Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review.

Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.

The Use of Computer Records: A Tool to Increase Productivity in Dairy Herds.

The level of adoption of herd management information system veterinary automated management and production control program (VAMPP) Bovine and its impact on productivity of 912 specialized dairy systems with at least 5 years of information recorded was studied. Herds were classified as low (n = 389), medium (n = 343), or high (n = 180) adoption level on the basis of extent and consistency of record keeping for variables related to production, reproduction, and health. For each herd, within-year averages were obtained for six performance traits: age at first calving (AFC), days open (DO), daily milk yield (DMY), productive life (PL), incidence of clinical mastitis (MAST), and incidence of lameness (LAM). These variables were investigated with a generalized linear mixed model that included the fixed effects of the adoption level, follow-up year, and their interaction, adjusted by the fixed effects of herd size, agroecological zone, calendar period, breed group, and the random effects of variation between/within herds. A significant effect of the adoption level over all the variables was observed, except DMY and PL. The follow-up year was significant for all the variables except LAM. There were marked reductions for AFC and DO in the first 4 years of follow-up. AFC was higher and DO shorter in the low compared to medium and high level of adoption herds (p < 0.001). DMY showed a significant increasing trend (p < 0.001), regardless of the adoption level. There was higher MAST and LAM incidence in the higher adoption level (p < 0.05). The economic benefit was estimated through a stochastic simulation model using an approach based in partial budget analysis. For a herd with a medium level of adoption, the change in gross margin (GMMIS $USD) and marginal return rate (MRRMIS %) for the first 5 years of use of the system was estimated. Under these conditions, there was a GMMIS of $6890 and MRRMIS of 163%. Variation of ±10% in DMY and DO caused changes in the GMMIS of ±$1000 and ±$110, respectively, and in MRRMIS ±24% and ±4%, respectively. The trends suggest a positive influence of VAMPP in productive and reproductive traits during the first years of implementation, with less benefit for the low adoption levels.

Late migration of a foreign body in the foot 5 years after initial trauma.

An 11-year-old boy presented to our emergency department because of the extrusion of a small piece of glass through the plantar skin, 5 years after the initial trauma. Another foreign body was identified on ultrasounds and removed surgically. Ultrasound is an accurate test for detection of foreign bodies and to assess potential complications. The treatment of all foreign bodies is surgical exploration and removal, except if the risks of attempting removal are higher than the potential damage of the foreign body in its existing location. Migrations of foreign bodies are not uncommon. Ultrasounds could help for localization and removal as an intraoperative procedure. In case of suspicion of a foreign body after trauma, complementary examinations are required.

In-vitro predatory activity of nematophagous fungi from Costa Rica with potential use for controlling sheep and goat parasitic nematodes.

In tropical and subtropical regions of the world, parasitic diseases are a main cause of losses in livestock productivity. The increased acquired resistence to anthelmintics by gastrointestinal nematodes, requires biological control be considered as a potential feasible and effective alternative. The most effective natural soil enemies of nematodes are nematophagous fungi. In order to collect and identify predator nematophagous fungi (PNF), samples were obtained from 51 farms distributed throughout the seven provinces of Costa Rica. The origin samples included: soil from different crops (potatoes, tomatoes, bananas, ornamental plants, squash and coffee); animal feces (cattle, sheep, goat and horse); soil and fallen leaves from forest; and plants with signs of nematode infection. Each sample was processed using three techniques for the extraction of fungi from soil: sprinkling technique, soil dilution and humidity chamber. Twenty four strains of nematophagous fungi were found in 19 farms; 83.3% of the fungi were isolated by sprinkling technique. The following fungi were identified: Arthrobotrys oligospora (n = 13); Candelabrella musiformis (n = 9); and for the first time there was isolation of A. conoides (n = 1) and A. dactyloides (n = 1) in the country. Moreover, 16 strains from Trichoderma (n=13), Beauveria (n = 1), Clonostachys (n = 1) and Lecanicillium (n = 1) were obtained. In addition, pH of each possible fungal isolation source was measured, and it varied from 5.2 to 9.9, however PNF isolates fell within the range of 5.6 to 7.5. The PNF strains were cultivated in four different media for the production of chhlamydospores: potato dextrose agar (PDA); corn meal agar (CMA); malt extract agar (MEA) and potato carrot agar (PCA). Out of these cultures, 95.8% of the strains formed chlamydospores primarily in the PCA. Of these strains, the profilic spore producers were subjected to ruminant artificial gastrointestinal conditions. A total of 14 fungi were tested, out of which 42.9% survived the digestive analysis. Neither A. conoides nor A. dactyloides were viable following the in vitro gastrointestinal test. The PNF isolated in this study demonstrated an action against ovine and caprine gastrointestinal nematodes and are candidates for use in biological control of these organisms. Among these microorganisms, Candelabrella musiformis appears to be the most promising fungi for use as a biological control agent in Costa Rica.

