Muscle-Skeletal Abnormalities and Muscle Oxygenation during Isokinetic Strength Exercise in Heart Failure with Preserved Ejection Fraction Phenotype: A Cross-Sectional Study.

Exercise intolerance, a hallmark of patients with heart failure (HF), is associated with muscle weakness. However, its causative microcirculatory and muscle characteristics among those with preserved or reduced ejection fraction (HFpEF or HFrEF) phenotype is unclear. The musculoskeletal abnormalities that could result in impaired peripheral microcirculation are sarcopenia and muscle strength reduction in HF, implying lowered oxidative capacity and perfusion affect transport and oxygen utilization during exercise, an essential task from the microvascular muscle function. Besides that, skeletal muscle microcirculatory abnormalities have also been associated with exercise intolerance in HF patients who also present skeletal muscle myopathy. This cross-sectional study aimed to compare the muscle microcirculation dynamics via near-infrared spectroscopy (NIRS) response during an isokinetic muscle strength test and ultrasound-derived parameters (echo intensity was rectus femoris muscle, while the muscle thickness parameter was measured on rectus femoris and quadriceps femoris) in heart failure patients with HFpEF and HFrEF phenotypes and different functional severities (Weber Class A, B, and C). Twenty-eight aged-matched patients with HFpEF (n = 16) and HFrEF (n = 12) were assessed. We found phenotype differences among those with Weber C severity, with HFrEF patients reaching lower oxyhemoglobin (O2Hb, µM) (-10.9 ± 3.8 vs. -23.7 ± 5.7, p = 0.029) during exercise, while HFpEF reached lower O2Hb during the recovery period (-3.0 ± 3.4 vs. 5.9 ± 2.8, p = 0.007). HFpEF with Weber Class C also presented a higher echo intensity than HFrEF patients (29.7 ± 8.4 vs. 15.1 ± 6.8, p = 0.017) among the ultrasound-derived variables. Our preliminary study revealed more pronounced impairments in local microcirculatory dynamics in HFpEF vs. HFrEF patients during a muscle strength exercise, combined with muscle-skeletal abnormalities detected via ultrasound imaging, which may help explain the commonly observed exercise intolerance in HFpEF patients.

Baclofeno intratecal en daño cerebral y recuperación de estado vegetativo persistente. A propósito de un caso / Intrathecal baclofen therapy in brain injury and recovery of persistent vegetative state. Apropos of a case

Pacientes con daño cerebral y espasticidad son candidatos a terapia de baclofeno intratecal (ITB) cuando dosis máximas de antiespásticos orales no son efectivas. Algunos autores describen una mejora en el nivel de consciencia en pacientes con daño cerebral y alteraciones del nivel de consciencia. Presentamos el caso de una paciente de 43 años con daño cerebral, espasticidad y estado vegetativo persistente que presentó mejora del nivel de consciencia tras administrar ITB para el manejo de la espasticidad. Durante la prueba de infusión de baclofeno intratecal monitorizamos la espasticidad según la Escala modificada de Ashworth y el nivel de consciencia mediante Coma Recovery Scale-Revised. Tras observar mejoría en Escala modificada de Ashworth y en Coma Recovery Scale-Revised, decidimos implantar la bomba de ITB y la paciente emergió de estado vegetativo persistente a estado de mínima consciencia. Sugerimos el beneficio añadido de ITB sobre el nivel de consciencia en pacientes con daño cerebral, alteraciones del nivel de consciencia y espasticidad, no existiendo evidencia suficiente para prescribirlo en el tratamiento de alteraciones del nivel de consciencia

Patients with brain injury and spasticity are candidates for intrathecal baclofen therapy (ITB) when maximal doses of oral antispastic drugs fail. Some authors have described an improvement in the level of consciousness in patients with brain injury and disorder of consciousness treated with ITB for spasticity. We present the case of a 43-year-old patient with brain injury, spasticity, and permanent vegetative state (PVS) who showed an improvement in the level of consciousness after ITB for spasticity. We performed an ITB infusion test, assessing the spasticity with the Modified Ashworth Scale (MAS) and level of consciousness with the Coma Recovery Scale-Revised (CRS-R) and observed an improvement in the spasticity and the level of consciousness. Consequently, the ITB pump was implanted and the patient recovered from PVS to minimal conscious state (MCS). We conclude that ITB is indicated in patients with brain injury and spasticity. We suggest the improvement in the level of consciousness as a possible additional benefit. There is a lack of evidence to recommend ITB in patients with altered level of consciousness

[Intrathecal baclofen therapy in brain injury and recovery of persistent vegetative state. Apropos of a case]. / Baclofeno intratecal en daño cerebral y recuperación de estado vegetativo persistente. A propósito de un caso.

