Serum thymosin α 1 levels in patients with chronic inflammatory autoimmune diseases.

Thymosin alpha 1 (Tα1) is a powerful modulator of immunity and inflammation. Despite years of studies, there are a few reports evaluating serum Tα1 in health and disease. We studied a cohort of healthy individuals in comparison with patients affected by chronic inflammatory autoimmune diseases. Sera from 120 blood donors (healthy controls, HC), 120 patients with psoriatic arthritis (PsA), 40 with rheumatoid arthritis (RA) and 40 with systemic lupus erythematosus (SLE), attending the Transfusion Medicine or the Rheumatology Clinic at the Policlinico Tor Vergata, Rome, Italy, were tested for Tα1 content by means of a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data were analysed in relation to demographic and clinical characteristics of patients and controls. A gender difference was found in the HC group, where females had lower serum Tα1 levels than males (P < 0·0001). Patients had lower serum Tα1 levels than HC (P < 0·0001), the lowest were observed in PsA group (P < 0·0001 versus all the other groups). Among all patients, those who at the time of blood collection were taking disease-modifying anti-rheumatic drugs (DMARD) plus steroids had significantly higher Tα1 levels than those taking DMARD alone (P = 0·044) or no treatment (P < 0·0001), but not of those taking steroids alone (P = 0·280). However, whichever type of treatment was taken by the patients, serum Tα1 was still significantly lower than in HC and there was no treatment-related difference in PsA group. Further prospective studies are necessary to confirm and deepen these observations. They might improve our understanding on the regulatory role of Tα1 in health and disease and increase our knowledge of the pathogenesis of chronic inflammatory autoimmune diseases.

Morphological and molecular analyses of larval and adult stages of Echinoparyphium recurvatum von Linstow 1873 (Digenea: Echinostomatidae) from central Mexico.

In central Mexico, populations of the freshwater snail Physella cubensis were infected with metacercariae from a species of Echinoparyphium (Digenea: Echinostomatidae). In the current study, we describe both larval and adult stages of this species obtained from experimental and natural infections. A total 180 snails were collected from Patzcuaro Lake, Michoacan state in central Mexico in July 2012. In the laboratory snails were placed in individual vials and exposed to light with the aim of observing emergence of cercariae. To obtain metacercariae, uninfected snails (P. cubensis) were exposed to cercariae. Chicks were infected with metacercariae to obtain adults. Nine days post-infection, eggs were recovered and incubated in tap water at room temperature to observe miracidia. Adults obtained from natural and experimentally infected hosts possess a head collar with 45 spines in two alternating rows, confirming the identification as Echinoparyphium recurvatum von Linstow 1873. To test the conspecificity of all stages, sequences of nuclear internal transcribed spacer 1 (ITS1), 5.8S and ITS2 rDNA were obtained from two adult worms recovered from chicks and also a natural avian host, the shoveler duck Anas clypeata, together with five cercarial and four metacercarial isolates from nine snails. The genetic divergence estimated among the 13 isolates was very low, ranging from 0 to 0.6%. Phylogenetic analyses inferred by maximum likelihood and Bayesian methods showed that all isolates of E. recurvatum form a single clade with strong support. The presence of E. recurvatum in P. cubensis and A. clypeata from central Mexico represents new host reports, and extends the distribution range in the Americas.

No Evidence of Dengue Virus Infections in Several Species of Bats Captured in Central and Southern Mexico.

Bats are reservoirs for viruses with zoonotic potential in the Americas, and scattered evidence exists suggesting that bats may act as reservoirs for dengue virus (DENV). To explore further the role of bats as part of DENV sylvatic cycles, 240 bats of 18 species were captured in 2 states of Mexico with contrasting ecological characteristics but concurrent DENV activity in humans. RT-PCR analysis of RNA extracted from liver or spleen tissue from de bats failed to show evidence for the presence of DENV nucleic acids in these organs. In addition, plasma assayed by plaque reduction neutralization test showed no evidence of neutralizing anti-DENV antibodies. These results suggest that American bats may not be reservoirs or amplification host for DENV infection.