In-vitro predatory activity of nematophagous fungi from Costa Rica with potential use for controlling sheep and goat parasitic nematodes

In tropical and subtropical regions of the world, parasitic diseases are a main cause of losses in livestock productivity. The increased acquired resistence to anthelmintics by gastrointestinal nematodes, requires biological control be considered as a potential feasible and effective alternative. The most effective natural soil enemies of nematodes are nematophagous fungi. In order to collect and identify predator nematophagous fungi (PNF), samples were obtained from 51 farms distributed throughout the seven provinces of Costa Rica. The origin samples included: soil from different crops (potatoes, tomatoes, bananas, ornamental plants, squash and coffee); animal feces (cattle, sheep, goat and horse); soil and fallen leaves from forest; and plants with signs of nematode infection. Each sample was processed using three techniques for the extraction of fungi from soil: sprinkling technique, soil dilution and humidity chamber. Twenty four strains of nematophagous fungi were found in 19 farms; 83.3% of the fungi were isolated by sprinkling technique. The following fungi were idenified: Arthrobotrys oligospora (n=13); Candelabrella musiformis (n=9); and for the first time there was isolation of A. conoides (n=1) and A. dactyloides (n=1) in the country. Moreover, 16 strains from Trichoderma (n=13), Beauveria (n=1), Clonostachys (n=1) and Lecanicillium (n=1) were obtained. In addition, pH of each possible fungal isolation source was measured, and it varied from 5.2 to 9.9, however PNF isolates fell within the range of 5.6 to 7.5. The PNF strains were cultivated in four different media for the production of chhlamydospores: potato dextrose agar (PDA); corn meal agar (CMA); malt extract agar (MEA) and potato carrot agar (PCA). Out of these cultures, 95.8% of the strains formed chlamydospores primarily in the PCA. Of these strains, the profilic spore producers were subjected to ruminant artificial gastrointestinal conditions. A total of 14 fungi were tested, out of which 42.9% survived the digestive analysis. Neither A. conoides nor A. dactyloides were viable following the in vitro gastrointestinal test. The PNF isolated in this study demostrated an action against ovine and caprine gastrointestinal nematodes and are candidates for use in biological control of these organisms. Among these microorganisms, Candelabrella musiformis appears to be the most promising fungi for use as a biological control agent in Costa Rica. Rev. Biol. Trop. 59 (1): 37-52. Epub 2011 March 01.

