Piómetra em cadela: variações no valor do pH vaginal
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2016-08-01
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A piómetra é, na cadela, uma das principais doenças envolvendo o útero, originando uma síndrome clínica grave devido aos sérios efeitos secundários que ameaçam a vida: uma infeção uterina leva ao aparecimento de uma endotoxemia e a uma progressão para uma síndrome sistémica de resposta inflamatória (SSRI), ou sépsis. Existem uma série de fatores de risco para a piómetra canina embora a doença apresente uma etiologia multifactorial. Para além das particularidades reprodutivas das espécies, outros fatores de risco comuns são a idade, a raça, o padrão da atividade reprodutiva, as gestações prévias e o intervalo entre gestações, a existência de doenças uterinas ou ováricas concorrentes e a utilização de contraceção médica. Neste estudo pretendeu-se analisar se a existência de piómetra induz ou não alterações no pH vaginal. Para isso, recolheram-se amostras de pH vaginal em 38 cadelas submetidas a ovariohisterectomia, de idades compreendidas entre 6 meses e os 14 anos, das quais 30 eram saudáveis e 8 tinham diagnóstico clinico de piómetra. As cadelas saudáveis representavam fêmeas pré e pós-púberes (respetivamente 6 e 24). Em todos os animais foi excluída a existência de vaginite antes da obtenção do valor de pH vaginal. A mensuração do valor de pH foi realizada imediatamente antes da cirurgia com recurso a papel indicador. O estadiamento do ciclo éstrico e a existência de piómetra foram confirmados pela inspeção da morfologia do útero e ovários e/ou pelo exame histopatológico da peça excisada. O valor do pH vaginal obtido nas cadelas com piómetra foi comparado com os de cadelas pré- e pós-púberes, e ainda com o de fêmeas nas diferentes fases do ciclo éstrico. Os resultados não evidenciaram diferenças no que respeita ao valor de pH e o estatuto reprodutivo das fêmeas, contrariamente ao descrito para outras espécies, apesar de a mediana para o valor de pH ser mais elevada em fêmeas que se apresentam antes da puberdade (p=0,082). O valor de pH não varia (p=0,111) nos grupos etários estudados (<1 ano com 10 animais; 1 a <3 anos com 12 animais; 3 a <6 anos com 8 animais; e 9 anos com 8 animais), mas não pudemos obter dados sobre a atividade reprodutiva anterior que pudessem esclarecer este ponto. Contrastando com o descrito anteriormente na cadela, não se obtiveram diferenças no valor de pH vaginal entre as fases de dominância estrogénica e não-estrogénica (p=0,280), apesar de o pH vaginal em cadelas ser diferente entre cadelas em anestro e cadelas em proestro (p= 0.0236) ou em diestro (p= 0.0079). O pH vaginal em cadelas com piómetra foi estatisticamente diferente apenas quando comparado com o de animais em fase de diestro e de anestro (respetivamente p= 0.0091 e p=0.0241).
Este trabalho apresenta alguns dados preliminares sobre a variação do pH vaginal em situação de piómetra, mas estes resultados deverão ser confirmados num grupo maior de animais de forma poder ser determinado a sua utilidade na prática clínica.
