[Health: an adaptive complex system]. / Salud: un sistema complejo adaptativo.

This article points out the enormous gap that exists between complex thinking of an intellectual nature currently present in our environment, and complex experimental thinking that has facilitated the scientific and technological advances that have radically changed the world. The article suggests that life, human beings, global society, and all that constitutes health be considered as adaptive complex systems. This idea, in turn, prioritizes the adoption of a different approach that seeks to expand understanding. When this rationale is recognized, the principal characteristics and emerging properties of health as an adaptive complex system are sustained, following a care and services delivery model. Finally, some pertinent questions from this perspective are put forward in terms of research, and a series of appraisals are expressed that will hopefully serve to help us understand all that we have become as individuals and as a species. The article proposes that the delivery of health care services be regarded as an adaptive complex system.

Electrodynamics of lipid membrane interactions in the presence of zwitterionic buffers.

Due to thermal motion and molecular polarizability, electrical interactions in biological systems have a dynamic character. Zwitterions are dipolar molecules that typically are highly polarizable and exhibit both a positive and a negative charge depending on the pH of the solution. We use multilamellar structures of common lipids to identify and quantify the effects of zwitterionic buffers that go beyond the control of pH. We use the fact that the repeat spacing of multilamellar lipid bilayers is a sensitive and accurate indicator of the force balance between membranes. We show that common buffers can in fact charge up neutral membranes. However, this electrostatic effect is not immediately recognized because of the concomitant modification of dispersion (van der Waals) forces. We show that although surface charging can be weak, electrostatic forces are significant even at large distances because of reduced ionic screening and reduced van der Waals attraction. The zwitterionic interactions that we identify are expected to be relevant for interfacial biological processes involving lipid bilayers, and for a wide range of biomaterials, including amino acids, detergents, and pharmaceutical drugs. An appreciation of zwitterionic electrodynamic character can lead to a better understanding of molecular interactions in biological systems and in soft materials in general.

Osteonecrosis maxilar inferior asociado a bifosfonatos / Lower jaw osteonecrosis associated with bisphosphonates / Osteonecrose do maxilar inferior associada a bisfosfonatos

Introducción: dada la alta prescripción de bifosfonatos, presentamos sus efectos adversos en la esfera odontológica, siendo una complicación poco frecuente, pero de difícil tratamiento. Sin necesidad de suspender el tratamiento, dado el importante beneficio en cuanto a la prevención de fractura por fragilidad. Estas fracturas causan una alta morbimortalidad en contraposición al bajo riesgo que conlleva la Osteonecrosis mandibular asociada a bifosfonatos. Objetivo: orientar al personal de salud que maneja estos fármacos y quien asiste dichas complicaciones a poseer conocimientos para la prevención de osteonecrosis. Identificar y diferenciar los pacientes con mayor riesgo, de acuerdo con la dosis de bifosfonatos y la frecuencia del tratamiento. Materiales y Método: se realizó una revisión bibliográfica en las siguientes fuentes: Scielo, Google académico, Medline/Pubmed, Biblioteca Virtual en Salud (Brasil), desde el año 2005 a la fecha, idiomas español, portugués e inglés. Los descriptores utilizados son bifosfonatos, mandíbula, maxilar, odontología, osteonecrosis, osteonecrosis de los maxilares asociada a bifosfonatos. Resultados: las últimas pautas de tratamiento fueron modificadas en 2014, por consenso de la Asociación Americana de cirugía Oral y Maxilofacial. La patogénesis de la osteonecrosis maxilar asociada a bifosfonatos no está completamente definida, aunque las publicaciones tratan de explicarla. El riesgo de desarrollarla por terapia oral es menor que por su administración vía intravenosa. Discusión: el médico que prescribe el antirresortivo debe conocer el estado de salud dental de su paciente y, en lo posible, remitirlo a examen con el odontólogo antes de iniciar la terapia con bifosfonatos.

Introduction: Given the high prescription of bisphosphonates, we present their adverse effects in the dental sphere, being an infrequent complication, but difficult to treat. There is no need to suspend treatment, given the important benefit in terms of prevention of fragility fractures. These fractures cause high morbimortality as opposed to the low risk associated with bisphosphonate-associated osteonecrosis of the jaw. Objective: To orient the health personnel who handle these drugs and who assist these complications to have knowledge for the prevention of osteonecrosis. To identify and differentiate patients at higher risk, according to the dose of bisphosphonates and frequency of treatment. Materials and Method: A literature review was performed in the following sources: Scielo, Google academic, Medline/Pubmed, Virtual Health Library (Brazil), from 2005 to date, Spanish, Portuguese and English languages. The descriptors used were bisphosphonates, mandible, maxilla, dentistry, osteonecrosis, osteonecrosis of the jaws associated with bisphosphonates. Results: The latest treatment guidelines were modified in 2014, by consensus of the American Association of Oral and Maxillofacial Surgery. The pathogenesis of bisphosphonate-associated maxillary osteonecrosis is not completely defined, although publications try to explain it. The risk of developing it by oral therapy is lower than by intravenous administration. Discussion: The physician who prescribes the antiresorptive drug should know the dental health status of his patient and, if possible, refer him for examination by a dentist before initiating bisphosphonate therapy.

Introdução: dada a alta prescrição de bisfosfonatos, apresentamos seus efeitos adversos na esfera odontológica, uma complicação rara, mas de difícil tratamento. Sem a necessidade de suspender o tratamento, dado o importante benefício em termos de prevenção de fraturas por fragilidade. Essas fraturas causam alta morbidade e mortalidade, em contraste com o baixo risco associado à osteonecrose da mandíbula associada aos bisfosfonatos. Objetivo: orientar a equipe de saúde que manipula esses medicamentos e que atende a essas complicações para que tenham conhecimento sobre a prevenção da osteonecrose. Identificar e diferenciar os pacientes de maior risco, de acordo com a dose de bisfosfonatos e a frequência do tratamento. Materiais e Método: foi realizada uma revisão da literatura nas seguintes fontes: Scielo, Google acadêmico, Medline/Pubmed, Biblioteca Virtual em Saúde (Brasil), de 2005 até a presente data, idiomas espanhol, português e inglês. Os descritores utilizados foram: bisfosfonatos, mandíbula, maxila, odontologia, osteonecrose, osteonecrose dos maxilares associada a bisfosfonatos. Resultados: as diretrizes de tratamento mais recentes foram modificadas em 2014, por consenso da Associação Americana de Cirurgia Oral e Maxilofacial. A patogênese da osteonecrose da mandíbula associada a bisfosfonatos não está totalmente definida, embora a literatura tente explicá-la. O risco de desenvolvê-la com a terapia oral é menor do que com a administração intravenosa. Discussão: o médico que prescreve o medicamento deve estar ciente do estado de saúde bucal do paciente e, se possível, encaminhar o paciente para ser examinado por um dentista antes de iniciar a terapia com bisfosfonatos.

