Caracterización espacial de la ganadería bovina en la Orinoquia colombiana / Spatial characterization of the bovine livestock in the Colombian Orinoquia

RESUMEN Objetivo. Utilizar los sistemas de información geográfica (SIG) como herramienta complementaria para caracterizar la ganadería bovina realizada en la región de la Orinoquia. Materiales y métodos. A través del uso de tecnologías espaciales se recopiló la información concerniente a la orientación ganadera, fisiografía, cobertura vegetal y catastro de la zona de estudio para su posterior análisis a través del software ACCESS de Microsoft. Resultados. En un alto porcentaje de los predios ganaderos ubicados en los cuatro departamentos de la Orinoquía (Casanare:72.7%, Meta:49.5%, Arauca:42% y Vichada:32%) predominan las coberturas de pastos, herbazales y vegetación secundaria, confirmando la expansión en la frontera agropecuaria que es promovida por la actividad ganadera en el país. Conclusiones. El uso de los SIG, permite realizar una mejor planificación y distribución eficiente de los recursos destinados a mejorar el funcionamiento de los sistemas de producción. Por ejemplo, en zonas donde la matriz de coberturas predominante son los pastizales y herbazales, las estrategias en pro de la sostenibilidad pueden enfocarse en la implementación de sistemas silvopastoriles, contrario a lo que pasaría en zonas donde la matriz de coberturas tenga un alto porcentaje de bosques naturales.

ABSTRACT Objective. Use Geographic Information Systems (GIS) as a complementary tool to characterize cattle farming in the Orinoquia region. Materials and methods. Through the use of space technologys, information concerning the livestock orientation, physiography, vegetation cover and land registry of the study zone was collected for further analysis over Microsoft ACCESS software. Results. In a high percentage of the cattle ranches located in the four departments (Casanare: 72.7%, Meta: 49.5%, Arauca: 42% and Vichada: 32%) the cover of pastures, grasslands and secondary vegetation predominates, confirming the expansion in the agricultural border that has had the cattle activity in the country. Conclusions. The use of complementary tools such as GIS allows for better planning and efficient distribution of resources to improve the functioning of production systems, for example, in zones where the predominant coverage matrix is grasslands, strategies in pro of sustainability can focus on the implementation of silvopastoral systems, contrary to what would happen in areas where the matrix has a high percentage of natural forests.

Best practices in mitigating the risk of biotin interference with laboratory testing.

Dietary biotin intake does not typically result in blood biotin concentrations that exceed interference thresholds for in vitro diagnostic tests. However, recent trends of high-dose biotin supplements and clinical trials of very high biotin doses for patients with multiple sclerosis have increased concerns about biotin interference with immunoassays. Estimates of the prevalence of high biotin intake vary, and patients may be unaware that they are taking biotin. Since 2016, 92 cases of suspected biotin interference have been reported to the US Food and Drug Administration. Immunoassays at greatest risk from biotin interference include thyroid and reproductive hormones, cardiac, and immunosuppressive drug tests. Several case studies have highlighted the challenge of biotin interference with thyroid hormone assays and the potential misdiagnosis of Graves' disease. Biotin interference should be suspected when immunoassay test results are inconsistent with clinical information; a clinically relevant biotin interference happens when the blood biotin concentration is high and the assay is sensitive to biotin. We propose a best practice workflow for laboratory scientists to evaluate discrepant immunoassay results, comprising: (1) serial dilution; (2) retesting after biotin clearance and/or repeat testing on an alternate platform; and (3) confirmation of the presence of biotin using depletion protocols or direct measurement of biotin concentrations. Efforts to increase awareness and avoid patient misdiagnosis should focus on improving guidance from manufacturers and educating patients, healthcare professionals, and laboratory staff. Best practice guidance for laboratory staff and healthcare professionals would also provide much-needed information on the prevention, detection, and management of biotin interference.

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries.

We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (≥1:1024) and positive immunoglobulin M titer (≥1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.

