Keeping profitable cows in the herd: A lifetime cost-benefit assessment to support culling decisions.

Increasing the productive lifespan of dairy cows is important to achieve a sustainable dairy industry, but making strategic culling decisions based on cow profitability is challenging for farmers. The objective of this study was to carry out a lifetime cost-benefit analysis based on production and health records and to explore different culling decisions among farmers. The cost-benefit analysis was conducted for 22 747 dairy cows across 114 herds in Quebec, Canada for which feed costs and the occurrence of diseases were reported. Costs and revenues related to productive lifespan were compared among cohorts of cows that left their respective herd at the end of their last completed lactation or stayed for a complete additional lactation. Hierarchical clustering analysis was carried out based on costs and revenues to explore different culling decisions among farmers. Our results showed that the knowledge of lifetime cumulative costs and revenues was of great importance to identify low-profitable cows at an earlier lactation, while only focusing on current lactation costs and revenues can lead to an erroneous assessment of profitability. While culling decisions were mostly based on current lactation costs and revenues and disregarded the occurrence of costly events on previous lactations, there was variation among farmers as we identified three different culling decision clusters. Monitoring cumulative costs and revenues would help farmers to identify low-profitable cows at an earlier lactation and make the decision to increase herd productive lifespan and farm profitability by keeping the most profitable cows.

Experiencia del síndrome de Guillain-Barré en una Unidad de Cuidados Intensivos neurológicos / Experience with Guillain-Barré syndrome in a neurological Intensive Care Unit

Introducción: El síndrome de Guillain-Barré (SGB) es la causa más común de parálisis flácida aguda. En algunos pacientes ocurre falla ventilatoria secundaria a este trastorno, con complicaciones secundarias al soporte ventilatorio y a la movilidad reducida. La mayoría de los casos tienen buen pronóstico; el tratamiento se hace con plasmaferésis o inmunoglobulinas, además del soporte básico. Objetivo: Describir las características sociodemográficas, clínicas, de laboratorio y electrofisiológicas de los pacientes con SGB hospitalizados en las Unidades de Cuidado Intensivo (UCI) y Cuidado Especial del Instituto Neurológico de Colombia entre 2006 y 2012. Metodología: Presentación de serie de casos. Resultados: Presentamos a 25 pacientes con SGB; el 68% de los pacientes fueron hombres, con una edad promedio de 54 años. El 60% de los pacientes ingresó entre los días 3 y 7 del inicio del cuadro, el 64% tuvo antecedente de infección respiratoria y el 20% de infección intestinal 20%. La mayoría de los pacientes (84%) presentó disociación albúmino-citológica. El 32% se presentó con polineuropatía inflamatoria desmielinizante aguda, el 28% con polineuropatía axonal motora y sensitiva aguda, el 28% con polineuropatía axonal motora aguda y el 12% con síndrome de Miller-Fisher. Los pacientes de UCI presentaron mayor tiempo de estancia hospitalaria, infecciones y un peor desenlace medido por Rankin modificado al mes. Conclusiones: Esta descripción corresponde a un grupo de pacientes críticos con SGB; su desenlace estuvo determinado por la severidad del cuadro clínico al ingreso. Nuestros hallazgos son comparables con lo publicado en la literatura mundial

Introduction: Guillain-Barré syndrome, an acute polyradiculoneuropathy that presents with weakness and areflexia, is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure is secondary to this disorder, eventually causing patients to require mechanical ventilation and experience additional complications due to diminished respiratory support and related mobility limitations. Prognoses for most of these cases are positive; treatment consists of basic support combined with plasmapheresis or administration of immunoglobulins. Objective. This study sought to describe the socio-demographic, clinical, laboratory and neurophysiological characteristics of patients with Guillain-Barré syndrome who were hospitalised in the Intensive Care Unit of the Neurological Institute of Colombia between 2006 and 2012. Methodology: This study presents a case series. Results: We surveyed 25 patients (32% female and 68% male) with Guillain-Barré syndrome and an average age of 54 years. Sixty per cent of these patients were admitted between days 3 and 7 after symptom onset; 64% had a history of respiratory infection and 20% had a history of intestinal infection. In addition, 84% of the patients presented with albuminocytological dissociation. We observed the following clinical subtypes of Guillain-Barré syndrome: inflammatory demyelinating polyneuropathy in 32%, acute motor-sensory axonal neuropathy in 28%, acute motor axonal neuropathy in 28%, and Miller Fisher syndrome in 12%. Conclusions: In this descriptive study of a group of critical care patients with GBS, results depended on patients’ clinical severity at time of admission. Our findings are similar to results published in the international literature

[Lactational breast abscesses: Do we still need surgery?]. / Abcès du sein lactant : et si on ne les opérait plus ?

