ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization.

The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.

Associations between forms of aggression and peer victimization: Does prosocial behavior matter?

Relatively little is known regarding factors that may mitigate the strength of the associations between forms of aggressive behavior and peer victimization. The goal of the current study was to investigate prosocial behavior as a moderator of these links over a 2-year period during middle childhood. Participants included 410 third-grade students (53% boys) and their homeroom teachers. Results indicated that prosocial behavior was associated with lower initial levels of victimization, whereas relational aggression was associated with higher initial levels of victimization. Physical aggression predicted more stable patterns of victimization over time, and prosocial behavior moderated the prospective link from relational aggression to peer victimization; specifically, relational aggression predicted decreases in victimization at higher levels of prosocial behavior and more stable patterns over time when levels of prosocial behavior were low. Further, gender differences were observed in the moderating effect of prosocial behavior on the prospective link from physical aggression to peer victimization, such that it served as a risk factor for boys and a protective factor for girls.

Foreign Body Ingestion by a Psychiatric Patient Requiring an Appendectomy: A Case Report.

In the surgical field, the correct approach to the psychiatric patient represents a medical challenge, given the special considerations to be taken in the individualization of their diagnosis and treatment. We present an uncommon case of a 29-year-old patient with associated psychiatric pathology who presented to the emergency room after the introduction of two foreign bodies into the nasal cavity. After the endoscopic removal of one of the foreign bodies, the X-ray follow-up shows a second foreign body into the esophagus, which progressed to the vermiform appendix, causing the classical clinical signs of acute appendicitis as a complication. The importance of considering that events treated by the otorhinolaryngology area may have complications for urgent management by the general surgery service is denoted in this article.

Examining the Efficacy of Online Administration of a Time-Limited School Readiness Intervention in the Face of COVID-19.

Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the feasibility, acceptability, and efficacy of a telemedicine delivery of the School Readiness Parenting Program (SRPP), an integrative adaptation of PCIT designed to address the behavioral and academic domains of school readiness. The present study takes the first step towards validating an online administration of the SRPP as a treatment for early childhood disruptive behavior. Data were collected for 64 children ages 2-6 years (Mage = 4.63, SD = 0.86; 78.1% Hispanic/Latinx) and their families, who received either in-person administration of time-limited PCIT (PCIT-TL; n=30) or online administration of SRPP (n=34). A series of repeated measures ANOVAS were conducted to examine within and between group effects. Results revealed that both SRPP and PCIT-TL significantly reduced inattention (d's = -0.54 to -0.88), aggression (d's = -0.55 to -1.06), and behavioral symptomology (d's = -0.55 to -0.85) and produced significant gains in parental skills (d's = -1.47 to 2.99). Notably, online SRPP demonstrated greater improvement in positive parental verbalization, whereas PCIT-TL demonstrated greater reductions in parental stress. Overall, findings support the utility of online SRPP for addressing behavioral school readiness concerns.

Common bile duct pressure after open intraoperative instrumentation in patients with uncomplicated choledocholithiasis.

BACKGROUND: Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations. MATERIAL AND METHODS: A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples. RESULTS: Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm H2O) registered were as follows: Initial = 19.5, week 1 = 16.2, week 2 = 14.3, week 3 = 13.0, week 4 = 12.1, week 5 = 11.1, and week 6 = 9.7. There were significant differences shown when comparing week 2 (p = 0.05), week 3 (p = 0.036), week 4 (p = 0.023), week 5 (p = 0.010), and week 6 (p = 0.004) with the initial value. CONCLUSIONS: CBDP decreases between 2nd and 3rd post-operative weeks. The use of choledochomanometry is useful in clinical scenarios with no access to imaging or interventionism facilities as in remote populations or rural locations.