Clinical uptake of antimicrobial stewardship recommendations following Nanosphere Verigene Blood Culture Gram-negative reporting.

We performed a retrospective chart review of patients to determine if the Verigene Gram-negative blood culture (BC-GN) results would lead to earlier deescalation of empiric therapy for inpatients with GN bacteremia with Citrobacter spp., Enterobacter spp., Klebsiella spp., and Escherichia coli to appropriate targeted coverage. A total of 899 records were reviewed from April 2014 to February 2016 from three institutions within the Baylor Scott & White Health network. The cases were reviewed for initial antibiotic coverage, timing of Verigene results, change in antibiotic coverage, and how these changes related to the timing of Verigene results. The lab reported the BC-GN results and final conventional susceptibility results within 2.5 ± 1.3 and 73.6 ± 40.0 hours from the Gram stain, respectively. Overall, 29.1% of patients were transitioned from empiric to targeted therapy at 12.2 ± 13.5 hours in response to BC-GN results, which was significantly earlier (P < 0.001) than results by conventional methods. After accounting for patients already on targeted therapy, polymicrobial infections, and patients deceased or lost to follow-up, we identified antibiotic stewardship opportunities in ∼28% of GN infections. Further subanalysis demonstrated site-specific differences in the uptake of stewardship recommendations, whereby 32.4%, 50.5%, and 15.0% of cases at different hospitals demonstrated the expected change in antibiotics. These results suggest that Verigene had the expected impact in a third of the cases and the results reporting algorithm minimized the real-time involvement of the pharmacist while maintaining optimal patient management. However, this impact varied substantially by clinical site and was tempered by variable initial antibiotic coverage and clinician response.

A rare hemoglobin variant, Hb Belliard.

There are many documented variants of hemoglobin; however, other than a limited number (such as sickle cell disease), very few are known to have any clinical significance. As advances in detection and identification continue through gel electrophoresis, capillary electrophoresis, and DNA sequencing, more rare variants are identified. Without case reporting, the significance of these variants will remain unknown or continue to be thought of as insignificant. Here we report a rare hemoglobin variant, Hb Belliard, which was detected in a 68-year-old Indian immigrant to the United States. He presented with elevated hemoglobin and was found to have a unique peak on capillary electrophoresis. The specimen was sent for sequencing and was subsequently found to have Hb Belliard. Currently, Hb Belliard is thought to be insignificant.

Myroides odoratimimus bacteremia in a diabetic patient.

Myroides species are a rare source of human infection. Though not part of the human microbiota, Myroides species are commonly found in the environment. Myroides infections are typically attributed to contact with contaminated water; the most common presentation is in immunocompromised patients. We present a patient with a diabetic foot ulcer who subsequently developed Myroides odoratimimus bacteremia and bone abscess.

Antibiotic utilization improvement with the Nanosphere Verigene Gram-Positive Blood Culture assay.

New technologies offer rapid identification of organisms and antimicrobial resistance markers in blood cultures several hours faster than conventional methods. We sought to determine whether implementation of the Verigene® Gram-Positive Blood Culture (BC-GP) assay paired with a well-defined results reporting algorithm would lead to earlier deescalation of empiric therapy for inpatients with methicillin-sensitive Staphylococcus aureus (MSSA) and vancomycin-resistant Enterococcus (VRE) bacteremia. The algorithm design focused on lessening the demand for pharmacist time by using electronic communications where possible. Our study compared inpatients with MSSA and VRE bacteremia from the time period before (pre-BC-GP) and after (post-BC-GP) implementation of the assay on June 25, 2013. The time from blood draw to identification and susceptibility results was decreased by 36.4 hours (P < 0.001) in the post-BC-GP group. The mean time from collection to the first dose of optimal antibiotics was reduced in the post-BC-GP group by 18.9 hours (P = 0.004) overall, with a 20.6-hour reduction (P = 0.009) for patients with MSSA and a 20.7-hour reduction (P = 0.077) for patients with VRE. Additionally, the percent of patients on empiric therapy who were placed on optimal antibiotics at any time after the Gram stain result was available increased from 64% (45/70) pre-BC-GP to 80% (43/54) post-BC-GP. The BC-GP led to an increased rate of deescalation of empiric antibiotics and a reduction in the time to optimal antibiotics for patients with MSSA and VRE bacteremia.

