Perspectives on the timing of ecosystem collapse in a changing climate.

Climate change is one of the most important drivers of ecosystem change, the global-scale impacts of which will intensify over the next 2 decades. Estimating the timing of unprecedented changes is not only challenging but is of great importance for the development of ecosystem conservation guidelines. Time of emergence (ToE) (point at which climate change can be differentiated from a previous climate), a widely applied concept in climatology studies, provides a robust but unexplored approach for assessing the risk of ecosystem collapse, as described by the C criterion of the International Union for Conservation of Nature's Red List of Ecosystems (RLE). We identified 3 main theoretical considerations of ToE for RLE assessment (degree of stability, multifactorial instead of one-dimensional analyses, and hallmarks of ecosystem collapse) and 4 sources of uncertainty when applying ToE methodology (intermodel spread, historical reference period, consensus among variables, and consideration of different scenarios), which aims to avoid misuse and errors while promoting a proper application of the framework by scientists and practitioners. The incorporation of ToE for the RLE assessments adds important information for conservation priority setting that allows prediction of changes within and beyond the time frames proposed by the RLE.

Perspectivas sobre el momento del colapso ecosistémico en un clima cambiante Resumen El cambio climático es uno de los principales causantes del cambio ecosistémico, cuyo impacto a escala global se intensificará en las próximas dos décadas. No sólo es un reto estimar el momento de los cambios sin precedentes, sino también es de gran importancia para el desarrollo de las directrices de conservación de los ecosistemas. El momento de aparición (MdA), el punto en el que el cambio climático puede diferenciarse de un clima previo; es un concepto de aplicación extensa en los estudios de climatología y proporciona una estrategia sólida pero poco explorada para evaluar el riesgo del colapso ecosistémico, como está descrito por el criterio C de la Lista Roja de Ecosistemas (LRE) de la Unión Internacional para la Conservación de la Naturaleza. Identificamos las tres consideraciones teóricas del MdA para la evaluación de la LRE (grado de estabilidad, análisis multifactoriales en vez de unidimensionales y distintivos del colapso ecosistémico) y cuatro fuentes de incertidumbre cuando se aplica la metodología MdA (difusión intermodelo, periodo de referencia histórica, consenso entre las variables y consideración de escenarios distintos), la cual busca evitar el mal uso y los errores mientras se promueve una aplicación adecuada del marco de los científicos y lo practicantes. La incorporación del MdA a las evaluaciones de la LRE añade información importante para el establecimiento de prioridades de conservación que permiten la predicción de cambios dentro y más allá del marco temporal propuesto por la LRE.

Avoiding novel, unwanted interactions among species to decrease risk of zoonoses.

Circumstances that precipitate interactions among species that have never interacted during their evolutionary histories create ideal conditions for the generation of zoonoses. Zoonotic diseases have caused some of the most devastating epidemics in human history. Contact among species that come from different ecosystems or regions creates the risk of zoonoses. In certain situations, humans are generating and promoting conditions that contribute to the creation of infectious diseases and zoonoses. These conditions lead to interactions between wildlife species that have hitherto not interacted under normal circumstances. I call for recognition of the zoonotic potential that novel and unwanted interactions have; identification of these new interactions that are occurring among wild animals, domestic animals, and humans; and efforts to stop these kinds of interactions because they can give rise to zoonotic outbreaks. Live animal markets, the exotic pet trade, illegal wildlife trade, human use and consumption of wild animals, invasive non-native species, releasing of exotic pets, and human encroachment in natural areas are among the activities that cause the most interactions among wild species, domestic species, and humans. These activities should not occur and must be controlled efficiently to prevent future epidemic zoonoses. Society must develop a keen ability to identify these unnatural interactions and prevent them. Controlling these interactions and efficiently addressing their causal factors will benefit human health and, in some cases, lead to positive environmental, ethical, and socioeconomic outcomes. Until these actions are taken, humanity will face future zoonoses and zoonotic pandemic.

Evitar interacciones novedosas e indeseadas entre especies para disminuir el riesgo de zoonosis Resumen Las circunstancias que promueven interacciones entre especies que nunca han interactuado durante sus historias evolutivas crean condiciones ideales para la generación de zoonosis. Las enfermedades zoonóticas han causado algunas de las epidemias más devastadoras en la historia de la humanidad. El contacto entre especies que provienen de diferentes ecosistemas o regiones crea el riesgo de zoonosis. En determinadas situaciones, los seres humanos estamos generando y promoviendo condiciones que contribuyen a la creación de enfermedades infecciosas y zoonosis. Estas condiciones conducen a interacciones entre especies silvestres que hasta ahora no habían interactuado en circunstancias normales. Hago un llamado para que se reconozca el potencial zoonótico que tienen las interacciones nuevas y no deseadas; que se identifiquen estas nuevas interacciones que provocamos entre animales silvestres, animales domésticos y humanos; y esforzarnos para detener este tipo de interacciones porque pueden dar lugar a brotes zoonóticos. Los mercados de animales vivos, el comercio de mascotas exóticas, el comercio ilegal de vida silvestre, el uso y consumo humano de animales silvestres, las especies invasoras no nativas, la liberación de mascotas exóticas y la invasión humana en áreas naturales, se encuentran entre las actividades que causan la mayor cantidad de interacciones entre especies silvestres, especies domésticas y humanos. Estas actividades no deberían ocurrir y deben controlarse eficientemente para prevenir futuras zoonosis epidémicas. La sociedad debe desarrollar una gran capacidad para identificar estas interacciones antinaturales y prevenirlas. Controlar estas interacciones y abordar eficientemente sus factores causales beneficiará la salud humana y, en algunos casos, conducirá a resultados ambientales, éticos y socioeconómicos positivos. Mientras estas medidas no se tomen, la humanidad enfrentará futuras zoonosis y pandemias zoonóticas.

