Time of Cold Ischemia and Delayed Graft Function in a Cohort of Renal Transplant Patients in a Reference Center.

There are many factors involved in the delayed graft function of a renal graft, with prolonged cold ischemia time being one of the most relevant. The aim of this study is to evaluate the relationship between the time of cold ischemia and the delayed graft function, and acute rejection and graft loss at 1 year of follow-up. A retrospective cohort of 347 renal transplant patients were evaluated during the years 2009-2013. The incidence of delayed graft function was 18.4% (n = 65). The cold ischemia time was an independent risk factor for delayed graft function (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.16). By grouping the time of cold ischemia by intervals, the risk of delayed graft function was greater in the 12-18 hours group (OR 2.06, 95% CI 1.02-4.15) and in the >18 hours group (OR 3.38, 95% CI 1.57-7.27). The risk of acute rejection did not increase with longer cold ischemia (p = 0.69), and cold ischemia time was not a risk factor for renal graft loss at 1-year follow-up (hazard ratio 0.97, 95% CI 0.88-1.06). In conclusion the time of cold ischemia (>12 hours) in renal transplant recipients of optimal deceased donors increases the risk of delayed graft function; however, this does not negatively impact the results in acute rejection or graft loss in the first year of the transplant.

Oxidative stability of a colombian criollo mango (Mangifera indica) drink fortified with peel / Estabilidad oxidativa de una bebida de mango criollo colombiano (Mangifera Indica) fortificada con cáscara

Background: the analysis of the oxidative stability allows to determine the functionality of the antioxidants present in food, over time. Objectives: in this research, a functional mango drink is elaborated and the changes in the antioxidant profile and physicochemical parameters of the drink subjected to accelerated storage conditions are evaluated. Methods: the drink was distributed at 22, 35 and 45°C for 80 days. To monitor oxidative stability, the antioxidant analyzes ABTS, ORAC, mangiferin, total phenols and total carotenoids were performed; in addition, physicochemical properties (pH and °Bx) and L*a*b*coordinates, were monitored. The fit of the data to the Arrhenius model was verified and the shelf life was determined considering a 50% loss in the evaluated attributes, such as the critical limit. Results: the deterioration of the antioxidant attributes and the color at the study temperatures is observed, being more pronounced at 45°C. The least stable attributes are the carotenoids and the b-coordinate, presenting losses greater than 50%. The values of mangiferin exhibit deterioration lower than 40% and similar in the temperatures evaluated. The pH and Brix degrees do not show significant changes. The deterioration reactions are of order one and followed the Arrhenius law, presenting coefficients of determination greater than 0.90. The values of the activation energy (Ea) are within the range reported for fruit juices, standing out the value found for the b* coordinate (44.59 kJ.mol-1). Conclusions: the ORAC units are the chosen attribute to condition the life of the beverage, giving 10 months of useful life at 4°C, however, it is recommended to perform sensory and microbiological analyzes under the same conditions.

Antecedentes: el análisis de la estabilidad oxidativa permite determinar la funcionalidad de los antioxidantes presentes en los alimentos, en el tiempo. Objetivo: en esta investigación se elaboró una bebida funcional de mango y se evaluaron los cambios en el perfil antioxidante y los parámetros fisicoquímicos de la bebida sometida a condiciones aceleradas de almacenamiento. Métodos: la bebida se distribuyó a 22, 35 y 45°C durante 80 días. Para hacer el seguimiento de la estabilidad oxidativa, se realizaron los análisis antioxidantes ABTS, ORAC, Mangiferina, Fenoles Totales y Carotenoides totales; además, se realizó seguimiento de las propiedades fisicoquímicas (pH y °Bx) y las coordenadas L*a*b*. Se verificó el ajuste de los datos al modelo de Arrhenius y la vida útil se determinó teniendo en cuenta una pérdida del 50% en los atributos evaluados, como el límite crítico. Resultados: se observó el deterioro de los atributos antioxidantes y el color en las temperaturas de estudio, siendo más pronunciado a 45°C. Los atributos menos estables fueron carotenoides y la coordenada CIELab b*, presentando pérdidas superiores al 50%. Los valores de mangiferina exhibieron un deterioro menor al 40% y similar en las temperaturas evaluadas. El pH y los grados Brix no presentaron cambios significativos. Las reacciones de deterioro fueron de orden uno y siguieron la ley de Arrhenius, presentando coeficientes de determinación mayores a 0,90. Los valores de la energía de activación (Ea) estuvieron dentro del rango reportado para jugos de fruta, destacándose el valor hallado para la coordenada b* (44,59 kJ.mol-1). Conclusión: los valores ORAC estimaron un tiempo de vida útil para la bebida en 10 meses, bajo un almacenamiento a 4°C, sin embargo, se recomienda realizar análisis sensoriales y microbiológicos complementarios, bajo las mismas condiciones.