Patients with brain injury and spasticity are candidates for intrathecal baclofen therapy (ITB) when maximal doses of oral antispastic drugs fail. Some authors have described an improvement in the level of consciousness in patients with brain injury and disorder of consciousness treated with ITB for spasticity. We present the case of a 43-year-old patient with brain injury, spasticity, and permanent vegetative state (PVS) who showed an improvement in the level of consciousness after ITB for spasticity. We performed an ITB infusion test, assessing the spasticity with the Modified Ashworth Scale (MAS) and level of consciousness with the Coma Recovery Scale-Revised (CRS-R) and observed an improvement in the spasticity and the level of consciousness. Consequently, the ITB pump was implanted and the patient recovered from PVS to minimal conscious state (MCS). We conclude that ITB is indicated in patients with brain injury and spasticity. We suggest the improvement in the level of consciousness as a possible additional benefit. There is a lack of evidence to recommend ITB in patients with altered level of consciousness.

Fine-needle aspiration of the Warthin-like variant of papillary thyroid carcinoma: A report of three cases.

In English literature, there are only few reports of Warthin-like papillary thyroid carcinoma. We presented three cases and provided clinical, grossing, cytological, and histological correlation. In our point of view, the diagnosis of Warthin-like papillary thyroid carcinoma is feasible based on cytomorphological aspects. Usually those cases present moderately or highly cellular smears with many atypical Hürthle cells showing obvious papillary thyroid carcinoma nuclear features and without papillary structures, even if the inflammatory background is mild.

Effect of odontoplasty on apparent digestibility and consumption time of diet for equines / Efeito da odontoplastia sobre a digestibilidade aparente e o tempo de consumo de dieta para equinos

The aim of this study was to investigate the effect of odontoplasty on apparent digestibility of diet for horses, consumption time, and particle size of feces. Nine horses were used, aged 14.5±3.3 years and weightng 531±38.7kg. The diet consisted of 1.5% of live weight (LW) in Tifton 85 hay and 0.75% of LW in concentrate for both assays. The experiment consisted of two tests of apparent digestibility using the method of total collection, before and after the odontoplasty, where the consumption time of hay and concentrate was also evaluated and the particle size of the feces was analyzed. An effect (P<0.05) of odontoplasty on the apparent digestibility coefficients of dry matter, organic matter, crude protein, neutral detergent fiber and acid detergent fiber was observed. Effect of the consumption time for the concentrate (P<0.05) was observed, but not for the forage (P<0.05). There was more retention (P<0.05) of the fecal particles in the sieves of bigger granulometry. The odontoplasty increases the digestibility of dietary nutrients and feces particle size, without changing feces quality. Animals after the procedure have shorter concentrate consumption time.(AU)

O objetivo deste estudo foi investigar o efeito da odontoplastia sobre a digestibilidade aparente de dieta para equinos, o tempo de consumo e o tamanho de partícula das fezes. Foram utilizados nove equinos, com idade de 14,5±3,3 anos e peso de 531±38,7kg. A dieta consistiu do oferecimento de 1,5% do peso vivo (PV) em feno de Tifton 85 e 0,75% do PV em concentrado para ambos os ensaios. O experimento compôs-se de dois ensaios de digestibilidade aparente pelo método de coleta total, antes e após a odontoplastia, em que também foi avaliado o tempo de consumo do feno e do concentrado e analisado o tamanho de partícula das fezes. Foi observado efeito (P<0,05) da odontoplastia sobre os coeficientes de digestibilidade aparente da matéria seca, matéria orgânica, proteína bruta, fibra em detergente neutro e fibra em detergente ácido. Verificou-se efeito do tempo de consumo para o concentrado (P<0,05), porém não se observou para o volumoso (P<0,05). Houve maior retenção (P<0,05) das partículas das fezes nas peneiras de maior granulometria. A odontoplastia aumenta a digestibilidade dos nutrientes da dieta e o tamanho de partículas nas fezes, sem alterar a qualidade destas. Animais após o procedimento apresentam menor tempo de consumo de concentrado.(AU)

Success rate and complications associated with dental implants in the incisive canal region: a systematic review.