Attention-deficit/hyperactivity disorder and comorbid disruptive behavior disorders: evidence of pleiotropy and new susceptibility loci.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD) or conduct disorder (CD) and substance abuse/dependence seems to represent a specific subset within the phenotypic ADHD spectrum. METHODS: We applied complex segregation and linkage analyses in a set of multigenerational families densely segregating ADHD comorbid with ODD, CD, alcohol abuse/dependence, and nicotine dependence. RESULTS: Our data suggest that ADHD cosegregates with disruptive behaviors as a unique, phenotypically variable trait as evidenced by highly significant pair-wise linkages among: ADHD and ODD (logarithm of odds [LOD]=14.19), ADHD and CD (LOD=5.34), ODD and CD (LOD=6.68), and CD and alcohol abuse/dependence (LOD=3.98). In addition to previously reported ADHD susceptibility loci, we found evidence of linkage for comorbid ADHD phenotypes to loci at 8q24, 2p21-22.3, 5p13.1-p13.3, 12p11.23-13.3, 8q15, and 14q21.1-22.2. These results were replicated with an affected status phenotype derived from latent class clusters. CONCLUSIONS: Patterns of cosegregation of ADHD with comorbidities can inform our understanding of the inheritance patterns not only of ADHD but also of disruptive behavioral disorders and alcohol abuse/dependence. Refining the comorbid ADHD phenotype by determining the cosegregation profile of specific comorbidities might be a powerful tool for defining significant regions of linkage.

Survey of gastrointestinal parasites, liver flukes and lungworm in feces from dairy cattle in the high tropics of Antioquia, Colombia.

A cross sectional study was undertaken to determine the prevalence and intensity of parasitic infections in dairy cattle in the high tropics of Colombia. A total of 1003 rectal samples were collected from dairy cows at 29 farms between May and June 2014 to represent the number of farms, age groups, and size of the 65,000-cow population in the municipality of San Pedro de los Milagros. Coprological techniques were used to detect gastrointestinal nematodes, liver flukes, coccidian oocysts, and first larval stage counts of Dictyocaulus viviparus. In order of decreasing prevalence, the following parasites were detected: coccidial oocyst (36.7%; 95% CIs, 31.6-42.7), strongyle nematodes (31.6%, 27.8-35.4), liver flukes (30.9%, 21.5-37.5), cestodes (8.4%, 7.1-9.7), and D. viviparus (5.4%, 3.4-7.5). Co-infections by all possible combinations of the three most predominant groups occurred in 11 to 15% of the animals. There were significant differences in infection rates between age groups, with higher risk of liver fluke infection in animals older than 1 year of age (odds ratio (OR) = 3.2), but lower presence for coccidia and strongyles (OR = 0.19 and 0.51, respectively). For Fasciola hepatica, within-herd prevalences of > 25% in 16 farms and 94 of 281 (33.5%) animals with > 5 eggs per gram (epg) indicate that significant production losses are likely occurring. The variation in the prevalence of gastrointestinal parasites and liver flukes, together with the level of infection among age groups, could be used in integrated management programs to establish selective anthelmintic treatments and select for heritable traits of host resistance. These results serve as a baseline for future studies to determine the success of control measures and should increase awareness that subclinical parasitism is widespread in the livestock sector.

Validation of two rating scales for attention-deficit hyperactivity disorder diagnosis in Colombian children.

This study assesses the validity of the Behavioral Assessment System for Children-parent and teacher questionnaires for attention-deficit hyperactivity disorder diagnosis in a randomized sample of 344 Colombian children (145 cases, 199 controls), males and females, ages 6 to 11, with an estimated Wechsler Full Scale Intelligence Quotient over 70. The assessment protocol for both groups included psychiatric, neurologic, and psychological interviews, parent and teacher rating forms, and an Attention-Deficit Hyperactivity Disorder Checklist. All Behavioral Assessment System for Children-parent and teacher dimensions, except withdrawal and somatization, significantly differentiated cases and controls. Parents and teachers rated attention-deficit hyperactivity disorder combined type children as significantly more aggressive. Both questionnaires had good discriminant accuracy for detecting cases and control children, but accuracy for discriminating between attention-deficit hyperactivity disorder subtypes was poor. The Behavioral Assessment System for Children-parent and teacher questionnaires for 6- to 11-year-olds may be useful tools for diagnosing the presence of attention-deficit hyperactivity disorder. Additional assessment methods will be needed to discriminate between the subtypes.

[Evaluation of the ELISA method for diagnosis of human cysticercosis in an endemic region]. / Evaluación del método ELISA de punto para el diagnóstico de la cisticercosis humana y para estimar valores de prevalencia en una región endémica en Colombia.

