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PURPOSE: To examine the extent to which personality and peer factors mediate the relationship between early cigarette use and later illicit drug use, as well as associated drug use problems, in a population of Colombian adolescents. METHODS: A longitudinal study (2-year interval), using face-to-face structured interviews was begun in 1996 using a community-based sample, randomly selected from census data in three cities in Colombia, South America. The participants were 2837 adolescents with a mean age of 15.0 (SD +/- 1.6) years at time 1 (T1). Males comprised 52% of the sample and 65% resided with two parents. Approximately 78% (N = 2226) completed the second structured interview 2 years later (T2). The main outcome measures were marijuana use, other illicit drug use, and associated drug use problems at T2. Three series of logistic regressions were conducted. RESULTS: The odds of marijuana use (adjusted odds ratio [AOR] = 1.64-2.01; confidence interval [CI]: 1.11-2.94), other illicit drug use (AOR = 1.77-2.49; CI: 1.03-4.19), and associated drug use problems (AOR = 2.25-3.47; CI: 1.45-5.26) at T2, was increased two- to three-fold among adolescents reporting cigarette use at T1, with control on the demographic, personality, and peer factors, as well as T1 drug use variables. CONCLUSIONS: Earlier adolescent cigarette smoking was directly associated with later marijuana use, other illicit drug use, and problems with drug use. [ABSTRACT FROM AUTHOR]

Although the use of different estradiol esters has been extensively studied in hormonal protocols in cows, such information is lacking in mares. The present study aimed to assess the effects of treatment with the same doses and administration frequency of estradiol cypionate, estradiol benzoate and 17β estradiol on plasma estradiol (E2) concentrations of acyclic mares and correlate the E2 profile to the endometrial edema score. Sixteen treatments were performed in 14 mares randomly divided into three groups: EB (n = 5), EC (n = 5), and 17β (n = 6), receiving 10 mg on day 0 (D0), 6 mg on D1, and 4 mg on D2 of estradiol benzoate, estradiol cypionate, and estradiol 17β, respectively. Blood samples, rectal palpations, and ultrasound evaluations were performed once daily, starting before the first estradiol treatment (D0) until edema disappearance or D8. Moderate to high edema was observed in all groups 24 hours after the first estradiol administration. Edema persisted above score 2 until D7, D5, and D4 in groups EC, EB, and 17β, respectively. Higher edema was found on D2 in EB group compared to 17β, on D6 and D7 in EC compared to 17β, and on D8 in EC compared to EB (p ≤ .05). Maximum E2 concentrations were detected on D1 in groups: EB, showing a sharp decrease from D2 to D3 (p < .0001); and 17β, where no differences were observed between treatment days (p ≥ .05). In the EC group, maximum concentrations were observed on D2, which remained high from D2 to D4 compared to the other days (p < .0001). Plasma concentration of E2 was higher in EB than the other groups on D0 and D1, and EB>EC>17β on D2. Plasma E2 concentrations and edema score were positively correlated, being moderate in groups EB and EC and weak in the 17β group. In conclusion, the most pronounced plasma E2 concentration was observed in EB group 24 hours after the administration of the first dose. Estradiol concentrations peaked 48 hours after EC administration, while a distinct peak was not observed in a 24h interval evaluation in the 17β group. Moreover, high edema does not necessarily reflect on high E2 concentrations in acyclic mares., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Current therapeutic ways adopted for the treatment of leishmaniasis are toxic and expensive including parasite resistance is a growing problem. Given this scenario, it is urgent to explore treatment alternatives for leishmaniasis. The aim of this study was to evaluate the effect of 3-phenyl-lawsone (3-PL) naphthoquinone on Leishmania ( Viannia ) braziliensis infection, both in vitro and in vivo , using two local routes of administration: subcutaneous (higher dose) and tattoo (lower dose). In vitro 3-PL showed low toxicity for macrophages (CC 50 >3200 µM/48h) and activity against intracellular amastigotes (IC 50 = 193 ± 19 µM/48h) and promastigotes (IC 50 = 116 ± 26 µM/72h), in which induced increased ROS generation. Additionally, 3-PL up-regulated the production of cytokines such as tumor necrosis factor alpha (TNF-α), monocyte chemotactic protein 1 (MCP-1), interleukin-6 (IL-6) and IL-10 in infected macrophages. However, the anti-amastigote action was independent of nitric oxide production. Treatment of hamsters infected with L. ( V. ) braziliensis from one week after infection with 3-PL by subcutaneous (25 µg/Kg) or tattooing (2.5 µg/Kg) route, during 3 weeks (3 times/week) or 2 weeks (2 times/week) significantly decreased the parasite load (p<0.001) in the lesion. The reduction of parasite load by 3-PL treatment was comparable to reference drug meglumine antimoniate administered by the same routes (subcutaneous 1mg/Kg and tattoo 0.1mg/Kg). In addition, treatment started from five weeks after infection with 3-PL per tattoo also decreased the parasite load. These results show the anti-leishmanial effect of 3-PL against L. ( V. ) braziliensis and its efficacy by subcutaneous (higher dose) and tattoo (lower dose) routes. In addition, this study shows that drug delivery by tattooing the lesion allows the use of lower doses than the conventional subcutaneous route, which may support the development of a new therapeutic strategy that can be adopted for leishmaniasis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Meira, Gomes, Schaeffer, Da Silva, Brito, Siqueira, Inácio, Almeida-Amaral, Da-Cruz, Bezerra-Paiva, Neves, Rodrigues, Dutra, Costa, da Silva and Da-Silva.)

