Sangrado rectal tras la administración de Dabigatrán

Presentamos el caso de tres pacientes intervenidos de prótesis total de cadera, que tras la administración protocolaria de tromboprofilaxis con Dabigatrán, presentaron un sangrado rectal importante, siendo este la primera manifestación de un cáncer colorrectal. Todos los casos se trataron durante el postoperatorio inmediato mediante cirugía tratamiento adyuvante. En el caso de un sangrado rectal tras la administración de los nuevos fármacos anticoagulantes es obligatorio descartar patología pre-existente antes de, simplemente, sustituir o suspender la medicación.We observed rectal bleeding in three asymptomatic patients after administration of Dabigatran in the postoperative period, being this the first manifestation of rectal cancer. In all cases Dabigatran was used as DVT prophylaxis. The cause of bleeding in the three cases was an asymptomatic and previously unknown colo-rectal cancer. All patients underwent tumoral resection surgery. With rectal bleeding in the inmediate postoperatory period after administration of oral anticoagulants, rectal cancer screening must be performed

Genetic analysis of post‐epizootic amphibian chytrid strains in Bolivia: Adding a piece to the puzzle

The evolutionary history and dispersal pattern of Batrachochytrium dendrobatidis (Bd), an emergent fungal pathogen responsible for the decline and extinctions of many species of amphibians worldwide, is still not well understood. In South America, the tropical Andes are known as an important site for amphibian diversification, but also for being a place where hosts are at greater risk of chytridiomycosis. In an attempt to understand the history and the geographic pattern of Bd‐associated amphibian declines in Bolivia, we isolated Bd from hosts at two locations that differ in their chronology of Bd prevalence and host survival outcome, the cloud forests of the Amazonian slopes of the Andes and Lake Titicaca in the altiplano. We genotyped Bd from both locations and sequenced the genome from the cloud forest isolate and then compared them to reference sequences of other Bd strains across the world. We found that the Bolivian chytrid isolates were nearly genotypically identical and that they belong to the global panzootic lineage (Bd‐GPL). The Bolivian Bd strain grouped with other tropical New World strains but was closest to those from the Brazilian Atlantic Forest. Our results extend the presence of Bd‐GPL to the central Andes in South America and report this hypervirulent strain at Lago Titicaca, where Bd has been detected since 1863, without evidence of amphibian declines. These findings suggest a more complex evolutionary history for this pathogen in Bolivia and may point to the existence of an old lineage of Bd that has since been extirpated following the arrival of the panzootic Bd‐GPL or that the timing of Bd‐GPL emergence is earlier than generally acknowledged.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162756/2/tbed13568_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162756/1/tbed13568.pd

Nuevas citas de Eleutherodactylus Duméril y Bibron, 1841 (Anura, Leptodactylidae) para Bolivia

Five species of the genus Eleutherodactylus (Anura, Leptodactylidae) are reported from Bolivia for the first time: E. altamazonicus from Departments Pando and La Paz; E. carvalhoi from Cochabamba; and E. ockendeni, E. skydmainos and E. zimmermanae from Pando. New departmental records are provided for other species: E. cruralis for Department Pando, E. danae for Beni and La Paz, E. platydactylus for Beni, E. toftae for Pando and La Paz and E. ventrimarmoratus for La Paz. Currently, 25 species of Eleutherodactylus are known in Bolivia. The taxonomic status of some species remains uncertain, new species are being described and others are still to be discovered. Therefore, the actual number of Bolivian Eleutherodactylus species is still unknown.En este trabajo se publican los primeros registros de cinco especies del género Eleutherodactylus (Anura, Leptodactylidae) para Bolivia: E. altamazonicus en los Departamentos de Pando y La Paz; E. carvalhoi en Cochabamba; y E. ockendeni, E. skydmainos y E. zimmermanae en Pando. Además, se aportan las primeras citas de E. cruralis para el Departamento de Pando, de E. danae para Beni y La Paz, de E. platydactylus para Beni, de E. toftae para Pando y La Paz y de E. ventrimarmoratus para La Paz. La diversidad conocida de Eleutherodactylus en Bolivia es de 25 especies, aunque los problemas taxonómicos sin resolver, las especies en descripción y el alto número de especies aún no citadas que se considera probable encontrar, hacen que aún desconozcamos la verdadera diversidad de este género en Bolivia

Correlates of species richness in the largest Neotropical amphibian radiation

Although tropical environments are often considered biodiversity hotspots, it is precisely in such environments where least is known about the factors that drive species richness. Here, we use phylogenetic comparative analyses to study correlates of species richness for the largest Neotropical amphibian radiation: New World direct-developing frogs. Clade-age and species richness were nonsignficantly, negatively correlated, suggesting that clade age alone does not explain among-clade variation in species richness. A combination of ecological and morphological traits explained 65% of the variance in species richness. A more vascularized ventral skin, the ability to colonize high-altitude ranges, encompassing a large variety of vegetation types, correlated significantly with species richness, whereas larger body size was marginally correlated with species richness. Hence, whereas high-altitude ranges play a role in shaping clade diversity in the Neotropics, intrinsic factors, such as skin structures and possibly body size, might ultimately determine which clades are more speciose than others

