[Video-assisted thoracoscopic treatment for two ports for idiopathic palmar and axillary hyperhidrosis in children]. / Tratamiento videotoracoscópico por dos puertos para la hiperhidrosis palmar y axilar idiopática en el niño.

JUSTIFICATION: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy. OBJECTIVES: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse. METHOD: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described. RESULTS: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment. CONCLUSIONS: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery.

FUNDAMENTACION: La hiperhidrosis primaria es una enfermedad benigna que consiste en la excesiva producción de sudor, principalmente en manos, axilas y pies, y por ello puede llegar a condicionar la vida social y laboral de quien la padece. Afecta hasta el 3% de la población. En Cuba no hay estudios epidemiológicos sobre su prevalencia. Una de las modalidades de tratamiento es la simpaticotomía videotoracoscópica. OBJETIVOS: Describir los resultados de la técnica de simpaticotomía videotoracoscópica por dos puertos usando oxigenación apneica para lograr el colapso pulmonar. METODO: Estudio descriptivo, retrospectivo, de una serie de 27 casos operados por hiperhidrosis primaria en el periodo de mayo de 2015 a junio de 2018. Se describen características demográficas y clínicas de pacientes operados, resultados de la técnica quirúrgica endoscópica, complicaciones postoperatorias y satisfacción. RESULTADOS: Los 27 pacientes eran adolescentes con edades comprendidas entre 11 y 19 años, siendo más frecuente en el sexo femenino. Todos los pacientes tuvieron solución total de los síntomas en el periodo intraoperatorio, demostrados por el cese del sudor en palmas o axilas y por la comprobación del aumento de la temperatura palmar en el monitor. Ningún paciente tuvo complicaciones intraoperatorias. El sudor compensatorio se presentó en cuatro pacientes y un paciente tuvo neuritis intercostal. El 100% de los pacientes estuvieron satisfechos con el resultado a los 30 días del tratamiento. CONCLUSIONES: Es una técnica segura, con pocas complicaciones, elevada satisfacción con los resultados y factible de realizar en hospitales pediátricos con recursos básicos de cirugía de mínimo acceso.

Seroepidemiology of Neospora caninum among goats (Capra hircus) in the state of Paraíba, northeastern Brazil / Soroepidemiologia de Neospora caninum em caprinos (Capra hircus) do estado da Paraíba, Nordeste do Brasil

Although goat dairy farms in Brazil may have a higher risk of infection by Neospora caninum than beef farms, risk factor evaluation on a representative population remains to be fully established in Brazil. Accordingly, this study aimed to establish the occurrence of anti-N. caninum antibodies and factors associated with exposure in 406 blood samples from five dairy and three beef goat farms in the state of Paraíba, northeastern Brazil. Anti-N. caninum antibodies were detected by indirect immunofluorescence assay (IFA), with samples considered positive when reacting with dilution ≥ 1:50. A total of 106/406 goats (26.11%; 95% CI: 21.96-30.72%) were seroreactive comprising 2/61 (3.28%), 10/45 (22.22%), 13/50 (26.00%), 17/51 (33.33%) to 29/46 (63.04%) in dairy farms, and from 3/54 (5.56%), 12/50 (24.00%) to 20/49 (40.82%) on the beef farms. No significant associations were found in relation to age, gender, dairy versus beef farms, occurrence of abortions or mummified fetuses, and seroreactivity to N. caninum (P>0.05). In conclusion, goat farms in the state of Paraíba showed the highest occurrence of anti-N. caninum antibodies to date in Brazil.(AU)

Embora as criações caprinas de leite no Brasil possam ter maior probabilidade de risco de infecção por Neospora caninum do que as de carne, a avaliação dos fatores de risco em uma população representativa ainda não está totalmente estabelecida no Brasil. Dessa forma, este estudo teve por objetivo estabelecer a soroprevalência de N. caninum e seus fatores associados à exposição em 406 amostras de sangue de cinco fazendas de leite e três de corte provenientes do estado da Paraíba, região Nordeste do Brasil. A detecção de anticorpos anti-N. caninum foi realizada utilizando-se a reação de imunofluorescência indireta (RIFI), com as amostras consideradas positivas na diluição ≥ 1:50. No total, 106/406 (26,11%; IC 95%: 21,96-30,72%) caprinos foram sororreagentes, variando de 2/61 (3,28%), 10/45 (22,22%), 13/50 (26,00%), 17/51 (33,33%) a 29/46 (63,04%) em fazendas de leite, e de 3/54 (5,56%), 12/50 (24,00%) a 20/49 (40,82%) em fazendas de corte. Não foram observadas associações significativas entre idade, sexo, criação de leite e carne, ocorrência de abortamentos ou fetos mumificados e sororreatividade para N. caninum (P>0,05). Em conclusão, fazendas de caprinos da Paraíba mostraram as mais altas ocorrências de anticorpos anti-N. caninum até o momento no Brasil.(AU)

