Dermoscopy in Patch Testing: How Can It Help? / Uso del dermatoscopio en la lectura de pruebas epicutáneas: ¿qué puede aportar?

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions.

Treatment practices after calving-related events on 45 dairy farms in California.

Retained fetal membranes (RFM), dystocia, and twinning are common postpartum events that increase the risk of metritis, impair reproductive performance, and contribute to antimicrobial use on dairies. The overall objective of this study was to describe treatment decisions after RFM, severe dystocia (cesarean section and fetotomy), nonsevere dystocia (nonmechanical and mechanical assistance to extract the calf), and twinning. A total of 44 dairies from California's San Joaquin Valley (39 Holstein and 6 Jersey or crossbreed herds) with 450 to 9,500 lactating cows were enrolled in this study. Researchers visited each dairy once to observe cow-side fresh cow health evaluations and to interview health evaluators and maternity workers, using a standardized survey tool. The survey included questions about antimicrobial (class, dose, and duration) and nonantimicrobial therapies for calving-related events. Antimicrobial therapy was used in all 44 dairies to treat RFM at 24 (n = 23), 48 (n = 10), or 72 h (n = 5) after calving, or when puerperal metritis signs were observed (n = 6). Antimicrobial therapy was used after all severe dystocia cases, and after nonsevere dystocia (n = 27) and twinning (n = 15). Ceftiofur products were the most common antimicrobial class; they were used to treat RFM cases (n = 29), nonsevere dystocia (n = 13), and twinning (n = 10). Supportive therapy for calving-related events included nonantimicrobial intrauterine treatments, nonsteroidal antiinflammatory drugs, oxytocin, i.v. calcium, or oral drenches. Our study highlights opportunities to reduce extra-label use of antimicrobials in postpartum cows affected with RFM, and the need for education and outreach efforts on judicious use of antimicrobials. Furthermore, antimicrobial treatment choices differed largely across dairies, indicating a need to reach consensus and promote standardized practices within the industry.

Metritis diagnosis and treatment practices in 45 dairy farms in California.

Minimizing the risk of antimicrobial-resistant organisms and antimicrobial residues in dairy and dairy beef products is a topic of nationwide interest. To design an effective outreach program on judicious use of antimicrobials, it is imperative to describe actual practices on dairies. Thus, our objective was to report current practices for metritis treatment in 45 dairies in California. Data were collected using a survey tool that included questions on systemic antimicrobial treatments, intrauterine treatments, supportive treatments, and treatment records. Researchers collected information based on cow-side observations and responses from fresh cow evaluators. Most dairies (n = 33; 70%) performed rectal exams for vaginal discharge (VD) evaluation and based systemic antimicrobial administration on the presence of (a) abnormal VD (fetid and nonfetid), regardless of fever (n = 11; 25%); (b) fever regardless of the odor of abnormal VD (n = 11; 25%); (c) fetid VD and fever (n = 1; 2%); (d) fetid VD (n = 3; 9%); or (e) fetid VD or fever (n = 3; 9%). Some dairies (n = 11; 24%) only detected abnormal VD if visible on tail, vulva, or floor; treatment decisions were based on the presence of abnormal VD (n = 9; 20%) or abnormal VD and fever (n = 2; 4%). On 3 (6%) dairies, VD characteristics were evaluated after rectal palpation, but no systemic treatments were administered. Cows exhibiting 1 nonspecific sign of health disorder (depressed general appearance, lack of appetite, or drop in milk yield) plus fever (n = 13; 29%), or even regardless of fever (n = 6; 13%), were treated with systemic antimicrobials. Overall, 8 (18%) dairies justified systemic antimicrobial treatment based on fever alone. Systemic antimicrobials used were ceftiofur products [ceftiofur hydrochloride (n = 26; 55%), ceftiofur sodium (n = 3; 7%), and ceftiofur crystalline-free acid (n = 8; 18%)], penicillin procaine (n = 8; 18%), and ampicillin (n = 3; 7%). Intrauterine infusions were done with penicillin procaine (n = 1; 2%) or oxytetracycline (n = 12; 27%). The dose and treatment length varied across dairies for i.m. ceftiofur hydrochloride (15 to 45 mL/d for 3 to 5 d), s.c. ceftiofur crystalline-free acid (20 to 25 mL once or twice), i.m. ceftiofur sodium (15 to 30 mL/d for 3 to 5 d), i.m. penicillin procaine (20 to 60 mL/d for 3 to 6 d), and i.m. ampicillin (25 to 35 mL/d for 3 to 6 d). The antimicrobial drug of choice, the dose, and the treatment length for metritis varied across the study dairies. Based on accepted industry best-management practices for metritis, a need exists to educate fresh cow evaluators on signs of health disorder indicative of metritis and on appropriate antimicrobial treatment regimens.

