The significantly lower prevalence of DM2 in people with lipedema compared with DD may be due to the greater amount of gynoid fat known to be protective against metabolic disorders. The high percentage of hypermobility in lipedema patients indicates that it may be a comorbid condition. The location of fat, high average daily pain, presence of lipomas and comorbid painful disorders in DD patients may help differentiate from lipedema.

Dercum Disease (DD) is a rare inflammatory disease of painful subcutaneous fat masses with known alterations in lymphatic vessels. DD masses vary from pearl to walnut-size or larger and occur anywhere in body fat. Signs and symptoms of DD are similar to fibromyalgia. While the etiology of DD is unknown, metabolic, autoimmune, or autosomal genetic transmission has been proposed. This series presents 7 cases where DD followed an infection either histoplasmosis, coccidioidomycosis or Lyme disease. Known changes in fat by infectious agents are reviewed. Early diagnosis and treatment of infections may prevent further damage to fat.

The purpose of this study was to verify the applicability of the compressive radiographic technique (pressures of 5, 10, 15 and 20mmHg) in the diagnosis of tracheal collapse in small breed dogs, in lateral cervicothoracic radiography. Out of the 50 dogs evaluated, 25 presented tracheal collapse (TG group), 23 did not present tracheal collapse (CG) and two were excluded because they did not tolerate a pressure of 20 mmHg. The TG group presented a smaller internal diameter of the trachea in the region of the fourth cervical vertebra (D4) and at the entrance of the thorax (TDE) compared to the CG group, in all the radiographic projections performed, as well as within the TG group where the compressive technique differed from conventional. Furthermore, there was a correlation between the clinical sign of coughing during cervical collar use and the presence of radiographic tracheal collapse at a pressure of 20 mmHg. It was concluded that the compressive radiographic technique was feasible and efficient in confirming the diagnosis of tracheal collapse in dogs, especially in the pressure of 20 mmHg, where it was associated with clinical signs, and can be used in isolation or complementary to the conventional technique.

Background: Diabetes (DM) and obesity are related health issues which are increasing in prevalence. But not all obesity is related to DM. Women suffering from Lipedema are categorized as gynoid obese. Nattokinase (Natto) is an enzyme supplement that has been shown to degrade fibrin. Patients with obesity tend to have elevated clotting factors which can lead to adipose tissue hypoxia, impaired insulin signaling, and lead to insulin resistance. Research in fat disorders noted that fat biopsies from women with Lipedema likely had micro-clots, and patients with Lipedema treated with Natto reported a decrease in clothing size and fat distribution. Objective: Determine the effect of Natto on participants with Obesity and DM and in patients with Lipedema without DM. Materials and Methods: Group 1: Involved subjects with Obesity and DM. This was a double blinded, randomized controlled clinical trial over 3 months. A total of 17 female patients were recruited from a rural clinic. Nine received Natto 2,000 FU daily and eight received an identical placebo capsule daily. Fasting labs, questionnaires, bioimpedance, and anthropometric measurements were completed at Baseline and 3 months. Group 2: 42 women with Lipedema seen at a Fat Disorder Clinic. 21 received Natto and 21 did not. We compared for weight only from the day Nattokinase was started until follow-up, which varied from 4 months to 1 year 8 months. Results: Group 1: After 3 months, there was no difference in weight loss in both groups. Per Bioimpedance, more subjects lost water weight in the Natto group (63%) compared to Placebo (33%). More subjects in the Natto group had a decrease in HbA1c (43%) compared to Placebo (22%), with average decrease in the Natto group of 0.9%. Also, more subjects in the Natto group had lower fasting insulin levels (75% vs 22%), lower fasting glucose level (50% vs 22%) and lower HOMA index (63% vs 22%). Group 2: 57% of patients in the Natto group lost weight compared to only 33% of patients not on Natto. Conclusions: In participants with obesity and DM, regardless of weight loss, metabolic health improved after taking Natto for 3 months. Higher percentage of subjects in the treated group had improved HbA1c, fasting Insulin, glucose, and HOMA score. We hypothesize that if treatment time was beyond 3 months, further metabolic improvement would be noted, indicating that Natto could have potential as an adjunct to DM care. The difference in weight loss between Metabolic Obesity and Lipedema reflects the difference in adipose tissue, likely differing in etiology and pathophysiology. Further studies are needed to evaluate long term benefits of Natto, including larger and longer randomized controlled trials, and assessment of clotting factors.