In dogs, pyometra is a major uterine disease, leading to a severe clinical syndrome associated to serious side effects that threaten life: a uterine infection leads to the onset of toxemia, which progress to a systemic inflammatory response syndrome (SSRI), or sepsis. There are a number of risk factors for canine pyometra although the disease presents a multifactorial aetiology. In addition to the reproductive characteristics of species, other common risk factors are age, race, the pattern of reproductive activity, previous pregnancies and the interval between pregnancies, the existence of uterine or ovarian diseases competitors and the use of medical contraception. This study aimed to analyze whether or not the existence of pyometra induces changes in the vaginal pH. In this study the vaginal pH was collected from 38 female dogs undergoing elective ovariohysterectomy; animals were aged between 6 months and 14 years old, of whom 30 were healthy and 8 had a clinical diagnosis for pyometra. Moreover, healthy dogs represented pre and post-pubertal females (6 and 24 respectively). Vaginitis was excluded in all the animals, before collecting the vaginal pH. Measurement of pH was carried out immediately before surgery using indicator paper. Staging of estrous cycle or the existence of pyometra were posteriorly confirmed by inspection of ovaries and from the uterine morphology and/or by the histopathological examination of the excised piece. The values for the vaginal pH obtained from bitches with pyometra were compared with those from pre-and post-pubertal female dogs and with those from healthy females in the different stages of the estrous cycle. The results failed to evidence a statistical effect of the stage of the cycle over the vaginal pH measurements; similarly, no differences were found between prepubertal and postpubertal females. Still, the median value for the vaginal pH tent to be higher in pre-pubertal females than in post-pubertal ones (p = 0.082). The class of age (<1 year with 10 animals; 1 to <3 years with 12 animals; 3 to <6 years with 8 animals; and 9 years with 8 animals) did not affect the values for the vaginal pH, but in the absence of data on the previous reproductive history of enrolled animals, no information could be extracted. In contrast to previous reports in dogs, no changes in the vaginal pH were noticed in the current study between estrogen associated and the other stages of the canine estrous cycle (p = 0.280); nevertheless, statistical differences were found between anestrus and proestrus (p= 0.0236) or diestrus (p= 0.0079). In general, no differences were found in vaginal pH were detected when the stage of the cycle was disregarded. However, significant differences were found between animals with pyometra and healthy animals in diestrus and anestrus (p= 0.0091 and p=0.0241, respectively). This work presents preliminary data on the changes in the value of vaginal pH in female dogs with pyometra, although these results need to be confirmed in a larger cohort study to establish its usefulness in the clinical practice.
In dogs, pyometra is a major uterine disease, leading to a severe clinical syndrome associated to serious side effects that threaten life: a uterine infection leads to the onset of toxemia, which progress to a systemic inflammatory response syndrome (SSRI), or sepsis. There are a number of risk factors for canine pyometra although the disease presents a multifactorial aetiology. In addition to the reproductive characteristics of species, other common risk factors are age, race, the pattern of reproductive activity, previous pregnancies and the interval between pregnancies, the existence of uterine or ovarian diseases competitors and the use of medical contraception. This study aimed to analyze whether or not the existence of pyometra induces changes in the vaginal pH. In this study the vaginal pH was collected from 38 female dogs undergoing elective ovariohysterectomy; animals were aged between 6 months and 14 years old, of whom 30 were healthy and 8 had a clinical diagnosis for pyometra. Moreover, healthy dogs represented pre and post-pubertal females (6 and 24 respectively). Vaginitis was excluded in all the animals, before collecting the vaginal pH. Measurement of pH was carried out immediately before surgery using indicator paper. Staging of estrous cycle or the existence of pyometra were posteriorly confirmed by inspection of ovaries and from the uterine morphology and/or by the histopathological examination of the excised piece. The values for the vaginal pH obtained from bitches with pyometra were compared with those from pre-and post-pubertal female dogs and with those from healthy females in the different stages of the estrous cycle. The results failed to evidence a statistical effect of the stage of the cycle over the vaginal pH measurements; similarly, no differences were found between prepubertal and postpubertal females. Still, the median value for the vaginal pH tent to be higher in pre-pubertal females than in post-pubertal ones (p = 0.082). The class of age (<1 year with 10 animals; 1 to <3 years with 12 animals; 3 to <6 years with 8 animals; and 9 years with 8 animals) did not affect the values for the vaginal pH, but in the absence of data on the previous reproductive history of enrolled animals, no information could be extracted. In contrast to previous reports in dogs, no changes in the vaginal pH were noticed in the current study between estrogen associated and the other stages of the canine estrous cycle (p = 0.280); nevertheless, statistical differences were found between anestrus and proestrus (p= 0.0236) or diestrus (p= 0.0079). In general, no differences were found in vaginal pH were detected when the stage of the cycle was disregarded. However, significant differences were found between animals with pyometra and healthy animals in diestrus and anestrus (p= 0.0091 and p=0.0241, respectively). This work presents preliminary data on the changes in the value of vaginal pH in female dogs with pyometra, although these results need to be confirmed in a larger cohort study to establish its usefulness in the clinical practice.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Doença do sistema vaginal feminino , Útero , Piómetra , Éstro , Ph vaginal , Cadelas , Exames histopatológicos