The synergic relationship of social anxiety, depressive symptoms and waist circumference in adolescents: Mediation analysis.

BACKGROUND: It is not well established whether depression leads to weight loss or weight gain, or whether a relationship exists among depression, social anxiety, and weight status. The aim of this study was to evaluate the synergic association among social anxiety, depressive symptoms, and waist circumference (WC) during adolescence and examine whether depression mediated the relationship between social anxiety and WC. METHODS: A cross-sectional study was performed with 1296 adolescents from a northeastern district in Brazil. It was used the Social Anxiety Scale for Adolescents (SAS-A) to evaluate symptoms of social anxiety and the Depression Scale of the Center for Epidemiologic Studies (CES-D) for symptoms of depression. Structural equation modeling was used to determine whether depression, social anxiety, and WC were synergically associated. Analysis was adjusted for sex, age, height, and mother's educational level. RESULTS: Symptoms of social anxiety were directly associated with symptoms of depression and WC, whereas symptoms of depression were not associated with WC. LIMITATIONS: This is a cross-sectional study, and so we cannot infer causality in the interpretation of results. CONCLUSION: Social anxiety was found to be associated with depressive symptoms and WC. General medical doctors and health practitioners who observe overweight adolescents with any symptoms of anxiety might consider a thorough evaluation of the patient's mental health.

Fifteen Year Results of Radiofrequency Ablation, Using VNUS Closure, for the Abolition of Truncal Venous Reflux in Patients with Varicose Veins.

OBJECTIVES: Endovenous thermal ablation (EVTA) of varicose veins was introduced in the late 1990s with radiofrequency ablation (RFA) using the VNUS Closure device. The results of the original VNUS Closure device for the abolition of truncal venous reflux at 15 years are reported. METHODS: A prospective audit of a group of patients treated with VNUS Closure 15 years previously was carried out, using clinical assessment and duplex ultrasound. A total of 189 patients were treated with VNUS Closure between March 1999 and December 2001 and were invited for clinical assessment (subjective and objective) and duplex ultrasonography (DUS) to assess treatment outcome and de novo disease progression. DUS outcome of the treated vein was graded: 1, complete success (complete atrophy); 2, partial success (> 1 patent section; none giving rise to recurrent varicose veins); 3, partial failure (≥ 1 patent sections giving rise to recurrent varicose veins); 4, complete failure. RESULTS: Fifty-eight patients (91 legs, 101 truncal veins) returned for follow-up DUS, giving a 31.5% response rate (many patients had moved or had died in the 15 years). Two truncal veins had been excluded following treatment elsewhere presumably for partial or complete failure. At a mean of 15.4 years post-procedure, 51 (56%) reported no varicose veins, 58 (100%) that they were pleased that they had the procedure and 57 (98%) that they would recommend the procedure. DUS showed 88% of patients achieved success with no clinical recurrence in the originally treated veins. De novo reflux was identified in 47 of 91 legs (51.6%), showing disease progression in veins that were originally competent. CONCLUSIONS: RFA with VNUS Closure achieved excellent long-term technical success in treating venous reflux in truncal veins 15 years post-procedure, demonstrated by DUS. This bodes well for the increased use of EVTA in treating truncal vein reflux.

Media Damage Following Detergent Sclerotherapy Appears to be Secondary to the Induction of Inflammation and Apoptosis: An Immunohistochemical Study Elucidating Previous Histological Observations.

OBJECTIVE/BACKGROUND: Traditionally, sclerotherapy has been thought to work by the cytotoxic effect of the sclerosant upon the endothelium alone. However, studies have shown that sclerotherapy is more successful in smaller veins than in larger veins. This could be explained by the penetration of the sclerosant, or its effect, into the media. This study aimed to investigate intimal and medial damage profiles after sclerosant treatment. METHODS: Fresh human varicose veins were treated ex vivo with either 1% or 3% sodium tetradecyl sulphate (STS) for 1 or 10 minutes. The effect of the sclerosant on the vein wall was investigated by immunofluorescent labelling of transverse vein sections using markers for endothelium (CD31), smooth muscle (α-actin), apoptosis (p53) and inflammation (intercellular adhesion molecule-1 [ICAM-1]). Polidocanol (POL; 3%) treatment at 10 minutes was similarly investigated. RESULTS: Endothelial cell death was concentration- and time-dependent for STS but incomplete for both sclerosants. Time, but not concentration, significantly affected cell death (p > .001). A 40% and 30% maximum reduction was observed for STS and POL, respectively. Destruction of 20-30% of smooth muscle cells was found up to 250 µm from the lumen after 3% STS treatment for 10 minutes. POL treatment for 10 minutes showed inferior destruction of medial cells. Following STS treatment and 24-hour tissue culture, p53 and ICAM-1 were upregulated to a depth of around 300 µm. This effect was not observed with POL. CONCLUSION: Inflammatory and apoptotic markers show the same distribution as medial cell death, implying that sclerotherapy with STS works by inducing apoptosis in the vein wall rather than having an effect restricted to the endothelium. Incomplete loss of endothelial cells and penetration of the sclerosant effect up to 250 µm into the media suggest that medial damage is crucial to the success of sclerotherapy and may explain why it is less effective in larger veins.

Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.

OBJECTIVES: To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women. METHODS: A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symptoms or signs of pelvic vein reflux were compared with the outcomes of treatment from pelvic vein embolisation. A repeat transvaginal duplex ultrasonography was performed 6 weeks later by a blinded observer and any residual reflux was identified. RESULTS: Results from 100 sequential patients were analysed. Mean age 44.2 years (32-69) with mode average parity of 3 (0-5 deliveries). Pre-treatment, 289/400 veins were refluxing (ovarian - 29 right, 81 left; internal iliac - 93 right, 86 left). Coil embolisation was successful in 86/100 patients and failed partially in 14/100 - 5 due to failure to cannulate the target vein. One false-positive diagnosis was made. CONCLUSION: Currently there is no accepted gold standard for pelvic vein incompetence. Comparing transvaginal duplex ultrasonography with the outcome from selectively treating the veins identified as having pathological reflux with coil embolisation, there were no false-negative diagnoses and only one false-positive. This study suggests that transvaginal duplex ultrasonography could be the gold standard in assessing pelvic vein reflux.

Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux.

OBJECTIVES: To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids. METHODS: Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated. RESULTS: Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved. CONCLUSION: There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered.

Ovarian Vein Diameter Cannot Be Used as an Indicator of Ovarian Venous Reflux.

OBJECTIVES: Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors aimed to investigate whether or not vessel diameter can be used as an indicator of reflux in the ovarian veins. METHODS: Nineteen female patients (mean 40.2 years, range 29-60) presenting to a specialist vein unit with leg varicose veins underwent duplex ultrasonography (DUS). All were found to have a significant pelvic contribution to their leg reflux on transvaginal duplex ultrasonography (TVS) and were referred to an interventional radiologist for treatment by transjugular coil embolization. During the procedure, the diameter of the ovarian veins was measured using digital subtraction venography. RESULTS: Thirty-four ovarian veins were measured (17 right, 17 left) and of these 18 were found to be non-refluxing while 16 displayed reflux. The mean diameter of the non-refluxing veins was 7.2 mm (range 3-13 mm)and that of the refluxing veins was 8.5 mm (range 4-13 mm). This difference was found to be insignificant at a 95% confidence level (Student t test, p = .204). CONCLUSIONS: There is no significant difference between the diameters of competent and refluxing ovarian veins and, as such, techniques that measure vein diameter may not be suitable for the diagnosis of venous reflux in the ovarian veins.

137Cesium-induced chromosome aberrations analyzed by fluorescence in situ hybridization: eight years follow up of the Goiânia radiation accident victims.

The radiation accident in focus here occurred in a section of Goiânia (Brazil) where more than a hundred individuals were contaminated with 137Cesium on September 1987. In order to estimate the absorbed radiation doses, initial frequencies of dicentrics and rings were determined in 129 victims [A.T. Ramalho, PhD Thesis, Subsidios a tecnica de dosimetria citogenetica gerados a partir da analise de resultados obtidos com o acidente radiologico de Goiânia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 1992]. We have followed some of these victims cytogenetically over the years seeking for parameters that could be used as basis for retrospective radiation dosimetry. Our data on translocation frequencies obtained by fluorescence in situ hybridization (FISH) could be directly compared to the baseline frequencies of dicentrics available for those same victims. Our results provided valuable information on how precise these estimates are. The frequencies of translocations observed years after the radiation exposure were two to three times lower than the initial dicentrics frequencies, the differences being larger at higher doses (>1 Gy). The accuracy of such dose estimates might be increased by scoring sufficient amount of cells. However, factors such as the persistence of translocation carrying lymphocytes, translocation levels not proportional to chromosome size, and inter-individual variation reduce the precision of these estimates.

Fluorescence in situ hybridization with comets.

We have adapted the fluorescence in situ hybridization technique to single-cell gel electrophoresis (comet assayed) preparations. Since cells were embedded in agarose, probed regions could be visualized in three dimensions. This system makes it possible to determine the spatial distribution of chromosome-specific DNA sequences at the level of the individual nucleus (nonelectrophoresed) as well as in chromatin fibers of comets (electrostretched chromosomal DNA). This methodology is likely to bring new insights into the field of interphase nuclear ultrastructure. Here, we present the preliminary data obtained with human blood lymphocytes in Gzero after they have been electrophoresed for different times. Chromosome-specific areas (all centromeres, all telomeres, chromosome 7-specific centromere, and long arm of chromosome 3-specific telomere, as well as three segments of the O6-methylguanine-DNA methyltransferase gene) were investigated. Our results are in agreement with the concept that telomeres are in close association with the nuclear membrane and suggest that centromeres are relatively less condensed structures located in the center of the interphase nucleus.

