Where to next with animal health in Latin America? The transition from endemic to disease-free status.

The Latin American and Caribbean region (LAC) is a leading global producer and exporter of animal products. Its livestock production systems are diverse, ranging from large-scale commercial enterprises to family farms. Countries in this region have sought to improve their animal health status through both public and private efforts. Despite significant advances in eradicating such diseases as foot and mouth disease and classical swine fever, other animal health challenges remain; constraining exports, causing negative economic impacts and threatening food security. Obtaining certification of disease-free status is only the first step towards gaining benefits from improvements in animal health. Increasing international trade means that countries must manage the sustainability of their disease-free status in conjunction with trade partners and must comply with additional food safety and animal welfare standards. This paper comments on the challenges created by this new scenario in relation to the epidemiology and economics of animal health, when seeking to improve decisionmaking for animal health management. The authors characterise the current LAC livestock landscape and animal health situation, describing transitions in disease control and the use of economics in improving animal health. They conclude with remarks on the challenges presented by decision-making, economic rationality, sources of benefits, distribution and incentives.

La région Amérique latine et Caraïbes est l'une des principales régions productrices et exportatrices de produits d'origine animale dans le monde. Les systèmes de production du secteur de l'élevage y sont très diversifiés, depuis les petites exploitations familiales jusqu'aux élevages commerciaux à grande échelle. Les pays de la région ont cherché à améliorer la situation de la santé animale sur leur territoire en y consacrant les efforts de leur secteur public et privé. Malgré les avancées considérables réalisées dans l'éradication de maladies comme la fièvre aphteuse et la peste porcine classique, la santé animale est encore confrontée à des problèmes qui freinent les exportations et ont un impact économique négatif, tout en menaçant la sécurité de l'approvisionnement alimentaire. La reconnaissance officielle du statut indemne de maladie ne représente qu'une première étape dans le processus visant à générer des bénéfices grâce à une meilleure santé animale. L'intensification des échanges internationaux impose aux pays de s'assurer de la durabilité de leur statut indemne aux côtés de leurs partenaires commerciaux et de respecter de nouvelles normes relatives à la sécurité sanitaire des aliments et au bien-être animal. Les auteurs analysent les conséquences de ce scénario sur l'épidémiologie et l'économie de la santé animale ainsi que ses enjeux dans la recherche d'une meilleure prise de décisions dans la gestion de la santé animale. Ils définissent ensuite le paysage actuel de l'élevage et la situation de la santé animale en Amérique latine et dans les Caraïbes et décrivent les évolutions à l'oeuvre en matière de lutte contre les maladies animales et d'utilisation de l'économie dans l'amélioration de la santé animale. Ils concluent sur quelques remarques concernant les difficultés qui se présentent en matière de prise de décision, de rationalité économique, de sources de profit, de distribution et d'incitation.

La región de América Latina y el Caribe es uno de los principales productores y exportadores de productos animales del mundo. Sus sistemas de producción ganadera exhiben gran heterogeneidad, pues van desde las grandes empresas de dimensión industrial hasta las pequeñas explotaciones familiares. Apoyándose en la iniciativa tanto pública como privada, los países de la región vienen tratando de mejorar su situación zoosanitaria. Pese a los importantes progresos registrados en la erradicación de enfermedades como la fiebre aftosa o la peste porcina clásica, subsisten otros problemas de sanidad animal que restringen las exportaciones, lastran la economía y amenazan la seguridad alimentaria. La certificación de «ausencia de enfermedad¼ es solo el primer paso para beneficiarse de las mejoras conseguidas en el terreno de la sanidad animal. Habida cuenta de la intensificación del comercio internacional, los países deben gestionar la continuidad a largo plazo de su estatuto de «libres de enfermedad¼ conjuntamente con sus socios comerciales y, para ello, cumplir normas adicionales en material de inocuidad de los alimentos y bienestar animal. Los autores exponen las dificultades que se plantean en esta nueva coyuntura de la epidemiología y la economía de la sanidad animal a la hora de mejorar los procesos decisorios en materia de gestión zoosanitaria. Tras caracterizar el actual paisaje de la ganadería y la situación zoosanitaria en América Latina y el Caribe, describen la transición que se está operando en cuanto al control de enfermedades y al uso de la economía para mejorar la sanidad animal y concluyen con una serie de observaciones sobre los problemas que surgen en relación con la adopción de decisiones, la racionalidad económica, las fuentes de beneficios y las cuestiones ligadas a la distribución y los incentivos.

A novel fibrinogen mutation: FGA g. 3057 C > T (p. Arg104 > Cys) impairs fibrinogen secretion.

