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Venezuela is living in a delicate social and political crisis that has taken thousands of lives. Beginning in March 2017, a series of continuous and increasingly violent demonstrations has taken place, with a high number of civilian casualties. These demonstrations typically have been outside the range of action of the government prehospital services. In addition, the number of casualties frequently overwhelmed the abilities of the available rescue services. Out of the need for a first aid team that could operate in this violent scenario, First Aid UCV (Central University of Venezuela) was created. A large number of professionals with medical, rescue, and tactical medicine experience integrated this new team, modifying their training and practice to adapt to a scenario in which unarmed medical students and medical doctors performed extractions, provided first aid, and managed the transport of demonstration casualties, doing so even when team members were sometimes targeted by the government police and military forces. This method has had successful results in all 60 operations conducted to date, with a total of 5,000 casualties being extracted among civilians, the military, and the police force. Only one member of the team was injured during the operations, and no deaths were reported during the process.

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Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.

Una Agenda para la Investigación y la Acción hacia un Futuro Diverso y Justo para la Vida sobre la Tierra Resumen Las décadas de investigación e intervenciones políticas sobre la biodiversidad han tratado significativamente los temas de la degradación de la biodiversidad y la justicia social. Debido a esto, se requieren nuevas estrategias. Diseñamos una agenda de investigación y acción que llama a la labor colectiva de revisar la biodiversidad hacia el objetivo de sustentar un futuro diverso y justo para la vida sobre la Tierra. Cuando se revisa la biodiversidad, se requiere de una reflexión crítica sobre las investigaciones, políticas y prácticas presentes y pasadas sobre la biodiversidad para inspirar un pensamiento creativo acerca del futuro. Desarrollamos la agenda por medio de un proceso de diálogo de dos años que involucró a casi 300 expertos de diversas disciplinas y localidades. Este proceso estuvo orientado por el conocimiento de las ciencias sociales que muestra cómo la investigación y la acción para la biodiversidad están sostenidas por las opciones de cómo están conceptualizados los problemas. Reconocimos al conocimiento, la acción y la ética como inseparables y sintetizamos un conjunto de principios que ayuda a navegar la labor de revisar la biodiversidad. La agenda articula cuatro áreas temáticas para la investigación en el futuro. Primero, los investigadores necesitan revisar las narrativas de la biodiversidad mediante el cuestionamiento de las conceptualizaciones que excluyen a la diversidad y consolidan la separación entre humanos, culturas, economías y sociedades y la naturaleza. Segundo, los investigadores deberían enfocarse en las relaciones entre el antropoceno, la biodiversidad y la cultura al considerar a la humanidad y la biodiversidad como interconectadas en contextos específicos. Tercero, los investigadores deberían enfocarse en la naturaleza y las economías al tener en mejor cuenta la interacción de las estructuras de los sistemas económico y financiero como conductores nucleares de la pérdida de la biodiversidad. Finalmente, los investigadores deberían permitir la investigación y acción transformadoras de la biodiversidad al reconfigurar las relaciones entre las comunidades humanas y no humanas dentro y a través de la ciencia, la política y la práctica. La revisión de la biodiversidad necesita de un enfoque renovado sobre el diálogo entre las comunidades de la biodiversidad y más allá, que reflexione críticamente sobre el pasado para canalizar a la investigación y acción hacia el fomento del futuro justo y diverso para la vida humana y no humana sobre la Tierra.

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BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

