Multistep IgE Mast Cell Desensitization Is a Dose- and Time-Dependent Process Partially Regulated by SHIP-1.

Multistep mast cell desensitization blocks the release of mediators following IgE crosslinking with increasing doses of Ag. Although its in vivo application has led to the safe reintroduction of drugs and foods in IgE-sensitized patients at risk for anaphylaxis, the mechanisms of the inhibitory process have remained elusive. We sought to investigate the kinetics, membrane, and cytoskeletal changes and to identify molecular targets. IgE-sensitized wild-type murine (WT) and FcεRIα humanized (h) bone marrow mast cells were activated and desensitized with DNP, nitrophenyl, dust mites, and peanut Ags. The movements of membrane receptors, FcεRI/IgE/Ag, actin, and tubulin and the phosphorylation of Syk, Lyn, P38-MAPK, and SHIP-1 were assessed. Silencing SHIP-1 protein was used to dissect the SHIP-1 role. Multistep IgE desensitization of WT and transgenic human bone marrow mast cells blocked the release of ß-hexosaminidase in an Ag-specific fashion and prevented actin and tubulin movements. Desensitization was regulated by the initial Ag dose, number of doses, and time between doses. FcεRI, IgE, Ags, and surface receptors were not internalized during desensitization. Phosphorylation of Syk, Lyn, p38 MAPK, and SHIP-1 increased in a dose-response manner during activation; in contrast, only SHIP-1 phosphorylation increased in early desensitization. SHIP-1 phosphatase function had no impact on desensitization, but silencing SHIP-1 increased ß-hexoxaminidase release, preventing desensitization. Multistep IgE mast cell desensitization is a dose- and time-regulated process that blocks ß-hexosaminidase, impacting membrane and cytoskeletal movements. Signal transduction is uncoupled, favoring early phosphorylation of SHIP-1. Silencing SHIP-1 impairs desensitization without implicating its phosphatase function.

Intractable airsickness associated with COVID-19: A case report.

A 29-yr-old male Melicopter co-pilot with high flight hours in air transport missions of the patients with COVID-19 tested positive for his RT-PCR due to clinical suspicion. With the diagnosis of SARS-CoV-2, he was treated based on the national protocol and stayed in the home quarantine for two weeks. Having been released for flying, he faced nausea, vomiting, facial cold sweat and pallor, dizziness, and imbalance that eventually caused flying avoidance during the three first flights. He has never had a similar problem or any predisposing factors during his pilot's training and afterwards. All the probable reasons ruled out after a complete assessment. Following the diagnosis of moderate airsickness, he was abstained from flying and treated with different prevention and rehabilitation techniques. None of them had enough clinical efficacies, applying the United States Air Force Preventive Airsickness Protocol as the last choice. Despite the three separate consecutive therapeutic courses, no significant clinical improvement was observed, and could not return to fly, yet. That is the first reported case of intractable airsickness in a flight crew that may be associated with SARS-CoV-2 infection.

Un varón de 29 años de edad, copiloto de helicóptero médico, con gran número de horas de vuelo en misiones de transporte aéreo de los pacientes de COVID-19, dio positivo en las pruebas rápidas de PCR, debido a sospecha clínica. Diagnosticándose SARS-CoV-2, fue tratado sobre la base del protocolo nacional, permaneciendo en cuarentena domiciliaria durante dos semanas. Habiendo sido eximido de volar, padeció náuseas, vómitos, sudores fríos y palidez facial, mareos y falta de equilibrio, que le abstuvieron de volar durante las primeras tres semanas. No había tenido nunca un problema similar ni factores predisponentes durante su formación como piloto, ni después de esta. Tras un reconocimiento completo se descartaron todas las causas probables. Al diagnosticarse mareo moderado al volar, se le recomendó que se abstuviera de viajar en avión, tratándosele con diferentes técnicas de prevención y rehabilitación. Ninguna de ellas tuvo eficacia clínica suficiente, aplicándose el protocolo para la prevención de mareo al volar de las Fuerzas Aéreas de los Estados Unidos como última elección. A pesar de realizar los tres cursos terapéuticos separados consecutivos no se observó una mejora clínica significativa, y no pudo volver a volar. Se trata del primer caso reportado de mareo al volar irresoluble en una tripulación de vuelo, que puede estar asociado a la infección por SARS-CoV-2.