BACKGROUND: Abnormal fibrinogens can be caused by clinically silent hereditary mutations. A new case was detected accidentally in an 11-year-old girl when routine pre-operative coagulation tests were performed for nasal turbinate surgery. METHODS: The fibrinogen genes FGA, FGG and FGB were sequenced using standard protocols. The kinetics of fibrin formation were followed by turbidity at 350 nm. Purified fibrinogen was incubated with plasmin, and the degradation products analyzed by SDS/PAGE. The formation of fibrinogen-albumin complexes was analyzed by immunobloting. Fibrin structure was examined in a Nikon Eclipse TE 2000-U laser microscope. Secretion of the variant protein was analyzed directly by reverse phase-electrospray time of flight-mass spectrometry (TOF-MS). RESULTS: DNA sequencing revealed a novel heterozygous g. 3057 C > T mutation in the FGA that predicts a p. Arg104 > Cys substitution, in the proband and her father. Both patients were asymptomatic with low functional and antigen fibrinogen concentrations. The proband's plasma fibrinogen polymerization was almost normal, with a 12% decrease in the final turbidity, while, the father's fibrin formation had a diminished slope and final turbidity (2.5× and 40%, respectively). Aα Arg104 is located at a plasmin cleavage site in the coiled-coil region of fibrinogen. However, the father's fibrinogen plasmin degradation was normal. Although the exchanged Cys introduces an unpaired -SH, immunoblotting showed no fibrinogen-albumin complexes. Furthermore, the plasma clot structure observed by confocal microscopy appeared almost normal. TOF-MS showed that the variant Aα chain was underrepresented in plasma and made up only about 25% of the total. CONCLUSIONS: The low expression of the Aα Arg104 > Cys chain in circulation could account for the observed hypodysfibrinogenemia.

In Vivo Analysis of NH4+ Transport and Central Nitrogen Metabolism in Saccharomyces cerevisiae during Aerobic Nitrogen-Limited Growth.

Ammonium is the most common N source for yeast fermentations. Although its transport and assimilation mechanisms are well documented, there have been only a few attempts to measure the in vivo intracellular concentration of ammonium and assess its impact on gene expression. Using an isotope dilution mass spectrometry (IDMS)-based method, we were able to measure the intracellular ammonium concentration in N-limited aerobic chemostat cultivations using three different N sources (ammonium, urea, and glutamate) at the same growth rate (0.05 h-1). The experimental results suggest that, at this growth rate, a similar concentration of intracellular (IC) ammonium, about 3.6 mmol NH4+/literIC, is required to supply the reactions in the central N metabolism, independent of the N source. Based on the experimental results and different assumptions, the vacuolar and cytosolic ammonium concentrations were estimated. Furthermore, we identified a futile cycle caused by NH3 leakage into the extracellular space, which can cost up to 30% of the ATP production of the cell under N-limited conditions, and a futile redox cycle between Gdh1 and Gdh2 reactions. Finally, using shotgun proteomics with protein expression determined relative to a labeled reference, differences between the various environmental conditions were identified and correlated with previously identified N compound-sensing mechanisms.IMPORTANCE In our work, we studied central N metabolism using quantitative approaches. First, intracellular ammonium was measured under different N sources. The results suggest that Saccharomyces cerevisiae cells maintain a constant NH4+ concentration (around 3 mmol NH4+/literIC), independent of the applied nitrogen source. We hypothesize that this amount of intracellular ammonium is required to obtain sufficient thermodynamic driving force. Furthermore, our calculations based on thermodynamic analysis of the transport mechanisms of ammonium suggest that ammonium is not equally distributed, indicating a high degree of compartmentalization in the vacuole. Additionally, metabolomic analysis results were used to calculate the thermodynamic driving forces in the central N metabolism reactions, revealing that the main reactions in the central N metabolism are far from equilibrium. Using proteomics approaches, we were able to identify major changes, not only in N metabolism, but also in C metabolism and regulation.

Hallazgos endoscópicos y patológicos en pacientes con VIH y síntomas digestivos de un hospital universitario / Endoscopic and Pathological Findings in Patients with HIV and Digestive Symptoms at a University Hospital