Genetic diversity of Saccharum complex using ISSR markers.

Sugarcane (Saccharum sp, Poaceae) is native to Southeast Asia, and due to growing demand as raw material, its cultivation recently expanded to new frontiers. The genetic diversity analysis is essential for targeting strategies in the formation and maintenance of a germplasm. This study aimed to assess the genetic diversity of 26 accessions of sugarcane from the Active Germplasm Bank of Embrapa Coastal Tablelands, using inter-simple sequence repeat (ISSR) molecular markers. Sixteen primers were used, resulting in 87 fragments with 91.13% of polymorphism. The similarity of the individuals ranged between 0.22 and 0.87. Individuals RB867515 and RB92579 were closer genetically, and the most distant ones were PI240785 and NSL 291970. Four distinct clusters were formed, using UPGMA. This information can be used to prioritize the selection of accessions for the conduction of hybridization in breeding and germplasm exchange actions.

Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity.

OBJECTIVES: To evaluate the prevalence of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) vs. controls, and to verify possible associations of MetS with specific disease-related factors. METHODS: The subjects were 283 RA patients and 226 healthy controls, frequency matched by age and sex. MetS was defined according to National Cholesterol Education Program (NCEP) criteria. Disease activity was evaluated with the Disease Activity Score using 28 joints (DAS28). A standardized clinical evaluation was performed and cardiovascular risk factors were assessed. RESULTS: The criteria for MetS were met by 39.2% RA patients vs. 19.5% in the control group (p < 0.001). Increased waist circumference, elevated blood pressure (BP), and fasting glucose were more frequent in RA patients than controls (p < 0.001 for all associations). By multiple logistic regression analysis (adjusted for age, sex, and years at school), the risk of having MetS was significantly higher for RA patients than for controls [odds ratio (OR) 1.87, 95% confidence interval (CI) 1.17-3.00, p = 0.009]. The DAS28 was significantly higher in RA patients with MetS than in those without MetS (3.59 ± 1.27 vs. 3.14 ± 1.53; p = 0.01). Disease duration, the presence of rheumatoid factor, and extra-articular manifestations were similar for patients with and without MetS. CONCLUSIONS: MetS frequency was higher in RA patients than in controls. Among RA patients, MetS was associated with disease activity. The higher prevalence of cardiovascular risk factors in RA suggests that inflammatory processes play a notable role in the development of cardiovascular disease (CVD), and indicates that tight control of systemic inflammatory activity and CVD modifiable risk factors should be recommended.

Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus.

BACKGROUND: Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. METHODS: Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 +/- 6.4 years (range, 27-66 years) and a mean BMI of 30.1 +/- 2.7 (range, 23.6-34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 +/- 4.6 years (range, 3-22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). RESULTS: The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3-19 months). The mean BMI was 23.8 +/- 4.1 kg/m(2), and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. CONCLUSIONS: Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.

Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m(2). METHODS: For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36-66 years). The mean BMI was 30.1 kg/m(2) (range, 23.4-34.9 kg/m(2)). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3-22 years). RESULTS: The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4-16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m(2) (range, 18.9-31.7 kg/m(2)). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. CONCLUSIONS: The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.

Nucleotide sequences provide evidence of genetic exchange among distantly related lineages of Trypanosoma cruzi.

