Social determinants in the access to health care for Chagas disease: A qualitative research on family life in the "Valle Alto" of Cochabamba, Bolivia.

INTRODUCTION: Chagas disease is caused by the Trypanosoma cruzi infection. It is a neglected tropical disease with considerable impact on the physical, psychological, familiar, and social spheres. The Valle Alto of Cochabamba is a hyperendemic region of Bolivia where efforts to control the transmission of the disease have progressed over the years. However, many challenges remain, above all, timely detection and health-care access. METHODS: Following the Science Shop process, this bottom-up research emerged with the participation of the civil society from Valle Alto and representatives of the Association of Corazones Unidos por el Chagas from Cochabamba. The aim of this study is to explore the social determinants in the living realities of those affected by Chagas disease or the silent infection and how families in the Valle Alto of Cochabamba cope with it. An interdisciplinary research team conducted a case study of the life stories of three families using information from in-depth interviews and performed a descriptive qualitative content analysis and triangulation processes. FINDINGS: Findings provide insights into social circumstances of the research subjects' lives; particularly, on how exposure to Trypanosoma cruzi infection affects their daily lives in terms of seeking comprehensive health care. Research subjects revealed needs and shared their experiences, thus providing an understanding of the complexity of Chagas disease from the socioeconomic, sociocultural, political, and biomedical perspectives. Results enlighten on three dimensions: structural, psychosocial, and plural health system. The diverse perceptions and attitudes toward Chagas within families, including the denial of its existence, are remarkable as gender and ethnocultural aspects. Findings support recommendations to various stakeholders and translation materials. CONCLUSIONS: Intersectional disease management and community involvement are essential for deciding the most appropriate and effective actions. Education, detection, health care, and social programs engaging family units ought to be the pillars of a promising approach.

Assessment of genetic diversity in the sorghum reference set using EST-SSR markers.

Selection and use of genetically diverse genotypes are key factors in any crop breeding program to develop cultivars with a broad genetic base. Molecular markers play a major role in selecting diverse genotypes. In the present study, a reference set representing a wide range of sorghum genetic diversity was screened with 40 EST-SSR markers to validate both the use of these markers for genetic structure analyses and the population structure of this set. Grouping of accessions is identical in distance-based and model-based clustering methods. Genotypes were grouped primarily based on race within the geographic origins. Accessions derived from the African continent contributed 88.6 % of alleles confirming the African origin of sorghum. In total, 360 alleles were detected in the reference set with an average of 9 alleles per marker. The average PIC value was 0.5230 with a range of 0.1379-0.9483. Sub-race, guinea margaritiferum (Gma) from West Africa formed a separate cluster in close proximity to wild accessions suggesting that the Gma group represents an independent domestication event. Guineas from India and Western Africa formed two distinct clusters. Accessions belongs to the kafir race formed the most homogeneous group as observed in earlier studies. This analysis suggests that the EST-SSR markers used in the present study have greater discriminating power than the genomic SSRs. Genetic variance within the subpopulations was very high (71.7 %) suggesting that the germplasm lines included in the set are more diverse. Thus, this reference set representing the global germplasm is an ideal material for the breeding community, serving as a community resource for trait-specific allele mining as well as genome-wide association mapping.

Isolation of microsatellite markers in the Calliptamus genus (Orthoptera, Acrididae).

The Calliptamus genus (Orthoptera: Acrididae) includes locust and grasshopper species, some of which have a high economic impact. Using an enriched methodology, 10 microsatellite markers have been developed from two species, Calliptamus italicus and Calliptamus barbarus. These polymorphic markers were tested on different populations of three Calliptamus species: C. italicus, C. barbarus, C. wattenwylianus. Two markers were amplified on the three species, as well as four on C. barbarus and two on C. italicus. In each species, 9 to 23 alleles per locus were observed. These molecular markers might prove to be a new and interesting tool for Calliptamus population genetics and dispersion studies.

Genetic differentiation of wild and cultivated populations: diversity of Coffea canephora Pierre in Uganda.

