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The diversification of angiosperms has largely been attributed to adaptive radiation of their pollination and mating systems, which are relevant drivers of the macroevolution processes. The fig (Ficus, Moraceae) and fig wasp (Agaonidae, Hymenoptera) interaction is an example of obligate mutualism. Passive and active pollination modes have been associated with morphological traits in both partners. However, more information is required to assess the relationship between floral traits and pollination modes, particularly in Neotropical Ficus species. This study evaluates the morphological traits of figs and fig wasps regarding pollination modes in species belonging to Neotropical Ficus sections (three species each of Americanae and Pharmacosycea). Pollination mode was identified by floral morphology, anther/ovule ratio, and specialized structures fig wasps use for pollen transport (pollen pocket and coxal combs). Fig species in sect. Americanae are actively pollinated because pistillate flowers form a synstigma, present anther/ovule ratios <0.11, and their pollinator Pegoscapus fig wasps have pollen pockets and coxal combs. In contrast, species in sect. Pharmacosycea have free pistillate flowers, with anther/ovule ratios >0.27; they are pollinated by Tetrapus wasps, which lack specialized structures to carry pollen. Each species of Ficus was associated with a single morphospecies of fig wasp. The results support previous contributions that consider reciprocal morphological traits between fig species and their pollinating wasps as evidence of a close co-evolutionary history., (© 2024 The Author(s). Plant Biology published by John Wiley & Sons Ltd on behalf of German Society for Plant Sciences, Royal Botanical Society of the Netherlands.)

This study aimed to determine the bacteriological quality and presence of diarrheagenic Escherichia coli pathotypes (DEP) and nontuberculous mycobacteria (NTM) species in 85 packaged ice samples from 12 different states of central Mexico. Three samples had a pH of 9.8 and therefore fell outside of the acceptable range for pH. All samples were positive for aerobic-mesophilic bacteria, with limits ranging from 1 to 3.47 log CFU/mL. In total, 35, 11, and 3 ice samples were positive for total coliforms (TC), fecal coliforms (FC), and E. coli, respectively. In the samples, the TC concentration ranged from <1.1 to >23 MPN/100 mL and from <1.1 to 23 MPN/100 mL for FC and E. coli. In total, 38 (44.7%) ice samples were outside of Mexico's official guidelines. None of the 12 E. coli strains isolated from the three ice samples belonged to DEP. NTM were recovered from 20 ice samples and included M. neoaurum (n = 7), M. porcinum (n = 2), M. flavescens (n = 2), M. fortuitum (n = 1), M. abscessus (n = 1), M. senegalense (n = 1), M. conceptionense (n = 1), and M. sp. (n = 1). In the remaining four samples, two NTM were isolated simultaneously. Thus, we recommend that producers should evaluate the microbiological quality of purified water used as a raw material as well as that of the final product, the ice should be packed in thick bags to avoid stretching and tearing during transportation or storage to prevent environmental contamination of ice, personnel involved in the production, and handling of ice should be trained in relative hygiene matters and how ice-machines should be cleaned and disinfected and the implementation of hazard analysis and critical control points must be applied throughout the chain of production. Finally, regular inspection by the authorities is also of great importance. These recommendations can be applied in different countries with low microbiological quality packaged ice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Co-occurrence of paracoccidioidomycosis and strongyloidiasis in immunosuppressed patients, particularly those infected with human T-lymphotropic virus type 1/2, is infrequent. We describe the case of a Peruvian farmer from the central jungle with human T-lymphotropic virus type 1/2 infection, with 2 months of illness characterized by respiratory and gastrointestinal symptoms associated with fever, weight loss, and enlarged lymph nodes. Strongyloides stercoralis and Paracoccidioides brasiliensis were isolated in sputum and bronchoalveolar lavage samples, respectively. The clinical evolution was favorable after the patient received ivermectin and amphotericin B. We hypothesize that autoinfestation by S. stercoralis in human T-lymphotropic virus type 1/2-infected patients may contribute to the disseminated presentation of Paracoccidioides spp. Understanding epidemiological context is crucial for suspecting opportunistic regional infections, particularly those that may coexist in immunosuppressed patients.

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes., Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors., Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1-35.6%) and shunt obstruction (7-16%)., Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Background: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown., Case Presentation: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma., Conclusion: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started., (© 2023. The Author(s).)

