[Ultrasound in the management of inflammatory dermatosis]. / Ecografía aplicada al manejo de las dermatosis inflamatorias.

Cutaneous ultrasound is a dermatological diagnostic imaging technique based on the interaction of high-frequency ultrasounds with the skin. Because it is non-invasive, rapid and accessible, it has increasingly wide clinical applications. This article reviews its use in the management of inflammatory dermatological diseases.

Short communication: Estimation of ileal digestibility in chickens using single- and dual-tracer methods.

Fractionation of digesta, as occurs during gastrointestinal transit in chickens, complicates accurate measurements of ileal digestibility using tracers. Dual-tracer methods using separate tracers for solid and fluid digesta phases may improve the accuracy of digestibility measurements when assumptions of the single tracer method are violated. The aim of the present study was to compare the apparent ileal digestibility (AID) of nutrients calculated with single- and dual-tracer methods in chickens fed diets varying in particle size, anticipating digesta phase separation in the proximal gastrointestinal tract. A total of 112 Dekalb White (BW: 1.53 ± 0.107 kg) and 112 Bovans Black (BW: 1.79 ± 0.127 kg) 29-week-old laying hens were distributed over 32 pens (seven birds/pen). Within breed, pens were randomly assigned to one of two experimental diets (coarse vs fine oat hulls; n = 8 replicate pens per diet/breed combination). Diets were supplemented with TiO2 (3 g/kg) and Co-EDTA (2 g/kg). On days 34, 35, or 36, birds were euthanised and digesta from the ileum was collected for tracer and nutrient analyses. Apparent ileal digestibility was subsequently calculated by single- and dual-tracer methods. Although coarse oat hulls were hypothesised to increase the fractionation of solid and fluid digesta phases, no breed or diet × method interactions were found. Using a single tracer method based on TiO2, AID of nitrogen (N) was overestimated by 3%-units (P < 0.01) compared with the dual-tracer method, whereas AID estimates of DM, starch, fat, and non-starch polysaccharides did not differ (P > 0.09) and precision of all AID estimates was improved. In conclusion, these results show that although from a conceptual perspective, dual-tracer methods are presumed to better account for the variation in flow behaviour of different digesta phases, AID estimates obtained by the commonly used single tracer method using solid-phase tracer TiO2 were more precise and only marginally differed from estimates obtained by a dual-tracer method using distinct tracers for solid (TiO2) and liquid (Co-EDTA) digesta phases. Considering technical and economical constraints, the single tracer method may thus be the method of choice in many situations. Only when digestibility of proteins or amino acids is of specific interest, single tracer methods using a solid-phase tracer may not suffice. Nevertheless, for both single- and dual-tracer methods, tracer selection is critical, and the choice of tracers should depend on the nutrient(s) of interest.

A dynamic model to measure retention of solid and liquid digesta fractions in chickens fed diets with differing fibre sources.

Dietary fibres impact multiple digestive processes, and insights into the effects of various types of fibre on digesta retention time are required to optimise current feed formulation systems. Therefore, the objective of this study was to apply a dynamic modelling approach to generate estimates for the retention time of solid and liquid digesta in broilers fed different fibre sources. A maize-wheat-soybean meal control diet was compared against three diets in which wheat was partially substituted with oat hulls, rice husks, or sugar beet pulp (3% w/w). Non-starch polysaccharide (NSP) digestibility was evaluated in broilers between 23 and 25 days of age (n = 60 birds/treatment) using titanium dioxide (TiO2, 0.5 g/kg) as a marker, after feeding the experimental diets for 21 days. Digesta mean retention time (MRT) was measured in another 108 birds at 30 days of age by the administration of an oral pulse dose of chromium sesquioxide (Cr2O3) as solid marker and Cobalt-EDTA as liquid marker, and subsequent measurement of marker recovery in compartments of the digestive tract (n = 2 or 3 replicate birds/time point/treatment). Marker recovery models to estimate fractional passage rates for solid and liquid digesta in crop, gizzard, small intestine, and caeca compartments of the gastrointestinal tract were developed to predict MRT of solid and liquid digesta for each dietary treatment. The models were composed of a series of first-order differential equations, representing the variation of marker concentration in a compartment over time. Estimated MRT of solid and liquid digesta in the gizzard varied from 20 min for oat hulls and 34 min for rice husks diets to 14 min for sugar beet pulp and 12 min for control diets. In the caeca, liquid MRT was decreased compared to the control diet (989 min) for the sugar beet pulp diet (516 min), while it was increased for both the oat hulls and rice husks diets (≈1 500 min). Overall, these estimates are greater than those previously reported, suggesting that liquid digesta retention in the caeca previously has been underestimated. Digestibility of total NSP was increased by dietary fibre inclusion, regardless of the fibre type, although degradation of constituent sugars of NSP varied among diets. In conclusion, the inclusion of fibre sources at a low level (3% w/w) in the diet of broiler modulated retention time mainly in the gizzard and caeca, and increased digestibility of NSP.

