Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial.

OBJECTIVE: Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. METHODS: In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0-III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM ("shave" group) or not ("no shave" group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. RESULTS: Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the "shave" group and 200 to the "no shave" group. Median patient age was 65 years (range; 29-94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the "shave" and "no shave" groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the "shave" group were significantly less likely than those in the "no shave" group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). CONCLUSION: Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.

Prevalence of Trypanosoma cruzi and organ alterations in Virginia opossums (Didelphis virginiana) from western Mexico - short communication.

Small populations of Virginia opossum (Didelphis virginiana) in western Mexico are endangered by hunting and natural predators as well as by different kinds of diseases. After two serological analyses using Serodia® latex particle agglutination and indirect haemagglutination (IHA) tests, 35 (53.03%) of 66 collected opossums in two small towns in western Mexico were positive for the presence of Trypanosoma cruzi. Twenty-eight of the 35 seropositive opossums had pathological lesions: 11 had changes in only one organ, 13 in two organs, and four had pathological changes in three organs. Splenomegaly was the most common finding in the examined opossums, followed by hepatomegaly. These potentially fatal pathological changes could contribute to the scarcity of the opossum population, even leading to the extinction of this species in western Mexico.

Life-History Data of a Mexican Population of Triatoma nitida (Hemiptera: Reduviidae).

This study reports the third collection of Triatoma nitida Usinger in Mexico, with a brief description of the collection area and an investigation of parameters related to its vectorial capacity. Whether a triatomine (Hemiptera: Reduviidae) species is a primary or secondary vector is determined by factors that include vectorial capacity, anthropophilic habits, geographic distribution, and capacity to invade and colonize human dwellings. However, when the primary vectors are removed, secondary vectors, such as T. nitida, can become important transmitters of Trypanosoma cruzi Chagas to humans. To estimate the vectorial capacity of T. nitida, the egg-to-adult development time, number of blood meals required to molt to the adult stage, accumulative mortality, onset time for feeding, and feeding and defecation times were examined. Triatoma nitida (n = 100) required a median of 590 d to complete its development time, with a median of 31 blood meals. Almost half (46.5%) of the nymphs died during the cycle. The onset of feeding time exceeded 5 min in all nymphal instars (except on fourth-instar) and adults and feeding times exceeded 22 min in all instars, except on first-instar nymphs. No defecation was observed for 65.6% (n = 383) of the triatomines during a 30-min observation period. Based on the six parameters, the vectorial capacity of T. nitida should be considered as low. However, surveillance programs should include this species because the potential importance of T. nitida as a vector has been demonstrated in other countries.

Intervención educativa sobre lactancia materna / Educational intervention on breast-feeding

Fundamento: la lactancia materna constituye el alimento natural de la especie humana, por ello debemos agotar todos nuestros esfuerzos en garantizar que el niño sea alimentado exclusivamente a pecho al menos hasta los primeros seis meses después de nacido. Objetivo: demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres. Método: se realizó un estudio de intervención educativa para demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres de diez consultorios del Policlínico Este, Municipio Camagüey desde enero de 2007 a mayo de 2008. Constituyeron el universo cincuenta y cinco madres con fechas probables de parto entre el primero de junio y el treinta y uno de agosto de 2007, a las que se les aplicó un formulario con diferentes variables y una encuesta de conocimientos antes y después de la intervención. Resultados: predominó el grupo de treinta a treinta y cuatro años. El 83,3 por ciento de las encuestadas no conocían adecuadamente de lactancia materna, y sólo el 9,72 por ciento la alcanzó en forma exclusiva hasta más de seis meses. Conclusiones: los niños que no recibieron lactancia materna exclusiva hasta el sexto mes se enfermaron con mayor frecuencia, la intervención resultó satisfactoria pues se elevó el nivel de conocimientos de las participantes y se logró que un mayor número de mujeres lactara hasta después del sexto mes(AU)

Background: breast-feeding constitutes the natural food of human species, that is why we should exhaust all our efforts in guaranteeing the boy is exclusively fed at least to breast until the first six months after born. Objective: to demonstrate the effectiveness of a breast-feeding program in a group of mothers. Method: an educational intervention study to demonstrate the effectiveness of a breast-feeding program in a group of mothers of ten doctor's offices of the East Polyclinic, Camagüey Municipality was performed from January 2007 to May 2008. The universe was constituted by 55 mothers with probable childbirth dates among June 1st and August 31 2007, to those were applied a form with different variables and a knowledge survey before and after the intervention. Results: the group from 30 to 34 years prevailed. The 83,3 percent of those interviewed didn't know appropriately of breast-feeding, and 9,72 percent only reached it in exclusive way until more than six months. Conclusions: children didn't receive exclusive breast-feeding until the sixth month got sick with more frequency, the intervention was satisfactory because the level of the participants' knowledge rose and it was achieved a bigger number of women suckled until after the sixth month(AU)

