A necropsia é essencial para a identificação da causa de morte e dos processos que culminaram no óbito do animal. O presente estudo visou à pesquisa da real ocorrência de morte súbita e inesperada em cães submetidos à necropsia, e à determinação da discrepância entre as suspeitas dos proprietários em relação ao estado de saúde prévio e à causa de morte de seus cães, quando comparadas às conclusões necroscópicas. Este trabalho também focou nas alterações morfológicas e funcionais nas glândulas adrenais de cães necropsiados, a fim de se estudar a aplicação de possíveis marcadores da resposta adrenal ao estresse sofrido pelo animal na iminência do óbito. Foram utilizados os dados de 82 cães necropsiados na FMVZ-USP para análise da ocorrência real de morte súbita nestes animais. As alterações morfológicas nas adrenais de 46 cães necropsiados foram avaliadas através de análises morfométricas e histopatológicas. Também foram avaliados os índices de proliferação e apoptose nas células do córtex adrenal em relação à causa de morte do animal, através da marcação imunoistoquímica para o antígeno nuclear de proliferação celular (PCNA) e para BAX e Bcl-2, proteínas envolvidas na regulação da apoptose. A análise das alterações funcionais sofridas pelas adrenais focou na quantificação das concentrações das catecolaminas adrenalina e noradrenalina na medula adrenal dos cães por cromatografia líquida de alta eficiência com detecção eletroquímica (CLAE-DE). Dentre os resultados encontrados, a suspeita do proprietário de que seu cão sofreu uma morte súbita e inesperada é muito maior do que a real ocorrência deste tipo de morte em cães, sendo o óbito por decorrência de complicações de doenças muito mais frequente. As características morfométricas das adrenais dos cães apresentaram maior influência pelo peso corpóreo do animal e pela presença ou ausência de hiperplasia cortical do que pela associação com doenças crônicas ou condições agudas. Cães que vieram a óbito em decorrência de complicações de doenças crônicas exibiram fibrose em região corticomedular e focos de infiltrado inflamatório, ausentes nos animais com morte súbita ou doenças agudas, além de maior ocorrência de hiperplasia adrenocortical. Cães que sofriam de alterações cardíacas crônicas apresentaram alterações histopatológicas significativas mais marcantes em suas adrenais, como necrose, fibrose e depleção vacuolar cortical. Por outro lado, a congestão severa nas adrenais foi um achado mais frequente nos animais previamente saudáveis que sofreram morte súbita ou que vieram a óbito por doenças agudas. A avaliação dos índices de proliferação celular e apoptose no córtex das adrenais através da marcação imunoistoquímica para PCNA e BAX e Bcl-2, respectivamente, não apresentou potencial relevante para o estudo dos efeitos do estresse por doenças crônicas sobre as adrenais de cães. As concentrações de adrenalina e noradrenalina na medula adrenal se mostraram muito maiores em cães machos quando comparados às fêmeas. Os achados deste estudo podem auxiliar nas conclusões da necropsia, sendo especialmente relevantes em casos médico-legais, nos quais todos os achados possíveis devem ser relatados e analisados a fim de se prover um diagnóstico preciso, seguro e incontroverso / The necropsy is essential to identify the cause of death and the processes that culminated in the death of the animal. The present study aimed to research the actual occurrence of sudden and unexpected death in dogs subjected to necropsy, and to determine the discrepancy between the suspicions of owners regarding the previous state of health or cause of death of their dogs when compared to the gross findings. This work also focused on the morphological and functional changes in the adrenal glands of dogs submitted to necropsy in order to study the application of possible markers of adrenal stress response experienced by the animal on the verge of death. The data of 82 dogs necropsied in FMVZ-USP was used for analysis of the actual occurrence of sudden death in these animals. The morphological changes in the adrenal glands of 46 necropsied dogs were evaluated by morphometric and histopathological analysis. The proliferation rates and apoptosis in cells of the adrenal cortex regarding the cause of death of the animal were also evaluated by immunohistochemical staining for the nuclear antigen of cellular proliferation (PCNA) and BAX and Bcl-2, proteins involved in apoptosis regulation. The analysis of functional changes in the adrenal gland focused on quantifying the concentrations of the catecholamines adrenaline and noradrenaline in the adrenal medulla of dogs by high-performance liquid chromatography with electrochemical detection (HPLC-DE). Regarding the results of this study, the owners’ suspicion that their dog suffered a sudden and unexpected death is much greater than the actual occurrence of this type of death in dogs, while death due to complications from diseases is far more frequent. The morphometric characteristics of the adrenal glands of dogs showed greater influence by the body weight of the animal and the presence or absence of cortical hyperplasia than by association with chronic or acute conditions. Dogs that died