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The Sustainable Development Goals (SDG) launched by the United Nations in 2015 were a global challenge calling for ending poverty, protecting the environment, and guaranteeing peace and prosperity to world citizens by 2030. Brazil has changed gears, accepted the SDG challenge and moved one step forward. On the dawn of January 1st, 2023, the very first day of President Lula's office, Brazil issued the Decree no. 11,349/2023 and created an additional SDG itself on animal health by establishing the Department of Animal Protection and Rights (DAPR). The DAPR primarily aims to establish a Federal Animal Code and other nationwide standard procedures for pet population management and mass neutering/spaying programs, services against animal cruelty, welfare meat production, meat substitutes, and enforcement of native fauna protection. Meanwhile, Brazil's new government has reduced in 48% the Amazon deforestation and mining, enforced the inspections on national parks and preserved areas, limited wild boar hunting. On top of it, Lula's G20 Bloc presidency starting this coming December has shown the Brazil commitment to reestablish its historical prominence on international conversation and diplomacy. Finally, recognition of a clear and unquestionable nexus among animal welfare, environment, and sustainability, beyond the United Nations original proposition, in a country level, particularly with still-preserved nature areas, should be understood and invested as humanity heritage., Competing Interests: None declared., (© 2024 The Authors. Published by Elsevier B.V.)

Introduction: Until now very few cases of an adverse cardiovascular event have been described following European viper envenomation (Aravanis et al., 1982) (Aravanis et al., 1982) (Aravanis et al., 1982) (Aravanis et al., 1982). In fact, cardiac toxicity following snake bite is rare and primary reported from tropical and subtropical areas with only twenty-one cases of myocardial infarction reported in literature. Herein, we report a case of European viper envenomation associated with coronary artery thrombosis complicated by acute myocardial infarction and cardiac arrest., Case Report: A 62-year-old man, with a history of cardiovascular disease, on dual antiplatelet therapy with ticagrelor and acetylsalicylic acid, was admitted to the Emergency Department, after a bite, on the right hand, from a snake recognized by a herpetologist as a Vipera aspis francisciredi. At ED presentation, 2 hours after the bite, he manifested with vomiting, hypotension (90/60 mmHg) and mild oedema at the bite site. Standard electrocardiogram and troponin were normal at admission. One hour after the admission the patient developed cardiocirculatory arrest (ACC) with return of spontaneous circulation (ROSC) after cardiopolmunary resuscitation. Post ROSC-ECG showed an ST-elevation on anteroseptal and lateral leads and 1-vial of Viper Venom Antitoxin (Biomed®) was i.v. administered. During the next 3 hours three other episodes of ACC occurred, always with restoration of spontaneous circulation. Percutaneous transluminal coronary angiography showed a thrombus on the bifurcation of anterior descending coronary artery and diagonal 1 without an underlined atherosclerotic plaque. Neurologic clinical manifestations also occurred 12 hours after the bite: bilateral ptosis and facial paresthesia and a second vial of the same viper antivenom administered. The patient was discharged after 9 days of hospitalization without sequelae., Conclusions: Our case show that cardiotoxicity is a rare but possible event after snake envenomation in Europe, even if with mechanisms remains to be studied. Vipera aspis has been known to cause primarily neurotoxic manifestations, but a coagulation factor X activator have also been isolated from its venom. Moreover, a specific serine peptidase that can target both PAR1 and PAR3, that are responsible for alternate pathways of platelet aggregation, have been characterized in the venom of a viper. Coronary thrombosis in our case could thus be secondary to a combination of prothrombotic systemic state and platelets dysfunction, in a patient with predisposing factors. Antivenom specific antidotal therapy role in preventing cardiotoxicity still need to be elucidated, but it remains the mainstay of treatment together with coronary angiography if necessary., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience., Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS)., Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections ( p < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections ( p = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases., Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.

