Acretismo placentario en gestaciones tempranas. Presentación de un caso / Placental accreta in early pregnancies. Case presentation

El acretismo placentario es la invasión de las vellosidades coriales al miometrio, siendo mayor el riesgo de presentarse en casos de placenta previa o antecedente de una o más cesáreas, causando hemorragia obstétrica mayoritariamente durante el tercer trimestre. Se presenta el caso de una paciente de 39 años de edad, con hemorragia obstétrica secundaria a acretismo placentario, en un embarazo de 19 semanas resuelto mediante histerectomía, con lo que se hace énfasis en la importancia de la sospecha y diagnóstico de acretismo en embarazos tempranos, ofreciendo así un tratamiento oportuno y disminución de la morbimortalidad materna.(AU)

Placental accreta is the invasion of the chorionic villi into the myometrium. It has a higher risk of occurring in cases of placenta previa, or a history of one or more caesarean sections, causing obstetric haemorrhage mainly during the third trimester. The case is presented of a 39-year-old patient with obstetric haemorrhage secondary to placental accreta in a 19-week pregnancy. It was resolved by hysterectomy. The importance of suspicion and diagnosis of accreta in early pregnancies is emphasised, as well as offering a timely treatment and reducing the maternal morbidity and mortality.(AU)

Short- and long-term effects of temporary early cow-calf separation or restricted suckling on well-being and performance in zebu cattle.

Information on weaning techniques in the tropics is scarce, particularly regarding the long-term effect of temporary early cow-calf separation or restricted suckling. Therefore, we studied the effects of these two handling practices on well-being and performance at 150 days postpartum in fifteen zebu cow-calf pairs randomly assigned to three treatments. Continuous suckling (CS) where calves remained with their dams from birth to weaning; restricted suckling (RS) calves were allowed to suckle 30 min/day from Day 34 until weaning at Day 150 and kept separated the rest of the time; temporary separation (TS) calves were separated for 72 h from their dams from Day 33 to 36 but remained with their dams the rest of the time. Blood samples and behavioral data were collected on Days 32-36 (1st period) and 149-153 (2nd period). In the 1st period, a greater percentage of RS and TS calves were observed close to the fence line (<10 m) that separated them from their dams (P < 0.0001) and vocalized more than CS calves (P < 0.0001), while in the 2nd period, RS calves had the highest cortisol concentration and vocalization rate (P < 0.05). Similarly, during the 1st period, a greater percentage of RS and TS cows were observed close to the fence line than CS cows (P < 0.0001), with TS cows vocalizing the most (P = 0.001). In the 2nd period, RS cows had greater cortisol concentration than TS (P = 0.037) and CS cows (P = 0.003). More TS and CS cows than RS were observed close to the fence line (P = 0.03 and P = 0.05). On Day 150, TS calves and cows vocalized more than RS and CS animals (P < 0.0001). Before calf-cow separation, 27 out of 45 cows were cycling (CS = 10; RS = 6; TS = 11). After separation, 12 of the remaining 18 cows resumed ovarian activity (CS = 3; RS = 5; TS = 4), and all cows were cycling after estrous synchronization treatment. The pregnancy rate was similar between CS, RS, and TS (60, 53, and 60% respectively). In conclusion, temporary separation increased calf distress response to definitive weaning even four months later, while restricted suckling seemed to reduce it.

Monitoring changes in back fat thickness and its effect on the restoration of ovarian activity and fertility in Bos indicus cows.

With the objective of testing the hypothesis if animals with a stable layer of body fat (FAT) during the peripartum have a better chance of becoming pregnant after calving, fifty-nine multiparous Brahman cows in their last trimester of pregnancy were used. Animals averaged four parturitions and were stocked at a rate of 1.25 animal units per hectare and divided into two groups depending on the time postpartum (dpp) that the intravaginal releasing device CIDR was inserted; Group 1 (<30 dpp; n = 30) received the implant at 25.2 ± 4.21 and withdrawn 9 days later. Group 2 (≥30 dpp; n = 29) received the CIDR at 38.41 ± 5.8. Animals were AI at detected oestrus until 170 dpp and calculated as pregnant at first service or requiring more than one service (1s and >1s), not pregnant but cycling (not pregnant) and those not cycling at all (anestrus). The FAT measurements were taken twice each month from the last trimester of gestation until 96 dpp. The onset of ovarian activity was monitored through blood levels of progesterone (P4) at days 14 and 9 prior to CIDR insertion and days 10, 13, 30 and 33 after CIDR withdrawal. Animals pregnant did not have any major changes in their fat thickness. In contrast, cows pregnant in the group ≥30 dpp had changes in their FAT homoeostasis, and pregnant animals in the 1s and >1s groups did not show differences in dorsal back fat in the last trimester of pregnancy and early postpartum. In contrast, animals not pregnant and in anestrus FAT values decreased considerably after parturition. Overall, fertility was 49%, but 18% of all the animals remained anestrus losing FAT. Thus, animals with adequate metabolic conditions will have a better chance of pregnancy regardless of the time postpartum when the reproductive programme starts.

[The age-dependent changes of sella turcica, frontal and sphenoid sinuses]. / Vozrastnye izmeneniia turetskogo sedla, lobnykh i klinovidnykh pazukh.

This article is designed to report the results of analysis of the literature publications concerning age-specific changes in the configuration of the sella turcica, frontal and sphenoid sinuses during the life span of a human being. It is shown that the subjects above the age of 20-25 years undergo age-dependent variations of the morphometric characteristics of the sella turcica, frontal and sphenoid sinuses. It suggests the necessity of the further development of the research methods with a view to increasing the number of techniques used in forensic medicine designed to enhance the accuracy of estimation of the human biological age.

Evaluation of the udder health status in subclinical mastitis affected dairy cows through bacteriological culture, somatic cell count and thermographic imaging.

Subclinical mastitis in dairy cows is a big economic loss for farmers. The monitoring of subclinical mastitis is usually performed through Somatic Cell Count (SCC) in farm but there is the need of new diagnostic systems able to quickly identify cows affected by subclinical infections of the udder. The aim of this study was to evaluate the potential application of thermographic imaging compared to SCC and bacteriological culture for infection detection in cow affected by subclinical mastitis and possibly to discriminate between different pathogens. In this study we evaluated the udder health status of 98 Holstein Friesian dairy cows with high SCC in 4 farms. From each cow a sample of milk was collected from all the functional quarters and submitted to bacteriological culture, SCC and Mycoplasma spp. culture. A thermographic image was taken from each functional udder quarter and nipple. Pearson's correlations and Analysis of Variance were performed in order to evaluate the different diagnostic techniques. The most frequent pathogen isolated was Staphylococcus aureus followed by Coagulase Negative Staphylococci (CNS), Streptococcus uberis, Streptococcus agalactiae and others. The Somatic Cell Score (SCS) was able to discriminate (p<0.05) cows positive for a pathogen from cows negative at the bacteriological culture except for cows with infection caused by CNS. Infrared thermography was correlated to SCS (p<0.05) but was not able to discriminate between positive and negative cows. Thermographic imaging seems to be promising in evaluating the inflammation status of cows affected by subclinical mastitis but seems to have a poor diagnostic value.

Maternal protective behavior of zebu type cattle (Bos indicus) and its association with temperament.

The objective of the study was to evaluate the maternal protective behavior of zebu-type cattle (Bos indicus) and its association with temperament. A total of 40 cow-calf pairs raised under extensive conditions were randomly assigned to 1 of 4 groups (n = 10), which were evaluated at 30, 60, 90, and 120 d postpartum (dpp), respectively. Measures obtained were defense responses of cows protecting their calves assessed by categorizing the behavioral response of the dams during handling of their calves and chute exit score and facial hair whorl (HW) position as indirect measures associated with temperament. No association was found between protective behavior and exit score or HW measures (rs < 0.22 and 0.13, respectively; P > 0.05). At 30 dpp, 90% of the cows responded to the stimulus of calves being handled, 40% reacted exclusively to alien calves, and 50% responded to their own or alien calves. Sixty days later, the proportion of cows responding to alien calves decreased (P < 0.05) to 10%, and at 120 dpp, cows responding to any calf decreased (P < 0.05) to 20%, while the nonresponding cows increased (P < 0.05) to 60%. Similarly, as dpp increased, the intensity of the reaction of the cows to the manipulation of their calves declined. The intensity of the response was exacerbated (P < 0.05) when a human being was less than 1 m distance from the calf, also when the calf was its own or when the calf vocalized. Furthermore, independent of the sex of their own calf, cows reacted more to male than female calves (P < 0.05). It was concluded that zebu cows may display maternal protective behavior to their own or alien calves, which weakens about 120 dpp and is not influenced by individual temperament.

[A case of hydatid cyst caused by Echinococcus granulosus in Puebla, Mexico, that resulted in successful surgical treatment]. / Un caso de quiste hidatídico por Echinococcus granulosus en Puebla, México, tratado con éxito por cirugía.

We present herein the case of a 16-year-old female from the southern portion of the State of Puebla, Mexico. When gathering her past medical history, it was revealed that she had grown up with pet dogs and that her family raised sheep. Because the patient presented with few symptoms, a benign lesion was suspected, and after laparoscopic exploration, the possibility of surgical management for a non-parasitic cyst was considered. A dull pain in the right hypochondrium persisted and open surgical exploration was performed in which a 6cm young, active, uncomplicated hydatid cyst was discovered. Its surgical removal was successful and the pathologist provided the definitive diagnosis. The three layers characteristic of a parasitic cyst were present and it was histologically consistent with Echinococcus granulosus. Postoperative progression was unremarkable and the control ultrasound study revealed complete restitution of the hepatic parenchyma.

Misuse of antimicrobials and selection of methicillin-resistant Staphylococcus pseudintermedius strains in breeding kennels: genetic characterization of bacteria after a two-year interval.

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) strains have been isolated from dogs with increasing frequency; prolonged or excessive use of antimicrobials is associated with the selection of MRSP, and misuse of antimicrobials is frequent in breeding kennels. This study was carried out in two breeding kennels (A and B) in which we had isolated MRSP in 2008: the aim was to assess colonization of previously positive bitches and of other bitches sharing the same environment and to assess the genetic profile of both the old and the new strains [spa typing, staphylococcal cassette chromosome mec (SCCmec) typing and Pulsed-field Gel Electrophoresis (PFGE)]. Six animals from Kennel A (two from 2008) and eight from Kennel B (one from 2008) were tested: 16 MRSP strains were isolated only from bitches housed in Kennel B. Old and new isolates were mecA positive, resulted spa type t02 and carried SSCmec II-III. PGFE showed that all isolates were related and belonged to the main clone lineage dominating in Europe, ST71-J-t02-II-III. Kennels A and B differ in the use of antimicrobials, which has been reduced over time in Kennel A, while has remained excessive in Kennel B, where many agents belonging to different classes (third-generation cephalosporins, fluoroquinolones, macrolids) are administered to dogs, without veterinary supervision, especially around parturition. Misuse of antimicrobials is the key factor for the selection of MRSP strains in healthy dogs and for their persistence over time. Dog breeders should be aware that infections caused by multiresistant bacteria have very limited therapeutical options and represent a huge challenge for animal health.

[Validation of the perceived safety scale for patients transported to hospital after an outpatient emergency]. / Validación de una escala de seguridad percibida para pacientes trasladados al hospital tras asistencia extrahospitalaria urgente.

OBJECTIVE: To design and validate a new tool to measure the perceived safety of patients who are transported to hospital after requesting urgent health care using the telephone number "061". METHODS: A multicentre, observational, descriptive and cross-sectional study to validate the score obtained using a telephone interview. The patients subject to study were those who were transported to the hospital after requesting urgent health care using the telephone number "061". The eight provincial services of the Public Emergency Medical Services Company of Andalusia participated. The data were collected from January to June of 2010. In addition to the basic criteria of the validation of the survey (endorsement frequency and discrimination ability between groups), an assessment was made of validity (validity of content and validity of construct or concept) and reliability (stability and homogeneity). The Retest-Test technique was used to assess stability, whereas the homogeneity was examined using two properties: internal consistency of its items (correlation coefficient checked item-scale) and internal consistency of the scale (Cronbach's Alpha coefficient). RESULTS: A total of 1011 questionnaires were obtained after 7538 phone calls (13.4%). The total scale score fluctuated between 0 and 80 points, with a mean of 73.95 (SD: 9.607), and a median of 79. The exploratory factor analysis detected two components that explained 62.3% of the total variance. The intraclass correlation coefficient (ICC) was 0.814 (95% CI: 0.725-0.874). The correlation coefficient checked item- scale to examine the internal consistency of its items was more than 0.625. The Cronbach's Alpha coefficient was 0.941 for the internal consistency of the scale. CONCLUSION: The Perceived Safety Survey ESP16 is a valid and reliable scale that quantified patients' perception of safety after being assisted and transported to the hospital.

A preliminary microbiological assessment of process hygiene of traditional outdoor camel slaughter in Sahrawi refugee camps.