Efectividad del modelo de reaprendizaje motor para la recuperación de la mano espástica del adulto con hemiplejía. Revisión sistemática y metaanálisis / Effectiveness of a motor relearning programme for recovery of the spastic hand in adults with hemiplegia. Systematic review and meta-analysis

Introducción: En la hemiplejía, la afectación de la función manual está asociada con dificultad en la ejecución de patrones selectivos de movimiento de tipo individual y bilateral, y aunque no está claro el potencial de recuperación, existen métodos de intervención que pueden disminuir los niveles de discapacidad, como el modelo de reaprendizaje motor. Objetivo: Determinar la efectividad del modelo de reaprendizaje motor en la función de la mano espástica del adulto con hemiplejía. Materiales y métodos: Se realizó una búsqueda sistemática de literatura científica en PubMed, registro Central Cochrane de Ensayos Clínicos Controlados, LILACS, Scielo, así como en diferentes bibliotecas virtuales desde julio de 2015 hasta febrero de 2016. Para determinar la calidad de los estudios se usó la lista de chequeo de la estrategia CONSORT (Consolidated Standars of Reporting Trials) y se evaluó la calidad metodológica mediante la escala de PEDro. Resultados: Se incluyeron 8 estudios, 4 de los cuales fueron seleccionados para metaanálisis e incluían entrenamiento orientado a tareas y de la fuerza muscular. Se encontró que los efectos del modelo no fueron estadísticamente significativos con relación a otro tipo de intervenciones, aunque hubo una tendencia a la mejoría. Conclusión: Los estudios muestran efectividad del modelo de reaprendizaje motor para el tratamiento de la mano espástica del adulto con hemiplejía, aunque no se evidencian estudios que muestren gran poder estadístico con suficiente calidad metodológica para determinar su efectividad frente a la terapia convencional

Introduction: In hemiplegia, the involvement of manual function is associated with difficulty in executing selective patterns of individual and bilateral movement. Although the potential for recovery is not clear, there are interventions that can reduce disability, such as the motor relearning model. Objective: To determine the effectiveness of the motor relearning model in improving the function of the spastic hand in adults with hemiplegia. Materials and methods: A systematic search of scientific literature was performed in PubMed, Cochrane Central Register of Controlled Trials, LILACS, and Scielo, as well as in different virtual libraries from July 2015 to February 2016. To determine the quality of the studies, the CONSORT strategy (Consolidated Standards of Reporting Trials) was used and the methodological quality was evaluated using the PEDro scale. Results: Eight studies were included, and 4 were selected for a meta-analysis. The selected studies included task-oriented and muscular strength training and found that the effects of the model were not statistically significant in relation to other types of interventions, although there was a tendency to improvement. Conclusion: The studies show the effectiveness of the motor relearning model for the treatment of spastic hand in adults with hemiplegia, although there are no studies showing strong statistical power and with sufficient methodological quality to determine their effectiveness compared with that of conventional therapy

Comparison of radial 4D Flow-MRI with perivascular ultrasound to quantify blood flow in the abdomen and introduction of a porcine model of pre-hepatic portal hypertension.

