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BACKGROUND: Measurement of retinal thickness by optical coherence tomography (OCT) shows higher diagnostic accuracy for diabetic macular edema (DME) than fundus photography alone. The expanding gap between the rising number of type 2 diabetes (T2D) individuals and the availability of OCT devices demands a targeted selection of individuals at higher risk of DME who would benefit the most from early referral. We sought to appraise if proteinuria should be considered in a targeted referral of T2D individuals to OCT examination. METHODS: This study was a cross-sectional analysis of 576 consecutive patients enrolled in the Brazilian Diabetes Study between June/2016 and December/2021 who underwent OCT exam and urinalysis to assess ME and proteinuria status, respectively. Differences in the prevalence of DME between proteinuria groups and across a range of diabetic retinopathy (DR) stages were evaluated. RESULTS: Among 1134 eyes included in this analysis, the prevalence of proteinuria was 22% and 18.2% of eyes had DME. Proteinuria was related to an increased prevalence of DME (13.2% vs 38.7% for control vs proteinuria, respectively; p < .001), with an OR of 4.08 [95% confidence interval (CI): 2.50-6.64, p < .001), after adjustment for covariates. Proteinuria was independently related to DME also among eyes with non-apparent DR [OR: 2.82; 95%CI: 1.34-5.93; p = .003] and non-proliferative DR (OR of 5.94, 95%CI 2.13-16.62, p < .001). Fundus photography spotted only half of the DME cases detected by OCT. CONCLUSION: In T2D individuals, early referral to OCT examination should be pursued for all individuals with concurrent proteinuria. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04949152.

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Accurate identification of mosquito species is essential to support programs that involve the study of distribution and mosquito control. Numerous mosquito species are difficult to identify based only on morphological characteristics, due to the morphological similarities in different life stages and large numbers of some species that are members of morphologically similar species complexes. In the present study, the mosquitoes collected in the Pantanos de Centla Biosphere Reserve, southeastern Mexico, were evaluated using a combination of morphological and molecular approaches (mitochondrial cytochrome c oxidase subunit I [COI] DNA barcode). A total of 1,576 specimens of 10 genera and 35 species, mostly adult stages, were collected. A total of 225 COI DNA barcode sequences were analyzed; most species formed well-supported groups in the neighbor joining, maximum likelihood, and Bayesian inference trees. The intraspecific Kimura 2-parameter (K2P) genetic distance averaged 1.52%. An intraspecific K2P distance of 6.20% was observed in Anopheles crucians s.l., while a deep split was identified in Culex erraticus and Cx. conspirator. This study showed that COI DNA barcodes offer a reliable approach to support mosquito species identification in Mexico.

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The general bacterial microbiota of the soft tick Ornithodoros turicata found on Bolson tortoises (Gopherus flavomarginatus) were analyzed using next generation sequencing. The main aims of the study were to establish the relative abundance of bacterial taxa in the tick, and to document the presence of potentially pathogenic species for this tortoise, other animals, and humans. The study was carried-out in the Mapimi Biosphere Reserve in the northern-arid part of Mexico. Bolson tortoises (n = 45) were inspected for the presence of soft ticks, from which 11 tortoises (24.4%) had ticks in low loads (1-3 ticks per individual). Tick pools (five adult ticks each) were analyzed through 16S rRNA V3-V4 region amplification in a MiSeq Illumina, using EzBioCloud as a taxonomical reference. The operational taxonomic units (OTUs) revealed 28 phyla, 84 classes, 165 orders, 342 families, 1013 genera, and 1326 species. The high number of taxa registered for O. turicata may be the result of the variety of hosts that this tick parasitizes as they live inside G. flavomarginatus burrows. While the most abundant phyla were Proteobacteria, Actinobacteria, and Firmicutes, the most abundant species were two endosymbionts of ticks (Midichloria-like and Coxiella-like). Two bacteria documented as pathogenic to Gopherus spp. were registered (Mycoplasma spp. and Pasteurella testudinis). The bovine and ovine tick-borne pathogens A. marginale and A. ovis, respectively, were recorded, as well as the zoonotic bacteria A. phagocytophilum,Coxiella burnetii, and Neoehrlichia sp. Tortoises parasitized with O. turicata did not show evident signs of disease, which could indicate a possible ecological role as a reservoir that has yet to be demonstrated. In fact, the defense mechanisms of this tortoise against the microorganisms transmitted by ticks during their feeding process are still unknown. Future studies on soft ticks should expand our knowledge about what components of the microbiota are notable across multiple host-microbe dynamics. Likewise, studies are required to better understand the host competence of this tortoise, considered the largest terrestrial reptile in North America distributed throughout the Chihuahuan Desert since the late Pleistocene.