Introducción: el tracto gastrointestinal es un sitio frecuentemente afectado por el VIH; sin embargo, en la práctica clínica algunos hallazgos normales en la endoscopia pueden no serlo, lo cual conlleva a estos pacientes a no recibir tratamiento oportuno para patologías gastrointestinales. Métodos: estudio observacional descriptivo en pacientes con VIH que consultaron por síntomas digestivos y que requirieron endoscopia y/o colonoscopia durante el año 2014 en el Hospital Universitario de Santander. Se tomaron datos sociodemográficos, clínicos y paraclínicos. Se realizaron 41 endoscopias altas y 29 colonoscopias en 54 pacientes. A todo estudio se le practicó biopsia. Resultados: la edad promedio fue de 39 años, la sintomatología digestiva con mayor reporte fue la diarrea y las lesiones orales; 87% tenían conteo menor a 200 CD4, solo 24% reciben actualmente TARAE. Los diagnósticos más frecuentes por anatomía patológica diferentes a normalidad fueron: Candidiasis (17%) en esófago, gastritis crónica moderada (26,7%) en estómago y colitis crónica inespecífica moderada tanto en colon izquierdo (44,8%) como en colon derecho (51,7%). Conclusiones: los hallazgos endoscópicos y patológicos concuerdan con la frecuencia de presentaciones reportadas en la literatura, aunque no se encontraron neoplasias ni agentes infecciosos como micobacterias. Los oportunistas más frecuentes fueron la cándida y el citomegalovirus. Al confrontar el diagnóstico de normalidad entre el endoscopista y la anatomía patológica, solamente en esófago había una concordancia aceptable, a diferencia del estómago y el colon, donde la disparidad es evidente. Por lo anterior, en pacientes con VIH/sida que requieran endoscopia sería importante siempre considerar la toma biopsias de manera protocolizada.

Introduction: Although the gastrointestinal tract is frequently affected by HIV, in clinical practice abnormalities related to HIV often appear to be normal when seen through an endoscope. The consequence is that these patients do not receive timely treatment for gastrointestinal diseases. Methods: This is an observational study of HIV patients who came to the hospital of the Universidad Industrial de Santander because of digestive symptoms that required either endoscopy or colonoscopy, or both ,during 2014. Socio-demographic, clinical and laboratory data were collected. A total of 41 upper endoscopies and 29 colonoscopies were performed in 54 patients. Biopsies were taken and analyzed in all cases. Results: The mean patient age was 39 years old, the most frequent digestive symptoms were diarrhea and oral lesions, 87% of these patients had CD4 counts below 200, and only 24% currently receive HAART. The most frequent diagnoses were: esophageal candidiasis (17%), moderate chronic gastritis in the stomach (26.7%), and moderate chronic nonspecific colitis in the left colon (44.8%) and in the right colon (51.7%). Conclusions: Endoscopic and pathological findings are consistent with the frequencies of presentations of gastrointestinal pathologies reported in the literature except that no tumors or infectious agents such as mycobacteria were found. The most common opportunistic infections were Candida and Cytomegalovirus. Diagnostic agreement between the endoscopist and pathologist varied. There was had only fair agreement for the esophagus, but there were large disparities for the stomach and colon. Consequently, when HIV/AIDS patients require endoscopy, it is important that the protocol call for biopsy samples and analysis.

Endothelial fibrinolytic response onto an evolving matrix of fibrin.

BACKGROUND: Fibrin provides a temporary matrix at the site of vascular injury. The aims of the present work were (1) to follow fibrin formation and lysis onto the surface of human dermal microvascular endothelial cells (HMEC-1), and (2) to quantify the secretion of fibrinolytic components in the presence of fibrin. METHODS: Fibrin clots at different fibrinogen concentrations were formed on top of (model 1) or beneath (model 2) the endothelial cells. Fibrin formation or lysis onto the surface of HMEC-1 cells, was followed by turbidity. Clot structure was visualized by laser scanning confocal microscopy (LSCM). The secretion of uPA and PAI-1 by HMEC-1 cells was quantified by ELISA. RESULTS: The rate of fibrin formation increased approximately 1.5-fold at low fibrinogen content (0.5 and 1 mg/mL; p < 0.05) compared to the condition without cells; however, it was decreased at 2 mg/mL fibrinogen (p < 0.05) and no differences were found at higher fibrinogen concentrations (3 and 5 mg/mL). HMEC-1 retarded dissolution of clots formed onto their surface at 0.5 to 3 mg/mL fibrinogen (p < 0.05). Secretion of uPA was 13 × 10(-6) ng/mL per cell in the absence of RGD and 8 × 10(-6) ng/mL per cell in the presence of RGD, when clots were formed on the top of HMEC-1. However, the opposite was found when cells were grown over fibrin: 6 × 10(-6) ng/mL per cell without RGD vs. 17 × 10(-6) ng/mL per cell with RGD. The secretion of PAI-1 by HMEC-1 cells was unrelated to the presence of fibrin or RGD, 7 × 10(-6) µg/mL per cell and 5 × 10(-6) µg/mL per cell, for the apical (model 1) and basal clots (model 2), respectively. CONCLUSIONS: HMEC-1 cells influence fibrin formation and dissolution as a function of the fibrin content of clots. Clot degradation was accentuated at high fibrin concentrations. The secretion of fibrinolytic components by HMEC-1 cells seemed to be modulated by integrins that bind RGD ligands.

Postoperative adjuvant treatment for gastric cancer improves long-term survival after curative resection and D2 lymphadenectomy. Results from a Latin American Center.

BACKGROUND: The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. METHODS: We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. RESULTS: The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. CONCLUSIONS: These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.

