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This retrospective study evaluated the impact of the clinical presentation of pyometra on the morbidity and mortality of the affected bitches. The medical records of 47 bitches surgically treated for pyometra between May and December 2017 were evaluated. The admission data were analyzed to classify the animals according to the clinical presentation of pyometra, presence of systemic inflammatory response syndrome (SIRS) and organic dysfunctions (cardiovascular, neurological, renal, and hemostatic). The outcomes were recorded for up to 14 days. The overall mortality rate was 13%. Open and closed pyometra were identified in 62% (n= 29) and 38% (n= 18) of the cases, respectively. The SIRS was present in 44 (94%) bitches, and 27 (57%) had at least one organ dysfunction. The most prevalent dysfunction was hemostatic, followed by neurological, cardiovascular, and renal dysfunction. The clinical presentation of pyometra and the presence of SIRS did not correlate with each other, or with the presence of organ dysfunction and mortality. However, cumulative organ dysfunction (r=0.532, P=<0.001) and the presence of neurological (r= -0.371; P=0.012) and renal dysfunction (r=0.303; P=0.041) were correlated with mortality. Thus, the identification of organ dysfunction through physical examination and routine laboratory analysis proved to be more effective in identifying and predicting the critically ill patients than the SIRS criteria or clinical presentation of the disease.

O objetivo deste estudo retrospectivo foi avaliar o impacto da apresentação clínica da piometra na morbimortalidade das cadelas afetadas. Foram avaliados os registros clínicos de 47 cadelas tratadas cirurgicamente para piometra entre maio e dezembro de 2017. Os dados recolhidos na admissão foram analisados para classificar os animais quanto à apresentação clínica da piometra, presença de critérios da Síndrome da Resposta Inflamatória Sistêmica (SRIS) e disfunções orgânicas - cardiovascular, neurológica, renal e hemostática. Foi registrado o desfecho durante 14 dias. A mortalidade global foi de 13%. Piometra aberta e fechada foram identificadas em 62% (n= 29) e 38% (n= 18) respectivamente. SRIS esteve presente em 44 (94%) cadelas e 27 (57%) tiveram pelo menos uma disfunção orgânica. A disfunção mais prevalente foi a hemostática, seguida da neurológica, cardiovascular e renal. A apresentação clínica da piometra e a presença de SRIS não se correlacionaram entre si ou com presença de disfunção orgânica e mortalidade. No entanto, a quantidade de disfunções orgânicas (r=0.532, P=<0.001) e a presença das disfunções neurológica (r= -0.371; P=0.012) e renal (r=0.303; P=0.041) foram correlacionados com mortalidade. Assim, a identificação de disfunções orgânicas através do exame físico e análises laboratoriais de rotina mostrou-se mais eficaz na identificação e previsão de pacientes críticos do que os critérios de SRIS ou a apresentação clínica da doença.

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BACKGROUND: Sepsis is a condition characterized by organic dysfunction, leading to hemodynamic instability and high morbidity and mortality rates in humans and animals. Early identification of perfusion changes and appropriate management of sepsis are crucial for improving patient prognosis. Currently, the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely studied for sepsis identification and evaluation of organ dysfunction. However, these scores do not assess gastrointestinal involvement, which is common in this condition. Contrast-enhanced ultrasound (CEUS) and Doppler have been considered promising diagnostic techniques for detecting changes in vascularization and microcirculation in a non-invasive and safe manner, particularly in the gastrointestinal system. This study aimed to evaluate duodenal perfusion using CEUS, as well as abdominal aortic and cranial mesenteric artery blood flow using Doppler ultrasound, and systolic arterial pressure (SAP) in 17 bitches with pyometra and in 10 healthy animals. RESULTS: The variables were compared between the pyometra and control groups, as well between patients with and without sepsis determined by the SOFA or SIRS scores. Pyometra was found to cause a reduction in abdominal aortic blood flow volume, aortic peak systolic velocity, and resistivity index as evaluated by Doppler ultrasound. Patients with sepsis according to the SOFA criteria only presented lower SAP. In contrast, sepsis animals identified by the SIRS score exhibited lower SAP, aortic peak systolic velocity, aortic blood flow volume, and aortic resistivity index and additionally, higher peak intensity of contrast in the duodenal wall. CONCLUSIONS: Pyometra causes a reduction in abdominal aortic blood flow, which is more pronounced in animals with sepsis identified by the SIRS criteria. These animals also exhibited a decrease in systolic blood pressure and an increase in duodenal perfusion, as evident by CEUS. However, these changes were not observed in patients with sepsis identified by the SOFA criteria. The alterations in intestinal perfusion observed in animals with sepsis indicate the presence of inflammation or dysfunction. In this regard, CEUS proves to be a valuable technique for detecting subtle changes in tissue hemodynamics that may not be apparent in conventional exams.

