The influence of lactation on insulin and glucose metabolism, lipid profile, and cytokines in pregnant mares.

Glucose metabolism adapts to gestation, resulting in progressive physiological insulin resistance and increased insulin secretion to maintain maternal euglycemia and glucose availability for the developing fetus. These changes can impact mare fertility and maternal and neonatal health. This is the first comparison of body condition, regional adiposity, insulin and glucose dynamics, lipid metabolism, and cytokine production between lactating and non-lactating mares before, during pregnancy, and early postpartum. Twelve pregnancies from 9 broodmares, five nonlactating (NL) and seven lactating (L), were used. Evaluations were performed on the day of ovulation, at 55, 110, 165, 220, 275, and 330 days of gestation (D55, D110, D165, D220, D275, D330) and 21 days postpartum (21pp). Mares in the L group had lower basal insulin and glucose at the beginning of pregnancy, smaller area under the curve of insulin and glucose, and greater insulin sensitivity and glucose tolerance. Resistin was higher in D110 and D165 than in D0, D275, 330 and 21pp, while leptin was higher in D55, and in D110, at D110 it was equal to D0, D220, and D275, but higher than at D330 and D21pp. As for the groups, L presented lower body condition score (BCS), crest neck score (CNS), rump fat thickness (RUM), basal insulin, glucose area under the curve (AUCg), MIRG and higher RISQI, adiponectin and tumor necrosis factor (TNFα). There was no effect over time in non-esterified fatty acids (NEFA) concentrations between the L mares; in the NL, D275 presented higher concentrations than those of D0, D55, and D110, which in turn were equal to the other time points; there were higher concentrations in NL mares than L in samples D165 and D275. In conclusion, a different metabolic profile during pregnancy was detected, and NL mares were closer to the metabolic threshold for the occurrence of metabolic syndrome during pregnancy. Understanding the impacts of these differences on mare's health and their offspring's future is fundamental as most of our recipient mares for embryo transfer are non-lactating. Therefore, we suggest that further studies be performed to evaluate lactation's influence on mares' metabolic parameters.

A comparative study across mule, equine and equine clone pregnancies regarding the determination of the day of birth.

Monitoring equine parturition effectively is essential for preemptive intervention in periparturient issues and ensuring the overall well-being of both mares and foals. However, its implementation in breeding farms is challenging due to variable gestational lengths and nocturnal births. Predictive techniques have the potential to streamline the monitoring process, reduce labor intensity, and minimize costs. Research on foaling prediction in mares carrying mule or equine clone fetuses is scarce. Therefore, this study aimed to comparatively analyze foaling prediction parameters in mares pregnant with mule, equine, or equine clone fetus. The study included vulvar relaxation, sacroiliac ligament tension, pH, BRIX index, and concentrations of calcium, phosphorus, magnesium, sodium, and potassium in prepartum mammary secretions. Sixty pregnant mares were used for this study and grouped as follows: 25 mares with mule fetuses (MF), 20 with equine clone fetuses (CF), and 15 with equine control fetuses (EF). Results showed significant differences in vulvar relaxation and sacroiliac ligament tension only in MF group (p < 0.05) on the day of parturition compared to the other days evaluated, different from the other groups. Levels of pH notably decreased on parturition day (mean 5.7 ± 0.04, p < 0.0001), with lower values in MF (6.05 ± 0.02) and CF (6.08 ± 0.04) compared to EF (6.26 ± 0.04) (p < 0.03). The BRIX index showed variation across mares and was not a good parameter for foaling prediction. Electrolytes correlated positively with impending parturition, showing no significant differences among groups. The MF and CF groups exhibited a substantial increase (102.13 % and 110.66 %, respectively) in mean calcium concentrations on the day before foaling, unlike EF (38.29 %). In conclusion, the pH values were different in mammary secretions between mares carrying mule and clone fetuses, in contrast to equine control fetuses. Nevertheless, there was a trend of decreasing pH values closer to parturition in all groups. Conversely, the BRIX index serves as a valuable indicator of colostrum quality yet does not offer insights into the proximity of parturition. While electrolyte concentrations did not reveal significant differences among groups, it is worth noting that the evaluation of phosphorus emerges as a new parameter to explore in mares nearing parturition, since it obtained a pattern similar to calcium.

Successful equine in vitro embryo production by ICSI - effect of season, mares' age, breed, and phase of the estrous cycle on embryo production.

