Plasma and milk metabolomics revealed changes in amino acid metabolism in Holstein dairy cows under heat stress.

Our understanding of metabolic alterations triggered by heat stress is incomplete, which limits the designing of nutritional strategies to mitigate negative productive and health effects. Thus, this study aimed to explore the metabolic responses of heat-stressed dairy cows to dietary supplementation with vitamin D3/Ca and vitamin E/Se. Twelve multiparous Holstein cows were enrolled in a split-plot Latin square design with two distinct vitamin E/Se supplementation levels, either at a low (ESe-, n = 6, 11.1 IU/kg vitamin E and 0.55 mg/kg Se) or a high dose (ESe+, n = 6 223 IU/kg vitamin E and 1.8 mg/kg Se) as the main plot. Treatment subplots, arranged in a replicated 3 × 3 Latin square design, comprised heat challenge (Temperature Humidity Index, THI: 72.0-82.0) supplemented with different levels of vitamin D3/Ca: either low (HS/DCa-, 1 012 IU/kg and 0.73%, respectively) or high (HS/DCa+, 3 764 IU/kg and 0.97%, respectively), and a pair-fed control group in thermoneutrality (THI = 61.0-64.0) receiving the low dose of vitamin D3/Ca (TN). The liquid chromatography-mass spectrometry-based metabolome profile was determined in blood plasma and milk sampled at the beginning (day 0) and end (day 14) of each experimental period. The results were analyzed for the effect of (1) TN vs. HS/ESe-/DCa-, and (2) the vitamin E/Se and vitamin D3/Ca supplementation. No group or group × day effects were detected in the plasma metabolome (false discovery rate, FDR > 0.05), except for triglyceride 52:2 being higher (FDR = 0.03) on day 0 than 14. Taurine, creatinine and butyryl-carnitine showed group × day interactions in the milk metabolome (FDR ≤ 0.05) as creatinine (+22%) and butyryl-carnitine (+190%) were increased (P < 0.01) on day 14, and taurine was decreased (-65%, P < 0.01) on day 14 in the heat stress (HS) cows, compared with day 0. Most compounds were unaffected by vitamin E/Se or vitamin D3/Ca supplementation level or their interaction (FDR > 0.05) in plasma and milk, except for milk alanine which was lower (-69%, FDR = 0.03) in the E/Se+ groups, compared with E/Se-. Our results indicated that HS triggered more prominent changes in the milk than in the plasma metabolome, with consistent results in milk suggesting increased muscle catabolism, as reflected by increased creatinine, alanine and citrulline levels. Supplementing with high levels of vitamin E/Se or vitamin D3/Ca or their combination did not appear to affect the metabolic remodeling triggered by HS.

Dietary supplementation of vitamin D3 and calcium partially recover the compromised time budget and circadian rhythm of lying behavior in lactating cows under heat stress.

