Differentiation of self, anxiety, triangling and distress: A test of Bowen theory.

Based in Bowen theory (Kerr, 2019; Kerr & Bowen, 1988), this study examined differentiation of self as a moderator of the relationship between anxiety and current triangling among a sample of adolescents. It also explored the relationship between specific triangle subtypes and psychological symptoms. We hypothesized that higher levels of anxiety would be associated with higher levels of triangling, and that this relationship would be weaker for participants who report higher levels of differentiation of self. Additionally, we hypothesized that psychological symptoms would be significantly lower for those who indicated a balanced triangle configuration to characterize their family structure (as compared to those selecting scapegoating, cross-generational coalition or mediator patterns). Results partially supported our hypotheses; differentiation performed as a moderator in two analyses, but not in others. Higher levels of psychological symptoms were associated with experience with mediator and cross-generational triangling.

Brown Bowel Syndrome: A Multi-institutional Case Series.

Brown bowel syndrome (BBS) is a rare condition associated with vitamin E deficiency and defined by prominent lipofuscin deposition in the muscularis propria. Eight unique cases of BBS were identified: 5 men and 3 women (mean age=58.6 y). Pertinent comorbidities included bariatric surgery=2, malnourishment=2, Crohn=2, cystic fibrosis=1, alcohol and cocaine abuse=1, and prior small bowel resections=1. Presenting symptoms included abdominal pain=3, bleeding=1, nausea and vomiting=1, and nonresponsiveness=1. Imaging studies were often abnormal: thickened bowel wall=3 (1 with a mass), small bowel obstruction=2, and edematous and dilated bowel wall=2. Most specimens were surgical resections (n=7, autopsy=1): extended right colectomy=2, small bowel only=5 (terminal ileum=3, jejunum=2). Two specimens were grossly described as mahogany, and 1 case contained a perforation. Histologic sections of all cases showed finely granular, brown cytoplasmic pigment in smooth muscle cells on hematoxylin and eosin. This pigment was most conspicuous in the muscularis propria (small bowel>colon), and it was not identified in the mucosa. The pigment was reactive with Fontana-Masson, carbol lipofuscin, Periodic acid-Schiff, and Periodic acid-Schiff with diastase, and electron microscopy was compatible with lipofuscin. The mean clinical follow-up was 208 weeks: 1 patient died of complications of encephalitis, the others were alive and well. BBS is important to recognize because it is linked with malnutrition, specifically vitamin E deficiency, and it can (rarely) clinically simulate malignancy. The diagnosis is based on the identification of the lipofuscin pigment in the cytoplasm of smooth muscle cells, which is most easily seen in the muscularis propria of the small bowel.

The safety of atovaquone-proguanil for the prevention and treatment of malaria in pregnancy: A systematic review.

BACKGROUND: Malaria infection poses a significant risk in pregnancy, yet chemoprophylaxis for pregnant women is limited. A systematic review was conducted to evaluate the incidence of adverse outcomes after atovaquone-proguanil (AP) exposure during pregnancy. METHODS: Following PRISMA guidelines, the authors searched PubMed, MEDLINE, and the Malaria in Pregnancy Consortium Library to identify relevant literature including infant outcomes after exposure to atovaquone, proguanil, or AP in pregnancy. Two authors independently screened the titles, abstracts, and full texts, and extracted data into an EpiInfo database. Overall proportions and 95% confidence intervals of adverse outcomes were determined by pooling data across studies. RESULTS: Of 455 records identified, 16 studies were included: ten AP studies and six proguanil studies. The overall proportions and 95% confidence intervals (CI) of adverse outcomes reported for the 446 women exposed to AP include miscarriage (8.08% CI: 5.07, 12.08%), stillbirth (1.05% CI: 0.03, 5.73%), early neonatal death (0% CI: 0, 7.4%), and congenital anomalies (2.56% CI: 1.28, 4.53%). CONCLUSIONS: The limited available data suggest that outcomes following AP exposure during pregnancy are similar to expected rates in similar populations. AP may be a promising option for pregnant women, but further data are needed on its safety in pregnancy.

Safety of atovaquone-proguanil during pregnancy.

