Plant size, latitude, and phylogeny explain within-population variability in herbivory.

Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.

CO2 fluxes from three different temperate grazed pastures using Eddy covariance measurements.

Grasslands cover around 25% of the global ice-free land surface, they are used predominantly for forage and livestock production and are considered to contribute significantly to soil carbon (C) sequestration. Recent investigations into using 'nature-based solutions' to limit warming to <2 °C suggest up to 25% of GHG mitigation might be achieved through changes to grassland management. In this study we evaluate pasture management interventions at the Rothamsted Research North Wyke Farm Platform, under commercial farming conditions, over two years and consider their impacts on net CO2 exchange. We investigate if our permanent pasture system (PP) is, in the short-term, a net sink for CO2 and whether reseeding this with deep-rooting, high-sugar grass (HS) or a mix of high-sugar grass and clover (HSC) might increase the net removal of atmospheric CO2. In general CO2 fluxes were less variable in 2018 than in 2017 while overall we found that net CO2 fluxes for the PP treatment changed from a sink in 2017 (-5.40 t CO2 ha-1 y-1) to a source in 2018 (6.17 t CO2 ha-1 y-1), resulting in an overall small source of 0.76 t CO2 ha-1 over the two years for this treatment. HS showed a similar trend, changing from a net sink in 2017 (-4.82 t CO2 ha-1 y-1) to a net source in 2018 (3.91 t CO2 ha-1 y-1) whilst the HSC field was a net source in both years (3.92 and 4.10 t CO2 ha-1 y-1, respectively). These results suggested that pasture type has an influence in the atmospheric CO2 balance and our regression modelling supported this conclusion, with pasture type and time of the year (and their interaction) being significant factors in predicting fluxes.

Analysis of biomolecules in cochineal dyed archaeological textiles by surface-enhanced Raman spectroscopy.

SERS spectroscopy is successfully employed in this work to reveal different components integrating the cochineal colorant employed for dying archaeological textile samples from the Arica Region in North Chile. This analysis was done by in-situ experiments that does not imply the material (colorant and biomolecules) extraction. The spectroscopic analysis of the archaeological textiles by SERS reveals the presence of bands attributed to carminic acid and nucleobases, mainly adenine and guanine. The identification of these biomolecules was also verified in raw cochineal extract and in cochineal dyed replica wool fibers fabricated by us following ancient receipts. The effect of Al on the complexation of carminic acid and other biomolecules was also tested in order to understand the changes induced by the metal interaction on the colorant structure. This study revealed that Al can also complex biomolecules existing in the cochineal extract. In particular, guanine residue seems to interact strongly with the metal, since SERS bands of this residue are enhanced. Furthermore, a theoretical analysis on the interaction of carminic acid and a silver surface was also performed in order to better understand the interaction mechanism between carminic acid and a metal surface that leads to the final SERS spectrum. The results of the present work will be very useful in the identification of different molecules and metal complexes that may be forming part of the cochineal colorant found in archaeological materials.

Reconnaissance of tumor immune microenvironment spatial heterogeneity in metastatic renal cell carcinoma and correlation with immunotherapy response.

A clearer understanding of the tumor immune microenvironment (TIME) in metastatic clear cell renal cell carcinoma (ccRCC) may help to inform precision treatment strategies. We sought to identify clinically meaningful TIME signatures in ccRCC. We studied tumors from 39 patients with metastatic ccRCC using quantitative multiplexed immunofluorescence and relevant immune marker panels. Cell densities were analyzed in three regions of interest (ROIs): tumor core, tumor-stroma interface and stroma. Patients were stratified into low- and high-marker density groups using median values as thresholds. Log-rank and Cox regression analyses while controlling for clinical variables were used to compare survival outcomes to patterns of immune cell distributions. There were significant associations with increased macrophage (CD68+ CD163+ CD206+ ) density and poor outcomes across multiple ROIs in primary and metastatic tumors. In primary tumors, T-bet+ T helper type 1 (Th1) cell density was highest at the tumor-stromal interface (P = 0·0021), and increased co-expression of CD3 and T-bet was associated with improved overall survival (P = 0·015) and survival after immunotherapy (P = 0·014). In metastatic tumor samples, decreased forkhead box protein 3 (FoxP3)+ T regulatory cell density correlated with improved survival after immunotherapy (P = 0·016). Increased macrophage markers and decreased Th1 T cell markers within the TIME correlated with poor overall survival and treatment outcomes. Immune markers such as FoxP3 showed consistent levels across the TIME, whereas others, such as T-bet, demonstrated significant variance across the distinct ROIs. These findings suggest that TIME profiling outside the tumor core may identify clinically relevant associations for patients with metastatic ccRCC.

