Dissertations / Theses on the topic 'Equine diagnostics'

There is an urgent need for detection of viral respiratory pathogens to identify the causal agent(s) involved and to prevent the spread of related diseases. The first part of this dissertation focuses on development, optimization and validation of Real-time reverse transcription polymerase chain reaction (rRT-PCR) assays for the detection of several common equine viral pathogens: equine arteritis virus (EAV), equine influenza virus and equine rhinitis viruses A and B. Emphasis of the second part of this dissertation is on studying the role of EAV envelope proteins in virus attachment and entry. Using an infectious cDNA clone of EAV and reverse genetics, a panel of chimeric viruses was generated by swapping the N-terminal ectodomains and full-lengths of the two major envelope proteins (GP5 and M) from porcine reproductive and respiratory syndrome virus (PRRSV). The recombinant viruses expressing the N-terminal ectodomain of PRRSV GP5 or M or both (GP5ecto, Mecto, and GP5&Mecto, respectively) in an EAV backbone were viable and genetically stable. Compared to the parental virus, these three chimeric viruses produced lower titers and smaller plaque sizes indicating that they have a crippled phenotype. Interestingly, the three chimeric viruses could only infect EAV susceptible cell lines but not the PRRSV susceptible cell line. Therefore, the exchange of GP5 and/or M protein N-terminal ectodomains from PRRSV did not alter the cellular tropism of the chimeric viruses. We also investigated the role of one of the minor envelope proteins (E) of EAV in virus attachment and entry. The results showed that EAV infection of equine endothelial cells is heparin-dependent and the Cterminus of the E protein contains a putative heparin-binding domain. We generated a panel of arginine to glycine mutations in the conserved region of both the full-length EAV infectious cDNA clone and individual E protein expression vectors. The triple mutation R52,60,65G construct grew significantly slower and produced much smaller plaques. The double mutant R52,60G completely blocked the interaction between E protein and heparin. Taken together, these data indicated that E protein interacts with heparin to facilitate virus attachment and plays a major role in EAV infection.

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In equine, the intersections between reproduction and genomics are numerous, however, little known about the genetic factors that acting on fertility. The conclusion of equine genome sequencing project, brings the oportunity to evaluate candidate genes and molecular biomarkers for specific reproductive characteristics. Based on this information, this PhD thesis aimed to develop genomic studies applied to equine reproduction. The first paper analyzed the expression of apoptotic-related genes (Bax, Bcl-2, survivin and p53) in equine cumulus-oocyte complex by qRT-PCR, comparing gene expression between morphologically distinct oocytes and cumulus cells during in vitro maturation. Results showed that survivin mRNA levels were higher (P<0.05) and p53 mRNA levels was lower (P<0.01) in oocytes compared to cumulus cells in morphologically healthy. On the other hand, expression of the Bax was significantly higher in morphologically healthy cumulus cells (P<0.02). The second paper analyzed a single nucleotide polymorphism (SNP) in the p53 gene, looking for associations with reproductive parameters in Thoroughbred mares. This is the first study demonstrating the Arginine/Proline SNP in equine exon 4 p53 gene. The heterozygous Arginine/Proline was found in 73.3% of Thoroughbreds compared to the homozygous Arg/Arg and Pro/Pro that was detected in 17.1% and 9.6% of mares, respectively. The Arginine/Proline genotype was significantly associated with abortion (P=0.02), while Proline/Proline mares had a lower probability of abortion (P<0.05). These results indicate that p53 may play a role in equine reproduction. The second paper analyzed a single nucleotide polymorphism (SNP) in the p53 gene, looking for associations with reproductive parameters in Thoroughbred mares. This is the first study demonstrating the Arginine/Proline SNP in equine exon 4 p53 gene. The heterozygous Arginine/Proline was found in 73.3% of Thoroughbreds compared to the homozygous Arg/Arg and Pro/Pro that was detected in 17.1% and 9.6% of mares, respectively. The Arginine/Proline genotype was significantly associated with abortion (P=0.02), while Proline/Proline mares had a lower probability of abortion (P<0.05). These results indicate that p53 may play a role in equine reproduction. The third article has determined the presence of circulating cell-free fetal DNA (ccffDNA) in pregnant mare s plasma, looking to develop a molecular test for the prenatal diagnosis of fetal sex determination using SRY gene amplification by PCR, reamplification by PCR (2nd-PCR) and real-time quantitative PCR (qPCR). This is the first report of ccffDNA in equine species. The molecular sexing test resulted in sensitivity of 72% and accuracy of 85% on the PCR. Using the 2nd-PCR and qPCR we obtained an increasing in the sexing sensitivity results (90.9%) and an accuracy of 95%. This study demonstrates for the first time the fetal sex determination in mares using ccffDNA. This PhD thesis resulted in the publication of three papers in international journals of reproduction and a patent application request. The results presented here collaborate to understand the equine reproductive biology, and indicate potential genetic markers to fertility parameters.
Em equinos, as intersecções entre a reprodução e a genômica são numerosas, no entanto, pouco se sabe sobre os fatores genéticos que atuam na fertilidade. Com o genoma equino completo, existe a possibilidade de análises moleculares e estudo de genes candidatos a biomarcadores para características reprodutivas específicas. Com base nestas informações, a presente tese teve como objetivo desenvolver estudos de genômica aplicada à reprodução equina. O primeiro artigo analisou a expressão de genes relacionados a apoptose (Bax, Bcl-2, survivin e p53) no complexo cumulus oócito equino através de qRT-PCR, comparando a expressão gênica entre oócitos e células do cumulus com diferentes características morfológicas durante a maturação in vitro. Como resultados, foi observada maior expressão do survivin (P<0.05) e menor expressão de p53 (P<0.01) em oócitos comparado a células do cumulus do grupo considerado morfologicamente saudável. Enquanto que a expressão de Bax foi maior (P<0.02) em células do cumulus do grupo saudável comparado ao grupo com características morfológicas não desejáveis. O segundo artigo analisou um polimorfismo de nucleotídeo único (SNP) no gene p53, relacionando-o a parâmetros reprodutivos de éguas Puro Sangue Inglês. Foi relatado pela primeira vez um SNP Arginina/Prolina na região do exon 4 do gene p53 equino. A prevalência foi de 73,3% para o genótipo heterozigoto, 17,1% do genótipo Arginina/Arginina e 9,6% do Prolina/Prolina. O genótipo Arginina/Prolina foi associado (P=0.02) a ocorrência de aborto, enquanto que o genótipo Prolina/Prolina foi associado (P<0.05) a menor probabilidade de aborto, indicando um papel da p53 na reprodução equina. O terceiro artigo determinou a presença de DNA fetal livre e circulante (ccffDNA) no plasma de éguas prenhas, desenvolvendo um teste molecular de diagnóstico pré-natal na determinação do sexo fetal através da amplificação do gene SRY pelas técnicas de PCR, de re-amplificação por PCR (2º-PCR) e de PCR quantitativo em tempo real (qPCR). Este é o primeiro relato do DNA fetal livre e circulante em equinos. O teste de sexagem molecular resultou em 72% de sensibilidade e 85% de acurácia na técnica de PCR. Com o 2º-PCR e qPCR a sensibilidade foi de 90,9% e 95% de acurácia. Este estudo demonstra pela primeira vez a determinação do sexo fetal em éguas utilizando o ccffDNA. Os resultados apresentados colaboram para o entendimento da biologia reprodutiva da espécie equina, e indicam marcadores genéticos em potencial para parâmetros de fertilidade. Esta tese resultou na publicação de três artigos em periódicos internacionais da área de Reprodução e um pedido de Patente de Invenção.

O presente relatório tem como objetivo relatar as atividades desenvolvidas no âmbito do estágio curricular do Mestrado Integrado em Medicina Veterinária da Universidade de Évora. O estágio foi realizado em clínica de equinos, em dois locais distintos: Clinique Équine de Meslay (CEM) e École Nationale Vétérinaire d’Alfort (EnvA) com passagem pelo Centre d’Imagerie et de Recherche sur les Affections Locomotrices Équines (CIRALE), França. Primeiramente encontra-se a descrição dos locais de estágio, seguida da quantificação e descrição da casuística médica e cirúrgica observada, categorizada nas diversas áreas da medicina de equinos. A segunda parte do relatório é composta por uma monografia relativa ao tema Parasitas gastrointestinais como causa de cólica, na qual é efetuada uma revisão bibliográfica sobre as cólicas equinas causadas por parasitas gastrointestinais e abordagem Médico-Veterinária. Por fim, apresentam-se três casos clínicos de cólicas de origem parasitária; Equine Practice Abstract: This report aims to report the activities developed during the integrated externship of the mater’s degree in Veterinary Medicine at the University of Évora. The externship was carried out in an equine clinic, in two different places: Clinique Équine de Meslay (CEM) and École Nationale Vétérinaire d’Alfort (EnvA) with a short period at the Centre d’Imagerie et de Recherche sur les Affections Locomotrices Équines (CIRALE), France. First, there is a description of the externship sites, followed by the quantification and description of the observed medical and surgical cases, categorized in the different areas of the equine clinic. The second part of the report is composed of a monography on the topic Gastrointestinal parasites as a cause of colic, in which a bibliographic review is carried out on equine colic caused by gastrointestinal parasites and the Medical Veterinary approach. Finally, three clinical cases of colics of parasitic origin are presented.

The present final report concluding the degree of the Integrated Master in Veterinary Medicine at the University of Évora is based on the curricular externship in an outpatient clinic with Dr. An Sleeckx in the Greater Lisbon / Ribatejo area. This report is divided into two parts. The first part presents the casuistic of the externship and describes clinical cases like abdominal pain, lameness, pre-purchase exam, intoxication with monensin, insect bite hypersensitivity and castration which were followed during the externship. As painful events like lameness and colic are very common in equine clinics, a literature research on pain assessment in horses was made and presented in the second part as a monography. The focus was on new composite pain scales including behavior and facial expressions which seem to be the most reliable to detect pain according to the newest publications; Resumo: Clínica e Cirurgia de Equinos O presente relatório de conclusão do curso de Mestrado Integrado em Medicina Veterinária da Universidade de Évora é baseado no estágio curricular realizado em clínica ambulatória com a Dra. An Sleeckx na zona da Grande Lisboa/ Ribatejo. O relatório é dividido em duas partes. A primeira parte apresenta a casuística do estágio e descreve casos clínicos como dor abdominal, claudicações, acto de compra, intoxicação com monensina, hipersensibilidade à picada de insectos e castração, que foram acompanhados durante o estágio. Uma vez que eventos dolorosos como as claudicações e as cólicas são muito comuns nas clínicas equinas, foi feita uma pesquisa bibliográfica sobre avaliação da dor em cavalos, que foi apresentada na segunda parte como uma monografia. O foco foi em novas escalas composta de dor, incluindo comportamento e expressões faciais que parecem ser as mais fiáveis para detectar a dor de acordo com as mais recentes publicações.

A videotoracoscopia vem ganhando espaço na Cirurgia Veterinária, inclusive na espécie equina, dispondo de estudos que evidenciam resultados promissores no que se refere às suas aplicações diagnósticas e terapêuticas. Este trabalho teve por objetivo comparar dois tipos de endoscópios utilizados para videotoracoscopia em equinos em estação. Foram utilizados 9 equinos com idades que variaram entre 3 e 20 anos. Os procedimentos cirúrgicos foram realizados com os animais em estação, sob sedação, analgesia e anestesia local. Os equinos tiveram cada hemitórax, escolhido de forma aleatória, inspecionado com o endoscópio flexível e o endoscópio rígido (ângulo de visão de 0º, 33 cm de comprimento e 10 mm de diâmetro) através do 12º espaço intercostal. Ambos os endoscópios proporcionaram avaliação efetiva do hemitórax acessado, porém o flexível permitiu um mapeamento mais amplo da cavidade torácica do que o rígido, oportunizando a visualização de um número maior de estruturas, enquanto que rígido apresentou melhor luminosidade, definição de cor e imagem. O uso do endoscópio flexível permitiu a observação da porção ventral da cavidade torácica, assim como, a região cranioventral, permitindo a visualização de estruturas como a veia cava cranial e lobo acessório do pulmão direito. Não foram observadas complicações clínicas significativas com a utilização de ambos os endoscópios.
Video thoracoscopy has been increasing in veterinary surgery, including the equine species, featuring studies have been showing promising results with regard to their diagnostic and therapeutic applications. This study aimed to compare two types of endoscopes used to perform thoracoscopy in standing horses. We used nine horses with ages ranging between 3 and 20 years. The surgical procedure was performed with the animals in standing, under sedation, analgesia and local anesthesia. The horses had each hemithorax, randomly chosen, inspected with the flexible endoscope and rigid endoscope (viewing angle of 0°, 33 cm long and 10 mm in diameter) through the 12th intercostal space. Both endoscopes have provided effective evaluation of the hemithorax accessed, but the flexible endoscope allowed a larger mapping of the chest cavity than the rigid, allowing the visualization of a greater number of structures, while the rigid endoscope showed better brightness, color definition and image. The use of flexible endoscope allowed observation of the ventral portion of the thoracic cavity and the cranio-ventral region, allowing visualization of structures such as the cranial vena cava and accessory lobe of the right lung. No significant clinically complications were observed with the use of both endoscopes.

