Keloids in male genitalia-Systematic review and illustrative case report.

Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case-control studies and case reports. Three hundred and sixty-one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies.

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant / Produção de secreção leitosa após reconstrução mamária tardia com retalho musculocutâneo de latíssimo do dorso com implante

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

Sex differences in the relationship between hepatic steatosis, mood and anxiety disorders.

OBJECTIVE: To investigate the association between non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), mental symptoms (mood, anxiety disorders and distress) by sex. METHODS: This a cross-sectional study performed in working-age adults from a Health Promotion Center (primary care) in São Paulo, Brazil. Self-reported mental symptoms from rating scales (21-item Beck Anxiety Inventory, Patient Health Questionnaire-9, and K6 distress scale) were evaluated by hepatic steatosis (NAFLD and ALD). Logistic regression models estimated the association between hepatic steatosis subtypes and mental symptoms by Odds ratios (OR) adjusted by confounders in the total sample and sex stratified. RESULTS: Among 7241 participants (70.5% men, median age: 45 years), the frequency of steatosis was of 30.7% (25.1% NAFLD), being higher in men than women (70.5% vs. 29.5%, p < 0.0001), regardless of the steatosis subtype. Metabolic risk factors were similar in both subtypes of steatosis, but not mental symptoms. Overall, NAFLD was inversely associated with anxiety (OR = 0.75, 95%CI 0.63-0.90) and positively associated with depression (OR = 1.17, 95%CI 1.00-1.38). On the other hand, ALD was positively associated with anxiety (OR = 1.51; 95%CI 1.15-2.00). In sex-stratified analyses, only men presented an association of anxiety symptoms with NAFLD (OR = 0.73; 95%CI 0.60-0.89) and ALD (OR = 1.60; 95%CI 1.18-2.16). CONCLUSIONS: The complex association between different types of steatosis (NAFLD and ALD), mood and anxiety disorders indicates the need for a deeper understanding of their common causal pathways.

Morphological, Cytological and Molecular Studies and Feeding and Defecation Pattern of Hybrids from Experimental Crosses between Triatoma sordida and T. rosai (Hemiptera, Triatominae).

Under laboratory conditions, Triatoma rosai and T. sordida are able to cross and produce hybrids. In the face of climate and environmental changes, the study of hybrids of triatomines has evolutionary and epidemiological implications. Therefore, we performed morphological, cytological and molecular studies and characterized the feeding and defecation pattern of hybrids from crosses between T. sordida and T. rosai. The morphological characterization of the female genitalia of the hybrids showed that characteristics of both parental species segregated in the hybrids. Cytogenetic analyzes of hybrids showed regular metaphases. According to molecular studies, the mitochondrial marker Cytochrome B (CytB) related the hybrids with T. sordida and the nuclear marker Internal Transcribed Spacer 1 (ITS-1) related the hybrids with T. rosai. Both parents and hybrids defecated during the blood meal. Thus, the hybrids resulting from the cross between T. sordida and T. rosai presented segregation of phenotypic characters of both parental species, 100% homeology between homeologous chromosomes, phylogenetic relationship with T sordida and with T. rosai (with CytB and ITS-1, respectively), and, finally, feeding and defecation patterns similar to the parents.

Retalho em hélice para reconstrução de sequelas em membros inferiores / Propeller flap for reconstruction of sequelae in lower limbs

Introdução: O retalho em hélice, ou propeller flap, é um tipo de retalho local baseado em vasos perfurantes. Apresenta diversas vantagens, como a reconstrução de tecidos semelhantes ao original, menor morbidade da área doadora, manutenção dos principais vasos da região e a possibilidade de amplo arco de rotação (até 180º). Entretanto, está sujeito a complicações, sendo a mais preocupante a necrose parcial ou total do retalho. Métodos: Estudo retrospectivo de uma série de três casos de sequelas de trauma em membros inferiores tratados com retalho em hélice. Resultados: Retalhos em hélice reduzem o tempo cirúrgico, dias de internação e custos. Todavia, não são isentos de complicações, encontra-se a ocorrência de necrose parcial de 10,5 a 11% e total de 1 a 5%. Outras complicações descritas são epidermólise (3,5%) e congestão venosa transitória (3%). Nos casos descritos, evoluíram sem complicações. Classicamente, os defeitos de membro inferior, principalmente no terço distal, têm indicação de reconstrução com retalhos microcirúrgicos. Conclusão: Os retalhos propeller podem ser uma alternativa nestes casos, principalmente em defeitos pequenos e moderados. Ainda não existem trabalhos comparando diretamente estas duas técnicas, mas algumas informações importantes já estão disponíveis, como a semelhança entre os percentuais de necrose total entre as técnicas.

Introduction: The propeller flap is a type of local flap based on perforating vessels. It has several advantages, such as the reconstruction of tissues similar to the original, less morbidity of the donor area, maintenance of the main vessels of the region and the possibility of a wide rotation arc (up to 180º). However, it is subject to complications, the most worrisome being partial or total necrosis of the flap. Methods: A retrospective study of a series of three cases of lower limb trauma sequelae treated with helix flaps. Results: Helical flaps reduce surgical time, hospitalization days, and costs. However, they are not free of complications, with partial necrosis occurring in 10.5 to 11% and total necrosis in 1 to 5%. Other complications described are epidermolysis (3.5%) and transient venous congestion (3%). In the cases described, they evolved without complications. Classically, lower limb defects, especially in the distal third, are indicated for reconstruction with microsurgical flaps. Conclusion: Propeller flaps may be an alternative in these cases, especially in small and moderate defects. There are still no studies directly comparing these two techniques, but some valuable information is already available, such as the similarity between the percentages of total necrosis between the techniques.

Intraspecific and Interspecific Phenotypic Differences Confirm the Absence of Cryptic Speciation in Triatoma sordida (Hemiptera, Triatominae).

Triatoma sordida is an endemic Chagas disease vector in South America, distributed in Brazil, Bolivia, Paraguay, and Uruguay. Chromosomal, molecular, isoenzymatic, and cuticular hydrocarbon pattern studies indicate cryptic speciation in T. sordida. Recently, T. rosai was described from specimens from Argentina initially characterized as T. sordida. Although several authors assume that the speciation process that supports this differentiation in T. sordida is the result of cryptic speciation, further morphological and/or morphometric studies are necessary to prove the application of this evolutionary event, because the only morphological intraspecific comparison performed in T. sordida is based on geometric morphometry and the only interspecific comparison made is between T. rosai and T. sordida from Brazil that evaluated morphological and morphometric differences. Based on this, morphological analyses of thorax and abdomen using Scanning Electron Microscopy and morphometric analyses of the head, thorax, and abdomen among T. sordida from Brazil, Bolivia, and Paraguay, as well as T. rosai, were performed to assess whether the evolutionary process responsible for variations is the cryptic speciation phenomenon. Morphological differences in the thorax and female external genitalia, as well as morphometric differences in the head, thorax, abdomen, pronotum, and scutellum structures, were observed. Based on this, the evolutionary process that supports, so far, these divergences observed for T. sordida populations/T. sordida subcomplex is not cryptic speciation. Moreover, we draw attention to the necessity for morphological/morphometric studies to correctly apply the cryptic species/speciation terms in triatomines.

Chagas Disease Vectors of Paraguay: Entomoepidemiological Aspects of Triatoma sordida (Stål, 1859) and Development of an Identification Key for Paraguayan Triatomines Based on Cytogenetics Data.

