Climatic and calf-related risk factors associated with failure of transfer of passive immunity in Holstein calves in a hot environment.

This retrospective observational study aimed to assess the effect of temperature-humidity index (THI) at calving and in the last trimester of pregnancy and calve-related factors affecting passive transfer of maternal immunoglobulin using Brix refractometry in Holstein calves. Blood samples from 4411 Holstein calves from a single large dairy farm in spring 2022 were used. A subset of data containing 6318 calvings was used to determine the effect of climatic conditions on the occurrence of agammaglobulinemia. Risk factors predictive of failure of passive transfer (FPT) were calculated using multiple logistic models. Females were 1.4 times more likely not to have FPT (56%; Brix% > 8 equivalent to ≥ 10 g/L IgG) than males (47.2%). Calves born as singles increased the likelihood of not presenting FPT (52.6%) than calves born as twins (42.9%). Calves from cows with no dystocic delivery had a lower risk for FPT (odds ratio = 2.3) than calves from cows with dystocia. Agammaglobulinemia was 1.5 and 1.8 times more likely to occur in calves with THI ≥ 80 and ≥ 82 in the last trimester of gestation and at calving, respectively, than in calves not experiencing heat stress. Agammaglobulinemia was twice as likely to occur in male than in female calves. Calves with birth weight ≥ 37 kg and gestation length ≥ 275 kg were less likely to present agammaglobulinemia than lighter calves and calves with shorter gestation periods. This study raises questions for management practices in Holstein calves undergoing in utero heat stress and around calving to avoid agammaglobulinemia.

Effects of parity, seasonal heat stress, and colostrum collection time postpartum on colostrum quality of Holstein cattle in an arid region.

The aim of this study was to determine effects of parity (primiparous vs. multiparous), seasonal heat stress at calving (summer vs. winter), and time postpartum on some parameters associated with colostrum quality in Holstein cows reared in the Sonoran Desert ecosystem. Forty-seven cows (11 primiparous and 36 multiparous) expected to calve during summer, and 46 cows during winter (14 primiparous and 32 multiparous) were randomly selected. Management and feeding before and after parturition were similar for cows in both seasons. After parturition, colostrum from all cows was evaluated for volume, weight, temperature, density, and content of fat, protein, solids non-fat (SNF), and immunoglobulins (IGG). Data were analyzed with a model that included effects of parity status, calving season, and time postpartum, as well as all interactions. Colostrum produced in summer was warmer (P < 0.01) by almost 6 °C than winter colostrum, while colostrum from multiparous was warmer (P = 0.02) by 1.2 °C than that produced by primiparous cows. Colostrum volume and weight were not impacted by parity, calving season or time postpartum. Density, protein, and SNF content in colostrum were higher (P < 0.01) in multiparous vs. primiparous cows, as well as at parturition (0 h postpartum) than at 12 h postpartum (P < 0.01). At calving (0 h), spring colostrum had higher fat content (P < 0.01) and lower (P < 0.01) IGG concentration than that collected in summer, and no difference (P > 0.05) between seasons was observed for these components at 12 h postpartum. Multiparous cows produced colostrum with higher (P < 0.01) IGG concentrations than primiparous cows. In conclusion, only 0-h colostrum and that from multiparous cows was categorized as "Excellent," meanwhile the colostrum produced under summer heat stress was characterized as "Good" with reduced fat content. While the lacteal secretion collected at 12 post-partum still classified as colostrum, substantially lower contents of IGG, protein, fat, and SNF decreased its classification to "Poor" from the classification of "Excellent" at 0 h postpartum.

Respiratory syncytial virus outbreak during the COVID-19 pandemic. How has it changed?

INTRODUCTION: The epidemiology of respiratory syncytial virus (RSV) infection has changed during the COVID-19 pandemic. Our objectives were to describe the RSV epidemic in 2021 and compare it with the previous years to the pandemic. METHODS: Retrospective study performed in Madrid (Spain) in a large pediatric hospital comparing the epidemiology and clinical data of RSV admissions during 2021 and the two previous seasons. RESULTS: 899 children were admitted for RSV infection during the study period. During 2021, the outbreak peaked in June and the last cases were identified in July. Previous seasons were detected in autumn-winter. The number of admissions in 2021 was significantly lower than in previous seasons. There were no differences between seasons regarding age, sex or disease severity. CONCLUSION: RSV hospitalizations during 2021 in Spain moved to summer with no cases in autumn and winter 2020-2021. Unlike other countries, clinical data were similar between epidemics.