Leishmaniasis is a parasitic disease caused by several species of intracellular protozoa of the genus Leishmania that present manifestations ranging from cutaneous ulcers to the fatal visceral form . Leishmania Viannia braziliensis is an important species associated with American tegumentary leishmaniasis and the main agent in Brazil, with variable sensitivity to available drugs. The search for new therapeutic alternatives to treat leishmaniasis is an urgent need, especially for endemic countries. Not only is quercetin well known for its antioxidant activity in radical scavenging but also several other biological effects are described, including anti-inflammatory, antimicrobial, and pro-oxidant activities. This study aimed to investigate the flavonoid quercetin's therapeutic potential in L. (V.) braziliensis infection. Quercetin showed antiamastigote (IC 50 of 21 ± 2.5 µM) and antipromastigote (25 ± 0.7 µM) activities and a selectivity index of 22. The treatment of uninfected or L. (V.) braziliensis -infected macrophages with quercetin increased reactive oxygen species (ROS)/H 2 0 2 generation without altering Nitric Oxide (NO) production. Oral treatment with quercetin of infected hamsters, starting at 1 week of infection for 8 weeks, reduced the lesion thickness (p > 0.01) and parasite load (p > 0.001). The results of this study suggest that the antiamastigote activity of the flavonoid quercetin in vitro is associated, at least in part, with the modulation of ROS production by macrophages. The efficacy of oral quercetin treatment in hamsters infected with L. (V.) braziliensis was presented for the first time and shows its promising therapeutic potential., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Santos, Da Silva, Brito, Inácio, Ventura, Mendes, Azevedo, Siqueira, Almeida-Amaral, Dutra and Da-Silva.)

Physical inactivity is one of the main causes of chronic diseases; however, strenuous exercise can induce immunosuppression. Several studies suggest that moderate amounts of exercise lead to a Th1 response, favoring the resolution of infections caused by intracellular microorganisms, while high volumes of exercise tend to direct the response to Th2, favoring infection by them. Leishmaniasis is a parasitic disease promoted by parasites of the Leishmania genus, with clinical manifestations that vary according to the species of the parasite and the immune response of the host. The experimental Leishmania major -BALB/C mouse model provides a good model for the resistance (Th1 response) or susceptibility (Th2 response) that determines the progression of this infection. The aim of this study was to evaluate the effect of aerobic training at different volumes on modulation of in vitro macrophage infection by L. major , as well as to assess the effect of high volume (HV) aerobic training on the development of L. major in vivo in BALB/c mice. Uninfected animals were submitted to various exercise volumes: none (SED), light (LV), moderate (MV), high (HV), very high (VHV), and tapering (TAP). The macrophages of these animals were infected by L. major and the LV and MV groups showed a decrease in the infection factor, while the VHV showed an increase in the infection factor, when treated with LPS. The cytokine concentration pattern measured in the supernatants of these macrophages suggested a predominant Th1 response profile in the LV and MV groups, while the Th2 profile predominated in the VHV and TAP groups. Groups of BALB/C mice infected with L. major were subjected to high volume (iHV) or non-periodized high volume (iNPHV) exercise or kept sedentary (iSED). The exercised animals suffered a significant increase in injuries caused by the parasites. The animals in the group submitted to high volume exercise (iHV) showed visceralization of the infection. These data strongly suggest that a very high volume of aerobic training increased the susceptibility of BALB/C mice to L. major infection, while moderate distribution of training loads promoted immunological balance, better controlling the infection by this parasite., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Guimarães, Gomes, Albuquerque, Lima, Braga, Souza, Assis, Brito, Santos, Da Silva, Siqueira, Ventura, Rodrigues, Terra, Da Silva and Dutra.)

The aim of this study was to investigate the effect of laser photobiomodulation (PBM) on the viability of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats subjected to the action of nicotine. We evaluated 60 albino Wistar rats, divided into six groups of ten animals. Group 1 (saline) underwent the surgical technique to obtain a TRAM flap; group 2 (laser 830 nm) underwent the surgical technique and was irradiated with a laser 830 nm; group 3 (laser 660 nm) underwent the surgical technique and was irradiated with a laser 660 nm; group 4 was treated with nicotine subcutaneously (2 mg/kg/2×/day/4 weeks) and underwent surgery; group 5 (nicotine + laser 830 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 830 nm; group 6 (nicotine + laser 660 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 660 nm. The application of PBM occurred immediately after surgery and on the two following days. The percentage of necrosis was assessed using the AxioVision® software. The number of mast cells (toluidine blue staining) was evaluated, and immunohistochemistry was performed to detect vascular endothelial growth factor expression (anti-VEGF-A), fibroblasts (anti-basic FGF), and neoformed vessels (anti-CD34). PBM with a wavelength of 830 nm increased the viability of the TRAM flap, with a smaller area of necrosis, increased number of mast cells, and higher expression of VEGF and CD34. PBM increases the viability of musculocutaneous flaps treated with to nicotine.

