RESUMEN La comprensión de los mecanismos para el desarrollo de la ascitis ha evolucionado a lo largo de los años, involucrando al hígado, peritoneo, corazón y riñones, pero no al intestino, como responsable clave en su formación. Poco se ha descripto tanto de su papel fisiopatológico como de las posibles alternativas terapéuticas clínicas y quirúrgicas. A fin de validar empíricamente este concepto se relata la situación de un hombre de 39 años, con trombosis aislada de la vena mesentérica superior y fallo intestinal. La necesidad de realizar una derivación quirúrgica nos llevó a construir un shunt desde una vena colateral de la mesentérica superior a la vena esplénica. La reducción de la presión del sistema mesentérico superior de 35 a 6 mm Hg sirvió para la resolución de los signos y síntomas clínicos en un mes. Este caso obliga a revisar conceptos fisiopatológicos básicos sobre la producción de ascitis, contribuye a la descripción de un nuevo tipo de shunt y amplía las opciones terapéuticas quirúrgicas en el tratamiento de la hipertensión venosa esplácnica.

ABSTRACT The understanding of the mechanisms for the development of ascites has evolved over the years to include the liver, peritoneum, heart and kidneys, but not the intestine, as key players in its formation. The pathophysiological role of the intestine as well as the possible clinical and surgical therapeutic options have been poorly described. In order to empirically validate this concept, we report the situation of a 39-year-old man with isolated thrombosis of the superior mesenteric vein and intestinal failure. The need to perform a surgical shunt led us to construct a shunt from a collateral vein of the superior mesenteric vein to the splenic vein. The reduction in pressure in the superior mesenteric venous system from 35 to 6 mm Hg resulted in resolution of clinical signs and symptoms within one month. This case study forces us to review the basic pathophysiological concepts of ascites formation, contributes to the description of a new type of shunt, and expands the surgical therapeutic options in the treatment of splanchnic venous hypertension.

ABSTRACT Introduction: Collar of Stokes is part of the clinical picture of Superior Vena Cava Syndrome. Patients who require hemodialysis need vascular access by placing a double-lumen catheter in the jugular or subclavian veins, which, when used for long periods of time, can favor the appearance of face/neck edema. Objective: To present a patient on hemodialysis with collar of Stokes edema, taking into account that it is a rarely discussed cause of edema. Clinical Case: Male patient, 26 years old, black skin color, apparent health history who arrives at the emergency room with a hypertensive emergency. Complementary tests showed elevated blood creatinine and urea with renal ultrasound showing small kidneys; He was considered a patient with chronic renal failure. Periodic intermittent hemodialysis treatment was started, which was maintained for 29 months until the time of evaluation. With multiple double-lumen catheters to receive the cleansing treatment, he developed gradual volume increase in his facial and neck region. Conclusion: The use of double-lumen catheters for hemodialysis can favor the appearance of collar of Stokes edema; which may be seen more frequently due to the accessibility of patients with stage 5 chronic kidney disease to conventional hemodialysis.

RESUMEN Introducción: El edema en esclavina forma parte del cuadro clínico del síndrome de la vena cava superior. Los pacientes que requieren de hemodiálisis necesitan de un acceso vascular colocando un catéter de doble luz en las venas yugular o subclavia que, utilizado por periodos prolongados de tiempo, puede favorecer la aparición de edema en esclavina. Objetivo: Presentar a un paciente en hemodiálisis con edema en esclavina, teniendo en cuenta que es una causa de edema poco comentada. Caso Clínico: Paciente masculino, 26 años de edad, color de piel negra, antecedentes de salud aparente que llega al cuerpo de guardia con una emergencia hipertensiva. Se le realizaron complementarios que mostraron creatinina y urea en sangre elevadas con ecografía renal que mostraba riñones pequeños; se consideró un paciente con insuficiencia renal crónica. Se inició tratamiento de hemodiálisis periódica intermitente, que se mantuvo por 29 meses hasta el momento de su valoración. Con múltiples catéteres de doble luz para recibir el tratamiento depurador, desarrolló aumento de volumen gradual de la región facial y el cuello. Conclusión: El uso de catéteres de catéteres de doble luz para hemodiálisis, por periodos prolongados, pueden favorecer la aparición de edema en esclavina.

Abstract Sodium-glucose cotransporter 2 inhibitors (SGLT2i), originally developed as innovative antihyperglycemic agents, have demonstrated significant benefits in improving metabolic markers and protecting the kidneys and heart in patients with or without type 2 diabetes mellitus. The mechanisms behind these unexpected cardiorenal benefits cannot be attributed solely to improved glycemic control. Recent data suggest that metabolic reprogramming plays a role in the development of cardiorenal metabolic disease. Despite the effectiveness of SGLT2i in the management of chronic kidney disease (CKD)-related comorbidities in adults, their use in the pediatric population remains to be validated. The challenge in pediatric CKD lies in the imbalance between the metabolic needs of a growing child and the declining functional capacity of a failing kidney. Developing strategies to address modifiable factors in the progression of kidney disease is critical given the extended lifespan of the pediatric population. SGLT2i have emerged as innovative candidates for the treatment of CKD in children. By improving renal hemodynamic adaptation and mitigating overall CKD complications, these agents have the potential to be a novel therapeutic option for pediatric patients. This review will focus on the current understanding of how SGLT2i may provide cardiorenal protection.