Holstein heifers in desert climate: effect of coat color on physiological variables and prediction of rectal temperature.

Two hundred Holstein heifers were divided by hair coat color in black (n1 = 60), white (n2 = 62), and mixed (n3 = 78) to accomplish two objectives: (1) to compare physiological variables using an analysis of variance, and (2) to construct regression equations to predict rectal temperature. In each heifer, rectal temperature (RT), respiration frequency (RF), and body surface temperatures (obtained with infrared thermography in eye, nose, forehead, head, neck, ear, shoulder, flank, belly, leg, loin, rump, and vulva) were measured. Black heifers had more RF and RT (P < 0.01) than mixed and white coat heifers; white heifers had similar RT than mixed color heifers, but they exhibited less RF (P < 0.05). In general, black and mixed coat color heifers had higher BST (P < 0.01) than white heifers in the majority of the anatomical regions measured. For black coat heifers, the best regression model to predict RT included three predictor variables: [RT = 35.59 - 0.013 (RH) + 0.045 (RF) + 0.019 (TEar); R2 = 71%]. For white coat heifers, the best model included two predictor variables: [RT = 35.29 + 0.035 (RF) + 0.033 (TForehead); R2 = 71%]; and for mixed coat color heifers, the best model included two predictor variables: [RT = 35.07 + 0.022 (RF) + 0.038 (THead); R2 = 44%]. Heifers with dark hair coat color showed higher physiological constants than white heifers; the prediction of rectal temperature was more precise in heifers with well-defined hair coat color. Physiological and climatic variables, along with infrared thermography, represent an appropriate combination to predict rectal temperature in Holstein heifers with predominant white or black hair coat color.

Respiratory syncytial virus outbreak during the COVID-19 pandemic. How has it changed?

Introduction: The epidemiology of respiratory syncytial virus (RSV) infection has changed during the COVID-19 pandemic. Our objectives were to describe the RSV epidemic in 2021 and compare it with the previous years to the pandemic. Methods: Retrospective study performed in Madrid (Spain) in a large pediatric hospital comparing the epidemiology and clinical data of RSV admissions during 2021 and the two previous seasons. Results: 899 children were admitted for RSV infection during the study period. During 2021, the outbreak peaked in June and the last cases were identified in July. Previous seasons were detected in autumn-winter. The number of admissions in 2021 was significantly lower than in previous seasons. There were no differences between seasons regarding age, sex or disease severity. Conclusion: RSV hospitalizations during 2021 in Spain moved to summer with no cases in autumn and winter 2020-2021. Unlike other countries, clinical data were similar between epidemics.

Introducción: La epidemiología de la infección por virus respiratorio sincitial (VRS) ha cambiado durante la pandemia de COVID-19. Nuestros objetivos fueron describir la epidemia de VRS en 2021 y compararla con las de los años previos a la pandemia. Métodos: Estudio retrospectivo realizado en Madrid (España), en un hospital pediátrico terciario, que compara los datos epidemiológicos y clínicos de los ingresos por VRS durante 2021 y las 2 temporadas anteriores. Resultados: Ingresaron 899 niños por infección por VRS en el período de estudio. Durante 2021, el brote alcanzó su punto máximo en junio y los últimos casos se identificaron en julio. En las temporadas anteriores se detectaron en otoño-invierno. El número de hospitalizaciones en 2021 fue significativamente menor que en temporadas anteriores. No hubo diferencias entre temporadas en cuanto a edad, sexo o gravedad de la enfermedad. Conclusión: Las hospitalizaciones por VRS durante 2021 en España se trasladaron a verano, sin casos en otoño e invierno 2020-2021. A diferencia de otros países, los datos clínicos fueron similares entre epidemias.

Seasonal prevalence of gastrointestinal parasites in desert bighorn sheep (Ovis canadensis) in northern Mexico.

This study aimed to describe the shedding pattern of gastrointestinal parasite eggs by a wild population of desert bighorn sheep (DBS; Ovis canadensis) in northern Mexico. Seventy-five fresh faecal samples were collected from the ground in each season within an hour after being expelled by these animals. The generalized linear mixed model showed that eggs per gram of faeces were highest in winter (577 ± 399) and lowest in summer (260 ± 198). Generalized linear models revealed that Strongyloides spp. predominated during most seasons with a peak in summer (85% of faecal samples analysed) and the absence of this helminth in winter. Nematodirus spp. was another helminth present in three seasons, with the presence of this nematode in 35% of the faecal samples in spring and 0% in summer. Other parasites in DBS faeces included Bunostomun spp., Trichostrongylus spp., Cooperia spp., Mecistocirrus digitatus, Haemonchus contortus, Chabertia ovina and Eimeria ovinoidalis. There were differences among seasons in the percentage of these helminths and coccidia in faecal samples for all these parasites. It was concluded that helminths egg output in DBS in a semi-arid rangeland is lowest in summer and spring and highest in autumn and winter. Furthermore, it was shown that DBS in the study site do not suffer from severe parasite burden. Therefore, this nematode parasite burden is compatible with the conservation and well-being of this particular population.