[Contact sensitization to allergens in the Spanish standard series at Hospital Costa del Sol in Marbella, Spain: a retrospective study (2005-2010)]. / Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010).

BACKGROUND: The prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis. OBJECTIVE: To determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis). MATERIAL AND METHODS: A retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC. RESULTS: Sensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed. CONCLUSIONS: Our results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered.

Safety of diabetes drugs in patients with heart failure. / Seguridad de los fármacos antidiabéticos en pacientes con insuficiencia cardiaca.

Heart failure (HF) and diabetes mellitus are 2 clinical conditions that often coexist, particularly in patients older than 65 years. Diabetes mellitus promotes the development of HF and confers a poorer prognosis. Hypoglycaemic agents (either by their mechanism of action, hypoglycaemic action or adverse effects) can be potentially dangerous for patients with HF. In this study, we performed a review of the available evidence on the safety of diabetes drugs in HF, focused on the main observational and experimental studies. Recent studies on cardiovascular safety have evaluated, although as a secondary objective, the impact of new hypoglycaemic agents on HF, helping us understand the neutrality, risks and potential benefits of these agents.

Application of bioelectrical impedance analysis to assess rabbit's body composition from 25 to 77 days of age.

The aim of the study was to develop prediction equations for assessing, in vivo, the whole body composition of growing rabbits. The accuracy of the models obtained was externally validated with independent data sets. One hundred fifty rabbits grouped at 5 different ages (25, 35, 49, 63, and 77 d) were used. A body composition analyzer with 4 terminals was used to obtain resistance (Rs; Ω) and reactance (Xc; Ω) values. The distance between internal electrodes (D; cm), body length (Len; cm), and live BW (g) were also registered. Average values of Rs, Xc, impedance (Z), Len, D, and BW were 83.5 ± 23.1 Ω, 18.2 ± 3.8 Ω, 85.6 ± 22.9 Ω, 30.6 ± 6.9 cm, 10.8 ± 3.1 cm, and 1,454 ± 845 g, respectively. At each selected age, animals were slaughtered, ground, and frozen (-20°C) for determining water, fat, CP, ash, and GE (70.5 ± 3.36%, 27.7 ± 7.61% DM, 54.9 ± 5.41% DM, 11.1 ± 1.55% DM, and 2,267 ± 183 kJ/100 g DM, on average, respectively). Fat and GE contents increased with the age, whereas CP, ash, and water contents decreased. A multiple linear regression analysis was used to determine the prediction equations, using BW, Len, and Z data as independent variables. Equations obtained to estimate water (g), CP (g), fat (g), ash (g), and GE (MJ) had coefficient of determination () values of 0.99, 0.99, 0.97, 0.98, and 0.99, respectively, and the relative mean prediction error (RMPE) was 2.79, 6.15, 24.3, 15.2, and 10.6%, respectively. When water was expressed as a percentage, the and RMPE were 0.85 and 2.30%, respectively. When prediction of the content of protein (% DM), fat (% DM), ash (% DM), and energy (kJ/100 g DM) was done, values of 0.79, 0.83, 0.71, and 0.86, respectively, for and 5.04, 18.9, 12.0, and 3.19%, respectively, for RMPE were obtained. It could be concluded that bioelectrical impedance analysis is a good, noninvasive method to estimate, in vivo, whole body composition of growing rabbits from 25 to 77 d of age.