Simple phylogenetic tests were applied to a large data set of nucleotide sequences from two nuclear genes and a region of the mitochondrial genome of Trypanosoma cruzi, the agent of Chagas' disease. Incongruent gene genealogies manifest genetic exchange among distantly related lineages of T. cruzi. Two widely distributed isoenzyme types of T. cruzi are hybrids, their genetic composition being the likely result of genetic exchange between two distantly related lineages. The data show that the reference strain for the T. cruzi genome project (CL Brener) is a hybrid. Well-supported gene genealogies show that mitochondrial and nuclear gene sequences from T. cruzi cluster, respectively, in three or four distinct clades that do not fully correspond to the two previously defined major lineages of T. cruzi. There is clear genetic differentiation among the major groups of sequences, but genetic diversity within each major group is low. We estimate that the major extant lineages of T. cruzi have diverged during the Miocene or early Pliocene (3-16 million years ago).

Phylogenetic relationships, historical biogeography and character evolution of fig-pollinating wasps.

Nucleotide sequences from the cytochrome oxidase I (COI) gene were used to reconstruct phylogenetic relationships among 15 genera of fig-pollinating wasps. We present evidence supporting broad-level co-cladogenesis with respect to most but not all of the corresponding groups of figs. Using fossil evidence for calibrating a molecular clock for these data, we estimated the origin of the fig-wasp mutualism to have occurred ca. 90 million years ago. The estimated divergence times among the pollinator genera and their current geographical distributions corresponded well with several features of the break-up of the southern continents during the Late Cretaceous period. We then explored the evolutionary trajectories of two characteristics that hold profound consequences for both partners in the mutualism: the breeding system of the host (monoecious or dioecious) and pollination behaviour of the wasp (passive or active). The fig wasp mutualism exhibits extraordinarily long-term evolutionary stability despite clearly identifiable conflicts of interest between the interactors, which are reflected by the very distinct variations found on the basic mutualistic theme.

Evolutionary history of microsatellites in the obscura group of Drosophila.

The evolutionary origins of microsatellites are not well understood. Some investigators have suggested that point mutations that expand repeat arrays beyond a threshold size trigger microsatellites to become variable. However, little empirical data has been brought forth on this and related issues. In this study, we examine the evolutionary history of microsatellites in six species within the obscura group of Drosophila, tracing changes in microsatellite alleles using both PCR product size and sequence data. We found little evidence supporting a general role of point mutations triggering initial microsatellite expansion, and no consistent threshold size for expansion was observed. Flanking region length variation was extensive when alleles were sequenced in distantly related species, and some species possessed altogether different repeat arrays between the same primer binding sites. Our results suggest extreme caution in using microsatellite allele sizes for phylogenetic analyses or to infer divergences between populations.

Testing Hamilton's rule with competition between relatives.

Hamilton's theory of kin selection suggests that individuals should show less aggression, and more altruism, towards closer kin. Recent theoretical work has, however, suggested that competition between relatives can counteract kin selection for altruism. Unfortunately, factors that tend to increase the average relatedness of interacting individuals--such as limited dispersal--also tend to increase the amount of competition between relatives. Therefore, in most natural systems, the conflicting influences of increased competition and increased relatedness are confounded, limiting attempts to test theory. Fig wasp taxa exhibit varying levels of aggression among non-dispersing males that show a range of average relatedness levels. Thus, across species, the effects of relatedness and competition between relatives can be separated. Here we report that--contrary to Hamilton's original prediction but in agreement with recent theory--the level of fighting between males shows no correlation with the estimated relatedness of interacting males, but is negatively correlated with future mating opportunities.

[National campaign to detect suspected diabetes cases in Brazil: a preliminary report]. / Campanha nacional de detecção de casos suspeitos de diabetes mellitus no Brasil: relatório preliminar.

The Ministry of Health of Brazil is implementing a National Plan for the Reorganization of Health Care for Hypertension and Diabetes Mellitus, with the aim of reducing the morbidity and mortality associated with diabetes. This plan is divided into four stages, one of which was a national campaign to detect suspected diabetes cases that was carried out in March and April 2001. This was the first survey of its kind carried out by public health services in Brazil, and the preliminary results are described in this article. Out of a total of 5,507 participating municipalities, 4,446 of them (81%) submitted data to the Ministry of Health. Twenty million people were tested (71% of the target population), and 3.3 million of them were identified as possibly having diabetes. The campaign will contribute towards restructuring the systematic and resolution-oriented care that the national, public Unified Health System provides to diabetics. The preliminary results confirm that diabetes is one of the main health problems in Brazil. Priority should be given to preventing type 2 diabetes.

