Infrared Thermography of Teat in French Dairy Alpine Goats: A Promising Tool to Study Animal-Machine Interaction during Milking but Not to Detect Mastitis.

There is a need to develop tools for mastitis management in goats and to measure the effects of milking machines on teats. Infrared thermography (IRT), as shown in cows, was a good candidate for early mastitis detection and focusing on milking equipment and settings implicated in potential problems. The aim of this study was to test IRT to detect udder inflammation and the effects of mechanical milking on teats in relation to inflammation status, udder balance, and teat shape in Alpine goats. IRT spectra were compared before and after milking in 551 goats from three commercial herds compared to their individual SCC (somatic cell count). We found no regression or trend between logSCC and IRT measurement or response to milking, even in highly inflamed goat udders. The effect of milking was significant (p < 0.05) with global temperature reduction after milking, but differences were seen between teat parts and unbalanced half udders. The highest reduction in skin temperature was observed at the teat orifice (-1.06 ± 0.05) and the lowest at the teat barrel (-0.37 ± 0.05). The teats with long barrels showed more IRT reactions, which clearly indicates poor adaptation to the liners used. In conclusion, the IRT was not able to detect mastitis, but it is a good tool to diagnose the effects of the milking machine in order to adapt milking equipment and settings to the goats and improve their welfare.

Premature ventricular complexes as a first manifestation in left ventricular non-compaction cardiomyopathy: A case report and focused review of the literature.

Left ventricular non-compaction (LVNC) cardiomyopathy is an uncommon unclassified or genetic myocardial disorder. Frequent premature ventricular complexes (PVCs) as unique finding in LVNC cardiomyopathy are rare. We report a case of a 36-year-old woman in whom isolated LVNC was diagnosed due to an incidental finding of PVCs in pre-operative consultation.

Efficacy of purified nucleotide supplements on the growth performance and immunity of hybrid striped bass Morone chrysops x Morone saxatilis.

Fishmeal is being increasingly replaced in aquatic animal diets with alternative plant protein feedstuffs such as soybean meal which have lower concentrations of nucleotides; therefore, supplemental sources of exogenous nucleotides in diets could become increasingly important. A 9-week feeding trial was conducted with triplicate groups of juvenile hybrid striped bass (average initial body weight ± standard deviation, 5.6 ± 0.1 g) to determine the effects of supplementing single purified nucleotides on the growth performance and immune parameters. The basal diet, which utilized menhaden fishmeal (25%) and soybean meal (75%) as protein sources, contained 44% protein, 10% lipid and an estimated digestible energy level of 3.5 kcal g-1. Single additions of 5'- adenosine monophosphate (AMP), 5'- uridine monophosphate (UMP), 5'- cytidine monophosphate (CMP), 5'- guanosine monophosphate (GMP), and 5'- inosine monophosphate (IMP) disodium salts (Chem-Impex International, Wood Dale, Illinois, USA) were evaluated with each nucleotide added to the basal diet at 0.5% of dry weight at the expense of cellulose. A positive control diet in this trial was a diet containing 5'- AMP from Sigma-Aldrich also supplemented at 0.5% by weight. Results showed significantly (P < 0.05) improved weight gain between fish fed AMP-supplemented diets and the basal diet. No statistical significance (P > 0.05) was detected in whole-body proximate composition and protein retention of fish fed any of the dietary treatments. The respiratory burst of whole blood phagocytes also was significantly (P < 0.05) higher in fish fed the AMP Sigma diet compared to the other dietary treatments. Dietary IMP and AMP both significantly (P < 0.05) enhanced the capacity of isolated phagocytes to generate extracellular superoxide anion compared to all other dietary treatments. No significant differences were seen in other innate immune parameters such as plasma lysozyme, total plasma protein, and total immunoglobulin. The ability of isolated B lymphocytes to proliferate prompted by the presence of lipopolysaccharides was significantly (P < 0.05) different among dietary treatments with the highest simulation index observed in fish fed the diets containing AMP Sigma and UMP; however, it was not significantly different from that of fish fed the basal diet. Based on all the measured responses, it is concluded that AMP at 0.5% of diet had the most positive influence on growth performance and innate immunostimulation of hybrid striped bass.

