfunction group (n=9; 10.71%). There also was a control group when the increase in serum creatinine remained lower than 30% (n=75; 89.28%). RESULTS: It was observed that intraoperative transfusion of fresh frozen plasma in the control group was 2.05 ± 0.78 units and 3.80 ± 2.16 units in the kidney dysfunction group with P= 0.032. CONCLUSION: It was possible to associate that fresh frozen plasma transfusion is a risk factor for postoperative kidney dysfunction after cardiovascular surgery.

OBJETIVO: A disfunção renal é uma complicação importante no cenário de pós-operatório de cirurgia cardiovascular. Como fatores de risco conhecidos no intraoperatório para o seu desenvolvimento destacam-se a circulação extracorpórea, a hemodiluição, drogas antifibrinolíticos e a transfusão sanguínea. O objetivo deste estudo é identificar os fatores de risco na transfusão de sangue e derivados para o desenvolvimento de disfunção renal em pacientes submetidos à cirurgia cardiovascular. MÉTODOS: Noventa e sete pacientes foram estudados e 84 foram analisados. A amostra foi estratificada em dois grupos, sendo que o incremento de 30% na creatinina sérica no pós-operatório foi considerado para o grupo com disfunção renal (n = 9; 10,71%). O grupo não disfunção renal foi caracterizado pela creatinina sérica, que permaneceu inferior a aumento de 30% no pós-operatório (n = 75; 89,28%). RESULTADOS: Foi observado que a transfusão de plasma fresco congelado no grupo não disfunção renal foi de 2,05 ± 0,78 unidades e 3,80 ± 2,16 unidades no grupo disfunção renal com P= 0,032. CONCLUSÃO: Foi possível associar, nesta série de pacientes, que a transfusão de plasma fresco congelado foi um fator de risco para disfunção renal pós-operatório de cirurgia cardiovascular.

Influence of fresh frozen plasma as a trigger factor for kidney dysfunction in cardiovascular surgery.

OBJECTIVE: Kidney dysfunction is a major complication in the postoperative cardiac surgery setting. Operative risk factors for its development are cardiopulmonary bypass, anemia, antifibrinolytic drugs and blood transfusion. The objective of this study was to identify the risk factors for developing kidney dysfunction in patients undergoing cardiac surgery. METHODS: Ninety-seven patients were studied and 84 were analyzed. The sample was stratified into two groups. A serum creatinine higher than 30% compared to the preoperative period was considered for the kidney dysfunction group (n=9; 10.71%). There also was a control group when the increase in serum creatinine remained lower than 30% (n=75; 89.28%). RESULTS: It was observed that intraoperative transfusion of fresh frozen plasma in the control group was 2.05 ± 0.78 units and 3.80 ± 2.16 units in the kidney dysfunction group with P= 0.032. CONCLUSION: It was possible to associate that fresh frozen plasma transfusion is a risk factor for postoperative kidney dysfunction after cardiovascular surgery.

Abordagem terapêutica dos projéteis retidos no coração / Management of bullets lodged in the heart

Paciente do sexo masculino, 29 anos, apresentando ferimento por arma de fogo, com projétil alojado no coração e que chegou ao hospital hemodinamicamente estável. O diagnóstico, evidenciando a localização da bala, foi feito pelo ecocardiograma transesofágico(ET). Após 18 dias, foi submetido a cirurgia eletiva, sem circulação extracorpórea(CEC), para retirada do projétil encravado em parede anterior do ventrículo direito(VD) e septo interventricular(SIV), com sucesso. Os autores discutem a conduta terapêutica para os projéteis retidos no coração, com base na literatura consultada, concluindo que a cirurgia para remoção dos mesmos pode ser indicada em pacientes assintomáticos individualizados

Cirurgia conservadora de próteses aórtica e mitral na endocardite infecciosa / Conservative surgery for aortic and mitral prosthesis in infective endocarditis