Prevalencia de sepsis neonatal confirmada microbiológicamente en una maternidad de la Ciudad Autó noma de Buenos Aires / Prevalence of microbiologically confirmed neonatal sepsis at a maternity center in the City of Buenos Aires

Introducción. En neonatos internados es frecuente sospechar sepsis neonatal, pero solo en el 25 % al 30 % se confirma con cultivos positivos. La selección del esquema antibiótico basándose en la epidemiología local favorece el uso racional y minimiza sus efectos colaterales. Objetivo primario. Describir la prevalencia de sepsis precoz y tardía con rescate microbiológico y sus características clínicas. Población y método. Estudio transversal retrospectivo, realizado del 1 de enero de 2013 al 31 de diciembre de 2017, en una maternidad pública de Argentina, que incluyó todos los recién nacidos internados en la unidad con diagnóstico de sepsis precoz y tardía con rescate microbiológico, y aquellos reingresados dentro del mes de vida. Resultados. Ingresaron 3322 recién nacidos, 1296 evaluados por sospecha de sepsis precoz, cultivos positivos en 25 (1,9 %; tasa: 0,86 ‰). El 52 % eran menores de 33 semanas de edad gestacional. Microorganismos: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Sepsis tardía (tasa 8,73 ‰), el 68 % ocurridas en menores de 33 semanas. Microorganismos intrahospitalarios: Staphylococcus coagulasa negativos 115, Staphylococcus aureus 47, Escherichia coli 30, Cándida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11 y Streptococcus agalactiae 10. En los reingresos: E. coli 11, S. aureus 12, SGB 3 y Haemophilus influenzae 3. Conclusiones. Se observa en el período estudiado una frecuencia de sepsis precoz similar a los reportes internacionales, con predominio de E. coli y L. monocytogenes. La tasa de sepsis tardía presentó una tendencia descendente en los años analizados, con predominio de los cocos grampositivos

Introduction. Neonatal sepsis is often suspected in hospitalized newborn infants, but only in 25­30% of cases it is confirmed via a positive culture. Selecting the antibiotics based on local epidemiology favors their rational use and minimizes their side effects. Primary objective. To describe the prevalence of early- and late-onset sepsis with microorganism isolation and their clinical characteristics. Population and method. Retrospective, cross-sectional study conducted between 01-01-2013 and 12-31-2017 in a public maternity center of Argentina in all hospitalized newborn infants with a diagnosis of early- and late-onset sepsis with microorganism isolation, and those re-admitted in their first month of life. Results. A total of 3322 newborn infants were admitted; 1296 were assessed for suspected early- onset sepsis; 25 had a positive culture (1.9%; rate: 0.86‰). Of these, 52% were born before 33 weeks of gestation. Microorganisms: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Also, 68% of late-onset sepsis cases (rate: 8.73‰) occurred in infants born before 33 weeks of gestation. Hospital-acquired microorganisms: coagulase-negative Staphylococcus 115, Staphylococcus aureus 47, Escherichia coli 30, Candida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11, and Streptococcus agalactiae 10. In re-admissions: E. coli 11, S. aureus 12, SGB 3, and Haemophilus influenzae 3. Conclusions. During the study period, the frequency of early-onset sepsis was similar to international reports, with a predominance of E. coli and L. monocytogenes. The rate of late-onset sepsis showed a downward trend in the analyzed years, with a predominance of Gram-positive cocci.

BASE GROWTH TEMPERATURE AND PHYLLOCHRON FOR KIKUYU GRASS (Cenchrus clandestinas; Poaceae) / Temperatura base de crecimiento y filocrono para el pasto kikuyo (Cenchrus clandestinus; Poacea)

ABSTRACT In order to estimate the base temperature (Bt) of growth through the appearance of leaves and calculate the phyllochron for kikuyu grass, three plots were established on three farms in the Provincia of Ubaté (Cundinamarca, Colombia) located at different altitudes (2560, 2640, 3143 m. a. s. l.). Measurements were made in four cycles in a period of eight months. The Bt was estimated by the least coefficient of variation method using a second order regression model and the model obtained was validated by the cross-validation method. The Bt values for the first, second, third and fourth leafwere 4.02, 3.68, 3.93, and 3.62 °C, respectively. For the appearance of the first leaf, the kikuyu required more thermal time (TT) (97.5 accumulated growing degree days (AGDD)) than for the second (74.2 AGDD), third (73.8 AGDD) and fourth leaf (76.0 AGDD) (p <0.05). There were no differences in TT among farms (p> 0.05). There was a tendency to a greater number of days required to reach each leaf stage in the farm located at higher altitude and with lower mean temperature. The validation showed an adequate adjustment (r2 = 0.94) and a substantial concordance (CCC = 0.97) between the observed values and the predicted values for the estimated TT with the Bt value obtained for each leaf stage. The results ofBt for kikuyu grass obtained, will allow to make more precise predictions about the phyllochron and generate growth models close to reality.