Statement of the Spanish Society of Allergology and Clinical Immunology on Provocation Tests With Aspirin/Nonsteroidal Anti-inflammatory Drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated.

Indications for small bowel capsule endoscopy and its safety and diagnostic yield in Mexican patients. Experience at a tertiary care hospital center. / Indicaciones, rendimiento diagnóstico y seguridad de la cápsula endoscópica de intestino delgado en pacientes mexicanos. Experiencia de un centro de tercer nivel.

INTRODUCTION: Appearing in the year 2000, capsule endoscopy revolutionized the study of the small bowel. It is the gold standard for the study of small bowel bleeding and is considered a safe procedure. OBJECTIVE: The aim of the present study was to identify the indications for, diagnostic yield, and safety of capsule endoscopy in Mexican patients. MATERIALS AND METHODS: A descriptive study was conducted on the first 500 small bowel capsule endoscopies performed at a tertiary care hospital center in Mexico City. Sex, age, type of video camera employed, bowel transit time, referral diagnosis, and capsule endoscopy findings and complications were registered. RESULTS: Mean patient age was 55years (±17.63) and 57.9% of the cases were women. Complete visualization of the small bowel was achieved in 420 capsule endoscopies (84%). Mean bowel transit time was 272.25minutes (±114.86). The most common indications for the procedure were small bowel bleeding (65.2%), search for neoplasia (14.4%), and Crohn's disease (10.2%). The presence of ulcers was the most common finding in small bowel bleeding (24.8%), followed by angioectasias (18.9%). Capsule retention was the only complication and it presented in 11 patients (2.2%). CONCLUSIONS: Capsule endoscopy is a safe and efficacious method for studying the small bowel. The results obtained in Mexican patients were similar to those described in the international literature. The present case series is the largest reported in a Mexican population.

Statement of the Spanish Society of Allergology and Clinical Immunology on provocation tests with aspirin/nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated

Los antiinflamatorios no esteroideos (AINE) son medicamentos ampliamente utilizados a nivel mundial y frecuentemente implicados en reacciones de hipersensibilidad que pueden comprender desde reacciones locales y/o leves a reacciones sistémicas y graves. La complejidad del diagnóstico ante la falta de pruebas cutáneas o de laboratorio estandarizadas y/o validadas, hace que en muchos casos debamos realizar pruebas de provocación de alto riesgo. Por ello, es necesario un exhaustivo estudio de estos pacientes en los que tienen gran importancia el correcto diagnóstico y la búsqueda de procedimientos más seguros ante pacientes con reacciones graves, así como también la búsqueda de opciones alternativas de tratamientos antiinflamatorios. Actualmente existen diversas guías y protocolos de actuación que describen el manejo de la hipersensibilidad a los AINE aunque con importante variabilidad entre diferentes países. Desde los distintos comités de Asma, Rinoconjuntivitis y Alergia a Fármacos de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC) proponemos un documento de posicionamiento sobre las opciones en las pruebas de provocación con aspirina/ AINE. Este documento es el resultado de una revisión exhaustiva de la evidencia actual, basada en publicaciones recientes sobre el diagnóstico de pacientes con hipersensibilidad a AINE, y de la discusión consensuada de un grupo de expertos de la SEAIC. El objetivo fundamental ha sido elaborar una guía práctica de fácil lectura dirigida a profesionales sanitarios de atención especializada implicados en el estudio y manejo de pacientes con sospecha de hipersensibilidad a AINE. Además, se ha realizado una actualización sobre las indicaciones, contraindicaciones y procedimientos de las pruebas de provocación oral, bronquial y nasal con aspirina/AINE