Resumo Os inibidores do cotransportador 2 de sódio e glicose (SGLT2), inicialmente considerados medicamentos antihiperglicémicos inovadores, demonstraram benefícios significativos na melhoria dos marcadores metabólicos e na proteção renal e cardíaca em doentes com ou sem diabetes mellitus tipo 2. Estas vantagens cardiorenais inesperadas não podem ser atribuídas exclusivamente ao controle glicémico melhorado. Dados recentes sugerem que a reprogramação metabólica desempenha um papel no desenvolvimento de doenças metabólicas cardiorenais. Apesar da eficácia dos inibidores do SGLT2 no tratamento de comorbilidades associadas à doença renal crónica (DRC) em adultos, o seu uso na população pediátrica aguarda validação. O desafio na DRC pediátrica reside no desequilíbrio entre as necessidades metabólicas da criança em crescimento e a capacidade funcional diminuída do rim em falência. Face à expectativa de vida prolongada da população pediátrica, é fundamental o desenvolvimento de estratégias dirigidas a fatores modificáveis na progressão da DRC. Os inibidores do SGLT2 surgem como candidatos inovadores para o tratamento da DRC em crianças. Ao melhorar a adaptação hemodinâmica renal e mitigar as complicações gerais da DRC, estes agentes afiguram-se como uma potencial nova abordagem terapêutica para doentes pediátricos. Esta revisão incidirá no entendimento atual de como os inibidores do SGLT2 podem conferir proteção cardiorrenal.

ABSTRACT Background: The ectopic pelvic kidney, a common renal anomaly, is often smaller and malformed, with a shorter and sometimes tortuous ureter (1). Muscle-invasive bladder cancer (MIBC), constituting 15-25% of bladder cancer cases (2), mandates radical cystectomy with a 50% 5-year survival rate (2). Despite the growing use of robot-assisted radical cystectomy (RARC) (3, 4), there is limited data on its application in ectopic kidneys. Only one RARC case has been reported (5), in contrast to numerous open radical cystectomies (1, 6) involving an ectopic kidney. Patient and methods: After being diagnosed with T2 high-grade urothelial carcinoma, the 66-year-old patient, previously treated with multiple transurethral resections and adjuvant BCG therapy, received neoadjuvant chemotherapy. Preoperative staging CT revealed a 2.6 x 2.2 cm bladder neoformation and an ectopic right pelvic kidney. Results: Using the da Vinci Surgical System, radical cystectomy with ileal conduit (sec Wallace II) and lymphadenectomy were performed. During the demolition phase, the shorter right ureter was dissected with care to avoid damage to the renal pedicle. The reconstructive phase included intracorporeal urinary diversion (ICUD) and uretero-ileal anastomosis, facilitated by the favorable position of the kidney. The 8-hour console surgery resulted in minimal blood loss. Discharged on day 16 due to COVID-19, the patient exhibited positive outcomes. A 2-month CT follow-up revealed no cancer recurrence, metastasis, hydronephrosis, and complete regression of the lymphocele. Imaging follow-up continues without postoperative adjuvant chemotherapy. Conclusion: Robotic surgery with intracorporeal urinary diversion holds potential for right-sided pelvic kidney cases, but additional studies are necessary for validation.

Resumo Introdução: Síndrome nefrótica (SN) é uma das causas de doença renal em estágio terminal. É importante elucidar a patogênese e oferecer novas opções de tratamento. Estresse oxidativo pode desencadear a patogênese sistemicamente ou isoladamente nos rins. O octreotide (OCT) tem efeitos antioxidantes benéficos. Nosso objetivo foi investigar a fonte de estresse oxidativo e efeito do OCT no modelo experimental de SN. Métodos: Dividimos 24 ratos albinos Wistar não urêmicos em 3 grupos. Grupo controle, 2 mL de solução salina intramuscular (im); grupo SN, adriamicina 5 mg/kg intravenosa (iv); grupo tratamento SN, adriamicina 5 mg/kg (iv) e OCT 200 mcg/kg (im) foram administrados no início do estudo (Dia 0). Aos 21 dias, mediram-se os níveis de creatinina e proteína em amostras de urina de 24 horas. Mediu-se a catalase (CAT) eritrocitária e renal e a substância reativa ao ácido tiobarbitúrico (TBARS). Avaliou-se também histologia renal. Resultados: Não houve diferença significativa entre os três grupos em termos de CAT e TBARS em eritrócitos. O nível de CAT renal foi menor no grupo SN e significativamente menor que no grupo controle. No grupo tratamento, o nível de CAT aumentou significativamente em comparação com o grupo SN. Quanto à histologia renal, as avaliações tubular e intersticial foram semelhantes em todos os grupos. O escore glomerular foi significativamente maior no grupo SN em comparação com o grupo controle e diminuiu significativamente no grupo de tratamento em comparação com o grupo SN. Conclusões: Estresse oxidativo na SN pode ser devido à diminuição do mecanismo de proteção antioxidante nos rins. O octreotide melhora níveis de antioxidantes e histologia do tecido renal e pode ser uma opção de tratamento.

