Centro De Medicina Veterinária Anjos De Assis

A ventricular septal defect (VSD) is usually a congenital cardiac condition. In the elderly, although it may be present from birth, VSD can be acquired and manifest as a complication of acute myocardial infarction (AMI), as endocarditis, or as a result of cardiac procedures. It can lead to heart failure and other severe consequences demanding medical intervention.This case study describes an 80-year-old obese woman who was diagnosed with inferolateral myocardial infarction with right ventricular (RV) involvement after being admitted with symptoms of acute coronary syndrome (ACS). VSD, a rare mechanical complication, was identified as a contributing factor to hemodynamic instability. The patient underwent percutaneous coronary intervention (PCI) to revascularize the occluded right coronary artery (RCA). Hemodynamic support with norepinephrine and levosimendan, along with mechanical ventilation, was crucial for stabilization. Transfer to a tertiary care facility with cutting-edge surgical skills was essential.This example emphasizes how challenging it can be to manage AMI in elderly people, particularly when unusual side effects like VSD occur. It also highlights how important a multidisciplinary approach is to improving outcomes and optimizing care.

The authors declare no conflict of interest.

AimTo identify sleep‐promoting nursing interventions in hospitalized adults and older people.BackgroundSleep is necessary for maintaining good physical and mental health, as well as a high quality of life. Hospitalization can significantly disrupt sleep patterns, which is an often‐overlooked issue. Nurses are the main participants in promoting sleep in hospitalized patients.MethodsSystematic literature review based on the question: “What interventions can nurses implement to promote sleep in hospitalized adults and older people?”. The research was conducted on April 4, 2023, in CINAHL Complete, MEDLINE, Cochrane, Scopus, and Web of Science, filtering the articles published in the last 10 years. For a study to be included, it must feature adult or older participants, an intervention that aims to enhance sleep, and the research should have been conducted within a hospital setting. We followed the PRISMA flow diagram and analyzed the quality of the articles according to the Joanna Briggs Institute criteria for quality assessment. The results were subjected to a narrative synthesis.Results or findingsOf the 712 articles found, 13 were selected. The sample encompasses 1975 participants. These selected articles emphasize educational and communicative interventions, dietary and sensory interventions, symptomatic and environmental control, daily activity planning, sleep assessment and documentation, and individualized nursing care.DiscussionThere is a need for a systematic approach incorporating physical, psychosocial, and relational dimensions within the care context.ConclusionIt is necessary to raise the nurses’ awareness of the factors that affect sleep experience and empower them to promote sleep in partnership with hospitalized patients.Implications for nursing and health policySleep interventions can be promoted by implementing hospital policies, including environmental modifications in the design and refurbishment of facilities and restricting nighttime patient transfers to reduce noise and disturbances. Encouraging research studies that explore the effectiveness of these interventions will further support the development of evidence‐based policies aimed at improving sleep quality in hospitalized patients.

The World Drug Report highlights that the prevalence of hepatitis C virus (HCV) is one of the leading causes of cirrhosis and hepatocellular carcinoma globally. This report estimates that HCV is responsible for the annual death of around 700,000 people due to liver disease and is associated with high levels of morbidity and mortality with high health and socio-economic costs. This exploratory study aims to evaluate the socio-economic return provided by HCV treatment of individuals integrated into the MOP developed by the NGO Ares do Pinhal in Portugal. Using the SROI (Social Return on Investment) methodology is estimated that for every euro invested in this program, the return for society is 3,75€. This is a significantly positive SROI value, highlighting the importance of this investment in the creation of monetized value for society, as well as to provide greater well-being to those who need it and to society as a whole.

Atresia Ani (AA) is a rare congenital anomaly in companion animals affecting rectal and anal development. Its incidence in cats remains unreported. This retrospective study aimed to characterize age, body condition, fistula size, and perioperative outcomes in Type IV Atresia Ani (with recto-vaginal fistula) in female cats. Surgical intervention is the primary treatment. Conducted over 2 years, the study included nine female cats diagnosed with Type IV Atresia Ani and recto-vaginal fistula undergoing surgery. Statistical analysis used the R program (version 4.2.1) with Rstudio®® extension. Significant results were observed at a 95% confidence interval and p < 0.05. The condition had an incidence of 4.7% among the 192 cats evaluated over a 2-year period. The findings suggest that a body condition score of 3, an age of 3 to 4 weeks, and a fistula length of 1 to 2 mm correlated with better surgical outcomes, reducing the likelihood of fecal incontinence and anal stenosis development, and enhancing defecation awareness during the perioperative period. This study is the first to report the disease incidence in cats undergoing surgery, according to the authors' knowledge.