due to chronic disease complications exhibited fibrosis in the corticomedullary region and foci of inflammatory infiltrate, absent in animals with sudden death or acute diseases, as well as higher incidence of adrenocortical hyperplasia. Dogs suffering from chronic cardiac conditions showed more marked significant histopathological changes in their adrenal glands, such as necrosis, fibrosis and cortical vacuolar depletion. On the other hand, severe congestion in the adrenal glands was a frequent finding in previously healthy animals who suffered sudden death or that died from acute illnesses. The evaluation of cell proliferation rates and apoptosis in the cortex of the adrenal by immunohistochemical staining for PCNA and BAX and Bcl-2, respectively, did not show significant potential for studying the effects of stress by chronic diseases in the adrenal glands of dogs. The adrenaline and noradrenaline concentrations in the adrenal medulla were much higher in male dogs when compared to females. This study’s findings may help the necropsy conclusions, which are particularly relevant in forensic cases where all possible findings should be reported and analyzed in order to provide an accurate, confident and uncontroversial diagnosis

A necropsia é essencial para a identificação da causa de morte e dos processos que culminaram no óbito do animal. O presente estudo visou à pesquisa da real ocorrência de morte súbita e inesperada em cães submetidos à necropsia, e à determinação da discrepância entre as suspeitas dos proprietários em relação ao estado de saúde prévio e à causa de morte de seus cães, quando comparadas às conclusões necroscópicas. Este trabalho também focou nas alterações morfológicas e funcionais nas glândulas adrenais de cães necropsiados, a fim de se estudar a aplicação de possíveis marcadores da resposta adrenal ao estresse sofrido pelo animal na iminência do óbito. Foram utilizados os dados de 82 cães necropsiados na FMVZ-USP para análise da ocorrência real de morte súbita nestes animais. As alterações morfológicas nas adrenais de 46 cães necropsiados foram avaliadas através de análises morfométricas e histopatológicas. Também foram avaliados os índices de proliferação e apoptose nas células do córtex adrenal em relação à causa de morte do animal, através da marcação imunoistoquímica para o antígeno nuclear de proliferação celular (PCNA) e para BAX e Bcl-2, proteínas envolvidas na regulação da apoptose. A análise das alterações funcionais sofridas pelas adrenais focou na quantificação das concentrações das catecolaminas adrenalina e noradrenalina na medula adrenal dos cães por cromatografia líquida de alta eficiência com detecção eletroquímica (CLAE-DE). Dentre os resultados encontrados, a suspeita do proprietário de que seu cão sofreu uma morte súbita e inesperada é muito maior do que a real ocorrência deste tipo de morte em cães, sendo o óbito por decorrência de complicações de doenças muito mais frequente. As características morfométricas das adrenais dos cães apresentaram maior influência pelo peso corpóreo do animal e pela presença ou ausência de hiperplasia cortical do que pela associação com doenças crônicas ou condições agudas. Cães que vieram a óbito em decorrência de complicações de doenças crônicas exibiram fibrose em região corticomedular e focos de infiltrado inflamatório, ausentes nos animais com morte súbita ou doenças agudas, além de maior ocorrência de hiperplasia adrenocortical. Cães que sofriam de alterações cardíacas crônicas apresentaram alterações histopatológicas significativas mais marcantes em suas adrenais, como necrose, fibrose e depleção vacuolar cortical. Por outro lado, a congestão severa nas adrenais foi um achado mais frequente nos animais previamente saudáveis que sofreram morte súbita ou que vieram a óbito por doenças agudas. A avaliação dos índices de proliferação celular e apoptose no córtex das adrenais através da marcação imunoistoquímica para PCNA e BAX e Bcl-2, respectivamente, não apresentou potencial relevante para o estudo dos efeitos do estresse por doenças crônicas sobre as adrenais de cães. As concentrações de adrenalina e noradrenalina na medula adrenal se mostraram muito maiores em cães machos quando comparados às fêmeas. Os achados deste estudo podem auxiliar nas conclusões da necropsia, sendo especialmente relevantes em casos médico-legais, nos quais todos os achados possíveis devem ser relatados e analisados a fim de se prover um diagnóstico preciso, seguro e incontroverso / The necropsy is essential to identify the cause of death and the processes that culminated in the death of the animal. The present study aimed to research the actual occurrence of sudden and unexpected death in dogs subjected to necropsy, and to determine the discrepancy between the suspicions of owners regarding the previous state of health or cause of death of their dogs when compared to the gross findings. This work also focused on the morphological and functional changes in the adrenal glands of dogs submitted to necropsy in order to study the application of possible markers of adrenal stress response experienced by the animal on the verge of death. The data of 82 dogs necropsied in FMVZ-USP was used