Fresh-cow handling practices and methods for identification of health disorders on 45 dairy farms in California.

The aim of the present study was to describe fresh-cow handling practices and techniques used during fresh cow evaluations to identify postpartum health disorders on 45 dairy farms in California ranging from 450 to 9,500 cows. Fresh cow practices were surveyed regarding (a) grouping and housing, (b) scheduling and work organization, (c) screening for health disorders, and (d) physical examination methods. Information was collected based on cow-side observations and responses from fresh cow evaluators. Cows were housed in the fresh cow pen for 3 to 14 (20%), 15 to 30 (49%), or >31 (31%) d in milk. Fresh cow evaluations were performed daily (78%), 6 times a week (11%), 2 to 5 times a week (9%), or were not routinely performed (2%). There was significant correlation between the duration of fresh cow evaluations and the number of cows housed in the fresh pen. Across all farms, the duration of evaluations ranged from 5 to 240 min, with an average of 16 s spent per cow. During fresh cow checks, evaluators always looked for abnormal vaginal discharge, retained fetal membranes, and down cows. Dairies evaluated appetite based on rumen fill (11%), reduction of feed in the feed bunk (20%), rumination sensors (2%), or a combination of these (29%). Milk yield was evaluated based on udder fill at fresh cow checks (40%), milk flow during milking (11%), milk yield records collected by milk meters (2%), or a combination of udder fill and milk meters (5%). Depressed attitude was evaluated on 64% of the dairies. Health-monitoring exams for early detection of metritis were implemented on 42% of the dairies based on rectal examination (13%), rectal temperature (22%), or both (7%). Dairies implementing health-monitoring exams took longer to perform fresh cow evaluations. Physical examination methods such as rectal examination, auscultation, rectal temperature evaluation, and cow-side ketosis tests were used on 76, 67, 38, and 9% of dairies, respectively. Across dairies, we found large variation in signs of health disorders screened and how those signs were evaluated. Fresh cows were primarily evaluated based on nonspecific and subjective observations during screening. Future research efforts should focus on developing and validating scoring systems to more objectively identify health disorders in postpartum cows.

Reproductive, endocrine and metabolic feto-maternal features and placental gene expression in a swine breed with obesity/leptin resistance.

The current study was conducted in a swine breed (Iberian pig) with a genotype that predisposed the pig to obesity. The aim of the study was to determine the morphological, metabolomic and endocrine features of early conceptuses and to elucidate how placental gene expression (related to placentation, angiogenesis and fetal nutrition), maternal hormones and the metabolome affect the fetal environment and fetal growth. Conceptus viability and growth were found to be related to maternal endocrine (plasma progesterone levels) and metabolic features (plasma levels of leptin, cholesterol, HDL-c, LDL-c and triglycerides). These features were related to the placental expression of the vascular endothelial growth factor A (VEGFA) and leptin (LEP) genes, the placental efficiency and, thus, the nutrition and the metabolism of the fetus (availability of glucose, triglycerides and cholesterol, as HDL-c). Viability of conceptuses in females with evidence of dyslipidemia (low plasma levels of total cholesterol due to low HDL-c concentration but high levels of triglycerides) was diminished. The availability of nutrients and metabolic substrates to the conceptus was also affected in females with higher fat deposition and evidence of dyslipidemia. In conclusion, the conceptus viability and growth appear to be strongly related to maternal metabolic features and, thus, affected in females with alterations in lipid metabolism.

Diet-induced swine model with obesity/leptin resistance for the study of metabolic syndrome and type 2 diabetes.

The objective of the present study was to determine the suitability of a swine breed with leptin resistance and predisposition to obesity (the Iberian pig) as model for studies on metabolic syndrome and type 2 diabetes. Thus, six Iberian sows had ad libitum access to food enriched with saturated fat (SFAD group; food consumption was estimated to be 4.5 kg/animal/day) whilst four females acted as controls and were fed with 2 kg/animal/day of a commercial maintenance diet. After three months of differential feeding, SFAD animals developed central obesity, dyslipidemia, insulin resistance and impaired glucose tolerance, and elevated blood pressure; the five parameters associated with the metabolic syndrome. Thus, the current study characterizes the Iberian pig as a robust, amenable, and reliable translational model for studies on nutrition-associated diseases.

