Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units.

BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

Hypoglycemic effect of Coffea arabica leaf extracts and major bioactive constituents.

The present study focused on investigating the antioxidant, antiglycation activity, digestive enzymes inhibition, bioaccessibility and hypoglycemic effect of C. arabica leaves extracts. The extracts deactivated the O2•-, ROO•, H2O2, HOCl reactive oxygen species. Coffee leaves showed strong inhibition of α-glucosidase (IC50 = 40.30 µg mL-1) greater than the isolated metabolites and acarbose. There was also inhibition of pancreatic lipase (IC50 = 56.43 µg mL-1) in addition to a hypoglycemic effect in zebrafish similar to acarbose and metformin. With the exception of rutin, all biocompounds were detected at all stages of in vitro digestion. Finally, these results suggest that C. arabica leaf extracts possess antidiabetic and anti-obesity properties that can be attributed to the main metabolites and the synergistic action between them.Communicated by Ramaswamy H. Sarma.

Post-Traumatic Stress Disorder (Ptsd) Following Burn Injuries: A Comprehensive Clinical Review.

Burns are a global public health problem with a large number of psychosocial and psychological problems that may ensue after burn injuries. One of the commonest psychological problems seen after burn injuries is depression, anxiety and post-traumatic stress disorder (PTSD). The following paper reviews the existing literature on PTSD following burn injuries. The concept of PTSD is explained for the non-psychiatrist involved in burn rehabilitation. The various psychosocial factors that determine the causation and course of PTSD following burn injuries are discussed. PTSD following burn injuries in special populations like women, children and adolescents, intentional burns and self immolation are also discussed. The role of cultural factors in the development of PTSD are elucidated and future research needs are laid out. PTSD is a very common occurrence after burn injuries and needs a multidisciplinary team evaluation for its management.

Les brûlures représentent un problème de santé publique mondial, avec un nombre élevé de séquelles psychologiques et psycho- sociales, les plus fréquentes étant l'anxiété et le SPT. Nous avons réalisé une revue de la littérature concernant le SPT, afin de l'expliquer aux brûlologues non psychiatres. Nous avons évalué les facteurs psycho- sociaux pouvant interférer avec la survenue et l'évolution du SPT ainsi que les rôles du terrain (femmes, enfants, adolescents) comme de la cause (agression, tentative de suicide). Les facteurs culturels ont aussi été étudiés. Des axes d'études futures sont proposés. Le SPT est fréquent après brûlure et doit faire l'objet d'une prise en charge multidisciplinaire.

Impact of Defocus and High-Order Aberrations on Light Disturbance Measurements.

PURPOSE: To evaluate the impact of different levels of positive and negative defocus on light disturbance (LD) measures and to understand how high-order aberrations (HOAs) and topographic quality parameters may influence the perception of photic phenomena. METHODS: Thirty young healthy subjects (21 females and 9 males) attended this cross-sectional study. LD was evaluated with the light distortion analyzer (LDA) in natural accommodative and cycloplegic conditions with positive and negative induced defocus of 1.00D. HOAs were taken for a natural mesopic (without cycloplegia) and for fixed 5 mm (with cycloplegia) pupil size. The impact of corneal morphological parameters (SAI, SRI, and Q-value) in LD was also investigated. RESULTS: Positive and negative induced defocus of 1.00D significantly increased the size of LD (p < 0.010, Wilcoxon signed rank test) but not its irregularity index. Spherical-like HOAs were associated with the size of LD, while coma-like and total-like HOAs were associated with LD irregularity. Our results showed that SRI was significantly correlated with the size of the disturbance area (r=0.519, p=0.003, Spearman correlation) and SAI with both size (r=0.502, p=0.005, Spearman correlation) and irregularity (r=0.371, p=0.044, Spearman correlation). However, no correlation between the Q-value and LD parameters was found. CONCLUSIONS: The uncorrected positive and negative refractive errors might increase the size of the LD, such as the spherical-like HOAs, SAI, and SRI, instead of asphericity. Coma-like and total-like HOAs and SAI may influence the perception of irregularities in the LD shape. These results might have an impact on postrefractive surgery visual performance that should be investigated.

