Anticonvulsivantes y su efecto en el metabolismo de la vitamina D: revisión del tema, a propósito de un caso / Anticonvulsants and their effect on the metabolism of vitamin D: literature review with case report

La epilepsia es una enfermedad neurológica frecuente que afecta a cerca de 50.000 millones de personas en el mundo. En Chile, la prevalencia estimada es de 10.8 a 17 por 1.000 habitantes. La primera opción para su tratamiento son los fármacos antiepilépticos (FAE) los cuales logran un aceptable control de enfermedad en la mayoría de los casos, sin embargo, tienen la potencialidad de desencadenar una serie de efectos adversos destacando entre ellos el desarrollo de hipocalcemia (HC) secundaria a hipovitaminosis D (HD), alteración que por lo general es leve y asintomática. Presentamos el caso de una mujer perimenopausica con antecedente de epilepsia en tratamiento con anticonvulsivante que desarrolla hipocalcemia severa. Además revisamos los mecanismos descritos a través de los cuales los FAE afectan el metabolismo de esta vitamina.

Epilepsy is a common neurological disease that affects about 50,000 million people in the world. The estimated prevalence is 10.8 to 17 per 1.000 inhabitants in Chile. The first option for its treatment are antiepileptic drugs (AEDs) which achieve an acceptable control of the disease in most cases, however, they have the potential to trigger a series of adverse effects (AE) highlighting among them the development of hypocalcemia (HC) secondary to hypovitaminosis D (HD), an alteration that is generally mild and asymptomatic. We present the case of a perimenopausal woman with a history of epilepsy under treatment with an anticonvulsant who develops severe hypocalcemia. We also review the mechanisms described through which AEDs affect the metabolism of this vitamin.

Consideraciones en el manejo del adulto con Hiperplasia Suprarrenal congénita clásica por déficit de 21-Hidroxilasa / Management considerations for the adult with congenital adrenal hyperplasia due 21-hydroxylase deficiency

La Hiperplasia Suprarrenal Congénita (HSRC) corresponde a un grupo de defectos genéticos en la síntesis de cortisol. El 95% de ellas son debidas al déficit de 21-hidroxilasa por lo que nos referiremos solo a esta deficiencia. La hiperplasia suprarrenal congénita clásica (HSRC-C) debuta en recién nacidos o lactantes con insuficiencia suprarrenal primaria, diferentes grados de hiperandrogenismo clínico en mujeres y puede coexistir con hipotensión, hiperkalemia e hiponatremia si hay un déficit clínico de aldosterona. El objetivo de este artículo es actualizar el conocimiento y enfoques sugeridos para el manejo de la HSRC-C desde el inicio de sus controles en la etapa adulta. El diagnóstico diferencial en retrospectiva de la HSRC-C y la no clásica (HSRC-NC) a veces resulta difícil ya que esta enfermedad es un espectro fenotípico continuo. La insuficiencia suprarrenal y la dependencia a terapia corticoidal son los eventos principales para diferenciar estas dos patologías que tienen enfoques terapéuticos diferentes. El tratamiento de la HSRC-C en adultos abarca 2 objetivos primarios: la adecuada sustitución de la falla suprarrenal y el control de hiperandrogenismo mediante el uso de corticoides en sus dosis mínimas efectivas. En la mujer existen terapias complementarias para el control del hiperandrogenismo como anticonceptivos y otras que se encuentran en diferentes fases de investigación. Esto permite disminuir las dosis de corticoides en algunos casos. Es importante a la vez abordar tres objetivos secundarios: controlar el riesgo cardiometabólico propio de la enfermedad, evitar el sobre tratamiento corticoidal y manejar la infertilidad. La correcta monitorización del tratamiento en adultos tomando en cuenta los objetivos descritos permite una mejor calidad de vida en estos pacientes. Finalmente el consejo genético debe realizarse en todos los pacientes con HSRC que deseen fertilidad y en sus parejas. El estudio requiere de secuenciación del gen CYP21A2 y debe realizarse en un laboratorio de experiencia.