BACKGROUND: Malaria during pregnancy increases the risk of maternal and foetal complications. There are very limited options for prophylaxis in pregnant travellers. Atovaquone-Proguanil (AP or Malarone®) is an effective and well-tolerated antimalarial medication, but is not recommended for use in pregnancy due to limited data on safety. Passively reported adverse event data may provide additional information on the safety of AP during pregnancy. METHODS: We analysed adverse event data on pregnancy and birth outcomes following accidental exposures to AP during pregnancy, which were passively reported to GlaxoSmithKline LLC (GSK) between 13 May 1997 and 15 August 2017. Birth outcomes of interest included live birth, miscarriage, and stillbirth. Adverse outcomes of interest were defined as any of the following: small for gestational age (SGA), low birth weight (LBW, <2500 gm), congenital anomalies, and a composite 'poor live birth outcome,' including preterm birth (PTB), LBW or SGA. RESULTS: Among 198 women who received AP during pregnancy or breastfeeding, 96.5% occurred in women taking malaria prophylaxis, and 79.8% of exposures occurred in the first trimester. Among 195 with available birth outcome data, 18.5% resulted in miscarriage and 11.8% were elective terminations. Available adverse outcomes included SGA in 3.5% (3/85), LBW in 7.0% of infants (6/86), and the composite 'poor live birth outcome' in 13.7% (14/102). Congenital anomalies were reported in 30/124 (24.2%), with no specific pattern to suggest an effect related to AP. CONCLUSIONS: These data provide a description of outcomes in the pregnancies reported to this dataset, and it should be noted that there is likely a bias towards reporting cases resulting in poor outcomes. While there was no specific signal to suggest a teratogenic effect of AP, AP data during pregnancy were too limited to determine AP's safety with confidence. As inadvertent exposures are not infrequent, better data are needed.

The Mother and Child Health Handbook in Japan as a Health Promotion Tool: An Overview of Its History, Contents, Use, Benefits, and Global Influence.

Background. The Mother and Child Health Handbook (MCHH), a tool used by almost all parents in Japan, serves as a record book shared by parents and health providers to monitor maternal health care throughout the perinatal period, track the child's health and growth, and provide educational information. Methods. A review of the existing literature was performed by narrative review using electronic databases with the search term "Maternal and Child Health Handbook" from January 1980 to February 2016. Results. Twenty-eight papers were obtained: 3 review articles, 17 original articles, 2 brief reports, 2 letters, 1 research note, and 3 proceedings. After the MCHH was initiated in 1947, Japan's infant mortality rate decreased to 2.6 per 1000 live births in 2007, and it is still decreasing. Information recorded in the MCHH at antenatal examinations can be used to evaluate a child's risk of obesity, cardiovascular disease, endocrine disease, mental illness, and infectious disease. Utah's Department of Health implemented a program called "Baby Your Baby" in 1987 based on the Japanese MCHH; this included a similar booklet with family records and educational information. Thus, the MCHH is a unique tool in Japan that has influenced other countries to adopt similar programs. Conclusion. We will confirm the importance of the MCHH's role in promoting health and open dialogue.

Distally based sural flap for ankle and foot coverage in children.

BACKGROUND: Coverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in paediatric patients, to describe the complications associated with its use, and to define its indications in paediatric patients with soft-tissue defects of the ankle and foot. HYPOTHESIS: We hypothesised that the sural flap was reliable for covering soft-tissue defects at the ankle and foot in paediatric patients. MATERIAL AND METHODS: A distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 20 paediatric patients between 1997 and 2013. The evaluation at last follow-up included a physical examination and determination of the modified functional Kitaoka score. Mean follow-up was 50.6 months (range, 10-192 months) and mean patient age at surgery was 8.8 years (range, 1.5-17 years). Trauma was the most common cause of soft-tissue defect (n=12); other causes were surgical-site infections (n=2), tumours (n=3), chronic ulcer (n=1), burn injury (n=1), and infusion fluid extravasation (n=1). RESULTS: Of the 20 flaps, 16 (80%) remained fully viable, whereas 4 developed partial necrosis requiring excision and skin grafting, which consistently ensured a good outcome. Other complications consisted of marginal necrosis (n=4), unsightly donor-site scars (n=5), and infection (n=2). Abnormal flap sensation was noted in 11 patients. The mean modified Kitaoka score was 65/80 (range, 0-80), and the score value indicated that function was excellent in 9 (45%) patients, good in 9 (45%) patients, and poor in 2 (10%) patients. DISCUSSION: The distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a strong blood supply. Its best indication is coverage of an acute traumatic soft-tissue defect with exposure of a vital structure. In patients requiring late reconstruction, caution is in order when considering the use of a distally based sural fascio-cutaneous flap, which can induce delayed complications, most notably at the donor site. LEVEL OF EVIDENCE: IV, retrospective case-series study.