A systematic review was conducted to evaluate the success rate of dental implants placed in the incisive canal region and the complications related to this procedure. An electronic search was performed in the PubMed, Scopus, and Web of Science databases. Articles reporting the incisive canal deflation technique or neurovascular bundle lateralization technique, with or without concomitant dental implant installation and grafting procedures, were evaluated. Ten articles met the inclusion criteria; only one retrospective study and one longitudinal clinical trial were found. A total of 91 implants were installed in this region, and implant success ranged from 84.6% to 100%. With regard to complications, three articles reported temporary sensory loss. Permanent sensory loss in the palatal mucosa region was reported in one study applying neurovascular bundle lateralization. Five studies were assessed in the quality analysis: four were of moderate quality and one was of low quality. Although a high success rate was described in the selected studies, caution is recommended when dental implants are installed in the incisive canal region due to the low level of evidence available. Regarding complications, there are no parameters for predicting the occurrence of sensory disturbances or the extent of damage with the use of incisive canal deflation or neurovascular bundle lateralization.

Multimodel precipitation responses to removal of U.S. sulfur dioxide emissions.

Emissions of aerosols and their precursors are declining due to policies enacted to protect human health, yet we currently lack a full understanding of the magnitude, spatiotemporal pattern, statistical significance, and physical mechanisms of precipitation responses to aerosol reductions. We quantify the global and regional precipitation responses to U.S. SO2 emission reductions using three fully coupled chemistry-climate models: Community Earth System Model version 1, Geophysical Fluid Dynamics Laboratory Coupled Model 3, and Goddard Institute for Space Studies ModelE2. We contrast 200 year (or longer) simulations in which anthropogenic U.S. sulfur dioxide (SO2) emissions are set to zero with present-day control simulations to assess the aerosol, cloud, and precipitation response to U.S. SO2 reductions. In all three models, reductions in aerosol optical depth up to 70% and cloud droplet number column concentration up to 60% occur over the eastern U.S. and extend over the Atlantic Ocean. Precipitation responses occur both locally and remotely, with the models consistently showing an increase in most regions considered. We find a northward shift of the tropical rain belt location of up to 0.35° latitude especially near the Sahel, where the rainy season length and intensity are significantly enhanced in two of the three models. This enhancement is the result of greater warming in the Northern versus Southern Hemispheres, which acts to shift the Intertropical Convergence Zone northward, delivering additional wet season rainfall to the Sahel. Two of our three models thus imply a previously unconsidered benefit of continued U.S. SO2 reductions for Sahel precipitation.

Guía de práctica clínica para el tratamiento de la diabetes mellitus tipo 2: manejo inicial / Clinical Practice Guideline for Treatment of Type 2 Diabetes Mellitus: Initial Treatment

Introducción: En la actualidad es ampliamente aceptada la metformina como manejo farmacológico inicial para el tratamiento de la diabetes mellitus tipo 2 (DMT2). Resulta, sin embargo, controversial si en algunos tipos de pacientes puede iniciarse tratamiento únicamente con cambios intensivos de estilo de vida o si existen grupos en quienes debería iniciarse desde el inicio terapia farmacológica combinada. Objetivo: Definir el impacto de estrategias de cambio intensivo en la dieta y de ejercicio, así como de la terapia farmacológica con metformina asociada a un segundo antidiabético oral como estrategias de manejo inicial en pacientes con DMT2 recién diagnosticada. Métodos: Se elaboró la guía de práctica clínica, siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social colombiano. Se revisó la evidencia disponible de forma sistemática y se formularon las recomendaciones utilizando la metodología GRADE. Conclusiones: En pacientes con DMT2 recién diagnosticada no se recomienda el manejo únicamente con cambios intensivos del estilo de vida; estos deben acompañar el manejo farmacológico con metformina, dando prelación a los componentes de la dieta mediterránea y al ejercicio aeróbico. En los pacientes con DMT2 recién diagnosticada y niveles de HbA1C > 8 % se recomienda utilizar terapia combinada desde el inicio con metformina y otro antidiabético oral, siendo de primera elección los inhibidores de DPP-4.

Introduction: Today, metformin is widely accepted as standard initial pharmacologic treatment for diabetes mellitus type 2 (DMT2). However, it is controversial if in some groups of patients, the treatment can be initiated only with life style changes, or if there are groups who should begin with combined therapy since the beginning. Aim: To define the effect of intensive strategies for change of diet or exercise, and the effect of combined therapy with metformin and a second oral antidiabetic, as initial treatment in patients with newly DMT2. Methods: A clinical practice guide has been developed following the broad outline of the methodological guide from the Colombian Ministry of Health and Social Welfare. with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Conclusions: In patients with recently diagnosed DMT2, initial treatment with lifestyle changes only is not recommended. However, it is recommended that lifestyles changes must begin simultaneously with metformin, including the components of a Mediterranean diet and aerobic exercise. In patients with recently diagnosed DMT2 and HbA1c levels >8%, it is recommended to administer a combined therapy from the beginning with metformin and another oral antidiabetic medication. The DPP4 inhibitor is recommended.

Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges.

Setting: While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited. Objective: To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India. Design: A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private. Results: Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected. Conclusion: In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions.

Contexte : La chirurgie de la tuberculose pulmonaire (TBP) est considérée comme un adjuvant important dans des cas spécifiques, notamment celui de la TB pharmacorésistante ; les preuves opérationnelles de sa faisabilité et de son efficacité sont cependant limitées.Objectif : Décrire les résultats de la chirurgie et les défis programmatiques liés à l'offre de chirurgie à Mumbai, Inde.Schéma : Une étude descriptive de données recueillies en routine relatives aux interventions chirurgicales de TBP de 2010 à 2014 dans deux hôpitaux de Mumbai (un public, un privé).Résultats : Sur 85 patients, 5 (6%) sont décédés, 17 (20%) ont eu des complications, dont la plus fréquente était une infection de la plaie. Une deuxième intervention a été nécessaire dans 12 cas (14%). La majorité des procédures a été réalisée en urgence et l'éligibilité a été établie tardivement au cours du traitement. Le délai médian de l'admission à la chirurgie a été de 51 jours. Les profils de résistance de la TB et le résultat final du traitement n'ont pas été recueillis de façon systématique.Conclusion : Dans un contexte lourdement touché comme Mumbai, des données importantes relatives à la chirurgie de la TBP ont été étonnamment limitées à la fois dans le secteur privé et public. L'éligibilité à la chirurgie a été établie tardivement, la culture et le test de pharmacosensibilité n'ont pas été systématiquement proposés, l'intervalle entre l'admission et la chirurgie a été long et les résultats en matière de TB n'ont pas été notés. Un recueil systématique des données permettrait une évaluation correcte de la chirurgie comme traitement adjuvant de toutes les formes de TB dans des conditions de programme.

Marco de referencia: El tratamiento quirúrgico se considera un complemento importante en el manejo de casos específicos de tuberculosis pulmonar (TBP), como la TB farmacorresistente; sin embargo, las pruebas operativas de su factibilidad y eficacia son escasas.Objetivo: Describir los desenlaces quirúrgicos y las dificultades programáticas de la prestación de opciones quirúrgicas a los casos de TBP en Bombay, en la India.Método: Fue este un estudio descriptivo de los datos recogidos de manera sistemática sobre las intervenciones quirúrgicas por TBP, realizadas del 2010 al 2014 en dos hospitales de Bombay (uno del sector público y otro del sector privado).Resultados: De los 85 pacientes tratados, cinco fallecieron (6%), 17 presentaron complicaciones (20%), de las cuales la infección de la herida fue la más frecuente. Fue necesaria una segunda intervención en 12 pacientes (14%). La mayoría de los procedimientos tuvieron lugar en un contexto de urgencia y los criterios de selección se analizaron tarde en el curso del tratamiento. La mediana del tiempo entre la hospitalización y la cirugía fue 51 días. El tipo de resistencia de la TB y los desenlaces terapéuticos no se registraron de manera sistemática.Conclusión: En un entorno con alta carga de morbilidad por TB como Bombay, los datos importantes sobre la cirugía por TBP son sorprendentemente escasos en el sector público y también en el sector privado de atención. Los criterios de selección para la cirugía se analizan tarde, no se ofrece de manera sistemática el cultivo y las pruebas de sensibilidad a los medicamentos, el intervalo entre la hospitalización y el procedimiento es prolongado y se desconocen los desenlaces clínicos de la tuberculosis. La recogida sistemática de datos facilitaría una evaluación adecuada de la cirugía como tratamiento complementario en todas las formas de TB en un contexto programático.

Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults.

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.

En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con diabetes mellitus tipo 2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.

Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults / Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.

En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con diabetes mellitus tipo 2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.

Prevalencia de Helicobacter pylori y características histopatológicas en biopsias gástricas de pacientes con síntomas dispépticos en un centro de referencia de Medellín / Prevalence of Helicobacter pylori and Histopathological Features in Gastric Biopsies from Patients with Dyspeptic Symptoms at a Referral Center in Medellin

Introducción: Helicobacter pylori produce la infección crónica más prevalente en el mundo, principalmente en países en desarrollo. Objetivo: el principal objetivo de este estudio fue estimar la prevalencia de la infección por H. pylori y gastritis en pacientes con síntomas dispépticos llevados a endoscopia digestiva superior y correlacionarlos con los principales hallazgos histopatológicos. Métodos: se revisaron 2708 biopsias gástricas de pacientes que consultaron por síntomas dispépticos entre el año 2012 y 2013 en la Clínica Diagnóstica Especializada VID de la Congregación Mariana de Medellín, y cuyas biopsias se estudiaron en el laboratorio de dicha institución. Las variables histológicas de los resultados reportados por el patólogo se analizaron con métodos estadísticos. Resultados: la prevalencia de la infección por H. pylori fue del 36,4%; la media de edad de los pacientes infectados fue de 46,5 años (DE 17,1), con un pico de prevalencia en el grupo de 40-49 años, a partir del cual disminuyó. La cantidad de H. pylori se correlacionó con la intensidad de la inflamación y de la actividad; asimismo, la presencia de la bacteria se asoció con metaplasia, folículos linfoides, atrofia y pólipos hiperplásicos. La intensidad de la inflamación se asoció con la cantidad de H. pylori y la actividad neutrofílica. Conclusión: la prevalencia de la infección por H. pylori en este estudio es baja comparada con otras investigaciones, y exhibió un comportamiento inusual en los grupos de edad descritos. La cantidad de H. pylori se correlacionó con la intensidad de la inflamación y de la actividad neutrofílica.

Introduction: Helicobacter pylori infection is considered to be the most prevalent chronic infection in the world. It occurs primarily in developing countries. Objective: The main objective of this study was to estimate the prevalence of H. pylori infections and gastritis in patients with dyspeptic symptoms who underwent upper endoscopy and correlate endoscopic findings with principal histopathological findings. Methods: We reviewed 2,708 gastric biopsies from patients who had come to the VID Specialized Diagnostic Clinic of the Congregación Mariana in Medellín because of dyspeptic symptoms in 2012 and 2013. Biopsies were studied in the VID Clinical Laboratory of the Congregación Mariana. Histological variables of the results reported by the pathologist were analyzed with statistical methods. Results: The prevalence of H. pylori infection was 36.4%, the average age of infected patients was 46.5 years (SD: 17.1) with a peak prevalence in the group between 40 and 49 years. Prevalence decreased after age 49. The amount of H. pylori was correlated with the intensity of inflammation and activity. The presence of the bacteria was associated with the presence of metaplasia, lymphoid follicles, atrophy and hyperplastic polyps. The intensity of inflammation was associated with the amount of H. pylori and neutrophil activity. Conclusion: The prevalence of H. pylori infection in our study is low compared with other research and exhibited unusual behavior by age group. The amount of H. pylori was correlated with the intensity of inflammation and neutrophil activity.