Laparoscopic reoperations after failed and complicated antireflux operations.

Nineteen patients underwent laparoscopic reoperations for failed or complicated antireflux operations from a total of 248 patients with gastroesophageal reflux disease who had been operated on by this approach. Sixteen had been submitted to open surgery and three to laparoscopic surgery over a period ranging from 5 days to 31 years before the study. Three patients had been submitted to two open antireflux surgeries previously. Seventeen patients had recurrent reflux esophagitis after different types of surgeries, and two patients presented with gastric strangulation after fundoplication. The causes of recurrence were: slipped total fundoplications (3), disruption of total and partial fundoplications (6), too-tight total fundoplication (1), too-low (gastric) partial fundoplication (1), Allison procedure (1), partial fundoplication and paraesophageal hernia (2), and unknown (3). The laparoscopic approach was used in 18 patients and a laparoscopic-thoracoscopic approach in 1. The procedures included laparoscopic total fundoplications (11), partial fundoplications (4), transhiatal esophagectomy (1), Collis-Nissen (1), Roux-en-Y gastrectomy and thoracoscopic vagotomy (1), and intrathoracic fundoplication (1). One patient was converted to open surgery. Intraoperative complications included 1 pneumothorax, 1 gastric perforation, and 1 esophageal perforation during the introduction of a Maloney dilator. Mean operative time was 210 min, ranging from 140 to 320 min. Mean hospital stay was 3.1 days after treatment of failed operations and 22 days after treatment of complications. Postoperative complications included subcutaneous infection (1), gastric fistula (1), and liver hematoma (1). The results have been excellent and good in 84.3% of the patients after a mean follow-up of 13 months. We concluded that laparoscopic reoperations are technically feasible with good preliminary results provided that the mandatory expertise is available.

The interaction of parafluorohexahydrosiladiphenidol at muscarinic receptors in vitro.

1. The antagonistic actions of parafluorohexahydrosiladiphenidol (pFHHSiD) at muscarinic receptors has been studied in cardiac muscle, smooth muscle and cell culture preparations. In this paper, the classification scheme of Doods et al. (1987) is employed. This scheme is based upon differential affinities of muscarinic antagonists. pFHHSiD exhibited high pA2 values at M3 receptors mediating contractions of guinea-pig ileum and oesophageal muscularis mucosae (7.8 and 8.2 respectively) whereas low values were determined at M2 receptors mediating negative inotropic responses in guinea-pig atria (6.0). Intermediate pA2 values were determined at M1 receptors mediating contractions of the canine femoral and saphenous veins. 2. The pA2 values of pFHHSiD at receptors mediating endothelial-dependent relaxation of rat aortic rings, rabbit jugular vein and canine femoral artery (7.6-7.9) were similar to those determined on the ileum. However, the pA2 values of pFHHSiD at receptors mediating contractions of the guinea-pig trachea (7.1), which has been previously shown to possess M3 receptors, were different from those determined in the ileum. 3. The similarity in pA2 values of pFHHSiD between the M3 receptors in guinea-pig ileum and the receptors mediating endothelial-dependent relaxations provide further evidence for the role of M3 receptors in this vascular response. Taken together, pA2 values for pFHHSiD range from 7.1 to 8.2, depending upon the M3 preparation used. The selectivity of the compound therefore for the M3 versus the M2 muscarinic receptor ranged from 13 to 163 fold. 4. At muscarinic receptors mediating stimulation of phosphatidylinositol hydrolysis, pFHHSiD paradoxically displayed a high affinity for the M1 receptor in the SH-SY5Y cell line (pA2 = 7.9) as well as for the M3 receptor in the human astrocytoma (1321 NI cell line (pA2 = 7.6). The value at the M1 receptor in SH-SY5Y cells was greater than was observed at M1 receptors mediating contractions of both the canine saphenous and femoral veins (7.1). 5. pFHHSiD, therefore, clearly delineated M3 from M2 muscarinic receptors, whilst the separation between M1 and M3 receptors was variable. The reason for the anomalous affinity estimates in some functional studies remains unclear. These data indicate that the pA2 values for pFHHSiD appear to be tissue-dependent since the M3 selectivity varies according to the preparations studied. As a result the utility of pFHHSiD in muscarinic receptor classification is limited.