A Study of Zn-Ca Nanocomposites and Their Antibacterial Properties.

This study aimed to develop Ca2+ doped ZnO nanoparticles (NPs) and investigate their antibacterial properties against microorganisms of dental interest. Zn-Ca NPs were synthesized by the sol-gel method with different concentrations of Ca2+ (1, 3, and 5 wt. %) and subsequently characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), UV-vis spectroscopy and Fourier transform infrared spectroscopy (FT-IR). The Kirby-Bauer method was used to measure antibacterial effects. NPs showed the wurzite phase of ZnO and bandgap energies (Eg) from 2.99 to 3.04 eV. SEM analysis showed an average particle size of 80 to 160 nm. The treatments that presented the best antibacterial activity were Zn-Ca 3% and Zn-Ca 5%. ZnO NPs represent an alternative to generate and improve materials with antibacterial capacity for dental applications.

Evaluation of tetracycline in milk following extra-label administration of topical tetracycline for digital dermatitis in dairy cattle.

Digital dermatitis (DD) is a painful infectious foot lesion commonly treated topically with extra-label tetracycline. Our objectives were to determine the concentrations of tetracycline in milk and plasma and to calculate a withdrawal interval following topical application at various doses. Another objective was to evaluate agreement between tests for measuring tetracycline in milk. A randomized block trial was conducted on 2 farms, where 50 cows with active DD lesions on 2 feet were allocated to 1 of 5 treatment groups (n = 10 cows per group). Treatment groups consisted of topical applications of tetracycline hydrochloride, in a paste or as a powdered form under a bandage, at 3 different dosing levels (2, 5, and 25 g) on each of the 2 affected feet. Following enrollment and treatment, samples were collected from milk, teat skin, and blood every 8 to 24 h for up to 7 d postdosing. Concentrations of tetracycline were measured by liquid chromatography-mass spectrometry and milk samples were further tested using the Charm ROSA TET test (Charm Sciences Inc., Lawrence, MA). Tetracycline was present in milk, plasma, and teat skin from all treatment groups. Tetracycline concentrations varied depending on time of sampling, method of application, and dosing level. At 8 h post-treatment, 11% of cows had tetracycline present in milk higher than 100 ng/mL (ppb) but none higher than 300 ng/mL. The 25-g treatment group had the longest estimated withdrawal interval, the highest observed concentrations (210-244 ng/mL) of tetracycline present in milk, and the longest observed consecutive period of tetracycline presence (from 8 to 72 h) among all treatment groups. Compared with liquid chromatography-mass spectrometry, the Charm test had a sensitivity of 77 and 100% for measuring tetracycline in milk at ≥30 and ≥100 ng/mL, respectively. Post-treatment samples of the teat skin were taken from 15 cows on 6 occasions, and every cow had tetracycline present in at least 1 of those 6 samples. This confirms an association between topical DD treatment with tetracycline and contamination of the teat. A total of 22% of blood samples had detectable tetracycline, and the majority (63%) occurred at 8 h post-treatment. At 100 ng/mL, the estimated cow-level milk withdrawal interval ranged from 0 to 70 h. At 300 ng/mL, the estimated cow-level withdrawal interval ranged from 0 to 34 h, and was 0 h at the bulk tank level. We recommend that conservative measures be adopted after extra-label use of topical tetracycline for DD treatment, including using a low dose and strategic post-treatment testing for tetracycline-class drugs in milk.

Evaluation of agreement among digital dermatitis scoring methods in the milking parlor, pen, and hoof trimming chute.