This retrospective study aimed at identifying factors that contribute to the success of equine in vitro embryo production by intracytoplasmic sperm injection (ICSI). A total of 7993 ovum pick-up (OPU) sessions were performed, totaling 2540 donor mares and semen from 396 stallions. Oocytes were aspirated at multiple sites in Brazil and were sent to the laboratory, within 6 h from OPU, in pre-maturation medium where they were in vitro matured (IVM) followed by ICSI and in vitro embryo culture for 7-8 days. The number of recovered oocytes, matured oocytes, cleaved embryos and blastocysts were used to explore the effect of age and breed of the donor mare, time of year in which the mare was aspirated and phase of the estrous cycle on the day of follicular aspiration. Mares between 6 and 15 years old were superior to other age groups in most parameters evaluated, including the average number of blastocysts per OPU. The impact of age was similar when evaluated within two breeds, American Quarter Horse (AQHA) and Warmblood mares. We observed that breed (AQHA, Warmblood, Crioulo, Lusitano and Mangalarga) had an important effect on most of the parameter evaluated, including number of oocytes recovered, blastocysts produced per OPU, and blastocyst rates. The overall impact of season was less pronounced than age and breed, with the only statistically significant difference being a higher rate of oocyte maturation during the summer season. Finally, most of the parameters evaluated were superior in follicular phase mares, with or without dominant follicle than luteal phase mares. In conclusion, this retrospective study revealed that breed, age, season and stage of estrous at the time of OPU are all important parameters for the success of equine embryo production by ICSI. This technology enables producing embryos all-year-round from mares of different breeds and ages from OPU-derived oocytes collected at multiple sites.

Comparative Assessment of Oxidative and Antioxidant Parameters in Mule and Horse Neonates during Their First Month of Extrauterine Adaptation.

After parturition, a rapid transition occurs from the intrauterine to the extrauterine milieu, exposing neonates to physiological circumstances characterized by oxidative conditions that instigate the generation of reactive oxygen species. These free radicals play pivotal roles in physiological processes; however, an imbalance between their production and the removal of antioxidants can result in severe cellular damage. The main objective of this study was to compare the oxidative and antioxidant profiles in mule and horse neonates immediately post-parturition, as well as at subsequent time points (1, 6, 12, and 24 h, 7 and 30 days) during their extrauterine existence. The parameters assessed included the systemic concentrations of Thiobarbituric Acid Reactive Substances (TBARS) and carbonyl groups; the activities of the antioxidants superoxide dismutase (SOD) and glutathione peroxidase (GPx); and the levels of the total, indirect, and direct bilirubin. Our results showed no interaction effect between the neonatal groups and the assessed time points for the variables under investigation. Notably, the concentrations of TBARS, as a marker of lipid peroxidation, and bilirubin were consistently lower in the mules, whereas the glutathione peroxidase (GPx) activity exhibited higher levels in this group. The bilirubin levels were notably reduced in the mule neonates. The TBARS demonstrated a progressive decrease over the observation period in both groups, while the GPx activity remained relatively stable from birth to 7 days, with a substantial increase evident at the 30-day mark. Protein oxidation was not affected by the group and time, while for the SOD values, all times were statistically similar, except for the lower activity at T1h. Consequently, our findings lead us to the conclusion that neonatal mules and horses manifest distinct patterns of oxidative activity and antioxidant capacity during the initial month of their extrauterine existence, potentially indicative of different adaptation mechanisms to the extrauterine environment.

Comparative stereological evaluation of the term allantochorion membrane in the mare pregnant with mule foals and equine foals.

Mules are derived from crossing horse mares with a donkey, in which the interest is due to gentleness and ability to work and equestrian sports. As the placenta is responsible for fetal development and maturation, knowing its typical microstructure allows us to understand how fetomaternal interactions occur in this interspecific pregnancy. Thus, the study performed a comparative stereological evaluation of volumetric composition and fetomaternal contact surface in the uterine body (UB), gravid uterine horn (GUH), and nongravid uterine horn (NGUH) of Mangalarga Paulista mare's term allantochorion membrane in mule and equine pregnancies. In equine gestation, the UB microcotyledon surface density was negatively correlated with the NGUH absolute area and the total volume of microvilli. In mule gestation, the base width and the number of microcotyledon were negatively correlated with the height and number of microcotyledons in the NGUH. Mule also showed a negative correlation between (1) the UB microcotyledon surface density and the GUH microcotyledons number per unit of membrane length, (2) the GUH total volume and the NGUH microcotyledon number. Such differences demonstrate a compensatory mechanism in conversion capacity among macrocompartments. A trend toward a greater total volume of allantoid vessels and total volume of allantoid mesoderm in UB microvilli was found in the equine and mule groups, respectively. There was a significant increase in the base width of microcotyledons in the NGUH of mules versus horses. These finds possibly influence the exchange capacity of each placental microregion and suggest a difference between mule versus horse term allantochorion membrane.

