A captive loggerhead turtle (Caretta caretta) of unknown sex, 3 years of age, presented with bilateral mucoid secretions, severe chemosis, conjunctival hyperemia, and globe retraction. The animal was evaluated ophthalmologically and systemically, and hematological, microbiological, and conjunctival cytological and biopsy samples were collected for complementary diagnosis. The histopathological examination showed amphophilic intranuclear inclusions associated with severe inflammatory infiltrate. The diagnosis of Chelonid alphaherpesvirus 5 (ChAHV 5) was confirmed with end point PCR. Following systemic treatment with L‐lysine, acyclovir and vitamin A, the ocular signs resolved. No amphophilic intranuclear inclusions were seen in a follow‐up biopsy 5 months later, and there has been no recurrence of clinical ophthalmic signs during a 4‐year follow‐up. It is suggested that ChAHV 5 be considered as a differential diagnosis in captive marine turtles that present for conjunctival disease other than fibropapillomatosis.

The objective of this study was to describe for the first time the clinical-epidemiological, laboratory and pathological aspects of different forms of enzootic ataxia in goats and lambs in the state of Bahia, as well as to propose an emergency oral treatment with copper sulfate in an individualized way for neonates. Three outbreaks of enzootic ataxia were studied. The history, clinical signs and epidemiological data were obtained from the owners and checked during the visits. The first outbreak (FO) occurred in 2013 in a property located in the municipality of Itaberaba and affected a herd composed of 90 goats and 130 sheep. The second outbreak (SO) occurred in 2014 in the municipality of Santa Luz and affected a herd of 90 goats and 110 sheep. The third outbreak (TO) occurred in 2018, in a property located in the same municipality of the SO, being the herd constituted by 80 sheep. Samples of blood were collected from all goats and sheep treated for serum copper dosage. Nine animals (five goats and four sheep) that presented a more severe clinical picture and unfavorable prognosis were necropsied for diagnostic confirmation. During the necropsy of the FO, SO and TO animals, liver samples were collected for copper dosage as well as fragments of several organs for histopathology. At the site where the SO occurred, samples of soil and the main forages where the animals were kept were collected to determine copper, iron, molybdenum, sulfur and zinc contents. The clinical and histopathological findings in the three outbreaks studied were characteristic of enzootic ataxia. In the outbreaks studied, the frequency of enzootic ataxia was higher in goats (52) than in lambs (39). In the goats the mean values of serum copper (0.05mg/kg) and hepatic (2.48mg/kg) of the FO and SO were well below their respective reference values, 12 times lower than serum levels and eight times lower in relation to liver contents. On the other hand, TO sheep presented mean values of serum copper (0.015mg/kg) reduced by 40 times. The levels of iron and sulfur were high in the fodder of the property where the SO occurred, already in the soil, iron levels were high and copper levels were reduced. The treatment tested in neonates and lambs with two doses of copper sulphate solution orally at a dose of 20mg/kg for sheep and 35mg/kg for goats during the first and second week of life was effective in prevention of enzootic ataxia in neonates and can be used for emergency control of the disease. The occurrence of enzootic ataxia (congenital and late form) in goats and sheep was first reported in Bahia. It is also worth noting that this disease caused by copper deficiency has caused great damage to the breeders of small ruminants, mainly due to the high mortality of the animals affected.

Introduction: Breast cancer is the most common cancer in women and the leading cause of cancer- related death in women worldwide. The high prevalence of physical and psychosocial suffering among breast cancer patients and their families justifies the need for an early interdisciplinary approach by a palliative care team. The effectiveness of early palliative care for patients with advanced cancer has been demonstrated in many studies. Early referral to outpatient palliative care services improves symptom control, reduces suffering and improves quality of end-of-life care. Aim: Evaluation of referral patterns of metastatic breast cancer patients to the outpatient embedded palliative care team. Methods: We retrospectively retrieved data from electronic medical records of patients who were treated at a private community oncology practice in Brazil who died from metastatic breast cancer during the years of 2018 until 2021.We evaluated the patient’s follow-up time by the palliative care team (follow-up > 12 weeks or not) and the year of referral to the service (pre-2020 vs 2020 and later) associated to the service referral type: Late referral (more than 8 weeks of metastatic diagnosis) or early referral. Each group was followed-up by cancer physicians and after referral was also followed-up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. We performed univariate comparisons analysis by Fisher’s Exact Test. p < 0.1 was deemed as statistically significant. Results: Of the 211 patients whose data were assessed, 99 patients were referred to Palliative Care team before 2020 and 112 patients after 2020. 13.1% of patients pre-2020 received early palliative care versus 33.9% of patients in the post-2020 referral group, resulting in a 3.37-fold odds of an early palliative care integration after 2020 (OR 3.37, CI95: 1.61 – 7.45; p< 0.001). Overall, 30.4% of longer follow-up patients were an early referral versus 19.3% of the shorter follow-up, resulting in an 82% greater chance (OR 1.82, CI: 0.92-3.63; p< 0.1) of prolonged assistance with early referral. Conclusions: In this analysis, early palliative care integration for patients with metastatic breast cancer has increased after 2019 despite the COVID-19 pandemic, leading to prolonged time of accompaniment by the multidisciplinary palliative care team. This suggests that even in the face of this challenging moment, a mature and consolidated service is offered by the palliative care team. Also, according to previous data in literature, prematurely integration show signs of correlation with better quality of life and death, supporting early palliative care for this group of patients. However, further work is needed to examine the effect of this care model in our cohort. Table: Palliative Care Assistance by time-referral Citation Format: Sarah A. GOMES, Danielle N. Silva, Thais Passarini, Julia A. Petrocchi, Marcela M. de Paula, Julia S. de sá, MatheusCosta e Silva, Tatiana A. Coelho, Rafaella L. de Aquino, Flávia S. Sorice, Patrícia Santos, Daniela Madureira, Erika Martins, Heloísa Cruz, Bruno L. Ferrari. Referral patterns of metastatic breast cancer patients to Palliative Care team at a Cancer Center in Brazil [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-11.