Abstract Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model. Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated. Results: There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group. Conclusions: Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.

Resumo Introdução: O síndroma de Bardet-Biedl (SBB) é uma doença multissistémica rara, de transmissão predominantemente autossómica recessiva, genética e clinicamente heterogénea. A sua prevalência na Europa varia entre 1:125.000 e 1:175.000, afetando de igual modo ambos os sexos. Este síndroma define-se por obesidade, polidactilia, anomalias genitourinárias, distrofia retiniana e dificuldades cognitivas, que se associam de forma variável e pode incluir um amplo espectro de outras manifestações menos prevalentes. O diagnóstico da SBB é clínico, sendo confirmado por análise molecular, o que permite o aconselhamento genético dos restantes membros da família e a realização do diagnóstico pré-natal. Atualmente não existe tratamento curativo, mas o diagnóstico precoce é importante para orientar o acompanhamento multidisciplinar. O médico de família, pela sua proximidade com o doente e seguimento longitudinal, poderá identificar sinais de alarme relativos ao diagnóstico e à identificação de complicações da doença, além de poder ajudar a mitigar impactos psicossociais deletérios. Descrição do caso: Utente do sexo masculino, quatro anos de idade, raça caucasiana, natural de Lisboa, primeiro filho de uma fratria de três. A gravidez foi vigiada pelo seu médico de família, tendo, por alterações na ecografia morfológica - rins poliquísticos e polidactilia - iniciado seguimento na consulta de genética médica, onde se estabeleceu o diagnóstico de SBB tipo 4. Nasceu por parto eutócico de uma gestação de termo sem outras intercorrências. Foi referenciado às consultas de pediatria, genética, nefrologia, oftalmologia, otorrinolaringologia, cirurgia pediátrica plástica e cardiologia pediátrica. Com cerca de um ano de idade foi-lhe diagnosticada miopia. Aos três anos foi submetido a desarticulação de dedos supranumerários. Presentemente mantém vigilância na consulta de saúde infantil da USF e acompanhamento nutricional, apresentando progressão estaturo-ponderal adequada. Comentário: O objetivo deste trabalho é relatar um caso de SBB e identificar o papel do médico de família na sinalização e acompanhamento da criança com doença genética rara.

Abstract Introduction: Bardet-Biedl syndrome (BBS) is a rare multisystem disorder, predominantly of autosomal recessive transmission, with genetic and clinical heterogeneity. Prevalence in Europe varies from 1:125,000 to 1:175,000, equally affecting both sexes. BBS is defined by a variable combination of obesity, polydactyly, genitourinary anomalies, retinal dystrophy, cognitive impairment, and other less prevalent manifestations. The diagnosis of BBS is clinical, confirmed by molecular analysis. This allows for genetic counseling of families and the possibility of prenatal diagnosis. Currently, there is no curative treatment for BBS, being early diagnosis is important to plan a multidisciplinary follow-up. Family physicians, owing to their closeness with the patient and longitudinal follow-up, may identify red flags leading both to early diagnosis and early detection of complications, and to detect and mitigate any psychosocial mishaps. Case description: Male, Caucasian, four years old, born in Lisbon, first of three children. The pregnancy was initially followed by the general practitioner. Due to changes in the routine morphological ultrasound - polycystic kidneys and polydactyly - a referral was made to a consultation of medical genetics, where the genetic study was carried out to establish the diagnosis of BBS type 4. He was born by eutocic delivery, at the end of a full-term gestation, without complications. He was referred to consultations in pediatrics, genetics, nephrology, ophthalmology, otorhinolaryngology, pediatric plastic surgery, and pediatric cardiology. At about one year of age, he was diagnosed with myopia. At the age of three, he underwent the first disarticulation of the supernumerary fingers and toes. The child keeps follow-up at the USF consultation and nutritional monitoring, so far showing adequate height-weight progression. Comment: The objective of this case report is to describe a case of BBS and to identify the role of the family physician in the referral and follow-up of a child with a rare genetic disorder.

SARS-CoV-2, which caused the coronavirus pandemic in 2019 (COVID-19), is a beta-coronavirus, and its infection in host cells can activate innate and adaptive immune responses through the activation of several pro-inflammatory cytokines. Thus, in this study we established the relationship between the severity and immunopathology of COVID-19 through the main inflammatory cytokines. Results show that tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ) and interleukins (IL), such as IL-6, are stimulated by the activation of T cell subsets, which results in immune-mediated cellular destruction. Several cytokines reduce the immune response and predispose to a pro-inflammatory and auto-reactive state, including IL-1β, IL-1RA, IL-7, IL-8, IL-9, IL-10, and associated inflammatory markers (LDH, GM-CSF and VEGF). These higher cytokine levels end up favoring tissue damage in multiple systems, including lungs, heart, gastrointestinal, brain, kidneys and other organs. Increasingly, a greater impact of the markers IL-6, ferritin, pro-calcitonin, lactic dehydrogenase, D-dimer and hypoalbuminemia was observed in patients with severe infection of the disease. In general, the data analyzed confirmed that COVID-19 severity is not caused simply by the viral infection, but rather by immune response and aberrant inflammation. In this way, this study allows a contribution to clinical practice, and it shows that it is essential to carry out in-depth studies about the immunopathology of COVID-19, in order to determine the severity markers involved in the pathogenesis of the viral infection.