Heat stress (HS) impedes cattle behavior and performance and is an animal comfort and welfare issue. The objective of this study was to characterize the time budget and circadian rhythm of lying behavior in dairy cows during HS and to assess the effect of dietary supplementation of vitamin D3 and Ca. Twelve multiparous Holstein cows (42.2 ± 5.6 kg milk/d; 83 ± 27 d in milk) housed in tiestalls were used in a split-plot design with the concentration of dietary vitamin E and Se as main plots (LESe: 11.1 IU/kg and 0.55 mg/kg, and HESe: 223 IU/kg and 1.8 mg/kg, respectively). Within each plot cows were randomly assigned to (1) HS with low concentrations of vitamin D3 and Ca (HS, 1,012 IU/kg and 0.73%, respectively), (2) HS with high concentrations of vitamin D3 and Ca (HS+D3/Ca; 3,764 IU/kg and 0.97%, respectively), or (3) thermoneutral pair-fed (TNPF) with low concentrations of vitamin D3 and Ca (1,012 IU/kg and 0.73%, respectively) in a Latin square design with 14-d periods and 7-d washouts. Lying behavior was measured with HOBO Loggers in 15-min intervals. Overall, cows in HS spent less time lying per day relative to TNPF from d 7 to 14. Daily lying time was positively correlated with milk yield, energy-corrected milk yield, and feed efficiency, and was negatively correlated with rectal temperature, respiratory rate, fecal calprotectin, tumor necrosis factor-α, and C-reactive protein. A treatment by time interaction was observed for lying behavior: the time spent lying was lesser for cows in HS than in TNPF in the early morning (0000-0600 h) and in the night (1800-2400 h). The circadian rhythm of lying behavior was characterized by fitting a cosine function of time into linear mixed model. Daily rhythmicity of lying was detected for cows in TNPF and HS+D3/Ca, whereas only a tendency in HS cows was observed. Cows in TNPF had the highest mesor (the average level of diurnal fluctuations; 34.2 min/h) and amplitude (the distance between the peak and mesor; 17.9 min/h). Both the mesor and amplitude were higher in HS+D3/Ca relative to HS (26.6 vs. 25.2 min/h and 3.91 min/h vs. 2.18 min/h, respectively). The acrophase (time of the peak) of lying time in TNPF, HS, and HS+D3/Ca were 0028, 0152, and 0054 h, respectively. Lastly, a continuous increase in daily lying time in TNPF was observed during the first 4 d of the experimental period in which DMI was gradually restricted, suggesting that intake restrictions may shift feeding behavior and introduce biases in the behavior of animals. In conclusion, lying behavior was compromised in dairy cows under HS, characterizing reduced daily lying time and disrupted circadian rhythms, and the compromised lying behavior can be partially restored by supplementation of vitamin D3 and Ca. Further research may be required for a more suitable model to study behavior of cows under HS.

Increased dietary vitamin D3 and calcium partially alleviate heat stress symptoms and inflammation in lactating Holstein cows independent of dietary concentrations of vitamin E and selenium.

Twelve multiparous Holstein cows (42.2 ± 5.6 kg of milk/d; 83 ± 27 d in milk) were used in a split-plot design testing the effects of mineral and vitamin supplementation on the time course of animal performance, metabolism, and inflammation markers during heat stress. The main plot was the average concentrations of dietary vitamin E and Se (adequate: 11.1 IU/kg of vitamin E and 0.55 mg/kg of Se, and high: 223 IU/kg of vitamin E and 1.8 mg/kg of Se, respectively). Within each plot, cows were randomly assigned to (1) heat stress (HS) with adequate concentrations of vitamin D3 and Ca (1,012 IU/kg and 0.73%, respectively), (2) HS with high concentrations of vitamin D3 and Ca (HS+D3/Ca; 3,764 IU/kg and 0.97%, respectively), or (3) pair-feeding (PF) in thermoneutrality with adequate concentrations of vitamin D3 and Ca (1,012 IU/kg and 0.73% Ca) in a Latin square design with 14-d periods and 7-d washouts. The highest rectal temperature was recorded at 1700 h for HS (39.4°C; mean of d 1 to 14), being 1.2 and 0.8°C greater than for PF and HS+D3/Ca, respectively. Respiratory rate and water intake were higher in HS (73 breaths/min and 115 L/d, respectively) relative to PF (28 breaths/min and 76 L/d). Heat stress decreased dry matter intake progressively, reaching a nadir on d 5 to 7 (33% reduction) and was not different between treatments. Milk yield decreased progressively in all treatments, but remained greater in PF relative to HS from d 3 to 14 (10%), whereas HS and HS+D3/Ca were not different. Milk fat, protein, and lactose concentrations and yields were lower in HS relative to PF from d 3 to 14, but not different between HS and HS+D3/Ca. Relative to PF, preprandial insulin concentrations were increased in HS, whereas plasma nonesterified fatty acids were decreased on d 7 and 14. Plasma lipopolysaccharide-binding protein concentrations increased in HS cows on d 7 and 14, respectively, relative to PF, whereas they were reduced in HS + D3/Ca on d 14. Plasma C-reactive protein, tumor necrosis factor-α, and fecal calprotectin were increased in HS relative to both PF and HS+D3/Ca on d 7 and 14. Rectal temperature was positively associated with plasma lipopolysaccharide-binding protein (r = 0.72), tumor necrosis factor-α (r = 0.74), C-reactive protein (r = 0.87), and with milk somatic cells (r = 0.75). Plasma 8-hydroxy-2-deoxyguanosine concentrations presented a 3-way interaction, where 8-hydroxy-2-deoxyguanosine was lower in HS than in PF on d 7 and 14, and lower in HS+D3/Ca relative to HS on d 14 in the adequate vitamin E and Se treatment, but no effects were observed in the high vitamin E and Se group. Plasma superoxide dismutase concentrations increased over time, and were higher in HS relative to PF on d 14, whereas HS+D3/Ca was similar to HS. Heat stress markedly reduced milk production and milk components while increasing markers of leaky gut and inflammation. In contrast, vitamin D3 and Ca supplementation reduced hyperthermia (d 7-14), markers of leaky gut, and inflammation independent of dietary concentrations of vitamin E and Se.

