Clínica médica e cirúrgica em animais de companhia

O presente relatório está inserido no âmbito da unidade curricular do Estágio Curricular do Mestrado Integrado em Medicina Veterinária da Universidade de Évora, sob orientação da Drª Sónia Lucena e coorientação da Drª Ângela Martins. Encontra-se dividido em duas partes, a primeira é referente à casuística acompanhada no Hospital Veterinário da Arrábida e Centro de Reabilitação Animal da Arrábida durante o período de cinco meses de estágio. Na casuística são expostos de forma breve os casos clínicos e procedimentos acompanhados durante o período de estágio. Na segunda parte é desenvolvida uma monografia intitulada “Maneio da dor crónica” acompanhada por uma descrição de um caso clínico assistido durante o estágio. A dor crónica é considerada uma dor patológica, deixando de ser um mecanismo de defesa do organismo e passando a ser considerada uma doença. É de difícil tratamento e requer um esforço multidisciplinar; ABSTRACT: Small Animal Medicine This report is conducted under the context of the curricular internship course unit of integrated master’s degree in Veterinary Medicine at the University of Évora under the supervision of Dr. Sónia Lucena and cosupervision of Dr. Ângela Martins. The first component refers to the assisted cases followed in Hospital Veterinário da Arrábida and Centro de Reabilitação Animal da Arrábida during the five months of the practice period. In the followed cases part it is explored briefly some clinical cases and procedures accompanied during that practice period. The second component consists of a monograph titled “Chronic pain management” accompanied with a description of a clinical case followed seen during the practice period. Chronic pain is considered a pathological pain, ceasing to be a defense mechanism of the body and to be considered a disease. It is difficult to treat and requires a multidisciplinary effort.

Veterinary allergy diagnosis: past, present and future perspectives

Fleas, several aeroallergens as well as many food allergens are the most common allergenic sources for animals and frequent cause of allergic reactions with different target organs such as skin, eyes, and respiratory or digestive systems. Allergy diagnosis needs to follow well-established guidelines under clinical and laboratory approaches. Since 1980 with the Hanifin & Rajka’s criteria for the diagnosis of atopic dermatitis (AD) in humans, successive proposals have been developed to identify atopic dermatitis in dogs. A consensual plan was first proposed by Willemse in 1986 undergoing several modifications in 1994. Prélaud and colleagues made important changes to the plan in 1998 and it was further adjusted by Favrot in 2009. In 2010, this plan was approved by the International Task Force on Canine Atopic Dermatitis (CAD). It was subjected in 2015 to minor updates with regard to therapeutic options. To improve diagnostic accuracy by integrating the basic knowledge on sensitization development and allergen nature and diversity, allergen sources and implicated molecular allergens for animals should be clearly identified. As well as in human medicine, this molecular epidemiology concept is essential for the veterinary allergy diagnosis in the near future, standing as the basis of a component-resolved diagnosis (CRD). Besides current pharma- cotherapy, it will be highly relevant to increase the efficiency of the avoidance measures and specific immunotherapy. Clinical guidelines will lead to at least 80 % of positive diagnosis of atopy, but newer laboratory methods in veterinary medicine aiming to a more precise diagnosis and a better integration of the clinical/laboratory diagnostic course are needed. Allergoms identification for animals, from different allergen sources proteoms should become a priority in veterinary allergology, in order to allow the intended CRD, which is essential to understand the cross-reaction phenomena, allowing a more precise and possibly effective component-resolved immunotherapy (CRIT). Further research has been carried out for a better understanding of the interaction between allergic clinical condition and immune pathophysiology. As well as in human medicine, a deeper knowledge of the molecular immunological mechanisms in veterinary allergy — with their specific allergen triggers — will also provide the veterinary allergist with the necessary information to act more efficiently in the future.

