Colombian ocular diseases epidemiology study (CODES): glaucoma incidence and sociodemographic characterisation 2015-2020.

CLINICAL RELEVANCE: Glaucoma encompasses a group of eye diseases that progressively damage the optic nerve, leading to vision loss and blindness. Understanding the incidence and demographic distribution is vital for public health planning and patient care. BACKGROUND: Previous small-scale studies in Colombia have reported the prevalence of glaucoma in individuals over 40 years between 1.1% and 5.29%. These data may not fully capture the true extent of the disease. Furthermore, with the ageing population, the incidence of glaucoma is likely to increase, highlighting the need for up-to-date incidence data to guide healthcare planning. METHODS: Data were obtained from the Social Protection Information System, the primary health record repository of Colombia, using the International Classification of Disease 10 for glaucoma. Crude incidence rates were calculated and adjusted for sex, age, and gender. The 2020 incidence was compared with estimated rates from previous years to assess the impact of the coronavirus disease 2019 lockdown. A standardised morbidity map was created to show regional variations. RESULTS: The average incidence of glaucoma in Colombia was 17.36 per 1,000 inhabitants, increasing from 12.29 in 2015 to 24.22 in 2019. Of the 212,700 reported cases, 60.75% were females. Primary open-angle glaucoma was the most prevalent type, with significant incidence in the elderly over 70 years of age, irrespective of sex. Bogotá, Antioquia, and Valle del Cauca had the highest numbers of new cases. CONCLUSION: The increasing incidence of glaucoma and its demographic and geographical variations necessitate the awareness of ophthalmologists and optometrists. This study emphasises the need for continuous monitoring, effective interventions, and developing healthcare strategies to address the escalating challenge of glaucoma in Colombia.

The Impact of Physical Effort on the Gut Microbiota of Long-Distance Fliers.

Flying pigeons (Columbia livia) are extensively studied for their physical endurance and superior sense of orientation. The extreme physical endurance of which these birds are capable creates a unique opportunity to investigate the possible impact of long-distance flying on the taxonomy and metabolic function of the gut microbiota. This project was enabled by access to two groups of pigeons raised by the same breeder in the same conditions, except that one group was trained in long-distance flying and participated in multiple races covering a total distance of over 2600 km over a 9-week period. In contrast, the second group did not fly. The fecal microbiota was analyzed using 16S amplicon sequencing, and the taxonomy and metabolic function were inferred from this sequence data. Based on phylogenetic distance and metabolic function, flying and non-flying pigeons were found to harbor distinct bacterial microbiota. The microbiota taxonomy varied extensively between the birds, whereas the inferred metabolic potential was relatively stable. Age was not a significant determinant of the fecal microbiota profile. In flying birds, the metabolic pathways annotated with biosynthesis were enriched, representing 60% of the 20 metabolic pathways that were most closely associated with flying.

The Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials in Mozambique, Pakistan, and India: an individual participant-level meta-analysis

To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. Methods: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564. Findings: Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22-30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90-1·51; p=0·24). No intervention-related serious adverse events occurred, and few adverse effects occurred after in-community...

The Case for Ancient Hot Springs in Gusev Crater, Mars.

The origin and age of opaline silica deposits discovered by the Spirit rover adjacent to the Home Plate feature in the Columbia Hills of Gusev crater remains debated, in part because of their proximity to sulfur-rich soils. Processes related to fumarolic activity and to hot springs and/or geysers are the leading candidates. Both processes are known to produce opaline silica on Earth, but with differences in composition, morphology, texture, and stratigraphy. Here, we incorporate new and existing observations of the Home Plate region with observations from field and laboratory work to address the competing hypotheses. The results, which include new evidence for a hot spring vent mound, demonstrate that a volcanic hydrothermal system manifesting both hot spring/geyser and fumarolic activity best explains the opaline silica rocks and proximal S-rich materials, respectively. The opaline silica rocks most likely are sinter deposits derived from hot spring activity. Stratigraphic evidence indicates that their deposition occurred before the emplacement of the volcaniclastic deposits comprising Home Plate and nearby ridges. Because sinter deposits throughout geologic history on Earth preserve evidence for microbial life, they are a key target in the search for ancient life on Mars.

Candida species isolated from pigeon (Columbia livia) droppings may express virulence factors and resistance to azoles.