Isolated C5-C6 avulsion in obstetric brachial plexus palsy treated by ipsilateral C7 neurotization to the upper trunk: outcomes at a mean follow-up of 9 years.

Cervical root avulsions are the worst pattern of injury in obstetrical brachial plexus injury (OBPI). The prognosis is poor and the treatment is mainly surgical with extraplexual neurotizations or muscle transfers. We present the outcomes of a technique performed in our institution to treat C5-C6 avulsion in obstetrical brachial plexus injury. This technique consists of a total ipsilateral C7 neurotization to the upper trunk. Ten babies with isolated C5-C6 root avulsion were operated on; we were able to review nine of them at over 12 months follow-up. The shoulder and the elbow function were assessed, as well as the Mallet Score. The mean follow-up was 9.2 years (SD 5.7). After a follow-up of 6 years, elbow flexion was restored with a range of motion ⩾130° and a motor function ⩾M3 in all patients. The average Mallet score was 18.1 (SD 1.2). This approach appears to be a viable alternative to extraplexual neurotizations for the treatment of C5-C6 nerve root avulsion.

Treatment of severe radial club hand by distraction using an articulated mini-rail fixator and transfixing pins.

INTRODUCTION: Treatment of severe radial club hand is difficult. Several authors have emphasized the importance of preliminary soft-tissue distraction before centralization. HYPOTHESIS: Treatment of severe radial club hand by articulated mini-rail allowing prior soft-tissue distraction improves results. MATERIAL AND METHODS: Thirteen patients were treated sequentially, with an initial step of distraction and a second step of centralization. The first step consisted in fitting 2 mini-fixators, one in the concavity and the other in the convexity of the deformity. Four transfixing wires through the ulna and metacarpal bone connected the 2 fixators. After this preliminary distraction, the fixator was removed and a centralization wire was introduced percutaneously, with ulnar osteotomy if necessary. Sagittal and coronal correction was measured on the angle between forearm and hand. RESULTS: Mean age at treatment was 37.5 months (range, 9-120 months). Mean distraction time was 53.2 days (26-90 days). Ulnar osteotomy was required in 8 cases (61%). There were no major complications requiring interruption of distraction. Sagittal and coronal correction after centralization reduced mean residual forearm/hand angulation to<12°. DISCUSSION: Soft-tissue distraction in the concavity ahead of centralization is essential to good correction, avoiding extensive soft-tissue release and hyperpressure on the distal ulnar growth plate. There have been several studies of distraction; the present technique, associating 2 mini-fixators connected by threaded K-wires, provided sufficient distraction in the concavity of the deformity to allow satisfactory correction in all cases. Subsequent complications (breakage or displacement of the centralization wires) testify to the complexity of long-term management. CONCLUSION: The present study confirms the interest of a preliminary soft-tissue distraction step in treating severe radial club hand.

Crystal structures and emission properties of the BF2 complex 1-phenyl-3-(3,5-dimethoxyphenyl)-propane-1,3-dione: multiple chromisms, aggregation- or crystallization-induced emission, and the self-assembly effect.