Pioderma gangrenoso como complicación de cicatriz de cesárea: comunicación de un caso y revisión de literatura / Pyoderma gangrenosum in a caesarean surgery: a case report and review of the literature

El Pioderma Gangrenoso (PG) es una infrecuente enfermedad inflamatoria dermatológica, caracterizada por una ulceración de la piel rápidamente progresiva y muy dolorosa, de bordes mal definidos. Su etiología es aún desconocida y dista de ser una patología infecciosa. La forma clásica y más frecuente de presentación es la ulcerativa. No existen criterios diagnósticos universales y aceptados para esta patología, los hallazgos histológicos y las alteraciones de laboratorio no son específicos para PG, pero sirven para descartar los diagnósticos diferenciales. La piedra angular del tratamiento es la supresión del proceso inflamatorio y el manejo óptimo de la herida, asegurando un adecuado proceso de cicatrización. Los corticoides son el tratamiento de primera línea.Presentamos el caso de una mujer de 23 años, que luego de una cesárea de urgencia evoluciona con dehiscencia de la herida operatoria, con importante compromiso necrótico y secreción purulenta, que no responde a antibióticos de amplio espectro. Se diagnostica pioderma gangrenoso, iniciándose tratamiento corticoidal, con excelente respuesta.

Pyoderma Gangrenosum (PG) is a rare dermatological condition characterized by rapidly progressive ulceration of the skin, with poorly defined edges and very painful. Its etiology is still unknown and far to be an infectious disease. The classic and most common form of presentation is ulcerative. There are no universal and accepted diagnostic criteria for this disease, the histologic findings and laboratory abnormalities are not specific for PG, but serve to rule out differential diagnosis. The cornerstone of treatment is the suppression of the inflammatory process and optimal wound management, to ensuring proper healing. The corticosteroids are the first line treatment. We report a case of a 23 years woman who evolves with wound dehiscence associated with tissue necrosis and purulent discharge after an emergency caesarean, not responding to broad spectrum antibiotics. The diagnosis of Pyoderma Gangrenosum was made and corticoidal treatment was started, with excellent response.

Scrapie diagnosis in a goat and four Santa Inês sheep from the same herd in Brazil / Diagnóstico de scrapie em um caprino e quatro ovinos Santa Inês de um mesmo rebanho no Brasil

Scrapie is a fatal and progressive transmissible spongiform encephalopathy (TSE) of natural occurrence in sheep and goats. The suspicion of scrapie may be based on clinical signs; however, the detection of pathological features of the prionic protein (PrP) in target tissues is necessary to diagnose the disease. The presence of an abnormal protein form (PrPSc) in lymphoreticular and nervous tissues is an important characteristic in diagnosis. This paper reports a case of scrapie in a flock of 55 Suffolk crossbred sheep, 19 Santa Inês sheep and 21 goats in the Mato Grosso state, midwestern Brazil. The animals were euthanized after the confirmation of a scrapie case with clinical signs in a Suffolk sheep in the same farm...

Scrapie é uma encefalopatia espongiforme transmissível (EET) progressiva e fatal de ocorrência natural em ovinos e caprinos. A suspeita de scrapie é baseada nos sinais clínicos, porém a manifestação patológica da proteína priônica (PrP) nos tecidos-alvo é necessária para a confirmação da doença. A presença de uma forma anormal da proteína (PrPSc) em tecido linforreticular e tecido nervoso constitui uma característica importante para o diagnóstico. Este trabalho é o relato de um foco de scrapie ocorrido em rebanho com 55 ovinos mistos Suffolk, 21 caprinos e 19 ovinos Santa Inês, na região Centro-Oeste do Brasil. Os animais foram eutanasiados após a confirmação de um caso de scrapie com sinais clínicos em um ovino Suffolk nessa propriedade...

Mananoligossacarídeo e ß-glucano em dietas de leitões desmamados / Mannan Oligosaccharides and ß-glucan in diets for weaned piglets

