How to Review a Surgical Scientific Paper: A Guide for Critical Appraisal.

It is important for surgeons to participate in the peer-review process of scientific literature. As the number of published manuscripts continues to increase, there is a great need for volunteerism in this arena. However, there is little formal or informal training, which can help surgeons provide unbiased and meaningful reviews. Therefore, it is critical to provide more resources and guidelines to aid surgeons during the review process. The purpose of this paper is to provide a structured guide for a quality review of a surgical paper. This review represents the work of the Association of Women Surgeons Publications Committee.

Surgical job negotiations: How current literature and expert opinion can inform your strategies.

BACKGROUND: Negotiation is an essential professional skill. Surgeons negotiating new roles must consider: 1) career level (e.g., new graduate, mid-career or leadership), 2) practice environment (e.g., academic, private practice), 3) organization (e.g., academic, university-affiliated, specialized center), and 4) work-life needs (e.g., geography, joint recruitment). METHODS: A review of the literature related to surgical job negotiation was conducted. Expert opinion was also sought. RESULTS: Current data and experience suggest that negotiation must be tailored to practice type, surgeon experience/skill set and should always occur with the advice of legal counsel. Understanding principled negotiation and engaging in preparation and practice will also improve negotiation skills. CONCLUSIONS: Our findings shed light on common blind spots among surgeons negotiating new professional roles and provide guidance on optimizing job negotiation skills.

Correlation between GLA variants and alpha-Galactosidase A profile in dried blood spot: an observational study in Brazilian patients.

BACKGROUND: Fabry disease is a rare X-linked inherited disorder caused by deficiency of α-Galactosidase A. Hundreds of mutations and non-coding haplotypes in the GLA gene have been described; however, many are variants of unknown significance, prompting doubts about the diagnosis and treatment. The α-Galactosidase A enzymatic activity in dried blood spot (DBS) samples are widely used for screening purposes; however, even when values below the normal are found, new tests are required to confirm the diagnosis. Here we describe an analysis of GLA variants and their correlation with DBS α-Galactosidase A enzymatic activity in a large Brazilian population with Fabry disease symptoms. RESULTS: We analyzed GLA variants by DNA sequencing of 803 male patients with suspected Fabry disease or belonging to high-risk populations; in 179 individuals, 58 different exonic variants were detected. From these, 50 are variants described as pathogenic and eight described as variants of unknown significance. The other individuals presented complex non-coding haplotypes or had no variants. Interestingly, the enzymatic activity in DBS was different among pathogenic variants and the other genotypes, including variants of unknown significance; the first presented mean of 12% of residual activity, while the others presented levels above 70% of the activity found in healthy controls. CONCLUSION: The activity of α-Galactosidase A in DBS was markedly reduced in males with known pathogenic variants when compared with subjects presenting variants of unknown significance, non-coding haplotypes, or without variants, indicating a possible non-pathogenic potential of these latter genotypes. These findings bring a better understanding about the biochemical results of α-Galactosidase A in DBS samples, as well as the possible non-pathogenic potential of non-coding haplotypes and variants of unknown significance in GLA gene. These results certainly will help clinicians to decide about the treatment of patients carrying variants in the gene causing this rare but life-threatening disease.

Greening the operating room.

BACKGROUND: Climate change will affect most populations in the next decades and put the health of billions of people at risk. Health care facilities represent a significant source of pollution around the world and contribute to environmental changes. To address this topic, we performed a review of the available literature on tactics to reduce operating room (OR) waste and the potential of these strategies to impact the environment. DATA SOURCES: A literature search was performed querying PubMed, Web of Science, and Science Direct. No comparative data were found; most were opinion papers, white papers, and case studies. For this reason, we proceeded with a narrative review, which provides an overview of the evidence on this topic and identifies areas for future research. RESULTS: This systematic review summarizes the available literature on the 5 "Rs" of waste management: reduction, reusing, recycling, rethinking, and renewable energies. CONCLUSIONS: Surgery has a unique opportunity to transition to more environmentally-friendly operating room strategies, which may help decrease waste and lessen the impact of climate change.