AIM: To show the effectiveness of ultrasound-guided puncture in the treatment of lactational breast abscess and identify its risk factors. MATERIALS AND METHODS: Retrospective descriptive study at the CHU of Lyon-Sud from December 2007 to December 2013, including patients with lactational breast abscess confirmed on ultrasound and treated with antibiotics and analgesics. Realisation of ultrasound-guided needle under local anesthesia by the radiologist and washing the cavity with physiological serum. RESULTS: Forty patients had lactational abscesses at an average of 10 weeks post-partum. Thirty-four patients were treated by needle aspiration, of which 2 had first surgical drainage. The average size of the abscess was 41.2mm. The success rate of needle aspiration was 91.2%. No cases of recurrence were observed, however, there were 5 fistulisations. In all, 91.2% were treated on an outpatient basis. In 87.8% of cases, breastfeeding was continued on the healthy side and in 48.5% of cases on the affected side. The major risk factor for abscess was mastitis in 91.1% of cases. CONCLUSION: Ultrasound guidance of needle aspiration should be gold standard for the treatment of lactational breast abscesses to continue breastfeeding including the affected side.

Experience with Guillain-Barré syndrome in a neurological Intensive Care Unit. / Experiencia del síndrome de Guillain-Barré en una Unidad de Cuidados Intensivos neurológicos.

INTRODUCTION: Guillain-Barré syndrome, an acute polyradiculoneuropathy that presents with weakness and areflexia, is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure is secondary to this disorder, eventually causing patients to require mechanical ventilation and experience additional complications due to diminished respiratory support and related mobility limitations. Prognoses for most of these cases are positive; treatment consists of basic support combined with plasmapheresis or administration of immunoglobulins. OBJECTIVE: This study sought to describe the socio-demographic, clinical, laboratory and neurophysiological characteristics of patients with Guillain-Barré syndrome who were hospitalised in the Intensive Care Unit of the Neurological Institute of Colombia between 2006 and 2012. METHODOLOGY: This study presents a case series. RESULTS: We surveyed 25 patients (32% female and 68% male) with Guillain-Barré syndrome and an average age of 54 years. Sixty per cent of these patients were admitted between days 3 and 7 after symptom onset; 64% had a history of respiratory infection and 20% had a history of intestinal infection. In addition, 84% of the patients presented with albuminocytological dissociation. We observed the following clinical subtypes of Guillain-Barré syndrome: inflammatory demyelinating polyneuropathy in 32%, acute motor-sensory axonal neuropathy in 28%, acute motor axonal neuropathy in 28%, and Miller Fisher syndrome in 12%. CONCLUSIONS: In this descriptive study of a group of critical care patients with GBS, results depended on patients' clinical severity at time of admission. Our findings are similar to results published in the international literature.

Angioedema agudo orolingual asociado a tratamiento con activador tisular del plasminógeno humano recombinante / Acute orolingual angioedema associated to recombinant human tissue plasminogen activator treatment

No disponible

Adaptación cultural del cuestionario LINQ (Lung Information Needs Questionnaire) en pacientes con enfermedad respiratoria crónica en un programa de rehabilitación pulmonar en Cali, Colombia / Cultural Adaptation of the LINQ (Lung Information Needs Questionnaire) Questionnaire in Patients with Chronic Respiratory Disease in a Pulmonary Rehabilitation Program in Cali, Colombia / Adaptação cultural do questionário LINQ (Lung Information Needs Questionnaire) em pacientes com doença respiratória crônica em um programa de reabilitação pulmonar em Cali, Colômbia