9542 Background: Immune checkpoint inhibitors (ICI) targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are now the standard of care in the treatment of metastatic melanoma (mM). The interplay between cancer cells and tumor microenvironment cells (e.g. immune cells) impacts cancer cell survival, local invasion, and metastatic dissemination. Chrono-immunotherapy is an emerging field as circadian oscillations are observed in the immune landscape (e.g immune cell numbers) as well as in the expression of immunotherapy targets (e.g. PD-1). Recently, a growing body of evidence suggests the outcome can be influenced by the time of the day when immunotherapy is administered (morning versus in the afternoon). This work aims to evaluate the impact of immunotherapy with ICIs administration timing on the overall survival (OS) and progression-free survival (PFS) of patients with mM. Methods: Multicentric, retrospective cohort study of mM patients under immunotherapy (ipilimumab/nivolumab, nivolumab, or pembrolizumab) with PS 0-1, between July 2016 and June 2023. Clinical, demographic characteristics, and time of treatment administration were obtained from medical records. Patients were distributed in two groups: those who received less than 75% of infusions after 2pm (morning group), and those who received at least 75% of infusions after 2pm (afternoon group). OS and PFS were calculated with Kaplan-Meier method and tested using a Cox regression model, with a 95% confidence interval. Results: We identified 168 patients from the 7 Oncology Centers included. The majority were men (n=100, 59.5%), with a median age of 69 years old, and 22% of the patients (n=37) were included in the afternoon group. No significant demographic or tumor burden differences were found between the morning and afternoon groups. The median follow-up time was 29 months, the estimated median PFS was 11.8 months (CI 95%, 8.0 - 14.6) and median OS was 31.4 months (CI 95%, 20.6 - NR). Patients in the afternoon group presented with shorter OS compared with those in the morning group (14.4 vs 37.6 months; HR 1.94 [CI 95% 1.16 to 3.23]; p 0,014). No statistically significant differences were observed in PFS. Subgroup analysis showed an increased detriment of performing ICIs infusions in the afternoon in women (OS 8.7 (4.2, 21.2) versus 30.9 months (18.9, NR), p=0.002; afternoon versus morning) and those older than 65 years old (OS 14.2 months (4.7, 31.4) versus 24.2 months (18.3, NR), p=0.002); afternoon versus morning). Conclusions: This work provides valuable insights into the potential role of the circadian timing of immunotherapy treatments for mM, suggesting patients may benefit from having ICIs infusion in the morning. Prospective randomized studies with a translational approach are needed to validate and fully understand the underlying mechanisms at play in circadian timing efficacy.

The skin contraction phenomenon occurs due to the energy emitted by the surgical CO2 LASER affecting the collagen architecture and intracellular water content in tissues. The study aimed to assess how gender, age, breed, body-weight, CO2 LASER emission mode, and potency influence skin contraction following the incision. The study involved 80 dogs (N = 80) of both genders, multiple breeds, undergoing major surgery with CO2 LASER. Subjects were grouped based on LASER potency (12 or 15 Watts) and emission mode (Superpulse-SP or Continuous-CT): GSP12, GSP15, GCT12, and GCT15. A 10mm incision was performed using the surgical CO2 LASER beam, consistently employing a focal point of 0.4mm, positioned at a distance of 1mm from the skin surface, and always maintained perpendicular to it, and resulting lengths measured with a digital caliper. Results were considered significant for p-value < 0.05. GSP12 showed minimal contraction, while GCT15 exhibited the most significant. Male subjects in GCT12, GCT15, and GSP12 experienced less contraction than females. Purebred dogs had greater contraction than mixed breeds. GSP12 individuals showed age-related contraction decrease (p < 0.01), with skin contracting by 0.09mm per year. Weight and skin contraction trended towards significance (p = 0.06), with a 0.02mm increase per unit weight. For a constant power of 12 W, the analysis of the relationship between the emission mode of the LASER beam and the final skin contraction (GSP12 vs. GCT12) revealed statistically significant differences (p < 0.01). This study suggests that the use of the Continuous mode of LASER emission, regardless of the power used, is associated with a higher level of final skin contraction. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: Project approval registration number by the Research and Teaching Ethics Committee (CEIE),Faculty of Veterinary Medicine-University of Lisbon (FMV_ULisboa), Lisboa-Portugal, N/Refª 015/2022.