A endocardite infecciosa (EI) acometendo próteses valvares é uma complicaçäo freqüente, sendo tratada geralmente com cirurgia, devido ao seu difícil controle clínico e má resposta à antibioticoterapia. Este relato descreve o caso de uma paciente com EI, acometendo simultaneamente as biopróteses aórtica (Ao) e mitral (Mi) após vinte e quatro meses de cirurgia de implantes valvares, submetida a tratamento cirúrgico conservador, e com resultado favorável. Discutem-se as vantagens deste procedimento em situaçöes específicas

Mixoma de átrio esquerdo associado a derrame pleural / Left atrial myxoma associated with pleural effusion

Homem de 65 anos apresentando emagrecimento, dispnÚia e derrame pleural (DP) recorrente. A avaliaçäo cardiológica evidenciou ruflar diastólico (3/6) no foco mitral e hiperfonese da 1ª bulha. O ecocardiograma e o estudo hemodinâmico mostraram uma grande massa tumoral no átrio esquerdo (AE), sugerindo mixoma e hipertensäo pulmonar. A biópsia pleural revelou pleurite crônica inespecífica. O paciente foi submetido à operaçäo com circulaçäo extracorpórea para exérese do tumor de AE e o estudo histopatológico confirmou o diagnóstico de mixoma. O DP tem sido manifestaçäo muito rara do mixoma cardíaco (MC), que às vezes apresenta somente sinais e sintomas inespecíficos de doença inflamatória crônica

Mixoma de átrio esquerdo provocando infarto agudo do miocárdio / Acute Myocardial Infarction Due to Myxoma of the Left Atrium

A 66-year-old male patient had an acute inferior wall myocardial infarction 55 days prior to the admission to the hospital. Echocardiogram and cardiac catheterization disclosed a tumor of the left atrium and the coronary arteriography was normal. The tumor was surgically removed and pathological examination revealed it to be a myxoma. In the absence of other etiologic possibilities, left atrial myxoma was considered the main hypothesis with the development of thrombi and coronary embolization.

A indução de fibrilação atrial não sustentada pré-implante constitui-se em critério para a não utilização da estimulação atrial definitiva? / Is atrial fibrilation inducibility prior to implant a criteria for do not performing permanent atrial pacing?

Este trabalho visa correlacionar a incidência de fibrilação atrial(FA) com os critérios para escolha do modo de estimulação cardíaca definitiva. Foi realizado um estudo prospectivo de 44 pacientes consecutivos, submetidos a implante de marcapasso com estimulação atrial definitiva(EAD). As indicações para o implante foram: disfunção do nó sinusal em 20 pacientes, BAV 3º grau em 11 pacientes, BAV de 2º grau em 7 pacientes, taquicardia paroxística supra-ventricular em 3 pacientes, hipersensibilidade do seio carotídeo em 2 pacientes e síncope vaso-vagal em 1 paciente. O modo de estimulação utilizado foi AAI (47,7 por cento) e DDD(48,7 por cento)e, em todos os casos, a estimulação foi feita com cabo-eletrodo de fixação ativa. O tempo médio de seguimento foi de 47,8 meses. Antes do implante do marcapasso os pacientes foram submetidos a testes de avaliação do sistema juncional AV (determinação do ponto de Wenckebach) e estabilidade atrial, com estimulação atrial transesofágica ou intra-cavitária, sendo selecionados para implante em EAD apenas pacientes que apresentaram fibrilação atrial não sustentada (FANS) ou átrio estável. Dos 44 pacientes etudados, 4 apresentaram FANS durante os testes. Destes,1 paciente desenvolveu FA crônica, tornando desnecessária a EAD, e outro apresentou episódios repetidos de FA, revertidos ao ritmo sinusal com amiodarona. Os outros 2 pacientes ainda estão em seguimento sem apresentar fibrilação atrial. Considerando que: 1 - o marcapasso com EAD associa-se a uma baixa incidência de FA no pós-operatório; 2 - a necessidade de alterar o modo de estimulação é mínima quando são observados os resultados dos testes pré-operatórios;3 - a indução da FANS no pré-operatório parece indicar que o paciente irá desenvolver FA durante a evolução, o que não impede que se proceda a EAD, mesmo que por um período de tempo limitado...

