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1.
Environ Pollut ; 314: 120220, 2022 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-36152708

RESUMEN

Pesticide contamination is a threat to many aquatic habitats, and runoff from residential homes is a major contributor of these chemicals in urban surface streams and estuaries. Improved understanding of their fate and transport can help identify areas of concern for monitoring and management. In many urban areas, runoff water congregates in numerous underground catch basins before draining into the open environment; however, at present essentially no information is available on pesticide presence in these systems. In this study, we collected water samples from a large number of underground urban catch basins in different regions of California during the active pest management season to determine the occurrence and profile of the widely used pyrethroid insecticides. Detectable levels of pyrethroids were found in 98% of the samples, and the detection frequency of individual pyrethroids ranged from no detection for fenpropathrin to 97% for bifenthrin. In the aqueous phase, total pyrethroid concentrations ranged from 3 to 726 ng/L, with a median value of 32 ng/L. Pyrethroids were found to be enriched on suspended solids, with total concentrations ranging from 42 to 93,600 ng/g and a median value of 2,350 ng/g. In approximately 89% of the samples, whole water concentrations of bifenthrin were predicted to have toxic units >1 for sensitive aquatic invertebrates. The high detection frequency of bifenthrin and overall pyrethroid concentrations, especially for particle-bound residues, suggest that underground urban catch basins constitute an important secondary source for extended and widespread contamination of downstream surface waters by pesticides such as pyrethroids in urban regions.


Asunto(s)
Insecticidas , Plaguicidas , Piretrinas , Contaminantes Químicos del Agua , Insecticidas/toxicidad , Monitoreo del Ambiente , Contaminantes Químicos del Agua/análisis , Piretrinas/toxicidad , Plaguicidas/análisis , Agua
2.
J Med Entomol ; 59(2): 638-647, 2022 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-35050361

RESUMEN

Piperonyl butoxide (PBO)-synergized pyrethroid products are widely available for the control of pyrethroid-resistant mosquitoes. To date, no study has examined mosquito resistance after pre-exposure to PBO and subsequent enzymatic activity when exposed to PBO-synergized insecticides. We used Culex quinquefasciatus Say (Diptera: Culicidae), an important vector of arboviruses and lymphatic filariasis, as a model to examine the insecticide resistance mechanisms of mosquitoes to PBO-synergized pyrethroid using modified World Health Organization tube bioassays and biochemical analysis of metabolic enzyme expressions pre- and post-PBO exposure. Mosquito eggs and larvae were collected from three cities in Orange County in July 2020 and reared in insectary, and F0 adults were used in this study. A JHB susceptible strain was used as a control. Mosquito mortalities and metabolic enzyme expressions were examined in mosquitoes with/without pre-exposure to different PBO concentrations and exposure durations. Except for malathion, wild strain Cx quinquefasciatus mosquitoes were resistant to all insecticides tested, including PBO-synergized pyrethroids (mortality range 3.7 ± 4.7% to 66.7 ± 7.7%). Wild strain mosquitoes had elevated levels of carboxylesterase (COE, 3.8-fold) and monooxygenase (P450, 2.1-fold) but not glutathione S-transferase (GST) compared to susceptible mosquitoes. When wild strain mosquitoes were pre-exposed to 4% PBO, the 50% lethal concentration of deltamethrin was reduced from 0.22% to 0.10%, compared to 0.02% for a susceptible strain. The knockdown resistance gene mutation (L1014F) rate was 62% in wild strain mosquitoes. PBO pre-exposure suppressed P450 enzyme expression levels by 25~34% and GST by 11%, but had no impact on COE enzyme expression. Even with an optimal PBO concentration (7%) and exposure duration (3h), wild strain mosquitoes had significantly higher P450 enzyme expression levels after PBO exposure compared to the susceptible laboratory strain. These results further demonstrate other studies that PBO alone may not be enough to control highly pyrethroid-resistant mosquitoes due to multiple resistance mechanisms. Mosquito resistance to PBO-synergized insecticide should be closely monitored through a routine resistance management program for effective control of mosquitoes and the pathogens they transmit.