ANTECEDENTES: La presión del conducto biliar común (PCBC) después de exploración quirúrgica no ha sido totalmente detallada. El objetivo fue describir los cambios de la PCBC tras exploración por coledocolitiasis. MATERIAL Y MÉTODOS: Estudio de antes y después, en pacientes con coledocolitiasis, que requirieron colecistectomía con exploración de vías biliares, registrando la PCBC por 6 semanas. Con colangiografía por sonda en T en la semana seis. Análisis con T de Student para muestras pareadas. RESULTADOS: Se incluyeron 13 pacientes (rango 17-69 años; 38,69 ± 17,97). Las presiones medias del CBC fueron: Inicial = 19.5, semana 1 = 16.2, semana 2 = 14.3, semana 3 = 13.0, semana 4 = 12.1, semana 5 = 11.1 y semana 6 = 9.7. Se mostraron diferencias significativas al comparar la semana 2 (p = 0.05), la semana 3 (p = 0.036), la semana 4 (p = 0.023), la semana 5 (p = 0.010) y la semana 6 (p = 0.004) contra el valor inicial. DISCUSIÓN: La PCBC disminuye entre la segunda y la tercera semana posoperatoria. La coledocomanometría muestra ser útil en escenarios clínicos sin acceso a intervencionismo como en poblaciones remotas o localidades rurales.

Diseño de un instrumento para evaluar las actividades profesionales confiables en cirugía general.

AIM: Competency-based medical education has become increasingly prevalent among surgical accreditation bodies that conduct assessments to ensure the competency of future professionals and judge the adequacy of training programs. MATERIALS AND METHODS: Cross-sectional study to validate an instrument to evaluate entrustable professional activities (EPA) according to the Single Program of Medical Specialties through content and construct validity by expert judgment, and internal consistency with Cronbach's alpha. RESULTS: Four of the rubrics scored high to optimal for univocity and relevance. Only one rubric had to be modified in two of its items. Internal consistency was high (Cronbach's alpha of 0.97). When applying the instrument, the residents showed differences in the level of competence according to postgraduate year, identifying better performance in the last year. DISCUSSION: The instrument was validated with a high degree of reliability in univocity and relevance, and high internal consistency. The residents demonstrated appropriate EPA to manage surgical patients safely, efficiently, with quality and warmth. The ability to reach the strategic level of performance is the main component of the competency-based medical education through the EPA.

OBJETIVO: La educación médica basada en competencias se ha vuelto cada vez más frecuente entre los organismos de acreditación quirúrgica que realizan evaluaciones para asegurar la competencia de los futuros profesionales y juzgar la idoneidad de los programas de formación. MATERIAL Y MÉTODOS: Estudio transversal para validar un instrumento para evaluar las actividades profesionales confiables (APC) según el Programa Único de Especialidades Médicas mediante validez de contenido y constructo por juicio de expertos, y consistencia interna con alfa de Cronbach. RESULTADOS: Cuatro de las rúbricas obtuvieron nivel alto a óptimo para univocidad y relevancia. Solo una rúbrica debió ser modificada en dos de sus ítems. La consistencia interna fue alta (alfa de Cronbach de 0.97). Al aplicar el instrumento, los residentes mostraron diferencias en el nivel competencial según el año de posgrado, identificando mejor desempeño el último año. DISCUSIÓN: El instrumento fue validado con un alto grado de fiabilidad en univocidad y relevancia, y una alta consistencia interna. Los residentes demostraron poseer las APC necesarias para tratar pacientes quirúrgicos de manera segura, eficiente, con calidad y calidez. La capacidad para alcanzar el nivel estratégico de desempeño es el componente principal de la educación médica basada en competencias a través de las APC.

Potential diagnostic biomarkers for pulmonary tuberculosis in humans are not elevated in Mycobacterium tuberculosis culture-positive Asian elephants (Elephas maximus).

