Universidad de Buenos Aires Facultad de Ciencias Veterinarias

CTEDRA: INGL

TCNIC!

TE"T!

Roberto Cataldo

2010

#ndice
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TRABA$! %RCTIC! & Ani)al *el+are *-at is ani)al <el+are.

AVMA - American Veterinary Medical Association, 2010

Animal welfare is the ethical responsibility of ensuring animal well-being. Animal well-being is the condition in which animals experience good health, are able to effecti ely cope with their en ironment, and are able to express a di ersity of species-typical beha iors 1. !rotecting an animal"s welfare means pro iding for its physical and mental needs. 2. #nsuring animal welfare is a human responsibility that includes consideration for all aspects of animal wellbeing, including proper housing, management, nutrition, disease pre ention and treatment, responsible care, humane handling, and, when necessary, humane euthanasia. $here are numerous perspecti es on animal welfare that are influenced by a person"s alues and experiences. $here are also arious means of measuring animal welfare, including %but not limited to& health, producti ity, beha ior, and physiological responses. $he American Veterinary Medical Association has defined its commitment to animal welfare through the adoption of the following Animal 'elfare !rinciples that ser es as guidance when the Association de elops policies and ta(es action to ensure the welfare of animals) AVMA Animal 'elfare !rinciples $he AVMA, as a medical authority for the health and welfare of animals, offers the following eight integrated principles for de eloping and e aluating animal welfare policies, resolutions, and actions. * $he responsible use of animals for human purposes, such as companionship, food, fiber, recreation, wor(, education, exhibition, and research conducted for the benefit of both humans and animals, is consistent with the Veterinarian"s +ath. * ,ecisions regarding animal care, use, and welfare shall be made by balancing scientific (nowledge and professional -udgment with consideration of ethical and societal alues. * Animals must be pro ided water, food, proper handling, health care, and an en ironment appropriate to their care and use, with thoughtful consideration for their species-typical biology and beha ior. * Animals should be cared for in ways that minimi.e fear, pain, stress, and suffering. * !rocedures related to animal housing, management, care, and use should be continuously e aluated, and when indicated, refined or replaced. * /onser ation and management of animal populations should be humane, socially responsible, and scientifically prudent. * Animals shall be treated with respect and dignity throughout their li es and, when necessary, pro ided a humane death. * $he eterinary profession shall continually stri e to impro e animal health and welfare through scientific research, education, collaboration, ad ocacy, and the de elopment of legislation and regulations. Adapted from the AVMA 0 the American Vetrerinary Medical Association, 2010. 1uestions about any of these policies may be directed to animalwelfare2a ma.org.

EJERCITACIN 1. 2. 3. =. ?. @. 4ea el t5tulo 67econoce algunas palabras8 6/u9l ser9 el tema principal del mismo8 61u: entiende por ;proteger el bienestar del animal<8 6/u9l es su punto de ista8 6/onfirma su expectati a inicial8 >ubraye palabras o frases cla es. 61u: puntos indica AVMA %$he American Veterinary Medical Association8 7esuma los ocho principios de la AsociaciAn 0 cada uno en dos renglones como m9ximo

TRABA$! %RCTIC! 0 tud1 u22ests 3&N& Virus 4ore Dan2erous T-an = us5ected

PHOTO CREDIT: Courtesy Dr. Yoshihiro Kawaoka The pandemic H ! "#u $irus %red& has 'een shown to 'e more $iru#ent than scientists pre$ious#y 'e#ie$ed. The "i#amentous shape o" the $irus( which in this ima)e has recent#y 'udded "rom in"ected ce##s( is a#so unusua#.

The new H ! in"#uen*a $irus is more patho)enic than seasona# in"#uen*a $iruses accordin) to an internationa# team o" researchers #ed 'y Dr. Yoshihiro Kawaoka( o" the +, -choo# o" .eterinary /edicine0s Institute "or In"#uen*a .ira# Research. In a study pu'#ished in Nature( Dr. Kawaoka detai#ed the new $irus0s patho)enic 1ua#ities. In contrast with run2o"2the2mi## seasona# "#u $iruses( the H ! $irus e3hi'its an a'i#ity to in"ect ce##s deep in the #un)s( where it can cause pneumonia and( in se$ere cases( death in humans. -easona# $iruses typica##y in"ect on#y ce##s in the upper respiratory system. Dr. Kawaoka( a pro"essor o" patho'io#o)ica# sciences at the +,2/adison -choo# o" .eterinary /edicine and a #eadin) authority on in"#uen*a says that there is a misunderstandin) a'out this $irus and that peop#e think this patho)en may 'e simi#ar to seasona# in"#uen*a. This study shows that is not the case. There is c#ear e$idence the $irus is di""erent "rom seasona# in"#uen*a.4 Dr. Kawaoka says that whi#e "indin) the H ! $irus to 'e a more serious patho)en than pre$ious#y reported is worrisome( the new study a#so indicates that e3istin) and e3perimenta# anti$ira# dru)s can "orm an e""ecti$e "irst #ine o" de"ense a)ainst the $irus and s#ow its spread. He a#so a)rees that there are current#y three appro$ed anti$ira# compounds. His team tested the e""icacy o" two o" those compounds and the two e3perimenta# anti$ira# dru)s in mice addin) that the e3istin) and e3perimenta# dru)s work we## in anima# mode#s( su))estin) they wi## work in humans. 5nti$ira# dru)s are $iewed as a "irst #ine o" de"ense since de$e#opment and production o" mass 1uantities o" $accines take months at 'est. In addition to his appointment at +,2/adison( Dr. Kawaoka a#so is a pro"essor at the +ni$ersity o" Tokyo. The new study was "unded 'y )rants "rom the +.-. !ationa# Institutes o" Hea#th( and the 6apanese /inistry o" Education( Cu#ture( -ports( -cience and Techno#o)y.