Intervención educativa sobre lactancia materna / Educational intervention on breast-feeding

Fundamento: la lactancia materna constituye el alimento natural de la especie humana, por ello debemos agotar todos nuestros esfuerzos en garantizar que el niño sea alimentado exclusivamente a pecho al menos hasta los primeros seis meses después de nacido. Objetivo: demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres. Método: se realizó un estudio de intervención educativa para demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres de diez consultorios del Policlínico Este, Municipio Camagüey desde enero de 2007 a mayo de 2008. Constituyeron el universo cincuenta y cinco madres con fechas probables de parto entre el primero de junio y el treinta y uno de agosto de 2007, a las que se les aplicó un formulario con diferentes variables y una encuesta de conocimientos antes y después de la intervención. Resultados: predominó el grupo de treinta a treinta y cuatro años. El 83,3 por ciento de las encuestadas no conocían adecuadamente de lactancia materna, y sólo el 9,72 por ciento la alcanzó en forma exclusiva hasta más de seis meses. Conclusiones: los niños que no recibieron lactancia materna exclusiva hasta el sexto mes se enfermaron con mayor frecuencia, la intervención resultó satisfactoria pues se elevó el nivel de conocimientos de las participantes y se logró que un mayor número de mujeres lactara hasta después del sexto mes.

Background: breast-feeding constitutes the natural food of human species, that is why we should exhaust all our efforts in guaranteeing the boy is exclusively fed at least to breast until the first six months after born. Objective: to demonstrate the effectiveness of a breast-feeding program in a group of mothers. Method: an educational intervention study to demonstrate the effectiveness of a breast-feeding program in a group of mothers of ten doctor's offices of the East Polyclinic, Camagüey Municipality was performed from January 2007 to May 2008. The universe was constituted by 55 mothers with probable childbirth dates among June 1st and August 31 2007, to those were applied a form with different variables and a knowledge survey before and after the intervention. Results: the group from 30 to 34 years prevailed. The 83,3 percent of those interviewed didn't know appropriately of breast-feeding, and 9,72 percent only reached it in exclusive way until more than six months. Conclusions: children didn't receive exclusive breast-feeding until the sixth month got sick with more frequency, the intervention was satisfactory because the level of the participants' knowledge rose and it was achieved a bigger number of women suckled until after the sixth month.

Caracterización social del embarazo en la adolescencia / Social characterization of pregnancy in adolescence

Fundamento: el embarazo en la adolescencia es un problema a nivel mundial, se ha convertido en seria preocupación por la mayor incidencia de resultados desfavorables o por las complicaciones que puede tener para la madre y el feto. Objetivo: caracterizar socialmente a las embarazadas adolescentes del Área de Salud Integral Comunitaria El Gaitero, Maracaibo, Venezuela. Método: se realizó un estudio transversal y descriptivo embarazadas adolescentes del Área de Salud Integral Comunitaria El Gaitero, de la Parroquia Luís Hurtado Higueras, Municipio Maracaibo, Estado Zulia, Venezuela, desde enero a septiembre de 2006. El universo se constituyó por en sesenta y una embarazadas pertenecientes a los catorce consultorios de Barrio Adentro que tiene esta ASIC, en edades comprendidas entre diez y diez y ocho años, se conformó la muestra de cincuenta y dos pacientes después de aplicados los criterios de inclusión, exclusión y salida. Resultados: predominó el grupo de quince a diez y ocho años, mas de la mitad satisfacían de forma regular sus necesidades básicas. Conclusiones: las embarazadas en su mayoría no tienen cubiertas sus necesidades básicas y asumen las relaciones sexuales precoces. Entre las situaciones sociales tuvieron mayor influencia las nuevas exigencias económicas y la privación de las actividades propias de su edad(AU)