INTRODUCTION: Cysticercosis is a worldwide public health problem. Currently it is diagnosed by detection of specific antibodies or by imaging techniques. OBJECTIVE: To evaluate an alternative diagnostic tool, a simple antibody detection assay, called Dot ELISA, for immunological diagnosis of patients with neurocysticercosis as well as for endemic population screening. MATERIALS AND METHODS: The test was applied to cysticercosis patients, as well as to healthy controls and individuals with other parasitic infections. A total of 45 serum, 41 plasma and 23 cerebrospinal fluid samples were obtained from patients meeting clinical, surgical, imaging and laboratory criteria for cysticercosis. Samples were processed by enzyme-linked immune-electro-transfer blot assay and by Dot ELISA. Controls included 37 serum, 64 plasma and 17 cerebrospinal fluid samples from healthy individuals without epidemiological history for taeniosis-cysticercosis. Similarly, 43 plasma samples from patients with parasitic infections different from cysticercosis and 663 samples from population survey for cysticercosis were also evaluated. RESULTS: A total of 933 samples were analyzed. In samples from cysticercosis patients and healthy control individuals, the Dot ELISA test showed an overall sensitivity of 80.7% (CI 95% = 80.2%-81.2%) and a specificity of 92.4% (CI 95% = 91.9%-92.8%). The Dot ELISA performed in serum had a sensitivity of 91.1%, in plasma 85.4%, and in cerebrospinal fluid 52.2%. Similarly, the same test performed in serum, plasma and cerebrospinal fluid, had a specificity of 100%, 85.9% and 100% respectively. The Dot ELISA was applied as a screening test for the diagnosis of cysticercosis in an endemic population in which 1.8% (12/663) of individuals had T. solium antibodies detected by Enzyme-linked immune-electro-transfer blot assay and showed a sensitivity of 58.3% (CI 95% = 54.0-62.7) and a specificity of 100% (CI 95% = 99.9-100.0) with a positive predictive value of 100% and a negative predictive value of 99.2%. All 43 samples from patients with parasitic infections different from cysticercosis were negative for both tests. CONCLUSIONS: These results indicated that Dot ELISA is a promising tool for the diagnosis of cysticercosis as a screening test, as well as for field epidemiological studies.

Concentraciones séricas de Beta-hidroxibutirato y su asociación con enfermedades posparto en bovinos de leche / Serum Beta-hydroxybutyrate concentrations and its association with postpartum diseases in dairy cows

RESUMEN Objetivo. Determinar la prevalencia de cetosis bovina según las concentraciones séricas (mmol/Lt) de beta-hidroxibutirato (βHB) y estimar su asociación con enfermedades del posparto temprano en vacas lecheras. Materiales y métodos. Se llevó a cabo un estudio epidemiológico de corte transversal con información individual de los niveles sanguíneos de βHB y presentación clínica de enfermedades puerperales de n=1149 animales; además se evaluó la eficiencia de la prueba como predictora de enfermedad posparto. Posteriormente, se realizó X 2 y un modelo de regresión logística final para explorar los factores asociados con hipercetonemia. La relación entre βHB sanguíneo, la presentación de cetosis y la ocurrencia de enfermedades puerperales se calculó analizando Característica Operativa del Receptor (Receiver Operating Characteristic -ROC). Resultados. Según los niveles de -3HB, la prevalencia de cetosis fue de 7.9%, cetosis clínica 0.6% y cetosis subclínica 7.3%. La prueba fue predictora de enfermedad puerperal (LR+ del 13.6). La condición corporal ≥3.5, número de partos igual a 2 y ≥3, la presentación de retención de placenta, fiebre de leche y la enfermedad posparto, son factores de riesgo de cetosis. El análisis de la curva ROC mostró que la medición de βHB (≥1.2 mmol/Lt) en sangre sirve para diagnosticar cetosis (p<0.0001). Conclusiones. La medición de niveles sanguíneos de βB permitió determinar que la presentación de cetosis es baja, es una alerta no solamente para esta enfermedad sino para las enfermedades del posparto temprano. Los resultados de este estudio confirman lo reportado en estudios previos sobre los factores de riesgo de cetosis.

ABSTRACT Objective. Determine the prevalence of bovine ketosis based on serum concentrations (mmol/Lt) of beta-hydroxybutyrate (βHB) and estimate its association with early postpartum diseases in dairy cows. Materials and methods. An epidemiological cross-sectional study was carried out with individual information on blood levels of βHB and clinical presentation of puerperal diseases in 1149 animals; In addition, the efficiency of the test was evaluated as a predictor of postpartum disease. Subsequently, univariate analysis and a final logistic regression model were performed to explore the factors associated with hyperketonemia. The association between blood βHB, the presentation of ketosis and the occurrence of puerperal diseases was calculated by analyzing the Receiver Operating Characteristic -ROC. Results. According to βHB levels, the prevalence of ketosis was 7.9%, clinical ketosis 0.6% and subclinical ketosis 7.3%. The test was a predictor of puerperal disease (LR+ of 13.6). Body condition score ≥3.5, number of births 2 and ≥3, presentation of retained fetal membranes, milk fever and postpartum disease, are risk factors for ketosis. The analysis of the ROC curve showed that the measurement of βHB (≥1.2 mmol/Lt) in blood serves to diagnose ketosis (p<0.0001). Conclusions. The measurement of βHB blood levels allowed to determine that ketosis presentation is low, it is an alert not only for this disease but for early postpartum diseases. The results of this study confirm risk factors observed in previous studies.

Tasa de incidencia de mastitis clínica y susceptibilidad antibiótica de patógenos productores de mastitis en ganado lechero del norte de Antioquia, Colombia* / Incidence rate of clinical mastitis and antibiotic susceptibility of mastitis-producing pathogens in dairy cattle from Northern Antioquia, Colombia / Taxa de incidência de mastite clínica e susceptibilidade antibiótica de patógenos produtores de mastite em gado leiteiro do norte de Antioquia, Colômbia

Resumen Introducción: la mastitis se define como la inflamación de la glándula mamaria causante de grandes pérdidas económicas en hatos lecheros, lo que amerita su investigación. Objetivo: determinar la tasa de incidencia de mastitis clínica TIMC, la etiología asociada y la sensibilidad antibiótica de patógenos aislados de casos de mastitis en ganado lechero. Materiales y métodos: se siguieron 37 hatos por 12 meses para el diagnóstico de mastitis cílínica (MC). A las muestras de leche de los casos de MC se les realizó cultivo bacteriológico y a estas, así como a los aislamientos de casos de mastitis subclínica de un estudio previo, se les efectuó prueba de susceptibilidad antibiótica. Para el análisis de la información se utilizó estadística descriptiva estándar. Resultados: TIMC fue de 13,8 casos por 100 vacas-año a riesgo. Se aislaron 188 patógenos totales de casos de MC, entre los cuales el Streptococcus agalactiae, el Streptococcus pyogenes y el Corynebacterium spp. fueron los más frecuentes, con 29,8; 11,7 y 5,9 %, respectivamente. Se halló una alta sensibilidad de las bacterias contagiosas para los antibióticos cloxacilina y cefoperazone. Conclusiones: en el presente estudio se encontró una TIMC de 13,8 casos por 100 vacas-año a riesgo. Los patógenos más prevalentes identificados en casos de MC fueron contagiosos. Se encontró una alta sensibilidad de las bacterias contagiosas para la mayoría de los antibióticos β-lactámicos.

