Fatores Maternos associados à ocorrência de Mielomeningocele: Uma Revisão Bibliográfica / Maternal Factors Associated with the Occurrence of Myelomeningocele: A Literature Review

Resumo- A mielomeningocele configura um defeito primário do tubo neural mais comum, tal defeito constitui uma das malformações congênitas mais graves do recém-nascido, uma vez que o sistema nervoso central tem início em um tubo que se desenvolve nas estruturas mais complexas do corpo humano. O defeito pode ocorrer na sua porção cranial, resultando em malformações como anencefalia e encefalocele ou na porção caudal resultando em malformações que em grupo são conhecidas como espinha bífida. A mielomeningocele é classificada como espinha bífida aberta e ocorre nas primeiras quatro semanas de gestação. O objetivo deste estudo foi identificar na literatura fatores maternos associados ao aparecimento da mielomeningocele. A coleta de dados foi realizada em outubro a novembro de 2021, nas bases de dados SciELO, Google acadêmico e BVS – Brasil utilizando as palavras chaves: “mielomeningocele”, “malformação tubo neural” e “fatores maternos”, sendo necessária também a pesquisa em livros específicos, constituindo uma amostra de 13 publicações. A deficiência de ácido fólico destacou-se como principal fator materno associado à ocorrência da mielomeningocele; além da ingestão materna de anticonvulsivantes, ingestão de fármacos antagonistas do ácido fólico, doenças como o diabetes e a obesidade, deficiência de zinco, baixas condições socioeconômicas e influências perturbadoras como a irradiação e a hipertermia materna. Conclui-se que medidas públicas no combate aos fatores maternos preveníveis são necessárias, uma vez que a mielomeningocele é uma patologia limitante, complexa, com impacto na qualidade de vida dos pacientes e de seus familiares além de requerer equipe especializada e multidisciplinar.Palavras-Chave: Mielomeningocele; Malformações; Espinha bífida. Abstract- Myelomeningocele is a primary defect of the most common neural tube, this defect is one of the most serious congenital malformations in newborns, since the central nervous system starts in a tube that develops in the most complex structures of the human body. The defect can occur in its cranial portion, resulting in malformations such as anencephaly and encephalocele, or in the caudal portion, resulting in malformations that, in group, are known as spina bifida. Myelomeningocele is classified as open spina bifida and occurs within the first four weeks of pregnancy. The aim of this study was to identify maternal factors associated with the onset of myelomeningocele in the literature. Data collection was carried out from October to November 2021, in the SciELO, Google Academic and BVS – Brazil databases using the keywords: “myelomeningocele”, “neural tube malformation” and “maternal factors”, also requiring the research in specific books, constituting a sample of 13 publications. Folic acid deficiency stood out as the main maternal factor associated with the occurrence of myelomeningocele; in addition to maternal intake of anticonvulsants, intake of drugs that are antagonists to folic acid, diseases such as diabetes and obesity, zinc deficiency, low socioeconomic conditions and disturbing influences such as radiation and maternal hyperthermia. It is concluded that public measures to combat preventable maternal factors are necessary, since myelomeningocele is a limiting and complex pathology, with an impact on the quality of life of patients and their families, in addition to requiring a specialized and multidisciplinary team.Keywords: Myelomeningocele. Malformations. Spina bifida.

Accuracy of B-mode ultrasound and ARFI elastography in predicting malignancy of splenic lesions in dogs: Preliminary study

The objective was to evaluate the accuracy of B-mode ultrasonography and ARFI elastography in detecting malignancy in canine splenic lesions. Thirty-seven spleens with abnormalities (16 benign and 11 malignant) from dogs of different breeds and ages were evaluated. Echogenicity, echotexture, organ length and height were evaluated using B-mode. By ARFI elastography, tissue stiffness was evaluated qualitatively (elastogram) and quantitatively (measuring the shear wave velocity - SWV). Lesions were classified as diffuse, focal or multifocal (cranial, medial or caudal portion) and comparisons of the SWV between the injured and non-injured areas were performed. In the B-mode, no features were associated to malignancy (P > 0.05). In the elastogram, 35 spleens were non-deformable and 2 deformable, having no association with malignancy. The greater SWV was observed in malignant lesions (3.4 ± 0.6 m/s), followed by areas free from alterations (2.1 ± 0.3 m/s) and benign lesions (1.7 ± 0.5 m/s), with difference between groups (P < 0.0001). It was found that a SWV > 2.6 m/s indicates malignancy of canine splenic lesions (sensitivity of 95%, specificity of 100%, PPV of 100%, NPV of 94% and accuracy of 97%), concluding that ARFI elastography is a promising technique for differentiating malignancy in these lesions.

