B-Mode and Doppler Ocular Ultrasound Evaluation in Healthy and Positive Dogs for Visceral Canine Leishmaniasis

Background: The use of ultrasound examination in the evaluation of ophthalmopathies has been gaining more and more space within the ophthalmologic clinical routine. The hemodynamic study of ocular vascularization may anticipate future changes, aiding in the adequate establishment of therapeutic conduits. The objective of this study was to evaluate the structures of the ocular bulb and to perform the hemodynamic evaluation of the flow of the external ophthalmic artery of dogs with canine visceral leishmaniasis (CVL) correlating with healthy animals.Materials, Methods & Results: For this purpose, 100 animals were used, of these 70 positive for CVL and 30 healthy animals, submitted to B-mode and Doppler ultrasound examination. Two-dimensional evaluation included identification of ocular changes and biometry of the following segments: axial length (M1), anterior chamber depth (M2), lens thickness (M3), lens length (M4), glass chamber depth (M5), optical disc length (M6) and optic nerve length (M7). The Doppler velocimetric evaluation included the identification and hemodynamic evaluation of the external ophthalmic artery, being measured: systolic peak velocity (SPV), final diastolic velocity (FDV), resistivity index (RI) and pulsatility index (PI). Ophthalmopathies were frequent in animals with leishmaniasis in both right (91.42%) and left (29.14%) eyes, with identification of capsular cataract, lens dislocation, retinal detachment and lens rupture. No significant statistical difference (P > 0.05) was observed when comparing the biometric values between the right and left eyes of the animals with CVL, as well as for the measurements between healthy and CVL animals. Hemodynamic indexes of the flow of the external ophthalmic artery presented narrow limits for the right and left eyes of the positive animals, not statistically different from each other. However, a significant difference was observed when compared to hemodynamic evaluations of the flow of the ophthalmic artery between the right eyes of the group of normal animals and that of the carriers of leishmaniasis, with the latter presenting values superior to the first one. The B-mode and Doppler ultrasonographic evaluation enabled the morphological characterization of the ocular bulb, the identification of ophthalmopathies and the hemodynamic evaluation of the external ophthalmic artery of dogs with canine visceral leishmaniasis, establishing values that could be used in clinical ophthalmologic routine.Discussion: The presence of ocular changes diagnosed by B-mode ultrasonography were common in dogs with canine visceral leishmaniasis. Ocular lesions were observed in 80.5% of dogs with leishmaniasis, presenting a high frequency, corroborating with the results in the present research. In 22% of the animals, B-mode ultrasonographic lesions were identified in both eyes, 64 of these presented changes only in the right eye and 16 in the left eye. Ophthalmopathies can be uni or bilateral and cause more than one alteration in the same eye, resulting from both the immune-mediated mechanisms caused by the agent and direct parasitism. Although the literature reports that the highest frequency of lesions is bilateral, only 16 animals had alterations in both eyes. The origin of ophthalmopathies may be related to the species and tropism of the parasite, type and duration of the immune response developed by the host. The greater frequency of bilateral ophthalmopathies can have correlation with the systemic disease, in which in the initial stages of the disease only one eye is affected and the occurrence of bilateral manifestations is related to the chronic cases.

Download Full-text

Contribution of ocular B-mode and triplex Doppler in the evaluation of 10 Poodle dogs with cataracts

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/s0102-09352013000200009 ◽

2013 ◽

Vol 65 (2) ◽

pp. 359-363 ◽

Cited By ~ 2

Author(s):

M.A.R. Feliciano ◽

M.A. Abrahim ◽

R.V.R. Peixoto ◽

K.L. Yasunaga ◽

W.R.R. Vicente ◽

...