Purpose: Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany., Methods: The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters., Results: We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53)., Conclusion: Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

To evaluate the efficacy of combined glaucoma surgery, 42 glaucomatous patients were randomly divided into two groups: deep sclerectomy with implant (DS) alone was performed in 21 patients, and combined deep sclerectomy and phacoemulsification (PDS) was performed in the other 21 patients. Follow-up was carried out at regular intervals for 12 months. A comparative study on intraocular pressure (IOP) was designed. Although further study is needed, PDS appears to have better postoperative long-term results in IOP control than DS alone., (Copyright 2003 S. Karger AG, Basel)

Purpose: To evaluate the incidence of secondary cataract in phacoemulsification and intraocular lens implantation using a capsular tension ring in case of zonular dehiscence., Methods: Phacoemulsification using a double capsular tension ring and intraocular lens implantation was done in 65 eyes with cataract and severe zonular weakness. One year after surgery capsular opacities and fibrosis were detected in a double-blind examination. The results were compared with a control group of 36 eyes that did not have a capsular tension ring but had similar surgery., Results: In the group with the capsular tension ring and implantation 7.7% of patients had moderate or severe posterior capsule opacification, compared with 36.1% in the control group., Conclusions: Capsular tension rings may influence the formation of capsule opacification.

Study Objective: To establish the crude effects of danazol and gonadotropin-releasing hormone (GnRH) analogs in the management of endometriosis., Design: Prospective case-control study., Setting: Unit of the Pathophysiology of Reproduction outpatient department., Patients: Two groups of 110 women each with endometriosis (American Fertility Society score 1-3) who received danazol and GnRH analogs, and a control group who did not receive any drugs., Interventions: Women in the treatment groups received danazol 200 mg every 8 hours for 6 months, or a different GnRH agonist at standard dosages for 6 months. Laparoscopy was performed twice, at the time of diagnosis and just before the end of treatment (or no therapy for controls). Surgical treatment of the implants was performed at the second laparoscopy., Measurements and Main Results: Samples of both eutopic and ectopic endometrium were collected during both laparoscopies. Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants, and there were no significant differences between the effects (p <0.001). Fibrosis was found after 6 months of observation in the implants in one control woman (0.9%), in 20 patients (18.2%) treated with danazol (p <0.001 vs controls), and in 4 patients (3.6%) treated with GnRH agonists (NS vs controls). A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28% of women, with poor agreement (k = 0.07)., Conclusions: Fibrosis, which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium, did not appear in eutopic endometria but it was found in some endometriotic implants. Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis, but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable.

To compare the efficiency of two surgical techniques to remove uterine myomata, 120 premenopausal women were included in this case control study based on the criteria of no previous operations, size of leiomyoma, and age. Sixty patients were treated by laparoscopy (group 1) and 60 by laparotomy (group 2). The hospital stay for group 1 was shorter than that for group 2 (3.53 &plusmn; 1.33 and 7.98 &plusmn; 2.05 days, p <0.001). The rate of total complications (body temperature >38&deg; C, hemoglobin <8.5 g/100 ml, infiltration of abdominal sutures, dysuria, reduction in blood platelets) was 13% in group 1 versus 53% in group 2 (p <0.001). The mean cost for each surgical treatment was $628.71 and $652.40, respectively. The mean entire cost (surgery plus hospital stay) was $1357.23 and $2298.90, respectively (p <0.001). The savings were detectable after 9 and 52 operations, respectively, whether including all expenditures or only the cost of surgery. The cost saving of the entire treatment for 60 operations was $56,500.12.

Study Objective: To determine the frequency of adhesion formation after myomectomy performed by operative laparoscopy or laparotomy., Design: Case-control study. Setting. Academic women's hospital., Patients: Thirty-two premenopausal women scheduled for myomectomy by one of two techniques., Interventions: Surgical removal of myomata., Measurements and Main Results: Of the 32 women, 16 underwent laparotomy and 16 laparoscopy. Second-look laparoscopy was performed in 28 patients, at which time adhesions were lysed. Compared with laparotomy, laparoscopy resulted in adhesions in significantly fewer patients, and in significantly lower scores when adhesions were detected., Conclusion: Laparoscopic removal of uterine myomata is associated with fewer adhesions than removal by laparotomy.