Maintaining professional activity during breast cancer treatment.

The question of returning to work and pursuing professional activity during cancer treatment is an increasingly important consideration. The present work focuses on factors affecting the feasibility of maintaining professional activity during treatment for breast cancer, for women who wished to do so. Written questionnaires were collected from 216 patients between March and November 2012. Since the onset of their treatment, 31.4% of the women (68/216) had not been on sick-leave. The main factors associated with the pursuit of professional activity were: considering the availability of their physician to answer questions as unimportant [OR = 18.83 (3.60-98.53); P ≤ 0.05]; considering the diagnosis of cancer as likely to have a weak impact on career perspectives [OR = 4.07 (2.49-6.64); P ≤ 0.05]; not having any children in the household [OR = 3.87 (2.38-6.28); P ≤ 0.05]; being in a managerial position [OR = 3.13 (1.88-5.21); P ≤ 0.05]. Negative predictive factors were: physician mentioning adverse effects of the treatment [OR = 0.31 (0.16-0.58); P ≤ 0.05], and patient rating workload as high [OR = 0.26 (0.15-0.46); P ≤ 0.05]. As a result of advances in therapeutic strategies, more patients will expect healthcare professionals, as well as employers and occupational health societies, to prioritise issues pertaining to the maintenance of professional activities during cancer treatment.

Control of experimental Triatoma infestans populations: effect of pour-on cypermethrin applied to chickens under natural conditions in the Argentinean Chaco region.

Among peridomestic structures, chicken coops are sites of major importance for the domestic ecology of Triatoma infestans (Hemiptera: Reduviidae). The aim of this study was to evaluate in an experimental context the effects of a cypermethrin pour-on formulation applied to chickens on blood intake, moulting and mortality in T. infestans, under the natural climatic conditions of a region endemic for Chagas' disease. Experimental chicken huts were made of bricks and covered with plastic mosquito nets. Ninety fourth-instar nymphs were maintained in each hut. The study used a completely random design in which chickens in the experimental group were treated with a cypermethrin pour-on formulation. Five replicates (= huts) of the experimental and control groups were conducted. The number of live T. infestans, blood intake and moults to fifth-instar stage were recorded at 1, 5, 20, 35 and 45 days after the application of cypermethrin. Cumulative mortality was higher in nymphs exposed to treated chickens (> 71%) than in control nymphs (< 50%) (P < 0.01). Blood intake and moulting rate were lower in nymphs fed on treated chickens than in control nymphs (P < 0.05). Pour-on cypermethrin was able to cause significant mortality, although it did not eliminate the experimental population of T. infestans.

Phenotypic diversity of Triatoma infestans at the microgeographic level in the Gran Chaco of Argentina and the Andean valleys of Bolivia.

Triatoma infestans (Klug) is the main vector of Trypanosoma cruzi, etiologic agent of Chagas disease. The phenotype of the species varies at different geographic scales. The objective of this study was to compare the antennal phenotype of spatially close T. infestans populations and to evaluate its usefulness as a marker of exchange of individuals between populations. The antennal phenotype of 190 T. infestans from Argentina and Bolivia was analyzed using uni- and multivariate techniques. This study shows heterogeneity of the antennal phenotypes of closely related T. infestans populations living in different habitats. Specimens collected in a goat corral and a rabbit cage in La Rioja (Argentina) were dissimilar to the specimens collected in the nearby intradomestic environment. Similarly, specimens from peridomestic corrals in Cochabamba (Bolivia) were different from the intradomestic and sylvatic specimens, indicating some degree of isolation between these populations. In contrast, T. infestans collected in chicken coops and the intradomestic environment were similar, in all studied regions, suggesting a frequent exchange of individuals between the two habitats and/or because of the similarity of the habitat due to the presence of chickens in the intradomestic environment. We propose that each habitat affects in a particular mode the insect morphology and these changes could be used to identify recolonizing T. infestans. These results support the hypothesis of different degrees of isolation between intradomestic and peridomestic habitats. Within this context, special attention should be given to chicken coops and other close peridomestic structures in relation to the recolonization process of domestic habitats by T. infestans.

[Bursitis due to Mycobacterium intracellulare in an immunocompetent patient]. / Bursite fistulisée à Mycobacterium intracellulare chez un adulte immunocompétent.