OBJECTIVE: To determine (1) if chemokine (C-X-C motif) ligand 1 (CXCL1), matrix metalloproteinase 8 (MMP8), interleukin-10 (IL-10), interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) can be detected in serum from Asian elephants, and (2) if their concentrations are significantly elevated in Mycobacterium tuberculosis (M.tb) culture-positive elephants compared to -negative elephants. CXCL1, MMP8, IL-10, IFN-γ, and TNF-α were recently identified as potential diagnostic biomarkers for pulmonary tuberculosis in experimental studies in animals and humans. Therefore, we hypothesized that they would be detectable and significantly elevated in M.tb culture-positive elephants compared to M.tb culture-negative elephants. SAMPLE: 101 Asian elephant serum samples, including 91 samples from 6 M.tb-negative elephants and 10 samples from 5 M.tb-positive elephants (none of which exhibited clinical signs of disease). M.tb status was determined by trunk wash culture. PROCEDURES: Commercially available ELISA kits were used to determine the concentrations of each biomarker in serum samples. RESULTS: Biomarker concentrations were below the limit of detection for the assay in 100/101 (99%) samples for CXCL1, 98/101 (97%) samples for MMP8, 85/101 (84%) samples for IL-10, 75/101 (74%) samples for IFN-γ, and 45/101 (45%) samples for TNF-α. Multiple M.tb culture-positive elephants did not have detectable levels of any of the 5 biomarkers. CLINICAL RELEVANCE: CXCL1, MMP8, IL-10, IFN-γ, and TNF-α were not elevated in M.tb culture-positive Asian elephants compared to M.tb culture-negative Asian elephants. This may be related to disease state (ie, clinically asymptomatic). More sensitive assays are needed to better understand the role of these biomarkers in M.tb infection in Asian elephants.

Mycobacterium tuberculosis sensu stricto in African Apes, What Is Its True Health Impact?

Since the Symposium on Mycobacterial Infections of Zoo Animals held at the National Zoological Park, Smithsonian Institution in 1976, our understanding of tuberculosis (TB) in non-domestic animals has greatly expanded. Throughout the past decades, this knowledge has resulted in improved zoo-habitats and facilities design, stricter biosecurity measures, and advanced diagnostic methods, including molecular techniques, that have significantly decreased the number of clinical disease caused by Mycobacterium tuberculosis in apes under human care settings. In the other hand, exponential growth of human populations has led to human encroachment in wildlife habitat which has resulted in increased inter-species contact and recurrent conflict between humans and wild animals. Although it is widely accepted that non-human primates are susceptible to M. tb infection, opinions differ with regard to the susceptibility to develop disease amongst different taxa. Specifically, some authors suggest that African apes are less susceptible to clinical tuberculosis than other species of primates. The aim of this review article is to evaluate the current scientific literature to determine the actual health impact of disease caused by Mycobacterium tuberculosis and more specifically Mycobacterium tuberculosis sensu stricto in African apes. The literature review included literature databases: Web of Science, Pubmed, Scopus, Wiley, Springer and Science direct, without temporal limit and proceedings of annual conferences in the field of wildlife health. Our general inclusion criteria included information about serological, molecular, pathological (macroscopic and/or microscopic), and clinical evidence of TB in African apes; while our, our more stringent inclusion selection criteria required that in addition to a gross pathology, a molecular test confirmed Mycobacterium tuberculosis sensu stricto as the cause of disease or death. We identified eleven reports of tuberculosis in African apes; of those, only four reports met the more stringent selection criteria that confirmed M. tb sensu stricto in six individuals. All reports that confirmed M. tb sensu stricto originated from zoological collections. Our review suggests that there is little evidence of disease or mortality caused by M. tb in the different species of African apes both under human care and free ranging populations. Additional studies are needed in free-ranging, semi-captive populations (sanctuaries) and animals under human care (zoos and rescue centers) to definitely conclude that this mycobacteria has a limited health effect in African ape species.

Fatal Sarcocystis calchasi-associated meningoencephalitis in 2 captive vulturine guineafowl.

Two captive vulturine guineafowl (Acryllium vulturinum) were presented with lethargy, hyporexia, weight loss, and progressive neurologic signs. One of the guineafowl was seropositive for Sarcocystis falcatula (1:50 dilution). Both guineafowl died within 5 d of presentation. Histologic examination revealed nonsuppurative meningoencephalitis with gliosis, associated with occasional schizonts in the neuropil. Using fresh-frozen brain tissue, PCR was performed to amplify the ITS1 RNA region and portions of the 18S ribosomal RNA gene (18S gene) and the 28S ribosomal RNA gene (28S gene). Analysis of nucleic acid sequences from the resulting amplicons indicated that Sarcocystis calchasi was the likely cause of disease. To our knowledge, S. calchasi-associated disease has not been reported previously in the order Galliformes.

Patterns of serum immune biomarkers during elephant endotheliotropic herpesvirus viremia in Asian and African elephants.