Tratamento do canal arterial persistente em neonatos prematuros: análise de 18 casos / Treatment of patent ductus arteriosus in neonate premature: analysis of 18 cases

A presente investigaçäo tem o propósito de analisar, retrospectivamente, os resultados obtidos em 18 pacientes neonatos prematuros, submetidos a operaçäo para oclusäo da PCA, no período entre julho de 1990 e dezembro de 1993 (42 meses), sendo 12 (66,6 por cento) pacientes do sexo feminino, com idade que variou entre 10 e 44 (20,8 mais ou menos 8,3)dias, idade gestacional entre 26 e 28 (27,1 mais ou menos 0,9) semanas. No dia da operaçäo o peso dos pacientes esteve compreendido entre 700 e 1380 (985,8 mais ou menos 181,6) gramas. A insuficiência respiratória ocorreu em todos os pacientes, sendo a principal indicaçäo cirúrgica, estando em 6 (33,3 por cento) pacientes associada à insuficiência cardíaca congestiva. A indometacina endovenosa foi utilizada no período pré-operatório em 9 (50 por cento) pacientes na tentativa de se obter o fechamento farmacológico, sem sucesso, do canal arterial e apesar de näo influenciar nos resultados pós-operatórios, apresentou como principal efeito secundário a reduçäo significativa da diurese (p,0,001), que se normalizou após quatro dias do uso da droga. A técnica operatória empregada fo a toracotomia póstero-lateral esquerda trans-pleural com fixaçäo de três ou quatro clipes metálicos para oclusäo do canal arterial. O exame ecocardiográfico pré-operatório, realizado em 15 (83,2 por cento) pacientes, mostrou que a relaçäo entre o diâmetro do átrio esquerdo/aorta estava aumentada com quatro meses após a operaçä, evidenciando tendência de normalizaçäo da funçäo cardíaca. Um (5,5 por cento) paciente apresentou reabertura do canal arterial no pós-operatório imediato, sendo submetido à reoperaçäo para ligadura do canal. Näo foi observada diferença significativa no tempo necessário de intubaçäo orotraqueal (IOT) (p=0.586) bem como do tempo de permanência com fraçäo inspiratória de oxigênio (FIO2), <40 por cento e >40 por cento,60 por cento no período pré e pós-operatório (p=0,841 e p=0,692, respectivamente), mas com reduçäo significativa do tempo de permanência com FIO2,60 por cento p=0,033). O período de internaçäo hospitalar variou de 43 a 157(96,0 mais ou menos 24,8)dias. Näo houve mortalidade operatória, observando-se ainda baixa morbidade com este método. As causas de óbito, no período pós-operatório, näo estiveram relacionadas com o tratamento cirúrgico. Pode-se concluir que a ligadura cirúrgica da PCA, nos pacientes neonatos e prematuros, é método eficaz e seguro, podendo ser praticado com baixa morbidade e mortalidade.

Mediastinite conseqüente a infecçäo dentária: relato de dois casos / Mediastinitis following dental infection: report of 2 cases

Relatam-se dois casos de mediastinite conseqüentes de infecçöes dentárias ocorridas no Serviço de Cirurgia Torácica do Hospital do Servidor Público Estadual "Francisco Morato de Oliveira". Comentam-se as vias de propagaçäo do processo supurativo pelas fáscias do pescoço, tratamento instituído e evoluçäo. Fazem-se comparaçäo com outros casos publicados na literatura mundial, onde puderam também constatar a alta morbidade e mortalidade da doença, apesar do melhor tratamento administrado. Alerta-se para a necessidade do diagnóstico precoce, que tem grande importância sobre o prognóstico