Digital dermatitis (DD) is the most common infectious foot lesion affecting welfare and productivity of dairy cattle. The key to DD control programs is routine and frequent identification of DD lesions. The objective was to evaluate accuracy of detecting and scoring DD lesions in 3 milking parlor designs and in 3 alternative settings compared with scoring in the hoof trimming chute as reference. A total of 552 cows and 1,104 hind feet from 17 freestall farms were scored by 1 observer in the milking parlor and in 1 other setting: pen, headlocks, or management rail. After being scored in the milking parlor and at least 1 other setting, cows were examined in the hoof trimming chute, considered the gold standard. In every setting, all hind feet were inspected visually using a flashlight and without prior washing of feet. Agreement of the scoring settings was assessed using the 5 M-stage scoring system and a dichotomous absence (M0 or M0/M1) or presence (M1 to M4.1 or M2 to M4.1) system. At trimming chute inspection, 44% of feet had a DD lesion, with estimates of 11, 5, 2, 10, and 16% for M1, M2, M3, M4, and M4.1 lesions, respectively. Apparent DD foot-level prevalence at the milking parlor, pen, management rail, and headlocks was 28, 22, 16, and 22%, respectively. M-stages were less discernible in the pen, management rail, and headlocks (apparent prevalence of M1, M2, M3, and M4.1 was ≤1%) compared with the trimming chute and milking parlor. Agreement beyond chance between any scoring setting and trimming chute scoring ranged from 0.48 to 0.70 for the dichotomous scoring system (absence = M0/M1 vs. presence = M2 to M4.1). Diagnostic test performance varied greatly among DD scoring settings but, in general, it had low sensitivity (<70%) and high specificity (>93%) for detecting any DD lesion. Agreement and test characteristics were not affected by the type of milking parlor. Although the milking parlor and headlocks were the most reliable settings in which to detect DD, none of the settings were reliable enough to replace inspection of feet in the trimming chute. However, scoring the presence or absence of DD in the milking parlor, pen, management rail, and headlocks could be used to estimate within-herd DD prevalence, to improve DD surveillance through routine monitoring, and to evaluate effects of interventions at the farm level.

Effectiveness of a standardized footbath protocol for prevention of digital dermatitis.

A footbath is the most common herd-level approach to control digital dermatitis (DD) in intensive dairy farming. However, wide variation in footbath design and protocols suggests a gap between evidence-based management practices and on-farm implementation. The objective was to evaluate effectiveness of a standardized footbath protocol in decreasing prevalence of active DD lesions in lactating dairy cattle. The protocol was based on current scientific literature, including footbath design and management. The M-stage classification system was used to score DD lesions. Scores were also combined into a simplified scoring system: no lesions (M0), active lesions (M1, M2, and M4.1), and chronic lesions (M3 and M4). A controlled intervention trial was conducted on 9 farms over 22 wk. Each farm served as its own control with data collected for 10 wk before and 12 wk after intervention. A total of 1,978 lactating cattle were assessed biweekly for DD lesions and leg cleanliness in the milking parlor. Lactating cattle were also inspected in the trimming chute at 3 time points: start, intervention, and end of trial. Intervention consisted of implementing an automated footbath that measured 3 m long, 0.50 m wide, held a fluid depth of 0.15 m, along with a weekly footbath protocol using 5% CuSO4 for 4 consecutive milkings, with footbath content replaced at a maximum of 200 cow passes. Multilevel logistic regression models for repeated measures were used to evaluate effects of the standardized footbath protocol in preventing active DD lesions. For the purpose of analysis, farms' within-herd prevalence of active DD lesions (at baseline) was assessed and categorized as low (<15%) or high (≥15%). Farms with low or high within-herd prevalence of active DD lesions at trial outset had a mean cow-level prevalence of active DD lesions of 8% (range, 2 to 13) and 31% (range, 18 to 43), respectively. At milking parlor inspections, apparent prevalence of active DD lesions decreased from the time of footbath intervention, but this effect interacted with the farms' baseline prevalence of active DD lesions. In that regard, on farms with high prevalence of active DD at baseline, apparent prevalence of active DD lesions decreased after intervention, whereas on farms with low prevalence of active DD at baseline, apparent prevalence of active DD lesions did not change. At the cow level, poor leg cleanliness was associated with higher prevalence of active DD lesions. At trimming chute inspections, prevalence of active DD lesions decreased from start to the end of the trial (22 and 14%, respectively); concurrently, prevalence of feet with no DD lesions (M0) increased (39 and 48%). We concluded that on farms with high DD prevalence, implementation of proper footbath design and improvement of footbathing management will decrease prevalence of active DD lesions and increase prevalence of feet without DD lesions. In addition, improving cow cleanliness will further result in control of active DD lesions.

Validation of the M-stage scoring system for digital dermatitis on dairy cows in the milking parlor.

A high prevalence of digital dermatitis (DD) and the benefits of early topical treatment highlight the need for simple tools for routine DD detection. The objective of this study was to determine the accuracy of scoring DD lesions using the 5 M-stage scoring system in the milking parlor compared with the trimming chute as the gold standard. Three observers inspected 3,585 cows and 6,991 hind feet from 9 farms in the milking parlor using a mirror (glued to a plastic kitchen spatula) and a headlamp, followed by inspection in a trimming chute within 5 d. Interobserver agreement for scoring DD in various settings was ≥82% (kappa >0.74; weighted kappa >0.76). At trimming chute inspections, 68% of cows had at least 1 DD lesion, 19% had 1 hind leg affected, and 49% had both hind legs affected. Within-herd DD prevalence ranged from 16 to 81% of cows affected. True within-herd prevalence was 2, 6, 0, 36, and 14% for M1, M2, M3, M4, and M4.1 lesions, respectively. At the foot level, DD prevalence was the same (58%) in the milking parlor and trimming chute inspection, but distribution of M-stages differed. Milking parlor inspection as a means of identifying the presence of DD lesions had a sensitivity of 92% and specificity of 88%, with positive and negative predictive values of 91 and 89%, respectively. Agreement between milking parlor and trimming chute inspections was 73% (kappa = 0.59, weighted kappa = 0.65) for the 5 M-stage scoring system and 90% (kappa = 0.80) if only the presence of a lesion was noted. Test characteristics varied greatly among M-stages, with the highest sensitivity for detecting M4 (82%) and M2 (62%) lesions, and the lowest for detecting M4.1 (20%), M1 (7%), and M3 (0%) lesions. In the milking parlor, 20% of M2 lesions were misclassified as M4.1, 8% of M4 lesions were misclassified as M0, and 68% of M4.1 lesions were misclassified as M4. The majority (87%) of DD lesions were located between the heel bulbs; 10 and 2% of DD lesions affected the interdigital space and the front of the foot, respectively. The sensitivity to detect the presence of a lesion when it occurred between the heel bulbs was 93%, but <67% if it occurred elsewhere on the foot. We concluded that inspection of the rear feet in the milking parlor was an inexpensive and simple method of detecting and scoring DD lesions. If the objective is to determine herd-level DD prevalence and routine monitoring, this method was adequately reliable. However, if the objective is to follow up DD in cows with history of interdigital hyperplasia or to detect M1 or M4.1 lesions, this method was not sufficiently reliable. Although DD scoring in the milking parlor as a routine practice should facilitate early detection, prompt treatment interventions, and herd monitoring, it was not sufficiently reliable to replace definitive identification of M-stages in the trimming chute.

Producer estimates of prevalence and perceived importance of lameness in dairy herds with tiestalls, freestalls, and automated milking systems.

Lameness is one of the most important welfare and productivity concerns in the dairy industry. Our objectives were to obtain producers' estimates of its prevalence and their perceptions of lameness, and to investigate how producers monitor lameness in tiestall (TS), freestall with milking parlor (FS), and automated milking system (AMS) herds. Forty focal cows per farm in 237 Canadian dairy herds were scored for lameness by trained researchers. On the same day, the producers completed a questionnaire. Mean herd-level prevalence of lameness estimated by producers was 9.0% (±0.9%; ±SE), whereas the researchers observed a mean prevalence of 22.2% (±0.9%). Correlation between producer- and researcher-estimated lameness prevalence was low (r = 0.19) and mean researcher prevalence was 1.6, 1.8, and 4.1 times higher in AMS, FS, and TS farms, respectively. A total of 48% of producers thought lameness was a moderate or major problem in their herds (TS = 34%; AMS =53%; FS = 59%). One third of producers considered lameness the highest ranked health problem they were trying to control, whereas two-thirds of producers (TS = 43%; AMS = 63%; FS = 71%) stated that they had made management changes to deal with lameness in the past 2 yr. Almost all producers (98%) stated they routinely check cows to identify new cases of lameness; however, 40% of producers did not keep records of lameness (AMS = 24%; FS = 23%; TS = 60%). A majority (69%) of producers treated lame cows themselves immediately after detection, whereas 13% relied on hoof-trimmer or veterinarians to plan treatment. Producers are aware of lameness as an issue in dairy herds and almost all monitor lameness as part of their daily routine. However, producers underestimate lameness prevalence, which highlights that lameness detection continues to be difficult in in all housing systems, especially in TS herds. Training to improve detection, record keeping, identification of farm-specific risk factors, and treatment planning for lame cows is likely to help decrease lameness prevalence.

Prevalence and distribution of foot lesions in dairy cattle in Alberta, Canada.

The objectives of this cross-sectional study were to determine the prevalence and distribution of foot lesions and associated cow- and herd-level risk factors in dairy cows in Alberta, Canada. Foot lesion data were recorded electronically by 7 hoof trimmers on 28,607 cows in 156 dairy farms from June 2009 to November 2012. Foot lesion prevalence estimates differed between farms that had the whole herd trimmed at once (≥80% of lactating cows were trimmed; n=69 farms and 8,020 cows) and farms on which part of the herd was trimmed (selection of cows was determined by farmer and <80% of lactating cows were trimmed; n=87 and 20,587 cows). Estimates were consistently higher for the latter likely because farmers presumably prioritized lame cows in partial-herd trims. On farms with whole-herd trims, digital dermatitis was the most common lesion among all housing types, present in 15% of cows and 94% of herds. Sole ulcers and white line disease were detected in 6 and 4% of the cows and 92 and 93% of herds, respectively. Other infectious and claw horn lesions each affected 1 to 2% of cows and 62 to 78% of herds. Intraclass correlation coefficients for hoof trimmers ranged from 0.01 to 0.20 for all lesions, indicating some clustering of recorded lesions by trimmer. Multilevel mixed logistic regression models were constructed (including hoof trimmer as fixed and farm as random effects) for the 3 most frequently identified lesions. Prevalence of digital dermatitis decreased with increasing parity, but this effect interacted with days in milk (DIM); primiparous cows had higher odds of digital dermatitis in mid lactation (100-199 DIM) and late lactation (≥200 DIM) compared with cows at other stages of lactation. In contrast, prevalence of sole ulcers and white line disease increased with increasing parity; compared with cows in parity 1, those in parity 4 had 5 or 7 times higher odds of having these lesions, respectively. Cows in mid lactation and late lactation had higher odds of sole ulcers and white line disease than cows at other stages of lactation, regardless of parity. Digital dermatitis prevalence was 2 times higher in herds housed in barns with access to an exercise area. The odds of sole ulcers and white line disease were ≥2 times higher in cows housed in freestalls than those housed in deep-bedded packs. Therefore, preventive measures for control of digital dermatitis merit emphasis, especially in primiparous cows and on farms with exercise areas. In addition, improving housing environment by providing a deep-bedded area for older cows in mid lactation or late lactation could reduce prevalence of claw horn lesions. We inferred that foot lesion data recorded by hoof trimmers can provide useful information not only to develop effective foot health programs at herd level, but also for disease surveillance and genetic improvement at regional and national levels.

Associations between lying behavior and lameness in Canadian Holstein-Friesian cows housed in freestall barns.