Light disturbance analysis in the controlled randomized clinical trial MiSight® Assessment Study Spain (MASS).

PURPOSE: To evaluate the perception of light disturbances (LD) in children wearing Dual Focus (DF) MiSight® contact lenses (CLs) for myopia control compared with children wearing single vision spectacles (SV). METHODS: This was a randomized, controlled clinical trial involving subjects aged 8-12 with myopia of -0.75 to -4.00D and astigmatism <1.00D allocated to MiSight® study CLs group or control group wearing SV. LD was determined at baseline, 12 and 24 months visit with a validated device, Light Disturbance Analyzer (LDA) to determine the shape, size and regularity of the LD phenomena with parameters of Light Disturbance Index (LDI) Best Fit Circle (BFC) and Standard Deviation between LD and BFC (BFCIrreg.SD). RESULTS: 74 children completed the study, 41 in the CL group and 33 in the SV group. SV group didn´t show any significant differences between monocular and binocular LD measurements throughout the study. Binocular BFCRadius was smaller at 24 months visit compared with 12 month visit (p < 0.05) and for BFCIrreg.SD was significantly smaller at 24 month visit compared with baseline (p < 0.05). In MiSight® group, binocular and monocular LDI, BFCRadius and BFCIrreg.SD measurements didn't show any significant change between 12 and 24 month visits (p > 0.05). However, monocular BFCIrreg. as well as monocular and binocular BFCIrreg.SD showed a significant decrease at 24 month visit compared with 12 month visit. CONCLUSIONS: DF lenses increase the monocular light disturbance perception compared with a single vision spectacle correction. However, this effect decreased over the follow-up time and presented a significant binocular attenuation effect.

The importance of integrative approaches in nematode taxonomy: the validity of Parapharyngodon and Thelandros as distinct genera.

Despite the advances of molecular tools, new nematode species are still described mainly based on morphological characters. Parapharyngodon and Thelandros are two genera of oxyurids with unclear related taxonomic histories. Here we use morphological characters (linear measurements and categorical variables) and genetic information (18S rRNA, 28S rRNA and COI partial gene sequences) to confirm the relationships between representatives of these two genera and to determine whether they can be discriminated morphologically. Genetic results confirm the existence of two main clades, mostly congruent with Parapharyngodon and Thelandros genera but with several discordances. Thelandros is polyphyletic, with two of the species analysed (T. filiformis and T. tinerfensis) being part of the Thelandros clade, but with a third one (T. galloti) falling within the Parapharyngodon clade. Regarding the Parapharyngodon clade, P. cubensis, P. scleratus and Parapharyngodon sp. from Mexico form congruent lineages, while most P. echinatus samples cluster in another group, with one exception. Interestingly, P. micipsae samples are scattered across the Parapharyngodon clade, suggesting that they were misidentified or rather represent alternative morphotypes of other species. Morphological analysis identified the length of the tail, number of caudal papillae, position of the nerve ring, presence of caudal alae and length of the lateral alae as reliable characters to distinguish between Parapharyngodon and Thelandros genetic clades. Our study highlights the current taxonomic inconsistency in these groups, mainly derived from the exclusive use of morphological data. As such, we advocate for the routine implementation of molecular data in nematode taxonomic studies.

Neutrophil-lymphocyte Ratio and C-reactive Protein Level in Patients with Major Depressive Disorder Before and After Pharmacotherapy.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) level are useful biomarkers of inflammation. This study aimed to assess NLR and CRP level in patients with major depressive disorder before and after pharmacotherapy to determine whether NLR or CRP could be used as biomarkers of severity of major depression and whether there was any sex difference. METHODOLOGY: Patients with major depression who received no pharmacotherapy 1 month prior to the study were included. Their haemoglobin, total white blood cell count, neutrophil and lymphocyte counts, NLR, and CRP levels were evaluated at baseline and 12 weeks post pharmacotherapy, as were the Montgomery Asberg Rating Scale for Depression, the Scale for Impact of Suicidality Management and Assessment and Planning of Care (SIS-MAP), and the Clinical Global Impression Scale - Severity. RESULTS: 24 male and 26 female patients were included. At 12 weeks after pharmacotherapy, males had a higher haemoglobin level (p = 0.025), higher total white blood cell count (p = 0.018), and lower percentage of neutrophils (p = 0.019) than females. There was no sex difference in NLR or CRP. From baseline to 12 weeks, males had no significant change in any blood parameter, but females had a significantly greater increase in the percentage of neutrophils (p = 0.0001) and decrease in the percentage of lymphocytes (p = 0.012), resulting in a significantly increased NLR (p = 0.001). Both males and females had significant improvement on all 3 scales (p < 0.001). At 12 weeks, in males, the increase in NLR positively correlated with CRP as well as the Montgomery-Asberg Depression Rating Scale and the SIS-MAP, but not the Clinical Global Impression-Severity Scale. In females, the increase in NLR did not correlate with CRP or any of the scales. CONCLUSION: In female patients, the NLR increased in response to antidepressant therapy while CRP remained unchanged. This indicated that inflammation has a role in the pathogenesis of major depression.