Dissertação de Mestrado Integrado em Medicina Veterinária
A cólica, ou dor abdominal aguda, é um sinal inespecífico que pode ter origem em disfunções do tracto gastrointestinal ou outras que não envolvam o mesmo, sendo neste caso denominada “falsa cólica”. A cólica é responsável pelo maior número de mortes em equinos, à excepção de morte por idade avançada. A etiologia das doenças do tracto gastrointestinal dos equinos que levam à cólica é complexa e diversa. Ainda por explicar permanecem alguns deslocamentos intestinais ou torções e impactações. Na prática clínica diária a maioria dos casos de cólica tem causa desconhecida, mas em geral, resultam da distensão do intestino por ingesta, gás, fluidos ou devido a uma interrupção da motilidade normal do intestino (Íleo). Os casos mais severos podem também resultar de danos da parede intestinal por processos de isquémia, inflamação, edema ou enfarte. No diagnóstico desta afecção existem vários parâmetros que devem ser avaliados, tais como: grau de dor; distensão abdominal; frequência cardíaca, respiratória e características do pulso; coloração das membranas mucosas; tempo de repleção capilar; temperatura rectal; motilidade gastrointestinal; refluxo gástrico; achados à palpação rectal; hematócrito; concentração plasmática de proteínas totais; concentração plasmática de fibrinogénio; contagem de leucócitos; quantificação electrolítica; análise de gases sanguíneos; quantificação das enzimas séricas; concentração de lactato plasmático; características do fluido peritoneal recolhido por abdominocentése; achados ecográficos; achados radiográficos; achados à endoscopia; achados à laparoscopia; e análise fecal. O objectivo deste trabalho consistiu no estabelecimento de pontos orientadores na difícil decisão da terapêutica a adoptar na cólica equina, analisando os vários parâmetros de diagnóstico que, conjuntamente, permitem alcançar um diagnóstico mais preciso da afecção em causa e como tal, poder tomar-se uma decisão mais acertada quanto ao tratamento a seguir, seja ele médico ou cirúrgico. No estudo efectuado sobre 13 casos de cólica abdominal, verificou-se que os casos cirúrgicos foram acompanhados de uma dor mais violenta, e apresentaram frequências cardíacas e tempos de repleção capilar superiores aos dos pacientes que necessitaram apenas de tratamento médico, enquanto que a concentração plasmática de proteínas totais foi superior nos casos médicos. Dos resultados do estudo efectuado e de outros estudos já previamente existentes concluiu-se que quando existe um grau de dor severa, achados anormais à palpação rectal e ausência de resposta à terapêutica analgésica, deve-se referenciar o paciente para cirurgia, mesmo que a frequência cardíaca, coloração das membranas mucosas, tempo de repleção capilar, e análise do fluido peritoneal estejam dentro dos valores normais.
ABSTRACT The colic, or acute abdominal pain, is a non specific sign which can be originated by several disorders of the gastrointestinal tract or others that do not regard this last one, in which case the colic is named “false colic”. The true colic is responsible for the majority of deaths in horses, except those cases in which horses die due to advanced aging. The aetiology of the disorders of the gastrointestinal tract that lead to equine colic is complex and diverse. Still, with no explanation remain some gut displacements or twists and impactions. In the practical daily clinic the majority of colic cases have an unknown cause, but in general, they are a result of gut distention by ingesta, gas, fluids or due to an interruption of the normal motility (Íleus). The most severe cases can also result from damages of the intestinal wall by processes of isquemia, inflammation, edema or infarction. In the diagnosis of this pathology there are several parameters that must be evaluated, such as: pain degree; abdominal distention; the respiratory, heart and pulse rate; mucous membranes; membrane refill time; rectal temperature; gastrointestinal motility; gastric reflux; findings in rectal examination; packed cell volume; total plasma protein value; plasma fibrinogen value; white blood cell count; electrolytic quantification; analysis of blood gases; quantification of serum enzymes; plasma lactate value; characteristics of the peritoneal fluid collected by abdominal paracentesis; ultrasonographic findings; radiographic findings; endoscopic findings; laparoscopic findings; and fecal analysis. The goal of this work consisted on the establishment of guiding points in the difficult decision of the appropriate treatment, analyzing some parameters of diagnosis that, jointly, supply tracks to reach a more specific diagnosis of the disorder which is causing the abdominal pain, and as such to be able to make the right decision regarding the necessary treatment, being either surgical or medical. The study, which was carried on 13 cases of abdominal colic, has shown that surgical cases had a more violent pain, and had presented a higher heart rate and membrane refill time than the patients who only needed medical treatment, whereas the total plasma protein value was higher in medical cases. From these results and other previously existing studies, one can conclude that when exists a severe degree of pain, abnormal findings in the rectal examination and absence of response to the analgesic therapy, the colic case must be referred for surgery, even thought there are no significant changes in the heart rate, mucous membrane, membrane refill time and in the analysis of the peritoneal fluid.

Although Rhodococcus equi (R. equi), previously known as Corynebacterium equi, was first isolated from pneumonic foals almost a century ago, it remains the most common cause of subacute or chronic granulomatous bronchopneumonia in foals. While the majority of foals exposed to R. equi develop a protective immune response (regressors), others exhibit a unique susceptibility to infection (progressors). The determinants for either outcome are not completely understood. Therefore, current diagnostic and preventive measures are suboptimal and require betterment. In light of this current need, we hypothesized that immunoglobulin G subisotype T [IgG(T)] against the virulence-associated protein A (VapA) of R. equi, and whole blood cytokine expression profile of foals predict the outcome of infection and can be used as diagnostic markers of clinical disease. Further, we hypothesized that the use of R. equi hyperimmune plasma (HIP) decreases severity of disease in naturally infected foals, playing an important role in disease prevention in the field. Lastly, we hypothesized that specific anti-Rhodococcus equi pili antibodies passively acquired by foals via colostrum after immunization of pregnant mares with a Rhodococcus equi pili-based candidate vaccine will confer protection against induced disease, and therefore have an immediate impact on R. equi pneumonia prophylaxis. The objectives of this study were: (1) to describe the humoral immune response of progressor and regressor foals to R. equi following experimental challenge and natural infection, (2) to compare the cytokine and cell-marker expression profile in whole blood of progressor and regressor foals after challenge, (3) to evaluate the Vap-A specific IgG profile of a commercially available HIP product and its value as a prophylactic tool on an endemic farm, and (4) to evaluate the efficacy of a vaccine based on the Rhodococcus equi pili (Rpl). Although the IgG(T) response of progressor foals after challenge or following natural infection tended to be more pronounced than that observed in regressor foals, its performance as a diagnostic test for predicting disease outcome was poor. Likewise, whole blood cell-marker and cytokine expression profiles of progressor and regressor foals were not significantly different, undermining its reliability as a diagnostic tool. Evaluation of the association of HIP VapA specific IgG profile and rhodococcal disease outcome in the field resulted in the conclusion that progressor foals received significantly less VapA specific IgG, suggesting that HIP may have provided some protection to regressor foals. Although HIP appeared to have provided some protection against clinical pneumonia, Rpl maternally-derived IgG failed to confer any advantage to foals born from vaccinated mares. The Rpl candidate vaccine failed to confer protection to foals after challenge, and did not decrease disease severity in comparison to a control group. In summary, the results of this study do not support the use of VapA specific IgG(T) or whole blood cytokine expression profile as predictors of disease outcome. Further, our results suggest a positive effect of HIP on disease outcome. Lastly, the presence of systemic and local Rpl antibodies was not protective in foals.

Recent studies have provided conflicting results in regards to equine intradermal skin testing and its use in defining causative antigens in IgE mediated diseases such as equine recurrent airway obstruction (RAO). This study was divided into two experiments. In the first experiment of this study, the hypothesis tested was normal horses would have minimal variability in the wheals formed by intradermal injection of positive control stimulants. This was evaluated by examining the repeatability of skin test wheals created by 5 concentrations of histamine, compound 48/80, and phaseolus vulgaris (PHA) within a normal horse and between 12 normal horses at 0.5 hours, 4 hours, and 24 hours post injection. Minimal variability was detected within individual horses and between 12 horses for histamine and compound 48/80 at 0.5 hours and for PHA at 4 hours. This information suggests that the intradermal injection of positive control substances is a repeatable test in normal horses. In the second experiment of this study, the hypothesis tested was normal horses react differently to intradermal injection of positive control stimulants (histamine, compound 48/80, PHA) and/or an environmental antigen (Aspergillus) in comparison to horses affected with RAO. This was evaluated by identifying differences in wheal responses between normal horses and RAO affected horses. Concentration response curves were created in normal and RAO affected horses to the aforementioned stimulants at 0.5 hours, 4 hours, and 24 hours post injection. No statistically significant differences were noted in concentration response between normal and ROA affected horses when compound 48/80 and PHA were evaluated. RAO affected horses demonstrated a greater slope at the 0.5 hour time when compared to normal horses suggesting that RAO affected horses are hypersensitive to intradermal injection of histamine. Injection of Aspergillus mix at 4000 protein nitrogen units/ml caused an intradermal wheal reaction at the 24-hour time in 4/5 RAO horses. This reaction was not noted in normal horses. This information suggests that there may be a positive relationship between causative antigens (i.e. Aspergillus) that may induce clinical RAO and positive intradermal skin test results. An additional aspect that was evaluated in both experiments involved histologic examination of skin biopsies taken from wheals created by intadermal injection of histamine, compound 48/80, PHA, and Aspergillus at various times post injection. In the first experiment, intradermal injection of histamine caused severe dermal edema and margination of neutrophils and eosinophils at 0.5 hours. Compound 48/80 demonstrated mild to modest dermal edema at 0.5 hours while PHA demonstrated severe dermal edema, hemorrhage, and lymphactic ectasia at 4 and 24 hours. PHA also demonstrated a neutophilic inflammation at 4 hours that progressed to a mixed lymphohistiocytic and neutrophilic inflammation at 24 hours. In the second experiment, no edema and modest to moderate neutrophilic inflammation was noted in normal horses after intradermal injection of Aspergillus at 24 hours. In contrast, RAO affected horses demonstrated mild to modest edema and a mild to moderate mixed inflammatory response (lympho-histocytic, neutrophilic, eosinophilic) after intradermal injection of Aspergillus at 24 hours suggesting a delayed type response.
Master of Science

Dissertação de Mestrado Integrado em Medicina Veterinária
A síndrome podotroclear corresponde à entidade clínica responsável pela claudicação, geralmente dos membros anteriores, associada a um processo doloroso com origem no osso navicular e/ou com as estruturas que com ele se relacionam. O seu diagnóstico resulta da conjugação da análise do exame estático, exame dinâmico, anestesias perineurais e intra-articulares e exames complementares de diagnóstico, tais como radiografia e ressonância magnética. O presente estudo tem como objetivo avaliar a importância clínica das alterações em bursografias de contraste. Para isso foi selecionada uma amostra de 10 cavalos com síndrome podotroclear nos quais se administrou um contraste iodado na bursa podotroclear e procedeu-se à realização de radiografias na projeção palmaroproximal-palmarodistal oblíqua. Dos 10 cavalos examinados, 9 apresentavam alterações na bursografia, podendo ser na fibrocartilagem, na face flexora do tendão digital profundo ou em ambas. Verificou-se que não há uma relação direta entre alterações radiográficas no osso navicular e as alterações encontradas na bursografia de contraste. Embora o tamanho a amostra não seja estatisticamente relevante, este estudo vem propor que a bursografia de contraste constitui um exame complementar de diagnóstico que pode fornecer informações pertinentes na avaliação de estruturas do aparelho podotroclear tais como a fibrocartilagem e a face flexora do tendão flexor digital profundo, podendo ter uma importância acrescida no diagnóstico de síndrome podotroclear quando meios como a ressonância magnética não estão disponíveis.
ABSTRACT - Preliminary study of contrast bursografias in horses with radiographic changes consistent with podotroclear syndrome - Navicular syndrome is the clinical condition that causes lameness, usualy in the forelimbs, associated with pain arising from the navicular bone and closely related structures. Diagnosis results from the combination of the visual examination at rest and at exercise, perineural anesthesia, intrasynovial anesthesia and the imaging procedures as radiology and magnetis resonance imaging. This study aims to evaluate the clinical significance of changes in contrast bursographs. With this purpose, was selected a sample of 10 horses with podothroclear syndrome in witch an iodinated contrast was administered in podotroclear bursa and proceeded to the accomplishment of the palmaroproximal-palmarodistal oblique radiographs. Of the 10 examined horses, 9 showed changes in bursography, that could be in the fibrocartilage, in the dorsal surface of the deep digital flexor tendon or both It was found that there is no direct relationship between radiographic changes in the navicular bone and the changes found in contrast bursographs. Although the population was not statistically significant, this study proposes that contrast bursography is a complementary diagnostic procedure that can provide relevant information in the assessment of the podothroclear apparatus structures such as fibrocartilage and the flexor surface of the deep digital flexor tendon and may have a greater importance in the diagnosis of navicular syndrome when imaging procedures such as magnetic resonance imaging are not available.

Malignant melanoma is a neoplasm of melanocytes. It typically originates in skin, but may metastasize to other body systems. It is a relatively common neoplasm in both humans and horses, with striking similarities across both species. Heritable genetic factors associated with melanoma have been identified in both human malignant melanoma (HMM) and equine malignant melanoma (EMM). This work investigates similarities and differences of EMM and HMM through comparative protein expression using immunohistochemical staining. Nestin, Pax-3/7, B-Raf, and SOX-10 are commonly expressed in HMM tissues. Expression of these proteins is not noted in normal human melanocytes, is associated with decreased melanocytic differentiation, and with increased proliferation leading to tumorigenesis. My findings demonstrate similar expression of these proteins in EMM. Aberrant protein expression patterns may signal underlying genetic mutations. Similar abnormal expression patterns suggest that EMM and HMM may share common genetic abnormalities.

Treatment of malignant melanoma presents similar challenges in both horses and humans. In general, early stages of the disease can be successfully treated with surgical excision; however, advanced stages of EMM and HMM are often refractory. Therefore, development of novel therapies for advanced stages of melanoma is essential in both species, with the horse representing a useful model for this process.

One novel therapy, frankincense oil (FO) is a resin distillate from trees of the genus Boswellia. Studies have demonstrated cytostatic and apoptotic-modulating properties of FO in various human cancer cell lines. No studies have evaluated FO as a therapy for skin neoplasms. In my work, the apoptotic properties of FO from Boswellia frereana were verified in a HMM cell line (SK-Mel-5). The cytotoxicity and therapeutic efficacy of FO were also studied by evaluating the effects of FO in cases of perianal EMM. FO was found to be consistently cytotoxic when injected directly into EMM tumors, but largely inconsequential when applied topically. FO was found to substantially decrease the size of injected masses. These findings suggest that FO could be useful for debulking large masses in late stage dermal EMM.

The combined results of these studies support further investigation of EMM as a translational model for HMM.

Ph. D.

Šis magistro baigiamasis darbas yra apie arklių šlubavimus ir dažniausiai naudojamus klinikinės diagnostikos metodus juos diagnozuoti. Šiam tyrimui buvo pasirinkta Danijos Horsholm Hestepraksis klinika, tyrimas atliktas nuo Liepos 1d iki Spalio 1d. Ši klinika yra viena iš didžiausių specializuotų arklių veterinarijos klinikų Danijoje. Šis darbas susideda iš 4 skyrių, kurie susideda iš įvado, literatūros apžvalgos, rezultatų, rezultatų aptarimo ir išvadų. Darbe yra 34 puslapiai, su 2 lentelėmis ir 22 paveikslėliais. Šiam tyrimui pasirinkta šimtas atsitiktinų arklių, kuriem buvo diagnozuota galūnių ligos. Buvo analizuojama kaip šlubavimui įtakos turi lytis, amžius, arklio veislė. Buvo nustatyta, kad dažniausiai šlubavimo problemų turintys arkliai, gydyti Horsholm Hestepraksis, yra sportui naudojami arkliai. Todėl pagrindinės galūnių ligos yra susyjusios su sąnarių, sausgyslių ir raiščių problemomis. Pagrindinės pažeistos kojos yra priekinės kojos, ypač priekinė kairė koja.
The current work is about horse lameness and the most common and useful clinical diagnostic methods to find it. For this research the Horsholm Hestepraksis clinic in Denmark was chosen, the term from July 01 to October 01 in 2013. This clinic is one of Denmark's largest specialised veterinary clinics in the field of equine diseases. This work consists of 4 chapters which consist from introduction, literature review, results, discussion of the results and conclusion. There are 34 pages with 2 tables and 22 pictures. 100 random horses were choosen for this work, which had diagnosed limb lameness. It was analyzed what is most common sex, age, breed of the horses. It was analyseds that the most common horses, which are treated in Horsholm Hestepraksis, are horses used for sport activity. Therefore the main limb diseases are related to joint, tendon and ligaments damage. The most common legs are front legs, especially front left leg.