Toxocariasis in migrant children: A 6 years' experience in a reference pediatric unit in Spain.

BACKGROUND: Toxocariasis is a worldwide distributed zoonosis that affects characteristically children. Clinical presentation is highly variable, often asymptomatic, and treatment duration is controversial. METHODS: A retrospective descriptive study (January 2014-December 2019) was performed in a referral Unit for Pediatric Tropical Diseases. Patients younger than 18 years of age diagnosed with toxocariasis were included. RESULTS: Out of 931 children screened for toxocariasis, 49 (5.3%) were seropositive. The median age was 11.0 years, 55.1% male and 30.6% referred contact with puppies. Overall, 34.7% were Latin-American, 24.5% Asiatic, 20.4% European, and 20.4% African. Only 34.7% presented symptoms, gastrointestinal the most common (52.9%). The 57.1% of children presented eosinophilia and 50% elevated total IgE. Most cases (95.9%) corresponded to covert toxocariasis. All children were treated with albendazole for 5, 14 or 21 days, and 4 children required a second course. Follow-up data were available in 32 children (65.3%) for a median of 7 months, showing a progressive decline in eosinophils, IgE-titers and ELISA optical density. CONCLUSION: Toxocariasis is mostly asymptomatic in children and eosinophilia is not always present. Serological tests should be included in migrant health screening and in the diagnostic assessment of eosinophilia. Eosinophil count, IgE-titers and ELISA optical-density could be useful during follow-up.

Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos / Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules

Se presenta el caso de una mujer de 49 años, tratada e intervenida por cáncer de mama, quien, a las 3semanas de presentar síndrome de axillary web (SAW), desarrolló nódulos subcutáneos, blandos e indoloros a lo largo de su recorrido y cerca de la flexura del codo. Las pruebas complementarias (ecografía Doppler y de partes blandas) descartaron etiología dérmica/subcutánea o neoplásica, y se evidenció trombosis venosa cefálica y cubital. Se pautó tratamiento con anticoagulante y a las 3-4 semanas el SAW mejoró y los nódulos desaparecieron. Con la clínica, evolución y las pruebas complementarias realizadas, junto con la evidencia científica publicada, se diagnosticó de SAW con nódulos subcutáneos. El SAW es una complicación posquirúrgica precoz del cáncer de mama conocida entre los profesionales y cuyo diagnóstico es clínico. La asociación del SAW con nódulos subcutáneos es una de las variantes poco frecuente, en las que es preciso ampliar el estudio. Se cree que los nódulos, al igual que el SAW, son debidos a procesos trombóticos linfovenosos (AU)

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis (AU)

Síndrome del trefinado / Syndrome of the trephined

El síndrome del trefinado (ST) consiste en el deterioro neurológico que se produce tras la realización de una craniectomía descompresiva en la que no se lleva a cabo reposición ósea. Su incidencia es variable, aunque se cree que esta entidad está infradiagnosticada. Se caracteriza por la reversión de los síntomas tras dicha reposición del hueso, por lo que este es el único tratamiento definitivo. Mostramos el caso de un paciente valorado por el servicio de rehabilitación en la unidad de cuidados intensivos tras sufrir un accidente cerebrovascular, que presenta alteración del nivel de consciencia y deterioro motor abrupto, siendo diagnosticado de ST. La intervención rehabilitadora, con cambios posturales precoces del paciente ayudó a mitigar los síntomas hasta que se realizó el tratamiento resolutivo final (AU)

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment (AU)

Tratamiento de la fractura conminuta de patela: ¿existen diferencias entre realizar o no una eversión? / Treatment of comminuted patellar fracture: are there differences between performing or not performing an eversion?