Congenital Adrenal Hyperplasia (CAH) are a group of genetic defects characterized by impaired cortisol synthesis. 95% of them are due to 21-hydroxylase deficiency. We will discuss only this enzyme's deficiency. Classic congenital adrenal hyperplasia (CAH-C) debuts in newborns or infants with primary adrenal insufficiency, some degree of clinical hyperandrogenism in newborn females, and can coexist with hypotension, hyperkalemia, and hyponatremia if there is a clinical aldosterone deficiency. The objective of this article is to update the knowledge and suggested approaches for the management of CAH-C from the beginning of its controls in the adult stage. The retrospective differential diagnosis of CAH-C and non-classical (CAH-NC) is sometimes difficult because this disease is a continuous phenotypic spectrum. Adrenal insufficiency and dependence on corticosteroid therapy are the main events to differentiate these two pathologies that have different therapeutic approaches. In adults, the treatment of CAH-C must include 2 primary objectives: adequate the replacement of adrenal failure and control of hyperandrogenism, through the use of corticosteroids in their minimum effective doses. In women there are complementary therapies for the control of hyperandrogenism, such as contraceptives and others that are in different phases of research. This makes it possible to reduce the doses of corticosteroids in some cases. It is important at the same time to address three secondary objectives: control the cardiometabolic risk of the disease secondary to corticosteroid treatment, avoid corticosteroid overtreatment and manage infertility. The correct monitoring of treatment in adults and taking in to account the objectives described, allows a better quality of life in these patients. Finally, genetic counseling must be carried out in all patients planning for children, with any type of CAH and in their partners. The study requires sequencing of the CYP21A2 gene and must be performed in a certified laboratory.

Co-adaptation of electric organ discharges and chirps in South American ghost knifefishes (Apteronotidae).

Animal communication signals that simultaneously share the same sensory channel are likely to co-evolve to maximize the transmission of each signal component. Weakly electric fish continuously produce a weak electric field that functions in communication. Fish modulate the electric organ discharge (EOD) on short timescales to produce context-specific signals called chirps. EODs and chirps are simultaneously detected by electroreceptors and processed in the electrosensory system. We analyzed these signals, first to explore whether EOD waveform is encoded in the signal received by electroreceptors and then to examine how EODs and chirps interact to influence conspicuousness. Our findings show that gross discrimination of sinusoidal from complex EOD waveforms is feasible for all species, but fine discrimination of waveform may be possible only for species with waveforms of intermediate complexity. The degree of chirp frequency modulation and chirp relative decay strongly influenced chirp conspicuousness, but other chirp parameters were less influential. The frequency difference between the interacting EODs also strongly impacted chirp conspicuousness. Finally, we developed a method for creating hybrid chirp/EOD combinations to independently analyze the impact of chirp species, EOD species, and EOD difference frequency on chirp conspicuousness. All three components and their interactions strongly influenced chirp conspicuousness, which suggests that evolutionary changes in parameters of either chirps or EODs are likely to influence chirp detection. Examining other environmental factors such as noise created by fish movement and species-typical patterns of sociality may enrich our understanding of how interacting EODs affect the detection and discrimination of chirps across species.

Evolution of electric communication signals in the South American ghost knifefishes (Gymnotiformes: Apteronotidae): A phylogenetic comparative study using a sequence-based phylogeny.

The electric communication signals of weakly electric ghost knifefishes (Gymnotiformes: Apteronotidae) provide a valuable model system for understanding the evolution and physiology of behavior. Apteronotids produce continuous wave-type electric organ discharges (EODs) that are used for electrolocation and communication. The frequency and waveform of EODs, as well as the structure of transient EOD modulations (chirps), vary substantially across species. Understanding how these signals have evolved, however, has been hampered by the lack of a well-supported phylogeny for this family. We constructed a molecular phylogeny for the Apteronotidae by using sequence data from three genes (cytochrome c oxidase subunit 1, recombination activating gene 2, and cytochrome oxidase B) in 32 species representing 13 apteronotid genera. This phylogeny and an extensive database of apteronotid signals allowed us to examine signal evolution by using ancestral state reconstruction (ASR) and phylogenetic generalized least squares (PGLS) models. Our molecular phylogeny largely agrees with another recent sequence-based phylogeny and identified five robust apteronotid clades: (i) Sternarchorhamphus+Orthosternarchus, (ii) Adontosternarchus, (iii) Apteronotus+Parapteronotus, (iv) Sternarchorhynchus, and (v) a large clade including Porotergus, 'Apteronotus', Compsaraia, Sternarchogiton, Sternarchella, and Magosternarchus. We analyzed novel chirp recordings from two apteronotid species (Orthosternarchus tamandua and Sternarchorhynchus mormyrus), and combined data from these species with that from previously recorded species in our phylogenetic analyses. Some signal parameters in O. tamandua were plesiomorphic (e.g., low frequency EODs and chirps with little frequency modulation that nevertheless interrupt the EOD), suggesting that ultra-high frequency EODs and "big" chirps evolved after apteronotids diverged from other gymnotiforms. In contrast to previous studies, our PGLS analyses using the new phylogeny indicated the presence of phylogenetic signals in the relationships between some EOD and chirp parameters. The ASR demonstrated that most EOD and chirp parameters are evolutionarily labile and have often diversified even among closely related species.