Reliability of serological methods for detection of leishmaniasis in Portuguese domestic and wild reservoirs

A direst agglutination test (DAT) and an immunofluorescence (IFAT) were compared for detection of Leishmania infantum infection in 43 dogs and five foxes from Alto-Douro and Arrabida, two known endemic areas in Portugal. In four dogs with proved canine leishmaniasis, both DAT and IFAT showed positive readings (titres ò1:320 and ò1:128). Of 34 samples collected form apparently healthly dogs, ten were positive by both serological tests and eight were serologically positive by one test or the other. Three foxes out of five captured in this area, scored titres indicative of leishmaniasis in both DAT and IFAT. The concordance between DAT and IFAT in all collected samples (48) was 81.25 per cent. Considering these and previous studies in the adjancent Mediterranean areas, the seroprevalence of L. infantum infection in the canine and vulpine populations appear to be high magnitude.

Reliability of serological methods for detection of leishmaniasis in Portuguese domestic and wild reservoirs.

A direct agglutination test (DAT) and an immunofluorescence technique (IFAT) were compared for detection of Leishmania infantum infection in 43 dogs and five foxes from Alto-Douro and Arrábida, two known endemic areas in Portugal. In four dogs with proved canine leishmaniasis, both DAT and IFAT showed positive readings (titres > or = 1:320 and > or = 1:128). Of 34 samples collected from apparently healthy dogs, ten were positive by both serological tests and eight were serologically positive by one test or the other. Three foxes out of five captured in this area, scored titres indicative of leishmaniasis in both DAT and IFAT. The concordance between DAT and IFAT in all collected samples (48) was 81.25%. Considering these and previous studies in the adjacent Mediterranean areas, the seroprevalence of L. infantum infection in the canine and vulpine populations appear to be of high magnitude.

Evora district as a new focus for canine leishmaniasis in Portugal.

On the basis of information acquired from local health authorities in Evora district of Portugal on cases of visceral leishmaniasis (VL), an epidemiology survey study was conducted. To determine the prevalence of anti-Leishmania antibodies in the local human and canine populations residing in Evora town and 14 adjacent villages, blood samples collected from 885 children and 3,614 dogs were tested in a direct agglutination test (DAT). Seropositivity for Leishmania parasite obtained by DAT in both endemic populations was further confirmed by an enzyme-linked immunosorbent assay (ELISA) and immunofluorescence test (IFAT). For identification of the responsible sandfly vector, 79 biotopes within the study areas were surveyed. In the infantile population assessed, none of the children screened showed an antibody level indicative (titer, > = 1:3200) of visceral leishmaniasis in the DAT. However, agglutinating antibody rates ranging from 0.7% to 6.9% were obtained in dogs residing in Evora and 11 adjacent villages. Concordant seropositivity of 94.04% was obtained by ELISA and IFAT in the same canine population (141) identified by DAT. Of the 159 sandflies captured, 67 were identified as Phlebotomus sergenti; 15, as P. ariasi; 58, as P. perniciosus; and 19, as Sergentomyia minuta. Unlike the results previously reported in Alto-Douro and Algarve districts of Portugal, as compared with the other three species, P. sergenti appears to be more abundant in Evora district.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic effects of the antichagasic benznidazole on human cells in vitro.

Benznidazole (bz) is a widely used trypanosomicidal agent in South America. Two test systems were used to evaluate its genotoxicity in human cells in vitro: (a) human blood lymphocytes from healthy volunteers for induction of sister-chromatid exchanges (SCEs) and chromosomal aberrations (CAs); (b) a human hepatoma cell line (Hep G2) for the induction of SCEs and micronuclei (MN). In spite of being non-clastogenic on human lymphocytes, there was a significant increase in the frequency of MN on hepatoma cells treated with different doses of bz. This results support previous data which indicated the necessity of nitroreduction of nitroimidazoles to observe their mutagenic effects. Interestingly, bz induced a significant increase in the frequency of SCEs in both test systems. The sensitivity of the parameters used and the role of cellular metabolic pathways are discussed.

[Canine leishmaniasis in the region of Enfidha (Central Tunisia). Assessment of seroprevalence with direct agglutination (DAT) and indirect immunofluorescence (IFAT)]. / La leishmaniose canine dans la région d'Enfidha (Tunisie centrale). Estimation de la séro-prévalence par agglutination directe (DAT) et immunofluorescence indirecte (IFAT).

In order to assess canine leishmaniasis prevalence rate in Enfidha area, considered to be the most important kala-azar focus in Sousse Governorate, a serological survey was carried out in 6 localities. 265 sera were examined by DAT and IFAT. 16 (6.03%) showed positive results for anti-leishmania antibodies with significant variations according to the locality. A fairly DAT-IFAT good correlation was observed.

A killing disease epidemic among displaced Sudanese population identified as visceral leishmaniasis.

A fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater than or equal to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy.