The First Record of Aedes vittatus (Diptera: Culicidae) in the Dominican Republic: Public Health Implications of a Potential Invasive Mosquito Species in the Americas.

Aedes vittatus Bigot is distributed throughout Africa, tropical Asia, and southern Europe and occurs in sylvatic as well as peridomestic environments where it readily feeds on humans. Although the vectorial capacity of Ae. vittatus is not well understood, this species is known to play a role in the maintenance and transmission of yellow fever, Zika, chikungunya, and dengue virus within its native range. In October 2019, after a routine inspection of mosquito-breeding containers in Jarabacoa, Dominican Republic, two Ae. vittatus females were captured via human landing catch method. After this finding, a CDC miniature light trap was deployed at the point of initial detection from 18:00 to 08:00 h, 2 d/wk from 3 to 31 October 2019. Potential larval habitats were also sampled via traditional dip method once per week spanning a 150 m radius from point of initial detection. In addition to the 2 adult females, 10 female and 2 male Ae. vittatus were captured. One Ae. vittatus larva also was found in a small puddle formed by an animal hoof print. Conventional PCR and Sanger sequencing were used to confirm morphological identification of collected specimens. This is the first detection of Ae. vittatus in the Dominican Republic as well as the Americas. Therefore, enhanced surveillance is needed to better understand the range and public health risks this potential invasive mosquito species may pose in the Dominican Republic, other Caribbean Islands, and/or the Americas.

Housework, paid work and psychiatric symptoms.

OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio - PR=2.04, 95% confidence interval - CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.

Selective screening for cervical neoplasia: an approach for resource-poor settings.

BACKGROUND: Cervical malignancies are the leading cause of cancer-related morbidity and mortality among women in developing countries. Although early detection programmes using cytological methods, followed by aggressive treatment of precursor lesions are accepted as the main disease control strategy, fiscal limitations make this strategy unfeasible in many countries. METHODS: To screen selectively, we developed two risk scores using data from a population-based case-control study in Jamaica with 202 cases and 363 controls. Independent risk factors for cervical neoplasia were determined using logistic regression. An unweighted risk score for each subject was developed by a simple count of risk factors present and a weighted risk score was calculated by summing regression coefficients for each risk factor. RESULTS: Four patient characteristics were independently predictive of cervical neoplasia, older age (OR = 3.4, 95% CI : 1.8-6.7), > or = 4 pregnancies (OR = 5.6, 95% CI : 1.2-18.7), poverty (OR = 2.1, 95% CI : 1.3-3.3) and cigarette smoking (OR = 1.9, 95% CI : 1.2-3.2). Using cut-off points of > or = 20 for the weighted scores and > 3 for unweighted scores, the sensitivity and specificity were 65% and 69% for the unweighted score and 75% and 61%, respectively, for the weighted score. Areas under the receiver operating characteristic (ROC) curves for the weighted versus the unweighted scores were similar, suggesting similar overall accuracy. CONCLUSION: Selective screening using risk assessment strategies is potentially useful, particularly in resource-poor settings. However, whether weighting factors is essential is dependent on prevalence of factors in a given setting. Although this approach needs validation in other populations, women at highest risk for cervical neoplasia can be identified using demographic factors available during a regular clinic visit.

Informal jobs: another occupational hazard for women's mental health?

OBJECTIVES: The hypothesis that informal jobs, which imply absence of formal labour contracts, instability and the absence of fringe benefits, are positively associated with psychiatric symptoms was evaluated in a poor urban area of Brazil. METHODS: With data from a cross-sectional study, the association between informal jobs and high number of psychological symptoms was estimated. The study population was composed of 327 women randomly selected from a community in the city of Salvador, Brazil. Women who reported having a job without a formal contract were classified as informal workers. Psychological symptoms were collected through a validated questionnaire, the QMPA. RESULTS: A positive association between informal work and a high number of psychological symptoms was found (crude prevalence ratio = 1.88, 95% confidence interval [CI]: 1.24-2.85). More than 4 hours of housework a day and being a family head were confounders, although adjustment for these variables did not significantly change the results (adjusted prevalence ratio = 1.97, 95% CI: 1.26-3.09). CONCLUSIONS: These findings are suggestive that informal work may be a risk for mental symptoms. Reinforcement of universal labour rights coverage and improvement in housework sharing are recommended.