for analysis of the actual occurrence of sudden death in these animals. The morphological changes in the adrenal glands of 46 necropsied dogs were evaluated by morphometric and histopathological analysis. The proliferation rates and apoptosis in cells of the adrenal cortex regarding the cause of death of the animal were also evaluated by immunohistochemical staining for the nuclear antigen of cellular proliferation (PCNA) and BAX and Bcl-2, proteins involved in apoptosis regulation. The analysis of functional changes in the adrenal gland focused on quantifying the concentrations of the catecholamines adrenaline and noradrenaline in the adrenal medulla of dogs by high-performance liquid chromatography with electrochemical detection (HPLC-DE). Regarding the results of this study, the owners’ suspicion that their dog suffered a sudden and unexpected death is much greater than the actual occurrence of this type of death in dogs, while death due to complications from diseases is far more frequent. The morphometric characteristics of the adrenal glands of dogs showed greater influence by the body weight of the animal and the presence or absence of cortical hyperplasia than by association with chronic or acute conditions. Dogs that died due to chronic disease complications exhibited fibrosis in the corticomedullary region and foci of inflammatory infiltrate, absent in animals with sudden death or acute diseases, as well as higher incidence of adrenocortical hyperplasia. Dogs suffering from chronic cardiac conditions showed more marked significant histopathological changes in their adrenal glands, such as necrosis, fibrosis and cortical vacuolar depletion. On the other hand, severe congestion in the adrenal glands was a frequent finding in previously healthy animals who suffered sudden death or that died from acute illnesses. The evaluation of cell proliferation rates and apoptosis in the cortex of the adrenal by immunohistochemical staining for PCNA and BAX and Bcl-2, respectively, did not show significant potential for studying the effects of stress by chronic diseases in the adrenal glands of dogs. The adrenaline and noradrenaline concentrations in the adrenal medulla were much higher in male dogs when compared to females. This study’s findings may help the necropsy conclusions, which are particularly relevant in forensic cases where all possible findings should be reported and analyzed in order to provide an accurate, confident and uncontroversial diagnosis

La cardiomyopathie/dysplasie arythmogène du ventricule droit (ARVC/D) est un désordre d’origine génétique caractérisé par le remplacement du myocarde par du tissus fibro-adipeux dans le ventricule droit. Ce désordre est responsable d’un grand pourcentage de mort subite, spécialement chez les plus jeunes. ARVC/D est difficile à diagnostiquer avec les outils cliniques actuels. Elle est causée en grande majorité par des mutations dans les protéines desmosomales. ARVC/D a donc des implications d’une grande importance chez les membres de la famille, qui peuvent sans le savoir, être aussi à risque de mort subite. Dans le but d’améliorer le diagnostique, un nouvel outil, le test génétique, est de plus en plus utilisé. Hypothèses: Dans le but d’évaluer la valeur du test génétique en complément du test clinique classique chez ARVC/D nous avons effectué une investigation clinique et génétique chez 23 cas-index atteints. Méthodes: Les cas-index sont diagnostiqué après une mort subite dans la famille ou après un examen clinique poussé pour arythmies. Le diagnostique d’ARVC/D a été fait avec les outils cliniques selon les critères. L’analyse génétique des protéines desmosomales associées à la maladie a été effectuée en séquençant leurs exons ainsi que les régions introniques nécessaires à l’épissage alternatif. Résultats: Le diagnostique clinique était clair dans 18/23 et incertain dans 5/23 des individus. Nous avons identifié 15 différentes mutations chez 10 cas-index. 64% des mutations n’avaient jamais été décrites. De plus, nous avons observé la présence de double ou triple mutant dans 40% des cas-index positifs. Les individus avec mutations sont plus jeunes et ont plus de symptômes que les individus sans mutation. Conclusion: Les tests génétiques sont positifs dans 43% des patients avec ARVC/D. L’utilisation de la technologie génétique basée sur l’identification de mutations connues a une valeur limitée vu le haut pourcentage des mutations nouvelles dans la maladie. La présence de double, même de triple mutant n’est pas associé avec un phénotype plus sévère, mais renforce l’idée de la nécessité d’un test génétique pour tous les gènes. Le test génétique est un outil fort utile à ajouter aux tests cliniques pour le diagnostique des patients qui ne remplissent pas tous les critères cliniques de la maladie. Mots clés: génétique, ARVC/D, mort subite, desmosome / Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetic disorder characterized by the presence of fibro-fatty replacement of the myocardium in the right ventricle. The disease is thought responsible for an important percentage of sudden cardiac death in the young. Hence the disease is usually difficult to diagnose with present clinical