Keyword(s):

Blood Flow ◽

Pulsatility Index ◽

Ophthalmic Artery ◽

Ultrasound Examination ◽

Resistive Index ◽

Ocular Diseases ◽

Ocular Ultrasound ◽

Doppler Evaluation ◽

The Right

The findings of b-mode and especially triplex Doppler ocular ultrasound in the evaluation of 10 Poodle dogs with cataracts, which bring a contribution not yet reported in veterinary medicine, were reported. Ten Poodle dogs of varied ages and presenting cataracts were used. All animals were evaluated for ophthalmic and ultrasound examination. The ultrasound examination allowed the evaluation of the sonographic anatomy of the eye and measurement of the axial thickness of the lens (ATL). Using the Doppler mode, the blood flow of the ophthalmic artery and its vascular indexes, systolic velocity (SV), resistive index (RI) and pulsatility index (PI) were measured. Values found for ATL were 5.89±1.05 for the right eye (OD) and 6.07±1.32 for the left eye (OS). Values found using Doppler evaluation were SV OD: 26.54±7.05 and SV OS: 29.21±11.18; PI OD: 1.89±0.61 and PI OS: 1.7±0.35; RI OD: 0.76±0.1 and RI OS: 0.72±0.09 (OS). It was concluded that triplex Doppler was important for the determination of vascular indexes of the ophthalmic artery, which can be used for monitoring animals with hemodynamic alterations of the eyes and monitoring the therapy of ocular diseases.

Download Full-text

Ocular Echobiometry and Resistivity Index of External Ophthalmic Artery in Agoutis (Dasyprocta prymnolopha)

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.117025 ◽

2021 ◽

Vol 49 ◽

Author(s):

Sabrina Barros Araújo ◽

Flávio Ribeiro Alves ◽

Gerson Tavares Pessoa ◽

Renan Paraguassu De Sá Rodrigues ◽

Laecio Da Silva Moura ◽

...

Keyword(s):

Anterior Chamber ◽

Ophthalmic Artery ◽

Color Doppler ◽

Two Dimensional ◽

Wild Rodents ◽

Resistivity Index ◽

Lens Thickness ◽

Ocular Ultrasound ◽

The Mean ◽

The Right

Background: Veterinary Ophthalmology provides complementary information for the diagnosis of ocular pathologies. Studies in wild species are essential. Among the diagnostic techniques in ophthalmology, two-dimensional ultrasonography stands out. The agouti is a rodent belonging to the Dasyproctidae family that has been widely used as an experimental model. For these animals, sight is one of the crucial senses for their survival. The aim of this study was to evaluate the effectiveness of the two-dimensional ocular ultrasound technique to obtain anatomical measurements and the external ophthalmic artery resistivity index, presumably normal in the species Dasyprocta prymnolopha.Materials, Methods & Results: Forty eye bulbs of 20 adult rodents of the species were evaluated by ultrasonography. In these animals, B-mode echobiometry was performed using the transpalpebral approach and the hemodynamic study of the external ophthalmic artery using the color Doppler technique. All examinations were initiated by the left eye bulb and all measurements were performed by only one examiner. The collected data related to echobiometry were analyzed using Bioest 5.0 for Windows. Initially, normality was tested using the Shapiro-Wilk test for each parameter, then the paired t-test was performed, comparing right and left eyes, and a significance level of 5% (P < 0.05) was adopted. Based on the methodology used, the following values were obtained for the right and left eyeballs, respectively: anterior chamber thickness - mean of 1.28 ± 0.3 mm and 1.22 ± 0.1 mm; lens thickness - 8.27 ± 0.9 mm and 8.11 ± 0.9 mm; vitreous chamber thickness - 5.35 ± 0.48 mm and 5.30 ± 0.47 mm and axial length - 12.7 ± 0.9 mm and 13 ± 0.68 mm. The mean external ophthalmic artery resistivity values were 0.4305 ± 0.0390 and 0.4258 ± 0.0387 (right and left eye, respectively), characterizing a low resistance. There was no statistical difference between the right and left eyeballs in any of the studied parameters.Discussion: The use of the convex transducer was feasible, promoting adequate contact with the ocular surface and images of satisfactory quality for obtaining measurements, similar to what was observed in studies evaluating the ocular biometry of primates and dogs. The anterior chamber thickness values in this experiment did not differ statistically between the antimers, as well as observed for dogs. The data obtained for lens thickness did not differ statistically for antimers, like those obtained for other rodent species evaluated with the same methodology. The mean values of vitreous chamber thickness were like those observed in chinchillas but correspond to about half of that obtained for capybaras. In this study, the external ophthalmic artery was characterized in all animals, but obtaining the spectral tracing was difficult due to its fine caliber. In wild animals, and especially in wild rodents, there are few data reporting the resistivity of the ophthalmic artery, and there is a lack of studies, which can be explained by the behavioral characteristics of defense and by the high susceptibility to stress in capture, since the performing the technique requires, as in other procedures, the use of chemical containment.Keywords: Doppler flow, ultrasound, eye, agouti.