Prognostic relevance of the expression of Tdt and CD7 in 335 cases of acute myeloid leukemia.

We have analyzed the expression of Tdt and CD7 in 335 cases of unequivocal acute myeloid leukemia (AML). Tdt was expressed in 80 (25%) of 321 evaluable cases. Twenty-six of 77 (34%) Tdt+ patients assessable for response, entered complete remission (CR) vs 121 of 209 (58%) Tdt- cases (P < 0.001). CD7 was expressed in 102 of 332 (30%) evaluable cases; 37 of 93 assessable (40%) CD7+ patients attained a CR as compared to 114/204 (56%) CD7- (P = 0.013). Duration of survival was significantly shorter for patients with CD7+ or Tdt+ AML (P = 0.006 and 0.001, respectively). In a multivariate analysis, Tdt was found to significantly adverse achievement of CR (P = 0.018), while CD7 affected duration of CR (P = 0.037). Overall the expression of either Tdt or CD7 correlated with a relatively high expression of CD34 (P < 0.001), GP-170 (P = 0.003), lymphoid antigens (LyAg) (P < 0.001), t(9;22) or anomalies of chromosome 5/7 (P < 0.001). Finally, we pooled the patients into four phenotypic classes, according to the presence of Tdt, CD7 or both: [Tdt-CD7-], [Tdt+CD7-], [Tdt-CD7+] and [Tdt+CD7+]. The category [Tdt+CD7+] was characterized by a more unfavorable outcome as suggested by a lower rate of CR (P < 0.001) and a shorter duration of survival as compared to cases [Tdt-CD7-], [Tdt+CD7-] and [Tdt-CD7+] (P = 0.002). This figure is consistent with the frequent convergence in the subset [Tdt+CD7+] of GP-170 positivity (P = 0.003), translocation t(9;22), anomalies of chromosome 5 and/or 7 (P < 0.001) and signs of lineage infidelity (deviant expression of lymphoid antigens) (P < 0.001). We conclude that the expression of Tdt or CD7 is associated with an unfavorable outcome and that the combination of both defines a clinical subset with a poorer prognosis due to the significantly higher association with MDR phenotype, and 'poor prognostic' chromosomal abnormalities.

Fine-scale predictions of distributions of Chagas disease vectors in the state of Guanajuato, Mexico.

One of the most daunting challenges for Chagas disease surveillance and control in Mexico is the lack of community level data on vector distributions. Although many states now have assembled representative domestic triatomine collections, only two triatomine specimens had been collected and reported previously from the state of Guanajuato. Field personnel from the state's Secretaría de Salud conducted health promotion activities in 43 of the 46 counties in the state and received donations of a total of 2,522 triatomine specimens between 1998 and 2002. All specimens were identified, and live insects examined for Trypanosoma cruzi. In an effort to develop fine-scale distributional data for Guanajuato, collection localities were georeferenced and ecological niches were modeled for each species by using evolutionary-computing approaches. Five species were collected: Triatoma mexicana (Herrich-Schaeffer), Triatoma longipennis (Usinger), Triatoma pallidipennis (Stål), Triatoma barberi (Usinger), and Triatoma dimidiata (Latreille) from 201 communities located at elevations of 870-2,200 m. Based on collection success, T. mexicana had the broadest dispersion, although niche mapping indicates that T. barberi represents the greatest risk for transmission of Chagas disease in the state. T. dimidiata was represented in collections by a single adult collected from one village outside the predicted area for all species. For humans, an estimated 3,755,380 individuals are at risk for vector transmission in the state, with an incidence of 3,500 new cases per year; overall seroprevalences of 2.6% indicate that 97,640 individuals are infected with T. cruzi at present, including 29,300 chronic cases.

The development and evaluation of a mathematical nutrition model to predict digestible energy intake of broodmares based on body condition changes.