tools. ARVC/D is it caused in greater part by mutations in desmosomal proteins. The diagnosis of the genetic carriers bears important implications in family members, who unknowingly may be at risk for sudden death. In order to improve the diagnosis, a new tool, genetic testing, is increasingly being used. Hypothesis: In order to assess the value of genetic testing in complementing clinical testing in ARVC/D, we undertook the project to collect and perform clinical and genetic investigation in 23 probands with the disease. Methods: The probands were usually identified either after the death of a family member or after their clinical investigation for arrhythmias. The diagnosis of ARVC was made with clinical tools according to accepted criteria. Genetic analysis of desmosomal proteins previously associated with the disease was performed by sequencing the exons and intron-exon boundaries. Results: The clinical diagnosis was clear in 18/23 and suspicious in 5/23 individuals. We identified 15 different mutations in 10 probands. 64% of the mutations were not previously described. Interestingly we also observed the presence of double or triple mutants in 40% of the positive individuals. Individuals with mutations were younger and had more symptoms than individuals with no mutation. Conclusion: Genetic testing is useful in 43% of patients with ARVC. The use of mutation-based genetic technology has a very limited value due to the high percentage of previously unknown mutations in this disease. The presence of double and even triple mutants is not associated with a more severe phenotype but it indicates the need to have genetic testing performed for all genes for familial screening. Genetic testing is a useful tool to add to the clinical testing for the diagnosis of patients who do not completely fulfill the clinical criteria for the disease. Key words: genetic, ARVC/D, sudden death, desmosome

No description available.

Sammanfattning Bakgrund: Inom akutsjukvård behandlas och vårdas kritiskt sjuka eller skadade patienter till följd av trauma eller sjukdom. Sannolikt kommer de i sällskap av närstående som kan vara oroliga och rädda. Om patienten dessutom plötsligt avlider kan situation bli traumatisk för närstående och resultera i bestående men. Omhändertagande av närstående i dessa situationer är därför av stor vikt och ligger inom sjuksköterskans kompetensområde. Genom att belysa sjuksköterskans erfarenheter av dessa möten syftar vi till att få en djupare förståelse och öka kunskapen inom omhändertagandet av närstående i samband med plötsliga dödsfall. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att möta närstående i samband med dödsfall inom akutsjukvård, med särskilt fokus på plötslig död.  Metod: Elva vetenskapliga artiklar har analyserats i enlighet med Fribergs (2017) metod och sammanställts i en litteraturöversikt. De använda databaserna var CINAHL Complete, Medline with Full Text samt PubMed. Både kvalitativa och kvantitativa artiklar inkluderades i resultatet.  Resultat: Denna litteraturöversikt resulterade i fyra huvudteman: sjuksköterskans upplevelser och uppfattning av dödsfall. Arbetsrelaterade faktorer med underteman utbildning, erfarenhet och miljöns påverkan. Närvaro av närstående med underteman vid återupplivningsförsök och hos döende patienter Sjuksköterskans roll i mötet med närstående med underteman sjuksköterskans kommunikativa roll och sjuksköterskans praktiska roll. Diskussion: I metoddiskussionen diskuterades styrkor och svagheter med litteraturöversikten. Styrkorna låg i författarnas gemensamma arbete att hitta relevanta vetenskapliga artiklar samt att vidare minska risken för språkliga feltolkningar då artiklarna var skrivna på engelska. I resultatdiskussionen diskuterade författarna den emotionella påverkan sjuksköterskor kan uppleva samt sjuksköterskans roll i samband med plötsliga   dödsfall. Vidare diskuterades hur närstående kunde påverkas av bristen på avskildhet inom akutsjukvården och hur det kunde relateras till Roys adaptionsmodell. Resultatet diskuterades även mot bakgrunden samt annan forskning.   Nyckelord: Sjuksköterskans erfarenheter, närstående, akutsjukvård, plötslig död. / Abstract  Background: In emergency medical care critically sick or injured patients are being cared and treated for following trauma or disease. They are likely accompanied by their family members who can be frightened and scared. If the patient also suddenly dies the situation can be traumatic for the family members and result in lasting marks. The care of family members in these situations is there for important and this lies within the nurses’ area of   competence. By illustrating nurses’ experiences of these encounters we aim to receive a deeper understanding and knowledge in caring for family members in conjunction with sudden death.      Aim: The aim was to illustrate nurses’ experiences of encountering with family members in conjunction with death in emergency medical care, with a particular focus on sudden death. Method: Eleven scientific articles were analyzed in accordance with Fribergs (2017) method and complied in a literature review. The databases CINAHL Complete, Medline with Full Text and PubMed were used. Both quantitative and qualitative articles were included in the   result.   