Effect of pulse dexamethasone therapy on the incidence and severity of chronic lung disease in the very low birth weight infant.

We conducted a prospective, randomized, double-blind trial to assess the efficacy and safety of pulse doses of dexamethasone on survival without supplemental oxygen in very low birth weight infants at high risk of having chronic lung disease. Seventy-eight infants with birth weights < or = 1500 gm who were ventilator dependent at 7 days of postnatal age were randomly assigned to receive pulse doses of dexamethasone, 0.5 mg/kg per day, divided twice daily (n = 39), or an equivalent volume of saline solution placebo (n = 39), for 3 days at 10-day intervals until they no longer required supplemental oxygen or assisted ventilation, or reached 36 weeks of postmenstrual age. At study entry, the groups did not differ by birth weight, gestational age, or severity of lung disease. At 36 weeks of postmenstrual age, there was both a significant increase in survival rates without oxygen supplementation (p = 0.03) and a significant decrease in the incidence of chronic lung disease (p = 0.047) in the group that received pulse therapy. Supplemental oxygen requirements were less throughout the study period in the group that received repeated pulse doses of dexamethasone (p = 0.013). The total numbers of deaths and the durations of supplemental oxygen, ventilator support, and hospital stay did not differ between groups. Recorded side effects in the pulse therapy group were minimal and included an increase in the use of insulin therapy for hyperglycemia (p < 0.05). We conclude that in this population of very low birth weight infants, treatment with pulse doses of dexamethasone resulted in improvement in pulmonary outcome without clinically significant side effects.

Recognition of malposition of the liver and spleen: CT, MRI, nuclear scan and fluoroscopic imaging.

Thirteen children initially suspected to have an intrathoracic or intraabdominal mass had malposition of the liver and/or spleen discovered by ultrasound. This group consisted of five children with diaphragmatic eventration or hernia and eight with wandering spleen or liver. Careful ultrasonographic examinations were diagnostic in all patients; seven had surgical confirmation. CT, MRI, nuclear scan and fluoroscopic imaging were useful in select instances. The liver and spleen have a characteristic anatomic configuration and sonographic appearance that should enable them to be recognized, and pathological alterations appreciated, even when these organs are ectopic in location or malformed.

The influence of social and political violence on the risk of pregnancy complications.

BACKGROUND: Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. METHODS: Neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from "high-violence" and three from "low-violence" neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. RESULTS: Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR = 5.0; 95% CI = 1.9-12.6; p less than 0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. CONCLUSION: Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women.

Pancreatic ductal abnormalities in children.

From 1979 to 1990, 33 children required operative treatment for pancreatitis. Causes included ductal abnormalities (12 children), trauma (10 children), idiopathic (four children), gallstones (three children), drug-induced (three children), and tumor (one child). This study reviews the characteristics and outcome of the 12 children with ductal abnormalities. Symptoms were present up to 9 years or less before diagnosis, with two patients undergoing negative appendectomies. At diagnosis, amylase levels averaged 612 IU/L and lipase, 4761 IU/L. Preoperative studies included ultrasonography (11 children), endoscopic retrograde cholangiopancreatography (nine children), and computerized tomography (six children). Intraoperative cholangiopancreatography was performed in nine patients and was essential in four to diagnosis their anomaly. Patients were categorized into those with a common channel (three children), ampullary stenosis (two children), ductal fusion error (one child), or combinations (six children). Operations included sphincteroplasty (seven patients), pancreaticobiliary separation (six patients), pancreatic duct enterostomy (three patients), and distal pancreatectomy (one patient). Three patients required more than one procedure to repair the combination anomalies. Symptoms resolved immediately in nine patients. Two patients had delayed resolution, with one patient requiring the addition of somatostatin. One patient was lost to follow-up. Recurrent or protracted pancreatitis, without obvious cause, requires expeditious endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiopancreatography. Operative therapy should be tailored to ductal anatomy and will resolve symptoms in most children.

Adrenal hemorrhage after liver transplantation.