Nicotine is the primary pharmacologic component of tobacco, and users of tobacco products seek out its effects. The highly addictive nature of nicotine is responsible for its widespread use and difficulty with quitting. This technical report focuses on nicotine and discusses the stages of use in progression to dependence on nicotine-containing products; the physiologic characteristics, neurobiology, metabolism, pharmacogenetics, and health effects of nicotine; and acute nicotine toxicity. Finally, some newer approaches to cessation are noted., (Copyright © 2017 by the American Academy of Pediatrics.)

Purpose: The objective of this study was to evaluate the effectiveness of mobilization with movement and kinesiotherapy in the treatment of patients with lateral epicondylosis., Methods: This cases series included eight volunteers who had chronic lateral epicondylosis. The patients were treated with stretching, massage deep transverse at the lateral epicondyle and mobilization with movement associated with eccentric exercise. The mobilization with movement that consisted of a force of lateral glide of the proximal forearm. We performed twelve sessions, twice a week for 45 min/session. All patients underwent an evaluation with a visual analog scale and functional assessment through questionnaires patient-rated tennis elbow evaluation (PRTEE) and disabilities of the arm, shoulder and hand (DASH), before and after the treatment. Data were analyzed by student's t test (p < 0.05)., Results: The results showed statistical differences in pain symptoms before and after treatment, in the analysis and functional assessment through both questionnaires comparing the pre and post treatment., Conclusion: The data obtained in this study demonstrates improvement of the function and pain status of the sample investigated.

Background: Accurate diagnostic techniques for schistosomiasis are essential for prevalence determination and identification of positive patients. A point-of-care test for detecting schistosome circulating cathodic antigen (POC-CCA) has been evaluated for its accuracy in different endemic regions. This reagent strip/dipstick based assay has showed high sensitivity for individuals with high or moderate worm burden, but the interpretation of light infections is less clear, especially for trace readings., Methodology/principal Findings: We introduced a urine lyophilization step to the POC-CCA assay to improve its sensitivity and clarify the interpretation of traces. We evaluated POC-CCA sensitivity and specificity within individuals with low parasite burdens in a Brazilian endemic area where a high number of traces were detected. Patients that were positive for other helminths were also evaluated for cross reactions. In all cases, a combined parasitological diagnosis using Kato-Katz (24 slides) and Saline Gradient (1 g of feces) were used as reference. At baseline, diagnosis by POC-CCA (1-2 cassettes) showed 6% sensitivity, inaccurately predicting a low prevalence of Schistosoma mansoni infections (2 POC-CCA positives/32 egg positives). After urine lyophilization, the sensitivity was increased significantly (p < 0.05). Prevalence rates changed from 2% to 32% (27 POC-CCA positives/32 egg positives), equivalent to parasitological techniques. Most of the trace readings changed to positive after lyophilization while some negatives turned into traces. Cross reaction analysis confirmed the specificity of POC-CCA., Conclusions/significance: Trace readings cannot be primarily defined as positive or negative cases. It is critical to verify case-by-case by concentrating urine 10 fold by lyophilization for the diagnosis. Following lyophilization, persistent trace readings should be read as negatives. No trained technician is needed and cost is restricted to the cost of a lyophilizer and the electricity to run it.

Introduction: Schistosomiasis, caused by Schistosoma mansoni, is a public health concern in Brazil. However, the most popular diagnostic method, the Kato-Katz technique, exhibits low sensitivity in low-endemicity areas. We aimed to compare the performance of an immunological assay, the point-of-care circulating cathodic antigen (POC-CCA®) test, with that of two parasitological techniques in a low-endemicity population., Methods: Our study included 141 individuals living in Estreito de Miralta, Minas Gerais, Brazil. Fecal samples were obtained from all participants and analyzed for schistosomiasis using two parasitological techniques: the Kato-Katz technique and the saline gradient technique. Additionally, POC-CCA® strips were utilized for testing urine samples. The results obtained by the different techniques were compared., Results: Analysis of two or 24 slides using the Kato-Katz technique resulted in a positivity rate of 10.6% (15/141) or 19.1% (27/141), respectively. The saline gradient technique yielded a positivity rate of 17.0% (24/141). The prevalence according to both parasitological techniques was 24.1% (34/141). The POC-CCA® test yielded a positivity rate of 22.7% (32/141); however, the positivity rate was merely 2.1% if trace results were considered negative. The agreements observed between POC-CCA® and the parasitological techniques were good (Kappa indexes > 0.64). The POC-CCA® test was more sensitive than the two-slide Kato-Katz technique (p < 0.05) in detecting cases of S. mansoni infection when trace results were considered positive., Conclusions: These findings reinforce the importance of using multiple diagnostic techniques in low-endemicity areas for effective control of disease.