El control biológico es en la actualidad una alternativa para el control de los nematodos gastrointestinales que desarrollaron resistencia a los principales grupos de antihelmínticos. Para el aislamiento e identificación de hongos nematófagos depredadores, se tomaron muestras de 51 fincas distribuidas entre todas las provincias de Costa Rica. La naturaleza de las muestras incluyó: suelos de diferentes sembradíos (papa, tomate, banano, plantas ornamentales, chayote y café), heces de animales (bovinos, ovinos, caprinos y equinos), suelo y hojarasca de bosques y plantas con signos de enfermedad causada por nematodos. Las muestras se procesaron mediante 3 técnicas diferentes para la extracción de hongos a partir del suelo: espolvoreado en placa, dilución de suelos y cámara húmeda. Veinticuatro cepas de hongos nematófagos fueron aisladas de 19 fincas; el 83.3% de éstos fueron aislados mediante las técnica de espolvoreado en placa. Los hongos fueron identificados como: Arthrobotrys oligospora (n=13), Candelabrella musiformis (n=9) y por primera vez se reporta el aislamiento de A. conoides (n=1) y A. dactyloides (n=1) en el país. Asimismo, se aislaron 16 cepas de hongos de los géneros Trichoderma (n=13), Beauveria (n=1), Clonostachys (n=1) y Lecanicillium (n=1). Adicionalmente se les midió el pH, el cual varió entre 5.2-9.9, ubicándose los HND dentro de un rango entre 5.6-7.5. Las cepas de HND fueron cultivadas en 4 medios diferentes para la producción de clamidosporas: papa dextrosa agar, harina de maíz, extracto de malta y agar papa-zanahoria. El 95.8% de las cepas aisladas produjeron clamidosporas, principalmente en el medio agar papa-zanahoria. De estas cepas, se escogieron las de mayor producción para ser sometidas a la prueba de digestibilidad in vitro. Un total de 14 cepas fueron sometidos a esta prueba, de las cuales el 42.9% resultaron viables; de éstas, las cepas de A. conoides y A. dactyloides no sobrevivieron a la prueba de digestibilidad in vitro. De los microorganismos aislados, Candelabrella musiformis se considera el más promisorio de los hongos como agente biológico en Costa Rica.

[What's up in patella dislocation? The medial femoro-patellaire ligament (MFPL)]. / Luxation de la rotule: rôle du ligament fémoro-patellaire médial.

Patella dislocation is an injury affecting teenagers. This pathology is associated in the majority of the cases with a dysplasia of the femoro-patellar joint. MFPL is a passive restraint to patellar lateral displacement. Rupture of the MFPL would predispose the patients to redislocate their patella. Therefore, a reconstruction of this ligament seems to be a logical proposal for the treatment of recurrent patellar instability. This surgery, carried out with three incisions of small size, would decrease the recurrent dislocation. However, a long-term analysis of the results of this surgery is recommended.

Nonunion after fracture of the anterior tibial spine: case report and review of the literature.

Nonunion of anterior tibial spine of tibia in children is quite rare, but it could be associated with significant instability of the knee as it involves the fixation of anterior cruciate ligament. We report one case in which open reduction and internal fixation was carried out with good functional results. A literature review was performed to identify the cases reported of tibial eminence nonunion in children.

Acetabular revision with freeze-dried irradiated and chemically treated allograft: a minimum 5-year follow-up of 17 cases.

We reviewed the results of 17 consecutive revision total hip arthroplasties performed with the use of freeze-dried irradiated bone allograft in 15 patients. These allografts were used in conjunction with five Kerboull rings, two steel meshes and ten cemented isolated cups. All the patients have had a follow-up of at least 5 years. The patients were evaluated clinically and radiographically. No revisions were necessary and X-rays confirmed partial or total ingrowth of the allografts. In acetabular revision surgery, hip reconstruction can be successfully treated by freeze-dried irradiated and chemically treated allografts. Additional studies with longer term follow-up are necessary to confirm this outcome.

[Osgood-Schlatter disease]. / Maltadie d'Osgood-Schlatter.

Osgood-Schlatter disease is a painful affection of the knee which touches particularly the active teenagers. Etiology of this frequent affection is unknown. This disease appears as an anterior knee pain and swelling started and worsened by the sports activities. Diagnosis is especially clinical. X-Rays, ultrasounds or IRM are not necessary for the diagnosis. Treatment is based on eviction of sports, analgesics and sometimes physiotherapy. Surgery is rarely proposed. Knee pain stops at the end of the growth. Long-term outcome is good for the majority of the patients. Some studies suggest a patella alta at the end of the growth, without an established correlation with knee arthritis.

Antifúngicos de uso clínico, análisis de un laboratorio de micología / Antifungal therapy for clinical use, analysis of a mycology laboratory

Se hace una revisión exhaustiva desde un punto de vista del laboratorio de micología al uso de los antifúngicos clásicos tanto de uso clínico como tópico para el uso en humano como el uso en animales además se describen los nuevos antifúngicos que han aparecido en el mercado como el Voriconazol, Terbinafina y las Equinocandinas, cuyo futuro es promisorio tanto en infecciones superficiales y sistémicas.