Assessing the potential of the dart model to discrete return lidar simulation—application to fuel type mapping

Fuel type is one of the key factors for analyzing the potential of fire ignition and propaga-tion in agricultural and forest environments. The increase of three-dimensional datasets provided by active sensors, such as LiDAR (Light Detection and Ranging), has improved the classification of fuel types through empirical modelling. Empirical methods are site and sensor specific while Radiative Transfer Models (RTM) approaches provide broader universality. The aim of this work is to analyze the suitability of Discrete Anisotropic Radiative Transfer (DART) model to replicate low density small-footprint Airborne Laser Scanning (ALS) measurements and subsequent fuel type classification. Field data measured in 104 plots are used as ground truth to simulate LiDAR response based on the sensor and flight characteristics of low-density ALS data captured by the Spanish National Plan for Aerial Orthophotography (PNOA) in two different dates (2011 and 2016). The accuracy assessment of the DART simulations is performed using Spearman rank correlation coefficients between the simulated metrics and the ALS-PNOA ones. The results show that 32% of the computed metrics overpassed a correlation value of 0.80 between simulated and ALS-PNOA metrics in 2011 and 28% in 2016. The highest correlations were related to high height percentiles, canopy variability metrics as for example standard deviation and Rumple diversity index, reaching correlation values over 0.94. Two metric selection approaches and Support Vector Machine classification method with variants were compared to classify fuel types. The best-fitted classification model, trained with the DART simulated sample and validated with ALS-PNOA data, was obtained using Support Vector Machine method with radial kernel. The overall accuracy of the classification after validation was 88% and 91% for the 2011 and 2016 years, respectively. The use of DART demonstrates its value for simulating generalizable 3D data for fuel type classification providing relevant information for forest managers in fire prevention and extinction

Upper gastrointestinal bleeding related to migraine: the importance of education for migraine care

Physicians involved in care of migraine patients should make a considerable effort to educate themselves and their patients. It is fundamental that doctors, patients and their families understand the causes of migraine, and know the different treatment strategies available to improve migraine care. Mallory-Weiss tears are lacerations in the region of the cardioesophageal junction due to vomiting. We report a case of Mallory-Weiss tear secondary to migraine that could had been reasonably avoided had the patient been treated with triptans since the first attack, according to the stratified care strategy. This case illustrates that inadequate management can cause serious medical consequences. It also proves that it is necessary to improve education about migraine for both patients and doctors

Respuesta hipofisaria y ovulatoria de conejas nulíparas alimentadas con dietas suplementadas con ácidos grasos poliinsaturados n-3.

Veinte conejas nulíparas se alimentaron ad libitum desde las 10 a las 16 semanas de edad con dos piensos isofibrosos, isoenergéticos e isoproteicos suplementados con dos fuentes de grasa diferentes: 0,75% de manteca para la dieta control (grupo C; n=10) ó 1,5% de un suplemento (Optomega-50; Optivite International Ltd., España) que contenía un 50% de extracto etérero y 38% de ácidos grasos poli-insaturados n-3 (AG n-3) para la dieta experimental (grupo P; n=10). A las 16 semanas de edad se determinó el consumo de pienso, así como la tasa de ovulación y las concentraciones plasmáticas de progesterona y LH a 0, 60 min, 5, 7 y 9 días post-inducción de ovulación con 20 μg de Gonadorelina (Inducel-GnRH, Lab. Ovejero). El consumo de pienso (150,5 g/d), el pico preovulatorio de LH (149,7±10,9 ng/ml), la tasa de ovulación (95%) y el número de cuerpos lúteos (9,8±0,7) fueron similares entre tratamientos. Las concentraciones plasmáticas de progesterona aumentaron a los 60 minutos (7,13±19 ng/ml) y 5 días (13,3±1,9 ng/ml) con respecto al día 0 (0,7±1,9 ng/ml; P<0.05), permaneciendo elevadas el día 9 en ambos grupos (19,4±1,9 ng/ml). Además, el día 5 y 7 post-inducción, las hembras alimentadas con la dieta P tendieron a tener niveles más elevados de progesterona en sangre que las alimentadas con la dieta C (16,6±1,9 vs.12,6±1,8 y 19,0±1,8 vs. 15,5±2,1 ng/ml, P=0,068 y P=0,082; respectivamente) que coinciden con el momento de la implantación embrionaria en esta especie. Por lo tanto, la suplementación con AG n-3 podría mejorar los niveles de progesterona en sangre y por lo tanto reducir la mortalidad embrionaria en este punto