Objetivo: Adaptar culturalmente el cuestionario LINQ (Lung Information Needs Questionnaire) en pacientes con enfermedad pulmonar crónica. Métodos: Estudio descriptivo, después de la traducción del cuestionario por traductor certificado y de la adaptación cultural, se aplicó en ocho pacientes para identificar las dificultades y dudas relacionadas con el entendimiento de las preguntas, la terminología y para evaluar no solo la calidad de la traducción, sino también para verificar aspectos prácticos de su aplicación. Posteriormente, se realizó una segunda traducción al idioma inglés la cual fue enviada a los autores para asegurar el contenido original del cuestionario y conseguir el aval para su uso. Resultados: La muestra en la fase de adaptación cultural fue constituida por 6 hombres y 2 mujeres con una edad promedio de 61 años. La versión en español del LINQ y la adaptación cultural fue comprensible y fácil de usar y no presentó discrepancias con la versión original durante el proceso de retratraducción. Conclusiones: La traducción al español y la adaptación del LINQ fue adecuada pues los pacientes no manifestaron dificultades para entender y responder las preguntas. Esto podrá facilitar la realización de futuros estudios que evalúen el componente educativo en los programas de rehabiltación pulmonar.

Objective: To perform a cultural adaptation of the LINQ (Lung Information Needs Questionnaire) for patients with chronic pulmonary disease. Method: Descriptive study. After the translation of the questionnaire by a certified translator, and after its cultural adaptation, it was applied in eight patients in order to identify the difficulties and doubts related to an understanding of the questions and of its terminology, not only to evaluate the quality of the translation, but to verify practical aspects of its application, as well. Afterward, a second translation was done from Spanish to English, and sent back to the authors to ensure the original content of the questionnaire was maintained, and to obtain endorsement for its use. Results: During the cultural adaptation phase, the sample was constituted by 6 men and 2 women, with an average age of 61 years. The Spanish version of the LINQ, as well as the cultural adaptation, was easy to use and did not show any discrepancies with the original version during the re-translation process. Conclusions: The LINQ's translation to Spanish and the cultural adaptation proved to be adequate, because the patients did not express any difficulties in understanding and answering the questions. This will facilitate future studies that evaluate the educational component in the pulmonary rehabilitation program.

Objetivo: adaptar culturalmente o questionário LINQ (Lung Information Needs Questionnaire) em pacientes com doença pulmonar crônica. Métodos: Estudo descritivo, depois da tradução do questionário por tradutor certificado e da adaptação cultural, aplicou-se a oito pacientes para identificar as dificuldades e dúvidas relacionadas com o entendimento das perguntas, a terminologia e para avaliar não só a qualidade da tradução, más também para verificar aspectos práticos de sua aplicação. Posteriormente, realizou-se uma segunda tradução ao idioma inglês a qual foi enviada aos autores para assegurar o conteúdo original do questionário e conseguir o aval para seu uso. Resultados: a amostra na fase de adaptação cultural foi constituída por 6 homens e 2 mulheres com uma idade média de 61 anos. A versão em espanhol de LINQ e a adaptação cultural foram compreensíveis e fáceis de usar e não apresentaram discrepâncias com a versão original durante o processo de retradução. Conclusões: a tradução ao espanhol e a adaptação do LINQ foi adequada pois os pacientes não manifestaram dificuldades para entender e responder as perguntas. Isto poderá facilitar a realização de futuros estudos que avaliem o componente educativo nos programas de reabilitação pulmonar.

Nanoparticle delivery of mycophenolic acid upregulates PD-L1 on dendritic cells to prolong murine allograft survival.

