[Frequency of spinopelvic alterations in postoperative total hip arthroplasty patients and their association with functional outcomes]. / Frecuencia de alteraciones espinopélvicas en pacientes postoperados de artroplastía total de cadera y su asociación con resultados funcionales.

INTRODUCTION: the analysis of spinopelvic imbalance in patients undergoing total hip arthroplasty has gained significance in recent years, being recognized as a risk factor for instability. Few reports exist regarding the prevalence of spinopelvic alterations in Latin American literature. The aim of this study is to determine the frequency of spinopelvic imbalance in our patients and to associate them with functional outcomes. MATERIAL AND METHODS: 29 patients who underwent total hip arthroplasty using a lateral approach (32 arthroplasties) were included. All patients completed clinical outcome questionnaires preoperatively. Twelve months after surgery, they underwent anteroposterior pelvic and lateral pelvic X-rays, both standing and sitting, and clinical outcome questionnaires were completed. The radiographic parameters examined were: pelvic incidence, lumbar lordosis, sacral slope, anterior pelvic plane and pelvic femoral angle. Functional outcome was assessed with the Harris Hip Score and WOMAC scales. Patients were classified according to their spinopelvic alteration and statistical analysis was performed to identify significant differences between the groups and the correlation with functional outcomes. RESULTS: there was a high frequency of spinopelvic balance alterations (46.8%); 6.2% (n = 2/32) presented isolated spinal stiffness (group 1B), 37.5% (n = 12/29) spinal deformity without spinal stiffness (group 2A) and 3.1% (n = 1/29) spinal deformity associated with stiffness (group 2B). We found no improvement in HHS and WOMAC scores in the groups with spinal stiffness (1B and 2B) (p = 0.98 y 0.15). There is association between spinal stiffness (SS < 10°) and poor functional outcomes (p = 0.02). CONCLUSIONS: the frequency of spinopelvic balance alterations was high. While there was no observed rise in prosthetic dislocations, the existence of spinal stiffness, defined by a SS of less than 10°, was associated to poor outcomes on functional scales.

INTRODUCCIÓN: el análisis de las alteraciones del balance espinopélvico en pacientes sometidos a artroplastía total de cadera ha adquirido importancia en años recientes, siendo reconocido como un factor de riesgo para inestabilidad. Existen pocos reportes de la prevalencia de alteraciones espinopélvicas en literatura latinoamericana. El objetivo de esta investigación es determinar la frecuencia de alteraciones del balance espinopélvico en nuestros pacientes y su asociación con los resultados funcionales. MATERIAL Y MÉTODOS: se incluyeron 29 pacientes intervenidos de artroplastía total de cadera mediante abordaje lateral (32 artroplastías). Todos los pacientes completaron escalas funcionales preoperatoriamente. A los 12 meses de la intervención, se valoró el balance espinopélvico mediante radiografías anteroposterior de pelvis y laterales de pelvis tanto de pie como en sedestación y completaron escalas funcionales. Los parámetros radiográficos valorados fueron: incidencia pélvica, lordosis lumbar, inclinación del sacro (sacral slope), plano pélvico anterior y ángulo pélvico femoral. El estado funcional se valoró con las escalas Harris Hip Score (HHS) y WOMAC. Se clasificó a los pacientes de acuerdo a su alteración espinopélvica y se realizó análisis estadístico para identificar diferencias significativas entre los grupos y la asociación con resultados funcionales. RESULTADOS: encontramos una elevada frecuencia de alteraciones del balance espinopélvico (46.8%); 6.3% (n = 2/32) presentaron rigidez espinal aislada (grupo 1B), 37.5% (n = 12/29) deformidad espinal sin rigidez espinal (grupo 2A) y 3.1% (n = 1/29) deformidad espinal asociada a rigidez (grupo 2B). En los grupos con rigidez espinal (1B y 2B) no hubo mejoría significativa en HHS y WOMAC (p = 0.98 y 0.15). Encontramos asociación entre la presencia de rigidez espinal (SS < 10°) y resultados funcionales subóptimos con valor de p = 0.02. CONCLUSIONES: la frecuencia de alteraciones en el balance espinopélvico fue elevada. A pesar de no verse reflejado en un aumento en la incidencia de luxaciones protésicas, la presencia de rigidez espinal caracterizada por un SS menor a 10° se asoció con resultados subóptimos en las escalas funcionales.