Effect of High Potency Growth Implants on Average Daily Gain of Grass-Fattened Steers.

High potency growth promoter implants (HGPs) are widely used under feedlot conditions but there are few reports under grazing conditions. The study's goal was to assess the effect of HGPs on the average daily gain of steers fattened in pastures. A total of 57 crossbreed steers (Hereford × Angus)-initial body weight = 356.65 kg ± 5.04 (SEM)-were randomly allocated to one of three groups: Control without HGP (n = 19), Synovex group (n = 17), and Revalor group (n = 21). The fattening period was 67 days using paddocks of Lolium perenne L. and Trifolium repens L. Body weight was recorded three times in the period. The data were analyzed using an analysis of covariance with a level of significance of 5%. The average daily gain (ADG) (1.55 ± 0.07 and 1.48 ± 0.09 kg/d) and the total weight gain (103.4 ± 4.9 and 99.2 ± 5.8 kg) were similar for Revalor and Synovex, respectively (p > 0.05). Moreover, HGP groups showed higher ADG and total weight gain (p < 0.01) than the control group (ADG = 0.93 ± 0.08 kg/d and a total weight gain of 62.2 ± 5.2 kg). Final body weights were 527.8 ± 8.5 kg and 512.2 ± 9.9 kg for Revalor and Synovex, respectively; and 479.9 ± 10.1 kg for Control. In conclusion, grazing-finished steers showed better performance when high potency HGPs were used, improving the ADG and final live body weight, generating a marginal income that justifies the use of the technology under grazing conditions.

Comparative study of some analytical methods to quantify lignin concentration in tropical grasses.

OBJECTIVE: Lignin plays a relevant role in the inhibition of cell wall (CW) structural carbohydrate degradation. Thus, obtaining accurate estimates of the lignin content in tropical plants is important in order to properly characterize the mechanism of lignin action on cell wall degradation. Comparing conflicting results between the different methods available for commercial use will bring insight on the subject. This way, providing data to better understand the relationship between lignin concentration and implications with tropical forage degradation. METHODS: Five grass species, Brachiaria brizantha cv Marandú, Brachiaria brizantha cv Xaraés (MG-5), Panicum maximum cv Mombaça, Pennisetum purpureum cv Cameroon and Pennisetum purpureum cv Napier, were harvested at five maturity stages. Acid detergent lignin (ADL), Klason lignin (KL), acetyl bromide lignin (ABL) and permanganate lignin (PerL) were measured on all species. Lignin concentration was correlated with in vitro degradability. RESULTS: Highly significant effects for maturity, lignin method and their interaction on lignin content were observed. The ADL, KL and ABL methods had similar negative correlations with degradability. The PerL method failed to reliably estimate the degradability of tropical grasses, possibly due to interference of other substances potentially soluble in the KMnO4 solution. CONCLUSION: ADL and KL methods use strong acid (H2SO4) and require determination of ash and N content in the lignin residues, therefore, increasing time and cost of analysis. The ABL method has no need for such corrections and is a fast and a convenient method for determination of total lignin content in plants, thus, it may be a good option for routine laboratory analysis.

¿Son los ácidos grasos de la carne y la leche bovina nocivos para la salud de las personas? / Are fatty acids from beef and milk from cattle harmful for human health?