Background: There is growing evidence that text messaging-"short message service" (SMS)-is useful for health promotion and behavior change. SMS has become a preferred channel of communication among adolescents. Despite burgeoning interest, there remains a critical need for formative research regarding developmentally and culturally appropriate SMS-based health promotion with teenagers., Objectives: The primary objective was to develop SMS message protocols and procedures effective for reducing underage drinking among Hispanic teens. Using focus groups, we sought our target population's perspectives on SMS parameters including scheduling, frequency, content, themes, and confirmation-of-receipt., Method: We conducted, recorded, and transcribed six mixed-gender focus groups (20 adolescents, 4-5 per group) recruited from the Division of Adolescent Medicine at Miami Children's Hospital. Alcohol-related and "attention control" text messages were assembled from two sources (http://www.mobilehealth4youth.org and the existing literature); these SMSs, along with SMS procedures, were the focus of discussion. The recordings and transcription were reviewed by two researchers who employed a qualitative iterative process analytical approach., Results: Findings revealed distinct preferences among teenagers about the scheduling, frequency, content, themes, and confirmation-of-receipt of SMSs. Moreover, teens were most enthusiastic about SMSs that addressed alcohol-related knowledge, self-efficacy, social support, or future orientation. Conclusion/Importance: Seeking our target population's perspectives on SMS parameters was essential for developing SMS message protocols and procedures with potential effectiveness for reducing underage drinking among Hispanic teens. It is strongly recommended that researchers or clinicians considering SMS-based interventions conduct a similar formative process prior to implementation.

Background: The objective of the study was to identify the presence of hydrosalpinx in postmenarchal nonsexually active girls in a children's hospital and to review the available literature on hydrosalpinx in this population., Cases: In a tertiary care children's hospital, we performed a retrospective review of charts from January 1, 2000 to December 31, 2014 and identified six cases of hydrosalpinx in postmenarchal nonsexually active female adolescents ranging in age from 12 to 19 years old. The diagnosis of hydrosalpinx was made using imaging studies. Four of six patients were symptomatic at presentation, and two patients were diagnosed when seen for unrelated reasons. Five of these six girls had previous abdominopelvic surgery. Four girls were given empiric antibiotic treatment for presumed pelvic inflammatory disease related to hydrosalpinx. Two patients required surgical intervention that resulted in complete resolution of the hydrosalpinx. The oldest patient in the series underwent ultrasound-guided drainage of the pyo- and/or hydrosalpinx with subsequent recurrence with tubal ovarian abscess five months later., Summary and Conclusions: The presence of hydrosalpinx might be discovered in the workup of pelvic pain in nonsexually active adolescents or on routine follow-up in patients with previous abdominal surgery, some of whom are asymptomatic. The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction. Early detection and prompt diagnosis will allow for appropriate conservative or definitive treatment., (Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

This study evaluated parasitological and molecular techniques for the diagnosis and assessment of cure of schistosomiasis mansoni. A population-based study was performed in 201 inhabitants from a low transmission locality named Pedra Preta, municipality of Montes Claros, state of Minas Gerais, Brazil. Four stool samples were analysed using two techniques, the Kato-Katz® (KK) technique (18 slides) and the TF-Test®, to establish the infection rate. The positivity rate of 18 KK slides of four stool samples was 28.9% (58/201) and the combined parasitological techniques (KK+TF-Test®) produced a 35.8% positivity rate (72/201). Furthermore, a polymerase chain reaction (PCR)-ELISA assay produced a positivity rate of 23.4% (47/201) using the first sample. All 72 patients with positive parasitological exams were treated with a single dose of Praziquantel® and these patients were followed-up 30, 90 and 180 days after treatment to establish the cure rate. Cure rates obtained by the analysis of 12 KK slides were 100%, 100% and 98.4% at 30, 90 and 180 days after treatment, respectively. PCR-ELISA revealed cure rates of 98.5%, 95.5% and 96.5%, respectively. The diagnostic and assessment of cure for schistosomiasis may require an increased number of KK slides or a test with higher sensitivity, such as PCR-ELISA, in situations of very low parasite load, such as after therapeutic interventions.