Kondo effect and enhanced magnetic properties in gadolinium functionalized carbon nanotube supramolecular complex.

We report on the enhancement of magnetic properties of multiwalled carbon nanotubes (MWNTs) functionalized with a gadolinium based supramolecular complex. By employing a newly developed synthesis technique we find that the functionalization method of the nanocomposite enhances the strength of magnetic interaction leading to a large effective moment of 15.79 µB and non-superparamagnetic behaviour unlike what has been previously reported. Saturating resistance at low temperatures is fitted with the numerical renormalization group formula verifying the Kondo effect for magnetic impurities on a metallic electron system. Magnetoresistance shows devices fabricated from aligned gadolinium functionalized MWNTs (Gd-Fctn-MWNTs) exhibit spin-valve switching behaviour of up to 8%. This study highlights the possibility of enhancing magnetic interactions in carbon systems through chemical modification, moreover we demonstrate the rich physics that might be useful for developing spin based quantum computing elements based on one-dimensional (1D) channels.

Characterization of virulence factors of vaginal and anal isolates of Candida albicans sequentially obtained from patients with vulvovaginal candidiasis in north-east Brazil.

In order to better understand the pathogenesis of VVC, focusing on the role of C. albicans virulence factors in triggering this infirmity; we evaluated four virulence factors of 62 clinical isolates of C. albicans sequentially obtained from the vagina and anus of patients with sporadic and recurrent VVC. Virulence factors were phenotypically evaluated in vitro, including: adhesion capacity to epithelial cells obtained from healthy individuals, morphogenesis in the presence of fetal bovine serum, biofilm formation in polystyrene microtiter plates and proteinase activity using bovine serum albumin. Colonizing anal isolates were as able as infecting vaginal isolates to express the virulence factors evaluated in vitro. It was observed an association between the expression of virulence factors studied and the signs and symptoms of VVC presented by the patients. No statistically significant difference was observed in the expression of virulence factors between vaginal isolates of C. albicans obtained from patients with sporadic VVC and those obtained from patients with recurrent VVC. Our results suggest that the ability to express virulence factors is important for the pathogenesis of VVC, but it seems not to be crucial for the transition from colonization to infection.

Burn-related factors affecting anxiety, depression and self-esteem in burn patients: an exploratory study.

Burns are physically, psychologically and economically challenging injuries, and the factors leading to them are many and under-studied. The aim of the current study was to assess level of anxiety, depression and self-esteem in burn patients, and look at various burn-related variables that affect them. This cross-sectional study included 100 patients with burn injuries admitted to a tertiary care private hospital in an urban metropolis in India. The patients were assessed for anxiety, depression and self-esteem using the Hamilton anxiety rating scale, Hamilton depression rating scale and Rosenberg self-esteem scale respectively. Assessment was carried out within 2-8 weeks of injury following medical stabilization. The data was tabulated and statistically analyzed. The study sample was predominantly male (54%), married (69%), with a mean age of 34.1 ± 10.8 years. Accidental burns (94%) were the most common modality of injury. The majority (46%) suffered burns involving 20-59% total body surface area (TBSA), and facial burns were present (57%). No significant association was found between TBSA and anxiety, depression or self-esteem, and the same was true for facial burns. Deep burns, however, were significantly associated with anxiety (p=0.03) and depression (p=0.0002). High rates of anxiety and depression are associated with burn injuries and related to burn depth. Adjustment and recovery in these patients depends on various other factors like the patient's psychological status, nature/extent of the injury and ensuing medical care. Further research is warranted to reveal the magnitude and predictors of psychological problems in burn patients.

