ABSTRACT The objective with this research was to compare milk quality parameters among herds characterized by different levels of milk production. The research involved 1080 bulk milk samples collected from 30 dairy herds, which produce milk for Parmigiano Reggiano cheese, during three years. Each milk sample was analysed for fat, crude protein, titratable acidity, total bacterial count, somatic cells, coliform bacteria, and Clostridia spores. Least mean values were obtained by ANOVA using milk production intervals from 6000 to 7999 (L-group), from 8000 to 9999 (M-group), and from 10000 to 12000 kg/cow/lactation (H-group) as fixed milk production classes. Increased milk production was associated with a reduction in milk fat content (from 3.54 in the L-group milk to 3.29 g/100 g in the H-group milk). An improvement in the hygienic-sanitary quality of milk was observed with increasing milk production. In fact, a progressive decrease in the total bacterial count (from 95 in the L-group milk to 45 103 cfu/mL in the H-group milk), number of coliforms (from 2294 in the L-group milk to 1342 cfu/mL in the H-group milk), and somatic cell number (from 382 in the L-group milk to 209 103 cells/mL in the H-group milk) was observed with the increase in milk production level. Finally, it appears that higher milk yield is connected with significant positive effects on the lactodynamometric properties of milk.

ABSTRACT Tuberous sclerosis complex (TSC) is an uncommon neurocutaneous disease often underdiagnosed in remote areas where specialists in neurology are usually not available. A 22 month-old girl was taken to a clinic in a rural village presenting refractory epilepsy of undetermined cause that started at 18 months of age with upward eye deviation episodes and epileptic extensor spasms. She also presented perinasal angiofibromas and hypomelanotic skin lesions in trunk. The interictal encephalogram done in the community showed multifocal and generalized epileptic activity. The girl had been taken to the city for a brain magnetic resonance, which revealed multifocal subcortical hyperintensities and subependymal nodules. By teleconsult between community doctors and national and international specialists, atypical TSC with late onset epileptic spasms was diagnosed. The recommended treatment resulted in controlled seizures, and a follow-up plan was established. This case illustrates that telemedicine units in rural areas are a technological option to provide access to specialized epilepsy care.

RESUMEN El complejo esclerosis tuberosa (CET) es una enfermedad neurocutánea infrecuente y subdiagnosticada en zonas remotas donde usualmente no hay neurólogos disponibles. Una niña de 22 meses fue llevada a una clínica en una comunidad rural por un cuadro de epilepsia refractaria de causa no determinada, de inicio a los 18 meses de edad con episodios de oculogiros y espasmos epilépticos en extensión. Además presentaba angiofibromas perinasales y lesiones hipomelanóticas en tronco. El encefalograma interictal hecho en la comunidad mostraba actividad epiléptica multifocal y generalizada. La niña había sido llevada a la ciudad para una resonancia cerebral, la cual reveló hiperintensidades subcorticales multifocales y nódulos subependimarios. Por teleconsulta entre médicos de la comunidad y especialistas nacionales e internacionales se diagnosticó CET atípico con espasmos epilépticos de inicio tardío. Se sugirió tratamiento que logró control de las crisis y se estableció un plan de seguimiento. El caso muestra que las unidades de telemedicina en zonas rurales son una opción tecnológica para brindar acceso a atención especializada de las epilepsias.