BACKGROUND: Cutaneous infections due to Mycobacterium intracellulare are infrequent. We report a case of bursitis in an immunocompetent patient. CASE-REPORT: A 80-year-old patient with a history of tuberculosis reported swelling of the elbow for six months with effusion due to olecranon bursitis, progressing to an abscess and skin ulceration. Examination of the synovial fluid revealed the presence of M. intracellulare. Histologic investigations showed epithelioid and gigantocellular granulations. Screening for immunodepression was negative. Treatment with clarithromycin and rifabutin proved effective, with partial healing at three months, although hepatic and ocular side effects occurred. DISCUSSION: While osteomyelitis, arthritis and cutaneous infections due to M. intracellulare have been described in immunocompromised patients, there are very few reported cases concerning immunocompetent individuals, and these suggest the possibility of special individual sensitivity to mycobacterial infections. Genetic mutations of the interleukin-12-interferon-gamma pathway involved in the immune response to mycobacterial infections have been demonstrated. Autoantibodies against interferon-gamma have also been described. Mycobacterium avium-intracellulare is resistant to the classical antibiotics used in tuberculosis. As in pulmonary infections, antibiotics with proven in vivo and in vitro efficacy must be used, taking into account the antibiogram and potential side effects, particularly for combined clarithromycin and rifabutin. CONCLUSION: This case report emphasizes the benefits of routine mycobacterial investigation of synovial fluid samples.

Electroantennogram responses of the Triatoma dimidiata complex to volatiles produced by its exocrine glands.

Members of the Triatoma dimidiata complex are vectors of the protozoan parasite Trypanosoma cruzi, the etiologic agent of Chagas disease. Morphological and genetic studies indicate that T. dimidiata complex has three principal haplogroups in Mexico. However, whether there are differences in the olfactory physiology among the haplogroups of this complex and a possible correlation with their antennal phenotype are not yet known. Antennal responses to 13 compounds released from the metasternal and Brindley´s glands, which are involved in the alarm and mating-related behaviours of T. dimidiata were investigated using electroantennography (EAG). Overall, of the 13 compounds tested, seven triggered EAG responses in both sexes of three Mexican haplogroups. The sensitivity of the EAG responses show some relationship with the total number of chemo-sensilla present on the antennae. Antennal sensitivity was different between sexes and haplogroups of the T. dimidiata complex. Discriminant analysis of EAG sensitivity was significant, separating the three haplogroups. Our finding is consistent with morphological and genetic evidence for haplogroups distinction within the complex.

[Granuloma annulare of the eyelid in a child: an atypical localization]. / Granulome annulaire des paupières: une localisation atypique.

BACKGROUND: Granuloma annulare is a common form of dermatosis in children and young adults. Lesions are typically found on the hands, the feet and the extensor surfaces of the limbs, and occasionally on the trunk. We report a case original in terms of its palpebral localization. CASE-REPORT: A 5 year-old girl consulted for papular lesions on the eyelids. The clinical examination revealed papules on the right lower eyelid measuring 8 mm, on the left lower eyelid measuring 5 mm and on the right upper eyelid measuring 3 mm. Laboratory tests including serum glucose, lipids and calcium as well as a complete blood count proved normal. Biopsy showed granulomatous lesions: a region of central necrosis surrounded by a palisade of inflammatory cells confirmed the diagnosis of granuloma annulare. The lesions disappeared in a few weeks without treatment. DISCUSSION: To our knowledge, 44 cases of granuloma annulare of the periorbital area have been reported, of which 19 concerned children. This presentation represents an atypical localization of granuloma annulare which must not be confused with many other palpebral disorders. Biopsy is necessary to confirm the diagnosis.

Phenotypic Variability of the Amazonian Species Rhodnius brethesi (Hemiptera: Reduviidae).

The wild species Rhodnius brethesi (Matta, 1919) (Hemiptera: Reduviidae) is found in areas of piassabais in microregion of Rio Negro, Amazonas, Brazil. Its geographical distribution overlaps the areas of Leopoldinia piassaba palm. In areas where palm trees are found, transmission cycle of Trypanosoma cruzi is related to the extractive activity of the palm fiber, exposing workers to wild vector transmission of this parasite. The close association with the palm tree L. piassaba suggests that this wild triatomine has special features in its sensory system allowing specificity of ecotope. The objective of the study is to identify the antennal sensilla phenotype and morphologically characterize the size and shape of the wings of wild R. brethesi, and to compare with the phenotype present in individuals reared in the laboratory. From the samples taken in the field, the presence of the species R. brethesi was found on both banks of the Rio Negro. The techniques used to verify the morphological patterns are important resources for observations of the triatomine populations, be they in an artificial or natural habitat.