Lying behavior is an important measure of comfort and well-being in dairy cattle, and changes in lying behavior are potential indicators and predictors of lameness. Our objectives were to determine individual and herd-level risk factors associated with measures of lying behavior, and to evaluate whether automated measures of lying behavior can be used to detect lameness. A purposive sample of 40 Holstein cows was selected from each of 141 dairy farms in Alberta, Ontario, and Québec. Lying behavior of 5,135 cows between 10 and 120 d in milk was automatically and continuously recorded using accelerometers over 4 d. Data on factors hypothesized to influence lying behavior were collected, including information on individual cows, management practices, and facility design. Associations between predictor variables and measures of lying behavior were assessed using generalized linear mixed models, including farm and province as random and fixed effects, respectively. Logistic regression models were used to determine whether lying behavior was associated with lameness. At the cow-level, daily lying time increased with increasing days in milk, but this effect interacted with parity; primiparous cows had more frequent but shorter lying bouts in early lactation, changing to mature-cow patterns of lying behavior (fewer and longer lying bouts) in late lactation. In barns with stall curbs >22 cm high, the use of sand or >2 cm of bedding was associated with an increased average daily lying time of 1.44 and 0.06 h/d, respectively. Feed alleys ≥ 350 cm wide or stalls ≥ 114 cm wide were associated with increased daily lying time of 0.39 and 0.33 h/d, respectively, whereas rubber flooring in the feed alley was associated with 0.47 h/d lower average lying time. Lame cows had longer lying times, with fewer, longer, and more variable duration of bouts compared with nonlame cows. In that regard, cows with lying time ≥ 14 h/d, ≤ 5 lying bouts per day, bout duration ≥ 110 min/bout, or standard deviations of bout duration over 4 d ≥ 70 min had 3.7, 1.7, 2.5, and 3.0 higher odds of being lame, respectively. Factors related to comfort of lying and standing surfaces significantly affected lying behavior. Finally, we inferred that automated measures of lying behavior could contribute to lameness detection, especially when interpreted in the context of other factors known to affect lying behavior, including those associated with the individual cow (e.g., parity and stage of lactation) or environment (e.g., stall surface).

Prevalence of lameness and associated risk factors in Canadian Holstein-Friesian cows housed in freestall barns.

Lameness is a severe welfare problem and a production-limiting disease in dairy farming. The objectives of this study were to determine prevalence of lameness and investigate cow- and herd-level factors associated with lameness in dairy cows housed in freestall barns in 3 Canadian provinces. A purposive sample of 40 Holstein-Friesian cows was selected from each of 141 dairy farms in Québec, Ontario, and Alberta. In total, 5,637 cows were scored once for lameness (presence of limping when walking). Data collected included information on individual cows (hock lesions, claw length, body condition score, parity, days in milk, and milk production), management practices (floor and stall cleaning routine, bedding routine, and footbath practices), and facility design (stall dimensions, stall base and bedding type, width of feed alley, flooring type, and slipperiness) hypothesized to be risk factors for lameness. Multilevel mixed logistic regression models were constructed (including farm as a random effect and province as a fixed effect). Herd-level lameness prevalence ranged from 0 to 69% (mean = 21%). Lameness prevalence increased with increasing parity; compared with first parity, cows in parity 2, 3, and ≥ 4 had 1.6, 3.3, and 4 times, respectively, higher odds of being lame. Furthermore, the odds of lameness were 1.6 times greater in cows with low body condition score (≤ 2.5) than in cows with a higher body condition score. In addition, injured hocks and overgrown claws were associated with 1.4- and 1.7-fold increased odds of being lame, respectively, whereas every 1 kg increase in daily milk production was associated with a 3% decrease in the odds of being lame. Lameness prevalence was higher in herds with ≤ 100 cows, but lower in barns with a sand or dirt stall base, or with bedding ≥ 2 cm deep. Cows exposed to very slippery floors had 2 times the odds of being lame compared with cows exposed to nonslippery floors. We attributed the wide range of lameness prevalence to the great variability in facilities and management practices among farms. Finally, we inferred that the prevalence of lameness could be decreased by improving management of multiparous, thin, or injured cows and by adopting management practices intended to improve cow comfort, namely the floor's slip resistance and the stall's lying surface.

[Pneumocystis jiroveci pneumonia: Clinical characteristics and mortality risk factors in an Intensive Care Unit]. / Neumonía por Pneumocystis jiroveci: características clínicas y factores de riesgo asociados a mortalidad en una Unidad de Cuidados Intensivos.

