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Objective: To determine the clinical and epidemiological characteristics of patients with noninfectious uveitis at a university hospital in Paraguay. Methodology: An observational, descriptive, cross-sectional, retrospective study was performed. Consecutive patients who attended the Ophthalmology Service of the Hospital de Clínicas from January 2020 to October 2021 and who were diagnosed with non-infectious uveitis were included. The variables studied were sex, age, origin, reason for consultation, anatomical classification, clinical course, systemic and ocular associations, and bilaterality. Results: A total of 78 medical records of patients meeting the inclusion and exclusion criteria were analyzed. Of the patients, 66.7% were female and 42 (53.8%) were from the Central Department. The anterior anatomical location of uveitis was the most frequent (53.9%), followed in decreasing order by panuveitis, posterior uveitis, and intermediate uveitis. Regarding anterior uveitis, 24 patients (57.1%) had unilateral uveitis, 40 (95.2%) were non-granulomatous, 19 (45.2%) presented an acute clinical course, the most frequent reason for consultation was "red and painful eye" with 15 patients (35.7%), the most frequent systemic association was HLA- B27+ in 16 patients (38.1%). As for panuveitis, 13 patients (50%) were associated with Vogt-Koyanagi-Harada syndrome, and of the latter, two patients were related to rheumatoid arthritis. Conclusion: The clinical and epidemiological patterns observed in this study were largely consistent with those reported in the literature. Notably, the most frequent associations differed from those reported in the literature: HLA-B27+ for anterior uveitis, rheumatoid arthritis for posterior uveitis, and a significant percentage of Vogt-Koyanagi-Harada syndrome among panuveitis cases.

Objetivo: Determinar las características clínicas y epidemiológicas de los pacientes con uveítis no infecciosas que acuden a un hospital universitario de Paraguay. Metodología: Se realizó un estudio observacional, descriptivo de corte transversal, retrospectivo. Se incluyeron casos consecutivos de pacientes que acudieron al Servicio de Oftalmología del Hospital de Clínicas de enero del 2020 a octubre del 2021 y que fueron diagnosticados con uveítis no infecciosa. Las variables estudiadas fueron sexo, edad, procedencia, motivo de consulta, clasificación anatómica, curso clínico, asociación sistémica y ocular y bilateralidad. Resultados: Se revisó los expedientes de 78 pacientes, el 66,7% fue de sexo femenino y 42 pacientes (53,8%) procedían del departamento Central. La localización anatómica anterior de la uveítis fue la más frecuente (53,9%), seguida en orden decreciente por la panuveítis, la posterior y la intermedia. Respecto a las uveítis anteriores, en 24 pacientes (57,1%) fueron unilaterales, en 40 (95,2%) no granulomatosas, 19 (45,2%) presentaron un curso clínico agudo, el motivo de consulta más frecuente fue "ojo rojo y doloroso" con 15 pacientes (35,7%), la asociación sistémica más frecuente fue HLA- B27+ en 16 pacientes (38,1%). En cuanto, a las panuveítis, 13 pacientes (50%) se asociaron con síndrome de Vogt-Koyanagi-Harada y de las posteriores 2 pacientes relacionados a Artritis reumatoidea. Conclusión: El patrón clínico y epidemiológico observado en este estudio es en su mayor parte similar al observado en la mayoría de las series encontradas en la literatura. Llaman la atención en este estudio que las asociaciones más frecuentes son diferentes de los reportados en la literatura: de la anterior, el HLA-B27+; de la posterior, la artritis reumatoidea; y que entre las panuveítis se observa un gran porcentaje de síndrome de Vogt-Koyanagi-Harada.

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PURPOSE: Vitamin D deficiency has been associated with higher rates of autoimmune disease, including noninfectious uveitis. This PRISMA-compliant review and meta-analysis aimed to analyze the correlation between noninfectious uveitis and vitamin D levels. METHODS: We searched PubMed, Embase, Cochrane, and Web of Science databases for studies, published in English, assessing vitamin D levels in patients diagnosed with noninfectious uveitis. The outcomes of interest were vitamin D deficiency, vitamin D mean level, vitamin D supplementation, and smoking rates. A subgroup analysis of inactive uveitis and active uveitis was performed. The heterogeneity was assessed with Cochrane Q-test and I2 statistics; p > 0.10 and I2 > 50% were considered significant for heterogeneity. Statistical analysis was conducted using Review Manager 5.3. RESULTS: 9 studies were included in the meta-analysis comprising a total of 10 711 patients, of whom 1,368 were diagnosed with noninfectious uveitis. Patients with noninfectious uveitis had worse results regarding vitamin D deficiency when compared with the control group (OR 0.58; CI 95% 0.44 to 0.77; p = 0.0002; I2 = 61%). Patients with inactive uveitis had better results towards vitamin D deficiency when compared with active uveitis (OR 5.00; CI 95% 2.84 to 8.81; p < 0.001; I2 = 0%). CONCLUSION: Our research supports the increasing evidence that associates vitamin D deficiency with noninfectious uveitis and its activity. Further investigation into the efficacy of vitamin D screening and supplementation in reducing the recurrence of uveitis is necessary.