Mathematical nutrition models have been developed for beef and dairy cattle to estimate dietary energy intake needed to change BCS. Similar technology has not been used to improve nutrition and feeding strategies for horses. An accurate equine nutrition model may enhance feeding management and reduce the costs of unnecessary overfeeding and promote an optimal level of fatness to achieve reproductive efficiency. The objectives of this study were to develop and evaluate a mathematical nutrition model capable of accurately predicting dietary energy changes to alter BW, rump fat (RF) thickness, and overall body fat (BF), which is needed to maximize profitability and productivity of mares. Model structure was similar to a previously developed model for cattle, and literature data for Quarter Horse mares were used to parameterize the horse model in predicting DE requirement associated with BCS changes. Evaluation of the horse model was performed using an independent dataset comprising 20 nonlactating Quarter Horse mares. Pretrial BCS was used to assign mares to 1 of 4 treatment groups and fed to alter BCS by 1 unit as follows: from 4 to 5 (Group 1), 5 to 4 (Group 2), 6 to 7 (Group 3), and 7 to 6 (Group 4). The BCS, RF thickness, and BW were measured for each mare before the commencement of the feeding trial and once per week thereafter for the duration of a 30-d feeding trial. Initial and target BCS, percent BF, and BW data were collected from each mare and inputted into the model. Mares were individually fed according to the DE suggestions proposed by the model to achieve the targeted BCS change within 30 d. The coefficient of determination of observed and model-predicted values (model precision) was 0.907 (P < 0.001) for BCS, 0.607 (P < 0.001) for percent BF, and 0.94 (P < 0.001) for BW. The BCS was highly correlated to percent BF (r = 0.808; P = 0.01). We concluded the reparameterized model was reliable to predict changes in BW and BCS, but more work is needed to improve the predictions of initial and final body composition.

Monitoreo de los indicadores del Programa "Chile Crece Contigo" 2008-2011 / Monitoring indicators of the program "Chile Grows with you" 2008-2011

Objective: To monitor coverage and outcomes associated with the activities of the integrated protection system for early childhood Chile Grows with You (CHCC), which includes the comprehensive psychosocial development of children between 18 months and 3 years old, in each of the 29 Health Services of the country, as well as the changes observed after 4 years. Material and Method: Database analysis of all local public networks in the country between 2008 and 2011 was performed. The application of the test regarding psychomotor development, prevalence of development delay and risk, participation of mothers in educational workshops, home visits and recovery rate of deficient children by age were studied. Median and observed changes of each indicator were analyzed developing a ranking based on the results observed. Results: Approximately 75% of children were evaluated, with a prevalence of delay or risk of about 5% and a rate of recovery close to 50%. The participation of mothers in educational workshops increased from 7.6 to 11.0% (p <0.001) and home visits to developmentally delayed children increased 6 times between 2009 and 2011 (p <0.001). Most changes were positive, although the prevalence of developmentally delayed children under 2 years slightly increased (0.6%), and the recovery of 3 year olds decreased (-14.4%). A great variability was observed among the Health Services. Conclusions: There are some positive results in relation to psychomotor development, with significant regional differences. A lower than expected deficit rate regarding psychomotor development was observed, which implies the need to further analyze the instrument used or the conditions of application.

Objetivo: Monitorear la cobertura y resultados de las principales actividades planificadas en el subsistema de protección social Chile Crece Contigo (CHCC) en relación al desarrollo psicosocial integral en niños de 18 meses y 3 años, en cada una de los 29 Servicios de Salud del país y los cambios observados en 4 años. Material y Método: Análisis de bases de datos de todos los establecimientos de la Red Pública del país, 2008 y 2011. Se estudió: aplicación del test de desarrollo psicomotor, prevalencia de retraso y riesgo del desarrollo, participación de madres en talleres educativos, visitas domiciliarias integrales y tasa de recuperación de niños con déficit según edad. Se analizó mediana y cambio observado de cada indicador por servicios de salud y se elaboró un ranking en función de los resultados observados. Resultados: Aproximadamente el 75% de los niños fueron evaluados, con una prevalencia de retraso o riesgo del orden de 5% y tasa de recuperación cercana al 50%. La participación de madres en talleres educativos aumentó de 7,6 a 11,0% (p < 0,001) y las visitas domiciliarias en niños con rezago 6 veces entre el 2009 y 2011 (p < 0,001). La mayor parte de los cambios fueron positivos, aunque aumentó levemente la prevalencia de rezago en menores de 2 años (0,6%) y disminuyó la recuperación de niños de 3 años (-14,4%). Destaca amplia variabilidad entre servicios de salud. Conclusiones: Existen algunos resultados positivos en relación al desarrollo psicomotor, con importantes diferencias regionales. Destaca una tasa de déficit del desarrollo psicomotor menor a lo esperado, lo que implica la necesidad de revisar el instrumento utilizado o las condiciones de aplicación.