Objective: Body dysmorphic disorder (BDD) is an often-severe condition in which individuals are preoccupied by misperceptions of their appearance as defective or ugly. Only serotonin reuptake inhibitors and cognitive-behavioral therapy have been demonstrated efficacious in randomized controlled trials. Psilocybin is a psychedelic drug with growing evidence for safety and efficacy in treatment of depression. This study aimed to pilot test the feasibility, tolerability, safety, and efficacy of psilocybin treatment of adults with BDD., Methods: In this open-label trial, 12 adults (8 women, 4 men) with moderate-to-severe non-delusional BDD that had been unresponsive to at least one serotonin reuptake inhibitor trial received a single oral dose of psilocybin 25 mg. There was no control group. Psychological support was provided before, during, and after the dosing session. The primary outcome measure for efficacy was the Yale-Brown Obsessive Compulsive Disorder Scale Modified for BDD (BDD-YBOCS) score during 12 weeks of assessments after dosing., Results: All participants completed dosing and all follow-up assessments. BDD-YBOCS scores decreased significantly over 12 weeks of follow-up (p < .001) with a large effect size (partial eta squared = 0.54), and significant changes from baseline were present at week 1 and persisted through week 12. Secondary efficacy measures of BDD symptoms, conviction of belief, negative affect, and disability also improved significantly, and no serious adverse events occurred. At week 12, seven participants (58%) were rated responders, based on ≥30% decrease in BDD-YBOCS., Conclusion: This study provides promising preliminary support for psilocybin as a treatment of BDD, warranting future controlled studies., Competing Interests: Summary declaration of interest statement Dr. Schneier has received research support from Compass Pathways, Otsuka, Vistagen, and NIMH, royalties from UptoDate, Cambridge University Press, and Guilford Press, and served as consultant to Receptor Life. Dr. Hellerstein has received research support from Compass Pathways, Relmada, Intracellular Therapies, Beckley Foundation, serves on the scientific advisory board for Reset Pharmaceuticals and has received royalties from Johns Hopkins University Press and Columbia University Press. Dr. Feusner receives research support from the NIMH, NIBIB, and the Klarman Family Foundation and serves as a consultant to NOCD, Inc. Dr. Wheaton, Ms. Cornejo, Ms. Mahesh Narainda, and Ms. Gomez have no financial relationships to report., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Marijuana is the most widely used illicit drug in the world, especially among young people. This study is relevant to policy makers because it expands the knowledge regarding drug use in vulnerable youth, allowing health authorities to reduce marijuana consumption via educational, family, and governmental strategies and policies. The objective of this study was to determine the prevalence of frequent marijuana consumption and its associated factors in young people before admission to juvenile detention centers in Peru. The data was taken from the 2016 National Population Census of the Youth Diagnostic and Rehabilitation Centers in Peru. The final sample was made up of 1,848 people with ages between 14 and 22 years old, with a median age of 17 (95.6% males). The variable frequent marijuana consumption was defined as the use of marijuana at least once a week, prior to entering the center. The main factors associated with frequent marijuana use were male sex, running away from home before the age of 15, physical abuse during childhood, having a family member who consumed alcohol or drugs frequently, and the presence of criminal gangs in the housing area. Additionally, it was found that living with parents up to a specific critical age decreases the probability of frequent use of marijuana in young people. These results could aid the development of strategies and public policies that help prevent the consumption of marijuana and other drugs from an early age.

Background: Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA)., Objectives: (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals., Methods: A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed., Results: A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals., Conclusion: Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: The clinical utility of cardiopulmonary exercise testing (CPET) has not been extensively studied yet in heart transplantation (HTX) patients., Objective: To analyze the predictive value of the CPET on hospitalizations and mortality in HTX recipients., Methods: A retrospective cohort was performed from a secondary database. Patients > 18 years with HTX who underwent a CPET between 3 and 12 months after transplantation were included. Time to the first primary endpoint (HTX-related hospitalization) was analyzed and adjusted using Cox proportional hazards regression model., Results: A total of 122 patients (mean age 50.1 years, 77.0% men) were included. Fifty-seven patients (46.7%) had the primary endpoint. Peak VO 2 (HR .95; CI 95% .90-.99, P = .03), oxygen pulse (HR .57; CI 95% .34-.96, P = .03) and predicted VO 2 (HR .97; CI 95% .96-.99, P = .002) were associated with the endpoint. We did not find a significant association between the other variables and the outcome., Conclusion: In HTX recipients, peak VO 2 , oxygen pulse, and predicted VO 2 were independently associated with hospitalizations at follow up., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA)., Objectives: (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals., Methods: A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed., Results: A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals., Conclusion: Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