Hemorrhagic disease (HD) caused by a group of elephant endotheliotropic herpesviruses (EEHV) is one of the leading causes of death for young elephants in human care. These viruses are widespread and typically persist latently in adult elephants with no negative effects; however, in juvenile Asian and more recently young African elephants, the onset of disease can be rapid and the mortality rate high. Measuring biomarkers associated with the immune response could be beneficial to understanding underlying disease processes, as well as the management of infection and HD. The goal of this study was to measure acute phase proteins and cytokines in serum collected from elephants infected with EEHV (13 Asian and 1 African) and compare concentrations according to presence, severity and outcome of disease. Serum amyloid A (SAA) and haptoglobin (HP) were higher in elephants with EEHV viremia than those without; concentrations increased with increasing viral load, and were higher in fatal cases compared to those that survived. In Asian elephants, SAA was also higher during EEHV1 viremia compared to EEHV5. Cytokine concentrations were typically low, and no statistical differences existed between groups. However, in individuals with detectable levels, longitudinal profiles indicated changes in tumor necrosis factor alpha (TNF-α) and interleukin-2 (IL-2) that may reflect an immune response to EEHV infection. However, the overall low concentrations detected using previously validated assays do not support the presence of a 'cytokine storm' and suggest more work is needed to understand if sub-optimal immune responses could be involved in disease progression. These results highlight the potential benefit of measuring circulating biomarker concentrations, such as APPs and cytokines, to improve our understanding of EEHV viremia and HD, assist with monitoring the progression of disease and determining the impact of interventions.

Comparison between three dosages of intramuscular alfaxalone and a ketamine-dexmedetomidine-midazolam-tramadol combination in golden-headed lion tamarins (Leontopithecus chrysomelas).

OBJECTIVES: To characterize the cardiopulmonary and anesthetic effects of alfaxalone at three dose rates in comparison with a ketamine-dexmedetomidine-midazolam-tramadol combination (KDMT) for immobilization of golden-headed lion tamarins (GHLTs) (Leontopithecus chrysomelas) undergoing vasectomy. STUDY DESIGN: Prospective clinical trial. ANIMALS: A total of 19 healthy, male, wild-caught GHLTs. METHODS: Tamarins were administered alfaxalone intramuscularly (IM) at 6, 12 or 15 mg kg-1, or KDMT, ketamine (15 mg kg-1), dexmedetomidine (0.015 mg kg-1), midazolam (0.5 mg kg-1) and tramadol (4 mg kg-1) IM. Immediately after immobilization, lidocaine (8 mg kg-1) was infiltrated subcutaneously (SC) at the incision site in all animals. Physiologic variables, anesthetic depth and quality of immobilization were assessed. At the end of the procedure, atipamezole (0.15 mg kg-1) was administered IM to group KDMT and tramadol (4 mg kg-1) SC to the other groups; all animals were injected with ketoprofen (2 mg kg-1) SC. RESULTS: A dose-dependent increase in sedation, muscle relaxation and immobilization time was noted in the alfaxalone groups. Despite the administration of atipamezole, the recovery time was longer for KDMT than all other groups. Muscle tremors were noted in some animals during induction and recovery with alfaxalone. No significant differences were observed for cardiovascular variables among the alfaxalone groups, whereas an initial decrease in heart rate and systolic arterial blood pressure was recorded in KDMT, which increased after atipamezole administration. CONCLUSIONS AND CLINICAL RELEVANCE: Alfaxalone dose rates of 12 or 15 mg kg-1 IM with local anesthesia provided good sedation and subjectively adequate pain control for vasectomies in GHLTs. KDMT induced a deeper plane of anesthesia and should be considered for more invasive or painful procedures. All study groups experienced mild to moderate hypothermia and hypoxemia; therefore, the use of more efficient heating devices and oxygen supplementation is strongly recommended when using these protocols.

Cefovecin pharmacokinetics after single-dose intramuscular administration in cheetahs (Acinonyx jubatus).

