Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review

Malakoplakia is a rare chronic granulomatous disease of unknown cause. It is thought to be caused by an acquired bactericidal defect of macrophages. Malakoplakia is associated with chronic infections and immunosuppression. Although it occurs mainly in the urinary tract, it has already been reported in almost every organ system. The isolation of bacteria, especially Escherichia coli, is common in malakoplakia patients. Here, we present a case of primary cutaneous malakoplakia in a kidney transplant recipient who had been taking prednisone, tacrolimus, and mycophenolate. Culture of a lesion grew Burkholderia cepacia complex. Treatment with high doses of trimethoprim-sulfamethoxazole was successful. We also present a systematic review of the literature, identifying 4 previously reported cases of malakoplakia after renal transplantation under similar immunosuppressive therapy, most occurring in the urinary tract or perineum and following benign courses to cure. Data in the literature suggest that malakoplakia has become even rarer since changes were made in the immunosuppressive therapy employed after kidney transplantation.

Is Drosera meristocaulis a pygmy sundew? Evidence of a long-distance dispersal between Western Australia and northern South America

South America and Oceania possess numerous floristic similarities, often confirmed by morphological and molecular data. The carnivorous Drosera meristocaulis (Droseraceae), endemic to the Neblina highlands of northern South America, was known to share morphological characters with the pygmy sundews of Drosera sect. Bryastrum, which are endemic to Australia and New Zealand. The inclusion of D. meristocaulis in a molecular phylogenetic analysis may clarify its systematic position and offer an opportunity to investigate character evolution in Droseraceae and phylogeographic patterns between South America and Oceania. was included in a molecular phylogenetic analysis of Droseraceae, using nuclear internal transcribed spacer (ITS) and plastid rbcL and rps16 sequence data. Pollen of D. meristocaulis was studied using light microscopy and scanning electron microscopy techniques, and the karyotype was inferred from root tip meristem. The phylogenetic inferences (maximum parsimony, maximum likelihood and Bayesian approaches) substantiate with high statistical support the inclusion of sect. Meristocaulis and its single species, D. meristocaulis, within the Australian Drosera clade, sister to a group comprising species of sect. Bryastrum. A chromosome number of 2n approx. 3236 supports the phylogenetic position within the Australian clade. The undivided styles, conspicuous large setuous stipules, a cryptocotylar (hypogaeous) germination pattern and pollen tetrads with aperture of intermediate type 78 are key morphological traits shared between D. meristocaulis and pygmy sundews of sect. Bryastrum from Australia and New Zealand. The multidisciplinary approach adopted in this study (using morphological, palynological, cytotaxonomic and molecular phylogenetic data) enabled us to elucidate the relationships of the thus far unplaced taxon D. meristocaulis. Long-distance dispersal between southwestern Oceania and northern South America is the most likely scenario to explain the phylogeographic pattern revealed.

Review of the Genus Cathorops (Siluriformes: Ariidae) from the Caribbean and Atlantic South America, with Description of a New Species

The New World genus Cathorops in the family Ariidae (Sea Catfishes) includes species that inhabit estuarine and coastal waters as well as freshwaters, playing an important role in Neotropical coastal and estuarine fisheries. The relatively conserved external morphology coupled with the marked sexual dimorphism and ontogenetic variation makes it difficult to recognize and diagnose the species. One of the major problems concerns the nomenclatural and geographical limits, of C. spixii, described from tropical Brazil and often treated as the only coastal marine species in the genus from the Western Atlantic. Examination of types of nominal species as well as comprehensive collections of non-types from Caribbean and Atlantic South America, lead us to conclude that C. spixii is restricted to Brazil and that C. nuchalis is a valid species, ranging from Venezuela to Guyana. The nominal species Arius laticeps, Arius nigricans, and Arius variolosus are synonyms of C. nuchalis, C. spixii, and C. arenatus, respectively. We also describe a new species in the Cathorops mapale species group from Colombia and Venezuela.

Cyclopropane- and spirolimonoids and related compounds from Hortia oreadica

The dichloromethane extract from taproots of Hortia oreadica afforded six limonoids, these are 9,11-dehydro-12 alpha-acetoxyhortiolide A, hortiolide C, 11 alpha-acetoxy-15-deoxy-6-hydroxyhortiolide C, hortiolide D, hortiolide E, 12 beta-hydroxyhortiolide E, in addition to the known limonoid, guyanin. The dichloromethane extract from stems of H. oreadica also afforded two limonoids 9,11-dehydro12 alpha-hydroxyhortiolide A and 6-hydroxyhortiolide C. As a result of this study and literature data, Hortia has been shown to produce highly specialized limonoids that are similar to those from the Flindersia (Flindersioideae). The taxonomy of Hortia has been debatable, with most authors placing it in the Toddalioideae. Considering the complexity of the isolated limonoids, Hortia does not show any close affinity to the genera of Toddalioideae. That is, the limonoids appear to be of little value in resolving the taxonomic situation of Hortia. (C) 2012 Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

A Simple Method to Evaluate, Correlate and Predict Boiling and Flash Points of Alkynes

Boiling points (T-B) of acyclic alkynes are predicted from their boiling point numbers (Y-BP) with the relationship T-B(K) = -16.802Y(BP)(2/3) + 337.377Y(BP)(1/3) - 437.883. In turn, Y-BP values are calculated from structure using the equation Y-BP = 1.726 + A(i) + 2.779C + 1.716M(3) + 1.564M + 4.204E(3) + 3.905E + 5.007P - 0.329D + 0.241G + 0.479V + 0.967T + 0.574S. Here A(i) depends on the substitution pattern of the alkyne and the remainder of the equation is the same as that reported earlier for alkanes. For a data set consisting of 76 acyclic alkynes, the correlation of predicted and literature T-B values had an average absolute deviation of 1.46 K, and the R-2 of the correlation was 0.999. In addition, the calculated Y-BP values can be used to predict the flash points of alkynes.