Adapted and excerpted from a story by $erry ,e itt 0 Bni eristy of 'isconsin, Co ember 200D

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TRABA$! %RCTIC! / Veterinar1 %u8lic 3ealt- and Feed and Food a+et1 9V%3'

IA+, 'G+ and +J# define Veterinary !ublic Gealth %V!G& as K$he contributions to the physical, mental and social well being of humans through an understanding and application of eterinary scienceK. Veterinary public health contributes to public health through the (nowledge, s(ills and resources of eterinary science. $his generally relates to the understanding, pre ention and control of .oonotic diseases and food safety issues. $he scope of V!G is clearly multidisciplinary, in ol ing not only eterinarians in public and pri ate sectors, but also other health and agriculture professionals, communication experts and scientists as well as paraprofessionals. An interdisciplinary team approach to problem sol ing, research, control programs and communication is essential for the impro ement of human health in a significant and sustainable manner. #nsuring safe food is paramount for the protection of human health and for enhancement of the Euality of life. >afe food plays an important role, whether domestically produced and consumed, imported or exported. Jn addition, the production of safe food represents an opportunity for income generation and mar(et access. + er the last decades, the food chain approach has been recogni.ed as an important step forward to ensure food safety from production up to consumption. $his approach reEuires the commitment of all players in the food chain, in ol ing producers, traders, processors, distributors, competent authorities as well as consumers. $he role of animal feed in the production of safe food is also recogni.ed worldwide, and se eral e ents ha e underlined its impacts on public health, feed and food trade, and food security. /oncerns prompted by the outbrea( of bo ine spongiform encephalopathy %L>#&, and other more common food problems associated with >almonella, enterohaemorrhagic #scherichia coli and other contaminants, ha e encouraged professionals and the feed industry to scrutini.e more closely the causes of these diseases and methods for their control. Measures may reEuire limiting the use of some ingredients or radically changing the way in which they are prepared %processed& or sourced. Jn some cases the locations where animals are gra.ed need to be restricted. IA+ therefore pro ides current (nowledge on animal feed and its impact on food safety, and orientation and ad ice on this matter. $ransmission of diseases between animals and human %.oonoses& occurs daily around the globe, whether through agricultural practices or e eryday acti ities. Moonoses consist of a wide range of diseases and range from endemic .oonoses such as brucellosis, anthrax, bo ine tuberculosis, parasitic diseases %hydatic disease, echinococcosis, trichinellosis& and rabies to emerging .oonoses as highly pathogenic a ian influen.a, CipahNGendra disease and Lo ine >pongiform #ncephalopathy. $he impact on public health and on producti e acti ities is considerable. 7is( based programs should therefore aim at pre enting or decreasing the transmission of .oonoses, through adeEuate policy framewor(s, pre ention and control measures, and education. Attention should also be paid to ecological, cultural, social and ethical aspects regarding the implementation of control programs. Lesides .oonoses pre ention and control, IA+Os program also aims at minimi.ing the ris( of contamination %biological, chemical and physical& entering the food chain trough animal products. IA+ is committed to pre ent and control the spread of .oonoses and food borne diseases e.g. salmonellosis, campylobacteriosis and Gaemolytic-uraemic syndrome %GB>& caused by #.coli +1?H and contamination through appropriate programs that) * promote the de elopment and adoption of adeEuate international, regional and national regulatory framewor(sP * enhance communication and cooperation between animal and human health sectorsP * impro e ser ice deli ery and strengthen capacitiesP * increase professional and public awareness on eterinary public health and food safety issuesP * de elop and pro ide rele ant informationP * foster partnerships, coordination and collaboration among sta(eholdersP * de elop policy ma(ing tools. $his is en isaged to be achie ed through the establishment of international and regional networ(s, discussion and information exchange platforms as well as through expert consultations, technical meetings, the implementation of pro-ects and the dissemination of rele ant information. /lose collaboration is established with other international organi.ations such as 'G+ and +J# as well as regional and national institutions, CQ+Os and pri ate sector associations.

+ er the years the field of eterinary public healthNIeed and Iood safety has changed. $his reEuires professionals acti e in this field to ha e the needed (nowledge and s(ills to address the issues ma(ing use of the new insights and tools. #specially with regard to the professionals there is a need to re ise and update the existing uni ersity curricula and engage in continuing education Adapted from a publication on ANIMAL PRODUCTION AND HEALTH DIVISION by FAO FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS for a world without hunger, >eptember, 200D

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TRABA$! %RCTIC! ; Ne< 4RI Is !5en to %atients #ste es el t5tulo del art5culo) S

1. 6,e Eu: tratar9 el texto8 2. >egRn su respuesta en el paso 1, 6Eu: palabras encontrar9 en el mismo8

New MRI Is Open to Patients

;'e now ha e e ery modality,< says ,r. $ony !ease, head of diagnostic imaging. ;Jn addition to M7J, we ha e state-of-the-art ultrasound and /$, fluoroscopy for horses and small animals, and nuclear medicine.< $he M7J facility has e erything that is needed for small animals, plus an eEuine table, anesthesia machine, and monitors, all of which are M7J compatible. $his allows M>B to perform M7Js on a wide ariety of patient si.es. $he ad antage of the M>B M7J is that it can) - #nhance soft tissue images - ,efine brain and spinal cord in-uries better than /$ - Jdentify muscle tears and muscle lesions ;'e are planning to do research with the M7J, as well as clinical cases,< !ease says. ;Ior example, we want to explore articular cartilage imaging and damage to the meniscus in horses in ways that nobody else in the eterinary field is doing, but is being performed in humans.< $he installation of the M7J is the culmination of four years of planning and sa ing. ;'e are not paying for the M7J through client charges,< !ease says. ;$he eterinary school and the V$G ha e been sa ing and planning for this for more than four years, and our price structure is designed to co er the maintenance costs. $he unit is a tribute to the forward thin(ing and dedication to excellence in teaching, patient care, and research that has made M>B one of the best eterinary schools in the country.< M7J examinations are not performed as an outpatient ser ice at this time. Jf you belie e an animal could benefit from an M7J, please contact the V$G for an appointment to a clinical ser ice that will e aluate your animal and prescribe an M7J examination of the appropriate region.