Calidad durante el almacenamiento de huevos de gallinas alimentadas con dietas con aceite de palma / Egg quality during storage of eggs from hens fed diets with crude palm oil

RESUMEN Objetivo. Evaluar el efecto del aceite crudo de palma (ACP) sobre la calidad del huevo almacenado por varios días a diferentes temperaturas. Materiales y métodos. Un total de 240 gallinas de 28 semanas se alimentaron con dietas con 30g/kg de aceite de soya (AS) o ACP. Después de 12 semanas, muestras de huevos se almacenaron durante 0, 4, 8 y 12 días a 4, 12 y 24°C. Las características de calidad del huevo fueron evaluadas. Resultados. El huevo y la albúmina de gallinas en la dieta con ACP fueron más pesados que aquellos en la dieta con AS (p<0.05). La alta temperatura de almacenamiento redujo el peso del huevo, albúmina y yema, unidades Haugh (UH), altura de la albúmina y la yema, pH y color (p<0.05), pero aumentó el ancho de la albúmina y la yema, y la longitud de la albúmina (p<0.05). A medida que aumentaba el tiempo de almacenamiento, el peso del huevo, el peso y la altura de la albúmina, y la altura de la yema, el pH y el color se redujeron (p<0.05). Sin embargo, el peso y el ancho de la yema, el ancho y la longitud de la albúmina aumentaron (p<0.05). La interacción aceite x tiempo de almacenamiento (p<0.05) indico que la altura de la albumina, UH y el color de la yema de los huevos de la dieta con ACP fueron mejores a los 12 días de almacenamiento que en la dieta con AS. Conclusiones. Las gallinas en la dieta con ACP tuvieron huevos y albuminas más pesadas que las de las de la adieta con AS. La calidad del huevo disminuyó conforme el tiempo y temperatura de almacenamiento se incrementó, pero, los huevos de las gallinas suplementadas con ACP tuvieron mejor calidad en algunas características a los 12 días de almacenamiento.

ABSTRACT Objective. Evaluate the effect of crude palm oil (CPO) on quality traits of eggs stored various days at different temperatures. Material and Methods. A total of 240 hens, 28 weeks of age were fed diets with 30 g/kg of soybean oil (SO) or CPO. After 12 weeks, sample of eggs were stored during 0, 4, 8 and 12 days at 4, 12 and 24 °C. Egg quality traits were evaluated. Results. Egg and albumen from hens in CPO diet were heavier than those in SO (p<0.05). High storage temperature reduced egg, albumen and yolk weights, Haugh units (HU), albumen and yolk heights, pH and color (p<0.05), but increased albumen and yolk widths and albumen length (p<0.05). As storage time increased, egg weight, albumen weight and height, and yolk height, pH and colour were reduced (p<0.05). However, yolk weight and width, albumen width and length increased (p<0.05). Oil x storage time interaction (p<0.05) indicated that albumen height, HU and yellowness of yolk from hens in CPO diets were better at 12 days of storage than for hens fed SO. Conclusions. Hens in CPO diet had heavier eggs and albumen than those in SO diet. Egg quality traits decreased as temperature and days of storage increased, but, eggs from hens supplemented CPO had better quality in some traits at 12 days of storage.

PillCam SB3 vs. PillCam SB2: Can technologic advances in capsule endoscopy improve diagnostic yield in patients with small bowel bleeding? / Pillcam SB3 vs. Pillcam SB2: ¿pueden los avances tecnológicos de la cápsula endoscópica mejorar el rendimiento diagnóstico en pacientes con hemorragia de intestino delgado?