New mariner elements in Anastrepha species (Diptera: Tephritidae).

Mariner-like elements (MLE) are members from class II of transposable elements also known as DNA transposons. These elements have a wide distribution among different groups of organisms, including insects, which can be explained by horizontal and vertical gene-transfer. MLE families have been described in tephritid flies and other genera. During screening for Wolbachia bacteria in fruit flies of the genus Anastrepha, we discovered two sequences related to mariner-like elements. Based on these sequences, we designed primers that allowed us to isolate and characterize two new mariner-like elements (Anmar1 and Anmar2) in Anastrepha flies. These elements, which belong to the mellifera and rosa subfamilies have a low nucleotide diversity, and are probably inactive and acquired by vertical transfer. This is the first report of mariner-like transposons in flies found in South America.

Feeding habits of the shortnose guitarfish, Zapteryx brevirostris (Müller and Henle, 1841) (Elasmobranchii, Rhinobatidae) in southeastern Brazil.

The feeding habits of the shortnose guitarfish, Zapteryx brevirostris, were studied based on 382 specimens from the northern São Paulo coast, southeast Brazil. The diet showed a predominance of crustaceans (carideans and amphipods), polychaete annelids, and occasionally small fish, sipunculids, and cephalopods. The diets of males and females were similar; however, differences in the proportion of prey items were found among juveniles, subadults, and adults. Differences in the ingestion of prey items were found during the year, probably influenced by oceanographic parameters, although in general, the species feeds mostly on crustaceans and polychaetes.

Feeding habits of the shortnose guitarfish, Zapteryx brevirostris (Müller and Henle, 1841) (Elasmobranchii, Rhinobatidae) in southeastern Brazil / Hábito alimentar da raia-viola-de-focinho-curto, Zapteryx brevirostris (Müller e Henle, 1841) (Elasmobranchii, Rhinobatidae) no sudeste do Brasil

The feeding habits of the shortnose guitarfish, Zapteryx brevirostris, were studied based on 382 specimens from the northern São Paulo coast, southeast Brazil. The diet showed a predominance of crustaceans (carideans and amphipods), polychaete annelids, and occasionally small fish, sipunculids, and cephalopods. The diets of males and females were similar; however, differences in the proportion of prey items were found among juveniles, subadults, and adults. Differences in the ingestion of prey items were found during the year, probably influenced by oceanographic parameters, although in general, the species feeds mostly on crustaceans and polychaetes.

Foram estudados os hábitos alimentares da raia-viola-de-focinho-curto, Zapteryx brevisrostris, com base em 382 espécimes coletados no litoral norte de São Paulo, sudeste do Brasil. A dieta mostrou predominância de crustáceos (carídeos e anfípodes), anelídeos poliquetos e ocasionalmente pequenos peixes, sipunculídeos e cefalópodes. A dieta de machos e fêmeas mostrou-se similar, entretanto, juvenis, subadultos e adultos demonstraram diferenças na composição de presas. As frequências dos itens diferiram ao longo do ano, provavelmente influenciadas por fatores oceanográficos, embora, em geral, a espécie se alimente predominantemente de crustáceos e poliquetos.

Feeding habits of the shortnose guitarfish, Zapteryx brevirostris (Müller and Henle, 1841) (Elasmobranchii, Rhinobatidae) in southeastern Brazil

The feeding habits of the shortnose guitarfish, Zapteryx brevirostris, were studied based on 382 specimens from the northern São Paulo coast, southeast Brazil. The diet showed a predominance of crustaceans (carideans and amphipods), polychaete annelids, and occasionally small fish, sipunculids, and cephalopods. The diets of males and females were similar; however, differences in the proportion of prey items were found among juveniles, subadults, and adults. Differences in the ingestion of prey items were found during the year, probably influenced by oceanographic parameters, although in general, the species feeds mostly on crustaceans and polychaetes.

