South American Programme: Brazil.

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Advances in the phylogenetic study of the tribe Cinchoneae (Rubiaceae) with emphasis on the genus Cinchona and Ladenbergia

In its current circumscription, the Cinchoneae tribe includes 9 genera of neotropical distribution. Its species occur mostly in the Andes in South America, with few reaching Central America. Preliminary phylogenetic studies have suggested the monophyly of Cinchoneae but intrageneric relationships are still debatable. In this study, we sampled 8 genera of Cinchoneae (with ca 50% of species for Cinchona and Ladenbergia) and obtained multiple single-copy nuclear loci (ca 207 genes) by using the “Angiosperm353 universal probe set”, which was complemented with a taxonomic review of Cinchoneae. Phylogenetic inferences were realized with multispecies pseudo-coalescent (ASTRAL III) and gene concatenation analysis (ML). Our results strongly support the monophyly of the tribe and most of the genera, except for Ladenbergia. Furthermore, Ciliosemina, Ladenbergia, and Remijia formed a clade, although the position of Ciliosemina (= Remijia pedunculata) and Ladenbergia muzonensis is still elusive. The position of Ladenbergia muzonensis is intriguing due to its intermedíate floral morphology, which resembles both Remijia and Ladenbergia species. Additionally, our phylogeny also supports the recognition of a new species in Cinchona. Finally, our results show that sequencing data using the probe set designed for multiple gene capture is a useful tool for phylogenetic reconstructions in taxonomically complex groups

[reasons For Cataract Surgery Cancellation].

To study the reasons for cancelling cataract surgeries, and to suggest actions to improve the efficiency of patient care. A cross-sectional study was carried out in a university hospital's ophthalmology clinic of the state of São Paulo, Brazil. Two hundred subjects were randomly selected. The mean age was 68+/- 11.4 years old. The reasons for cancelling surgery were: unpropitious clinical condition (23.1%); tight schedule (35.9%); and patient non-attendance (41%). Most of the reasons related to social issues and the hospital's administrative aspects.35487-

Técnica modificada de postioplastia en toros cebuínos con balanopostitis ulcerativa del trópico mexicano

El objetivo del presente trabajo es mostrar los resultados de toros con postitis que se les practicó Técnica Modificada de Postioplastia como manejo quirúrgico de esta patología. Se realizó un estudio de tipo descriptivo no probabilístico en toros reproductivamente activos que presentaron postitis crónica ulcerativa. Los casos clínico-quirúrgicos se presentaron en diferentes ranchos de la zona sur de Veracruz. Los pacientes fueron 10 toros cebús de los cuales 7 eran de la raza brahmán, 1 indubrasil y 2 Sardo Negro, con buena condición corporal y con postitis crónica ulcerativa. Ninguno de los animales había recibido tratamiento quirúrgico. Se aplicó xilacina al 2 % a la dosis de 0,1 mg/kg de peso vivo como tranquilizante por vía intramuscular. Posteriormente, para la anestesia, se infiltró clorhidrato de lidocaína al 2 % a dosis de 1 ml/cm3 de tejido en la base del prepucio. Una vez tranquilizado el paciente y realizadas las maniobras de derribo, se hizo lavado y evaluación detallada de la lesión. Se realizó una incisión en el limbo mucocutáneo y no en piel para reducir las posibilidades de fimosis cicatrizal. Se ligaron los vasos de gran calibre con puntos de transfixión con material absorbible acidó poliglicólico del calibre 0. Para la hemostasia de los vasos pequeños fue suficiente el pinzamiento y torsión. La divulsión se realiza en 360° hasta conseguir el desprendimiento de todo el tejido afectado incluyendo la mucosa prepucial dañada. Una vez practicada la correcta hermostasis se procedió sujetar la mucosa con pinzas de goma para evitar la retracción, así mismo se le colocaron 4 puntos de forma cardinal con sutura de  nylon monofilico para expandir la mucosa y poder suturarla a la piel, esos mismo puntos de sujeción se fijaron con punto de cirujano y posteriormente se colocaran 4 puntos entre ellos. Los 10 toros operados con la técnica descrita tuvieron recuperación en un período de 90 días posoperatorio en promedio, dos de ellos tuvieron complicación de estenosis cicatrizal.  Se concluye que la técnica quirúrgica empleada en este estudio tuvo resultados favorables. Se considera que si el posoperatorio no se lleva correctamente trasciende seriamente en el éxito o fracaso de esta cirugía

Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer

BACKGROUND: Advances in the treatment of metastatic colorectal cancer (mCRC) in the last decade have significantly improved survival; however, simple biomarkers to predict response or toxicity have not been identified, which are applicable to all community oncology settings worldwide. The use of inflammatory markers based on differential white-cell counts, such as the neutrophil/ lymphocyte ratio (NLR), may be simple and readily available biomarkers. METHODS: Clinical information and baseline laboratory parameters were available for 349 patients, from two independent cohorts, with unresectable mCRC receiving first-line palliative chemotherapy. Associations between baseline prognostic variables, including inflammatory markers such as the NLR and tumour response, progression and survival were investigated. RESULTS: In the training cohort, combination-agent chemotherapy (P ¼ 0.001) and NLRp5 (P ¼ 0.003) were associated with improved clinical benefit. The ECOG performance status X1 (P ¼ 0.002), NLR45 (P ¼ 0.01), hypoalbuminaemia (P ¼ 0.03) and single-agent chemotherapy (Po0.0001) were associated with increased risk of progression. The ECOG performance status X1 (P ¼ 0.004) and NLR45 (P ¼ 0.002) predicted worse overall survival (OS). The NLR was confirmed to independently predict OS in the validation cohort (Po0.0001). Normalisation of the NLR after one cycle of chemotherapy in a subset of patients resulted in improved progression-free survival (P ¼ 0.012). CONCLUSION: These results have highlighted NLR as a potentially useful clinical biomarker of systemic inflammatory response in predicting clinically meaningful outcomes in two independent cohorts. Results of this study have also confirmed the importance of a chronic systemic inflammatory response influencing clinical outcomes in patients with mCRC

[use And Causes Of Discontinuation Of Eye Surgical Interventions At A University Ambulatory Surgery Center].

To study the efficiency of an ambulatory surgery center located at a university public hospital we studied the number of surgical interventions performed and suspensions and their causes. We collected data on the number of surgical interventions performed, suspension and causes of suspension from January to December of 1992 of the ambulatory surgery center of the Clinical Hospital of University of Campinas, UNICAMP, in São Paulo. A comparison of performance of the Ophthalmology Department and the other medical specialties were made. Of the 6,574 surgical interventions booked 4,938 (75.11%) were performed and 1,636 (24.88%) suspended. Of the 4,938 surgical interventions 2,514 (51%) were performed by the Ophthalmology Department and 2,423 (49%) by other 11 medical specialties. The main causes of suspension of eye operations were unfavorable clinical condition (46.38%), absence of the patient (32.71%) and administrative problems (8.44%). CONCLUSION AND SUGGESTIONS: The Ophthalmology Department has 40% of the space available at the facility and did 51% of the interventions. A better control and planning of the surgical operations may increase the number of interventions and performance of the ambulatory surgery center. It is important for the optimization of the available resources to introduce a periodic control of surgical interventions done, suspension and their causes.41233-

[practicability Of Cataract Surgery At University Hospitals: Searching For An Economic Model].

Resources available for health care all over the world are not enough to cover all the demand in this sector. Cataract Free Zones conducted in many regions of the country show that only 10% to 20% of blind patients caused by senile cataract can get operated on. To demonstrate feasibility of a model for cataract surgery with intraocular lens implantation at the Clinical Hospital from the University of Campinas, Unicamp, São Paulo, when considering the remuneration payed by the government for universitary services. Costs with disposable material were collected for extracapsular cataract surgery, with posterior intraocular lens implant, at the Clinical Hospital, Unicamp. The model includes outpatient surgery under local anesthesia, and costs rationalization in acquisition and wear of material. University Hospitals have a different situation in the health system, where fixed costs and part of the variable costs of cataract surgery are subsidized by the State government. Cataract surgery performed under the proposed methodology is economically feasible, considering disposable components only, and the price achieved was US$77 with government payment of US$ 474. More surgical interventions increases the efficiency of the institution, provides more surgical training to residents and better community health care. The authors consider that it is an obligation of University Hospitals, regard their commitment with training, research and quality of eye care deliverance, to increase the number of cataract surgeries for the lowest possible price.40186-