Familial clustering of systemic lupus erythematosus in the cayman islands.

OBJECTIVE: To describe the unusual clustering of systemic lupus erythematosus (SLE) in a family from the Cayman Islands. METHOD: An observational retrospective study of SLE was done following an index case of mixed connective tissue disease in a 51-year old West Indian woman of African descent. Her two daughters of the same father, who is of Cayman Islands origin, were also diagnosed with SLE. A family tree was subsequently drawn up to 1890 to identify other cases in the same family. RESULTS: There were 13 cases identified and all occurred between the 6th and the 8th generation. A family tree linked all cases to a man from the Cayman Islands who died in 1890. The nine cases with full medical records showed eight females and one male (8:1). The mean age at diagnosis was 29 years; polyarthritis occured in all nine patients (100%), kidney involvement in 6/9 (66.6%), skin rash in 6/9 (66.6%), pleuritis and pericarditis in 6/9 (66.6%) and anaemia in 6/9 (66.6%). The autoantibodies were mainly ANA in all patients (100%) and anti-dsDNA in 8/9 (88.8%). CONCLUSION: The unusual extensive familial clustering in this study represents the first to be described in a West Indian population where SLE is most prevalent and may suggest a genetic predisposition.

Antibiotic residues in milk from small dairy farms in rural Peru.

The use of antibiotics in livestock can pose a public health threat, especially if antibiotic residues remain in the food product. Understanding how often and why farmers sell products with antibiotic residues is critical to improving the quality of these products. To understand how often milk with antibiotic residues is sold on small farms in a major dairy-producing region of Peru and identify factors associated with selling milk with antibiotic residues, we tested milk samples for antibiotic residues from every provider on three routes of commercial milk companies and from bulk tanks of farmers currently treating cows with antibiotics. We also asked farmers if they sold milk from treated cows and examined factors associated with the tendency to do so. The prevalence of milk contamination with antibiotic residues on commercial routes was low (0-4.2%); however, 33/36 farmers treating their animals with antibiotics sold milk that tested positive for antibiotic residues. The self-reported sale of milk from treated cows had a sensitivity, specificity, and positive and negative predictive values of 75.8%, 100%, 100% and 27.2%, respectively (with testing of milk for residues as the gold standard). Finally, 69/156 randomly selected farmers reported selling milk from treated cows, and farmers' knowledge of antibiotics and the milk purchaser were significantly associated with a farmer's tendency to report doing so. Educating farmers on the risks associated with antibiotics and enforcement of penalties for selling contaminated milk by milk companies are needed to improve milk quality.

Comparison of two methods for collecting antibiotic use data on small dairy farms.

Antibiotics are commonly used in animal agriculture; they can improve animal health and productivity, but their use may also represent a public health threat. Very little is known about antibiotic use on small farms in lower/middle income countries. To understand antibiotic use on these farms and promote the judicious use of these drugs, pharmacoepidemiologic data are necessary. However, acquiring such data can be difficult, as farmers are often illiterate (and therefore cannot participate in written surveys or keep treatment records), antibiotics can be obtained over-the-counter (in which case no prescriptions are generated) and monitoring and surveillance systems for drug use are often non-existent. The goal of this study was to compare two methods of acquiring pharmacoepidemiologic data pertaining to antibiotics that are well-adapted to farms in lower-middle income countries: self-report and the collection of discarded drug packaging. A convenience sample of 20 farmers in Cajamarca, Peru, participated in the study. Farmers placed discarded antibiotic packaging in bins for six months. At the end of the six-month period, farmers were interviewed and asked to recall the antibiotic usage that occurred on their farm over the past month and past six months; these self-reported data were quantitatively and qualitatively compared to the bin contents collected in the last month and previous six months. We found that the agreement between the bins and self-report was relatively poor for both the quantity and types of antibiotics used. The bins appeared to perform better than self-report when bottles and mLs of antibiotics were measured, while self-report appeared to perform better for intra-mammary infusions. The bins also appeared to perform better when data pertaining to an extended time period (six months) were collected. The results of this study will provide guidance to investigators seeking to collect pharmacoepidemiologic data in similar environments.

The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis.