Infections by protozoa of the Sarcocystidae family have worldwide distribution and are common in ruminants, causing important economic losses. This study evaluated Sarcocystis spp., Toxoplasma gondii and Neospora caninum infections in sheep from Southwest region of Rio Grande do Sul, Brazil. Myocardium samples of 80 sheep raised on extensive system were collected. Tissue cysts were detected by direct examination and the presence of the agents was also confirmed by PCR. Macroscopic evaluation did not reveal changes, but direct microscopic examination showed cysts in 76.2% (61/80) of samples and all cysts were morphologically similar with Sarcocystis tenella or Sarcocystis arieticanis. PCR detected Sarcocystis spp. DNA in 21.2% (17/80) of samples tested and T. gondii DNA in 15% (12/80). In 6.2% (5/80) DNA of both protozoan were detected. Presence of N. caninum nucleic acids was not observed in the samples tested. All PCR-positive samples (23.7% - 19/80) were also positive by direct examination (microscopic cysts). Thus, a high occurrence of microscopic tissue cysts in sheep from the Southwest region of the state of Rio Grande do Sul was detected. Although PCR did not show a good sensitivity to identify the causative agents of these cysts, was possible to verify the presence of Sarcocystis spp. and T. gondii in cardiac muscle samples of the ovine. This may be a risk factor for animal and human contamination, not only through consumption, but also through handling the carcasses of these animals. Equine protozoal myeloencephalitis is a neurologic disease of horses, most often caused by the Sarcocystis neurona. However, the role of horses in the life cycle this parasite is not completely understood. This study attempts to elucidate the role of horses as intermediate hosts in S. neurona cycle, through occurrence of cysts in these animals and determine the antibodies frequency for Sarcocystis spp., Neospora spp. and T. gondii in slaughtered horses. Were collected 197 serum and heart samples of equines. None of the myocardium samples were detected tissue cysts, nucleic acids or histopathological changes associated to Sarcocystis spp. In antibodies detection, 146 (74.1%) serum samples were positive for studied protozoa. Antibodies against Sarcocystis spp. were detected in 36% (71/197), to Neospora spp. in 39.1% (77/197) and to T. gondii in 47,2% (93/197). Thus, the failure in detect tissue cysts, associated with antibodies anti-Sarcocystis spp. detection, increases the role of horses as accidental hosts in the cycle this protozoan, declining your participation in the epidemiology of Sarcocystis infection.
As infecções causadas por protozoários da família Sarcocystidae têm distribuição mundial e são comuns em ruminantes, causando perdas econômicas importantes. Este estudo avaliou infecções de Sarcocystis spp., Toxoplasma gondii e Neospora caninum em ovinos da região sudoeste do Rio Grande do Sul, Brasil. Foram coletadas amostras de miocárdio de 80 ovelhas criadas em sistema extensivo. Cistos de tecido foram detectados por exame direto e a presença dos agentes também foi confirmada por PCR. A avaliação macroscópica não revelou alterações, mas o exame microscópico direto mostrou cistos em 76,2% (61/80) das amostras e todos os cistos eram morfologicamente semelhantes a Sarcocystis tenella ou Sarcocystis arieticanis. A PCR detectou DNA de Sarcocystis spp. em 21,2% (17/80) das amostras testadas e DNA de T. gondii em 15% (12/80). Em 6,2% (5/80) foram detectados DNA de ambas os protozoários. Todas as amostras de PCR positivas (23,7% - 19/80) também foram positivas pelo exame direto (cistos microscópicos). Assim, uma alta ocorrência de cistos teciduais microscópicos em ovinos da região do sudoeste do estado do Rio Grande do Sul foi detectada. Apesar de o PCR não ter mostrado boa sensibilidade para identificar os agentes causadores destes cistos, foi possível verificar a presença de Sarcocystis spp. e T. gondii em amostras do músculo cardíaco de ovinos. Isso pode ser um fator de risco para animais e contaminação humana, não só através do consumo, mas também através de manipulação das carcaças desses animais. A Mieloencefalite Equina por Protozoário (MEP) é uma enfermidade neurológica que acomete equinos e possui como principal agente o protozoário Sarcocystis neurona. Porém o papel dos equinos no ciclo deste protozoário não está completamente esclarecido. O objetivo deste trabalho foi elucidar o papel dos equinos como hospedeiros intermediários no ciclo do protozoário S. neurona, através da ocorrência de cistos nestes animais e determinar a frequência de detecção de anticorpos anti- Sarcocystis spp., Neospora spp. e T. gondii em equinos abatidos em frigorífico no Estado do Rio Grande do Sul, Brasil. Foram coletadas 197 amostras de soro e coração de equinos. Das amostras pesquisadas, não houve detecção de cistos, ácidos nucléicos ou alterações histopatológicas relacionadas ao Sarcocystis spp. Relacionado com a detecção de anticorpos, 146 (74,1%) foram positivos para pelo menos um dos protozoários pesquisados. Anticorpos para Sarcocystis spp. foram encontrados em 36% (71/197), para Neospora spp. em 39,1% (77/197) e para T. gondii em 47,2% (93/197). Assim a não detecção de cistos teciduais, associado com a detecção de anticorpos anti-Sarcocystis spp., reforça a participação dos equinos como hospedeiros acidentais no ciclo deste protozoário, minimizando a participação destes animais na epidemiologia da infecção por Sarcocystis spp.

This study aims to evaluate the clinical signs and the histological findings compatible with theDegenerative Suspensory Ligament Desmopaty (DSLD), as reduction of the angles ofmetatarsophalangeal joints (MPJ) and the presence of proteoglycan accumulation in suspensory(SL) and nucal (NL) ligament of suspected animals. 108 animals (64 males and 44 females), mixedbreedand pure Brasileiro de Hipismo, from the Military Police of Minas Gerais (MPMG), had theirMPJ angles measured. They were separated in tree groups, according to their age, that didnt showsignificant differences between their averages of MPJ angle values. Only tree animals (one from the8 to twelve years and two from the > 13 years), detached from the rest, presented MPJ angles lowerthan 1460. Such a reduced prevalence tax may be explained by the accurate selection of animalsdestined to reproduction. In addition, the presence of proteoglycans (PG) accumulation wasevaluated in samples of suspensory ligaments (SL) (n=28) from animals of abattoir, consideredsuspicious, all mixed-breed Mangalarga Marchador. Although there were observed no significantdifference between the groups, PG accumulation was predominant in the samples of SL, derivedfrom animals of the 13 years group, demonstrating a relation between the presence of PGaccumulation and advancing of age. In the same way, the NL (n=15) from the animals owned byMPMG, considered suspicious of DSLD, that were divided in two groups by age, didnt present adifference among the groups, beside the predominance in the group with more than 15 years. Therewas positive correlation between the PG presence in NL samples and the clinical signs of dorsalMPA angle reduction, proving the systemic nature of DSLD, as observed by Halper et al. (2006).The histological exam of the suspensory and the nuchal ligaments can be considered acomplementary method of DSLD diagnosis
Este estudo teve como objetivos avaliar os sinais clínicos da Desmopatia Degenerativa do Suspensório da Articulação Metatarso Falangiana (DDSAMF) de redução do ângulo da articulação metatarso falangiana (AMF), bem como o acúmulo de proteoglicanos (PG) nos ligamentos suspensório (LS) e nucal (LN) de animais suspeitos da afecção. Foram mensurados os ângulos das AMF de 108 animais, (64 machos e 44 fêmeas), da raça Brasileiro de Hipismo e mestiços da raça, provenientes da Polícia Militar de Minas Gerais (PMMG). Estes foram separados em três grupos, segundo a idade, não apresentando diferença entre os grupos, quando considerados os valores angulares médios da AMF. Somente três animais (um do grupo entre 8 e 12 anos e dois do grupo > 13 anos) se destacaram dos demais, apresentando ângulos das AMF inferiores a 1460. Essa reduzida taxa de prevalência pode ser explicada pela acurada seleção dos animais para a reprodução. Adicionalmente avaliou-se a presença de acúmulos de PG em amostras de LS (n=28) de mestiços da raça Mangalarga Marchador provenientes de abatedouro. Embora não fosse observada diferençasignificativa entre as faixas etárias, os acúmulos de PG predominaram nas amostras provenientes de animais do grupo > 13 anos, demonstrando discreto aumento de acúmulos de PG com o avanço daidade. Igualmente, nos LN (n=15), provenientes de animais da PMMG, considerados suspeitos de serem portadores de DDSAMF, que foram divididos em duas faixas etárias, demonstraram predomínio de acúmulo de PG no grupo > 15 anos, com igualdade estatística para o grupo < 14anos. Houve correlação positiva entre a presença de PG em amostras de LN e sinal clínico de redução do ângulo dorsal da AMF, comprovando a natureza sistêmica da DDSAMF. O exame histológico dos ligamentos LS e LN pode ser considerado um método de diagnóstico complementar da DDSAMF

Dissertação de Mestrado Integrado em Medicina Veterinária
As lesões tendinosas e ligamentosas dos membros dos cavalos de desporto, representam grande parte da patologia músculo-esquelética da prática clínica em equinos. As principais preocupações que se colocam relativamente a estas patologias são os prolongados tempos de recuperação e a incerteza de uma recuperação total no final do tratamento. Para garantir maiores taxas de sucesso os animais são retirados da actividade desportiva por longos períodos de tempo, para que assim possam ser implementados programas de tratamento complexos e morosos e ainda para que a sua recuperação possa ser cuidadosamente monitorizada, até que estejam novamente aptos a retornar a actividade desportiva. Na maioria dos casos este período de afastamento da competição não é inferior a um ano. A redução do tempo de recuperação, a obtenção de tecidos cicatriciais resistentes e o retorno do animal aos níveis desportivos anteriores, são os principais motivos que têm incentivado os veterinários a recorrer ao uso de mais métodos de diagnóstico e de protocolos terapêuticos menos complexos e mais eficazes. A presente dissertação de mestrado reúne os estudos mais recentes nas áreas de diagnóstico e de tratamento que se têm realizado nos últimos 10 anos e que actualmente representam novas e melhores ferramentas ao dispor dos médicos veterinários. Os métodos de diagnóstico são mais complexos e permitem uma melhor compreensão de determinadas lesões, bem como o diagnóstico de outras que até então se desconheciam e que comprometiam o sucesso terapêutico. As novas modalidades terapêuticas complementam os protocolos anteriores e permitem uma redução dos tempos de tratamento assim como, maiores taxas de sucesso clínico.
ABSTRACT - Diagnosis and treatment of the most important tendon and ligament lesions in horses - The lesions that occur in tendons and ligaments on the distal aspect of the limbs in horses, correspond to the majority of clinical problems of the musculoskeletal system on equine practice. The major concerns are related to the long periods of recovery and the uncertainty of a full recovery of these lesions by the end of the treatment. To warrant higher rates of successful treatments the animals should be removed from active sport competition for long periods of time. By this time treatment protocols for these lesions can be initiated and a close monitoring of the lesions can be performed until full recovery is achieved. Most of the times these long periods away from active sport competition can extend to almost a year. The main reasons that promote the use of more efficient diagnostic aids by the equine practitioners and that makes them study less complex treatment protocols are the reduction of the recovery periods, the achievement of regenerated tissues that are more resistant to tension and the ultimate goal of returning to the previous level of exercise that horses had right before the lesion. This work collects the information of some studies from the last ten years regarding the diagnostic and treatment aids that represent newer and better tools available to practitioners. The most recent diagnostic procedures are more complex and allow a better understanding of certain lesions and the diagnosis of others, that previously where unnoticed, that could compromise the therapeutic success. The new therapeutical tools complement previously designed protocols, allowing a reduction of the recovery periods and the increase of clinical success rates.