Abstract Introduction: Mastitis is defined as the inflammation of the mammary gland causing great economic losses in dairy herds, which merits investigation. Objective: To determine the incidence rate of clinical mastitis IRCM, associated etiology, and antibiotic sensitivity of pathogens isolated from cases of mastitis in dairy cattle. Materials and methods: 37 herds were followed during 12 months for clinical mastitis (CM) diagnosis. Milk samples from CM cases were bacteriologically cultured, which underwent, along with isolates from subclinical mastitis cases from a previous study, antibiotic susceptibility testing. For data analysis, standard descriptive statistics were used. Results: The IRCM was 13.8 cases per 100 cows-year at risk. A total of 188 pathogens of CM cases were isolated, among which Streptococcus agalactiae, Streptococcus pyogenes, and Corynebacterium spp. were the most frequent, with 29.8%, 11.7%, and 5.9%, respectively. A high susceptibility of contagious bacteria was found for cloxacillin and cefoperazone. Conclusions: The present study found an IRCM of 13.8 cases per 100 cows-year at risk. The most prevalent pathogens identified in cases of CM were contagious. A high sensitivity of contagious bacteria was found for most β-lactam antibiotics.

Resumo Introdução: a mastite se define como a inflamação da glândula mamária causante de grandes perdas econômicas em rebanhos de gado leiteiro, o que justifica a sua pesquisa. Objetivo: determinar a taxa de incidências de mastite clínica TIMC, a etiologia associada e a sensibilidade antibiótica de patógenos isolados de casos de mastite em gado leiteiro. Materiais e métodos: seguiram-se 37 rebanhos bovinos durante 12 meses para o diagnóstico de mastitis clínica (MC). Com as amostras de leite dos casos de MC realizou-se cultivo bacteriológico e a estas, assim como aos isolamentos de casos de mastite subclínica de um estudo prévio, efetuou-se prova de susceptibilidade antibiótica. Para a análise da informação se utilizou estatística descritiva padrão. Resultados: a TIMC foi de 13,8 casos por 100 vacas-ano a risco. Foram isolados 188 patógenos totais de casos de MC, entre os quais o Streptococcus agalactiae, o Streptococcus pyogenes e o Corynebacterium spp. foram os mais frequentes, com 29,8; 11,7 e 5,9 %, respectivamente. Constatou-se uma alta sensibilidade das bactérias contagiosas para os antibióticos cloxacilina e cefoperazone. Conclusões: neste estudo evidenciou-se uma TIMC de 13,8 casos por 100 vacas-ano a risco. Os patógenos mais prevalentes identificados em casos de MC foram contagiosos. Encontrou-se uma alta sensibilidade das bactérias contagiosas para a maioria dos antibióticos β-lactâmicos.

Cross-sectional study of 13 Leptospira serovars in cows in a Colombian dairy region / Estudio transversal de 13 serovares de Leptospira en vacas en una región lechera colombiana / Estudo transversal de 13 sorotipos de Leptospira em vacas em uma região leitera colombiana

Abstract Background: Leptospirosis in cattle is recognized as a major cause of reproductive loses due to abortions, early embryonic death, and infertility. The type of Leptospira serovars that are currently circulating in Colombian herds is largely unknown due to the lack of national reports. Objective: The prevalence of antibodies specific to 13 Leptospira spp serovars was investigated in unvaccinated cows from 26 herds in San Pedro de los Milagros (Province of Antioquia) dairy region. Methods: Microscopic agglutination test was used on serum samples, following WHO recommendations. Results: A total of 112/900 (12.4%) of the animals had antibody titers of 1:100 or greater to at least one Leptospira serovar. Of those positive, 34/900 (3,8%) animals seroconverted to two or more serovars. In order of decreasing prevalence, the serovars detected were: hardjo prajitno, pomona, grippotyphosa, tarassovi, copenhageni, canicola, cellodeni and bratislava. There were 28 animals seropositive to serovar hardjo. Conclusion: Our results indicate that leptospirosis should be included as a differential diagnosis for various reproductive problems in this region.

Resumen Antecedentes: La leptospirosis es la mayor causal de pérdidas reproductivas debidas a abortos, muerte embrionaria temprana e infertilidad. Se desconocen los serovares de Leptospira que actualmente se encuentran circulando en el rebaño colombiano debido a la falta de reportes nacionales. Objetivo: Se investigó la prevalencia de anticuerpos específicos para 13 serovares de Leptospira spp en vacas no vacunadas de 26 rebaños en la región lechera de San Pedro de los Milagros (Provincia de Antioquia). Métodos: La prueba de aglutinación microscópica fue empleada en muestras de suero de acuerdo a las recomendaciones de la OMS. Resultados: Un total de 112/900 (12,4%) de los animales presentaron títulos de anticuerpos de 1:100 o superiores para al menos un serovar de Leptospira. Entre los positivos, el 34/900 (3,8%) de los animales presentaron seroconversión para dos o más serovares. En orden decreciente de prevalencia, los serovares detectados fueron: hardjo prajitno, pomona, grippotyphosa, tarassovi, copenhageni, canicola, cellodeni y Bratislava. En total, 28 animales fueron seropositivos al serovar hardjo. Conclusión: La leptospirosis debería ser incluida como diagnóstico diferencial en problemas reproductivos en esta región.

Resumo Antecedentes: Aleptospirose em bovinos é reconhecida como uma das principais causas de perdas reprodutivas devido a abortos, morte embrionária precoce e infertidade. Os sorotipos de Leptospira que estão atualmente em circulação no rebanho colombiano não se conhecem devido à falta de reportes nacionais. Objetivo: Neste estúdio foi investigada a prevalência de anticorpos específicos para 13 sorovares de Leptospira spp em vacas não vacinadas de 26 rebanhos leiteiros da região de San Pedro, Antioquia. Métodos: Foi empregado o teste de aglutinação microscópica (MAT) em amostras de soro de acordo com as recomendações da OMS. Resultados: Um total de 112/900 (12,4%) animais apresentaram títulos de anticorpos de 1:100 ou superiores para pelo menos um sorotipo de Leptospira. Dos animais positivos, 34/900 (3,8%) soroconverteram para dois ou mais sorotipos. A fim de diminuir a prevalência, foram detectados os sorotipos: hardjo, prajitno, pomona, grippotyphosa, tarassovi, copenhageni, canicola, cellodeni e Bratislava. Um total de28 animais foram soropositivos para o sorotipo hardjo. Conclusão: Os resultados indicam que a leptospirose deveria ser incluída nos diagnósticos diferenciais para o diagnóstico diferencial de problemas em doenças reprodutivas nos bovinos de Antioquia.