Avaliou-se o efeito da suplementação de mananoligossacarídeo, ß-glucano e antibiótico em dietas de leitões machos castrados, durante a fase de creche (21 aos 54 dias de idade), sobre o desempenho, características morfo-histológicas da mucosa intestinal e ocorrência de diarreia. Foram utilizados 368 leitões de mesma linhagem, distribuídos em delineamento inteiramente ao acaso, com quatro tratamentos (1: 330g de mananoligossacarídeo t/ração (oriundos do núcleo), 2: 1.830g de mananoligossacarídeo t/ração (330g oriundos do núcleo + 1.550g da suplementação), 3: 330g de mananoligossacarídeo (oriundos do núcleo) + 500g de ß-glucano t/ração e 4: 330g de mananoligossacarídeo (oriundos do núcleo) + 250g de Colistina t/ração) e quatro repetições com 23 animais por unidade experimental. O desempenho foi avaliado pelo ganho de peso, consumo de ração e conversão alimentar. As características morfo-histológicas da mucosa intestinal estudadas foram altura de vilosidade, profundidade das criptas intestinais, perímetro de vilosidade e a relação altura de vilosidade:profundidade de cripta do duodeno, jejuno e íleo. A ocorrência de diarreia foi observada diariamente pela avaliação de escore fecal. A suplementação de mananoligossacarídeo, ß-glucano e antibiótico na dieta de leitões machos castrados, na fase de creche, não influenciaram o desempenho e a ocorrência de diarreia. Maior altura de vilosidade e maior profundidade de criptas no duodeno e íleo foram verificadas nos animais suplementados com ß-glucano. No jejuno foi observado maior perímetro de vilosidade nos animais suplementados com ß-glucano e nos animais que não receberam suplemento adicional na dieta.(AU)

The aim of this study was to evaluate the effect of supplementation with mannan oligosaccharides, ß-glucan and antibiotic in diets for castrated male piglets during the nursery phase (21 to 54 days of age) on performance, morpho-histological characteristics of the intestinal mucosa and occurrence of diarrhea. A total of 368 piglets of the same strain, distributed in a completely randomized design with four treatments (1- 330 g mannan oligosaccharides/t of diet (derived of nucleus); 2 - 1,830 g mannan oligosaccharides/t of diet (330g derived of nucleus + 1550g of supplementation); 3 - 330g mannan oligosaccharides (derived of nucleus) + 500g ß-glucan/t of diet; and 4 - 330g mannan oligosaccharides (derived of nucleus) + 250g colistin/t of diet) and four replications with 23 animals per experimental unit. Performance was assessed through weight gain, feed intake and feed conversion. The morpho-histological characteristics of the intestinal mucosa studied were villus height, intestinal crypt depth, villus circumference and villus height:crypt depth of duodenum, jejunum and ileum ratio. The occurrence of diarrhea was observed daily by the evaluation of fecal score. Supplementation of mannan oligosaccharides, ß-glucan and antibiotic in the diet of castrated male piglets in the nursery phase did not affect performance and occurrence of diarrhea. Greater villus height and crypt depth in the duodenum and ileum were verified in the animals supplemented with ß-glucan. In the jejunum, greater villus circumference was observed in the animals supplemented with ß-glucan and in the animals that did not receive additional supplemented diet.(AU)

Avaliação de níveis de glicina+serina em dietas de frangos de corte com reduzido teor de proteína bruta / Evaluation of glycine+serine levels in low crude protein diets for broiler chickens

O experimento foi conduzido em delineamento inteiramente ao acaso para avaliar os efeitos de diferentes níveis de glicina+serina (gli+ser) total em dietas de baixa proteína bruta (PB) sobre o desempenho e características de carcaça de frangos de corte de um a 21 dias de idade. Foram utilizadas 750 aves, distribuídas em cinco tratamentos, cinco repetições e 30 aves por unidade experimental. As dietas utilizadas continham 190g/kg de PB e níveis de gli+ser de 16,7; 19,2; 21,7 e 24,2g/kg; a dieta controle continha 230g/kg de PB. Avaliaram-se os efeitos dos níveis de glicina+serina sobre o desempenho e composição de carcaça. Os dados foram submetidos à análise de variância e os resultados obtidos com as dietas de baixos níveis proteicos com diferentes níveis de gli+ser foram comparados à dieta controle pelo teste de Dunnett. Os níveis de gli+ser apresentaram efeito linear sobre a conversão alimentar, ganho de peso e peso aos 21 dias, sendo o nível de 24,2g/kg de gli+ser com resultado semelhante à dieta controle. A redução proteica aumentou o conteúdo de extrato etéreo na carcaça.(AU)