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There are ~240 species of Culicidae in Mexico, of which some are vectors of arthropod-borne viruses such as Zika virus, dengue virus, chikungunya virus, and West Nile virus. Thus, the identification of mosquito feeding preferences is paramount to understanding of vector-host-pathogen interactions that, in turn, can aid the control of disease outbreaks. Typically, DNA and RNA are extracted separately for animal (insects and blood meal hosts) and viral identification, but this study demonstrates that multiple organisms can be analyzed from a single RNA extract. For the first time, residual DNA present in standard RNA extracts was analyzed by DNA barcoding in concert with Sanger and next-generation sequencing (NGS) to identify both the mosquito species and the source of their meals in blood-fed females caught in seven sylvan communities in Chiapas State, Mexico. While mosquito molecular identification involved standard barcoding methods, the sensitivity of blood meal identification was maximized by employing short primers with NGS. In total, we collected 1,634 specimens belonging to 14 genera, 25 subgenera, and 61 morphospecies of mosquitoes. Of these, four species were new records for Mexico (Aedes guatemala, Ae. insolitus, Limatus asulleptus, Trichoprosopon pallidiventer), and nine were new records for Chiapas State. DNA barcode sequences for >300 bp of the COI gene were obtained from 291 specimens, whereas 130 bp sequences were recovered from another 179 specimens. High intraspecific divergence values (>2%) suggesting cryptic species complexes were observed in nine taxa: Anopheles eiseni (5.39%), An. pseudopunctipennis (2.79%), Ae. podographicus (4.05%), Culex eastor (4.88%), Cx. erraticus (2.28%), Toxorhynchites haemorrhoidalis (4.30%), Tr. pallidiventer (4.95%), Wyeomyia adelpha/Wy. guatemala (7.30%), and Wy. pseudopecten (4.04%). The study increased the number of mosquito species known from 128 species to 138 species for Chiapas State, and 239 for Mexico as a whole. Blood meal analysis showed that Aedes angustivittatus fed on ducks and chicken, whereas Psorophora albipes fed on humans. Culex quinquefasciatus fed on diverse hosts including chicken, human, turkey, and Mexican grackle. No arbovirus RNA was detected by reverse transcriptase-polymerase chain reaction in the surveyed specimens. This study demonstrated, for the first time, that residual DNA present in RNA blood meal extracts can be used to identify host vectors, highlighting the important role of molecular approaches in both vector identification and revealing host-vector-pathogen interactions.

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Mosquitoes are the most important arthropods from the point of view of public health, due to the fact that they can transmit a large number of pathogens which can cause diseases to humans and animals. Aedes aegypti (L.) is one of the most important vector species in the world, since it can transmit numerous pathogens such as dengue, Zika, and chikungunya. Therefore, studies involving the molecular aspects of this and other mosquitoes species are currently increasing. In this report, we describe the comparison between two DNA extraction techniques, Chelex and cetyltrimethylammonium bromide (CTAB), for carrying out DNA extraction in larvae, pupae and adult female of Ae. aegypti. The Chelex technique was superior in the amount and purity of DNA as compared to the CTAB technique in the three life stages we tested.