The Global Paleomonsoon as seen through speleothem records from Asia and the Americas

The regional monsoons of the world have long been viewed as seasonal atmospheric circulation reversal-analogous to a thermally-driven land-sea breeze on a continental scale. This conventional view of monsoons is now being integrated at a global scale and accordingly, a new paradigm has emerged which considers regional monsoons to be manifestations of global-scale seasonal changes in response to overturning of atmospheric circulation in the tropics and subtropics, and henceforth, interactive components of a singular Global Monsoon (GM) system. The paleoclimate community, however, tends to view 'paleomonsoon' (PM), largely in terms of regional circulation phenomena. In the past decade, many high-quality speleothem oxygen isotope (delta O-18) records have been established from the Asian Monsoon and the South American Monsoon regions that primarily reflect changes in the integrated intensities of monsoons on orbital-to-decadal timescales. With the emergence of these high-resolution and absolute-dated records from both sides of the Equator, it is now possible to test a concept of the 'Global-Paleo-Monsoon' (GPM) on a wide-range of timescales. Here we present a comprehensive synthesis of globally-distributed speleothem delta O-18 records and highlight three aspects of the GPM that are comparable to the modern GM: (1) the GPM intensity swings on different timescales; (2) their global extent; and (3) an anti-phased inter-hemispheric relationship between the Asian and South American monsoon systems on a wide range of timescales.

A simple method to evaluate, correlate and predict boiling and flash points of alkynes

Boiling points (T B) of acyclic alkynes are predicted from their boiling point numbers (Y BP) with the relationship T B(K) = -16.802Y BP2/3 + 337.377Y BP1/3 - 437.883. In turn, Y BP values are calculated from structure using the equation Y BP = 1.726 + Ai + 2.779C + 1.716M3 + 1.564M + 4.204E3 + 3.905E + 5.007P - 0.329D + 0.241G + 0.479V + 0.967T + 0.574S. Here Ai depends on the substitution pattern of the alkyne and the remainder of the equation is the same as that reported earlier for alkanes. For a data set consisting of 76 acyclic alkynes, the correlation of predicted and literature T B values had an average absolute deviation of 1.46 K, and the R² of the correlation was 0.999. In addition, the calculated Y BP values can be used to predict the flash points of alkynes.

Extra and intradural spinal Hemangioblastoma

Hemangioblastomas of the central nervous system (CNS) are low-grade highly vascularized tumors that may be sporadic or associated with Von Hippel-Lindau disease. Extradural hemangioblastomas are uncommon and those located extra and intradurally are even rarer. This study uses an illustrative case and literature review to discuss the difficulties to consider the correct diagnosis and to select the best surgical approach. A 57 years-old white male patient presented with myelopathy and right C5 radiculopathy. The images showed a lobulated, hourglass shaped, highly enhanced extra/intradural lesion that occupied the spinal canal and widened the C4-C5 right intervertebral foramen. Total resection of the intradural lesion was achieved through a posterior approach, but the extradural part could only be partially removed. Complete improvement was observed after four months of follow-up and the residual tumor has been followed up clinically and radiologically. Even though the preoperative impression was of a spinal schwannoma, the histopathological examination revealed grade I hemangioblastoma as per WHO. Despite their rarity, current complementary exams allow considering the diagnosis of hemangioblastoma preoperatively. That is essential to a better surgical planning in view of the particular surgical features of this lesion.

On the morphological differentiation between Libinia spinosa and L. ferreirae (Crustacea: Brachyura: Majoidea: Epialtidae)

Libinia spinosa H. Milne Edwards in Guérin, 1832 and L. ferreirae Brito Capello, 1871, inhabit very similar environments, and their geographic and bathymetric distributions overlap for about 3000 km along the southwestern Atlantic. Both species are commonly caught in the same haul and differentiating between them can often be difficult. Traditionally, morphological differentiation between L. spinosa and L. ferreirae has been based exclusively on the number of spines along the median, longitudinal line of the carapace and the development of a process at the anterolateral angle of the basal segment of the antenna. Because Libinia spinosa and L. ferreirae share similar numbers of median spines (7 and 6, respectively), and the number of median spines of the carapace and the process at the anterolateral angle of the basal antennal segment are variable, they are of little value in separating these species. It is shown herein that unequivocal identification can be easily achieved based on features of the male and female thoracic sternum, pereiopod dactyli, and infraorbital notch. A lectotype is designated for L. spinosa and its authorship and date are corrected. Libinia gibbosa A. Milne-Edwards, 1878, is demonstrated to be a junior synonym of L. ferreirae. The holotype of L. gibbosa is figured for the first time.