Allergological evaluation of a dog population in a veterinary immuno-allergology consultation: What correlates in a canine model

Introduction: Allergic dermatitis (AD) is the most common canine pruritic condition in veterinary dermatology. Allergic dermatitis to flea bites presents the highest prevalence, followed by atopic dermatitis and food AD. This study aimed to identify possible correlation between data from clinical signs, intradermal tests (IDT) and specific IgE levels, which are used in dog AD assessment. Methods: Fifty five dogs from the Veterinary Hospital of the University of Évora (Portugal) and Rof Codina University Hospital (Lugo, Spain) outpatient consultations were studied by means of clinical inquiry, IDT and specific IgE determination. Thirty five of the patients belonged to predisposed breeds, 30 were females and 25 males. Forty one (74%) were indoor. Results: In 82% of cases first clinical signs appeared before the age of 3 years and 24% even before 1 year old. In 70% of the individuals clinical signs included itching, which was generalized in 66%, with 78% of paw licking and chewing. Clinical profile showed seasonal worsening in 64% of cases. From the 69.1% of dogs already presenting with dermatitis, 50% also presented external otitis and 28.9% self-inflicted alopecia. "Intense itching" was found in 10.5%, "medium itching" in 81.6% and “mild itching” in 5.26% of the patients. Prevalence of positive IDT was 37.3 % to Lep d, 29.41% to Der f, 27.5% to Der p, 25.5% to Dac g and 21.6% to Malassezia sp. From the 37 dogs submitted to food IDT, 40.5% revealed positive to beef, 27% to chicken, 27% to porc and 5.4% to lamb. Specific IgE > 150 EAU was found in 84% of dogs to indoor allergen sources and in 68% to pollens. A negative correlation was found between an outdoor life and the intensity (p = 0.033) and precocity (p = 0.026) of clinical signs. Sensitization to pollens was found positively correlated with the seasonality of clinical signs (p = 0.001) and the positivity for Dac g (p = 0.007). The prevalence of chronic otitis correlated positively with alopecia and reactivity to Lep d (p = 0.008), Plantago lanceolata (p = 0.026) and Platanus acerifolia (p = 0.017). There was no correlation between the results of ITD and specific IgE. Conclusion: We can conclude that correlation between different clinical signs and positive testing for some allergenic sources may occur, as well as between sensitization to pollens and the beginning, the intensity and the seasonality of dog patient clinical signs.

Avaliação da sensibilidade ao latex em profissionais de saúde num hospital do norte alentejano

Nos profissionais de saúde a alergia ao látex representa um importante problema de saúde ocupacional. Em contexto hospitalar, a principal fonte de exposição alergénica é a utilização de luvas látex empoadas e a inalação dos bioaerossóis que se formam pela manipulação das mesmas. Mediante consentimento informado, os participantes preencheram um inquérito de resposta fechada e realizaram os testes cutâneos (TC). Aqueles que apresentaram reacção foram encaminhados para a consulta de imunoalergologia e realizaram TC para alimentos, doseamentos séricos de imunoglobulinas (lgE total e específica). Foram incluídos no estudo 44 dos 48 participantes (a=0.1). A sensibilidade ao látex foi posta em evidência em 15 dos elementos da amostra, seis dos quais reagem ao extracto de látex utilizado nos TC. A alergia ao látex foi diagnosticada em duas pessoas. A aplicação de questionários na avaliação sensibilização ocupacional ao látex pode vir a constituir ferramenta válida de auscultação deste problema nas instituições prestadoras de cuidados de saúde. ABSTRACT: Latex allergy is a major occupational disease among health care workers. ln hospitals, the main source of allergen exposure is the powdered latex gloves latex and the inhalation of the aerosols formed by its direct manipulation. By means of informed assent, the participants filled an inquiry and carried out the SPT. Those with cutaneous reaction to the latex extract went to an immunoallergology appointment. SPT for fruit and pollen with cross reactivity to latex allergens where performed, and blood levels of total and specific lgE where determined. The study group included 44 of the 48 participants (a=0.1). Fifteen elements showed latex sensitization and six of them had cutaneous reaction to the latex extract used in the SPT. Latex allergy was found in two health care professionals. Questionnaires may provide a reliability tool to access the sensitization due to natural rubber products and the symptoms more commonly associated with it, in health care facilities.