Nutritional recommendations of the past 35-40 years have promoted the reduction of fat intake, calories and particularly saturated fatty acids (SFA), emphasizing lower consumption of red meat and high fat dairy products, because of its association with cardiovascular diseases (CVD), being in turn replaced by sugars and refined carbohydrates. There is consensus that the SFA concentration in blood plasma, particularly palmitic acid, are associated with an increased risk of CVD and heart attacks. However, there is no evidence of causality between CVD and consumption of SFA, raising reasonable doubts about the relation ship between consumption of SFA with those present in blood plasma, as well as with the CVD risk. This review presents scientific evidence that demonstrates that the inclusion of fats in the diet, specifically animal fats from ruminants, provide important health benefits for people, especially when accompanied by a reduction in the consumption of carbohydrates. It is also proposed that ruminant products and their fatty acids contribute with beneficial saturated fats for people's health, especially those from pastoral production systems such as vaccenic, rumenic and linolenic acids.

Las recomendaciones nutricionales de los últimos 40 años han promovido la reducción del consumo grasas, calorías y particularmente ácidos grasos saturados (AGS), enfatizando un menor consumo de carnes rojas y productos lácteos altos en materia grasa debido a su asociación con enfermedades cardiovasculares (ECV), siendo reemplazados por azúcares y carbohidratos refinados. Existe consenso en que la concentración de AGS en el plasma sanguíneo, particularmente ácido palmítico, se asocia con un mayor riesgo de ECV y ataques al corazón. Sin embargo, no hay evidencias de causalidad entre ECV y consumo de AGS, planteando dudas razonables sobre la existencia de una relación entre el consumo de AGS con los presentes en el plasma sanguíneo, y con el riesgo de ECV. La presente revisión plantea evidencia científica que demuestra que la incorporación de grasas en la dieta, específicamente grasas de origen animal, aporta importantes beneficios para la salud de las personas, en especial cuando se acompaña de una reducción en el consumo de carbohidratos. Asimismo, se plantea que los productos de rumiantes y sus grasas contribuyen con ácidos grasos beneficiosos para la salud de las personas, en especial aquellos provenientes de sistemas de producción pastoriles como los ácidos vaccénico, ruménico y linolénico.

Prediction efficiency by near-infrared spectroscopy of immunoglobulin G in liquid and dried bovine colostrum samples.

The objective of this study was to compare the prediction efficiency of IgG concentration in bovine colostrum by NIRS, using liquid and dried (Dry-Extract Spectroscopy for Infrared Reflectance, DESIR) samples by transflectance and reflectance modes, respectively. Colostrum samples (157), obtained from 2 commercial Holstein dairy farms, were collected within the first hour after calving and kept at -20 °C until analysis. After thawing and homogenisation, a subsample of 500 mg of liquid colostrum was placed in an aluminium mirror transflectance cell (0·1 mm path length), in duplicate, to collect the spectrum. A glass fiber filter disc was infused with another subsample of 500 mg of colostrum, in duplicate, and dried in a forced-air oven at 60 °C for 20 min. The samples were placed in cells for dry samples to collect the spectra. The spectra in the VIS-NIR region (400-2500 nm) were obtained with a NIRSystems 6500 monochromator. Mathematical treatments, scatter correction treatments and number of cross-validation groups were tested to obtain prediction equations for both techniques. Reference analysis for IgG content was performed by radial immunodiffusion. The DESIR technique showed a higher variation in the spectral regions associated with water absorption bands, compared with liquid samples. The best equation for transflectance method (liquid samples) obtained a higher coefficient of determination for calibration (0·95 vs. 0·94, respectively) and cross validation (0·94 vs. 0·91, respectively), and a lower error of cross validation (9·03 vs. 11·5, respectively) than the best equation for reflectance method (DESIR samples). In final, both methods showed excellent capacity for quantitative analysis, with residual predictive deviations above 3. It is concluded that, regarding accuracy of prediction and time for obtaining results of IgG from bovine colostrum, NIRS analysis of liquid samples (transflectance) is recommended over dried samples (DESIR technique by reflectance).

Evaluation of Ocimum americanum essential oil as an additive in red drum (Sciaenops ocellatus) diets.

