Comparative analysis of diagnostic methods and risk factors for Aelurostrongylus abstrusus infection in brazilian cats.

This study aimed to prospectively evaluate the risk factors of infection by Aelurostrongylus abstrusus in Brazilian cats with cough and/or radiographic changes, using as diagnostic tools the Baermann method (BM), polymerase chain reaction (PCR) of feces, bronchoalveolar lavage fluid (BALF), and cytology. Forty-three cats that were presented with cough or lung radiographic abnormalities compatible with bronchoalveolar disease were included in the study. After clinical evaluation, feces samples were collected to investigate lungworm parasitism through BM and PCR. BALF was performed to provide samples for cytology, bacteriology, and fungal culture. Stool PCR was considered the gold standard for diagnosis tests, and the other methods were evaluated by their agreement. PCR presented 74% (32/43) of positivity for A. abstrusus, while in the BM, 41% (18/43) were positive. BM showed sensitivity of 56.25% and specificity of 100% when compared with PCR. No larva was found in the cytological evaluation of 21 BALF samples. Lungworm is an important cause of bronchopulmonary disease in domestic cats in Brazil and should be included as a differential diagnosis when a cat is presented with cough or radiographic abnormalities. BM is a sensitive, non-invasive, and cheap technique to diagnose the disease, but it is not as sensitive as PCR.

Temporary hyperpigmentation as a complication of fixing the FreeStyle Libre sensor in a cat: a case report / Hiperpigmentação temporária como complicação da fixação do sensor FreeStyle Libre em um gato: relato de caso

This report described temporary hyperpigmentation occurring in a cat after use of the FreeStyle® Libre sensor by applying three different adhesive glues. The device was continuously used as an aid for the treatment of diabetes mellitus. Histopathological examination revealed mild focal chronic active dermatitis. While the coat color change occurred due to inflammation and did not affect the device functioning, owners should be alerted to the possibility of this complication.

Este relato de caso descreveu a hiperpigmentação temporária que ocorreu em um gato após o uso do sensor FreeStyle® Libre, no qual foram aplicadas três colas adesivas diferentes. O dispositivo foi usado continuamente como auxiliar no tratamento do diabetes mellitus. O exame histopatológico revelou dermatite crônica ativa focal leve. Embora a mudança de cor da pelagem tenha ocorrido devido à inflamação e não tenha afetado o funcionamento do dispositivo, os proprietários devem ser alertados para a possibilidade dessa complicação.

Perception of veterinarians on monitoring diabetic cats with emphasis on the flash glucose monitoring system / Percepção dos veterinários sobre o monitoramento de gatos diabéticos com ênfase no sistema flash de monitoramento de glicose

This study aimed to understand the perception of veterinarians regarding monitoring blood and interstitial glucose levels in cats with diabetes mellitus and/or diabetic ketoacidosis, with emphasis on the flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, Brazil). This research consisted of two stages. In all, 516 response forms were obtained, and of these, 480 (93%) were considered valid. In total, 333 (69.4%) veterinarians did not use the FGMS, while 147 (30.6%) did. The cost of the FGMS (116, 78%) was the greatest deterrent to acceptability. Veterinarians who use the device consider it indispensable in the hospital monitoring of diabetic ketoacidosis and a facilitator in the accurate monitoring of measurements. In addition, the preferred location for application of the sensor is the cranial lateral wall of the chest and it is quite tolerable. Monitoring a diabetic cat requires commitment from the owner and the veterinary team to ensure feline-friendly management.

Objetivou-se, com este estudo, conhecer a percepção dos médicos veterinários quanto à monitorização da glicose sanguínea e intersticial em gatos com diabetes mellitus (DM) e/ou cetoacidose diabética, com ênfase no sistema flash de monitoramento da glicose (SFMG) (FreeStyle Libre, Abbott, Brasil). Esta pesquisa foi composta por duas etapas. Ao todo, foram obtidos 516 formulários de resposta. Desses, 480 (93%) foram considerados válidos. No total, 333 (69,4%) veterinários não utilizavam o SFMG, enquanto 147 (30,6%) o utilizavam. O custo do SFMG (116, 78%) foi a maior barreira para a aceitabilidade. Os médicos veterinários que utilizam o dispositivo consideram-no indispensável no monitoramento hospitalar da cetoacidose diabética por ser um facilitador no acompanhamento preciso das aferições. Além disso, o local de preferência para aplicação do sensor é na parede lateral cranial do tórax e é bem tolerável. Monitorar um felino diabético requer comprometimento do tutor e da equipe veterinária e que assegure um manejo amigo do gato.

Enhanced peri-operative care to improve outcomes for high-risk surgical patients in Brazil: a single-centre before-and-after cohort study.

Mortality and morbidity for high-risk surgical patients are often high, especially in low-resource settings. Enhanced peri-operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before-and-after cohort study aimed to assess the effectiveness of a postoperative 48-hour enhanced care pathway for high-risk surgical patients ('high-risk surgical bundle') who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high-risk post-anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in-hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high-risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high-risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30-0.72). The high-risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49-0.80]) and surgical re-interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30-0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high-risk surgical patients in a resource-constrained setting could reduce in-hospital mortality.

Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients.

We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV) infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone). Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Forty-eight patients (78.7%) developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8%) presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P<0.005) in the number of CD3+, CD4+, CD8+ and CD3+HLA-DR+ cells. No significant changes were observed in natural killer cells or B lymphocytes during the disease. We conclude, as observed in all viremic patients recovering from infection, that recovery is associated with an increase in the number of T cell subsets. The monitoring of different lymphocyte subsets along with antigenemia can be extremely useful in the detection of patients at high risk of developing CMV symptoms, allowing the early introduction of antiviral therapy or the reduction of immunosuppression therapy.

Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients

We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV) infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone). Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Forty-eight patients (78.7 percent) developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8 percent) presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P<0.005) in the number of CD3+, CD4+, CD8+ and CD3+HLA-DR+ cells. No significant changes were observed in natural killer cells or B lymphocytes during the disease. We conclude, as observed in all viremic patients recovering from infection, that recovery is associated with an increase in the number of T cell subsets. The monitoring of different lymphocyte subsets along with antigenemia can be extremely useful in the detection of patients at high risk of developing CMV symptoms, allowing the early introduction of antiviral therapy or the reduction of immunosuppression therapy

An evaluation of clinical, serologic, anatomopathologic and immunohistochemical findings for fifteen patients with mucosal leishmaniasis before and after treatment.

Treatment of mucosal leishmaniasis (ML) can be controlled by clinical examination and by serologic titers by the indirect immunofluorescence serologic reaction (IISR). We studied the correlation between the presence of antigen in tissue determined by immunohistochemistry, the IISR titers and the anatomopathologic findings in fifteen patients with ML before and after healing of the lesions as determined by otorhinolaryngologic evaluation, and evaluated these parameters to determine which of them could be useful during follow-up. Tissue antigens became negative in four patients (group A) after treatment, with a statistically significant reduction or negativity of IISR titers (p < 0.05). This did not occur in patients in whom the antigen persisted after treatment (group B), suggesting that serologic follow-up should be performed together with the search for tissue antigen, a combination which, to our knowledge, has not been used in previous studies. The negativity of tissue antigens and the behavior of IIRS titers in group A patients probably indicate a lower possibility of recurrence. Upon anatomopathologic examination the inflammatory process was found to persist after treatment even in group A, suggesting that the permanence of inflammatory activity even in clinically healed lesions is possibly correlated with the presence of the antigen or of some unknown factor.