RESUMEN Con el fin de estimar la temperatura base (Tb) de crecimiento a través de la aparición de hojas y calcular el filocrono para el pasto kikuyo, se establecieron tres parcelas en tres fincas de la provincia de Ubaté (Cundinamarca, Colombia) ubicadas a diferente altitud (2560, 2640, 3143 m. s. n. m.). Se realizaron cuatro ciclos de mediciones en un tiempo total de ocho meses. La Tb se estimó por el método de mínimo coeficiente de variación utilizando un modelo de regresión de segundo grado y el modelo obtenido se validó por el método de validación cruzada. La Tb para la primera, segunda, tercera y cuarta hoja fue 4,02, 3,68, 3,93 y 3,62 °C, respectivamente. El kikuyo requirió mayor tiempo térmico (TT) para la aparición de la primera hoja (97,5 grados día de crecimiento acumulados (GDCA)) que para la segunda (74,2 GDCA), tercera (73,8 GDCA) y cuarta hoja (76,0 GDCA) (p<0,05). No hubo diferencias en el TT entre fincas (p > 0,05). Hubo tendencia a un mayor número de días calendario requeridos para alcanzar cada estado de hoja en la finca ubicada a mayor altitud y con menor temperatura media. La validación mostró un adecuado ajuste (r2 = 0,94) y una concordancia sustancial (CCC= 0,97) entre los valores observados y los valores predichos para el TT estimado con los valores de Tb obtenidos para cada estado de hoja. Los resultados de Tb de crecimiento del pasto kikuyo obtenidos permiten realizar predicciones más precisas sobre el filocrono y generar modelos de crecimiento cercanos a la realidad.

Endocarditis infecciosa en canino con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna: reporte de caso / Infectious Endocarditis in Dogs with a Previous Diagnosis of Peripheral Vestibular Syndrome Secondary to Probable Otitis Media-Interna: A Case Report

Resumen La endocarditis infecciosa es un proceso patológico de baja incidencia en la clínica diaria; su principal etiología son los agentes bacterianos, los cuales colonizan con mayor prevalencia de válvula mitral y aortica. En este artículo se presenta el estudio de un perro con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna. Se presenta con un soplo de aparición súbita, claudicaciones intermitentes, inapetencia, depresión y fiebre, por lo cual se hace la valoración ecocardiográfica, donde se evidencia engrosamiento valvular mitral, acompañado de estructuras hiperecoicas en el borde libre que corresponden a lesiones vegetativas. Por medio de los criterios de Duke modificados se obtiene un diagnóstico definitivo de endocarditis infecciosa, para lo cual se realiza manejo médico intrahospitalario, sin evolución favorable. Los hallazgos clínicos y paraclínicos coinciden con lo reportado en la literatura. Los criterios de Duke modificados permiten orientar el diagnóstico y evidenciar signos clínicos de alarma. El manejo médico antimicrobiano deberá realizarse con base en hemocultivos y pruebas de sensibilidad, siempre teniendo en cuenta la prevalencia de patógenos y el origen primario de la infección. Se debe considerar como una patología con un pronóstico malo y un porcentaje de fatalidad alto. Finalmente, se concluye que la principal limitación del caso es la falta de confirmación histopatológica.

Abstract Infectious endocarditis is a pathological process with low incidence in the daily clinical practice. The main etiology are the bacterial agents that colonize with higher prevalence the mitral and aortic valves. This paper reports the case of a dog with a previous diagnosis of peripheral vestibular syndrome secondary to probable otitis media-interna. The dog has a sudden heart murmur, intermittent claudications, lack of appetite, depression and temperatures. It is performed an echocardiographic assessment that shows mitral valve thickening with hyperecoic structures in the free border that indicates vegetations. Using the Modified Duke Criteria, a definitive diagnosis of infectious endocarditis is concluded. The dog is provided a medical treatment at the clinic without success. The clinical and paraclinical findings match the background found in the literature. Modified Duke Criteria allow guiding the diagnosis process and uncovering the alarm clinical signs. Antimicrobial clinical treatment must be administered based on blood cultures and sensitivity tests and considering both the pathogen prevalence and infection primary origin. Doctors must deem this condition as a bad prognosis pathology with a high mortality percentage. Finally, it is concluded that the main limitation in this case is a lack of histopathological confirmation.

Transformações do/no analista: assombrações e assombros / Transformations of/in the analyst / Transformaciones del/en el analista / Transformations de/chez l'analyste

Neste trabalho a autora procura pensar a experiência clínica com dois pacientes, com os quais surgiram vivências estranhas e ameaçadoras, que ela nomeia de início como assombrações. Suas reflexões sugerem que as transformações que o analista pode fazer dessas assombrações - suas intuições, seu pensamento onírico e funcionamento alfa - podem trazer desenvolvimentos úteis à dupla analítica, como o surgimento de novos vértices, a ampliação do espaço mental e a possibilidade de digerir e elaborar fortes emoções, movimentos mais ligados à noção de assombro, pensado como propiciador do conhecer e do ser. O trabalho aborda também as transformações vividas pelo analista em sua formação, as transformações propiciadas pela escrita analítica, bem como as transformações existenciais durante a vida do analista, que podem dificultar sua função analítica, necessitando constantes cuidados e reanálises.

In this article the author seeks to reflect on the clinical experience with two patients who lived through strange and threatening episodes, which, right from the very start, the author named as hauntings. Her considerations suggest that these hauntings may be transformed - through the analyst's intuition, oneiric thought and alpha function - and the result of these transformations may bring useful unfoldings to the analytical pair, such as the springing of new vertex, the amplification of the mental space and the possibility to digest and elaborate strong emotions, movements closer to the notion of haunt regarded as a sponsor for knowledge and for being. This article also approaches the transformations experienced by the analyst in their formation, the transformations the analytical writing may provide, as well as existential transformations in the analyst's own life, which may hamper the analytical activity, demanding constant care and reanalyses.

En el presente trabajo, la autora plantea la experiencia clínica con dos pacientes, en la que surgen experiencias extrañas y amenazantes, que inicialmente denomina apariciones. Sus reflexiones sugieren que las transformaciones de estas experiencias que el analista puede llevar a cabo (sus intuiciones, su pensamiento onírico y su funcionamiento alfa) pueden aportar desarrollos útiles al dúo analítico, como la aparición de nuevos vértices, la expansión del espacio mental y la posibilidad de digerir y elaborar emociones fuertes, movimientos más vinculados a la noción de asombro, pensado como propiciador del saber y del ser. El trabajo también aborda las transformaciones experimentadas por el analista en su formación, las transformaciones proporcionadas por la escritura analítica, así como las transformaciones existenciales durante la vida del analista, que pueden obstaculizar su función analítica, lo que requiere un cuidado constante y reanálisis.