Conventional immunosuppressive drug delivery requires high systemic drug levels to provide therapeutic benefit, but frequently results in toxic side effects. Novel drug delivery methods, such as FDA-approved poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs), are promising drug delivery platforms to reduce drug doses and minimize toxicity. Using murine models of skin transplantation, we investigated whether PLGA NPs would effectively deliver mycophenolic acid (MPA), a common clinical immunosuppressant, and avoid the toxicity of conventional drug delivery. We found that intermittent treatment with NPs encapsulated with MPA (NP-MPA) resulted in a significant extension of allograft survival than intermittent conventional MPA treatment even though the concentration of MPA within NP-MPA was a 1000-fold lower than conventional drug. Importantly, recipients who were administered NP-MPA intermittently avoided drug toxicity, whereas those treated with daily conventional drug manifested cytopenias. Dendritic cells (DCs) endocytosed NP-MPA to upregulate programmed death ligand-1 (PD-L1) and displayed a decreased ability to prime alloreactive T cells. Importantly, the ability of NP-MPA to promote allograft survival was partly PD-L1 dependent. Collectively, this study indicates that NPs are potent drug delivery tools that extend allograft survival without drug toxicity.

Anaplastic transformation of an atypical intraventricular meningioma with metastases to the liver: case report.

OBJECTIVE: Malignant intraventricular meningiomas are very rare. To the best of our knowledge, only eleven cases have been reported thus far. Seven of them developed cerebrospinal fluid (CSF) metastases. We present herein the first case of a malignant intraventricular meningioma with extraneural metastases. CLINICAL PRESENTATION: We report a 44 year-old-man with a history of progressive headache and disorientation. Magnetic resonance imaging (MRI) revealed a 5-cm homogeneously-enhancing mass in the right trigone. INTERVENTION: The lesion was totally resected via a parietooccipital transcortical approach. Histological examination demonstrated an atypical meningioma. Thereafter, the tumor recurred twice. At first recurrence, the tumor was completely removed again and external radiotherapy was administered. At surgery at second recurrence, the tumor was more aggressive, invading the brain parenchyma. Histological examination showed anaplastic meningioma. The patient was readmitted to hospital with fever and pain in right hypochondrium. Abdominal ultrasound examination disclosed multiple hypoechoic liver lesions. Biopsy was consistent with liver metastases of a malignant meningioma. The patient died of acute liver failure seven months after initial diagnosis. CONCLUSION: Malignant intraventricular meningiomas are prone to recur and develop metastases, mainly through the CSF. Nevertheless, our case shows that extraneural metastases are also possible. Therefore, when systemic deterioration occurs in a patient with a malignant intraventricular meningioma, metastases to extraneural organs such as the liver must be ruled out.

Anaplastic transformation of an atypical intraventricular meningioma withmetastases to the liver: case report

Objective. Malignant intraventricular meningiomasare very rare. To the best of our knowledge, only elevencases have been reported thus far. Seven of them developedcerebrospinal fluid (CSF) metastases. We presentherein the first case of a malignant intraventricularmeningioma with extraneural metastases.Clinical presentation. We report a 44 year-old-manwith a history of progressive headache and disorientation.Magnetic resonance imaging (MRI) revealed a5-cm homogeneously-enhancing mass in the right trigone.Intervention. The lesion was totally resected via aparietooccipital transcortical approach. Histologicalexamination demonstrated an atypical meningioma.Thereafter, the tumor recurred twice. At first recurrence,the tumor was completely removed again andexternal radiotherapy was administered. At surgeryat second recurrence, the tumor was more aggressive,invading the brain parenchyma. Histological examinationshowed anaplastic meningioma. The patientwas readmitted to hospital with fever and pain in righthypochondrium. Abdominal ultrasound examinationdisclosed multiple hypoechoic liver lesions. Biopsywas consistent with liver metastases of a malignantmeningioma. The patient died of acute liver failureseven months after initial diagnosis.Conclusion. Malignant intraventricular meningiomasare prone to recur and develop metastases, mainlythrough the CSF. Nevertheless, our case shows thatextraneural metastases are also possible. Therefore,when systemic deterioration occurs in a patient with amalignant intraventricular meningioma, metastases toextraneural organs such as the liver must be ruled out (AU)