Les brûlures ont des conséquences physiques, psychologiques et économiques aux facteurs favorisants encore peu étudiés. Le but de cette étude est d'évaluer les niveaux de ces conséquences et les variables éventuellement corrélées. Elle a inclus 100 patients hospitalisés dans un hôpital privé référent d'une métropole indienne. L'anxiété, la dépression et l'estime de soi ont été mesurées respectivement pas les échelles d'anxiété et de dépression de Hamilton et l'échelle d'estime de soi de Rosenberg, les patients ayant été vus 2 à 8 semaines après stabilisation. Les patients étaient des hommes (54%) mariés (69%), âgés de 34,1 +/- 10,8 ans. Les brûlures étaient accidentelles dans leur grande majorité (94%). Presque la moitié (46%) des brûlures touchaient 20 à 59% de la SCT avec une atteinte du visage dans 57% des cas. Ni cette atteinte de la face ni la surface brûlée n'étaient corrélées aux paramètres étudiés. En revanche, les brûlures profondes étaient fréquemment associées à l'anxiété (p=0,03) et à la dépression (p=0,0002). La guérison et la réintégration de ces patients dépendent aussi d'autres facteurs comme l'état psycho-social préalable, la nature et l'étendue des brûlures, la prise en charge. Des études supplémentaires sont nécessaires pour préciser l'étendue de ces conséquences psychologiques et leurs facteurs prédictifs.

Effect of RRR-α-tocopherol supplementation on serum of breastfeeding women up to 60 days after delivery: a randomised controlled trial.

BACKGROUND: Maternal supplementation is a viable strategy to combat vitamin E deficiency in newborns, although a protocol for maternal vitamin E supplementation has not been defined. The present study assessed the effect of maternal supplementation in a single dose on the serum of postpartum women up to 60 days after delivery. METHODOLOGY: Fifty healthy breastfeeding women were recruited at two maternity hospitals both located in Natal, RN, Brazil. The participants were randomly allocated to a control group and a treatment group in a 1 : 1 ratio. Serum was collected 1, 20, 30 and 60 days after delivery. Immediately after the first collection, the treatment group received a single dose of 400 IU of RRR-α-tocopherol. α-Tocopherol was quantified by high-performance liquid chromatography. The usual dietary vitamin E intake was determined using four 24-h recalls, and intake adequacy was assessed based on the estimated average requirements for lactating women (16 mg day-1 ). RESULTS: The mean dietary vitamin E intakes of the both groups were similar (P > 0.05) and inadequate. The serum levels of α-tocopherol assessed at 1, 20, 30 and 60 days indicated adequate vitamin E status in both the control group (1194.6, 907.7, 910 and 748.6 µg dL-1 , respectively) and treatment group (1183.7, 956.0, 935.9 and 766.4 µg dL-1 , respectively). The comparison at each day showed no difference between treatments (P > 0.05). CONCLUSIONS: A single vitamin E supplement did not change the mean serum level of α-tocopherol in breastfeeding women; thus, it does not improve their vitamin E status in the first 60 days after delivery.

Cola humana: lesión rara con disrafismo espinal oculto / Human tail: rare lesion with occult spinal dysraphism

Los apéndices cutáneos caudales, también denominados colas humanas, pueden ser clasificados en colas verdaderas y pseudocolas. Las colas humanas verdaderas son entidades clínicas raras. Los autores presentan el caso de un recién nacido varón con un apéndice móvil localizado en la línea media en la región sacra revestido por piel, sin otras alteraciones en la exploración física. La resonancia magnética de la columna lumbosacra reveló disrafismo espinal oculto, con médula anclada y lipoma intradural. Sospecha de agenesia renal izquierda en la semana 32 de gestación, que se confirmó en la evaluación postnatal. Serealizó resección quirúrgica del apéndice y el informe histopatológico demostró tratarse de cola verdadera. Mantiene seguimiento clínico, sin déficits neurológicos aparentes. La presencia de apéndices cutáneos se asocia con frecuencia a disrafismo espinal oculto. El papel del pediatraes excluir la existencia de un disrafismo espinal oculto ante un marcador cutáneo sospechoso para así prevenir las lesiones neurológicas irreversibles originadas por la médula anclada que está asociada en la mayoría de los casos