Cefovecin is a third-generation cephalosporin with potential value for use in exotic felids due to its long duration of action. A sparse sampling protocol was implemented with 18 zoo-housed cheetahs (Acinonyx jubatus) to evaluate the pharmacokinetics of cefovecin (Convenia® ) after a single 8 mg/kg intramuscular injection. Blood was collected serially for 15 days following administration, and plasma cefovecin concentrations were determined using high-pressure liquid chromatography with ultraviolet detection. Pharmacokinetic parameters were estimated using population pharmacokinetic methods and non-linear mixed effects modeling (NLME). Cefovecin was well tolerated by all cats, with no adverse effects observed. Peak plasma cefovecin concentration was 84.75 µg/ml, with a mean residence time of 207.9 h and an elimination half-life of 144.1 h (6.00 days). Plasma concentrations of cefovecin were maintained >7 µg/ml in all individuals for the entire study duration (15 days). These concentrations are lower, and the half-life slightly shorter, than the values reported for domestic cats. Cefovecin was highly protein-bound (approximately 99.9%) in cheetah plasma, which is nearly identical to domestic cats. These results indicate that cefovecin is potentially useful as a long-acting antibiotic in cheetahs.

Canine Distemper Outbreak by Natural Infection in a Group of Vaccinated Maned Wolves in Captivity.

Canine distemper virus (CDV) is one of the most significantinfectious disease threats to the health and conservation of free-ranging and captive wild carnivores. CDV vaccination using recombinant canarypox-based vaccines has been recommended for maned wolf (Chrysocyon brachyurus) after the failure of modified live vaccines that induced disease in vaccinated animals. Here, we report a CDV outbreak in a captive population of maned wolves that were previously vaccinated. Five juveniles and one adult from a group of seven maned wolves housed in an outdoor exhibit died in April-May 2013 in a zoo in the Metropolitan Region, Chile. Clinical signs ranged from lethargy to digestive and respiratory signs. Diagnosis of CDV was confirmed by histopathology, antibody assays, and viral molecular detection and characterization. The phylogenetic analyses of the nucleotide sequence of the H gene of the CDV genome identified in the two positive samples suggest a close relation with the lineage Europe 1, commonly found in South America and Chile. CDV infections in maned wolves have not been previously characterized. To the authors' best knowledge, this is the first report of the clinical presentation of CDV in a canine species previously immunized with a recombinant vaccine.

Preliminary Pilot Study of Itraconazole After a Single Oral Dose of a Veterinary Formulation Solution in African Penguins (Spheniscus demersus).

Aspergillosis is a common cause of morbidity and mortality in captive penguins. Itraconazole, an antifungal drug, is commonly used to treat aspergillosis infections in avian species; however, commercially available human formulations are costly, and studies have shown the effectiveness of compounded formulations to be unreliable. The US Food and Drug Administration (FDA) recently approved a veterinary formulation of itraconazole, Itrafungol, for use in cats. This study provides preliminary results from limited sampling evaluating whether this veterinary formulation is suitable for future studies in the African penguin (Spheniscus demersus). A 20 mg/kg PO itraconazole dose was administered to 9 African penguins. Blood samples were taken over the course of 24 hours; each sample was collected from a different bird to minimize stress to the animals. Plasma was analyzed by high-performance liquid chromatography for concentrations of itraconazole. The drug was absorbed in all penguins, and plasma concentrations in 5 of 9 penguins (56%) were found to be greater than the established therapeutic dose of 1.0 µg/ mL. To our knowledge, this is the first study that has investigated a 20 mg/kg dose of itraconazole in a penguin species. The small sample size limits the conclusions that can be drawn from this preliminary study. Nonetheless, we demonstrate encouraging evidence that the FDA-approved formulation of oral itraconazole solution should be considered for future study as a cost-effective treatment for aspergillosis in African penguins and other avian species.

Glomerular filtration rate determined by measuring serum clearance of a single dose of inulin and serum symmetric dimethylarginine concentration in clinically normal cheetahs (Acinonyx jubatus).