Monitoreo de la implementación del programa Chile Crece Contigo en el embarazo: 2008 - 2011 / Evaluation of the degree of implementation of Chile Crece Contigo program: 2008-20110

Objetivo: Evaluar el grado de implementación de las actividades de Chile Crece Contigo en el embarazo y parto en los 29 Servicios de Salud del país. Método: Análisis de bases de datos del DEIS, Ministerio de Salud 2008 y 2011 por Servicios de Salud. Se analizó mediana y percentiles de gestantes en riesgo psicosocial, visitas domiciliarias integrales, participación de madres en talleres educativos, parto acompañado y apego precoz y el cambio de cada uno de ellos en el período estudiado. En función de la magnitud de los cambios se generó un nuevo indicador que permitió clasificar a los Servicios de Salud en terciles, considerando el tercil superior aquellos con cambios más positivos. Resultados: Ingresaron a control prenatal cerca de 200 mil mujeres cada año, que representan aproximadamente el 80 por ciento de los recién nacidos del país. Se observó un aumento significativo de 16 a 22 puntos porcentuales en todas las variables estudiadas (p<0,005), excepto en visitas domiciliarias en gestantes en riesgo psicosocial, que disminuyeron de 1,6 a 1,1 (p<0,001), con variaciones importantes entre Servicios de Salud. Conclusión: Ha habido un esfuerzo importante para modernizar el Programa de la Mujer y mejorar el control prenatal, parto y puerperio, aunque no se ha reflejado en los indicadores de salud. Las diferencias de comportamiento por Servicios de Salud ofrece la oportunidad de profundizar en el análisis de las causas que lo explican y la posibilidad de definir estrategias para lograr mejores resultados...

Objective: To assess the degree of implementation of the activities of Chile Crece Contigo in pregnancy and childbirth in the 29 country's health services. Method: Analysis of DEIS databases, Ministry of Health 2008 and 2011 by Health Services. Median and percentiles were analyzed at psychosocial risk in pregnant women, comprehensive home visits, mothers participate in educational workshops, childbirth accompanied and early bonding and changing during the study period. Depending on the magnitude of the changes generated a new indicator that allowed classification of Health Services in tertiles, the highest tertile considering those with more positive changes. Results: prenatal entered nearly 200,000 women each year, approximately 80 percent of all pregnant women in the country. We observed a significant increase of 16-22 percentage points for all variables studied (p<0.005), except home visits to pregnant women in psychosocial risk decreased from 1.6 to 1.1 (p<0.001), with important variations by Health Services. Conclusion: There has been a major effort to modernize the Program for Women and improving prenatal care, childbirth and postpartum, although not reflected in health indicators. The differences in behavior Health Services offers the opportunity to deepen the analysis of the causes that explain and the ability to define strategies to achieve better results...