For women of reproductive age, excessive gestational weight gain and/or postpartum weight retention can increase the risk of obesity. This systematic review evaluates the effectiveness of lifestyle modification control trials that utilize exercise interventions, with or without dietary intervention, on weight loss among postpartum women. A search of randomized clinical trials (RCT) was performed using the follow databases and the bibliography of candidate studies: MEDLINE, Web of Science, EMBASE, CENTRAL/Cochrane and Physiotherapy Evidence Database. English language RCT papers published up to 31 October 2012, which present changes on maternal body weight from baseline to the end of exercise intervention were included. The primary meta-analysis examined the effects of exercise interventions, with or without complementary dietary intervention, on weight loss during the postpartum period compared with usual standard of care. Five subgroup analyses were performed to examine differences in study interventions and exercise modalities: duration of intervention, quality of study methodology, supervision of exercise intervention, exercise intervention goals used and the type of dietary intervention. In total 11 studies met eligibility criteria with 769 participants, 409 under intervention and 360 in the control group. The primary meta-analysis included all 11 studies and found a mean difference (MD) on weight loss of -2.57 kg (95% CI -3.66 to -1.47). The subgroup analysis demonstrated that the most effective interventions in reducing weight in postpartum women were exercise programs with objectively defined goals, such as the use of heart rate monitors or pedometer (MD of -4.09 kg-95% CI -4.94 to -3.25, I(2)=0%) and exercise combined with intensive dietary intervention (MD of -4.34 kg-95% CI -5.15 to -3.52, I(2)=0%). Thus, there is benefit from overall lifestyle interventions on weight loss in postpartum women and exercise plus intensive diet and objective targets are the most effective intervention strategies.

The use of antibiotics on small dairy farms in rural Peru.

Very little is known about the use of antibiotics on small dairy farms in lower/middle-income countries. The use of these drugs can have profound impacts on animal health, farmer income and public health. A survey of 156 farmers was conducted in Cajamarca, a major dairy-producing center in the highlands of Peru characterized by small farms (<15 cows) to assess patterns and determinants of antibiotic use and farmers' knowledge of antibiotics. The reported incidence of disease on these farms was relatively low (0.571 episodes of disease per cow-year), but more than 83% of the reported episodes were treated with antibiotics. The most commonly used antibiotics were oxytetracycline, penicillin and trimethoprim-sulfamethoxazole drugs; antiparasitic drugs were also used to treat what were likely bacterial infections. An increased incidence of treated disease was significantly associated with smaller farm size, lower farmer income, the previous use of the Californian Mastitis test on the farm and antibiotic knowledge. Farmers' knowledge of antibiotics was assessed with a series of questions on antibiotics, resulting in a "knowledge score". Increased knowledge was significantly associated with the use of antibiotics for preventative reasons, the purchase of antibiotics from feed-stores, the experience of complications in animals after having administered antibiotics, the number of workers on the farm and the educational level of the farmer. Overall, antibiotics appeared to be used infrequently, most likely because therapeutic interventions were sought only when the animal had reached an advanced stage of clinical disease. Few farmers were able to define an antibiotic, but many farmers understood that the use of antibiotics carried inherent risks to their animals and potentially to the consumers of dairy products from treated animals. The results of this study are useful for understanding the patterns of antibiotic use and associated management, demographic and knowledge factors of farmers on small dairy farms in rural Peru.

The association of birth order with later body mass index and blood pressure: a comparison between prospective cohort studies from the United Kingdom and Brazil.

BACKGROUND: Previous studies have found greater adiposity and cardiovascular risk in first born children. The causality of this association is not clear. Examining the association in diverse populations may lead to improved insight. METHODS: We examine the association between birth order and body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP) in the 2004 Pelotas cohort from southern Brazil and the Avon Longitudinal Study of Parents and Children (ALSPAC) from Bristol, south-west England, restricting analysis to families with two children in order to remove confounding by family size. RESULTS: No consistent differences in BMI, SBP or DBP were observed comparing first and second born children. Within the Pelotas 2004 cohort, first born females were thinner, with lower SBP and DBP; for example, mean difference in SBP comparing first with second born was -0.979 (95% confidence interval -2.901 to 0.943). In ALSPAC, first born females had higher BMI, SBP and DBP. In both cohorts, associations tended to be in the opposite direction in males, although no statistical evidence for gender interactions was found. CONCLUSIONS: The findings do not support an association between birth order and BMI or blood pressure. Differences to previous studies may be explained by differences in populations and/or confounding by family size in previous studies.

The role of veterinarians and feed-store vendors in the prescription and use of antibiotics on small dairy farms in rural Peru.