Salmonellae are enteric bacteria infecting animals and humans. Large animal clinics and Veterinary Teaching Hospitals are greatly affected by Salmonella outbreaks and nosocomial infection. The risk of environmental contamination and spread of infection is increased when animals are confined in close contact with each other and subjected to increased stress factors. This study was designed to compare double-enrichment culture techniques with Gel-based and Real-time PCR assays in the quest for improved diagnostic methods for detecting Salmonella in equine fecal samples. 120 fecal samples submitted to the Clinical Microbiology Laboratory of the Veterinary Medical Teaching Hospital at Texas A&M University (CML, VMTH, TAMU) were tested for Salmonella using all three techniques. Double-enrichment bacterial culture detected 29 positive results (24%), Real-time PCR detected 33 positive results (27.5%), and Gel-based PCR detected 73 positives results (60.8%). While culture and real-time PCR methods had similar results, the gel-based PCR method detected many more positive results, indicating probable amplicon contamination. Real-time PCR can be completed as soon as the day after submission while culture techniques may take 2 to 5 days to complete. However, viable bacterial cells are needed for antimicrobial susceptibility testing and serotyping: both important for epidemiological studies. Therefore, double-enrichment bacterial culture performed concurrently with real-time PCR methods could be efficient in clinical settings where both accurate and expedient results are required.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
A artéria carótida comum em equinos se trifurca com algumas variações anatômicas e é o principal vaso que fornece sangue arterial para o cérebro, sendo que é conhecido que sua oclusão causa lesões encefálicas em ratos e humanos. Há muito pouca literatura a respeito de estudos anatômicos e ultrassonográficos desse vaso nessa espécie. Esse estudo avaliou a artéria carótida comum de 50 equinos da raça Quarto de Milha em diferentes idades, divididos em três grupos (grupo I: >2anos, n=14; grupo II: 3-10 anos, n=21; grupo III 15-30 anos, n=15), e obteve valores de referencia para espessura intima-media (EIM), índice de resistividade (IR), índice de pulsatilidade (IP) e diâmetro para ambas artérias carótidas comuns. Os exames foram feitos utilizando um transdutor de 18 MHz no sulco jugular, na altura de C5-C6. O diâmetro esquerdo médio foi de 8,71 ± 1,09 mm para o grupo I; 10,11 ± 0,72 mm para o grupo II e 10,72 ± 0,96 mm para o grupo III. O diâmetro direito médio foi de 8,92 ± 1,24 mm para o grupo I; 10,96 ± 1,06 mm para o grupo II e 11,76 ± 1,07 mm para o grupo III. A EIM foi de 0,90 ± 0,15 mm; 1,02 ± 0,09 mm e 0,97 ± 0,10 mm para os grupos I, II e III, respectivamente. Os valores médios de IR e IP obtidos foram 0,75 ± 0,07 e 1,63 ± 0,33 para o grupo I; 0,81 ± 0,06 e 2,08 ± 0,46 para o grupo II; 0,90 ± 0,10 e 3,20 ± 0,74 para o III, respectivamente. As variáveis IR, IP e EIM não são influenciadas por sexo ou lado, mas sim por idade. Já o diâmetro está correlacionado com o lado e idade, sendo sempre maior do lado direito
Common carotid artery in horses trifurcates with some anatomical variations and it is the main supply of arterial blood to the brain. It is known that carotid occlusion can cause encephalic lesions in rats and humans. There are few studies on this vessel, including ultrasonografic evaluation of his vessel in this species. This study evaluated the common carotid artery in 50 American Quarter horses with different ages, separated into three groups (group I: >2years, n=14; group II: 3-10 years, n=21; group III 15-30 years, n=15), and reference values for intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI) and diameter were obtained for both arteries. Exam was performed using an 18 MHz transducer on jugular groove, on level of C5-C6. Mean left diameter was 8.71 ± 1.09 mm for group I; 10.11 ± 0.72 mm for group II and 10.72 ± 0.96 mm for group III. Right diameter was 8.92 ± 1.24 mm for group I; 10.96 ± 1.06 mm for group II and 11.76 ± 1.07 mm for group III. IMT was 0.90 ± 0.15 mm; 1.02 ± 0.09 mm and 0.97 ± 0.10 mm for groups I, II and III, respectively. Mean RI and PI obtained were 0.75 ± 0.07 and 1.63 ± 0.33 for group I; 0.81 ± 0.06 and 2.08 ± 0.46 for group II; 0.90 ± 0.10 and 3.20 ± 0.74 for group III, respectively. The variables RI, PI and IMT are not influenced by gender or side, but were by age. Diameter was influenced by both, age and side, and right diameter was always greater than the left

Orientador: Vânia de Vasconcelos Machado
Coorientador: Noeme Sousa Rocha
Banca: Priscila Macedo de Souza
Banca: Rogério Martins Amorim
Resumo: A artéria carótida comum em equinos se trifurca com algumas variações anatômicas e é o principal vaso que fornece sangue arterial para o cérebro, sendo que é conhecido que sua oclusão causa lesões encefálicas em ratos e humanos. Há muito pouca literatura a respeito de estudos anatômicos e ultrassonográficos desse vaso nessa espécie. Esse estudo avaliou a artéria carótida comum de 50 equinos da raça Quarto de Milha em diferentes idades, divididos em três grupos (grupo I: >2anos, n=14; grupo II: 3-10 anos, n=21; grupo III 15-30 anos, n=15), e obteve valores de referencia para espessura intima-media (EIM), índice de resistividade (IR), índice de pulsatilidade (IP) e diâmetro para ambas artérias carótidas comuns. Os exames foram feitos utilizando um transdutor de 18 MHz no sulco jugular, na altura de C5-C6. O diâmetro esquerdo médio foi de 8,71 ± 1,09 mm para o grupo I; 10,11 ± 0,72 mm para o grupo II e 10,72 ± 0,96 mm para o grupo III. O diâmetro direito médio foi de 8,92 ± 1,24 mm para o grupo I; 10,96 ± 1,06 mm para o grupo II e 11,76 ± 1,07 mm para o grupo III. A EIM foi de 0,90 ± 0,15 mm; 1,02 ± 0,09 mm e 0,97 ± 0,10 mm para os grupos I, II e III, respectivamente. Os valores médios de IR e IP obtidos foram 0,75 ± 0,07 e 1,63 ± 0,33 para o grupo I; 0,81 ± 0,06 e 2,08 ± 0,46 para o grupo II; 0,90 ± 0,10 e 3,20 ± 0,74 para o III, respectivamente. As variáveis IR, IP e EIM não são influenciadas por sexo ou lado, mas sim por idade. Já o diâmetro está correlacionado com o lado e idade, sendo sempre maior do lado direito
Abstract: Common carotid artery in horses trifurcates with some anatomical variations and it is the main supply of arterial blood to the brain. It is known that carotid occlusion can cause encephalic lesions in rats and humans. There are few studies on this vessel, including ultrasonografic evaluation of his vessel in this species. This study evaluated the common carotid artery in 50 American Quarter horses with different ages, separated into three groups (group I: >2years, n=14; group II: 3-10 years, n=21; group III 15-30 years, n=15), and reference values for intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI) and diameter were obtained for both arteries. Exam was performed using an 18 MHz transducer on jugular groove, on level of C5-C6. Mean left diameter was 8.71 ± 1.09 mm for group I; 10.11 ± 0.72 mm for group II and 10.72 ± 0.96 mm for group III. Right diameter was 8.92 ± 1.24 mm for group I; 10.96 ± 1.06 mm for group II and 11.76 ± 1.07 mm for group III. IMT was 0.90 ± 0.15 mm; 1.02 ± 0.09 mm and 0.97 ± 0.10 mm for groups I, II and III, respectively. Mean RI and PI obtained were 0.75 ± 0.07 and 1.63 ± 0.33 for group I; 0.81 ± 0.06 and 2.08 ± 0.46 for group II; 0.90 ± 0.10 and 3.20 ± 0.74 for group III, respectively. The variables RI, PI and IMT are not influenced by gender or side, but were by age. Diameter was influenced by both, age and side, and right diameter was always greater than the left
Mestre

Employees in the field of human services can influence the health and rate of progress of the clients they serve. A human service supervisor’s responsibilities include identifying why an employee may be performing poorly and provide an effective intervention to ensure improved performance. The Performance Diagnostic Checklist for Human Services (PDC-HS) has been used in treatment clinics to identify the variables that can contribute to poor employee performance, and subsequently recommend an intervention to improve performance. The special education classroom is a human service setting in which special education teachers supervise paraeducator’s skills and performance. A paraeducator’s role includes providing instruction to students. Discrete trial instruction is an effective method for students requiring specialized instruction to acquire new skills and concepts. Poor instruction can have an adverse impact on a student’s performance resulting in a slow rate of progress or regression. Special education teachers are trained in specialized instruction, behavior management and classroom organization, but are rarely prepared to supervise and train other adults. Additional challenges are time to provide professional development and training preparation, given the background and experience of paraeducators. Research has demonstrated that a systematic approach for training and performance evaluation is required in order to provide quality instruction. This research evaluated the effectiveness of the PDC-HS, as completed by classroom teachers, in a public school special education setting to improve the performance of paraeducators for discrete trial instruction. Three teachers first identified which paraeducators were not correctly implementing the steps for discrete trial instruction. They then used the PDC-HS to determine why their paraeducators were performing poorly and which interventions could improve their performance. The results indicated that a lack of training was contributing to poor performance and a Behavior Skills Training (BST) package would most likely increase their performance. The BST package began with defining the steps for discrete trial instruction, modeling the steps, practicing the steps and providing feedback on progress. Once the paraeducator was able to correctly demonstrate the steps with an adult, they were able to continue instruction with their students. The data demonstrated that their performance significantly increased after they were provided BST. The social validity results indicated that the teachers had a positive experience using the PDC-HS. All teachers reported that this was the first time they had consistently taken data on a paraeducator’s performance and were appreciative of the training and pleased with the results. The results also indicated that all were unaware of their paraeducator’s skill in discrete trial instruction and saw the value and outcomes of using data analysis for both the paraeducators and the students they were working with.

Trata-se de um estudo quantitativo com delineamento exploratório-descritivo, cujos objetivos foram analisar a percepção dos trabalhadores de enfermagem de uma empresa de medicina diagnóstica acerca da qualidade da assistência de enfermagem prestada, considerando-se as dimensões de estrutura, processo e resultado e conhecer os fatores intervenientes na qualidade dessa assistência sob a ótica dos trabalhadores de enfermagem. A população foi constituída por 203 profissionais de enfermagem de uma empresa de medicina diagnóstica. A coleta de dados ocorreu entre os meses de maio e junho de 2010, por meio de um questionário, empregando-se a escala de Likert. Os dados foram analisados em função dos índices percentuais e testes estatísticos específicos. O instrumento de coleta de dados mostrou-se confiável, obtendo-se o Alpha de Cronbach igual a 0,90. Na caracterização dos sujeitos, foi verificado que 55% eram auxiliares de enfermagem, 36% técnicos de enfermagem e 9% enfermeiros; 83% pertenciam ao sexo feminino e 17% ao sexo masculino, com idade média de 34,1 anos e, em média, 10,8 anos de formação e 6,6 anos de atuação na instituição. Na dimensão de estrutura, os participantes demonstraram percepção favorável aos aspectos que envolveram os materiais, equipamentos, mobiliário, disponibilização dos equipamentos de proteção individual (EPIs), capacitação da equipe e a existência de protocolos referentes à segurança do usuário, porém não houve clareza na tendência acerca do quantitativo de trabalhadores e adequação da área física. Em processo, os itens com melhores percentuais relacionaram-se ao cumprimento das ações e orientações que evitam as não conformidades e riscos ao usuário; quanto aos piores resultados nessa dimensão, o desperdício de tempo devido às distâncias percorridas na área física da instituição foi apontado com maior ênfase. Referente à dimensão de resultado, evidenciou-se maior favorabilidade relacionada à atitude ética dos trabalhadores e à satisfação dos profissionais com a qualidade do atendimento. Na comparação das três dimensões, a melhor avaliada foi a de resultado com escore de 59,0 (dp±10,1) e a pior foi a de processo, 56,8 (dp± 10,3). Acredita-se que este estudo contribua para a reorganização dos pontos vulneráveis nas dimensões avaliadas, sobretudo na de processo, que apresentou menor favorabilidade.
This is about a quantitative study with an exploratory-descriptive shaping, whose objectives were to analyze the perception of the nursing staff of a company of diagnostic medicine about the quality of the nursing care delivered, taking into account the dimensions of structure, process and result and to know the factors which intervene in the quality of this care under the nursing staff\'s view. The population consisted of 203 nursing professionals of a company of diagnostic medicine. The data collection occurred between May and June, 2010, through a questionnaire using the Likert scale. These data were analyzed considering the percentage rates and specific statistic tests. The instrument of data collection turned out to be reliable, obtaining the Cronbach\'s Alpha equal to 0.90. In the characterization of the subjects, it was verified that 55% were nursing assistants, 36% nursing technicians and 9% were graduate nurses. 83% were females and 17%, males, with average age of 34.1 years old and, on average, 10.8 years of nursing experience and 6.6 years working in the institution. In the structure dimension, the participants showed perception favorable to the aspects which involve the materials, equipment, furniture, access to the individual protection equipment (IPE), training of the team and the existence of the protocols related to the user\'s security. However, the tendency about the number of workers and physical area adequacy were not clear. In the process dimension, the items with best percentage rates related to the fulfillment of actions and guidance which avoid the noncompliance and risks to the user; as for the worst results in this dimension, the waste of time due to distances between the physical areas in the institution was pointed out with bigger emphasis. As for the result dimension, the study showed higher favorability to the ethical attitude and the workers satisfaction with the care quality. Comparing the three dimensions, the best assessed one was the result dimension with the score of 59.0 (dp±10.1) and the worst one was the process dimension, 56.8 (dp± 10.3). It is believed that this study may contribute to the reorganization of the vulnerable points in the dimensions assessed, mainly in the process dimension, which showed lower favorability.

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A Leishmaniose é uma doença parasitária infeciosa, causada por protozoários do gênero Leishmania e transmitida pelo vetor flebótomo. Caracterizada como Doença Tropical Negligenciada, acomete diversas espécies de mamíferos, sendo o cão, atualmente, o principal reservatório em área urbanas. Os equinos também podem ser infectados, especialmente quando estão em contato com reservatórios ou vetores. No município de Uruguaiana – RS há um expressivo número de equinos utilizados na tração de cargas e como meio de transporte, com constante movimentação dentro do perímetro urbano. Esses animais vivem em condições precárias, submetidos a trabalhos excessivos e má nutrição. Frente a estes fatores somados à atual situação epidemiológica da leishmaniose visceral canina no município, o presente estudo foi realizado com o objetivo de identificar a presença de Leishmania sp em equinos urbanos do município de Uruguaiana-RS. Para a condução do experimento foram utilizadas amostras sanguíneas de 192 equinos testadas em três técnicas: sorológica (ELISA), imunocromatográfica (TR-DPP) e molecular (PCR). Na técnica de ELISA foi utilizado soro, testado com o Kit Ensaio Imunoenzimático para Diagnóstico da Leishmaniose Visceral Canina – Bio-Manguinhos e para o teste imunocromatográfico Teste Rápido Dual Path Platform utilizaram-se amostras de sangue total. As reações de PCR, após extração de DNA de sangue periférico dos animais, foram realizadas com quatro pares de iniciadores distintos. Todas as amostras testadas apresentaram-se não reagentes nos ensaios imunológicos. Entretanto, com o emprego da técnica PCR, mais sensível, houveram amostras positivas. Dos quatro pares de iniciadores testados, 75 amostras foram positivas, 52 com pelo menos um dos pares. Contudo, ao analisarmos individualmente os iniciadores, 58,6% foram positivos para LITSV/L5.8SR, 44% para LITSV/LISTSR, 28% para RV1/RV2, e 4% LITSR/L5.8S. Os resultados apresentados no experimento indicam a possibilidade de existência de Leishmania em equinos na região de Uruguaiana, embora os testes sorológicos não tenham apresentado reatividade para Leishmania. A técnica molecular possibilitou a detecção do gênero Leishmania nas amostras de sangue periférico dos equinos. Este foi o primeiro relato da infecção na espécie equina na região do extremo oeste do estado do Rio Grande do Sul. Contudo, se faz importante a realização de sequenciamento do fragmento para que se possa confirmar a identidade genética de Leishmania sp.
Leishmaniasis is an parasitic infectious disease caused by protozoa genus Leishmania and transmitted by the sandfly vector. Characterized as Neglected Tropical Disease, affects several species of mammals, and the dog are main reservoir in urban areas. The horses can also be infected especially when they are in contact with reservoirs or vectors. In Uruguaiana’s city, there is a significant number of horses used in the tensile loads and means of transport, with constant movement within the city, living in precarious work’s conditions, subjected to excessive and poor nutrition. In view of these factors added to the current epidemiological situation of LVC in the city, the present study aim to identify the presence of Leishmania in urban horses the municipality of Uruguaiana-RS. For the experiment, blood samples from 192 horses were used for holding three techniques: serological (ELISA), immunochromatographic (TR-DPP) and molecular (PCR). For conducting ELISA’s Test serum was used and tested with Bio-Manguinhos kit and for TR-Dual Path Platform Rapid Test whole blood samples were employed. In the PCR technique, DNA was extracted from peripheral blood of animals and amplifications were performed with primers RV1 / RV2, LITSR / LITSV, LITSR / L5.8S / LITSV / L5.8SR.. All tested samples showed negative results in immunoassays. However, employing sensitive techniques such as PCR, positive samples were detected. Considering the four primer pairs tested, 75 animals were positive, 52 with at least one of the pairs. However, when analyzing the individual primers, 58.6% were positive for LITSV/L5.8SR, 44% to LITSV/LISTSR, 28% for RV1/RV2, and 4% LITSR/L5.8S.In The results presented in the experiment indicate the possibility of Leishmania in horses in the region of Uruguaiana city, although serological tests have not submitted reactivity to Leishmania. Molecular technich shows results to consider the Leishmania’s presence in horse’s peripheral blood samples. This was the first report of infection in equine species in westernmost region of the Rio Grande do Sul state. However, it is important to conduct sequencing of the fragment so that we can confirm the genetic identity of Leishmania sp.