Morphology of the genital organs of male and female giant anteaters (Myrmecophaga tridactyla)

Background The giant anteater belongs to the supraorder Xenarthra which occupies a systematically isolated position among placental mammals. The species is categorized as Vulnerable by the International Union for Conservation of Nature, and understanding its reproductive characteristics is critical for future conservation efforts. Methods Gross and microscopic anatomy of the genital organs of 23 male and 21 female adult and young roadkill giant anteaters in Brazil were studied. Results Male giant anteaters presented a short conical penis, intraabdominal testes, and prostate, vesicular and bulbourethral glands. A tubular remnant of the partially fused Müllerian ducts extended from the seminal colliculus through the prostate gland, continued cranially in the genital fold, bifurcated, and attached with one elongation each to the left and right epididymal corpus. The structure presented a total length of up to 10 cm and contained a yellowish liquid in its lumen. Histologically, the caudal section of this structure resembled the female vagina, the middle portion corresponded to the uterus, and the extensions showed characteristics of uterine tubes. In adult female giant anteaters, ovoid ovaries with occasional seminiferous cord-like structures were observed. The animals possessed a simple uterus, which was directly continuous with the vaginal canal. The caudal portion of the vagina had two lumina, separated by a longitudinal septum and opening into two apertures into the vaginal vestibule, cranial to the urethral opening. In the urethral and the lateral vestibular wall, glandular structures with characteristics of male prostate and bulbourethral glands, respectively, were found. The vestibule opened through a vertical vulvar cleft to the exterior. A pair of well-differentiated Wolffian ducts with a central lumen originated ventrally at the vaginal opening into the vestibule and passed in a cranial direction through the ventral vaginal and uterine wall. Each duct extended highly coiled along the ipsilateral uterine tube until the lateral pole of the ovaries where it merged with the rete ovarii. Discussion The reproductive morphology of giant anteaters reveals characteristics shared with other Xenarthrans: intraabdominal testes, a simple uterus, and a double caudal vagina. The persistence of well-differentiated genital ducts of the opposite sex in both males and females, however, singles them out among other species. These structures are the results of an aberration during fetal sexual differentiation and possess secretory functions. The possibility of a pathological degeneration of these organs should be considered in reproductive medicine of the species. Conclusion Knowledge of the unique reproductive characteristics of the giant anteater is essential for future reproductive management of the species. Additionally, further research on the peculiarities of the persisting genital duct structures might help to understand sexual differentiation in placental mammals in general.

Case Report: Isolated Cystic Dilatation of the Cystic Duct: A Misdiagnosed Case Preoperatively

A 33-year-old female with a mild elevation of liver transaminase was sent to the general surgery department for medical services due to upper-right abdominal pain for 2 weeks. A liquid dark area ~4 × 3 × 3 cm in size in the theoretical location of the pancreatic segment of the common bile duct was detected by abdominal CT with no enhancement of the cystic wall found in the enhanced CT scan. The patient was then diagnosed with a choledochal cyst based on the results of the radiological images preoperatively. During the operation, the isolated cystic dilatation was found in the middle part of the cystic duct, and its caudal portion was found behind the head of the pancreas and converged into the common bile duct at an acute angle and low insertion. According to the intraoperative evaluation, the female was then diagnosed with a cystic duct cyst (CDC). The surgery was converted to a laparotomy for the unclear structure and the possibility of anatomic variation of the bile duct. The caudal portion of the cystic duct was found communicated with the common bile duct with a narrow base, and the extrahepatic bile duct was not cystic. The CDC was removed in the surgery. One week later, the patient was discharged from the hospital for the disappearance of abdominal pain and normal liver transaminase and did not report any discomfort in the 1-month-long follow-up. The lessons drawn from this case were as follows: (1) the distinction between the relatively frequent choledochal cyst and the isolated CDC should always be taken in mind; (2) a surgical strategy should be given priority for an intraoperatively confirmed CDC; (3) a common bile duct exploration is recommended for patients with choledocholithiasis or jaundice.