Pentavalent antimonials have saved the lives of thousands of Leishmania-infected patients more than seventy years but, unfortunately, they are highly toxic and require parenteral delivery. Therefore, the search for safer and orally delivered alternative is a need. This paper describes the antileishmanial properties of PMIC4, a novel hydroxyethylpiperazine analogue. PMIC4 showed potent activity against intracellular amastigotes of Leishmania amazonensis, with IC50 of 1.8 μM and selectivity index higher than 100-fold, calculated in relation to the toxicity on the host cell. Following laboratory animal welfare policies, we analyzed the absorption, distribution, metabolism, excretion and toxicity (ADMET) properties and calculated the Lipinski's rule of five of PMIC4 before proceeding to in vivo tests. PMIC4 satisfied Lipinski's rule of five and presented high probability of human intestinal absorption, suggesting a good chance of druglikeness and oral bioavailability. For in vivo studies, PMIC4 was administered via intralesional injection (3.4 mg/kg/day, three times a week) or orally (34.0 mg/kg/day, five times a week) to L. amazonensis-infected BALB/c mice throughout the 98 day experiments. At the end of the treatment period, serum markers of toxicity were measured. When administered orally, PMIC4 controlled the lesions in L. amazonensis-infected BALB/c mice without altering serological markers of toxicity. These results demonstrate that PMIC4 is a promising molecular scaffold, orally effective against experimental leishmaniasis.

Abstract We report a case of a 17-year-old girl with a history of congenital human immunodeficiency virus (HIV) infection and lipodystrophy secondary to highly active antiretroviral therapy (HAART). She developed severe worsening of preexisting hypertriglyceridemia after treatment with oral contraceptive pills (OCP) for polycystic ovary syndrome. Her hypertriglyceridemia improved upon OCP discontinuation. Although it is known that estrogen combined with progestins have a negative effect on triglycerides and high-density lipoprotein (HDL) cholesterol levels, to our knowledge the association of HAART-related lipodystrophy and severe hypertriglyceridemia after OCP use has not been reported in the literature. We recommend avoiding the use of OCPs in patients with lipodystrophy due to the increased risk of worsening hypertriglyceridemia.

Drug testing is often used as part of an assessment for substance use in children and adolescents. However, the indications for drug testing and guidance on how to use this procedure effectively are not clear. The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance to pediatricians and other clinicians on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations.

Schistosoma mansoni tegument is involved in essential functions for parasite survival and represents a target for screening candidates for vaccine and diagnosis. Our group using reverse vaccinology selected six candidates, previously demonstrated by proteomics studies to be expressed in the parasite tegument, among them was Sm200. In this work we have cloned and expressed a recombinant form of Sm200 C-terminal (1069-1520) region. The efficacy of rSm200 (1069-1520) in the diagnosis of schistosomiasis and in the formulation of a vaccine against S. mansoni was assessed respectively in an ELISA based diagnostic assay and immunization protocols in mice. Significant differences between non-infected and acutely infected or chronically infected animals were observed and no cross-recognition was observed with sera from Ascaris suum or Ancylostoma ceylanicum infected mice. rSm200-ELISA test could also discriminate infected individuals from healthy donors not living in endemic area for schistosomiasis but failed to discriminate between individuals from a low endemic area for schistosomiasis known to have positive or negative stools after examination. Recombinant Sm200 also failed to induce protection against schistosomiasis, demonstrating that the C-terminal part of Sm200 is unable to induce protective immune response in mice. Therefore rSm200 (1069-1520)-ELISA represents an important tool to be used in the diagnosis of schistosomiasis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10 J/cm(2), 40 J/cm(2) and 80 J/cm(2) of laser AsGaAl (830 nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000 g whose load was applied for 10 min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40 J/cm(2), when compared with the sham group (p < 0.05). On the 14th day the groups irradiated with 40 J/cm(2) and 80 J/cm(2) also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (p > 0.05). It was possible to observe that the LLLT at fluency of 40 J/cm(2) and 80 J/cm(2) had a positive influence on the acceleration of the functional nerve recovery.

Background: The eco-epidemiological complexity of American cutaneous leishmaniasis (ACL) has made it difficult to devise an efficient strategy for management of the disease, and development of an effective vaccine remains the most promising approach. The objective of the study was to determine the reduction in incidence of ACL following intramuscular administration of two doses of a killed Leishmania (Leishmania) amazonensis vaccine., Methods: A cluster randomised trial was conducted from 2002 to 2011 in 108 localities in an endemic area of southeast Brazil. Communities were stratified according to population size, and randomly allocated to receive vaccine (n = 50) or placebo (n = 58). The post-vaccination ACL incidence rates in the two groups were compared through covariance analysis., Results: A cyclic fluctuation in the number of cases recorded during the 18-year pre-vaccination period was similar in both groups. Following the vaccination campaign, a significant reduction in the number of cases of ACL was observed in the vaccine group compared with the placebo group. This group also included the individuals who refused to participate in the trial., Conclusion: This study demonstrated that the vaccine has been able to confer protection against ACL up to the present time. It is necessary to continue epidemiological surveillance to determine the duration of the vaccine's effectiveness.