Growth curve and diet density affect eating motivation, behavior, and body composition of broiler breeders during rearing.

The aim of this work has been to assess the effect of diet density [control (CON) or 15% diluted (DIL)] and growth curve [recommended by the genetic line (RBW) or 15% heavier (HBW)] and their interaction on BW uniformity, feeding motivation, behavior, and body composition of broiler breeder pullets. A total of 3,000 one-day-old female breeders Ross 308, distributed in 20 pens, was randomly assigned to each treatment. Feed allowance was weekly adjusted to reach the desired BW. Feed was provided as pelleted (zero to 3 wk) and crumble (4 to 19 wk). Time eating was measured at 7, 11, and 19 weeks. A feeding rate test was performed after 11 weeks. Behavior was observed at 9 and 15 wk, by visual scan. At 6, 13, and 19 wk of age, one bird/pen was slaughtered for weighing different organs and analyzing the composition of empty whole bodies. Treatments did not affect BW uniformity; relative weights of the ovary, oviduct, or gizzard; or protein content of empty BW. Time eating varied with the growth curve at 19 wk (P < 0.05), HBW pullets spent 19 more min eating than RBW pullets. DIL led to 4 and 8 more min eating at 19 wk for pullets of RBW and HBW (P < 0.05), respectively. Pullets fed DIL consumed 30% (P < 0.05) less during the feeding rate test when kept on a restricted regimen, and they had lower compensatory energy intake after ad libitum feeding than those fed CON, indicating lower feeding motivation. Behavior was affected by the age and by the time of the d measured, but it did not change with the treatments. Birds spent most time pecking objects (50%), feeding (28%), and drinking (17%). Pullets fed DIL had 8% lower breast yield at different ages and higher empty digestive tracts at 6 weeks. Body composition varied with age; fat content increased from 12.7 to 15.9 to 19.8% for 6, 13, and 19 wk, respectively. The lowest body fat was observed for RBW pullets fed DIL (P = 0.003) at 19 weeks. Feeding DIL diets to HBW pullets could be done to increase the time spent eating and reduce their feeling of hunger without negative effects on body composition. However, its influence on behavior and BW uniformity was not proved.

[Phylephebitis due to diverticulitis]. / Pileflebitis secundaria a diverticulitis.

A case of a 52 year-old-male, with past medical history of renoureteral crisis and recurrent episodes of abdominal pain, is presented. The patient presented to the Emergency Department with abdominal pain (similar to previous episodes), fever and abnormal liver function test (marked elevation of gammaglutamyltranspeptidase and alkaline phosphatase). An abdominal ultrasound was performed showing hepatomegaly, and enlarged spleen and an echogenic material that suggested a thrombosis. A CT scan confirmed the thrombosis of the inferior mesenteric vein extending up to the splenic vein and the portal vein. It also showed a large number of diverticulum. Surgery was performed in order to rule out an acute diverticulitis. A phylephlebitis, infective suppurative thrombosis of the portal vein and its branches (inferior mesenteric vein and splenic vein) was found due to an acute diverticulitis with neither perforation nor abscess. A ligature of the inferior mesenteric vein and a Hartmann procedure with resection of the diseased colon, and end colostomy and creation of a rectal stump, were performed. A favourable outcome was obtained with antibiotics and anticoagulation. Some aspects of the aetiology, symptoms, diagnosis and treatment of this unusual complication of diverticulitis are also presented.

[Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation]. / Hemocultivos en urgencias pediátricas. Guía práctica de recomendaciones: indicaciones, técnica de extracción, procesamiento e interpretación.

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.

Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods.