Preovulatory follicle dynamics and ovulatory efficiency in sows with thrifty genotype and leptin resistance due to leptin receptor gene polymorphisms (Iberian pig).

This study compares follicular function and ovulatory efficiency in 20 sows with obesity/leptin resistance genotype (Iberian pig) and 20 females of lean commercial crosses (Large White × Landrace; LW×L). Estrous cycle was synchronized with progestagens; ovulation was induced with eCG and hCG, in half of the females of each group, to determine its effect. In females of both breeds not treated with gonadotropins, the number of follicles larger than 4.9 mm and the estradiol secretion increased throughout the follicular phase (P<0.05); estradiol values were similar at estrus detection (22.5±1.2 vs. 26.5±0.6 pg/ml respectively, for Iberian and LW×L sows). Moreover, ovulation rate was higher in Iberian pigs (15.3±1.3 CLs) than in LW×L (10.2±1.3 CLs; P<0.05), with mean progesterone values being 18.1±0.7 ng/ml in Iberian and 16.8±0.6 ng/ml in LW×L pigs. Thus, the preovulatory follicular growth and the ovulatory efficiency seem not to be the main limiting factors for reproductive efficiency in Iberian swine. The gonadotropins induced a significant increase, when compared to untreated females (P<0.05), in the number of follicles larger than 4.9 mm growing throughout the follicular phase; however, estradiol values at estrus were lower (P<0.05) in both breeds (9.2±0.7 pg/ml in Iberian vs. 8.6±0.8 pg/ml in LW×L), when compared with the nontreated animals, which suggests defective follicular function after gonadotropin stimulation. There were also no differences between genotypes in ovulation rate (15.2±1.3 vs. 12.7±1.8) and progesterone secretion (21.2±0.8 ng/ml in Iberian and 20.9±0.7 ng/ml in LW×L sows) in the treated animals. In conclusion, the current findings indicate that preovulatory follicular growth and ovulatory efficiency are not main limiting factors for prolificacy in a pig model of leptin resistance and obesity.

Plasma leptin, ghrelin and indexes of glucose and lipid metabolism in relation to the appearance of post-weaning oestrus in Mediterranean obese sows (Iberian pig).

Iberian pig is the most abundant Mediterranean swine. The lack of knowledge of the reproductive physiology of Mediterranean genotypes, with predisposition to obesity, led us to evaluate the influence of body condition and metabolic status at weaning on the resumption of follicular growth and the appearance of post-weaning oestrus. Females failing to display post-weaning oestrus showed a high decrease in backfat mass during lactation; backfat depth at weaning was therefore lower than in sows becoming in oestrus. Females not bearing oestrus behaviour showed lower plasma leptin levels and higher ghrelin concentrations at weaning. Moreover, these sows evidenced dyslipidemic profile (increased triglyceridemia and cholesterolemia) and mobilization of fat reserves. Hence, changes in metabolic regulation of Iberian pigs may originate large effects on the resumption of ovulatory activity after weaning.

Patterns of corpora lutea growth and progesterone secretion in sows with thrifty genotype and leptin resistance due to leptin receptor gene polymorphisms (Iberian pig).

The current study aimed to compare luteal function, as measured by corpora lutea dynamics and progesterone secretion, in 10 sows with obesity/leptin resistance genotype (Iberian pig) and 10 females of lean commercial crosses (Large White × Landrace). In all the animals, the oestrous cycle was synchronized with progestagens, and ovulation was induced by exogenous gonadotrophins. Thereafter, number and size of follicles and plasma oestradiol concentration were determined at oestrus detection, and number and size of corpora lutea and progesterone concentration were evaluated from Day 4 to 12 of the cycle. There were no differences between genotypes in follicle population and oestradiol concentration, and ovulation rate (15.2±1.3 in Iberian vs 12.7±1.8 in LWxL sows); however, there was a higher percentage of Iberian than control sows showing luteal cysts (66.7% vs 30%, respectively; p<0.05). In both breeds, both total luteal area and plasma progesterone concentration grew linearly from Day 4 to 8 (p<0.01) and remained more stable between Days 8 and 12, without significant differences between genotypes. In conclusion, current study supports that ovulatory processes and luteal functionality are not the main limiting factors for prolificacy in a pig model of leptin resistance and obesity.

Ultrasonographic imaging in small ruminant reproduction.