OBJECTIVE: To describe the epidemiological characteristics of the population with Pneumocystis jiroveci (P. jiroveci) pneumonia, analyzing risk factors associated with the disease, predisposing factors for admission to an intensive care unit (ICU), and prognostic factors of mortality. DESIGN AND PATIENTS: A retrospective observational study was carried out, involving a cohort of patients consecutively admitted to a hospital in Spain from 1 January 2007 to 31 December 2011, with a final diagnosis of P. jiroveci pneumonia. SETTING: The ICU and hospitalization service of Hospital del Mar, Barcelona (Spain). RESULTS: We included 36 patients with pneumonia due to P. jiroveci. Of these subjects, 16 required ICU admission (44.4%). The average age of the patients was 41.3 ± 12 years, and 23 were men (63.9%). A total of 86.1% had a history of human immunodeficiency virus (HIV) infection, and the remaining 13.9% presented immune-based disease subjected to immunosuppressive therapy. Risk factors associated to hospital mortality were age (51.8 vs. 37.3 years, P=.002), a higher APACHE score upon admission (17 vs. 13 points, P=.009), the need for invasive mechanical ventilation (27.8% vs. 11.1%, P=.000), requirement of vasoactive drugs (25.0% vs. 11.1%, P=.000), fungal coinfection (22.2% vs. 11.1%, P=.001), pneumothorax (16.7% vs. 83.3%, P=.000) and admission to the ICU (27.8% vs. 72.2% P=.000). CONCLUSIONS: The high requirement of mechanical ventilation and vasoactive drugs associated with fungal coinfection and pneumothorax in patients admitted to the ICU remain as risk factors associated with mortality in patients with P. jiroveci pneumonia.

Prevalence of and factors associated with hock, knee, and neck injuries on dairy cows in freestall housing in Canada.

Injuries are a widespread problem in the dairy industry. The objective of this study was to determine the prevalence of and explore the animal-based and environmental factors associated with hock, knee, and neck injuries on dairy cows in freestall housing in Ontario and Alberta, Canada. Freestall dairy farms in the provinces of Ontario (n=40) and Alberta (n=50) were visited for cross-sectional data collection. A purposive sample of 40 lactating Holstein cows was selected for detailed observation on each farm. Cows were scored for hock, knee, and neck injuries on a 3- or 4-point scale, combining the attributes of hair loss, broken skin, and swelling and with a higher score indicating a more severe injury. The highest hock and highest knee score were used in the analysis. Animal-based and environmental measures were taken to explore which factors were associated with injury. Overall, the prevalence of cows with at least one hock, knee, and neck injury was 47, 24, and 9%, respectively. Lame cows had a greater odds of hock injury [odds ratio (OR)=1.46] than nonlame cows, whereas cows with fewer days in milk (DIM) had reduced odds of hock injury compared with those >120 DIM (OR=0.47, 0.64, and 0.81 for <50, 50-82, and 83-120 DIM, respectively). The odds of hock injury was lower on sand (OR=0.07) and concrete (OR=0.44) stall bases in comparison to mattresses. Conversely, the odds of knee injury was greater on concrete (OR=3.19) stall bases compared with mattresses. Cows in parity 1 (OR=0.45 and 0.27 for knee and neck injury, respectively) and 2 (OR=0.49 and 0.40 for knee and neck injury, respectively) had lower odds of knee and neck injury compared with cows in parity 4+. Low feed rail heights increased the odds of neck injury (OR=76.71 for rails between 128 and 140 cm and OR=43.82 for rails ≤128 cm). The odds of knee injury was greater on farms where any cows were observed slipping or falling when moving into the holding area for milking (OR=2.69) and lower on farms with rubber flooring in the alley along the feed bunk compared with bare concrete floors (OR=0.19). These results demonstrate that individual animal characteristics, as well as barn design and animal management, are associated with hock, knee, and neck injuries. These data can help to guide investigations into causes and prevention of injuries.

Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders.

Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.

Benign familial macrocephaly in a mother-son pair.