Even though it is widely known that Cryptococcus spp. may transmit cryptococcosis trough aerosol formed when dried birds (mainly pigeons) droppings are dispersed and become airborne, little is known about the role of these birds in harboring other pathogenic yeasts in their gastrointestinal tract, feathers and beaks, specifically because these animals often stay and reproduce close or even above air conditioner units. Here we evaluated the prevalence of pathogenic yeasts isolated from pigeon droppings collected in the outside area of a University Hospital in Brazil. We also aimed to investigate the pathogenic potential and antifungal susceptibility of Candida species of medical interest isolated from these samples. Therefore, we performed the evaluation of virulence factors attributes expression in vitro, including the ability to adhere to human buccal epithelial cells and biofilm formation and to produce lytic enzymes, such as phospholipases, proteinases and hemolysins. Antifungal susceptibility testing against fluconazole, itraconazole, amphotericin and micafungin was also performed. The Candida genus was the most prevalent in our study, with several medically important species being isolated. Of note, these strains were able to express several virulence factors in vitro, clearly showing their pathogenic potential. Our study was able to demonstrate that Candida spp. isolated from pigeon droppings may express virulence factors in the same manner of clinical isolates, suggesting a pathogenic potential for these yeasts. The fact these strains were collected from the outside area of a tertiary hospital may be of interest, because they may be a source of infection, specifically to immunocompromised hosts.

Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review.

Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding.

Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents / Validación psicométrica de la escala de Columbia de severidad de suicidio en adolescentes hispano-hablantes

Abstract Introduction: Adolescent suicide is a major public health issue, and early and accurate detection is of great concern. There are many reliable instruments for this purpose, such as the Columbia-Suicide severity rating scale (C-SSRS), but no validation exists for Spanish speaking Latin American adolescents. Objetive: To assess psychometric properties and cut-off scores of the C-SSRS in Spanish speaking adolescents. Methods: Exploratory assessment with principal component analysis (PCA) and Varimax rotation, and confirmatory analysis (CFA) were performed on two groups with 782 and 834 participants respectively (N=1616). Mean age was 24.8 years. A Receiver operator analysis was applied to distinguish between control and suicide-risk subgroups adolescents. Results: Promax rotation yielded two 10-items factors, for suicide ideation and behavior respectively. C-SSRS was positively correlated with other suicide risk scales, such as Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, or PHQ-9. Confirmatory factor analysis yielded a two-factor solution as the best goodness of fit model. C-SSRS showed adequate ability to detect suicide risk group with positive predictive value of 68.3%. ROC analyses showed cutoff scores of ≥ 6 and ≥ 4 for suicide ideation and behavior scales respectively Conclusion: This research offers data supporting psychometric validity and reliability of C-SSRS in nonclinical Spanish-speaking students. Added benefits are flexible scoring and management easiness. This questionnaire yields data on distinct aspects of suicidality, being more parsimonious than separate administration of a bunch of questionnaires.

Resumen Introducción: Suicidio adolescente es un problema de salud pública y su detección temprana es de gran interés. Hay numerosos instrumentos confiables para este objetivo, como la escala Columbia para la detección del riesgo de suicidio, pero no ha sido validada para población adolescente de habla hispana en Latinoamérica. Objetivo: Validar psicométricamente y explorar los puntos de corte para la escala Columbia en adolescentes de habla hispana. Métodos: Analisis exploratorio con extracción de componentes principales y rotación Varimax así como análisis confirmatorio fueron llevados a cabo sobre 782 y 834 participantes respectivamente (N=1616). La edad media fue de 24.8 años. El análisis ROC distinguió entre controles y adolescentes en riesgo de suicidio. Resultados: La rotación Promax arrojó dos factores de 10 ítems, para ideación y comportamiento suicida respectivamente. La C-SSRS correlaciono positivamente con otras escalas de detección de riesgo de suicidio como Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, o el PHQ-9. El análisis factorial confirmatorio ofreció una solución de 2 factores como el modelo con mejor ajuste. El análisis ROC tuvo puntos de corte ≥ 6 y ≥ 4 para las escalas de ideación y comportamiento suicida respectivamente Conclusión: Esta investigación ofrece datos que apoyan la validez psicométrica y confiabilidad de la C-SSRS en población de estudiantes adolescentes hispano-hablantes latinoamericanos. Beneficios adicionales son un sistema de puntaje flexible y facilidad de administración. Este cuestionario ofrece datos sobre distintos aspectos de suicidalidad siendo más robusto que la administración separada de varios cuestionarios diferentes.

Physician opinions concerning legal abortion in Bogotá, Colombia.

