Cortical plasticity in phantom limb pain: A fMRI study on the neural correlates of behavioral clinical manifestations.

The neural mechanism of phantom limb pain (PLP) is related to the intense brain reorganization process implicating plasticity after deafferentation mostly in sensorimotor system. There is a limited understanding of the association between the sensorimotor system and PLP. We used a novel task-based functional magnetic resonance imaging (fMRI) approach to (1) assess neural activation within a-priori selected regions-of-interested (motor cortex [M1], somatosensory cortex [S1], and visual cortex [V1]), (2) quantify the cortical representation shift in the affected M1, and (3) correlate these changes with baseline clinical characteristics. In a sample of 18 participants, we found a significantly increased activity in M1 and S1 as well as a shift in motor cortex representation that was not related to PLP intensity. In an exploratory analyses (not corrected for multiple comparisons), they were directly correlated with time since amputation; and there was an association between increased activity in M1 with a lack of itching sensation and V1 activation was negatively correlated with PLP. Longer periods of amputation lead to compensatory changes in sensory-motor areas; and itching seems to be a protective marker for less signal changes. We confirmed that PLP intensity is not associated with signal changes in M1 and S1 but in V1.

[Frequency of footprints alterations in school children from a Mexican community]. / Frecuencia de alteraciones de la huella plantar en escolares de una comunidad mexicana.

INTRODUCTION: Alterations in the plantar footprint in the child are a cause for concern in parents. OBJECTIVE: Determine the frequency of plantar footprint alterations in school children. Determine if there is a relationship between overweight and obesity with the presence of alterations of the plantar footprint. MATERIAL AND METHODS: Observational, transversal and prospective study. 959 schoolchildren aged six to 13 were evaluated. Weight, size, body mass index for age were recorded. The plantar footprint was cataloged on flat foot and cavus foot using the arch index. For statistical analysis and comparison, the SPSS version 24 program was used with the 2 and ANOVA tests. RESULTS: 530 children (55.3%) and 429 girls (44.7%). The median age was 8.97 years. 182 children were found (19%) with alteration of the plantar footprint, 42.3% with flat foot and 57.7% with cavus foot. None of them had foot symptoms. 131 children were overweight and 52 obese, without influencing the presence of any alteration of the plantar footprint (p = 0.20). The flat-foot ratio was higher in men (2.5:1) and standing cavus major in women (1.3:1). CONCLUSIONS: In our study group we find a higher prevalence of the cavus foot compared to the flat foot. Body weight did not influence plantar footprint alterations.

INTRODUCCIÓN: Las alteraciones de la huella plantar en el niño es causa de preocupación en los padres de familia. OBJETIVO: Determinar la frecuencia de alteraciones de la huella plantar en escolares. Determinar si existe relación entre el sobrepeso y la obesidad con la presencia de alteraciones de la huella plantar. MATERIAL Y MÉTODOS: Estudio observacional, transversal y prospectivo. Se evaluaron 959 escolares de seis a 13 años de edad. Se registró peso, talla, índice de masa corporal para la edad. La huella plantar se catalogó en pie plano y pie cavo utilizando el índice del arco. Para el análisis y comparación estadística se utilizó el programa SPSS versión 24 con las pruebas 2 y ANOVA. RESULTADOS: Se revisaron 530 niños (55.3%) y 429 niñas (44.7%). La media de edad fue de 8.97 años. Se observaron 182 niños (19%) con alteración de la huella plantar, 42.3% con pie plano y 57.7% con pie cavo. Ninguno mostró sintomatología del pie. Ciento treinta y un niños tenían sobrepeso y 52 obesidad, sin influir en la presencia de alguna alteración de la huella plantar (p = 0.20). La relación de pie plano fue mayor en los hombres (2.5:1) y de pie cavo fue mayor en las mujeres (1.3:1). CONCLUSIONES: En nuestro grupo de estudio se encontró mayor prevalencia del pie cavo en comparación con el pie plano. El peso corporal no influyó en las alteraciones de la huella plantar.

Human Brucella canis Infection and Subsequent Laboratory Exposures Associated with a Puppy, New York City, 2012.

Human Brucella canis infection incidence is unknown. Most identified cases are associated with pet dogs. Laboratory-acquired infections can occur following contact with Brucella spp. We identified a paediatric B. canis case, the source and other exposed persons. A 3-year-old New York City child with fever and dyspnoea was hospitalized for 48 h for bronchiolitis. After her admission, blood culture grew B. canis, she was prescribed anti-microbials and recovered. B. canis was also isolated from blood of the child's pet dog; these isolates were genetically similar. The dog originated from an Iowa breeding facility which was quarantined after identification of the dog's infection. Additionally, 31 laboratory workers were exposed and subsequently monitored for symptoms; 15 completed post-exposure prophylaxis. To our knowledge, this is the first report strongly suggesting B. canis zoonotic transmission to a child in the United States, and highlights the need for coordinated control policies to minimize human illness.