This study aimed to describe and compare the role of veterinarians and feed-store vendors in the use of antibiotics on small dairy farms in Cajamarca, Peru, a major dairy-producing center characterized by small, rural farms with poor, mostly uneducated farmers. We used a purposive sampling strategy to recruit 12 veterinarians into 2 focus group discussions and supplemented these data with 8 semi-structured interviews with feed-store vendors. Participants reported that inappropriate antibiotic usage was widespread among their clients, which may prevent the efficient use of drugs on farms where animal disease can be devastating to the livelihood of the farmer. Participants also identified many barriers to appropriate prescribing and use, including availability of drugs, competition from other prescribers, economic constraints and habits of farmers, and limited farmer knowledge of drugs and disease. Veterinarians expressed mistrust toward nonprofessional prescribers, whereas feed-store vendors felt that veterinarians were important partners in promoting the health of their clients' animals.

Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK.

BACKGROUND: Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)-maternal education and family income-and maternal and infant health outcomes between ALSPAC and Pelotas cohorts. METHODS: Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. RESULTS: An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. CONCLUSIONS: Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.

Hormonal and behavioral correlates of morphological variation in an Amazonian electric fish (Sternarchogiton nattereri: Apteronotidae).

The weakly electric fish from the main channel of the Amazon river, Sternarchogiton nattereri, offers a striking case of morphological variation. Females and most males are toothless, or present only few minute teeth on the mandible, whereas some males exhibit exaggerated, spike-like teeth that project externally from the snout and chin. Androgens are known to influence the expression of sexually dimorphic traits, and might be involved in tooth emergence. In this study we assess the relationship in S. nattereri between morphological variation, 11 ketotestosterone (11-KT) and testosterone (T). We also examine relationships of morphology and androgen levels with electric organ discharge (EOD) frequency, reproductive condition, and seasonality. Our main finding is that male morph categories differed significantly in plasma concentrations of 11-KT, with toothed males showing higher levels of 11-KT than toothless males. By contrast, we did not detect statistical differences in T levels among male morph categories. Reproductive condition, as measured by gonadosomatic indexes (GSI), differed across two sample years, increased as the season progressed, and was higher in toothed males than in non-toothed males. EOD frequency was higher in toothed males than in either toothless males or females. Taken together, our findings suggest that S. nattereri male sexual characters are regulated by 11-KT levels, and that both morphology and androgens interact with reproductive condition and EOD frequency in ways that vary within and across reproductive seasons.

Variation in the number of ovarian follicles in cattle: possible causes and consequences

Background: Antral follicle count (AFC, follicles e"3 mm in diameter) varies between 5 and 50 follicles in among Bos taurus cattle. AFC is highly repeatable within animals, and is correlated with the total number of follicles in ovaries. Cattle with low AFC have higher circulating concentrations of FSH and LH, but lower concentrations of AMH, progesterone and androgens than animals with high AFC. Review: The cause of the inherently high variation in the number of follicles is unknown but it is reasonable to speculate that maternal nutrition during gestation, at the time of ovarian development in their foetuses, may impact oogonia proliferation and thus follicle numbers postnatally. We have recently started to test this hypothesis by restricting nutrition of beef heifers to 0.6 of their maintenance energy requirements, from shortly before conception to the end of the first trimester of pregnancy (period encompassing the peak in oocyte numbers in foetuses). Results show that calves born to nutritionally restricted mothers have a 60% lower peak, minimum and mean AFC during follicular waves compared with calves born to mothers fed control diets. Interestingly these calves from restricted mothers also had higher blood pressure compared to controls. Additional studies also provide evidence to suggest that fertility may be compromised in animals with low AFC due to effects on oocytes, progesterone and the endometrium compared to animals with high AFC. To test this hypothesis we performed ovarian ultrasonography on 306 dairy cows during the first wave of follicular development 1 to 4 months post partum and recorded their reproductive performances during the breeding season; cows with a high AFC had higher pregnancy rates, shorter calving to conception intervals and received fewer services during the breeding season compared to cows with a low AFC. Conclusion: Recent studies suggest that the numbers of follicles in follicle waves, and in total in the ovaries, may now be an important consideration for further efforts to understand and manipulate fertility. Since ovarian follicle numbers are reflective of the environment during foetal development when all the organ systems are developing, altered follicle numbers may also be reflective of other developmental difference in organs that may have more profound effects on the animals health and welfare beyond effects on reproduction and fertility.

Video image analysis as a potential grading system for Uruguayan beef carcasses.