Supplementation of DHA-Gold pre and/or postnatally to goat kids modifies in vitro methane production and rumen morphology until 6 mo old.

This study aimed to investigate the effect of pre and/or postnatal supplementation of a dry whole cell algae (DHA-Gold) to goat kids, on in vitro methane (CH4) production, animal growth, and rumen morphology at the age of 6 mo. Furthermore, the in vitro retreatment effect of DHA-Gold was evaluated. Twenty pregnant Saanen goats giving birth to 2 male kids were used. Half of these does were supplemented (D+) with 18.2 g/d of DHA-Gold in the last 3 wk of pregnancy, whereas the other half was not (D-). After kidding, one goat kid per doe in both groups was supplemented daily with 0.28 g/kg of body weight of DHA-Gold (k+) until 12 wk, whereas the other goat kids were untreated (k-). This resulted in 4 experimental groups D+k+, D+k-, D-k+, and D-k-. In vitro incubations were performed at the ages of 4 wk, 11 wk, and 6 mo. At the age of 6 mo, goat kids were euthanized and additional incubations were performed supplementing 4 doses of DHA-Gold (0, 0.4, 0.8, and 1.6 mg/mL). Additionally, rumen tissue of the atrium ruminis, ventral rumen, and dorsal blind sac were collected to assess rumen morphology. Rumen inocula of 4-wk-old goat kids supplemented D+ showed lower (P < 0.05) in vitro CH4 production, however, this was mainly due to a reduction in the overall fermentation, while CH4 expressed relatively to total volatile fatty acids (VFA) was higher when goat kids were treated D+ or k+. The detrimental D+ effect on VFA production diminished at 11 wk old but remained a tendency (0.05 < P < 0.1). As for 4 wk D+ as well as k+ supplementation of DHA-Gold stimulated rather than inhibited in vitro CH4 production expressed relative to total VFA. Supplementation of DHA-Gold either D+ or k+ decreased density, width, and surface area of the ruminal papillae. However, no effect on animal growth was observed. Moreover, detrimental effects of D+ or k+ treatment on VFA production or stimulation of relative CH4 production were no longer observed at 6 mo old. Nevertheless, direct exposure of DHA-Gold to 6-mo-old inoculum linearly (P < 0.05) decreased CH4 and VFA production, which tended (P = 0.06) to be greater when using D-rumen inoculum. Accordingly, neither D+ nor k+ DHA-Gold supplementation showed potential for reduction of rumen methanogenesis. Furthermore, this early life intervention could represent some risk for impaired rumen papillae development, which, however, did not impair animal performance.

Polyunsaturated fatty acids are less effective to reduce methanogenesis in rumen inoculum from calves exposed to a similar treatment early in life.