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Background: Cystoisospora spp. is considered a potential pathogen to cause diarrhoea in cats, and the disease occurs clinically, especially in young, weak and immunocompromised cats. The present study aimed to evaluate the clinical utility and diagnostic roles of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte (MLR) ratios in diarrheal cats infected with Cystoisospora spp. Materials, Methods & Results: Twenty-five cats with diarrhea due to infection caused by Cystoisospora spp. and 15 healthy cats were included in this study. The anamnesis, clinical and laboratory findings of all cats were recorded. A clinical severity score was generated for diarrheal cats, which included activity, appetite, presence of vomit, and faecal consistency. Also, cats infected with Cystoisospora spp. were classified as systemic inflammatory response syndrome (SIRS) positive (+) and SIRS (-) group according to the presence of at least 3 of the SIRS criteria. The Cystoisospora spp. oocysts were diagnosed by direct smear and simple faecal flotation. Cats found positive for other parasitic and protozoal agents by faeces examination were excluded from the study. Complete blood counts (CBC) were performed with an automated blood cell counter for all cats. Blood smears were prepared (with May-Grunwald Giemsa) from samples, and the CBC results were confirmed microscopically (obj.100x). White blood cell (WBC), neutrophil, lymphocyte and monocyte counts were recorded directly from the CBC. The neutrophil-to-lymphocyte ratio was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count. The monocyte-to-lymphocyte was calculated as the absolute monocyte count ratio to the absolute lymphocyte count. White blood cell (P = 0.015), neutrophil (P = 0.001), monocyte (P = 0.033), NLR (P = 0.000) and MLR (P = 0.042) of diarrheal cats infected with Cystoisospora spp. were significantly higher than in the healthy group. There was no significant difference between groups in the lymphocyte counts (P > 0.05). SIRS (+) group had statistically significantly higher WBC (P = 0.014), neutrophil counts (P = 0.000), NLR (P = 0.000) and MLR (P = 0.037) than the healthy group. Also, neutrophil counts and NLR of the SIRS (+) group were statistically significantly higher than the SIRS (-) group (P = 0.032; P = 0.001, respectively). However, there was no significant difference SIRS (+), SIRS (-), and healthy groups regarding lymphocyte and monocyte counts (P > 0.05). The clinical severity of the disease positively correlated with NLR and MLR. Also, the best cut-off value of NLR to predict SIRS was > 1.67, with 92.86% sensitivity and 84.62% specificity. MLR was not a useful predictor for SIRS. Discussion: NLR and MLR are parameters derived from complete blood count. In recent years, they have been used in human and veterinary medicine as a biomarker in the diagnosis, prognosis and treatment follow-up of various diseases and provide valuable information about inflammation. In cats, there are limited studies on NLR, and to our knowledge, there are no studies on MLR. The current study suggests that NLR and MLR may be used to determine the severity of the inflammatory condition in diarrheal cats infected with Cystoisospora spp., and NLR is a useful marker for predicting SIRS status in these cats. In addition, this study also will contribute to larger-scale studies in the future.

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Systemic inflammatory response syndrome (SIRS) is a common condition in horses with gastrointestinal disorders. If not prevented or controlled, SIRS promotes multiple organ dysfunctions that may culminate in serious disabilities or even death. The objective of this study was to evaluate the effects of Lithothamnion supplementation on systemic inflammatory response and organ function variables in horses undergoing oligofructose overload (OFO) intake. Twelve healthy horses were randomly divided into control and treated groups. The treated group received Lithothamnion (100 mg/kg bw PO BID) for 7 days before oligofructose intake (10 g/kg PO). Horses underwent clinical and laboratory evaluation immediately before and 6, 12, 18, and 24 h following administration of oligofructose. Parametric data were subjected to ANOVA in randomized blocks, followed by Tukey, and Student's t-tests for mean comparsions. Non-parametric data were analyzed by the Friedman, Dunn's, and Mann-Whitney tests (P < .05). Systemic inflammation and organ dysfunction was evident in both groups; however, these changes were milder and delayed in the treated group. Supplementation attenuated and delayed the tachycardia, tachypnea, leukocytosis, hyperproteinemia, hyperbilirubinemia, hyperalbuminemia and hyperglycemia in treated horses undergoing OFO. Furthermore, increases in packed cell volume, red blood cells, hemoglobin, globulin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, indirect and direct bilirubin and creatinine were observed only in the control group, remaining unchanged in the treated group. These findings demonstrate the potential of oral supplementation with Lithothamnion to ameliorate systemic inflammation and organ dysfunction in horses at risk of acquiring gastrointestinal disorders.