Since the decriminalisation of abortion in 2006, women in Colombia have continued to seek clandestine abortions, endangering their health and contributing to maternal mortality and morbidity. The goal of this study was to explore physicians' opinions towards and knowledge about legal abortion in Bogotá, Colombia, and key barriers to the legal abortion access. We conducted 13 key informant interviews followed by a survey with a probability sample of 49 doctors working in public hospitals in Bogotá. Interview and survey data showed lack of technical experience in the provision of abortion and nuanced opinions towards its practice. Key informants described ignorance and lack of abortion training in medical schools as key barriers to provision. In the survey, 16/49 respondents had performed an abortion, 24/49 had referred a woman for an abortion and only 33/49 showed correct knowledge of the law.

Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents.

INTRODUCTION: Adolescent suicide is a major public health issue, and early and accurate detection is of great concern. There are many reliable instruments for this purpose, such as the Columbia-Suicide severity rating scale (C-SSRS), but no validation exists for Spanish speaking Latin American adolescents. OBJETIVE: To assess psychometric properties and cut-off scores of the C-SSRS in Spanish speaking adolescents. METHODS: Exploratory assessment with principal component analysis (PCA) and Varimax rotation, and confirmatory analysis (CFA) were performed on two groups with 782 and 834 participants respectively (N=1616). Mean age was 24.8 years. A Receiver operator analysis was applied to distinguish between control and suicide-risk subgroups adolescents. RESULTS: Promax rotation yielded two 10-items factors, for suicide ideation and behavior respectively. C-SSRS was positively correlated with other suicide risk scales, such as Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, or PHQ-9. Confirmatory factor analysis yielded a two-factor solution as the best goodness of fit model. C-SSRS showed adequate ability to detect suicide risk group with positive predictive value of 68.3%. ROC analyses showed cutoff scores of ≥ 6 and ≥ 4 for suicide ideation and behavior scales respectively. CONCLUSION: This research offers data supporting psychometric validity and reliability of C-SSRS in nonclinical Spanish-speaking students. Added benefits are flexible scoring and management easiness. This questionnaire yields data on distinct aspects of suicidality, being more parsimonious than separate administration of a bunch of questionnaires.

INTRODUCCIÓN: Suicidio adolescente es un problema de salud pública y su detección temprana es de gran interés. Hay numerosos instrumentos confiables para este objetivo, como la escala Columbia para la detección del riesgo de suicidio, pero no ha sido validada para población adolescente de habla hispana en Latinoamérica. OBJETIVO: Validar psicométricamente y explorar los puntos de corte para la escala Columbia en adolescentes de habla hispana.Métodos: Analisis exploratorio con extracción de componentes principales y rotación Varimax así como análisis confirmatorio fueron llevados a cabo sobre 782 y 834 participantes respectivamente (N=1616). La edad media fue de 24.8 años. El análisis ROC distinguió entre controles y adolescentes en riesgo de suicidio. RESULTADOS: La rotación Promax arrojó dos factores de 10 ítems, para ideación y comportamiento suicida respectivamente. La C-SSRS correlaciono positivamente con otras escalas de detección de riesgo de suicidio como Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, o el PHQ-9. El análisis factorial confirmatorio ofreció una solución de 2 factores como el modelo con mejor ajuste. El análisis ROC tuvo puntos de corte ≥ 6 y ≥ 4 para las escalas de ideación y comportamiento suicida respectivamente. CONCLUSIÓN: Esta investigación ofrece datos que apoyan la validez psicométrica y confiabilidad de la C-SSRS en población de estudiantes adolescentes hispano-hablantes latinoamericanos. Beneficios adicionales son un sistema de puntaje flexible y facilidad de administración. Este cuestionario ofrece datos sobre distintos aspectos de suicidalidad siendo más robusto que la administración separada de varios cuestionarios diferentes.

Extrusão de disco intervertebral em cão Relato de Caso / Extrusion of intervertebral disc in dog - Case Report

We report a case of an 11-year-old poodle dog that entered the veterinary clinic with nohistory of mechanical trauma presenting a mild ataxia without proprioceptive alterationsand underwent a CT scan, where a frame was observed characteristic of intervertebral discextrusion and a stenosis in the left vertebral foramen between the second and third thoracicvertebrae.(AU)

Extrusão de disco intervertebral em cão – Relato de Caso / Extrusion of intervertebral disc in dog - Case Report

We report a case of an 11-year-old poodle dog that entered the veterinary clinic with nohistory of mechanical trauma presenting a mild ataxia without proprioceptive alterationsand underwent a CT scan, where a frame was observed characteristic of intervertebral discextrusion and a stenosis in the left vertebral foramen between the second and third thoracicvertebrae.