Prematuros moderados y tardíos, un grupo de riesgo de menor desarrollo cognitivo en los primeros años de vida / Moderately and late preterm newborns, a risk group for low cognitive development in the first years of life

Introduction: Recent studies show that moderately and late preterm infants (MLI) (Gestational age (GA) 32 to 36(6)), are in high risk for delayed psychomotor development (PMD) and learning disabilities. Objective: To compare PMD between MLI and full term infants (FTI) and to analyze associated perinatal risk factors. Methodology: 131 MLI and 119 FTI were recruited between May 2008 and April 2011 in a private health center in Santiago, Chile. Both groups were compared according to age, gender and socio-economic level. At the ages of 8, 18 and 30 months the children were evaluated by means of the Bayley III Scale for Infantile Development 3rd edition (BAYLEY-III). PMD was compared in both groups and multiple lineal regression analysis was performed. Results: MLI showed a significantly lower development coefficient, but it matched the FTI when corrected by GA, (99 +/- 10.4 versus 100.8 +/- 9.9). Even with corrected GA, the cognitive performance was lower (98 +/- 10.4 vs 103.1 +/- 11.4 p < 0.05). Multiple lineal regressions showed that GA and gender were associated with lower cognitive development. Conclusion: Cognitive performance of MLI was below that of FTI. This increases the need to have especial standards of care and stimulation for these children.

Introducción: Estudios recientes refieren que los prematuros moderados y tardíos (PMT) (Edad Gestacional (EG) 32 a 36(6)), presentan un elevado riesgo de retraso del desarrollo psicomotor (DSM) y dificultades de aprendizaje. Objetivo: Comparar el DSM entre niños nacidos PMT y recién nacidos de término (RNT) y analizar los factores de riesgo perinatal asociados. Metodología: En un centro de salud de Santiago de Chile, entre mayo 2008 y abril 2011, se reclutaron 131 PMT y 119 RNT, pareados por edad, género y nivel socioeconómico. A los 8, 18 o 30 meses se les aplicó la Escala de Bayley III de Desarrollo Infantil-3ª edición. Se comparó el DSM entre los dos grupos y se implementó una regresión lineal múltiple. Resultados: Los PMT presentaron un coeficiente de desarrollo significativamente inferior al no corregir EG, equiparándose con los RNT al corregirla (99 +/- 10,4 vs 100,8 +/- 9,9). Aún con EG corregida, el desempeño cognitivo fue inferior (98 +/- 10,4 vs 103,1 +/- 11,4 p < 0,05). En la regresión lineal múltiple el género y la EG se asociaron con menor desarrollo cognitivo. Conclusión: El desempeño cognitivo de los PMT fue inferior a los RNT. Se plantea la importancia de implementar un estándar de cuidado y estimulación para este grupo de niños.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of Traditional Psychomotor Development Evaluation versus a Self-Administered Test?

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79% en EEDP y 12,73% en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de los padres, madres y cuidadores en la observación del desarrollo de sus hijos.

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were conducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79% of patients through the use of EEDP and in 12.73% through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of traditional psychomotor development evaluation versus a self-administe-red test

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were con-ducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79 percent of patients through the use of EEDP and in 12.73 percent through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79 por ciento en EEDP y 12,73 por ciento en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de ...

Museum specimen data predict crop damage by tropical rodents.

Museum collections constitute a massive store of information on biological diversity. We used museum specimen data to generate ecological niche models that provide predictions of geographic distributions of native rodent pest species and agricultural census data that summarize the geographic distribution of nine crops in the state of Veracruz, Mexico, as well as crop losses between planting and harvest. Herein, we show that crop damage is related significantly to the predicted presence of rodent species for seven of nine crops. Museum collections may thus provide important baseline information for designing land-use and agricultural pest-management programs.

An outbreak of lupinosis in sheep.

Lupinosis is a mycotoxicosis caused by the ingestion of toxins produced by the fungus phomopsis leptostromiformis which grows on lupin plants. An outbreak of natural lupinosis in lambs occurred in Caceres, Spain. Clinical signs were inappetence, depression, constipation, weakness and different degrees of jaundice. Blood samples were analysed every 7 d for 5 w for hematocrit, total protein, glucose, total bilirubin, and GOT, GPT and alkaline phosphatase activities. The last 4 parameters were increased and returned to normal values after 2-3 w. The liver was swollen and a bright yellow color; microscopically fatty metamorphosis, necrotic areas and infiltration of polymorphonuclears were observed. This is the first time that lupinosis is described in Spain.