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PURPOSE: We investigated the aqueous humor proteome and associated plasma proteome in patients with infectious or noninfectious uveitis. METHODS: AH and plasma were obtained from 28 patients with infectious uveitis (IU), 29 patients with noninfectious uveitis (NIU) and 35 healthy controls undergoing cataract surgery. The proteins profile was analyzed by SomaScan technology. RESULTS: We found 1844 and 2484 proteins up-regulated and 124 and 161 proteins down-regulated in the AH from IU and NIU groups, respectively. In the plasma, three proteins were up-regulated in NIU patients, and one and five proteins were down-regulated in the IU and NIU patients, respectively. The results of pathway enrichment analysis for both IU and NIU groups were related mostly to inflammatory and regulatory processes. CONCLUSION: SomaScan was able to detect novel AH and plasma protein biomarkers in IU and NIU patients. Also, the unique proteins found in both AH and plasma suggest a protein signature that could distinguish between infectious and noninfectious uveitis.

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OBJECTIVE: To review the prevalence, incidence, and risk factors for developing anti-drug antibodies (AAA) in patients with non-infectious uveitis (NIU) treated with Adalimumab (ADA). METHODS: A systematic literature search was performed on PubMed, EMBASE, Virtual Health Library, Cochrane, and medRxiv. Meta-analysis was performed using random effects. RESULTS: Nine out of 2,373 studies were included. The prevalence of AAA in NIU patients treated with ADA was 9% (95% CI: 2% to 37%, I2 = 95% with a P<0.01), it was significantly higher in real-life scenarios (observational studies) than in clinical trials. The pooled incidence at 12 months was 27% (CI 95% 16%-42% I2 = 0%). Several factors have been associated with AAA generation in NIU patients, including the non-use of concomitant immunosuppressants, presence of autoimmune systemic disease, female gender, etc. CONCLUSION: This study showed that AAA prevalence is higher in real-life scenarios compared to clinical trials. Further research is needed to elucidate the factors that trigger AAA generation in NIU patients.

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Native and exotic avian species can act as reservoirs of pathogens, including bacteria and viruses, with conservation and public health implications. A retrospective study on the diagnosis and frequency of diseases in wild and exotic avian species was conducted. The occurrence of particular diseases was associated with the type of captivity or the bird's origin. The investigation included macroscopic and microscopic descriptions and the molecular determination of the causative agent(s). Additional immunohistochemical (IHC) analysis, PCR, and genetic sequencing were conducted. A total of 243 cases were compiled for the study, mainly consisting of native wild species (39.1%) obtained from illegal trade. Primary infectious diseases, mainly parasitic (18.1%) and viral (17.7%), were the most common, although coinfections were substantial (18.1%) in birds rescued from trafficking. Fractures and neoplasms accounted for 3.7% and 3.3% of the cases, respectively. Parasitic and viral diseases were the most common in both exotic and wild birds. Chlamydia psittaci, a lethal and zoonotic bacterium, was an important cause of death, especially in native Psittaciformes. The recent detection of Psittacid alphaherpesvirus 5 (PsAHV 5) in exotic psittacines and the diagnosis of coinfections in trafficked birds highlight the importance of monitoring avian health to control potential pathogens that may endanger conservation efforts.

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The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hepatic involvement is common in SARS-CoV-2-infected individuals. It is currently accepted that the direct and indirect hepatic effects of SARS-CoV-2 infection play a significant role in COVID-19. In individuals with pre-existing infectious and non-infectious liver disease, who are at a remarkably higher risk of developing severe COVID-19 and death, this pathology is most medically relevant. This review emphasizes the current pathways regarded as contributing to the gastrointestinal and hepatic ailments linked to COVID-19-infected patients due to an imbalanced interaction among the liver, systemic inflammation, disrupted coagulation, and the lung.