Mandibulectomy in feline with bacterial fibrosing osteomyelitis

Background: Fibrosing osteomyelitis is a chronic inflammatory process caused by infectious agents that lead to the destruction and replacement of bone tissue by fibroblasts. The diagnosis is based especially on histopathological and bacterial culture. In cases where extensive and irreversible injuries are observed, surgical treatment may be indicated. The objective of this work is to report the clinical, radiographic, histopathological, and microbiological aspects of a cat presenting fibrosing osteomyelitis.Case: A 10-year-old male feline, no defined breed, weighing 3.9 kg was referred to one Private Veterinary Clinic of Fortaleza, CE, Brazil with a history of left mandibular enlargement, presenting dysphagia, sialorrhea, an increase in firm consistency along of the left mandibular body, temporomandibular arthralgia and decreased joint motion range. On cranium radiograph, signs of proliferative osteopathy of irregular contours were observed in the branch and body of the left mandible and extending to the rostral region of the right mandible, suggesting a neoplastic process. After anesthesia, for better assessment of the oral cavity, a sample was collected by incisional biopsy, however, the histopathological result was nonspecific. In view of the inconclusive condition, it was decided to perform left hemimandibulectomy combined with right partial mandibulectomy. Tissue samples were obtained and sent for microbiological and histopathological analyses. The last test revealed an inflammatory reaction consisting of neutrophils and plasma cells, associated with a large amount of fibrous connective tissue, multifocal bacterial aggregates, necrosis and bone resorption. Based on the findings, the diagnosis of chronic bacterial osteomyelitis was concluded. The microbiological culture demonstrated the growth of the bacterium Pseudomonas aeruginosa, with sensitivity to cefovecin, which was administered to the treatment in doses of 8 mg/kg/SC, every 15 days, for 60 days. After 10 days of the surgery, the patient was able to start the process of swallowing and seizing pasty food.Discussion: Although radiography is a diagnostic method of choice to assess the extent of bone involvement, it hardly allows the distinction between neoplastic processes and osteomyelitis. Thus, in addition to the cranium radiographic examination, that revealed signs of proliferative osteopathy with irregular contours in branch and body topography of the left mandible were required biopsy and bacterial culture. After mandibulectomy, difficulty in retracting the tongue and anorexia were observed in the first days. Despite that, from the 12th day on, there was an improvement in food seizure, with the return to voluntary feeding. Mandibulectomy is indicated in cases where extensive and irreversible lesions are observed, although excision of the caudal mandible to the third or fourth premolar tooth is not recommended, because it compromises the sublingual musculature, with fall of the tongue and loss of function apprehension. In the present case, the caudal portion of the right mandibular branch was maintained, which facilitated the return of spontaneous feeding. The tissue removed was necessary to perform a microbiological culture with antibiogram, essential to determine the possible etiologic agent and choosing antimicrobial drugs. For the treatment of P. aeruginosa infection, cefovecin was prescribed due to the dosage and route of administration that collaborate with the mandibular surgery, once that the oral treatment is more difficult. Post-surgical complications related to mandibular resection, such as anorexia and difficulty in grasping food, are common. However, in the present case, the patient had an adequate reestablish after 15 days. Therefore, hemimandibulectomy is effective in treating fibrosing osteomyelitis, with maintenance of the patient's ingestive function.

The Caudal Septum Pivot Technique for Short Nose Correction

The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.

Spermatotoxic effects of selected traditional alcoholic beverages from North-Central Nigeria on adult male albino rats

Challenges associated with habitual intake of alcohol including health, social, psychological and especially reproductive health needs urgent attention. This study aimed to determine the spermatotoxic effect of selected traditional alcoholic beverages in rats. A total of 30 normal male Spaque dawley strain albino rats weighing 180-220g, divided into 5 groups of 6 rats in each were administered with 10ml/kg p.o each of pito, goskolo and ogogoro, goskolo respectively and 0.5ml/kg normal saline for a period of 21 days. Sperm samples were harvested from the left caudal portion epididymis assayed for sperm motility, sperm morphology and sperm count after which histological examination was carried out on the testes. Results showed that active, sluggish and dead sperm cells were goskolo>pito>burukutu>control>ogogoro, ogogoro> burukutu> control>goskolo>pito and control>pito>ogogoro>burukutu>goskolo respectively. For morphology of sperm cells, it was goskolo>ogogoro>burukutu>control>pito (normal) and pito>control>burukutu> ogogoro> goskolo (abnormal). Also, that of sperm count was goskolo>ogogoro>pito>burukutu>control. Results further showed that ogogoro and goskolo caused significant negative effects on quantity and quality of sperm cells with alteration of histological parameters marked with altered secondary spermatogonia and spermatid. These effects were however mild with pito and burukutu. Traditional alcoholic beverages from North central Nigeria ‘pito’, 'burukutu', 'ogogoro', and goskolo' have negative on the quantity and quality of sperm cells with marked with infraction of spermatogonia of male albino rats. As a result of the spermatotoxic properties of these locally available and often ingested drinks by males predominantly in the reproductive age brackets will do well to avoid and or minimize its use as it leads to reprotoxicity.

Aberrant right subclavian artery in a dog ˗ case report

ABSTRACT The brachiocephalic trunk and the left subclavian artery originate from the aortic arch, and both supply blood to the head, neck, and thoracic limbs. Anatomical variations, such as an aberrant right subclavian artery, are congenital conditions rarely observed in dogs, Thus, the objective of the present report was to describe a case of aberrant right subclavian artery in a 9-year-old Dalmatian. However, this anomaly was a finding in which the patient was asymptomatic during its 9 years of life and only at this age did he exhibit signs including sialorrhea, vomiting, hyporexia, and noisy deglutition. Blood count, biochemical profile, and thoracic radiography led to a diagnosis of megaesophagus and aspiration pneumonia. Despite the recommended treatment, the patient did not respond well; as such, the owner elected to euthanize the animal. On necropsy, the right subclavian artery originated directly from the aortic arch, followed a route from left to right dorsally to the esophagus, and then formed an impression of the vascular path over the muscular wall of the esophagus. The esophagus, in turn, exhibited a flaccid wall and dilation in the caudal portion to the vascular path made by the ectopic position of the right subclavian artery.

Isometry of Potential Attachment Sites for the Iliotrochanteric Suture in Dogs: an ex vivo Study

Background: Coxofemoral luxation is the most common traumatic luxation in dogs and the iliotrochanteric suture is one of the surgical treatment options. The orthopedic suture aimed at surgically restoring joint movement should be employed in an isometric manner in order to maintain adequate tension throughout the arc of motion. This study aimed to determine the isometric points for the iliotrochanteric suture in dogs during the joint extension and flexion movements. This evaluation was performed both in the intact hip joint and in the luxation model, establishing the best combination, among the determined points, for the reestablishment of normal joint movement.Materials, Methods & Results: Radiographic analyses of 12 canine cadaveric hips, both intact and in craniodorsal luxation model, were performed in a neutral position, flexion at 50°, and extension at 150°. In the trochanteric segment, two parallel lines were drawn, creating the central vertical axis and the secondary vertical axis. Three points were then determined on each axis, from proximal to distal, corresponding to 25, 50, and 75% of the height of the axis, and were labelled as T1, T2, and T3 and T4, T5, and T6, respectively. In the iliac segment, a line perpendicular to the longitudinal axis of the ilium was drawn, and 25, 50, and 75% of this height corresponded to points I1, I2, and I3, respectively. The lengths between the points were measured, with the objective of evaluating which combination of points presented less variation in the joint positions. The central location of the iliac and trochanteric segments, determined respectively by I2 and T2, provided smaller variations during the maximal movements of hip flexion and extension.Discussion: The surgical techniques of iliotrochanteric suture target to maintain the internal rotation of the femoral head inside the acetabulum and abduction of the femur until the soft tissues have healed. The described techniques for the iliotrochanteric suture present a great anatomical variety in the arrangement of the anchor points of the suture. It is known that if during motion, the attachment sites move closer to one another, the suture will become lax and, if the attachment sites move away from one another, the suture will tighten. Therefore, the implantation in isometric sites assists in reducing the variation of the distance between the points of origin and insertion of the suture during joint movement, keeping the suture tension constant and allowing the functional recovery of the joint. This study demonstrates that there are some locations for the origin and insertion of an iliotrochanteric suture that are associated with less length change than others. I2-T2 combination is the point closest to isometry for the iliotrochanteric suture during hip extension and flexion, so that, T2 is the most central point of the greater trochanter, corresponding to 50% of the height of its central vertical axis, as well as I2, which corresponds to the most central point of the ilium, representing 50% of the height of the most caudal portion of its body. The isometric point found by us details the exact location of perforation in all aspects (height and length), both in the ilium and the trochanter. In addition, it is a personalized point created for each patient from its radiographic examination and taking into consideration its anatomical variations, so that there is no damage to the suture during hip extension and flexion movements.