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Postpartum uterine infections of dairy cows promote a local and systemic inflammation and interfere with reproductive efficiency. The aim of this study was to evaluate the effect of steroid hormones including progesterone (P4) and estradiol (E2) on the systemic inflammatory response of cows after being challenged with an intrauterine infusion of lipopolysaccharide (LPS). For this, a hemogram and serum dosage of haptoglobin (Hp) in eight primiparous Gir cows ovariectomized were performed on day (day 0) and after 24 h (day +1). Four cows (n = 4) were challenged (day 0) with 20 mL of 0.9% NaCl + 12.5 µg/kg LPS, and four cows (n = 4) were challenged (day 0) with 20 mL of 0.9% NaCl. For this, the study was divided in four experimental groups as: (1) Control group: without any hormonal treatment before day 0; (2) Group 24 h - E2: 1 mg of estradiol benzoate 24 h before (day -1); (3) Group 24 h - P4: 2.0 g of P4 device 24 h before (day -1); (4) Group 14 d - P4: 2.0 g of P4 device 14 days before (day -14). In the systemic response to LPS, there was an increase in Hp (control group; 24 h - P4 group; 14 d - P4 group), and on day +1 the Hp of 14 d - P4 group was higher when compared to the other groups. On day 0, the 14 d - P4 group had an increase in circulating leukocytes and lymphocytes cells than the control group (P < 0.01). On day +1 after LPS-challenge the 14 d - P4 group showed a decrease in circulating lymphocytes, eosinophils, and monocytes (P < 0.05). A neutrophilia with left shift in the two treatments with P4 (day +1), in addition to a thrombocytopenia and lower platelets compared to the 24 h - E2 group (P < 0.05) (day 0) were recorded. It was concluded that ovariectomized cows challenged with LPS, previously submitted to steroid hormones induce a systemic inflammatory response. Also, the systemic response is more intense after previous prolonged exposure to P4 and less intense after exposure to E2. This study provided important information relating the effect of ovarian steroids on the systemic inflammatory response of cows challenged with intrauterine LPS.

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O presente trabalho teve como objetivo descrever complicaçoes multissistêmicas associadas à hernia inguino-escrotal em equino. Um equino da raça Brasileiro de Hipismo, de 7 anos, foi encaminhado para atendimento veterinário apresentando dor abdominal moderada, desidrataçao severa e sinais de síndrome da resposta inflamatória sistêmica (SIRS). Indicou-se laparotomia e a hernia inguino-escrotal foi corrigida. Entretanto houve necessidade de uma segunda laparotomia realizada seis dias após a primeira intervenção cirúrgica devido aos sinais de dor e refluxo incessantes. No momento da admissão o animal já apresentava sinais de SIRS e no pós operatório apresentou íleo adinâmico, insuficiência renal aguda e duodeno-jejunite proximal, além de complicações respiratórias e disfagia. Ao final o animal se recuperou de todas essas complicações, porém desenvolveu laminite e acabou sendo eutanasiado devido à posição permanente de decúbito.

The aim of the present study was to describe multisystemic complications associated with inguinal hernia in a horse. A 7-year-old Brazilian-saddle horse was referred to veterinary care with moderate abdominal pain, severe dehydration and signs of systemic inflammatory response syndrome (SIRS). A laparotomy was indicated and the condition was treated. However, a second laparotomy was required six days after due to incessant pain and reflux. Upon admission the animal had signs of SIRS and showed adynamic ileus, acute renal failure and proximal duodenum-jejunitis during the postoperative period, in addition to respiratory complications and dysphagia. The horse recovered from all these complications but developed laminits and euthanasia was elected due to permanent decubitus.