INTRODUCTION AND OBJECTIVE: The SB3 capsule endoscopy system has better image resolution and the capacity to increase the number of images from 2 to 6 frames per second. Small bowel bleeding is the most common indication. The aim To determine if the advances in capsule endoscopy technology increase diagnostic yield in cases of small bowel bleeding, according to the Saurin classification. MATERIAL AND METHODS: A retrospective, observational, analytic, cross-sectional study included 100 SB2 capsule endoscopies and 100 SB3 capsule endoscopies in patients that presented with small bowel bleeding. The findings obtained with both systems were evaluated. The lesions identified by the two capsules were categorized using the Saurin classification. The relation between the lesions identified with the SB3 and those found with the SB2 was identified through a logistic regression analysis. RESULTS: In the SB2 capsule endoscopy group, 60% were women, patient age was 59 years (42.2, 73), and intestinal transit time was 271min (182, 353). In the SB3 group, 57% were women, patient age was 60 years (42.5, 73), and intestinal transit time was 277min (182, 352). There were no significant differences in the identification of P0 and P2 lesions between the two systems. The SB3 capsule endoscope identified more P1 lesions (p=0.020, OR: 2.35, 95% CI:1.12-4.90). There was no significant difference in relation to location of the lesions in the small bowel. CONCLUSIONS: A greater number of P1 lesions were detected through the technologic advances made in SB3 capsule endoscopy, but the diagnostic yield for P2 lesions was not modified.

Impact of an antimicrobial stewardship program on urinary tract infections caused by extended-spectrum ß-lactamase-producing Escherichia coli.

OBJECTIVE: To analyze the clinical and economic impact of an antimicrobial stewardship program (ASP) targeting urinary tract infections (UTI) caused by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli. METHODS: An observational retrospective study that included adults with a diagnosis of UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between January 2014 and December 2015. The impact of the ASP was analyzed in terms of clinical and economic outcomes. RESULTS: A total of 222 patients met the inclusion criteria and an intervention was made by the ASP team in 104 cases (47%). ASP intervention was an independent variable related to clinical cure (p = 0.008). Other variables influencing clinical outcomes were the McCabe Jackson score (p = 0.005) and outpatient status (p < 0.001). The ASP interventions in this study had no economic impact. CONCLUSIONS: Antimicrobial stewardship has a positive clinical impact on UTIs caused by ESBL-producing E. coli. Further prospective studies are needed to assess the economic impact of ASPs on UTI caused by ESBL-producing E. coli.

Situación actual de la rehabilitación respiratoria en los hospitales de la Comunidad de Madrid / No disponible

Introducción: A pesar de que la rehabilitación respiratoria (RR) es considerada como una intervención terapéutica con alto nivel de evidencia científica, la estructura y la organización de las unidades de RR pueden repercutir en sus resultados. Nuestra intención era conocer la situación actual de las unidades de RR de la Comunidad de Madrid. Material y métodos: Análisis de los resultados de la encuesta distribuida a todos los hospitales de la Comunidad de Madrid mediante correo electrónico desde la Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) y la Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). La encuesta fue diseñada de acuerdo a los estándares de calidad asistencial en RR propuestos por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Resultados: Once (61,6%) hospitales señalaron que contaban con una unidad de RR y en el 54,5% de ellas no existía acceso desde atención primaria. El 72,7% de unidades indicó que la derivación de pacientes no era adecuada. Casi todas las unidades ofrecían programas de fisioterapia, entrenamiento aeróbico, de fuerza muscular y soporte educativo, sin embargo solo el 27,3% daba soporte nutricional y 18,2% apoyo psicosocial. El 45,4% usaba la prueba de esfuerzo progresivo para pautar el entrenamiento. Existían 3 cicloergómetros (rango intercuartílico 2-5) y 1 tapiz rodante (0-2) por unidad. Todas las unidades contaba con médicos rehabilitadores y fisioterapeutas y en el 60% también participaban neumólogos. Conclusiones: No todos los hospitales de la Comunidad de Madrid cuentan con unidades de RR. Además, el análisis de los indicadores de calidad asistencial en RR demuestran limitaciones en protocolos, evaluación del paciente, componentes y características de los programas, y aspectos administrativos y de investigación