A study was conducted in 2 phases to evaluate the effectiveness of 1) the VIAscan Beef Carcass System (BCSys; hot carcass system) and the CVS BeefCam (chilled carcass system), used independently or in combination, to predict Uruguayan beef carcass fabrication yields; and 2) the CVS BeefCam to segregate Uruguayan beef carcasses into groups that differ in the Warner-Bratzler shear force (WBSF) values of their LM steaks. The results from the meat yield phase of the present study indicated that the prediction of saleable meat yield percentages from Uruguayan beef carcasses by use of the BCSys or CVS BeefCam is similar to, or slightly better than, the use of USDA yield grade calculated to the nearest 0.1 and was much more effective than prediction based on Uruguay National Institute of Meat (INAC) grades. A further improvement in fabrication yield prediction could be obtained by use of a dual-component video image analysis (VIA) system. Whichever method of VIA prediction of fabrication yield is used, a single predicted value of fabrication yield for every carcass removes an impediment to the implementation of a value-based pricing system. Additionally, a VIA method of predicting carcass yield has the advantage over the current INAC classification system in that estimates would be produced by an instrument rather than by packing plant personnel, which would appeal to cattle producers. Results from the tenderness phase of the study indicated that the CVS BeefCam output variable for marbling was not (P > 0.05) able to segregate steer and heifer carcasses into groups that differed in WBSF values. In addition, the results of segregating steer and heifer carcasses according to muscle color output variables indicate that muscle maturity and skeletal maturity were useful for segregating carcasses according to differences in WBSF values of their steaks (P > 0.05). Use of VIA to predict beef carcass fabrication yields could improve accuracy and reduce subjectivity in comparison with use of current INAC grades. Use of VIA to sort carcasses according to muscle color would allow for the marketing of more consistent beef products with respect to tenderness. This would help facilitate the initiation of a value-based marketing system for the Uruguayan beef industry.

Early life diarrhoea and later blood pressure in a developing country: the 1982 Pelotas (Brazil) birth cohort study.

BACKGROUND: It has recently been hypothesised that acute dehydration in early childhood may "programme" increased blood pressure via salt retention. We examined whether there was an association between episodes of diarrhoea (a proxy for acute dehydration) and later measured blood pressure. METHODS: In the 1982 Pelotas birth cohort study (Brazil), parents/carers reported hospital admissions for diarrhoea in the first 12 and 20 months of study members' lives. Blood pressure was subsequently measured directly in adolescence (aged 15, 18, 19 years) and early adulthood (aged 23 years). RESULTS: We found no evidence of an association between diarrhoea in the first 12 months of life and blood pressure measured at any point in adolescence or early adulthood. These findings were unchanged after adjustment for a range of covariates. Equally null results were apparent when diarrhoea admissions in the first 20 months of life, access to home sanitation and use of piped water were the exposures of interest. CONCLUSIONS: Early life proxies for dehydration and diarrhoea were unrelated to later blood pressure in this examination, the most comprehensive to date, of the potential association.

¿Es efectiva la consejería para aumentar el consumo de frutas y verduras y disminuir el riesgo cardiovascular en prevención secundaria?: una revisión / Is counseling an effective strategy to increase fruits and vegetables consumption and decrease the cardiovascular risk in secondary prevention?: a review

Introducción: El consumo de frutas y verduras, dado su alto contenido de fibra y antioxidantes, se ha asociado a una mejoría de algunos de los parámetros biológicos que modifican el riesgo cardiovascular, como el colesterol total, colesterol LDL y la presión arterial. Dentro de las estrategias dirigidas a aumentar la ingesta de vegetales, la consejería es una de las más estudiadas. Métodos: se realizó una búsqueda en la base de datos MEDLINE, y en referencias de otras revisiones. Resultados: se revisaron 42 resúmenes (36 de MEDLINE y 6 de la revisión del United States Preventive Service Task Forcé) de los cuales se seleccionaron 30. De estos 30, 8 cumplieron con los criterios de inclusión. Se encontró evidencia epidemiológica sólida que asoció el consumo de frutas y verduras a una disminución del riesgo cardiovascular (RCV). No encontramos evidencia suficiente respecto a la efectividad de la consejería para modificar el perfil de riesgo en prevención secundaria. Conclusiones: la consejería produce cambios modestos en la dieta y el perfil de riesgo en pacientes sanos, sin embargo se necesita más información respecto su efectividad en pacientes con enfermedad CV y a sus efectos a largo plazo.

