Effects of predictive and incentive value manipulation on sign- and goal-tracking behavior.

When a neutral stimulus is repeatedly paired with an appetitive reward, two different types of conditioned approach responses may develop: a sign-tracking response directed toward the neutral cue, or a goal-tracking response directed toward the location of impending reward delivery. Sign-tracking responses have been postulated to result from attribution of incentive value to conditioned cues, while goal-tracking reflects the assignment of only predictive value to the cue. We therefore hypothesized that sign-tracking rats would be more sensitive to manipulations of incentive value, while goal-tracking rats would be more responsive to changes in the predictive value of the cue. We tested sign- and goal-tracking before and after devaluation of a food reward using lithium chloride, and tested whether either response could be learned under negative contingency conditions that precluded any serendipitous reinforcement of the behavior that might support instrumental learning. We also tested the effects of blocking the predictive value of a cue using simultaneous presentation of a pre-conditioned cue. We found that sign-tracking was sensitive to outcome devaluation, while goal-tracking was not. We also confirmed that both responses are Pavlovian because they can be learned under negative contingency conditions. Goal-tracking was almost completely blocked by a pre-conditioned cue, while sign-tracking was much less sensitive to such interference. These results indicate that sign- and goal-tracking may follow different rules of reinforcement learning and suggest a need to revise current models of associative learning to account for these differences.

Subregional Differences in Medium Spiny Neuron Intrinsic Excitability Properties between Nucleus Accumbens Core and Shell in Male Rats.

The nucleus accumbens (NAc) is known for its central role in reward and motivation (Day and Carelli, 2007; Floresco, 2015; Salgado and Kaplitt, 2015). Decades of research on the cellular arrangement, density, and connectivity of the NAc have identified two main subregions known as the core and shell (Záborszky et al., 1985; Berendse and Groenewegen, 1990; Zahm and Heimer, 1990). Although anatomically and functionally different, both the NAc core and shell are mainly comprised of GABAergic projection neurons known as medium spiny neurons (MSNs) (Matamales et al., 2009). Several studies have identified key morphologic differences between core and shell MSNs (Meredith et al., 1992; Forlano and Woolley, 2010) but few studies have directly addressed how core and shell MSNs differ in their intrinsic excitability (Pennartz et al., 1992; O'Donnell and Grace, 1993). Using whole-cell patch-clamp recordings in slices prepared from naive and rewarded male rats, we found that MSNs in the NAc shell were significantly more excitable than MSNs in the NAc core in both groups. In the shell, MSNs had significantly greater input resistance, lower cell capacitance, and a greater sag. This was accompanied by a lower action potential current threshold, a greater number of action potentials, and faster firing frequency compared with core MSNs. These subregional differences in intrinsic excitability could provide a potential physiological link to the distinct anatomic characteristics of core and shell MSNs and to their distinct functional roles in reward learning (Zahm, 1999; Ito and Hayen, 2011; Saddoris et al., 2015; West and Carelli, 2016).

¿Es necesaria la formación anual sobre reanimación cardiopulmonar en el colegio? / Is annual training on cardiopulmonary resuscitation necessary at school?

Objetivo: evaluar los conocimientos sobre reanimación cardiopulmonar (RCP) adquiridos en estudiantes de 5º de primaria de un colegio de Zaragoza (España) tras realizar un taller teórico-práctico y las diferencias en función de su repetición o no el año posterior.Método: ensayo controlado aleatorizado realizado entre 2019 y 2021. Se incluyó a 72 estudiantes matriculados que se asignaron aleatoriamente a dos grupos iguales. Un grupo recibió un taller teórico-práctico sobre RCP en dos sesiones de una hora, otro repitió la formación también el curso siguiente. Se midieron edad, sexo y conocimientos mediante test autoadministrado diseñado ad hoc (puntuación 0 a 13 máx.) antes y después del primer año y tras el segundo. Se realizaron índices de estadística descriptiva y contraste de hipótesis.Resultados: participaron 72 alumnos de 10,6 años de media. La puntuación se incrementó de manera estadísticamente significativa en ambos grupos (valor p< 0,001) el primer año. En el segundo año, la mediana de la puntuación total obtenida fue 11,0 (RIC= 2,0) en el grupo sin repetición y 13,0 (RIC= 1,0) en el que sí se repitió (p< 0,001). Este último grupo identificó mejor la comprobación inicial de consciencia, la actuación mientras llega ayuda, la actuación en inconsciencia sin respiración y la relación compresiones/ventilaciones (p< 0,05).Conclusión: la participación en el taller mejoró el conocimiento de los estudiantes. Quienes recibieron de nuevo la formación el año siguiente obtuvieron mayores conocimientos que aquellos que solo lo obtuvieron en una ocasión.(AU)