The benefits provided by tropical rainforests are unevenly distributed throughout the landscape and are shaped by abiotic and biotic components that influence the spatial distribution and functional traits of the species involved. We tested whether environmental stratification of the rainforest in biophysical Landscape Units (LU), defined by topography and soil, is related to the spatial distribution of diversity, abundance and productivity (standing biomass) of tree assemblages that provide potential forest products (PFP). Considering that different PFP are associated with specific plant traits, we also tested whether a phylogenetic signal exists among the species that comprise specific use categories. Non-metric multidimensional scaling ordinations and permutational analysis of variance were based on the frequency, abundance and productivity of 129 species, the PFP of which were classified as fodder, food, fuelwood, medicinal, melliferous, ornamental, plywood and timber in 15 plots of 0.5 ha each. We constructed a phylogenetic tree of the studied species and analyzed the phylogenetic signal strength (D-statistic) among them. The spatial distribution of diversity and abundance of useful species changes among the LU. Specific PFP can be provided in contrasting habitat conditions, but generally not by the same species. The PFP categories that presented a phylogenetic signal were associated with wood characteristics (fuelwood and plywood) and the palatability of the leaves and reproductive structures (fodder). The Moraceae family was significantly related to fodder and plywood, whereas Meliaceae, Myrtaceae and Sapotaceae were mostly used for fuelwood. The medicinal species presented convergent traits distributed throughout the phylogeny. However, since our study included a broad variety of plant structures, it is possible that phylogenetic dispersion can change if we consider the specific uses within each category. Our findings show that the assemblages of PFP suppliers can be clustered through biophysical units based on soil and topography, and specific categories of PFP are often supplied by phylogenetically related species. This knowledge is fundamental in order to incorporate the high diversity of tree species and their potential uses into productive reforestation and agroforestry programs., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Salting is one of the oldest methods of preserving food. The main limitation of salting is its extended processing time due to slow salt diffusion. A moderate electric field (MEF) can improve the mass transfer rate through electroporation. Regularly, mass transfer processes are modeled with Fick's second law. However, due to the anisotropic nature of food microstructures, it might be more appropriate to use an anomalous model. The main objective of this study was to search for a phenomenological explanation for salt and water diffusion in the salmon brining process coupled with MEF. Salmon fillets were cut into finite cylinders (0.025 × 0.025 m) and brined in two salt concentrations (6 and 24% w/w NaCl) at 6 °C for 20 h. MEFs were applied in the range of 0 to 2 V/cm. The salt and water contents of the salmon were measured during the process. Fick's second law and anomalous model based on fractional calculus were used to describe the diffusion phenomena. The results showed that an MEF tended to reduce the brining processing time and increase the salt content of salmon. This effect is predominantly due to an increase in the equilibrium salt concentration in the salmon tissue. Mathematical analysis shows that the anomalous diffusion model is more suitable for representing the brining process, exhibiting superdiffusion behavior (α > 1). An MEF accelerates the salt mass transfer into salmon tissue even at lower temperatures, significantly reducing the processing time. In addition, the diffusion process can be characterized with an anomalous model., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru., Materials and Methods: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted., Results: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas., Conclusions: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.