Dans ce travail, l'auteur essaie de réfléchir l'expérience clinique avec deux patients, où des expériences étranges et menaçantes ont émergé, qu'elle nomme d'abord comme des hantises. Ses réflexions suggèrent que les transformations que l'analyste peut faire de ces hantises - ses intuitions, sa pensée onirique et son fonctionnement alpha - peuvent apporter des développements utiles au duo analytique, tels que l'émergence de nouveaux sommets, l'expansion de l'espace mental et la possibilité de digérer et élaborer des émotions fortes, des mouvements plus liés à la notion d'étonnement, pensé comme apportant de la connaissance et de l'être. Le travail aborde également les transformations vécues par l'analyste dans sa formation, les transformations apportées par l'écriture analytique, ainsi que les transformations existentielles au cours de la vie de l'analyste, qui peuvent entraver sa fonction analytique, nécessitant des soins constants et réanalyses.

Statin treatment and increased diabetes risk. Possible mechanisms.

Statins have been associated with an increased risk of new-onset diabetes mellitus (NODM), as confirmed in previous observational studies and meta-analyses. Controversy exists as to whether this risk varies depending on statin type or dose. However, there appears to be unanimity regarding the different associated factors that raise this risk. Furthermore, diverse pathophysiologic mechanisms have been described that could explain the increased risk of diabetes in patients with statin treatment. These fundamentally cause a rise in insulin resistance together with a decrease in insulin secretion. The present review aimed to describe the relationship between statin treatment and the presence of diabetes and provide an update of previous published evidence and the possible mechanisms involved.

Influence of dietary protein intake on body composition in chronic kidney disease patients in stages 3-5: A cross-sectional study.

INTRODUCTION: A controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease (CKD) patients. This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3-5. METHOD: Cross-sectional study in 134 CKD patients in stages 3-5 (mean e-GFR: 19.4±8.7ml/min/1.73m2; males 68.7% and primary CKD etiology was diabetes mellitus, 35.8%). Demographic, clinical and nutritional parameters were evaluated. Normalized protein nitrogen appearance (nPNA), was used as a surrogate marker of dietary protein intake. The sample was classified into three nPNA groups (Gn): G1: <0.8g/kg/day; G2: 0.8-1g/kg/day and, G3: ≥1g/kg/day. Assessment of nutritional status using the malnutrition-inflammation score (MIS), anthropometric measures and laboratory parameters. Analysis of body composition and hydration status by bioelectrical impedance analysis (BIVA-101-RJL system). Statistical analysis by SPSS v.20. RESULTS: Overall mean nPNA values were 0.91±0.23g of protein/kg BW/day and only 32.1% had a dietary protein intake <0.8g of protein/kg BW/day. Most of the CKD patients (65.5%) were in stages 4 or 5. Prevalence of protein-energy-wasting (PEW) syndrome measured by MIS was 15%. By analyzing differences between nPNA groups, body weight (BW), BMI and triceps-skinfold (TSF) thickness were significantly higher in the group with nPNA ≥1g/kg BW/day (G3), whereas a significant inverse relationship was found with the percentages of body cell mass (BCM%), fat-free mass (FFM%), muscle mass (MM%) and phase angle (PA) in the group with the lowest nPNA (G1). Analysis of gender among subjects showed significant differences with BW, FFM%, TSF and mid-arm muscle circumference (MAMC%). Linear regression analysis showed that resistance, BCM%, MM%, and serum albumin were significant predictors of nPNA as a surrogate marker of daily protein intake (R=0.51; R2=0.29; R2 adjusted=0.23; p<0.001). CONCLUSION: Controlled protein intake is one of the cornerstones of treatment in CKD patients. A low protein intake in patients with CKD stages 3 and 4-5 was associated with loss of muscle mass in the advanced-CKD unit. The loss of muscle mass appears as an early indicator of nutritional comprised. Factors such, elderly age and loss of eGFR, showed lower protein intake and were associated with muscle loss, especially in women. Further longitudinal studies are required to evaluate the contribution of different protein intakes to uremic symptoms, nutritional status, body composition and CKD progression.

Depression as the middle-and long-term impact for pre-symptomatic testing of late-onset neurodegenerative disorders / A depressão como indicador do impacto psicológico a médio e longo prazo do teste pré-sintomático de doenças neurodegenerativas de início tardio / La depresión como el indicador de impacto psicológico a la media y largo plazo de la prueba pre-sintomática para enfermedades de aparición tardía

This cross-sectional study investigated depression as the middle- (4 years) and long-term (7 and 10 years) psychological impact of pre-symptomatic testing (PST) for 3 autosomal dominant late-onset diseases: Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloidotic polyneuropathy (FAP) TTR V30M. It included 203 subjects: 170 (83.7%) underwent the PST for FAP, 29 (14.3%) for HD and 4 (2%) for MJD. Of these 203, 73 were still asymptomatic carriers, 29 (14.5%) were symptomatic, 9 (4.5%) were FAP liver transplanted patients and 89 (44.5%) were non-carriers. Subjects were mainly women (58.1%) and married (66.5%). The Beck Depression Inventory (BDI) was used to evaluate depression. Scores were higher for symptomatic carriers and for those who have made one or more psychological support consultations over the years. For the formers, the mean scores pointed to mild depression. Asymptomatic carriers and non-carriers had similar scores but it was impossible to differentiate the psychological impact between the medium and long-term. For symptomatic carriers, there were significant differences between the middle- and long-term. The study indicates that depression occurs only when subjects had previously manifested the first symptoms of their neurologic disease.