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BACKGROUND: Anthropogenic disturbances are the main threats to nonhuman primates conservation, and infectious diseases may also play a key role in primate population decline. This study aimed to determine the main causes of death in neotropical primates. METHODS: A retrospective study of post-mortem examinations was conducted on 146 neotropical primates between January 2000 and December 2018. RESULTS: Conclusive diagnoses were obtained in 68.5% of the cases, of which 59 corresponded to non-infectious causes and 41 to infectious diseases. Trauma was the main cause of death (54/100), with anthropogenic stressors caused by blunt force trauma injuries (collision with vehicles) and puncture wound injuries associated with interspecific aggression (dog predation) were the most common factors. Other causes of death included bacterial diseases (27%), followed by parasitic diseases (12%), neoplasms (2%), and viral diseases (2%). CONCLUSIONS: Free-ranging primates were mostly affected by non-infectious causes, while captive primates were by infectious conditions.

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ABSTRACT Uveitis is a broad term that refers to a large group of eye disorders categorized by intraocular inflammation, a leading cause of visual impairment. Historically, treatment of noninfectious uveitis has depended on corticosteroid drugs. Owing to the myriad of side effects caused by corticosteroids, immunomodulatory therapy has become the preferred treatment for chronic noninfectious intraocular inflammation. Recently, biological response modifiers have established a new era in uveitis therapy, with the range of targets continuing to expand. In this review, we aimed to convey up-to-date information on the treatment of noninfectious uveitis to the general ophthalmologist.

RESUMO Uveíte é um termo amplo utilizado para denominar várias desordens categorizadas como inflamação intraocular, uma causa importante de deficiência visual. Historicamente, o tratamento das uveítes não infecciosas baseou-se no uso de corticosteróides. Devido aos diversos efeitos colaterais do uso de corticosteróides a longo prazo, a terapia imunomoduladora é indicada no tratamento das uveítes não infecciosas crônicas. A introdução dos medicamentos biológicos estabeleceu uma nova era no tratamento das uveítes, com constante desenvolvimento de novas drogas. O objetivo desta revisão é trazer informações atuais sobre tratamento das uveítes não infecciosas para a prática clínica do oftalmologista geral.

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The spectrum of autoimmune encephalitis (AE) encompasses several entities characterized by a variable frequency of psychiatric symptoms, cognitive dysfunction, focal deficits, and seizures. Although patients with AE can be categorized in specific syndromes, overlapping manifestations are also common. Furthermore, atypical correlations between clinical phenotypes and autoantibody profiles could occur in rare cases. Here, we report the rare case of a young adult man attending due to new-onset seizures and a history of memory loss, autonomic disturbances, headache, behavioral changes, and visual and olfactory hallucinations. The patient was subjected to a complete diagnostic approach that included a comprehensive laboratory workup, neuropsychological testing, electroencephalogram, cerebrospinal fluid (CSF) analysis, brain MRI, and positron emission tomography/computed tomography scan that revealed a functional and structural compromise of the bilateral medial temporal lobes. Together with the clinical manifestations of the patient, these findings were compatible with the diagnosis of autoimmune limbic encephalitis (ALE). Strikingly, further analysis of the CSF showed autoantibodies against the N-methyl-D-aspartate (NMDA) receptor. We found very few cases of the co-occurrence of anti-NMDA receptor antibodies and nonparaneoplastic ALE in the literature, especially in male patients. Our report exemplifies the complicated differential diagnosis of ALE and adds clinical information of the association with anti-NMDA receptor antibodies.

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Background: Summer Pasture Associated Obstructive Pulmonary Disease (SPAOPD), or Equine Pasture Asthma (EPA),has been described as an environmentally-induced respiratory disease that occurs during the warmer and more humidmonths, leading to reversible airway obstruction, persistent and non-specific airway hyper-responsiveness, and chronicneutrophilic airway inflammation. Exacerbation of clinical signs vary according to warm seasons and range from mildto severe episodes of wheezing, coughing, and laboured breathing, being highly debilitating to the equine. This reportdescribed two cases of Equine Pasture Asthma that showed clinical and environmental similarities with Summer PastureAssociated Obstructive Pulmonary Disease.Cases: The patients were crossbreed geldings that have never been stabled and were used for cattle management in a farmin southeastern Brazil. They presented poor performance and a persistent cough for over 3 years. Initially, the respiratorysigns were only observed after exercise but, over the years, it gradually progressed to being observed when the horses wereat rest. Both animals had a history of regular deworming and were previously treated by other veterinarians with antibiotics,clenbuterol, and mucokinetics. Little improvement was noticed by the owner and the signs returned over time as treatmentwas often discontinued. Clinical findings were compatible with the grade 3 mucus classification as well as with score 2for Severe Asthma. BALF cytology was done according to routine procedure. Animal 1 presented slides with free yeast,macrophages, and mucus with Curschmanns spiral and counting of 29.7% of neutrophils (NE), 43.7% of lymphocytes(LP), 25.3% of macrophages (MC) and 1.3% of eosinophils (EO). Animal 2 presented slides with phagocytized yeast,mucus and counting of 27% of NE, 38.5% of LP, 33% of MC and 1.5% of EO...(AU)