Results: This literature review resulted in four main themes: Nurses experiences and perception of death. Work related factors with subthemes education, experience and environmental impact. Presence of family members with subthemes during resuscitation attempts and with dying patients. Nurses role while encountering with family members with subthemes nurses communicative role and nurses practical role. Discussion: In the method discussion the authors discussed strengths and weaknesses with the literature review. The strengths were a joint effort to find relevant scientific articles and to further reduce the likelihood of linguistic misinterpretations when the articles were written in English. In the outcome discussion, the authors discussed the emotional impact nurses may experience as well as the nurse's role in the event of sudden deaths. Furthermore, it was discussed how family members could be affected by the lack of privacy in emergency medical care and how it could be related to Roys adaptation model. The result was also discussed against the background and other research. Keywords: Nurses experiences, family members, emergency medical care, sudden death.

Esse estudo descreve casos de “morte súbita” em bovinos associados com a ingestão de Amorimia (Mascagnia) exotropica em seis propriedades rurais localizadas na região metropolitana de Porto Alegre e da serra gaúcha. Os bovinos intoxicados foram encontrados mortos sem história de sinais clínicos prévios, ou apresentaram tremores musculares, quedas bruscas, movimentos de pedalagem, opistótono, respiração ofegante e decúbito lateral, quando induzidos ao movimento poucos minutos antes da morte. Registrou-se maior número de casos entre os meses de maio e agosto. Nove bovinos foram necropsiados e os principais achados macroscópicos observados foram mucosa oral levemente cianótica (3/9), hidropericárdio leve a moderado (3/9), petéquias e equimoses no epicárdio (5/9), coágulo no interior do ventrículo esquerdo (4/9), edema pulmonar (5/9) e mucosas vermelhas no abomaso e no intestino delgado (6/9). Histologicamente havia necrose de coagulação no miocárdio (9/9) caracterizada por retração celular, aumento da eosinofilia do citoplasma com perda das estriações, núcleos em picnose e ocasionais núcleos em cariorrexia e cariólise. No coração, edema intersticial (3/9) e infiltrado inflamatório intersticial, predominantemente, mononuclear (7/9) também foram observados. Nos rins de três bovinos havia degeneração hidrópicovacuolar multifocal das células epiteliais dos túbulos contorcidos distais associada com núcleos picnóticos deslocados para periferia da célula. As lesões cardíacas desses bovinos foram demonstradas através da imuno-histoquímica para troponina cardíaca C (cTnC). Nos corações dos bovinos intoxicados ocorreu diminuição acentuada de cTnC no citoplasma de grupos dos cardiomiócitos com características microscópicas de degeneração e necrose e, em algumas áreas havia perda total de imunomarcação. Raras fibras musculares cardíacas sem alteração histológica apresentaram perda de imunomarcação. Nos demais cardiomiócitos dos bovinos intoxicados sem lesões histológicas observou-se intensa marcação citoplasmática. / This study describes cases of sudden death in cattle that were associated with the consumption of Amorimia (Mascagnia) exotropica and occurred in six ranches located in the mountainous region of Rio Grande do Sul and the metropolitan region of Porto Alegre, Brazil. Affected cattle were found dead with no history of previous clinical signs, or showed muscular tremors, falls, paddling, opistotonus, panting, and lateral recumbence after being induced to move, few minutes before death. Most cases were recorded between May and August. Nine cattle were necropsied and main gross findings were oral mucosa slightly cyanotic (3/9), mild to intermediate hydropericardium (3/9), epicardial petechiae and ecchymoses (5/9), clot within the left ventricle (4/9), lung edema (5/9), apart of abomasal and small intestinal reddened mucosa (6/9). Histologically, there was myocardial coagulation necrosis (9/9), which was characterized by cellular retraction, enhanced cytoplasmic eosinophilia, lack of cytoplasmic striations and occasional nuclear karyorrhexis and karyolysis. There also were interstitial edema (3/9) and interstitial inflammatory infiltrate (mainly mononuclear) (7/9) in the heart. Apart of multifocal vacuolar-hydropic degeneration in the epithelial cells of the distal convoluted tubules associated with pyknotic and eccentric nuclei in the kidneys of three cattle. The cardiac lesions of these cattle were demonstrated by immunohistochemistry for cardiac troponin C (cTnC). In the hearts of cattle intoxicated was severe reduction of the cTnC in the cytoplasm of cardiomyocytes groups with microscopic features of degeneration and necrosis, and in some areas with complete loss of immunoreactivity. Rare cardiac muscle fibers showed no histological abnormality loss of immune-marking. In the remaining cardiomyocytes in cattle poisoned histological lesions were absent, but an intense cytoplasmic staining in these cells was observed.