Download Full-text

RENAL HISTOPATHOLOGICAL FINDINGS IN DOGS WITH VISCERAL LEISHMANIASIS

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652013000200008 ◽

2013 ◽

Vol 55 (2) ◽

pp. 113-116 ◽

Cited By ~ 11

Author(s):

Rosangela Silva Rigo ◽

Cristiano Marcelo Espínola Carvalho ◽

Michael Robin Honer ◽

Gisele Braziliano de Andrade ◽

Iandara Shetter Silva ◽

...

Keyword(s):

Renal Failure ◽

Visceral Leishmaniasis ◽

Focal Segmental Glomerulosclerosis ◽

Membranoproliferative Glomerulonephritis ◽

Inflammatory Infiltrate ◽

Renal Involvement ◽

Serological Diagnosis ◽

Canine Visceral Leishmaniasis ◽

Significant Difference ◽

Inflammatory Changes

Visceral leishmaniasis affects various organs including the kidneys; which can lead to renal failure and death. In order to verify this renal involvement, material was evaluated from 100 dogs naturally infected and with serological diagnosis of canine visceral leishmaniasis (CVL). Inflammatory changes were present in 25.3% of the tubules, in 67.0% of interstitium and in 52.0% of glomeruli. There was no significant difference (p > 0.05) between the presence of glomerulonephritis in symptomatic and oligosymptomatic dogs. The membranous and membranoproliferative glomerulonephritis were the most frequent, both with 18.0% frequency, followed by focal segmental glomerulosclerosis with 14.0%. Changes such as cylindruria, tubular and fibrosis hypertrophy, periglomerular inflammatory infiltrate, and multifocal and diffuse peritubular inflammatory infiltrate were observed. The findings are consistent with those of other authors indicating that renal involvement is common in CVL and the standards of membranous and membranoploriferative glomerulonephritis, as well as the tubulointerstitial involvement, are frequent.

Download Full-text

Epidemiological aspects and spatial distribution of human and canine visceral leishmaniasis in an endemic area in northeastern Brazil

Geospatial health ◽

10.4081/gh.2017.503 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 7

Author(s):

Roseane Campos ◽

Márcio Santos ◽

Gabriel Tunon ◽

Luana Cunha ◽

Lucas Magalhães ◽

...

Keyword(s):

Spatial Distribution ◽

Visceral Leishmaniasis ◽

Urban Areas ◽

Systemic Disease ◽

Northeastern Brazil ◽

Sand Fly ◽

Canine Visceral Leishmaniasis ◽

Positive Serology ◽

Exponential Increase ◽

The City

Visceral leishmaniasis (VL) is a systemic disease endemic in tropical countries and transmitted through sand flies. In particular, <em>Canis familiaris</em> (or domesticated dogs) are believed to be a major urban reservoir for the parasite causing the disease Leishmania. The average number of human VL cases was 58 per year in the state of Sergipe. The city of Aracaju, capital of Sergipe in Northeastern Brazil, had 159 cases of VL in humans. Correlatively, the percentage of serologically positive dogs for leishmaniasis increased from 4.73% in 2008 to 12.69% in 2014. Thus, these studies aimed to delineate the spatial distribution and epidemiological aspects of human and canine VL as mutually supportive for increased incidence. The number of human cases of VL and the frequency of canine positive serology for VL both increased between 2008 and 2014. Spatial distribution analyses mapped areas of the city with the highest concentration of human and canine VL cases. The neighbourhoods that showed the highest disease frequency were located on the outskirts of the city and in urbanised areas or subjected to development. Exponential increase in VL-positive dogs further suggests that the disease is expanding in urban areas, where it can serve as a reservoir for transmission of dogs to humans via the sand fly vector.

Download Full-text

Prevalence and Associated Factors of Canine Visceral Leishmaniasis in an Endemic Area of Mato Grosso, Brazil

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.81301 ◽

2018 ◽

Vol 44 (1) ◽

pp. 6

Author(s):

Mahyumi Fujimori ◽

Arleana Do Bom Parto Ferreira de Almeida ◽

Álvaro Felipe Lima Ruy Dias ◽

Juliana Yuki Rodrigues ◽

Luciano Nakazato ◽

...