In tropical dry forests, although seed germination and seedling establishment are in general limited by the seasonal availability of water, high interspecific variability, nonetheless, exists in terms of seedling traits and germination dynamics. Differences among species in seed germination and seedling traits may be related to other plant life-history traits, such that assessing these relationships may increase our understanding of factors influencing plant establishment, which would affect the regeneration pathways of tropical dry forest communities. In this study, taking into consideration the effect species' phylogeny, we evaluated the relationships of seed germination metrics (percentage, lag time, and rate of germination) and seedling types (i.e. cotyledons functional morphology), with plant life-history traits (growth form, seed mass, dispersal syndrome and dispersal phenology) for 110 species in a Neotropical dry forest in Mexico. A total of 92% of the species studied disperse their seeds during the dry season, mainly at the beginning of this season (66%), a strategy mostly associated with autochorous herbs. Seed germination was more frequent in species that dispersed seeds at the end of the dry season. Germination percentage was not related to any of the traits studied. However, germination lag time and rate were negatively related to seed mass, a trait that in turn depended on growth form and dispersal syndrome. The dominant seedling type in the community was phanerocotylar epigeal with foliaceous cotyledons (56%), which was mostly associated with small seed mass and herbaceous growth form. Our results provide evidence that several plant life-history traits explain an important part of the variation in seed germination and seedling characteristics observed among species. Therefore, these plant life-history traits may be useful for grouping species in terms of their establishment strategies and roles on the regeneration of tropical dry communities., Competing Interests: The authors have declared that no competing interests exist.

Introduction/objectives: Cardiovascular risk management of patients with systemic lupus erythematosus (SLE) is medically relevant. The objectives were to estimate the cardiovascular risk by different strategies in patients with SLE, analyzing which proportion of patients would be candidates to receive statin therapy, and identify how many patients with statin indication received such drugs., Method: A cross-sectional study was performed from a secondary database. Following the recommendations of National Institute for Health and Care Excellence (NICE) guidelines and the Argentine Consensus, the QRISK-3 and the adjusted Framingham (multiplying factor × 2) scores were calculated in primary prevention subjects. The indications for statin therapy according to these recommendations were analyzed., Results: In total, 110 patients were included. Regarding patients without previous cardiovascular history, the median adjusted Framingham score was 12.8% (4.1-21.9), and 45.2%, 22.6%, and 32.2% of them were classified at low, moderate, or high risk. The median QRISK-3 score was 6.0% (2.1-14.1) and 42.1% of subjects were classified "at risk". Only 60% of subjects in secondary prevention received statins, although no patient received the recommended doses. Analyzing patients in primary prevention who did not receive statins (87%), 43.4% and 45.2% of the patients were eligible for statin therapy according to NICE guidelines and Argentine Consensus, respectively., Conclusions: Our findings showed that a large proportion of patients with SLE have a considerable cardiovascular risk and many of them would be eligible for statin therapy. However, the statin use observed was low.Key Points• A large proportion of patients with lupus have a considerable cardiovascular risk, explained in part by dyslipidemia.• Many patients with SLE would be eligible for statin therapy according to risk stratification based on conventional risk factors.• The use of statins in this population is inadequate.

Our article tackles gender and sexual diversity scholarship in Colombia and Perú, two countries without institutionalized LGBT studies programs. By analyzing the impact of literary works in Perú and an annual conference in Colombia's capital, we show how LGBT-related scholarship (and activism) has been advanced in these Andean countries with tactful maneuvering, as they offset contemporary violence-and a strong religious influence. Our comparison allows us to showcase two of the most common ways through which these countries have engaged in LGBT research and activism. This region-centered, dual-country approach underscores the broader need of researching and documenting these efforts.

In tropical dry forests, a high interspecific variation in the strategies of fruiting phenology has been documented. Therefore, phenological responses may be mediated by influence of environmental variables, functional plant attributes or phylogenetic inertia. During 2 years, we recorded the fruiting phenology of 151 species belonging to 5 different growth forms of a Neotropical dry forest in Mexico. We evaluated the relationships between fruiting phenology, abiotic factors (precipitation, temperature, day-length) and functional attributes (growth form, dispersal syndrome, size and time for fruit development) using phylogenetic least squares models (PGLS). More species had ripe fruits during the dry season (92%) than during rainy months and dispersed their seeds by autochory and endozoochory. We found that fruit development time was positively correlated with fruit size and together the morphological fruit traits (size and dispersal syndrome) showed an important relationship with the growth form, but with a strong phylogenetic signal. Environmental seasonality had a strong influence on fruit ripening time, without a relevant association to the phylogeny of plant species. However, the phenological response to the environment (rainfall and day-length) at the community level was mediated by growth form. In woody species, we documented a high interspecific fruiting variation linked with the different dispersal syndromes. In herbaceous species, fruiting phenology is a trait restricted by the duration of their life cycle by rainfall seasonality, which in turn might have selected some traits (e.g., dry fruit, presence of spines, explosive dehiscence) for maximizing seed dispersal during the dry season.

