The role of the rural surgeon as endoscopist

As the number of physicians and surgeons practicing in rural communities decreases the roles of those physicians must necessarily expand to meet the needs of the community. Nowhere is this more apparent than in the field of endoscopy. This analysis was undertaken to examine the role of the rural general surgeon in the performance of endoscopy and the outcomes of endoscopic procedures in the hands of the general surgeon. This is a retrospective analysis of all endoscopic procedures performed at a single institution between July 1, 1996 and December 31, 1998. Data were stratified on the basis of type of procedure, indication, and findings. The patient group was a consecutive sample of all patients during the study period referred to the single general surgeon at a small acute-care hospital in rural east-central Mississippi for endoscopic procedures. All patients met accepted criteria for the proposed procedure. Patients underwent either esophagogastroduodenoscopy, colonoscopy, or diagnostic laparoscopy. Endoscopy comprised 24 per cent of all cases performed by the surgeon. Upper endoscopy accounted for 65 per cent of the total, colonoscopy for 29 per cent, and diagnostic laparoscopy for 6 per cent. Positive findings of significance were found in 75 per cent of endoscopic cases overall. Endoscopy comprises a significant proportion of the general surgeon's practice in the rural setting. With good patient selection in this setting the positive-finding rate is very high.     

Frequency of antibodies to Toxocara in Cuban schoolchildren

Objective The aim of the study was to determine the frequency of antibodies to Toxocara in Cuban schoolchildren. Methods The frequency of antibodies to Toxocara canis was assessed with a commercial enzyme‐linked immunosorbent assays kit in school‐aged children from two municipalities of Cuba. Univariate analysis and a multivariable logistic regression analysis adjusted for age, sex, municipality and co‐infection with helminth and/or protozoa were conducted. Results The percentage of children with antibodies to Toxocara was 38.8% (392/1011; 95% CI = 36.8–42.8). Antibody positivity was significantly associated with gender and co‐infections with intestinal parasites, but not with age or municipality. Conclusion Cuban children are highly exposed to the Toxocara parasite, corresponding well with reported environmental contamination with Toxocara parasite eggs and T. canis prevalences in dogs in Cuba. Relevant policy makers and the Cuban population need to be better informed about this preventable infection.     

Cyclic filling cystourethrography in the study of febrile urinary tract infection in children

PURPOSE: To assess the value of cyclic voiding cystourethrography (VCUG) for the detection of reflux in a large population of children with urinary tract infection. MATERIALS AND METHODS: 234 patients (67% less than 3 years of age) underwent VCUG with two fillings in 214 cases and three fillings in 139 cases. Appearance or increase in the grade of reflux compared with previous filling was expressed as "modification of the radiology report" (MRR). The amount of contrast material, the duration of fluoroscopy and the number of films were recorded. RESULTS: The rate of reflux was 18.4% at the first filling, 16% at the second filling with 9.8% MRR and 14.7% at the third filling with 10% MRR. These results were the same for children younger and older than 3 years. For children under three years, if one considered reflux grade higher than 1, the MRR was 9.6% at the second filling and 7.5% at the third while it was 5.8% and 3% for older children. On average, the use of contrast material increased 50% with a third filling, number of films was not modified and the time of fluoroscopy increased by 6 sec per filling. CONCLUSION: VCUG is recommended in all children. The detection of reflux higher than grade 1 is more frequent with multiple fillings in children under 3 years. The increase in radiation exposure and cost seems negligible.     

Optimization of random amplified polymorphic DNA techniques for its use in genetic studies of Trichomonas vaginalis isolates.

The random amplified polymorphic DNA (RAPD) technique is a simple method to detect DNA polymorphism. Several factors can affect the amplification profiles causing the presence of false bands and assay non-reproducibility. In this study, we analyzed the effect of changing concentrations of the primer, template DNA and Taq DNA polymerase with the goal of determining their optimum concentration for the standardization of the RAPD technique for genetic studies of Trichomonas vaginalis, a parasite that is of major epidemiological relevance in Cuba.     

Genetic characterization of three Cuban Trichomonas vaginalis virus. Phylogeny of Totiviridae family

Trichomonas vaginalis can be infected with double stranded RNA (dsRNA) viruses known as T. vaginalis virus (TVV). This viral infection may have important implications for trichomonal virulence and disease pathogenesis. In this study we identified and genetic characterized three strains of TVVs isolated from T. vaginalis in Cuba. The three new predicted sequences of capsid protein and RNA-dependent RNA polymerase amounted to the previously determined 20 TVV sequences and other 21 viruses of Totiviridae family were used for a phylogenetic analysis. Four distinct monophyletic clades are shown in a phylogenetic tree. One corresponds with TVVs, other with Victorivirus, Leishmaniavirus and Eimeria brunetti virus and, other with viruses of the genus Totivirus and the last with Giardiavirus. The E. brunetti virus is identified in the phylogenetic tree as independent taxon between Leishmaniavirus and Victorivirus isolates, most closely related to Victorivirus. TVV constitute a monophyletic cluster distinguishable from all other viruses in Totiviridae family. This result suggested that TVV may be grouped in a separated genus and not inside of Giardiavirus. TVVs appear to be more closely related to protozoan viruses in the genus Leishmaniavirus and to fungal viruses in the genus Victorivirus than to other protozoan and fungal viruses in Giardiavirus and Totivirus. Among TVVs, four main groups can be recognized within Trichomonasvirus cluster, which correspond with the previous species classification proposed. Further studies, with more TVV strains, especially TVV3 and 4 strains, are needed in order to determine the phylogenetic relationship among Trichomonasvirus genus and specifically if TVV2 and 3 each also constitute a well-delimited group.     

Monoclonal antibodies against a 62 kDa proteinase of Trichomonas vaginalis decrease parasite cytoadherence to epithelial cells and confer protection in mice

Trichomonas vaginalis infects the epithelium of the genital tract. The mechanism by which it invades the tissue leading to the disease is not thoroughly understood. However, results of several studies seem to agree that parasite adhesion to epithelium cells is the initial step leading to infection in women. T. vaginalis is associated with high levels of proteolytic activity. The role of some of these proteinases in the development of infection has been demonstrated. The current study establishes the role of a 62 kDa excretion-secretion proteinase in parasite cytoadherence. Monoclonal antibodies (MAbs) against this enzyme were tested for their ability to inhibit this process. Three stable hybrid producers of IgG(1)class MAbs (4D8, 1A8, 3C11) against the 62 kDa proteinase were obtained. Two of them (4D8 and 1A8) showed parasite recognition by immunofluorescence. Parasite cytoadherence to a monolayer of HeLa cells was inhibited by the 4D8, 1A8 and 3C11 antibodies. MAb 4D8 administered 24 h before a challenge with T. vaginalis by the intraperitoneal route was able to protect the majority of mice. Nitric oxide levels in the serum of animals inoculated with MAb 4D8 and challenged with the parasite were significantly different from those recorded in mice treated with an unrelated MAb. These studies show that an appropriate antibody against 62 kDa proteinase can help the host resist a challenge by the intraperitoneal route with T. vaginalis.