This study evaluated an anaerobic fluidized bed reactor (AFBR) that contained polystyrene particles as a support material for the treatment of vinasse that resulted from the alcoholic fermentation of sugarcane molasses. The AFBR was inoculated with sludge from an upflow anaerobic sludge blanket reactor that treated poultry slaughterhouse wastewater. The AFBR was operated with a hydraulic retention time of 24 h at a temperature of 30°C with influent vinasse concentrations that ranged from 2273 to 20,073 mg COD L(-1). The reactor was subjected to increased organic loading rates (OLR) that ranged from 3.33 to 26.19 kg COD m(-3) d(-1), with COD removal efficiencies that ranged from 51% to 70% and maximum removal at an OLR of 13.93 ± 2.18 kg COD m(-3) d(-1). The maximum biogas productivity was 5.37 m(3) CH4 m(-3) d(-1) for an OLR of 25.32 kg COD m(-3) d(-1) (average removal of 51%)..

Background: Coarctation of the aorta (CoA) accounts for 5% to 7% of congenital heart disease, with an incidence of 0.3 to 0.4 per 1000 live births. Surgery was the only choice of therapy for CoA until 1982 when balloon angioplasty became an available alternative for its treatment. Re-coarctation, aneurysm and aortic dissection remain the disadvantages of both treatments. To avoid those disadvantages, in 1990 endovascular stents were introduced for native coarctation and re-coarctation and since then they have become an alternative approach to surgical repair. The best approach to treat the CoA, whether open surgery or by stent placement, is not clear., Objectives: To analyze the effectiveness and safety of stent placement compared with open surgery in patients with coarctation of the thoracic aorta., Search Methods: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched September 2011) and CENTRAL (2011, Issue 3). We also searched MEDLINE, EMBASE, CINAHL, AMED, Web of Science and LILACS (last searched in September 2011). We evaluated the located references and applied the inclusion criteria to selected studies. There was no restriction on language., Selection Criteria: Randomized or quasi-randomized controlled clinical trials that compared patients with CoA undergoing open surgery or stent placement., Data Collection and Analysis: The review authors independently assessed the studies identified for eligibility for inclusion. We excluded studies after a consensus meeting., Main Results: All identified studies were screened and had the selection criteria applied to the title and abstract. In total, we selected five studies for full-text analysis. After detailed evaluation, we excluded all studies because there was no comparison between stent placement and open surgery., Authors' Conclusions: There is insufficient evidence with regards to the best treatment for coarctation of the thoracic aorta. This review suggests a need to perform a randomized controlled clinical trial with emphasis on the allocation method, evaluation of primary outcomes, size and quality of the sample, and long-term follow-up.

This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.

Objective: The purpose of this study was to evaluate the effect of 830-nm laser in blocking the action of nicotine on the viability of skin flap., Background Data: The authors have analyzed the deleterious effect of cigarette smoke or nicotine on the skin flap alone with evidence of increased skin necrosis in the flap., Materials and Methods: Twenty-four Wistar-albino rats were divided into three groups of eight animals each: Group 1 (control), subjected to a surgical technique to obtain a flap for cranial base, laser irradiation simulation, and a subcutaneous injection of saline; Group 2, similar to Group 1, with subcutaneous injection of nicotine (2  mg/kg/day) for a period of 1 week before and 1 week after surgery; and Group 3, similar to Group 2, with skin flaps subjected to a λ 830-nm laser irradiation. The laser parameters used were: power 30 mW, beam area 0.07 cm(2), irradiance 429 mW/cm(2), irradiation time 84  sec, total energy 2.52  J, and energy density 36 J/cm(2). The laser was used immediately after surgery and for 4 consecutive days, in one point at 2.5  cm of the flap cranial base. The areas of necrosis were examined by two macroscopic analyses: paper template and Mini-Mop(®). The pervious blood vessels were also counted., Results: The results were statistically analyzed by ANOVA and post-test contrast orthogonal method (multiple comparisons), showing that the laser decreased the area of necrosis in flaps subjected to nicotine, and consequently, increased the number of blood vessels (p < 0.05)., Conclusions: The laser proved to be an effective way to decrease the area of necrosis in rats subjected to nicotine, making them similar to the control group.

This work describes the synthesis and characterization of three novel complexes derived from N-benzyl-ethylenediamine and oxalate. Precursor compounds were synthesized by reacting N-benzyl-ethylenediamine with K(2)PtCl(4). Subsequent substitution of chlorides by oxalate led to the final products. Elemental analysis and the infrared, (1)H, (13)C, and (195)Pt NMR spectra of these complexes were provided. The cytotoxic activities were investigated against human non-small cell lung carcinoma (A(549)), mouse non-metastatic cell skin melanoma (B16-F1), mouse metastatic cell skin melanoma (B16-F10), human cell breast adenocarcinoma (MDA-MB-231) and normal cell lines such as baby hamster cell kidney (BHK-21), hamster cell ovary (CHO) and compared to cisplatin and carboplatin under the same experimental conditions. The presence of oxalate as a leaving group conferred an interesting cytotoxicity profile to the complexes in the tested cell lines.