Common mental disorders among medical students: systematic review and meta-analysis of Brazilian studies.

BACKGROUND: Common mental disorders (CMDs) have been correlated with consequences in different domains of life. OBJECTIVE: To summarize the prevalence rates of CMDs and factors associated with them among students at Brazilian medical schools. DESIGN AND SETTING: Systematic review and meta-analysis of studies developed in Brazilian medical schools. METHODS: In October 2021, searches were carried out in seven electronic databases, in Google Scholar and in reference lists. Observational studies reporting prevalence rates of CMDs among students at Brazilian medical schools were sought. Variables associated with CMDs arising from multivariate regression models were included in the synthesis. A meta-analysis was developed using a random-effects model and the risk of bias was assessed using an instrument developed from previous references. RESULTS: Fourteen original studies were included. The pooled prevalence rate of CMDs among undergraduate students at Brazilian medical schools was 43.3% (95% confidence interval = 38.9% to 47.6%; I2 = 87%; n = 3,927). Among the nine studies in which multivariate analyses were conducted, five showed risk associations between CMDs and medical school-related dissatisfactions, among which the desire to abandon the medical course can be highlighted (n = 3). In three studies, CMDs were associated with sleep indicators. CONCLUSION: Considering that the prevalence of CMDs among medical students is higher than in the general population, we recommend that Brazilian medical schools should give greater attention to this topic, and should enable expansion of care offerings relating to mental health. SYSTEMATIC REVIEW REGISTRATION: Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020142184).

Common mental disorders among medical students: systematic review and meta-analysis of Brazilian studies

ABSTRACT BACKGROUND: Common mental disorders (CMDs) have been correlated with consequences in different domains of life. OBJECTIVE: To summarize the prevalence rates of CMDs and factors associated with them among students at Brazilian medical schools. DESIGN AND SETTING: Systematic review and meta-analysis of studies developed in Brazilian medical schools. METHODS: In October 2021, searches were carried out in seven electronic databases, in Google Scholar and in reference lists. Observational studies reporting prevalence rates of CMDs among students at Brazilian medical schools were sought. Variables associated with CMDs arising from multivariate regression models were included in the synthesis. A meta-analysis was developed using a random-effects model and the risk of bias was assessed using an instrument developed from previous references. RESULTS: Fourteen original studies were included. The pooled prevalence rate of CMDs among undergraduate students at Brazilian medical schools was 43.3% (95% confidence interval = 38.9% to 47.6%; I2 = 87%; n = 3,927). Among the nine studies in which multivariate analyses were conducted, five showed risk associations between CMDs and medical school-related dissatisfactions, among which the desire to abandon the medical course can be highlighted (n = 3). In three studies, CMDs were associated with sleep indicators. CONCLUSION: Considering that the prevalence of CMDs among medical students is higher than in the general population, we recommend that Brazilian medical schools should give greater attention to this topic, and should enable expansion of care offerings relating to mental health. SYSTEMATIC REVIEW REGISTRATION: Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020142184).

Prenatal or postnatal corticosteroids favor clinical, respiratory, metabolic outcomes and oxidative balance of preterm lambs corticotherapy for premature neonatal lambs.

Challenges of the extrauterine environment can be life threatening for a premature fetus with inadequate fetal maturity. Maternal corticosteroids therapy is widely employed to induce fetal pulmonary maturation. Nevertheless, whenever therapeutic pregnancy interruption has to be performed in a time manner insufficient to treat the dam, postnatal corticotherapy can be considered an alternative. However, it is not known if antenatal and postnatal corticotherapy can improve similarly neonatal outcomes and pulmonary function. This research aimed to analyze antenatal and postnatal corticotherapy on premature lambs vitality, pulmonary functioning, metabolic and oxidative status. Lambs were evaluated according to the mode of treatment: Prenatal Corticosteroid Group (8 lambs born after maternal betamethasone treatment 48 h prior to birth), Postnatal Corticosteroid Group (9 lambs subjected to betamethasone treatment 10 min after birth) and Control Group (5 lambs remained untreated). Lambs were medically followed-up from birth to 72 h thereafter through a complete physical examination, as well as lactatemia, glycaemia, blood acid-base balance and antioxidant status. Treated lambs had higher vitality score than the Control Group. Heart rate was higher in postnatal therapy compared to prenatal treatment. Respiratory rate and rectal temperature were higher in treated groups. Treated lambs had hyperglycemia, while the Postnatal Group had higher lactatemia than the Control Group. The Prenatal Group had lower and normal pCO2 from 60 min onwards. The Postnatal Group had higher superoxide dismutase activity than untreated lambs. In conclusion, prenatal and postnatal betamethasone treatments favor neonatal clinical outcome, respiratory function, glucose homeostasis and oxidative balance.