Objective: to evaluate the knowledge about cardiopulmonary resuscitation acquired by students in their 5th year of Primary School from a school in Zaragoza (Spain) after conducting a theoretical-practical workshop, and the differences based on whether it was repeated or not on the following year.Method: a controlled randomized study conducted between 2019 and 2021, which included 72 enrolled students who were randomly assigned to two equal arms. One of the arms attended a theoretical-practical workshop on cardiopulmonary resuscitation (CPR) in two one-hour sessions; the other arm also repeated the training the following year. Age, gender and knowledge were measured through a self-administered test which was designed ad hoc (scores from 0 to 13 maximum) before and after the first year and after the second year. Descriptive statistics indexes and hypothesis contrast were used.Results: the study included 72 students with 10.6 years as mean age. There was a statistically significant increase in scores in both arms (p value< 0.001) on the first year. On the second year, the median total score obtained was 11.0 (IQR= 2.0) in the arm without repetition and 13.0 (IQR= 1.0) in the arm with repetition (p< 0.001). This last arm presented better identification of the initial verification of consciousness, the action while waiting for help, the action in lack of consciousness without respiration, and the compression / ventilation ratio (p< 0.05).Conclusion: participation in the workshop improved the knowledge of students. Those who received training again on the following year obtained higher knowledge than those who only received it once.(AU)

Percepción del método Baby Led Weaning por parte de las familias y de los profesionales de Enfermería / Perception of the Baby-Led Weaning method by families and nursing professionals

Objetivo: describir el conocimiento acerca del método Baby Led Weaning (BLW), así como las ventajas y los inconvenientes entre los profesionales de Enfermería y su aplicación en la práctica clínica; e identificar el perfil de las familias que utilizan el método, así como la forma de llevarlo a cabo y la satisfacción con el mismo. Método: estudio descriptivo transversal en profesionales de Enfermería de Atención Primaria y Especializada de Aragón, y en progenitores que habían realizado el taller “Aprender a comer solito” en el Centro de Salud del Arrabal de Zaragoza. Para la recogida de los datos se utilizaron cuestionarios ad hoc autoadministrados a través de Google Forms®. Resultados: el 92,6% de los profesionales conocía el BLW; el punto fuerte que obtuvo mayor porcentaje (83,4%) fue que el BLW permitía al bebé experimentar y conocer los alimentos, siendo el punto débil más prevalente el riesgo de atragantamiento (67,6%). Las familias que habían realizado el BLW recomendarían efectuar el método en un 94,4%; destacaron, con un 88,9% como punto fuerte: “Método más natural que facilita el paso de la lactancia materna exclusiva a una alimentación complementaria”, y como punto débil, con un 77,8%: “Falta de tiempo”. Conclusiones: el BLW es un método ampliamente conocido por los profesionales de Enfermería, aunque se han encontrado barreras en su recomendación en la práctica diaria, especialmente ligadas al riesgo de atragantamiento. Las familias destacaron la autonomía y diversión que el método proporcionaba al bebé, así como la naturalidad en la transición a alimentos, manifestando un alto grado de satisfacción del método BLW y considerándolo recomendable.(AU)

Objective: to describe the awareness among Nursing professionals regarding the Baby-Led Weaning (BLW) method, as well as its advantages and drawbacks and its application in clinical practice; and to identify the profile of families using this method, as well as the way to conduct it and the level of satisfaction with it. Method: a descriptive cross-sectional study among Primary and Specialized Care Nursing professionals in Aragon, and among parents who participated in the “Aprender a comer solito” (“Learning to eat on your own”) workshop in the Arrabal Primary Care Centre in Zaragoza. Self-administered ad hoc questionnaires were used for data collection, through Google forms®. Results: there was awareness of BLW in 92% of professionals; the strength with the highest rate (83.4%) was that BLW allowed babies to experiment and get to know foods, while the most prevalent weakness was the risk of choking (67.6%). Families who had conducted BLW would recommend the method on a 94.4%; they highlighted as a strength, with 88.9%, “A more natural method which allows moving from exclusive breastfeeding to complementary diet”, and as a weakness, with 77.8%, “Lack of time”. Conclusions: BLW is a method widely known by Nursing professionals, though barriers have been found for its recommendation in daily practice, particularly linked to the risk of choking. Families highlighted the autonomy and enjoyment that the method provided to babies, as well as a natural transition to foods, stating a high level of satisfaction with the BLW method and considering it recommendable.(AU)