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To document and update the mosquito species of Tabasco, Mexico, field collection trips were conducted in the two physiographic regions of Tabasco: the coastal plain of the southern gulf and the mountains of Chiapas and Guatemala. Mosquitoes were collected as immature and adult stages during the dry and rainy seasons from 2014 through 2015. Additionally, the Reference Collection of Arthropods of Medical Importance (CAIM-InDRE) containing mosquitoes of Tabasco was re-examined. In total, 4,913 specimens were collected and examined, which are divided into seven tribes, 18 genera, 27 subgenera, and 104 species. Of these, one genus (Shannoniana Lane and Cerqueira), two subgenera (Georgecraigius Reinert, Harbach and Kitching, and Carrollia Lutz), and 21 species are new records for the mosquito fauna of Tabasco. Culex metempsytus Dyar is a new record for Mexico and Wyeomyia jocosa (Dyar and Knab) is removed from the Mexican mosquito fauna. Seventeen species historically reported were not found in the field collections conducted here. Taxonomic notes, new distribution limits, and comments about the medical importance of species of mosquitoes of Tabasco are discussed. Tabasco is the second state in Mexico with the largest mosquito richness (104 species), followed by Veracruz with 139 species.

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BACKGROUND: The aim of this study was to detect and molecularly identify Rickettsia spp. in Rhipicephalus sanguineus (sensu lato) collected from free-roaming dogs in 30 communities from five municipalities in the south of Coahuila State, northern Mexico, where Rocky Mountain spotted fever is endemic. METHODS: In total, 60 dogs from each municipality were examined for engorged ticks. DNA was isolated from tick pools and conventional PCR assays targeting the 23S-5S ribosomal RNA intergenic spacer and outer membrane protein (ompA) gene of Rickettsia spp. were performed. RESULTS: All ticks (n = 1238) were morphologically identified as R. sanguineus (s.l.). Six pools (each with six engorged females) from four municipalities were positive to Rickettsia spp. DNA sequencing and phylogenetic analyses confirmed the presence of R. rickettsii and R. rhipicephali in R. sanguineus (s.l.) in these ticks. CONCLUSIONS: This study confirms the presence of R. rickettsii and R. rhipicephali in R. sanguineus (s.l.) from stray dogs in the south of Coahuila. This suggests that stray dogs may play a role in the inter-municipal dissemination of infected ticks in this region. Further research is required to assess whether ticks from stray dogs could serve as good indicators for the molecular xenomonitoring of R. rickettsii in this region. Considering that R. sanguineus (s.l.) is a proven vector of R. rickettsii in Mexico, increased awareness regarding permanent tick control in dogs is warranted.

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The tick-borne pathogens Ehrlichia canis and Anaplasma platys are the causative agents of canine monocytic ehrlichiosis (CME) and canine cyclic thrombocytopenia (CCT). Although molecular evidence of E. canis has been shown, phylogenetic analysis of this pathogen has not been performed and A. platys has not been identified in Mexico, where the tick vector Rhipicephalus sanguineus sensu lato (s.l.) is common. The aim of this research was to screen, identify and characterize E. canis and A. platys by PCR and phylogenetic analysis in dogs from La Comarca Lagunera, a region formed by three municipalities, Torreon, Gomez-Palacio and Lerdo, in the Northern states of Coahuila and Durango, Mexico. Blood samples and five engorged R. sanguineus s.l. ticks per animal were collected from 43 females and 57 male dogs presented to veterinary clinics or lived in the dog shelter from La Comarca Lagunera. All the sampled dogs were apparently healthy and PCR for Anaplasma 16S rRNA, Ehrlichia 16S rRNA, and E. canis trp36 were performed. PCR products were sequenced and used for phylogenetic analysis. PCR products were successfully amplified in 31% of the samples using primers for Anaplasma 16S rRNA, while 10% and 4% amplified products using primers for Ehrlichia 16S rRNA and E. canis trp36 respectively. Subsequent sequencing and phylogenetic analyses of these products showed that three samples corresponded to A. platys and four to E. canis. Based on the analysis of trp36 we confirmed that the E. canis strains isolated from Mexico belong to a conservative clade of E. canis and are closely related to strains from USA. In conclusion, this is the first molecular identification of A. platys and the first molecular characterization and phylogenetic study of both A. platys and E. canis in dogs in Mexico.