The aim of this study was to evaluate the dose response on in vitro methane (CH) production of PUFA to which the inoculum donor animals had been exposed early in life. Sixteen Holstein calves (160 ± 3 and 365 ± 2 kg BW) at 6 and 12 mo of age were used as inoculum donors. Half of the calves were given increasing amounts of extruded linseed from birth (22 g/d) until 4 mo of age (578 g/d) first mixed with milk and then included in their concentrate. Linseed oil (LSO) was supplemented in vitro at 5 different doses (0, 0.6, 1.2, 2.4, and 4.8 mg/mL). Supplementation of LSO in the rumen inocula at both ages linearly decreased ( < 0.05) the in vitro CH production. Total in vitro VFA production was not affected by LSO supplementation. Inhibition of CH was smaller when using the rumen inoculum from calves that had received a similar treatment early in life ( < 0.05). Differences in response to in vitro supplementation of a type of fatty acids similar to those applied during early life suggest some "changes" in the functioning of the rumen microbial community.

Population genetic structure in farm and feral American mink (Neovison vison) inferred from RAD sequencing-generated single nucleotide polymorphisms.

Feral American mink populations (), derived from mink farms, are widespread in Europe. In this study we investigated genetic diversity and genetic differentiation between feral and farm mink using a panel of genetic markers (194 SNP) generated from RAD sequencing data. Sampling included a total of 211 individuals from 14 populations, 4 feral and 10 from farms, the latter including a total of 7 color types (Brown, Black, Mahogany, Sapphire, White, Pearl, and Silver). Our study revealed similar low levels of genetic diversity in both farm and feral mink. Results are consistent with small effective population size as a consequence of line selection in the farms and founder effects of a few escapees from the farms in feral populations. Moderately high genetic differentiation was found between farm and feral animals, suggesting a scenario in which wild populations were founded from farm escapes a few decades ago. Currently, escapes and gene flow are probably limited. Genetic differentiation was higher among farm color types than among farms, consistent with line selection using few individuals to create the lines. Finally, no indications of inbreeding were found in either farm or feral samples, with significant negative values found in most farm samples, showing farms are successful in avoiding inbreeding.

Revisiting the phylogeography and demography of European badgers (Meles meles) based on broad sampling, multiple markers and simulations.

Although the phylogeography of European mammals has been extensively investigated since the 1990s, many studies were limited in terms of sampling distribution, the number of molecular markers used and the analytical techniques employed, frequently leading to incomplete postglacial recolonisation scenarios. The broad-scale genetic structure of the European badger (Meles meles) is of interest as it may result from historic restriction to glacial refugia and/or recent anthropogenic impact. However, previous studies were based mostly on samples from western Europe, making it difficult to draw robust conclusions about the location of refugia, patterns of postglacial expansion and recent demography. In the present study, continent-wide sampling and analyses with multiple markers provided evidence for two glacial refugia (Iberia and southeast Europe) that contributed to the genetic variation observed in badgers in Europe today. Approximate Bayesian computation provided support for a colonisation of Scandinavia from both Iberian and southeastern refugia. In the whole of Europe, we observed a decline in genetic diversity with increasing latitude, suggesting that the reduced diversity in the peripheral populations resulted from a postglacial expansion processes. Although MSVAR v.1.3 also provided evidence for recent genetic bottlenecks in some of these peripheral populations, the simulations performed to estimate the method's power to correctly infer the past demography of our empirical populations suggested that the timing and severity of bottlenecks could not be established with certainty. We urge caution against trying to relate demographic declines inferred using MSVAR with particular historic or climatological events.

Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica.

INTRODUCTION: Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization. OBJECTIVES: We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica. METHODS: We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated. RESULTS: During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%. CONCLUSIONS: Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries.

Predictive factors, microbiology and outcome of patients with parapneumonic effusion.