This study evaluated productive parameters, whole-body composition, non-specific immune responses and pH and microbiota of digestive tract contents of red drum (Sciaenops ocellatus) fed diets supplemented with Ocimum americanum essential oil (OAEO) (0 - control, 0.25, 0.5, 1.0 and 2.0 g/kg diet). After 7 weeks no significant differences in productive parameters and whole-body composition were observed. Plasma and intestinal lysozyme measurements and pH of the stomach and intestine (6 h after feeding) did not show significant differences among groups. Intestinal microbial community in fish fed the basal and OAEO diets (all concentrations) were identical. However, red drum fed the diet with OAEO at 1.0 g/kg had significantly increased intraperitoneal fat deposition and stomach pH (2 h after feeding) and decreased superoxide ion production (NBT-test) compared to the control group. Hemolytic activity of the complement system increased in fish fed diets containing OAEO. Red blood cells from fish fed the lowest OAEO concentration (0.25 g/kg) showed significant lower fragility in erythrocyte osmotic fragility assay, but fish fed 0.5 and 1.0 g/kg showed significant higher erythrocyte fragility. Lysozyme measurement in the supernatant of stomach content was significantly higher in fish fed the diet supplemented at 0.5 g/kg. Based on these various results, OAEO at different supplementation levels did not influence growth performance and intestinal microbial community; however, the EO added to the diet showed effects on immunological responses of red drum.

[Glomus tumour of the lung: a case report and literature review]. / Tumor glómico en pulmón: reporte de un caso y revisión bibliográfica.

BACKGROUND: Glomus tumours are neoplasms arising from cells of the neuromyoarterial glomus bodies, which almost always occur in a subungual location. A lung location is extremely rare, with few cases reported in the literature. CLINICAL CASE: The case is presented of a 33 year-old male, with non-productive cough, dyspnoea at rest, intermittent fever, and mild pain in rib cage. A chest radiograph showed a consolidation in the left lung, and computed tomography revealed a lesion in the hilum that extended to the bronchus of the lingula obstructing, and causing post-obstructive pneumonia. A biopsy was obtained by rigid bronchoscopy biopsy, which showed a well circumscribed tumour constituted by intermediate-sized cells, and abundant cytoplasm that are arranged in a pattern surrounding numerous thin-walled blood vessels, with no pleomorphism, significant mitotic activity or necrosis. Immunohistochemistry revealed diffuse positivity with smooth muscle actin, vimentin, caldesmon; focal reactivity with desmin and CD117, CD34 highlights the vascular pattern. Ki67 proliferation rate was 1%. Synaptophysin, EMA and cytokeratin cocktail were negative, making the diagnosis of glomus tumour. CONCLUSIONS: Glomus tumours are rare neoplasms that usually appear in the dermis and subcutaneous tissue, where it is common to find glomus bodies. Occasionally glomus tumours can occur in extra-cutaneous sites such as the gastrointestinal tract, bone and respiratory system, with this case being a new case of rare lung location.

Adaptación marginal y ajuste interno en estructuras de zirconia-ytria elaboradas con los sistemas CAD/CAM Procera® y Cerec in-Lab® / Marginal adaptation and internal fit of zirconia-ytrya frameworks fabricated with Procera® and Cerec in-Lab® CAD/CAM systems