BACKGROUND: Improving obstetric care in resource-limited countries is a major international health priority. OBJECTIVE: To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods. METHODS: Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate. RESULTS: Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04). CONCLUSION: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

A reliable endocrine test with human menopausal gonadotropins for diagnosis of true hermaphroditism in early infancy.

In true hermaphroditism diverse phenotypes and karyotypes are found; there are no distinctive laboratory features that can distinguish it from other intersex disorders, thus the diagnosis is made by the histological findings. Existence of Leydig cells is demonstrated by testosterone levels above the female range; however, presence of ovarian tissue cannot be ascertained because of the absence of a reliable functional test. Unless appropriate biopsies are performed or the whole gonad is removed, there is a risk of not diagnosing true hermaphroditism. To find a reliable test that can differentiate patients with true hermaphroditism from those with other intersex disorders, we investigated the estradiol (E2) response to human menopausal gonadotropins (hMG) in infants with genital ambiguity. These results were correlated with the histological findings. Eleven infants with genital ambiguity and four with a high scrotal testis were stimulated every 12 h with 2 IU/kg hMG. If E2 rose above 80 pg/mL (cut-off point), the test was discontinued; if after 7 days E2 remained below 80 pg/mL, the hMG dose was doubled and stimulation extended for 7 additional days. In five patients in whom true hermaphroditism was later histologically demonstrated, E2 rose above 80 pg/mL. In two of them, ovarian tissue was removed and hMG stimulation repeated; no response above our cut-off point was observed during the second test. The maximal E2 response to hMG in the remaining 10 individuals was 43 pg/mL; after laparotomy or gonadal biopsies no ovarian tissue was found. The hMG stimulation test can be considered a reliable and safe dynamic procedure for demonstrating the presence or absence of ovarian tissue in infants with genital ambiguity.

[Cardiac tamponade in a woman with primary hypothyroidism]. / Taponamiento cardiaco en una mujer con hipotiroidismo primario.

Pericardial effusion is not infrequent as a manifestation of hypothyroidism, however, cardiac tamponade is exceptional in these patients. We report a case of a female patient with cardiac tamponade that in the forward workshop was diagnosed of primary hypothyroidism. A brief presentation of clinical history is reported. The literature's review emphasizes the rarity of this case, the importance of the knowledge of triggering factors to establish a precious diagnosis and satisfactory clinical evolution with hormonal treatment without recurrences of the cardiac tamponade after pericardiocentesis is performed, although the resolution of the pericardial effusion is usually slow.

[An ACTH-secreting carcinoid tumor of the thymus. A report of a new case]. / Tumor carcinoide de timo secretor de ACTH. Presentación de un nuevo caso.

Carcinoid tumour of the thymus is a rare condition, with less than a hundred cases reported in the literature. Diagnosis is complex as they are usually asymptomatic. We describe a case of a severe Cushing syndrome developed in a 51-year-old man. The diagnosis of a thymic carcinoid was established. Three years ago, the patient was treated by surgical resection of an anterior mediastinal mass. A massive tumour dissemination was detected by MIBG and CT image techniques. Both techniques are currently considered useful for this kind of diagnosis. ACTH secretion was detected immunohistochemically. Although the treatment with SMS-201-995 octreotide was effective in controlling the clinical symptoms, the patient died three months later with extensive metastases. The carcinoid tumours of the thymus associated to Cushing syndrome are aggressive tumours and usually produce local and distant metastases.

[Pancreatitis and inappropriate ADH secretion syndrome associated with amiodarone]. / Pancreatitis y síndrome de secreción inadecuada de ADH asociados a amiodarona.

We describe a case of hepatotoxicity, pancreatitis and inappropriate ADH secretion syndrome developed in a patient receiving chronic amiodarone treatment, not related to other causes. Hepatic toxicity is a well known condition. Inappropriate ADH secretion syndrome has not been described yet and there has been a single case-report of pancreatitis in the literature reviewed.

Processes and impacts of acid discharges on a natural substratum under a landfill.