Human tails can be classified as either true tails or pseudotails. True human tails are rare clinical entities. We describe a newborn with a midline sacral cutaneous appendage. Magnetic resonance imaging of the lumbosacral area revealed occult spinal dysraphism with tethered cord and intradural lipoma. Prenatal diagnosis of left renal agenesis was confirmed on postnatal evaluation. Surgical excision of the appendage was performed and histopathological examination demonstrated a truetail. The child recovered uneventfully and has been asymptomatic for 3years. Dorsal cutaneous appendages are a marker of underlying occultspinal dysraphism and requires detailed neuroimaging investigation in order to prevent irreversible neurological damaged

Synergistic antigen combinations for the development of interferon gamma release assays for paucibacillary leprosy.

The development of immunodiagnostic tests for paucibacillary leprosy (PB) is based on Mycobacterium leprae specific-cell mediated immunity (CMI)/IFN-γ production. Recently, novel M. leprae protein antigens that stimulate CMI have been described. This study evaluated different M. leprae antigen combinations in whole blood assay (WBA). Five study groups were tested (20 per group): newly diagnosed, untreated PB patients and multibacillary leprosy patients (MB); household contacts of MB patients (HHC); healthy endemic controls (EC); pulmonary tuberculosis patients (TB). WBA (heparinized, 24 h 37 °C 5% CO2) were stimulated with: 10 µg/ml of each individual M. leprae recombinant protein (rML) and five combinations of rML (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044, ML0276 + 46f, ML2055 + LID-1)-M. leprae cell sonicate (MLCS, 10 µg/ml), PHA (1 µg/ml), and PBS alone. Human IFN-γ ELISA (QuantiFERON-TB Gold/QFT-G, Cellestis) was performed using stimulated plasma (arbitrary cut-off = 50 pg/ml). Three out of five antigen combinations (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044) were able to increase the levels of IFN-γ production in WBA in a larger number of responders among both PB leprosy and contacts. However, the magnitude of IFN-γ responses was higher among contacts. The antigen combination (46f + ML0276) stimulated IFN-γ only in symptomatic PB leprosy patients and not in asymptomatic contacts. Few controls (EC, TB) responded to combinations (0-15%), indicating the specificity of the response in an endemic area with high BCG coverage. The synergistic effect of new combinations of M. leprae proteins upon IFN-γ production in WBA indicates their potential use for the development of an interferon gamma release assay/IGRA for the diagnosis of PB leprosy.

Regional variations and time trends of hantavirus pulmonary syndrome in Brazil.

Hantavirus pulmonary syndrome (HPS) is a zoonosis and a public health concern in the Americas due to its high fatality rate. Since the first cases were identified in USA in 1993, HPS has been observed over a wide area of the American continents. Over 1600 HPS cases have been confirmed in Brazil since 1993, and different genotypes of hantavirus have been identified in several biomes in this country of continental dimensions. We performed a retrospective study of data from 2001 to 2011 that encompassed all notified cases of HPS in the National Disease Notification System (SINAN) of Brazil to determine the regional differences and temporal trends of the disease. During the study period, 1486 cases were reported, and analyses of the temporal trends of the disease revealed that the number of cases in Brazil increased over this period (P < 0·01). The frequency distributions of the cases stratified by region revealed different patterns of seasonality; however, these patterns were not statistically significant with the exception of the South region (P < 0·05). We found regional differences in the occurrence of the disease throughout the year and a trend towards an increasing number of cases. These findings reinforce the necessity of adjusting surveillance tools and control policies to respond effectively to this public health problem.

[Human tail: rare lesion with occult spinal dysraphism]. / Cola humana: lesión rara con disrafismo espinal oculto.