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TRABA$! %RCTIC! 7 olvin2 t-e 41ster1 o+ Genetics Vi2orous 2enetic researc- 5ro?ects at 4 U o++er insi2-t and -o5e Iew areas in eterinary and human medicine offer more promise 0 or challenge 0 than genetic studies. Iew eterinary colleges are better poised to meet the challenges and to deli er the promises than Michigan >tate Bni ersityOs /ollege of Veterinary Medicine %M>B /VM&. D

,r. Tohn Iyfe, an associate professor in /VM, established an inherited disease research program in the ,epartment of Microbiology and Molecular Qenetics when he came to M>B in 1DD=. Ge says we ga e it a formal name, the 4aboratory of /omparati e Medical Qenetics when we began offering mutation-based carrier tests to the general public in 2002. Ge also adds that as the name implies we are interested in genetic changes that cause disease in any species, including humans. Qenetic diseases are considered natureOs ;(noc(out< experimentsP they occur spontaneously in all species, and a ma-or mission of the laboratory is to characteri.e inherited disorders that occur in companion animals so they can be pre ented. Jn estigation of these disorders pro ides insight into human genetic disorders, as well. Iyfe explains how the whole ;(noc(out< analogy saying that certainly, the arious differences in loo(, beha ior and physiology of different species and healthy indi iduals within a species are determined by differences in ,CA. Gowe er, some ,CA changes are incompatible with gene function. Jnherited disease occurs if a ,CA mutation eliminates or radically changes the function of an essential gene and if that mutation is present in the ,CA of the sperm or egg of an animal that contributes to the next generation. Lecause two copies of most genes are present in e ery cell, half-function of a gene wor(s well enough much of the time. Lut an unhealthy animal can result when a mutation is present in both copies of the same gene. Iyfe says that the disease from this (ind of mutation is inherited as what we call a recessi e traitP you donOt see the effect of the mutation unless both chromosomes ha e it. Jn domestic animals, this state almost always occurs because the same mutation is inherited from each parent who, in turn, are related to each other. Cew spontaneous mutations can lead to new genetic diseases, Iyfe continues, which is what he and his colleagues study. Jn a different approach, use in many other laboratories, ,CA alterations are intentionally produced in certain species of worms, fruit flies, mice, or .ebra fish. 7esearchers then study the changes produced by these genetic alterations. Ge also says such a laboratory manipulation that halts expression of a gene is called a gene (noc(out. Jn contrast, the spontaneously occurring diseases he in estigates are gene (noc(outs produced by nature. Gence, natureOs U(noc(out experimentsO 0 referring to the words used on the labOs website 0 since ,CA mutations occur in all species fairly often, all species are sub-ect to such spontaneously occurring genetic diseases. $hat is a lot to loo( into, but /VM is on it 0 in a big way. Jn addition to the 4aboratory of /omparati e Medical Qenetics, many other laboratories in the /ollege of Veterinary Medicine are studying genetic disorders. Jn estigators are loo(ing into cancer in dogs and catsP retinal degeneration that causes blindness, genetic components of asthma and other respiratory disorders, immune deficiencies, and much more. $here is a ma-or interdisciplinary aspect to all of this, according to him 0 it should be ob ious 0 that no one can be an expert in the assessment of all organ systems or areas of physiology. $he interdisciplinary nature of our wor( is that when an animal is brought to us, and if we are con inced that it is exhibiting a genetic disease, one of the most important acti ities is to delineate e erything that is wrong with the animal. $his can reEuire any or many of the clinical specialties of /VMOs Veterinary $eaching Gospital, the pathology ser ice, and further expertise in biochemistry or cell biology. Much of this expertise is a ailable in /VM or elsewhere on the M>B campus, but sometimes we organi.e essential collaborations with in estigators at other institutions worldwide. Lreeders and owners are important collaborators, as well. 'hile J always try to do a portion of the in estigation myself, J often find myself organi.ing and collating the acti ities and results of other in estigators, each pro iding expertise in a different discipline. Jn a sense, you could say that for Iyfe, it all started with giant schnau.ers. About 2? years ago, he began in estigating the cause of a disorder in these dogs that caused growth retardation, mild anemia, and poor appetite. Iour years of IyfeOs initial studies showed

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the culprit to be a itamin L-12 deficiency and that this deficiency existed because the dogs were incapable of absorbing the itamin from food. IyfeOs studies went on and, with the help of his laboratory staff and graduate students, came to se eral conclusions) 1. $he normal physiology of dogs and cats utili.es a protein called intrinsic factor and a receptor-mediated system for itamin L-12 absorption, -ust as in humans and other species. 2. Vitamin L-12 is essential for dog and cat healthP they both de elop anemia, white blood cell deficiency, and bone marrow abnormalities when they are L-12 deficient, but the blood cell changes loo( different than in humans. 3. $he all important intestinal receptor for itamin L-12 is a product of two genes, and mutations of either gene cause the same disorder of L-12 malabsorption. Ge reports they ha e studied many disorders o er the years. Jn addition to L-12 malabsorption in fi e breeds of dogs, they ha e also studied two types of glycogen storage disease in horses, cats and dogsP three types of congenital hypothyroidism in dogsP and two motor neuron disorders, one dog and one cat. >o what does Iyfe thin( is the most important result of some 20 years of study8 $he elimination of mutation carriers from breeding populations, he says. Ge continues saying that finding the mutations causing these problems has become easier in the last decade due to contributions from many in the dog and cat genetics community as well as CJG %Cational Jnstitutes of Gealth& funding to seEuence the dog and cat genomes. 'hene er their studies lead them to a mutation, they de elop a ,CA-based mutation detection assay that they offer as a carrier test to the owners and breeders of the animals in ol ed. Jn this way, they can determine which of their breeding stoc( are carriers of these recessi e diseases and ma(e informed mating decisions. JtOs the most effecti e (ind of pre entati e medicine) the potentially affected animals are not e en concei ed. +ngoing studies in Iyfe"s lab that may benefit humans include the study of spinal muscular atrophy %>MA& in Maine coon cats and congenital hypothyroidism in arious dog breeds. Guman >MA is he says a common genetic disorder occurring at a rate of 1 in @000 births and is lethal in infancy or causes lifelong disability. Although less common than >MA, congenital hypothyroidism is important in human medicine because, unless it is diagnosed and treated ery early in life, the patient suffers se ere and irre ersible mental retardation. Ge adds that it is a tragedy of lost human potential to miss the diagnosis, but it also costs the health system so much to maintain these indi iduals o er a lifetime that it is less costly to test e ery newborn infant in the country. #arly treatment is crucial. $heir studies ha e benefited from ad ances in human disease genetics 0 reciprocally, they always hope that the insights gained in animal studies will lead to pre ention or new therapies for the similar human disorders.