Introduction: Consumption of fruits and vegetables, due to their high fiber and antioxidant contain, has been associated with an improvement in some biological parameters that modify cardiovascular risk, such as total cholesterol, LDL cholesterol and blood pressure. One of the most investigated strategies to increase the consumption of vegetables is counselling. Method: We searched the MEDLINE database and other review references. Results: 42 abstraéis were reviewed (36from MEDLINE and 6 of United States Preventive Service Task Force Review) and 30 were selected. Of the 30, 8 match with the inclusion criteria. We found solid epidemiological evidence that showed the association between the intake of fruits and vegetables and cardiovascular risk factors. We did not find enough evidence to demonstrate that counselling is effective in modifying the risk profile in secondary prevention. Conclusion: counselling produces modest changes in the diet and the risk profile in healthy patients, but there is still a need for more information about its effectiveness in long term changes in patients with high cardiovascular risk.

Aumento del daño en el ADN y estrés oxidativo en espermatozoides de pacientes con oligozoospermia idiopática y antecedentes de criptorquidismo / Extent of sperm DNA damage in spermatozoa from men examined for infertility. Relationship with oxidative stress

Background: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. Aim: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress. Patients and methods: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay. Results: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8±5.6; TUNEL+: 26.9±3.0) or cryptorchidism (DFI: 26.4±10.1; TUNEL+: 29.1±3.9), compared with controls (DFI: 7.1±0.9; TUNEL+: 14.2±1.2). Similarly, both groups of patients had significantly higher (p <0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation. Conclusions: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

Saharan dust - a carrier of persistent organic pollutants, metals and microbes to the Caribbean? / Polvo sahariano: ¿portador de contaminantes orgánicos persistentes, metales y microbios al Caribe?

An international team of scientists from government agencies and universities in the United States, U.S. Virgin Islands (USVI), Trinidad & Tobago, the Republic of Cape Verde, and the Republic of Mali (West Africa) is working together to elucidate the role Saharan dust may play in the degradation of Caribbean ecosystems. The first step has been to identify and quantify the persistent organic pollutants (POPs), trace metals, and viable microorganisms in the atmosphere in dust source areas of West Africa, and in dust episodes at downwind sites in the eastern Atlantic (Cape Verde) and the Caribbean (USVI and Trinidad & Tobago). Preliminary findings show that air samples from Mali contain a greater number of pesticides, polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) and in higher concentrations than the Caribbean sites. Overall, POP concentrations were similar in USVI and Trinidad samples. Trace metal concentrations were found to be similar to crustal composition with slight enrichment of lead in Mali. To date, hundreds of cultureable micro-organisms have been identified from Mali, Cape Verde, USVI, and Trinidad air samples. The sea fan pathogen, Aspergillus sydowii, has been identified in soil from Mali and in air samples from dust events in the Caribbean. We have shown that air samples from a dust-source region contain orders of magnitude more cultureable micro-organisms per volume than air samples from dust events in the Caribbean, which in turn contain 3-to 4-fold more cultureable microbes than during non-dust conditions. Rev. Biol. Trop. 54 (Suppl. 3): 9-21. Epub 2007 Jan. 15.

Un grupo internacional de agencias gubernamentales y universidades de los Estados Unidos, las Islas Vírgenes (EUA), Trinidad y Tobago, la República de Cabo Verde y la República de Mali (África Oeste), está trabajando en conjunto para elucidar el papel que el polvo del Sahara puede estar jugando en el deterioro de los ecosistemas caribeños. El primer paso ha sido identificar y cuantificar los Contaminantes Orgánicos Persistentes (POPs, por sus siglas en inglés), los metales traza y los microorganismos viables presentes en la atmósfera de las áreas fuente de polvo de África occidental y en áreas ubicadas en la dirección del viento, como el Atlántico este (Cabo Verde) y el Caribe (IVEUA y Trinidad y Tobago), durante los episodios de transporte de polvo. Resultados preliminares indican que las muestras de aire de Mali contienen mayor número y mayores concentraciones de pesticidas, bifenilos policlorinados (PCBs) e hidrocarburos policíclicos aromáticos (PAHs) que las de los sitios del Caribe. Las concentraciones de POPs fueron similares en las muestras de USVI y de Trinidad. Se encontró que las concentraciones de metales traza fueron similares a las de la composición de la corteza, con un ligero enriquecimiento de plomo en Mali. Hasta la fecha, cientos de microorganismos cultivables han sido identificados en las muestras de Mali, Cabo Verde, IVEUA y Trinidad. Hallamos el patógeno de los abanicos de mar, Aspergillus sydowi, en las muestras de aire de Mali y en las muestras del Caribe durante polvaredas. Hemos demostrado que las muestras de aire provenientes de una región fuente de polvo, contienen más microorganismos cultivables por volumen -en órdenes de magnitud- que las muestras de aire tomadas en polvaredas en el Caribe, las cuales a su vez contienen tres a cuatro veces más microorganismos cultivables que aquellas tomadas cuando no hay polvaredas.