Este estudo transversal investigou a depressão como indicador do impacto psicológico do teste pré-sintomático (TPS) a médio (quatro anos) e longo prazo (de 7 a 10 anos) de doenças neurológicas de início tardio: a doença de Huntington (DH), doença de Machado-Joseph (DMJ) e polineuropatia amiloidótica familiar PAF (TTR V30M). 203 sujeitos participaram no estudo: 170 (83,7%) submetidos ao TPS para PAF, 29 (14,3%) para o DH e 4 (2%) para DMJ. Destes 203, 73 eram portadores assintomáticos, 29 (14,5%) já eram sintomáticos, 9 (4,5%) pacientes com PAF, já tinham realizado o transplante hepático e 89 (44,5%) eram não-portadores. A amostra era constituída maioritariamente por mulheres (58,1%) e por sujeitos casados (66,5%). Utilizou-se o Inventário da Depressão de Beck (BDI). Os scores mais elevados foram observados nos portadores sintomáticos e nos sujeitos que tinham realizado consultas de psicologia com scores indicadores de depressão leve. Os portadores assintomáticos e os não-portadores apresentaram médias semelhantes. Para os portadores sintomáticos, encontrámos diferenças significativas entre o médio e o longo prazo. Este estudo conclui que a depressão pode ocorrer nos indivíduos que já manifestam os primeiros sintomas da respectiva doença neurológica.

Este estudio transversal investigó la depresión a la media (4 años) y largo plazo (7 y 10 años) del impacto psicológico de la prueba pre-sintomática (PPS) para 3 enfermedades autosómicos, dominantes, de aparición tardía: la enfermedad de Huntington (EH), la enfermedad de Machado-Joseph (EMJ) y la polineuropatia amiloide familiare (PAF) o polineuropatia amiloide da transtiretina FAP (TTR V30M). Participaron 203 sujetos: 170 (83,7%) para PPS para PAF, 29 (14,3%) para EH y 4 (2%) para EMJ. De estos 203, 73 estaban todavía portador asintomático, 29 (14,5%) eran sintomáticos, 9 (4,5%) fueron PAF pacientes con trasplante hepático y 89 (44,5%) eran no-portadores. Eran en su mayoría mujeres (58,1%) y casados (66,5%). Se utilizó el Inventario de Depresión de Beck (IDB). Los puntajes fueron mayores para las portadoras sintomáticas y para aquellos que han hecho consultas de apoyo psicológico con puntuaciones medias de depresión leve. Los portadores asintomáticos y no portadores tuvieron puntajes similares. Para portadores sintomáticos, hubo diferencias significativas entre el medio y largo plazo. Este estudio concluye que la depresión puede ocurrir en personas que ya muestran los primeros síntomas de la enfermedad neurológica.

Depression as the middle-and long-term impact for pre-symptomatic testing of late-onset neurodegenerative disorders / A depressão como indicador do impacto psicológico a médio e longo prazo do teste pré-sintomático de doenças neurodegenerativas de início tardio / La depresión como el indicador de impacto psicológico a la media y largo plazo de la prueba pre-sintomática para enfermedades de aparición tardía

This cross-sectional study investigated depression as the middle- (4 years) and long-term (7 and 10 years) psychological impact of pre-symptomatic testing (PST) for 3 autosomal dominant late-onset diseases: Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloidotic polyneuropathy (FAP) TTR V30M. It included 203 subjects: 170 (83.7%) underwent the PST for FAP, 29 (14.3%) for HD and 4 (2%) for MJD. Of these 203, 73 were still asymptomatic carriers, 29 (14.5%) were symptomatic, 9 (4.5%) were FAP liver transplanted patients and 89 (44.5%) were non-carriers. Subjects were mainly women (58.1%) and married (66.5%). The Beck Depression Inventory (BDI) was used to evaluate depression. Scores were higher for symptomatic carriers and for those who have made one or more psychological support consultations over the years. For the formers, the mean scores pointed to mild depression. Asymptomatic carriers and non-carriers had similar scores but it was impossible to differentiate the psychological impact between the medium and long-term. For symptomatic carriers, there were significant differences between the middle- and long-term. The study indicates that depression occurs only when subjects had previously manifested the first symptoms of their neurologic disease.(AU)

Este estudo transversal investigou a depressão como indicador do impacto psicológico do teste pré-sintomático (TPS) a médio (quatro anos) e longo prazo (de 7 a 10 anos) de doenças neurológicas de início tardio: a doença de Huntington (DH), doença de Machado-Joseph (DMJ) e polineuropatia amiloidótica familiar PAF (TTR V30M). 203 sujeitos participaram no estudo: 170 (83,7%) submetidos ao TPS para PAF, 29 (14,3%) para o DH e 4 (2%) para DMJ. Destes 203, 73 eram portadores assintomáticos, 29 (14,5%) já eram sintomáticos, 9 (4,5%) pacientes com PAF, já tinham realizado o transplante hepático e 89 (44,5%) eram não-portadores. A amostra era constituída maioritariamente por mulheres (58,1%) e por sujeitos casados (66,5%). Utilizou-se o Inventário da Depressão de Beck (BDI). Os scores mais elevados foram observados nos portadores sintomáticos e nos sujeitos que tinham realizado consultas de psicologia com scores indicadores de depressão leve. Os portadores assintomáticos e os não-portadores apresentaram médias semelhantes. Para os portadores sintomáticos, encontrámos diferenças significativas entre o médio e o longo prazo. Este estudo conclui que a depressão pode ocorrer nos indivíduos que já manifestam os primeiros sintomas da respectiva doença neurológica.(AU)