Lactated Ringer's solution or 0.9 por cento sodium chloride as fluid therapy in pigeons (Columba livia) submitted to humerus osteosynthesis / Fluidoterapia com Ringer lactato ou cloreto de sódio 0.9 percent em pombos (Columbia livia) submetidos à osteossíntese de úmero

The study aimed to compare the effects of intraosseous infusion of lactated Ringer's and 0.9% sodium chloride solutions on the electrolytes and acid-base balance in pigeons submitted to humerus osteosynthesis. Eighteen pigeons were undergoing to isoflurane anesthesia by an avalvular circuit system. They were randomly assigned into two groups (n=9) receiving lactated Ringer's solution (LR) or 0.9% sodium chloride (SC), in a continuous infusion rate of 20mL/kg/h, by using an intraosseous catheter into the tibiotarsus during 60-minute anesthetic procedure. Heart rate (HR), and respiratory rate (RR) were measured every 10 min. Venous blood samples were collected at 0, 30 and 60 minutes to analyze blood pH, PvCO2, HCO3 -, Na+ and K+. Blood gases and electrolytes showed respiratory acidosis in both groups during induction, under physical restraint. This acidosis was evidenced by a decrease of pH since 0 min, associated with a compensatory response, observed by increasing of HCO3 - concentration, at 30 and 60 min. It was not observed any changes on Na+ and K+ serum concentrations. According to the results, there is no reason for choosing one of the two solutions, and it could be concluded that both fluid therapy solutions do not promote any impact on acid-base balance and electrolyte concentrations in pigeons submitted to humerus osteosynthesis.(AU)

O presente estudo avaliou os efeitos da infusão das soluções de Ringer lactato ou cloreto de sódio 0,9%, no equilíbrio ácido-base e hidroeletrolítico de pombos submetidos à osteossíntese de úmero. Foram utilizados 18 animais, os quais foram submetidos à anestesia por isofluorano, e mantidos em circuito avalvular durante o período anestésico (60 min). Os animais foram distribuídos aleatoriamente em dois grupos (n=9) recebendo Ringer lactato (LR) ou cloreto de sódio 0,9% (SC), administradas na taxa de 20mL/kg/h pela via intraóssea (tibiotarso). Foram monitoradas as frequências cardíaca e respiratória a cada 10 minutos e colhidas amostras sanguíneas venosas aos 0, 30 e 60 min de anestesia, obtendo-se a partir destas, valores de pH sanguíneo, bicarbonato (HCO3), pressão venosa de CO2 (PvCO2), sódio (Na+) e potássio (K+). Os valores referentes ao equilíbrio ácido-base indicam que houve acidose respiratória em ambos os grupos, a qual foi decorrente do processo de indução sob contenção física, caracterizada por diminuição no pH desde o 0 min, associado ao aumento compensatório nos valores de HCO3 -, nos momentos 30 e 60 min. No entanto, no que se refere aos valores obtidos de Na+ e K+ séricos, durante a infusão de ambos os fluidos, não foram observadas alterações que justifiquem a predileção por alguma destas soluções. Diante destes resultados conclui-se que a escolha entre uma das soluções avaliadas não promoveu impacto sob o equilíbrio ácido-base e hidroeletrolítico de pombos submetidos a osteossíntese de úmero.(AU)

Lactated Ringer's solution or 0.9 por cento sodium chloride as fluid therapy in pigeons (Columba livia) submitted to humerus osteosynthesis / Fluidoterapia com Ringer lactato ou cloreto de sódio 0.9 percent em pombos (Columbia livia) submetidos à osteossíntese de úmero

The study aimed to compare the effects of intraosseous infusion of lactated Ringer's and 0.9% sodium chloride solutions on the electrolytes and acid-base balance in pigeons submitted to humerus osteosynthesis. Eighteen pigeons were undergoing to isoflurane anesthesia by an avalvular circuit system. They were randomly assigned into two groups (n=9) receiving lactated Ringer's solution (LR) or 0.9% sodium chloride (SC), in a continuous infusion rate of 20mL/kg/h, by using an intraosseous catheter into the tibiotarsus during 60-minute anesthetic procedure. Heart rate (HR), and respiratory rate (RR) were measured every 10 min. Venous blood samples were collected at 0, 30 and 60 minutes to analyze blood pH, PvCO2, HCO3 -, Na+ and K+. Blood gases and electrolytes showed respiratory acidosis in both groups during induction, under physical restraint. This acidosis was evidenced by a decrease of pH since 0 min, associated with a compensatory response, observed by increasing of HCO3 - concentration, at 30 and 60 min. It was not observed any changes on Na+ and K+ serum concentrations. According to the results, there is no reason for choosing one of the two solutions, and it could be concluded that both fluid therapy solutions do not promote any impact on acid-base balance and electrolyte concentrations in pigeons submitted to humerus osteosynthesis...