First Confirmed Diagnosis of Nocardioform Placentitis (Amycolatopsis lexingtonensis) in South America.

Nocardioform placentitis is a pathologically unique form of placental disease first diagnosed in central Kentucky in the mid-80s. Since then, the occurrence of nocardioform placentitis in the region has varied over the years, from sporadic cases to outbreaks. The disease has been sporadically detected in other countries and has not been confirmed in South America. A 13-year-old multiparous Mangalarga delivered a healthy filly at 340d gestation. The mare passed the fetal membranes 33 minute after foaling. Gross examination of the fetal membranes identified two focal lesions on the chorionic surface consistent with focal mucoid placentitis. Histopathologic evaluation revealed hyperplasia and degeneration of the allantoic mesoderm, intense mononuclear inflammatory infiltrates with marked lymphocytes and plasma, and occasional macrophages and neutrophils in the microvilli. Necrotic debris and exudate were identified in the chorionic epithelium, with macrophages, plasma cells, and neutrophils confirming the diagnosis of focal mucoid placentitis. The exudate culture revealed white, firm, punctiform colonies of ∼1 mm diameter. Gram staining revealed bacilli with rounded ends and branching aspect typical of actinomycetes. PCR using primers for the 16S rRNA identified the genera of bacteria as Amycolatopsis. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis identified the isolate as Amycolatopsis lexingtonensis. In conclusion, we described the first confirmed case of nocardioform placentitis in South America. The present case was associated with the birth of a full-term healthy live foal; this result is consistent with Amycolatopsis spp and, in this case, was caused by A. lexingtonensis.

Efeitos psicoterapêuticos em um participante de um ato socionômico / Psychotherapeutic effects on a participant in a socionomic act / Efectos psicoterapéuticos en un participante en un acto socionómico

RESUMO Partindo da experiência de um psicodrama público realizado no Centro Cultural São Paulo, em 2018, evidencio os efeitos psicoterapêuticos de atos socionômicos públicos. Destaco um participante deste trabalho, o qual trouxe o tema protagônico e foi atendido individualmente ao longo de quatro sessões psicoterapêuticas para a elaboração do vivido, reafirmando a efetividade do trabalho. No ato socionômico em questão, utilizamos a linguagem teatral, peça fundamental do dispositivo criado pelo grupo Gota D'Água, como norteador do trabalho. Inicialmente visto como dispositivo de intervenção socioeducativa, defendo, neste artigo, seu potencial psicoterapêutico. Nessa perspectiva, este trabalho é, sobretudo, uma reafirmação da ação dramática entendida como mola propulsora para um trabalho que transita entre o artístico e o psicoterapêutico.

ABSTRACT This article aims to highlight the psychotherapeutic effects of public socionomic acts. A public psychodrama experience took place at the São Paulo Cultural Center in 2018. One of the participants in this act, which brought the protagonist theme in an intense way, was later individually attended to during four psychotherapeutic sessions. During individual consultations, it was possible to elaborate what was experienced in public psychodrama, reaffirming the effectiveness of the work. In the socionomic act in question, we used theatrical language, a fundamental part of the device created by the Gota D'Água group, as a guide for the work. Initially seen as a socio-educational intervention device, I defend, in this article, its psychotherapeutic potential given by the dramatic action.

RESUMEN Este artículo tiene como objetivo resaltar los efectos psicoterapéuticos de los actos sociales económicos públicos. A partir de una experiencia de psicodrama público, realizada en el Centro Cultural São Paulo en 2018, se destaca la actuación de un participante, quien trajo el tema protagonista y, posteriormente, fue atendido individualmente durante cuatro sesiones psicoterapéuticas. Durante las consultas individuales, se pudo elaborar lo vivido en el psicodrama público, reafirmando la efectividad del trabajo. En el acto socionómico en cuestión, utilizamos el lenguaje teatral, parte fundamental del dispositivo creado por el grupo Gota D'Água, como guía para el trabajo. Visto inicialmente como un dispositivo de intervención socio-educativo, defiendo, en este artículo, su potencial psicoterapéutico combinado con la acción dramática.

Exogenous surfactant replacement immediately at birth as preventive therapy for lung prematurity in neonatal lambs.