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Background: Summer Pasture Associated Obstructive Pulmonary Disease (SPAOPD), or Equine Pasture Asthma (EPA),has been described as an environmentally-induced respiratory disease that occurs during the warmer and more humidmonths, leading to reversible airway obstruction, persistent and non-specific airway hyper-responsiveness, and chronicneutrophilic airway inflammation. Exacerbation of clinical signs vary according to warm seasons and range from mildto severe episodes of wheezing, coughing, and laboured breathing, being highly debilitating to the equine. This reportdescribed two cases of Equine Pasture Asthma that showed clinical and environmental similarities with Summer PastureAssociated Obstructive Pulmonary Disease.Cases: The patients were crossbreed geldings that have never been stabled and were used for cattle management in a farmin southeastern Brazil. They presented poor performance and a persistent cough for over 3 years. Initially, the respiratorysigns were only observed after exercise but, over the years, it gradually progressed to being observed when the horses wereat rest. Both animals had a history of regular deworming and were previously treated by other veterinarians with antibiotics,clenbuterol, and mucokinetics. Little improvement was noticed by the owner and the signs returned over time as treatmentwas often discontinued. Clinical findings were compatible with the grade 3 mucus classification as well as with score 2for Severe Asthma. BALF cytology was done according to routine procedure. Animal 1 presented slides with free yeast,macrophages, and mucus with Curschmann’s spiral and counting of 29.7% of neutrophils (NE), 43.7% of lymphocytes(LP), 25.3% of macrophages (MC) and 1.3% of eosinophils (EO). Animal 2 presented slides with phagocytized yeast,mucus and counting of 27% of NE, 38.5% of LP, 33% of MC and 1.5% of EO...

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Resumen Justificación: La uveítis idiopática y la asociada a artritis idiopática juvenil son condiciones oculares que llevan a deterioro visual. En Costa Rica, la incidencia en pediatría se desconoce; aunque existe una clínica especializada en el Hospital Nacional de Niños para el manejo de estas patologías, no hay guías ni recomendaciones de manejo que hayan sido publicadas. Objetivos: Resumir las recomendaciones de manejo vigentes para uveítis no infecciosas y ofrecer una guía adaptada a la realidad costarricense, específicamente para población pediátrica. Métodos: Se efectuó una revisión no sistemática de bibliografía médica indexada en las plataformas PubMed y Scielo, sobre el diagnóstico y manejo de uveítis no infecciosa orientado a población pediátrica y en artritis idiopática juvenil. Se revisaron las guías recomendadas en Europa y se ajustaron a lo que se realiza en la Clínica de Uveítis del Hospital Nacional de Niños. Conclusiones: Se realiza una propuesta de manejo que incluye una valoración oftalmológica oportuna, diagnóstico certero, y tratamiento temprano y agresivo para prevención de complicaciones y minimizar secuelas.

Summary Importance: Idiopathic uveitis and that associated with juvenile idiopathic arthritis are ocular conditions that lead to visual impairment. In Costa Rica, the incidence in pediatric population is unknown; although there is a specialized clinic at the National Children's Hospital for the management of these pathologies, there are no guidelines or recommendations published in our country. Aims: To summarize the current management recommendations for non-infectious uveitis and offer a guide adapted to the Costa Rican reality, specifically for the pediatric population. Methods: A non-systematic review of indexed medical literature on PubMed and Scielo platforms was carried out on the diagnosis and management of non-infectious uveitis aimed to pediatric patients and in juvenile idiopathic arthritis. The recommended guidelines in Europe were reviewed and adjusted to what is done at the Uveitis Clinic of the National Children's Hospital. Conclusions: A management proposal is made that includes a timely ophthalmological evaluation, accurate diagnosis; early and aggressive treatment to prevent complications and minimize sequelae