Asunto(s)
Culicidae , Insecticidas , Piretrinas , Animales , Sistema Enzimático del Citocromo P-450 , Resistencia a los Insecticidas/genética , Insecticidas/farmacología , Control de Mosquitos/métodos , Mosquitos Vectores , Butóxido de Piperonilo/farmacología , Piretrinas/farmacología
3.
Sci Rep ; 11(1): 12667, 2021 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-34135430

RESUMEN

An extensive network of storm water conveyance systems in urban areas, often referred to as the "underground storm drain system" (USDS), serves as significant production habitats for mosquitoes. Knowledge of whether USDS habitats are suitable for newly introduced dengue vectors Aedes aegypti and Ae. albopictus will help guide surveillance and control efforts. To determine whether the USDS functions as a suitable larval habitat for Culex, Ae. aegypti and Ae. albopictus in southern California, we examined mosquito habitat utilization and larval survivorship using laboratory microcosm studies. The data showed that USDS constituted 4.1% of sampled larval habitats for Ae. aegypti and Ae. albopictus, and 22.0% for Cx. quinquefasciatus. Furthermore, USDS water collected in the summer completely inhibited Aedes larval development, but yielded a 15.0% pupation rate for Cx. quinquefasciatus. Food supplementation in the microcosms suggests that nutrient deficiency, toxins and other factors in the USDS water led to low success or complete failure of larval development. These results suggest that USDS habitats are currently not major productive larval habitats for Aedes mosquitoes in southern California. Our findings prompt inclusion of assessments of pupal productivity in USDS habitats and adult mosquito resting sites in the mosquito surveillance program.


Asunto(s)
Mosquitos Vectores , Aedes/crecimiento & desarrollo , Aedes/fisiología , Animales , California , Ciudades , Culex/crecimiento & desarrollo , Culex/fisiología , Ecología , Ecosistema , Larva/crecimiento & desarrollo , Larva/fisiología , Mosquitos Vectores/crecimiento & desarrollo , Mosquitos Vectores/fisiología , Reproducción , Salud Urbana , Agua
4.
J Med Entomol ; 58(1): 398-402, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-32914856

RESUMEN

The juvenile hormone analog S-methoprene is the only synthetic biopesticide that is registered with the United States Environmental Protection Agency to control arthropods of economic importance in public health, livestock, pets, urban, and stored products. The high activity, relative target specificity, and benign environmental profile of S-methoprene have been well documented. While the risk of resistance in mosquitoes to S-methoprene is generally low, there is a lack of information regarding cross resistance in S-methoprene-resistant mosquitoes to other pesticides. In this paper, a population of the southern house mosquito Culex quinquefasciatus Say from southern California acquired low levels of resistance to S-methoprene in the field, where the resistance ratios ranged 7.0- to 8.8-fold as compared with a laboratory reference colony. After 30 generations of laboratory selections by S-methoprene when resistance was elevated to 57.4- to 168.3-fold relative to an unselected population, various levels of cross resistance to other commonly used pesticides were revealed in the selected population. Cross resistance to the microbial mosquito larvicide Lysinibacillus sphaericus (Meyer & Neide) (Bacillales: Bacillaceae) was the most profound, amounting to 77.50- to 220.50-fold. The mechanism and potential management tactics toward cross resistance are discussed to preserve the unique value of this synthetic biopesticide.


Asunto(s)
Culex/efectos de los fármacos , Resistencia a los Insecticidas , Hormonas Juveniles/farmacología , Metopreno/farmacología , Control de Mosquitos , Animales , Bacillaceae/química , Toxinas Bacterianas
5.
Am J Trop Med Hyg ; 99(2): 291-296, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29869607

RESUMEN

Presently, few studies have investigated the role of domestic cats (Felis catus) in the recrudescence of flea-borne rickettsioses in California and the southern United States. In this study, we aimed to investigate the presence of Rickettsia typhi or Rickettisa felis in domestic cats (F. catus) and the fleas (primarily Ctenocephalides felis, the cat flea) associated with these cats in Riverside County, California. Thirty cats and 64 pools of fleas collected from these cats were investigated for rickettsial infections. Three cats and 17 flea pools (from 10 cats) tested positive for rickettsial infections. polymerase chain reaction and DNA sequencing indicated that one of the cats was positive for R. felis infections, whereas two were positive for Candidatus Rickettsia senegalensis infection. In addition, 12 of the flea pools were positive for R. felis, whereas five were positive for Ca. R. senegalensis. By contrast, no cats or their associated fleas tested positive for R. typhi. Finally, eight sera from these cats contained spotted fever group Rickettsia (SFGR) antibodies. The detection of R. felis and SFGR antibodies and the lack of R. typhi and TGR antibodies support R. felis as the main rickettsial species infecting cat fleas. The detection of Ca. R. senegalensis in both fleas and cats also provides additional evidence that cats and their associated fleas are infected with other R. felis-like organisms highlighting the potential risk for human infections with R. felis or R. felis-like organisms.