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The aim of this study was to evaluate the effect of a co-treatment of follicle-stimulating hormone (FSH) plus equine chorionic gonadotrophin (eCG) on serum insulin and insulin-like growth factor 1 (IGF-1) concentrations, superovulatory response, ovulatory rate, and number and production of embryos in Katahdin breed ewes during the non-breeding season. Twenty Katahdin ewes were synchronized with progestagens (CIDR) and assigned to two superovulation treatments (n = 10): (1): ewes treated with 200 mg ewe-1 of FSH from day 5 to 8 after CIDR insertion at decreasing doses every 12 h (FSH group) and (2) ewes treated as FSH group plus 300 IU of eCG on day 5 after CIDR insertion (FSH + eCG group). Estrous behavior was monitored and direct mating was performed. On days - 7 (CIDR insertion), 0 (CIDR withdrawal), and 7 (embryo recovery), blood samples were collected to determine serum hormone concentrations. Co-treatment with eCG (FSH group) did not affect (P > 0.05) serum hormone levels. Superovulation response, ovulation rate, recovery rate, fertilization, and number of embryos were also similar (P > 0.05) between treatments. Compared with FSH group, FSH + eCG ewes had lower (P < 0.05) number of transferable embryos and higher (P < 0.05) number of oocyte and a tendency to increase the number of degenerated embryos (P = 0.07). Overall results suggest that the administration of eCG is not beneficial either to improve the ovulatory response or the amount of transferable embryos in Katahdin ewes superovulated with a protocol using progesterone and FSH at decreasing doses.

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La presente investigación tuvo la finalidad de conocer y evaluar el conocimiento sobre el método Dáder de seguimiento farmacoterapéutico en farmacias comunitarias del patrimonio histórico de la ciudad de Sucre, ya que es necesario e importante el seguimiento farmacoterapéutico en la población para detectar problemas relacionados con los medicamentos y prevenir como solucionar respuestas negativas asociadas a los medicamentos siendo útil el método Dáder por ser un procedimiento operativo sencillo pero con parámetros fundamentales y bien estructurados para realizar el seguimiento farmacoterapéutico de una forma sistematizada, continuada y documentada para registrar, monitorizar y evaluar los efectos de la farmacoterapia. Las farmacias comunitarias son farmacias privadas de interés público, en el que se accede diariamente a comprar medicamentos, en las que el farmacéutico brinda un servicio individualizado y puede coordinar con el paciente un plan de seguimiento, lo que es diferente en una farmacia hospitalaria en la cual sus acciones son limitadas por el hospital o médicos, y se tomó en cuenta la zona del patrimonio histórico de la ciudad de Sucre ya que es muy concurrida con mucha afluencia de gente y las farmacias tienen mayor gama de productos farmacéuticos e innovadores, lo cual permite realizar seguimiento farmacoterapéutico. Entre los resultados se obtuvo un insuficiente conocimiento del método Dáder de seguimiento farmacoterapéutico en las farmacias comunitarias, dando un valor del 77% (n=27) de los farmacéuticos encuestados de un total de 35 con un conocimiento insuficiente, además se relacionaron el género, edad, cargo profesional del farmacéutico en las farmacias comunitarias y asistencia del farmacéutico a cursos de Seguimiento Farmacoterapéutico, como también el uso del Método Dáder.

The present investigation had the purpose of knowing and evaluating the knowledge about the Dader Method of Pharmacotherapeutic Monitoring in community pharmacies of the historical heritage of the city of Sucre, since it is necessary and important the Pharmacotherapeutic Monitoring in the population to detect problems related to medications and prevent how to solve negative responses associated with medications, the Dader Method being useful because it is a simple operating procedure but with fundamental and well-structured parameters to carry out Pharmacotherapeutic Follow-up in a systematic, continuous and documented way to record, monitor and evaluate the effects of Pharmacotherapy Community pharmacies are private pharmacies of public interest, which are accessed daily to buy medications, in which the pharmacist provides an individualized service and can coordinate with the patient a follow-up plan, which is different in a hospital pharmacy in the which their actions are limited by the hospital or doctors, and the area of the historical heritage of the city of Sucre was taken into account since it isvery busy with a lot of people and pharmacies have a greater range of pharmaceutical and innovative products, which allows pharmacotherapeutic follow-up. Among the results, insufficient knowledge of the Dader Method of Pharmacotherapeutic Follow - up was obtained in community pharmacies, giving a value of 77% (n = 27) of the pharmacists surveyed out of a total of 35 with insufficient knowledge, in addition the gender was related, Age, professional position of the pharmacist in the community pharmacy and assistance of the pharmacist to Pharmacotherapeutic Follow-up courses, as well as the use of the Dader Method.