Extended colostrum feeding for 2 weeks improves growth performance and reduces the susceptibility to diarrhea and pneumonia in neonatal Holstein dairy calves.

The objective of this study was to determine the effect of partial replacement of whole milk with colostrum on the growth performance and health status of Holstein dairy calves. Neonatal heifer calves (n = 144; 2 d of age; 39.3 ± 0.82 kg of body weight, BW; mean ± SE) were assigned randomly to 3 groups with partial replacement of pasteurized whole milk with pasteurized colostrum at 0 (C0; 0 kg/d of colostrum + 5 kg/d of whole milk), 350 g (C350; 0.350 kg/d of colostrum + 4.650 kg/d of whole milk), or 700 g (C700; 0.700 kg/d of colostrum + 4.300 kg/d of whole milk) for 14 d; there were no refusals of liquid feed. From d 15 onward, the calves were fed with 5 kg/d of pasteurized whole milk, weaned on d 61, and monitored until d 81 of life. Throughout the study, the calves had free access to fresh clean water and calf starter. Partial replacement of whole milk with colostrum increased liquid feed dry matter intake (DMI) but decreased milk DMI; however, intakes of starter DMI, total DMI, metabolizable energy, crude protein, and ether extract were not affected by treatments. Overall, the C700 calves recorded greater weaning weight, final BW, heart girth change, feed efficiency, and average daily gain (ADG). The calves fed milk had a higher chance of having rectal temperature ≥39.4°C and general appearance score ≥2 compared with those receiving colostrum in their milk. Diarrhea was more prevalent in C0 versus C700 calves. The occurrence of pneumonia tended to be higher in milk-fed calves compared with C350 and C700 animals. Colostrum feeding resulted in fewer days with a rectal temperature ≥39.4°C, general appearance ≥2, diarrhea, and pneumonia. We computed Cliff's delta (effect sizes) of the extended colostrum feeding (C350 vs. C0, C700 vs. C0, and C700 vs. C350) on starter and milk DMI, ADG, BW, and feed efficiency. In C350 calves, the effect sizes (Cliff's delta) for milk DMI, ADG, BW, and feed efficiency were positive and small, but negative in C700 calves. Compared with C350 treatment, C700 treatment resulted in greater final BW with moderate effect size. Positive and moderate effects of feeding colostrum (C700 vs. C0) were observed on postweaning ADG and final BW. The findings showed that the inclusion of 700 g of colostrum in 5 kg of milk may be beneficial to the growth and health of dairy calves.

FadA-positive Fusobacterium nucleatum is prevalent in biopsy specimens of Iranian patients with colorectal cancer.

Fusobacterium nucleatum has been increasingly implicated as a causative agent of various diseases, such as inflammatory bowel disease. Moreover, the gastrointestinal tracts of patients with colorectal cancer (CRC) also have been shown to be colonized by this bacterium. We aimed to determine the prevalence of F. nucleatum among CRC and non-CRC Iranian patients and to investigate potential associations between fadA-positive F. nucleatum and diagnosed CRC cases. Eighty patients admitted to two main hospitals in Tehran, Iran, were enrolled. The patients were aged between 20 and 75 and were diagnosed by a gastroenterologist. A trained surgeon used standard surgical protocols to collect two CRC biopsy samples per patient. One of the samples was used for pathologic examination, and the other was subjected to DNA extraction and PCR. Lesion colonization by F. nucleatum and expression of its major virulence factor, fadA, were investigated. The fadA-positive F. nucleatum strain was absent in all the lesions obtained from non-CRC patients. All patients with lesions that were colonized with fadA-positive F. nucleatum were diagnosed as CRC (p < 0.05); selected patients were sent for further intensive treatment. We found a significant association between the presence of F. nucleatum colonization and lesions from CRC patients (p  0.0001; odds ratio, 6.74; 95% confidence interval, 2.5-18.07). Our study confirmed colonization of the fadA-positive F. nucleatum on lesions from 80 Iranian CRC patients. New therapeutic strategies to achieve eradication of F. nucleatum are necessary for clinical management of patients suspected of having or prone to developing CRC.