Adapted from ,r. Tohn IyfeVs studies on >ol ing the Mystery of Qenetics, 200D

EJERCITACIN 1. 2. 3. =. ?. @. 4ea el t5tulo y anticipe de Eue tratar9 el art5culo - 61u: palabras le resultan conocidas8 4ea la introducciAn - 6est9 de acuerdo8 6/Amo relaciona ,r Iyfe la gen:tica con la causa de enfermedades8 6+pina Bd. lo mismo8 61u: entiende por ;(noc(out experiments<8 61u: dice el art5culo sobre los laboratorios8 6/Amo comen.A ,r Iyfe su estudio8 11

H. 6A Eu: resultado llegA :l8 S. 61u: parte del art5culo le resultA interesante8 D. 61u: palabras le resultaron conocidas y lo lle aron a interpretar el texto8 dificultaron la comprensiAn8

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TRABA$! %RCTIC! A tudies to I)5rove Treat)ent o+ Bone Cancer

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An image of normal bone stained to detect the presence of beta-catenin within the cells shows ery little response to the stain. A deeper understanding of genetic abnormalities in bone cancer cells, or osteosarcoma, in dogs may yield clues that lead to impro ed treatment in both canine and human osteosarcoma. $hat"s what ,r. $imothy >tein, an assistant professor of oncology at the B'-Madison >chool of Veterinary Medicine, hopes to accomplish with a study of spontaneously-occurring tumors in dogs. Ge and his colleagues at the school"s Veterinary Medical $eaching Gospital are collecting samples of bone tumors from dogs as part of an CJG-funded study at the B' Jnstitute for /linical and $ranslational 7esearch %J/$7&. ,r. >tein then loo(s for differences in genes from dogs that ha e a higher le el of an en.yme, al(aline phosphatase %A4!&. A4! has been associated with a poorer outcome in both dogs and people with osteosarcoma. Jf there are differences in the genes expressed between tumors from dogs with normal as opposed to ele ated le els of A4!, oncologists may be able to de elop a new direction for potential cancer treatments. ,r. >tein is also loo(ing at the role of beta-catenin, a protein important for (eeping cells together as well as for cell growth and di ision, in osteosarcoma cases. Leta-catenin is altered in a ariety of cancers, including human osteosarcoma, and may allow these cells to proliferate out of control. Ge says he is trying to clarify the role of beta-catenin in osteosarcoma 0 Js it abnormally expressed8 $hat is, is it in cells when it shouldn"t be8 'hat, if anything, does it contribute to bone cancer de elopment8

A cancerous bone sample treated with the same stain clearly shows the presence of beta-catenin in the cells %the beta-catenin turns brown&. ,r. $imothy >tein, a eterinary oncologist at the Bni ersity of 'isconsin-Madison >chool of Veterinary Medicine, hopes to learn more about whether or how beta-catenin influences bone cancer. $he hope is that brea(throughs in these canine bone cancer studies will yield new treatments for humans as well, because dog and human bone cancers are similar. ,r. >tein encourages animal owners to contact the school"s Veterinary Medical $eaching Gospital if their pet is diagnosed with cancer and they want options, especially for bone cancer. Ge says often they ha e clinical trials a ailable 0 the trials can help offset the cost of treatment, and there is the potential to help not only the animal being treated, but future animals as well Adapted from a publication, Bni ersity of 'isconsin 0 Madison , Co ember 1D, 200D

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EJERCITACIN 1. 2. 3. =. ?. @. 61u: le sugiere el t5tulo8 61u: representan los dos gr9ficos8 6/Amo comien.a el art5culo8 61u: significa A4! 0 A Eu: asocia el ,r. >tein A4! 8 61u: otra prote5na menciona8 6!or Eu:8 6A Eu: conclusiAn llega el art5culo8

TRABA$! %RCTIC! : %enn3I% %rocedure Availa8le at VT3 /anine hip dysplasia affects millions of dogs each year and can result in debilitating osteoarthritis %+A& of the hip. !ennGJ!, short for Bni ersity of !ennsyl ania Gip Jmpro ement !rogram, is an e idence-based technology to screen canine hips for susceptibility to +A.

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7adiologist ,r. $ony !ease is among a networ( of eterinarians who ha e been trained and certified to perform the !ennGJ! procedure, which V$G has been offering since Tanuary 200D. ,r !ease says !ennGJ! is an alternati e to +IA Wthe +rthopedic Ioundation for AnimalsXP both in ol e radiographic e aluation, but !ennGJ! can be done as early as 1@ wee(s, while +IA waits until the dog is two years old and by that time the owner has already made a significant in estment in the dog. $he !ennGJ! method ma(es use of three separate radiographs) the distraction iew, which obtains Euantitati e measurements of hip -oint laxityP the compression iew, which obtains hip -oint congruity readingsP and the hip-extended iew, which obtains information regarding the existence of +A in the hip -oint. +IA uses the hip-extended iew only. ,r !ease adds with !ennGJ!, a distraction index is assigned to each hip -oint based on precise measurements and mathematical calculations. $he ownerVs dog is compared against e ery other dog in their breed. Jf there are not enough dogs in the breed to be significant, their dog is matched with e ery other dog in its weight range. $he findings are reported in terms of percentiles. Ior example, you may learn that your dog is at the D0th percentile for 4abrador retrie ers. +IA descriptions are more sub-ecti e Y li(e Uexcellent,O Ugood,O or Ufair.O $his sub-ecti ity can lead to o erestimating or underestimating the problem. !ease cites a recent case of a Qerman shepherd whose +IA shots indicated the dog had mild dysplasia. Lut the !ennGJ! shots showed this dog was at the S0th percentile for its breed Y actually Euite good. 'ith !ennGJ!, e ery case is submitted to the database %good or bad& to ma(e sure there is an accurate representation of the breed. $his ensures that the database is not corrupted by recei ing reports of only the best films but also emphasi.es that there are no ;good< or ;bad< hips. 7ather, if your animal has hips with a lower percentile, it should be bred to a dog with a higher percentile. Adapted from ,r $ony !easeVs publication, M>B EJERCITACIN 1. 4ea el t5tulo - 6de Eu: tratar9 el art5culo8 2. 6>obre Eu: animales es el estudio8 3. 6/ompara yNo diferencia el ,r. !ease - !ennGJ! y +IA8 =. 61u: se interpreta por ;distraction< en ;distraction view< y ;distraction index<8 ?. 6A Eu: sub-eti idad se refiere el ,r !ease8 @. 61u: caso reciente cita el ,r !ease8 H. 6A Eu: conclusiAn llega el ,r !ease8

TRABA$! %RCTIC! B Use o+ IR to Treat Intra-e5atic -unt

A case study of Mander, a chocolate lab, that had an intrahepatic shunt and needed special treatment.