The aim of this study was to investigate the hygiene performance of a camel (Camelus dromedarius) slaughtering process as carried out with the traditional method in the Sahrawi refugee camps located in southwestern Algeria. The camel slaughtering process in this region differs significantly from that carried out in commercial abattoirs. Slaughtering is performed outdoors in desert areas, and dehiding of the carcass is approached via the dorsoventral route rather than the classic ventrodorsal route. Samples were taken from 10 camel carcasses from three different areas: the hide, the carcass meat immediately after dehiding, and the meat after final cutting. Enterobacteriaceae counts (EC) were enumerated employing conventional laboratory techniques. Carcass meat samples resulted in EC below the detection limit more frequently if the hide samples from the same carcass had also EC counts below the detection limit. Because of the low number of trials, the calculation of statistical significance of the results was not possible. Further experimental research is needed in order to validate the results presented in this study. The comparison of the microbiological hygiene performance between dorsal dehiding and traditional ventral dehiding of slaughtered animals could serve to validate the hypothesis of the potential positive impact of the dorsal dehiding method in carcass meat hygiene.

Antimicrobial resistance in bacteria from breeding dogs housed in kennels with differing neonatal mortality and use of antibiotics.

This work examines the antimicrobial resistance of potentially pathogenic bacteria (Staphylococcus pseudintermedius, Streptococcus canis, Escherichia coli) found in the vaginal tract in prepartum mammary secretions and postpartum milk of bitches housed in breeding kennels (N = 20; 92 bitches). The kennels were divided into three categories: no routine antimicrobial administration around parturition (category 1); routine administration of one antibiotic around parturition (category 2); routine administration of multiple antimicrobials around parturition (category 3). Bacteriological cultures and antibiotic susceptibility tests were performed on vaginal specimens, prepartum mammary secretions, and postpartum milk. Stillbirths and neonatal deaths were recorded for each whelping and analyzed as "within-litter stillbirths" and "within-litter neonatal deaths" according to kennel category, by Pearson χ(2) test and the Kruskal-Wallis nonparametric test, respectively. The frequency of isolation and antimicrobial resistance of bacteria were analyzed according to kennel category by Pearson χ(2) test. Kennel category was not significantly associated with differing numbers of stillbirths or neonatal death events, nor was the frequency of isolation of potentially pathogenic bacteria in the three kennel categories significantly different. Kennel category 3 had a significantly higher frequency of isolation of multiresistant gram-positive bacterial strains. Our results show that intense administration of antibiotics to breeding bitches does not effectively reduce neonatal mortality; on the contrary, it induces multiresistance in potentially pathogenic bacteria. Breeders and veterinarians should be aware of the risk of selecting pathogenic bacteria by uncontrolled treatment in prepartum bitches.

Impacto de la prediabetes y el sexo en el riesgo cardiovascular asociado al síndrome metabólico / Impact of prediabetes and gender in cardiovascular risk associated to the metabolic syndrome

ObjetivosAnalizar la influencia de la prediabetes y el sexo en el riesgo cardiovascular (RCV) asociado al síndrome metabólico (SM) en pacientes con índice de masa corporal ≥25kg/m2. Adicionalmente, se evaluó la calidad de la asistencia prestada a pacientes con SM y prediabetes.Material y métodosEstudio epidemiológico, transversal, multicéntrico en el que participaron 138 médicos de atención primaria de toda España que incluyeron de forma aleatoria a 2.280 pacientes. Para el diagnóstico del SM se utilizaron los criterios de la International Diabetes Federation. El RCV se estimó aplicando la ecuación de Framingham calibrada. Para la evaluación de la calidad asistencial se construyeron doce criterios de evaluación explícitos y normativos.ResultadosEl 70,4% de los pacientes presentó un nivel de glucemia basal <126mg/dl. Se obtuvieron diferencias estadísticamente significativas al comparar el RCV de los varones no diabéticos con SM y varones sin SM, que fue más elevado en el primer grupo de pacientes. Las diferencias en el RCV fueron también significativas entre las mujeres no diabéticas con SM y las mujeres no diabéticas sin SM. Al comparar el RCV de los pacientes con glucemia basal inferior a 100mg/dl y de los pacientes en situación de prediabetes se observaron diferencias estadísticamente significativas en ambos sexos.ConclusiónLa implicación de la hiperglucemia en el RCV es muy elevada, asociada o no al SM. La participación y compromiso de la atención primaria es clave para detectar a los pacientes prediabéticos con alto riesgo de desarrollo de diabetes de tipo 2 y enfermedad cardiovascular(AU)