It is known that electron donating groups have quite a different effect on the π-delocalization of a conjugate system when bonded at ortho and para as compared to meta positions in the phenyl ring. In the present work, the BF2 complex of 1-phenyl-3-(3,5-dimethoxyphenyl)-propane-1,3-dione (1), a molecule with two methoxy groups in one of the phenyl rings at meta positions, was prepared. Compound 1 exists as two polymorphs having different mutual orientations of the two methoxy groups: in polymorph A away from each other (termed anti), while in polymorph B one methoxy group is oriented toward the other (syn-anti). In both crystals, the molecules which are antiparallel (the subPh rings as well as dioxaborine are on opposite sides) form stacks through face-to-face π-π interactions, while in polymorph A the crystal packing is further stabilized by intermolecular C(phenyl)-H···F and C(methoxy)-H···F hydrogen bonds. Solid A possesses numerous chromic effects, including mechano-, thermo-, and chronochromism, though the latter to a lesser extent, as well as the effect of rearrangement of the amorphous phase into a more stable crystalline phase A, associated with crystallization-induced emission enhancement (CIEE). The solid-state emission can be repeatedly switched regarding its color and efficiency with excellent reversibility by external stimuli. On the other hand, crystalline solid B undergoes thermal interconversion of syn-anti to the anti conformer. Compound 1 shows a solvatochromic effect (SE), is aggregation-induced emission (AIE) active, and through the sublimation process displays self-assembling crystalline platelike microstructures or microfibers that reveal an obvious optical waveguide effect.

New perspectives for population genetics of Chagas'disease vectors in the Northeastern Brazil: isolation of polymorphic microsatellite markers in Triatoma brasiliensis.

Triatoma brasiliensis is the most important Chagas disease vector in semiarid areas of Northeastern Brazil. Although generally found in natural environment, it regularly colonizes or reinvades domiciliary ecotopes. In order to analyse gene flow between habitats, we identified and characterized six microsatellite loci using a microsatellite-enriched genomic library. To assess the usefulness of these microsatellites for genetic studies, we investigated their variability in two natural populations of the T. brasiliensis complex sampled in two Brazilian districts (Corone Jose Dia, South of Piaui state; Curaça, North of Bahia state). The taxonomic status of the samples was checked using cytb sequences. Phylogenetic analyses confirmed that the individuals from Bahia belonged to the T. juazeirensis species. Moreover, primers cross-amplification was tested in 5 Triatoma species and 4 loci successfully amplified in T. infestans and T. guasayana.

Hypophosphataemia in burns.

Hypophosphataemia is defined as a phosphate level of less than 2.5 mg/dl (0.8 mmol/l). Many of the pathophysiological changes and therapeutic interventions in the first week post-burn affect serum phosphorus concentration. A retrospective study reviewed the medical records of nine severely burned patients, and a special reference of decreased phosphate serum level was noted. Serum phosphorus levels declined, with a nadir between days 2 and 6 post-burn. The severe hypophosphataemia that often follows major burns returns to normal phosphorus levels on days 18 to 20 post-burn. Weight-based phosphorus dosing is safe to use in critically burned patients receiving nutritional support. Moderate doses effectively increase serum phosphorus concentrations.

Tuberculosis drug resistance in an area of low endemicity in 2004 to 2006: semiquantitative drug susceptibility testing and genotyping.

We determined the quantitative levels and the genetic mechanisms of resistance in drug-resistant clinical isolates of Mycobacterium tuberculosis sampled over a period of 3 years (n = 45; 17 of the isolate were multidrug resistant). Our results led us to hypothesize that some strains categorized as resistant to isoniazid, ethambutol, or streptomycin by standard laboratory procedures of in vitro drug susceptibility testing may still respond to a treatment regimen that includes these agents.

Microsatellite markers in Triatoma pseudomaculata (Hemiptera, Reduviidae, Triatominae), Chagas' disease vector in Brazil.

Six polymorphic microsatellite loci were isolated and characterized using a microsatellite-enriched genomic library from the Chagas' disease vector Triatoma pseudomaculata. This species is found in Brasil in Caatinga areas and predominantly in peridomestic habitats. All the microsatellites tested on a population of T. pseudomaculata sampled in the Bahia State, Brazil, were polymorphic (2-15 alleles). Markers amplification was also tested on six Triatoma species and some loci successfully amplified in the most phylogenetically related species, in particular Triatoma brasiliensis.

Microsatellite markers from the Chagas disease vector, Rhodnius prolixus (Hemiptera, Reduviidae), and their applicability to Rhodnius species.

