Primary bedaquiline resistance in Karakalpakstan, Uzbekistan.

BACKGROUND: Bedaquiline (BDQ) is widely used in the treatment of rifampicin-resistant TB (RR-TB). However, resistance to BDQ is now emerging. There are no standardised regimens for BDQ-resistant TB. This study aims to share experience in managing primary BDQ-resistant TB.METHODS: We performed a retrospective study of patients treated for RR-TB in Karakalpakstan, Uzbekistan, from January 2017 to March 2022. We identified patients with resistance to BDQ with no history of BDQ exposure. We describe baseline characteristics, treatment and follow-up of these patients.RESULTS: Twelve of the 1,930 patients (0.6%) had baseline samples resistant to BDQ with no history of BDQ exposure, 75% (9/12) of whom had been previously treated for TB. Ten (83.3%) were resistant to fluoroquinolones; respectively 66% and 50% had culture conversion by Month 3 and Month 6. The interim treatment outcomes were as follows: unfavourable treatment outcomes (3/12, 25%), favourable outcomes (2/12, 17%); the remaining seven (58%) were continuing treatment.CONCLUSIONS: A large proportion of the cases had previously been treated for TB and had TB resistant to quinolone. Both patients who had not experienced culture conversion by Month 3 had an unfavourable treatment outcome. Therefore, we recommend monthly monitoring of culture status for patients on treatment regimens for BDQ resistance.

Concordance of three approaches for operationalizing outcome definitions for multidrug-resistant TB.

BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.

Consenso Internacional sobre Tromboembolismo Venoso (ICM-VTE) en COT, cambiará en algo nuestra práctica clínica? / International Consensus Meeting on Venous Thromboembolism (ICM-VTE) after orthopedic procedures, any change in our clinical practice?

Las aportaciones del Consenso Internacional sobre Tromboembolismo Venoso (ICM-VTE) modificarán nuestra práctica diaria, recogiendo la evidencia actual que no aparece en la mayoría de las guías de práctica clínica hasta la fecha. Muchos de nuestros procedimientos de cirugía ortopédica y traumatología no requieren de una profilaxis tromboembólica que solo se administra cuando existen factores de riesgos individuales o cirugías mayores (artroplastia total de miembros inferiores, cirugía de columna o fracturas que requieran inmovilización y limitación en la carga precoz). Dentro de las opciones de profilaxis debemos tener en cuenta la potencia del fármaco para prevenir el tromboembolismo venoso, pero también el efecto de hemorragia y sangrado que pueda producir. El uso de aspirina y medidas mecánicas se establece como la combinación más segura y eficaz en muchos de los casos.(AU)

The International Consensus Meeting on Venous Thromboembolism (ICM-VTE), will change our current practice as most recent evidence is included. This fact is not usual in most clinical practice guidelines to date. Many orthopedic and trauma procedures do not require thromboembolic prophylaxis, but it should be considered depending on individual risk factors or major surgeries (total hip or knee arthroplasty, spine surgery or fractures that require immobilization and weight bearing restriction). Within the prophylaxis options, we must notice the strengh of the drug preventing venous thromboembolism, but also the effect of hemorrhage and bleeding that it may produce. The use of aspirin and mechanical prophylaxis has been described as the safest and most effective combination in most cases.(AU)

[Translated article] International Consensus Meeting on Venous Thromboembolism (ICM-VTE) after orthopedic procedures, any change in our clinical practice? / Consenso Internacional sobre Tromboembolismo Venoso (ICM-VTE) en COT, cambiará en algo nuestra práctica clínica?

Las aportaciones del Consenso Internacional sobre Tromboembolismo Venoso (ICM-VTE) modificarán nuestra práctica diaria, recogiendo la evidencia actual que no aparece en la mayoría de las guías de práctica clínica hasta la fecha. Muchos de nuestros procedimientos de cirugía ortopédica y traumatología no requieren de una profilaxis tromboembólica que solo se administra cuando existen factores de riesgos individuales o cirugías mayores (artroplastia total de miembros inferiores, cirugía de columna o fracturas que requieran inmovilización y limitación en la carga precoz). Dentro de las opciones de profilaxis debemos tener en cuenta la potencia del fármaco para prevenir el tromboembolismo venoso, pero también el efecto de hemorragia y sangrado que pueda producir. El uso de aspirina y medidas mecánicas se establece como la combinación más segura y eficaz en muchos de los casos.(AU)