Morfea lineal en golpe de sable: a propósito de un caso / Linear morphea in saber coup: about a case

La morfea lineal en golpe de sable es una entidad dermatológica caracterizada por la inflamación esclerosante y progresiva del tejido cutáneo en la región frontal y/o en el cuero cabelludo. La cefalea y las crisis convulsivas son dos de los síntomas extracutáneos más frecuentes y están causados por el crecimiento subyacente de la lesión. Es importante un diagnóstico temprano para frenar la progresión e intentar evitar las complicaciones secundarias, principalmente neurológicas. El diagnóstico se basa en el cuadro clínico y el estudio histológico, que permite la confirmación definitiva. El tratamiento de elección es la terapia combinada con corticoides orales y metotrexato. Aun con el tratamiento farmacológico adecuado, esta patología puede presentar un curso recidivante y dejar secuelas a largo plazo. Se presenta el caso de una niña en quien se realizó un diagnóstico rápido de esta enfermedad, a pesar de un cuadro clínico inespecífico. Fue tratada con metotrexato oral con buena respuesta, sin efectos secundarios.

Linear morphea in coup de sabre is a dermatological entity characterized by progressive, sclerosing inflammation of the skin tissue in the frontal region and on the scalp. Headache and seizures are two of the most frequent extracutaneous symptoms and they are caused by the growth of the lesion towards underlying structures. An early diagnosis is important to stop cranial progression and try to avoid secondary complications, mainly neurological. The diagnosis is relied on compatible clinical signs and a pathological study that allows a definitive confirmation. The treatment of choice is combination therapy with oral corticosteroids and methotrexate. Despite an adequate pharmacological treatment, this pathology can present a recurrent course and cause long-term sequelae. We present the case of a girl who was diagnosed quickly, despite a not very noticeable symptoms. She has been treated with oral methotrexate with a good response, without side effect

[Linear morphea in saber coup: about a case]. / Morfea lineal en golpe de sable: a propósito de un caso.

Linear morphea in coup de sabre is a dermatological entity characterized by progressive, sclerosing inflammation of the skin tissue in the frontal region and on the scalp. Headache and seizures are two of the most frequent extracutaneous symptoms and they are caused by the growth of the lesion towards underlying structures. An early diagnosis is important to stop cranial progression and try to avoid secondary complications, mainly neurological. The diagnosis is relied on Morfea lineal en golpe de sable: a propósito de un caso Linear morphea in saber coup: about a case compatible clinical signs and a pathological study that allows a definitive confirmation. The treatment of choice is combination therapy with oral corticosteroids and methotrexate. Despite an adequate pharmacological treatment, this pathology can present a recurrent course and cause long-term sequelae. We present the case of a girl who was diagnosed quickly, despite a not very noticeable symptoms. She has been treated with oral methotrexate with a good response, without side effects.

La morfea lineal en golpe de sable es una entidad dermatológica caracterizada por la inflamación esclerosante y progresiva del tejido cutáneo en la región frontal y/o en el cuero cabelludo. La cefalea y las crisis convulsivas son dos de los síntomas extracutáneos más frecuentes y están causados por el crecimiento subyacente de la lesión. Es importante un diagnóstico temprano para frenar la progresión e intentar evitar las complicaciones secundarias, principalmente neurológicas. El diagnóstico se basa en el cuadro clínico y el estudio histológico, que permite la confirmación definitiva. El tratamiento de elección es la terapia combinada con corticoides orales y metotrexato. Aun con el tratamiento farmacológico adecuado, esta patología puede presentar un curso recidivante y dejar secuelas a largo plazo. Se presenta el caso de una niña en quien se realizó un diagnóstico rápido de esta enfermedad, a pesar de un cuadro clínico inespecífico. Fue tratada con metotrexato oral con buena respuesta, sin efectos secundarios.