Este estudio transversal investigó la depresión a la media (4 años) y largo plazo (7 y 10 años) del impacto psicológico de la prueba pre-sintomática (PPS) para 3 enfermedades autosómicos, dominantes, de aparición tardía: la enfermedad de Huntington (EH), la enfermedad de Machado-Joseph (EMJ) y la polineuropatia amiloide familiare (PAF) o polineuropatia amiloide da transtiretina FAP (TTR V30M). Participaron 203 sujetos: 170 (83,7%) para PPS para PAF, 29 (14,3%) para EH y 4 (2%) para EMJ. De estos 203, 73 estaban todavía portador asintomático, 29 (14,5%) eran sintomáticos, 9 (4,5%) fueron PAF pacientes con trasplante hepático y 89 (44,5%) eran no-portadores. Eran en su mayoría mujeres (58,1%) y casados (66,5%). Se utilizó el Inventario de Depresión de Beck (IDB). Los puntajes fueron mayores para las portadoras sintomáticas y para aquellos que han hecho consultas de apoyo psicológico con puntuaciones medias de depresión leve. Los portadores asintomáticos y no portadores tuvieron puntajes similares. Para portadores sintomáticos, hubo diferencias significativas entre el medio y largo plazo. Este estudio concluye que la depresión puede ocurrir en personas que ya muestran los primeros síntomas de la enfermedad neurológica.(AU)

Microcefalia e Zika Vírus: características e associações / Microcephaly and Zika Virus: clinical features and associations / Microcefalia y Virus Zika: características y asociaciones

Objetivo: Discutir a associação entre microcefalia e a infecção materna por Zika Vírus. A microcefalia é o tamanho da cabeça menor do que o esperado em comparação com bebês do mesmo sexo e idade. Entre as causas conhecidas, estão as infecções congênitas. O aumento de casos entre outubro e novembro de 2015 no nordeste brasileiro, que coincidiu com a presença da circulação de novo vírus no país, em maio do mesmo ano, criou a hipótese de associação entre a microcefalia e a infecção materna durante a gravidez. O Zika Vírus é um arbovírus similar ao da Febre Amarela e da Dengue, transmitido principalmente através da picada do Aedes aegypti. A provável transmissão por relação sexual e transfusão de sangue, além de outros vetores como o Aedes albopictus e possivelmente até o pernilongo (Culex sp) aumentam a necessidade de cuidados preventivos em relação à infecção. O exame para detecção viral idealmente é realizado até o quinto dia após o início dos sintomas. Sorologias ainda não são amplamente disponíveis no Brasil. Métodos: Revisão narrativa da literatura. Conclusão: A associação entre casos de microcefalia e o Zika Vírus é embasada nos relatos de relação têmporo-espacial, padrão de alterações neurológicas associado a malformações congênitas, presença do RNA viral no líquido amniótico e nos tecidos de fetos. As respostas definitivas de causalidade serão possíveis após pesquisas e disponibilidade de exames laboratoriais. As evidências até agora apoiam fortemente esta hipótese e todas as medidas preventivas devem ser estimuladas.

Objective: To discuss the association between microcephaly and intrauterine infection by Zika virus. Microcephaly occurs when a child is born with a head smaller than expected when compared to babies of the same sex and age. Known causes of microcephaly include congenital infections. The increase in the number of microcephaly cases in Northeast Brazil between October and November 2015, which coincided with the emergence of Zika virus in the country in May of the same year, led to the hypothesis of an association between microcephaly and intrauterine Zika virus infection. Zika is an arbovirus that is closely related to yellow fever and dengue viruses. Aedes aegypti mosquitoes are the primary vector of transmission. Possible transmission through sexual contact and blood transfusion, as well as the implication of other vectors, such as Aedes albopictus and even Culex sp increases the need for preventive action. The test for viral detection is ideally performed before the 5th day following the onset of symptoms. Serology tests are not yet widely available in Brazil. Methods: We performed a narrative literature review. Conclusion: The hypothesis of an association between microcephaly and Zika virus is based on reports of spatial/temporal relationship, pattern of neurologic alterations associated with congenital malformations, and findings of viral RNA in amniotic fluid and fetal tissue. Definitive conclusions about the causality can only be reached after further research and availability of laboratory tests. The current evidence strongly supports the association between microcephaly and Zika infection, and all preventive measures must be stimulated.

Objetivo: Discutir las asociaciones entre microcefalia e infección materna por Virus Zika. La microcefalia es el tamaño de la cabeza menor de lo esperado en comparación con los bebés del mismo sexo y edad. Entre las causas conocidas están las infecciones congénitas. El aumento de casos entre octubre y noviembre de 2015 en el nordeste de Brasil, que coincidió con la presencia de la nueva circulación del virus en el país en mayo del mismo año, creó la hipótesis de asociación entre la microcefalia y la infección de la madre por Virus Zika durante el embarazo. El virus Zika es un arbovirus similar al dengue y la fiebre amarilla. El virus se transmite a través de la picadura del mosquito Aedes aegypti. La probable transmisión por vía sexual y por la transfusión de sangre - además de otros vectores como el Aedes albopictus y posiblemente el mosquito Culex sp - aumentan la necesidad de atención preventiva contra la infección. El cuadro clínico es benigno, autolimitado, caracterizado por erupción maculopapular asociado con otros síntomas tales como conjuntivitis, artralgia y la inflamación de las articulaciones. El examen para la detección del virus se realiza idealmente por el quinto día después de la aparición de los síntomas. Las pruebas serológicas no están ampliamente disponibles en Brasil. Métodos: Revisión de literatura. Conclusión: La asociación entre los casos de microcefalia y el virus Zika se basa en informes de patrón de relación temporo-espacial de los trastornos neurológicos asociados con malformaciones congénitas, el ARN viral presente en el líquido amniótico y tejidos de fetos. Las respuestas definitivas de causalidad serán posibles después de la investigación y la disponibilidad de pruebas de laboratorio. Hasta ahora, las evidencias apoyan firmemente esta hipótesis y todas las medidas preventivas deben ser estimuladas.