Introducción: el objetivo fue determinar ex vivo la adaptación marginal y ajuste interno en estructuras de zirconiaytria elaboradas con los sistemas CAD/CAM Procera® y Cerec In-lab®. Métodos: se tomaron 15 pilares protésicos prefabricados contorneados de implantes divididos en tres grupos. Se fabricaron estructuras en aleación noble Pd-Au (control), Procera AllZircon® y Cerec In-lab YZ cubes®. Para evaluar la adaptación marginal se tomaron ocho medidas en la circunferencia del pilar protésico, tomando la distancia entre el borde de la estructura y el pilar. Para determinar el ajuste interno se hicieron ocho medidas desde la superficie externa del pilar a la superficie interna de la restauración. Las mediciones fueron hechas por microscopia óptica (50X). Los datos obtenidos fueron analizados por medio del análisis de varianza de una vía, la t de Student y prueba de Dunnett. Resultados: el promedio de adaptación marginal del grupo control fue 18,24 μm ±4,81; el grupo Procera®21,62 μm ±12,15 y el grupo Cerec In-lab® de 47,34 μm ±17,72. El promedio de ajuste interno para las estructuras Pd-Au fue 34,60 μm ±16,16; Procera® 118,67 μm ±50,84 y el Cerec In-lab® 65,62 μm ±25,80. Conclusiones: los valores de adaptación marginal de las estructuras de aleación metálica y de zirconia-ytria elaboradas con los sistemas CAD/CAM Procera® y CerecIn-lab® están entre los valores clínicamente aceptables. Las medidas de ajuste interno obtenidos para los grupos aleación metálica y Cerec® se encuentran dentro del rango reportado en la literatura. Mientras que el promedio obtenido para el grupo Procera® 118,67 μm ±50,84, aunque se acercó al límite máximo de ajuste interno reportado en la literatura, no se evidenció diferencia estadísticamente significativa con el sistema Cerec In-lab®.

Introduction: the purpose of this in vitro study was to determine the marginal adaptation and internal fit in zirconia ytrya frameworks fabricated with Procera® and Cerec In-lab® CAD/CAM systems. Methods: fifteen prefabricated implant abutmentswere divided in three equally sized groups; noble metal alloy Pd-Au structures were then fabricated (control group), Procera® and Cerec In-lab YZ cubes® (n = 5). The marginal gap was determined by measuring 8 points around the abutment circumferencetaking the distance between the margin of the structure and the abutment. In order to determine internal fit, 8 measures were taken from the abutment´s external surface to the internal surface of the restoration. The measures were done with an opticalmicroscope (50X). The data was the statistically analyzed using 1-way ANOVA, Student’s paired t test and Dunnett´test. Results: marginal adaptation mean for the control group was 18.24±4.81μm and Procera® 21.62 μm ±12.15 μm, while the average for Cerec In-lab® was 47.34 μm ±17.72 μm. The internal fit for the control group was 34,60 μm ±16.16 μm and Procera® group was of 118.67 μm ±50.84 μm in average and Cerec In-lab® 65.62 μm ±25.80 μm. Conclusions: the metal alloy and zirconia ytrya frameworksfabricated with Procera® and Cerec In-lab® CAD/CAM systems showed clinically acceptable marginal gap values. The internal fit values for metal alloy and Cerec® frameworks are within the ranges reported in the literature. While the mean for the Procera®group was 118.67 μm ±50.84, which is close to the internal fit maximum limit reported in the literature, there was no statistically significant difference when compared with the Cerec-In-lab® system.

Aneurismas das artérias coronárias: uma rara manifestação da doneça renal policística autossômica dominante / Coronary aneurysms: a rare manifestation of autosomal dominant polycystic kidney disease

A doença renal policística autossômica dominante (DRPAD), uma das anormalidades genéticas mais comuns, é responsável por 10 por cento dos casos de insuficiência renal crônica terminal. O acometimento extrarrenal da DRPAD manifesta-se por cistos no fígado e pâncreas, aneurismas intra e extracranianos, e anormalidades cardíacas valvares, comprometendo a raiz da aorta e as valvas aórtica e mitral. Neste artigo descrevemos o caso de um paciente com aneurisma das artérias coronárias no contexto de outras manifestações sugestivas de DRPAD.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic abnormalities and is responsible for over 10% of end-stage chronic kidney disease cases. Extrarenal involvement of ADPKD is manifested by liver and pancreatic cysts, intra and extracranial aneurysms and valvular heart disease, involving the aortic root and the aortic and mitral valves. In this article we report a case of a patient with large coronary artery aneurysms in the context of other manifestations suggesting ADPKD.