CONTENTS: Ultrasonography is a simple, reliable and non-invasive imaging technique without secondary effects. Application of ultrasonography in veterinary practice, and specifically in small ruminants, has developed to become the most efficient diagnostic tool for managing reproduction. The objectives of current revision are to offer an overview, after a short reminder of equipment and techniques for imaging genitalia in small ruminants, of the uses and utility of ultrasonography for the evaluation of physiological and pathological conditions in males and females and for the application of assisted reproductive technologies.

Advanced onset of puberty in gilts of thrifty genotype (Iberian pig).

The Iberian pig is an autochthonous breed of the Mediterranean area, reared extensively in the central and southern areas of Spain and Portugal and that is known worldwide for the production of Iberian ham. The characteristics of the Iberian ham are related to its abundance of intramuscular fat, owing to the high capacity of the pig to accumulate fat under its skin and between the muscular fibres. This ability to store excess fat enables survival during periods of scarcity and it has been found in other antique animal breeds and even in humans, being named as the thrifty genotype. The reproductive management of the Iberian pig, in spite of a lack of accurate information unlike in other swine breeds, is based on the assumption of lower reproductive precocity and efficiency than the modern commercial breeds. The current study characterized and compared the onset of puberty in gilts of Iberian breed and meat commercial crosses (Large White × Landrace) reared in the same conditions by assessing weekly plasma progesterone profiles. At the end of the experimental period, when the gilts became 180 days old, the percentage of Iberian females that had reached puberty was 72.2%, with a mean age and weight of 160.5 ± 2.6 days and 92.9 ± 4.7 kg, respectively. The percentage of Large White × Landrace cross-breed females reaching puberty at 180 days was only 15% (p < 0.05). The mean age and weight were 165.0 ± 4.1 days and 107.8 ± 2.2 kg (p < 0.05), respectively. Thus, converse to the traditional assumption, onset of puberty was advanced in Iberian gilts. These results are important for the reproductive management of the Iberian pig but, at the same time, may set the basis for future studies on the metabolism-reproduction link and, specifically, on the possible relationship between earlier accumulation of fat and attainment of puberty.

In vivo virtual histology of mouse embryogenesis by ultrasound biomicroscopy and magnetic resonance imaging.

Feasibility of magnetic resonance imaging (MRI) and ultrasound biomicroscopy (UBM) for sequential in vivo study of mouse embryo development between Days 6.5 and 13.5 of pregnancy was assessed in a first experiment. A second trial, based on the results of the first, determined the accuracy of UBM for imaging morphogenesis from implantation to the late embryo stage (Days 4.5 to 15.5). MRI allowed imaging of the entire uterus and all gestational sacs and embryos inside whilst the small scanning range of UBM precluded accurate counting of fetuses; however, its high resolution identified the decidual reaction at implantation sites from Day 4.5. At later stages, it was possible to assess key morphogenetic processes such as differentiation of the placenta, the cephalic region, the thoracic and abdominal organs, the skeletal system and the limbs, and dynamic structures such as the cardiovascular system. Thus, both techniques are reliable for in utero imaging of mouse embryo development. MRI may be more appropriate for studying embryo lethality and intrauterine growth retardation, because the entire uterus can be viewed. UBM may be more suitable for studies of cellular components of organs and tissues and assessment of haemodynamic changes in the circulatory system.

Use of ultrasound imaging for early diagnosis of pregnancy and determination of litter size in the mouse.

Precocity and efficiency of ultrasonography for pregnancy diagnosis and determination of litter size in mice were assessed on a total of 46 adult mice of different lines (19 BALB/c, 15 C57BL/6 and 12 CD1) from Day 4.5 after vaginal plug. Different commercial ultrasound machines and probes (linear versus sectorial; 7.5 MHz versus 10 MHz) were compared. The best images were obtained by the use of 10 MHz linear transducers. The first visualization compatible with pregnancy, specifically with the implantation sites, was observed at Day 4.5 in three animals. Presence of embryonic vesicles was differentiated at Day 5.5 in all the females. The embryos and remaining gestational structures inside the vesicles were clearly distinguished at Day 8.5. Data were validated not only after delivery but also by comparison with postmortem findings on crucial days (Days 4.5 and 8.5). The efficiency for counting the exact number of embryos was very low, due mostly to underestimation in highly prolific females. Conversely, the estimation of the range of the number of conceptuses, instead of the total number, was more accurate. Sensitivity, specificity and total efficiency reached 100% at Day 8.5. Ultrasonography can be accurately used as an alternative non-invasive technique for pregnancy diagnosis and determination of litter size in the mouse from very early stages of gestation, replacing other procedures currently used and increasing efficiency in animal management and research.