Asunto(s)
Enfermedades de los Gatos/epidemiología , Gatos/microbiología , Ctenocephalides/microbiología , Infestaciones por Pulgas/veterinaria , Infecciones por Rickettsia/veterinaria , Animales , Anticuerpos Antibacterianos/sangre , California/epidemiología , Enfermedades de los Gatos/microbiología , Infestaciones por Pulgas/epidemiología , Reacción en Cadena de la Polimerasa , Infecciones por Rickettsia/epidemiología , Infecciones por Rickettsia/transmisión , Rickettsia felis/genética , Rickettsia felis/aislamiento & purificación , Rickettsia typhi/genética , Rickettsia typhi/aislamiento & purificación , Análisis de Secuencia de ADN
6.
PLoS One ; 11(8): e0160604, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27537367

RESUMEN

Due to a resurgence of flea-borne rickettsioses in Orange County, California, we investigated the etiologies of rickettsial infections of Ctenocephalides felis, the predominant fleas species obtained from opossums (Didelphis virginiana) and domestic cats (Felis catus), collected from case exposure sites and other areas in Orange County. In addition, we assessed the prevalence of IgG antibodies against spotted fever group (SFGR) and typhus group (TGR) rickettsiae in opossum sera. Of the 597 flea specimens collected from opossums and cats, 37.2% tested positive for Rickettsia. PCR and sequencing of rickettsial genes obtained from C. felis flea DNA preparations revealed the presence of R. typhi (1.3%), R. felis (28.0%) and R. felis-like organisms (7.5%). Sera from opossums contained TGR-specific (40.84%), but not SFGR-specific antibodies. The detection of R. felis and R. typhi in the C. felis fleas in Orange County highlights the potential risk for human infection with either of these pathogens, and underscores the need for further investigations incorporating specimens from humans, animal hosts, and invertebrate vectors in endemic areas. Such studies will be essential for establishing a link in the ongoing flea-borne rickettsioses outbreaks.


Asunto(s)
Gatos/parasitología , Ctenocephalides/microbiología , Infestaciones por Pulgas/veterinaria , Insectos Vectores/microbiología , Zarigüeyas/parasitología , Infecciones por Rickettsia/veterinaria , Rickettsia/aislamiento & purificación , Animales , California/epidemiología , Gatos/sangre , Gatos/microbiología , Brotes de Enfermedades , Infestaciones por Pulgas/complicaciones , Humanos , Inmunoglobulina G/sangre , Zarigüeyas/sangre , Zarigüeyas/microbiología , Infecciones por Rickettsia/sangre , Infecciones por Rickettsia/epidemiología , Infecciones por Rickettsia/transmisión , Rickettsia felis/aislamiento & purificación , Rickettsia typhi/aislamiento & purificación
7.
PLoS One ; 8(7): e68586, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23861921

RESUMEN

The Asian tiger mosquito, Aedes albopictus, is an anthropophilic aggressive daytime-biting nuisance and an efficient vector of certain arboviruses and filarial nematodes. Over the last 30 years, this species has spread rapidly through human travel and commerce from its native tropical forests of Asia to every continent except Antarctica. In 2011, a population of Asian tiger mosquito (Aedes albopictus) was discovered in Los Angeles (LA) County, California. To determine the probable origin of this invasive species, the genetic structure of the population was compared against 11 populations from the United States and abroad, as well as preserved specimens from a 2001 introduction into California using the mitochondrial cytochrome c oxidase 1 (CO1) gene. A total of 66 haplotypes were detected among samples and were divided into three main groups. Aedes albopictus collected in 2001 and 2011 from LA County were genetically related and similar to those from Asia but distinct from those collected in the eastern and southeastern United States. In view of the high genetic similarities between the 2001 and 2011 LA samples, it is possible that the 2011 population represents in part the descendants of the 2001 introduction. There remains an imperative need for improved surveillance and control strategies for this species.