Macrocephaly can be found isolated or associated with other anomalies as a part of specific syndrome. Benign Familial Macrocephaly (BFM) is a primary macrocephaly and autosomal dominant and multifactorial inheritances had been proposed. Cole and Hughes (5), described clinically seven patients. We report two BFM cases, a boy and his mother. The male propositus showed macrocephaly with dolicocephaly shape, frontal bossing, narrowing biparietal and a square-shaped face. Neurological examination was normal. He had two computed tomography (CT) scans of the skull, one at 7 months of age showing extracerebral fluid collection in the anterior convexity and increased interhemispheric subarachnoid space and a second normal CT scan at 3 years of age. The mother showed macrocephaly with dolycocephaly shape and dished-out mid-face. This family exhibited the full clinical spectrum of BFM, with an autosomal dominant inheritance.

[Relation between leptin serun with weight and body fat distribution in postmenopausal women]. / Leptina sérica, su relación con peso y distribución de grasa corporal en mujeres posmenopáusicas.

UNLABELLED: Leptin is a peptidic hormone secreted by the fat tissue and plays an important role in body weight regulation. After menopause, weight gain increases as well as android-like obesity. Previous studies suggest a relationship between leptin level, body mass index (BMI) and fat distribution. OBJECTIVE: To establish the relationships between serum leptin, BMI, waist circumference (WC), and waist/hip ratio (WHR). METHODOLOGY: 48 women under the age of 60 years and with amenorrhea for longer than one year were assessed. Leptin and estradiol (ELISA) levels were determined; normal values: 3.63-11.09 ng/mL and 0-65 pg/Ml. BMI (WHO), WC > 88 cm, and WHR > 0.80 were considered as indicators of cardiometabolic risk. RESULTS: Mean age for the group was 54 +/- 3.9 years; leptin: 8.4 +/- 3.7 ng/mL, and estradiol: 17.6 +/- 10.0 pg/mL; BMI: 27.0 +/- 4.9 kg/m(2); WC: 86.2 +/- 8.6 cm; and WHR: 0.84 +/- 0.06. Twenty percent of the women had hyperleptinemia, 58.4% malnourishment due to excessive intake, 35% presented WC cardiovascular risk. The highest leptin value was found in obese women. There was no association between serum leptin levels and anthropometrical variables. There was a significantly positive correlation between weight, height, BMI, WC, hip circumference, and estradiol. CONCLUSIONS: Postmenopausal women presented a high prevalence of overweight/obesity, android-like body fat distribution and normal serum leptin levels. The group assessed is considered to be at risk for cardiometabolic diseases according to anthropometrical indicators.

[Small fibre neuropathy: A review]. / Neuropatía de fibras pequeñas: una revisión.

Small fibre neuropathy is a disorder of the peripheral nervous system for which main clinical manifestation is chronic neuropathic pain, often accompanied by alterations of the autonomic nervous system. This disease affects the small diameter myelinated (Aδ) and non-myelinated nerve fibres (C). Its causes are primary or secondary, such as metabolism defects, infection, and autoimmune, neurological or toxic diseases, among others. Routine neurophysiological tests are usually negative. Diagnosis can be made with complementary tests which are difficult to access from Primary Health Care. These include microneurography, and the sensory stimulation test; but the most used technique is the skin biopsy. Treatment is directed at the causes and the neurological symptoms. Due to the variability of symptoms that can be presented, the importance of being aware of this condition is emphasised in order to reach a diagnosis and offer the appropriate treatment.

Alexithymia and obesity: controversial findings from a multimethod assessment.

OBJECTIVE: The aim of the study is to assess alexithymia levels in obese patients using a multimethod measurement (TAS-20 and TSIA) to evaluate both possible differences between the two instruments and their relationship with body weight. PATIENTS AND METHODS: 54 obese patients, seeking surgical treatment, were enrolled. They completed a socio-demographic questionnaire, 20-items Toronto Alexithymia Scale and the Toronto Structured Interview for Alexithymia. RESULTS: Data analysis showed a significant positive association between TAS-20 and TSIA total scores (r=.28, p<.05), but only the TSIA score was positively related to body weight (r=.39; p<.001). Multivariable linear regression models showed the predictive effects of TSIA total score (beta=.41; p<.001) and difficulty in identifying feelings (DIF) (beta=.56; p<.001) respectively on weight. CONCLUSIONS: The findings showed a different association between body weight and alexithymia according to the instrument employed to evaluate alexithymia, supporting the importance of a multimethod assessment in some clinical conditions.