We aimed to determine the incidence, clinical consequences and microbiological findings related to the presence of pleural effusion in community-acquired pneumonia, and to identify predictive factors for empyema/complicated parapneumonic effusion. We analysed 4,715 consecutive patients with community-acquired pneumonia from two acute care hospitals. Patients were classified into three groups: no pleural effusion, uncomplicated parapneumonic effusion and empyema/complicated parapneumonic effusion. A total of 882 (19%) patients had radiological evidence of pleural fluid, of whom 261 (30%) met criteria for empyema/complicated parapneumonic effusion. The most important event related to the presence of uncomplicated parapneumonic effusion was a longer hospital stay. Relevant clinical and microbiological consequences were associated with empyema/complicated parapneumonic effusion. Five independent baseline characteristics could predict the development of empyema/complicated parapneumonic effusion: age < 60 yrs (p = 0.012), alcoholism (p = 0.002), pleuritic pain (p = 0.002), tachycardia >100 beats·min⁻¹ (p = 0.006) and leukocytosis >15,000 mm⁻³ (p < 0.001). A higher incidence of anaerobes and Gram-positive cocci was found in this subgroup of patients. We conclude that only the development of empyema/complicated parapneumonic effusion carried relevant consequences; this condition should be suspected in the presence of some baseline characteristics and managed by using antimicrobials active against Gram-positive cocci and anaerobes.

Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia.

BACKGROUND: Recommendations for diagnostic testing in hospitalised patients with community-acquired pneumonia remain controversial. The aim of the present study was to evaluate the impact of a therapeutic strategy based on the microbiological results provided by urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila. METHODS: For a 2-year period, hospitalised patients with community-acquired pneumonia were randomly assigned to receive either empirical treatment, according to international guidelines, or targeted treatment, on the basis of the results from antigen tests. Outcome parameters, monetary costs and antibiotic exposure levels were compared. RESULTS: Out of 194 enrolled patients, 177 were available for randomisation; 89 were assigned to empirical treatment and 88 were assigned to targeted treatment. Targeted treatment was associated with a slightly higher overall cost (euro 1657.00 vs euro 1617.20, p=0.28), reduction in the incidence of adverse events (9% vs 18%, p=0.12) and lower exposure to broad-spectrum antimicrobials (154.4 vs 183.3 defined daily doses per 100 patient days). No statistically significant differences in other outcome parameters were observed. Oral antibiotic treatment was started according to the results of antigen tests in 25 patients assigned to targeted treatment; these patients showed a statistically significant higher risk of clinical relapse as compared with the remaining population (12% vs 3%, p=0.04). CONCLUSIONS: The routine implementation of urine antigen detection tests does not carry substantial outcome-related or economic benefits to hospitalised patients with community-acquired pneumonia. Narrowing the antibiotic treatment according to the urine antigen results may in fact be associated with a higher risk of clinical relapse.

Biomarkers of infection for the differential diagnosis of pleural effusions.

We aimed to investigate whether pleural fluid concentrations of biomarkers for bacterial infection, namely triggering receptor expressed on myeloid cells (sTREM-1), procalcitonin (PCT), lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP), might identify infectious effusions and discriminate between complicated (CPPEs) and uncomplicated parapneumonic effusions (UPPEs). Stored pleural fluid samples from 308 patients with different causes of pleural effusion were used to measure the four biomarkers. Receiver-operating characteristic analysis determined the accuracy of the new tests. Median pleural fluid levels of CRP, sTREM-1 and LBP were significantly higher in CPPE compared with those in other aetiologies. The area under the curve for distinguishing infectious (parapneumonics and tuberculosis) from noninfectious effusions was 0.87 for CRP, 0.86 for sTREM-1, 0.57 for PCT and 0.87 for LBP. Regarding the discrimination of nonpurulent CPPE versus UPPE, a multivariate analysis found that pleural fluid glucose < or =60 mg x dL(-1), LBP > or =17 microg x mL(-1) and CRP > or =80 mg x L(-1) were the best parameters. Individually, none of the new biomarkers achieved better performance characteristics than pH, glucose or lactate dehydrogenase in labelling CPPE. In conclusion, elevated pleural fluid levels of CRP, sTREM and LBP identify patients with infectious effusions, particularly those with CPPE. PCT has no value for the differential diagnosis of pleural effusions.