The International Consensus Meeting on Venous Thromboembolism (ICM-VTE), will change our current practice as most recent evidence is included. This fact is not usual in most clinical practice guidelines to date. Many orthopedic and trauma procedures do not require thromboembolic prophylaxis, but it should be considered depending on individual risk factors or major surgeries (total hip or knee arthroplasty, spine surgery or fractures that require immobilization and weight bearing restriction). Within the prophylaxis options, we must notice the strengh of the drug preventing venous thromboembolism, but also the effect of hemorrhage and bleeding that it may produce. The use of aspirin and mechanical prophylaxis has been described as the safest and most effective combination in most cases.(AU)

International Consensus Meeting on Venous Thromboembolism (ICM-VTE) after orthopedic procedures, any change in our clinical practice? / Consenso Internacional sobre Tromboembolismo Venoso (ICM-VTE) en COT, ¿cambiará en algo nuestra práctica clínica?

The International Consensus Meeting on Venous Thromboembolism (ICM-VTE), will change our current practice as most recent evidence is included. This fact is not usual in most clinical practice guidelines to date. Many orthopedic and trauma procedures do not require thromboembolic prophylaxis, but it should be considered depending on individual risk factors or major surgeries (total hip or knee arthroplasty, spine surgery or fractures that require immobilization and weight bearing restriction). Within the prophylaxis options, we must notice the strengh of the drug preventing venous thromboembolism, but also the effect of hemorrhage and bleeding that it may produce. The use of aspirin and mechanical prophylaxis has been described as the safest and most effective combination in most cases.

[Translated article] International Consensus Meeting on Venous Thromboembolism (ICM-VTE) after orthopedic procedures, any change in our clinical practice?

The International Consensus on Venous Thromboembolism (ICM-VTE), will change our current practice as most recent evidence is included. This fact is not usual in most clinical practice guidelines to date. Many orthopedic and trauma procedures do not require thromboembolic prophylaxis, but it should be considered depending on individual risk factors or major surgeries (total hip or knee arthroplasty, spine surgery or fractures that require immobilization and weight bearing restriction). Within the prophylaxis options, we must notice the strength of the drug preventing venous thromboembolism, but also the effect of hemorrhage and bleeding that it may produce. The use of aspirin and mechanical prophylaxis has been described as the safest and most effective combination in most cases.

Factores asociados al control de síntomas nucleares en pacientes pediátricos con trastorno de déficit de atención e hiperactividad, en un centro especializado de Medellín entre 2018 y 2019 / Factors associated with the control of nuclear symptoms in pediatric patients with Attention Deficit Hyperactivity Disorder in a specialized center in Medellín between 2018 and 2019 / Fatores associados ao controle de sintomas nucleares em pacientes pediátricos com transtorno de déficit de atenção e hiperatividade, em um centro especializado em Medellín entre 2018 e 2019

Objetivo: el trastorno de déficit de atención e hiperactividad (TDAH) ha sido descrito como el trastorno del neurodesarrollo más común en la infancia. Esta condición se asocia a un significativo deterioro en calidad de vida, múltiples comorbilidades y, a largo plazo, a menores logros académicos y laborales. A pesar de que se ha evidenciado que en los pacientes de ascendencia latina se presenta un posible subdiagnóstico, que en Colombia se han estimado prevalencias mayores a las descritas en el planeta, y que los efectos de la pandemia por Covid-19 han podido exacerbar esta problemática, el volumen de estudios con estimaciones reproducibles sobre las características, tratamientos recibidos y control de síntomas de estos pacientes aún requiere ampliarse. Este estudio busca establecer los factores sociodemográficos, clínicos y del tratamiento asociados al control de los síntomas nucleares de este trastorno, que consisten en patrones persistentes y generalizados de inatención, impulsividad e hiperactividad. Metodología: estudio descriptivo con intención analítica en una cohorte retrospectiva de pacientes pediátricos con trastorno de déficit de atención e hiperactividad seguidos durante seis meses en un centro especializado de Medellín, Colombia, entre 2018 y 2019. Resultados: se identificó una incidencia de control de síntomas de 46,7% que se asoció de manera significativa con la adherencia al tratamiento y con historia familiar de TDAH. Conclusiones: puede afirmarse que, en pacientes pediátricos con TDAH, estos factores podrían aumentar la probabilidad de lograr el control de los síntomas nucleares.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) has been described as the most common neurodevelopmental disorder in childhood. This condition is associated with significant deterioration in the quality of life, multiple comorbidities and, in the long term, lower academic and work achievements. Despite the fact that it has been shown that patients of Latin descent present a possible underdiagnosis, that in Colombia higher prevalence has been estimated than those described worldwide, and that the effects of the Covid-19 pandemic have been able to exacerbate this problem, the volume of studies with reproducible estimates on the characteristics, treatments received, and symptom control of these patients still needs to be expanded. This study seeks to establish the sociodemographic, clinical and treatment factors associated with the control of the core symptoms of this disorder, which consist of persistent and generalized patterns of inattention, impulsivity and hyperactivity. Methodology: Descriptive study with analytical intent in a retrospective cohort of pediatric patients with attention deficit hyperactivity disorder followed up for 6 months in a specialized center in Medellín, Colombia, between 2018 and 2019. Results: An incidence of symptom control of 46.7% was identified, which was significantly associated with adherence to treatment and with a family history of ADHD. Conclusions: It can be affirmed that, in pediatric patients with ADHD, these factors could increase the probability of achieving control of nuclear symptoms.