Introduction: Although respiratory rehabilitation (RR) is considered as a therapeutic intervention with a high level of scientific evidence, the structure and organization of the RR units may have repercussions on its results. Our intention was to know the current situation of RR units in the Community of Madrid. Material and Methods: Analysis of results of the survey distributed to all hospitals in the Community of Madrid by email from the Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) and the Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). The survey was designed according to the standards of care quality in RR proposed by the Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Results: 11 (61.6%) hospitals reported that they had a RR unit. 54.5% of them did not have an access from primary care. 72.7% of the units indicated that referral of patients was not adequate. Almost all the units offered programs of physical therapy, aerobic training, muscular strength and educational support, however only 27.3% gave nutritional support and 18.2% psychosocial support. Progressive incremental test was used by 45.4% RR units. There were 3 cycle ergometers (interquartile range 2-5) and 1 treadmill (0-2) per unit. All units had rehabilitation physicians and physiotherapists, and 60% also had pulmonologists. Conclusions: Not all hospitals in the Community of Madrid have RR units. Moreover, the analysis of the indicators of care quality of the RR shows limitations in protocols, patient evaluation, components and characteristics of the programs, administrative and research aspects

Rasch analysis of the Mini Mental State Examination (MMSE) in older adults in Antioquia, Colombia / Análisis rasch del mini mental state examination (mmse) en adultos mayores de antioquia, colombia

Resumen Objetivo. Evaluar las evidencias de validez del Mini Mental State Examination que sustentan su interpretación en adultos mayores. Métodos. Estudio de fuente secundaria con la participación de 4034 adultos mayores residentes de Antioquia, Colombia, 2012. Se siguieron los lineamientos de Wolfe y Smith para análisis desde el modelo Rasch. Resultados. Se identificó dependencia local entre los ítems de atención y cálculo. Estos producen una segunda medida que afecta la unidimensionalidad del instrumento. La confiabilidad de los ítems fue de 0,80, la medida explicó el 45,2% de la varianza de las puntuaciones crudas. Conclusión. Los resultados sugieren diferenciar las habilidades de atención y cálculo de los demás procesos cognitivos considerados por el instrumento. El MMSE presenta limitaciones de validez de generalización que potencialmente afectan comparaciones transculturales.

Abstract Objective. To evaluate validity of the Mini-Mental State Examination (MMSE) that supports the interpretability in older adults. Methods. Secondary data study administered in 4.034 older adults in Antioquia, Colombia, 2012. Data were analyzed from Rasch models according to Wolfe and Smith guidelines. Results. Attention and calculation items showed local dependency. They produce a second relevant measure affecting the unidimensional type of the test. The reliability of the items was of 0.80, the measure explained 45.2% of the raw score variance. Conclusion. Results suggest differentiating attention and calculation abilities from the other cognitive processes considered by the test. MMSE shows generalization validity limitations that may affect transcultural comparisons.

El humanismo en nuestra profesión / No disponible

No disponible

Increased regional gray matter atrophy and enhanced functional connectivity in male multiple sclerosis patients.

Evidence suggests that sex/gender is an important factor for understanding multiple sclerosis (MS) and that some of its neuropathological consequences might manifest earlier in males. In the present study, we assessed gray matter (GM) volume and functional connectivity (FC) in a sample of female and male MS patients (MSp) and female and male healthy controls (HCs). As compared to female MSp, male MSp showed decreased GM volume in the bilateral frontal areas and increased FC between different brain regions. Because both sets of changes correlated significantly and no differences in cognitive performance were observed, we suggest that the FC increase observed in male MSp acts as a compensatory mechanism for their more extensive GM loss and that it promotes a functional convergence between male- and female-MSp.