Commotio cordis.

CONTENT: Commotio cordis is blunt, nonpenetrating trauma to the chest resulting in irregular heart rhythm and often leading to sudden death. This article presents the epidemiology, variables leading to commotio cordis, theories on predisposing factors, diagnosis, treatment, treatment outcomes, and return-to-play recommendations. EVIDENCE ACQUISITION: A PubMed (MEDLINE) search for commotio cordis was conducted on July 1, 2008, and it yielded 106 results, of which 26 were used for this review, including experimental models, simulation studies, case analysis studies, case reports, general recommendation, review articles, and editorials. RESULTS: There are more than 190 reported cases of commotio cordis in the United States. Forty-seven percent of reported cases occurred during athletic participation. Commotio cordis is the second-most common cause of sudden cardiac death in athletes. Occurrence of commotio cordis is related to time of impact during the cardiac cycle, direct impact over the heart, the hardness and speed of the projectile, and the ineffectiveness of chest barriers. As a result, the US Consumer Product Safety Commission recommends that softer "safety" baseballs be used for youth baseball. Resuscitation using defibrillation was effective in only 15% of cases. Resuscitation within 3 minutes resulted in a survival rate of 25% (17 of 68 cases). Survival drops to 3% when resuscitation is delayed beyond 3 minutes. Survival of commotio cordis has risen from 10% to 15% since 2001. Reduced ventricular ejection fraction has been identified in some commotio cordis survivors. CONCLUSION: Preventive measures, such as using soft "safety" balls and making automated external defibrillators available at sporting venues, can reduce commotio cordis morbidity and mortality. Chest protector designs can be improved to enhance protection. Return to play is best left to clinical judgment given that data are lacking with regard to susceptibility for reoccurrence.

[Knowledge and practices concerning taeniasis-cysticercosis in Colombian pig-breeders]. / Conocimiento y prácticas sobre teniasis-cisticercosis en una comunidad Colombiana.

OBJECTIVE: Describing knowledge and practices regarding taeniasis-cysticercosis and cysticercosis prevalence in the village of Andagoya, Colombia. METHODS: The study design was qualitative and quantitative. The study population consisted of pig breeders and their families, local groups and pigs. RESULTS: Study participants had partial knowledge of the taeniasis-cysticercosis complex. They considered taeniasis to be an illness resulting from faecal transmission and not caused by becoming infected with cysticercosis after consuming pork. Pig breeding is not carried out in confined conditions and, although breeders know the right measures for controlling some parasitic illnesses, these practices are not observed. There was 8.7% presence of T. solium antibodies in pig breeders and their relatives and 20.9% in the pigs. CONCLUSIONS: An educational programme aimed at raising the population's awareness of the taeniasis-cysticercosis complex cycle should be developed; this will facilitate control measures being applied.

Association of BoLA-DRB3 and TLR4 alleles with subclinical mastitis in cattle from Colombia / Asociación de los alelos BoLA-DRB3 y TLR4 con mastitis subclínica en vacas de Colombia / Associação de Bola-DRB3 alelos e TLR4 com mastite subclínica em vacas da Colômbia

Background: molecular markers for genetic resistance can be used to control mastitis in dairy cattle. The Major Histocompatibility Complex and the Toll-like receptor 4 (TLR4) are two promising genes that warrant investigation. Objective: to identify associations between genotypes of BoLA-DRB3 locus and T4CRBR2 fragment and subclinical mastitis (SM). Methods: 996 lactating cows from 32 herds comprising Holstein (80%), Holstein x Jersey cross (12.5%), and other crosses (7.5%) were evaluated monthly during two years, diagnosed for SM and genotyped for the second exon of BoLA DRB3 and the TLR4 coreceptor-binding region 2 (T4CRBR2) using a Polymerase chain reaction-restriction fragment length polymorphism technique (PCRRFLP). The association between candidate alleles and subclinical mastitis was measured by logistic regression. Results: the most frequently observed alleles for BoLA-DRB3 were DRB3.2 *8, *22, *24, *16, *10, *23, *gba, *11, *2, *mbb, *jba, *3, and *15, accounting for 58.9% of the population. Frequencies for T4CRBR2 alleles A and B were 0.352 and 0.647, respectively. Based on 57,408 observations during the period, the mean SM prevalence was 16.2% (95% CI 13.0 and 19.4) per udder quarter and 37.6% (95% CI 32.1 and 43.2) per cow. The predominant microorganisms isolated from SM quarters were Streptococcus agalactiae and Coagulase-Negative Staphylococci (CNS). Allele DRB3.2 *23 was associated with SM occurrence and CNS infection. No alleles were associated with Streptococcus agalactiae infection. Allele *mbb was associated with occurrence of CNS infection and alleles *jba and *15 were associated with resistance to CNS infection. No significant relationship between T4CRBR2 and SM was observed. Conclusion: DRB3.2 gen may play an important role in the occurrence of SM and certain alleles may confer resistance to specific pathogens.