Presence of a thapsigargin-sensitive calcium pump in Trypanosoma evansi: Immunological, physiological, molecular and structural evidences.

In higher eukaryotes, the sarco-endoplasmic reticulum (ER) Ca(2+)-ATPase (SERCA) is characterized for its high sensitivity to low concentrations of thapsigargin (TG), a very specific inhibitor. In contrast, SERCA-like enzymes with different sensitivities to TG have been reported in trypanosomatids. Here, we characterized a SERCA-like enzyme from Trypanosoma evansi and evaluated its interaction with TG. Confocal fluorescence microscopy using BODIPY FL TG and specific anti-SERCA antibodies localized the T. evansi SERCA-like enzyme in the ER and confirmed its direct interaction with TG. Moreover, the use of either 1 µM TG or 25 µM 2',5'-di (tert-butyl)-1,4-benzohydroquinone prevented the reuptake of Ca(2+) and consequently produced a small increase in the parasite cytosolic calcium concentration in a calcium-free medium, which was released from the ER pool. A 3035 bp-sequence coding for a protein with an estimated molecular mass of 110.2 kDa was cloned from T. evansi. The corresponding gene product contained all the invariant residues and conserved motifs found in other P-type ATPases but lacked the calmodulin binding site. Modeling of the three-dimensional structure of the parasite enzyme revealed that the amino acid changes found in the TG-SERCA binding pocket do not compromise the interaction between the enzyme and the inhibitor. Therefore, we concluded that T. evansi possesses a SERCA-like protein that is inhibited by TG.

Functional expression of a heterologous nickel-dependent, ATP-independent urease in Saccharomyces cerevisiae.

In microbial processes for production of proteins, biomass and nitrogen-containing commodity chemicals, ATP requirements for nitrogen assimilation affect product yields on the energy producing substrate. In Saccharomyces cerevisiae, a current host for heterologous protein production and potential platform for production of nitrogen-containing chemicals, uptake and assimilation of ammonium requires 1 ATP per incorporated NH3. Urea assimilation by this yeast is more energy efficient but still requires 0.5 ATP per NH3 produced. To decrease ATP costs for nitrogen assimilation, the S. cerevisiae gene encoding ATP-dependent urease (DUR1,2) was replaced by a Schizosaccharomyces pombe gene encoding ATP-independent urease (ure2), along with its accessory genes ureD, ureF and ureG. Since S. pombe ure2 is a Ni(2+)-dependent enzyme and Saccharomyces cerevisiae does not express native Ni(2+)-dependent enzymes, the S. pombe high-affinity nickel-transporter gene (nic1) was also expressed. Expression of the S. pombe genes into dur1,2Δ S. cerevisiae yielded an in vitro ATP-independent urease activity of 0.44±0.01 µmol min(-1) mg protein(-1) and restored growth on urea as sole nitrogen source. Functional expression of the Nic1 transporter was essential for growth on urea at low Ni(2+) concentrations. The maximum specific growth rates of the engineered strain on urea and ammonium were lower than those of a DUR1,2 reference strain. In glucose-limited chemostat cultures with urea as nitrogen source, the engineered strain exhibited an increased release of ammonia and reduced nitrogen content of the biomass. Our results indicate a new strategy for improving yeast-based production of nitrogen-containing chemicals and demonstrate that Ni(2+)-dependent enzymes can be functionally expressed in S. cerevisiae.

[Spondylodiscitis in children: a case report]. / Espondilodiscitis en pediatría: caso clínico.

INTRODUCTION: Spondylodiscitis (discitis plus osteomyelitis) is an infection of the spine that involves the intervertebral disc and the vertebral body. Patients present common symptoms although little specific, and suspicion for diagnosis is required. Most cases are resolved with pharmacological management; antibiotics remain as the main treatment. OBJECTIVE: To describe a patient with a spondylodiscitis, the diagnostic and therapeutic approach. CASE REPORT: A 2-year-old preschooler, with three months of refusal to walk, pain associated with standing and sitting, and absence of fever throughout evolution is presented. Physical examination reported tenderness in the lumbar region, muscle contracture and decreased lumbar lordosis. No neurological involvement and negative Gowers' sign were described. Lumbosacral spine X-ray and pelvic MRI showed abnormality of the L5-S1 disc, with bone erosions compatible with spondylodiscitis. Antibiotic treatment, physical rehabilitation and analgesia were administered, the patient completely evolved from condition. CONCLUSION: Spondylodiscitis must be considered in children with acute ambulation changes. The importance of prompt diagnosis and treatment involving the entire multidisciplinary team in order to improve the prognosis of patients is emphasized.