Metronidazole-resistant Helicobacter pylori isolates without rdxA mutations obtained from Iranian dyspeptic patients.

Antibiotic resistance is now accepted as an inevitable factor in Helicobacter pylori treatment failure, so a survey on the antibiotic susceptibility profile of H. pylori is welcomed. In addition, the main molecular mechanism of antibiotic resistance in H. pylori is not fully determined, particularly for metronidazole. Our single-centre study was designed to evaluate the local antibiotic resistance profile of H. pylori strains recovered from individuals with dyspepsia. Gastric biopsy specimens from 200 individuals underwent bacterial culture for H. pylori, and bacterial identification was confirmed by positive reports from biochemical and genotypic universal protocols. Antibiotic susceptibility tests were performed on the 73 isolates obtained, by both disc diffusion and E-test methods. DNA extraction was carried out on single colonies of H. pylori confirmed by biochemical tests, then PCR was used to amplify the rdxA and 23srRNA genes. Metronidazole and clarithromycin resistance phenotypes were checked to detect possible mutations at rdxA and 23SrRNA genes. Successful bacterial culture was reported for 73 of the 200 patients (27 male (36%) and 46 female (63%) with an age range from 25 to 80 years (mean 54 years)). None of the patients reported pre-treatment. Among the 73 biochemically and genotypically confirmed H. pylori isolates in this analysis, antibiotic resistance rates were 45% (33/73) for metronidazole and 23% (17/73) for clarithromycin. Additionally, ten H. pylori isolates were multidrug resistant (13%). According to the antibiogram analysis, 13/17 (76%) had the A2142G mutation, although 3/17 (17%) samples also showed A2143G. None of the resistant isolates were carrying the A2142C and A2144G mutations. Moreover, none of the metronidazole-resistant strains showed any of the point mutations. Identification of H. pylori isolates without the rdxA mutation reveals the need for an urgent investigation to select an effective antibiotic before drug prescription by gastroenterologists.

The association of surface adhesin genes and the biofilm formation among Klebsiella oxytoca clinical isolates.

Bacterial adhesins mediate the attachment and biofilm production leading to the persistence of colonized strains. The aim of this study was evaluation of the association of surface adhesin genes with the biofilm formation among Klebsiella oxytoca isolates. Among 50 isolates of K. oxytoca from patients with antibiotic-associated diarrhoea, the susceptibility test, MIC (according to CLSI 2016) and phenotypic biofilm formation (with microtitre tissue-plate assay) were performed. The presence of adhesins was investigated using PCR. Thirty-three (66%) isolates produced moderate-level biofilms, but none of them exhibited strong biofilm formation. The presence of adhesins was as follows: fimA, 60% (n = 30), mrkA, 42% (n = 21), matB, 96% (n = 48) and pilQ, 92% (n = 46). The biofilm formation was related to the presence of fimA (odds ratio (OR) 0.8571, 95% CI 1.733-6.267, p <0.0001), mrkA (OR 0.2462, 95% CI 2.723-4.622, p 0.001), matB (OR 0.4521, 95% CI 1.353-5.332, p 0.008) and pilQ (OR 0.1481, 95% CI 1.691-6.117, p <0.0001). The npsB toxin-encoding gene was detected among 46 (92%) isolates. Resistance to non-ß-lactam antibiotics was significantly associated with the presence of adhesin-encoding genes. The presence of adhesins and the capsular encoding gene was significantly associated with biofilm formation among K. oxytoca isolates. The presence of surface adhesin-encoding genes was significantly associated with the biofilm formation and also with resistance to non-ß-lactam antibiotics among K. oxytoca clinical isolates. In addition, biofilm production was not significantly associated with ß-lactam resistance among the isolates.