Ultrasound control of magnet growing rod distraction in early onset scoliosis. / Control ecográfico en la distracción de los tallos de crecimiento magnéticos en la escoliosis de aparición precoz.

The growing rod technique is currently one of the most common procedures used in the management of early onset scoliosis. However, in order to preserve spine growth and control the deformity it requires frequent surgeries to distract the rods. Magnetically driven growing rods have recently been introduced with same treatment goal, but without the inconvenience of repeated surgical distractions. One of the limitations of this technical advance is an increase in radiation exposure due to the increase in distraction frequency compared to conventional growing rods. An improvement of the original technique is presented, proposing a solution to the inconvenience of multiple radiation exposure using ultrasound technology to control the distraction process of magnetically driven growing rods.

[Knowledge of Andalusian pediatricians and parents about early-onset tooth decay]. / Conocimiento de pediatras y padres andaluces sobre caries de aparición temprana.

OBJECTIVES: To determine the level of knowledge of pediatricians and parents from Andalucía (southern Spain) about early-onset tooth decay, and to assess if pediatricians provide information to parents about pediatric oral care and visits to the pediatric dentist. MATERIAL AND METHOD: A random sample of 113 pediatricians and 112 parents with children under 3 years of age received an anonymous questionnaire comprising 14 items for pediatricians and 16 items for parents, grouped into five blocks: visits to the dentist, oral hygiene, caries, nutritional habits, and treatment of caries. The chi-squared test was used to assess differences between groups. RESULTS: Pediatricians showed deficiencies in their knowledge about visits to the dentist and treatment of caries, however their level of knowledge on oral hygiene, tooth decay and nutritional habits were adequate. Parents showed a low level of knowledge in all aspects of the study, mainly about the treatment of tooth decay. There were no significant differences between pediatricians and parents in the knowledge about visits to the dentist, however pediatricians had more knowledge than the parents about hygiene, tooth decay, nutritional habits and treatment (P<0.001). Most of the parents indicated that pediatricians did not provide them detailed information on oral care, and about the possibility of visiting a pediatric dentist. CONCLUSIONS: Andalusian pediatricians should improve their knowledge about early-onset tooth decay, and provide more information to parents about the oral care and the possibility of visiting a pediatric dentist. Parents have a very low level of knowledge about early-onset tooth decay, and particularly about treatment.

Factores de riesgo asociados a la prevalencia de caries de aparici¢n temprana en ni¤os de 1 a 3 a¤os en una poblaci¢n peruana / Risk factor associated with the prevalence of early childhood caries in 1-3 year old peruvian children

El objetivo del estudio fue identificar los principales factores de riesgo asociados a la prevalencia de caries de aparición temprana en niños en edad preescolar de 1-3 años de Salas de Estimulación Temprana (SET) en Ica-Perú. Material y métodos: Se ejecutó un estudio de corte transversal con 231 niños preescolares de 1 a 3 años. La recolección de datos fue realizada previa calibración del examinador, para las estimaciones estadísticas se aplicó el programa estadístico SPSS v.20 se utilizó la prueba de Chi-cuadrado para determinar la asociación y la prueba de Odss Ratio (OR) para evaluar la probabilidad de riesgo de cada factor. Resultados: La prevalencia de CAT fue del 65,8%. Se encontró una relación estadísticamente significativa entre la caries dental y niños con higiene bucal inadecuada (OR=3,01), con un consumo frecuente de alimentos con azúcar (OR=3,34), sin aplicación de flúor profesional (OR=1,91) y pH salival ácido (OR=6,52) con p <0,001 Conclusión: El pH salival ácido y la higiene oral mala son los factores de riesgo que más se asocian con la prevalencia de CAT en niños de 1 a 3 años.

The aim of the present survey was to determine the prevalence of Early Childhood Caries (ECC) and association of risk factors with ECC in preschool children in Ica-Peru. Risk factors evaluated were: consumption sugary foods, professional fluoride application, and degree of training of the mother, degree improper oral hygiene and salivary pH. Three kindergarten schools in Ica were included and data of 231 children of age group (1 - 3) years was collected. A structured questionnaire was sent to the parents before conducting the study. A prior consent for dental examination was taken from the parents. Caries status, oral hygiene status and salivary pH was evaluated. Chi square tests were applied for evaluation of risk factors. The prevalence of ECC was found out to be 65.8%. A statistically significant relationship was found between dental caries and children with improper oral hygiene, with frequent consumption of sugary foods, without professional fluoride application and acid salivary pH (p< 0001). The prevalence of Early Childhood Caries was 65.8% in preschool children of Ica. It was more in children with improper oral hygiene, with frequent consumption of sugary foods, without professional fluoride application and acid salivary pH.