ObjectivesTo analyze the impact of prediabetes and gender on cardiovascular risk (CVR) related to the metabolic syndrome (MS) in patients with BMI≥25kg/m2. Quality of medical care given to patients with MS and prediabetes was also evaluated.Material and methodsEpidemiological, cross-sectional, multicenter study in which 138 Primary Care Physicians from all of Spain participated. They randomly included 2,280 patients. International Diabetes Federation (IDF) criteria were used in the MS diagnosis. CVR was calculated using the calibrated Framingham function. Medical care quality was studied by constructing 12 explicit and normative evaluation criteria.ResultsA total of 70.4% of the patients presented blood fasting glucose<126mg/dl. Statistically significant differences were obtained when CVR of the non-diabetic males was compared with MS and males without MS. The differences in CVR were significantly higher between the non-diabetic women with MS and non-diabetic women without MS. When CVR of the patients with baseline glycemia less than 100mg/dl with prediabetic patients, statistically significant differences were observed in both genders.ConclusionThe impact of hyperglycemia on CVR is very high, regardless of whether it is associated to MS or not. The participation and commitment of primary care is key to detect prediabetic patients having a high risk of developing type 2 diabetes and cardiovascular disease(AU)

Pólipo estromal mesodérmico de la vagina: estudio clínico-patológico e inmunohistoquímico de cuatro casos y revisión de la literatura / Mesodermic strumal polyps of the vagina: clinical pathological and immunohistochemical study in four cases and review of the literature

El pólipo estromal mesodérmico de vagina es una lesión benigna, asintomática que se diagnóstica en forma incidental y se presenta a cualquier edad (recién nacidas a 71 años). Se localiza en las paredes laterales en el tercio inferior de la vagina, es generalmente único, de aspecto digitiforme o nodular. Aun cuando su origen no es claro, la presentación en mujeres embarazadas o con manejo hormonal hace suponer que la estimulación hormonal juega un papel relevante en su desarrollo. Se informan cuatro casos estudiados en el Instituto, la edad de presentación osciló entre 19 y 54 años, dos pacientes se encontraban embarazadas y dos con manejo hormonal, el diagnóstico se realizó en todas de forma incidental, el tamaño de las lesiones varió de 1.5 a 5 cm de eje mayor. Se efectuó excisión local en todos los casos, sin presentar recurrencias con un seguimiento de 1 a 40 meses. Histológicamente eran bien circunscritos, revestidos por epitelio escamoso, el estroma incluyó un espectro de lesiones constituidas por tejido fibroconectivo laxo, poco celular sin atipias, hasta lesiones constituidas por estroma fibroconectivo denso, con aumento en la celularidad, presencia de atipias y escasa actividad mitótica . Los receptores hormonales fueron positivos en todos lo casos. Estos resultados apoyan el comportamiento indolente y la influencia de los factores hormonales en el desarrollo de estas lesiones.

Effect of blood metabolites, body condition and pasture management on milk yield and postpartum intervals in dual-purpose cattle farms in the tropics of the state of Veracruz, Mexico.

Research was conducted on typical smallholder farms with dual-purpose cattle (DPC) (Bos indicus x B. taurus) in the coastal north-central area of Veracruz, Mexico. The study was divided into two phases. The aim of the first phase was to investigate the effect of blood metabolities, body condition and pasture management on milk yield and postpartum intervals, in order to investigate if the former are suitable indicators of the reproductive and nutritional status of DPC. One hundred and sixty-five calvings of crossbred cows were recorded from January 1992 to November 1994 on 12 small farms. Milk samples were collected twice a week for progesterone analysis. Blood samples and BCS were taken once a month. However, in Phase II emphasis was placed on the effect of pasture management upon reproductive and productive performance of DPC. Records of four farms were obtained from June 1995 to November 1996. Stocking rates were 0.40, 0.87, 0.35 and 1.5 cows/ha for farms A, B, C and D, respectively. Farms A and C used a slow rotation while B and D used a rapid rotation. In Phase I, the changes in BCS during the last month of pregnancy and first month postpartum did not correlate (p > 0.05) with milk yield or reproductive performance. Blood the metabolite profiles were not consistently related to productive or reproductive variables. The effect of farm and season was significant (p < 0.05) on most of the response variables and low productivity on overstocked farms lead to the conclusion that the low reproductive performance of DPC was linked to poor pasture management. During Phase II, farms A (FA) and D (FD) produce more milk than the others. Days to first service, days open, and calving interval were similar for farms B (FB) and C (FC), highest for Farm A, and lowest for Farm D. The forage availability mean was above the critical range of 6-8 kg of dry matter per 100 kg of liveweight (kg DM/100 kg LW) in all farms (range from 6.1 +/- 5.0 to 21.1 +/- 11.2 kg DM/100 kg LW). Farm D had the highest stocking rate (1.5 cows/ha), a rapid rotation (10 paddocks), a good forage availability (7.1 +/- 3.9 kg DM/100 kg LW) with a good quality for a tropical pasture (11.6 +/- 2.4% crude protein), and an economic energy supplementation. These results suggest this type of management could be more widely employed to improve the productivity of DPC on smallholder farms in the Mexican tropics.