Objetivo: o transtorno dedéficit de atenção e hiperatividade (TDAH) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. Apesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade. Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, signifi-cativamente associada à adesão ao tratamento e ao histórico familiar de TDAH.Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.

Dinámicas de producción y emisiones modeladas de gases de efecto invernadero en sistemas regionales de producción lechera de Honduras / Production dynamics and greenhouse gas modeled emissions from regional dairy production systems in Honduras

RESUMEN El objetivo del estudio fue la caracterización productiva y de emisiones modeladas de gases de efecto invernadero (GEI) en 61 sistemas lecheros localizados en cinco regiones de Honduras. Durante las fases inicial (FI) y final (FF), con encuestas aplicadas individualmente a los productores, se identificaron aspectos técnicos y de productividad. Variables numéricas expresadas en Microsoft Excel ® permitieron, con el modelo FAO de evaluación ambiental de la ganadería global-interactivo (GLEAM-i, por sus siglas en inglés) de ciclo de vida, estimar emisiones anuales de metano (CH4), óxido nitroso (N2O) y dióxido de carbono (CO2) en cada finca. Cálculos intermedios (GEI/animal) fueron derivados de la modelización GLEAM-i en Excel®. Durante la FI las fincas conjuntamente emitieron 25.038 t CO2 equivalente (CO2-eq), mientras que dichas emisiones fueron 10,5% menores en la FF. Emisiones de GEI/animal (2,85 ± 0,08 t CO2-eq) y de GEI/kg de proteína láctea (96,91 ± 4,50 kg CO2-eq) durante la FI fue-ron 13 y 21% menores en la FF, respectivamente. Valores de 52,82 ± 1,64 (CH4) y 2,66 ± 0,10 (N2O) kg/animal en la FI fueron 13% y 17% menores en la FF, respectivamente. La región Centro-Sur-Oriente emitió la menor cantidad de CH4 (42,95 ± 2,37 kg/animal) y N2O (1,82 ± 0,15 kg/animal, mientras las regiones Occidente y Norte experimentaron una reducción del 27% en GEI/kg proteína láctea entre la FI y FF. Se concluyó que la metodologia usada identificó los impactos productivos y medioambientales, derivados de alternativas técnicas implementadas en sistemas de producción lechera de Honduras.

