Sow Vaccination with a Protein Fragment against Virulent Glaesserella (Haemophilus) parasuis Modulates Immunity Traits in Their Offspring.

Glaesserella (Haemophilus) parasuis, an early colonizer of the nasal cavity in piglets, is a highly heterogeneous species, comprising both commensal and virulent strains. Virulent G. parasuis strains can cause fibrinous polyserositis called Glässer's disease. Colostrum is a source of passive immunity for young piglets. When vaccinating sows, protective antibodies are transferred to their offspring through the colostrum. Here, sow vaccination was performed with a protein fragment, F4, from the outer membrane trimeric autotransporters VtaAs exclusively found in virulent G. parasuis. Piglets were allowed to suckle for 3 weeks, following which a challenge with two virulent strains of G. parasuis was performed. A group of nonvaccinated sows and their piglets were included as a control. Antibodies against F4 were confirmed using ELISA in the vaccinated sows and their offspring before the G. parasuis challenge. Compared to the control group, F4-vaccination also resulted in an increased level of serum TGF-ß both in vaccinated sows and in their offspring at early time points of life. After the challenge, a lower body temperature and a higher weight were observed in the group of piglets from vaccinated sows. One piglet from the non-vaccinated group succumbed to the infection, but no other significant differences in clinical signs were noticed. At necropsy, performed 2 weeks after the virulent challenge, the level of surfactant protein D (SP-D) in bronchoalveolar lavage was higher in the piglets from vaccinated sows. Vaccination did not inhibit the nasal colonization of the piglets by the challenge strains.

Impacto de la participación del residente y su rol en desenlaces clínicos de los pacientes llevados a colecistectomía en un hospital universitario / Impact of resident participation and their role on clinical outcomes of patients undergoing cholecystectomy at a university hospita

Introducción. La colecistectomía es uno de los procedimientos quirúrgicos más realizados a nivel mundial, por lo que su aprendizaje es cada vez más necesario para los médicos residentes en entrenamiento, pero sin comprometer la seguridad de los pacientes. El objetivo de este estudio fue determinar el impacto de la participación de los médicos residentes en los principales desenlaces clínicos de la colecistectomía. Métodos. Se realizó un estudio prospectivo de cohortes, donde se incluyeron los pacientes llevados a colecistectomía laparoscópica, desde junio de 2019 hasta julio de 2020. Se llevó a cabo el análisis estadístico para describir medidas de frecuencia, tendencia central, dispersión y análisis bivariados para los desenlaces de interés. Resultados. Se incluyeron 482 pacientes a quienes se les practicó colecistectomía, 475 de ellas por vía laparoscópica. El 62,5 % fueron mujeres y el 76,2 % se realizaron de carácter urgente. En el 96 % de los procedimientos se contó con la participación de un residente. En el análisis bivariado no se encontró una diferencia estadísticamente significativa entre la participación del residente y un impacto negativo en los desenlaces clínicos de las variables relevantes. Discusión. No hay evidencia de que la participación de médicos residentes en la colecistectomía laparoscópica se asocie con desenlaces adversos en los pacientes, lo que sugiere estar en relación con una introducción temprana y responsable a este procedimiento por parte de los docentes, permitiendo que la colecistectomía sea un procedimiento seguro

Introduction. Cholecystectomy is one of the most performed surgical procedures worldwide, so its learning is increasingly necessary for resident physicians in training, but without compromising the safety of patients. The objective of this study was to determine the impact of the participation of resident physicians on the main clinical outcomes of cholecystectomy. Methods. A prospective cohort study was performed, which included patients undergoing laparoscopic cholecys-tectomy from June 2019 to July 2020. Statistical analysis was carried out to describe measures of frequency, central tendency, dispersion, and bivariate analysis for outcomes of interest. Results. 482 patients who underwent cholecystectomy were included, 475 of them laparoscopically; 62.5% were women and 76.2% were performed urgently, and 96% of the procedures involved the participation of a resident. In the bivariate analysis, no statistically significant difference was found between resident participation and a negative impact on the clinical outcomes of the relevant variables. Discussion. There is no evidence that the participation of resident physicians in laparoscopic cholecystectomy is associated with adverse outcomes in patients, which suggests being related to an early and responsible introduction to this procedure by teachers, allowing cholecystectomy to be a safe procedure

Microcarcinoma papilar de tiroides: ¿es adecuada la selección para protocolo de vigilancia activa? / Papillary thyroid microcarcinoma: is selection suitable for active surveillance protocol?