Surfactant treatment is a manner to reduce alveolar superficial tension and increase pulmonary compliance in premature neonates. Thus, we aimed to analyze the effect of exogenous surfactant treatment in combination with manual ventilation for preterm lambs. We used 15 ewes and their lambs (n = 16), prematurely born at 135 days. At birth, lambs were submitted to orotracheal intubation attached to a handheld resuscitation device and randomly allocated to: Control Group (n = 5; only manual ventilation), Single Surfactant Group (n = 5; manual ventilation coupled by intratracheal administration of 100 mg/kg surfactant) and Double Surfactant Group (n = 6; surfactant volume was divided into two doses (50 mg/kg + 50 mg/kg) administrated at birth and 30 min thereafter). A complete physical exam, arterial gas analysis, blood glucose, urea and creatinine concentration and chest radiographic assessment were performed at fixed times. All lambs had decreased body temperature until 20 min after birth. However, control and double surfactant groups reached a thermic plateau after 30 min. Regardless of the time-point, control lambs had higher heart rate in comparison to treated neonates, including bradycardia in Single Surfactant Group. Single instillation led to lower oxygenation degree, compared to the Double Surfactant Group, suggesting that surfactant treatment was not able to adequately spread within the alveoli. Lambs treated with surfactant had severe impairment of aerobic activity, leading to anaerobic metabolism. All groups had hypercapnia, which can be explained by inadequate respiratory pattern and pulmonary opacity (89% of the lambs had severe or moderate lung content). In conclusion, exogenous surfactant therapy in association with manual ventilation is ineffective in reverting pulmonary immaturity of the preterm lamb, leading to less vitality, hypoxemia, delayed pulmonary clearance and high mortality rate.

Independência funcional após acidente vascular cerebral (AVC) isquêmico em relação à fisiopatologia de acordo com TOAST / Functional independence after ischemic stroke in relation to pathophysiology according to TOAST

FUNDAMENTO: O Acidente Vascular Cerebral é uma das principais causas de morte no Brasil. O conhecimento sobre a etiologia do AVC é fundamental para uma adequada abordagem dessa doença. OBJETIVO: Avaliar se existe relação entre o subtipo de AVC isquêmico com o prognóstico dele e os fatores de risco. MÉTODOS: Foram avaliados 86 casos de AVC isquêmico no Ambulatório de Neurologia do Hospital Universitário da cidade de Canoas-RS, no período de outubro de 2018 a novembro de 2019. Foi analisada a relação do prognóstico (mRankinS) com fatores de risco de AVC e TOAST. RESULTADOS: Avaliando 86 pacientes com 60.5 (±10.1) anos (40 homens), identificamos que oclusão de pequenos vasos apresentou melhor prognóstico (p: 0.031) e cardioembolia um pior prognóstico de acordo com mRankinS (p< 0.001). Diabetes mellitus também apresentou um pior prognóstico (p: 0.021). CONCLUSÃO: Pacientes com AVC isquêmico secundário a oclusão de pequenos vasos apresentam melhor prognóstico de acordo com mRs. Mecanismos cardioembólicos e a presença de DM estão associados com o pior prognóstico neurológico

BACKGROUND: Stroke is one of the main causes of death in Brazil. Knowledge about the etiology of stroke is essential for an adequate approach to this disease. OBJECTIVE: To assess whether there is a relationship between the ischemic stroke subtype and its prognosis and risk factors. METHODS: 86 cases of ischemic stroke were evaluated at the Neurology Outpatient Clinic of the University Hospital in the city of Canoas-RS, from October 2018 to November 2019. The relationship between prognosis (mRankinS) and stroke risk factors and TOAST. RESULTS: Evaluating 86 patients aged 60.5 (±10.1) years (40 men), we identified that small vessel occlusion had a better prognosis (p: 0.031) and cardioembolism a worse prognosis according to mRankinS (p <0.001). Diabetes mellitus also had a worse prognosis (p: 0.021). CONCLUSION: Patients with secondary ischemic stroke small vessel occlusion have a better prognosis according to mRs. Cardioembolic mechanisms and the presence of DM are associated with a worse neurological prognosis

Oxidative state in equine neonates: Anti- and pro-oxidants.