Objectives: About one third of overweight women with polycystic ovary syndrome (PCOS) have either impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM) by the age of 30. We sought to determine if overweight Hispanic adolescents with PCOS are more likely to be insulin resistant and glucose intolerant than those without PCOS., Methods: A retrospective chart review of 101 subjects with PCOS and 40 without PCOS was conducted. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting glucose/insulin ratio (FGIR) values were calculated by using fasting glucose and insulin levels. Insulin resistance (IR) was defined as a fasting insulin level of >15 microU/mL, a 2-hour insulin level of >75 microU/mL, a HOMA-IR value of >3.16, a QUICKI value of <0.357, and/or a FGIR value of <7., Results: Of the 101 overweight subjects with PCOS (BMI: 33.2 +/- 5.9 kg/m(2)), 4 had IGT and 2 had DM versus none of the 40 subjects without PCOS (BMI: 32.4 +/- 5.3 kg/m(2)). IR was more frequent in the overweight PCOS than in the overweight non-PCOS group (QUICKI: 68.4% vs 14.3%, P = .014) and FGIR (47.4% vs 0%, P = .024). Of the 6 subjects with glucose intolerance, only the QUICKI value was abnormal in all., Conclusions: This retrospective study demonstrated that overweight Hispanic adolescents with PCOS had more IR, IGT and DM than their non-PCOS counterparts. As the QUICKI Index was abnormal in all subjects with IGT and DM, we suggest its use as the first step in deciding which overweight Hispanic adolescents with PCOS should be further tested with an OGTT.

This study examines differences in risk and protective factors for binge drinking among six ethnic/national subgroups of Hispanic adolescents in Florida. We note differences in the frequency of binge drinking by gender and ethnic subgroup as well as differences in the salience of items drawn from the five domains of risk and protective factors among these subgroups. Rather than treating all Hispanics as a unitary culture, tailoring of prevention programs to address risk and protective factors that differentially affect national/ethnic subgroups may be a valuable strategy when adolescents live in communities that are relatively homogenous in terms of nationality/ethnicity.

Background: A severe cyclic constellation of affective symptoms during the luteal phase of the menstrual cycle is termed premenstrual dysphoric disorder (PMDD)., Case: A 17-yr-old female was referred for evaluation of behavior changes with her menses. Parents noted behavior changes, two to three days before the onset and lasting till the end of her menses. Menarche was at 13 years. Periods were regular, with normal flow and duration and no dysmenorrhea. Psychosocial history was unremarkable. There was no history of sexual activity or abuse. Her physical exam was unremarkable. With the working diagnosis of premenstrual dysphoric syndrome she was asked to keep track of her menses on a menstrual calendar and her symptoms with a daily diary. She was treated with Fluoxetine 20 mg/day during the luteal phase of her menstrual cycle with complete resolution of her symptoms., Comments: In PMDD the mood disturbance occurs during the late luteal phase of the menstrual cycle (approximately 1 week before the onset of menstrual bleeding), remits after the onset of menses, and can be established by a prospective daily symptom log for two consecutive cycles. The symptoms are more severe than that of premenstrual syndrome, are associated with significant functional impairment and are cyclical. Symptoms were documented prospectively as starting a few days before her menstrual bleeding and remitting at the end of it. She responded to episodic use of a selective serotonin reuptake inhibitor. This disorder needs to be better recognized, because it can be easily treated.

Purpose: To determine (1) the prevalence of use, (2) risk and protective factors for use of inhalants in Florida youth., Methods: The Florida Youth Substance Abuse Survey 2004 is a comprehensive assessment of youth substance abuse attitudes and practices obtained by sampling youth from sixty-five counties., Results: The sample consisted of 60,345 students from 6th to 12th grade; ages 10 to 19 + years (mean 14.5 years +/- 4), 53% were female with 59% White, 19% African-American, 16% Hispanic, 5% Native American, 2% Asian and 7% other. Lifetime use was highest among 14 year olds (16.5%), and current use among 13 year olds (16.7%). Females had significantly (p < .000) higher rates than males for lifetime (14.2% vs. 12.7%) and current use (5.1% vs. 4.1%). Native Americans had the highest rates of lifetime use (17%) followed by Whites (15%), mixed/other (15%), Hispanics (14%), Asians (13%), and Blacks (9%). The younger the age of first use of alcohol, cigarettes and marijuana, the higher the lifetime and current prevalence of use of inhalants. Inhalant users were more likely to be depressed, acknowledge deviant behavior and skipping school, have lower grades, have siblings and friends who used illegal substances and parents with a history of antisocial behavior (p < .000)., Conclusion: Inhalant use may be a marker for adolescents with a high-risk profile for subsequent illegal drug use. Prevention efforts should be directed to these students at an early age.

The health of adolescent females can be compromised by new social morbidities resulting from high-risk behaviors. The presence of various risk factors will increase the chances of their becoming involved in these behaviors and decrease their ability to reach the milestones of this developmental age. Protective factors will moderate these risks. Physicians and other health care providers can help foster resilience in the face of adversity by developing a better understanding of these factors and using a multidisciplinary approach to care.