Encefalitis por Anticuerpos contra el Receptor N-metil D-aspartato(NMDAR) en Pediatría. Reporte de caso y revisión de la literatura / Encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) in pediatrics. Case report

La Encefalitis por Anticuerpos contra el Receptor N-metil D-aspartato (NMDAR) es un trastorno grave conuna presentación inicial puramente neuropsiquiátrica, que evoluciona hacia una encefalopatía severa, y es acompañadopor movimientos involuntarios, convulsiones e inestabilidad autonómica; el curso de la enfermedadusualmente se prolonga y necesita tratamiento inmunomodulador agresivo.Se describe el caso de un paciente de 5 años con diagnóstico de Encefalitis por Anticuerpos contra el ReceptorN-metil D-aspartato (NMDAR), manejado con tratamiento inmunomodulador, logrando así control y noprogreso de enfermedad...

Anti-NMDA receptor encephalitis is a severe disorder with a dramatic clinical presentation, often showing apurely initial neuropsychiatric phase, and evolving into a severe encephalopathy accompanied by involuntarymovements, seizures and autonomic instability; the disease course is typically prolonged and needs intensivecare treatment.We report the case of a 5-year-old child, diagnosed with Anti-NMDA receptor encephalitis with immunemodulatory therapy...

Hematopoyesis extramedular renal: caso clínico / Renal extramedullary hematopoiesis: case report

Introducción: La Hematopoyesis Extramedular (HEM) se define como la producción de células precursoras de la línea eritrocítica, granulocítica y megacariocítica fuera de la médula ósea, con una rara incidencia, la cual se limita a reportes de casos. Objetivo: Describir un caso de HEM renal secundaria a un proceso hipóxico crónico. Caso clínico: Adolescente de 16 años portador de hipoxia crónica, cianosis central, acropaquia, viviendo a una altura superior a 2.500 metros sobre el nivel del mar. Hipoxia crónica, probablemente secundaria a Hipertensión Pulmonar, no pesquisada previamente ni tratada. Consultó por masa en hipocondrio izquierdo, de 3 meses de evolución. Ecocardiograma mostró Hipertensión pulmonar que no pudo ser valorada por estudios hemodinámicos. En la Tomografía Computarizada (TC) se evidenciaron masas intrarenales bilaterales, de predominio izquierdo e intrapélvicas. Hemograma con marcada policitemia, por lo que se realizó aspirado de médula ósea, que descartó patología maligna que la invada. La biopsia de la masa renal reportó HEM con sus tres líneas hematopoyéticas. Conclusión: Este caso de HEM, se plantea como respuesta al proceso de hipoxia crónica y no a lesión de medula ósea como usualmente se ha descrito.

Extramedullary hematopoiesis (EMH) is defined as the formation and development of erythrocytic, granulocytic and megakaryocytic cell lines outside the bone marrow; it is a rare occurrence, which is limited to case reports. Objective: To describe a case of renal EMH secondary to chronic hypoxia. Case report: The patient is a 16 year old teenager who developed chronic hypoxia, central cyanosis, clubbing and lives more than 2,500 m above sea level. Chronic hypoxia is probably secondary to pulmonary hypertension, neither detected nor previously treated. The Consultation was due to a mass in the left upper quadrant for the last three months. An Echocardiogram showed pulmonary hypertension that could not be assessed by hemodynamic parameters. A computed tomography showed bilateral left renal pelvic masses. The hemogram showed polycythemia, so bone marrow aspiration was performed, which rule out malignant pathology. A biopsy of the renal mass reported EMH with three hematopoietic cell lines. Conclusion: This EMH case is a response to chronic hypoxia rather than to a bone marrow lesion as it has usually been described.

Espondilodiscitis en pediatría: caso clínico / Spondylodiscitis in children: a case report

Introduction: Spondylodiscitis (discitis plus osteomyelitis) is an infection of the spine that involves the intervertebral disc and the vertebral body. Patients present common symptoms although little specific, and suspicion for diagnosis is required. Most cases are resolved with pharmacological management; antibiotics remain as the main treatment. Objective: To describe a patient with a spondylodiscitis, the diagnostic and therapeutic approach. Case report: A 2-year-old preschooler, with three months of refusal to walk, pain associated with standing and sitting, and absence of fever throughout evolution is presented. Physical examination reported tenderness in the lumbar region, muscle contracture and decreased lumbar lordosis. No neurological involvement and negative Gowers' sign were described. Lumbosacral spine X-ray and pelvic MRI showed abnormality of the L5-S1 disc, with bone erosions compatible with spondylodiscitis. Antibiotic treatment, physical rehabilitation and analgesia were administered, the patient completely evolved from condition. Conclusion: Spondylodiscitis must be considered in children with acute ambulation changes. The importance of prompt diagnosis and treatment involving the entire multidisciplinary team in order to improve the prognosis of patients is emphasized.