O presente estudo avaliou os efeitos da infusão das soluções de Ringer lactato ou cloreto de sódio 0,9%, no equilíbrio ácido-base e hidroeletrolítico de pombos submetidos à osteossíntese de úmero. Foram utilizados 18 animais, os quais foram submetidos à anestesia por isofluorano, e mantidos em circuito avalvular durante o período anestésico (60 min). Os animais foram distribuídos aleatoriamente em dois grupos (n=9) recebendo Ringer lactato (LR) ou cloreto de sódio 0,9% (SC), administradas na taxa de 20mL/kg/h pela via intraóssea (tibiotarso). Foram monitoradas as frequências cardíaca e respiratória a cada 10 minutos e colhidas amostras sanguíneas venosas aos 0, 30 e 60 min de anestesia, obtendo-se a partir destas, valores de pH sanguíneo, bicarbonato (HCO3), pressão venosa de CO2 (PvCO2), sódio (Na+) e potássio (K+). Os valores referentes ao equilíbrio ácido-base indicam que houve acidose respiratória em ambos os grupos, a qual foi decorrente do processo de indução sob contenção física, caracterizada por diminuição no pH desde o 0 min, associado ao aumento compensatório nos valores de HCO3 -, nos momentos 30 e 60 min. No entanto, no que se refere aos valores obtidos de Na+ e K+ séricos, durante a infusão de ambos os fluidos, não foram observadas alterações que justifiquem a predileção por alguma destas soluções. Diante destes resultados conclui-se que a escolha entre uma das soluções avaliadas não promoveu impacto sob o equilíbrio ácido-base e hidroeletrolítico de pombos submetidos a osteossíntese de úmero...

Height-independent estimation of glomerular filtration rate in children: an alternative to the Schwartz equation.

OBJECTIVE: To compare the diagnostic performance of 2 height-independent equations used to calculate estimated glomerular filtration rate (eGFR), those of Pottel (eGFR-Pottel) and the British Columbia Children's Hospital (BCCH) (eGFR-BCCH), with the commonly used Schwartz equation (eGFR-Schwartz). STUDY DESIGN: We externally validated eGFR-Pottel and eGFR-BCCH in a well-characterized pediatric patient population (n = 152) and compared their diagnostic performance with that of eGFR-Schwartz using Bland-Altman analysis. All patients underwent glomerular filtration rate measurement using the gold standard single-injection inulin clearance method (GFR-inulin). RESULTS: Median GFR-inulin was 92.0 mL/min/1.73 m² (IQR, 76.1-107.4 mL/min/1.73 m²). Compared with GFR-inulin, the mean bias for eGFR-Schwartz was -10.1 mL/min/1.73 m(2) (95% limits of agreement [LOA], -77.5 to 57.2 mL/min/1.73 m(2)), compared with -12.3 mL/min/1.73 m² (95% LOA, -72.6 to 47.9 mL/min/1.73 m(2)) for eGFR-Pottel and -22.1 mL/min/1.73 m² (95% LOA, -105.0 to 60.8 mL/min/1.73 m(2)) for eGFR-BCCH. eGFR-Pottel showed comparable accuracy to eGFR-Schwartz, with 77% and 76% of estimates within 30% of GFR-inulin, respectively. eGFR-BCCH was less accurate than eGFR-Schwartz (66% of estimates within 30% of GFR-inulin; P < .01). CONCLUSION: The performance of eGFR-Pottel is superior to that of eGFR-BCCH and comparable with that of eGFR-Schwartz. eGFR-Pottel is a valid alternative to eGFR-Schwartz in children and could be reported by the laboratory if height data are not available.

Risk factors for febrile status epilepticus: a case-control study.