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Este trabalho teve como objetivo determinar a prevalência de Escherichia coli produtoras de Shigatoxinas (STEC) e E. coli dos sorogrupos O157, O111 e O113 em rebanhos leiteiros do Município de Jaboticabal, SP, Brasil. A presença de sequências gênicas stx1, stx2e eae foi detectada pela reação em cadeia da polimerase (PCR) em amostras de fezes. Todas as amostras stx e eae positivas foram submetidas a uma nova reação de PCR para detecção das sequências rfb O157, O111 e O113. Observou-se uma alta prevalência (72,16%) de sequências stx nas fezes dos bovinos, sendo que o perfil genotípico encontrado com maior frequência foi o stx1 associado à stx2. Os coeficientes de prevalência das sequências rfb O157, O111 e O113 foram, respectivamente, 14,77%, 0,2% e 30,83%. Animais de todos os rebanhos (100%) apresentaram em suas fezes STEC e E. coli O113 e os sorogrupos O157 e O111 foram observados em 60,0% e 10,0% dos rebanhos, respectivamente. Concluiu-se que a alta prevalência de STEC detectada em rebanho leiteiro evidenciada nas fezes de bovinos desempenham um papel importante na contaminação ambiental e podem oferecer risco de agravo à saúde pública.

The purpose of this study was to determine the prevalence of Shigatoxigenic Escherichia coli (STEC) and serogroups O157, O111 and O113 in dairy cattle from Jaboticabal, state of São Paulo, Brazil. Feces samples were collected from 10 herds and assessed for the presence of the virulence genes stx1, stx2 and eae by polymerase chain reaction (PCR). All samples positive for stx and eae were submitted to a second PCR reaction targeting the sequences rfb O157, rfb O111 and rfb O113. A high prevalence of stx (72.16%) was detected in the fecal samples, the most frequent being stx1 associated to stx2. The prevalence of sequences rfb O157, rfb O111 and rfb O113 was 14.77%, 0.2% and 30.83%, respectively. STEC and serogroup O113 was identified in all herds (100%), and serogroups O157 and O111 were observed in 60% and 10% of the herds. In conclusion, the high STEC prevalence detected in dairy herds evidences that bovine feces might play an important role as a contamination source in the region of Jaboticabal.

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ABSTRACT The purpose of this study was to determine the prevalence of Shigatoxigenic Escherichia coli (STEC) and serogroups O157, O111 and O113 in dairy cattle from Jaboticabal, state of São Paulo, Brazil. Feces samples were collected from 10 herds and assessed for the presence of the virulence genes stx1, stx2 and eae by polymerase chain reaction (PCR). All samples positive for stx and eae were submitted to a second PCR reaction targeting the sequences rfb O157, rfb O111 and rfb O113. A high prevalence of stx (72.16%) was detected in the fecal samples, the most frequent being stx1 associated to stx2. The prevalence of sequences rfb O157, rfb O111 and rfb O113 was 14.77%, 0.2% and 30.83%, respectively. STEC and serogroup O113 was identified in all herds (100%), and serogroups O157 and O111 were observed in 60% and 10% of the herds. In conclusion, the high STEC prevalence detected in dairy herds evidences that bovine feces might play an important role as a contamination source in the region of Jaboticabal.