Seroprevalence of anti-Leptospira antibodies in equines and associated workers-Isolation of Leptospira interrogans serogroup Canicola from equine urine.

To investigate seroprevalence of anti-Leptospira antibodies in equines and associated workers in Uruguay, 891 equine and 150 human sera were drawn; 212 equine urine samples were also taken for culture. Environmental conditions and equine raising or managing practices were recorded in all 72 visited establishments; epidemiological information was obtained from each worker. Microscopic agglutination technique (MAT) was performed with 10 Leptospira strains for equines and 18 for human sera, that were also studied with IgM indirect immunofluorescence (IgM-IIF). Equine titres ≥100 were considered positive, and human sera titres ≥200 suggested probable recent or past infection. Urines were cultured in Ellinghausen-McCullough-Johnson-Harris (EMJH) media; local identification of one obtained isolate with lipL32 PCR, Multiple Locus Variable number tandem repeat Analysis and partial rrs gene sequencing, were completed at Institut Pasteur, Paris. Estimated reactivity was 61.3% for equines, which was higher than the studied bovine national levels (21%) and mainly observed with Icterohaemorrhagiae serogroup (40.3%), Sejroe, Canicola, Pomona or Ballum. Aged animals from slaughterhouses and cattle farms were the most frequently positive. Multiple regression analysis confirmed a significant association between seropositivity and equine age. Only one positive culture could be fully studied, and confirmed to be Leptospira interrogans serogroup Canicola; it was added to the MAT antigen panel and revealed fairly frequent reaction with equine and human sera. Three workers (2%) showed titres = 200 with Icterohaemorrhagiae or Canicola serogroups, without recent clinical manifestations. Their attended equines reacted with the same serogroups, suggesting common source infections or infection transmitted by equines. Three other humans yielded titres = 100, and none of the 150 showed an IgM-IIF-positive result. Equines seem not to be an important origin of regional human leptospirosis, except perhaps during acute animal infection. More culture work is required to study intensity and lapses of leptospiruria, as well as to further identify circulating strains.

The lateral hypothalamus and orexinergic transmission in the paraventricular thalamus promote the attribution of incentive salience to reward-associated cues.

RATIONALE: Prior research suggests that the neural pathway from the lateral hypothalamic area (LHA) to the paraventricular nucleus of the thalamus (PVT) mediates the attribution of incentive salience to Pavlovian reward cues. However, a causal role for the LHA and the neurotransmitters involved have not been demonstrated in this regard. OBJECTIVES: To examine (1) the role of LHA in the acquisition of Pavlovian conditioned approach (PavCA) behaviors, and (2) the role of PVT orexin 1 receptors (OX1r) and orexin 2 receptors (OX2r) in the expression of PavCA behaviors and conditioned reinforcement. METHODS: Rats received excitotoxic lesions of the LHA prior to Pavlovian training. A separate cohort of rats characterized as sign-trackers (STs) or goal-trackers (GTs) received the OX1r antagonist SB-334867, or the OX2r antagonist TCS-OX2-29, into the PVT, to assess their effects on the expression of PavCA behavior and on the conditioned reinforcing properties of a Pavlovian reward cue. RESULTS: LHA lesions attenuated the development of sign-tracking behavior. Administration of either the OX1r or OX2r antagonist into the PVT reduced sign-tracking behavior in STs. Further, OX2r antagonism reduced the conditioned reinforcing properties of a Pavlovian reward cue in STs. CONCLUSIONS: The LHA is necessary for the development of sign-tracking behavior; and blockade of orexin signaling in the PVT attenuates the expression of sign-tracking behavior and the conditioned reinforcing properties of a Pavlovian reward cue. Together, these data suggest that LHA orexin inputs to the PVT are a key component of the circuitry that encodes the incentive motivational value of reward cues.

Effects of a Reserve Protein on Spodoptera frugiperda Development: A Biochemical and Molecular Approach to the Entomotoxic Mechanism.

