Adequacy of therapeutic effort: Challenges in pediatrics

The term "therapeutic limitation" has been replaced by "adequacy of therapeutic effort" and is defined as the decision to withhold or withdraw diagnostic and therapeutic measures in response to the patient's condition, avoiding potentially inappropriate behaviors and redirectong treatment goals towards comfort and well-being. In the pediatric population, this decision is even more challenging given the nature of the physician-patient-family relationship and the paucity of guidelines to address treatment goals. The adequacy of therapeutic effort is framed by ethical and legal principles, but, in practice, there are several challenges. Each adequacy process is unique and dynamic, and should be addressed by taking into account with what measures, how, when, and in whom it should be implemented.

Descriptions of two new species of flea of the genus Plocopsylla in northwestern Argentina

Two new species of flea of the genus Plocopsylla, subgenus Plocopsylla, (Siphonaptera: Stephanocircidae) collected from sigmodontine rodents in northwestern Argentina are described and a key to identification of species of the genus Plocopsylla, subgenus Plocopsylla, in Argentina is presented. Plocopsylla (P.) inti is cited for the first time in Argentina, extending its distribution ∼ 970 km further south than previously documented. New locality data and flea-host associations are recorded. The contributions of this study are relevant because they increase knowledge of the diversity of flea fauna in northwestern Argentina bordering a plague endemic area and will be useful in the implementation of plague control management plans in the future.

Clinical cytohistologic correlations of lesions of the female genital tract: our experience in Panama

Between 1982 and 2002, applying the uterine/cervix cancer prevention protocol of the Gynecology Institute of the University of Padua [1] modified to our needs, we diagnosed 5,008 (53.8%) cases of oncogenic risk out of 9,312 evaluated patients. Values were obtained through the analysis of three diagnostic methodologies: colposcopy, cytology and directed biopsy, taking into consideration the limitations of each one of these and their effectiveness in identifying specific abnormalities or pathologies. The results fully demonstrate that the integration of the three diagnostic methodologies is necessary to decrease false-negative results.

Twenty years of contributions to the study and prevention of uterine cancer

During 20 years of preventive study of the oncogenic risk of cervix-uterine cancer in the Republic of Panama, applying the protocol of the Gynecology Institute of the University of Padua, Italy, we diagnosed 5,009 cases out of the 9,312 patients studied. We classified them according to the degree of the pathology, guiding the patients to the appropriate treatment and the respective follow-up, and concluding that those women who do not follow recommendations have five times more probability of suffering from cervix-uterine cancer. Moreover, the age groups between 20 and 40 years old with HPV infection that do not have access to these procedures are highly vulnerable.

In vitro toxicity of stimulant soft drinks

Some drinks containing natural products with stimulant properties are highly consumed among young adults. The market for these drinks has increased in past years around the globe, and, although they might be harmless, overdoses or combination of these with other drinks could be harmful to the health of some consumers in certain circumstances. Samples were obtained at food shops and different popular brands were chosen. Cytotoxicity tests used were neutral red uptake, total protein content, and tetrazolium assay on Chinese hamster ovary cells. Results revealed that tested samples were not cytotoxic; however, studies have demonstrated the toxicity of high concentrations of some of these products. For this reason, the authors considered it to be of critical importance to carryout an in vitro toxicity screening of stimulant soft drinks that are highly consumed.

Sister chromatid exchange induced by several types of coffees in Chinese hamster ovary cells

Different brands of commercial caffeinated and decaffeinated coffees (roasted, high roast, blend ground, and instant coffees) were studied. These coffees were tested for their ability to induce sister chromatid exchanges (SCE) in CHO-K1 cells. Tests were performed in the presence and in the absence of a metabolic activation system (S-9 mix). Results were compared to the roasting procedure because genotoxic products could be formed from these processes. Our results indicate that caffeinated instant coffees showed higher genotoxic activity than decaffeinated coffees. Non-significant genotoxic activity was detected with the green coffee (unroasted). The highest increase of the frequency of SCE occurred when the caffeinated instant coffee was tested in the absence of metabolic activation system. The repeatability of the test was checked through three assays with the same sample.

Randomized clinical study of the T-Cu 380A and the Lippes loop C, in Campinas, Brazil

The copper IUD model T-Cu 380A has shown the best performance when compared with other copper and inert IUDs in studies carried out in the U.S.A., but it had not been tried out in developing countries yet. T-Cu 380A and Lippes loop C were inserted at random in 328 healthy parous women, in Campinas, SP, Brasil. Forty-five percent of the T-Cu 380A insertions and 40% of the Lippes loop insertions were performed by trained midwives. No pregnancies occurred in 1419 woman-months of use of T-Cu 380A, against 5 pregnancies in 1454 woman-months of use of Lippes loop. The difference was significant at the 5% level. No other significant differences were found. The continuation rate after one year of use was 82.5 for the T-Cu 380A and 75.1 for the Lippes loop. These results suggest that the performance of the T-Cu 380A in developing countries could be similar to the one observed in the United States, provided that the users are carefully selected and that an adequate insertion technique is followed.