Objetivos. Los meningiomas malignos intraventricularesson muy infrecuentes. En la bibliografía existentesólo se han descrito once casos hasta ahora. Sietede ellos desarrollaron metástasis a través del líquidocefalorraquídeo (LCR). Presentamos el primer caso deun meningioma maligno intraventricular con metástasisextraneurales.Caso clínico. Paciente varón de 44 años de edad conuna clínica de cefalea progresiva y desorientación. Laresonancia magnética mostraba un proceso expansivointracraneal en el trígono derecho con captación decontraste de forma homogénea.Intervención. Se practicó una resección total de lalesión a través de un acceso transcortical. El análisishistológico mostró un meningioma atípico. A pesarde la resección total, el tumor recidivó otras dosveces. Después de la primera recidiva, el tumor fueextirpado nuevamente y el paciente recibió radioterapiaexterna. En la segunda recidiva, el tumorse comportó de forma más agresiva, invadiendo elparénquima cerebral. El análisis histológico mostrabaun meningioma anaplásico. El paciente fueingresado nuevamente por fiebre y dolor en el hipocondrioderecho. Una ecografía abdominal mostrómúltiples lesiones hipoecogénicas hepáticas. La biopsiade dichas lesiones fue compatible con metástasisdel meningioma maligno. El paciente falleció debidoa una insuficiencia hepática aguda siete meses despuésdel diagnóstico inicial.Conclusiones. Los meningiomas malignos intraventricularestienden a recurrir y producir metástasis,principalmente a través del LCR. Sin embargo,nuestro caso muestra que los meningioma malignosintraventriculares también pueden metastatizar fueradel sistema nervioso central, siendo el primer caso descrito. Por lo tanto, cuando un deterioro sistémicoocurra en un paciente con un meningioma malignointraventricular debería descartarse la posibilidad demetástasis extraneurales como sucedió en este caso (AU)

[Intraoperative neurophysiological monitoring of the spinal cord: our experience]. / Monitorización neurofisiológica intraoperatoria de la médula espinal: nuestra experiencia.

INTRODUCTION: The main objective of intraoperative monitoring of the spinal cord is to detect any neurological damage that may occur (and which would otherwise go unnoticed) while it is still reversible. AIM: To retrospectively evaluate the effectiveness of neurophysiological monitoring in spine and spinal cord surgery since the time such procedures were first implemented within our centre. PATIENTS AND METHODS: The patients were divided into three groups, according to their pathologies. They were clinically evaluated with the McCormick scale before surgery, on discharge from hospital and at six months after the operation. Neurophysiological monitoring was performed with motor evoked potentials, somatosensory potentials and screw stimulation, when appropriate. RESULTS: The sample finally consisted of 49 subjects, with a mean age of 51 +/- 19.4 years. Distribution by groups was 53.1% spinal cord tumours, 22.4% traumatic injuries to the spinal cord and 24.5% bone/disc pathologies. During surgery potentials improved in 4.08% of patients, in 63.26% they remained intact, 20.41% were alerted by the neurophysiologist with intact potentials, 10.2% suffered a transitory decline and in one case there was permanent loss. All the patients who were submitted to a follow-up at six months displayed a clinical status that was the same or better than the one before their operation. CONCLUSIONS: Neurophysiological monitoring is a valuable tool that prevented, in 30.61% of our patients, damage that could otherwise have occurred. From the clinical point of view, its high predictive value is also worth highlighting.

Monitorización neurofisiológica intraoperatoria de la médula espinal: nuestra experiencia / Intraoperative neurophysiological monitoring of the spinal cord: Our experience

Introducción. El principal objetivo de la monitorización intraoperatoria de la médula espinal es la detección decualquier daño neurológico, que de otro modo pudiese pasar inadvertido, durante el período en el que éste es reversible. Objetivo. Evaluar retrospectivamente la efectividad de la monitorización neurofisiológica en la cirugía vertebral y de médula espinal desde su implantación en nuestro centro. Pacientes y métodos. Los pacientes se dividieron en tres grupos según patologías. Se evaluaron clínicamente antes, en el momento del alta y a los seis meses de la cirugía con la escala de McCormick. La monitorización neurofisiológica se realizó con potenciales evocados motores, potenciales somatosensoriales y estimulaciónde tornillos donde procedía. Resultados. El tamaño de la muestra fue de 49 sujetos, con una media de edad de 51 ± 19,4 años. La distribución por grupos fue de un 53,1% de tumores medulares, un 22,4% de traumatismo medular y un 24,5% de patologíaosteodiscal. Durante la cirugía, el 4,08% de los pacientes presentó una mejoría de sus potenciales, el 63,26% los mantuvo intactos, el 20,41% sufrió una alerta por parte del neurofisiólogo con unos potenciales intactos, el 10,2% sufrió una caída transitoria, y en un caso hubo una pérdida permanente. Todos los pacientes seguidos a los seis meses presentaron un estadoclínico igual o mejor al prequirúrgico. Conclusiones. La monitorización neurofisiológica constituye una herramienta de gran valor que evitó, en el 30,61% de nuestros pacientes, daños que de otro modo podrían haberse producido. Debe reseñarse tambiénsu importante valor predictivo desde el punto de vista clínico