ABSTRACT The study aimed to characterize production dynamics and greenhouse gas (GHG) emissions from 61 dairy farms in five regions in Honduras. Farm data were collected through individual surveys during the initial and final phases (IP; FP). Using Microsoft Excel, data was incorporated into the global livestock environmental assessment model-interactive (GLEAM-i, FAO) life cycle framework to estimate annual emissions of methane (CH4), nitrous oxide (N2O), and carbon dioxide (CO2) at the farm system level. Animal emissions (GHG/animal) were derived in Excel® from the GLEAM-i predictions. Together, farms during the IP emitted 25.038 t CO2 equivalent (CO2-eq) while these emissions were 10,5% lower in the FP. Emissions of GHG/animal (2,85 ± 0,08 t CO2-eq) and GHG/kg of milk protein (96,91 ± 4,50 kg CO2-eq) during the IP were 13% and 21% lower in the FP, respectively. Methane and N2O emission values (52,82 ± 1,64 vs. 2,66 ± 0,10 kg/animal) were 13% and 17% higher in the IP than in FP. The South-Central region emitted the lowest amount of CH4 and N2O (42,95 ± 2,37 kg/animal vs. 1,82 ± 0,15 kg/animal) while 27% lower GHG/kg milk protein was observed between the IP and FP of the Western and Northern regions. It was concluded that the used methodology identified productive and environmental impacts derived from implemented technical interventions in dairy production systems in Honduras.

Substantial variability in morphological scaling among bumblebee colonies.

Differences in organ scaling among individuals may play an important role in determining behavioural variation. In social insects, there are well-documented intraspecific differences in colony behaviour, but the extent that organ scaling differs within and between colonies remains unclear. Using 12 different colonies of the bumblebee Bombus terrestris, we aim to address this knowledge gap by measuring the scaling relationships between three different organs (compound eyes, wings and antennae) and body size in workers. Though colonies were exposed to different rearing temperatures, this environmental variability did not explain the differences of the scaling relationships. Two colonies had differences in wing versus antenna slopes, three colonies showed differences in wing versus eye slopes and a single colony has differences between eye versus antenna slopes. There are also differences in antennae scaling slopes between three different colonies, and we present evidence for putative trade-offs in morphological investment. We discuss the utility of having variable scaling among colonies and the implication for understanding variability in colony fitness and behaviour.

Effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir and combinations thereof in hospitalized patients with COVID-19: a pragmatic, open-label randomized trial.

BACKGROUND: The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. METHODS: This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095. FINDINGS: Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. INTERPRETATION: The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.

Femoracetabular impingement treated with surgical hip dislocation: Short-term results. / Pinzamiento femoroacetabular tratado con luxación quirúrgica de la cadera: resultados a corto plazo.

BACKGROUND AND OBJECTIVE: Most of the studies available in the literature related to the treatment of femoroacetabular impingement (FAA) with surgical hip dislocation (CLD) come from Europe and North America. This study describes the short-term results of the LQC technique for treating PFA in a cohort of Colombian patients. PATIENTS AND METHODS: We retrospectively analysed 42 cases of PFA treated with LQC from 2006 to 2018. The same orthopaedic surgeon performed all surgeries. Clinical outcome was assessed using the Merle d'Aubigné scores, while radiological assessment was performed using the Tönnis score. RESULTS: Fifteen women and 25 men were included in the study, with a mean age of 36.3 years. Two patients had bilateral symptomatic involvement. Of the 42 cases, there were 13 cam type, 11 pincer type and 18 mixed. Preoperatively, 31 hips were classified as poor and moderate, and 11 as good according to the Merle d'Aubigné scale. The preoperative Tönnis radiological classification showed grade 0 in half of the cases. The mean duration of follow-up was 24 months (12 to 37). The final postoperative Merle d'Aubigné scores classified 7 cases as poor or moderate, and 35 as good to excellent (p<0.05). The postoperative Tönnis score showed no significant variation. As complications, one patient had heterotopic ossification, and three had trochanteric nonunion requiring refixation. CONCLUSION: Our results suggest that the LQC technique for the treatment of patients with PFA shows satisfactory short-term results with a low complication rate. To our knowledge, this is the first report of results of the surgical procedure for hip dislocation in our region.

Perspectives on the Implementation of Screening and Treatment for Depression and Alcohol Use Disorder in Primary Care in Colombia.

Depression and alcohol use disorder (AUD) greatly contribute to the burden of disease worldwide, and have large impact on Colombia's population. In this study, a qualitative analysis evaluates the implementation of a technology-supported model for screening, decision support, and digital therapy for depression and AUD in Colombian primary care clinics. Patient, provider, and administrator interviews were conducted, exploring attitudes towards depression and AUD, attitudes towards technology, and implementation successes and challenges. Researchers used qualitative methods to analyze interview themes. Despite stigma around depression and AUD, the model improved provider capacity to diagnose and manage patients, helped patients feel supported, and provided useful prevalence data for administrators. Challenges included limited provider time and questions about sustainability. The implementation facilitated the identification, diagnosis, and care of patients with depression and AUD. There is ongoing need to decrease stigma, create stronger networks of mental health professionals, and transition intervention ownership to the healthcare center.