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INTRODUCTION: The deficiencies in the communication between the doctor and the patient have an impact on the care process and its therapeutic outcome. The objective of this study was to determine the perception of the information provided by treating physicians by parents or primary caregivers and the deficits observed in their relationship during the hospitalization of pediatric patients in high, medium and low complexity units. MATERIALS AND METHODS: Descriptive study carried out from January to May 2017 at the Foundation Hospital de la Misericordia, Bogotá (Colombia), through an anonymous, self-filled survey during the hospital stay, consisting of a first part of open questions, and the second by a survey Likert type with qualitative variables. The qualitative variables evaluated through the survey were summarized in frequencies; in addition, the Kaiser-Meyer-Olkin test was performed with principal component analysis under a Varimax rotation. RESULTS: Three hundred and eighty-seven primary caregivers were surveyed, 68.5% belonged to the general stay area, 20.4% to intermediate care and 11.1% to intensive care. Ninety percent of the respondents agreed on the way in which the patient's evolution was explained, expressing satisfaction with the information delivered, the language in which it was expressed and the interest towards their concerns; despite this, 41% indicated uncertainty regarding the medical evolution of their son. CONCLUSIONS: An adequate warning was received regarding the medical information provided, the language used, the treatment of the patient and teaching the main caregiver about the pathology presented by the patient. The uncertainty regarding the evolution of patients is the factor that contributes the most to dissatisfaction with the quality of the information.

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INTRODUCTION: Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. METHODS: Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. RESULTS: A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. CONCLUSIONS: The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction.

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Cytomegalovirus (CMV) remains one of the most important infections in kidney transplantation. Only a handful of images have been reported in the literature thus far. We present classic pathologic and gross images of CMV duodenitis in an immunosuppressed patient more than one year post-renal transplantation.

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The aim of this research was to evaluate the effectiveness of three pFSH doses (80 mg; 145 mg and 215 mg) on ovarian response and on quantity and quality of transferable embryos of goats during the breeding and the non-breeding seasons. Ovary structures were exposed (laparatomy under general anaesthesia) and numbers of follicles and corpora lutea were registered. Surgical embryo flushing was conducted to count and classify embryos. There were more follicles (3.4 ± 1.1) in does administered 80 mg of pFSH (p < 0.05) than in goats administered 145 mg of pFSH (2.2 ± 1.1) and 215 mg of pFSH (0.9 ± 0.6). Numbers of corpora lutea, blastocysts, and recovered and transferable embryos of goats administered 145 mg pFSH (13.4 ± 3.7, 2.42 ± 1.0, 3.4 ± 1.2 and 3.2 ± 1.1, respectively) and those of goats administered 215 mg pFSH (11.6 ± 2.6, 3.2 ± 0.9, 5.7 ± 1.5, and 5.6 ± 1.5) were greater (p < 0.05) than values obtained from goats administered 80 mg pFSH (4.0 ± 1.5, 0.5 ± 0.3, 1.0 ± 0.5, and 0.8 ± 0.5). Numbers of morula of does administered 80 and 145 mg pFSH (0.4 ± 0.4 and 0.8 ± 0.3) were lower (p < 0.05) than those obtained from animals treated with 215 mg pFSH (2.4 ± 0.9). There was no effect of season upon the analyzed variables. In conclusion, under the prevalent conditions in north-eastern Mexico, administration of 145 or 215 mg pFSH in a decreasing dose schedule over 3.5 days to bred goats provided a satisfactory superovulatory result.