Ten microsatellites were isolated and characterized from a partial genomic library of Rhodnius prolixus, the principal Chagas disease vector in Venezuela, Colombia and Central America. These polymorphic molecular markers could be particularly useful in Chagas disease control initiatives. A wider applicability of the primer-pairs isolated was shown, from 6 to 10 loci being amplifiable in five out of the ten Rhodnius species tested, namely R. domesticus, R. nasutus, R. neglectus, R. neivai and R. robustus. Interestingly, all the loci were amplified in the latter. These markers may be of interest to trace the colonization of human dwellings from triatomine sylvatic populations in order to better define epidemiological risk patterns.

Genotyping reveals a wide heterogeneity of Tropheryma whipplei.

Tropheryma whipplei, the causative agent of Whipple's disease, is associated with various clinical manifestations as well as an asymptomatic carrier status, and it exhibits genetic heterogeneity. However, relationships that may exist between environmental and clinical strains are unknown. Herein, we developed an efficient genotyping system based on four highly variable genomic sequences (HVGSs) selected on the basis of genome comparison. We analysed 39 samples from 39 patients with Whipple's disease and 10 samples from 10 asymptomatic carriers. Twenty-six classic gastrointestinal Whipple's disease associated with additional manifestations, six relapses of classic Whipple's disease (three gastrointestinal and three neurological relapses), and seven isolated infections due to T. whipplei without digestive involvement (five endocarditis, one spondylodiscitis and one neurological infection) were included in the study. We identified 24 HVGS genotypes among 39 T. whipplei DNA samples from the patients and 10 T. whipplei DNA samples from the asymptomatic carriers. No significant correlation between HVGS genotypes and clinical manifestations of Whipple's disease, or asymptomatic carriers, was found for the 49 samples tested. Our observations revealed a high genetic diversity of T. whipplei strains that is apparently independent of geographical distribution and unrelated to bacterial pathogenicity. Genotyping in Whipple's disease may, however, be useful in epidemiological studies.

[Triatominae and Cactaceae: a risk for the transmission of the American trypanosomiasis in the peridomicilary space (Northeast Brazil)]. / Triatominae et Cactaceae: un risque pour la transmission de la Trypanosomose américaine dans le péridomicile (nord-est du Brésil).

Field observations carried in semi-arid Brazil Northeast point out the frequent association, in the peridomiciliary space, between a cactus, Cereus jamacaru, the occurrence of nests in its branches and the occurrence of two species of insects vectors of Trypanosoma cruzi, pathogenic agent of Chagas disease: Rhodnius neglectus and Triatoma pseudomaculata. The analysis of the architectural variables of this Cactaceae shows that the presence of nests, and thus of insects, depends on the traditional practices of management of this cactus. This study underlines the relevance of an integrated approach of the ecology of Triatominae for the identification of factors of risk.

[Neonatal Volkmann's compartment syndrome. A report of two cases]. / Le syndrome de Volkmann néonatal. A propos de deux cas.

Neonatal Volkmann's compartment syndrome is a rare entity. This diagnosis may be suspected when a case presents cutaneous damage associated with poor hand and wrist function after delivery. We present two such cases of neonatal Volkmann compartment syndrome with long term clinical and x-ray follow-up. In our patients, a hand surgeon was not consulted in the perinatal period and early fasciotomy was not performed. No particular aetiology or associated cerebrovascular accident was found. A series of operations was necessary in order to improve function of the hand. Neonatal Volkmann compartment syndrome must be recognised early in order to enable further investigation of any underlying condition and to perform early surgical decompression. Long term clinical and x-ray follow-up is necessary to prevent and treat wrist deformation and finger contractures.

[Congenital pseudarthrosis of the forearm in a neurofibromatosis patient: case report and review of the literature]. / Pseudarthrose congénitale de l'avant-bras associée à la neurofibromatose: à propos d'un cas et revue de la littérature.

We report a case of congenital pseudarthrosis of the forearm associated with neurofibromatosis type 1 which was treated by free vascularized periosteal flap transplant and repeated bone grafting. The young female patient recovered good hand and forearm function. A review of the literature revealed the rare occurrence of this disease (approximately 100 cases reported to date), which probably explains the wide variety of surgical proposals.