OBJECTIVE: To identify risk factors for developing a first febrile status epilepticus (FSE) among children with a first febrile seizure (FS). STUDY DESIGN: Cases were children with a first FS that was FSE drawn from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts. Controls were children with a first simple FS and separately, children with a first complex FS that was not FSE. Identical questionnaires were administered to family members of the 3 cohorts. Magnetic resonance imaging protocol and readings were consistent across cohorts, and seizure phenomenology was assessed by the same physicians. Risk factors were analyzed using logistic regression. RESULTS: Compared with children with simple FS, FSE was associated with younger age, lower temperature, longer duration (1-24 hours) of recognized temperature before FS, female sex, structural temporal lobe abnormalities, and first-degree family history of FS. Compared with children with other complex FS, FSE was associated with low temperature and longer duration (1-24 hours) of temperature recognition before FS. Risk factors for complex FS that was not FSE were similar in magnitude to those for FSE but only younger age was significant. CONCLUSIONS: Among children with a first FS, FSE appears to be due to a combination of lower seizure threshold (younger age and lower temperatures) and impaired regulation of seizure duration. Clinicians evaluating FS should be aware of these factors as many episodes of FSE go unnoticed. Further work is needed to develop strategies to prevent FSE.

Adherence to clinical practice guidelines in the management of children, youth, and young adults with type 1 diabetes--a prospective population cohort study.

OBJECTIVE: To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. STUDY DESIGN: This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. RESULTS: Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). CONCLUSIONS: The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.

Metodologia científica na formação do médico veterinário: experiênciateórico-prática na análise de fontes urbanas de Cryptococcus spp – Jaboticabal, SP – Brasil / Scientific methodology in veterinary medical training: a theoretical andpractical experience in the analysis of urban sources of Cryptococcus spp in Jaboticabal, SP – Brazil / Metodología científica en la formación médica veterinaria: la experienciateórica y práctica en el análisis de fuentes urbanas de Cryptococcus spp de Jaboticabal, SP – Brasil

O artigo apresenta resultados de um projeto de ensino de Metodologia Científica em Curso de Graduação deMedicina Veterinária. Pautou-se por uma reflexão crítica da necessidade de interação entre as dimensões teórica eprática na formação do profissional e realizou-se análise de fontes urbanas de Cryptococcus spp em fezes de pombos(Columbia livia), evidenciando a importância de orientação à população sobre os riscos de contágio, caracterizando a patogenicidade dos agentes identificados em dez ambientes públicos.

This article presents the results of an educational project for the Scientific Methodology degree course for veterinary medicine. The project was guided by the critical reflection on the necessity for the interaction between the theoretical and practical dimensions of professional training. An analysis was performed of urban sources of Cryptococcus spp in excrements of pigeons (Columbia livia), indicating the need for education of the population about the risks factors of transmission and characterizing the pathogenicity of the identified agents in ten public places.

El artículo presenta los resultados de un proyecto de enseñanza de Metodología Científica en el Curso de Graduaciónde Medicina Veterinaria. Se marcó por una reflexión crítica da la necesidad de la interacción entre las dimensionesteóricas y prácticas en la formación del profesional y se realizó un análisis de fuentes urbanas de Cryptococcus sppen excremento de palomas (Columbia livia), mostrando la importancia de la orientación a la población sobre losriesgos del contagio, caracterizando la patogenicidad de los agentes identificados en diez ambientes públicos.

Evaluación biológica de dos sistemas de apareamiento en ovinos de raza Columbia en producción intensiva / Biological evaluation of two breeding systems of intensive production in the Columbia breed sheep

The biological efficiency of two breeding systems for sheep in the Mexican high plateau was evaluated. A total of 300 adult and 60 replacement sheep of the Columbia breed were randomly distributed into two groups of 150 adults and 30 young ones (mean age to first birth of 18 months). Mates of 36 days with natural mount every eight months (March, November and July) were done in the first group (intensive system). In the second group (annual system), a 45-day mating was done starting on November every year. Marker males were introduced 15 days before mating in all cases, which were replaced on the first day of mating for stallions at a one male for every 20 female ratios. The physical condition of all females was evaluated every month. The animals grazed 8 to 9 hours in grasslands of alfalfa (Medicago sativa) and Orchard (Dactylis glomerata) and Rye (Lolium perenne) grasses irrigated by aspersion. Only the sheep in the intensive system received supplement during lactation and re-mating. Breeding was achieved in both systems in all seasons. The mean fertility of the three breeding of the intensive system was 83.9%; while the mean fertility of the two annual breeding was 88.3% (P < 0.05). Prolificacy was 1.12 vs 1.32 (P < 0.05) for the intensive and annual breeding, respectively; mortality at weaning was 5.3% vs 6.4% (P < 0.05), weaning rate was 0.89 vs 1.09 (P < 0.05), the number of weaned lambs per ewe in two years was 2.5 vs 2.0 and lamb weight was 55.9 vs 44.4 kg (P < 0.05), respectively. Adult ewes were superior to the young ones in all the evaluated parameters, regardless of the kind of mating (P < 0.05). Results in this study allowed to compare the biological efficiency between an intensive breeding system every eight months and an annual breeding system. They also show the possibility of mating sheep of the Columbia breed in an intensive way.