Determining Changes in Electromyography Indices when Measuring Maximum Acceptable Weight of Lift in Iranian Male Students.

BACKGROUND: In spite of the increasing degree of automation in industry, manual material handling (MMH) is still performed in many occupational settings. The aim of the current study was to determine the maximum acceptable weight of lift using psychophysical and electromyography indices. METHODS: This experimental study was conducted among 15 male students recruited from Tehran University of Medical Sciences. Each participant performed 18 different lifting tasks which involved three lifting frequencies, three lifting heights and two box sizes. Each set of experiments was conducted during the 20 min work period using free-style lifting technique and subjective as well as objective assessment methodologies. SPSS version 18 software was used for descriptive and analytical analyses by Friedman, Wilcoxon and Spearman correlation techniques. RESULTS: The results demonstrated that muscle activity increased with increasing frequency, height of lift and box size (P<0.05). Meanwhile, MAWLs obtained in this study are lower than those in Snook table (P<0.05). In this study, the level of muscle activity in percent MVC in relation to the erector spine muscles in L3 and T9 regions as well as left and right abdominal external oblique muscles were at 38.89%, 27.78%, 11.11% and 5.55% in terms of muscle activity is more than 70% MVC, respectively. The results of Wilcoxon test revealed that for both small and large boxes under all conditions, significant differences were detected between the beginning and end of the test values for MPF of erector spine in L3 and T9 regions, and left and right abdominal external oblique muscles (P<0.05). The results of Spearman correlation test showed that there was a significant relation between the MAWL, RMS and MPF of the muscles in all test conditions (P<0.05). CONCLUSION: Based on the results of this study, it was concluded if muscle activity is more than 70% of MVC, the values of Snook tables should be revisited. Furthermore, the biomechanical perspective should receive special attention in determining the standards for MMH.

An Update on Biomedical Application of Nanotechnology for Alzheimer's Disease Diagnosis and Therapy.

Approximately 35 million people worldwide suffer from Alzheimer's disease (AD). The cellular uptake and specific transport of drugs and imaging agents to brain are common issues in the diagnosis and therapy of AD. New advances in nanotechnology have supplied favorable solutions to this issue. Various nanocarriers such as polymeric nanoparticles, liposomes, micelles, dendrimers and nanogels have been studied for the delivery of drugs and imaging agents to brain. This review presents a succinct discussion of the applications of nanotechnology for Alzheimer's disease diagnosis and therapy.

Relation of intelligence quotient and body mass index in preschool children: a community-based cross-sectional study.

OBJECTIVE: Overweight and obesity in children is a global problem. Besides physical effects, obesity has harmful psychological effects on children. METHODS: We carried out cross-sectional community-based study to investigate the relation between body mass index (BMI) and cognitive functioning in preschool children. Thirteen socioeconomical elements of 1151 children were measured and analyzed based on their intelligence quotient (IQ) test results. Thirteen out of 33 provinces were selected randomly, and schools were selected as clusters in rural and urban areas. Descriptive statistics, t-test, analysis of variance and regression were used when appropriate. RESULTS: Our analysis showed that IQ was associated with household income, place of residence, delivery type, type of infant feeding and father's and mother's education level (P<0.001 for all). Using penalized linear regression for eliminating the impact of confounding factor, our study shows that, living in metropolitan (ß=2.411) and urban areas (ß=2.761), the level of participants' father's education (ß=5.251) was positively and BMI (ß=-0.594) was negatively related with IQ test results.ConclusionsThe findings of the present study showed that a lower IQ score is associated with higher BMI. However, this relation appears to be largely mediated when the socioeconomic status was considered.