Human tails can be classified as either true tails or pseudotails. True human tails are rare clinical entities. We describe a newborn with a midline sacral cutaneous appendage. Magnetic resonance imaging of the lumbosacral area revealed occult spinal dysraphism with tethered cord and intradural lipoma. Prenatal diagnosis of left renal agenesis was confirmed on postnatal evaluation. Surgical excision of the appendage was performed and histopathological examination demonstrated a true tail. The child recovered uneventfully and has been asymptomatic for 3 years. Dorsal cutaneous appendages are a marker of underlying occult spinal dysraphism and requires detailed neuroimaging investigation in order to prevent irreversible neurological damaged.

Laryngoscope blades and handles as sources of cross-infection: an integrative review.

The lack of standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, which may be important sources of infection during their clinical use, has been reported previously, revealing contamination with blood, body fluids and micro-organisms. This paper aimed to evaluate the evidence available in the literature regarding the risk of laryngoscope blades and handles as a source of patient contamination. An integrative review of the literature was performed using databases such as Medline, LILACS, SciELO, Cochrane Library, BDENF and PubMed, and keywords in Medical Subject Headings (MeSH). The sample comprised 20 articles published between 1994 and 2012. The studies demonstrated risk of cross-infection and no consensus in current guidelines regarding cleaning and disinfection of this equipment. It was concluded that there are important gaps to be filled and urgent investigations required in order to facilitate standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, and in turn to reduce the potential risk to which the patient and/or health team is exposed.

Modified Bentall operation - outcomes with emphasis on the aortic index.

OBJECTIVES: Analysis of the early results and long term outcome after the modified Bentall operation with a mechanical prosthesis in a single Institution, emphasizing the use of the aortic index in elective procedures to assist the difficult decision of replacing the ascending aorta in patients with aortic valve disease. METHODS: Prospective study of 126 consecutive patients operated in a 16 year period. In 82 patients (65%) the surgeries were performed electively but the remaining 44 patients were operated urgently for acute aortic dissection or acute bacterial endocarditis. Total follow-up time was 519.96 patient-years. Time related analyses, including freedom from event analysis, were calculated with the Product Limited Method of Kaplan and Meier and tested with the Log-Rank and Cox Regression tests. RESULTS: Early mortality was 7.9% for the entire cohort. There was no mortality on elective primary operations. The aortic index was computed in 93% of the elective procedures, ranging between 1.9 and 6.9 cm2/ m2. For all patients, survival at 15 years was 67.3% and freedom from local complications requiring reoperation was 95.6 % at same time. CONCLUSIONS: The modified Bentall operation can be performed with low mortality and morbidity in selected patients and an exceptionally low rate of local complications in the long term. The aortic index is a valuable tool to help cardiac surgeons to decide when to replace a dilated ascending aorta.

Genetic diversity of Metrodorea nigra (Rutaceae) from a small forest remnant in Brazil assessed with microsatellite markers.

Metrodorea nigra (Rutaceae) is an endemic Brazilian tree of great ecological importance, frequently found in the submontane regions of ombrophilous dense and semideciduous forests. This tree is useful for reforesting degraded areas and the wood can be employed in construction. We developed 12 microsatellite markers from a genomic library enriched for GA/CA repeats, for this species. Polymorphisms were assessed in 40 trees of a highly fragmented population found in Cravinhos, State of São Paulo, in southeastern Brazil. Among the 12 loci, 8 were polymorphic and only one had fixed alleles in this population. The number of alleles per locus and expected heterozygosity ranged from 2 to 11 and from 0.190 to 0.889, respectively. These results revealed moderate levels of genetic variation in M. nigra population when compared to other tropical species. Additionally, transferability of the 12 primers was tested in seven other Brazilian Rutaceae tree species (endemics: M. stipularis, Galipea jasminiflora, Esenbeckia leiocarpa and non-endemics: E. febrifuga, E. grandiflora, Balfourodendron riedelianum, Zanthoxylum riedelianum). Transferability ranged among species, but at least 8 loci (~67%) amplified in M. stipularis, demonstrating a high potential for transferring microsatellite markers between species of the same genus in the Rutaceae family.

Psychological aspects of prostate cancer: a clinical review.

Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.