Feasibility of Routine Ambulatory Laparoscopic Cholecystectomy in Brazil.

BACKGROUND AND OBJECTIVES: In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital. METHODS: Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC. RESULTS: Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3). CONCLUSIONS: ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.

Egg laying pattern, egg weight, body weight at hatch, and sex ratio bias relative to oviposition time of young-and mid-age broiler breeders.

Two experiments were conducted to determine oviposition pattern and the effect of oviposition time on egg weight, body weight at hatch, and sex ratio of hatched chickens. In Experiment 1, eggs were collected from young and mid-age broiler flocks for 6 consecutive days at hourly intervals between 0400 and 2000h. In Experiment 2, eggs were categorized to represent eggs where oviposition occurred early, middle and late in the clutch (later in the day). These eggs were incubated to determine body weight at hatch and sex ratio of hatched chickens relative to oviposition time. Time of oviposition was affected by age. For the young flock, the percentage of ovipositions occurring before the 1100h was 79%. In contrast to the young flock, the percentage of ovipositions occurring before the 1100h in the mid-age flock was less (68%; P<0.01). Furthermore, for the mid-age flock, the percentage of ovipositions occurring from 1200 to 1700h was greater (P<0.01) at 32% in comparison to that of the younger flock at 21%. Egg weights when oviposition occurred earlier in the day were greater (P<0.01) than when oviposition occurred in the middle and later in the clutch (later in the day). Similarly, body weight at hatch of chicks from eggs where oviposition occurred earlier in the day was heavier than when oviposition occurred in the middle and later in the clutch (later in the day).With hatching of the eggs from hens when ovipositions occurred earlier in the day, there was a female sex bias. Differences in egg weights, body weight at hatch, and sex ratio due to time of oviposition suggest that oviposition time together with incubation conditions should be considered for obtaining greater uniformity and growth of chickens.

Prevalence and transmission of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) in Ugandan children and adolescents.

We studied the seroprevalence and transmission of Kaposi's sarcoma-associated herpesvirus (KSHV/HHV8), among 215 Ugandan children, adolescents and young adults. We measured antibodies to a latent nuclear antigen (LANA) and a lytic cycle protein encoded by open reading frame (orf) 65. Infection with KSHV/HHV8 occurred during early childhood and reached adult levels (approx. 50%) before the age of puberty. In children younger than 12 years of age, antibodies to LANA and the orf65 protein were independently associated with hepatitis B infection (p < 0.005). KSHV/HHV8 infection was not associated with antibodies to hepatitis A virus and hepatitis C virus, nor with the quality of the water supply, household size, previous blood transfusions, number of boy/girl friends or marital status. Antibodies to the orf65 protein, but not LANA, were weakly associated with a history of i.v. injections. Our results show that, in contrast to its sexual mode of transmission among homo/bisexual men and sexually transmitted diseases clinic attendees of Northern Europe and the US, transmission of KSHV in Uganda occurs largely before puberty. Among Ugandan children, KSHV transmission follows a horizontal pattern similar to other herpesviruses, in particular the related gamma herpesvirus, Epstein-Barr virus. Transmission of KSHV may be facilitated by living conditions that also promote infection with hepatitis B virus.

Delusions of ocular parasitosis.

PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.