Asunto(s)
Aedes/genética , Insectos Vectores/genética , Especies Introducidas , Aedes/clasificación , Animales , California , ADN Mitocondrial/genética , Variación Genética , Genética de Población , Haplotipos , Humanos , Insectos Vectores/clasificación , Datos de Secuencia Molecular , Control de Mosquitos , Filogenia , Filogeografía , Dinámica Poblacional , Salud Pública
8.
PLoS One ; 8(5): e64656, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23717647

RESUMEN

Complex decisions dramatically affect animal dispersal and space use. Dispersing individuals respond to a combination of fine-scale environmental stimuli and internal attributes. Individual-based modeling offers a valuable approach for the investigation of such interactions because it combines the heterogeneity of animal behaviors with spatial detail. Most individual-based models (IBMs), however, vastly oversimplify animal behavior and such behavioral minimalism diminishes the value of these models. We present program SEARCH (Spatially Explicit Animal Response to Composition of Habitat), a spatially explicit, individual-based, population model of animal dispersal through realistic landscapes. SEARCH uses values in Geographic Information System (GIS) maps to apply rules that animals follow during dispersal, thus allowing virtual animals to respond to fine-scale features of the landscape and maintain a detailed memory of areas sensed during movement. SEARCH also incorporates temporally dynamic landscapes so that the environment to which virtual animals respond can change during the course of a simulation. Animals in SEARCH are behaviorally dynamic and able to respond to stimuli based upon their individual experiences. Therefore, SEARCH is able to model behavioral traits of dispersing animals at fine scales and with many dynamic aspects. Such added complexity allows investigation of unique ecological questions. To illustrate SEARCH's capabilities, we simulated case studies using three mammals. We examined the impact of seasonally variable food resources on the weight distribution of dispersing raccoons (Procyon lotor), the effect of temporally dynamic mortality pressure in combination with various levels of behavioral responsiveness in eastern chipmunks (Tamias striatus), and the impact of behavioral plasticity and home range selection on disperser mortality and weight change in virtual American martens (Martes americana). These simulations highlight the relevance of SEARCH for a variety of applications and illustrate benefits it can provide for conservation planning.


Asunto(s)
Ecosistema , Animales , Conducta Animal
9.
J Med Entomol ; 49(6): 1485-94, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23270180

RESUMEN

Results of an environmental assessment conducted in a newly emergent focus of murine typhus in southern California are described. Opossums, Didelphis virginiana Kerr, infested with cat fleas, Ctenocephalides felis Buché, in the suburban area were abundant. Animal and flea specimens were tested for the DNA of two flea-borne rickettsiae, Rickettsia typhi and Rickettsia felis. R. felis was commonly detected in fleas collected throughout this area while R. typhi was found at a much lower prevalence in the vicinity of just 7 of 14 case-patient homes identified. DNA of R. felis, but not R. typhi, was detected in renal, hepatic, and pulmonary tissues of opossums. In contrast, there were no hematologic polymerase chain reaction findings of R. felis or R. typhi in opossums, rats, and cats within the endemic area studied. Our data suggest a significant probability of human exposure to R. felis in the area studied; however, disease caused by this agent is not recognized by the medical community and may be misdiagnosed as murine typhus using nondiscriminatory serologic methods.


Asunto(s)
Rickettsia felis/aislamiento & purificación , Rickettsia typhi/aislamiento & purificación , Siphonaptera/microbiología , Tifus Endémico Transmitido por Pulgas/microbiología , Animales , California/epidemiología , Gatos , Enfermedades Endémicas , Femenino , Humanos , Masculino , Ratones , Zarigüeyas , Ratas , Tifus Endémico Transmitido por Pulgas/epidemiología
10.
J Med Entomol ; 49(3): 687-96, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22679878

RESUMEN

The host preference of a vector mosquito species plays a significant role in determining human and animal risk of infection with mosquito-transmitted pathogens. Host preferences of common southern California Culex species for four bird species, American crow (Corvus brachyrhynchos), house sparrow (Passer domesticus), house finch (Carpodacus mexicanus), and mourning dove (Zenaida macroura), were examined by determining the proportion of each mosquito species that successfully engorged on each of the four bird species presented equally within a net trap to wild host-seeking mosquitoes. Bloodmeals in engorged mosquitoes captured within the net trap were identified to avian species by using a multiplex polymerase chain reaction assay targeting the cytochrome b gene sequence. There were significant differences in host selection by all three Culex species captured in numbers sufficient for analysis, with Culex erythrothorax Dyar preferentially biting American crows, Culex tarsalis Coquillett preferentially biting house sparrows, and Culex quinquefasciatus Say preferentially biting house finches. All three Culex species demonstrated more frequent engorgement on passerine birds (sparrows, finches, and crows) than the nonpasserine mourning dove. A greater preference for passerine birds might be expected to increase the transmission of pathogens, such as West Nile virus, to which passerine birds are particularly competent hosts.