Keyword(s):

Risk Factors ◽

Visceral Leishmaniasis ◽

Canine Leishmaniasis ◽

Enzyme Linked Immunosorbent Assay ◽

Lutzomyia Longipalpis ◽

Canine Visceral Leishmaniasis ◽

Prevalence Rates ◽

Mato Grosso ◽

Significant Difference ◽

Endemic Areas

Background: Canine visceral leishmaniasis is a chronic and severe disease of great interest to global public health. In Brazil, the main species causing visceral leishmaniasis is Leishmania chagasi [syn. Leishmania infantum], which is transmitted by sandflies of the species Lutzomyia longipalpis and Lu. cruzi. This study aimed to determine the risk factors and prevalence of visceral leishmaniasis in dogs residing in endemic areas of the municipality of Várzea Grande, Mato Grosso.Material, Methods & Results: The study was conducted in the Várzea Grande neighbourhoods Jardim Eldorado, Parque Sabiá and São Mateus, which are located in the Brazilian Cerrado region and are endemic for visceral leishmaniasis. The Várzea Grande is a mostly commercial and industrial municipality and relies on subsistence farming. To describe the general characteristics of the dog population and housing environment, an interview was carried out with the dog owners in each household. This interview addressed local demographics and the identification of dogs to establish epidemiological aspects of canine illness and risk factors for infection. The dogs were examined and physically restrained for blood collection by jugular venipuncture. For serological testing, a commercial enzyme-linked immunosorbent assay (ELISA) was used. A Chi-square test or Fisher’s exact test was used to identify associations between independent variables and the seroprevalence of dogs with anti-Leishmania antibodies. It were collected blood from 521 animals, including 160 belonging to Jardim Eldorado, 129 to Parque Sabiá and 232 to São Mateus. Of these animals, 120 were reactive by ELISA, with a prevalence of 23.0%. There was no statistically significant difference (P > 0.05) according to gender, age, racial definition, origin, time with family, presence of ectoparasites, or the presence of people with skin wounds at home or on other pets. The major risk factor for canine infection was fur length; dogs with short fur were 2.2 times more likely to be infected than dogs with long fur.Discussion: The prevalence of canine leishmaniasis in endemic areas was found to be similar to studies in Cuiaba, a city in Várzea Grande, which also included neighbourhoods endemic for visceral leishmaniasis as study areas. Other studies have shown prevalence rates that differ from those found in this study. This difference may either be because the neighbourhoods in this study had already experienced outbreaks of the disease or because serum samples were cross-reactive with other trypanosomatids. While infection was more readily detected in dogs with clinical signs, asymptomatic dogs with anti-Leishmania antibodies were found in greater numbers, which is consistent with the literature. Hair length was the only factor associated with canine leishmaniasis in this study; short-haired animals were most at risk of contracting the disease because they had more skin exposure to sandflies during blood feeding. In conclusion, endemic districts of Várzea Grande had high prevalence rates of canine visceral leishmaniasis, and a short length coat was associated with infection.

Download Full-text

Risk factors associated to canine visceral leishmaniasis in Uruguaiana city, Brazil

Semina Ciências Agrárias ◽

10.5433/1679-0359.2018v39n1p211 ◽

2018 ◽

Vol 39 (1) ◽

pp. 211

Author(s):

Taiane Acunha Escobar ◽

Gabriela Döwich ◽

Luísa Zuravski ◽

Letícia Carvalho Cantele ◽

Claudia Acosta Duarte ◽

...

Keyword(s):