Une banque aleatoire d'hexapeptides exprimes a la surface de la proteine mineure d'enveloppe piii du bacteriophage filamenteux fd a ete soumise au criblage de ses composants par des immunoglobulines de type g provenant d'anti-serums equins polyclonaux diriges pour chacun d'entre eux contre un virus pathogene donne du cheval. Des experiences de biopanning (qui est le nom donne a la technique de criblage) ont consiste a selectionner parmi les quarante millions des clones phagiques qui composent la banque, ceux qui se liaient specifiquement aux paratopes des anticorps diriges contre les virus etudies. Ces phages ont systematiquement ete utilises en tant qu'antigenes dans des tests diagnostiques de type immuno-enzymatiques. Un test elisa utilisant comme antigene un melange de cinq phages a ete developpe. Il permet de detecter 99% (specificite) de chevaux trouves positifs vis-a-vis du virus de l'arterite equine et 71% (sensibilite) de chevaux negatifs vis-a-vis de ce meme virus. Des experiences d'immuno-empreinte ont montre que ce test elisa permettait de detecter pour certains des serums (environ 50%) des anticorps diriges specifiquement contre le virus alors que d'apres le test de seroneutralisation, ces serums s'averaient etre negatifs. L'utilisation tests elisa, moins couteux et moins longs que les tests classiques de serologie, ne peuvent certes pas encore les remplacer mais ils constituent assurement une avancee vers le diagnostic precoce d'une infection. Il a par ailleurs ete montre que les phages sont d'excellentes entites immunogenes et plusieurs auteurs ont decrit l'obtention d'anticorps diriges contre des peptides etrangers inseres dans une proteine de surface phagique. Il est donc envisageable d'utiliser en tant qu'entites immunogenes des particules phagiques qui exposent a leur surface des epitopes specifiques dans le cadre d'une vaccination.

INTRODUÇÃO: Vários sistemas de derivações eletrocardiográficas são utilizados na espécie equina e os principais incluem o método de Einthoven, o Ápice-base e o Dubois. O intuito desses sistemas é de captar ondas e complexos de modo que o processo de condução elétrica seja avaliado de maneira eficaz. A disposição dos eletrodos pela metodologia de Dubois tenta posicionar o coração do equino no meio de um triângulo virtual dentro do tórax, assim como descrito por Einthoven, que se baseou no modelo humano. Entretanto, ao se fazer um paralelo com o posicionamento desses eletrodos no ser humano é possível verificar que, apesar da centralização do coração do equino no triangulo virtual, as referências de direita e de esquerda não são respeitadas. Este fato é explicado pela relação entre o ventrículo direito e o ventrículo esquerdo, que nos equinos e outros animais domésticos (na maioria quadrúpedes) se faz no sentido crânio-caudal, enquanto que a posição do coração dentro do tórax do ser humano (bípede) é predominantemente no sentido ântero-súpero-póstero-inferior. OBJETIVOS: O objetivo primário desta tese é o estabelecimento de uma nova e mais adequada metodologia de aquisição eletrocardiográfica para a espécie equina e o objetivo secundário é usar as medidas das variáveis eletrocardiográficas aqui encontradas como valores de referência para essa espécie. MATERIAIS E MÉTODOS: Foram utilizados 22 cavalos da raça Puro Sangue Inglês, sendo 11 fêmeas e 11 machos, com idades variando entre 2 e 5 anos, residentes do Jockey Club de São Paulo, Brasil. Foram realizados 2 eletrocardiogramas sequenciais em cada animal, sendo o primeiro pelo método de Dubois e o segundo de acordo com a nova metodologia aqui instituída, a qual foi nomeada de método Fré. Foi realizado ecocardiograma prévio em todos os equinos e estudo Holter em quatro animais do experimento, os quais foram submetidos à análise de TWA. RESULTADOS: Pelo eletrocardiograma, foi constatado que as derivações esquerdas do plano frontal (DI e aVL) apresentaram complexo QRS de maior duração e amplitude pela nova metodologia e o inverso ocorreu nas derivações inferiores (DII, DIII e aVF), com p < 0,0001. CONCLUSÃO: O método Fré proposto neste estudo mostrou ser mais adequado, quando comparado ao método de Dubois, na obtenção dos fenômenos elétricos cardíacos que ocorrem nos animais da espécie equina. As medidas eletrocardiográficas obtidas pelo método Fré podem ser usados como referência de valores normais para a espécie equina
INTRODUCTION: Many electrocardiographic methods are used for the equine species, among which the most used include Einthoven, Base-apex and Dubois lead systems. They aim to capture waves and complexes to evaluate the process of electric heart conduction in the most effective way. Placement of the electrodes by the Dubois lead system attempts to position the equine heart at the center of a virtual triangle inside the animal\'s thorax, as described by Einthoven, who based his system on the human model. However, in attempting to make a parallel with the positioning of electrodes in the human torso, it is possible to find out that, despite the centralization of the equine heart inside the virtual triangle, the references of right and left are not respected. This can be explained by the relationship between the right and left ventricles, which in the equines and pets (mostly quadrupeds) is done in the cranio-caudal direction, while the position of the heart inside the human thorax (biped) determines that this relationship is predominantly in the anterior-superior-posterior-inferior direction. OBJECTIVES: The primary objective of this thesis is the establishment of a new and most suitable methodology of electrocardiographic acquisition in equines and the secondary objective is the establishment of the electrocardiographic variables thus obtained as reference for this species. MATERIALS AND METHODS: Twenty-two Thoroughbred horses were used, 11 females and 11 males, aged 2 to 5 years old, all reared at the São Paulo Jockey Club, Brazil. Two sequential electrocardiograms were recorded from each animal, the first according to the Dubois lead system and the second according to the new methodology here suggested, which was denominated Fré lead system. All the horses had a previous echocardiogram recorded, in addition to a Holter-ECG obtained from four animals of this experiment, which were subjected to TWA analysis. RESULTS: Through the electrocardiogram it was observed that the values obtained in the left leads of the frontal plane (DI and aVL) showed a larger and taller QRS complex by the new methodology, the reverse happening with the inferior leads such as DII, DIII and aVF, with p < 0,0001. CONCLUSION: The Fré lead system proposed here is more suitable when compared to the Dubois lead system to acquire the cardiac electric phenomena in equines. Electrocardiographic measurements obtained by the Fré lead system can be used as normal reference values for equines

Magister Public Health - MPH
Summary:The aim of this study was to produce a preliminary assessment of the DRAF by determining its face validity, testing reliability and usability of its diagnostic classification tool, and to produce a set of preliminary recommendations on the viability of the DRAF before it is released for use within the Family Health Programme.

Este estudo apresenta uma análise de rejeição, realizada na clínica Diagnóstico Avançado Por Imagem – DAPI, com dados de 647 mamografias rejeitadas realizadas de março a novembro de 2015, antes e após treinamentos realizados com a equipe técnica de mamografia, para análise do desempenho. As informações foram coletadas na base de dados do software de análise de rejeição dos mamógrafos, e incluem: incidência; quantidade de repetições; motivo da repetição; identificação da profissional; compressão do exame rejeitado e do exame aceito. Observou-se que após o treinamento os índices de rejeição por posicionamento (a maior causa das rejeições) foram reduzidos em 2%. Identificou-se que as profissionais desenvolveram critérios mais rigorosos, o que também contribuiu para aumento das repetições após o treinamento. A incidência mais rejeitada foi a Crânio Caudal Direita – CCD, tanto antes (32%) quanto após o treinamento (36%). A análise do desempenho da equipe técnica em relação aos critérios de qualidade em mamografia digital pôde ser realizada, uma vez que houve a análise individual das profissionais para contribuição da qualificação da equipe e aumento da qualidade dos exames. A profissional “A”, que possuía o maior índice de rejeição por posicionamento, após o treinamento houve uma redução de 17% das repetições devido a posicionamento inadequado. Foram identificadas imagens com qualidade aceitável que foram rejeitadas desnecessariamente: 8% antes e 3,6% após o treinamento. Antes do treinamento, a equipe técnica realizava as mamografias com valores de compressão entre 80 a 89 N, e após o treinamento a maioria dos exames foi realizada com 90 N ou mais. Esse aumento resulta em exames com melhor qualidade e menor dose para a paciente.
This study presents a rejection analysis performed at the clinic Diagnóstico Avançado Por Imagem - DAPI, with data from 647 rejected mammograms performed three months before and three months after a training session of the mammography team, to analyze the performance of them after the training. The information was collected in the database of mammography rejection analysis software,these data include: Incidence; Number of repetitions; Reason for the repetition; Identification of the professional; Rejection examination and accepted examination. It was observed that, after the training, the rejection indexes by positioning (the greatest cause of the rejections) were reduced. It was observed that the group developed rigorous criteria, which also contributed to increase the repetitions after the training. The most rejected incidence was Cranio Caudal Right - CCD, both before (32%) and after training (36%).The analysis of the performance of the technical team, in relation to the quality criteria in digital mammography, could be performed by the individual analysis of the professionals to contribute to the qualification of the team and to increase the quality of the exams. The "A" professional, who had the highest index of rejection by positioning, after the training there was a reduction of 17% of the repetitions due to improper positioning. Acceptable quality images have been identified that are rejected unnecessarily 8% before and 3,6% after training. Before the training, the technical team performed the mammograms with values of compression between 80 and 89 N, and after training most of the exams were performed with 90 N or more. This increase which results in better quality tests and lower dose for the patient.

Le métier de dirigeant est riche et complexe et un changement de « numéro un » mal appréhendé peut avoir un impact sur la performance socio-économique, la stratégie, la politique ou encore l’organisation de l’entreprise. Faciliter l’arrivée du nouveau dirigeant est donc un enjeu important pour la survie-développement de l’organisation, d’autant que sa socialisation organisationnelle reste peu étudiée. La première partie explicite les fondements conceptuels et méthodologiques de la recherche, et présente les terrains d’expérimentations de nos hypothèses et de nos outils. L’exploitation d’entretiens réalisés avec des dirigeants permet de définir le métier de dirigeant et de mettre en exergue les rôles et les compétences spécifiques du dirigeant salarié. La relation entre le dirigeant et sa Gouvernance est également étudiée. Son besoin particulier de socialisation organisationnelle est alors démontré, notamment par rapport à un repreneur d’entreprise et à un salarié « classique ». Dans la seconde partie, la théorie de la socialisation organisationnelle est adaptée au métier exigeant et unique de dirigeant, via le concept de Socialisation Organisationnelle du Dirigeant (SOD). Ce modèle répond aux besoins spécifiques de socialisation du dirigeant, notamment lors de l’intégration, étape charnière de la socialisation organisationnelle. Elle est constituée de quatre types de reprises : une reprise politico-stratégique, une reprise organisationnelle, une reprise managériale et une reprise du rôle de dirigeant. La qualité de ces reprises aboutit à la qualité de l’intégration du dirigeant, requalifiée d’intégration stratégique à cause de ses enjeux. Une grille d’analyse est proposée afin de permettre au nouveau dirigeant de mieux appréhender l’organisation qu’il va diriger, mais également ses propres besoins de socialisation organisationnelle au travers des variables et facteurs qui la composent
The job of CEO is rich and complex and the "number one" change, poorly understood, may have an impact on the socio-economic performance, strategy, policy and the organization of the company. Facilitate the arrival of new manager is an important issue for the survival and development of the organization, as well as its organizational socialization remains little studied.The first part explains the conceptual and methodological research, and presents lots of experiments of our assumptions and our tools. We use interviews with executives to define the business leadership and highlight the specifics CEO’s roles and skills. The specific relationship between the leader and its Governance is also studied. Its specific needs of organizational socialization are then demonstrated, particularly in relation to a buyer company and a "classic" employee.In the second part, the concept of organizational socialization is suitable for demanding and unique leader, through the concept of CEO’s Organizational Socialization. This model meets the needs of leader’s socialization, especially during integration, organizational socialization’s milestone. It consists of three types of recoveries: politico-strategic, organizational and managerial. The quality of these recoveries led to the quality of leader’s integration, reclassified strategic integration because of its strategic challenges. An analytical framework is proposed to allow both the new leader to better understand the organization that will lead, but also its own needs through organizational socialization variables and factors that compose it

Thesis (M.S.)--University of Georgia, 2003.
Directed by Karen Paige Carmichael. Includes an article submitted to The journal of the American Veterinary Medical Association. Includes bibliographical references (leaves 53-61).