Esse estudo descreve casos de “morte súbita” em bovinos associados com a ingestão de Amorimia (Mascagnia) exotropica em seis propriedades rurais localizadas na região metropolitana de Porto Alegre e da serra gaúcha. Os bovinos intoxicados foram encontrados mortos sem história de sinais clínicos prévios, ou apresentaram tremores musculares, quedas bruscas, movimentos de pedalagem, opistótono, respiração ofegante e decúbito lateral, quando induzidos ao movimento poucos minutos antes da morte. Registrou-se maior número de casos entre os meses de maio e agosto. Nove bovinos foram necropsiados e os principais achados macroscópicos observados foram mucosa oral levemente cianótica (3/9), hidropericárdio leve a moderado (3/9), petéquias e equimoses no epicárdio (5/9), coágulo no interior do ventrículo esquerdo (4/9), edema pulmonar (5/9) e mucosas vermelhas no abomaso e no intestino delgado (6/9). Histologicamente havia necrose de coagulação no miocárdio (9/9) caracterizada por retração celular, aumento da eosinofilia do citoplasma com perda das estriações, núcleos em picnose e ocasionais núcleos em cariorrexia e cariólise. No coração, edema intersticial (3/9) e infiltrado inflamatório intersticial, predominantemente, mononuclear (7/9) também foram observados. Nos rins de três bovinos havia degeneração hidrópicovacuolar multifocal das células epiteliais dos túbulos contorcidos distais associada com núcleos picnóticos deslocados para periferia da célula. As lesões cardíacas desses bovinos foram demonstradas através da imuno-histoquímica para troponina cardíaca C (cTnC). Nos corações dos bovinos intoxicados ocorreu diminuição acentuada de cTnC no citoplasma de grupos dos cardiomiócitos com características microscópicas de degeneração e necrose e, em algumas áreas havia perda total de imunomarcação. Raras fibras musculares cardíacas sem alteração histológica apresentaram perda de imunomarcação. Nos demais cardiomiócitos dos bovinos intoxicados sem lesões histológicas observou-se intensa marcação citoplasmática. / This study describes cases of sudden death in cattle that were associated with the consumption of Amorimia (Mascagnia) exotropica and occurred in six ranches located in the mountainous region of Rio Grande do Sul and the metropolitan region of Porto Alegre, Brazil. Affected cattle were found dead with no history of previous clinical signs, or showed muscular tremors, falls, paddling, opistotonus, panting, and lateral recumbence after being induced to move, few minutes before death. Most cases were recorded between May and August. Nine cattle were necropsied and main gross findings were oral mucosa slightly cyanotic (3/9), mild to intermediate hydropericardium (3/9), epicardial petechiae and ecchymoses (5/9), clot within the left ventricle (4/9), lung edema (5/9), apart of abomasal and small intestinal reddened mucosa (6/9). Histologically, there was myocardial coagulation necrosis (9/9), which was characterized by cellular retraction, enhanced cytoplasmic eosinophilia, lack of cytoplasmic striations and occasional nuclear karyorrhexis and karyolysis. There also were interstitial edema (3/9) and interstitial inflammatory infiltrate (mainly mononuclear) (7/9) in the heart. Apart of multifocal vacuolar-hydropic degeneration in the epithelial cells of the distal convoluted tubules associated with pyknotic and eccentric nuclei in the kidneys of three cattle. The cardiac lesions of these cattle were demonstrated by immunohistochemistry for cardiac troponin C (cTnC). In the hearts of cattle intoxicated was severe reduction of the cTnC in the cytoplasm of cardiomyocytes groups with microscopic features of degeneration and necrosis, and in some areas with complete loss of immunoreactivity. Rare cardiac muscle fibers showed no histological abnormality loss of immune-marking. In the remaining cardiomyocytes in cattle poisoned histological lesions were absent, but an intense cytoplasmic staining in these cells was observed.