Effect of environmental factor on some litter traits of sows in the tropics Mexican / Efecto de factores ambientales sobre algunas características de la camada de cerdas en el trópico de México

Objective. To determine the effect of environmental factors on litter traits at birth and weaning, and their repeatabilities in four farms in the sub-humid tropics of Mexico. Materials and methods. Data from 46.249 to 50.316 litters for litter size at birth (LSB), number of piglets born alive (NBA), litter weight at birth (LWB), number of piglets weaned (NPW) and litter weight at weaning (LWW) were used. The statistical model for LSB, NBA and LWB included the effects of farm, farrowing year, farrowing season, parity number, simple interactions, random effects of sow and the error term. NPW and LWW were analyzed using the previous model plus the linear and quadratic effects of lactation length (LL). Results. The means for LSB, NBA, LWB, NPW and LWW were 11.7 piglets, 11.0 piglets, 16.1 kg, 10.3 piglets and 61.3 kg, respectively. All effects in the model affected the litter traits. Farrowing year x season interaction was significant for NPW, LWB and LWW. The dry season had the highest LSB, NBA y NPW. First parity sows had higher LSB and NBA means than for second parity sows. Parity increase until parity 4 to decrease thereafter. LL had a quadratic effect on NPW and LWW. Repeatability estimates for LSB, NBA, and LWB were 0.12, 0.12 and 0.14, respectively. Conclusions. All traits studied were influenced by the environmental factors studied. Repeatabilities for LSB, NBA and LWB were low.

Objetivo. Determinar el efecto de factores ambientales sobre características de la camada al nacer y al destete, y sus repetibilidades en cuatro granjas en el trópico sub-húmedo de México. Materiales y métodos. Se utilizaron los datos de 50.316 a 46.249 camadas para el total de lechones nacidos (LSB), lechones nacidos vivos (NBA) y peso de la camada al nacimiento (LWB), lechones destetados (NPW) y peso de la camada al destete (LWW). El modelo estadístico para LSB, NBA y LWB incluyen los efectos de granja, año, época, número de parto, interacciones simples, efecto aleatorio de cerda y error. El modelo para NPW y LWW incluyó los factores anteriores y además, los efectos lineal y cuadrático de largo de lactación (LL). Resultados. Las medias para LSB, NBA, LWB, NPW y LWW fueron 11.7 lechones, 11.0 lechones, 16.1 kg, 10.3 lechones y 61.3 kg, respectivamente. Todos los factores estudiados afectaron las características de la camada. La interacción de año x época fue significativa para NPW, LWB y LWW. La época seca presentó las mayores medias de LSB, NBA y NPW. Las cerdas primer parto obtuvieron medias de LSB y NBA superiores que las cerdas del segundo parto. Las medias por número de parto incrementaron hasta el cuarto, para después disminuir. La LL obtuvo un efecto cuadrático sobre NPW y LWW. Las repetibilidades estimadas para LSB, NBA, y LWW fueron 0.12, 0.12 y 0.14, respectivamente. Conclusiones. Todos los factores ambientales estudiados afectaron las características de la camada al nacer y al destete. Las repetibilidades estimadas fueron bajas.

Fascitis necrosante en un niño. Evolución y tratamiento / Necrotizing fasciitis in a child. Evolution and treatment

La fascitis necrosante es una grave infección de progresión rápida y fulminante. Debe ser sospechada ante la progresión de lesiones dérmicas con necrosis de tejidos y afectación del estado general. En los niños no requiere una situación de inmunodepresión ni enfermedad de base. El tratamiento de elección es el abordaje quirúrgico precoz con desbridamiento amplio de la zona afectada. La situación funcional tras el tratamiento puede verse mermada. Presentamos un caso de fascitis necrosante en un niño, su evolución, el tratamiento y el abordaje rehabilitador tras la cirugía (AU)