Novel protein pathways in development and progression of pulmonary sarcoidosis.

Pulmonary involvement occurs in up to 95% of sarcoidosis cases. In this pilot study, we examine lung compartment-specific protein expression to identify pathways linked to development and progression of pulmonary sarcoidosis. We characterized bronchoalveolar lavage (BAL) cells and fluid (BALF) proteins in recently diagnosed sarcoidosis cases. We identified 4,306 proteins in BAL cells, of which 272 proteins were differentially expressed in sarcoidosis compared to controls. These proteins map to novel pathways such as integrin-linked kinase and IL-8 signaling and previously implicated pathways in sarcoidosis, including phagosome maturation, clathrin-mediated endocytic signaling and redox balance. In the BALF, the differentially expressed proteins map to several pathways identified in the BAL cells. The differentially expressed BALF proteins also map to aryl hydrocarbon signaling, communication between innate and adaptive immune response, integrin, PTEN and phospholipase C signaling, serotonin and tryptophan metabolism, autophagy, and B cell receptor signaling. Additional pathways that were different between progressive and non-progressive sarcoidosis in the BALF included CD28 signaling and PFKFB4 signaling. Our studies demonstrate the power of contemporary proteomics to reveal novel mechanisms operational in sarcoidosis. Application of our workflows in well-phenotyped large cohorts maybe beneficial to identify biomarkers for diagnosis and prognosis and therapeutically tenable molecular mechanisms.

Long term beef production in extensive cow-calf systems in the tropical savannas of eastern Colombia / Producción continua de carne en sistemas extensivos de cría en las sabanas tropicales del oriente de Colombia

ABSTRACT Replacement beef heifers in extensive systems of the neotropical savannas of Colombia are low priority animals and are assigned to native savannas and low-quality pastures, with scarcely researched long-term consequences. The study pooled data from four contemporary grazing experiments to determine the effects of low growth rates of heifers on their lifetime production of liveweight gains (LWGs) per year and per hectare (ha) subject to different management strategies. Three growth rates were imposed on grazing heifers during the growing phase (i.e. nine-36 months of age) on Brachiaria humidicola pastures. Upon the end of the previous phase, animals were allocated to a B. humidicola paddock with a reduced stocking rate or introduced to a B. decumbens sward to allow compensatory LWGs during the breeding phase (i.e. cows plus weaned calves). Severely limited heifers allowed to make compensatory growth did not reach the outputs of better fed animals. Regardless of the strategy followed, high producing years tended to be followed by lower production in the following year. Comparison with reasonably fed breeding cows full-time on well-managed B. decumbens showed important and significant differences in favor of the more intensive system over the lifetime of the animals. Over the nine-year period, the systems' beef output (i.e. weaned calves plus cows' LWGs) ranged between 86 and 206 kg/ha/year and demonstrated that a wide array of low input management alternatives is feasible. Beef output increases if the LW of cull cows is considered, particularly if they are allowed a short period of fattening during the rainy reason on a low input pasture.

RESUMEN Las novillas de reemplazo en los sistemas extensivos de cría de los Llanos Orientales de Colombia son animales de baja prioridad para el productor y generalmente se les asignan sabanas nativas o pasturas de baja calidad. Las consecuencias de dicha estrategia de manejo han sido poco investigadas. Este trabajo reunió datos de cuatro experimentos de pastoreo contemporáneos y de largo plazo para estimar el efecto de las bajas tasas de crecimiento sobre la ganancia de peso por año y por hectárea (ha) de novillas sometidas a diferentes estrategias de manejo. Se usaron tres cargas animales durante la fase de crecimiento para lograr tasas de crecimiento contrastantes entre los nueve y 36 meses de edad, con pasturas de baja calidad de Brachiaria humidicola, caracterizadas por bajo contenido de proteína bruta y baja digestibilidad. Durante la fase de cría y reproducción las novillas pasaron a pasturas de B. humidicola o de B. decumbens con cargas reducidas, para permitir ganancias de peso compensatorias. Los animales de menor ganancia durante el crecimiento no lograron ganancias compensatorias que les permitieran alcanzar a aquellos mejor alimentados. Independientemente de la estrategia de alimentación, años de relativamente alta producción fueron seguidos por años de baja producción en forma cíclica. La comparación con animales mejor alimentados con pastura de B. decumbens bien manejada, mostró diferencias considerables y significativas acumuladas durante su vida útil. A lo largo de nueve años de experimentación, la producción de ganancia de peso de vacas más terneros destetos varió entre 86 y 206 kg/ha/año, demostrando las consecuencias de largo plazo del amplio rango de estrategias de manejo experimentadas. La producción de carne en estos sistemas se puede aumentar si se le suma el peso de vacas de descarte, particularmente, si le les permite un periodo de ceba corto durante la estación lluviosa, incluso usando pasturas de calidad baja.