The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.

Successful performance and execution of rapid diagnostics in a clinical laboratory hinges heavily on careful validation, accurate and timely communication of results, and real-time quality monitoring. Laboratories must develop strategies to integrate diagnostics with stewardship and evidence-based clinical practice guidelines. We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. Utilization of resources was optimized by reviewing current treatment strategies and antibiogram and formulary options. Core strategies consisted of input from infectious disease leadership, pharmacy, and laboratory staff. Concierge services included automated Micro-eUpdate and physician-friendly actionable reports. Education modules were user-specific, and support was provided through a dedicated 24/7 microbiology hotline. Surveillance was performed by daily audit by the director. Using the SUCCESS model, the turnaround time for the detailed report with actionable guidelines to the physician was ∼3 hours from the time of culture positivity. The overall correlation between rapid methods and culture was 94% (546/579). Discrepant results were predominantly contaminants such as a coagulase-negative staphylococci or viridans streptococci in mixed cultures. SUCCESS is a cost-effective and easily adaptable model for clinical laboratories with limited stewardship resources.

Comparison of length of stay and outcomes of patients with positive versus negative blood culture results.

In the United States, sepsis is the leading cause of death in critically ill patients. The fatality rate for severe sepsis is about 40%, and treatment costs over $16 billion annually. It is critical to identify and treat the source of sepsis. While there are varying guidelines determining when to draw blood for culture, at Baylor University Medical Center at Dallas, blood cultures are ordered for patients with new onset of fever, immunosuppression, or a suspicion of an underlying infectious etiology. We conducted a retrospective study of patients who had blood cultures after hospital admission or in the emergency department in December 2013. We compared length of stay and outcomes of patients with positive versus negative blood cultures. There was no significant difference for length of stay or outcomes among patients with positive and negative blood cultures. For patients admitted from the emergency department, there was a longer length of stay for patients with positive cultures; however, the overall prognosis was not worse.

Comparison of the frequency and level of serum total cholesterol >300 mg/dL in patients at the same Texas hospital in a single month in 1993 and in 2013.

The clinical pathology laboratory database of a large tertiary hospital in Dallas, Texas, was searched for patients having a serum total cholesterol > 300 mg in a single month in 1993 and in 2013. In September 1993, 63 patients had a serum total cholesterol > 300 mg/dL (range 302-1515 [mean 431, median 349]), and in September 2013, 12 patients had serum total cholesterol levels > 300 mg/dL (range 303-442 [mean 334, median 316.5]), an 81% decline in the numbers of patients and a 23% decline in the average total cholesterol levels during the 20-year period.

Prevalencia de caries, gingivitis y maloclusiones en escolares de Ciudad Victoria, Tamaulipas y su relación con el estado nutricional / Prevalence of caries, gingivitis and malocclusions in school-age children in Ciudad Victoria, Tamaulipas, and its relationship with their nutritional status