Introduction. The main objective of intraoperative monitoring of the spinal cord is to detect any neurological damage that may occur (and which would otherwise go unnoticed) while it is still reversible. Aim. To retrospectively evaluate the effectiveness of neurophysiological monitoring in spine and spinal cord surgery since the time such procedures were firstimplemented within our centre. Patients and methods. The patients were divided into three groups, according to their pathologies. They were clinically evaluated with the McCormick scale before surgery, on discharge from hospital and at sixmonths after the operation. Neurophysiological monitoring was performed with motor evoked potentials, somatosensory potentials and screw stimulation, when appropriate. Results. The sample finally consisted of 49 subjects, with a mean age of 51 ± 19.4 years. Distribution by groups was 53.1% spinal cord tumours, 22.4% traumatic injuries to the spinal cord and 24.5% bone/disc pathologies. During surgery potentials improved in 4.08% of patients, in 63.26% they remained intact, 20.41% were alerted by the neurophysiologist with intact potentials, 10.2% suffered a transitory decline and in one case there was permanent loss. All the patients who were submitted to a follow-up at six months displayed a clinical status that was the same or better than the one before their operation. Conclusions. Neurophysiological monitoring is a valuable tool that prevented, in 30.61% of our patients, damage that could otherwise have occurred. From the clinical point of view, its high predictive value is also worth highlighting

Gastrosquisis: reporte de un caso y revisión bibliográfica / gastroschisis: a case report and literature review

Se presenta el caso de Paciente femenina de 23 años de edad, II gesta, I Para, quien es referida a este centro por hallazgo ecográfico de malformación fetal y oligoamnios severo. Se le diagnóstico gastrosquisis a las 29 semanas a través de un ecograma pélvico. Al momento del ingreso se le realiza un nuevo ecograma, evidenciándose un embarazo de 35 semana por biometría fetal y 37 semanas por FUM, gastrosquisis con esas dilatadas (16 mm), RCF y liquido amniótico en suficiente cantidad; motivo por el cual la paciente es trasladada al servicio de obstetricia. Se planifica la intervención en conjunto con cirugía pediátrica e intensivista pediátrica. Se realiza cesárea segmentarea electiva, obteniéndose recién nacido de sexo femenino en con apgar de 7 pts al minuto y 9 pts a los 5 minutos, con liquido amniótico claro con grumos, se evidencio defecto de cierre de pared anterior con protusión de asas intestinales dilatadas. Se realiza de forma inmediata intervención de cirugía pediátrica, realizándose intento fallido de cierre de pared abdominal, y se coloca bolsa de bogota. Se mantiene en la unidad de cuidados intensivos por 3 días y fallece por sepsis fetal con punto de partida enteral. La madre evoluciona bien en su post operatorio y es dada de alta.

Process development for a Cuban cholera vaccine based on the attenuated strain Vibrio cholerae 638.

Genetically modified Vibrio cholerae strain 638 (biotype El Tor, serotype Ogawa) has previously been shown to be immunogenic in animal models and in human trials. Our objective in the work reported herein was to describe the process development methods for the production of the 638 attenuated cholera vaccine. Cell seed bank, culture of biomass, lyophilization and final formulation were processes were developed. The results show kinetics of culture that fulfils a logistical model. The microbiological properties, colonizing capability, immunogenicity and non-toxigenicity of the final product were indistinguishable from the properties of the working seed lot. We conclude that the non-reactogenic, immunogenic and protective strain 638 is robust and can withstand the fermentation processes required for large-scale production of a vaccine.