Foram estudados os hábitos alimentares da raia-viola-de-focinho-curto, Zapteryx brevisrostris, com base em 382 espécimes coletados no litoral norte de São Paulo, sudeste do Brasil. A dieta mostrou predominância de crustáceos (carídeos e anfípodes), anelídeos poliquetos e ocasionalmente pequenos peixes, sipunculídeos e cefalópodes. A dieta de machos e fêmeas mostrou-se similar, entretanto, juvenis, subadultos e adultos demonstraram diferenças na composição de presas. As frequências dos itens diferiram ao longo do ano, provavelmente influenciadas por fatores oceanográficos, embora, em geral, a espécie se alimente predominantemente de crustáceos e poliquetos.

Sulfenic acid formation in human serum albumin by hydrogen peroxide and peroxynitrite.

Human serum albumin (HSA), the most abundant protein in plasma, has been proposed to have an antioxidant role. The main feature responsible for this property is its only thiol, Cys34, which comprises approximately 80% of the total free thiols in plasma and reacts preferentially with reactive oxygen and nitrogen species. Herein, we show that the thiol in HSA reacted with hydrogen peroxide with a second-order rate constant of 2.26 M(-1) s(-1) at pH 7.4 and 37 degrees C and a 1:1 stoichiometry. The formation of intermolecular disulfide dimers was not observed, suggesting that the thiol was being oxidized beyond the disulfide. With the reagent 7-chloro-4-nitrobenzo-2-oxa-1,3-diazol (NBD-Cl), we were able to detect the formation of sulfenic acid (HSA-SOH) from the UV-vis spectra of its adduct. The formation of sulfenic acid in Cys34 was confirmed by mass spectrometry using 5,5-dimethyl-1,3-cyclohexanedione (dimedone). Sulfenic acid was also formed from exposure of HSA to peroxynitrite, the product of the reaction between nitric oxide and superoxide radicals, in the absence or in the presence of carbon dioxide. The latter suggests that sulfenic acid can also be formed through free radical pathways since following reaction with carbon dioxide, peroxynitrite yields carbonate radical anion and nitrogen dioxide. Sulfenic acid in HSA was remarkably stable, with approximately 15% decaying after 2 h at 37 degrees C under aerobic conditions. The formation of glutathione disulfide and mixed HSA-glutathione disulfide was determined upon reaction of hydrogen peroxide-treated HSA with glutathione. Thus, HSA-SOH is proposed to serve as an intermediate in the formation of low molecular weight disulfides, which are the predominant plasma form of low molecular weight thiols, and in the formation of mixed HSA disulfides, which are present in approximately 25% of circulating HSA.

El impacto económico de las infecciones nosocomiales en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social (Enero a Diciembre, 1987) / The economic impact of the nosocomials infections in the Complejo Hospitalario Metropolitano de la Caja de Seguro Social (january a december, 1987)

Las infecciones nosocomiales aumentan la morbilidad, la mortalidad y el costo de la reclusión institucional. El Comité de Infecciones Nosocomiales del Complejo Hospitalario Metropolitano de la Caja de Seguro Social de Panamá (CHMCSS) hizo el estudio del problema en el año de 1987 y determinó que de un total de 29.576 pacientes admitidos, 820 pacientes desarrollaron 994 infecciones asociadas al hospital (prevalencia anual de 3.69 por ciento). Esta incidencia representó 5,191 días adicionales de reclusión, un costo conservador de $840.153 balboas, y fue la causa de 24 fallecimientos. Se recomienda un eficiente y adecuado programa de control de las infecciones asociadas al nosocomio

Evaluación microbiológica de la efectividad de un compuesto de clorhexidina al 0.2 (por ciento) frente a ciertos microorganismos periodontopáticos / Microbiological evaluation of the efectivity one compound the clorhexidina 0.2 (por ciento) front a some microorganism periodontopatics