Se evaluó la eficacia biológica de dos sistemas de apareamiento en ovinos del altiplano central de México. Un total de 300 ovejas adultas y 60 de reemplazo de la raza Columbia se distribuyeron al azar en dos grupos de 150 adultas y 30 jóvenes (edad promedio al primer parto de 18 meses). En el primer grupo (sistema intensivo) se realizaron empadres de 36 días, con monta natural cada ocho meses (marzo, noviembre y julio), mientras que en el segundo grupo (sistema anual) se llevó a cabo un empadre de 45 días, iniciando en noviembre de cada año. En todos los casos, quince días antes del empadre se introdujeron machos marcadores, que en la fecha de inicio del empadre se sustituían por sementales en proporción de un macho por cada 20 hembras. Mensualmente se evaluó la condición física de todas las hembras. Los animales pastorearon de ocho a nueve horas diarias en praderas de alfalfa (Medicago sativa) y pastos orchard (Dactylis glomerata) y rye grass (Lolium perenne) irrigadas por aspersión. Solamente las ovejas del sistema intensivo recibieron complemento durante la lactancia y el reempadre. En los dos sistemas se lograron apareamientos en todas las épocas, la fertilidad en los tres empadres del sistema intensivo fue de 83.9%, mientras que el promedio de los dos empadres anuales fue de 88.3% (P < 0.05). En el mismo orden, la prolificidad fue de 1.12 vs 1.32 (P < 0.05); la mortalidad al destete, 5.3% vs 6.4% (P > 0.05); la tasa de destete, 0.89 vs 1.09 (P < 0.05); el número de corderos destetados por oveja en dos años fue de 2.5 vs 2.0, y de kg de cordero de 55.9 vs 44.4 kg (P < 0.05). Independientemente del tipo de empadre, las ovejas adultas fueron superiores a las jóvenes en todos los parámetros evaluados (P < 0.05). Los resultados de este estudio permiten comparar la eficacia biológica entre un sistema de apareamiento intensivo cada ocho meses y uno anual, también muestra la posibilidad de aparear ovejas de la raza Columbia en forma intensiva.

El efecto macho como inductor de la actividad reproductiva en sistemas intensivos de apareamiento en ovinos / Use of the male effect to induce reproductive activity in ovine intensive breeding systems

The presence of the male effect and its importance in the reproductive management of Columbia ewes was evaluated during a comparative study between a herd of ewes subjected to an annual breeding system with services in November (AS) and another herd subjected to an intensive system with breeding periods in November, July and March (IS). The two herds were kept on intensive irrigated prairies with moderate climate: the ewes in the IS were supplemented during the lactation and rebreeding periods. Estrus expression was detected by the presence of marks on the rump left by aniline-impregnated teaser males. In addition, the concentrations of progesterone were determined in blood samples from 20 adult ewes and 5 ewe-lambs from each breeding system. These samples were taken twice per week from the time the teaser males were introduced. The conception date for each ewe was retrospectively calculated from the date of lambing. The results indicate a clear male effect in the IS group during the breeding periods of July and March, when such a male effect proved to be very important for the reproductive success of the herd. In contrast, the male effect was not apparent during November breeding periods because the animals of both herds were already cycling when the teaser males were introduced at that time of the year. It is concluded that the use of the male effect can improve the reproductive efficiency of Columbia ewes exposed to intensive breeding systems in Mexico.

Se determinó la presencia del efecto macho y su importancia en el manejo reproductivo de ovejas de la raza Columbia, en un estudio comparativo entre un rebaño sometido a un sistema de apareamiento anual con empadres en noviembre (S-A) y otro intensivo con empadres en noviembre, julio y marzo (S-I). Los rebaños se mantuvieron en condiciones de pastoreo intensivo en praderas irrigadas de clima templado: las ovejas en el S-I se complementaron durante la lactancia y el reempadre. Se estableció la ocurrencia de estros por medio de la presencia de marcas de anilina que los machos vasectomizados dejaron en la grupa. Además, en cada sistema de empadre se determinaron las concentraciones de progesterona en muestras sanguíneas de 20 ovejas adultas y cinco primalas dos veces por semana a partir de la introducción de los machos. La distribución de los partos permitió calcular la fecha de concepción. Los resultados indican un claro efecto macho en el grupo S-I durante los empadres de julio y marzo, cuando dicho efecto macho confirmó su importancia en el éxito reproductivo del rebaño.. En cambio, el efecto macho no se presentó durante el empadre de noviembre del grupo S-I, ni durante los empadres del grupo S-A, debido a que al inicio de dichos empadres las ovejas se encontraban ciclando. Se concluye que el efecto macho puede ser utilizado para mejorar la eficiencia reproductiva de ovejas de la raza Columbia sometidas a sistemas intensivos de apareamiento en México.