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Equine colic is one of the most common cause of death in horses, but few studies have investigated specifically the conditions at the necropsy. This study aimed to describe the epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract in horses. A retrospective study was conducted in search of cases of these diseases affecting horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114). Mixed breeds horses (56/114) and males (69/114) were mostly affected. The horses had a median and mean age of 10 and 10.9-years old, respectively. Primary gastric dilation was characterized by distension of the stomach by moderate to large amounts of content, which in 21 cases caused tearing of the stomach wall at the greater curvature (peritonitis), and the main predisposing factor was alimentary overload (17/27). Intestinal volvulus occurred within the small intestine (14 cases) and within the large intestines (13 cases). Grossly, there was intestinal ischemia with reddened to deep-black serosa and diffusely red mucosae. Enterolithiasis caused partial or complete obstruction of the right dorsal colon (9/20), transverse colon (4/20), small colon and right dorsal colon (3/20), rectum and right dorsal colon (2/20), and small colon (2/20). Viscera perforation and peritonitis occurred in 11 cases. Rectal (colonic) perforation involved the rectum (10/15), rectum/small colon (4/15), and the small colon (1/15). It was characterized by a focally extensive transmural tearing, associated with reddened borders, and retroperitoneal to diffuse peritonitis. Palpation related iatrogenic injuries (11/15) were the main cause...(AU)

A cólica em equinos é considerada como a principal causa de morte de cavalos, porém poucos estudos têm investigado especificamente as condições envolvidas através da necropsia. O objetivo desse estudo foi descrever os aspectos epidemiológicos e patológicos de doenças não infecciosas do trato gastrointestinal de equinos. Foi conduzido um estudo retrospectivo em busca de casos dessas doenças envolvendo cavalos de 2005 a 2017. Durante esse período, 114 equinos morreram devido a doenças não infecciosas do trato gastrointestinal, e as principais causas foram: dilatação gástrica (27/114), vólvulos (27/114), enterolitíase (20/114), ruptura retal (colônica) (15/114), compactação gástrica ou cecocolônica (10/114), encarceramentos (6/114), intussuscepções (4/114), e outros (5/114). Animais sem raça definida (56/114) e machos (69/114) foram mais afetados. Os equinos apresentavam uma média e mediana de idade de 10 e 10,9 anos, respectivamente. A dilatação gástrica primária era caracterizada por distensão do estômago por moderada a grande quantidade de conteúdo, que em 21 casos provocava ruptura da parede gástrica na curvatura maior (peritonite), e o principal fator predisponente foi sobrecarga alimentar (17/27). Vólvulo intestinal ocorreu no intestino delgado e no intestino grosso (14 e 13 casos, respectivamente). Macroscopicamente, havia isquemia intestinal com serosa avermelhada a enegrecida e mucosa difusamente avermelhada. A enterolitíase causou obstrução parcial ou completa do cólon dorsal direito (9/20), cólon transverso (4/20), cólon menor e cólon dorsal direito (3/20), cólon menor (2/20), e reto e cólon maior direito (2/20). Perfuração de vísceras e peritonite foram observadas em 11 casos. A ruptura retal (colônica) envolveu o reto (10/15), reto/cólon menor (4/15) e cólon menor (1/15). Essa era caracterizada por ruptura transmural focalmente extensa, com bordos avermelhados e peritonite retroperitoneal a difusa...(AU)

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Equine colic is one of the most common cause of death in horses, but few studies have investigated specifically the conditions at the necropsy. This study aimed to describe the epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract in horses. A retrospective study was conducted in search of cases of these diseases affecting horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114). Mixed breeds horses (56/114) and males (69/114) were mostly affected. The horses had a median and mean age of 10 and 10.9-years old, respectively. Primary gastric dilation was characterized by distension of the stomach by moderate to large amounts of content, which in 21 cases caused tearing of the stomach wall at the greater curvature (peritonitis), and the main predisposing factor was alimentary overload (17/27). Intestinal volvulus occurred within the small intestine (14 cases) and within the large intestines (13 cases). Grossly, there was intestinal ischemia with reddened to deep-black serosa and diffusely red mucosae. Enterolithiasis caused partial or complete obstruction of the right dorsal colon (9/20), transverse colon (4/20), small colon and right dorsal colon (3/20), rectum and right dorsal colon (2/20), and small colon (2/20). Viscera perforation and peritonitis occurred in 11 cases. Rectal (colonic) perforation involved the rectum (10/15), rectum/small colon (4/15), and the small colon (1/15). It was characterized by a focally extensive transmural tearing, associated with reddened borders, and retroperitoneal to diffuse peritonitis. Palpation related iatrogenic injuries (11/15) were the main cause. Impactions affected the large colon (7/10), the cecum (2/10), and the stomach (1/10). Incarcerations consisted of inguinoscrotal hernias (2/6), small intestine entrapment by a mesenteric failure (2/6), diaphragmatic hernia, and umbilical eventration. Grossly, the organs were constricted by a hernial ring, with intestinal ischemia and reddened to dark-red serosa. Predisposing factors included previous surgeries (2/6) and patent inguinal ring (1/6). Intussusception involved the small intestine (3/4) and ileocecum (1/4). Foals with lack of colostrum intake and concomitant pneumonia was a characteristic presentation (3/4). Grossly, the intussusceptum slipped into intussuscipiens, with diffuse deep black-red discoloration. Other causes included large colon displacement (2/5), extrinsic and intrinsic obstruction of the small intestine (2/5), and an intestinal adenocarcinoma. Noninfectious gastrointestinal diseases are major causes of death in horses. Epidemiological and gross features of the conditions should be accounted to obtain a final diagnosis of the cause of the colic.(AU)