Conservatism of ecological niches in evolutionary time

Theory predicts low niche differentiation between species over evolutionary time scales, but little empirical evidence is available. Reciprocal geographic predictions based on ecological niche models of sister taxon pairs of birds, mammals, and butterflies in southern Mexico indicate niche conservatism over several million years of independent evolution (between putative sister taxon pairs) but little conservatism at the level of families. Niche conservatism over such time scales indicates that speciation takes place in geographic, not ecological, dimensions and that ecological differences evolve later.

Clinical and pathological aspects of an outbreak of equine leukoencephalomalacia in Spain.

In 1988 an outbreak of leukoencephalomalacia was diagnosed in equids that had eaten corn with a pinkish fungal growth. The fungus was then identified as Fusarium moniliforme. The main symptoms observed appeared acutely and were overexcitement, blindness, incoordination, facial paralysis and death within 24 h. The main pathological changes were restricted to the central nervous system. Macroscopically they consisted of hyperemia and haemorrhages, the consistency was friable and the gyri were somewhat flattened. Microscopically, the lesions were profuse and had extensive haemorrhages, and numerous neurons appeared in different stages of degeneration and necrosis, with satellitosis and neuronophagia. Perivascular cuffs formed by macrophages, plasma cells and lymphocytes were also observed. These lesions were present in both brain and cerebellum, with a marked oedema and massive necrosis of the Purkinje cell layer of the latter.

Thoracic bioimpedance and Doppler cardiac output measurement: learning curve and interobserver reproducibility.

Nine previously untrained health professionals learned to measure cardiac output (Qt) by suprasternal continuous-wave Doppler ultrasound (QtDopp) and by thoracic bioimpedance (Qtbi). Each received standardized written, videotaped, and individual instruction. First the novice, then the reference examiner, measured QtDopp or Qtbi in triplicate in an adult male subject. The reference examiner was blind to the novice measurements and the novice was not informed of the reference measurements. Each novice repeatedly measured QtDopp or Qtbi in different subjects until the mean novice QtDopp or Qtbi was within 10% of the corresponding mean reference measurement in three of four consecutive subjects. The novice observers required an average of 12.9 +/- 3.5 trials to learn to measure QtDopp, and an average of 8.4 +/- 4.5 trials to learn to measure Qtbi. The likelihood of novice agreement with the reference improved with experience. The same degree of intraobserver variability as reported for Qt measured by thermodilution (coefficient of variance less than or equal to 10%) was achieved with Qtbi in 150 (99%) of 152 triplicate measurements and QtDopp in 216 (97%) of 222 triplicate measurements. More importantly, interobserver agreement (within 10%) was achieved with both Qtbi and QtDopp. Reproducible noninvasive Qt measurement will allow these techniques to be used to monitor trend changes in Qt.

Minimally differentiated acute myeloid leukemia (AML-M0): comparison of 25 cases with other French-American-British subtypes.

We compared the immunophenotypic and karyotypic features of 25 cases of minimally differentiated acute myeloid leukemia (AML-M0) with those of 247 cases comprising all AML French-American-British (FAB) classification. Myeloperoxidase (MPO) was detectable with a specific monoclonal antibody in all cases of AML-M0, whereas CD13 and CD33 were both negative in 4 of the 25 cases. Thus, anti-MPO reliably detects minimal myeloid differentiation in AML-M0. CD34 and terminal deoxynucleotidyl transferase (TdT) were more frequently expressed in AML-M0 (96% and 68% of the cases, respectively) than in the other FAB subsets (P < .001 for both). By contrast, GP-170 and CD7 were less frequently expressed in AML-M0 than in FAB classes such as M1, M4, and M5 (P = .02 and .003, respectively). A total of 80% of AML-M0 cases carried lymphoid markers (including TdT), and 48% showed a coordinate positivity for two or more of them. CD2, CD5, CD10, and CD19 were expressed in a similar fashion among the different FAB groups, whereas CD4 expression was significantly more frequent in AML-M0, AML-M4, and AML-M5 (P = .014). AML-M0 was characterized by a more frequent occurrence of complex karyotypes. In addition, approximately 20% of cases had TdT positivity, complex karyotypes, and anomalies of chromosome 5 and/or 7, a pattern not observed in the other FAB subsets. Finally, 80% of anomalies of chromosome 5 and/or 7 in AML-M0 were comprised within complex karyotypes, whereas only 13% of the remaining FAB cases carried this feature. In summary, AML-M0 frequently expresses immunophenotypic and karyotypic aspects that are likely to identify a "stem cell" pattern.