A new method for induction and synchronization of oestrus and fertile ovulations in mice by using exogenous hormones.

Four consecutive experiments were conducted to design and establish the effectiveness of different protocols for induction and synchronization of oestrus and ovulation in mice. Results showed that the highest synchronization degree and the highest fertility rates were obtained using two intraperitoneal doses of 0.5 microg of cloprostenol, three days apart, plus a single subcutaneous dose of 3 microg of progesterone coincidentally with the first injection of cloprostenol. Of the main advantages of the new method, we have to highlight the short time elapsed for appearance, and the high degree of synchronization of oestrus and ovulations (almost 100% of the animals responding to the treatment in 48 h; 78.4% with fertile mates at 24 h), plus the high fertility rate obtained after a programmed mating (100%). Overall, these yields are superior to those obtained by classical methods based on the use of male pheromones; hence the proposed protocol arises as an adequate alternative for reproductive management in mice.

Non-invasive ultrasonographic characterization of phenotypic changes during embryo development in non-anesthetized mice of different genotypes.

This study aimed to determine phenotypic changes during embryo development in the mouse, and the influence of genetic background, by non-invasive real-time ultrasonography. Serial scannings were performed from Day 4.5 after the appearance of the vaginal plug in a total of 34 adult mice of different strains (9BALB/c, 10C57BL/6 and 15 CD1). Embryonic vesicle diameter was measurable from Day 4.5 of pregnancy. Images of embryos were obtainable from Day 5.5 of gestation onwards, and crown-rump length and trunk parameters (diameter and area) were measured. At more advanced stages, the positions of fetuses prevented accurate measurement of crown-rump length; therefore, head diameters (occipito-snout length and biparietal diameter) were used as an alternative index of fetal size. All measurements correlated highly with gestational age (P<0.0005). No significant differences were observed between genotypes in early pregnancy, but during the last week of gestation trunk measurements were larger in CD1 embryos (P<0.05) while head diameters were larger in C57BL/6 conceptuses (P<0.05). There was a significant effect of genetic background on heart rate throughout pregnancy; although heart rate was similar in CD1 and C57BL/6 embryos (154.5+/-2.8 and 147.8+/-4.5 beats/min, respectively), it was significantly lower in BALB/c mice (127.0+/-2.1; P<0.005 vs. CD1 and C57BL/6).

The influence of anthropic actions on the evolution of an urban beach: Case study of Marineta Cassiana beach, Spain.

Coastal areas have been historically characterized as being a source of wealth. Nowadays, beaches have become more relevant as a place for rest and leisure. This had led to a very high population pressure due to rapid urbanisation processes. The impacts associated with coastal tourism, demand the development of anthropic actions to protect the shoreline. This paper has studied the impacts of these actions on the Marineta Cassiana beach, in Denia, Spain. This particular Mediterranean beach has traditionally suffered a major shoreline regression, and the beach nourishments carried out in the 1980s would not have achieved the reliability desired. This research has analysed the historic evolution of the beach and its environment for a period of 65years (1950-2015). A Geographic Information System (GIS) has been used to integrate and perform a spatial analysis of urban development, soil erosion, stream flow, swell, longshore transport, submerged vegetation species and shoreline evolution. The results show how the anthropic actions have affected the shoreline. After the excessive urban development of the catchments, there is no natural sediment supply to the beach. The change in the typology of the sediment, from pebbles to sand, during the beach nourishments has led to a crucial imbalance in the studied area. Moreover, the beach area gained has disappeared, affecting the Posidonia oceanica meadow, and incrementing the erosion rates. The findings obtained are relevant, not only in the management and maintenance of the beaches, but also, in the decision-making for future nourishments.

[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]. / Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores.

OBJECTIVE: To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. MATERIAL AND METHOD: Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. SAMPLE: 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. VARIABLES: Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. DATA SOURCES: Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. RESULTS: 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). CONCLUSION: To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

[Adrenal gland surgery. Review of 34 cases]. / Cirugía de las suprarrenales. Revisión de 34 casos.

Over the last few years, a better anatomical and functional knowledge of the adrenal glands has allowed us to diagnose and treat optimally most of these gland's conditions. A variety of medical (endocrinology, anaesthesiology) and surgical specialties have been used to this aim. This paper reviews the adrenal gland's diseases treated in our unit over the last 9 years. Pre-operative management, ways of approach, morbidity and mortality as well as results are analyzed and compared with those obtained by other authors.