Talisin is a storage protein from Talisia esculenta seeds that presents lectin-like and peptidase inhibitor properties. These characteristics suggest that talisin plays a role in the plant defense process, making it a multifunctional protein. This work aimed to investigate the effects of chronic intake of talisin on fifth instar larvae of Spodoptera frugiperda, considered the main insect pest of maize and the cause of substantial economic losses in several other crops. The chronic intake of talisin presented antinutritional effects on the larvae, reducing their weight and prolonging the total development time of the insects. In addition, talisin-fed larvae also showed a significant reduction in the activity of trypsin-like enzymes. Midgut histology analysis of talisin-fed larvae showed alterations in the intestinal epithelium and rupture of the peritrophic membrane, possibly causing an increase of aminopeptidase activity in the midgut lumen. Talisin also proved to be resistant to degradation by the digestive enzymes of S. frugiperda. The transcription profile of trypsin, chymotrypsin and aminopeptidase genes was also analyzed through qPCR technique. Talisin intake resulted in differential expression of at least two genes from each of these classes of enzymes. Molecular docking studies indicated a higher affinity of talisin for the less expressed enzymes.

Mechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders.

Psychoactive substance use is a nearly universal human behavior, but a significant minority of people who use addictive substances will go on to develop an addictive disorder. Similarly, though ~90% of people experience traumatic events in their lifetime, only ~10% ever develop post-traumatic stress disorder (PTSD). Substance use disorders (SUD) and PTSD are highly comorbid, occurring in the same individual far more often than would be predicted by chance given the respective prevalence of each disorder. Some possible reasons that have been proposed for the relationship between PTSD and SUD are self-medication of anxiety with drugs or alcohol, increased exposure to traumatic events due to activities involved in acquiring illegal substances, or addictive substances altering the brain's stress response systems to make users more vulnerable to PTSD. Yet another possibility is that some people have an intrinsic vulnerability that predisposes them to both PTSD and SUD. In this review, we integrate clinical and animal data to explore these possible etiological links between SUD and PTSD, with an emphasis on interactions between dopaminergic, adrenocorticotropic, GABAergic, and glutamatergic neurobehavioral mechanisms that underlie different emotional learning styles.

Seroprevalencia de leptospirosis en grupos humanos en riesgo por factores ambientales, laborales o sociales / Seroprevalence of leptospirosis in human groups at risk due to environmental, labor or social conditions

Abstract Leptospirosis is important in Uruguay due to the economic loss caused by the diseases of production animals, mainly bovines, and also due to frequent human infection. We decided to study anti-Leptospira antibodies in the sera of dairy workers, rice laborers, veterinarians, suburban slum dwellers and garbage recyclers. Our aims were to estimate the seroprevalence of infection by Leptospira spp. in these people at risk, the relative importance of the known risk factors associated with infection, and the impact of human infections in each setting. Groups at risk were identified and 35 visits to their locations were made, conducting field surveys and exchange talks for information and education. Simple epidemiological questionnaires were administered and sera samples were taken from 308 persons. The microagglutination Technique (MAT) and the IgM Indirect Immunofluorescence (IIF) assay were employed to detect antibodies. Environmental water samples, canine and equine sera were also examined. More than 45% of human sera were reactive and the studied groups were confirmed to be widely exposed to infection. Female sera were frequently reactive, though most illnesses occur in men, and the most severe cases in elderly males; the emergence and evolution of the disease may strongly depend on the host condition and functions. Animal contact and unsafe water usage were the main identified risk factors to be considered in prevention. Fifty per cent of the studied horses showed a positive MAT reaction. The underdiagnosis of the illness and its long-term symptoms require further study, as well as greater health and social attention efforts.

Resumen La leptospirosis es importante en Uruguay por las pérdidas económicas que ocasionan las enfermedades en los animales de producción, principalmente en los bovinos, y a causa de la frecuente infección humana. Decidimos estudiar anticuerpos anti -Leptospira en trabajadores de tambo y de plantaciones de arroz, así como en veterinarios, habitantes de asentamientos y recicladores de residuos. Buscamos evaluar la importancia de distintos factores de riesgo conocidos asociados con la infección por Leptospira spp., y estimar la frecuencia y el impacto de las infecciones humanas en la población expuesta. Se efectuaron 35 visitas a colectivos de riesgo, realizando relevamientos de campo e intercambios educativos, llenando formularios epidemiológicos sencillos y tomando muestras de sangre a 308 personas. Se investigaron anticuerpos séricos con técnicas de microaglutinación (MAT) e inmunofluorescencia indirecta para IgM. Se examinaron también, muestras de agua ambiental, y sueros caninos y equinos. Más del 45% de los sueros humanos fueron reactivos y se confirmó que los grupos estudiados estaban ampliamente expuestos a la infección. Los sueros de mujeres fueron frecuentemente reactivos, aunque la mayoría de las enfermedades ocurren en varones, y los casos más graves en varones añosos. La emergencia y la evolución de la afección pueden depender fuertemente del estado del huésped y su respuesta. El contacto con animales y el uso de agua insegura fueron los principales factores de riesgo identificados para considerar en la prevención. El 50% de los sueros equinos fueron reactivos por MAT. Es necesario incrementar los esfuerzos de atención social y sanitaria en estos sectores, superar el subdiagnóstico y estudiar la evolución y la sintomatología a largo plazo de los pacientes.

Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos / Design and validation of the scale to assess the fragility of chronic patients

Objetivo: Crear una escala y herramienta que nos permita medir la fragilidad del paciente crónico. Diseño: Estudio observacional sobre crónicos del área. Emplazamiento: Se ha realizado entre enero de 2011 a diciembre 2015, una población de 2.108 individuos. Los datos se recogieron de la historia clínica y aplicación expresa para el registro de los pacientes frágiles, sobre hoja estructurada de recogida de datos. Participantes: Sujetos frágiles del área Sanitaria Norte de Málaga. Intervención: Diseño y validación de una escala. Mediciones principales: Variable principal de resultado: escala de fragilidad Antequera (EPADI) constituida por seis criterios/factores valorables: edad, Pfeiffer, Barthell, Charlson, sociofamiliar y pluripatológico. Las variables de resultados en accesibilidad se utilizaron como variables de predicción. Las variables cuantitativas se describen mediante la media y desviación estándar. Las variables cualitativas las presentamos en frecuencias junto con sus porcentajes. Para obtener un modelo de predicción de la utilización de recursos la muestra se dividió en dos sub-muestras de igual tamaño. Resultados: A partir de las variables de interés por expertos, se identificaron predictores univariantes en la utilización de recursos en la muestra M_EPADI1, para construir un modelo de regresión logística multivariante que permita predecir la utilización de recursos. Para la validación de la escala se utilizó la muestra M_EPADI2. Conclusiones: Se ha podido comprobar que los criterios utilizados en nuestra escala son adecuados para definir la fragilidad, por lo tanto la escala EPADI valora perfectamente el grado de fragilidad de los usuarios crónicos en base a los recursos consumidos

Objective: To create a scale and tool that allows us to measure the fragility of the chronic patient. Design: Observational study on the area's chronicles. Location: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. Participants: Fragile subjects of the North Sanitary Area of Malaga. Intervention: Design and validation of a scale. Main measurements: Study variables. Main outcome variable: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. Results: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. Conclusions: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. Conclusions: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed

Seroprevalence of leptospirosis in human groups at risk due to environmental, labor or social conditions.

Leptospirosis is important in Uruguay due to the economic loss caused by the diseases of production animals, mainly bovines, and also due to frequent human infection. We decided to study anti-Leptospira antibodies in the sera of dairy workers, rice laborers, veterinarians, suburban slum dwellers and garbage recyclers. Our aims were to estimate the seroprevalence of infection by Leptospira spp. in these people at risk, the relative importance of the known risk factors associated with infection, and the impact of human infections in each setting. Groups at risk were identified and 35 visits to their locations were made, conducting field surveys and exchange talks for information and education. Simple epidemiological questionnaires were administered and sera samples were taken from 308 persons. The microagglutination Technique (MAT) and the IgM Indirect Immunofluorescence (IIF) assay were employed to detect antibodies. Environmental water samples, canine and equine sera were also examined. More than 45% of human sera were reactive and the studied groups were confirmed to be widely exposed to infection. Female sera were frequently reactive, though most illnesses occur in men, and the most severe cases in elderly males; the emergence and evolution of the disease may strongly depend on the host condition and functions. Animal contact and unsafe water usage were the main identified risk factors to be considered in prevention. Fifty per cent of the studied horses showed a positive MAT reaction. The underdiagnosis of the illness and its long-term symptoms require further study, as well as greater health and social attention efforts.

Hamartoma de las glándulas de Brunner como causa inusual de sangrado gastrointestinal

RESUMEN Los tumores benignos del intestino delgado son infrecuentes. Entre ellos, los hamartomas de las glándulas de Brunner se localizan en su mayoría en el bulbo duodenal, generalmente son asintomáticos y detectados mediante una endoscopía de manera incidental. Cuando son de mayor tamaño, clínicamente se pueden presentar con sintomatología obstructiva o manifestaciones hemorrágicas. El tratamiento para este tipo de lesiones benignas es mediante su resección endoscópica o quirúrgica. Reportamos un caso infrecuente de sangrado gastrointestinal producido por un hamartoma de las glándulas de Brunner que fue tratado de manera exitosa mediante resección endoscópica.