Antecedentes: los marcadores moleculares genéticos de resistencia para mastitis bovina son una herramienta para el control de la enfermedad en rebaños lecheros. Los genes del Complejo Mayor de Histocompatibilidad y el Receptor tipo Toll 4 (TLR4) son dos genes candidatos promisorios que justifica investigar. Objetivo: identificar asociaciones entre los genotipos del locus BoLA-DRB3 y del fragmento T4CRBR2 con la ocurrencia de mastitis subclínica. Métodos: 996 vacas lactantes de 32 hatos de las razas Holstein (80%), Holstein x Jersey (12,5%) y otros cruces (7,5%), fueron visitadas mensualmente por dos años, diagnosticadas para mastitis subclínica y genotipificadas para el segundo exón del DRB3 y para la región 2 de unión al correceptor del TLR4 (T4CRBR2) por medio de las técnicas de Reacción en cadena de la polimerasa y de Longitud del polimorfismo del fragmento de restricción (PCR-RFLP). La asociación entre los alelos candidatos y la mastitis subclínica se midió por regresión logística. Resultados: los alelos más frecuentes para el DRB3.2 fueron *8, *22, *24, *16, *10, *23, *gba, *11, *2, *mbb, *jba, *3 y *15, que suman el 58,9% del total en la población. Las frecuencias para los alelos A y B del T4CRBR2 fueron de 0,352 y 0,647, respectivamente. Basados en 57.408 observaciones, la prevalencia de MS a nivel de cuarto fue 16,2% (95% IC 13,0 y 19,4) y a nivel de vaca fue de 37,6% (95% IC 32,1 y 43,2). Los microorganismos más frecuentes fueron Streptococcus agalactiae y Estafilococo Coagulasa Negativo (ECN). El alelo DRB3.2 *23 fue el más asociado con la ocurrencia de MS y con la infección por ECN. No se hallaron alelos asociados a infección con mastitis por Streptococcus agalactiae. Con respecto a la infección por ECN, el *mbb se asoció con la ocurrencia y los alelos *jba y *15 se asociaron con resistencia. No se observó asociación entre T4CRBR2 y MS. Conclusión: el gen DRB3.2 puede jugar un papel importante en la presencia de MS y ciertos alelos pueden conferir resistencia a patógenos específicos.

Antecedentes: o uso de marcadores moleculares de resistência para mastites permite controlar esta doença em rebanhos leiteiros. Os genes Toll Like Receptor 4 (TLR4) e o Complexo Mayor de Histocompatibilidade são dois genes candidatos promissórios que justifica pesquisar. Objetivo: identificar associações entre genótipos do locus BoLA-DRB3 e do fragmento T4CRBR2 com a ocorrência de mastite subclínica. Método: 996 vacas em lactação de 32 rebanhos da raça Holandesa (80%), Holandesa x Jersey (12,5%) e outras cruzas (7,5%) foram visitadas mensalmente por dois anos, diagnosticadas para mastites subclínica e genotipadas para o exon segunda BoLA DRB3 e região 2 da ligação co-receptor TLR4 (T4CRBR2) através das técnicas de Reação em Cadeia da Polimerase e do Polimorfismo de Comprimento do Fragmento de Restrição (PCRRFLP). A associação entre alelos candidatos e mastite subclínica foi realizada por meio de regressão logística. Resultados: os alelos mais frequentes *8, *22, *24, *16, *10, *23, *gba, *11, *2, *mbb, *jba, *3 e *15, com um 58,9% do total da população. As frequências dos alelos A e B do T4CRBR2 foram 0,352 e 0,647, respectivamente. Com base em 57.408 observações, a prevalência da SM em quartos mamários foi de 16,2% ((IC 95% 13,0 e 19,4) e ao nível de vaca foi de 37,6% (IC 95% 32,1 e 43,2). Os microrganismos mais comuns foram: Streptococcus agalactiae e Estafilococos Coagulase-negativo, ECN. O alelo DRB3.2 *23 foi o mais associado com a ocorrência de SM e com a infecção por ECN. Não foram encontrados alelos associados à infecção por Streptococcus agalactiae. Em relação à infecção por ECN, o *mbb esteve associado com ocorrência e os alelos *jba e *15 estiveram associados com resistência. Não existiu associação entre MS e os alelos do T4CRBR2. Conclusão: o gene DRB3.2 bovino pode desempenhar um papel importante na presencia de MS e alguns alelos podem conferir resistência à patógenos específicos.

Polymorphisms in the neural nicotinic acetylcholine receptor α4 subunit (CHRNA4) are associated with ADHD in a genetic isolate.

The neural nicotinic acetylcholine receptor α4 subunit (CHRNA4), at 20q13.2-q13.3, is an important candidate gene for conferring susceptibility to attention deficit/hyperactivity disorder (ADHD). Several studies have already looked for association/linkage between ADHD and CHRNA4 in different populations. We used the Pedigree Disequilibrium Test to search for evidence of association between ADHD and six SNP marker loci in families from the isolated Paisa population. We found that the T allele of SNP rs6090384 exhibits a deficit of transmission in unaffected individuals (OR = 5.43, IC 1.54-19.13) (global P value = 0.014). We also found significant association and linkage to extended haplotypes rs2273502-rs6090384 (combination of variants C-T, respectively) (P = 0.02) and rs6090384-rs6090387 (P = 0.04) (combination of variants T-G, respectively). SNP rs6090384, variant T, has also been reported to be associated with inattention in a previous study. This makes ours the ninth study to examine the association of CHRNA4 with ADHD and the seventh one to find evidence for association in a population with a different ethnicity.

Distribution of dengue cases in the state of Oaxaca, Mexico, during the period 2004-2006.

BACKGROUND: Dengue virus infection is an emergent viral disease and the most important transmitted by a vector worldwide. In Mexico it has been an important public health problem since 1995 and Oaxaca is one of the most affected states in the country. OBJECTIVE: To determine the geographic distribution of confirmed dengue cases in the state of Oaxaca, Mexico, the serotypes circulating, and the main gender and age groups affected. STUDY DESIGN: Information about confirmed dengue cases obtained by LESPO during the period 2004-2006 was classified, sorted, and analysed. A RT-PCR technique was used to determine the serotype of the virus in serum samples. RESULTS: A substantial increment in the number of dengue cases was noticed during the period of this study. The most affected sanitary jurisdiction was located on the coast where the climatic conditions were ideal for vector development and where there is significant migratory activity. The most affected group was the 11-15-year-old group. Dengue haemorrhagic fever was more frequent in men than in women over 16 years old, with a significant difference evaluated by chi(2)-test (p<0.001). Four serotypes of the virus were detected in the state and two co-infections with DEN2-3 and DEN3-4 were identified. CONCLUSIONS: The increment in the number of dengue cases in the state of Oaxaca could be explained by several factors such as the presence of the four serotypes of the virus, the migratory phenomenon, the climatic conditions and the socioeconomic level of the population.

Latent class subtyping of attention-deficit/hyperactivity disorder and comorbid conditions.