BACKGROUND: In newborns, exposure to the extrauterine environment with high oxygen tension and sudden pulmonary adaptation leads to an increase in reactive oxygen species (ROS). ROS have several physiological roles, which are essential for neonatal development, however, when unbalanced, these highly unstable molecules can cause cellular destabilisation, compromising vital processes. OBJECTIVES: To characterise the oxidative status in healthy equine neonates, evaluating an indicator of lipid peroxidation and both enzymatic and nonenzymatic antioxidant systems, during the first week of life. STUDY DESIGN: Experimental cohort. METHODS: Twenty-four foals were evaluated, with blood collections performed at 5 minutes, 12, 72 and 168 hours after birth. The degree of lipid peroxidation was quantified using Thiobarbituric Acid Reactive Substances (TBARS). Superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic activities, and total, conjugated and unconjugated serum bilirubin levels were also analysed. Comparisons were performed using ANOVA followed by a Tukey's test. Additionally, dependent variables were also evaluated with Pearson's correlation tests. RESULTS: Higher GPx activity was observed at 12 and 72 hours when compared to 5 minutes. An increase in TBARS levels was found at 5 minutes after birth, followed by a decrease at 72 hours and stabilisation through subsequent moments until 168 hours after birth. No differences were observed in SOD activity when comparing the four time points. Bilirubin concentrations were lower at 5 minutes after birth and total and unconjugated bilirubin increased at 12 hours and decreased between 72 and 168 hours after birth. CONCLUSIONS: Lipid peroxidation at birth was high, suggesting an increase in ROS levels relating to physiological events in neonatal adaptation. Antioxidant systems, involving unconjugated bilirubin and GPx, were activated and these biomolecules act concomitantly to reduce ROS levels, thus maintaining oxidative homeostasis. Overall, our results suggest a pro-oxidant balance during the first 168 hours after birth in equine neonates.

Gestação e parâmetros fisiológicos neonatais em potros muares / Pregnancy and neonatal physiological parameters in mule foals

Os muares são híbridos, provenientes do cruzamento de éguas com jumentos e que apresentam um número cromossômico diplóide (2n = 63). Estes animais herdam a combinação de traços comportamentais de ambas as espécies base, e demonstram frequentemente vigor híbrido nas suas características físicas e cognitivas. A popularidade, bem como o interesse econômico tem crescido, devido as características como docilidade, rusticidade e habilidades para atividades de trabalho e esporte. Entretanto, existe uma nítida falta de informação sobre híbridos muares, desde parâmetros gestacionais, a comportamentais, físicos e fisiológicos dos neonatos. Esta revisão, tem por objetivo trazer as informações da literatura e resultados das últimas pesquisas desenvolvidas pelo LEPPE (Laboratório de Estudos da Prenhez e Periparto em Equídeos), sobre parâmetros de éguas gestantes de potros híbridos muares, bem como parâmetros neonatais. A principal finalidade, é permitir um correto manejo e uma abordagem clínica, permitindo a identificação e intervenção precoce em problemas.

Mules are hybrids, products of mares and donkeys, with a diploid chromossomic number (2n = 63). These animals inherit a combination of behavioral traits from both species and often show hybrid vigor in their physical and cognitive characteristics. Their popularity, as well as their economic value, has increased because of their characteristics such as docility, rusticity, and ability for work and pleasure. However, there is a lack of published information about hybrid mules, such as gestational, behavioral, physical, and physiological neonatal parameters. Therefore, this review aims to bring published information and results from the most current research projects developed by LEPPE (Laboratory of the Study of Pregnancy and Peripartum in Equids), about parameters of pregnant mares with mule foals, as well as neonatal parameters. The main purpose is to assist in the correct management and clinical approach, allowing diagnosis and early intervention when there are problems.

Effects of a systemic high urea concentration on the endometrial and embryonic transcriptome of mares / Efeitos de concentrações sistêmicas elevadas de ureia no transcriptoma do endométrio e embriões de éguas

It has been shown in ruminants that increased dietary protein leading to elevated blood urea nitrogen concentrations (BUN) can be a factor in decreased survival of early embryos. This work is a review of the effects of elevated BUN on endometrium and embryos from mares. An experimental model was used to elevate BUN with intravenous urea infusion, acute treatment, or oral urea, chronic treatment. After the acute urea treatment there was a decrease in uterine pH and changes in genes related to cell pH and ion homeostasis. After the chronic urea treatment there was no difference in uterine pH but genes related to necrosis and cellular movement had a different expression. The effect of high BUN was also evaluated on equine embryo transcriptome, with a positive correlation between plasma BUN and blastocoele fluid urea nitrogen concentration. Additionally, the expression of genes related to survival of organism and adhesion were different. Lastly, using mares from private farms, lower pregnancy rate was seen when embryos were collected from mares with higher BUN concentrations. In conclusion, these novel results show that high BUN results in endometrial and embryonic alterations, suggesting that it might lead to decreased fertility.

The Effect of Gabapentin on Postoperative Pain of Orthopedic Surgery of Lower Limb by Sciatic and Femoral Blockage in Children: A Clinical Trial.