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The sudden death syndrome (SDS), caused by species of Fusarium, is a disease difficult to control and there are no management techniques and resistant cultivars that give long-term positive results. This study aimed to assess populations of Fusarium spp. and Trichoderma spp. associated to eight soybean genotypes, cultivated under no tillage; to determine if the control of Fusarium varies among isolates of Trichoderma; to identify isolates of Fusarium spp. obtained from different genotypes, and to determine their toxicity and pathogenicity to two genotypes of soybean. Soil and roots were collected from experimental plots located at the Fundação Centro de Experimentação e Pesquisa (FUNDACEP), obtaining isolates of Fusarium spp. and Trichoderma spp. There were no differences in the population of Fusarium spp. in plants with symptoms of SDS among the different genotypes. For Trichoderma spp. there was a significant difference among genotypes from plants with and without symptoms of SDS and the genotype CEPS 06006 RR had the biggest population of the antagonist. In the direct confrontation test, eight isolates of Trichoderma spp. obtained the highest score (1) in relation to the control of Fusarium spp. and isolates of Trichoderma spp. from soil of areas with the SDS symptom were more aggressive. Nine species of Fusarium: F. avenaceum, F. solani, F. equiseti, F. Acuminatum, F. kyushuense, F. graminum, F. subglutinans, F. verticillioides and F. lateritium were identified. All isolates promoted internerval chlorosis, necrosis and death of seedlings in the toxicity test. In the pathogenicity test in plants inoculated with the pathogen there was an increase in leaves and roots dry weight and in the number of pods, indicating that there may be species specificity of the species studied in relation to genotype. / A Podridão Vermelha da Raiz da soja (PVR), causada por espécies de Fusarium, é uma doença de difícil controle, não existindo técnicas de manejo e cultivares resistentes que tenham resultados positivos a longo prazo. Assim, este trabalho objetivou quantificar populações de Fusarium spp. e Trichoderma spp. associadas à oito genótipos de soja, cultivados em sistema plantio direto, observar se o biocontrole de Fusarium spp. difere entre isolados de Trichoderma spp., identificar isolados de Fusarium spp. obtidos de diferentes genótipos e verificar sua toxicidade e patogenicidade a dois genótipos de soja. Amostras de solo e raízes foram coletadas em parcelas experimentais na Fundação Centro de Experimentação e Pesquisa (FUNDACEP), obtendo-se isolados de Fusarium spp. e Trichoderma spp. Não houve diferença na população de Fusarium spp. em plantas com sintomas de PVR entre os diferentes genótipos. Para Trichoderma spp., houve diferença entre as populações nos genótipos de plantas com e sem sintomas de PVR, tendo o genótipo CEPS 06006 RR apresentado maior população do antagonista. No teste de confronto direto, oito isolados de Trichoderma spp. obtiveram a melhor nota (um), em relação a Fusarium spp. e isolados de Trichoderma spp. oriundos de solo em áreas com o sintoma de PVR foram mais eficientes. Foram identificadas nove espécies de Fusarium: F. avenaceum, F. solani, F. equiseti, F. acuminatum, F. kyushuense, F. graminum, F. subglutinans, F. verticillioides e F. lateritium. Todos os isolados de Fusarium spp. provocaram clorose internerval, necrose e morte de plântulas no teste de toxicidade. No teste de patogenicidade, em plantas inoculadas com o patógeno houve aumento na massa seca de parte aérea e de raízes, no número de vagens, indicando que pode haver especificidade das espécies estudadas em relação ao genótipo.