OBJECTIVE: To establish a reference interval for glomerular filtration rate (GFR) determined by measuring serum clearance of a single IV dose of inulin in clinically normal cheetahs (Acinonyx jubatus) and compare serum symmetric dimethylarginine (SDMA) concentration in cheetahs with GFR. ANIMALS: 33 cheetahs housed at 3 institutions. PROCEDURES: A single bolus of inulin (3,000 mg/m2) was administered IV, and 5 serial blood samples were collected and analyzed for serum inulin concentration with the anthrone technique. The GFR was estimated with a modified slope-intercept method for the slow component of the serum concentration-versus-time curve. Blood urea nitrogen and serum creatinine concentrations were measured in samples obtained immediately prior to inulin administration, and serum SDMA concentration was measured in stored samples. RESULTS: Mean ± SD measured GFR was 1.58 ± 0.39 mL/min/kg, and the calculated reference interval was 0.84 to 2.37 mL/min/kg. There were significant negative correlations between GFR and serum creatinine concentration (r = -0.499), BUN concentration (r = -0.592), and age (r = -0.463). Serum SDMA concentration was not significantly correlated with GFR (r = 0.385), BUN concentration (r = -0.281), or serum creatinine concentration (r = 0.165). CONCLUSIONS AND CLINICAL RELEVANCE: A reference interval for GFR in clinically normal cheetahs was obtained. Further evaluation of animals with renal disease is needed to determine whether measuring serum clearance of a single IV dose of inulin is a reliable diagnostic test for early detection of renal disease in cheetahs.

Quality and patient satisfaction after ambulatory laparoscopic management of non-severe and uncomplicated gallbladder pathology.

INTRODUCTION: Ambulatory laparoscopic cholecystectomy (ALC) reduces the use of hospital beds and benefits the patient by returning home sooner. Therefore, it is important to evaluate the degree of patient satisfaction. MATERIALS AND METHODS: A controlled clinical trial was designed to assess the efficacy, safety, and satisfaction of ALC, compared to the usual laparoscopic cholecystectomy (ULC). Efficacy and safety were evaluated based on; recovery of the oral route, spontaneous urination, gas channeling, presence of pain, nausea, vomiting, bleeding, pain, penrose expense. Satisfaction was explored through an adaptation of the SATISCORE questionnaire. RESULTS: We included 71 patients, 38 from the experimental group (ALC) and 33 from the control group (ULC). There was a higher proportion of women, average age at the fifth decade, and a similar distribution of comorbidities. In safety and efficacy, the results were similar. In the survey, the ALC group showed an 89.5% high degree of satisfaction. DISCUSSION: There was a good postoperative recovery in both groups as they reincorporated earlier, identified in a better satisfaction index referred by the patient. CONCLUSION: The ALC is as effective and safe as ULC, so it can be considered as the new "gold standard" for the surgical management of uncomplicated biliary pathology.

INTRODUCCIÓN: La colecistectomía laparoscópica ambulatoria (CLA) disminuye la utilización de camas y beneficia al paciente al no hospitalizarse, siendo importante evaluar su grado de satisfacción. MATERIAL Y MÉTODOS: Se diseñó un ensayo clínico controlado para eficacia, seguridad y satisfacción de CLA comparándola con colecistectomía laparoscópica habitual (CLH). Eficacia y seguridad se evaluaron en cuanto; recuperación de vía oral, micción espontánea, canalización de gases, dolor, nausea, vómito, sangrado, y gasto del penrose. La satisfacción a través de una adaptación del cuestionario SATISCORE. RESULTADOS: Se incluyeron 71 pacientes, 38 del grupo experimental (CLA) y 33 del control (CLH). En ambos hubo una mayor proporción de mujeres, edad promedio en la quinta década, y distribución de comorbilidades semejante. En seguridad y eficacia, los resultados fueron semejantes. En la encuesta el grupo de CLA manifestó 89.5% de alto grado de satisfacción. DISCUSIÓN: Hubo una buena recuperación en ambos grupos, con una reincorporaron más temprana y un mejor índice de satisfacción referido por el enfermo en el grupo experimental (CLA). CONCLUSIÓN: La CLA es tan efectiva y segura como la CLH, por lo que se puede considerar como el nuevo "Estándar de oro" para el manejo quirúrgico de la patología biliar no complicada.

Erosive Enteritis and Intestinal Obstructions Caused by Decomposed Granite in a Flock of Lesser Flamingos (Phoeniconaias minor).