O SARS-CoV-2, causador da doença coronavírus 2019 (COVID-19), é um beta-coronavírus, e sua infecção nas células do hospedeiro pode ativar respostas imunes inata e adaptativa, por meio da secreção de várias citocinas pró-inflamatórias. Assim, estabelecemos neste estudo a correlação da gravidade e imunopatologia da COVID-19 com as principais citocinas inflamatórias. Resultados mostram que o fator de necrose tumoral alfa (TNF-α), interferon-gama (IFN-γ) e interleucinas (IL), como a IL-6, são estimulados pela ativação de subconjuntos de células T, o que resulta em destruição celular imunomediada. Sendo que, diversas citocinas deprimem a resposta imune sadia, e predispõem a um estado pró-inflamatório e auto-reativo, dentre elas, IL-1β, IL-1RA, IL-7, IL-8, IL-9, IL-10, e os marcadores inflamatórios associados (LDH, GM-CSF e VEGF). Isso acaba por favorecer danos teciduais em múltiplos sistemas, como no pulmonar, cardíaco, gastrointestinal, cerebral, renal, dentre outros. Acrescenta-se que foi observado um impacto maior dos marcadores IL-6, ferritina, pró-calcitonina, desidrogenase láctica, D-dímero e hipoalbuminemia em pacientes com infecção grave da doença. De forma geral, pela análise de dados, verificou-se que a gravidade da doença COVID-19 parece ser modulada não apenas pela infecção viral, mas também por respostas imunes e inflamatórias aberrantes no hospedeiro. Dessa forma, este estudo permite contribuir para o auxílio da prática clínica, sendo imprescindível a realização de estudos aprofundados acerca da imunopatologia da COVID-19, a fim de que se determine os marcadores de gravidade envolvidos na patogênese da infecção viral.

Resumen La caprinocultura es una actividad muy importante en el norte de México por la producción de leche y carne. En este sentido, el cabrito es un platillo típico de esta región con valor económico y cultural elevado, no obstante, la información que describe la composición morfoestructural y calidad de carne de estos ejemplares locales, ha sido poco documentada. Debido a lo anterior, el objetivo fue evaluar las características morfoestructurales, calidad de canal y carne en cabritos locales de acuerdo con el sexo (machos y hembras) en la región noreste de México, para esto se sacrificaron 14 cabritos (7 machos y 7 hembras) de 57 días de edad. Para evaluar la composición morfoestructural, se consideraron 22 variables zoométricas y fenotípicas. Las características de la canal se evaluaron considerando las distintas estructuras corporales, rendimiento en canal y grado de engrasamiento. Se determinó calidad de carne midiendo las características fisicoquímicas, valor nutricional y perfil de ácidos grasos. Se evaluó el efecto del sexo mediante una prueba de t de medias independientes y Chi cuadrada. La estructura morfoestructural de los cabritos locales es heterogénea, y no mostraron diferencias (P≥0,05) respecto del sexo. El peso de la canal, riñones, cabeza, cuello, costillar y lomo fueron mayores en machos que en hembras (P≤0,05). Las características fisicoquímicas y valor nutricional de la carne no mostraron diferencias entre sexos. Los ácidos grasos (AG) que se encontraron en mayor proporción fueron; palmítico (C16:0), oleico (C18:1, n-9), esteárico (C18:0), y mirístico (C14:0). Estos AG comprendieron el 80,85 % del perfil lipídico de la carne de los machos, mientras que en hembras representaron el 76,83 %. Estos resultados son la base para futuros programas de mejora del sistema productivo y donde las diferencias encontradas podrían arrojar luz sobre esfuerzos futuros, sobre cómo diferenciar la carne de cabrito en esta región de México e ingresar a nuevos mercados que beneficiarían directamente a los pequeños productores.

Abstract Goat farming is an important activity in northern Mexico. In this sense, “cabrito” or kid goat is a typical regional dish with high economic and cultural value. However, information on the morphostructural composition and meat quality of these local specimens is scarce. Given this, the objective was to evaluate morphostructural characteristics, carcass and meat quality in local kids according to sex in the northeastern region of Mexico. For this purpose, 14 kids (7 males and 7 females) 57 days old were slaughtered. Morphostructural composition was evaluated with 22 zoomometric and phenotypic variables. Carcass characteristics were evaluated by considering different body structures, carcass yield and degree of fatness. Meat quality was determined by physicochemical characteristics, nutritional value and fatty acid profile. The sex effect was evaluated by t-test of independent means and Chi-square. Meat physicochemical characteristics, nutritional value and morphostructure of local kids were heterogeneous and showed no differences (P≥0.05) concerning sex. Carcass, kidneys, head, neck, rib and loin weights were higher in males than in females (P≤0.05). Fatty acids (FA) found in greater proportion were palmitic (C16:0), oleic (C18:1, n-9), stearic (C18:0), and myristic (C14:0). These FA comprised 80.85 % of the lipid profile of male meat and 76.83% of females. These results are the basis for future programs aimed to improve production systems. Differences found could shed light on future efforts on how to differentiate goat meat from this region of Mexico and enter new markets directly benefiting small producers.