BACKGROUND: There are meta-analyzes in adults demonstrating the benefits of using gabapentin to improve postoperative pain in orthopedic surgeries. In pediatrics, it has never been studied. OBJECTIVES: The aim of this study was to evaluate the use of gabapentin 10 mg/kg, orally, in postoperative analgesia, hemodynamic stability and its pre/postoperative anxiolytic effect in children subjected to unilateral inferior limb surgery. METHODS: We performed a double-blinded, randomized study. 84 patients in Albert Sabin Children's Hospital were selected for elective surgery that were divided into 2 groups: gabapentin group, who received gabapentin 1 to 2 hours before the procedure and the control group. Both groups were submitted to the same general anesthesia protocol with 0.125% bupivacaine femoral and sciatic block. Patients received scheduled dipyrone and morphine was used as the rescue analgesic up to 2/2 h. Postoperative pain was assessed using a scale appropriate for age (CRIES, CHIPPS or Wong-Baker face scale). We registered hemodynamic parameters, analgesic consumption and pre/postoperative anxiolytics. RESULTS: A decrease in pain intensity in the 4th and 8th postoperative hours was observed in gabapentin group, both groups had the same opioid consumption. Children in the gabapentin group had an odds ratio of 25.6 for preoperative sedation and gabapentin promoted reduction of postoperative agitation. During orotracheal intubation the gabapentin group exhibited attenuation of the hemodynamic response. CONCLUSIONS: Gabapentin was superior to placebo in reducing postoperative pain. Children who received gabapentin were more sedated in the operating room, less agitated in the postoperative period and the autonomic response to intubation was reduced.

Gabapentin in Improvement of Procedural Sedation and Analgesia in Oncologic Pediatric Patients: A Clinical Trial.

BACKGROUND: Preoperative anxiety and distress can produce significant psychological impacts on children undergoing oncologic care or investigation. Adjuvant therapy is used for pain management in children; however, pre-analgesia options are restricted because they can cause undesirable outcomes. OBJECTIVES: Our study aimed to investigate the use of gabapentin in procedural sedation as adjuvant therapy in children undergoing oncologic treatment. METHODS: We performed a double-blinded, randomized, clinical trial at Albert Sabin Infant's Hospital in Fortaleza, Brazil. Children aged 1 - 6 years who had myelogram or lumbar puncture (associated or not with intrathecal chemotherapy) received placebo or gabapentin syrups (15 mg/kg and 30 mg/kg) one to two hours before the procedure. Preoperative anxiety was evaluated by the Yale preoperative anxiety scale modified (m-YPAS scale). The pediatric anesthesia emergence delirium (PAED) and children and infants postoperative pain scale (CHIPP) scales were used for emergence delirium and pain intensity measurement, respectively. RESULTS: We evaluated 135 patients. We observed that the gabapentin groups presented lower m-YPAS scores than the placebo group at separation and induction times. Postoperatively, the gabapentin groups had lower PAED and CHIPP scores than the placebo group; however, only had PAED scores clinical relevance. No significant differences were found between the gabapentin groups. Furthermore, children with less than three prior similar procedures were more likely to benefit from gabapentin. Postoperative vomiting was prevented by 30 mg/kg gabapentin. CONCLUSIONS: Although gabapentin has little preoperative effects, it ameliorates anxiety before induction, improves anesthetic induction, and reduces the occurrence of emergence delirium and postoperative vomiting up to eight hours after the procedure. Thus, we indicate gabapentin as adjuvant therapy for procedural sedation.

Prevalência de rastreio positivo para síndrome de Cushing em indivíduos obesos candidatos ao tratamento cirúrgico para obesidade / Prevalence of positive screening for Cushing's syndrome in obese indivi-duals who are candidates for bariatric surgery

Introdução: A obesidade afeta mais de um terço dos norte-americanos e sua prevalência está aumentando nos brasileiros. Em casos graves, a cirurgia bariátrica é considerada o tratamento mais bem-sucedido e duradouro. Durante a avaliação pré operatória, deve-se investigar causas secundárias de obesidade e, especificamente no Brasil, deve-se excluir síndrome de Cushing (SC) nesses pacientes, apesar de recomendações controversas de rastreio de SC em diretrizes atuais. A prevalência de SC endógena é extremamente baixa, mas parece ser maior em populações específicas, como pacientes diabéticos, com hipertensão resistente, ou portadores de obesidade Objetivo: Avaliar a prevalência de triagem positiva para SC em obesos candidatos a cirurgia bariátrica e discutir possíveis fatores de risco ou co-morbidades associadas à positividade do rastreio. Material e Métodos: Estudo retrospectivo com 629 pacientes atendidos no ambulatório de obesidade da Santa Casa de Belo Horizonte entre 2008 e 2016. Realizada a triagem da SC com o teste de supressão noturna com 1mg de dexametasona (1mg-DST), dosando o cortisol na manhã seguinte (ponto de corte ≥1,8µg/dL). Resultados: 80 dos 629 pacientes apresentaram rastreio positivo para SC. Destes, 20 pacientes foram considerados negativos após repetirem o 1mg-DST e 6 pacientes foram negativos após o teste Liddle 1. Conclusão: A prevalência de rastreio positivo para SC foi igual a 12,7%, semelhante aos dados da literatura. Nenhum fator de risco ou co-morbidade pôde ser diretamente associado à positividade do teste de rastreamento.