OBJECTIVES: Objectives of this study were to compare radial time-resolved phase contrast magnetic resonance imaging (4D Flow-MRI) with perivascular ultrasound (pvUS) and to explore a porcine model of acute pre-hepatic portal hypertension (PHTN). METHODS: Abdominal 4D Flow-MRI and pvUS in portal and splenic vein, hepatic and both renal arteries were performed in 13 pigs of approximately 60 kg. In six pigs, measurements were repeated after partial portal vein (PV) ligature. Inter- and intra-reader comparisons and statistical analysis including Bland-Altman (BA) comparison, paired Student's t tests and linear regression were performed. RESULTS: PvUS and 4D Flow-MRI measurements agreed well; flow before partial PV ligature was 322 ± 30 ml/min in pvUS and 297 ± 27 ml/min in MRI (p = 0.294), and average BA difference was 25 ml/min [-322; 372]. Inter- and intra-reader results differed very little, revealed excellent correlation (R 2 = 0.98 and 0.99, respectively) and resulted in BA differences of -5 ml/min [-161; 150] and -2 ml/min [-28; 25], respectively. After PV ligature, PV flow decreased from 356 ± 50 to 298 ± 61 ml/min (p = 0.02), and hepatic arterial flow increased from 277 ± 36 to 331 ± 65 ml/min (p = n.s.). CONCLUSION: The successful in vivo comparison of radial 4D Flow-MRI to perivascular ultrasound revealed good agreement of abdominal blood flow although with considerable spread of results. A model of pre-hepatic PHTN was successfully introduced and acute responses monitored. KEY POINTS: • Radial 4D Flow-MRI in the abdomen was successfully compared to perivascular ultrasound. • Inter- and intra-reader testing demonstrated excellent reproducibility of upper abdominal 4D Flow-MRI. • A porcine model of acute pre-hepatic portal hypertension was successfully introduced. • 4D Flow-MRI successfully monitored acute changes in a model of portal hypertension.

Lesiones en la sustancia blanca en el paciente anciano: Utilización de la terminología adecuada / White matter lesions in an elderly patient: Using the proper terminology

En Neurorradiología los cambios de la sustancia blanca periventricular o subcortical en pacientes ancianos son descritos generalmente con leucoaraiosis, fenómenos hipóxico-isquémicos crónicos, leucoencefalopatía microangiopática o simplemente con alteraciones en la densidad o intensidad según el método elegido. Sin embargo, ¿es correcto el empleo de estas denominaciones?, ¿funcionan como sinónimos?, ¿tienen un mismo mecanismo de producción? Las lesiones que afectan a la sustancia blanca se aprecian hipodensas en tomografía computada, hiperintensas en las secuencias ponderadas en T2 o FLAIR e hipointensas en la resonancia magnética en ponderación T1. Describimos las distintas entidades que pueden afectar selectivamente la sustancia blanca en el paciente anciano y sus probables mecanismos de acción, para establecer una correcta denominación y realizar los diagnósticos diferenciales.

In Neuroradiology the changes in the deep or sub-cortical white matter in elderly people are generally described as leukoaraiosis, chronic hypoxic-ischaemic processes, microangiopathic leucoencephalopathy, or they are simply mentioned as density or intensity changes according to the selected imaging method. However, are these terms correct?, Are they synonyms?, Do they have the same aetiology? The lesions that affect white matter are hypodense in computed tomography, hyperintense in T2-weighted or FLAIR, or hypointense in T1 images in magnetic resonance. A description is presented on the different conditions that can selectively affect the white matter in the elderly patient and their probable mechanisms of action in order to establish a correct nomenclature, as well as make differential diagnoses.

Interspecific competition counteracts negative effects of dispersal on adaptation of an arthropod herbivore to a new host.

Dispersal and competition have both been suggested to drive variation in adaptability to a new environment, either positively or negatively. A simultaneous experimental test of both mechanisms is however lacking. Here, we experimentally investigate how population dynamics and local adaptation to a new host plant in a model species, the two-spotted spider mite (Tetranychus urticae), are affected by dispersal from a stock population (no-adapted) and competition with an already adapted spider mite species (Tetranychus evansi). For the population dynamics, we find that competition generally reduces population size and increases the risk of population extinction. However, these negative effects are counteracted by dispersal. For local adaptation, the roles of competition and dispersal are reversed. Without competition, dispersal exerts a negative effect on adaptation (measured as fecundity) to a novel host and females receiving the highest number of immigrants performed similarly to the stock population females. By contrast, with competition, adding more immigrants did not result in a lower fecundity. Females from populations with competition receiving the highest number of immigrants had a significantly higher fecundity than females from populations without competition (same dispersal treatment) and than the stock population females. We suggest that by exerting a stronger selection on the adapting populations, competition can counteract the migration load effect of dispersal. Interestingly, adaptation to the new host does not significantly reduce performance on the ancestral host, regardless of dispersal rate or competition. Our results highlight that assessments of how species can adapt to changing conditions need to jointly consider connectivity and the community context.