Visceral Leishmaniasis ◽

Odds Ratio ◽

Canine Visceral Leishmaniasis ◽

Endemic Region ◽

Potential Vector ◽

Factors Associated ◽

Significant Difference ◽

Green Areas ◽

Lower Education ◽

The City

The present study aimed to evaluate factors associated with canine visceral leishmaniasis (CVL) in areas with higher seroprevalence of it in Uruguaiana city, Rio Grande do Sul state, Brazil, during the year of 2012. A semi-structured questionnaire with socioeconomic and environmental questions was applied in Leishmania endemic regions of the city. The survey data were analyzed by multivariate statistics and the associations between them were presented as odds ratio within a 95% confidence limit. The relationships between the studied variables showed no statistically significant difference between the dwellings with positive and negative dogs. However, when analyzing the odds ratio, the presence of green areas larger than 10m² turned the house into an area of potential risk for CVL (OR= 2.53). There was no difference among the socioeconomic variables education and income, though the groups with lower education and income showed a higher seroprevalence of CVL. The city of Uruguaiana is already located within the CVL broadcasting area and is taken as an endemic region of the disease, with seropositive dogs in all neighborhoods. Thus, the determinants for an increased Leishmania sp. infection could not be indicated, even so, the maintenance of green areas around the households represented a risk factor for being a potential vector shelter.

Download Full-text

Bilateral Anophthalmia in Feline

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.110141 ◽

2021 ◽

Vol 49 ◽

Author(s):

Ana Claúdia De Souza Andrade ◽

Laisa Marina Rosa Rey ◽

Isabela Carvalho dos Santos ◽

Lucas Lima Da Silva ◽

Sarah Gabriella Delallo Charnovski ◽

...

Keyword(s):

Differential Diagnosis ◽

Clinical Examination ◽

Ultrasound Examination ◽

Histopathological Examination ◽

Cartilaginous Tissue ◽

Histological Findings ◽

Favorable Prognosis ◽

Ocular Ultrasound ◽

Congenital Anophthalmia ◽

The Right

Background: Anophthalmia is a rare, congenital condition, defined as the complete absence of the eye bulb due to inadequate growth of the vesicle or optic dome. The malformation can be primary (in the absence of complete), secondary (in the presence of only residual tissue), or degenerative (in which the eye begins to form, but for some reason, it begins to degenerate). This condition is rare in dogs, cats, cattle, and sheep. Microscopic evaluation of orbital tissue for identification is always recommended. The aim of this study was to report a case of bilateral anophthalmia in a domestic cat.Case: A feline male, healthy, Maine Coon breed with 60 days of life was attended at the one veterinary private clinic. The cat, negative for FIV and FeLV, was born in a commercial cattery, belonging to his mother's third litter, healthy litter with the exception of this feline. He arrived with a complaint of not opening his eyelids, like the rest of the litter. In the clinical examination, it was found the normality of vital signs, absence of other visible anatomical abnormalities, only the ocular region was observed with closed eyelids. The initial suspicions were anophthalmia and microphthalmia. The patient was referred for an ocular ultrasound, which showed the complete absence of the right and left eye bulbs. The right and left orbital cavities had only a volume of soft, amorphous, and predominantly homogeneous tissue. After the ultrasound report, the patient underwent a surgical procedure to remove a fragment of tissue from the eye socket, which was sent for histopathological examination to confirm anophthalmia and discard the differential diagnosis of microphthalmia. Microscopy revealed immature, epithelial, and glandular tissue in the middle of discrete and moderate connective tissue, loosely arranged. In some fragments, cartilaginous tissue was also revealed. Thus, the histological findings are compatible with immature, pseudoformed tissues and without neoplastic characteristics. The diagnosis of secondary anophthalmia was reached with use of ultrasound and histological reports.Discussion: Congenital malformations in domestic cats are less frequent than in dogs, some of which are rare, and little reported. Secondary anophthalmia in the reported patient was confirmed by histological and ultrasound examination. Bilateral secondary anophthalmia is characterized by the absence of the eyeball, but with the presence of adjacent tissue. The animal was submitted to an ocular ultrasound examination and the complete absence of ocular bulbs was found. The differential diagnosis of microphthalmia was ruled out because there was no evidence of the eyeball. Microphthalmia is a common congenital ophthalmic disorder in veterinary medicine. Representative fragments were submitted to histopathological examination, where immature, epithelial tissue was found. In some fragments sent for analysis, cartilaginous tissue was observed. The histological findings are compatible with immature, pseudoformed tissues, thus verifying bilateral congenital anophthalmia in the reported animal. The clinical examination in these cases serves to ensure that the animal does not have any other congenital changes, allowing a favorable prognosis in puppies. Based on the information presented, the animal in this study has bilateral secondary congenital anophthalmia, with a favorable prognosis for the patient to live with certain normality, with quality and well-being.