Canine visceral leishmaniasis: a comparative study of real-time PCR, conventional PCR, and direct agglutination on sera for the detection of Leishmania infantum infection.

Canine visceral leishmaniasis (CVL) is endemic in northwestern Iran. This study aimed to compare real-time PCR, conventional PCR, and the direct agglutination test (DAT) for the diagnosis Leishmania infantum infection in 167 serum samples of domestic dog. Bone marrow was used for parasitological examination (smears and/or culture) in symptomatic visceral leishmaniasis, and serum was used for detection of L. infantum kinetoplast DNA (kDNA) by both conventional PCR and real-time PCR, while anti-L. infantum antibodies in sera were measured by DAT. The sera were collected from 37 symptomatic and 112 asymptomatic dogs during April to May 2011. Eighteen presumed negative samples were obtained from healthy dogs kept in non-endemic areas with no history of CVL and used as controls. All 18 samples were negative by DAT and Dipstick rK39. DAT confirmed previous exposure to L. infantum for all 149 serum samples collected from symptomatic and asymptomatic dogs in CVL endemic areas of Iran. Among the 37 symptomatic dogs, 20 (54%), 25 (67.6%), 36 (97.3%), and 37 (100%) showed L. infantum infection by parasitological methods, conventional PCR, real-time PCR, and DAT (≥ 1:80), respectively. Of 112 asymptomatic dogs, 79 (70.5%), 111 (99.1%), and 112 (100%) were shown to be positive by conventional PCR, and DAT (≥ 1:80), respectively. For ethical reasons, no asymptomatic or healthy control dogs were examined by parasitological methods. Three (16.7%) control dogs were positive by real-time PCR, but were negative by DAT, dipstick rK39, and conventional PCR methods. Parasitemia levels were measured by real-time PCR targeting kDNA using SYBR(®) green assay. This quantitative technique detected infection in 89.9% (150/167) of the domestic dogs that harbored L. infantum kDNA, ranging from 0.01 49 to 310.1 parasites/ml. The average was 16.60 parasites/ml. A good agreement (0.97) was found between real-time PCR and DAT at ≥ 1:80 titer, used as cut-off value by Kappa analysis. Thus, real-time PCR as a quantitative PCR assay on serum samples represents a valuable tool for initial diagnosis of CVL when whole blood is not available.

Comparison of real-time PCR and conventional PCR with two DNA targets for detection of Leishmania (Leishmania) infantum infection in human and dog blood samples.

Zoonotic visceral leishmaniasis (VL) is endemic in northwestern Iran. Real-time PCR, conventional PCR, and the direct agglutination test (DAT) were used to diagnose Leishmania infantum infection in blood samples from 100 domestic dogs and 100 humans. Based on clinical evaluation, 82 humans and 72 dogs from the endemic area were categorized as having asymptomatic infection, DAT positive with no clinical signs of VL, or symptomatic infection, DAT positive with at least one sign of VL. Eighteen human samples containing no Leishmania antibodies (DAT(-)) and 28 dog DAT(-) sera from non-endemic areas with no history of VL constituted negative controls. All 46 DAT(-) samples were also negative by Dipstick rK39. Bone marrow material was used for parasitological examinations in symptomatic VL, and peripheral blood samples were used for detection of L. infantum infection using conventional PCR and real-time PCR in non-symptomatic subjects. Two DNA targets (ITS1 kDNA) were used for conventional PCR. L. infantum antibodies in sera were detected by DAT. Parasitemia was measured by real-time PCR targeting kDNA using Taqman Assay. All 72 (100%) symptomatic (38/38) and asymptomatic (34/34) dog DAT(+)samples, 45 of 48 (93.8%) symptomatic human DAT(+) samples, and 32 of 34 (94.1%) human asymptomatic cases were identified by real-time PCR. The mean (59.19 vs 12.38 parasite equivalents/mL of blood) and median (16.15 vs 1 parasite equivalents/mL of blood) ranges of parasitemia were higher in dogs than in humans (P<0.05). The highest agreement was obtained between real-time PCR and DAT (99% in dogs and 95% in humans). Sensitivity of 100% and 93.9%, specificity of 96.4% and 100%, positive predictive values of 98.6% and 100%, and negative predictive values of 100% and 78.3% were found by real-time PCR for dog and human samples, respectively.