Laparoendoscopic single-site surgery simple prostatectomy: initial report.

OBJECTIVES: To report the first case and detailed technique of laparoendoscopic single-site (LESS) surgery simple prostatectomy for benign hypertrophy. METHODS: A 67-year-old man presented with acute urinary retention requiring catheterization. Serum prostate-specific antigen level was 5 ng/mL, and a biopsy revealed benign hypertrophy with a transrectal ultrasound volume estimation of 110 mL. LESS simple prostatectomy was performed using a single multilumen port inserted through a solitary 2.5-cm intraumbilical incision. Standard laparoscopic ultrasonic shears and needle drivers, articulating scissors, and specifically designed bent grasping instruments facilitated dissection and suturing. RESULTS: An R-port was placed intraperitoneally through a 2.5-cm intraumbilical incision. No extraumbilical skin incisions were made. Total operative time was 120 minutes and estimated blood loss was 200 mL. A closed suction drain was externalized through the umbilical incision. No intraoperative or postoperative complications occurred. Hospital stay was 2 days, the retropubic drain was removed at 3 days, and the catheter removed at 1 week. Specimen weight was 95 g and final pathology revealed benign prostatic hyperplasia. At 3 months follow-up, the patient was completely continent and voiding spontaneously with a Q(max.) of 85 mL/s. CONCLUSIONS: We demonstrate technical feasibility and describe the detailed surgical technique of LESS simple prostatectomy. Our initial experience suggests that this technique may be an alternative for large-volume benign prostatic hyperplasia in lieu of open surgery. Comparative studies with other surgical techniques will determine its place in the surgical armamentarium of benign prostatic hyperplasia.

Collision tumors of the sella: craniopharyngioma and silent pituitary adenoma subtype 3: case report.

Collision tumors of the sella turcica are rare and consist mainly of more than one type of pituitary adenoma, usually a corticotropin- and a prolactin-producing adenoma. The association of a craniopharyngioma and a pituitary adenoma is rare. Herein, we report the first case of an association between craniopharyngioma and silent pituitary adenoma subtype 3. It involved a 12-year-old boy who underwent a frontal craniotomy with surgical removal of a calcified sellar tumor. Histology revealed an adamantinomatous craniopharyngioma; however, by electron microscopy, there was conclusive evidence of adenoma cells showing the ultrastructural features of silent pituitary adenoma subtype 3. Endocrine and neuroimaging as well as detailed immunohistochemical and ultrastructural studies were undertaken. The literature is also reviewed.

Implante percutâneo de prótese valvar na estenose aórtica em pacientes adultos / Percutaneous valve prosthesis in aortic stenosis in adults

Em decorrência da maior expectativa de vida e do aumento progressivo do número de idosos na população geral, as doenças degenerativas se tornam cada vez mais frequentes. Dentre elas, a doença valvar aórtica merece especial atenção, por ter elevada prevalência e por representar geralmente mau prognóstico para o paciente que apresenta sua forma avançada. Até alguns anos atrás, o único tratamento disponível para tal doença era cirúrgico, reservado basicamente para aqueles com risco pré-operatório médio ou baixo. Em 2002, o primeiro implante percutâneo de prótese valvar aórtica em humanos constituiu, sem dúvida, um dos maiores avanços na área da cardiologia dos últimos tempos, estabelecendo-se como opção terapêuticapara pacientes antes considerados "incuráveis". Inicialmente testados em pacientes com mau prognóstico e pobre expectativa de vida, os trabalhos mais recentes demonstraram resultados comparáveis com o tradicional procedimento de correção cirúrgica, criando, assim, um campo novo dentro da cardiologia. Esta monografia apresenta, de forma reduzida, os aspectos mais relevantes da evolução dessas novas técnicas e relata um breve histórico desde os primeiros implantes até a última série de casos, revelando as indicações e contraindicações do procedimento e comparando-as com aquelas da cirurgia. Também são descritas as técnicas , os dispositivos atualmente disponíveis, os resultados obtidos atualmente disponíveis, os resultados obtidos até o momento e a evolução dos pacientes tratados. Ainda com grande potencial de desenvolvimento, o campo da abordagem percutânea das valvopatias continua sua busca pelo procedimento ideal para o tratamento dessas doenças.