Resumo Pseudomonas fluorescens é uma das principais causas de doenças septicêmicas em peixes de água doce, causando graves perdas econômicas e diminuindo a eficiência da fazenda. Assim, esta pesquisa teve como objetivo investigar a ocorrência de P. fluorescens em peixes de tilápia-do-nilo (O. niloticus) no Egito, sequenciamento do gene 16S rDNA e suscetibilidade antimicrobiana. Cepas de P. fluorescens foram detectadas em 32% (128\400) de peixes tilápia-do-nilo aparentemente saudáveis (9%; 36\400) e doentes (23%; 92\400). A maior prevalência foi observada nas brânquias dos peixes, 31,3%, seguida pelo intestino 26,9%, fígado 24,2% e rins 17,6%. Os resultados da PCR para o gene 16SrDNA de P. fluorescens mostraram o gene 16SrDNA em 30% dos isolados examinados. Além disso, a homogeneidade e uma forte relação entre cepas de P. fluorescens foi confirmada usando sequências de 16SrDNA. Além da responsabilidade do gene 16SrDNA na virulência de P. fluorescens. Os resultados dos testes de suscetibilidade antimicrobiana revelaram que todas as cepas foram resistentes à piperacilina (100%), seguida pela ceftazidima (29,7%) e cefepima (25,8%). As cepas de P. fluorescens foram altamente sensíveis à cefotaxima (74,2%), seguida pela ceftriaxona e levofloxacina (70,3% cada). Curiosamente, 29,7% das cepas de P. fluorescens eram multirresistentes a antimicrobianos (MAR).

Abstract Pseudomonas fluorescens is one of the main causes of septicemic diseases among freshwater fish, causing severe economic losses and decreasing farm efficiency. Thus, this research was aimed to investigate the occurrence of P. fluorescens in Nile Tilapia (O. niloticus) fish in Egypt, gene sequencing of 16SrDNA gene, and antimicrobial susceptibility. P. fluorescens strains were detected in 32% (128\400) of apparently healthy (9%; 36\400) and diseased (23%; 92\400) Nile tilapia fish. The highest prevalence was observed in gills of fish, 31.3% followed by intestine 26.9%, liver 24.2%, and kidneys 17.6%. The PCR results for the 16SrDNA gene of P. fluorescens showed 16SrDNA gene in 30% of examined isolates. Moreover, Homogeny and a strong relationship between strains of P. fluorescens was confirmed using 16SrDNA sequences. Beside the responsibility of 16SrDNA gene on the virulence of P. fluorescens. The results of antimicrobial susceptibility tests revealed that all strains were resistant to piperacillin (100%), followed by ceftazidime (29.7%), and cefepime (25.8%). The strains of P. fluorescence were highly sensitive to cefotaxime (74.2%), followed by ceftriaxone and levofloxacin (70.3% each). Interestingly, 29.7% of strains of P. fluorescens were multiple antimicrobial-resistant (MAR).

Resumo Surtos frequentes do vírus da gripe aviária H9N2 no Paquistão revelaram que esse subtipo se tornou endêmico na avicultura e, além das perdas econômicas, representa uma ameaça à saúde pública. O presente estudo descreve a caracterização molecular e as alterações patológicas em frangos de corte naturalmente infectados com a atual cepa H9N2 e sua dinâmica filogenômica. Neste estudo, amostras de tecidos (traqueia, pulmões, rim e intestino) de 100 lotes comerciais de frangos foram coletadas de julho de 2018 a agosto de 2019. As amostras foram submetidas à detecção molecular, filogenia e posterior exame patológico. O comprimento completo do gene HA foi amplificado com sucesso em cinco amostras. O sequenciamento de nucleotídeos revelou amostras positivas colocadas em um clado pertencente à sublinhagem B2 do genótipo G1 e categorizado como LPAIV com base na sequência de aminoácidos do gene da hemaglutinina (HA) no local de clivagem (PAKSSR/G). A análise genética do gene da HA revelou: nt = 80,5%-99,5%; aa = 83,8%-98,9% de homologia com cepas de H9N2 relatadas anteriormente no Paquistão e em países vizinhos (A/Quail/Hong Kong/G1/97). As lesões macroscópicas incluíram aerossaculite leve, hemorragias leves, congestão difusa e exsudato purulento na mucosa traqueal, cilindro fibrinonecrótico no lúmen da traqueia e congestão pulmonar leve. As alterações histopatológicas incluíram descamação de células epiteliais, infiltração de células inflamatórias na traqueia, infiltração de células mononucleares (MNCs), congestão pulmonar e exsudato no lúmen dos parabrônquios, congestão peritubular nos rins com degeneração das células epiteliais tubulares, alterações degenerativas nas células epiteliais das vilosidades intestinais e hiperplasia de células caliciformes. A análise imunoistoquímica confirmou a presença do antígeno AIVH9N2 na traqueia, nos pulmões, no rim e no intestino. A microscopia eletrônica revelou alterações ultraestruturais na traqueia, incluindo cílios degenerados, inchaço mitocondrial e retículo endoplasmático aumentado. Com base em todas as análises, o presente estudo revelou a distribuição do vírus H9N2 do genótipo G1 em Punjab, Paquistão, com patogenicidade de leve a moderada.