Background: pregnancy in the adolescence is a problem at world level, it has become a serious concern because of the biggest incidence of unfavorable results or the complications that may have for mother and fetus. Objective: to characterize socially pregnant adolescents of the Community Integral Health Area El Gaitero, Maracaibo, Venezuela. Method: a cross-sectional and descriptive study to pregnant adolescents of the Community Integral Health Area El Gaitero, of the Parish Luís Hurtado Higueras, Maracaibo Municipality, Zulia State, Venezuela was performed, from January to September 2006. The universe was constituted by sixty-one pregnant adolescents belonging to fourteen consulting rooms of Barrio Adentro that has this Community Integral Health Area, in ages between ten and eighteen years, the sample was conformed by fifty-two patients after having applied the inclusion, exclusion and outlet criteria. Results: the group from fifteen to eighteen years prevailed, more than the half satisfied in a regular way their basic necessities. Conclusions: pregnant ones in its majority do not have covered their basic necessities and they assume precocious sexual intercourses. Among the social situations had bigger influence the new economic demands and the privation of the activities characteristic of their ag(AU)

Caracterización social del embarazo en la adolescencia / Social characterization of pregnancy in adolescence

Fundamento: el embarazo en la adolescencia es un problema a nivel mundial, se ha convertido en seria preocupación por la mayor incidencia de resultados desfavorables o por las complicaciones que puede tener para la madre y el feto. Objetivo: caracterizar socialmente a las embarazadas adolescentes del Área de Salud Integral Comunitaria El Gaitero, Maracaibo, Venezuela. Método: se realizó un estudio transversal y descriptivo embarazadas adolescentes del Área de Salud Integral Comunitaria El Gaitero, de la Parroquia Luís Hurtado Higueras, Municipio Maracaibo, Estado Zulia, Venezuela, desde enero a septiembre de 2006. El universo se constituyó por en sesenta y una embarazadas pertenecientes a los catorce consultorios de Barrio Adentro que tiene esta ASIC, en edades comprendidas entre diez y diez y ocho años, se conformó la muestra de cincuenta y dos pacientes después de aplicados los criterios de inclusión, exclusión y salida. Resultados: predominó el grupo de quince a diez y ocho años, mas de la mitad satisfacían de forma regular sus necesidades básicas. Conclusiones: las embarazadas en su mayoría no tienen cubiertas sus necesidades básicas y asumen las relaciones sexuales precoces. Entre las situaciones sociales tuvieron mayor influencia las nuevas exigencias económicas y la privación de las actividades propias de su edad.

Background: pregnancy in the adolescence is a problem at world level, it has become a serious concern because of the biggest incidence of unfavorable results or the complications that may have for mother and fetus. Objective: to characterize socially pregnant adolescents of the Community Integral Health Area El Gaitero, Maracaibo, Venezuela. Method: a cross-sectional and descriptive study to pregnant adolescents of the Community Integral Health Area El Gaitero, of the Parish Luís Hurtado Higueras, Maracaibo Municipality, Zulia State, Venezuela was performed, from January to September 2006. The universe was constituted by sixty-one pregnant adolescents belonging to fourteen consulting rooms of Barrio Adentro that has this Community Integral Health Area, in ages between ten and eighteen years, the sample was conformed by fifty-two patients after having applied the inclusion, exclusion and outlet criteria. Results: the group from fifteen to eighteen years prevailed, more than the half satisfied in a regular way their basic necessities. Conclusions: pregnant ones in its majority do not have covered their basic necessities and they assume precocious sexual intercourses. Among the social situations had bigger influence the new economic demands and the privation of the activities characteristic of their age.

Seroepidemiología familiar de la toxocariasis / Familial seroepidemiology of toxocariasis

Se estudio prospectivamente 78 casos índices pediátricos, infectados por Toxocara sp. y su grupo familiar que dio un total de 356 personas, conjuntamente con 28 familias conformadas por 97 integrantes, libres de esta infeccion, siendo ambos grupos comparables. A cada familia se le aplicó el índice de Graffar modificado con el fin de evaluar el nivel socioeconómico y cultural de los hogares. Además a cada persona se le hizo una anamnesis, examen físico y ELISA para toxocariasis. Los hábitos como geofagia, juegos o manipulación de tierra, el inadecuado lavado de las manos en especial antes de ingerir alimentos, al igual que la edad de los perros, resultaron estadísticamente mas frecuentes en la familias infectadas. En los hogares con un paciente con toxocariasis, un promedio de 2,8 de sus integrantes tenía serología positiva para la parasitosis a títulos significativos. Se destaca la distribución intrafamiliar de esta infección y la importancia de su prevención primaria