Introducción: La Espondilodiscitis (discitis más osteomielitis) es la infección de la columna que compromete el disco intervertebral y el cuerpo vertebral. Esta entidad cursa con sintomatología típica, aunque poco específica y requiere un alto índice de sospecha para su diagnóstico. La mayoría de los casos se resuelven con manejo farmacológico, siendo los antibióticos el pilar en el tratamiento. Objetivos: Caracterizar una paciente con Espondilodiscitis, su abordaje diagnóstico y terapéutico. Caso clínico: Preescolar de 2 años, con historia de 3 meses con rechazo de la marcha, dolor con la bipedestación y sedestación, sin fiebre durante toda su evolución. Al examen físico destacaba dolor a la palpación de la región lumbar, contractura de los músculos para espinosos y disminución de la lordosis lumbar. Sin compromiso neurológico, signo de Gowers negativo. Radiografía de columna lumbosacra normal y resonancia magnética con contraste de pelvis, evidenció alteración del disco L5-S1, con erosiones óseas compatibles con Espondilodiscitis. Se administró tratamiento antibiótico, analgesia y rehabilitación física, evolucionando con resolución completa del cuadro. Conclusión: En niños con alteraciones agudas en la deambulación debe pensarse en la Espondilodiscitis. Se destaca la importancia de un diagnóstico y tratamiento oportuno, que involucra a todo un equipo médico multidisciplinario, para mejorar el pronóstico de los pacientes.

[Renal extramedullary hematopoiesis. Case report]. / Hematopoyesis extramedular renal. Caso clínico.

UNLABELLED: Extramedullary hematopoiesis (EMH) is defined as the formation and development of erythrocytic, granulocytic and megakaryocytic cell lines outside the bone marrow; it is a rare occurrence, which is limited to case reports. OBJECTIVE: To describe a case of renal EMH secondary to chronic hypoxia. CASE REPORT: The patient is a 16 year old teenager who developed chronic hypoxia, central cyanosis, clubbing and lives more than 2,500 m above sea level. Chronic hypoxia is probably secondary to pulmonary hypertension, neither detected nor previously treated. The Consultation was due to a mass in the left upper quadrant for the last three months. An Echocardiogram showed pulmonary hypertension that could not be assessed by hemodynamic parameters. A computed tomography showed bilateral left renal pelvic masses. The hemogram showed polycythemia, so bone marrow aspiration was performed, which rule out malignant pathology. A biopsy of the renal mass reported EMH with three hematopoietic cell lines. CONCLUSION: This EMH case is a response to chronic hypoxia rather than to a bone marrow lesion as it has usually been described.

Prevalencia de depresión en pacientes adultos con enfermedad celíaca / Prevalence of depression in adult celiac disease patients

Introduction: Celiac disease (CD) is an autoimmune disorder that affects the gastrointestinal tract and other systems like the neuropsychiatric system, where depression is the most frequent disease. Objectives: To determine the prevalence of depression in adult celiac patients and relate these results with the adherence to a gluten-free diet. Materials and Methods: Descriptive cross-sectional study, with +18-year-old patients diagnosed with CD, confirmed with biopsy. 123 subjects from Fundación Convivir and from Instituto de Diagnóstico Gastroenterológico answered Beck Depression Inventory II (BDI-II) vía e-mail, which consists of 21 questions on personal aspects of their life; and also a survey on general aspects generales. A result of > 20 points was considered depression. Results: Average age was 38.9 years, 82.9 percent female. 17.1 percent (21 cases) present with depression according to BDI-II score. 62.6 percent adhere to the diet and 10.4 percent present depression; on the other hand, of 37.4 percent that are non-adherent, 28.3 percent present this disease. The association between both variables is statistically significant (p < 0.014). Discussion: High prevalence of depression was determined in CD patients compared to 9 percent, corresponding to the countries global figure. Most of them showed previous history of depressive disease. Adequate adherence to a gluten-free diet is associated to lower prevalence of depression.

Introducción: La enfermedad celíaca (EC) es una patología autoinmune que afecta al aparato gastrointestinal y a otros sistemas como el neuro-psiquátrico, área en la que la depresión es la patología más frecuente. Objetivos: Determinar la prevalencia de depresión en pacientes adultos con EC y relacionar resultados con la adherencia o no a una dieta libre de gluten. Materiales y Métodos: Estudio descriptivo de corte transversal que incluyó a pacientes de 18 años o más, con diagnóstico de EC confirmado por biopsia. Se aplicó vía correo electrónico el Inventario de Depresión de Beck II (BDI-II) que consta de 21 preguntas sobre aspectos de su vida personal; y una encuesta de antecedentes generales a 123 sujetos provenientes de la Fundación Convivir y del Instituto de Diagnóstico Gastroenterológico. Se consideró depresión si el puntaje es > 20 puntos. Resultados: La edad promedio fue de 38,9 años y el 82,9 por ciento eran mujeres. El 17,1 por ciento (21 casos) presentan depresión según la escala de BDI-II. El 62,6 por ciento son adherentes a la dieta y presentan depresión el 10,4 por ciento; en cambio del 37,4 por ciento que no son adherentes, el 28,3 por ciento presenta esta patología. La asociación entre ambas variables es estadísticamente significativa (p < 0,014). Discusión: Se determinó una alta prevalencia de depresión en pacientes con EC en comparación con 9 por ciento que corresponde a la cifra global del país. La mayoría de ellos presentaban antecedentes previos de enfermedad depresiva. Una adecuada adherencia a la dieta libre de gluten se asocia a una menor frecuencia de depresión.