Master’s Dissertation in Veterinary Medicine
Degenerative lumbosacral stenosis (DLSS) is a multifactorial degenerative disorder characterized by an acquired narrowing of the vertebral canal, intervertebral foramina, or both due to degenerative changes of the lumbosacral area. Stenosis of the L7-S1 intervertebral foramen and compression of the sciatic nerve are relevant components of lumbosacral disease that causes lower back pain and neurologic deficits. Magnetic resonance imaging is a sensitive and non-invasive diagnostic tool for lesion localization and characterization in DLSS, providing great diagnostic value in determining presence of foraminal stenosis and compressive radiculopathy. A correct and efficient diagnosis of nerve injury is extremely important as the earlier the diagnosis is made, the earlier a treatment plan can be applied and the higher are the chances of functional recovery. The water excitation technique (WET) is a fat suppression imaging sequence that increases conspicuity between normal and pathological tissue by eliminating the hyperintense signal of fat that usually encircles nervous structures. In the particular case of evaluating the lumbosacral region, this sequence is used on the dorsal plane with the aim of improving visualization of the spinal nerve roots. Including these types of sequences in the imaging studies can help to identify lesions that would otherwise not be clearly visible in conventional sagittal and transverse T1, T2-weighted imaging. A retrospective study analysis of 31 dogs was conducted to explore the hypothesis that WET would increase the diagnostic accuracy of sciatic nerve root pathology due to lumbosacral foraminal stenosis. Therefore, an agreement study was performed between the diagnosis obtained from T1 and T2-weighted imaging and the diagnosis obtained from the water excitation method. The study supported the hypothesis that WET increases the diagnostic accuracy of sciatic nerve root pathology and helps to decide for a conservative or surgical treatment route by adding valuable information to the conventional T1, T2-weighted imaging.

Orientação : Manuel Pequito
Os equinos de desporto estão sujeitos a uma diversidade de problemas locomotores que se manifestam clinicamente por claudicações. Estas são o principal motivo de consulta veterinária, decréscimo de performance e perda económica. O Lameness Locator (LL) é um sistema de sensores inerciais, utilizado para a avaliação objetiva de claudicação. Foi criado para auxiliar os Médicos Veterinários na deteção de claudicações subtis, aquelas de difícil observação através dos métodos subjetivos. Este estudo teve como principais objetivos a descrição da utilização deste sistema de sensores inerciais em 5 cavalos com claudicação previamente diagnosticada, aferir a sensibilidade do mesmo, na população, e contribuir para a determinação da sua utilidade na deteção e quantificação de claudicações. Foi efetuada uma análise individual descritiva do deslocamento da cabeça e do pélvis, antes e depois de um bloqueio anestésico, e uma análise de grupo para complementação dos resultados. Os resultados do presente estudo confirmaram a sensibilidade do LL como método de deteção objetiva de claudicações. O facto de se ter estudado uma população pequena e heterogénea, resultou na ausência de resultados de grupo significativos, no entanto os resultados individuais foram bastantes esclarecedores.
Sport horses are susceptible to a great range of locomotion injuries that are demosntrated through lameness. These are the main reason for veterinary intervention, decrease in perfermance and economical loss. The Lameness Locator is an inertial sensorial system, used for the objective evaluation of lameness. It was created to aid Veterinarians in the most subtle lameness, those which are difficult to notice through subjective methods. This study has, as primary goals, the description of the value of this inertial sensorial system in 5 different horses with previously diagnosed lameness, pinpoint the sensibility in this sample and contribute to its definition of utility in the deteccion and quantification of this problem. An individual descriptive analisis of the head's and pelvis' movement, before and after a nerve block; and a group analysis for greater results. The results of this study confirm the LL’s sensitivity as an objective lameness detection method. The small and heterogeneous population that was studied resulted in the absence of significant group results, however the individual results were quite enlightening.

In der veterinärmedizinischen Wissenschaft spielt das equine akustische Organ sowie dessen Erkrankungen und Funktionsstörungen bislang eine stark untergeordnete Rolle. Mangelnde Visualisierungs- und Untersuchungsmöglichkeiten, geringe Patienten- Compliance sowie fehlende Referenzen erschweren die Diagnose aurikulärer Erkrankungen (SARGENT et al. 2006; SOMMERAUER et al. 2012). Das übergeordnete langfristige Ziel dieser Forschungsarbeit ist es, humanmedizinische objektive audiometrische Messtechnik an das Pferdeohr anzupassen. Von speziellem Interesse ist dabei die Messung otoakustischer Emissionen zur objektiven Überprüfung der Innenohrfunktion. Die grundlegende Voraussetzung jeglicher Messungen und Adaptierungen ist zunächst die otoskopische Kontrolle des externen Gehörkanales und Trommelfelles. So können die Messung behindernde Faktoren, beispielsweise ein hoher Verschmutzungsgrad oder Fremdkörper im externen Gehörkanal, ausgeschlossen werden. Mit Hilfe herkömmlicher Videobronchoskope oder Videogastroskope (Durchmesser von 7 mm bzw. 9 mm) und der Anwendung eines standardisierten Protokolls konnten im Rahmen der Basisstudie die externen Gehörkanäle und Trommelfelle von 38 sedierten Pferden bilateral endoskopisch untersucht werden. Aus praktischer Sicht ist dabei hervorzuheben, dass die bislang obligatorische Leitungsanästhesie der Ohrnerven und das damit verbundene Risiko einer Fazialisparese vollständig umgangen werden konnte. Im Zuge dieses optimierten Verfahrens wurden physiologische und pathologische endoskopische Referenzen des externen Gehörkanales und Trommelfelles erstellt. Pathologische otoskopische Befunde (z.B. Tympanosklerose) sowie mangelnde veterinärmedizinische Fachliteratur verdeutlichen den Bedarf der histologischen Aufarbeitung des equinen akustischen Organs. Im Rahmen der Folgestudie wurden die Ohren von zehn Schlachtpferden für die detaillierte histologische Aufarbeitung herangezogen. Die Ergebnissedieser Arbeit beschreiben und verbildlichen erstmalig das vollständige equine akustische Organ. Im Folgenden sind nun die wesentlichen Ergebnisse der Basis- und Folgestudie zusammengefasst. Der physiologische kartilaginöse externe Gehörkanal ist pigmentiert, mit Haaren sowie mit cerumenproduzierenden Talg- und Schweißdrüsen ausgekleidet. Im Vergleich zum ossären externen Gehörkanal weist der kartilaginöse Anteil einen deutlich höheren Verschmutzungsgrad auf. Der Übergang zwischen dem kartilaginösen und ossären äußeren Gehörgang ist histologisch gekennzeichnet durch einen abrupten Wechsel zu einem unpigmentierten, haarlosen und drüsenfreien mehrschichtig verhornten Epithel. Endoskopisch ist dieser Übergang anhand kranzartig angeordneter beigefarbener Keratinschuppen erkennbar, welche Produkte des Selbstreinigungsmechanismus des knöchernen Gehörganges darstellen. Letzterer besitzt eine rund-ovale Form, ein trockenes zartrosafarbenes Epithel mit konzentrischen Keratinringen und schwach durchscheinender Gefäßzeichnung. Das physiologische equine Trommelfell stellt sich endoskopisch als eine klar in ihre Bestandteile (Pars tensa, Pars flaccida, Stria mallearis) differenzierte semitransparente Membran ohne positiven Lichtreflex dar. Auf der Grundlage der etablierten physiologischen Referenzen konnten pathologische Befunde bei sieben Pferden (vier Pferde mit Aural Plaques, drei Pferde mit Otitis externa) nachgewiesen werden. Zu den typischen Kennzeichen einer Otitis externa zählen die Schwellung und Rötung des ossären Epithels, das Verstreichen der konzentrischen Keratinringe und/oder die Ablösung der schützenden Keratinschicht im ossären Gehörkanal sowie ein positiver Lichtreflex im Bereich des Trommelfelles. Bei einem der an Otitis externa erkrankten Pferde konnte ein möglicher Zusammenhang zu einer Temporohyoidosteoarthropathie (THO) hergestellt werden. Darüber hinaus konnte bei zwei weiteren Pferden erstmalig eine Tympanosklerose diagnostiziert werden. Die Resultate dieser Dissertation liefern die Grundlage für weitere Forschungsansätze auf dem Gebiet des equinen akustischen Organs. Die Ohrendoskopie am stehenden sedierten Pferd ist eine praktikable, schonende sowie diagnostisch wertvolle Untersuchungsmöglichkeit. Sie sollte insbesondere bei der Abklärung einer THO, Fazialisparese, Vestibularsyndrom, Headshaking, Kopfscheue, parasitären Infektionen oder bei Kopftraumata zum Einsatz kommen. Die Ohrendoskopie ist zudem der Ausgangspunkt für die Anpassung und Anwendung humanmedizinischer audiometrischer Messsonden an das Pferdeohr. Die gewonnenen histologischen Erkenntnisse bilden die Basis für weiterführende Untersuchungen hinsichtlich angeborener oder erworbener Mittel- und Innenohrerkrankungen, welche Einfluss auf die Messung der otoakustischen Emissionen haben.:Inhaltsverzeichnis Einleitung ...................................................................................................................... 1 Literaturübersicht .......................................................................................................... 4 Anatomie des equinen akustischen Organs ................................................................. 4 8 Danksagung 2.4.1 2.4.2 2.4.3 2.4.4 Otoskopie ........................................................................................................ 10 Tympanometrie ............................................................................................... 11 Messung otoakustischer Emissionen (OAE) ................................................... 12 Hirnstammaudiometrie (BERA) ....................................................................... 14 Äußeres Ohr...................................................................................................... 4 Mittelohr ............................................................................................................ 4 Innenohr ............................................................................................................ 5 Hörbahn ............................................................................................................ 7 Gleichgewichtsbahn .......................................................................................... 7 2.1.1 2.1.2 2.1.3 2.1.4 2.1.5 Physiologie des Hörvorganges ..................................................................................... 8 Physiologie des Vestibularorgans................................................................................. 9 Untersuchungsmethoden des akustischen Organs .................................................... 10 Ergebnisse .................................................................................................................. 15 Publikation 1: Endoscopic findings of the external ear canal in a group of clinically normal horses and horses with head shaking or vestibular disease .......................... 15 Publikation 2: Histological Study of the External, Middle and Inner Ear of Horses .... 25 Diskussion .................................................................................................................. 44 Otoskopie.................................................................................................................... 45 Der physiologische equine externe Gehörkanal und das Trommelfell ....................... 46 Pathologische Befunde des equinen externen Gehörkanales und Trommelfelles ..... 48 Histologie des equinen akustischen Organs............................................................... 50 Diagnostische Möglichkeiten - OAE ........................................................................... 51 Zusammenfassung ..................................................................................................... 53 Summary .................................................................................................................... 55 Literaturverzeichnis..................................................................................................... 57 Anhang ....................................................................................................................... 64
The equine acoustic organ, including its diseases and disorders, still plays a minor role in veterinary science. Due to insufficient visualization and examination equipment, little patient compliance and sparse references the diagnosis of auricular diseases is rather difficult (SARGENT et al. 2006; SOMMERAUER et al. 2012). The overall aim of this research project is to adapt human objective audiometric testing devices onto the equine acoustic organ. Particularly, the measurement of so-called otoacoustic emissions is of importance for an objective evaluation of the inner ear function. The otoscopic examination of the external ear canal and tympanic membrane is the fundamental precondition for the adaption of probes and every audiometric testing. Circumstances that may prevent us from having successful measurements, like a high degree of ceruminous and cellular debris or even foreign bodies within the external ear canal, can be identified and eliminated by otoscopy. By the use of common veterinary videobronchoscopes or videogastroscopes (calibre 7 mm/9 mm) the external ear canal and tympanic membrane of 38 standing sedated horses were bilaterally examined following a standardized protocol. Special emphasis should be placed on the fact that the obligatory local nerve block anaesthesia of the auricular nerves and the associated risk of a facial nerve paralysis were completely eliminated. With the help of this simplified procedure physiological and pathological references could be established. Pathological findings and a lack of relevant veterinary literature prompted us to take a closer look at histological aspects of the equine acoustic organ. In this context, the ears of ten slaughter horses were histologically examined in detail. The results of this follow-up study describe and illustrate the complete histology of the equine acoustic organ for the first time. In the following the essential results of the basic- and follow-up study are summarized. The physiological cartilaginous external ear canal is pigmented and contains hair, as well as ceruminous and sebaceous glands. In comparison to the osseous external ear canal, the cartilaginous part has higher degree of ceruminous and cellular debris. The intersection between both- the cartilaginous and osseous portion- is histologically characterized by an abrupt change to a non-pigmented, hairless, aglandular keratinized stratified squamous epithelium. Endoscopically, the intersection can be identified by a rim of beige keratin scales, which are products of the self-cleaning mechanism of the osseous epithelium. The osseous ear canal is round to oval shaped and lined with pale pink coloured epithelium that contains concentric keratin formations and visible capillary drawing. The physiological equine tympanic membrane is endoscopically characterized by a well-differentiated semi- transparent membrane, which shows no positive light reflex. On basis of the established physiological references pathological changes were found in seven horses (four horses with aural plaques, three horses with otitis externa). Typical sings of otitis externa were swelling and reddening of the osseous epithelium, the loss of the concentric keratin layer formation and/or detachment of the protective osseous keratin layer, as well as a positive light reflex on the tympanic membrane. In one diseased horse a possible correlation between the Otitis externa and severe temporohyoid osteoarthropathy (THO) could be revealed. Additionally, tympanosclerotic changes within two equine eardrums could be visualized for the first time. The results of this study provide a basis for further research on the equine acoustic organ. The otoscopic examination in standing sedated horses is a viable, safe, easy and quick to perform beneficial diagnostic procedure for a complete work-up of ear-related diseases, such as THO, facial nerve paralysis, vestibular disease, head shaking, parasitic infections or head trauma. In addition, the otoscopic examination is a basic requirement for the adaption and the use of human audiometric measuring probes in equine ears. The results obtained in the histological study can be employed as references for further research on equine congenital and acquired middle and inner ear diseases, which can influence the measurement results of otoacoustic emissions.:Inhaltsverzeichnis Einleitung ...................................................................................................................... 1 Literaturübersicht .......................................................................................................... 4 Anatomie des equinen akustischen Organs ................................................................. 4 8 Danksagung 2.4.1 2.4.2 2.4.3 2.4.4 Otoskopie ........................................................................................................ 10 Tympanometrie ............................................................................................... 11 Messung otoakustischer Emissionen (OAE) ................................................... 12 Hirnstammaudiometrie (BERA) ....................................................................... 14 Äußeres Ohr...................................................................................................... 4 Mittelohr ............................................................................................................ 4 Innenohr ............................................................................................................ 5 Hörbahn ............................................................................................................ 7 Gleichgewichtsbahn .......................................................................................... 7 2.1.1 2.1.2 2.1.3 2.1.4 2.1.5 Physiologie des Hörvorganges ..................................................................................... 8 Physiologie des Vestibularorgans................................................................................. 9 Untersuchungsmethoden des akustischen Organs .................................................... 10 Ergebnisse .................................................................................................................. 15 Publikation 1: Endoscopic findings of the external ear canal in a group of clinically normal horses and horses with head shaking or vestibular disease .......................... 15 Publikation 2: Histological Study of the External, Middle and Inner Ear of Horses .... 25 Diskussion .................................................................................................................. 44 Otoskopie.................................................................................................................... 45 Der physiologische equine externe Gehörkanal und das Trommelfell ....................... 46 Pathologische Befunde des equinen externen Gehörkanales und Trommelfelles ..... 48 Histologie des equinen akustischen Organs............................................................... 50 Diagnostische Möglichkeiten - OAE ........................................................................... 51 Zusammenfassung ..................................................................................................... 53 Summary .................................................................................................................... 55 Literaturverzeichnis..................................................................................................... 57 Anhang ....................................................................................................................... 64