Robotic repair of rectovesical fistula resulting from open radical prostatectomy.

OBJECTIVES: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 57-year-old man underwent open radical prostatectomy with recognized rectal injury, primary closure of the rectal wall, and loop colostomy. The patient developed urine leakage per rectum after colostomy closure. We diverted the fecal stream with end colostomy and placed a suprapubic tube. An open transsacral (Kraske) repair failed 1 month later. We have previously described the laparoscopic approach, and report the technique and results of our first robotic assisted operation. METHODS: The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic initial dissection (4) mobilization of omental pedicle flap, (4) cystotomy extending toward the fistulous tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, and (10) drain placement. RESULTS: Operative time was 180 minutes. Hospital stay was 1 day. The suprapubic tube was removed at 2 months after normal cystography. Bowel continuity was restored at 4 months, with no fistula recurrence at 1-month follow-up. CONCLUSIONS: We await longer follow-up and experience in larger series. For now, robotic repair of rectovesical fistula appears feasible and represents an attractive alternative to open and laparoscopic approaches.

Complicaciones crónicas y factores asociados en diabéticos tipo 2 / Chronic complications and associated factors in type 2 diabetic patients

La diabetes mellitus conlleva al desarrollo de complicaciones, representando las causas más importantes de morbilidad y mortalidad asociadas a esta enfermedad. La presente investigación tuvo como objetivo determinar el grado de control metabólico y la frecuencia de complicaciones crónicas y factores asociados a estas complicaciones como hemoglobina glicosilada, tiempo de evolución de la diabetes mellitus e historia de hipertensión arterial en diabéticos tipo 2 que asistieron al hospital “Dr. Agustín Hernández”, Juan Griego, Estado Nueva Esparta. Se consultaron las historias clínicas de 59 diabéticos, con el fin de obtener altos referentes al tipo de diabetes y tratamiento, tiempo de diagnóstico de la diabetes, presencia de complicaciones crónicas e hipertensión arterial; la determinación de hemoglobina glicosilada (HbA1c) se realizó por cromatografía de intercambio catiónico. La cuantificación de HbA1c permitió determinar que el 98,31 por ciento de los diabéticos tenían un mal control metabólico, con niveles de HbA1c > 7,0 por ciento. Dieciséis 27,12 por ciento) registraron en sus historias clínicas complicaciones crónicas; la gran mayoría fueron microvasculares (62,50 por ciento), la retinopatía (10,17 por ciento) y neuropatía periférica (8,47 por ciento) fueron las más frecuentes. La mayoría de los pacientes con complicaciones como retinopatía (83,33 por ciento), neuropatía (66,67 por ciento) y neuropatía periférica (60,00 por ciento), fueron más frecuentes en pacientes con tiempo de evolución mayor a 10 años. La hipertensión arterial fue más frecuente en enfermedad coronaria del corazón (100,00 por ciento), neuropatía periférica (80,00 por ciento) y retinopatía (50,00 por ciento). El análisis de regresión logística reveló asociación significativa con los siguientes factores de riesgo: hemoglobina glicosilada con nefropatía (p=0,024)

El tiempo de los estudiantes de medicina en las rotaciones clínicas y el sistema de créditos / Medical Student's Use of Time during Clinical Clerkships and the Credits Based System