A missense mutation, p.V132G, in the X-linked spermine synthase gene (SMS) causes Snyder-Robinson syndrome.

Snyder-Robinson syndrome (SRS, OMIM 309583) is a rare X-linked syndrome characterized by mental retardation, marfanoid habitus, skeletal defects, osteoporosis, and facial asymmetry. Linkage analysis localized the related gene to Xp21.3-p22.12, and a G-to-A transition at point +5 of intron 4 of the spermine synthase gene, which caused truncation of the SMS protein and loss of enzyme activity, was identified in the original family. Here we describe another family with Snyder-Robinson syndrome in two Mexican brothers and a novel mutation (c.496T>G) in the exon 5 of the SMS gene confirming its involvement in this rare X-linked mental retardation syndrome.

Metaphyseal chondrodysplasia, upper limb mesomelia and normal height (mesomelic dysplasia camera type): second report in a Mexican patient.

Mesomelic dysplasias (MD) are a group of skeletal disorders with exclusive or predominant shortness of the middle segment of the limbs, with or without involvement of the hands/feet or other body parts. Short stature is a usual consequence due to involvement of the lower limbs. In 2003, Camera and Camera reported an unusual upper limb MD with normal stature and radiological evidence of long bone metaphyseal dysplasia. Here, we describe a Mexican patient showing a similar clinical and radiological phenotype, in addition to esophageal atresia, palpebral ptosis and slight lower limb asymmetry. This represents the second case reported in the literature, corroborating the existence of this rare entity.

Schilbach-Rott syndrome in a third family: further delineation of an autosomal dominant trait.

We describe a father-son Mexican pair with typical features of Schilbach-Rott syndrome (SRS): ocular hypotelorism, cleft palate, hypospadias (only in the child), and microcephaly. This observation documents for the first time a male to male transmission and therefore confirms that the SRS is inherited as an autosomal dominant trait with variable expressivity.

[Overweight and associated pathologies in adult women]. / Exceso de peso y patologías asociadas en mujeres adultas.

UNLABELLED: Overweight and obesity represent an important public health problem in the world, including developed and underdeveloped countries, as contributing factors for non transmissible chronic illnesses in the adult, affecting both sexes, but especially to women. OBJECTIVE: To associate excess in weight to the presence of comorbidities in adult women. METHODOLOGY: 130 women, age 25 to 70 years with body mass index (BMI) > 25 kg/m(2) were assessed. Weight, height, arm, waist and hip circumferences, tricipital and subescapular skinfolds. BMI, waist/hip ratio (W/H ratio) and fatty area were determined. Presence of diabetes mellitus (DM); high blood pressure (HBP), dyslipidemia and arthropathy were assessed. Overweight and obesity were classified according to OMS criteria. Data was analyzed by SPSS version 11.0. RESULTS: 24,6% of women (n = 32) were overweight; 38,5% (n = 50) were obese I; 23,8% (n = 31) were obese II; and 13,1% (n = 17) had obesity III. Associated pathologies were present in 80,8% of the studied women: 46,9% (n = 61) with dyslipidemia; 42,3% (n = 55) with HBP; 33,1% (n = 43) with arthropaties; and 16,2% (n = 21) with DM. Overweight and obese I women showed a higher prevalence of dyslipidemia (56%) and (52%), respectively; while in Obese II and Obese III, 38,7% and 47,1% presented HBP respectively. There was a positive correlation (Spearman) among DM, HBP and dyslipidemia (p < 0,05) with age; and significant correlation (Pearson, p < 0,05) between W/H ratio and DM. CONCLUSION: There was a high prevalence of associated pathologies in the valued women, being the most frequent dyslipidemia, HBP and arthropathy, which are directly proportional with the age and the IC/C.