Study Objective: To report the lifetime prevalence of lysergic acid diethylamide (LSD) and to identify unique correlates of using this substance in the last year among a large multiethnic sample of sexually active adolescent and young adult women aged 14 to 26 yrs., Design, Setting, Participants: A cross-sectional survey, administered at university-based ambulatory reproductive health clinics, was completed by 904 women between April and November of 1997 to identify risk factors associated with their use of LSD within the past 12 months. Subjects who reported lifetime, but not past 12 months', use of marijuana, LSD, or other illicit drugs were excluded, leaving a sample of 368 nonusers and 56 users of LSD. In addition, 231 young women who reported only using marijuana in the last year were used as a comparison group to identify unique factors associated with LSD use., Results: Of the total sample (n=904), 13% (n=119) reported lifetime use of LSD, and 58% (n=536) reported lifetime use of marijuana. Logistic regression analyses controlling for age and race/ethnicity found distinct profiles for those who reported using LSD or only marijuana in the last year when compared to those who reported no substance use. Common to both groups was reporting being drunk at least 10 times during the last year, regular smoking of at least half a pack of cigarettes, and identification as a high-sexual-risk taker. However, LSD users as compared to nonusers were more likely to report white ethnicity (as compared to nonwhite), be less than or equal to 17 years of age (as compared to at least 18 years), report a history of physical abuse, and be categorized as having severe depressive symptomatology. In contrast, those who reported only using marijuana were more likely to report single marital status, young age at first intercourse, having half or more of their friends use marijuana, and poor grades., Conclusions: The female LSD user presents a distinct profile that might aid clinicians in identifying potential LSD use in this population as well as alerting clinicians to the relationship between LSD use and high-risk sexual behaviors.

Objectives: To compare perceived reasons for continued smoking and withdrawal symptoms between current smokers and quitters in an inner-city adolescent population. To examine the relationship of nicotine dependence, stress, and coping methods between smokers and quitters and, using the Transtheoretical Model of Change, among adjacent smoking cessation stages., Design: A cross-sectional study using a self-administered questionnaire., Participants: The study comprised 354 clinic patients between the ages of 12 and 21 years who reported past or present smoking., Main Outcome Measures: Demographic characteristics, smoking status, perceived reasons for continued smoking, attempts to quit, and withdrawal symptoms, as well as standardized scales assessing nicotine dependence, stress, and coping methods., Results: The overall prevalence of smoking in this population was 26%. Smokers were significantly more likely to report smoking more cigarettes per day as well as higher levels of physical addiction (P<.01), greater levels of perceived stress (P<.02), and less use of cognitive coping methods (P<.02) than quitters (P<.005). However, comparison of consecutive stages revealed a significant difference only between precontemplation and contemplation in cognitive coping methods (P<.01). Three of 20 withdrawal symptoms (cravings, difficulty dealing with stress, and anger) were reported more frequently among current smokers who had attempted to quit in the last 6 months than among former smokers (P<.01)., Conclusion: Interventions for inner-city adolescents who smoke should be designed to target those with the highest levels of nicotine dependence, stress, and decreased use of cognitive coping methods because they are the least likely to quit on their own, rather than developing stage-specific models.

The risk of infection after rape is believed to be low. The use of presumptive treatment is, therefore, controversial. Some experts recommend treatment of all patients, and others suggest treatment if the doctor suspects infection, if the patient requests it, if follow-up examination of the victim cannot be ensured, or if the assailant has a known infection. No regimen will cover all possible pathogens. The Centers for Disease Control's empiric regimen for victims of sexual assault is effective against gonorrhea, chlamydia, and, most likely, syphilis. We present a case of incubating syphilis following rape, that did not respond to ceftriaxone.

Sporadic cases of anorexia nervosa in the male patient have been described. We present three cases of weight loss in adolescent males. The first is a typical case of primary anorexia nervosa. The second illustrates weight loss in the competitive adolescent athlete. The third was mistakenly thought to have primary anorexia nervosa. At autopsy, he had regional enteritis. These patients are compared to call attention to the differential diagnosis of anorexia nervosa in the adolescent male.

We compared tissue cell culture isolation with the Microtrak fluorescent monoclonal antibody direct specimen test for detection of endocervical Chlamydia trachomatis in an inner-city population of sexually active Black and Hispanic adolescent girls. Of the 95 patients screened, C. trachomatis was identified in 26.3%. The sensitivity of the direct specimen test was 91.7%, and its specificity was 98.6%. The positive predictive value was 95.6%, and the negative predictive value was 97.2%. No significant difference was found between Blacks (28.6%) and Hispanics (24.1%) in the incidence of endocervical C. trachomatis, nor was the use of an oral contraceptive significantly associated with the diagnosis of C. trachomatis (p greater than 0.10). Neisseria gonorrhoeae was isolated in 8.4% of the patients. The direct specimen test appears to be an accurate and convenient method of screening sexually active adolescent girls for genital C. trachomatis. Further study is needed to determine if an oral contraceptive increases the risk of Chlamydia infection in adolescents.