Las enfermedades periodontales inflamatorias crónicas, causadas por bacterias gram negativas anaerobicas esencialmente, son responsables del 70 (por ciento) de las pérdidas dentales en los pacientes adultos. Hasta recientemente, la mejor manera de controlar estas enfermedades era mediante métodos mecánicos, pero ahora se ensaya con éxito, sobre todo en los países europeos, con el gluconato de clorhexidina para lograr este propósito. En el presente trabajo se evalúa la efectividad de este compuesto de clorhexidina producido localmente, mediendo su actividad inhibitoria en concentraciones predeterminadas frente a doce cepas microbianas estandarizadas, algunas periodontopáticas. Demostramos que el gluconato de clorhexidina requiere <30 segundos para tener acción letal sobre varios microorganismos, entre ellos especies periodontopáticas; tiene acción letal en una concentración de 0.2 (por ciento) frente a Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus viridans, Escherichia coli, Bacteroides melaninogenicus, Actinomyces viscosus y Candida albicans. Determinada la eficacia del producto local de gluconato de clorhexidina frente a varios microorganismos, nos encontramos en condiciones de estudiar la acción de este compuesto en el paciente para prevenir y/o eliminar la formación de la placa dentobacteriana

Prevalencia de la infección por Paracoccidioides brasiliensis en niños panameños: informe preliminar / The prevalence of Paracoccidioides brasiliensis in panamanian children: preliminary report

Mediante la aplicación intracutánea de 50 microgramos de paracoccidioidina en 110 niños demostramos la prevalencia de infección debida a la Paracoccidioides brasiliensis en 14 (12.73%) niños. Los varones se infectaron más frecuentemente que las mujeres, en proporción de 1.45:1. El niño de menor edad tenía 2 años. Observamos una relación directa entre la edad y la frecuencia de la infección (a mayor edad aumenta el número de niños con reacción positiva); siempre más frecuente en el varón. El 93% (13 de 14) de los niños infectados, vive y se desarrolla en ambiente rural

Infección por Paracoccidioides brasiliensis en personas residentes en Coclé y en Veraguas, República de Panamá / Infection by Paracoccidioides brasiliensis in residents persons in Coclé and in Veraguas, República de Panamá

La aplicación intracutánea de paracoccidioidina, obtenida por sonificación y lisis de la fase en levadura del hongo, a 111 personas de la provincia de Veraguas (68 varones y 43 mujeres) y a 130 individuos de la provincia de Coclé (57 varones y 73 mujeres) produjo en 10 de los 111 (9.01%) veraguenses y en 34 de los 130 (26.15%) coclesanos una reacción de tipo papular, entre 5 y 27 mm de diámetro (la mayoría entre 11 y 20 mm). La infección era más frecuente entre los hombres (1:1.47 en Veraguas y 1:1.28 en Coclé). Se demuestra que la prevalencia de infección con P. brasiliensis en la República de Panamá es de 21.95%

Detección de aflatoxinas y aislamiento de Aspergillus flavus toxigênico en maiz y arroz

Se estudió la contaminación con aflatoxinas y la presencia de Aspergillus flavus toxigénico en 50 muestras de maíz y 50 muestras de arroz obtenidas de abarroterías y empresas distribuidoras de cereales en la Ciudad de Panamá. Los resultados demonstraron que 26 (52%) de las muestras de arroz estaban contaminadas con aflatoxinas, a niveles iguales o mayores a los 5 microgramos. Los estudios micológicos demonstraron que el hongo productor de aflatoxinas estaba presente en 34 (68%) especímenes de maíz y en 25 (50%) muestras de arroz. Se discute la importancia de estos hallazgos y las implicaciones que para la salud humana representa el consumo de cereales contaminados con aflatoxinas