Comparación de medios de cultivos y procedimientos para detectar colonización por Streptococcus agalactiae en mujeres embarazadas / Comparison between culture media and procedures to detect Streptococcus agalactiae in pregnant women

Introducción: La detección de Streptococcus agalactiae en la vagina y/o el recto de las mujeres embarazadas y la administración de profilaxis antimicrobiana intraparto en las colonizadas, es el método recomendado para prevenir la infección neonatal precoz por este patógeno. En consecuencia, es importante seleccionar los medios de cultivos y el sitio de toma de muestra más adecuado para la detección de S. agalactiae en mujeres colonizadas. Objetivo: Comparar diferentes medios de cultivos y procedimientos para la recuperación de S. agalactiae en mujeres embarazadas con complicaciones gineco-obstétricas. Metodología: Se tomaron hisopados vagino-ano-rectales y endocer-vicales de 60 mujeres embarazadas. Con la primera muestra se realizó cultivo directo en agar sangre Columbia selectivo (ASCSD), y caldo selectivo Todd Hewitt (CSTH) incubados a 37 °C, y subcultivos a las 4 y 18 horas en agar sangre Columbia selectivo (ASCS). La segunda muestra se cultivó en ASCS. El ASCSD y ASCS se incubaron en atmósfera microaeróñla a 37 °C durante 24 a 48 horas. La identificación de S. agalactiae se realizó mediante pruebas convencionales. Resultados: Utilizando hisopado vagino-ano-rectal se detectaron 21 pacientes colonizadas con S. agalactiae, de la siguiente manera: 19(31,7 por ciento) en el ASCSD, 21 (35 por ciento) en el CSTH a las 4 horas y 20 (33,3 por ciento) a las 18 horas. De las 21 pacientes colonizadas sólo a una paciente se le detectó S. agalactiae en la muestra de secreción vagino-ano-rectal y endocervical simultáneamente. Conclusión: Los tres procedimientos ensayados presentaron igual efectividad para la recuperación de S. agalactiae; sin embargo, con el uso del ASCSD, se disminuyen los costos y el tiempo de identificación de dicho microorganismo. Por otra parte, el hisopado vagino-ano-rectal resultó ser la muestra más idónea para detectar colonización por S. agalactiae en mujeres embarazadas.

Detection of Streptococcus agalactiae in pregnant women's vagina and rectum and intrapartum antibiotic prophylaxis administered to colonized women are currently recommended to prevent neonatal precocious infections by this organism. In turn, it is very important to select the culture media and adequate sample collection site for S. agalactiae detection in colonized women. To standardize this methods in laboratory, different culture media and procedures for S. agalactiae recovery in pregnant women with obstetric and gynecologic complications were compared. Vaginorectal and endocervical swab specimens were collected from 60 pregnant women. The first sample was placed onto selective Columbia blood agar directly and onto selective Todd-Hewitt broth incubated at 37 °C and subcultured onto selective Columbia blood agar at 4 and 18 hours. The second sample was cultured on selective Columbia blood agar. Both culture media were incubated in a microaerophilic atmosphere at 37 °C from 24 to 48 hours. S. agalactiae was identified using conventional tests. 21 patients colonized with S. agalactiae were detected using vaginoanorectal samples. 19 (31.7 percent) patients tested positive for S. agalactiae through the culture of specimens directly onto selective Columbia blood agar; 21 (35 percent) and 20 (33 percent) patients were found to be positive for S. agalactiae by the selective Todd-Hewitt broth at 4 and 18 hours, respectively. Only one patient tested positive for S. agalactiae in the endocervical tract. The results show that the three procedures followed for S. agalactiae recovery are effective. Nevertheless, the procedure in which the sample was placed directly onto selective Columbia blood agar permits reducing costs and the time for bacteria identification. On the other hand, the vaginoanorectal swab was the best sample to detect colonization by S. agalactiae in pregnant women.