Abstract Frequent outbreaks of avian influenza H9N2 virus in Pakistan revealed that this subtype has become endemic in the poultry industry and, besides economic losses, poses a threat to public health. The present study describes the molecular characterization and pathological alterations in naturally infected broiler chickens with the current H9N2 field strain and their phylogenomic dynamics. In this study, tissue samples (trachea, lung, kidney and intestine) from 100 commercial chicken flocks were collected from July 2018 to August 2019. Samples were subjected to molecular detection, phylogeny and subsequent pathological examination. The complete length of the HA gene was successfully amplified in five samples. Nucleotide sequencing revealed positive samples placed in a clade belonging to the B2 sub-lineage of the G1 genotype and categorized as LPAIV based on the amino acid sequence of the HA gene at the cleavage site (PAKSSR/G). Genetic analysis of the haemagglutinin (HA) gene revealed nt: 80.5%-99.5%; aa: 83.8%-98.9% homology to H9N2 strains reported previously from Pakistan, neighbouring countries, and (A/Quail/Hong Kong/G1/97). Gross lesions include a slight airsacculitis, mild hemorrhages, diffuse congestion and purulent exudate in tracheal mucosa, fibrinonecrotic cast in the trachea lumen and mild pulmonary congestion. Histopathological alterations include sloughing of epithelial cells and infiltration of inflammatory cells in the trachea, mononuclear cells (MNCs) infiltration, pulmonary congestion and exudate in the lumen of parabronchi, peritubular congestion in the kidneys with degeneration of tubular epithelial cells and degenerative changes in the intestinal villi epithelial cells and goblet cell hyperplasia. Immunohistochemistry analysis confirmed the presence of AIVH9N2 antigen in the trachea, lungs, kidney and intestine. Electron microscopy revealed ultrastructural changes in the trachea, including degenerated cilia, mitochondrial swelling and enlarged endoplasmic reticulum. Based on all essential analysis, the present study revealed the distribution of the H9N2 virus of G1 genotype in Punjab, Pakistan, with mild to moderate pathogenicity.

Resumo Os efeitos protetores antidiabéticos e hepatorrenais dos extratos etanólicos de Citrullus colocynthis e Momordica charantia foram investigados em ratos albinos machos diabéticos induzidos por estreptozotocina (STZ). Ratos diabéticos foram tratados com extrato misto de C. colocynthis, M. charantia ou C. colocynthis + M. charantia na dose de 250 mg/kg de peso corporal por via oral por dia durante 21 dias. O peso corporal médio de todos os grupos de ratos diabéticos no dia 1 de tratamento (dia 10 de diabetes) foi significativamente menor do que o grupo de ratos controle normal (P < 0,05). O nível de glicose no sangue de todos os grupos de ratos diabéticos no dia 1 de tratamento (dia 10 de diabetes) foi significativamente (P < 0,05) maior (> 200 mg/dl) do que o grupo de ratos controle normal (95,5 ± 2,7). Ao final do tratamento (dia 21), os ratos diabéticos tratados com extratos vegetais apresentaram aumento significativo (P < 0,05) no peso corporal e redução significativa (P < 0,05) na glicemia quando comparados aos animais controle diabéticos. Aumento significativo (< 0,05) foi observado nos níveis séricos de bilirrubina, alanina transaminase (ALT), aspartato transaminase (AST), fosfatase alcalina (ALP), ureia e creatinina do grupo controle diabético. Os níveis séricos desses parâmetros hepáticos e renais de ratos diabéticos tratados com extrato vegetal foram significativamente menores quando comparados ao grupo controle de ratos diabéticos (p < 0,05). Fotomicrografias de microseções de fígado e rim de ratos diabéticos tratados com esses extratos vegetais mostraram melhora nas histoarquiteturas hepatorrenais. Concluiu-se que os extratos metanólicos de C. colocynthis e M. charantia são antidiabéticos e hepatorrenais protetores em ratos machos diabéticos induzidos por STZ. O tratamento de ratos diabéticos com extrato misto de C. colocynthis + M. charantia é mais eficaz na melhora do diabetes e lesões hepatorrenais em ratos machos diabéticos induzidos por STZ.