Protothecal bursitis after simultaneous kidney/liver transplantation: a case report and review.

Solid organ transplantation is an accepted therapy for end-stage diseases of the kidneys, liver, heart, and lungs. Unfortunately, transplantation is associated with infectious complications. Here, we present a case report of Prototheca wickerhamii olecranon bursitis and review all of the cases in solid organ transplant (SOT) recipients published in the literature to date. In our patient, the infection resolved with surgical therapy and limited antifungal therapy, and no symptoms have recurred over 24 months of follow-up. A review of the literature suggests that 50% of SOT recipients with Prototheca infection present with disseminated infection, and the overall mortality is 75%. More studies are required to determine the optimal management of protothecosis in this population.

A novel in vivo approach to assess radial and axial distensibility of large and intermediate pulmonary artery branches.

Pulmonary arteries (PAs) distend to accommodate increases in cardiac output. PA distensibility protects the right ventricle (RV) from excessive increases in pressure. Loss of PA distensibility plays a critical role in the fatal progression of pulmonary arterial hypertension (PAH) toward RV failure. However, it is unclear how PA distensibility is distributed across the generations of PA branches, mainly because of the lack of appropriate in vivo methods to measure distensibility of vessels other than the large, conduit PAs. In this study, we propose a novel approach to assess the distensibility of individual PA branches. The metric of PA distensibility we used is the slope of the stretch ratio-pressure relationship. To measure distensibility, we combined invasive measurements of mean PA pressure with angiographic imaging of the PA network of six healthy female dogs. Stacks of 2D images of the PAs, obtained from either contrast enhanced magnetic resonance angiography (CE-MRA) or computed tomography digital subtraction angiography (CT-DSA), were used to reconstruct 3D surface models of the PA network, from the first bifurcation down to the sixth generation of branches. For each branch of the PA, we calculated radial and longitudinal stretch between baseline and a pressurized state obtained via acute embolization of the pulmonary vasculature. Our results indicated that large and intermediate PA branches have a radial distensibility consistently close to 2%/mmHg. Our axial distensibility data, albeit affected by larger variability, suggested that the PAs distal to the first generation may not significantly elongate in vivo, presumably due to spatial constraints. Results from both angiographic techniques were comparable to data from established phase-contrast (PC) magnetic resonance imaging (MRI) and ex vivo mechanical tests, which can only be used in the first branch generation. Our novel method can be used to characterize PA distensibility in PAH patients undergoing clinical right heart catheterization (RHC) in combination with MRI.

Histoplasmosis in renal transplant patients in an endemic area at a reference hospital in Medellin, Colombia.