A case of natural infection with Dirofilaria immitis in a coati (Nasua narica) from Mexico.

This paper aims to describe the natural infection with Dirofilaria immitis in Nasua narica (white-nosed coati) from Yucatán, Mexico. Two carcasses of N. narica were collected on a highway that crosses through a dense forest with patches used for agriculture and livestock activities. We performed necropsies, and two female adult nematode parasites from the heart of one specimen were collected and preserved for their molecular identification using a conventional PCR directed at a fragment of the small subunit (18S) ribosomal RNA (18S-rRNA) gene. Bioinformatic analysis showed a similarity of 99 % with three sequences from D. immitis (two from Japan). Additionally, we performed a phylogenetic tree with the recovered sequence. All these analyses showed that D. immitis is present in N. narica from Mexico. The transmission of D. immitis toward populations of Nasua sp. may be due to indirect and accidental contact with domestic dogs or wild canids that share the same environment.

Ecology of fleas and their hosts in the trifinio of north-east Argentina: first detection of Rickettsia asembonensis in Ctenocephalides felis felis in Argentina.

Fleas are important in public health due to their role as parasites and vectors of pathogens, including Rickettsia. The aim of this study was to evaluate the diversity, abundance and prevalence of fleas and the presence of Rickettsia in the trifinio of north-east Argentina. Fleas from household and synanthropic animals were obtained from urban and periurban areas. They were taxonomically identified and samples of 227 fleas in 86 pools were analysed by polymerase chain reaction targeting the gltA and ompB genes of Rickettsia spp. The study revealed that Ctenocephalides felis felis was dominant on dogs, cats and opossums, with higher prevalence in the periurban area. The Shannon-Wiener and Morisita-Horn indices expressed differences in the diversity and similarity values of the absolute abundances of the species between the areas compared. DNA amplifications revealed 30.8% C. f. felis pools positive for Rickettsia spp. Phylogenetic analysis showed that the haplotype obtained was identical to Rickettsia asembonensis from Peru and Brazil. This is the first detection in Argentina of R. asembonensis that infects C. f. felis, and we emphasize the importance of conducting research from a 'One Health' perspective on the role of opossums and rodents in the integration of the transmission cycles of rickettsial bacteria.

Inferring distributional shifts of epidemiologically important North and Central American sandflies from Pleistocene to future scenarios.

Nine sandfly species (Diptera: Psychodidae) are suspected or proven vectors of Leishmania spp. in the North and Central America region. The ecological niches for these nine species were modelled in three time periods and the overlaps for all time periods of the geographic predictions (G space), and of ecological dimensions using pairwise comparisons of equivalent niches (E space), were calculated. Two Nearctic, six Neotropical and one species in both bioregions occupied a reduced number of distribution areas. The ecological niche projections for most sandfly species other than Lutzomyia shannoni and Lutzomyia ovallesi have not expanded significantly since the Pleistocene. Only three species increase significantly to 2050, whereas all others remain stable. Lutzomyia longipalpis shared a similar ecological niche with more species than any other, although both L. longipalpis and Lutzomyia olmeca olmeca had conserved distributions over time. Climate change, at both regional and local levels, will play a significant role in the temporal and spatial distributions of sandfly species.

Factors affecting carriage and intensity of infection of Calodium hepaticum within Norway rats (Rattus norvegicus) from an urban slum environment in Salvador, Brazil.

Urban slum environments in the tropics are conducive to the proliferation and the spread of rodent-borne zoonotic pathogens to humans. Calodium hepaticum (Brancroft, 1893) is a zoonotic nematode known to infect a variety of mammalian hosts, including humans. Norway rats (Rattus norvegicus) are considered the most important mammalian host of C. hepaticum and are therefore a potentially useful species to inform estimates of the risk to humans living in urban slum environments. There is a lack of studies systematically evaluating the role of demographic and environmental factors that influence both carriage and intensity of infection of C. hepaticum in rodents from urban slum areas within tropical regions. Carriage and the intensity of infection of C. hepaticum were studied in 402 Norway rats over a 2-year period in an urban slum in Salvador, Brazil. Overall, prevalence in Norway rats was 83% (337/402). Independent risk factors for C. hepaticum carriage in R. norvegicus were age and valley of capture. Of those infected the proportion with gross liver involvement (i.e. >75% of the liver affected, a proxy for a high level intensity of infection), was low (8%, 26/337). Sixty soil samples were collected from ten locations to estimate levels of environmental contamination and provide information on the potential risk to humans of contracting C. hepaticum from the environment. Sixty percent (6/10) of the sites were contaminated with C. hepaticum. High carriage levels of C. hepaticum within Norway rats and sub-standard living conditions within slum areas may increase the risk to humans of exposure to the infective eggs of C. hepaticum. This study supports the need for further studies to assess whether humans are becoming infected within this community and whether C. hepaticum is posing a significant risk to human health.

First molecular evidence of Toxoplasma gondii in opossums (Didelphis virginiana) from Yucatan, Mexico.

Toxoplasma gondii is an obligate intracellular parasite recognized as a causal agent of toxoplasmosis; zoonotic disease endemic in many countries worldwide, including Mexico. Different species of animals participate in the wild cycle infection, including opossums of the species Didelphis virginiana. Thirteen D. virginiana were captured in Yucatan, Mexico. Detection of T. gondii was achieved by Polymerase Chain Reaction, which determined an infection of 76.9% (10/13) in brains. Positive amplicons were sequenced for analysis, this produced results similar to T. gondii with identity and coverage values of 98% and 96-100%, respectively. This study presents the first molecular evidence of the circulation of T. gondii in D. virginiana from Mexico.

Assessing the importance of four sandfly species (Diptera: Psychodidae) as vectors of Leishmania mexicana in Campeche, Mexico.

Localized cutaneous leishmaniasis represents a public health problem in many areas of Mexico, especially in the Yucatan Peninsula. An understanding of vector ecology and bionomics is of great importance in evaluations of the transmission dynamics of Leishmania parasites. A field study was conducted in the county of Calakmul, state of Campeche, during the period from November 2006 to March 2007. Phlebotomine sandfly vectors were sampled using Centers for Disease Control light traps, baited Disney traps and Shannon traps. A total of 3374 specimens were captured in the two villages of Once de Mayo (93.8%) and Arroyo Negro (6.1%). In Once de Mayo, the most abundant species were Psathyromyia shannoni, Lutzomyia cruciata, Bichromomyia olmeca olmeca and Psychodopygus panamensis (all: Diptera: Psychodidae). The Shannon trap was by far the most efficient method of collection. The infection rate, as determined by Leishmania mexicana-specific polymerase chain reaction, was 0.3% in Once de Mayo and infected sandflies included Psy. panamensis, B. o. olmeca and Psa. shannoni. There were significant differences in human biting rates across sandfly species and month of sampling. Ecological niche modelling analyses showed an overall overlap of 39.1% for the four species in the whole state of Campeche. In addition, the finding of nine vector-reservoir pairs indicates a potential interaction. The roles of the various sandfly vectors in Calakmul are discussed.

Incrimination of four sandfly species previously unrecognized as vectors of Leishmania parasites in Mexico.

Cutaneous leishmaniasis (CL) is endemic to the Yucatan Peninsula of Mexico. The main causative agent is the parasite Leishmania mexicana (Biagi) (Kinetoplastida: Trypanosomatidae) and, based on the classic work of Dr Biagi's research team, it has been generally accepted and frequently reported that the only vector of L. mexicana in the region is the sandfly Lutzomyia olmeca olmeca (Vargas & Diáz-Nájera) (Diptera: Psychodidae). Evidence gathered from recent entomological studies conducted mainly in Calakmul, Campeche, however, suggests that other species may also be vectors of L. mexicana. We conducted a field study in two villages in Calakmul, Campeche in the Yucatan Peninsula, where recent cases of CL have been reported, to document the species composition and relative abundances of the sandfly fauna and to identify which species are likely to be the main vectors by assessing the biting rates and parasite infection rates of the suspected vector species. Sandfly catches were conducted from November 2005 to February 2006 in Unión 20 de Junio and Dos Lagunas Sur. Sandflies were captured using Shannon (18.00-22.00 hours), Disney and CDC light traps (18.00-06.00 hours). Biting and infection rates were calculated for the four most abundant species: Lutzomyia cruciata (Coquillett), Lu. o. olmeca, Lutzomyia panamensis (Shannon) and Lutzomyia shannoni (Dyar). In Dos Lagunas Sur, Lu. panamensis and Lu. o. olmeca exhibited the highest biting rates throughout the sampling period. In Unión 20 de Junio, Lu. cruciata and Lu. o. olmeca had the highest biting rates over the same period. Regarding infection rates, we report herein the establishment of a polymerase chain reaction protocol and validation of IR1 and LM17 oligonucleotides to analyse the infection rates of sandflies. Out of 769 females analysed, the overall infection rates were 1.4% in Dos Lagunas Sur and 5.3% in Unión 20 de Junio. In Dos Lagunas Sur we found L. mexicana infections in two sandfly species, Lu. shannoni and Lutzomyia ylephiletor (Fairchild & Hertig), whereas in Unión 20 de Junio we found infections in Lu. shannoni, Lu. cruciata, Lu. o. olmeca and Lu. panamensis. The possible role of these four sandfly species in relation to L. mexicana transmission in Calakmul is discussed.

Produção de biomassa e óleo essencial de alecrim (Rosmarinus officinalis L. ) em função da altura e intervalo entre cortes / Biomass production and essential oil of rosemary (Rosmarinus officinalis L. ) in function of the height and interval between the cuts

O alecrim é planta exótica e o interesse no seu cultivo tem crescido ao longo dos anos, pois pode ser utilizado tanto para fins medicinais como aromáticos; no entanto, o conhecimento fitotécnico sobre a espécie é bastante limitado. Dessa forma, o trabalho objetivou avaliar a influência da altura de corte e do intervalo destes sobre a produção de biomassa e no rendimento do óleo essencial de alecrim. O experimento foi realizado no Instituto Agronômico, em Campinas - SP, no período de janeiro de 2006 a julho de 2007. O delineamento experimental utilizado foi em blocos ao acaso, com 8 tratamentos em esquema fatorial 2 x 4, sendo duas alturas de corte (20 e 40 cm) e quatro intervalos entre cortes (60, 80, 100, 120 dias) e três repetições. Foram avaliadas as características altura da planta, massa seca da parte aérea, rendimento e qualidade do óleo essencial. Observou-se que maiores intervalos entre cortes proporcionaram maior altura da planta e maior massa seca da parte aérea. O rendimento e a qualidade do óleo essencial não foram afetados ao longo do período experimental.

Rosemary is an exotic plant and the interest in its cultivation has been growing along the years, because it can be used for medicinal or aromatic ends, however the agricultural knowledge about the species is quite limited. The goal of this research was to evaluate the influence of the cutting height and of the interval of these cuts on the biomass production and on the yield of the rosemary essential oil. The experiment was conducted at the Agronomical Institute, in Campinas - SP, from January 2006 through July 2007. It was organized in a completely randomized design with 8 treatments in a 2 x 4 factorial system, with two cutting heights (20 and 40 cm) and four intervals between cuts (60, 80, 100, 120 days) and three replications. Characteristics such as plant height, dry mass of the aerial part, yield and quality of its essential oil were evaluated. It was observed that longer intervals among cuttings provided longer height of the plant and greater dried mass of the aerial part. The yield and the quality of the essential oil were not affected throughout the experimental period.

Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units.

The purpose of this study was to assess the use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. The directors of 38 pediatric units and 31 neonatal units reported that analgesics were infrequently used for intravenous cannulation (10%), suprapubic bladder aspiration (8%), urethral catheterization (2%), or venipuncture (2%). Analgesics were used significantly more regularly in pediatric than in neonatal intensive care units for arterial line placement, bone marrow aspiration, central line placement, chest tube insertion, paracentesis, and lumbar puncture.

Duodenal ulceration in sickle cell anaemia

Duodenal ulcer is commonly associated with homozygous sickle cell (SS) disease in Jamaica. A mechanism for vessel obstruction and tissue infarction exists in SS disease and this association may allow observations on the role of primary mucosal damage in the genesis of duodenal ulceration. The relationship between the 2 conditions has therefore been investigated in the present report. (AU)

Benign sickle-cell an‘mia

Clinical, h‘matological, genetic, chemical, and oxygen-affinity studies have been carried out on a group of 18 Shiite Saudi Arabians with sickle-cell an‘mia. Apart from occasional attacks of mild musculo-skeletal pain they are well and have few of the complications which are usual in the sickling disorders. The unusually mild course of the illness is attributable, at least in part, to a genetically determined ability to produce large amounts of fetal h‘moglobin (Summary)