Infestation of rural houses by Triatoma infestans (Hemiptera: Reduviidae) in southern area of Gran Chaco in Argentina.

The impact of control activities against Triatoma infestans (Klug) (Hemiptera: Reduviidae) in South America has a marked contrast within and outside the Gran Chaco region. Development of a geographic information system, as part of an improvement in control program activities, allowed analysis of the spatial pattern of house infestations by T. infestans before and after house spraying with deltamethrin in the San Martin Department (an arid Chaco region of central Argentina). The overall peridomestic infestation index decreased from 48.2 to 28.2% after insecticide application. House infestation was spatially clustered in regions with low or high infestation levels that were located east and southwest of the department, respectively. This pattern was detected both before and after the insecticide application. Three environmental variables calculated from a temporal series of MODIS imagery (average of night temperature, maximum of day temperature, and temporal variation of vegetation index) were capable of correctly discriminating 96% of the places belonging to either high or low house infestation observed after the insecticide application.

Antennal phenotype of Triatoma dimidiata populations and its relationship with species of phyllosoma and protracta complexes.

Triatoma dimidiata (Latreille 1811) Reduviidae Triatominae is the main vector of Chagas disease in several countries of Latin America. As for other vector species, the characterization of T. dimidiata subpopulations within particular geographical regions or occupying different habitats could help in better planning of vector control actions. A first objective in this study was to evaluate the antennal phenotype as a phenetic marker to characterize populations of T. dimidiata collected in different geographic areas and domestic and sylvatic habitats. A second objective was to evaluate the phenetic relationships of T. dimidiata with other species of the phyllosoma complex: longipennis, pallidipennis, and phyllosoma. The antennal sensilla of T. dimidiata specimens collected in Mexico, Central America, and Colombia were analyzed and compared with the antennal sensilla of T. longipennis, T. pallidipennis, and T. phyllosoma. T. barberi was used as an outgroup in the analysis. For each specimen, the ventral side of the three distal segments of the antennae was drawn, identifying and counting four types of sensilla. In T. dimidiata, univariate and multivariate analysis showed differences between sexes, among populations collected in different habitats within the same region, and among populations collected in different geographic regions. Two types of antennal sensilla showed a latitudinal variation. Domestic specimens showed intermediate characteristics of the antennal phenotype, between sylvatic cave- and sylvatic forest-collected specimens. The antennal phenotypes show high similarities among T. pallidipennis, T. phyllosoma, and T. longipennis, with a better differentiation of T. pallidipennis. T. dimidiata is separated from the other members of the complex by a similar distance to T. barberi, of the protracta complex.

Vectorial transmission of Trypanosoma cruzi: an experimental field study with susceptible and immunized hosts.

The dynamics of vectorial transmission of Trypanosoma cruzi and the level of host (guinea pigs) protection after immunization with attenuated parasites (TCC strain) was studied under natural climatic conditions in an endemic region of northern Argentina. The experimental design included two guinea pig corrals isolated by mosquito netting. One (controls) had 17 healthy and susceptible adult guinea pigs. The other had 19 guinea pigs immunized with attenuated T. cruzi TCC strain. Each corral was colonized in April 1988 with equal-sized populations of Triatoma infestans naturally infected by T. cruzi. To evaluate relevant variables in the natural transmission of Chagas' disease, corrals were sampled in both winter and late spring to assess vector populations, and to carry out parasitologic studies on both vertebrate and invertebrate hosts. In both corrals, vector density decreased in winter and reached a maximum in the hot season. The vector infection rate was very high (greater than 50%) throughout the experiment. Vector infectivity increased with temperature and vector age, but did not differ between the experimental and control corrals. The vector-host contact rate showed a close relationship with temperature, although a very high vector density decreased this rate, even with high ambient temperatures. Initial infections by T. cruzi occurred among guinea pigs only during the hot season. Vectorial transmission risk was estimated from the total number of bug bites per day, the proportion of infected bugs, and the daily incidence in the guinea pig population. During the hot season, this risk was 6.84 x 10(-4) in the control group and 1.82 x 10(-4) in the immunized group.

An evaluation of two primary care interventions for alcohol abuse among Mexican-American patients.

AIMS: This study examined the effects of two primary care interventions (a physician intervention and a clinic-based psychoeducational group) on drinking patterns, psychosocial problems and blood test results (MCV, GGT, SGOT and SGPT). DESIGN: Subjects were randomized into one of four treatment groups: physician intervention, psychoeducation, both interventions, or no intervention. Follow-up data were collected at 12 and 18 months. SETTING: Subjects were recruited from a family practice outpatient clinic managed by a public hospital. PARTICIPANTS: Included 175 Mexican-American female and male primary care patients who screened positive for alcohol abuse or dependence. These patients were not seeking help for alcohol problems. INTERVENTIONS: Included a brief physician intervention and a 6-week patient psychoeducational group. MEASUREMENTS: The Diagnostic Interview Schedule assessed subjects for alcohol abuse; the Addiction Severity Index measured alcohol-related problems, including psychosocial issues. FINDINGS: All four treatment groups demonstrated significant improvement over time, with few differences between intervention and control groups. CONCLUSIONS: Assessment can be confounded with brief interventions; future investigators should use non-assessed control groups.

Dispersive flight by Triatoma sordida.

One hundred and thirty-two male and female Triatoma sordida were marked with fluorescent paint and released at an experimental site on the salt flats of central Argentina, distant from any inhabited dwellings. Flight by these bugs commenced just after sunset, and the bugs were then systematically searched for using portable ultraviolet lights. There was no apparent tendency for the bugs to fly in any particular direction, but those whose flight could be observed directly all seemed to fly in approximately straight lines at a height of 0.5-1 m. Of the 86 bugs that flew from the release point, 16 made trivial flights of less than 5 m, 4 landed at distances of 60-90 m away, while the other bugs were not recovered and appear to have flown further than 100 m. As expected from similar studies with T. infestans, the proportion of bugs initiating flight declined with increasing weight-length ratio, but T. sordida showed a much higher propensity for flight under these conditions than did T. infestans.

Seasonal changes in infectivity of domestic populations of Triatoma infestans.

This paper examines the infection rate of Trypanosoma cruzi in Triatoma infestans, the main vector of Chagas disease in Argentina and neighbouring countries. The study was carried out in 1986-1987 on 5 houses (ranchos) in the endemic area of central Argentina. Domestic T. infestans populations were sampled in each season with a constant capture effort (2.5 man-hours/house) using a chemical irritant. The rectal content of the bugs was examined for the presence of T. cruzi. The vector population density showed seasonal changes with highest values during the hot season (November-April). The percentage of infected bugs was higher in mid-spring (November) and autumn (April) than in winter (August) and early spring (October). The mean number of parasites (epimastigotes and trypomastigotes) per microliter of rectal material was very high during mid- and late spring (December). The percentage and number of metacyclic forms differed between seasons, reaching the highest values in late spring. The percentage of infected bugs in houses with children younger than 10 years old was higher than that in houses without children, during all the seasons. Late spring seemed to be the period when domestic populations of T. infestans had the highest vector potential.

Trypanosoma cruzi transmission risk index (TcTRI): an entomological indicator of Chagas disease vectorial transmission to humans.

The goal of this project was to obtain an index of Chagas disease vectorial transmission to people living in infested houses. The proposed measure is an entomological indicator that estimates the number of risky bites that a human being receives per night. Based on very simple techniques, the method combines control measures--the use of fumigant canisters--with fast and accurate methods to look at the physiological and parasitological stage of insects. The index can be used to compare the importance of different vector species in Chagas transmission and also, as an entomological indicator of transmission risk in vector control programmes.

Feeding frequency and nutritional status of peridomestic populations of Triatoma infestans from Argentina.

We studied the nutritional characteristics of peridomestic populations of Triatoma infestans from 25 habitats in an endemic area of Chagas disease in Argentina. The aim was to determine the feeding frequency, fresh weight of adults and older nymphs, and the gonotrophic status of females, in order to compare them with previous studies of domestic populations in the same region. The average infection rate of the bugs and blood meal origins were also determined in order to calculate the maximum risk for Trypanosoma cruzi transmission in these habitats. The number of bugs in each habitat correlated positively with the number of hosts. The estimated number of bites per night was strongly correlated with the total number of bugs collected from that habitat. The shortest biting interval (1.9 and 1.7 days) occurred in November and February, where 52-60% of insects suck blood each night. Adults and nymphs recently fed showed significantly higher fresh weight in November. There was no apparent correlation between the mean weights of adults or nymphs and the number of insects found within each habitat. Bloodmeal analysis showed that most of the bugs (87%) had fed from chicken, with human and dog scarcely represented and no bloodmeals identified from cat. However, human bloodmeals were only identified from chicken coops near the house (< 12 m). Almost all females (92-100%) captured during the spring months had been mated, whereas the proportion of mated females decreased significantly during summer (60-71%). The maximum risk (MR) average from these peridomestic habitats was 0.35 bites from infective bugs/night, tenfold lower than MR from domestic habitats. The good nutritional status of recently fed bugs, found in these chicken coops during all the hot season, suggest that active dispersal is unlikely to occur from peridomestic habitats.

Sensilla associated with the rostrum of eight species of triatominae.

Scanning electron microscopy (SEM) permits description of 10 types of rostral sensilla of eight species of Triatominae. The chaetica sensilla are the most abundant over all the rostral surface. On the second and third rostral segments, these sensilla are arranged in six columns along the main axis. A distinctive sensory field lies on the third segment very close to the emergence of the stylet. The total number of chaetica sensilla increases significantly on the last segment. The number and distribution of sensilla do not differ between nymphs and adults. The pattern of rostral sensilla of five species--Triatoma sordida, T. platensis, T. protracta, T. infestans, and T. guasayana--were analyzed, and the results were compared by multivariate discriminant analysis. Interspecific variability was found. The method is proposed as a taxonomic tool.

Antennal sensilla patterns indicate geographic and ecotopic variability among Triatoma infestans (Hemiptera: Reduviidae) populations.

Antennal sensilla patterns were used to explore intraspecific variability among Triatoma infestans (Klug) from domestic habitats in Argentina and Bolivia, and from sylvatic habitats in Bolivia. The sensilla pattern was effective in distinguishing individuals at sexual, ecotopic, and geographic levels, and supported the idea of a lack of gene flow between sylvatic and domestic habitats.

Development of Trypanosoma cruzi in Triatoma infestans: influence of temperature and blood consumption.

This work had 2 objectives. The first was to quantify Trypanosoma cruzi development within Triatoma infestans maintained at 2 different temperatures, using an experimental design that simulated the natural transmission process and, second, to learn how the vector blood consumption rate modifies the parasite's development. Two hundred and three, fifth-stage nymphs of T. infestans were infected with the X-1 strain of T. cruzi (about 10(4) trypanosomes/ml blood), maintained at 20 and 28 C, and daily offered the opportunity to feed on uninfected laboratory mice. From 24 hr to the 55th day after the infective meal, the total number of epimastigotes and rectal and fecal metacyclic trypomastigotes were counted. Epimastigote multiplication began on the first day after the infective meal at both temperatures. This parasitic stage developed similar population densities within the vector under both temperature regimes. Trypomastigotes appeared in the rectum and feces at 20 C, 32 and 24 days later, respectively, than at 28 C; however, once they became infective, insects developed similar population densities of fecal metacyclic forms. Blood consumption was related to epimastigote and rectal trypomastigote development at 28 C, but not to the number of trypomastigotes in the feces. A minimum of 120 and 180 mg of fresh blood consumed assured that all bugs developed epimastigotes and trypomastigotes. In spite of the delay in producing metacyclic forms at 20 C, the insect's infective capacity was similar at both temperatures.

Stress in families of HIV-positive children living in south Texas.

The purpose was to conduct a pilot study of the extent of stress and differences in sources of stress experienced by HIV+ and HIV- caregivers of HIV+ children living in South Texas. 13 infected and 9 uninfected caregivers each completed the Questionnaire on Resources and Stress for their preschool-aged HIV+ child. Both HIV+ and HIV- caregivers experienced clinically significant stress. HIV+ caregivers reported that relative to the HIV- group, they perceived themselves to be in poorer physical or emotional health, to receive less social support from others, and to be less pessimistic about the future of their child or family.

Phylogenetic relationships of the Spinolai complex and other Triatomini based on mitochondrial DNA sequences (Hemiptera: Reduviidae).

In this study, we performed a phylogenetic analysis of 35 species of the tribe Triatomini by means of available 16S ribosomal DNA and cytochrome b (Cyt b) gene sequence data, adding taxa of the spinolai complex, to clarify phylogenetic relationships of this complex and related triatomines. The phylogenetic analysis suggests a monophyletic clustering of the spinolai complex related to the South American species of triatomines.