Evaluación de la estrategia, atención integrada a las enfermedades prevalentes de la infancia, AIEPI, en servicios de salud, Bolivia 1999 / Evaluation of the strategy, integrated management of childhood illines, IMCI, in health services, Bolivia 1999

La implementación de la estrategia AIEPI en Bolivia, se inicio a fines del año 1996; en este proceso se capacitó y realizó visitas de seguimiento a personal de salud de tres distritos considerados como iniciales. El presente artículo presenta los resultados de la aplicación de una metodología de evaluación del impacto de la capacitación y seguimiento de AIEPI, recomendada por la Organización Mundial de la Salud (OMS), la cual se constituye en la primera prueba mundial. Los objetivos de la primera prueba mundial de la evaluación AIEPI fueron: conocer la calidad de atención al niño menor de cinco años, disponibilidad de medicamentos y equipamiento para la atención integral en servicios de salud de primer nivel de tres distritos; identificar las barreras que impiden la integridad de la atención; validar la metodología propuesta por la OMS. La evaluación fue realizada en abril de 1999 en los distritos rurales Altiplano Valle Sur en La Paz, Valles Cruceños y Chuquitania Centro en Santa Cruz. Consistió en la visita de equipos de evaluadores para observar el manejo de casos, realizar una entrevista de salida a la madre, re-examinar al niño y revisar el equipamiento y provisión de medicamentos. Se incluyeron 36 servicios de salud seleccionados aleatoriamente, se observó a 54 trabajadores de salud que atendieron 102 niños. Los resultados mostraron que las habilidades clínicas han mejorado ostensiblemente, en comparación con la línea de base del año 1997. Hubo una reducción en el uso innecesario de antibióticos. Las debilidades estuvieron relacionadas con la identificación y conducta hacia la clasificación de anemia y con aspectos de consejería a la madre. Se identificaron problemas con la disponibilidad de medicamentos y la vacunación en servicios. Luego del análisis de la información recolectada se efectuaron talleres de devolución de la información a los niveles operativos, los cuales consiguieron que el personal de salud plantee recomendaciones orientadas a mejorar la aplicación de AIEPI en sus servicios. Finalmente se realizaron recomendaciones sobre la metodología de evaluación

Perspectivas actuales del duelo en el fallecimiento de un reciÚn nacido / Perspectives in the grief of a newborn child death

La muerte constituye un evento cotidiano en la medicina, sin embargo, los eventos psicológicos que la acompañan y el enfrentamiento humano de ella ha sido estudiado pocas veces con rigurosidad cientifica. Hace 25 años, frente a la muerte de un reciÚn nacido, se recomendaba que la madre no tuviese contacto con el niño, administrar tranquilizantes a la familia para evitar toda manifestación emocional, no hablar del tema, olvidar al niño y tener otros hijos. Las recomendaciones actuales son diametralmente opuestas, pero aunque hay mes información objetiva, a veces sistemáticamente obtenida, aún son escasos los estudios bien controlados. En general muchas guias clinicas se fundamentan en reportes cualitativos del duelo de unos pocos padres y opiniones de especialistas como psiquiatras o psicoterapeutas. El propósito de este articulo, basado en la literatura y en la experiencia clínica de los autores, es sugerir a partir del conocimiento actual, pautas que faciliten el proceso de acompañamiento de los padres en el fallecimiento de un reciÚn nacido.