Relación entre la disfunción temporomandibular y las alteraciones del oído medio. Primeros resultados del tratamiento rehabilitador / Relationship between temporomandibular dysfunction and middle ear disorders. First results of rehabilitation treatment

Introducción. La disfunción tubárica suele determinar una hipoacusia de transmisión o barotraumas por cambios de presión no compensada por la trompa obstruida. Objetivo. Revisar la relación entre la disfunción temporomandibular y las alteraciones del oído medio. Realizar una primera valoración de la eficacia del tratamiento primario de la disfunción temporomandibular y de ejercicios específicos en pacientes con disfunción tubárica. Material y métodos. Estudio prospectivo sobre 14 pacientes bajo el criterio de inclusión de padecer una mala adaptación a los cambios de presión o una hipoacusia de conducción secundaria a una disfunción tubárica. Se estableció un protocolo de tratamiento dirigido no sólo a la disfunción temporomandibular sino también al oído medio y la trompa de Eustaquio. Resultados. Se incluyeron 14 pacientes, 10 mujeres y 4 hombres con una edad media de 37,14 años (R: 13-74). El 92,85 % presentaba un síndrome de disfunción temporomandibular, el 85,71 % hipoacusia de transmisión y el 64,28 % mala adaptación a los cambios de presión. Casi todos los pacientes empezaron el tratamiento con un timpanograma y una audiometría previos, y tras dicho tratamiento se repitieron estas pruebas, mejorando el 71,42 % de los timpanogramas y el 85,75 % de las audiometrías. Subjetivamente se encontraba mejor el 92,85 % de los pacientes. Conclusiones. La mayoría de los pacientes respondió muy bien a los ejercicios específicos, con casos espectaculares desde las primeras sesiones. Mejoraron síntomas como la hipoacusia y la mala adaptación a los cambios de presión. La rehabilitación de la disfunción tubárica es eficaz, sencilla y no necesita de gran aparataje, pero sí de una gran colaboración terapeuta-paciente

Introduction. Tubal dysfunction generally determines transmission hypoacusis or barotraumas due to uncompensated pressure changes by obstructed tube. Objective. Review the relationship between temporomandibular dysfunction and middle ear disorders. Perform a first assessment of primary treatment efficacy of the temporomandibular dysfunction and of specific exercises in patients with tubal dysfunction. Material and methods. Prospective study on 14 patients with the enrollment criterion of suffering poor adaptation to pressure changes or transmission hypoacusis secondary to tubal dysfunction. A treatment protocol aimed not only at temporomandibular dysfunction but also at the middle ear and Eustachian tube was also established. Results. Fourteen patients, 10 women and 4 men with a mean age of 37.14 years (R: 13-74) were enrolled. A total of 92.85 % had temporomandibular dysfunction syndrome, 85.71 % transmission hypoacusis and 64.28 % poor adaptation to pressure changes. Almost all the patients began treatment with a previous tympanogram and audiometry and the tests were repeated after this treatment, 71.42 % of the tympanograms and 85.75 % of the audiometries improving. A total of 92.85 % of the patients felt better subjectively. Conclusions. Most of the patients responded very well to specific exercises, with spectacular cases from the first sessions. Symptoms such as hypoacusis, poor adaptation to pressure changes, etc. improved. Rehabilitation of tubal dysfunction is effective, simple and does not need much equipment but does need great therapist-patient collaboration

Liquen plano vulvar en la infancia / Childhood vuvar lichen planus in children

El liquen plano (LP) es una dermatosis inflamatoria, no infecciosa, que puede afectar a piel, mucosas y anejos. Es infrecuente en niños, sobre todo en las formas de afectación de mucosas. Mientras que la historia natural del liquen plano cutáneo tiende a la remisión espontánea, las lesiones orogenitales y, en particular, la forma erosiva, suelen ser persistentes. La clínica del liquen plano vulvar puede comprender desde casos asintomáticos, hasta pacientes con prurito, gran dolor y quemazón vulvar. Puede autorresolverse, responder al tratamiento o bien progresar hacia una alteración de la estructura genital externa, con formación de sinequias e incluso estenosis vaginal. El tratamiento clásico consiste en la aplicación de corticoides tópicos de elevada potencia, requiriendo los casos complicados tratamientos más agresivos. Recientemente, se ha utilizado el tacrolimus como terapéutica del liquen plano y se han obtenido buenos resultados. Se presenta el caso de una niña prepuberal con liquen plano vulvar