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#milee and #ric Fennedy, of !etos(ey, lo e their dog Mander, a chocolate lab, and when they felt something was wrong with him, they immediately too( measures to find out if their suspicions were correct. >ure enough, they disco ered that Mander had an intrahepatic shunt and needed special treatment. Ge was referred to ,r. Matthew Leal, a specialist in emergency and critical care medicine, who is also the director of Jnter entional 7adiology >er ices at the V$G. ;'e were immediately impressed by his (nowledge of his field and his caring nature,< says #milee Fennedy. At the time, Mander was ery thin from a lac( of appetite. Leal (ept Mander at the Veterinary $eaching Gospital and initiated treatment for se ere hepatic encephalopathy and started him on an antibiotic, because Mander had many toxins built up in his system and a ery high ammonia le el. After being with Leal for two days of ery close obser ation, tests, and lots of tender lo ing care, Mander was released to #milee and #ric for the purpose of building up his strength and weight in preparation for a future coil emboli.ation of his intrahepatic shunt in the future. Mander was going to need surgery, and he was not strong enough to come through it yet. +nce Mander was at a satisfactory weight and free from most signs of hepatic encephalopathy, Leal performed the percutaneous trans-ugular coil emboli.ation procedure. $he procedure is performed endo ascularly using catheters, guidewires, a stent, and then coils to partially attenuate the shunt %these types of shunts cannot be closed acutely& and impro e blood flow into the portal system of the li er, thus impro ing li er function. $he procedure was performed with the aid of fluoroscopic guidance, and Mander went home the following day with only a fi e millimeter incision o er his -ugular ein.

$he procedure went ery smoothly, but Mander unfortunately de eloped a large clot in the portal system that resulted in life-threatening portal hypertension. Ge was rushed bac( to the fluoroscopy suite, and the clot was lysed with the use of thrombolytic agents %$!A&. ManderOs portal pressure decreased, and he was again released home on antihemostatic medications. Mander was gradually weaned from these medications and those for his li er dysfunction, as well as his prescription diet. Ge returned for a rechec( examination, and a /$ scan showed beautiful branching of the portal ein into the li er and ery nice de elopment of li er asculature and si.e. Mander had gained 2? pounds at the time and was acting ery much ;li(e a lab.< $hrough all of the stressful times, #milee and #ric felt assured of LealOs and his associateOs genuine lo e for Mander. Leal credits much of ManderOs success to the unwa ering commitment of his owners, whom he considers to be some of the best clients he has e er had the opportunity to wor( with. ;$hey allowed me to do my -ob with no restrictions,< Leal says. All of this happened to Mander before he was e en one year old, and the Fennedys report that Mander has maintained his good-natured personality through e erything. School of Veterinary Medicine Michigan State University, 2009

EJERCITACIN 1@

1. 2. 3. =. ?. @.

4ea el t5tulo 0 6Eu: palabras reconoce8 61u: sabe del tema8 61u: se entiende por ;intahepatic shunt<8 61u: s5ntomas presentaba Mander8 6/Amo siguiA el tratamiento de Mander una e. recuperado8 6/Amo describe ,r Leal los pasos Eue siguiA 0 Eu: m:todos empleA8

TRABA$! %RCTIC! = Food u55l1 Veterinar1 4edicine 9F V4' %rotectin2 A)ericaDs Food u55l1 Veterinarians protect America"s 0 and the world"s 0 food supply from the farm to the dinner table. 1H

+n the farm, practicing eterinarians wor( to protect the health of animals that produce por(, eggs, poultry, mil(, beef, lamb, fish, and other products. !re ention and control of disease are (ey elements in the practice of eterinary medicine, particularly in animal agriculture, where the focus is on population medicine. $his concept of disease pre ention and control through herd health is analogous to public health efforts. As eterinarians, charged ethically with promoting public health in addition to protecting animal health and welfare, we ha e great interest in the pre ention, control, and treatment of disease. Vigilance Veterinarians who wor( for the B>,A Iood >afety and Jnspection >er ice ha e the necessary s(ills to recogni.e the wide ariety of clinical signs in animals submitted for slaughter. $heir duties and responsibilities include) - >ur eillance for disease - Monitoring for disease that can increase shedding of bacteria such as >almonella - Monitoring for disabled animals - Monitoring for signs that might indicate recent drug treatment or exposure to contaminants - Monitoring for disease that might ser e as a ris( to human health Veterinarians ha e (nowledge and experience in pathology, microbiology, and toxicology to e aluate human health ha.ards postmortem. Guidance At food processing plants, the eterinarian"s responsibility is to o ersee the entire process for food safety compliance and to assess ris(s. Veterinary medical s(ills enable eterinarians to assess and erify Ga.ard Analysis and /ritical /ontrol !oint food safety plans at production, processing, and retail le els to ensure safe meat and poultry. * Veterinarians also pro ide the o ersight for laboratory analyses of processed meat samples, including super ision of laboratory personnel, o ersight of eEuipment and scientific methods utili.ed, and e aluation of microbiological and chemical analyses. At the retail and distribution le el, corporate eterinarians pro ide food safety o ersight for global food supply corporations. $heir positions include o ersight of programs and trade of animal commodities. * Iederal eterinarians within the Iood and ,rug Administration also wor( to pro ide data to be used by the B.>. $rade 7epresentati e in free trade agreement negotiations. Pr !ec!i n Iinally, Veterinarians are also the predominant, internationally recogni.ed authority to audit and inspect foreign establishments that export animal foods to the B.>. Ior example, Air Iorce eterinarians e aluate food safety of local foods pro ided to military bases o erseas. Jn addition, local public health departments ha e eterinarians who pro ide public health and food safety o ersight in some -urisdictions. +ther ways eterinarians ha e roles in protecting our food supply include) * /enters for ,isease /ontrol and !re ention eterinarians wor( in food safety outbrea(s, in public health crises such as .oonotic disease epidemics, and in importation of animals and animal products. * B>,A eterinarians also wor( in grant programs for food supply research, in policy de elopment for regulatory o ersight of the B.>. food supply, in executing specific disease eradication and control, and in appro ing animal accines. * I,A eterinarians wor( in new animal drug re iews and appro als, in identification of chemical and drug residues in foods deri ed from animals, in dairy and seafood safety and other foods deri ed from animals. * Veterinarians wor( as members of /ongress, staff to /ongress, and to the 'hite Gouse in the +ffice of >cience and $echnology !olicy. $hey pro ide ad ice on eterinary medical and public health issues, some of which ha e impacts on the B.>. food supply. * Veterinarians at uni ersities wor( to perform research to promote food animal production and to educate local producers on new food supply technologies and procedures. * Veterinarians wor(ing for indi idual states ensure that public health and agricultural regulations are followed. EJERCITACIN 1. 2. 3. =. ?. 4ea el t5tulo y la introducciAn 0 de Eu: trata la publicaciAn8 61u: rol cumplen los eterinarios en una gran-a8 61u: entiende el autor por pre enciAn de la enfermedad8 6La-o Eu: tres subt5tulos se clasifica este publicaciAn8 7esuma cada uno de ellos 0 en no m9s de ? %cinco& reglones cada uno. 1S

@. 6#st9 Bd. de acuerdo con el mismo8

TRABA$! %RCTIC! &@ Veterinar1 %u8lic 3ealt- 9V%3' *-at is Veterinar1 %u8lic 3ealt-.