Introducción. Los microcarcinomas papilares de tiroides son tumores de hasta 10 mm en su diámetro mayor. Su tratamiento es sujeto de debate y se propone, desde seguimiento clínico, hasta intervención quirúrgica temprana. Este estudio buscó identificar factores de riesgo relacionados con compromiso ganglionar, que permitan una mejor selección de los pacientes en nuestro medio, en quienes se propone manejo quirúrgico inmediato o vigilancia activa, en consonancia con la clasificación del riesgo de progresión. Métodos. Estudio de cohorte analítica ambispectiva que incluyó pacientes con microcarcinoma papilar de tiroides llevados a tiroidectomía más vaciamiento central. Se caracterizó la población y se realizó un análisis de regresión logística multivariado para definir factores preoperatorios asociados al compromiso ganglionar. Adicionalmente, se evaluó de manera retrospectiva la eventual asignación a grupos de riesgo de progresión, según los criterios de Miyauchi, y su comportamiento respecto al estado nodal. Resultados. Se incluyeron 286 pacientes. El 48,9 % presentó compromiso ganglionar, y de estos, el 33,5 % presentó compromiso ganglionar significativo, que modificó su clasificación de riesgo de recaída. De estos últimos, el 59,5 % hubiesen sido manejados con vigilancia activa, según los criterios propuestos por Miyauchi. Se identificó que la edad menor de 55 años, los ganglios sospechosos en la ecografía y los nódulos mayores de 5 mm, se relacionan con compromiso ganglionar significativo. Discusión. El manejo quirúrgico inmediato parece ser una opción adecuada para pacientes con sospecha de compromiso ganglionar en ecografía preoperatoria, pacientes menores de 55 años y nódulos mayores de 5 mm. Es posible que los actuales criterios para definir vigilancia activa no seleccionen adecuadamente a los pacientes en nuestro medio.

Introduction. Papillary thyroid microcarcinomas are tumors up to 10 mm in greatest diameter. Its treatment is subject of debate, and it is proposed from clinical follow-up to early surgical intervention. The aim of the study was to identify risk factors related to lymph node involvement, which allow a better selection of patients in our setting, in whom immediate surgical management or active surveillance is proposed, in accordance with the classification of risk of progression.Methods. Ambispective analytic cohort study that included patients with papillary thyroid microcarcinoma who underwent thyroidectomy and central dissection. The population was characterized and a multivariate logistic regression analysis was performed to define preoperative factors associated with lymph node involvement. Additionally, eventual assignment to progression risk groups, according to the Miyauchi criteria, and their nodal state were evaluated.Results. 286 patients with papillary thyroid microcarcinoma were included. Among them, 48.9% had lymph node disease, and 33.5% had a significant lymph node disease that increased their relapse risk classification. Of the latter, 59.5% could have had a conservative treatment, under Miyauchi's criteria. For ages < 55 years old, suspect nodes in ultrasound and nodules > 5 mm were identified as related to significant lymph node involvement.Discussion. Immediate surgical management appears to be an appropriate option for patients with suspected lymph node involvement on preoperative ultrasound, patients younger than 55 years and nodules larger than 5 mm. It is possible that the current criteria for defining active surveillance do not adequately select patients in our setting.

Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial.