Methane emissions of extensive grazing breeding herds in relation to the weaning and yearling stages in the Eastern Plains of Colombia / Emisiones de metano en hatos de carne en pastoreo extensivo relacionadas con los períodos de destete y levante en los Llanos

ABSTRACT A substantial proportion of beef production in Colombia originates in its extensive Eastern Plains. However, in this scenario and in a global context, demand for cattle production increasingly requests that it satisfies social and environmental expectations in addition to being economically efficient. A dataset containing five-year long records of cow-calf production systems collected at Carimagua Research Centre located in the Meta Department was retrospectively interrogated to understand the liveweight (LW)-derived flux matrix dynamics of methane (CH4) emissions. Estimated total CH4 (kg) emissions during the gestation period, were similar between conventional weaned (CW; 37.86 ± 0.506 kg) and early weaned (EW; 37.47 ± 0.476 kg) cows. However, averaged over two lactations, total CH4 emissions were larger (p < 0.0001) in CW cows (38.67 ± 0.456 kg) than in their EW (14.40 ± 0.435 kg) counterparts. Total gas emissions from birth to comparable commercial yearlings age were higher (p < 0.0001) for CW (43.11 ± 0.498 kg) calves than for EW (40.27 ± 0.472 kg) calves. It was concluded that mid and long-term pastoral datasets and new concerns are well suited to understand different contexts and adaptations to the contemporary weather conditions. Nevertheless, conventional farming systems will be less environmentally vulnerable if EW management practices involve the strategic and temporal use of improved pastures. The roles of veterinary medicine and animal sciences are briefly discussed in the context of unprecedented climate variability to provide a guide to the uncertain future.

RESUMEN Una proporción substancial de la producción de carne de res en Colombia se origina en sus Llanos Orientales. Sin embargo, allí, así como en un contexto global, dicha producción ganadera debe ser económicamente eficiente y satisfacer expectativas sociales y ambientales. Considerando algunos de esos intereses, se analizaron cinco años de eventos productivos y de manejo del destete implementados en el Centro de Investigaciones Carimagua, localizado en el departamento del Meta, para interpretar en vacas de carne y sus crías las dinámicas de peso vivo asociadas con emisiones derivadas de metano (CH4). Emisiones totales de CH4 (kg) durante la gestación fueron similares entre las vacas destetadas convencionalmente (CW; 37.86 ± 0.506 kg) y aquellas destetadas tempranamente (EW; 37.47 ± 0.476 kg). Sin embargo, el promedio de dos lactancias demostró mayores (p < 0.0001) emisiones en vacas CW (38.67 ± 0.456 kg) que en vacas EW (14.40 ± 0.435 kg). Emisiones acumuladas entre el nacimiento y el levante fueron mayores (p < 0.0001) en terneros CW (43.11 ± 0.498 kg) que en terneros EW (40.27 ± 0.472 kg). Se concluyó que nuevos cuestionamientos y datos de pastoreo de mediano y largo plazo son apropiados para entender contextos innovadores y adaptaciones a las condiciones climáticas actuales. Sin embargo, el manejo convencional en las fincas será menos vulnerable al medio ambiente si prácticas de destete temprano son introducidas considerando el uso estratégico y temporal de pastos mejorados. Los roles de la medicina veterinaria y las ciencias animales se discuten brevemente en el contexto de la variabilidad climática existente.

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery.

Aims: The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods: This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates. Results: The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics. Conclusion: These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125-32.

Left ventricular hypertrophy and cognitive function: a systematic review.