Review of brucellosis cases from laboratory exposures in the United States in 2008 to 2011 and improved strategies for disease prevention.

Five laboratory-acquired brucellosis (LAB) cases that occurred in the United States between 2008 and 2011 are presented. The Centers for Disease Control and Prevention (CDC) reviewed the recommendations published in 2008 and the published literature to identify strategies to further prevent LAB. The improved prevention strategies are described.

Evidence of exposure to spotted fever group rickettsiae among Arizona dogs outside a previously documented outbreak area.

Since 2003, two communities in eastern Arizona have experienced a sustained outbreak of Rocky Mountain spotted fever (RMSF), caused by Rickettsia rickettsii, associated with transmission by Rhipicephalus sanguineus, the brown dog tick; 70 human cases, including eight deaths, were reported from these communities during 2003 through 2008. In both of the affected communities, antibodies to spotted fever group rickettsiae (SFGR) were present in dogs before the notice of the first human cases, suggesting that dogs may serve as useful sentinels for human risk of RMSF in this region. During 2005 and 2006, an exploratory serosurvey was conducted among stray and relinquished dogs presenting to animal control facilities in eastern Arizona located outside the area where human cases had been reported. Antibodies to SFGR were detected in 5.7% (14 of 247) dogs assessed outside the RMSF outbreak area. Animal shelters located in counties that either included or shared large borders with the outbreak area were significantly more likely to have seropositive dogs than facilities in more geographically separated counties (P = 0.01). In addition, stray dogs were significantly more likely to be antibody-positive than relinquished animals (P = 0.01), suggesting that control of stray dog populations should be considered as a means of limiting SFGR transmission in this region. The findings from this study may be extrapolated to suggest that the current risk for human RMSF infection may extend beyond the noted outbreak area. Heightened surveillance for human disease is needed in the region.

The prevalence, correlates and impact of dementia in Cuba. A 10/66 group population-based survey.

BACKGROUND: We aimed to estimate the prevalence, correlates and impact of dementia in Havana and Matanzas, Cuba. METHODS: A 1-phase catchment area survey of all over 65-year-old residents of 7 catchment areas in Havana and 1 in Matanzas was conducted. Dementia diagnosis was established according to DSM-IV and our own, pre-validated 10/66 criteria. The impact of dementia was assessed through associations with needs for care, cutting back on work to care and caregiver psychological morbidity. RESULTS: We interviewed 2,944 older people, a response proportion of 96.4%. The prevalence of DSM-IV dementia was 6.4% and that of 10/66 dementia 10.8%. Both dementia outcomes were associated with older age, less education, a family history of dementia, shorter leg length and smaller skull circumference. Dementia, rather than physical health problems or depression, was the main contributor to needs for care (population-attributable prevalence fraction = 64.6%) and caregiver cutting back on work (population-attributable prevalence fraction = 57.3%). CONCLUSION: The prevalence of dementia in Cuba is similar to Europe. Among health conditions, dementia is the major contributor to dependency and caregiver economic and psychological strain. More attention needs to be given to it and other chronic diseases associated more with disability than premature mortality.

Un extraño en el Congreso. Evaluación etnográfica del XXIV Congreso de Medicina de Familia y Comunitaria. Sevilla, 8-11 de diciembre de 2004 / A stranger in the congress. Ethnographic evaluation of the XXIV Congress of Family and Community Medicine, Sevilla, 8-11 december 2004

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Canine surveillance system for Lyme borreliosis in Wisconsin and northern Illinois: geographic distribution and risk factor analysis.

A seroprevalence survey for Borrelia burgdorferi was conducted among the healthy canine pet population in selected counties of Wisconsin and northern Illinois to determine the distribution of Lyme disease and associated risk factors. Information obtained for each dog included place of residence, Lyme disease vaccination status, history of travel and tick exposure, signalment, and medical history. Serum samples were screened by enzyme-linked immunosorbent assay and confirmed by an immunoblot procedure. Seroprevalence by county ranged 0-40%, with the highest estimates from west-central Wisconsin. The spatial pattern was significantly correlated with human incidence of Lyme disease and with abundance of the tick vector, Ixodes scapularis. A geographic information system (GIS) was used to integrate environmental data with the location of the residences of the dogs to determine environmental risk factors. Seropositivity among dogs was positively associated with increased tick exposure and time spent outdoors and negatively associated with vaccination against Lyme disease. Seropositivity was also associated with living in forested and urban areas, and on sandy, fertile soils. A canine surveillance system is a useful method for assessing the geographic distribution of Lyme disease, and in combination with a GIS, it can be effective in determining environmental factors associated with I. scapularis endemicity.

Funciones de los equipos directivos de Atención Primaria del INSALUD de Madrid. Necesidades de formación / Function of the Primary Health Care directors of the INSALUD of Madrid. Needs of training

Objetivos: son escasos los estudios en los que se analizan las funciones de los equipos directivos de Atención Primaria y sus necesidades de formación, siendo los objetivos de este trabajo: a) analizar la dedicación a las distintas funciones de la gestión; b) conocer los atributos sociales requeridos para el desempeño de su rol; c) determinar las necesidades de formación en gestión y los métodos preferidos. Material y métodos: estudio descriptivo transversal, mediante cuestionario enviado por correo en noviembre de 1999. La población diana son 77 personas, que constituyen los equipos directivos de las gerencias de Atención Primaria de Madrid. Las variables estudiadas fueron: a) tiempo que dedica a cada una de las funciones de su puesto de trabajo y el que le gustaría dedicar; b) importancia para el desempeño de su rol de distintos atributos sociales; c) grado de formación sobre sus funciones; d) métodos de formación preferidos. Resultados : contestaron un 84,4 por ciento. La distribución del tiempo que dedican a las distintas funciones es: coordinación (26,3 por ciento), dirección (22 por ciento), organización (21,4 por ciento), planificación (15,8 por ciento) y evaluación (13,7 por ciento), y el orden deseado: planificación (23 por ciento), dirección (21,2 por ciento), coordinación (20,6 por ciento), organización (19,7 por ciento) y evaluación (16,4 por ciento). Se evidencia una aceptable concordancia (Coeficiente de Kendall W= 0,408) en el orden de importancia que conceden a los atributos personales. Sólo un 32,3 por ciento tienen una titulación para la gestión. Las necesidades de formación resultan poco homogéneas (W = 0,19). Si existe aceptable concordancia en los métodos de aprendizaje de preferencia (W= 0,408). Conclusiones: se confirma una ligera discordancia entre la realidad de la gestión y el ideal que de ella tienen los gestores. Las necesidades de formación resultan heterogéneas. La formación en la práctica diaria es el método preferido por los encuestados. (AU)

Quantitative approach for the serodiagnosis of canine Lyme disease by the immunoblot procedure.

Serum samples obtained from healthy, asymptomatic dogs in areas of Wisconsin and northern Illinois where Lyme disease is endemic or nonendemic were assayed for antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), and positive results were confirmed by immunoblot assay. We found that 56.9% (562 of 1,077) of the samples were positive by ELISA and 82.0% (461 of 562) were positive by immunoblotting. A logistic regression model was developed to distinguish between nonvaccinated dogs naturally infected with B. burgdorferi from areas where the disease is endemic and dogs from areas where the disease is nonendemic that were vaccinated against Lyme disease. Of the 18 protein bands analyzed, 8 were found to be significantly different (P<0.05) between the two groups. p93, p34, p31, and p28 occurred with increased frequency in vaccinated dogs, while p58, p37, p35, and p30 occurred more frequently in naturally infected dogs. The logistic regression equation obtained was used to determine the probability of natural infection among vaccinated dogs residing in areas where the disease is endemic. Of 125 samples, 87.2% had a very low probability of natural infection and only 2.4% were highly likely to be infected. Logistic regression is a useful method for distinguishing between vaccinated and naturally infected dogs and predicting the serological status of vaccinated dogs from areas where Lyme disease is endemic.

[Dementia syndrome and risk factors in adults older than 60 years old residing in Habana]. / Síndrome demencial y factores de riesgo en adultos mayores de 60 años residentes en La Habana.

INTRODUCTION: The dementias and Alzheimer's disease are a growing problem in countries with a long life expectancy. OBJECTIVE: To find the prevalence of the dementia syndrome in the population aged over 60 years in the municipality of Marianao, La Habana, during the first three months of 1998, and the relationship with certain associated biosocial factors. PATIENTS AND METHODS: A descriptive transversal study in which 799 elderly persons were assessed in their homes, out of a population of 22,590 elderly persons, by means of conglomerate sampling in two stages. In the same way, we selected a sample from the municipality of Bauta representing 340 adults. The probable diagnosis of dementia syndrome or Alzheimer's disease was based on criteria of DSM III R and NINCDS-ADRDA. A second analytical phase was done by studying cases and witnesses. Univariate and multivariate hypothesis tests were done by means of the multiple logistic regression method. RESULTS AND CONCLUSIONS: The prevalence of the dementia syndrome was 8.2% (6.27-10.42); and that of Alzheimer's disease and vascular dementia was 5.13% and 1.93% respectively. Age, female sex, previous clinical history and no spouse (due to widowhood or being single), were risk factors in this population. Early detection of the dementia syndrome allows development of projects to intervene in old people to actively improve their state of health and socio-familial adaptation.