OBJECTIVE: Genetic studies of attention-deficit/hyperactivity disorder (ADHD) generally use discrete DSM-IV subtypes to define diagnostic status. To improve correspondence between phenotypic variance and putative susceptibility genes, multivariate classification methods such as latent class analysis (LCA) have been proposed. The aim of this study was to perform LCA in a sample of 1,010 individuals from a nationwide recruitment of unilineal nuclear families with at least one child with ADHD and another child either affected or clearly unaffected. METHOD: LCA models containing one through 10 classes were fitted to data derived from all DSM-IV symptoms for ADHD, oppositional defiant disorder, and conduct disorder (CD), as well as seven items that screen for anxiety and depression from the National Initiative for Children's Healthcare Quality Vanderbilt Assessment Scale for Parents. RESULTS: We replicated six to eight statistically significantly distinct clusters, similar to those described in other cross-cultural studies, mostly stable when comorbidities are included. For all age groups, anxiety and depression are strongly related to Inattentive and Combined types. Externalizing symptoms, especially CD, are strongly associated with the Combined type of ADHD. Oppositional defiant disorder symptoms in young children are associated with either conduct disorder or anxiety-related symptoms. CONCLUSIONS: Methods such as LCA allow inclusion of information about comorbidities to be quantitatively incorporated into genetic studies. LCA also permits incorporation of milder but still impairing phenotypes than are allowed using the DSM-IV. Such methods may be essential for analyses of large multicenter datasets and relevant for future clinical classifications. This population-based ADHD classification may help resolve the contradictory results presented in molecular genetic studies.

Salud: un sistema complejo adaptativo / Health: an adaptive complex system

Este artículo destaca la enorme distancia existente entre el pensamiento complejo de índole intelectual, difundido en nuestro medio, y el pensamiento complejo de índole experimental, que ha permitido lograr los desarrollos científico-tecnológicos que han cambiado radicalmente el mundo. Invita a considerar como sistemas complejos adaptativos entidades tales como la vida, el ser humano, la sociedad global y todo aquello que se llama salud, para lo cual resulta prioritario adoptar un enfoque diferente que amplíe su conocimiento. Al reconocer esta racionalidad, se sustentan las principales características y propiedades emergentes de la salud como sistema complejo adaptativo, siguiendo un modelo de prestación de cuidados y servicios. Finalmente, se plantean algunas preguntas de investigación pertinentes desde esta perspectiva, y se expresan una serie de apreciaciones que se espera sirvan para comprender todo lo que como individuos y como especie hemos llegado a ser. Se propone en este trabajo que la salud y la prestación de servicios de asistencia sanitaria se consideren como sistemas complejos adaptativos.

This article points out the enormous gap that exists between complex thinking of an intellectual nature currently present in our environment, and complex experimental thinking that has facilitated the scientific and technological advances that have radically changed the world. The article suggests that life, human beings, global society, and all that constitutes health be considered as adaptive complex systems. This idea, in turn, prioritizes the adoption of a different approach that seeks to expand understanding. When this rationale is recognized, the principal characteristics and emerging properties of health as an adaptive complex system are sustained, following a care and services delivery model. Finally, some pertinent questions from this perspective are put forward in terms of research, and a series of appraisals are expressed that will hopefully serve to help us understand all that we have become as individuals and as a species. The article proposes that the delivery of health care services be regarded as an adaptive complex system.

Environmental influences that affect attention deficit/hyperactivity disorder: study of a genetic isolate.

Three independent complex segregation analyses found that the cause of Attention Deficit/Hyperactivity Disorder (ADHD) was the presence of major genes interacting with environmental influences. In order to identify potential environmental risk factors for ADHD in the Paisa community--a very well described, genetically isolated group--we randomly selected a sample of 486 children between 6 and 11 years of age. This group included 200 children with ADHD (149 males and 51 females) and 286 healthy controls (135 males and 151 females). The ADHD DSM-IV diagnosis was obtained using the DICA and BASC evaluation instruments, and the children's mothers or grandmothers filled out a questionnaire on each child's exposure to prenatal, neonatal, and early childhood risk factors. The data were analyzed using cross tabulation and stepwise logistic multiple-regression analyses. Cross tabulation associated ADHD with a variety of factors, including miscarriage symptoms, premature delivery symptoms, maternal respiratory viral infection, moderate to severe physical illness in the mother during gestation, prenatal cigarette and alcohol exposure, neonatal seizures, asphyxia or anoxia, severe neonatal illness, mild speech retardation, moderate brain injury, and febrile seizures (odds ratio >or= 2, P < 0.05). Stepwise logistic multiple-regression analysis also uncovered a block of variables, including male gender, maternal illnesses, prenatal alcohol exposure, mild speech retardation, febrile seizures, and moderate brain injury (odds ratio >or= 2.0, P < 0.05). Future studies on the risk of developing ADHD must include these environmental factors as covariates.

Prevalence of mastitis in dairy herds in Eastern Antioquia / Prevalencia de mastitis en siete hatos lecheros del oriente antioqueño / Prevalência da mastite em sete rebanhos leiteiros na região leste da Antioquia

Seven dairy cattle farms from eastern Antioquia were tested for mastitis in a cross-sectional study with a non-probabilistic convenience sampling procedure. Each udder quarter of 290 lactating cows was evaluated through the California Mastitis Test in order to determine the prevalence of subclinical mastitis. Milk from positive quarters underwent somatic cell count (SCC), cell culture and antibiotic sensitivity tests. The prevalence of subclinical mastitis per quarter was 19.9% (228 quarters). Only 11 quarters (0.95%) had clinical mastitis. The average SCC for all quarters was 1,105,733 cells/mL. Streptococcus dysgalactiae was the most common bacteria observed (29.5%) in the 226 cultures evaluated, followed by coagulasenegative staphylococci (CNS, 23%), and Staphylococcus aureus (10.3%). The frequency of contagiouspathogens and environmental pathogens was 37.8% and 49.3%, respectively. This study confirms that mastitis remains elevated in this region, suggesting a continuous lack of milking hygiene and education of farm personnel.