Bakgrund: Plötslig död är ett svårdefinierat begrepp då det kan orsakas av många faktorer. Att hantera plötslig död och sorg som sjuksköterska samt att bemöta anhöriga i dessa situationer är utmanande. Sorgereaktioner är individuella och kan skilja sig mycket från person till person. Det är oftast sjuksköterskor som etablerar kommunikationen mellan anhöriga och vårdteamet vilket ställer höga krav på professionen. Syfte: Beskriva sjuksköterskors upplevelser av att bemöta anhöriga i sorg efter plötsliga dödsfall som inträffat inom akutsjukvård.Metod: En litteraturöversikt med kvalitetsgranskade kvalitativa artiklar från åren 2012–2021. Artikelsökningar gjordes i databaserna; Cinahl, Medline och PubMed. Analysen gjordes utifrån Fribergs (2017) beskrivning av en femstegs analys. Resultat: I resultatet framkom tre teman: Emotionell påverkan (Känslomässiga aspekter, känslor av misslyckande och otillräcklighet samt otrygg i mötet), Kommunikation (Informerande samtal och bygga goda relationer) samt Arbetsmiljö (Tidsbrist och samverkan i team). Slutsats: Sjuksköterskor upplevde mötet med anhöriga vid plötslig död som komplicerat. Bristfällig kunskap inom ämnet sågs som ett problemområde. Att ge möjlighet för sjuksköterskor att utveckla sina färdigheter genom utbildningar kring bemötande vid sorg skulle kunna medföra en hälsosammare arbetsmiljö för sjuksköterskan. Ökad utbildning skulle också kunna ha betydelse för kvalitén på vården då det gäller stöd till anhöriga. / Title: The nurse`s meeting with relatives in the event of sudden death: A qualitative literature review Background: Sudden death is a difficult concept to define as it can be caused by many factors. Dealing with sudden death, relatives and bereavement as a nurse is challenging. Reactions in bereavement are individual, it can differ between people. It is the nurse who often establishes the communication between relatives and healthcare, which places high demands on the nurse. Aim: Describe nurses´ experiences of treating relatives in bereavement after sudden deaths that occurred in emergency care. Method: A literature review was performed with a base in quality reviewed qualitative articles from the years 2012-2021. Searches of articles were made in databases Cinahl, Medline and PubMed. The analysis was based on a five-step analysis described by Friberg (2017).Result: The result revealed three themes: Emotional impact (Emotional aspects, feelings of failure and inadequacy and insecurity during the meeting), Communication (Informative conversations and create good relations) and Work environment (Lack of time and team collaboration). Conclusion: Nurses experienced the meeting with bereaved relatives after sudden death as complicated. Lack of knowledge in the subject was seen as a problem. Providing opportunities for nurses to develop their skills through education in bereavement could lead to a healthy work environment and a healthcare with high quality to support relatives.

Malmgren, P & Rang, A. När det oväntade inträffar. Litteraturstudie om vårdpersonals upplevelser i mötet med anhöriga vid plötslig död. Examensarbete i omvårdnad 15 poäng. Malmö högskola: Hälsa och Samhälle, Utbildningsområde omvårdnad, 2009.Att möta människor i sorg och kris är en del av vårdpersonalens arbete. När patienter dör plötsligt och oväntat behövs extra mycket stöd åt de anhöriga. I många fall leder ett bra omhändertagande i det akuta skedet till att krisreaktionen och sorgeprocessen underlättas för de anhöriga. Det är inte enbart språket som är det centrala i mötet, utan även det kroppsspråk som används för att förmedla något.Syftet med litteraturstudien var att beskriva vårdpersonals upplevelser i mötet med anhöriga vid plötslig och oväntad död. Studien är en litteraturstudie som bygger på vetenskapliga artiklar, där artiklarna är av både kvantitativ och kvalitativ art. En litteratursökning gjordes för att få fram den forskning som fanns inom det valda området.Resultatet redovisas under fem teman som skapats utifrån analyserat material. De fem teman är: utbildning, känslor, kommunikation, stödsamtal och resurser. Resultaten från de olika studierna är likartade och tyder på att kunskap och upplevelser kring ämnet oväntad död inom hälso- och sjukvården har förhållit sig på samma sätt under många år. Det framgår tydligt att kunskapen i många fall är begränsad hos vårdpersonalen, när det gäller bemötande med anhöriga vid plötslig och oväntad död. / To meet people in grief and crisis is a part of the work of health staff. When patients die suddenly and unexpectedly, the relatives need extra support. In many cases, a good treatment in the acute phase, makes it easier for the family members to handle the crisis and to start the grieving process. It is not just the verbal communication that matters in the meeting, the message is also conveyed by the non-verbal communication.The aim of this study was to describe the experience of health professionals taking care of suddenly bereaved relatives. The study is a literature review based on scientific articles, quantitative as well as qualitative ones. A literature search was made to explore the research that existed in the area. The results of this review are centred around five themes, created from the analyzed material. The five themes are: education, emotions, communication, counseling and support, and resources. The results from the different studies are similar, and suggest that knowledge and experiences on the subject of unexpected death in health care have remained the same for many years. It is clear that in many cases there is a lack of knowledge among health staff taking care of suddenly bereaved families.