Aparición de la osteopenia en recién nacidos de pretérmino en un servicio de neonatología / Time of onset of osteopenia in preterm newborn in a neonatology service

Introducción. La osteopenia es la disminución de la densidad ósea secundaria a menor mineralización del hueso, y puede presentarse como raquitismo, osteomalacia y osteoporosis. El objetivo del estudio fue detectar el momento en que se presenta la osteopenia en prematuros de un servicio de neonatología. Métodos. Se realizó un estudio observacional, prospectivo, comparativo y clínico. Se incluyeron 30 recién nacidos de pretérmino (RNPT) que ingresaron de noviembre del 2010 a agosto del 2011 y cumplieron con los criterios de inclusión. En todos los pacientes se determinaron los niveles séricos de Ca, P y fosfatasa alcalina, y radiografías de huesos largos a las dos, cuatro, seis y ocho semanas a partir del ingreso. Para el análisis de los datos se utilizó estadística descriptiva e inferencial. Se consideró significación cuando p <0.05. Resultados. La población estudiada estuvo conformada por 30 RNPT con una mediana de edad gestacional de 29 semanas. La mediana de peso al nacimiento fue de 1,055 g. En todos los pacientes se manejó nutrición mixta. Los cambios radiológicos sugestivos de osteopenia fueron reportados en 83.3% de los pacientes durante las primeras dos semanas de estudio. Al final del estudio, 86.7% de los pacientes la presentaron (n = 26). La mediana de la edad de detección de la osteopenia fue de 19 días de vida extrauterina. Conclusiones. La osteopenia del prematuro se presenta alrededor de la tercera semana de vida extrauterina. Estos resultados dan un panorama diferente a lo reportado en la literatura. Por ello, la prevención de la desmineralización ósea debe realizarse más tempranamente.

Introduction. Osteopenia is a decrease in bone density secondary to low bone mineralization and can present as rickets, osteomalacia and osteoporosis. The aim of this study is to detect when osteopenia is presented in preterm newborns (PNB) of a neonatal ward. Methods. We carried out an observational, prospective, comparative clinical trial (study cohort) that included 30 PNB admitted from November 2010 to August 2011 and who met the criteria selection. Alkaline phosphatase levels were considered elevated from 280 IU/L. All patients were administered Ca, P, alkaline phosphatase serum. X-rays of long bones at 2, 4, 6 and 8 weeks after admission were taken. Statistical analysis was performed using descriptive and inferential statistics. Significance levels were set at p <0.05. Results. The study population consisted of 30 PNB with a median gestational age of 29 weeks and median birth weight of 1055 g. Parenteral and enteral nutrition (mixed) was managed in all patients. Radiological changes suggestive of osteopenia were reported in 83.3% of patients during the first 2 weeks of study and at the end of the study in 86.7% of patients (n = 26). The median age of detection of osteopenia was 19 days of life. Conclusions. Osteopenia of prematurity occurs at approximately the third week after birth. These results present a different picture to that reported in the literature since the time of reporting these data. Preventing bone disease should be more timely.

[Early onset scoliosis. What are the options?]. / Escoliosis de aparición precoz. ¿Qué opciones tengo?

The prognosis of children with progressive early onset scoliosis has improved considerably due to recent advances in surgical and non-surgical techniques and the understanding of the importance of preserving the thoracic space. Improvements in existing techniques and development of new methods have considerably improved the management of this condition. Derotational casting can be considered in children with documented progression of a <60° curve without previous surgical treatment. Both single and dual growing rods are effective, but the latter seem to offer better results. Hybrid constructs may be a better option in children who require a low-profile proximal anchor. The vertical expandable prosthetic titanium rib (VEPTR(®)) appears to be beneficial for patients with congenital scoliosis and fused ribs, and thoracic Insufficiency Syndrome. Children with medical comorbidities who may not tolerate repeated lengthenings should be considered for Shilla or Luque Trolley technique. Growth modulation using shape memory alloy staples or other tethers seem promising for mild curves, although more research is required to define their precise indications.

La inclusión social por la vía del cuerpo en mujeres diagnosticadas con anorexia bulimia en la ciudad de Medellín, Colombia / Social inclusion through the body in women with anorexia-bulimia in Medellín, Colombia

Este informe presente los hallazgos de la investigación ''Narrativas identitarias sobre la vivencia corporal en mujeres diagnosticadas con trastorno de la alimentación'' efectuada en Medellín. Objetivo: reconocer cómo el significado atribuido a la vivencia corporal devela la construcción de la identidad en mujeres con trastornos de la alimentación. Metodología: enfoque cualitativo, con diseño de casos múltiples analizados mediante los procedimientos del método fenomenológico-hermenéutico. Se hicieron entrevistas en profundidad y grupos focales. El estudio se ajustó a los principios éticos para la investigación en que participan seres humanos, incluyendo el consentimiento informado de cada una de las participantes. Resultados: 1) la evaluación que estas mujeres hacen de sí mismas está cruzada por la mirada de los otros; 2) existen contextos sociales de aparición que estimulan la anorexia-bulimia; 3) se hallaron tres formas de configuración de la anorexia-bulimia: estético-erótica, estético atlética y estético-afectiva; 4) la recuperación no consiste solamente en comer, sino también en permitir que el cuerpo se historice, es decir, que muestre en él las marcas del paso del tiempo.

This report presents the findings of a research entitled ''Identity narratives about the body experience of women diagnosed with eating disorders'' which was carried out in Medellín, Colombia. Objective: to recognize how the meaning given to body experience reveals the identity construction of women with eating disorders. Methodology: a qualitative approach with a multiplecase design. Cases were analyzed using procedures of the phenomenological hermeneutic method. In-depth interviews and focus groups were done. The project complied with the ethical principles for medical research involving human subjects, including the informed consent.Results: 1) self-evaluation of these women is strongly influenced by the perception of other persons; 2) there are social contexts of occurrence that stimulate the development of anorexia-bulimia; 3) three ways of configuration of anorexia-bulimia were found, namely: the aesthetic-erotic, the aesthetic-athletic, and the aesthetic-affective; 4) recovery from anorexiabulimia does not consist solely of eating, but also of allowing the patients'body to historicize itself, that is, to show the effects of time.