A cólica em equinos é considerada como a principal causa de morte de cavalos, porém poucos estudos têm investigado especificamente as condições envolvidas através da necropsia. O objetivo desse estudo foi descrever os aspectos epidemiológicos e patológicos de doenças não infecciosas do trato gastrointestinal de equinos. Foi conduzido um estudo retrospectivo em busca de casos dessas doenças envolvendo cavalos de 2005 a 2017. Durante esse período, 114 equinos morreram devido a doenças não infecciosas do trato gastrointestinal, e as principais causas foram: dilatação gástrica (27/114), vólvulos (27/114), enterolitíase (20/114), ruptura retal (colônica) (15/114), compactação gástrica ou cecocolônica (10/114), encarceramentos (6/114), intussuscepções (4/114), e outros (5/114). Animais sem raça definida (56/114) e machos (69/114) foram mais afetados. Os equinos apresentavam uma média e mediana de idade de 10 e 10,9 anos, respectivamente. A dilatação gástrica primária era caracterizada por distensão do estômago por moderada a grande quantidade de conteúdo, que em 21 casos provocava ruptura da parede gástrica na curvatura maior (peritonite), e o principal fator predisponente foi sobrecarga alimentar (17/27). Vólvulo intestinal ocorreu no intestino delgado e no intestino grosso (14 e 13 casos, respectivamente). Macroscopicamente, havia isquemia intestinal com serosa avermelhada a enegrecida e mucosa difusamente avermelhada. A enterolitíase causou obstrução parcial ou completa do cólon dorsal direito (9/20), cólon transverso (4/20), cólon menor e cólon dorsal direito (3/20), cólon menor (2/20), e reto e cólon maior direito (2/20). Perfuração de vísceras e peritonite foram observadas em 11 casos. A ruptura retal (colônica) envolveu o reto (10/15), reto/cólon menor (4/15) e cólon menor (1/15). Essa era caracterizada por ruptura transmural focalmente extensa, com bordos avermelhados e peritonite retroperitoneal a difusa. Traumas relacionados à palpação (11/15) foram a principal causa. Compactações afetaram o cólon maior (7/10), ceco (2/10) e estômago (1/10). Encarceramentos consistiram em hérnias inguinoescrotais (2/6), encarceramento de alças intestinais por falha no mesentério (2/6), hérnia diafragmática e eventração umbilical. Macroscopicamente, os órgãos estavam constritos por um anel hernial, com isquemia intestinal e serosa avermelhada a vermelho-escura. Fatores predisponentes incluíram cirurgias prévias (2/6) e anel inguinal patente (1/6). Intussuscepções envolveram o intestino delgado (3/4) e íleoceco (1/4). A apresentação característica foi em potros com falta de colostro e concomitante pneumonia. Macroscopicamente, o intussuscepto deslizava em direção ao intussuscepiente, exibindo coloração vermelho-enegrecida difusa. Outras causas incluíram deslocamento de cólon maior (2/5), obstrução extrínseca e intrínseca do intestino delgado (2/5), e um caso de adenocarcinoma intestinal. Doenças não infecciosas são importantes causas de morte em equinos. Os aspectos epidemiológicos e macroscópicos das condições devem ser considerados para o que o diagnóstico final da causa da cólica seja obtido.(AU)

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Introduction: The treatment strategies for noninfectious uveitis (NIU) aim to achieve disease remission, prevention of recurrences, and preserving vision, while minimizing the side effects associated with the therapies used.Areas covered: The index review aims to provide a detailed overview of the adverse events and safety parameters associated with the systemic therapies for the management of the NIU.Expert opinion: Despite being the cornerstone of management of acute cases of NIU, long-term corticosteroid use is associated with multi-system side effects, requiring the use of steroid-sparing agents. Adalimumab was recently approved by the FDA for the management of NIU based on the results of VISUAL studies. Similarly, newer drugs targeting various aspects of the inflammatory cascade are being developed. However, until we completely understand the molecular pathways of the inflammatory diseases, the therapeutic profile of these newer agents needs to be broad enough to suppress inflammatory cascade and narrow enough to spare normal cellular processes. Another strategy that has shown some potential in decreasing the systemic side effects is to provide local drug delivery. Therefore, the future of management of NIU is very bright with many novel therapeutic agents and strategies of drug delivery on the horizon.