Cognitive impairment is common in patients with hypertension. Left ventricular hypertrophy (LVH) is recognised as a marker of hypertension-related organ damage and is a strong predictor of coronary artery disease, heart failure and stroke. There is evidence that LVH is independently associated with cognitive impairment, even after adjustment for the presence of hypertension. We conducted a systematic review that examined cognitive impairment in adults with LVH. Independent searches were performed in Ovid MEDLINE, Ovid psycInfo and PubMed with the terms left ventricular hypertrophy and cognition. Seventy-three studies were identified when both searches were combined. After limiting the search to studies that were: (1) reported in English; (2) conducted in humans; (3) in adults aged 50 years and older; and (4) investigated the relationship between LVH and cognitive performance, nine papers were included in this systematic review. The majority of studies found an association between LVH and cognitive performance. Inspection of results indicated that individuals with LVH exhibited a lower performance in cognitive tests, when compared to individuals without LVH. Memory and executive functions were the cognitive domains that showed a specific vulnerability to the presence of LVH. A possible mechanism for the relationship between LVH and cognition is the presence of cerebral white matter damage. White matter lesions occur frequently in patients with LVH and may contribute to cognitive dysfunction. Together, the results of this review suggest that memory impairment and executive dysfunction are the cognitive domains that showed a particular association with the presence of LVH.

A GHEP-ISFG collaborative study on the genetic variation of 38 autosomal indels for human identification in different continental populations.

A collaborative effort was carried out by the Spanish and Portuguese Speaking Working Group of the International Society for Forensic Genetics (GHEP-ISFG) to promote knowledge exchange between associate laboratories interested in the implementation of indel-based methodologies and build allele frequency databases of 38 indels for forensic applications. These databases include populations from different countries that are relevant for identification and kinship investigations undertaken by the participating laboratories. Before compiling population data, participants were asked to type the 38 indels in blind samples from annual GHEP-ISFG proficiency tests, using an amplification protocol previously described. Only laboratories that reported correct results contributed with population data to this study. A total of 5839 samples were genotyped from 45 different populations from Africa, America, East Asia, Europe and Middle East. Population differentiation analysis showed significant differences between most populations studied from Africa and America, as well as between two Asian populations from China and East Timor. Low FST values were detected among most European populations. Overall diversities and parameters of forensic efficiency were high in populations from all continents.

Human leucocyte antigen (HLA)-DQB1*03:02 and HLA-A*02:01 have opposite patterns in their effects on susceptibility to HIV infection.

OBJECTIVES: The objective of this study was to seek correlates of immune protection in HIV infection. We sought to elucidate the association between the presence of human leucocyte antigen (HLA) alleles, as well as killer immunoglobulin receptor (KIR) genotypes, and the susceptibility to HIV infection in a Spanish cohort of HIV-exposed seronegative (HESN) individuals. METHODS: A total of 152 individuals were evaluated: 29 HESN individuals in stable heterosexual relationships with an HIV-infected partner admitting high-risk sexual intercourse for at least 12 months prior to inclusion in the study, 61 HIV-infected patients and 62 healthy controls. HLA class I and II alleles and KIR genotypes were assessed in genomic DNA from all individuals in the study by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) using bead array technology. RESULTS: HESN individuals showed a higher prevalence of HLA-A3 (62%) and HLA-B44 (83%) supertypes compared with HIV-infected individuals (42% and 66%, respectively). Regarding specific HLA alleles, HESN individuals had a higher prevalence of HLA-A*33:01, DRB1*04 and DQB1*03:02 alleles (14%, 34% and 31%, respectively) and a lower prevalence of the HLA-A*02:01 allele (27%) than HIV-infected patients (3%, 15%, 11% and 52%, respectively; P < 0.05). Interestingly, in a multivariate analysis, only the presence of DQB1*03:02 and the absence of A*02:01 alleles were independently associated with HESN status [odds ratio (OR) 3.4 (95% confidence interval (CI) 1.1-10.5) and 0.4 (95% CI: 0.1-0.9), respectively; P < 0.05]. No KIR genotype was associated with susceptibility to HIV infection. CONCLUSIONS: Our data showed that the presence of the HLA class II allele DQB1*03:02 was a correlate of immune protection against HIV infection, while the presence of the HLA class I allele A*02:01 was associated with being infected with HIV.