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Veterinary !ublic Gealth %V!G& was defined by the 'G+ consultation on Kfuture trends in eterinary public healthK held in $eramo, Jtaly in 1DDD as Kthe sum of all contributions to the physical, mental and social well-being of humans through an understanding and application of eterinary scienceK. Guman health is inextricably lin(ed to animal health and production. $his lin( between human and animal populations, and with the surrounding en ironment, is particularly close in de eloping regions where animals pro ide transportation, draught power, fuel and clothing as well as proteins %meat, eggs and mil(&. Jn both de eloping and industriali.ed countries, howe er, this can lead to a serious ris( to public health with se ere economic conseEuences. A number of communicable diseases %(nown as .oonoses& are transmitted from animals to humans. Veterinary medicine has a long and distinguished history of contributing to the maintenance and promotion of public health. Zoonoses and public health

About H?Z of the new diseases that ha e affected humans o er the past 10 years ha e been caused by pathogens originating from an animal or from products of animal origin. Many of these diseases ha e the potential to spread through arious means o er long distances and to become global problems. Jn addition a number of well (nown and pre entable animal diseases that can be transmitted to humans %i.e. .oonoses& such as rabies, brucellosis, leishmaniasis and echinococcosis continue to occur in many countries especially in the de eloping world where they mostly affect the poorest segment of the human population. $hey cause a serious amount of deaths and millions of affected people e ery year. All ma-or .oonotic diseases pre ent the efficient production of food of animal origin, particularly of much-needed proteins, and create obstacles to international trade in animals and animal products. $hey are thus an impediment to o erall socioeconomic de elopment. Irom way bac( eterinary medicine played a ma-or role in the pre enting of and inter entions against animal diseases including .oonoses.

Core domains

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$he core domains of V!G include the following) diagnosis, sur eillance, epidemiology, control, pre ention and elimination of .oonosesP food protectionP management of health aspects of laboratory animal facilities and diagnostic laboratoriesP biomedical researchP health education and extensionP and production and control of biological products and medical de ices. +ther V!G core domains may include management of domestic and wild animal populations, protection of drin(ing-water and the en ironment, and management of public health emergencies. Veterinary !ublic Gealth is an essential part of public health and includes arious types of cooperation between the disciplines that lin( the health triad, people-animals-en ironment, and all of its interactions.

The role of WHO V!G acti ities contribute to 'G+"s global efforts to strengthen the sur eillance of and response to all communicable diseases which are or may emerge as public health threats. Jn collaboration with its 7egional +ffices, 'G+ supports Member >tates in the sur eillance and containment in humans and animals of .oonoses and foodborne .oonotic diseases of public health importance, and animal diseases with (nown or potential public health implicationsP and in the sur eillance and containment of resistance to antimicrobial agents in animals, with implications for human medicine. V!G acti ities are currently implemented by 'G+ GeadEuarters through the ,epartment of /ommunicable ,iseases /ontrol, !re ention and #radication %/!#& in close collaboration with the Iood >afety program. Iocal points exist in all 'G+ 7egional +ffices. Ly its ery nature, the V!G program in 'G+ has been closely lin(ed with arious aspects of the wor( of the Iood and Agriculture +rgani.ation of the Bnited Cations %IA+& and the 'orld +rganisation for Animal Gealth %+J#& in relation to .oonoses, food safety, and the public health aspects of trade in animals and animal products. $here is also much collaboration with 'G+ collaborating centres, other uni ersities, research centres and institutions. * Jdentifying and e aluating microbiological ha.ards to human health of animal origin) new, emerging and re-emerging .oonotic diseases, and foodborne diseases, including those due to antimicrobial resistant bacteria. * ,e eloping policies, guidelines, operational research and strategies for the control of .oonotic and foodborne diseases. * !romoting research on .oonotic and foodborne diseases and their management in humans. * >trengthening global sur eillance of .oonotic diseases and antimicrobial resistance in foodborne pathogens by enhancing the epidemiological capabilities of national laboratories. * ,isseminating rele ant information to experts in public health, eterinary science and other scientific disciplines, as well as to consumer groups and the public. * /ontributing to field and laboratory in estigations of .oonotic and foodborne diseases. * Iacilitating acti e contributions to public health by the eterinary ser ices of Member >tates, an essential reEuirement for the cost-effecti e sur eillance and control of .oonotic and foodborne diseases in their animal hosts. * !ro iding technical and scientific assistance to Member >tates for their sur eillance and control programmes, when reEuested. Adapted form, V!G 0 'G+ %'orld Gealth +rgani.ation&, 200D

EJERCITACIN

21

1. 2. 3. =. ?. @. H. S.