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BACKGROUND: Skin testing-guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis (EoE), whereas empiric six-food elimination diet (SFED) achieves an efficacy of 70%. OBJECTIVE: To compare the efficacy of food-specific serum IgE-targeted elimination diet (sIgE-ED) and SFED. METHODS: Prospective study in adult patients with EoE. Food-specific serum IgE, skin prick test (SPT) and atopy patch test (APT) to foods included in SFED were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6-week sIgE-ED, whereas non-IgE-sensitized patients underwent a 6-week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment. RESULTS: Forty-three EoE patients were included (26 sIgE-ED and 17 SFED). Regarding sIgE-ED, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81 vs 6; P < 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between sIgE-ED and SFED (73% vs 53%, P = 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients. sIgE exhibited the higher accuracy to predict offending foods in IgE-sensitized patients (sensitivity 87.5%, specificity 68% (κ = 0.43)), with k values of 1 for cow's milk. APT results were all negative. CONCLUSIONS: Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.

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BACKGROUND: Food bolus esophageal impaction is often the first symptom in patients diagnosed with eosinophilic esophagitis, representing a change in the epidemiology and management of this urgency. AIM: To detect eosinophilic esophagitis predictive factors in patients with esophageal impaction due to food bolus. METHODS: Patients seen for foreign body impaction were retrospectively analyzed. Epidemiologic characteristics, endoscopic findings, and impaction history were studied. The statistical analysis was carried out using the Student's t test and the chi square test and a logistic regression model. RESULTS: Of the 131 patients, 65% were men and the mean age was 56 years. The endoscopic suspicion of eosinophilic esophagitis was the most frequent finding in patients with food bolus impaction (n=89); those patients that did not have histologic confirmation were excluded (n=7). The remaining patients (n=82) were divided into two groups: confirmed eosinophilic esophagitis (Group A) (n=18) and other endoscopic findings (Group B) (n=64). Group A presented with a lower mean age (36.47 vs. 64.45, P=.001) and a more frequent past history of impaction (38% vs. 6%, OR=15.70, 95% CI (3.60-62.50), P=.001) than Group B. Age and impaction history acted as predictors for eosinophilic esophagitis with 82% sensitivity, 80% specificity, and 84% diagnostic accuracy (P<.001). CONCLUSIONS: Age and a history of impaction predict the presence of eosinophilic esophagitis in patients with food bolus impaction.

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In an acute assay, rats fasted for 24 h were sounded with 2 ml of fresh yogurt, sterilised yogurt or distilled water, and sacrificed at 2, 4, 8 and 24 h. They were compared with non-sounded rats. The survival of the lactic bacteria of the yogurt administered in the animals' stomach and intestines was determined, and the bacteria isolated were to the Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus profiles belonging to the strains isolated originally from the yogurt. Counts of the total number of microorganisms that were grown in lactobacilli and lactic streptococci media were also made. Analyses of the different types of resulting colonies in the lactobacilli and lactic streptococci media was performed. No L. delbrueckii subsp. bulgaricus or S. thermophilus were characterized in this acute assay. The statistical analysis of the results did not show significant differences in the log UFC. g-1, of the intestinal microbiota microorganisms of the three groups of animals in any of the times. In a chronic assay, three groups of animals, after 30 days of nourishment ad libitum with either a semisynthetic diet with 10% of fresh yogurt, or with 10% of sterilised yogurt or controls, housed in individual metabolism cells, were sacrificed. The results did not show meaningful differences in the long UFC. g-1 of the intestinal microbiota microorganisms from the three groups of animals in any of the times. In turn, in the study of the different types of colonies resulting in the lactobacilli and lactic streptococci media, no L. delbrueckii subsp. bulgaricus or S. thermophilus were characterised in this chronic assay. The results did not show meaningful differences in the log CFU. g-1 of the intestinal flora microorganisms from the three groups of animals in any of the times. In turn, no L. delbrueckii subsp. bulgaricus or S. thermophilus were characterised in this chronic assay.

