Encuesta multinacional y transversal sobre las controversias del reemplazo de la raíz aórtica con conservación valvular / Multinational and Cross-Sectional Survey on Valve-Sparing Aortic Replacement Controversies

RESUMEN Introducción : El reemplazo de la raíz aórtica con conservación valvular (valve-sparing aortic root replacement, VSAR) se ha consolidado como un procedimiento eficaz para el tratamiento del aneurisma de la raíz aórtica, el síndrome de Marfan, la válvula bicúspide y la disección aórtica. Sin embargo, es necesario llegar a una opinión unánime sobre los aspectos clave del VSAR. Material y métodos : Se realizó una revisión bibliográfica de los debates y controversias más frecuentes del VSAR. A partir de esta información se elaboró una encuesta en línea que se envió a cirujanos con experiencia comprobada en VSAR para conocer su opinión sobre los factores relacionados con los pacientes, los aspectos técnicos, la ecocardiografía, la investigación, la formación y el futuro del VSAR. Resultados : Veinte cirujanos completaron la encuesta. Según 14 de cada 20 encuestados, la fracción de eyección grave se consideró una contraindicación para el llevar a cabo este procedimiento. El límite del diámetro del anillo aórtico para la remodelación fue heterogéneo entre los participantes. Todos ellos consideraron que el VSAR es un procedimiento seguro para los pacientes con síndrome de Marfan y válvula bicúspide. En el caso de disección de tipo A, 11 de cada 20 prefirieron este procedimiento solo para los pacientes jóvenes. En lo que respecta al tamaño del injerto, la altura del triángulo intervalvar (8/20) y el diámetro sinotubular (7/20) fueron los más frecuentes. Los cirujanos informaron una tasa de fracaso del 7% en la conversión al procedimiento de Bentall, y un cambio de estrategia intraoperatoria del 26%. No se consideró que un abordaje mínimamente invasivo mejorara los resultados. La mayoría de los cirujanos coincidieron en que el VSAR lo deben realizar cirujanos con mucha experiencia. Conclusiones : El VSAR ha sido aceptado como una opción terapéutica para el aneurisma de la raíz aórtica, y, aunque todavía no es posible llegar a un consenso definitivo, se presenta la valiosa experiencia de los cirujanos más destacados en este campo.

ABSTRACT Background : The valve-sparing aortic root replacement (VSAR) has been established as a successful procedure for aortic root aneurysms, Marfan's syndrome, bicuspid valves, and aortic dissections. However, there is a need for a consensus opinion regarding key aspects of VSAR. Methods : A literature review was performed regarding the most frequent debates and controversies in VSAR. An online survey was developed based on this information, and sent to surgeons with known expertise in VSAR regarding their opinion on patient-related factors, technical aspects, echocardiography, research, training, and the future of VSAR. Results : Twenty surgeons completed the survey. The reduction of left ventricular ejection fraction was considered a contra indication to VSAR when severe by 14/20 surveyed. The aortic annulus diameter cutoff point for the remodeling was heterogenous among participants. All of them felt that VSAR is safe for the Marfan´s syndrome population and bicuspid valves. For type A dissections, 11/20 preferred this procedure only in young patients. Regarding to graft sizing, the height of the interleaflet triangle (8/20) and the sino-tubular diameter (7/20) were the more frequent considered parameters. Surgeons reported a 7% of failure rate, leading to conversion to Bentall surgery, and a 26% change of strategy intraoperatively. A minimally invasive approach was not considered to improve results. Most of the surgeons agreed that VSAR should be performed by high-experienced surgeons. Conclusions : The VSAR has been accepted as a treatment option for the aortic root´s aneurysms, and even though there is still not possible to reach a final consensus, a valuable experience from the most relevant surgeons in the field is presented.

Effectiveness of spiritual intervention on religious struggle among COVID-19 patients

Background@#Spiritual struggle is a state of distress a person experiences when relationships with the sacred are fundamentally challenged or broken. Its presence has been associated with increased morbidity and mortality. During the COVID-19 pandemic, attempts to address the whole being of patients, including spiritual well-being, were explored to improve outcomes of care. @*Objective@#The study determined the prevalence of spiritual struggle among COVID-19 related cases and assessed the effectiveness of a formulated spiritual regimen versus the standard pastoral care. @*Methods@#This is a randomized, triple-blind, controlled trial. COVID-19 patients tagged as having religious struggle were randomized into two equal groups (chaplain-led spiritual intervention and self-driven standard pastoral care). The Religious Struggle Screening Scale (RSSS) was measured at baseline and 4 weeks after the intervention in both groups. @*Results@#Prevalence of spiritual struggle among COVID-19 patients was 67%. Baseline patient demographics were similar for both groups. The overall RSSS slightly decreased throughout the 4-week duration for both groups. In addition, the six dimensions of the RSSS, namely: divine, demonic, interpersonal, moral, ultimate meaning and doubt were noted to have slightly improved. However, the differences in the two groups were not significant. @*Conclusion@#There is no difference in the effect on religious struggle of a formulated spiritual regimen and standard care given to COVID-19 patients.

Botulinum toxin as adjunct therapy in surgical management of a periprosthetic scapular spine fracture: a case report

Six months after undergoing reverse total shoulder arthroplasty (RSA) a 73-year-old woman sustained a periprosthetic scapular spine fracture following a fall. She was treated with open reduction and internal fixation (ORIF), followed by botulinum toxin injection into the deltoid muscle to temporarily minimize strain at the fracture. Fracture union was achieved by three months, with excellent clinical function more than one year following fracture fixation and full resolution of deltoid function. Scapular spine fracture following RSA can be treated with ORIF and temporary deltoid paralysis using botulinum toxin in the immediate postoperative period to safely support fracture healing.

Norms about Alcohol Use among US Firefighters

Background@#Problem drinking is a perennial concern in the US fire service. A large literature has documented the importance of addressing alcohol norms in intervention research. The purpose of this study was to explore alcohol norms in a national cohort of firefighters (FFs) to inform intervention development in this occupational group. @*Methods@#Data were from a national online survey of career and volunteer FFs (N = 674). Participants were recruited through national fire service listservs and a database of FFs who had agreed to be contacted for research. @*Results@#When asked about “acceptable” levels of alcohol consumption, FFs on average suggested levels which exceeded public health guidelines. Further, approximately half of career and volunteer FFs believed that, at least under some circumstances, drinking until intoxicated was normative. When asked how long should elapse between a FFs last drink and reporting for duty, the average suggested lag was 11.2 hours (sd = 4.6). However, among male volunteer FFs who reported heavy drinking, the average was 6.68 hours (sd = 4.77). @*Conclusions@#Given the high prevalence of heavy and binge drinking in the fire service, it is not surprising that the alcohol norms found in this study were consistent with a culture of drinking. Participants' reports of alcohol use among their peers were consistent with the actual prevalence of problem drinking. Thus, education and prevention efforts in this occupation should focus on changing norms about alcohol use, including linking heavy drinking to other health and safety issues they face.

Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia

Objective To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia. Methods We used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis. Findings Pre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred. Conclusion Implementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.

An analytical cross-sectional study on the knowledge, attitudes, and practices (KAP) on biomedical waste management among nurses and medical technologists in the Philippines / The Health Sciences Journal

INTRODUCTION@#Unregulated biomedical waste management is an emerging public health problem in the Philippines. This study aimed to differentiate the knowledge, attitudes, and practices of nurses and medical technologists toward biomedical waste management.@*METHODS@#Using an analytic cross-sectional study design, an online survey of nurses and medical technologists from hospitals around the Philippines was conducted. A 27-item questionnaire covering knowledge, attitudes and practices was used. The percentages of correct answers and mean scores in each domain was compared between the nurses and medical technologists.@*RESULTS@#A total of 196 respondents consisting of 77 registered nurses and 119 medical technologists were included in the study. Medical technologists had significantly better knowledge scores than nurses on disposal procedures for expired blood units and by-products waste (55% vs. 19%, p = 0.026). Both had low correct responses on adequate disposal of human tissue remains, throwing blood waste into domestic waste, and throwing of expired medications in domestic waste. There was no significant difference in the attitude of nurses and medical technologists. Nurses had significantly better practice scores on disposal of liquid waste in bags (84.4% vs. 68.9, p = 0.018), but medical technologists fared better at disposal of human tissue together with other waste (13.0% vs. 2.5%, p = 0.006). @*CONCLUSION@#Both nurses and medical technologists had adequate knowledge of some aspects but were lacking in others. There was no significant difference in the attitude of nurses and medical technologists towards biomedical waste management. Half of the respondents practiced proper biomedical waste management.

The cost of gold: Mercury contamination of fishes in a Neotropical river food web

In South America, mercury contamination due to gold mining operations is a threat to both biodiversity and human health. We examined mercury (Hg) concentrations in fishes that constitute important subsistence fisheries from mined and non-mined tributaries in the middle Mazaruni River, Guyana. Mercury concentrations and trophic food web structure (based on carbon and nitrogen stable isotopes) were characterized for primary basal sources and 39 fish species representing seven trophic guilds. Fishes collected at mined sites had higher mercury concentrations; piscivores and carnivores had the highest Hg concentrations and exhibited significant Hg biomagnification. Our results showed that medium- to large-bodied fishes commonly eaten by local people contained Hg values that exceed the World Health Organization (WHO) criteria, and pose a health concern for riverine communities along the Mazaruni River that depend on fish as their main source of protein. Further research to determine the sources of Hg contamination and how it affects human health in this neotropical river must become a top priority. In addition, more research on how Hg contamination impacts the fishes themselves and overall aquatic biodiversity is also needed in the Mazaruni River which has both high fish endemism and diversity.(AU)

Na América do Sul, a contaminação por mercúrio devido às operações de mineração de ouro é uma ameaça à biodiversidade e à saúde humana. Nós examinamos as concentrações de mercúrio (Hg) em peixes que constituem importantes pescarias de subsistência em afluentes minerados e não minerados no médio rio Mazaruni, Guiana. As concentrações de mercúrio e a estrutura trófica da teia alimentar (baseada em isótopos estáveis ​​de carbono e nitrogênio) foram caracterizadas para fontes basais primárias e 39 espécies de peixes representando sete guildas tróficas. Os peixes coletados em locais minerados tiveram maiores concentrações de mercúrio; piscívoros e carnívoros tiveram as maiores concentrações de Hg e exibiram biomagnificação significativa de Hg. Nossos resultados mostraram que peixes de corpo médio a grande comumente consumidos pela população local continham valores de Hg que excedem os critérios da Organização Mundial de Saúde (OMS) e representam uma preocupação para a saúde das comunidades ribeirinhas ao longo do rio Mazaruni que dependem dos peixes como sua principal fonte de proteína. Outras pesquisas para determinar as fontes de contaminação por Hg e como isso afeta a saúde humana neste rio neotropical devem se tornar uma prioridade. Além disso, mais pesquisas sobre como a contaminação por Hg impacta os próprios peixes e a biodiversidade aquática em geral também são necessárias no rio Mazaruni, que tem alto endemismo e diversidade de peixes.(AU)

Total knee arthroplasty following intramedullary tibial nailing

Methods@#This is a retrospective case series of patients who underwent TKA after IMN fixation of tibial fractures.Patient and case data, including need for hardware removal, staged vs non-staged procedures, operative time, and need for revision implants, were recorded. Postoperative data, including complications and revision, were recorded.Oxford Knee Score (OKS) was performed at follow-up. @*Results@#Nine patients were identified consisting of eight women and one man. Follow-up ranged from 0.8–13 years. Non-staged removal of the intramedullary hardware occurred in three cases that had increased operative lengths recorded. There were no complications related to wound healing or infection. No patients required revision.Two of the three patients who underwent non-staged TKA developed arthrofibrosis requiring manipulation. OKS scores in patients who underwent non-staged surgery were consistently low. @*Conclusions@#Conversion TKA after tibial IMN fixation can result in satisfying outcomes in many patients. However, intramedullary hardware presents challenges to TKA similar to more extensively studied conversion TKA scenarios.Removing hardware in either a staged or non-staged fashion results in increased resource utilization and imparts perioperative challenges with only theoretical benefits of one approach compared to the other. Increased stiffness may be associated with a non-staged approach to hardware removal and TKA. Several technical factors may permit component positioning without removal of hardware. Despite limitations, this is the first series to discuss this challenging clinical scenario and provides surgeons with technical guidance and data on operative outcomes.

The Interaction of Cognitive Interference, Standing Surface, and Fatigue on Lower Extremity Muscle Activity

BACKGROUND: Performing cognitive tasks and muscular fatigue have been shown to increase muscle activity of the lower extremity during quiet standing. A common intervention to reduce muscular fatigue is to provide a softer shoe-surface interface. However, little is known regarding how muscle activity is affected by softer shoe-surface interfaces during static standing. The purpose of this study was to assess lower extremity muscular activity during erect standing on three different standing surfaces, before and after an acute workload and during cognitive tasks. METHODS: Surface electromyography was collected on ankle dorsiflexors and plantarflexors, and knee flexors and extensors of fifteen male participants. Dependent electromyography variables of mean, peak, root mean square, and cocontraction index were calculated and analyzed with a 2 × 2 × 3 within-subject repeated measures analysis of variance. RESULTS: Pre-workload muscle activity did not differ between surfaces and cognitive task conditions. However, greater muscle activity during post-workload balance assessment was found, specifically during the cognitive task. Cognitive task errors did not differ between surface and workload. CONCLUSIONS: The cognitive task after workload increased lower extremity muscular activity compared to quite standing, irrespective of the surface condition, suggesting an increased demand was placed on the postural control system as the result of both fatigue and cognitive task.

Gene Expression Profiling and Assessment of Vitamin D and Serotonin Pathway Variations in Patients With Irritable Bowel Syndrome

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a multifaceted disorder that afflicts millions of individuals worldwide. IBS is currently diagnosed based on the presence/duration of symptoms and systematic exclusion of other conditions. A more direct manner to identify IBS is needed to reduce healthcare costs and the time required for accurate diagnosis. The overarching objective of this work is to identify gene expression-based biological signatures and biomarkers of IBS. METHODS: Gene transcripts from 24 tissue biopsy samples were hybridized to microarrays for gene expression profiling. A combination of multiple statistical analyses was utilized to narrow the raw microarray data to the top 200 differentially expressed genes between IBS versus control subjects. In addition, quantitative polymerase chain reaction was employed for validation of the DNA microarray data. Gene ontology/pathway enrichment analysis was performed to investigate gene expression patterns in biochemical pathways. Finally, since vitamin D has been shown to modulate serotonin production in some models, the relationship between serum vitamin D and IBS was investigated via 25-hydroxyvitamin D (25[OH]D) chemiluminescence immunoassay. RESULTS: A total of 858 genetic features were identified with differential expression levels between IBS and asymptomatic populations. Gene ontology enrichment analysis revealed the serotonergic pathway as most prevalent among the differentially expressed genes. Further analysis via real-time polymerase chain reaction suggested that IBS patient-derived RNA exhibited lower levels of tryptophan hydroxylase-1 expression, the enzyme that catalyzes the rate-limiting step in serotonin biosynthesis. Finally, mean values for 25(OH)D were lower in IBS patients relative to non-IBS controls. CONCLUSIONS: Values for serum 25(OH)D concentrations exhibited a trend towards lower vitamin D levels within the IBS cohort. In addition, the expression of select IBS genetic biomarkers, including tryptophan hydroxylase 1, was modulated by vitamin D. Strikingly, the direction of gene regulation elicited by vitamin D in colonic cells is “opposite” to the gene expression profile observed in IBS patients, suggesting that vitamin D may help “reverse” the pathological direction of biomarker gene expression in IBS. Thus, our results intimate that IBS pathogenesis and pathophysiology may involve dysregulated serotonin production and/or vitamin D insufficiency.

Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis

BACKGROUND: Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS: Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS: A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I 2=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P heterogeneity=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION: Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.

Objectively measuring subjectively described traits: geographic variation in body shape and caudal coloration pattern within Vieja melanura (Teleostei: Cichlidae) / Midiendo objetivamente caracteres subjetivos: variación geográfica en la forma del cuerpo y patrones de coloración caudal de la especie Vieja melanura (Teleostei: Cichlidae)

AbstractVieja melanura is a Neotropical cichlid occurring in the Petén-lake district systems of Guatemala, as well as the Río Grijalva-Usumacinta basin, and other systems in Southern México, Belize, and Guatemala. A caudal stripe, extending forward from the caudal peduncle, is characteristic of this species. This stripe is sloped downward in nearly all individuals of V. melanura, but the degree of the slope is highly variable throughout its range. The slope and shape of the stripe has previously been used in diagnosing and differentiating between species of Vieja. The purpose of this study was to use objective methods to investigate morphological variation in the caudal stripe and body shape throughout the range of V. melanura. We studied geometric morphometric analyses of body shape and empirical measurements of the slope of the caudal stripe in 215 specimens ofV. melanura. We also used the mitochondrial cytochrome b marker to study population level patterns within V. melanura. Results from our analyses showed significant geographic variation in body shape and patterns of coloration with little mitochondrial phylogeographic structure. These patterns likely correspond to differences in riverine habitats throughout the species' distribution. In conclusion, these results can be used to inform other studies of color and shape variation as it applies to taxonomy and systematics.

ResumenViejamelanura es un cíclido neotropical (subfamilia Cichlinae; tribu Heroini) que se encuentra en los lagos del distrito de Péten en Guatemala, así como en la Cuenca del Río Grijalva-Usumacinta, y otros sistemas acuáticos en el sur de México, Belice y Guatemala. Una banda oscura que se extiende desde el pedúnculo caudal hacia la porción anterior del mismo es característica de esta especie. Esta banda está inclinada hacia abajo en casi todos los individuos de V. melanura, pero el grado de inclinación es altamente variable a lo largo del rango de distribución de la especie. La pendiente y forma de la banda se ha utilizado anteriormente como carácter diagnóstico entre especies del género Vieja. El propósito de este estudio fue investigar la variación morfológica en la forma del cuerpo y en los patrones de coloración de la banda caudal a lo largo del rango de distribución de V. melanura utilizando métodos objetivos. Analizamos la forma del cuerpo utilizando morfometría geométrica, medimos empíricamente la pendiente de la banda caudal en 215 especimenes. Finalmente evaluamos si existen patrones de estructura genética a nivel de poblaciones utilizando el marcador mitocondrial Citocromo b a lo largo del rango de distribución de V. melanura. Nuestros resultados muestran que la forma del cuerpo y los patrones de coloración de la banda caudal varian significantemente a lo largo del rango de distribución de V. melanura pero presenta poca estructura filogeografica. Estos patrones pueden ser explicados plausiblemente por diferencias en los hábitats riverinos presentes a lo largo del rango de distribución de la especie. En conclusión estos resultados se pueden utilizar como referencia en otros trabajos de taxonomía y sistemática que investiguen variación en la forma del cuerpo y patrones de coloracion en peces neotropicales.

Effectiveness of a healthy lifestyle intervention for low back pain and osteoarthritis of the knee: protocol and statistical analysis plan for two randomised controlled trials

ABSTRACT Background These trials are the first randomised controlled trials of telephone-based weight management and healthy lifestyle interventions for low back pain and knee osteoarthritis. This article describes the protocol and statistical analysis plan. Method These trials are parallel randomised controlled trials that investigate and compare the effect of a telephone-based weight management and healthy lifestyle intervention for improving pain intensity in overweight or obese patients with low back pain or knee osteoarthritis. The analysis plan was finalised prior to initiation of analyses. All data collected as part of the trial were reviewed, without stratification by group, and classified by baseline characteristics, process of care and trial outcomes. Trial outcomes were classified as primary and secondary outcomes. Appropriate descriptive statistics and statistical testing of between-group differences, where relevant, have been planned and described. Conclusions A protocol for standard analyses was developed for the results of two randomised controlled trials. This protocol describes the data, and the pre-determined statistical tests of relevant outcome measures. The plan demonstrates transparent and verifiable use of the data collected. This a priori protocol will be followed to ensure rigorous standards of data analysis are strictly adhered to.

Musculoskeletal pain in children and adolescents

ABSTRACT Introduction Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research. Results Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults. Conclusion Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies.

Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors

To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.

Application of the BMWP-Costa Rica biotic index in aquatic biomonitoring: sensitivity to collection method and sampling intensity

The use of aquatic macroinvertebrates as bio-indicators in water quality studies has increased considerably over the last decade in Costa Rica, and standard biomonitoring methods have now been formulated at the national level. Nevertheless, questions remain about the effectiveness of different methods of sampling freshwater benthic assemblages, and how sampling intensity may influence biomonitoring results. In this study, we compared the results of qualitative sampling using commonly applied methods with a more intensive quantitative approach at 12 sites in small, lowland streams on the southern Caribbean slope of Costa Rica. Qualitative samples were collected following the official protocol using a strainer during a set time period and macroinvertebrates were field-picked. Quantitative sampling involved collecting ten replicate Surber samples and picking out macroinvertebrates in the laboratory with a stereomicroscope. The strainer sampling method consistently yielded fewer individuals and families than quantitative samples. As a result, site scores calculated using the Biological Monitoring Working Party-Costa Rica (BMWP-CR) biotic index often differed greatly depending on the sampling method. Site water quality classifications using the BMWP-CR index differed between the two sampling methods for 11 of the 12 sites in 2005, and for 9 of the 12 sites in 2006. Sampling intensity clearly had a strong influence on BMWP-CR index scores, as well as perceived differences between reference and impacted sites. Achieving reliable and consistent biomonitoring results for lowland Costa Rican streams may demand intensive sampling and requires careful consideration of sampling methods. Rev. Biol. Trop. 62 (Suppl. 2): 275-289. Epub 2014 April 01.

En Costa Rica el uso de macroinvertebrados acuáticos como bioindicadores de la calidad ambiental del agua ha aumentado considerablemente en la última década, y se han aplicado métodos estandarizados a nivel nacional. Sin embargo, aún existe controversia sobre la efectividad de los métodos de muestreo y su intensidad. En este estudio comparamos una metodología cualitativa y otra cuantitativa, en 12 sitios de nueve ríos localizados en la cuenca baja del río Sixaola, al sur de la vertiente del Caribe de Costa Rica. Muestras cualitativas fueron recolectadas con un colador durante un período de tiempo establecido y los macroinvertebrados fueron separados en el campo. En el muestreo cuantitativo se recolectaron diez muestras utilizando un Surber y los macroinvertebrados fueron separados en el laboratorio utilizando con esteroscopio. El colador produjo un número menor de individuos y familias que las muestras cuantitativas. Como resultado, la puntuación del índice biótico Biological Monitoring Working Party-Costa Rica (BMWP-CR) en cada sitio dependió del método. La categoría de calidad de agua con ese índice también diferió entre los dos métodos en 11 de los 12 sitios en 2005, y en 9 de los 12 sitios en 2006. La intensidad de muestreo claramente tuvo una fuerte influencia en los resultados del índice BMWP-CR, así como diferencias entre sitios de referencia y los sitios afectados. Debido a la coherencia en los resultados es posible aceptar el método cuantitativo pero con una cantidad prudente de repeticiones en estudios de biomonitoreo acuático.

Infant Robotic Bilateral Upper Urinary Tract Surgery

We describe a case of robot-assisted laparoscopic bilateral upper urinary tract surgery in a 4-month-old infant for complex bilateral upper urinary tract duplication anomalies.

Seroepidemiology and risk factors of hepatitis B virus in Aden, Yemen

There is little published data concerning hepatitis B virus [HBV] infection in Aden and no data concerning risk factors for infection. This study aimed to determine the prevalence of HBV infection and risk factors for infection in Aden, Yemen. A prospective cross sectional survey of individuals attending primary health care facilities was stratified by age and population size. Five hundred and thirty five participants were interviewed and serum was screened for the presence of Immunoglobin G HBV core antibodies [antiHBc]. AntiHBc positive participants were tested for antibodies to hepatitis B surface antigen [HBsAg]. A case-control analysis of risk factors for HBV was undertaken comparing risk factors between antiHBc positive cases and seronegative controls. The age-standardized seroprevalence for antiHBc was 16.2% [95% confidence interval [CI] 13.1-19.3] and for HBsAg was 1.5% [95% CI 0.5-2.5]. The seroprevalence of antiHBc and HBsAg was estimated to range from 5.5% and 0% in infants to 40% and 4.6% in adults, respectively [p < 0.001]. Age [AOR = 1.03, 95% CI = 1.01-1.05], household size [>5-9 members, AOR = 2.9, 95% CI = 1.1-7.6] and ownership of a landline telephone [AOR = 2.8, 95% CI = 1.3-5.8] were independent risk factors for HBV infection. HBV is still a public health problem in this community, with older individuals having much higher prevalence than younger generations. The results of this study would categorise Aden as a low HBV endemic zone. Perinatal transmission does not seem to be a major route of transmission