OBJETIVO Comparar los resultados clínicos, funcionales e imagenológicos de dos técnicas quirúrgicas para el manejo de fracturas conminutas de patela: con y sin eversión patelar. MÉTODOS En una serie de casos retrospectivos de fracturas conminutas de patela tratadas en el mismo centro entre 2014 y 2017, con un seguimiento ≥ 3 meses, se hizo una comparación entre el grupo con eversión y el grupo sin eversión. Los criterios de exclusión fueron patelectomía parcial o total, reinserción tendínea, o rehabilitación incompleta. Las variables analizadas fueron edad, sexo, tabaquismo, diabetes mellitus, energía del accidente, tipo de fractura, variables quirúrgicas (banda de tensión, tornillos, alambres, nudos, cerclaje circular), rango de movimiento (RDM) articular postoperatorio, presencia de osteosíntesis sintomática, puntaje de escalas funcionales (de Tegner-Lysholm y de Kujala) al alta definitiva, complicaciones (rigidez articular, infección, trombosis venosa profunda), y variables imagenológicos con tomografías computarizadas pre- y postoperatorias (brecha, desnivel articular > 2 mm, elementos de fijación intraarticular). RESULTADOS En total, 20 de 22 pacientes, 13 con eversión y 7 sin eversión, cumplieron con los criterios de selección. El seguimiento fue de 3 a 12 meses, y no hubo diferencias estadísticamente significativas respecto a las variables demográficas entre ambos grupos, lo cual los hace comparables. Destacaron el tiempo desde el ingreso al alta, con 7 meses para los pacientes con eversión y 5 meses para los sin eversión (p = 0.032), la proporción de pacientes con desnivel articular > 2 mm, con 7.7% para los con eversión y 14.3% para los sin eversión (p = 0.016), y una tendencia a resultados superiores en escalas funcionales para el grupo con eversión. CONCLUSIÓN El tratamiento de fracturas conminutas de patela con eversión parece ser una alternativa viable dados sus resultados imagenológicos y funcionales superiores a los de la técnica habitual.

PURPOSE To compare the clinical, functional and imaging outcomes of two surgical techniques for the treatment of comminuted patellar fractures: with and without eversion. METHODS In a retrospective series of cases of comminuted patellar fractures treated at a single center between 2014 and 2017, with a follow-up 3 months , we performed a comparison between the eversion group and the non-eversion group. The exclusion criteria were partial or total patellectomy, tendon reinsertion, or incomplete rehabilitation. The variables analyzed were age, gender, smoking, diabetes mellitus, the energy of the accident, the fracture type, surgical variables (tension band, screws, wires, knots, circular cerclage), postoperative joint range of motion (ROM), presence of symptomatic osteosynthesis, the scores on the functional scales (of Tegner-Lysholm and of Kujala) at the final discharge, complications (joint stiffness, infection, deep vein thrombosis), and pre- and postoperative computed tomography imaging variables (gap, step-off > 2mm, intra-articular fixation elements). RESULTS In total, 20 out of 22 patients, 13 undegoing eversion and 7 not undergoing eversion, met the selection criteria.. The follow-up ranged from 3 to 12 months, and there were no statistically significant differences regarding the demographic variables between both groups, which makes them comparable. The most remarkable results were the time from admission to final discharge, of 7 months for the patients in the eversion group, and of 5 months for those in the non-eversion group (p » 0.032), the proportion of patients with a step-off > 2 mm, with 7.7% for the eversion group and 14.3% for the non-eversion group (p » 0.016), and a tendency towards higher scores in the functional scales for the eversion group. CONCLUSION The treatment of comminuted patellar fractures with eversion seems to be a viable alternative, given its superior imaging and functional results compared to those of the usual technique.

Effect of co-positivity for brucellosis and tuberculosis on milk yield and fertility of Holstein cows.