Approximately 150,000 people are living with Chagas disease in Paraguay. Although the country has been since 2008 considered as one of the countries that succeeded in interrupted the vector transmission of Chagas by Triatoma infestans in houses of the eastern region, there are nine other species notified in the country that are potential vectors and also deserve attention from vector control programs. Thus, we carried out an entomoepidemiological study of T. sordida in the eastern and western regions of the country and we developed an identification key for Paraguay's triatomines based on cytogenetic data. Between the years 2003 to 2004, 271 specimens of T. sordida were captured in domestic, peridomestic, and wild ecotopes, with 131 insects caught in the eastern (Alto Paraguay, Boquerón and Pte. Hayes) and 140 in the western region of Paraguay (Guairá and Paraguarí). High rates of peridomicillary infestation were observed for both regions. Besides that, the natural infection of the captured insects was detected by optical microscopy in 12% and 10%, and by PCR in 21% and 20% in the eastern and western regions, respectively. Based on cytogenetic data from nine of ten species notified in Paraguay, an identification key was developed to differentiate all taxa. Thus, given the vectorial importance of T. sordida, we highlight the need for continued attention from Paraguay's vector control programs for this species. Further, we provide a taxonomic key that assists in the correct classification of Paraguayan triatomines.

Triatoma rosai sp. nov. (Hemiptera, Triatominae): A New Species of Argentinian Chagas Disease Vector Described Based on Integrative Taxonomy.

Chagas disease is the most prevalent neglected tropical disease in the Americas and makes an important contribution to morbidity and mortality rates in countries where it is endemic since 30 to 40% of patients develop cardiac diseases, gastrointestinal disorders, or both. In this paper, a new species of the genus Triatoma is described based on specimens collected in the Department San Miguel, Province of Corrientes, Argentina. Triatoma rosai sp. nov. is closely related to T. sordida (Stål, 1859), and was characterized based on integrative taxonomy using morphological, morphometric, molecular data, and experimental crosses. These analyses, combined with data from the literature (cytogenetics, electrophoresis pattern, molecular analyses, cuticular hydrocarbons pattern, geometric morphometry, cycle, and average time of life as well as geographic distribution) confirm the specific status of T. rosai sp. nov. Natural Trypanosoma cruzi infection, coupled with its presence mostly in peridomestic habitats, indicates that this species can be considered as an important Chagas disease vector from Argentina.

CytoKey: Identification Key for the Chagas Disease Vectors of the Largest Brazilian Urban Center (São Paulo State), Based on Cytogenetic Data.

Chagas disease is caused by the protozoan Trypanosoma cruzi. This disease is distributed in 21 Latin American countries, where it is mostly vector-borne. In Brazil, there are 68 triatomine species. To date, the epidemiological surveys indicate that the state of São Paulo presents 11 species of triatomines, and most of these species have already been collected in a home environment and found to be infected with T. cruzi. Problems in correctly identifying species can lead to incorrect panorama of distribution of Chagas disease vectors. Thus, we developed an identification key for the triatomines of the state of São Paulo, based on cytogenetic data. With the exception of Panstrongylus diasi that does not present cytogenetic data available in the literature, all species were differentiated by cytogenetic characteristics. We emphasize the importance of using this key as a simple and objective tool in the entoepidemiological surveys conducted by the vector control programs.

Triatoma vitticeps (Stal, 1859) (Hemiptera, Triatominae): A Chagas Disease Vector or a Complex of Vectors?

Triatoma vitticeps is a Chagas disease vector that was found infected with Trypanosoma cruzi in homes. As this species is endemic from Brazil (Bahia, Espírito Santo, Minas Gerais, and Rio de Janeiro) and no study comparing the specimens from different Brazilian states was conducted, we analyzed the genetic distance (16S rDNA, Cyt b, and COI mitochondrial genes) and the chromosomal characteristics for T. vitticeps from Minas Gerais, Rio de Janeiro, and Espírito Santo. All specimens showed the same cytogenetic characteristics. On the other hand, the different mitochondrial genes demonstrated high intraspecific variation between the genetic distances of T. vitticeps from different states ranging from 2.3% to 7.2%. Based on this, our results suggest that possibly what is characterized as T. vitticeps is a complex of cryptic species (or subspecies).