Respuesta hipofisaria y ovulatoria de conejas nulíparas alimentadas con dietas suplementadas con ácidos grasos poliinsaturados n-3

Twenty rabbit does were fed ad libitum from 10 to 16 weeks of age two isofibrous, isoenergetic and isoproteic diets (n=10) supplemented with two different fat sources: 0.75% lard for diet C (control) or 1.5% of a supplement (Optomega-50; Optivite International Ltd., Spain) containing a 50% of EE and 38% of n-3 polyunsaturated fatty acids for diet P (PUFA n-3). Does feed intake, ovulation rate and plasma progesterone and LH concentrations at 0, 60 min, 5, 7 and 9 days post-induction of ovulation with 20 μg of Gonadorelina (Inducel-GnRH, Lab. Ovejero) at 16 weeks of age were assessed. Average daily intake (150.5 g/d), ovulation rate (95%), preovulatory peak of plasma LH (149.7±10.9 ng/ml ng/ml) and number of corpora lutea (9.8±0.7) were similar between dietary treatments. Plasma progesterone concentrations increased at 60 minutes (7.13±1.9 ng/ml) and 5 days (13.3±1.9 ng/ml) after induction with respect to day 0 (0.7±1.9 ng/ml; P&lt;0.05), remaining constant afterward in both groups (19.4±1.9 ng/ml). Moreover, plasma progesterone of does fed diet P tended to be higher than for diet C on day 5 and 7 post-induction (16.6±1.9 vs.12.6±1.8 and 19.0±1.8 vs. 15.5±2.1 ng/ml, P=0.068 and P=0.082; respectively). Therefore, PUFA n-3 supplementation in does rabbit diets might be related with high progesterone levels and reduced early embryo mortality.Veinte conejas nulíparas se alimentaron ad libitum desde las 10 a las 16 semanas de edad con dos piensos isofibrosos, isoenergéticos e isoproteicos suplementados con dos fuentes de grasa diferentes: 0,75% de manteca para la dieta control (grupo C; n=10) ó 1,5% de un suplemento (Optomega-50; Optivite International Ltd., España) que contenía un 50% de extracto etérero y 38% de ácidos grasos poli-insaturados n-3 (AG n-3) para la dieta experimental (grupo P; n=10). A las 16 semanas de edad se determinó el consumo de pienso, así como la tasa de ovulación y las concentraciones plasmáticas de progesterona y LH a 0, 60 min, 5, 7 y 9 días post-inducción de ovulación con 20 μg de Gonadorelina (Inducel-GnRH, Lab. Ovejero). El consumo de pienso (150,5 g/d), el pico preovulatorio de LH (149,7±10,9 ng/ml), la tasa de ovulación (95%) y el número de cuerpos lúteos (9,8±0,7) fueron similares entre tratamientos. Las concentraciones plasmáticas de progesterona aumentaron a los 60 minutos (7,13±19 ng/ml) y 5 días (13,3±1,9 ng/ml) con respecto al día 0 (0,7±1,9 ng/ml; P&lt;0.05), permaneciendo elevadas el día 9 en ambos grupos (19,4±1,9 ng/ml). Además, el día 5 y 7 post-inducción, las hembras alimentadas con la dieta P tendieron a tener niveles más elevados de progesterona en sangre que las alimentadas con la dieta C (16,6±1,9 vs.12,6±1,8 y 19,0±1,8 vs. 15,5±2,1 ng/ml, P=0,068 y P=0,082; respectivamente) que coinciden con el momento de la implantación embrionaria en esta especie. Por lo tanto, la suplementación con AG n-3 podría mejorar los niveles de progesterona en sangre y por lo tanto reducir la mortalidad embrionaria en este punto

Esófago de Barrett

El esófago de Barrett (EB) es una complicación de la enfermedad por reflujo gastroesofágico consistente en la sustitución del epitelio escamoso por epitelio columnar metaplásico. Otros agentes lesivos, como los ácidos biliares, pueden favorecer su aparición. Es una lesión premaligna, que puede evolucionar a adenocar cinoma. Este tumor ocasiona síntomas tardíos, lo que obliga a un seguimiento endoscópico con múltiples biopsias, para detectar el grado de displasia o el adenocarcinoma en estadíos susceptibles de tratamiento eficaz. Dada la alta prevalencia de EB, el coste de los programas de vigilancia es alto y su seguimiento difícil. Actualmente dos objetivos son prioritarios: 1) Definir factores predictivos de evolución a displasia-carcinoma, que obligan a un seguimiento estrecho. 2) Conseguir la remisión completa o impedir la progresión a adenocarcinoma. Ninguno de los tratamientos actualmente aceptados ha demostrado efectividad inequívoca. Recientemente se han desarrollado nuevas técnicas endoscópicas con resultados preliminares prometedores, que requieren confirmación en series amplias