Study of the allergenic profile of pollen from Platanus hybrida in the city of Evora, Portugal

Background and Aim: Although grasses and olive are the most relevant allergenic species in the Alentejo region, aggravation of allergic symptoms in the early spring, unrelated with those species pollen seasons, has been reported, particularly in urban environment. Plane trees, hence pollen, are highly abundant in the city of Évora, nonetheless allergen pollen profile has not yet been evaluated. The aim of this work was to characterize the allergen profile of pollen from Platanus hybrida, one of the most representative species in Evora showing pollination prior to the main pollen season in Alentejo. Methods: Pollen from Platanus hybrida and Dactylis glomerata was extracted with ammonium bicarbonate buffer, lyophilized and stored at -80ºC until analysis. Protein content was determined by the Bradford method. SDS-PAGE followed by western blot, using allergic patient sera (obtained from the Hospital do Espírito Santo de Évora – HESE), were performed to evaluate the allergen profile of the pollen. Sensitization and cross-reactivity was assessed by solid phase immunoblot. Results: Half of the patient exhibited sensitization to pollen extracts of P. Hybrida. Western blot have shown several immunoreactive bands in the Mr 10-90 kDa range. Immunoreactive bands were also observed in the protein profile according to the pI in the pI range 4.0-6.1. Cross-reactivity of P. hybrida with D. glomerata was found. Although several bands are common to D. glomerata, a band with ~50kDa was observed in P. hybrida but not in D. glometata. Conclusion: These results evidenced allergens found in P. hybrida pollen. Moreover, cross–reactivity between P. hybrida and highly allergenic species such as D. glomerata was found which probably contributes for aggravation of pollinosis in the early spring. Acknowledgments: This work was supported by FEDER through the “Programa Operacional Fatores de Competitividade – COMPETE” (Strategic projects of ICAAM and ICT 2013-2015).

Allergenic profile of Quercus rotundifolia pollen in Alentejo, Portugal

Background and Aim: Grasses and olive are the most relevant allergenic species in the Alentejo region. However, aggravation of allergic symptoms has been reported in the early spring, before grass and olive pollen seasons. Quercus pollen is the most abundant pollen type in the early spring in Alentejo, nonetheless its allergen profile has not yet been evaluated. The aim of this work was to characterize the allergen profile of pollen from Quercus rotundifolia among the most representative species showing pollination in April, prior to the main pollen season in Alentejo. Methods: Pollen from Quercus rotundifolia, Olea europaea and Dactylis glomerata was extracted with ammonium bicarbonate buffer, lyophilized and stored at -80ºC until analysis. Extract from Quercus ilex pollen was kindly offered by Bial. Protein content was determined by the Bradford method. SDS-PAGE followed by western blot, using allergic patient sera (obtained from the Hospital do Espírito Santo de Évora – HESE), were performed to evaluate the allergen profile of the pollen. Sensitization and cross-reactivity was assessed by solid phase immunoblot. Results: Most of the patient evidenced sensitization to pollen extracts of Q. rotundifolia. Protein profile of Q. rotundifolia has shown several bands in the Mr 10-90 kDa, mostly overlapping with Q. ilex. Western blot have shown several immunoreactive bands. Immunoreactive bands were also observed in the protein profile according to the pI in the range 4.0-6.1. Cross-reactivity between Q. rotundifolia with O. europaea and D. glomerata was found. Conclusion: These results evidenced allergens found in Q. rotundifolia pollen. It also shows that protein profile of Q. rotundifolia and Q. ilex are mostly alike suggesting that similarities in allergen profile are expected. Moreover, cross–reactivity between Q. rotundifolia and highly allergenic species such as O. europaea and D. glomerata was found which probably contributes to the aggravation of pollinosis in the early spring. Acknowledgments: This work was supported by FEDER through the “Programa Operacional Fatores de Competitividade – COMPETE” (Strategic projects of ICAAM and ICT 2013-2015). We also aknowledge Bial-Aristegui for supplying pollen and extract samples of Q. ilex.