The white band disease type II pathogen in Puerto Rico / El patógeno de la enfermedad de la banda blanca tipo II en Puerto Rico

The white band disease type I (WBD-I) epizootic event of the early 1980’s resulted in significant changes in the structure and composition of coral communities throughout the wider Caribbean. The disease decimated populations of acroporid corals throughout their geographic distribution and it is still affecting the surviving and recovering populations of these corals in a number of localities in the wider Caribbean. The putative pathogen for this syndrome (WBD-I) was never identified. A second pattern of white band was described later as white band type II (WBD-II). A potential pathogen named Vibrio charchariae was identified but Koch’s postulates were never fulfilled. In this work, we present results of a preliminary approach to confirm the identity of the pathogen of WBD-II. During the fall months of 2004, samples of Acropora cervicornis with signs of WBD-II were collected from a small population in Mario reef, an isolated patch reef off La Parguera, southwest coast of Puerto Rico. Bacteria extracted from these samples were isolated in TCBS agar, grown in Glycerol Seawater agar, and then used to inoculate separated, healthy-looking colonies of the same population in the same reef. Isolation, culture, and inoculations of bacteria were conducted under controlled conditions within hours of collection, and no microorganisms that were not already in the reef community were introduced with these experiments. Some of the newly inoculated colonies developed the disease signs within 24 hr. These were subsequently sampled and bacterial re-isolated to be identified, thus complying with the first steps to fulfill Koch ’s postulates for this disease. Rates of advance of the disease signs varied between 0.5 and 2 cm/day. Preliminary analyses indicated that the potential cause of WBD-II is a Vibrio species very close to Vibrio harveyi, a synonymy of V. charchariae. All inoculated coral colonies that developed the signs of WBD-II, behaved as the naturally infected colonies, and all of them showed no signs of the disease after two months of the inoculation when water temperatures dropped due to winter in the area. Rev. Biol. Trop. 54 (Suppl. 3): 59-67. Epub 2007 Jan. 15.

El evento epizoótico de la enfermedad de banda blanca tipo I (WBD-I) al principio del decenio de 1980 causó cambios significativos en la composición de las comunidades coralinas a todo lo largo del Gran Caribe. La enfermedad eliminó altas proporciones de las poblaciones de acropóridos y aún hoy continua afectando la recuperación de sus poblaciones en muchas localidades. El agente causante de esta enfermedad (WBD-I) nunca fue identificado. Un conjunto de características diferentes de esta enfermedad fue descrito en 1998, como banda blanca tipo II (WBD-II), y la bacteria Vibrio charchariae fue identificada como la posible causante. Sin embargo, los postulados de Koch nunca se cumplieron. En este trabajo presentamos los resultados de estudios preliminares para identificar el agente causante de WBD-II en el Caribe. Durante los meses de otoño del 2003 y 2004, recolectamos muestras de Acropora cervicornis con signos de WBD-II en Mario, un arrecife de parche aislado en La Parguera, costa sur occidental de Puerto Rico. Las bacterias extraídas de estas muestras fueron aisladas en agar TCBS, criadas en agar Glicerol Agua de mar y luego utilizadas para infectar colonias separadas sin signos de enfermedad en la misma población y localidad. El aislamiento, cultivo e inoculación de bacterias se hizo en condiciones controladas, y no introdujimos ningún microorganismo que no hubiera estado previamente en el arrecife. Algunas de las colonias inoculadas desarrollaron signos de la enfermedad en 24 hr. Tomamos muestras de estas colonias y las bacterias fueron nuevamente aisladas para ser identificadas y así completar los postulados de Koch. Las tasas de avance de los signos de la enfermedad variaron entre 0.5 y 2 cm/día. Preliminarmente confirmamos que la causa de WBD-II es una especie de Vibrio muy cercana a Vibrio harveyi, sinónimo de V. charchariae. Todas las colonias coralinas inoculadas que desarrollaron signos de WBD-II se comportaron como las colonias infectadas naturalmente y ninguna de ellas presentó signos de la enfermedad al cabo de dos meses, cuando las temperaturas del agua descendieron con el invierno.