Necrotizing fasciitis is a serious bacterial infection with rapid progression and fulminant course. It should be suspected in patients with rapidly progressing skin lesions with soft tissue necrosis and deterioration of general health status. This infection can occur in children without immunodepression or underlying diseases. The treatment of choice is wide surgical debridement of dead tissue. Functional recovery after treatment may be limited. We report a case of necrotizing fasciitis in a boy and his outcome, as well as the treatment of this infection and the approach to rehabilitation after surgery (AU)

Tuberculosis cutánea y pulmonar en paciente inmunocompetente / No disponible

La tuberculosis continúa siendo, en la actualidad, una enfermedad frecuente en nuestro medio debido principalmente a dos factores, la inmigración y la coinfección con el virus de la inmunodeficiencia humana. La afectación cutánea por Mycobacterium tuberculosis es muy poco habitual y, concretamente, la forma periorificial o ulcerosa, que se asocia a tuberculosis pulmonar extensa, es excepcional. Sin embargo, su incidencia puede aumentar en el futuro debido a los factores anteriormente citados junto a la inmunodepresión asociada al envejecimiento de la población y a los tratamientos inmunosupresores, por lo que se hace imprescindible incluir dicha enfermedad en el diagnóstico diferencial de las lesiones cutáneas en pacientes con tuberculosis pulmonar. Su diagnóstico requiere el aislamiento en el cultivo o la positividad en la técnica de reacción en cadena de la polimerasa de M. tuberculosis, y su tratamiento es el mismo que el de la tuberculosis pulmonar

Tuberculosis remains today a common disease in our daily lives mainly due to two causes, immigration and coinfection with the human immunodeficiency virus. Skin involvement by Mycobacterium tuberculosis is highly unusual, and particularly periorificial or ulcer form, which is associated with extensive pulmonary tuberculosis, is uncommon. However, its appearance may increase in the future due to the causes mentioned above, as well as immunosuppression associated with an aging population, and immunosuppressive treatments. Therefore, it is essential to include this disease in the differential diagnosis of skin lesions in patients with pulmonary tuberculosis. Diagnosis requires culture isolation or positivity of the M. tuberculosis polymerase chain reaction technique. Its treatment is the same as that of the pulmonary tuberculosis

Tuberculosis pulmonar y cerebral en un paciente inmunocompetente / No disponible

La infección por Mycobacterium tuberculosis tiene una alta prevalencia y está en íntima relación con la migración. Afecta fundamentalmente al pulmón, pero también a otros órganos, como el sistema nervioso central, conllevando una alta morbilidad y mortalidad. Se considera a los tuberculomas una forma de presentación a nivel cerebral, diagnosticándose mediante punción-aspiración o biopsia quirúrgica cuando es accesible o a través de técnicas de imagen. En caso de afectación meníngea, es obligado el estudio del líquido cefalorraquídeo. En función de la clínica, el tratamiento de los tuberculomas será quirúrgico o predominantemente farmacológico con cuatro antituberculostáticos y corticoides. Para la prevención de complicaciones, especialmente en inmunocomprometidos, es fundamental el diagnóstico precoz así como el tratamiento inmediato ante la mínima sospecha clínica. Presentamos el caso de un paciente varón de 41 años inmunocompetente que, tras estudio radiológico y microbiológico, se diagnosticó de tuberculosis pulmonar y cerebral y que mejoró satisfactoriamente

Infection with Mycobacterium tuberculosis is highly prevalent and is closely related to migration. It mainly affects lungs, but can also involve other organs such as the central nervous system. This neurologic complication is accompanied by a high morbidity and mortality. Tuberculomas are considered one form of presentation in the brain, and could be diagnosed by needle aspiration or surgical biopsy when they are accessible, or through imaging techniques. In the case of meningeal involvement, study of the cerebrospinal fluid is required for the diagnosis. Anti-tuberculosis drugs and corticosteroids are mainly used for the treatment of tuberculomas, but depending on the clinical situation, surgical procedures could also be performed. To prevent complications, especially in immunocompromised patients, early suspect and diagnosis is important to start immediately the administration of anti-tuberculosis drugs. We report the case of a 41-year-old-man immunocompetent who was diagnosed of pulmonary and cerebral tuberculosis and who was effectively treated