This study aimed to determine whether cows detected as tuberculosis (bTB) reactors and seropositive to brucellosis (bBR), as well as co-positive to bBR and bTB (bBR-bTB) and with a complete lactation before slaughter, were associated with reduced milk production and fertility. A total of 8068 productive and reproductive records of high-yielding Holstein cows from a single large dairy herd with a high prevalence of bTB and bBR were collected from 2012 to 2015. Lactation derived either from calving (n = 6019) or hormonally induced lactation (n = 2049), and all cows received growth hormone throughout lactation. For cows not induced into lactation, pregnancy rate to first service for healthy cows (C; 26.6%) was higher (P < 0.01) than bBR (15.2%), bTB (15.8%), and bBR-bTB (1.3%) cows. For induced cows, pregnancy rate to first service did not differ significantly among C, bBR, and bTB (14.5-17.3%) cows, but the percentage success of first service was extremely low (1.3%; P < 0.01) in bBR-bTB cows. Services per pregnancy (only pregnant cows) were lowest for C (3.3 ± 2.9; P < 0.01) and highest (6.4 ± 3.4) for bBR-bTB non-induced cows. This variable was lowest for C (2.9 ± 2.5; P < 0.01) and highest for bBR-bTB non-induced cows (6.3 ± 3.1). Pregnancy rate to all services did not differed for C (79.5%), bBR (76.7%), and bTB (75.9%) but was lower (58.9%; P < 0.01) for bBR-bTB non-induced cows. For induced cows this variable was highest for bBR (53.3%) and lowest for bBR-bTB (34.1%; P < 0.01) non-induced cows. 305-d milk production was increased by 4%, and total milk yield by 7% in TB-positive cows compared to that of the negative cows non-induced hormonally into lactation. This study showed the negative impact of the co-positivity for bTB and bBR on the reproductive efficiency of Holstein cows, although positive bTB and bBR tests enhanced milk yield.

A Bayesian Model to Predict COVID-19 Severity in Children.

BACKGROUND: We aimed to identify risk factors causing critical disease in hospitalized children with COVID-19 and to build a predictive model to anticipate the probability of need for critical care. METHODS: We conducted a multicenter, prospective study of children with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care. We used a multivariable Bayesian model to estimate the probability of needing critical care. RESULTS: The study enrolled 350 children from March 12, 2020, to July 1, 2020: 292 (83.4%) and 214 (73.7%) were considered to have relevant COVID-19, of whom 24.2% required critical care. Four major clinical syndromes of decreasing severity were identified: multi-inflammatory syndrome (MIS-C) (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome (19.6%). Main risk factors were high C-reactive protein and creatinine concentration, lymphopenia, low platelets, anemia, tachycardia, age, neutrophilia, leukocytosis, and low oxygen saturation. These risk factors increased the risk of critical disease depending on the syndrome: the more severe the syndrome, the more risk the factors conferred. Based on our findings, we developed an online risk prediction tool (https://rserver.h12o.es/pediatria/EPICOAPP/, username: user, password: 0000). CONCLUSIONS: Risk factors for severe COVID-19 include inflammation, cytopenia, age, comorbidities, and organ dysfunction. The more severe the syndrome, the more the risk factor increases the risk of critical illness. Risk of severe disease can be predicted with a Bayesian model.

Risk for post-thrombotic syndrome after lower-limb deep vein thrombosis: location of the thrombus or residual thrombi? / Risk razvitiia posttromboflebiticheskogo sindroma posle tromboza glubokikh ven nizhnikh konechnostei: lokalizatsiia tromba ili rezidual'nyi tromboz?

BACKGROUND: Many works aimed to determine factors that influence the onset of postthrombotic syndrome after an acute episode of deep venous thrombosis. We aimed to compare the prognostic value of the most proximal extent of thrombus (proximal and distal DVT) versus the residual thrombosis as identified by venous ultrasonography performed during follow-up. METHOD: We conducted a retrospective study of prospectively collected 1183 consecutive cohort patients in the RIETE registry after a first episode of deep venous thrombosis and assessed for postthrombotic syndrome after 12 months. RESULTS: Multivariate analysis revealed that: residual thrombosis (OR 1.40; 95% CI 0,88-2,21), the presence of cancer (OR 1.38; 95% CI: 0,64-2,97), immobility (OR 1.31; 95% CI 0,70-2,43) and estrogen-containing drugs use (OR 2.08, 95% CI 0,63-6,83), all had a predictive value for the occurrence of PTS. CONCLUSION: Our study results revealed that ultrasound finding of residual thrombosis is more predictive than proximal location of thrombus for postthrombotic syndrome after episode of deep venous thrombosis. Real life data from a large group of patients from the RIETE registry substantiates that.

Permanence time in the herd and milk production of Holstein cows with up to five successive extended lactations.