Lichen planus is an noninfectious, inflammatory dermatosis that usually affects the skin, mucosa, hair and nails. It is uncommon in children, in whom mucosal involvement is especially rare. While cutaneous lichen planus eventually resolves spontaneously, the oral and genital lesions, in particular in the erosive form, are usually persistent. Vulvar lichen planus can be asymptomatic or can be accompanied by symptoms ranging from itching to intense pain and burning sensation of the vulvar region. It can resolve without any treatment or respond well to treatment, or its progression may lead to changes in the structure of the external genitalia, with synechia that may cause vaginal narrowing or closure. Highly potent topical corticosteroids are very useful. although complicated cases may require more aggressive treatments. Tacrolimus has recently been used with very good results

Displasia renal multiquística unilateral y megacaliosis contralateral. Una asociación inusual / Unilateral multicystic dysplastic kidney and contralateral megacalycosis. An unusual association

La dilatación de vías urinarias no siempre es sinónimo de obstrucción. Es conocido que existen malformaciones con aparente hidronefrosis en las que el flujo de la orina no está interrumpido. Por otra parte, con cierta frecuencia, se observa que en un mismo paciente pueden coexistir dos o más malformaciones distintas de vías urinarias. Se presenta un caso clínico en el que coexistían una displasia renal multiquística unilateral y una megacaliosis contralateral, asociada a un megauréter segmentario distal ipsolateral. Esta asociación es inusual en la literatura médica. A pesar de ello, la función glomerular renal es normal y existe, únicamente, un ligero defecto de la capacidad de concentración renal (AU)

[Unilateral multicystic dysplastic kidney and contralateral megacalycosis. An unusual association]. / Displasia renal multiquística unilateral y megacaliosis contralateral. Una asociación inusual.

Dilation of the genitourinary tract is not always synonymous with obstruction. It is well known that malformations with apparent hydronephrosis and normal urinary flow can exist. In addition, two or more distinct malformations of the genitourinary tract can coexist in the same patient. We present a case of coexistence of a unilateral multicystic dysplastic kidney and contralateral megacalycosis associated with ipsilateral distal segmental megaureter. This association is unusual in the literature. Glomerular renal function was normal, with only a slight defect of renal concentration capacity.

Los pies del niño, motivo de consulta en rehabilitación / Foot problems in a children's rehabilitation service

Uno de los motivos más frecuentes de consulta en Rehabilitación infantil es la enfermedad podológica. Las consultas sobre posibles alteraciones de los pies tienen su importancia por el alto número de éstas, por tratarse de niños con padres preocupados, y porque, en ocasiones, son alteraciones secundarias a afecciones neurológicas, infecciosas y traumáticas, entre otras. En la mayoría de los casos, sólo es necesario recomendar un calzado adecuado, sencillas normas posturales y realizar un seguimiento del paciente, por lo que consideramos fundamental el conocimiento del desarrollo evolutivo normal del pie infantil. En menos casos, será precisa la indicación de ejercicios, estiramientos, estimulación, calzados correctores y adaptaciones ortopédicas. Las indicaciones quirúrgicas quedan reducidas a un porcentaje mínimo de los pacientes. En esta revisión intentaremos familiarizarnos con el crecimiento y el desarrollo del pie normal y distinguir las alteraciones más frecuentes observadas en Rehabilitación; por último, se tratarán algunos aspectos del tratamiento de estas alteraciones (AU)

Enfermedad de Duchenne: tratamiento rehabilitador / Rehabilitation in Duchenne muscular dystrophy: a review