RESUMO Este trabalho teve como objetivo determinar a prevalência de Escherichia coli produtoras de Shigatoxinas (STEC) e E. coli dos sorogrupos O157, O111 e O113 em rebanhos leiteiros do Município de Jaboticabal, SP, Brasil. A presença de sequências gênicas stx1, stx2e eae foi detectada pela reação em cadeia da polimerase (PCR) em amostras de fezes. Todas as amostras stx e eae positivas foram submetidas a uma nova reação de PCR para detecção das sequências rfb O157, O111 e O113. Observou-se uma alta prevalência (72,16%) de sequências stx nas fezes dos bovinos, sendo que o perfil genotípico encontrado com maior frequência foi o stx1 associado à stx2. Os coeficientes de prevalência das sequências rfb O157, O111 e O113 foram, respectivamente, 14,77%, 0,2% e 30,83%. Animais de todos os rebanhos (100%) apresentaram em suas fezes STEC e E. coli O113 e os sorogrupos O157 e O111 foram observados em 60,0% e 10,0% dos rebanhos, respectivamente. Concluiu-se que a alta prevalência de STEC detectada em rebanho leiteiro evidenciada nas fezes de bovinos desempenham um papel importante na contaminação ambiental e podem oferecerrisco de agravo à saúde pública.

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Múltiples técnicas se han propuesto para el tratamiento de las secuelas cicatrizales de quemaduras en cuello. El colgajo supraclavicular representa una opción muy valiosa por presentar un pedículo constante que al aportar tejido de la vecindad, logra una mejor restauración cosmética. Presentamos una serie de 111 pacientes tratados entre 1997 y 2010. En el 65,76% (n=73) se lo talló a pedículo cutáneo y en el 34,23% (n= 38) en isla. El cierre de la zona dadora fue realizado en forma primaria en el 63,82% (n=70) de los casos y en el 36,17% (n=41) se emplearon autoinjertos. El porcentaje de complicaciones fue del 9%, repartidos entre dos necrosis totales del colgajo (1,8%), seis necrosis distales (5,4%) y dos hematomas (1,8%). Exponemos nuestra experiencia con el colgajo supraclavicular para el tratamiento de las complejas retracciones cervicales. Esta técnica es de suma utilidad y la anatomía vascular está ampliamente descripta, lo que permite evitar lesiones al pedículo.

Multiple techniques have been put forward for the treatment of burned neck contractures. The supraclavicular flap technique is a valued option as it contains a constant pedicle and because it uses neighbouring tissues, achieving a better cosmetic restoration. We present our portfolio of 111 patients who received treatment between 1997 and 2010. In 65,76% of the cases (n=73) it was harvested preserving a skin pedicle and in 34,23% of the cases (n=38) the island flap technique was utilized.* The donor site was closed primarily in 63,82% (n=70) and in 36,17% of the cases (n=41) split-thickness skin grafts were used. The percentage of cases which showed complications was 9%, including two full flap necrosis (1.8%), six distal necrosis (5.4%) and two hematomas (1.8%). We present our experience on the supraclavicular flap technique for treatment of complex cervical retractions. This technique is very useful and the vascular anatomy is described in great detail, which prevents injuries to the pedicle.

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BACKGROUND: Insertion of long-term central venous catheters (CVC) plays a vital role in providing continuous venous access for therapy in children. CVC line fractures are most commonly seen after long-term periods of therapy during removal. Usual place of rupture is proximal, at the point of entrance of the catheter into the vein, when the subclavian approach is utilized. We discuss a case that shows that CVC can also fracture in places different than the most common location and is possible not to detect that a fracture has occurred if a substantial portion of catheter is removed. METHOD: We report a two-year-old child that was incidentally found to have a distal fragmented piece of CVC left after previous "successful" removal on simple chest films. At time of removal the catheter length was deemed properly. A CT Scan confirmed the suspected diagnosis. Fragment of catheter was successfully removed via femoral percutaneous endovascular technique. RESULTS: CVC fractures can be suspected when there is resistance during removal or the length retrieved is too short. In this case the ease of retrieval and unusual site of rupture was the cause of not noticing that a part of catheter remained fixed to the vessel wall. Different potential mechanisms of CVC rupture include mechanical trauma, manufacturing defect or material degradation. Ruptures should be detected early to prevent complications such as sepsis, endocarditis, thrombosis, embolization, vessel stenosis and dysrhythmia. Best method to remove the fragmented catheter is via percutaneous endovascular retrieval method. After catheter removal a hyperdensity silhouette on a CXR can mimic the fragmented portion of a catheter known as a calcified cast or "ghost". To differentiate a "ghost" from an actual fragmented portion of catheter a CT Scan or echocardiogram is needed. CONCLUSION: Most important single step in preventing such complication is to keep record of the patient length of catheter that was inserted...

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Abdominal situs inversus is a rare condition usually associated with malformations of asymmetric organs such as the heart, liver, spleen and malrotation of the intestines. A case of abdominal situs inversus with intestinal malrotation and preduodenal portal vein is reported. Patient underwent prophylactic Ladd's procedure and preduodenal portal vein was left undisturbed during surgery. This case highlights the importance of rigorous investigation of anatomic features prior to surgery in a patient with heterotaxia. The authors advocate radiological investigation of patients with heterotaxia and prophylactic Ladd's procedure in those with intestinal malrotation.

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We discuss a 16-year-old male patient who presented with three episodes of recurrent pancreatitis within the last 6 months. Preoperative imaging studies suggested a choledochal cyst within the second portion of the duodenum. Patient was taken to surgery and the lesion was removed. Pathology examination of the cyst revealed a duodenal duplication. The accessory pancreatic papilla entering the closed duplication cyst was the main cause of the pancreatitis in this child.

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El alcoholismo es considerado en la actualidad una tragedia de la humanidad que ha cobrado fuerzas en las últimas décadas. El consumo de las bebidas alcohólicas y las repercusiones de él derivadas se consideran como uno de los problemas sociosanitarios más severos con que se enfrentan las sociedades occidentales. Se realizó un estudio epidemiológico observacional descriptivo con 558 pacientes mayores de 15 años pertenecientes al Consultorio Médico de Familia No. 30, Hoyo Colorado, Área de Salud del municipio Martí, en el período de enero del 2004 a enero del 2005, con el objetivo de contribuir al conocimiento de algunas características sobre el consumo de bebidas alcohólicas en dicha población. Se aplicó una encuesta a toda la población mayor de 15 años, complementándose la información con una entrevista estructurada a cada uno de los consumidores de bebidas alcohólicas detectados y a informantes claves de la comunidad. Los datos obtenidos fueron introducidos en el programa SPSS versión 10.0, con los cuales se conformaron una base de datos para el procesamiento y análisis teniendo en cuenta las medidas de resumen para variables cualitativas y cuantitativas. Obtuvimos como resultado que en los consumidores de bebidas alcohólicas predominó el grupo etáreo de 35 a 44 años y el sexo masculino, prevaleciendo el nivel escolar de secundaria básica y el mayor por ciento de éstos tenían como ocupación de obrero, siendo más frecuente el bebedor social, destacándose las crisis familiares entre los bebedores.

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We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.

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Se realiza un estudio comparativo a dos grupos de pacientes alcohólicos abusivos primarios, a uno de los cuales se trata con filmaciones en estado ebrio y debates diferidos y se comparan con los de un grupo control de pacientes seleccionados con iguales requisitos y tratados en grupo de psicoterapia de actitudes. Se evidencian resultados significativamente superiores en los primeros, tomando como referencia de cambio evolutivo la ingestión actual, las relaciones interpersonales, las relaciones con la pareja y la actitud laboral. Los criterios se consideraron tres meses después de iniciada la experiencia de tratamiento. Los resultados alientan a uso de esta modalidad de intervención terapéutica en pacientes refractarios a otros métodos por las notables resistencias psicológicas...(AU)

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This is the case of an 11-year-old girl who presented with a right adnexal mass and vague abdominal symptoms since seven months prior to her hospital admission for surgery. CT-scan and sonographic images were those of a benign lesion, probably ovarian torsion or infarction. Serum tumoral markers were normal. A right salpingo-oophorectomy and appendectomy were performed. Pathology examination revealed a cavernous hemangioma of the ovary. The clinicopathologic presentation of this unusual benign ovarian tumor is discussed.

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