Research priorities in medical education in the Eastern Mediterranean Region.

Ways are needed to effect quality improvement in medical education research in the Eastern Mediterranean Region (EMR). This study aimed to determine the principle themes and to draw up a list of priorities in medical education research in EMR. Using the nominal group technique with a group of 30 experts, a list of major themes in medical education research was prepared. In a 2-round Delphi survey the list was sent to another 47 experts in the Region with a questionnaire that included open questions about change and reform in medical education. In the final list of 20, the 5 highest priorities identified were: training physicians to be effective teachers; community-driven models for curriculum development; clinical teaching models; education about professionalism and ethics; and education for evidence-based medicine. Themes determined by this survey can help researchers in EMR to focus on priority areas in research.

PP006. The comparison of serum VEGF and sFlt-1 on preeclampsia and eclampsia pregnant woman before and after delivery at Ulin Hospital, Banjarmasin, Indonesia.

INTRODUCTION: Preeclampsia is the main cause of maternal morbidity and mortality at Indonesia. In 2010, 228 maternal deaths occur in 100,000 live birth. Ulin Hospital, Banjarmasin, a tertiary care hospital has high prevalence of preeclampsia and eclampsia (22%). Vascular angiogenesis has a role on pathogenesis of preeclampsia, including angiogenic factor and anti-angiogenic factor like VEGF and sFlt-1. OBJECTIVES: To evaluate changes of sFlt-1 and VEGF levels on preeclampsia and eclampsia woman before and after delivery. METHODS: This is a cross sectional research, which include 30 pregnant women with preeclampsia and eclampsia at Ulin Hospital, Banjarmasin, whom pregnancy was terminated vaginaly or abdominaly. Every patient was checked for the serum level of sFlt-1 and VEGF before and 3days after delivery. RESULTS: There are significant changes of the serum level sFlt-1 and VEGF before and after delivery. Serum sFlt-1 mean value decrease significantly after delivery (18251.4pg/ml vs 1193.9pg/ml; p<0.0001). Serum VEGF mean value increase significantly after delivery (50.4pg/ml vs 836.1pg/ml; p<0.0001). Mean value of the angiogenic factor before and after delivery was not significantly different between early-onset PE, late-onset PE and eclampsia. CONCLUSION: There are significant changes of the angiogenic factors (sFlt-1 and VEGF) before and 3days after delivery.

Research priorities in medical education in the Eastern Mediterranean Region

Ways are needed to effect quality improvement in medical education research in the Eastern Mediterranean Region [EMR]. This study aimed to determine the principle themes and to draw up a list of priorities in medical education research in EMR. Using the nominal group technique with a group of 30 experts, a list of major themes in medical education research was prepared. In a 2-round Delphi survey the list was sent to another 47 experts in the Region with a questionnaire that included open questions about change and reform in medical education. In the final list of 20, the 5 highest priorities identified were: training physicians to be effective teachers; community-driven models for curriculum development; clinical teaching models; education about professionalism and ethics; and education for evidence-based medicine. Themes determined by this survey can help researchers in EMR to focus on priority areas in research

Genotyping of Acanthamoeba isolated from water in recreational areas of Tehran, Iran.