Background: Pseudomyxoma peritonei is a disease characterized by an intraperitoneal adenomucinous tumor cell disemination, being cecal appendix the most common etiology., Objective: To report a surgeon's group experience and a detailed up to date literature review., Clinical Cases: 1. A 74 year old woman with a history of four days with mesogastrium and right lower quadrant abdominal pain associated with diarrhea and fever was admitted to our institution. Upon admission she presented with signs of peritoneal irritation and muscular rigidity, leukocytosis of 14,500 cels/mm(3), 89% neutrophils and 1% bands. An acute appendicitis diagnosis was established, being scheduled for diagnostic laparoscopy, during procedure, significant bowel distention was found, so conversion to laparotomy was required. Case 2. A 73 year old male with a history of one year with intermittent abdominal pain at right iliac fossa and hypogastrium was admitted to our institution. Dyspnea, constipation alternating with periods of diarrhea, gastric fullness and heartburn occurred. On physical examination only a palpable tumor occupying mesogastrium and both iliac fossae was noticed, therefore, a laparotomy was performed. In both cases diagnoses were made during procedure, finding multiple scattered multilobulated mucinous tumor implants within the peritoneal cavity. Histopathological studies confirmed a pseudomyxoma peritonei diagnoses., Conclusions: Peritoneal pseudomyxoma is a rare malignant tumor with a difficult diagnosis characterized by copious production of mucinous ascites and multiple tumors implants on serosa of intracavitary viscera. The gold standard treatment consists of cytoreductive surgery and perioperative intraperitoneal chemotherapy and/or adjuvant chemotherapy.

We used sentinel animal enclosures to measure the rate of infestation by the Chagas disease vector, Triatoma infestans, in an urban community of Arequipa, Peru, and to evaluate the effect of deltamethrin-impregnated netting on that rate. Impregnated netting decreased the rate of infestation of sentinel enclosures (rate ratio, 0.23; 95% confidence interval, 0.13-0.38; P < 0.001), controlling for the density of surrounding vector populations and the distance of these to the sentinel enclosures. Most migrant insects were early-stage nymphs, which are less likely to carry the parasitic agent of Chagas disease, Trypanosoma cruzi. Spread of the vector in the city therefore likely precedes spread of the parasite. Netting was particularly effective against adult insects and late-stage nymphs; taking into account population structure, netting decreased the reproductive value of migrant populations from 443.6 to 40.5. Impregnated netting can slow the spread of T. infestans and is a potentially valuable tool in the control of Chagas disease.

Intestinal obstruction is one of the most frequently abdominal problems that concern general surgeons. One of the infrequent causes of mechanical obstruction is sclerosing encapsulating peritonitis (SEP); this entity causes intense fibrosis of the components in the peritoneal layer, resulting in adhesion of abdominal organs. SEP can be primary or secondary; both are a type of peritoneal fibrosclerosis that causes intestinal obstruction with difficult resolution and a great number of complications. In terms of frequency and etiology, there are few data, and the problem is considerated a multifactorial disease with association to neoplasms, toxics, drugs, and idiopathic form. This article presents three cases of sclerosing encapsulating peritonitis and the possible factors that play an important role in the development of this infrequent entity.

A double-blind study was undertaken to determine the efficacy of an oral dose of midazolam 7.5 mg as compared to placebo in a sample of 32 children who had refused dental care after the conventional psychological approach alone was used to reduce fear and apprehensive behavior. Parameters assessed before and 30 minutes after the oral administration of either midazolam or placebo were mental attitude, hypnotic activity, motor activity, quality of sedation and of dental treatment. A three-point scale was designed in each studied parameter and mean values +/- s.e.m. were compared before and after treatment by using Wilcoxon's rank test. It was shown that an oral dose of midazolam 7.5 mg significantly improved all parameters under evaluation (p < 0.01) as compared to placebo, effects which appeared thirty minutes after administration. It is concluded that oral midazolam provides a fast and adequate sedation in children refusing dental care. Thus, the drug is an alternative to other sedative or hypnotic drugs currently used in the premedication of the apprehensive child.