Orientação: Ana Maria Duque de Araújo Munhoz ; co-orientação: Gonçalo José Carmona Santana Paixão
Este estudo incidiu sobre a avaliação do parasitismo gastrointestinal de um grupo de equinos estabulados na Escola das Armas, Mafra, por meio das técnicas de McMaster e Mini-FLOTAC, comparando os seus respetivos resultados. O estudo foi composto por 30 animais, com idades compreendidas entre os 5 e os 24 anos das raças Lusitana, Cruzada Portuguesa, Puro Sangue Inglês e Puro Sangue Árabe. O sexo predominante o masculino. O estudo decorreu num período de 4 meses, com um total de 10 análises fecais. As amostras foram submetidas as técnicas qualitativas de Willis e Sedimentação Simples e as técnicas quantitativas de McMaster e Mini-FLOTAC e coprocultura. O OPG médio anterior à desparasitação foi 472 OPG através da técnica de McMaster e 351 com a técnica de Mini-FLOTAC. Pela técnica de McMaster observou-se que 76,7% dos animais encontravam-se positivos e pela técnica de Mini-FLOTAC observou-se 93% positivos para infeção por estrongilídeos gastrointestinais. Pela técnica de McMaster foi determinado o grau de infeção por estrongilídeos: 53,3% para infeções baixas, 20% para infeções moderadas e 26,7% para infeções altas. Através da técnica Mini-FLOTAC foram observadas 66,7% de infeções baixas, 10% de infeções moderadas e 23,3% de infeções altas. A técnica de Willis confirmou a presença de ovos de estrongilídeos, enquanto a técnica de Sedimentação permitiu a identificação de ovos de Parascaris spp. e oocistos de Eimeria leuckarti. Após a desparasitação com ivermectina todos os equinos foram examinados através das técnicas de McMaster e Mini-FLOTAC para comprovação do TRCOF que resultou em 100% de eficácia pela técnica McMaster e 99,7% obtido pelo Mini-FLOTAC. As coproculturas revelaram a maior prevalência do género Cyathostomum spp. Este estudo identificou a técnica de Mini-FLOTAC como mais exata e precisa quando comparada com a técnica de McMaster.
This study focused on the evaluation of the gastrointestinal parasistism in a group of equines stabled in Escola das Armas, Mafra, using the McMaster and Mini-FLOTAC while comparing both techniques. The studied sample consisted on a total of 30 animals, aged between 5 and 24 years old, whose breeds were Lusitanos, Portuguese Cross Horses, Tthoroughbred and Arabian. The predominant gender were males. This study was developed during 4 months, with a total of 10 fecal analysis. The samples were analyzed through the Willis and Simple Sedimentation technique and also the quantitative McMaster and Mini-FLOTAC technique. In the period prior to deworming, the EGP were 472 with the McMaster technique and,351 with the Mini-FLOTAC. Using the McMaster technique 76,7% were positive for EPG while 93% were positive on Mini-FLOTAC technique. On the Mini-FLOTAC technique 66,7% were low infections, 10% were moderate and 23,3% were high. The Willis technique confirmed the presence of strongyles eggs, while the Sedimentation technique allowed the identification of Parascaris spp. eggs and Eimeria leuckarti oocysts. After the deworming with ivermectin all the equines were examined through the McMaster and Mini-FLOTAC techniques to compare the results of the FECRT (Fecal Egg Count Reduction Test) shown 100% efficacy using McMaster technique and 99,7% using the Mini-FLOTAC technique. The coprocultures revealed the prevelance of Cyathostomum spp. This study concluded that the Mini-FLOTAC is a more exact and precise technique when compared with the McMaster technique.

Trabalho de Projeto do Mestrado em Economia apresentado à Faculdade de Economia
A equidade na utilização dos cuidados de saúde é um ponto essencial das políticas de saúde em Portugal, bem como nos países pertencentes à Organização para a Cooperação e Desenvolvimento Económico (OCDE). Posto isto, o principal objetivo deste trabalho passa por tentar perceber se o princípio da equidade horizontal – associando a igual necessidade igual utilização - se verifica, em termos da utilização de meios complementares de diagnóstico, no âmbito dos rastreios dos cancros da mama, do colo do útero e colorretal, e internamento hospitalar. Para tal, foram utilizados dados do Inquérito Nacional de Saúde de 2014 (INS). De forma a se poder avaliar a equidade na utilização destes cuidados, recorremos ao cálculo de índices de concentração da utilização e procedeu-se a uma padronização da utilização pela necessidade, no caso do internamento hospitalar. Nos rastreios de base populacional, existem recomendações quanto ao sexo e idade dos indivíduos que devem realizar os exames, bem como quanto aos intervalos entre exames. Deste modo, analisámos, primeiramente, a equidade na utilização dentro dos grupos-alvo, comparando, posteriormente, com o uso fora das idades e intervalos recomendados. Indo ao encontro dos resultados obtidos por estudos anteriores, os resultados sugerem uma iniquidade favorável aos mais ricos na utilização de cuidados preventivos, contudo, a evidência suscita a possibilidade de parte da iniquidade encontrada resultar de utilização sem necessidade pelos mais ricos, em particular, em termos de uma frequência superior à recomendada. No que diz respeito à utilização do internamento hospitalar padronizada pela necessidade, não se pode excluir a hipótese de uma utilização equitativa, observando-se assim uma evolução bastante favorável quanto aos objetivos da política de saúde para garantir um acesso universal e equitativo aos cuidados de saúde, face a dados de há duas décadas.
Equity in the use of health care is an essential point of health policies in Portugal, as well as in OECD countries. That said, the main objective of this work is to assess the principle of horizontal equity - equal utilization for equal need - in the cases of screening of breast, cervical and colorectal cancers and of inpatient hospital care. To this end, data from the 2014 National Health Survey were used. In order to evaluate equity in the use of health care, we resorted to the calculation of concentration indexes. In the case of hospital care, utilization was standardized by need. In population-based screening programs, there are guidelines regarding the age and sex of individuals who should do the exams, as well as regarding intervals between exams. Hence, we started by analyzing equity within target groups, comparing, afterwards, with use outside these groups and intervals. In line with the results obtained by previous studies, the results suggest pro-rich inequity in the use of preventive care, however; the evidence obtained suggests that some of the inequity found might stem from utilization without need by the rich, particularly, in terms of higher than recommended frequency of exams. Regarding the needs-standardized utilization of hospitalization, the possibility of equitable use cannot be excluded, indicating a quite favorable evolution in terms of health policy objectives to guarantee universal and equitable access to health care in comparison with evidence from almost two decades ago.

Orientação: Manuel Pequito ; co-orientação: Cole Sciba
A laminite é a doença mais grave do dígito do equino, afetando 34% dos cavalos e comumente é necessária a eutanásia. A venografia digital prediz o deslocamento da falange distal através da avaliação da perfusão vascular. É uma ferramenta muito valiosa que pode ser utilizada no diagnóstico, tratamento, monitorização e prognóstico da laminite. O objetivo do presente estudo consiste em reportar os dados clínicos observados no primeiro venograma de todos os casos clínicos, descrever um caso clínico de um cavalo com laminite onde foram realizados vários venogramas com o objetivo de diagnosticar, monitorizar, estabelecer um tratamento e prognóstico e inferir a importância do venograma digital no diagnóstico de laminite. Para tal, recorreu-se a uma amostra de 7 éguas previamente diagnosticadas com laminite e submetidas aos mesmo procedimento de venografia digital no Hospital Equino Weems e Stephens. Desta forma foi possível avaliar as alterações encontradas em diferentes áreas venográficas e a atribuição a um significado clínico. Este estudo permitiu reconhecer a importância dos venogramas em casos clínicos com laminite, uma vez que à medida que existem alterações no aparelho suspensório do casco é possível detetar precocemente essas alterações com a venografia digital sendo crucial no prognóstico dos cavalos afetados.
Laminitis is the most serious disease of the equine digit, affecting 34% of horses and euthanasia is commonly requerid. The digital venography predicts the displacement of the distal phanlanx through the evaluation of the vascular perfusion. It is a very valuable tool that can be used in the diagnosis, treatment, monitoring and prognosis of laminitis. The objective of the presente study was to report the clinical data observed in the first venogram of all cases, to describe a clinical case of a horse with laminitis where several venograms were performed with the purpose of diagnosing, monitoring, establishing a treatment and prognosis and inferring the importante of the digital venogram in the diagnosis of laminitis. For this, a sample of 7 mares previously diagnosed with laminitis and submitted to the same digital venography procedure were used at the Weems and Stephens Equine Hospital. In this way it was possible to evaluate the alteration found in different venographic areas and the attribution to a clinical significance. This study allowed to recognize the importance of the venograms in clinical cases with laminitis, since as there are alterations in suspensory apparatus of the distal phalanx it is possible to detect these alterations early with the digital venography being crucial in the prognosis of the affected horses.

Orientação: Manuel Pequito
A ecocardiografia em equinos é um meio complementar de diagnóstico. É útil na identificação de alterações cardíacas, permite observar o tamanho e forma cardíaca, bem como a função e morfologia das estruturas intracardíacas. O presente trabalho tem como objetivo sistematizar medidas de ecocardiografia, em cavalos adultos saudáveis e comparar os resultados obtidos com valores de referência publicados. Este trabalho baseia-se na avaliação ecocardiográfica, realizada em cavalos de lazer e reformados, incluindo 8 cavalos com mais de 12 anos. Nenhum cavalo apresentava sinais clínicos gerais de doença sistémica, nem específicos de doença cardíaca. Os cavalos da população em estudo foram sujeitos a um exame ecocardiográfico, em modo B, modo M e Doppler, tendo sido utilizadas as janelas paraesternal direita e esquerda. Foram medidos o diâmetro da aorta ao nível da válvula aórtica (AoR), diâmetro da aorta ao nível do seio da valsalva (LVOT), diâmetro da aorta ao nível da junção sinotubular (AoST), espessura do septo interventricular em diástole (IVSd), diâmetro interno do ventrículo esquerdo em diástole (LVIDd), espessura da parede livre do ventrículo esquerdo em diástole (LVPWd), espessura do septo interventricular em sístole (IVSs), diâmetro interno do ventrículo esquerdo em sístole (LVIDs), espessura da parede livre do ventrículo esquerdo em sístole (LVPWs), fração de encurtamento (FS), diâmetro da artéria pulmonar (MPA) e diâmetro do átrio esquerdo (LA). As medidas de AoR, AoST e FS encontram-se abaixo dos valores de referência publicados e os restantes dentro dos valores normais. A ecocardiografia corresponde a um método facilmente realizável em cavalos, bem tolerado, repetível e seguro. Apresenta desvantagens como o custo inicial do equipamento e aquisição de treino necessário à aplicação apropriada das técnicas e interpretação de resultados.
The equine echocardiography is a complementary diagnostic method. It’s useful in identifying cardiac variations, allowing to measure the size and heart shape, as well as the function and morphology of intra-cardiac structures. The present study aims to systematize echocardiographic measurements in healthy adult horses and compare the results obtained with published reference values. This work is based on echocardiographic evaluation performed on leisure and retired horses, includes 8 horses older than 12 years. No horse demonstrated clinical signs of systemic disease or specific heart disease. The horses of the study were submitted to an echocardiographic examination, in B mode, M mode and Doppler, and the right and left parasternal windows were used. Were measured the diameter of the aorta at the level of the aortic valve (AoR), aorta diameter at the level of the sinus of the valsalva (LVOT), aorta diameter at the level of the sinotubular junction (AoST), the thickness of the interventricular septum in diastole (IVSd), diastolic left ventricular diameter in diastole (LVIDd), left ventricular free wall thickness in diastole (LVPWd), interventricular septal thickness in systole (IVSs), left ventricular internal diameter in systole (LVIDs), wall thickness left ventricle in systole (LVPWs), shortening fraction (FS), pulmonary artery diameter (MPA) and left atrial diameter (LA). The AoR, AoST and FS measurements are below the published reference values and the remaining values are within normal values. Echocardiography corresponds to an achievable method in horses, tolerated, repeatable and safe. It presents disadvantages such as the initial cost of the equipment and acquisition of training, necessary for the appropriate application of the techniques and interpretation of results.

Orientação: Manuel Pequito
São indubitáveis as questões relacionadas com a dor, a nível do dorso, em cavalos de desporto. Um assunto com uma importância cada vez maior, à medida que as exigências com estes animais vão também aumentando. Assim, é crucial a aposta no diagnóstico e compreensão do significado clínico deste tipo de patologias, inclusive as toracolombares. Pretendeu-se com o presente trabalho analisar, num grupo de cavalos de desporto, as alterações, a nível da região toracolombar, no exame semiológico estático e avaliação radiográfica, focada nos processos espinhosos dorsais. Assim como, associar as mesmas em função do género, da idade, raça e aptidão dos animais, e estabelecer uma correlação entre elas. Para tal, examinaram-se e radiografaram-se quarenta equinos, de ambos os géneros, com idades compreendidas entre os cinco e os vinte e quatro anos, de quatro raças distintas e com diferentes aptidões. Com a execução deste estudo, verificou-se que estão presentes alterações, a nível de ambos os exames, nos seus diversos graus, num grande número de equinos. A idade mostrou ser a caraterística relacionada com um maior número de variáveis referentes a estes exames. A pouca correlação, detetada entre os achados dos dois exames, permite deduzir que as alterações radiográficas podem não ter relevância clínica. Concluiu-se que seria benéfico associar meios complementares de diagnóstico e estabelecer efetivamente uma correlação entre os achados detetados nos mesmos e os sinais clínicos apresentados pelos animais.
Questions related with back pain issues of sport horses are undoubtedly present. This is a subject with an increasing importance, as the demands on these animals are also growing. Thus, it is crucial to focus on the diagnosis and on the understanding of the clinical significance of this type of pathologies, including the thoracolumbar ones The aim of this study was to analyze, in a group of sport horses, alterations in the thoracolumbar region, through static semiological examination and radiographic assessment, focused on dorsal spinous processes. As well as, to associate the same ones according the gender, age, breed and work disciplines of the animals and to establish a correlation between them. For this purpose, forty horses of both gender, aged between five and twenty-four, from four different breeds and with different work disciplines were examined and radiographed. With the execution of this study, it was verified that alterations are present, in both examinations, in its various degrees and in a great number of horses. Age proved to be the variable associated to a larger number of variables in both examinations. The few correlation found between the findings of the two exams, suggests that radiographic changes may not have clinical significance. It was concluded that it would be beneficial to associate complementary means of diagnosis and effectively establish a correlation between the findings detected in them and the clinical signs presented by the animals.