Motivación y educación en el control de infecciones nosocomiales / Motivation and education in control of nasocomial infections

Consideramos importante analizar el papel de la educación y la motivación en todo programa de control de infecciones nosocomiales, dado que éstos son y serán siempre uno de los riesgos ineludibles para todo paciente recluído en una institución de salud. Se establece la íntima relación existente entre educación y motivación, y planteamos como mecanismos para lograr la sensibilización los siguientes: el desarrollo y mantenimiento de programas de educación en servicio permanentes que abarcan todos los empleados; la edecuación de estos programas para el nivel del personal; y la inclusión de información sobre los principios y fundamentos de los reglamentos vigentes para el control de infecciones nosocomiales. Se describe el perfil del personal que desarrolla el programa de control de infecciones asociadas al hospital y se mencionan algunos de los obstáculos que dificultan el cumplimiento del programa. Finalmente, acetamos las limitaciones humanas y exhortamos a que éstas se mantengan a su mínima expresión

Infección por Paracoceidioides brasiliensis en la población panameña / Infection due to Paracoccidioides brasiliensis in a Panamenian population

Investigamos la prevalencia de infección con Paracoccidioides brasiliensis en la población panameña, mediante la intradermoreacción frente a la paracoccidioidina. El antígeno se aplicó a 893 personas de las distintas provincias de la República de Panamá. La reacción fue positiva en 205 (22.95%) personas, de las cuales 105 (51.2%) eran mujeres y 100 (48.8%) eran varones. La mayoría de los casos positivos eran de la provincia de Panamá (28.02%); la minoría, de la provincia de Bocas del Toro (14.47%). La alta inmunoprevalencia observada entre los agricultores del Darién confirmó la experiencia de otros investigadores, de la estrecha relación existente entre la infección y la actividad en el agro

Primer aislamiento de Paracoccidioides brasiliensis en Panamá / First isolation of Paracoccidioides brasiliensis

Comunicamos nuestra experiencia con el primer aislamiento de Paracoccidioides brasiliensis de la sangre periférica, en un agricultor panameño de 59 años de edad, después de varias semanas de incubación; la demostración del dimorfismo se obtuvo a los 60 días de incubación a temperatura ambiente, en caldo de Sabouraud

Reactividad cutánea de la población Panameña frente a tres antígenos fúngicos / Cutaneous reactivity of the Panamean population to 3 fungal antigens

Se determina la prevalencia de infección con tres hongos dimórficos mediante la administración intradérmica de sus respectivos antígenos a 555 individuos en la República de Panamá. Así se demuestra una prevalencia de infección con Histoplasma capsultum de 54.23%, con Paracoccidioides brasiliensis de 19.81% y con Sporothrix schenckii de 2.70%. Cabe señalar que antes de diagnosticarse el primer caso de paracoccidioidomicosis en Panamá, ya se tenía conocimiento de la infección por medio de la cutirreacción con el antígeno específico. Se observaron reacciones cruzadas entre los antígenos de H. capsulatum, P. brasiliensis y S. schenckii al constatar que hubo 96 personas sensibles a dos antígenos y que cinco, fueron reactivos a los tres antígenos utilizados en la encuesta

[Fishing seawater microbiology of the Mar de Plata]. / Estudio microbiológico de las aguas del Puerto Pesquero de Mar del Plata

This work deals with different groups of microorganisms in the polluted water of the fishery section of Mar del Plata harbour and in the way followed by the fisher's boats. Bacteriological determinations were: total count, MPN of coliforms, proteolitic and anaerobic bacteria. These groups were selected because of their activity in fish spoilage and/or infection. The microbial groups were studied as follows: direct plate count for total number, most probable number (MPN) for coliforms and fecal type strains according with Mc Crady tables; proteolitic and anaerobic bacteria were cualitatively tested, cuantitative determinations are given in two tables. Obtained results show a heavy water pollution that rapidly decreases towards the harbour entrance.