A completely randomized experimental design was carried out to evaluate the effects of total gly+ser levels in low crude protein diets on performance and body composition of male broiler chickens from 1 to 21 days of age. Seven hundred and fifty broiler chickens were used in each one of the production phases. The birds were randomly allotted to five treatments and five replicates. The diets contained 190g/kg crude protein (CP) and total gly+ser levels of 16.7; 19.2; 21.7 and 24.2g/kg; and a control diet with 230 g/kg CP. The effect of glycine+serine levels on performance and body composition was evaluated. Data were subjected to analysis of variance and the results obtained with the diets of low crude protein levels with different levels of Gly + Ser were compared to the control diet by Dunnett's test. The gly+ser levels improved the feed linearly: weight gain ratio; weight gain and final weight. The broilers fed 24.2g/kg gly+ser diet showed a performance similar to broilers fed control diets. The carcass fat increased with CP reduction.(AU)

TRPV4 activates autonomic and behavioural warmth-defence responses in Wistar rats.

AIM: In this study, we aimed at investigating the involvement of the warmth-sensitive channel - TRPV4 (in vitro sensitive to temperatures in the range of approx. 24-34 °C) - on the thermoregulatory mechanisms in rats. METHODS: We treated rats with a chemical selective agonist (RN-1747) and two antagonists (RN-1734 and HC-067047) of the TRPV4 channel and measured core body temperature, metabolism, heat loss index and preferred ambient temperature. RESULTS: Our data revealed that chemical activation of TRPV4 channels by topical application of RN-1747 on the skin leads to hypothermia and this effect was blocked by the pre-treatment with the selective antagonist of this channel. Intracerebroventricular treatment with RN-1747 did not cause hypothermia, indicating that the observed response was indeed due to activation of TRPV4 channels in the periphery. Intravenous blockade of this channel with HC-067047 caused an increase in core body temperature at ambient temperature of 26 and 30 °C, but not at 22 and 32 °C. At 26 °C, HC-067047-induced hyperthermia was accompanied by increase in oxygen consumption (an index of thermogenesis), while chemical stimulation of TRPV4 increased tail heat loss, indicating that these two autonomic thermoeffectors in the rat are modulated through TRPV4 channels. Furthermore, rats chemically stimulated with TRPV4 agonist choose colder ambient temperatures and cold-seeking behaviour after thermal stimulation (28-31 °C) was inhibited by TRPV4 antagonist. CONCLUSION: Our results suggest, for the first time, that TRPV4 channel is involved in the recruitment of behavioural and autonomic warmth-defence responses to regulate core body temperature.

Teor de metionina + cistina para codornas de corte do nascimento aos 21 dias de idade / Total methionine + cystine level for European quail from hatch to 21 days of age

Estudou-se o efeito do teor de metionina + cistina sobre o desempenho de codornas de corte durante a fase inicial (nascimento ao 21° dia). Foram utilizadas 360 codornas, de ambos os sexos, distribuídas em delineamento experimental inteiramente ao acaso. Os tratamentos consistiram em seis níveis de metionina + cistina total (0,86; 0,96; 1,06; 1,16; 1,26 e 1,36), quatro repetições e 15 aves por unidade experimental. As características avaliadas foram o peso corporal, ganho de peso, consumo e conversão alimentar para fase inicial. Observou-se efeito quadrático significativo do teor de metionina + cistina sobre todas as variáveis avaliadas do nascimento ao 21° dia de idade, sendo observado melhor desempenho nas codornas alimentadas com 1,21% de metionina + cistina para peso corporal e ganho de peso, 1,36% de metionina + cistina para consumo e 1,1% de metionina + cistina para conversão alimentar. A exigência de metionina + cistina para máximo ganho de peso na fase inicial é de 1,21%.

The effect of total methionine + cystine level on the performance traits of European quails during the initial phase of the growth period (from hatch to 21 days of age) was evaluated in a completely randomized experimental design with six levels of total methionine + cystine (.86; .96; 1.06; 1.16;1.26;1.36), with four replicates and 15 quails per experimental unit. Body weight, weight gain, feed intake and feed: weight gain ratio were evaluated. Significant quadratic effects of total methionine + cystine level on the performance traits recorded from hatch to 21 days of age were observed. Highest body weight and weight gain were estimated for quails fed 1.21% total methionoine + cystine diets, lowest feed intake was estimated for quails fed 1.36% diets and best feed: weight gain ratio was estimated for quails fed 1.1% total methionoine + cystine diet. The total methionine + cystine requirement for weight gain from hatch to 21 days of age is 1.21%.