Objetivo: Estimar la prevalencia de caries, gingivitis y maloclusiones en escolares de Ciudad Victoria, Tamaulipas y determinar su relación con el estado nutricional. Metodología: Se realizó un estudio transversal comparativo en 402 escolares entre 7 y 12 años de edad los cuales contaban con la medición de su composición corporal, seleccionados aleatoriamente del listado del estudio ''Obesidad en la población menor de 30 años de Tamaulipas: efectos sobre la salud, tratamiento y prevención'' que se lleva a cabo en este hospital. Previo consentimiento por escrito, a todos ellos se les realizó un examen bucal, determinando la presencia de caries dental, gingivitis y maloclusiones según la OMS. Para el análisis estadístico, la base de datos electrónica se transfirió al programa STATA versión 9.0. Resultados: El 50 % de los escolares nunca había acudido a una consulta dental, 36.2% tenían sobrepeso y obesidad, la prevalencia de caries fue de 87%, de gingivitis de 63% y de maloclusiones de 33%, el índice ceo-d de 2.97 y el CPO-D de 3.08. El análisis multivariado mostró relación entre el índice ceo-d con la edad (p = 0.00), con el sobrepeso y obesidad y con las maloclusiones (p = 0.016), así como relación entre la edad con la gingivitis (p = 0.01) y las maloclusiones (p = 0.042). Conclusiones: La prevalencia de caries y maloclusiones es similar a la de otros estudios en el país; en cambio, la gingivitis se presenta con mayor frecuencia en nuestra casuística, la relación más significativa es entre el índice ceo-d y el sobrepeso y obesidad.

Aim: Assessment of caries, gingivitis and malocclusion prevalence in school-age children in the city of Ciudad Victoria, Tamaulipas, Mexico and determination of its relationship with their nutritional status. Methodology: A comparative, cross-sectional study was conducted on 402 school-age children (ages 7-12 years). These children could exhibit measurement of body composition. Children were randomly selected from the study list of ''Obesity in Tamaulipas' under 30 population, effects on health, treatment and prevention'' conducted in this hospital. All subjects provided written consent, thereafter, oral examination was performed in order to determine, according to WHO parameters, presence of dental caries, gingivitis and malocclusions. Version 9.0 of STRATA program was used to conduct statistical analysis. Results: 50% of school age children had never attended a dental office. 32.2% were overweight or obese. Caries prevalence was 87%, gingivitis was present in 63% of all cases, and malocclusions were present in 33% of patients. Ceo-d index was 2.97 and CPO-D was 3.08. Multivariate analysis revealed relationship between the ceo-d index with age (p = 0.00), with overweigh and obesity and with malocclusions (p = 0.016) as well as relationship between age and gingivitis (p = 0.01) and age and malocclusion (p = 0.042). Conclusions: Malocclusion and caries prevalence resulted similar to that observed in other studies performed in Mexico. Nevertheless, gingivitis was more frequent. In our casuistry; the most significant relationship was that found between ceo-d index with overweight and obesity.

Identification of designer drug 2C-E (4-ethyl-2, 5-dimethoxy-phenethylamine) in urine following a drug overdose.

In recent years, access to information regarding acquisition and synthesis of newer designer drugs has been at an all-time high due largely to the Internet. As these drugs have become more prevalent, laboratory techniques have been developed and refined to identify and screen for this burgeoning population of drugs. This provides a unique opportunity for learning about many of these methods. Laboratory testing techniques and instrumentation are obscure to many health care professionals, yet their results are crucial. Here, we present a case of an overdose of an uncommon designer drug (2C-E) and discuss the basics of liquid chromatography and mass spectrometry, two important techniques used in isolating and identifying the drug. Although often overlooked and taken for granted, these techniques can play a pivotal role in the diagnosis and subsequent management of select patients.

Lateralization on neuroimaging does not differentiate frontotemporal lobar degeneration from Alzheimer's disease.

Lateralization on neuroimaging was compared in cases of frontotemporal lobar degeneration (FTLD; n = 10) and cases of definite Alzheimer's disease (AD; n = 17). All of the cases were pathologically confirmed and semi-quantitative and statistical parametric mapping methods were employed. Seven of the 10 FTLD cases had lateralization on at least one neuroimaging modality: single photon emission computerized tomography (SPECT), MRI, or CT. All 6/6 FTLD cases with SPECT showed lateralization. MRI results generally agreed with SPECT findings. Three of 4 FTLD cases had lateralized atrophy on CT. For the AD cases, 10/17 SPECTs, 2/7 MRIs, and 1/9 CTs showed lateralized findings. Of the neuroimaging modalities utilized, SPECT was the most sensitive in detecting lateralization.