BACKGROUND AND PURPOSE: Shoulder pain is a prevalent condition in older adults. Some authors associate nonspecific shoulder pain with myofascial trigger points (MTrPs) in the infraspinatus muscle. Dry needling is recommended to relieve the MTrP pain of shoulders in the short term (<9 days). Active MTrPs dry needling improves shoulder pain and the irritability of the satellite MTrPs in the referred pain area. Nociceptive activity at a latent MTrP may influence motor activity and the sensitivity of MTrPs in distant muscles at a similar segmental level. Therefore, this study aimed to evaluate dry needling on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle of older adults with nonspecific shoulder pain. METHODS: A single-center, randomized, single-blinded, controlled study (NCT02032602) was carried out. Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder were randomly assigned to (1) of (2) treatment groups. A session of dry needling on the infraspinatus was performed in (1) the most hyperalgesic active and latent MTrP or (2) only the most hyperalgesic active MTrP. The Numeric Rating Scale, the pressure pain threshold (primary outcome) on the anterior deltoid and extensor carpi radialis brevis latent MTrPs, and grip strength were assessed before, after, and 1 week after the intervention. RESULTS: Statistically significant differences in the reduction of pain intensity (P ≤ .001; η = 0.159-0.269; d = 1.017-1.219) and the increase of pressure pain threshold (P < .001; η = 0.206-0.481; d = 0.870-1.924) were found for the (1) treatment group immediately and 1 week postintervention. Nevertheless, no statistical significant differences were found in grip strength (P >. 05; η = 0.006-0.033; d = 0.158-0.368). CONCLUSIONS: One dry needling intervention of the latent MTrP associated with the key active MTrP of the infraspinatus reduces pain intensity and the irritability of the satellite MTrPs located in the referred pain area in the short term in older adults with nonspecific shoulder pain.

Reformas de sector salud en el camino de la integración: aprendizaje y perspectivas

Documento presentado Seminario Internacional Reformas del Sector Salud en el Camino de la Integración que contiene informes de representantes de la salud de cada país de la región andina abordando las cuestiones del sistema de salud como su contexto histórico, político y económico. Documento en formato PDF, requer Acrobat Reader.

Memoria 2003-2006 / Report 2003-2006

Esta publicación pretende recoger los pasos significativos que los países han ido dando con el objetivo de consolidar el papel vitalizador que la salud tiene frente al proceso de integración subregional andina. En ella se recogen también los principales momentos de la actividad de la Secretaría Ejecutiva para auspiciar ese proceso en el período 2003 - 2006, conservándose así una memoria complementaria a la ya publicada que abarca el 2001 2002. Como resultado de un trabajo consensuado entre los Ministerios de Salud, los países se han visto beneficiados con acciones conjuntas tales como: las negociaciones de Medicamentos Antirretrovirales y compra conjunta de Medicamentos Antimaláricos, y otros. Por otro lado, hechos como el Proyecto "Control de la Malaria en las Zonas Fronterizas en la Región Andina: Un Enfoque Comunitario" representan desde el punto de vista sanitario, la implementación de una "estrategia compartida" para intervenir una enfermedad que representa un problema común de salud pública para nuestros países.

Abdominal pregnancies in farm rabbits.

Abdominal pregnancy is defined as the implantation and development of a fertilized ovum or a embryo in the peritoneal cavity. Although this has been reported in several species, it is considered as a low incidence process. It is classified as a primary abdominal pregnancy, if there is no evidence of uterine rupture, with presumed regurgitation of early embryos from the uterine tube and as a secondary abdominal pregnancy, when there is evidence of uterine rupture. During a necropsy study of 550 adult fertile female New Zealand white rabbits (Oryctolagus cuniculus) from two rabbit farms in Valencia (Spain), the main causes of elimination were studied. Twenty-eight abdominal pregnancies were diagnosed. Seven animals showed no lesions in their reproductive tract. The remaining twenty one animals showed acute or chronic lesions in the reproductive tract. The classification as a primary or secondary condition is discussed. It may be concluded therefore that extrauterine pregnancies would not be such an unusual finding in rabbits, and that this premise should be considered in the diagnostic approach when assessing rabbit doe pathology. New husbandry systems in rabbits such as artificial insemination are factors to be considered.