BACKGROUND: Histoplasmosis is an uncommon systemic fungal infection, but it is potentially fatal in immunosuppressed populations. In Latin America, which is considered an endemic area for this mycosis, there have been no published reports regarding the incidence, clinical presentation, morbidity, and mortality of histoplasmosis in renal transplant patients. The objective of this study was to describe cases of histoplasmosis in renal transplant patients treated at the Pablo Tobon Uribe Hospital (Medellin, Colombia) between 2006 and 2013. METHODS: This is a descriptive, retrospective study. RESULTS: The incidence of histoplasmosis in our renal transplant population was 1.1%. The ages of the 9 patients (4 men and 5 women) ranged between 27 and 59 years. In 2 of these patients, histoplasmosis appeared during the first year after transplantation. At the time of transplantation, 66% of patients received induction with alemtuzumab; 88% had a prior rejection episode and required increased immunosuppressive medication; 88% had renal graft dysfunction with creatinine levels >1.5 mg/dL; and the primary clinical presentation was disseminated histoplasmosis followed by the pulmonary form of the disease. Diagnoses were performed by histology in 6 patients, blood culture in 2 patients, and antigenuria in 1 patient. Three patients required treatment with amphotericin B for the severity of their infection, and 2 of these patients died before receiving the cumulative dose of amphotericin B. The 7 remaining patients received itraconazole for 12 months and had a successful treatment response. Regarding complications, 2 patients had hemophagocytic syndrome. At the 1-year follow-up appointment, renal function remained stable in all patients, and no patients had acute rejection or required renal replacement therapy. Thus, the overall mortality rate observed was 22.2%. CONCLUSIONS: In this series, histoplasmosis in renal transplant patients presented as an aggressive opportunistic infection with a higher incidence than that previously reported in the literature. The following risk factors have been associated with histoplasmosis: renal graft dysfunction, previous acute rejection, immunosuppression with tacrolimus-mycophenolate, and induction with alemtuzumab. The clinical presentation of histoplasmosis was nonspecific, which complicated disease diagnosis, and the treatment regimens were highly toxic and associated with significant morbidity and mortality rates.

Four-dimensional velocity mapping of the hepatic and splanchnic vasculature with radial sampling at 3 tesla: a feasibility study in portal hypertension.

PURPOSE: To demonstrate the feasibility of PC-VIPR (Phase Contrast Vastly undersampled Imaging with Projection Reconstruction) for the depiction and hemodynamic analysis of hepatic and splanchnic vessels in patients with portal hypertension. MATERIALS AND METHODS: Twenty-four cirrhotic patients (55.9 ± 10.4 years) were scanned using 5-point PC-VIPR for high spatial resolution imaging with large volume coverage at 3 Tesla (T) using a 32-channel body coil. Vessel segmentation and hemodynamic visualization included color-coded three-dimensional (3D) streamlines and particle traces. Segmentation quality was compared with contrast-enhanced multi-phase liver imaging. Flow pattern analysis was performed in consensus of three readers. The MELD score was calculated to estimate disease severity and was correlated to image quality. RESULTS: Good to excellent visualization quality was achieved in 23/24 cases. All arterial vessels and 144/168 vessels of the portal venous (PV) circulation were unambiguously identified. No correlation with the MELD score was found. Eight of 148 vessels of the PV circulation demonstrated reverse (hepatofugal) flow. Hepatofugal flow in small tributaries to PV flow were present in three cases despite hepatopetal flow in the PV. CONCLUSION: This feasibility study demonstrates the feasibility of PC-VIPR for simultaneous morphological and hemodynamic assessment of the hepatic and splanchnic vasculature in cirrhosis and portal hypertension. Future studies with quantitative analyses are warranted.

Comparison of biotransformation of inorganic selenium by Lactobacillus and Saccharomyces in lactic fermentation process of yogurt and kefir.

The aim of the present study was to characterize, quantify, and compare the different selenium species that are produced when lactic fermentation with two different types of microorganisms, bacteria (Lactobacillus) and yeast (Saccharomyces), take place to produce yogurt and kefir, respectively, and to study the transformation process of these species as a function of time. These two dairy products were chosen for the study because they are highly consumed in different cultures. Moreover, the microorganisms present in the fermentation processes are different. While the bacteria Lactobacillus is the one responsible for yogurt fermentation, a partnership between bacteria and the yeast Saccharomyces causes kefir fermentation. A comparative study has been carried out by fermenting Se(IV) enriched milk in the presence of both types of microorganisms, where the concentration range studied was from 0.5 to 20 microg g (-1). Enzymatic extraction enabled selenium speciation profiles, obtained by anionic exchange and ion-pairing reversed phase high performance liquid chromatography (IP-RP-HPLC) with inductively coupled plasma mass spectrometry (ICP-MS) detection. Scanning electron microscopy (SEM) applied to the enriched samples showed segregated Se (0), at added concentrations higher than 5 microg g (-1). The main Se species formed depended on the type of microorganism involved in the fermentation process, SeCys 2 and MeSeCys being the main species generated in yogurt and SeMet in kefir. The results obtained are different for both kinds of samples. Lactic fermentation for yogurt produced an increment in selenocystine (SeCys 2) and Se-methylselenocysteine (MeSeCys), while fermentation to produce kefir also incremented the selenomethionine (SeMet) concentration. The Se species are stable for at least 10 and 15 days for kefir and yogurt, respectively. After this period, selenocystine concentration decreased, and the concentration of Se-methylselenocysteine was found to significantly increase.

[Mycobacterial infections in HIV-infected patients in Cali, Colombia]. / Infecciones micobacterianas en pacientes infectados por el virus de la inmunodeficiencia humana en Cali, Colombia.

The prevalence of mycobacterial infections was determined in a sample of 155 individuals infected with human immunodeficiency virus (HIV) who were treated in the Social Security Institute (SSI) of Cali, Colombia. A tuberculin test (2 TU PPD RT23) was used, and the presence of mycobacteria was checked through direct microscopy and culturing blood, urine, feces, and gastric aspirate. When clinically indicated, samples of cerebrospinal fluid, bone marrow, and sputum were also examined and cultivated. The absence of reactivity to tuberculin was significantly more frequent in the patients than in the controls (91.3%, compared to 57.4%; chi 2 = 33, P = 0). The prevalence of tuberculosis was 6.5%, in comparison with 0.04% among a group of HIV-negative ISS members (exact binomial 95% confidence interval: 0.0313% to 0.1154%). Nontuberculous mycobacteria (NTM), present in 43 patients, were significantly more frequent than Mycobacterium tuberculosis (27.7%, versus 6.5%; chi 2 = 24.78, P = 0.000,001), but they caused illness only in some cases. The most common species were those of the M. avium-intracellulare complex. M. avium-intracellulare and M. fortuitum had a total prevalence of 7.1% and were the most-prevalent NTM that caused disease in these patients (4.5%); they were also responsible for three cases of disseminated infection. Clinical disease caused by M. tuberculosis or NTM and complete tuberculin anergy were associated with stage-IV HIV infection and with CD4 lymphocyte counts < or = 400/microL. However, the lack of immunocellular response, shown by limited tuberculin reactivity, was found beginning with the asymptomatic HIV carrier stage. The progressive deterioration of the immune system of HIV-positive patients is the determining factor in the high morbidity and mortality with mycobacteria infections and requires prompt chemoprophylaxis or treatment.

Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.

OBJECTIVE: To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy. PATIENTS, DESIGN, AND INTERVENTIONS: During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996). During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin-stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers; (2) blood, skin, and primary tumor eosinophilia; and (3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996). SETTING: A dermatology department at a university hospital. RESULTS: During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4+ cells were observed. No antiepidermal autoantibodies were found. CONCLUSIONS: The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.

[Early diagnosis of Hansen disease: study of the health services in Recife (Pernambuco), Brazil]. / Diagnóstico precoce da hanseníase: o caso dos serviços de saúde no Recife (Pernambuco), Brasil.

This paper presents the results of a descriptive study carried out in the city of Recife, state of Pernambuco, Brazil, between March and September 1994. The study aimed at health services available for performing early diagnosis of Hansen's disease with emphasis on accessibility and quality of the services provided. The sample consisted of 32 health clinics visited for diagnostic purposes by 183 patients with Hansen's disease. Information on organizational infrastructures was collected by means of interviews with health clinic managers. Information regarding routine procedures in the 32 clinics was collected by observation, with special attention given to archival and inspection activities. A total of 1,998 patients were interviewed to determine accessibility of services. Time spent in consultation with the physician was determined for 1,000 patients who were seen by 123 physicians at the clinics during the interviews. To explore physicians' attitude and knowledge regarding Hansen's disease, 133 were randomly selected from a list of names. The following factors were identified as hindering early diagnosis of Hansen's disease: the large number of people seeking service who could not be seen by a physician on the same day; the long time elapsed between appointment scheduling and the actual visit (for those not seen on the same day); the long wait for the consultation; the brevity of the consultation; the low availability of trained personnel; the low proportion of physicians who examined all body surfaces; difficulties in the clinical recognition of the disease; and physicians not prepared to make a differential diagnosis. These obstacles can precipitate the physical deterioration of Hansen's disease patients and stimulate the persistence of transmissibility; therefore, they need to be overcome if Hansen's disease is to be eliminated.

[Perceptions regarding leprosy and resulting handicaps prior to diagnosis in Recife, Brazil]. / Percepción de la lepra y las discapacidades antes del diagnóstico en Recife, Brasil.

This article reports on a case-control study conducted in Recife, Brazil, between November 1993 and July 1994, to determine how leprosy patients' perceptions and notions influence disease management and use of health services. The sample was composed of 183 residents of Recife between the ages of 20 and 70 years who sought diagnostic services in the dermatology clinics of two referral centers situated in the third, fourth, and sixth political and administrative regions. Sixty-four patients having handicaps or their precursor lesions were classified as cases; the remaining 119 were used as controls. All were diagnosed during the study period. For the analysis, adjustments were made for sex, age, schooling, and a previous history of Hansen's disease among patients. The study revealed the simultaneous presence of two types of "invisibility" of the disease in an area where endemicity is increasing: 1) for patients in both groups, the low frequency of spontaneous explanatory models related to the illness, even in the presence of disease, and 2) for health professionals, the limitations of detection methods. Since such deficiencies affect decisions bearing on individual and collective disease management, they are a risk factor in and of themselves and stand in the way of eliminating leprosy as a public health problem.

An epidemiologic case-control study in a population with vitiligo.

BACKGROUND: Previous epidemiologic studies of vitiligo have not included a sex- and age-matched population. OBJECTIVE: Our purpose was to attempt to determine possible risk factors and clinical differences associated with unilateral and bilateral vitiligo. METHODS: Two hundred thirty-four patients and 234 normal control subjects were examined and questioned. RESULTS: Patients with unilateral vitiligo were younger and had an earlier age at onset. Koebner's phenomenon and halo nevus were infrequent in the total vitiligo group, but no difference between vitiligo types was observed. Subjects with bilateral vitiligo more frequently had light skin (types I, II, and III) and more commonly had an associated autoimmune disease. CONCLUSION: Unilateral and bilateral vitiligo differ substantially in several clinical aspects, which suggests a different pathogenic mechanism for each condition.

The minigrafting test for vitiligo: detection of stable lesions for melanocyte transplantation.

BACKGROUND: Selected patients with stable and refractory vitiligo may consider melanocyte transplantation as a therapeutic alternative. A method to anticipate the response to surgical repair is not available. OBJECTIVE: We evaluated the pigment spread of minigrafts when implanted within achromic lesions of stable vitiligo as a test to identify good candidates for surgical repigmentation. METHODS: Four to six minigrafts of 1.0 to 1.2 mm were implanted within lesions of patients with unilateral (localized) and bilateral (generalized) vitiligo. Pigment spread was assessed 3 months later. RESULTS: Forty-seven subjects were examined. In unilateral vitiligo 19 of 20 patients (95%) had a positive test result in comparison with only 13 of 27 patients (48%) with bilateral vitiligo (p = 0.002). CONCLUSION: The minigrafting test is a reliable tool to identify patients with stable vitiligo who may respond to melanocyte transplantation. Unilateral (localized) vitiligo is the best indication for surgical repigmentation.

[Popular conceptions regarding cutaneous leishmaniasis in Colombia and their applicability in control programs]. / Conceptos populares sobre la leishmaniasis cutánea en Colombia y su aplicabilidad en programas de control.

A study was carried out to obtain information on prevailing popular ideas and attitudes about cutaneous leishmaniasis and its treatment in an isolated endemic area on the Colombian Pacific Coast. Interviews were conducted with a representative sample of individuals from the community and with health agents. The formal survey covered 736 households, 332 of them in a rural area (where leishmaniasis is endemic) and 404 in the city of Buenaventura (where there is no transmission of the disease.) The results showed that cutaneous leishmaniasis is well known in the rural area. The people have names for it (ya-te-vi or bejuco), have an understanding of its etiology (although their interpretation differs from that accepted by the scientific community), and have developed methods for preventing and treating it. The popular understanding of the disease results in behavior directed toward its prophylaxis and treatment that shares many characteristics with Western medicinal practices. The traditional treatments should be taken into account in the application of measures to control the disease in that area.