Coffea canephora Pierre ex Frohener is a perennial plant originated from Africa. Two main groups, Guinean and Congolese, have already been identified within this species. They correspond to main refugia in western and central Africa. In this paper we present the analysis of a region that has not yet been studied, Uganda. Two wild, one feral (once cultivated but abandoned for many years), and two cultivated populations of C. canephora from Uganda were evaluated using 24 microsatellite markers. Basic diversity, dissimilarity and genetic distances between individuals, genetic differentiation between populations, and structure within populations were analysed. Expected heterozygosity was high for wild compartments (0.48 to 0.54) and for cultivated and feral ones (0.57 to 0.59), with the number of private alleles ranging from 12 for cultivated genotypes to 37 for a wild compartment. The Ugandan samples show significant population structuring. We compared the Ugandan populations with a representative sample of known genetic diversity groups within the species using 18 markers. Coffea canephora of Ugandan origin was found to be genetically different from previously identified diversity groups, implying that it forms another diversity group within the species. Given its large distribution and extremely recent domestication, C. canephora can be used to understand the effect of refugia colonization on genetic diversity.

Phylogeographic evidence of crop neodiversity in sorghum.

Sorghum has shown the adaptability necessary to sustain its improvement during time and geographical extension despite a genetic foundation constricted by domestication bottlenecks. Initially domesticated in the northeastern part of sub-Saharan Africa several millenia ago, sorghum quickly spread throughout Africa, and to Asia. We performed phylogeographic analysis of sequence diversity for six candidate genes for grain quality (Shrunken2, Brittle2, Soluble starch synthaseI, Waxy, Amylose extender1, and Opaque2) in a representative sample of sorghum cultivars. Haplotypes along 1-kb segments appeared little affected by recombination. Sequence similarity enabled clustering of closely related alleles and discrimination of two or three distantly related groups depending on the gene. This scheme indicated that sorghum domestication involved structured founder populations, while confirming a specific status for the guinea margaritiferum subrace. Allele rooted genealogy revealed derivation relationships by mutation or, less frequently, by recombination. Comparison of germplasm compartments revealed contrasts between genes. Sh2, Bt2, and SssI displayed a loss of diversity outside the area of origin of sorghum, whereas O2 and, to some extent, Wx and Ae1 displayed novel variation, derived from postdomestication mutations. These are likely to have been conserved under the effect of human selection, thus releasing valuable neodiversity whose extent will influence germplasm management strategies.

Isolation and characterization of microsatellite markers for Casearia sylvestris Sw. (Salicaceae), a neotropical medicinal tree.

Casearia sylvestris Sw. is a widespread neotropical tree utilized in popular medicine. Recent research ranked Casearia as one of the most promising genus in the search of drugs against cancer. Despite its wide distribution and pharmacological importance, no microsatellite markers have yet been developed for this genus. In this study, we provide 10 polymorphic microsatellite loci specifically designed for C. sylvestris, used to analyse 90 individuals distributed in two populations from São Paulo state, Brazil. On average, 12.3 alleles per locus were identified, showing the ability of the markers to detect microsatellite polymorphism in this species.

Genetic structure at range edge: low diversity and high inbreeding in Southeast Asian mangrove (Avicennia marina) populations.

Understanding the genetic composition and mating systems of edge populations provides important insights into the environmental and demographic factors shaping species' distribution ranges. We analysed samples of the mangrove Avicennia marina from Vietnam, northern Philippines and Australia, with microsatellite markers. We compared genetic diversity and structure in edge (Southeast Asia, and Southern Australia) and core (North and Eastern Australia) populations, and also compared our results with previously published data from core and southern edge populations. Comparisons highlighted significantly reduced gene diversity and higher genetic structure in both margins compared to core populations, which can be attributed to very low effective population size, pollinator scarcity and high environmental pressure at distribution margins. The estimated level of inbreeding was significantly higher in northeastern populations compared to core and southern populations. This suggests that despite the high genetic load usually associated with inbreeding, inbreeding or even selfing may be advantageous in margin habitats due to the possible advantages of reproductive assurance, or local adaptation. The very high level of genetic structure and inbreeding show that populations of A. marina are functioning as independent evolutionary units more than as components of a metapopulation system connected by gene flow. The combinations of those characteristics make these peripheral populations likely to develop local adaptations and therefore to be of particular interest for conservation strategies as well as for adaptation to possible future environmental changes.

Microsatellite-based high density linkage map in oil palm (Elaeis guineensis Jacq.).

A microsatellite-based high-density linkage map for oil palm (Elaeis guinensis Jacq.) was constructed from a cross between two heterozygous parents, a tenera palm from the La Me population (LM2T) and a dura palm from the Deli population (DA10D). A set of 390 simple sequence repeat (SSR) markers was developed in oil palm from microsatellite-enriched libraries and evaluated for polymorphism along with 21 coconut SSRs. A dense and genome-wide microsatellite framework as well as saturating amplified fragments length polymorphisms (AFLPs) allowed the construction of a linkage map consisting of 255 microsatellites, 688 AFLPs and the locus of the Sh gene, which controls the presence or absence of a shell in the oil palm fruit. An AFLP marker E-Agg/M-CAA132 was mapped at 4.7 cM from the Sh locus. The 944 genetic markers were distributed on 16 linkage groups (LGs) and covered 1,743 cM. Our linkage map is the first in oil palm to have 16 independent linkage groups corresponding to the plant's 16 homologous chromosome pairs. It is also the only high-density linkage map with as many microsatellite markers in an Arecaceae species and represents an important step towards quantitative trait loci analysis and physical mapping in the E. guineensis species.

Estudio de costo/beneficio de un programa de control de Enfermedad de Chagas Congénita en Bolivia / Cost effectiveness study of a control program of congenital Chagas disease in Bolivia

Cost effectiveness analysis of Chagas' vertical transmission control program in Bolivia: Today, Bolivia is the most concerned country in America by Chagas disease: Trypanosoma cruzi infection affects 20% of whole population, around 1800000 inhabitants, and mother-to-child transmission is around 5%, from 1.6 to 9.8%. Direct and indirect costs derived from disease complications and death, from birth to adulthood, add up around US$ 21 millions per year for 2,718 infected new-borns. This cost falls on individual, family and society, when the nation is struggling in a depressed economy. On the other side, an effective control program could detect and treat all cases with an investment of US$ 123 per infected new-born, or US$ 1.2 per new-born in Bolivia. Indirect benefits, apart of suffering relieve and improving of life quality, are related with Chagas vector control program, increasing the demand thanks to increasing risk awareness and also induced demand testing all pregnant women in endemic areas. So the conclusion is that such investment is profitable.

[1000 cases of cholecystectomy: 500 by laparotomy versus 500 by laparoscopy]. / 1.000 cas de cholécystectomie: 500 par laparotomie versus 500 par laparoscopie.

The authors report 1,000 cases of cholecystectomy for cholelithiasis, excluding all cases with associated common bile duct surgery. The aim of the study was to compare two groups of cholecystectomies, one of 500 laparotomic procedures, evaluated retrospectively, and one of 500 laparoscopic ones, evaluated prospectively. Sex ratio was the same in both groups, and mean age was higher in the second group (54 vs 60) (p < 0.05): acute cholecystitis ratio was similar in both groups (23% vs 19%; NS). During the laparoscopic period, 84 laparotomic interventions were performed (17%), with a 0% mortality and a 18% morbidity rate. Mean operating time was 69' in the first group vs 91' in the second one, with a mean hospital stay of 11 vs 4.5 days (p < 0.001). Mortality rate was 1% vs 0% (p < 0.03) for laparotomic and laparoscopic procedures, and morbidity rate was respectively 11% and 1% (p < 0.001). Conversion rate in laparoscopic surgery was 7%. Two cases (0.4%) in laparoscopic group had a common bile duct lesion diagnosed intraoperatively and 1 case (0.2%) had a residual stone in common bile duct. Laparoscopic surgery is at present the standard technique for the treatment of cholelithiasis and laparotomic cholecystectomy seems only indicated when laparoscopic procedure is contraindicated or impossible.

[The musculocutaneous flap of the latissimus dorsi in the treatment of recurrences of breast cancer]. / Le lambeau musculo-cutané du grand dorsal dans le traitement des récidives de cancer du sein.

Breast cancers local recurrence treatment usually requires a large chirurgical resection. Latissimus dorsi myocutaneous flap was used after mastectomy in 27 patients. This technique was performed in 14 patients who had a recurrence after exclusive radiotherapy treatment. The follow-up of all the patients was more than 5 years. A 42% survival rate has been quoted in this group, after a 11 years period. Latissimus dorsi myocutaneous flap seems to be a satisfactory alternative when performing reconstruction after wall excision under 300 cm2, excepted for recurrence of fast kinetic cancers.

[Surgical treatment of pyloric stenosis of ulcerous origin. Apropos of 68 cases]. / Le traitement chirurigical de la sténose pylorique d'origine ulcéreuse. A propos de 68 cas.

The study turns about 68 cases of post ulcerous pyloric stenosis operated from 1970 to 1990, that means 8.5% of the duodenal ulcers (796 cases) operated during this period. The stenosis was entire or strangled in 27 cases (39.7%) with an important gastric dilatation in 34 cases (50%). The treatment has been composed of a gastroenterostomy (30 cases--44%), most of the time with a troncular vagotomy, of a pyloroplasty with vagotomy in 20 cases (29.5%) and of an inferior polar gastric resection in 18 cases (26.5%). The operative mortality was 2 cases (3%). The at distance-results (average follow-up of 7 years) show that 71% of the re-examined patients (45 cases) are classified Visick 1 or 2 and 9% visick 4. Ones concludes to the value of troncular vagotomy with gastroenterostomy which can be realised in all of the occasions and gives good functional results when the vagotomy with pyloroplasty seems to lie more frequently in state to uncertain functional results.

[Mechanical trans-sutural colorectal anastomosis in the treatment of cancers of the rectum. Apropos of 70 cases]. / L'anastomose colo-rectale mécanique trans-suturaire dans le traitement des cancers du rectum. A propos de soixante-dix cas.

The reduction in the acceptable length of distal margin below the tumor makes low anterior resection more suitable for rectal cancers. The technical difficulties of low anastomosis are reduced by performing stapled colorectal anastomosis through the suture. Seventy patients were submitted to this procedure. There was no operative mortality, while the reported morbidity was 14%. Sixteen patients underwent preoperative radiotherapy of 30 Gy without any subsequent leakage. This technique is discussed in relation to the hand-sewn colo-anal anastomosis.

[Esophagectomy without thoracotomy as a treatment of esophageal cancer. Indications, technical features and results]. / L'oesophagectomie sans thoracotomie comme traitement du cancer de l'oesophage. Indications, points de technique opératoire et résultats.

Between 1980 and 1989, 229 patients with squamous cell carcinoma of the esophagus underwent esophagectomy without thoracotomy. The tumor was located in cervical and thoracic esophagus in 112 and 117 cases, respectively. Out the patient with a tumor of the thoracic esophagus, the mean age was 63 years (range 32-81). There were 90 males and 27 females. The locations inside the thoracic esophagus were as follows: upper thoracic 39, middle thoracic 40, lower thoracic 38 cases. A complete resection of the tumor was performed in 87 patients and in 30 cases the procedure was palliative. The digestive tract was reconstructed by means of esophago-gastrostomy in 101 patients, esophago-colostomy in 13, esophago-jejunostomy in 2, and pharyngo-colostomy in 1 patient, respectively. The post-operative morbidity was as follows: pulmonary complications 13.6%, anastomotic leak 17.1%, necrosis 5.1%, recurrent laryngeal nerve injuries 10.2%. The overall hospital mortality was 7.6%. Actuarial survival rates after curative and palliative resection were 82.4% and 47.1% at 7 year, 46.3% and 8.1% at 2 years, 39.0% and 0% at 3.5 and 6 years. In our experience, esophagectomy without thoracotomy is an excellent technique, with low morbidity but with oncologic limitations. Patients with carcinomas of the thoracic esophagus in whom thoracotomy is contraindicated can be resected with this technique with morbidity and mortality rates comparable to those of patients undergoing transthoracic esophagectomy.

[Recovery of a complete cervical spinal cord injury with tetraplegia (author's transl)]. / Tétraplégie post-traumatique haute et complète suivie de récupération. Réflexions à propos d'une fracture de l'odontoïde.

The prognosis of a complete cervical spinal cord injury is based on an accurate initial diagnosis and on immediate treatment in order to release the medullary compression and stabilise the spine. The diagnosis of a complete traumatic quadriplegia depends upon a thorough neurological examination, particularly noting sensation and motor power of the sacral segments, looking for a sacral sparing which is a sign of a better prognosis. The authors analysed a well documented case of progressive recovery obtained after nearly immediate open reduction and synthesis of a C1 C2 fracture-dislocation with complete quadriplegia.

[Lumbar disc herniation in childhood (author's transl)]. / La hernie discale lombaire chez l'enfant.

Two cases of lumbar disc herniation are reported in children. The disease is very rare during growth and the authors describe the clinical aspect and discuss treatment. A new concept of the pathogenesis is proposed.

[Comments about 600 club feet (author's transl)]. / A propos de six cents pieds bots.

This review summarizes functional treatment of club foot along 25 years lead by the pediatric orthopedists of the Bretonneau's Hospital (Paris). The efficiency of this technic is therefore appreciated through 600 cases submitted to a long follow up. The results are analyzed according analytic, clinical and radiographic tests. Its synthesis is also considered at the main stages of the growth of the child and till the end of the growth for most of them. The homogeneity of the team and the long follow-up of this process elaborated at the Bretonneau's Hospital in 1952 accounts the rate of good results which avoid surgery for half of the children. The constant improvement of this functional treatment will refine this original procedure in the future.