Introduction: Obesity affects more than a third of Americans and its prevalence is increasing in Brazilians. In severe cases, bariatric surgery is considered the most successful and long-lasting treatment. During the preoperative evaluation, secondary causes of obesity should be investigated and, specifically in Brazil, Cushing's Syndrome (CS) should be excluded in these patients, despite controversial recommendations for CS screening in current guidelines. The prevalence of endogenous SC is extremely low, but appears to be higher in specific populations, such as diabetics, patients with resistant hypertension or those with obesity. Aim: To evaluate the prevalence of positive screening for CS in obese candidates for bariatric surgery and to discuss possible risk factors or comorbidities associated with screening positivity. Material and Methods: A retrospective study was conducted with 629 patients attended at the Obesity Outpatient Clinic of Santa Casa, Belo Horizonte between 2008 and 2016. CS screening was performed with a 1mg dexamethasone (1mg-DST) suppression test, dosing cortisol in the next morning (cut-off point ≥1.8µg / dL). Results:80 of the 629 patients had positive screening for SC. Of these, 20 patients were considered negative after repeated 1mg-DST and 6 patients were negative after the Liddle 1 test. Conclusion: The prevalence of positive screening for SC was 12.7%, similar to the literature. No risk factor or co-morbidity could be directly associated with the positivity of the screening test.

Transplacental transmission of Theileria equi in mules: Should we worry?

Equine piroplasmosis, disease globally responsible for significant economic losses, is caused by the transmission of the hemoprotozoa Theileria equi and Babesia caballi by ticks. Transplacental transmission has been reported previously in horses, which is not the case for mules´ foals. The present study investigated, by Real Time-PCR (RT-PCR), the presence of both Theileria equi and Babesia caballi in newborn mules before the ingestion of colostrum. Blood samples of 18 mares and their respective mules´ foals were collected and analyzed by RT-PCR. Only one mare was positive for B. caballi. In contrast, 13 mares were positive for T. equi, with two foals (11.1%) positive for the same protozoon, both of affected mares. We may conclude that transplacental transmission of Theileria equi also occurs in mules which may be an important concern while breeding such animals.

Mudanças comportamentais e fisiológicas determinadas pelo ciclo biológico feminino ­ climatério à menopausa / Behavioral and physiological changes determined by the female biological cycle ­ climacteric to menopause

A menopausa, período da falência ovariana, aparece como um marco corporal desencadeando sinais e sintomas que necessitam de controle e avaliação para garantir qualidade de vida no processo do envelhecimento feminino. O objetivo deste trabalho foi investigar as ações do estrogênio no período que caracteriza o climatério/menopausa, a partir de uma revisão integrativa, cujos descritores foram: ações do estrogênio, sinais/sintomas do climatério/menopausa e terapia de reposição hormonal. O estrogênio apresenta receptores em todos os órgãos e, portanto, atua nas características anatômicas, fisiológicas e emocionais; estimula o crescimento da massa óssea e muscular; atua como antioxidante; exerce ação cardioprotetora e neuroprotetora; contribui na vitalidade emocional e sexual. Com isso, percebe-se que no climatério ocorre uma redução drástica nos níveis de estrogênio, que culmina com a ausência estrogênica na menopausa e esse fato acarreta desequilíbrio de diferentes sistemas, até atingir uma nova adaptação.(AU)

Menopause appears as a body landmark in the aging process, where along with ovarian failure, it can trigger signs and symptoms that require control and evaluation to ensure a good quality of life. The objective of this work was to investigate how the estrogen actions in the period that characterize the climacteric / menopause. From an integrative review, the descriptors were: estrogenic effects, signs and symptoms of climacteric and menopause and hormone replacement therapy. Estrogen has receptors in all organs and, therefore, acts on anatomical, physiological and emotional characteristics; in determining bone and muscle mass growth; action as antioxidant; as cardioprotective and neuroprotective; contribution to emotional and sexual vitality. It was verified that in the climacteric occurs a reduction of the hormonal levels that culminates with the menopause and that the estrogen absence causes in disequilibrium of different systems, until reaching a new adaptation.(AU)