ABSTRACT Benign tumors of the small intestine are infrequent. Among them, the Brunner's glands hamartomas are located mostly in the duodenal bulb, are usually asymptomatic and incidentally detected by an endoscopy. When they are larger, clinically they can present obstructive symptoms or hemorrhagic manifestations. The treatment for this type of benign lesions is the endoscopic or surgical resection. We report an infrequent case of gastrointestinal bleeding produced by a Brunner's gland hamartoma that was successfully treated by endoscopic resection.

Protein and surface expression of HCN2 and HCN4 subunits in mesocorticolimbic areas after cocaine sensitization.

The Ih is a mixed depolarizing current present in neurons which, upon activation by hyperpolarization, modulates neuronal excitability in the mesocorticolimbic (MCL) system, an area which regulates emotions such as pleasure, reward, and motivation. Its biophysical properties are determined by HCN protein expression profiles, specifically HCN subunits 1-4. Previously, we reported that cocaine-induced behavioral sensitization increases HCN2 protein expression in all MCL areas with the Ventral Tegmental Area (VTA) showing the most significant increase. Recent evidence suggests that HCN4 also has an important expression in the MCL system. Although there is a significant expression of HCN channels in the MCL system their role in addictive processes is largely unknown. Thus, in this study we aim to compare HCN2 and HCN4 expression profiles and their cellular compartmental distribution in the MCL system, before and after cocaine sensitization. Surface/intracellular (S/I) ratio analysis indicates that VTA HCN2 subunits are mostly expressed in the cell surface in contrast to other areas tested. Our findings demonstrate that after cocaine sensitization, the HCN2 S/I ratio in the VTA was decreased whereas in the Prefrontal Cortex it was increased. In addition, HCN4 total expression in the VTA was decreased after cocaine sensitization, although the S/I ratio was not altered. Together, these results demonstrate differential cocaine effects on HCN2 and HCN4 protein expression profiles and therefore suggest a diverse Ih modulation of cellular activity during cocaine addictive processes.

[Design and validation of the scale to assess the fragility of chronic patients]. / Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos.

OBJECTIVE: To create a scale and tool that allows us to measure the fragility of the chronic patient. DESIGN: Observational study on the area's chronicles. LOCATION: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. PARTICIPANTS: Fragile subjects of the North Sanitary Area of Malaga. INTERVENTION: Design and validation of a scale. MAIN MEASUREMENTS: Study variables. MAIN OUTCOME VARIABLE: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. RESULTS: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. CONCLUSIONS: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. CONCLUSIONS: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.

aPKC-Mediated Persistent Increase in AMPA/NMDA Ratio in the VTA Participates in the Neuroadaptive Signal Necessary to Induce NAc Synaptic Plasticity After Cocaine Administration.

Chronic cocaine exposure produces enduring neuroadaptations in the brain's reward system. Persistence of early cocaine-evoked neuroadaptations in the ventral tegmental area (VTA) is necessary for later synaptic alterations in the nucleus accumbens (NAc), suggesting a temporal sequence of neuroplastic changes between these two areas. However, the molecular nature of the signal that mediates this sequential event is unknown. Here we used the behavioral sensitization model and the aPKC inhibitor of late-phase LTP maintenance, ZIP, to investigate if a persistent increase in AMPA/NMDA ratio plays a role in the molecular mechanism that allows VTA neuroadaptations to induce changes in the NAc. Results showed that intra-VTA ZIP microinfusion successfully blocked cocaine-evoked synaptic enhancement in the VTA and the expected AMPA/NMDA ratio decrease in the NAc following cocaine sensitization. ZIP microinfusions also blocked the expected AMPA/NMDA ratio increase in the NAc following cocaine withdrawal. These results suggest that a persistent increase in AMPA/NMDA ratio, mediated by aPKCs, could be the molecular signal that enables the VTA to elicit synaptic alterations in the NAc following cocaine administration.

Isolation of pathogenic Leptospira strains from naturally infected cattle in Uruguay reveals high serovar diversity, and uncovers a relevant risk for human leptospirosis.