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Introduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador. Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador. Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs. Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.

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La necesidad de un rápido y eficaz tratamiento por vía intravenosa a pacientes críticamente enfermos y con imposibilidad de tratamiento por otras vías ha hecho imperioso el acceso a través de las vías venosas centrales (CVC), se ha asociado con eventos adversos que prolongan la estancia hospitalaria, aumentan los costos hospitalarios, pueden agregar morbilidad e incluso mortalidad al paciente. Objetivo: analizar complicaciones de los pacientes con acceso vascular central hospitalizados en los servicios de Urgencias, Terapia Intensiva Pediátrica, Cirugía General y Cuidados Intensivos Neonatales del Hospital de Niños "J.M. de los Ríos", en el período marzo-agosto 2016. Método: Estudio retrospectivo, longitudinal y descriptivo con seguimiento de la evolución según registros de la historia clínica de cada paciente. Se registraron características demográficas, diagnóstico, criterios de indicación, características de los catéteres y su localización, complicaciones infecciosas y no infecciosas, duración y tipo de manipulación del CVC. Resultados: Se estudiaron 54 pacientes en total con CVC determinando que no existe diferencia importante en cuanto al sexo, 52 % masculino frente a 48,1 % femenino. La localización más frecuente fue a nivel de la vena yugular interna derecha en 56 % de casos. En un 41 % no se cumplieron con los criterios de colocación. Se identificó un 37 % de complicaciones de las cuales 22 % fueron de causa no infecciosa destacando la obstrucción como causa más frecuente y un 15 % de etiología infecciosa siendo la bacteriemia la principal causa en un 56 %. Conclusiones: se obtuvo con mayor frecuencia aislamiento de K. pneumoniae y P. aeruginosa. La permanencia de la mayoría de CVC fue mayor de 7 días. No se cumplen con los bundles de inserción ni de mantenimiento. Al analizar los diferentes factores de riesgo para complicación infecciosa, se obtuvo que la duración del catéter incrementa el riesgo de infección.

The need for rapid and effective intravenous treatment of critically ill patients who are unable to treat by other means has made access through the central venous pathways (CVC) imperative, has been associated with adverse events that prolong hospital stay, increase hospital costs, can add morbidity and even mortality to the patient. Objective: To analyze complications of patients with central vascular access hospitalized in the Emergency Services, Pediatric Intensive Care, General Surgery and Neonatal Intensive Care of Children's Hospital "J.M. de Los Rios, in the period March-August 2016. Method: Retrospective, longitudinal and descriptive study with follow-up of the evolution according to records of the clinical history of each patient. Patient demographics, diagnosis, indication criteria, catheter characteristics and location, infectious and noninfectious complications, duration and type of CVC manipulation were recorded. Results: A total of 54 patients with CVC were studied, determining that there is no significant difference in sex, 52 % male versus 48.1 % female. The most frequent localization was at the level of the right internal jugular vein in 56 % of cases. In 41 %, the placement criteria were not met. 37 % of complications were identified, of which 22 % were of non-infectious cause, the most frequent cause being obstruction and 15 % of infectious etiology, with bacteremia being the main cause in 56 %. Conclusions: Among the isolated microorganisms K. pneumoniae and P. aeruginosa were most frequently found. The permanence of the majority of CVC was greater than 7 days. Insertion and maintenance bundles are not met. When analyzing the different risk factors for infectious complication, it was obtained that the duration of the catheter increases the risk of infection.

RESUMEN

Resumen La fiebre es un signo común en la unidad de cuidados intensivos; implica el reto de descubrir su causa, por lo general refleja la existencia de infección, aunque puede tener origen no infeccioso o estar condicionada por síndromes de hipertermia. La Sociedad Americana de Enfermedades Infecciosas (IDSA, por sus siglas en inglés) y el Colegio Americano de Medicina en Cuidados Críticos definen la fiebre en pacientes críticamente enfermos como la temperatura igual o mayor a 38.3oC. La fiebre es una reacción fisiológica compleja de alguna enfermedad, mediada por el incremento de las citocinas y la generación de reactantes de fase aguda. Existen diferentes métodos para medir la temperatura y los médicos debemos saber el grado de precisión y las limitaciones de cada uno de ellos. En la unidad de cuidados intensivos, la temperatura corporal puede medirse mediante diversas técnicas, entre las que el catéter en la arteria pulmonar se considera el patrón de referencia. La fiebre en los pacientes críticamente enfermos puede clasificarse en tres categorías principales: síndromes de hipertermia, origen infeccioso y no infeccioso. Un episodio de temperatura mayor o igual a 38.3oC debe evaluarse. La historia clínica, el examen físico y las características de la fiebre (magnitud, duración, frecuencia y su relación con intervenciones diagnósticas o terapéuticas) son imprescindibles. Existe controversia en relación con el tratamiento de la fiebre; la evidencia actual le otorga un papel dual y opuesto, beneficios y perjuicios, de acuerdo con cada situación.

Abstract Fever is a common sign in the intensive care unit, this involves the challenge of discovering its cause, usually reflects the presence of infection, but may have no infectious origin or be conditioned by hyperthermia syndromes. The Infectious Diseases Society of America (IDSA) and the American College of Critical Care Medicine define fever in critically ill patients as temperature equal or greater than 38.3°C. Fever is a complex physiological reaction to a disease mediated increase of cytokines and generation of acute phase reactants. There are different methods to measure temperature; physicians should know the degree of accuracy and limitations of each. In the intensive care unit body temperature can be measured using different techniques among which the catheter in the pulmonary artery is considered the gold standard. Fever in critically ill patients can be classified into three main categories: hyperthermia syndromes, infectious origin and noninfectious. An episode of greater than or equal to 38.3°C temperature should be evaluated. The clinical history, physical examination and characteristics of fever (magnitude, duration, frequency and its relation to diagnostic or therapeutic interventions) are essential. There is controversy regarding the treatment of fever, current evidence gives a dual and opposite, benefits and harms, role depending on the situation.

RESUMEN

INTRODUCTION: Fever of unknown origin (FUO) remains a syndrome with difficult approach and changing spectrum. Our aim was to compare two series of FUO patients seen at the Department of Internal Medicine, Hospital de Especialidades Centro Medico La Raza, Mexico City. METHODS: Data from FUO series from 1979-87 were compared with those from 2004-14 series. We analyzed demographic data, final diagnoses, and diagnostic tests used. We report median and range for numerical variables and frequencies for nominal data, bivariate analysis was done with chi-square or Fisher´s test as needed using SPSS version 17.0 for MAC and open-epi version 3.7. RESULTS: One hundred twenty seven patients were included in the 1979-87 series and 118 in the 2004-14 series. There were more non-infectious inflammatory diseases (p=0.0004) and less infectious diseases (p=0.024) in the 2004-14 series. We observed no significant differences in neoplastic diseases and undiagnosed cases between the two series. Laboratory tests and their diagnostic utility were similar in both series, but image studies were less useful in the 2004-14 series. Biopsy and laparotomy remained as frequent and useful tools in both series. CONCLUSIONS: The recent series had more non-infectious inflammatory diseases and less infectious causes of FUO. Invasive studies remain as useful diagnostic aids in a significant number of cases.

Introducción: la fiebre de origen oscuro (FOO) es un síndrome de abordaje difícil y espectro cambiante. El objetivo fue comparar dos series de FOO estudiadas en el departamento de Medicina Interna del Hospital de Especialidades del Centro Médico La Raza.Métodos: fue un estudio comparativo de datos secundarios: los datos de la serie 1979-87, que fueron publicados por Frati et al. y los de la serie 2004-14, registrados en la base de datos de FOO del departamento de Medicina Interna. Se compararon datos demográficos, diagnósticos finales y pruebas diagnósticas utilizadas. Se describen mediana y amplitud para las variables numéricas y distribución de frecuencias para las variables nominales. El análisis bivariado se hizo con chi cuadrada o prueba de Fisher con los programas SPSS versión 17.0 para MAC y open epi versión 3.7.Resultados: se incluyeron 127 pacientes en la serie 1979-87, y 118 en la 2004-14. La serie más reciente tuvo menos casos ocasionados por infecciones, (p = 0.024), y más enfermedades inflamatorias no infecciosas (p = 0.0004). Se mantuvieron constantes las enfermedades neoplásicas y los casos con diagnóstico desconocido. Variaron poco las pruebas de laboratorio realizadas y su utilidad diagnóstica; en cambio los estudios de imagen fueron menos útiles en la serie 2004-14 (p = 0.00003). Las biopsias y la laparotomía fueron frecuentemente realizadas y útiles en ambas series.Conclusiones: En la última serie hubo más enfermedades inflamatorias no infecciosas a expensas de un menor número de infecciones. Los estudios invasivos siguen siendo necesarios.

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