ABSTRACT The effects of dietary digestible protein (DP) levels (22, 26, 29, 32, and 34%) and different stressors (cold-induced stress, CIS; heat/dissolved oxygen-induced stress, HDOIS; transport-induced stress, TIS; and size-sorting-induced stress, SSIS) on hemato-biochemical parameters were evaluated. Four hundred and forty Nile tilapia fingerlings were distributed into 40-250 L aquaria and fed experimental diets for 110 days, and fed each of the five experimental diets, that were randomly distributed to eight replicates per treatment. Then, different groups of fish were subjected to one type of stress. Groups of 40 fish were used on CIS (17 °C), HDOIS (32 °C), and TIS (4 h), and a group of 140 fish on SSIS (15 min air exposure and 60 s handling). There was no effect on hemato-biochemical profile when DP levels were compared, neither before nor after stress; however, there was a significant stress effect. Digestible protein did not mitigate stress response under SSIS and CIS; lymphopenia and neutrophilia were the main cell-mediated immune response; dietary 22 and 26% DP impaired oxygenation on SSIS and TIS; fish under HDOIS and SSIS demanded more energy using triglycerides as an energy source; the diet formulated to contain 22% DP was not adequate to keep homeostasis under temperature stress. Cluster analysis showed that, for DP levels below the requirement for growth, SSIS and CIS were considered the most stressful conditions. At 34% DP level, HDOIS response was comparable to that of non-stressing conditions.

O derrame parapneumónico caracteriza-se pela necessidade de um processo invasivo para a sua resolução e o empiema pela presença de pus na cavidade pleural. Em ambos os casos, o diagnóstico por TAC e o tratamento precoces resultando em menores morbilidade e mortalidade. São indicação para um tratamento invasivo os derrames loculados, os que ocupam mais de 50% do tórax, os que revelam coloração por Gram e exame cultural positivos, ou derrames com pH inferior a 7,20, glucose inferior a 60 mg/dl, e nível de DHL superior a três vezes o limite normal no soro. Estas características resultam da evolução através de três estádios dos derrames incorrectamente tratados: 1) exsudativo; 2) fibrino-purulento; 3) fibrótico. Dependendo do estádio evolutivo, a abordagem terapêutica varia entra toracentese terapêutica, colocação de drenagem torácica com ou sem instilação de fibrinolíticos, cirurgia toracoscópica vídeo-assistida e decorticação pulmonar. Os autores fazem uma revisão do estudo destas situações baseados em três casos clínicos com apresentações muito dispares: uma doente com empiema por Streptococcus pyogenes que faleceu rapidamente por hemoptise maciça; um doente com empiema resultante de pneumonia aguda ocorrida durante um voo de avião; uma doente com empiema e bacteriemia por Streptococcus pneumoniae conduzindo a diagnóstico até então desconhecido de infecção por VIH.

Complicated parapneumonic effusion is one in which an invasive procedure is necessary for its resolution and empyema means pus in the pleural space. An early diagnosis and therapy of these conditions results in less morbidity and mortality. CT of the chest is important to study complex pleural effusions. Loculated effusions, those occupying more than 50% of the thorax, or which show positive Gram stain or bacterial culture, or a purulent effusion with a pH below 7.20, with a glucose level below 60 mg/dl or a LDH level more than three times the upper limit of normal for serum, are indications for an invasive procedure. These characteristics result from the evolution of a not well treated parapneumonic effusion, through the three stages: (1) exsudative; (2) fibrinopurulent; (3) fibrotic. Depending on the stage therapeutic methods vary from therapeutic thoracentesis, insertion of a chest tube with or without instillation of fibrinolytics, video-assisted thoracoscopic surgery, and lung decortication. A review of all these aspects are done based on a series of three cases reports with very different clinical presentation: one patient with empyema by Streptococcus pyogenes and that died rapidly due to massive hemoptysis; a patient with empyema due to acute pneumonia developing during an airflight; a patient with empyema and bacteraemia by Streptococcus pneumonia leading to the diagnosis of an unknown HIV infection.