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O presente trabalho teve como objetivo descrever complicaçoes multissistêmicas associadas à hernia inguino-escrotal em equino. Um equino da raça Brasileiro de Hipismo, de 7 anos, foi encaminhado para atendimento veterinário apresentando dor abdominal moderada, desidrataçao severa e sinais de síndrome da resposta inflamatória sistêmica (SIRS). Indicou-se laparotomia e a hernia inguino-escrotal foi corrigida. Entretanto houve necessidade de uma segunda laparotomia realizada seis dias após a primeira intervenção cirúrgica devido aos sinais de dor e refluxo incessantes. No momento da admissão o animal já apresentava sinais de SIRS e no pós operatório apresentou íleo adinâmico, insuficiência renal aguda e duodeno-jejunite proximal, além de complicações respiratórias e disfagia. Ao final o animal se recuperou de todas essas complicações, porém desenvolveu laminite e acabou sendo eutanasiado devido à posição permanente de decúbito.(AU)

The aim of the present study was to describe multisystemic complications associated with inguinal hernia in a horse. A 7-year-old Brazilian-saddle horse was referred to veterinary care with moderate abdominal pain, severe dehydration and signs of systemic inflammatory response syndrome (SIRS). A laparotomy was indicated and the condition was treated. However, a second laparotomy was required six days after due to incessant pain and reflux. Upon admission the animal had signs of SIRS and showed adynamic ileus, acute renal failure and proximal duodenum-jejunitis during the postoperative period, in addition to respiratory complications and dysphagia. The horse recovered from all these complications but developed laminits and euthanasia was elected due to permanent decubitus.(AU)

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E. coli is the main bacteria isolated from infected uterus and bacterial endotoxin can lead to fatal endotoxic shock. Systemic inflammatory response syndrome (SIRS) precedes the endotoxic shock. Thus, early recognition of SIRS is important for patient treatment and prognostic. In Brazil, Gram positive bacteria are responsible for approximately 20% of all pyometra cases, and there is limited information about pathophysiology of shock and tissue injury. The aim of this study was to investigate the capacity of Gram positive bacteria to cause SIRS in bitches with pyometra. A prospective follow-up of 67 bitches with pyometra was performed, which were classified as SIRS + and SIRS- on admission. All bitches were surgically treated (ovariohysterectomy), uterine contents were collected in a sterile manner and the material was submitted to microbiological evaluation. Were identified in 55.2% of bitches E. coli (G1), 23.9% other Gram negative bacteria (G2) and 20.9% Gram positive bacteria (G3). The leukocyte profile, serum biochemistry and prevalence of SIRS were similar between the groups. It is concluded that Gram positive bacteria have the capacity to promote tissue damage and can lead the patient to death after SIRS and shock, as well as by E. coli and other Gram negative.(AU)

A Escherichia coli é reportada como principal agente etiológico da piometra canina e as endotoxinas bacterianas podem desencadear choque endotóxico e óbito. A síndrome da resposta inflamatória sistêmica (SIRS) antecede o choque e sua identificação pode predizer o prognóstico do paciente. No Brasil, bactérias Gram positivas são responsáveis por aproximadamente 20% dos casos de piometra, e informações a respeito da fisiopatologia do choque ou da lesão tecidual nesses casos são escassos. Assim, o objetivo foi investigar a capacidade de bactérias Gram positivas desencadear SIRS em cadelas com piometra. Foram acompanhadas de maneira prospectiva 67 cadelas com piometra, que na admissão passaram por exame clínico, exames laboratoriais e foram classificadas como SIRS+ e SIRS-. Todos os animais foram tratados cirurgicamente (ovariohisterectomia), o conteúdo uterino foi coletado de forma estéril e o material foi submetido à avaliação microbiológica. Em 55,2% das cadelas foi identificada E. coli (G1), 23,9% outras bactérias Gram negativas (G2) e 20,9% Gram positivas (G3). O perfil leucocitário, a bioquímica sérica e a prevalência de SIRS foram semelhantes entre os grupos. Conclui-se que bactérias Gram positivas possuem capacidade de promover dano tecidual podendo levar o paciente a óbito após desencadear SIRS e choque, assim como por E. coli e outras Gram negativas.(AU)