Leptospirosis is a neglected zoonosis with worldwide distribution. The causative agents are spirochete bacteria of the Leptospira genus, displaying huge diversity of serovars, the identity of which is critical for effective diagnosis and vaccination purposes. Among many other mammalian species, Leptospira infects cattle, eliciting acute signs in calves, and chronic disease in adult animals often leading to abortions. In South America, and including in Uruguay, beef and dairy export are leading sources of national income. Despite the importance of bovine health, food safety, and bovine-related dissemination of leptospirosis to humans, extremely limited information is available as to the identity of Leptospira species and serovars infecting cattle in Uruguay and the South American subcontinent. Here we report a multicentric 3-year study resulting in the isolation and detailed characterization of 40 strains of Leptospira spp. obtained from infected cattle. Combined serologic and molecular typing identified these isolates as L. interrogans serogroup Pomona serovar Kennewicki (20 strains), L. interrogans serogroup Canicola serovar Canicola (1 strain), L. borgpetersenii serogroup Sejroe serovar Hardjo (10 strains) and L. noguchii (9 strains). The latter showed remarkable phenotypic and genetic variability, belonging to 6 distinct serogroups, including 3 that did not react with a large panel of reference serogrouping antisera. Approximately 20% of cattle sampled in the field were found to be shedding pathogenic Leptospira in their urine, uncovering a threat for public health that is being largely neglected. The two L. interrogans serovars that we isolated from cattle displayed identical genetic signatures to those of human isolates that had previously been obtained from leptospirosis patients. This report of local Leptospira strains shall improve diagnostic tools and the understanding of leptospirosis epidemiology in South America. These strains could also be used as new components within bacterin vaccines to protect against the pathogenic Leptospira strains that are actually circulating, a direct measure to reduce the risk of human leptospirosis.

Experiencia del paciente: una nueva forma de entender la atención al paciente oncológico / Patient experience: A new way to understand care for the oncological patient

En el presente trabajo se analiza el concepto de Experiencia del Paciente (PX) así como las variables que contribuyen a la mejora del mismo. El objetivo es explicar su utilidad clínica en el ámbito de la salud, en concreto sobre la población oncológica, además de demostrar el papel activo que la Psicooncología puede tener en la implementación de esta estrategia, en relación directa con la humanización de la asistencia sanitaria. Para ello, se ha revisado la literatura con evidencia empírica existente hasta el momento y que sitúa la experiencia del paciente como un pilar indispensable a la hora de mejorar la calidad de la atención clínica, junto con la efectividad del tratamiento y la seguridad del paciente. Estos elementos presentan una interacción positiva entre ellos y están moderados por la comunicación médico-paciente, lo que evidencia la necesidad de desarrollar habilidades de comunicación por los profesionales en la práctica clínica, la coordinación de la atención sanitaria, el acceso a los servicios y la percepción del paciente respecto a la atención recibida. La experiencia del paciente resulta clínicamente relevante e influyente en la recuperación del estado de salud del paciente, así como constituye un cambio en la cultura sanitaria, cuyo protagonista es el paciente y en torno a él debe girar dicho cambio de manera multidisciplinar e integral por parte de los profesionales sanitarios implicados en su cuidado. Se concluye con una nueva línea de actuación del psicooncólogo en la experiencia del paciente para promover un servicio oncológico de calidad (AU)

In the present paper, the concept of Patient Experience (PX) is analyzed, as well as the variables that contribute to its improvement. The aim is to explain its clinical utility in the field of health, specifically on the oncology population, in addition to demonstrating the active role that Psychooncology can have in the implementation of this strategy, in direct relation with the humanization of health care. For this, the literature has been reviewed with empirical evidence that has existed up to now and which places the patient's experience as an essential pillar when improving the quality of clinical care, together with the effectiveness of treatment and patient safety. These elements present a positive interaction between them and are moderated by the doctor-patient communication, which evidences the need to develop communication skills by professionals in clinical practice, the coordination of healthcare, access to services and perception of the patient regarding the care received. The patient's experience is clinically relevant and influential in the recovery of the health status of the patient, as well as constitutes a change in the health culture, whose protagonist is the patient and around him must turn this change in a multidisciplinary and integral way of the health professionals involved in their care. It is concluded with a new line of action of the psycho-oncologist in the patient’s experience to promote a quality oncological service (AU)