Asunto(s)
Culex/fisiología , Especificidad del Huésped , Insectos Vectores/fisiología , Pájaros Cantores/parasitología , Fiebre del Nilo Occidental/veterinaria , Animales , California , Femenino
11.
Vector Borne Zoonotic Dis ; 11(8): 1063-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21438695

RESUMEN

Transmission of West Nile virus (WNV) on mainland California poses an ongoing threat to the island scrub-jay (ISSJ, Aphelocoma insularis), a species that occurs only on Santa Cruz Island, California, and whose total population numbers <5000. Our report describes the surveillance and management efforts conducted since 2006 that are designed to understand and mitigate for the consequences of WNV introduction into the ISSJ population. We suspect that WNV would most likely be introduced to the island via the movement of infected birds from the mainland. However, antibody testing of >750 migrating and resident birds on the island from 2006 to 2009 indicated that WNV had not become established by the end of 2009. Several species of competent mosquito vectors were collected at very low abundance on the island, including the important mainland vectors Culex tarsalis and Culex quinquefasciatus. However, the island was generally cooler than areas of mainland California that experienced intense WNV transmission, and these lower temperatures may have reduced the likelihood of WNV becoming established because they do not support efficient virus replication in mosquitoes. A vaccination program was initiated in 2008 to create a rescue population of ISSJ that would be more likely to survive a catastrophic outbreak. To further that goal, we recommend managers vaccinate >100 ISSJ each year as part of ongoing research and monitoring efforts.


Asunto(s)
Enfermedades de las Aves/prevención & control , Enfermedades de las Aves/virología , Fiebre del Nilo Occidental/prevención & control , Vacunas contra el Virus del Nilo Occidental/administración & dosificación , Animales , Enfermedades de las Aves/epidemiología , Enfermedades de las Aves/transmisión , Aves , California/epidemiología , Estudios de Casos y Controles , Culex/virología , Vigilancia de Guardia , Temperatura , Vacunación/métodos , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/transmisión , Virus del Nilo Occidental/inmunología , Virus del Nilo Occidental/aislamiento & purificación
12.
Am J Trop Med Hyg ; 83(6): 1269-82, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21118934

RESUMEN

Southern California remains an important focus of West Nile virus (WNV) activity, with persistently elevated incidence after invasion by the virus in 2003 and subsequent amplification to epidemic levels in 2004. Eco-epidemiological studies of vectors-hosts-pathogen interactions are of paramount importance for better understanding of the transmission dynamics of WNV and other emerging mosquito-borne arboviruses. We investigated vector-host interactions and host-feeding patterns of 531 blood-engorged mosquitoes in four competent mosquito vectors by using a polymerase chain reaction (PCR) method targeting mitochondrial DNA to identify vertebrate hosts of blood-fed mosquitoes. Diagnostic testing by cell culture, real-time reverse transcriptase-PCR, and immunoassays were used to examine WNV infection in blood-fed mosquitoes, mosquito pools, dead birds, and mammals. Prevalence of WNV antibodies among wild birds was estimated by using a blocking enzyme-linked immunosorbent assay. Analyses of engorged Culex quinquefasciatus revealed that this mosquito species acquired 88.4% of the blood meals from avian and 11.6% from mammalian hosts, including humans. Similarly, Culex tarsalis fed 82% on birds and 18% on mammals. Culex erythrothorax fed on both birds (59%) and mammals (41%). In contrast, Culex stigmatosoma acquired all blood meals from avian hosts. House finches and a few other mostly passeriform birds served as the main hosts for the blood-seeking mosquitoes. Evidence of WNV infection was detected in mosquito pools, wild birds, dead birds, and mammals, including human fatalities during the study period. Our results emphasize the important role of house finches and several other passeriform birds in the maintenance and amplification of WNV in southern California, with Cx. quinquefasciatus acting as both the principal enzootic and "bridge vector" responsible for the spillover of WNV to humans. Other mosquito species, such as Cx. tarsalis and Cx. stigmatosoma, are important but less widely distributed, and also contribute to spatial and temporal transmission of WNV in southern California.


Asunto(s)
Aves/sangre , Insectos Vectores , Mamíferos/sangre , Fiebre del Nilo Occidental/veterinaria , Virus del Nilo Occidental/fisiología , Animales , Anticuerpos Antivirales/sangre , California/epidemiología , Culex , Femenino , Humanos , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/virología
13.
PLoS One ; 5(11): e15437, 2010 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-21103053

RESUMEN

Understanding the conditions underlying the proliferation of infectious diseases is crucial for mitigating future outbreaks. Since its arrival in North America in 1999, West Nile virus (WNV) has led to population-wide declines of bird species, morbidity and mortality of humans, and expenditures of millions of dollars on treatment and control. To understand the environmental conditions that best explain and predict WNV prevalence, we employed recently developed spatial modeling techniques in a recognized WNV hotspot, Orange County, California. Our models explained 85-95% of the variation of WNV prevalence in mosquito vectors, and WNV presence in secondary human hosts. Prevalence in both vectors and humans was best explained by economic variables, specifically per capita income, and by anthropogenic characteristics of the environment, particularly human population and neglected swimming pool density. While previous studies have shown associations between anthropogenic change and pathogen presence, results show that poorer economic conditions may act as a direct surrogate for environmental characteristics related to WNV prevalence. Low-income areas may be associated with higher prevalence for a number of reasons, including variations in property upkeep, microhabitat conditions conducive to viral amplification in both vectors and hosts, host community composition, and human behavioral responses related to differences in education or political participation. Results emphasize the importance and utility of including economic variables in mapping spatial risk assessments of disease.


Asunto(s)
Culicidae/virología , Clase Social , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/aislamiento & purificación , Algoritmos , Animales , California/epidemiología , Ambiente , Geografía , Humanos , Incidencia , Insectos Vectores/virología , Pobreza/estadística & datos numéricos , Prevalencia , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/transmisión
14.
J Pediatr Orthop ; 29(6): 564-9, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19700984

RESUMEN

BACKGROUND: The Ponseti method has been shown to be a highly effective way to correct congenital clubfeet nonoperatively. Children treated with the technique frequently require percutaneous Achilles tenotomies, however, and until recently have experienced frequent relapses of their deformity. The purpose of this study was to see if Botulinum a A toxin (BTX-A) (manufactured by Allergan, Irvine CA) and administered before starting treatment with the Ponseti method might decrease the time in cast to correction, reduce the need for percutaneous Achilles tenotomy, and reduce the frequency of relapse. METHODS: After IRB approval and informed consent, 20 newborns (age 0 to 30 d) with Dimeglio lll congenital clubfeet (N=32) were randomized into either BTX-A or placebo groups. All clubfeet underwent serial manipulation and casting according to the Ponseti technique. Outcomes measured were days in cast to correction of deformity (judged clinically and radiographically), and the need for percutaneous Achilles tenotomy to achieve correction. Recurrence requiring further treatment after initial correction was also recorded. RESULTS: We were unable to demonstrate a significant difference (t test and chi2 procedures) between the BTX-a group and the placebo group in the outcomes measured. CONCLUSIONS: We were not able to demonstrate that BTX-A as administered in this study speeds correction, reduces the need for percutaneous Achilles tenotomy, or decreases the chance of relapse after treatment when used as an adjunct to serial manipulation and casting for congenital clubfoot. It is possible that BTX-A could have a treatment effect that due to the power of our study would not have been detected by our study. LEVEL OF EVIDENCE: Level 1b.


Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Moldes Quirúrgicos , Pie Equinovaro/terapia , Fármacos Neuromusculares/uso terapéutico , Tendón Calcáneo/cirugía , Preescolar , Pie Equinovaro/fisiopatología , Terapia Combinada , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Prevención Secundaria , Resultado del Tratamiento
15.
J Child Orthop ; 2(1): 11-4, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19308597

RESUMEN

In patients with immature skeletons, ligamentous injuries rarely accompany ankle fractures. In this article, we report about deltoid ligament tears and syndesmotic disruptions accompanying triplane ankle fractures in two children, and make recommendations as to the evaluation and treatment of children with such injuries.

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