Mediante el presente trabajo realizamos una revisión actualizada de la enfermedad de Duchenne, dando especial relevancia al tratamiento rehabilitador. La enfermedad de Duchenne es la distrofia muscular más frecuente, con una incidencia del orden de 10 a 30 casos/100.000 habitantes. Se transmite de forma recesiva ligada al cromosoma X, y afecta a los hombres, pero es transmitida por las mujeres. La patogénesis no está clara y la sintomatología se inicia generalmente antes de los 2-3 años. Las manifestaciones clínicas más frecuentes son: la seudohipertrofia de pantorrillas, “marcha de pato” o en Trendelenburg, la dificultad para levantarse del suelo o de una silla, la hiperlordosis y el abdomen prominente, la cifoscoliosis, el desequilibrio entre grupos musculares agonistas y antagonistas, la deficiencia mental leve y las fracturas fáciles. Suele existir un retraso en el control del tronco en la bipedestación y la deambulación. Cuando el paciente logra la deambulación, lo hace con dificultad y caídas frecuentes; pierde la capacidad de deambulación a los 10-15 años, por lo que debe utilizar una silla de ruedas. Generalmente, estos pacientes fallecen antes de los 25 años por insuficiencia cardiorrespiratoria. El diagnóstico se establece después de la sospecha clínica mediante analítica, electromiografía y biopsia. El tratamiento rehabilitador es la única alternativa terapeútica para el “paciente Duchenne”, y se basa en una cinesiterapia general y específica respiratoria, balneoterapia, tratamiento ortopédico, terapia ocupacional e integración escolar (AU)

We present an update on Duchenne muscular dystrophy, focusing especially on rehabilitación therapy. This disease is the most common type of muscular dystrophy, with an incidence ranging from 10 to 30 cases per 100,000 population. It is an X-linked recessive disorder that is transmitted to male children by their mothers. The pathogenesis is unclear and the symptoms generally appear between the ages of 2 and 3 years. The most common clinical signs are calf pseudohypertrophy, duck gait or Trendelemburg, difficulty in rising from the floor or chair, hyperlordosis and prominent abdomen, kyphoscoliosis, imbalance between agonist and antagonist muscle groups, mild mental retardation and easy fractures. There is usually delayed trunk control on standing and walking. Walking, when achieved, is difficult and falls are frequent; the ability to walk is lost between the ages of 10 and 15 years, after which the child requires a wheelchair. These patients usually die before the age of 25 years due to cardiorespiratory failure. When clinically suspected, the diagnosis is established on the basis of laboratory analyses, electromyography and biopsy. Rehabilitation, the only therapeutic alternative for Duchenne patients, involves general kinesiotherapy, respiratory therapy, hydrotherapy, orthopedic treatment, occupational therapy and integration into school life (AU)

Tos crónica y fiebre como forma de presentación de una arteritis de células gigantes / Chronic cough and fever at the onset of giant cell arteritis

No disponible

Nonsevere community-acquired pneumonia: correlation between cause and severity or comorbidity.

BACKGROUND: Community-acquired pneumonia frequently constitutes a nonsevere infection manageable at home. However, for these low-risk episodes, the epidemiological features have not been carefully analyzed. OBJECTIVES: To determine the cause of nonsevere community-acquired pneumonia and to investigate if a correlation exists between cause and severity or comorbidity. METHODS: During a 3-year period, all patients with nonsevere community-acquired pneumonia, according to the Pneumonia Patient Outcome Research Team prognostic classification (patients in groups 1-3), were included in the study. Causes were investigated through the following procedures: cultures of blood, sputum, and pleural fluid; serologic tests; and polymerase chain reaction methods to detect Streptococcus pneumoniae DNA in whole blood or Mycoplasma pneumoniae and Chlamydia pneumoniae DNA in throat swab specimens. RESULTS: Of 317 initially included patients, 247 were eligible for the study. A microbial diagnosis was obtained in 162 patients (66%), and the main pathogens detected were S pneumoniae (69 patients [28%]), M pneumoniae (40 patients [16%]), and C pneumoniae (28 patients [11%]). For the 58 patients in prognostic group 1, M pneumoniae was the most prevalent cause, and atypical microorganisms constituted 40 (69%) of the isolated agents. In contrast, for patients in prognostic groups 2 and 3, S pneumoniae was the leading agent, and a significant reduction of M pneumoniae cases and a greater presence of other more uncommon pathogens were observed. The existence of comorbid conditions was not a determining factor for particular causes. CONCLUSIONS: Among low-risk patients with community-acquired pneumonia, there was a certain correlation between severity and cause. In contrast, the existence of a comorbidity did not have a predictive causative value.