Abstract The antidiabetic and hepato-renal protective effects of Citrullus colocynthis and Momordica charantia ethanol extracts were investigated in streptozotocin (STZ) induced diabetic male albino rats. Diabetic rats were treated with C. colocynthis, M. charantia or C. colocynthis + M. charantia mixed extract at a dose of 250 mg /kg body weight per oral per day for 21 days. The mean body weight of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly lower than the normal control rat group (P<0.05). The blood glucose level of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly (P<0.05) higher (> 200 mg/dl) than the normal control rat group (95.5 ± 2.7). At the end of treatment (day 21), the diabetic rats treated with plant extracts showed significant increase (P<0.05) in body weight and significant (P<0.05) reduction in blood glucose level when compared to diabetic control animals. Significant increase (< 0.05) was observed in the serum bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea and creatinine levels of diabetic control rat group. The serum levels of these liver and kidney-related parameters of diabetic rats treated with plant extract were significantly lower when compared to diabetic control rat group (p < 0.05). Photomicrographs of liver and kidney microsections from diabetic rats treated with these plant extracts showed amelioration in the hepato-renal histoarchitectures. It was concluded that the C. colocynthis and M. charantia methanol extracts are antidiabetic and hepato-renal protective in STZ induced diabetic male rats. Treatment of the diabetic rats with C. colocynthis + M. charantia mixed extract is more effective in the amelioration of diabetes and hepato-renal injuries in STZ induced diabetic male rats.

RESUMEN Objetivo. Presentar una descripción integral de la donación, utilización y descarte de órganos en todo el proceso de donación en Colombia. Métodos. Estudio retrospectivo de 1 451 donantes posibles, distribuidos en tres regiones de Colombia, que fueron evaluados en el 2022. Se describen las características generales, el diagnóstico y las causas de contraindicación de los donantes potenciales. Resultados. De los 1 451 donantes posibles, 441 (30,4%) cumplían con los criterios de muerte encefálica y constituyeron el conjunto de donantes potenciales. Las familias consintieron la donación de órganos en 141 casos aptos desde el punto de vista médico, mientras que en 60 casos se recurrió a la presunción legal, con lo que se llegó a 201 donantes aptos (13,9%). De estos, 160 (11,0%) fueron donantes reales (en los que se les practicó una incisión quirúrgica para la extracción de órganos o se obtuvo al menos un órgano). En última instancia, hubo 147 donantes utilizados (10,1%) (de los que se trasplantó al menos un órgano). Se observaron diferencias estadísticamente significativas entre las regiones en cuanto a edad, sexo, diagnóstico de muerte encefálica y vía crítica del donante. Se trasplantaron un total de 411 órganos procedentes de 147 donantes utilizados; los riñones fueron los órganos obtenidos y trasplantados con mayor frecuencia, ya que supusieron 280 (68,1%) del total de órganos, seguidos del hígado (85, 20,7%), el corazón (31 , 7,5%), los pulmones (14, 3,4%) y el páncreas (1, 0,2%). La tasa de descarte de los donantes fallecidos disponibles fue del 8,1%. Conclusiones. Aproximadamente una décima parte de los donantes son utilizados, de hecho, para realizar trasplantes. Estos datos destacan las áreas en las que se han obtenido buenos resultados y aquellas en las que se presentan desafíos, lo cual proporciona una base para futuras mejoras en Colombia.

ABSTRACT Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

RESUMO Objetivo. Obter uma visão geral e abrangente da doação, do aproveitamento e do descarte de órgãos em todo o processo de doação na Colômbia. Métodos. Estudo retrospectivo de 1 451 possíveis doadores em três regiões da Colômbia que foram avaliados em 2022. Foram descritas as características gerais, o diagnóstico e os motivos para a contraindicação de potenciais doadores. Resultados. Dentre os 1 451 possíveis doadores, 441 (30,4%) preencheram os critérios de morte encefálica, formando o grupo de potenciais doadores. Em 141 casos considerados clinicamente aptos, as famílias consentiram com a doação de órgãos, e em 60 casos utilizou-se o princípio da presunção legal, resultando em 201 doadores elegíveis (13,9%). Desses, 160 (11,0%) foram doadores efetivos (ou seja, doadores nos quais foi feita uma incisão cirúrgica com a intenção de remover um órgão ou pessoas com pelo menos um órgão removido). Por fim, foram identificados 147 doadores utilizados (10,1%) (ou seja, que doaram pelo menos um órgão que foi transplantado). Foram encontradas diferenças estatisticamente significantes entre idade, sexo, diagnóstico de morte encefálica e itinerário crítico de doação entre as regiões. Um total de 411 órgãos foram transplantados de 147 doadores utilizados. Os rins foram os órgãos mais frequentemente removidos e transplantados, representando 280 (68,1%) do total, seguido de 85 fígados (20,7%), 31 corações (7,5%), 14 pulmões (3,4%) e 1 pâncreas (0,2%). A taxa de descarte de doadores falecidos com órgãos removidos foi de 8,1%. Conclusões. Cerca de um décimo dos doadores são efetivamente usados para fins de transplante. Nossos achados destacam áreas de sucesso e desafios, oferecendo uma base para futuras melhorias na Colômbia.

RESUMEN La granulomatosis con poliangeítis es una vasculitis sistémica, necrosante y granulomatosa que afecta el tracto respiratorio superior e inferior y los riñones. Se presenta el caso de una paciente blanca, de 59 años de edad, hipertensa y fumadora inveterada, que ingresó por presentar síntomas constitucionales, orinas turbias y hemáticas, así como creatininemia elevada con valor previo normal. Con impresión diagnóstica inicial de infección del tracto urinario se indica antibioticoterapia. Después del tercer día de iniciado el tratamiento, mejoraron los síntomas constitucionales y, de forma progresiva, comenzó con manifestaciones multiorgánicas (renal, respiratoria, cutánea y musculoesquelética) sugestivas de vasculitis sistémica. Como elementos significativos, en exámenes complementarios se detectaron azoados y reactantes de fase aguda aumentados, sedimento urinario activo, imagen nodular en vértice pulmonar derecho y microhemorragias multifocales en ambos campos pulmonares, detectados mediante tomografía computarizada y c-ANCA altamente positivo. Se indicó tratamiento inmunosupresor y citotóxico potente, obteniéndose control inicial de las manifestaciones graves de la enfermedad. Evolutivamente desarrolló complicaciones propias de la entidad y secundarias al tratamiento médico, que la hicieron tributaria de terapia de sustitución renal, falleciendo a los dos años de recibir hemodiálisis iterada. El cuadro clínico, unido a los estudios imagenológicos e inmunológicos (c-ANCA), fueron elementos claves para realizar el diagnóstico.

ABSTRACT Granulomatosis with polyangiitis is a systemic, necrotizing, granulomatous vasculitis that affects the upper and lower respiratory tract and kidneys. The case of a 59-year-old white female patient, who is hypertensive and inveterate smoker, is presented; she was admitted for presenting constitutional symptoms, turbid and bloody urine, as well as elevated creatininemia with a normal previous value. With the initial diagnostic impression of urinary tract infection, antibiotic therapy was indicated. After the third day of starting treatment the constitutional symptoms improved, and progressively began with multiorgan manifestations (renal, respiratory, skin and musculoskeletal) suggestive of systemic vasculitis. As significant elements, complementary examinations detected increased nitrogen and acute phase reactants, active urinary sediment, nodular image in the right lung apex and multifocal microhemorrhages in both lung fields through computed tomography, and highly positive c-ANCA. Potent immunosuppressive and cytotoxic treatment was indicated, obtaining initial control of severe manifestations of the disease. Evolutionarily she developed complications specific to the entity and secondary to medical treatment which made her subject to renal replacement therapy, dying two years after receiving iterated hemodialysis. The clinical characteristics, together with the imaging and immunological studies (c-ANCA) were key elements to make the diagnosis.

Carcass characteristics and primal pork cuts of local pig breeds are rarely documented, therefore, the current study was conducted to establish the relation between incremental levels of Amarula oil cake (AOC), carcass traits, primal pork cuts, and relative internal organ weight of Windsnyer pigs. Twenty-five clinically healthy, growing, male Windsnyer pigs with an initial body weight of 19.92 ± 8.74 kg (mean ± standard deviation) were used. Pigs were used in their growing period when they were about 67 days old. The study lasted six weeks excluding one week of adaptation period. Pigs were allotted to pens in a completely randomized design and assigned to each of the five experimental diets, which contained 0, 50, 100, 150 and 200 g/kg DM of Amarula oil cake, respectively. Feed and water were offered ad libitum. Post slaughter, data for carcass characteristics, primal pork cuts, and relative organ weights of Windsnyer pigs were analysed using polynomial regression. There was a negative linear relationship between increasing levels of Amarula oil cake, carcass length, warm carcass weight and cold carcass weight. Stomach weight, backfat thickness, drip loss, and the hepatosomatic index increased linearly with increasing levels of Amarula oil cake. The kidneys, small intestines, and large intestine weight had a quadratic response to Amarula oil cake inclusion level. The heart, lungs, and spleen were not related to increasing levels of Amarula oil cake inclusion. Incremental levels of Amarula oil cake diets impaired carcass characteristics and the selected visceral organs, therefore Windsnyer pigs can be fed Amarula oil cake up to100 grams per kilograms dry matter.

This study aimed to evaluate the effects of phytase and tannase addition in broiler diets on the growth performance and meat quality of broilers fed sorghum-based diets. Twelve experimental diets were formulated at three sorghum levels (0, 50, and 100%) and four enzyme levels (no enzyme, 5000 FTU phytase, 25 TU tannase, and a combination of 5000 FTU phytase + 25 TU tannase). Data on voluntary feed intake, average weekly weight gain, and feed conversion ratio were recorded and used to assess growth performance. Technical and nutritional parameters were used to determine meat quality. Broilers fed total sorghum diets with phytase and tannase enzyme combination had the highest feed intake in the first (24.4 ± 0.04 g/bird/day) and second weeks of life (23.0 ± 1.06 g/bird/day), respectively. Complete sorghum diets with phytase (83.0 ± 0.88 g/bird/day) and tannase (122.0 ± 0.88 g/bird/day) showed the highest feed intake in the third and fourth weeks, respectively. Broilers fed 50% sorghum diets with tannase (135.3 ± 0.05 g/bird/day) and complete maize diets with phytase (158.1 ± 0.88 g/bird/day) had the highest feed intake during weeks five and six, respectively. Broilers fed a 50% sorghum diet without enzymes showed the highest weight gain in the final week (606.5 ± 32.39 g). Comparable feed conversion was observed in birds fed complete maize and 50% sorghum diets. Dietary treatment substantially influenced the live body, carcass, liver, kidneys, abdominal fat pad weight, and intestinal length. However, it did not affect nutritional and technical parameters or Pectoralis major meat.