Neumonía por Pneumocystis jiroveci: características clínicas y factores de riesgo asociados a mortalidad en una Unidad de Cuidados Intensivos / Pneumocystis jiroveci pneumonia: Clinical characteristics and mortality risk factors in an Intensive Care Unit

Objetivo: Describir las características epidemiológicas de la población con neumonía por Pneumocystis jiroveci (P. jiroveci), analizando factores de riesgo asociados a la enfermedad, factores predisponentes para ingreso en una unidad de cuidados intensivos (UCI) y factores pronóstico de mortalidad. Diseño y pacientes: Estudio observacional y retrospectivo de una cohorte de pacientes ingresados consecutivamente en un hospital de España desde el 1 de enero del 2007 al 31 de diciembre del 2011 cuyo diagnóstico final fue neumonía por P. jiroveci. Ámbito: UCI y servicio de hospitalización del Hospital del Mar, Barcelona. Resultados: Se incluyeron 36 pacientes con neumonía por P. jiroveci de los que 16 (44,4%) precisaron de ingreso en UCI. La edad media de todos los pacientes fue de 41,3 ± 12 años, de los que 23 (63,9%) eran hombres. El 86,1% tenía antecedente de infección por virus de la inmunodeficiencia humana (VIH) y el resto (el 13,9%) de alguna enfermedad inmunológica con tratamiento inmunosupresor. Los factores de riesgo asociados a mortalidad hospitalaria fueron la edad (51,8 vs. 37,3 años; p = 0,002), APACHE mayor al ingreso (17 vs. 13 puntos; p = 0,009), la necesidad de ventilación mecánica invasiva (27,8 vs. 11,1%; p = 0,000), requerimiento de fármacos vasoactivos (25 vs. 11,1%; p = 0,000), coinfección fúngica (22,2 vs. 11,1%; p = 0,001), neumotórax (16,7 vs. 83,3%; p = 0,000) ingreso en UCI (27,8 vs. 72,2%; p = 0,000). Conclusiones: Los altos requerimientos de ventilación mecánica y de fármacos. vasoactivos asociado a la coinfección fúngica y presencia de neumotórax en pacientes ingresados en la UCI continúan siendo factores de riesgo asociados a mayor mortalidad en pacientes con neumonía por P. jiroveci

Objective: To describe the epidemiological characteristics of the population with Pneumocystis jiroveci (P. jiroveci) pneumonia, analyzing risk factors associated with the disease, predisposing factors for admission to an intensive care unit (ICU), and prognostic factors of mortality. Design:and patients A retrospective observational study was carried out, involving a cohort of patients consecutively admitted to a hospital in Spain from 1 January 2007 to 31 December 2011, with a final diagnosis of P. jiroveci pneumonia. Setting The ICU and hospitalization service of Hospital del Mar, Barcelona (Spain). Results: We included 36 patients with pneumonia due to P. jiroveci. Of these subjects, 16 required ICU admission (44.4%). The average age of the patients was 41.3 ± 12 years, and 23 were men (63.9%). A total of 86.1% had a history of human immunodeficiency virus (HIV) infection, and the remaining 13.9% presented immune-based disease subjected to immunosuppressive therapy. Risk factors associated to hospital mortality were age (51.8 vs. 37.3 years, P = .002), a higher APACHE score upon admission (17 vs. 13 points, P = .009), the need for invasive mechanical ventilation (27.8% vs. 11.1%, P = .000), requirement of vasoactive drugs (25.0% vs. 11.1%, P = .000), fungal coinfection (22.2% vs. 11.1%, P = .001), pneumothorax (16.7% vs. 83.3%, P = .000) and admission to the ICU (27.8% vs. 72.2% P = .000). Conclusions: The high requirement of mechanical ventilation and vasoactive drugs associated with fungal coinfection and pneumothorax in patients admitted to the ICU remain as risk factors associated with mortality in patients with P. jiroveci pneumonia