Angiomatosis cavernosa cerebral múltiple en pediatria / Cavernous angiomatosis in children

Las malformaciones vasculares intracraneanas en niños son lesiones congénitas debidas a alteraciones en el desarrollo de la red arteriocapilar. Se presentan por orden de frecuencia: malformaciones arteriovenosas, angiomas cavernosos o cavernomas, angiomas venosos y telangiectasias. Se describe el caso de un paciente de 3 años de edad con diagnostico de angiomatosis cavernosa cerebral múltiple derecha, con variadas manifestaciones clínicas, como crisis convulsivas focales complejas motoras, alteración en la marcha, hemiparesia izquierda, entre otras que están relacionadas con esta patología. Los casos descritos de angiomatosis cavernosa múltiple son en pacientes adultos, es evidente entonces que este caso clínico contribuye a una identificación en la literatura por sus características especiales de presentación clínica y manejo en pacientes pediátricos.

Intracranial vascular malformations are congenital lesions due to alterations in network development arterioca-pillary. Are presented in order of frequency, arteriovenous malformations, cavernous angiomas or cavernomas, venous angiomas and telangiectasias. This paper describe the case of a 3 year old boy diagnosed with multiple peripheral cerebral cavernous angio-matosis right with different clinical symptoms such as focal motor seizures, left hemiparesis, among others related to this pathology. Multiple cavernous angiomatosis has been described in adult patients, it is clear then that the case report contributes to the literature identifying special characteristics of clinical presentation and management in pediatric patients.

Characterization of backyard poultry production systems and disease risk in the central zone of Chile.

Backyard poultry production systems (BPS) are an important and widespread form of poultry production. There is a common perception that biosecurity standards in BPS are generally poor and BPS are usually associated with animal diseases and zoonoses. In this study BPS were identified in the vicinity of six wetlands, having these a higher risk of presenting and introducing avian diseases such as HPAI and Newcastle disease, as defined by the national veterinary services, in to Chile's main poultry production area. BPS were characterized through a field questionnaire and the main areas covered by the survey were BPS structure, biosecurity and value chain. The BPS identified in this study share most characteristics on biosecurity, poultry management and product commercialization, but it was possible to identify a certain degree of variation within and among the study sites. BPS in Chile are similar to those in other regions, with a relatively small flock size (average 37 birds), a low level of biosecurity measures and lack of poultry disease management. Management findings include that most farmers used mixed/partial confinement, with low or no biosecurity and disease control measures in place. Eggs were the main output and were used mainly for home consumption or sale at local markets. Sick birds' treatment with drugs approved for other species or for human use could represent a risk to human health, owing to the possible presence of drug residues in poultry products. Despite the different structures of the poultry sector worldwide, BPS can play a major role in disease maintenance and spread because its management conditions characteristics and the lack of animal health services adapted to these production systems. This should be an alert message to the veterinary authorities to improve coverage of veterinary assistance and surveillance activities in backyard poultry production.

First Report of Black Spots on Avocado Fruit Caused by Neofusicoccum parvum in Mexico.