During orthotopic liver transplantation, ligation and division of the right adrenal vein during recipient hepatectomy may lead to hemorrhagic infarction and/or hematoma formation in the right adrenal gland. Findings in seven liver transplant recipients included initially echogenic or anechoic suprarenal masses on ultrasound scans and inhomogeneous but predominantly hypoattenuating masses on computed tomographic scans. In patients who survived for 4 months or longer, hematomas resolved as early as 20 days and persisted as long as 11 weeks. There was autopsy proof of adrenal hemorrhage in three cases. The adrenal hematomas in this series produced no massive hemorrhages, adrenal insufficiency, or other clinical manifestations. Adrenal hemorrhage after liver transplantation should be recognized and specifically documented, but a hematoma that remains stable in size can be left alone.

Gastric trichobezoars--sonographic and computed tomographic appearance.

We report two young girls with gastric trichobezoars in whom ultrasound, computed tomography and upper gastrointestinal contrast studies were done. Since sonography and, less frequently, computed tomography are usually the first studies obtained in a child with an abdominal mass it is important to recognize the rather distinctive appearance of a trichobezoar on these images.

Primary alveolar capillary dysplasia.

We describe two neonates with a lethal form of pulmonary maldevelopment. Both infants had bilateral dysplastic immature lungs with poor capillary formation and lack of alveolar development. This rare entity should be considered in the differential diagnosis of a newborn infant with mild diffuse radiographic pulmonary abnormality and severe respiratory distress.

Neonatal abdominal calcification: is it always meconium peritonitis?

Intraluminal meconium calcifications are a rare cause of neonatal abdominal calcifications and can easily be misinterpreted as meconium peritonitis. We report three patients with anorectal anomalies, rectourethral fistula, and intraluminal calcified meconium. Intestinal stasis and mixing of urine and meconium may be predisposing factors for the calcification of meconium. Intraluminal calcifications appear as discrete punctate flecks within the distribution of the bowel, in contrast to meconium peritonitis, where the calcifications are linear and plaque-like, occurring anywhere in the abdominal cavity and scrotum. Careful differentiation of abdominal calcifications will allow more appropriate planning of the need and timing of surgery and can suggest the possibility of other anomalies that may not be suspected initially.

[Politico-administrative distribution of nutritional status according to a height census of 1st grade school children in Panama]. / Distribución político-administrativa del estado nutricional según el censo de talla de niños escolares del primer grado en Panama.

Height is the anthropometric measurement that best summarizes the effects of socioeconomic factors on the health and nutritional status of a given community. For the purpose of identifying the lowest disaggregation level, the political-administrative areas with the highest malnutrition prevalences, a height census that included 58,000 children who attended the 3,000 schools of the country was carried out. The Republic of Panama is politically-administratively divided into 9 provinces, 65 districts, one Indian community and 505 "corregimientos." The results obtained showed marked differences in height retardation among provinces, among districts and among "corregimientos." In the latter, retardation in first grade children varies from 0 to 95%. Important differences were also observed within a same district among "corregimientos", as is the case with the District of Natá, which vary from 4 to 40%. The height census permitted the identification and quantification of nutritional damage in 28 districts and 204 priority "corregimientos", where it is expected, resources from the public sector will be assigned in order to substantially reduce the prevailing poverty, as well as the food and nutrition problems.

Pediatric trauma associated with all-terrain vehicles.

The frequency of injuries secondary to use of all-terrain vehicles (ATV) is increasing at an alarming rate, and these injuries are usually multiple and severe. Between January 1, 1983, and February 28, 1985, 415 pediatric patients were admitted to the University of Virginia Hospital for care of injuries secondary to trauma; 66 of these patients required intensive care. Of the 415 patients, 12 were injured secondary to ATV use, and four of these required intensive care. The average age was 12 years (range 2 to 16 years), and the average hospital stay was 20 days. Injuries included five closed head injuries, two associated with a basilar skull fracture requiring intracranial pressure monitoring; five long bone fractures, two requiring open reduction and internal fixation; two small bone fractures; two splenic ruptures; two liver lacerations, one of them requiring laparotomy; and one renal hematoma. One patient has required long-term rehabilitation for neurologic deficits. Physicians and the public should be aware of the injury potential of these vehicles and should advocate legislation promoting helmet laws and high safety standards for ATV users.