Download Full-text

Evaluation of the euthanasia of seropositive dogs for canine visceral leishmaniasis as the only method of controling the disease in the enzootic area in the Midwestern Minas Gerais

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6165 ◽

2020 ◽

Vol 40 (2) ◽

pp. 107-112 ◽

Cited By ~ 1

Author(s):

Talita Pereira Vaz ◽

Marcella Oliveira Gama-Melo ◽

Patrícia Flávia Quaresma ◽

Célia Maria Ferreira Gontijo ◽

Gilmar Santos ◽

...

Keyword(s):

Visceral Leishmaniasis ◽

Urban Area ◽

Enzyme Linked Immunosorbent Assay ◽

Canine Visceral Leishmaniasis ◽

Ministry Of Health ◽

Blood Samples ◽

Current Prevalence ◽

Significant Difference ◽

The Impact ◽

Enzootic Area

ABSTRACT: Human Visceral Leishmaniasis (VL) is expanding, and it is distributed in the five geographic regions of Brazil, with the Northeast being the region that presents the most significant number of registered cases. The main urban reservoir of the etiological agent of VL is the domestic dog, and it is known that canine cases precede human cases. One of the control actions of VL, recommended by the Ministry of Health, is performing the euthanasia of seropositive dogs. In 2013, in the municipality of Iguatama/MG, the first canine serological survey was carried out in the city, with a prevalence of 8.3% of seropositive dogs for Leishmania infantum. Of the seropositive animals for Canine Visceral Leishmaniasis (CVL) in this survey, 84% were euthanized, and 16% died within two years after diagnosis. No other control measures for CVL were taken in the municipality. The objectives of the present study were to determine the current prevalence of seropositive dogs for CVL in the municipality of Iguatama and to observe the impact of euthanasia of seropositive dogs to VL as the only control measure performed in this municipality, which is considered an enzootic area of the disease. For this, a new canine epidemiological survey was carried out in the municipality of Iguatama, following the guidelines of the Manual of Surveillance and Control of Visceral Leishmaniasis. Blood samples were collected from 270 dogs and tested by DPP® immunochromatographic test and by Enzyme-Linked Immunosorbent Assay (ELISA). The animals that presented inconclusive results had new blood samples collected and analyzed. The only animal that showed a positive result in DPP® and undetermined in the ELISA, in the first evaluation, became seropositive four months later, so this study reinforces the recommendation of the Ministry of Health to reassess dogs that present inconclusive results for CVL. From a total of 270 samples, 21 (7.8%) were reagents in both tests. Thus, the prevalence of seropositive dogs for CVL, in 2017, in the urban area of the municipality of Iguatama was 7.8%. The Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) molecular technique confirmed infection by L. infantum in the ten dogs sampled with CVL-positive serology. The comparison between the current prevalence (after euthanasia) with that found in 2013 (8.3%), there was no significant difference (p=0.764). The prevalence of CVL in the urban area of the municipality of Iguatama is still high, making it possible to presume that the euthanasia of seropositive dogs for CVL, and the absence of monitoring or other interventions measures, did not contribute to decrease the transmission of the parasite and was not sufficient for the control of CVL in the municipality of Iguatama, an area considered as non-endemic to CVL until 2013.

Download Full-text

Suicidal Ideation and Self-Determination in Institutionalized Elderly

Crisis ◽

10.1027//0227-5910.22.1.15 ◽

2001 ◽

Vol 22 (1) ◽

pp. 15-19 ◽

Cited By ~ 9

Author(s):

Andrée Fortin ◽

Sylvie Lapierre ◽

Jacques Baillargeon ◽

Réal Labelle ◽

Micheline Dubé ◽

...

Keyword(s):

Self Determination ◽

Current Debate ◽

Elderly Persons ◽

Rational Suicide ◽

Institutionalized Elderly ◽

Significant Difference ◽

Social Subscale ◽

Civil Status ◽

The Right ◽

Taking Action

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

Download Full-text

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i4.89 ◽

2019 ◽

Vol 1 (4) ◽

pp. 133-139

Author(s):

Yasser Hamdy ◽

Mohammed Mahmoud Mostafa ◽

Ahmed Elminshawy

Keyword(s):

Right Ventricular ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Early Postoperative Period ◽

Tricuspid Valve Repair ◽

Ring Annuloplasty ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

Download Full-text