Avocado (Persea americana L.) production for export markets has increased in Mexico during the past 10 years. The production system, however, is affected by several sanitation factors, including diseases. During the spring of 2009, smooth, black, circular spots were noted on the surface of avocado fruit. A study was conducted during the winter of 2010 to ascertain the etiology and identify the fungus associated with black spot symptoms on avocado fruit in orchards of Nuevo Parangaricutiro County (19°25'00″ and 102°07'43″) in Michoacan, Mexico. Several fungal isolates were obtained on potato dextrose agar (PDA) from the margin of lesions on immature fruit. The internal transcribed spacer region (ITS) of the rDNA from representative isolates was sequenced with universal primers ITS5 and ITS4 (2). BLAST searches in GenBank showed 100% similarity of the nucleotide sequences with Neofusicoccum parvum (Pennycook & Samuels) Crous, Slippers & A.J.L. Phillips, GenBank Accession Nos. GU188001 to GU188007 and GU187985 to GU187987. A representative nucleotide sequence of this region was deposited in GenBank under the Accession No. JN203129. Strains of N. parvum produced aerial and compact mycelium on acidified PDA, the anamorph state of Botryosphaeria parva. Mycelium was initially white, turning gradually gray to black. Conidia were one celled, hyaline, ellipsoidal to fusiform, externally smooth, thin walled, nonseptate, with one or two septa with age, and an average length and width of 14.5 (9.5 to 19) × 5.8 (4.0 to 7.2) µm (n = 100). Pathogenicity tests were conducted with six avocado fruit cv. Hass. Fruit were inoculated at three evenly spaced locations on the fruit surface, either by wounding the tissue with a needle that had been dipped in a conidial mass from an 8-day-old monoconidial culture of N. parvum strain CIAD-021-11 or by placing 5 µl of 1 × 106 conidia ml-1 suspension on each inoculation site. Inoculated fruit were maintained in a moist chamber at 25°C for 2 weeks. Black lesions appeared on all wounded sites 2 days postinoculation (dpi) and on unwounded sites 4 dpi. The delay of symptom development was likely due to penetration through the lenticels, which took longer to initiate infection. No symptoms were observed in the control fruit. The pathogen was reisolated from the lesions of all inoculated fruit, thus fulfilling Koch's postulates. The results confirmed the pathogenic potential of this fungus and indicated its possible involvement in the etiology of black spot on avocado fruit. N. parvum is a cosmopolitan, plurivorous pathogen causing disease in several hosts of economic importance, such as grapes and kiwi, as well as causing stem-end rot of avocado fruit in New Zealand (1) and avocado twigs in Spain (3). To our knowledge, this is the first report of N. parvum causing black spots on avocado fruit in Mexico. References: (1) W. F. T. Hartill et al. N.Z.J. Crop Hortic. Sci. 30:249. 2002. (2) T. J. White et al. Page: 315 in: PCR Protocols: A Guide to Methods and Application. M. A. Innis et al., eds. Academic Press, San Diego, CA, 1990. (3) T. Zea-Bonilla et al. Plant Dis. 91:1052, 2007.

Immunolocalization of endocan during the endothelial-mesenchymal transition process.

Endocan is a dermatan sulfate proteoglycan (DSPG) that has been observed in the cytoplasm of endothelial cells of small and large vessels in lung, kidney, liver, colon, ovary and brain tumors. This DSPG has been implicated in the regulation of cellular activities such as adhesion, migration, and proliferation. Given the important roles played by endocan in such processes, we sought to determine whether this DSPG is present in the chicken embryo aortic wall in embryonic days 12 and 14, when intimal thickening and endothelial transformation are notorious. Immunolabeling of serial paraffin cross-sections revealed endocan immunoreactivity at the endothelium and some mesenchymal cells constituting the intimal thickening but not in the cells arranged in lamellar layers. We also investigated whether endocan was present in monolayers of primary embryonic aortic endothelial cells attached to fibronectin when they were deprived of serum and stimulated with epidermal growth factor. Immunofluorescence determined that in the epidermal growth factor (EGF) condition where separating, detaching, and migrating cells were observed, endocan appeared organized in arrays typical of focal complexes in the leading edge of these cells. In serum-free medium condition in which the endothelial cells displayed a cobblestone appearance, endocan appeared mainly delineating the margin of many cells. This study demonstrates for the first time the presence of endocan during the aortic wall remodeling, and provides evidence that suggests a possible contribution of this DSPG in the endothelial-mesenchymal transition (EndoMT) process.

[Lymphomas associated with human immunodeficiency virus infection: retrospective review of medical records]. / Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: experiencia de un centro hospitalario de la V región, Chile.

BACKGROUND: The incidence of lymphoma increases enormously in patients infected with the human immunodeficiency virus (HIV). AIM: To describe the incidence, clinical and histological characteristics, treatments and survival of lymphomas associated with HTV infection. MATERIAL AND METHODS: Retrospective review of medical records of patients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. RESULTS: Twenty-two male patients were included but 14 had immunohistochemical confirmation of the lymphoma. The accumulated incidence for this period was 2.8%. The median age at lymphoma diagnosis was 39.5 years. Twelve patients (86%) had non-Hodgkin lymphoma (NHI) and two (14%) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50%). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86%) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29%) received chemotherapy with or without radiotherapy, one patient (7%) received radiotherapy alone and two patients (14%) received palliative symptomatic treatment. Six cases (43%) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57% (8 patients) with a median survival time of 5.8 months (2.6-26.2). CONCLUSIONS: In this series of patients infected with HIV, a predominance of aggressive histological subtypes of lymphomas and low complete remission rates, were observed.

Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile / Lymphomas associated with human immunodeficiency virus infection: Retrospective review of medical records

Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8 percent. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86 percent) had non-Hodgkin lymphoma (NHI) and two (14 percent) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50 percent). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86 percent) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29 percent) received chemotherapy with or without radiotherapy, onepatient (7 percent) received radiotherapy alone and two patients (14 percent) received palliative symptomatic treatment. Six cases (43 percent) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57 percent (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed.