No abstract

Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker and has been proved to be related to a worse prognosis in heart diseases. However, the precise relationship between elevated CA125 in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been sufficiently studied. We set out to determine the association of CA125 with all-cause mortality at 6 months in STEMI. CA125, N-terminal pro brain natriuretic peptide (NTproBNP) and high sensitive C-reactive protein (hs-CRP) were measured in 245 patients admitted consecutively with STEMI undergoing coronary angioplasty. The mean age in our sample was 63.7 years, 64.9% were males, 28.3% had diabetes and 17.7% presented with acute heart failure (Killip ≥ 2). The median serum level of CA125 was 8.1 U/ml. At 6 months, the rate of all-cause mortality was 18% (44 patients). Receiver operating characteristic curve analysis demonstrated that CA125 presented similar performance to predict mortality as NTproBNP and hs-CRP. Patients with CA125 ≥ 11.48 had a higher rate of mortality (Hazard Ratio = 2.07, 95% confidence interval = 1.13-3.77, p = 0.017) than patients with CA125 < 11.48. This study suggests that elevated CA125 levels might be used to identify patients with STEMI with a higher risk of death at 6 months. CA125 seems to be a similar predictor of mortality compared to NTproBNP and hs-CRP. Myocardial infarction with ST-segment elevation (STEMI) is a life-threatening disorder with high morbidity and mortality despite advances in treatment. Patients presenting with STEMI tend to be heterogeneous and immediate risk stratification at the time of presentation is essential for optimal management 1-4. Markers of congestion and inflammation, such as natriuretic peptides (NP) and high sensitive C-reactive protein (hs-CRP), have been shown to be prognostic markers. However, the biomarkers currently available are not perfect, and their correct interpretation requires careful consideration of the specific clinical scenario 5. Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker. It has been studied in patients with heart diseases, especially heart failure 6. However, the precise relationship between elevated CA125 in patients with STEMI and cardiovascular events has not yet been sufficiently studied. This study set out to evaluate the relationship between CA125 and mortality in STEMI patients in comparison with N-Terminal pro brain natriuretic peptide (NTproBNP) and hs-CRP. Methods patients and study design. This was a prospective cohort at a single center. Patients consecutively admitted with STEMI undergoing primary angioplasty were included. The diagnosis of STEMI was made based on the third universal definition 7. Two hundred and seventy one patients were considered to be included. Patients were excluded if they had chronic heart failure (n = 3), previous coronary revascularization (n = 11), kidney failure (n = 8), absence of severe coronary disease (n = 4), end-stage liver disease, ongoing infection or malignancy.

RESUMO Infecção relacionada com assistência à saúde (IRAS) é atribuída aos quadros adquiridos tanto no momento da admissão em ambientes de atenção à saúde, quanto durante a internação, e até mesmo após alta médica, sendo assim, correlacionada com a permanência hospitalar. Na rotina cirúrgica veterinária, pacientes tanto hígidos quanto imunocomprometidos, tornam-se susceptíveis. Ressalva-se, que a ferida cirúrgica infectada por microrganismos endógenos ou exógenos, com classificação de multirresistentes ou não, pode desencadear quadros sépticos. Denomina-se infecção no sítio cirúrgico (ISC), a colonização da ferida cirúrgica por microrganismos, sendo sua ocorrência no pós-operatório, uma das principais complicações relacionadas à IRAS. Os principais fatores que podem levar a ISC estão ligados ao pré, trans e pós-operatório. Os médicos veterinários que atuam diretamente em ambiente hospitalar, devem estar preparados para prevenir e tratar casos de ISC de maneira integrada e dinâmica. Entre as ferramentas importantes nesse processo, destacam-se os programas multidisciplinares de Antibiotic Stewardship associados ao desenvolvimento de técnicas diagnósticas rápidas e ao incentivo de medidas consagradas para o controle da infecção hospitalar. Objetiva-se com o presente trabalho ressaltar os principais fatores de risco, medidas profiláticas, e o programa Antibiotic Stewardship, para o controle da ISC.

Despite its clinical relevance, the pathogenesis of canine pyometra remains poorly understood. To date, it is recognized as a non-transmissible infectious disease. In this study, the simultaneous occurrence of pyometra and Escherichia coli in two cohabitant female dogs underwent in-depth investigation due to the hypothesis of transmission between these animals. Two 5-year-old Chow Chow dogs (namely, dogs 23 and 24—D23 and D24) were referred to a veterinary hospital with suspected pyometra. Both animals showed prostration, anorexia, and purulent vulvar discharge over a 1-week period. After ovariohysterectomy, uterine tissue, uterine contents, and rectal swabs were collected for histopathological and microbiological analysis. Uterine histology demonstrated purulent material and multifocal necrosis with endometrial ulceration, and a morphological diagnosis of pyometra was confirmed. Furthermore, E. coli from the same phylogroup (B2) and positive for the same virulence factors with the same antimicrobial susceptibility profile was isolated from the uterine contents of both dogs and the rectum of D23. Conversely, the E. coli strains recovered from D24 differed in phylogroup (one isolate), virulence factors (all three isolates), and antimicrobial susceptibility (all three isolates). Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) suggested that all isolates from the uterine content of both dogs and the rectal swab of D23 were 100% the same, but different from all isolates in the rectal swab of D24. One isolate from the uterine content of each animal as well as rectal swabs were subjected to whole-genome sequencing (WGS). Both whole-genome multilocus sequence typing(wgMLST) and single-nucleotide polymorphism (SNP) analysis supported the hypothesis that the isolates from the uterine content of both animals and the rectal swab of D23 were clonal. Taken together, these clinical features, pathology, microbiology, and molecular findings suggest, to the best of our knowledge, the first transmission of E. coli associated with pyometra between two animals. These results could impact the management of sites where several females cohabit in the same local area such as kennels.

A osteopatia crânio mandibular (OCM) é uma afecção óssea rara de caráter degenerativo, osteopetrótico, autolimitante, não neoplásico, sem predileção sexual, que acomete cães na fase pré-púbere. As raças mais predispostas são as Terries em destaque para o West Highland White Terrier. Os sinais clínicos são variáveis dependendo dos ossos alterados e do grau de acometimento. Dentre os mais comuns estão febre, dor ao abrir a boca, aumento de volume da mandíbula, hiporexia e sialorreia. Os ossos do crânio são os mais acometidos, em especial, os mandibulares, os das articulações temporomandibulares e as bulas timpânicas. O diagnóstico se baseia nos achados clínicos, radiográficos e histopatológicos. As alterações radiográficas mais comuns são aumento da radiopacidade e volume das mandíbulas e das bulas timpânicas. O tratamento é sintomático, tendo como ponto principal o controle de dor e suporte nutricional. O prognóstico é heterogêneo. Os pacientes podem passar pela remissão completa da afecção ou serem submetidos à eutanásia por anquilose da articulação temporomandibular.