Introducción: La formación en ciencias clínicas del pregrado de medicina se fundamenta en rotaciones clínicas. Para implementar el sistema de créditos es necesario conocer cómo se llevan a cabo estas experiencias. Objetivo: Describir cómo los estudiantes utilizan el tiempo durante las rotaciones clínicas, el valor académico y el grado de disfrute que le asignan a las actividades. Metodología: Estudio descriptivo con una muestra aleatoria estratificada de cien estudiantes de los semestres clínicos. Se recolectó información sobre el tiempo empleado durante una semana, el valor educativo y el grado de disfrute de las actividades de las rotaciones clínicas. Los datos fueron analizados en Excel® 98 y SPSS. Resultados: Las actividades de un día ocuparon en promedio 10.8 h, con 7.3 h (69%) dedicadas a actividades académicas. La actividad asistencial con docente representó el mayor porcentaje de utilización del tiempo (15.4%). Durante una semana, el 56% (28 h) del tiempo efectivo estuvo dedicado al trabajo asistencial y 22.4 h (44.5%) al trabajo independiente en el sitio de práctica. El tiempo dedicado al aprendizaje en la rotación clínica corresponde a 19 créditos para un semestre de 18 semanas. Las actividades calificadas con mayor valor educativo fueron el estudio independiente por fuera de la institución (4.6) y las actividades académicas con el docente (4.5). Las calificadas como de mayor disfrute fueron las extracurriculares y la docencia formal. Conclusiones: Los estudiantes tienen mayor tiempo de contacto con los pacientes que el reportado en la literatura. El trabajo presencial de nuestros estudiantes es mayor al reportado en estudios similares.

Introduction: Comprehensive undergraduate education in clinical sciences is grounded on activities developed during clerkships. To implement the credits system we must know how these experiences take place. Objectives: to describe how students spend time in clerkships, how they assess the educative value of activities and the enjoyment it provides. Method: We distributed a form to a random clustered sample of a 100 students coursing clinical sciences, designed to record the time spent, and to assess the educative value and the grade of enjoyment of the activities in clerkship during a week. Data were registered and analyzed on Excel® 98 and SPSS. Results: mean time spent by students in clerkship activities on a day were 10.8 hours. Of those, 7.3 hours (69%) were spent in formal education activities. Patient care activities with teachers occupied the major proportion of time (15.4%). Of the teaching and learning activities in a week, 28 hours (56%) were spent in patient care activities and 22.4 hours (44.5%) were used in independent academic work. The time spent in teaching and learning activities correspond to 19 credits of a semester of 18 weeks. The activities assessed as having the major educational value were homework activities (4.6) and formal education activities (4.5). The graded as most enjoyable were extracurricular activities, formal educational activities and independent academic work. Conclusion: our students spend more time in activities with patients than the reported in literature. The attending workload of our students is greater than the one reported in similar studies.

Familial clustering of autoimmune diseases in patients with type 1 diabetes mellitus.

We investigated the familial aggregation of autoimmune diseases (AIDs) among first-degree relatives (FDR) of patients with type 1 diabetes mellitus (T1D). Relatives of 98 T1D patients defined according to the guidelines diagnosis of the American Diabetes Association and 113 matched controls without any AID, were interviewed using a questionnaire that sought information about demographic and medical characteristics including a list of 18 AIDs. Genetic analysis was performed using the program ASSOC and by calculating recurrent risk ratios. In cases, 25.5% of the families had at least one member having an AID, while in controls there were 9% (odds ratio [OR]: 3.96, 95% confidence interval [CI]=1.74-9.0, p=0.0006). An AID was registered in 8.3% of 312 FDR of patients as compared with 2.4% of 362 FDR in controls (OR: 3.56, 95% CI=1.64-7.73, p=0.0008). The most frequent AIDs registered in FDR of cases were autoimmune thyroid disease (AITD) and T1D, which disclosed coefficients of aggregation. These results indicate that AIDs cluster within families of T1D patients adding further evidence to consider that clinically different autoimmune phenotypes may share common susceptibility gene variants, which may act pleiotropically as risk factors for autoimmunity.