Tetralogy of Fallot is a rare congenital disease consisting of pulmonary valve stenosis, right ventricular hypertrophy, ventricular septal defect and aortic dextroposition. Pathophysiological consequences and clinical presentation depend mainly on the degree of pulmonary artery obstruction. Symptoms include cyanosis, exercise intolerance, dyspnea, and syncope. Definitive diagnosis and prognosis are obtained by Doppler echocardiography. Surgery is the only effective method of treatment, however, pharmacotherapy may be indicated as palliative treatment in mild cases of the disease. This work reports on the case of an eleven-month-old mongrel dog, diagnosed with tetralogy of Fallot and highlights the importance of Doppler echocardiography as the definitive diagnostic tool for this disease.

Background: Athlete's heart syndrome comprises a set of functional and anatomic cardiac changes secondary to intense and prolonged physical exercise in humans and animals. The heart adapts to the type of activity performed, and Doppler echocardiography is the best tool for identifying these changes. Speckle tracking echocardiography (STE) has provided new data on cardiovascular adaptations secondary to physical exercise in humans, information that conventional echocardiography cannot provide. Although physical activity and work in dogs are well documented, there are few studies on cardiovascular adaptations secondary to exercise in dogs, and no studies to date evaluated these adaptations using STE. Materials, Methods & Results:A total of 31 dogs of the Border Collie and Ovelheiro Gaúcho Brasileiro breeds were divided into two groups: a herding group (HG, n = 15), which performed herding activity five to six times a week for at least 4 months, and a sedentary group (SG, n = 16), with no history of physical activity in the past twelve months. All dogs were previously subjected to electrocardiography and blood pressure measurement. After that, the animals underwent echocardiographic examination at rest at a single time point. The data were analyzed by two-way multivariate analysis of variance (ANOVA) at a level of significance of 5% (P < 0.05) and a trend at 90% (P < 0.1). The dogs of the HG had higher values for left-ventricular end-systolic diameter (LVESD) and systolic volume (SV), and lower values for leftventricular myocardial performance index (Tei index) and systolic septal movement. STE results indicated that the HG presented lower values for strain and strain rate in some myocardial segments in the radial, circumferential, longitudinal, and transverse directions. Discussion: The increase in LVESD is justified by the increase in preload (volume) required to meet the increased oxygen demand, whereas SV is directly related to the Frank-Starling mechanism. The lower Tei index in the HG indicates better systolic-diastolic performance, explained by a shorter isovolumetric relaxation time and isovolumetric contraction time and by an increase in left ventricular (LV) ejection time. Similar results were not observed in LV systolic wall motion. Therefore, we believe that the most likely explanation is a higher systolic efficiency, associated with lower energy demand at rest. According to STE criteria, the lower strain and strain rate in the HG in some myocardial segments in all directions suggest less need for myocardial deformation and lower deformation velocity in order to maintain systolic function. In conclusion, conventional echocardiography and STE were complementary and fundamental to understand cardiovascular adaptations in herding dogs.

The analysis of the level of vehicular congestion that occurs in the surrounding sectors of the downtown neighborhood in the city Villavicencio, Colombia specifically on Alfonso López Avenue and both of its main intersections are presented. The results of the analysis of the measurements of the speeds that were obtained taking the different modes of transportation such as private, public (taxis and buses), and plate method. Speeds were taken at peak and off-peak hours in the morning and afternoon for 15 continuous days through cycles that incorporate a series of fluid and congested traffic or combined taking into account the relationship variables between flow, velocity, density, interval, and spacing. Additionally, at intersections, traffic flow indicators were obtained to propose a solution that allowed improving the level of service on each one using the simulation tool Synchro. The previous analysis seeks to contribute to the discussion about the impact of the different modes of transportation on traffic congestion, the road and signals infrastructure, and how to diagnose and propose solutions to improve mobility.