A comprehensive survey assessing the presence of Acanthamoeba was conducted on 50 samples from water sources in parks and public squares from 22 municipal districts of Tehran, Iran. The prevalence and genotypes of Acanthamoeba were determined by PCR and the PCR fragments of ribosomal RNA genes sequenced. Sixteen (32%) samples were positive for Acanthamoeba spp. Sequence analysis revealed that the positive isolates belonged to the T4 and T5 genotypes. Fourteen isolates (87.5%) were T4, and two (12.5%) were T5. Acanthamoeba may be a problematic organism for contact lens wearers and for immunocompromised individuals. In Iran, Acanthamoeba keratitis has increased in recent years, mainly due to poor hygiene in contact lens wearers. A thorough survey for the prevalence of this amoeba could have a significant role in prevention of disease. This is the first report of the T5 genotype from water in recreational areas of Tehran.

Comparison of the effects of cows' milk, fortified soy milk, and calcium supplement on weight and fat loss in premenopausal overweight and obese women.

BACKGROUND AND AIMS: Recent studies suggest that calcium metabolism and perhaps other components of dairy products may contribute to shifting the energy balance and thus play a role in weight regulation. We compared the effects of cows' milk, calcium fortified soy milk and calcium supplement on weight and body fat reduction in premenopausal overweight and obese women. METHODS AND RESULTS: In this clinical trial, 100 healthy overweight or obese premenopausal women were randomized to one of the following dietary regimens for 8 weeks: (1) a control diet providing a 500kcal/day deficit, with 500-600mg/day dietary calcium; (2) a calcium-supplemented diet identical to the control diet with 800mg/day of calcium as calcium carbonate; (3) a milk diet providing a 500kcal/day deficit and containing three servings of low-fat milk; (4) a soy milk diet providing a 500kcal/day deficit and containing three servings of calcium fortified soy milk. At baseline and after 8 weeks, weight, waist circumference, and hip circumference were measured. Three 24-h dietary records and physical activity records were also taken. Comparing the mean differences in weight, waist circumference, body mass index (BMI) and waist-to-hip ratio (WHR) using repeated measure of variance analysis showed that changes in waist circumference and WHR were significant among the four groups (p=0.029 and p=0.015, respectively). After adjustment for baseline values, changes in weight and BMI were also significant (p=0.017 and p=0.019, respectively). Weight reductions in high milk, soy milk, calcium supplement and control groups were 4.43±1.93(kg), 3.46±1.28(kg), 3.89±2.40(kg) and 2.87±1.55(kg), respectively. The greatest changes were seen in the high dairy group in all variables. CONCLUSION: Increasing low fat milk consumption significantly reduces the general and central obesity beyond a low calorie diet.

Pilomatricomas múltiples. Presentación de un caso / Multiple pilomatricomas. A case report

El pilomatricoma, o epitelioma calcificado de Malherbe, es un tumor cutáneo benigno de origen ectodérmico, relativamente raro, aunque es más común en la infancia, sobre todo antes de los 10 años; habitualmente es único y sólo el 3,5% de los casos son formas múltiples. Suelen ser pequeños (0,5-3 cm) y la localización más habitual es la cefálica. Se presentan como nódulos subcutáneos solitarios y asintomáticos, de consistencia pétrea. El diagnóstico de sospecha puede realizarse mediante una exploración clínica cuidadosa; sin embargo, con frecuencia el diagnóstico preoperatorio de pilomatricoma es incorrecto, fundamentalmente debido a la falta de familiaridad de los clínicos con este tumor. Este hecho y la poca frecuencia de los pilomatricomas múltiples nos motivaron a presentar este caso clínico (AU)

Pilomatricoma, or calcifying epithelioma of Malherbe, is a benign cutaneous tumour of ectodermal origin, relatively rare, although it is more common during childhood, especially in children under ten; it is normally unique and only 3.5% of the mare of multiple forms. They are usually small (0.5-3.0 cm) and the most usual location is the cephalic one. They are usually asymptomatic solitary subcutaneous nodules with a petreous consistency. The suspected diagnosis may be done with a very careful clinical examination; however preoperative diagnosis of pilomatricoma is often incorrect, mainly because the examining physician is not familiar with it. This event and the fact that multiple pilomatricomas are not very frequent are the reason for us to present this case report (AU)