Se realizó un estudio descriptivo de corte, y se hizo un muestreo no probabilístico de conveniencia, en siete fincas de ganado de leche localizadas en el oriente antioqueño. Se evaluó cada cuarto de 290 vacas en producción láctea mediante la realización del California Mastitis Test (CMT) con el fin de determinar la prevalencia de mastitis por cuarto y por vaca. A la leche proveniente de los cuartos positivos mayores a trazas, se les realizó recuento de células somáticas (RCS), cultivo y antibiograma. La prevalencia de mastitis subclínica por cuarto fue de 19.9% (228 cuartos) y 11 cuartos (0.95%) presentaron mastitis clínica. El promedio del RCS para todos los cuartos fue de 1.105.733 céls/ml. En los 226 cultivos, Streptococcus dysgalactiae fue la bacteria más común (29.5%), le siguieron estafilococos coagulasa negativo (ECN) (23%) y Staphylococcus aureus (10.3%). La frecuencia de patógenos contagiosos fue 37.8%, entre tanto que la de ambientales fue 49.3%.

Foi realizado um estudo de corte, e se realizou uma amostragem não probabilística em sete fazendas de gado leiteiro localizado no leste da Antioquia. Foram avaliados trimestralmente 290 vacas em produção de leite mediante a implementação do California Mastitis Test (CMT) para determinar a prevalência de mastite subclínica em cada quarto da vaca. Nos quartos positivos foi realizada a contagem de células somáticas (CCS) no leite, o cultivo microbiológico e análises de sensibilidade. A prevalência de mastite subclínica por quarto foi de 19.9% (228 quartos) e 11 (0.95%) apresentaram mastite clínica. A CCS média para todas os quartos foi 1.105.733 células / ml. Em 226 cultivos, o Streptococcus dysgalactiae foi a bacteria mais comum (29.5%), seguido por estafilococus coagulase negativo (ECN) (23%) e Staphylococcus aureus (10.3%). A reqüência de agentes patogénicos contagiosos foi de 37.8% e patógenos ambientais foi de 49.3%.

Factores asociados a mastitis en vacas de la microcuenca lechera del altiplano norte de Antioquia, Colombia / Factors associated to mastitis in cows from the dairy production basin in the northern highlands of Antioquia, Colombia / Fatores associados à mastite em vacas da microbacia leiteira do altiplano norte da Antioquia, Colômbia

Se efectuó un estudio de corte sobre la prevalencia de mastitis bovina en una muestra representativa de las granjas lecheras del altiplano norte de Antioquia, Colombia. Se evaluaron los resultados del California Mastitis Test (CMT), Recuento de Células Somáticas (RCS) y cultivo bacteriológico de leche, y se analizaron los factores de riesgo asociados a mastitis bovina. El análisis estadístico de la información se efectuó por medio de estadística descriptiva, análisis de razón de prevalencias y regresión logística multinivel. Con la prueba de CMT se detectó un 20% de cuartos afectados con mastitis, la prevalencia de mastitis subclínica por vaca fue del 39,5% y la de mastitis clínica fue del 1,7%. Se efectuaron 648 cultivos de muestras de leche, de las cuales 23,9% fueron negativas, 34% positivas a Streptococcus agalactiae y 10,2% a Estafilococo coagulasa negativo. El análisis de regresión reveló que las vacas que tuvieron más de seis meses de lactancia presentaron una Odds Ratio (OR) de 2,65 en comparación con las de un mes de lactancia (p < 0,05). Se halló un OR de 1,24 para la asociación de la edad y la mastitis (p < 0,05). Para el lavado de manos se encontró un OR de 0,36 en comparación con no hacerlo (p < 0,05). En conclusión, se halló una alta frecuencia de mastitis por vaca. El microorganismo más hallado fue el Streptococcus agalactiae. El trauma podría ser una causa importante de mastitis dado que no se observó crecimiento bacteriano en 23,9% de los cultivos de muestras de leche de cuartos con mastitis...

A study was conducted on the prevalence of bovine mastitis in a representative sample from dairy farms in the northern highlands of Antioquia, Colombia. The results of California Mastitis Test (CMT) were evaluated, as well as the Somatic Cell Count (SCC) and the bacteriological culture of milk. The risk factors associated with bovine mastitis were also analyzed, and the statistical analysis of the information was made through descriptive statistics, prevalence ratio analysis and multilevel logistic regression. The CMT test detected that 20% of the cow were affected with mastitis, the prevalence of subclinical mastitis per cow was of 39.5%, and of clinical mastitis was 1.7%. Six hundred and forty eight (648) cultures were made of milk samples, 23.9% of which came out negative, 34% positive with Streptococcus agalactiae, and 10.2% with coagulase-negative staphylococci. The regression analysis revealed that cows that had more than six months of lactation showed an Odds Ratio (OR) of 2.65 compared to cows that had one month of lactation (p < 0.05). An OR of 1.24 was found in the association between age and mastitis (p<0.05). Finally, an OR of 0.36 was found associated to washing hands compared to not doing it (p<0.05). In conclusion, a high prevalence of mastitis per cow was found. The most frequently found micro-organism was Streptococcus agalactiae. Trauma could be a major cause of mastitis since no bacterial growth was observed in 23.9% of the milk sample cultures from cow with mastitis...

Realizou-se um estudo de corte sobre a prevalência da mastite bovina em uma mostra representativa das fazendas leiteiras do altiplano norte da Antioquia, Colômbia. Foram avaliados os resultados do exame CMT (California Mastitis Test), Recontagem das Células Somáticas (RCS) e cultivo bacteriológico do leite, e analisaram-se os fatores de risco associados à mastite bovina. A análise estatística da informação foi efetuada por meio da estatística descritiva, análise de razão de prevalências e regressão logística multinível. Com o exame CMT detectou-se 20% de quartos afetados com mastite, a prevalência de mastite subclínica por vaca foi de 39,5% e a de mastite clínica foi de 1,7%. Efetuaram-se 648 cultivos de mostras de leite, das quais 23,9% foram negativas, 34% positivas a Streptococcus agalactiae e 10,2% a Estafilococo coagulase negativo. A análise de regressão revelou que as vacas que tiveram mais de seis meses lactância apresentaram uma Odds Ratio (OR) de 2,65 em comparação com as de um mês de lactância (p<0,05). Foi encontrado um OR de 1,24 para a associação da idade e a mastite (p<0,05). Para a lavagem de mãos encontrou-se um OR de 0,36 em comparação com não fazê-lo (p<0,05). Em conclusão, foi encontrada uma alta frequência de mastite por vaca. O micro-organismo encontrado com mais frequência foi o Streptococcus agalactiae. O trauma poderia ser uma causa importante de mastite dado que não se observou crescimento bacteriano em 23,9% dos cultivos de mostras de leite de quartos com mastite...