Introduction: Au Nigeria, la couverture de la détection et du traitement de la tuberculose pharmaco-résistante (TPR) est toujours faible malgré la mise en place de services gratuits depuis 2011. Le pays se classe au sixième rang mondial avec une proportion de cas de patients résistants aux médicaments de 4,3% et de 15% dans les cas d’une réinitialisation au traitement. Le pays a aussi un fardeau élevé pour la tuberculose, la TPR, et le VIH, avec une prévalence de 219 et 11 pour 100 000 habitants pour la tuberculose et la TPR et de 1,28 pour 1 000 habitants pour le VIH. Sans traitement, la mortalité due à la tuberculose est d'environ 70% en dix ans, augmentant avec la coïnfection par le VIH, et la résistance aux médicaments; et descendant en dessous de 5% avec traitement. Les taux de survie de la tuberculose pharmaco-résistante sont plus faibles et le traitement est plus long, plus coûteux et plus toxique. Cela peut poser des défis différents à la fois pour les patients et les systèmes de santé comparativement à la tuberculose de la forme commune. Cependant, la réponse au traitement et la survie sont influencées par la détection précoce et à l'initiation rapide au traitement, idéalement dans les quatre semaines suivant le diagnostic, en particulier avec la coïnfection par le VIH. Les caractéristiques sociodémographiques interagissent souvent de manière complexe avec des facteurs systémiques, pour accroître la vulnérabilité et les désavantages - ces interactions sont particulièrement bien examinées à travers un cadre conceptuel d'équité à l'accès à la santé, et pourrait offrir des analyses et des recommandations pertinentes pour les politiques. Cette thèse explore les barrières et les facilitateurs à l’accès au diagnostic et au traitement au niveau des patients et du système de santé au Nigéria. Méthodes: Cette thèse est une étude transformative de méthodes mixtes. Nous avons d’abord réalisé une revue systématique mixte pour identifier les obstacles et les facilitateurs influençant l’accès au diagnostic et au traitement de la TPR en Afrique subsaharienne. Nous avons par la suite mené une méta-synthèse qualitative pour examiner en profondeur les obstacles aux soins de la tuberculose auxquels se heurtent les patients, la communauté, et le système de santé. Nous avons utilisé les résultats des deux revues systématiques pour affiner notre cadre conceptuel afin d'orienter la conception et l'analyse de l'étude empirique qui a suivi. Le cadre conceptuel adapté est basé sur le cadre de Levesque. Ce cadre centré sur les patients conceptualise l’accès aux soins selon des dimensions du système de santé et des patients. Cette étude comprenait également une analyse rétrospective d’une cohorte de patients diagnostiqués en 2015 (n = 996) à l'aide de données secondaires nationales et une analyse en cascade des soins de la tuberculose pharmaco-résistante entre 2013 et 2017. Nous avons mené des analyses statistiques descriptives et analytiques. Nous avons effectué une régression logistique et d'autres tests d’association pour mesurer la relation entre les variables catégorielles. L’étude qualitative était une étude de cas qui consistait à examiner la dynamique de soins du point de vue des patients (n = 86 participants, n = 7 groupes de discussions, 5 entretiens approfondis avec des patients diagnostiqués et non traités), leurs familles (n = 19 participants, n = 1 groupe de discussion, 7entretiens approfondis ), membres de la communauté (n = 23 , n=2 groupes de discussion), agents de santé (n = 5 entretiens approfondis) et gestionnaires de programme (n = 29 entretiens approfondis) dans quatre États du Nigéria. Nous avons analysé nos données qualitatives à l'aide d'une analyse thématique. Résultats: Notre revue systématique mixte et notre méta-synthèse qualitative ont indiqué des obstacles et des facilitateurs à l’accès aux soins de la tuberculose pharmaco-résistante au niveau du système de santé et des patients. Les problèmes de fonctionnement des laboratoires et des cliniques, l’absence de connaissances et les attitudes des prestataires de soins, et la gestion de l'information étaient des obstacles à l’accès aux soins de la TPR. Les facteurs facilitateurs comprenaient des outils de diagnostic plus récents, la décentralisation des services et le coût gratuit des soins. Au niveau des patients, la perte de suivi avant ou pendant les soins en raison de la perception négative des soins dans les services publics, le genre, la famille, l’engagement professionnel ou scolaire, et le recours aux soins dans le secteur privé constituaient des obstacles. Les facilitateurs étaient la séropositivité pour VIH, la multitude de symptômes, et le soutien financier des patients. Nos résultats quantitatifs ont révélé une certaine amélioration mais des progrès insuffisants dans le diagnostic et la couverture du traitement au Nigeria entre 2013 et 2017. Notre analyse en cascade a montré des abandons significatifs entre chaque étape des soins, en commençant par les tests et en terminant par l'achèvement du traitement. En moyenne, 80% des cas estimés n'ont pas eu accès au test; 75% de ceux qui ont été testé n'ont pas été diagnostiqués; 36% des personnes diagnostiquées n'ont pas commencé le traitement et 23% d'entre elles n'ont pas terminé le traitement pour la période entre 2013-2017. En 2015, les patients et les enfants atteints de la TB qui résident au nord du Nigéria avaient une probabilité de 0,3 [IC à 95% 0,1-0,7] et 0,4[0,3-0,5] de terminer le traitement une fois la maladie diagnostiquée comparativement aux patients et aux enfants qui résident au sud du pays. Les hommes avaient une probabilité de 1,34 [IC à 95% 1,0-1,7] plus élevée de terminer le traitement après le diagnostic comparativement aux femmes. La localisation géographique et les niveaux de soins étaient associés à un traitement et / ou à un traitement rapide. Notre étude qualitative a identifié des obstacles aux soins aux niveaux individuel, familial, communautaire, et du système de santé. Certains groupes sociodémographiques de patients avaient un accès inéquitable aux soins de la TPR. Alors que les patients étaient pour la plupart traités de manière égale au niveau de l'établissement, certains patients avaient plus de difficulté à accéder aux soins en fonction de leur sexe, de leur âge, de leur profession, de leur niveau d'éducation, et de leur religion. La dynamique familiale et conjugale influencent l’accès aux soins des patients, en particulier des enfants et des femmes. Elle agissait parfois comme un obstacle aux soins. D’autres facteurs qui ont probablement entravé l’accès incluaient l’absence de considérations sur les droits d’accès et la protection des patients dans les directives de traitement et les protocoles de soins. Les patients ignoraient pour la plupart les causes de la tuberculose pharmaco-résistante et la disponibilité des soins gratuits. Le nombre d'agents de santé et les problèmes de formation, la faible performance des laboratoires et des cliniques sont des obstacles aux soins de la tuberculose au niveau du système de santé. Les principaux facilitateurs à l’accès aux soins comprenaient le soutien familial, le soutien financier aux patients et le traitement gratuit. Conclusions: Malgré la gratuité des tests et des traitements de la TB pharmaco-résistante au Nigéria depuis 2011, les couvertures de diagnostic et de traitement restent constamment faibles. Les obstacles à l’accès au diagnostic et au traitement de la TB et de la TB pharmaco-résistante sont similaires. Toutefois, la TB pharmaco-résistante présente des défis particuliers en raison de la complexité des procédures de prétraitement et des toxicités résultant des médicaments eux-mêmes. Notre étude avait pour objectif de mieux comprendre les facteurs qui influencent l’accès à l'initiation au traitement de la TB pharmaco-résistante. Nos résultats montrent que les obstacles les plus importants sont l'accès aux tests et au diagnostic, malgré les progrès technologiques de diagnostic et des protocoles cliniques. Notre étude a identifié plusieurs obstacles liés aux patients et au système de santé. La plupart des patients atteints de TB pharmaco-résistante n'ont pas accès aux tests et ne sont pas diagnostiqués, souvent en raison d'un manque d'information. Les politiques et les programmes de lutte contre la tuberculose pharmaco-résistante ne sont pas toujours équitables, en particulier pour les populations vivant dans les zones rurales, les enfants, et les femmes. Les résultats de notre étude ont généré des données probantes pertinentes pour les décideurs et les partenaires internationaux pour remédier aux disparités systémiques et fournir des services plus équitables. L'élimination des obstacles à l’accès aux soins en temps opportun devrait être une priorité urgente pour améliorer le programme de lutte contre la tuberculose au Nigéria. Dans la faible détection des cas et la couverture thérapeutique, les interventions devraient viser l'équité en facilitant l’accès aux soins des populations vulnérables.
Background: Detection and treatment coverage for drug-resistant tuberculosis (DR-TB) in Nigeria are persistently low despite the implementation of free diagnostic and treatment services since 2011. Nigeria has a high burden for tuberculosis, ranking 6th globally with 4.3% drug resistance in new, and 15% in retreatment cases. The World Health Organization classifies the country as a high burden for TB, DR-TB, and HIV, with a prevalence of 219 and 11 per 100,000 population for TB and DR-TB, and 1.28 per 1,000 population HIV. Without treatment, mortality from tuberculosis is approximately 70% within ten years, increasing with HIV co-infection and drug resistance - and decreasing to below 5% with treatment. DR-TB survival rates are lower, and treatment is longer, costlier, and more toxic; this may pose different challenges to both patients and health systems than is the case for drug-sensitive (DS-) TB. However, treatment response and survival are positively impacted by early detection and treatment initiation, ideally within four weeks of diagnosis, especially with HIV co-infection. Socio-demographic characteristics often interact in complex ways with systemic factors, to increase vulnerability and disadvantage – these interactions are particularly well examined through an equity of health access framework and could offer policy-relevant analyses and recommendations. This study explores patient and health system barriers and facilitators to diagnosis and treatment for DR-TB in Nigeria. Methods: This is a sequential transformative mixed-methods study. First, a mixed-methods systematic review identified barriers and facilitators affecting diagnosis and treatment for DR-TB in sub-Saharan Africa. A subsequent qualitative meta-synthesis was used to examine in more depth the patient, community, and health system barriers to TB care. The results of the systematic reviews were used to refine our conceptual framework and to guide the design and the analysis of the subsequent empirical study. The adapted conceptual framework is based on the Levesque framework for patient-centred healthcare access, which conceptualises access to care as having health system and patient dimensions. This study also included a retrospective cohort analysis of patients diagnosed in 2015 (n= 996 ) using National secondary data, and a DR-TB care cascade analysis of the period between 2013 and 2017. We used descriptive statistics, logistic regression and other tests of association to measure the relationship between variables categorical. The qualitative phase used a case study design to examine the dynamics of care from patients' perspectives (n= 86 participants, N= 7 focus group discussions (FGD), 5 in-depth interviews (IDIs) with diagnosed and untreated patients), their relatives (n= 19 participants, N= 1 FGD, 7 IDIs ), community members (n=23 in 2 FGDs), healthcare workers (n= 5 IDIs ), and program managers (n= 29 IDIs) in four States in Nigeria. We analysed our qualitative data using thematic analysis. Results: Our mixed methods systematic review and qualitative meta-synthesis revealed barriers and facilitators to DR-TB care at the health system and patient levels. Health system laboratory and clinic operational issues, poor provider knowledge and attitudes and information management were some barriers. Facilitators included newer diagnostic tools, decentralisation of services and free cost of care. At the patient level, loss to follow-up before or during care due to negative public sector care perceptions, gender, family, work or school commitments and using private sector care were some barriers. Facilitators were HIV positivity, having more symptoms, and financial support. Our quantitative findings revealed some improvement but inadequate progress in diagnosis and treatment coverage in Nigeria between 2013 and 2017. Our cascade analysis showed significant dropouts between each stage of care, starting with testing and ending with treatment completion. On average, between 2013-2017, 80% of estimated cases did not access testing; 75% of those who test were not diagnosed; 36% of those diagnosed were not initiated on treatment and 23% of these did not finish treatment. In 2015, children and patients in Northern Nigeria had odds of 0.3 [95% CI 0.1-0.7] and 0.4 [0.3-0.5] of completing treatment once diagnosed; compared with adults and patients in Southern Nigeria; while males were shown to have a 1.34 [95% CI 1.0-1.7] times greater chance of completing treatment after diagnosis compared to females.. Geographic locations and levels of care were associated with ever receiving treatment and or timely treatment. Our qualitative data and document review identified barriers to care at individual, family, community, and health systems levels. Some patient socio-demographic groups had inequitable access. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Parental and spousal influences affected patients, particularly children, and women, and were sometimes barriers to care. Other factors that likely hampered access include the absence of considerations for patients’ access rights and protection in the treatment guidelines and workers manuals. Patients were mostly unaware of the causes of DR-TB disease and the availability of free care. Health worker numbers and training, clinic, and operational laboratory issues limited patients’ access at the health system level. The main facilitators to care included family support, patient financial support, and free treatment. Conclusions: Despite the provision of free DR-TB testing and treatment in Nigeria since 2011, coverage for diagnosis and treatment remain persistently low. Our literature review identified many of the same access factors affecting both DS-TB and DR-TB. However, DR-TB had peculiar challenges due to complexities in pre- treatment procedures, and in toxicities as a result of the medications themselves. This study was designed to investigate the access factors impacting DR-TB treatment initiation identified in literature. However, our findings showed that the biggest barriers to DR-TB care were essentially in access to testing and diagnosis, making any advances in diagnostic technology and treatment regimens of little benefit to DR-TB patients in Nigeria. Several patient and health system factors were shown to impede access to DR-TB care, particularly for certain groups of patients. Most DR-TB patients are not accessing testing and do not get diagnosed, often due to a lack of information. Also, DR-TB policies, structures and processes are not always equitable, especially for rural dwellers, children and women. Findings from our mixed methods study provided the additional insights needed by policymakers and implementing partners to address systemic disparities and provide more equitable services based on the population's needs. Eliminating barriers that negatively impact timely access to care should be an urgent priority for the TB program in Nigeria. In Nigeria's low case-finding and treatment coverage, interventions should target equity and ease of access, specifically for the barriers identified at the patient and health system levels.