Decomposed granite is a material commonly used in zoos as a base for flamingo exhibits. In 2012, the artificial turf over the decomposed granite in the Fort Worth Zoo flamingo exhibit was removed and pressure washed, the granite was replaced, and the turf was then restretched in place. Approximately 8 months later, 3 lesser flamingos (Phoeniconaias minor) showed signs of lethargy and hematochezia. Results of physical examination revealed poor body condition in all birds, with variable hematologic abnormalities, including anemia, hypoproteinemia, and electrolyte disturbances. Radiographs of birds showed large amounts of radiopaque material in the ventriculus and dilated intestinal loops. Two birds died either during treatment or surgery, and 1 bird was euthanatized. Postmortem examination of all 3 birds revealed large amounts of fine, granite-like material in the ventriculus and intestines, severe congestion of intestinal mucosa, and obstruction of intestinal lumen by caseous plugs surrounded by fecal material. Microscopic evaluation of the material removed from the ventriculus showed birefringent crystals that corresponded to microscopic silica grains, consistent with the decomposed granite from the exhibit. Histologic examination of tissues showed marked chronic erosive colitis, mild erosive proventriculitis, and lesions in the muscular layer of the ventriculus. Subsequently, 82 remaining flamingos in the flock were radiographed. Results showed the same material in the ventriculus of most birds, but no intestinal obstructions were identified. Different treatment techniques were attempted unsuccessfully to remove the material from the flamingos that had the largest amount of decomposed granite in their gastrointestinal tracts. Ultimately, all birds were treated with oral gastrointestinal protectants, adsorbents, laxatives, and lubricants, along with antibiotics administered in drinking water. No further mortalities occurred once medical treatments were implemented.

Population pharmacokinetics of itraconazole solution after a single oral administration in captive lesser flamingos (Phoeniconaias minor).

Aspergillosis is an infectious, non-contagious fungal disease of clinical importance in flamingo collections. Itraconazole is an antifungal drug commonly used in the treatment and prophylaxis of avian aspergillosis. Studies have shown that dosage regimes in birds vary based on different itraconazole presentation and administration methods. This investigation used a population pharmacokinetic approach to study itraconazole in lesser flamingos. Itraconazole was administered orally at 10 mg/kg to 17 flamingos. A sparse blood sampling was performed on the subjects, and samples were collected at 1, 2, 3, 5, 8, 12, 16, 21, and 24 hr post-drug administration. Twelve flamingos were sampled three times, three birds bled twice and two sampled once. Itraconazole in plasma was quantified using high-pressure liquid chromatography (HPLC). A one-compartment pharmacokinetic model with first order absorption was fitted to the data using nonlinear mixed effects modeling (NLME) to determine values for population parameters. We identified a long half-life (T½) of more than 75 hr and a maximum plasma concentration (CMAX ) of 1.69 µg/ml, which is above the minimal inhibitory concentrations for different aspergillus isolates. We concluded that plasma drug concentrations of itraconazole were maintained in a population of flamingos above 0.5 ug/ml for at least 24 hr after a single oral dose of 10 mg/kg of itraconazole solution.

DISSEMINATED OSSEOUS METAPLASIA OF THE VENTRAL SCALES OF A GRAY-BANDED KINGSNAKE ( LAMPROPELTIS ALTERNA).

A 22-yr-old, female gray-banded kingsnake ( Lampropeltis alterna) was examined for stomatitis and hard ventral scales. On examination, the ventral scales palpated as rigid and brittle. A blood sample yielded marked hypovitaminosis D (11 nmol/L). Radiographs revealed a generalized bone radiopacity outlining the ventral scales; scale biopsies were obtained for histologic examination and presented linear, superficial, and midzonal foci of well-differentiated dermal bone and bone marrow. The stomatitis was successfully treated, but the general condition of the snake declined, and it was euthanized. The most significant finding in the postmortem examination was abnormally pale kidneys. Histologic examination revealed diffuse renal gout and diffuse osseous metaplasia in the dermis of all of the ventral scales. Generalized osseous metaplasia of the ventral scales in snakes has not, to our knowledge, been reported; the cause in this report was not identified, but given the extensiveness of the lesion, it is likely that the cause was multifactorial.