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E. coli is the main bacteria isolated from infected uterus and bacterial endotoxin can lead to fatal endotoxic shock. Systemic inflammatory response syndrome (SIRS) precedes the endotoxic shock. Thus, early recognition of SIRS is important for patient treatment and prognostic. In Brazil, Gram positive bacteria are responsible for approximately 20% of all pyometra cases, and there is limited information about pathophysiology of shock and tissue injury. The aim of this study was to investigate the capacity of Gram positive bacteria to cause SIRS in bitches with pyometra. A prospective follow-up of 67 bitches with pyometra was performed, which were classified as SIRS + and SIRS- on admission. All bitches were surgically treated (ovariohysterectomy), uterine contents were collected in a sterile manner and the material was submitted to microbiological evaluation. Were identified in 55.2% of bitches E. coli (G1), 23.9% other Gram negative bacteria (G2) and 20.9% Gram positive bacteria (G3). The leukocyte profile, serum biochemistry and prevalence of SIRS were similar between the groups. It is concluded that Gram positive bacteria have the capacity to promote tissue damage and can lead the patient to death after SIRS and shock, as well as by E. coli and other Gram negative.

A Escherichia coli é reportada como principal agente etiológico da piometra canina e as endotoxinas bacterianas podem desencadear choque endotóxico e óbito. A síndrome da resposta inflamatória sistêmica (SIRS) antecede o choque e sua identificação pode predizer o prognóstico do paciente. No Brasil, bactérias Gram positivas são responsáveis por aproximadamente 20% dos casos de piometra, e informações a respeito da fisiopatologia do choque ou da lesão tecidual nesses casos são escassos. Assim, o objetivo foi investigar a capacidade de bactérias Gram positivas desencadear SIRS em cadelas com piometra. Foram acompanhadas de maneira prospectiva 67 cadelas com piometra, que na admissão passaram por exame clínico, exames laboratoriais e foram classificadas como SIRS+ e SIRS-. Todos os animais foram tratados cirurgicamente (ovariohisterectomia), o conteúdo uterino foi coletado de forma estéril e o material foi submetido à avaliação microbiológica. Em 55,2% das cadelas foi identificada E. coli (G1), 23,9% outras bactérias Gram negativas (G2) e 20,9% Gram positivas (G3). O perfil leucocitário, a bioquímica sérica e a prevalência de SIRS foram semelhantes entre os grupos. Conclui-se que bactérias Gram positivas possuem capacidade de promover dano tecidual podendo levar o paciente a óbito após desencadear SIRS e choque, assim como por E. coli e outras Gram negativas.

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A sepse é hoje, reconhecidamente, uma das principais causasde mortalidade e de elevados custos nas unidades de terapiaintensiva de todo o mundo. Diversas são as alterações que agastroenterite, em especial a causada pela parvovirose, podemcausar nos parâmetros fisiológicos do paciente acometido, taisquais nos perfis hematológico e bioquímico, como também nahemodinâmica, verificada na maioria das vezes em casos desepse grave e choque séptico. Este estudo teve por objetivoavaliar a frequência de SIRS, sepse, sepse grave e choque sépticoem 50 cães com gastroenterite, atendidos na sala de urgência, eposterior necessidade de hospitalização para cuidados intensivos.Dos pacientes, apenas 10% não se enquadraram em algumadas classificações, e dos demais, a maior frequência observadafoi de sepse grave, uma vez que 66% dos pacientes foramclassificados nesta categoria. Com os resultados obtidos, concluiseque diversas são as alterações fisiológicas e metabólicas quecães com gastroenterite podem apresentar, levando-os a quadrosinflamatórios sistêmicos, infecciosos ou não, e agravados pordisfunções orgânicas.(AU)

Sepsis is recognized as a major cause of mortality and highcosts in intensive care units around the world. There are severalchanges that gastroenteritis, especially that caused by parvovirus,can cause in the physiological parameters of patients affected,such that the hematological and biochemical profiles, as well asin hemodynamics, observed most often in cases of severe sepsisand septic shock. This study aimed to evaluate the frequencyof SIRS, sepsis, severe sepsis and septic shock in 50 dogs withgastroenteritis treated in the emergency room, and later requiredhospitalization for intensive care. Only 10% of patients didnot fit into any of the classifications, and about the rest, thegreater frequency was of severe sepsis, since 66% of patientswere classified in this category. With the obtained results, it isconcluded that there are several physiological and metabolicchanges that occur in dogs with gastroenteritis, leading themto systemic inflammatory conditions, infectious or not, andaggravated by organ dysfunction.(AU)

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