4ea el t5tulo y escriba sobre el tema principal 6/Amo define 'G+ %'orld Gealth +rgani.ation& a V!G %Veterinary !ublic Gealth&8 6,e Eu: manera humanos y animales contraen enfermedades8 61u: se entiende por ;.oonoses<8 61u: enfermedades pueden pre enirse 0 segRn el art5culo8 61u: impiden las principales enfermedades transmitidas por animales8 61u: incluye ;$he core domains of V!G<8 6/Amo resume el art5culo el rol de ;'G+<8 61ui:nes participan8

TRABA$! %RCTIC! && Ne< t-eor1 )a1 -el5 avoid navicular

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'hat does a horseOs foot ha e in common with a Ci(e running shoe8 A lot, according to ,r. 7obert Low(er, an associate professor in the /ollege of Veterinary MedicineOs ,epartment of Anatomy. Low(er has put together a new picture of eEuine foot physiology that suggests ascular systems in the horse foot functions in much the same way that air- or gel-filled running shoes do. Ge said mo ing liEuids are the best way to dissipate energy and that is why, he adds, some of the ma-or running shoe manufacturers mar(et products that contain liEuids in their soles. ,r. Low(er has theori.ed a Khemodynamic flowK process in which he proposes that much of the blood in horse feet fulfills purposes other than pro iding nutrients to hoof tissues 0 adding that it dissipates energy within feet that is created during the act of galloping, trotting or wal(ing. /urrently, eEuine foot physiology researchers subscribe to one of two anatomical theories [ pressure theory or depression theory [ which are, in many respects, mirror images of each other 0 prressure theory says that when the hoof hits the ground, the pressure of the impact hits the frog of the hoof, which causes the bac( part of the foot to mo e outward. ,epression theory suggests that when impact on the ground occurs, the pastern descends and depresses the digital cushion inside the hoof. According to both theories, these actions push hoof cartilage to the outside, with the digital cushion absorbing the energy. Loth theories state that blood is pumped from the hoof at impact. \et both theories share a single problem. 7esearchers who attempt to duplicate depression or pressure theory in the lab or on li e horses are unable to do so. !roblems arise when researchers attempt to account for how the energy of the hoofOs impact with the ground is dissipated as the digital cushion is made of soft, elastic tissue and acts li(e a spring, so for e ery action, researchers would expect a reaction of eEual force. \et when they put energy measurement de ices into digital cushions, that does not happen. 'hen the hoof is in the air, it registers .ero pressure, but when it hits the ground, instead of registering positi e pressure, it is actually negati e. Low(erOs hemodynamic flow hypothesis suggests this negati e pressure is actually created by the outward mo ement of the hoof cartilage. $his mo ement creates a acuum action that suc(s blood from beneath the coffin into the rear portion of the hoof. As the blood mo es to the rear of the hoof through micro essels in the lateral hoof cartilage, it dissipates the energy caused by its impact on the ground, much li(e fluid-filled running shoes do. Jn de eloping this new theory, Low(er obser ed that horses with good feet ha e more blood essels in the lateral cartilage of their hoo es than those that had histories of foot problems. Additionally, blood essels in healthier animals were located inside the lateral cartilage of the hoof, and the digital cushion on these animals tended to be made of cartilaginous material instead of elastic tissue. Low(erOs theory not only proposes a new physiology for horse feet, it also suggests some of the more widely held iews in the eEuine industry should be re ised or, at least, reexamined. Ior example, he presents a wholly different iew of the horse foot that sees it as ery responsi e and adaptable to ground impact. >timulation of the internal foot structures will result in the de elopment of more efficient ways to dissipate energy and support the horseOs weight, he belie es. Jt also suggests horses with na icular disease may not need to be put down and that hoof trimming techniEues might need to be re iewed. Veterinarians need to be trimming hoo es so that more of the bac( part of the foot[including the frog[bears the initial ground impact forces and weight. $rimming the foot so that the brea(o er is much shorter and the frog and bac( part of the feet support a lot of the horse"s weight encourages de elopment of tissues that dissipate more energy when hoo es hit the ground. Jf hoo es are trimmed so that the frog rests on the ground, it stimulates the bac( part of the hoof to grow more fibrous and cartilaginous digital cushions, which appear to be Uprotecti eO of the more chronic foot problems. /on ersely, with digital cushions constructed of only elastic and fatty tissues with little or no fibrocartilage, the ground impact energy is transmitted to foot bones and ligaments, resulting in internal foot problems, such as na icular disease. Across most of the breeds examined, en ironmental %i.e. nongenetic& factors seem to be a ma-or contribution to the de elopment of the internal tissues of the bac( part of the foot. Ge added that some of these factors include the frog resting on the ground, husbandry of the horse, trimming and shoeing methods, and so forth. Gorse feet with good en ironmental stimulation of the bac( part of the foot, the digital cushion, and the lateral cartilages will respond by becoming more robust structures to dissipate the initial impact energies and pro ide better support for the horse when the horse is standing Jn those horses that do not ha e good en ironmental stimulation of the bac( part of the foot %for example, a trimmed or recessed frog, rather than one resting on the ground&, regardless of the breed, the internal tissues of the bac( part of the foot will be underde eloped, which will lead to internal foot problems such as na icular syndrome.

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According to Low(er, doctors can de elop trimming and shoeing methods that can stimulate the bac( part of the foot [ much li(e physical therapy to the bac( part of the foot, which will stimulate the internal tissues of the foot [ to pro ide a more efficient system of energy dissipation and pro ide better support for the weight of the horse Low(er firmly belie es that as we begin to understand internal foot biology, we will be able to decrease the incidence of na icular-type and other foot diseases.

Adapted from ,r. 7obert Low(erVs publication 0 /ollege of Veterinary MedicineOs ,epartment of Anatomy, Michigan >tate Bni ersity 0 March, 1DDD

EJERCITACIN 1. 2. 3. =. ?. @. H. S. 4ea el t5tulo y de una hipAtesis sobre el tema del art5culo 6A Eu: compara ,r. Low(er el ;pie< de un caballo8 6!or Eu: llega a este sentido8 6/Amo compara la descripciAn hecha por los in estigadores sobre el tema8 61u: se entiende por la teor5a de la depresiAn en el caminar de un eEuino8 6/u9l es la hipAtesis de Low(er8 61u: palabra del t5tulo asocia con la teor5a de Low(er sobre el tema8 6A Eu: conclusiAn se llega8

TRABA$! %RCTIC! &0 Veterinar1 Researc-: T-e NeCt Generation

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Gradua!e "!uden!" and re"iden!" #la$ a %i!al r le a! CVM