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En un ensayo agudo, ratas en ayunas de 24 h fueron sondadas con 2 ml de yogur fresco, yogur termizado o agua destilada, y se sacrificaron a las 2, 4, 8 y 24 h después, siendo comparadas con ratas sin sondar. Se determinó la supervivencia de las bacterias lácticas del yogur administrado en estómago e intestinos de los animales, y si las bacterias aisladas tenían el perfil de las cepas de Lactobacillus delbrueckii subsp. bulgaricus y Streptococcus thermophilus aisladas originalmente del yogur. Tambien se hizo el recuento del número de microorganismos totales que crecían en el medios para lactobacilos y estreptococos lácticos. Se hicieron análisis de los diferentes tipos de colonias resultantes en los medios para lactobacilos y estreptococos lácticos. Ninguna de las colonias caracterizadas en este ensayo agudo resultó ser L. delbrueckii subsp. bulgaricus o S. thermophilus. El análisis estadístico de los resultados no mostró diferencias significativas en el log UFC - g- 1, de la microbiota intestinal de los cuatro grupos de animales en ninguno de los tiempos.En un ensayo crónico, se sacrificaron tres grupos de animales, alojados en células individuales de metabolismo, tras 30 días de alimentación ad libitum con dieta semisintética con 10 por ciento de yogur fresco, con 10 por ciento de yogur termizado o solo con dieta semisintética. Los resultados no mostraron diferencias significativas en el log UFC - g- 1 de los microorganismos de la microbiota intestinal entre los tres grupos de animales en ninguno de los tiempos. A su vez, se caracterizaron los diferentes tipos de colonias resultantes en los medios para lactobacilos y estreptococos lácticos, y ninguna de las colonias caracterizadas en este ensayo crónico resultó ser L. delbrueckii subsp. bulgaricus o S. thermophilus (AU)

In an acute assay, rats fasted for 24 h were sounded with 2 ml of fresh yogurt, sterilised yogurt or distilled water, and sacrificed at 2, 4, 8 and 24 h. They were compared with non-sounded rats. The survival of the lactic bacteria of the yogurt administered in the animals’ stomach and intestines was determined, and the bacteria isolated were to the Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus profiles belonging to the strains isolated originally from the yogurt. Counts of the total number of microorganims that were grown in lactobacilli and lactic streptococci media were also made. Analyses of the different types of resulting colonies in the lactobacilli and lactic streptococci media was performed. No L. delbrueckii subsp. bulgaricus or S. thermophilus were characterized in this acute assay. The statistical analysis of the results did not show significant differences in the log UFC · g-1, of the intestinal microbiota microorganisms of the three groups of animals in any of the times. In a chronic assay, three groups of animals, after 30 days of nourishment ad libitum with either a semisynthetic diet with 10% of fresh yogurt, or with 10% of sterilised yogurt or controls, housed in individual metabolism cells, were sacrificed. The results did not show meaningful differences in the log UFC · g-1of the intestinal microbiota microorganisms from the three groups of animals in any of the times. In turn, in the study of the different types of colonies resulting in the lactobacilli and lactic streptococci media, no L. delbrueckii subsp. bulgaricus or S. thermophilus were characterised in this chronic assay. The results did not show meaningful differences in the log CFU · g-1 of the intestinal flora microorganisms from the three groups of animals in any of the times. In turn, no L. delbrueckii subsp. bulgaricus or S. thermophilus were characterised in this chronic assay (AU)

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Cleft lip or palate has not been reported in the medical literature as a part of Williams' syndrome. We present a patient who had cleft palate among other congenital manifestations. This patient's immediate postnatal period clinically seemed to have a Pierre Robin sequence. With the development of the craniofacial complex, microgenia and micrognathia with glossoptosis gradually became apparent. On further assessment, the patient showed other clinical findings that suggested a syndromic association. This required a complete evaluation to discard other conditions that present with low psychomotor development and distinctive facies, such as Kabuki syndrome or fetal alcohol syndrome. The diagnosis for Williams' syndrome was established based on the clinical features and supported by the fluorescent in situ hybridization test. Williams' syndrome has been described as a rare, congenital disorder characterized by physical and developmental problems. Common features include characteristic "elfin-like" facies, supravalvular aortic stenosis, hypercalcemia, low birth weight, slow weight gain, feeding problems, impulsive and outgoing personality, limited spatial skills and motor control, and intellectual disability. Although individuals with Williams' syndrome may show competence in areas such as language, music, and interpersonal relations, their IQs are usually low and they are considered moderately to mildly retarded.

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