Liver growth factor purified from human plasma is an albumin-bilirubin complex.

We have reported that a liver growth factor isolated from plasma of partially hepatectomized rats is an albumin-bilirubin complex. In this paper, we characterize the liver growth factor purified from subjects with hepatitis (h-LGF). This factor increases synthesis of DNA in a dose-dependent manner both in vivo in mouse hepatocytes, with a dose of maximal stimulation of 150 ng of h-LGF/mouse, and in vitro in rat liver cell culture, with maximal effect at 7.5 to 10 ng of h-LGF/ml. In vivo, h-LGF increases the mitotic index of mouse hepatocytes, its action being organ-specific, acting on liver, but not on spleen, kidney, lung or brain. In vitro, h-LGF stimulates the uptake of 22Na+ by hepatocytes. In addition, we carried out a study comparing it with human serum albumin in terms of absorbance, fluorescence, circular dichroism spectra, amino acid composition, tryptic maps and antigenic determinants (Ouchterlony immunodiffusion). All these tests suggested that human serum albumin is a constituent of h-LGF. Moreover, when albumin isolated from humans without hepatic pathology is incubated with bilirubin, the albumin-bilirubin complex formed mimics the activity of the human liver growth factor with respect to stimulation of DNA synthesis and the effects on the mitotic index of mouse hepatocytes in vivo. We propose that this human liver growth factor is an albumin-bilirubin complex.

Comparison of the susceptibility of Brucella abortus isolates obtained before and after cows were treated with oxytetracycline and streptomycin.

Eight isolates of Brucella abortus were obtained from cows before and after they were treated with oxytetracycline and streptomycin. The susceptibility to these antibiotics was determined by broth-dilution minimal inhibitory and minimal lethal concentrations. Differences were not found in the minimal lethal concentrations of oxytetracycline or streptomycin in isolates obtained from cows before and after they were treated. This indicates that treatment failures in the cows were not the result of development of resistance to the antibiotics by B abortus.

Trisomy 6qter resulting from a familial (6;10) (q23;q26) translocation.

An infant deceased at 2 months of age was found to have a 46,XY,-10, +der(10),t (6;10) (q23;q26) mat karyotype. Since the clinical findings were similar to those of the trisomy 6qter syndrome, the present observation agrees with the assignment of the 6q23----qter segment as the pathogenetic determiner of this entity.

Whole-arm t(X;17) (Xp17q;Xq17p) and gonadal dysgenesis. A further exception to the critical region hypothesis.

A 19-year-old female patient with gonadal dysgenesis and a de novo t(X;17) (Xp17q;Xq17p) is described. Since the critical segment Xq13----q26 was intact, this case is a further exception to the critical region hypothesis.

Cortical blindness, growth and psychomotor retardation and postaxial polydactyly: a probably distinct autosomal recessive syndrome.

A 14-month-old female infant with a syndrome mainly consisting of cortical blindness, psychomotor retardation and postaxial polydactyly (type B in hands and type A in feet) was studied. Two deceased sibs were similarly affected. Differential diagnosis and the review of medical literature permit the individualization of a distinct syndrome with a probable autosomal recessive pattern of inheritance.

Tetrasomy 18p: a distinctive syndrome.

A 10-month-old girl with growth and psychomotor retardation and pyramidal signs, was found to have a 47,XX,inv(9)(p11q13),+i(18p) karyotype. Whereas the inverted chromosome was inherited from the father, the isochromosome was of unknown origin. A comparative analysis with 17 similar cases from the literature lead to the conclusion that the tetrasomy 18p actually constitutes a distinctive syndrome.

High repetition rate frequency-doubled Nd:YAG laser for airborne bathymetry.

A flashlamp pumped frequency-doubled Nd:YAG laser producing 7-nsec 2.8-mJ pulses at 530 nm and 400 pps has been developed for use in airborne bathymetry. A flashlamp gas mixture of krypton and xenon provides efficient laser operation and rapid lamp recovery. Pulse transmission mode operation is used to achieve a narrow pulse width. Thermally induced lensing and birefringence in the rod are compensated for in the optical resonator. Rapid, high repetition rate Pockels cell switching is accomplished with a thyratron driver. A CD*A crystal cut for 85 degrees phase matching at 55 degrees C is used to provide high conversion efficiency second harmonic generation.