Dr. Kenneth ierce has spent a lot of time !ith Cor"is the past couple of #ears. $s a resident in Comparati%e Ophthalmolo"# at &ichi"an 'tate (ni%ersit#)s Colle"e of *eterinar# &edicine +&'( C*&,- ierce has been conductin" important research on the effects of phosphodiesterase inhibitors on retinal function and %ision in do"s !ith retinal phosphodiesterase mutations. Cor"is- it turns out- are "reat models for this research because .the# e/perience a similar 0ind of spontaneous "enetic mutation found in humans !ith a condition 0no!n as retinitis pi"mentosa-1 ierce sa#s. 2ut ierce also has spent a lot of time !ith #oun" %eterinar# students. .&# role as a resident is first to be trained to become a specialist-1 he sa#s- .and to pass certification e/ams and carr# on a hi"her 3ualit# of &edicine in *eterinar# Ophthalmolo"#. 2ut another important part of the pro"ram is to further the education and trainin" of our soon4to4be4%eterinarians before the# "o out and practice. We teach the third4 and fourth4#ear students.1 ierce- a nati%e of 5e! Orleans- is half!a# throu"h his four4#ear residenc# at C*& and one of t!o current residents !or0in" !ith Dr. 'imon etersen46ones- rofessor of Comparati%e Ophthalmolo"# in the Department of 'mall $nimal Clinical 'ciences. ierce is close to publishin" the results of his research on retinal function and %ision in these do"s. This stud# ma# lead to future and lar"er studies usin" this animal model- ierce hopes. ierce also e/emplifies the role "raduate students and residents pla# at C*& e%er# da#. Their contributions to teachin" are important- but perhaps far more crucial is their role in research and !hat it means for the future of %eterinar# medicine. 7n !inter term 2008- there !ere 192 "raduate students and about 9: residents at C*&. .What the#)re doin" reall# is pi%otal to !hat !e "enerate here-1 sa#s Dr. 'usan ;!art$ssociate Dean of Research and <raduate 'tudies. .The#)re functional in the labs- the# are in the thic0 of thin"s in terms of learnin" ho! to "enerate and anal#=e information. $nd residents also are learnin" to see cases- !or0in" in teams- !ith a 'enior >acult# &ember as a leader of those teams. The# "raduates and residents reall# ha%e been an inte"ral part of the team- both in terms of "eneratin" ne! information and con%e#in" it to students.1 etersen46ones a"rees. .Residents are e/tremel# important-1 he sa#s. .&ore important in the lon" term is "i%in" them a feel or desire to continue to do research. The# can certainl# help a lot !ith on"oin" pro?ects- but !e hope this !or0 li"hts a spar0 for research in them. That)s important because !e need to encoura"e the ne! "eneration of %eterinarians !ho !ill dri%e the sub?ect for!ard and research in their o!n areas.1 That certainl# is !hat has happened !ith one former %eterinar# and "raduate student !ho recentl# finished her !or0 at C*&. Dr. <illian 'ha! earned her D*& and &' at &'( C*& in 200@. $s a %eterinar# student bet!een 2002 and 200@- 'ha! sa#s- .7 !as pro%ided !ith se%eral opportunities to culti%ate m# interest in biomedical research alon" !ith m# clinical trainin". &# t!o free summers !ere spent !or0in" in t!o different research laboratories at &'(- both of !hich stron"l# reinforced m# desire to pursue biomedical research as a career.1 7n all- 'ha! !or0ed three #ears in C*&)s comparati%e ophthalmolo"# laborator# !or0in" on her &aster)s De"ree. Her research centered on the stud# of a spontaneous chic0en model of a retinopath# to help characteri=e their uni3ue retinal d#stroph#. .The summer research e/perience led me to pursue a master)s de"ree in an 57H4funded +5ational 7nstitutes of Health, student pro"ram !ith the Comparati%e &edicine and 7nte"rati%e 2iolo"# <raduate +C&72, ro"ram at &'(-1 'ha! e/plains. .7 continued !or0in" !ith the chic0en model of retinopath# under the tutela"e of Dr. etersen46ones. &# research techni3ues included positional candidate "ene screenin"- immuno4histo4chemistr# and electro4retino"raph# usin" pharmacolo"ical dissection.1

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<raduate students and residents- in her &'( e/perience- pla#ed si"nificant roles- 'ha! sa#s. .Residents at C*& pla# a hu"e part in the education of *eterinar# students- and in pro%idin" care for animals at the teachin" hospital-1 she sa#s- referrin" to the *eterinar# Teachin" Hospital. .*et students benefit "reatl# from interaction !ith residents. $nd in "eneral- one could sa# that residents are %aluable in that the# are recei%in" further trainin" to e%entuall# speciali=e in a field of %eterinar# medicine and !ill be capable of contributin" to biomedical 0no!led"e that could help both animals and people.1 <rad students also recei%e ad%anced trainin" !hich renders them capable of pursuin" biomedical careers re"ardless of !hether the# are centered in basic- clinical- human or %eterinar# research- she belie%es. .*eterinarians are uni3ue because of the 0no!led"e the# can brin" to 2iomedical Research-1 'ha! sa#s. .The# are trained in this from the first da# the# be"in *eterinar# 'chool. 7t)s somethin" 7 heard man# times !hile 7 !as at &'(- and no! that 7 am at a &edical 'chool7 reali=e ho! much our e/perience and trainin" as D*&s means to 2iomedical Research.1 'ha! no! li%es in 2altimore- &ar#land and is participatin" in a dual pro"ram as a resident in Comparati%e atholo"#- and a "raduate student !ith the 'chool of &edicine at 6ohns Hop0ins (ni%ersit#. &ean!hile- ierce plans to pursue Ophthalmolo"# because of his !or0 !ith etersen46ones!ho identified the Cor"i retinal "enetic mutation upon !hich ierce has built some of his research. .7 fell in lo%e !ith it-) ierce sa#s of Ophthalmolo"#. .7t combines &edicine and 'ur"er#- and 7 can !or0 !ith multiple species- not ?ust cats and do"s.1 He made presentations in 6anuar# 2008 at &'( C*&)s Resident 'eminar and at the &ichi"an *eterinar# Conference in ;ast Aansin"- &ich. He o!es a lot to C*&- he adds. .The#)re reall# "reat. The facilities and support staff here reall# ha%e helped me "et thin"s mo%in" and also "a%e me the abilit# and resources to research. The infrastructure &'( has is incredibl# efficient for "rad students and residents.1 4ic-i2an tate Universit1E su))erF0@@=

EJERCITACIN 1. 64ea el t5tulo y de una hipAtesis del mismo 2. 61u: dice la publicaciAn sobre la Iacultad de Medicina Veterinaria de la Bni ersidad de Michigan8 3. 61u: dice sobre ,r. !ierce8 =. 61u: estudio est9 haciendo sobre los graduados y residentes8 ?. 61u: dice la Vice ,ecana %Associate ,ean&, ,r. >usan #wart8 @. 61ui:nes est9n de acuerdo con ella8 H. 6A Eu: conclusiAn llegan8

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2H