Analyses of substratum samples under a landfill were performed to assess the pollution impact of waste over a clay-sand material after nine years of exposure. These samples presented different illite/kaolinite ratios and an acid pH, especially low near the waste/soil contact in a 1-1.5 m soil thickness with low density and despite the basic pH of the collected actual methanogenic leachate. This study has raised the effects of a presumably acid stage in the waste leachate on the substratum final quality of clay and its physical-chemical properties as an attenuation buffer. These effects were the dissolution of carbonate minerals, decrease of dry density, increase of hydraulic conductivity, release of metals and formation of clays with low cationic exchange capacity (CEC) as kaolinite. The large presence of H(+) and Al(OH)(3-x)(x+) depleted the neutralizing capacity of the substratum and occupied exchangeable sites, decreasing therefore the available sites for retaining leachate pollutants, which traveled further than the first-meter depth of the substratum. In order to combat and prevent pollution as well as to preserve the good barrier properties under new landfills it is proposed to select illitic materials better than kaolinitic substratum, to avoid acid landfilling and if not possible to add lime.

Pollution profiles and physicochemical parameters in old uncontrolled landfills.

The long-term effectiveness of the geological barrier beneath municipal-waste landfills is a critical issue for soil and groundwater protection. This study examines natural clayey soils directly in contact with the waste deposited in three landfills over 12 years old in Spain. Several physicochemical and geological parameters were measured as a function of depth. Electrical conductivity (EC), water-soluble organic carbon (WSOC), Cl(-), NH(4)(+), Na(+) and exchangeable NH(4)(+) and Na(+) were used as parameters to measure the penetration of landfill leachate pollution. Mineralogy, specific surface area and cationic-exchange capacities were analyzed to characterize the materials under the landfills. A principal component analysis, combined with a Varimax rotation, was applied to the data to determine patterns of association between samples and variables not evident upon initial inspection. The main factors explaining the variation in the data are related to waste composition and local geology. Although leachates have been in contact with clays for long time periods (13-24 years), WSOC and EC fronts are attenuated at depths of 0.2-1.5m within the clay layer. Taking into account this depth of the clayey materials, these natural substrata (>45% illite-smectite-type sheet silicates) are suitable for confining leachate pollution and for complying with European legislation. This paper outlines the relevant differences in the clayey materials of the three landfills in which a diffusive flux attenuation capacity (A(c)) is defined as a function (1) of the rate of decrease of the parameters per meter of material, (2) of the age and area of the landfill and (3) of the quantity and quality of the wastes.

Expression and regulation of chemerin during rat pregnancy.

BACKGROUND: Chemerin is an adipocytokine that is expressed in different fat deposits and has been shown to play an important role in adaptive and innate immunity due to its activity as a chemoattractant. Chemerin acts as a ligand for the G protein-coupled receptor chemokine-like receptor 1 (CMKLR1). Chemerin has been shown to regulate the development and metabolic function of adipocytes, liver and muscle tissue. OBJECTIVE: There is evidence indicating that several adipocytokines play an important role in placenta. This study aimed to investigate the regulation of chemerin in rat and human placentas throughout gestation. DESIGN AND SETTING: Chemerin was examined in rat and human placentas using immunohistochemistry. The chemerin expression pattern in the placenta and adipose tissue of female Sprague Dawley rats on days 12, 16, 19 and 21 of gestation (each of these days represents a group of 12 rats) was determined using TaqMan probe-based quantitative real-time PCR. Rat chemerin serum levels were analyzed with ELISA on days 8, 12, 16, 19 and 21 and compared to virgin controls. RESULTS: Chemerin expression was detected in the cytoplasm of rat placental trophoblastic cells and third trimester human placental cytotrophoblast and Hofbauer's cells. The serum chemerin levels of rats decreased significantly as gestation progressed. Furthermore, placental chemerin mRNA levels rose significantly at day 16 of gestation and decreased significantly towards the end of the gestation period. CONCLUSION: Taken together, this data suggests that chemerin may be an important regulator of maternal-fetal metabolism and metabolic homeostasis during pregnancy.