A total of 1338 high-yielding cows with five lactations from a large well-managed commercial dairy operation in a hot environment of northern Mexico were used to evaluate milk yield and reproductive performance of cows undergoing unplanned extended lactations (EL; > 450 days). The null hypothesis that cumulative milk yield during five consecutive lactations is the same in cows not having unplanned EL and cows with several EL was tested. All EL resulted from cows failing to become pregnant with ≥ 4 services. Cows were allocated to 1 of 6 groups according to the number of EL (EL0 for cows with no EL to EL5 for cows with 5 EL). Cumulative milk yield was highest (P < 0.01) for EL5 cows (95,499 kg) and lowest for EL0 cows (56,236 kg). Likewise, cumulative days in milk were greatest (P < 0.01) in EL5 (2968 days) and lowest in EL0 (1857 days) cows. Mean milk yield per lactation increased linearly with the increase in the number of extended lactations with a maximum of 19,099 kg of milk/lactation for EL5 cows. Mean daily milk yield/productive life was lowest (P < 0.01) for EL0 (30.2 kg) and highest for EL5 (32.1 kg). The percentage of days in milk relative to days from birth to the end of the fifth lactation was highest for EL5 (78.1%) and lowest for EL0 (59.6%), with EL2 to EL4 cows intermediate. Length of calving interval was longest (P < 0.01) for EL5 (24.7 months) and shortest for EL0 (15.5 months) cows. It was concluded that it is worthwhile maintaining high-yielding cows incapable to conceive before 230 days in milk because they did conceive again and produced considerable amounts of milk during their productive life, which substantially prolonged their permanence time in the herd.

[Syndrome of the trephined]. / Síndrome del trefinado.

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment.

Climate change vulnerability of confined livestock systems predicted using bioclimatic indexes in an arid region of México.

Climate change is a major world-wide challenge to livestock production because food security is likely to be compromised by increased heat stress of the animals. The objective of this study was to characterize, using bioclimatic indexes, two livestock regions located in an arid zone of México, and to use this information to predict the impact of global warming on animal production systems of these regions located in the state of Baja California (México). A 5-year database (i.e., 2011 to 2015) consisting of about one million data points from two zones (i.e., coast, valley) from four meteorological stations in the north of Baja California were used. Bioclimatic indexes were constructed for the four types of livestock production systems most common in this region, being: dairy cattle, beef cattle, sheep, pigs. The temperature-humidity index (THI) thresholds used to classify heat stress were determined and scaled for each livestock species as: THIbeef and THIpig 74 units; THImilk 72 units; and THIsheep 23 units. Statistical differences between indices were detected (P < 0.01) during summer for the valley and coast zones as (THIbeef = 72.9 and 51.8; THImilk = 80.6 and 67.4; THIpigs = 83.9 and 65.2; THIsheep = 29.5 and 20.1 units). Coast zone weather did not suggest vulnerability of livestock production systems to heat stress at any time of the year, but heat stress risk during summer for valley zone dairy cattle, sheep and pigs was classified as severe, but lower for feedlot cattle. Prediction models showed significant adjustment just in the coastal zone for THImilk, THIsheep, and THIsheep, suggesting more impact of global warming during summer in the coastal zone. Use of management strategies to reduce heat load of domestic animals during summer in northern Baja California is essential to maintain their productivity, with more emphasis in the valley zone.

[Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules]. / Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos.

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis.

Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal / Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: a cross-sectional study

OBJETIVO: El objetivo de este estudio es analizar el impacto y la organización tanto asistencial como docente en los Servicios de Medicina Física y Rehabilitación de España ante el nuevo y cambiante escenario debido a la pandemia por la COVID-19. MÉTODOS: Se realiza una encuesta dirigida a los tutores de los Servicios de Rehabilitación. Un total de 31 preguntas divididas en 6 apartados: información general de los Servicios, adaptación del Servicio durante el periodo COVID, labor asistencial de los médicos rehabilitadores, abordaje rehabilitador de pacientes COVID, consecuencia de la pandemia sobre la salud de los rehabilitadores y labores de tutoría durante ese periodo. RESULTADOS: Se recibieron un total de 54 encuestas. Casi la mitad de los Servicios cancelaron todas las consultas presenciales (40%) y las salas de terapias se destinaron a camas de pacientes COVID (48%). En 30 hospitales (55,6%) los facultativos han trabajado en plantas COVID. La gran mayoría de los Servicios han elaborado material gráfico y audiovisual con ejercicios, así como protocolos de derivación y tratamiento rehabilitador de pacientes COVID ingresados. Casi la mitad de los Servicios encuestados han tenido algún caso de ansiedad en el personal médico. Las labores de tutoría se han anulado (40,7%) o disminuido (35,2%). CONCLUSIONES: La organización de los Servicios de Rehabilitación para hacer frente a la pandemia ha sido similar en todo el territorio español. La respuesta de los Servicios a la crisis sanitaria ha visualizado la versatilidad de trabajo de los médicos rehabilitadores

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians