Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Desempenho de fungicidas no controle da mancha-de-macrospora na cultura do milho

Fungicide application is one of the control strategies of fungal diseases in corn leaves. In Brazil, there are no fungicides recorded for the control of corn macrospora leaf spot (MLS). The aim of this study was to assess the efficacy of 16 fungicides on MLS control in a protective, curative and eradicant form. Fungicides of the chemical groups of benzimidazoles, strobilurins and triazoles were used alone or in mixture, in completely randomized block design, with six replicates of five plants, totaling 30 plants per treatment. The experiments were carried out in a greenhouse with the single-cross hybrid AS 1565 in phenological stage of two to six expanded leaves, using an isolate of S. macrospsora from the same hybrid. The inoculum was deposited into the cartridge of plants at 48 hours after, 48 hours before and 10 days before fungicide applications for preventive, curative and eradicant action, respectively. The experiment was repeated twice. The data underwent analysis of variance (p<0.05), and the means of treatments were compared by using the Scott-Knott test (p<0.05). Severity was estimated at 21 days after inoculations. All fungicides significantly differed from the control treatment in the preventive, curative and eradicant action. For the preventive action, mean disease control was 85%. The mixture of triazoles plus strobilurins controlled, on average, 75% of the disease severity, while the isolated products such as strobilurins reduced it by 62%, benzimidazoles by 55% and triazoles by 38% for the curative action. The lowest control was obtained for the eradicant action, with mean reduction of 40.1% in the disease severity and no significant difference among fungicides.

Análises técnicas e econômicas no sistema de integração lavoura-pecuária submetido à adubação nitrogenada

Sustainable agriculture, reduced production costs and adding value to the system are achieved through the use of agricultural areas throughout the year, in integrated or mixed system. The study aimed to determine the technical coefficients to estimate and evaluate the operational cost and profitability indicators of the consortium of corn with two species of Brachiaria (B. brizantha, MG-5 and B. ruziziensis). The crops were submitted to N rates (0, 100, 200, 300 e 400kg ha-1year-1) at sidedressing, using urea, and winter common bean in succession, in crop-livestock integration under no-tillage, in irrigated conditions, in 2008/2009 agricultural year in Cerrado region (Selvíria - MS). The experiment was conducted in a randomized complete block design with four replications in a 2 x 5factorial. It was concluded thatcathe inputs were the components that most increased the producing cost of corn and common bean in the ILP study. The total operational cost has increased as a function of increasing doses of N. In all treatments the levels of profitability were positive indicating the viability of the system. The treatment that showed the best technical and economic performance was intercropped with corn and B. brizantha, fertilized with 100kg ha-1year-1N and common bean in succession.

Optimal low-cost transfer to L4 and L5 lagrangian points based on G-family of periodic orbits

An alternative transfer strategy to send spacecrafts to stable orbits around the Lagrangian equilibrium points L4 and L5 based in trajectories derived from the periodic orbits around LI is presented in this work. The trajectories derived, called Trajectories G, are described and studied in terms of the initial generation requirements and their energy variations relative to the Earth through the passage by the lunar sphere of influence. Missions for insertion of spacecrafts in elliptic orbits around L4 and L5 are analysed considering the Restricted Three-Body Problem Earth- Moon-particle and the results are discussed starting from the thrust, time of flight and energy variation relative to the Earth. Copyright© (2012) by the International Astronautical Federation.

Estudo da mcrobiota fúngica gastrintestinal de morcegos (Mammalia, Chiroptera) da região noroeste do estado de São Paulo: Potencial zoonótico

Bats are hosts of a rich diversity of microorganisms. Many studies indicate a close link between bats and fungi with pathogenic potential, especially for living in environments such as caves, caverns and hollow trees, favorable to the maintenance and spread of fungi. The objective was to study the gastrointestinal mycoflora of bats. Of the 98 samples belonging to 11 species of bats coming from 15 studied cities, 20% of the species were Carollia perspicillata, 19% Artibeus lituratus, 17% Molossus rufus, 13% Glossophaga soricina, 9% Nyctinomops macrotis, 8% Molossus molossus, 7% Desmodus rotundus, 2% Lasiurus ega and 1% Eptesicus furinalis, Myotis nigricans and Tadarida brasiliensis. The genus Aspergillus sp. was isolated from 29% of the samples, followed by 6% Microsporum sp. and Penicillium sp. 4% Trichophyton sp. and zygomycetes and 2% Fusarium sp. Of yeast species, 14% were from Rhodotorula sp., 10% Candida sp. and 2% Cryptococcus sp., 22% of isolates remained unidentified. All 82 cultures of organs were negative for Histoplasma capsulatum. There was a statistically significant association between the results of microbiological culture and bat species (p < 0.05). We conclude that the bats can act as disperser agents of fungi with pathogenic potential, although other studies should be performed to establish strategies to identify the main factors correlated with the growth and spread of microorganisms in nature and implication of bats in the epidemiological cycle.

A Pilot Study Addressing the Impact of Religious Practice on Quality of Life of Breast Cancer Patients During Chemotherapy

The aim of this preliminary study was to investigate whether religious practice can modify quality of life (QoL) in BC patients during chemotherapy. QoL and religion practice questionnaire (RPQ) scores were evaluated in a sample of BC patients in different moments. Before chemotherapy initiation, women with lower physical and social functional scores displayed higher RPQ scores. On the other hand, low RPQ patients worsened some QoL scores over time. Body image acceptance was positively correlated with religious practice and specifically praying activity. This preliminary study suggests the importance of religion in coping with cancer chemotherapy. © 2011 Springer Science+Business Media, LLC.

Lack of reliability of nanotechnology in the of free plasma DNA in samples of patients with prostate cancer

Background: Several studies seek biological markers that give diagnostic and degree of tumor development. The aim of this study was to validate the determination of plasma DNA using nanotechnology (Nanovue™-NV) in samples of 80 patients with prostate cancer. Methods. Blood samples of 80 patients of the Urology Ambulatory of Faculdade de Medicina do ABC with prostate cancer confirmed by anatomical-pathology criteria were analyzed. DNA extraction was performed using a GFX TM kit (Amersham Pharmacia Biotech, Inc, USA) following the adapted protocol. Plasma was subjected to centrifugation. Results: There was a big difference between the first and the second value obtained by NanoVue Only two samples had no differences between duplicates. Maximum difference between duplicates was 38 μg/mL. Average variation between 51 samples was 10.29 μg/mL, although 21 samples had differences above this average. No correlation was observed between pDNA obtained by traditional spectrophotometry and by nanotechnology. Conclusion: Determination of plasma DNA by nanotechnology was not reproducible. © 2013 Moreno et al; licensee BioMed Central Ltd.

Structural and Phylogenetic Studies with MjTX-I Reveal a Multi-Oligomeric Toxin - a Novel Feature in Lys49-PLA2s Protein Class

The mortality caused by snakebites is more damaging than many tropical diseases, such as dengue haemorrhagic fever, cholera, leishmaniasis, schistosomiasis and Chagas disease. For this reason, snakebite envenoming adversely affects health services of tropical and subtropical countries and is recognized as a neglected disease by the World Health Organization. One of the main components of snake venoms is the Lys49-phospholipases A2, which is catalytically inactive but possesses other toxic and pharmacological activities. Preliminary studies with MjTX-I from Bothrops moojeni snake venom revealed intriguing new structural and functional characteristics compared to other bothropic Lys49-PLA2s. We present in this article a comprehensive study with MjTX-I using several techniques, including crystallography, small angle X-ray scattering, analytical size-exclusion chromatography, dynamic light scattering, myographic studies, bioinformatics and molecular phylogenetic analyses.Based in all these experiments we demonstrated that MjTX-I is probably a unique Lys49-PLA2, which may adopt different oligomeric forms depending on the physical-chemical environment. Furthermore, we showed that its myotoxic activity is dramatically low compared to other Lys49-PLA2s, probably due to the novel oligomeric conformations and important mutations in the C-terminal region of the protein. The phylogenetic analysis also showed that this toxin is clearly distinct from other bothropic Lys49-PLA2s, in conformity with the peculiar oligomeric characteristics of MjTX-I and possible emergence of new functionalities inresponse to environmental changes and adaptation to new preys. © 2013 Salvador et al.

Incomplete mandibular fracture after lateralization of the inferior alveolar nerve for implant placement

PURPOSE: The present case describes an inferior alveolar nerve lateralization for implant placement that caused mandible fracture a few days after surgery. CLINICAL REPORT: In this case, a 56-year-old female patient who had a severely atrophied jaw and showing bone height less than 7 mm from the bone crest and the mandibular canal was submitted to surgery lateralization of the inferior alveolar conducted with piezzo. Even with all postoperative care, the patient suffered an incomplete fracture of the mandible a few days after lateralization of the inferior alveolar nerve for implant placement. The patient was treated with soft diet and medications for pain and antibiotics, besides removing the implant associated with the fracture. CONCLUSION: It is suggested that this procedure may be conducted in 2 operative periods: firstly, the lateralization of the inferior alveolar; and secondly, after a period of 3 months, the implant placement in a situation of more bone stability. Copyright © 2013 by Mutaz B. Habal, MD.

Anatomia radicial de Mormodes sinuata Rchb. f. & Warm.; (Catasetinae, Cymbidieae: Orchidaceae)

Since there is a lack of information on the root organization of the sub-tribe Catasetinae, current research describes the anatomy of Mormodes sinuata roots and indicate adaptations related to water provision and other taxonomical traits. Five roots of three plants, cut at the median region with a blade, were fixed and preserved in alcohol 5%. Cuts were stained by saffron blue 0.05% and mounted in glycerin. Although the roots have structural characteristics adapted to epiphytism, some anatomic characteristics demonstrate that the species requires more watering or wetter environments when compared with other types of Catasetinae. Root anatomic characteristics foreground results by authors who include the sub-tribe Catasetinae within the tribe Cymbidieae. Further, anatomic characteristics have a generic uniformity and are a tool for the genus's systematics.

Evolução de pacientes com AIDS pós cART: Evolução clínica e laboratorial de pacientes com AIDS após 48 semanas de tratamento antirretroviral

Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.

Teores de iodo em dietas secas e úmidas para gatos adultos comercializadas na cidade do Rio de Janeiro, Brasil

Were analyzed 29 samples, 16 wet and 13 dry cat food of different flavors. The iodine levels ranged from 2.7 to 3.4 (average 2.95 mg/kg/MS) in dry food and 2.9 to 4.0 (average 3.4 mg/kg/MS) in the wet food. Eight samples (27.6%) specified on the package the assurance level (maximum) of iodine, with a dry (2.0 mg/kg/diet) and seven wet (0.04 mg/kg/diet). All non-compliant, because the values were higher than declared. Cats fed commercial diets consume proportionally more iodine in wet food than cats fed dry diets, but both with high levels of iodine. All samples analyzed were above the amounts stated on the labels. Accordingly, the wet and dry commercial food for cats show no reliable values with those reported, resulting in a possible excessive intake of this trace element for animals in question.

Características agronômicas do feijão caupi inoculado em função de lâminas de irrigação e de níveis de nitrogênio

The aim of this study was to evaluate the effect of different irrigation depths and nitrogen levels on the agronomic characteristics of inoculated cowpea. The experiment was arranged in splitplots, with the levels of nitrogen in the plots and the depth of irrigation in the splitplots, in a randomized block design, with two repetitions. The irrigation depth corresponded to 578 mm (L1), 512 mm (L2), 429 mm (L3), 299 mm (L4) and 240 mm (L5), and the nitrogen levels of 0, 30, 60 and 90 kg ha-1 of N. The nitrogen levels showed significant effect on the yield components of cowpea. The irrigation depth showed significant effects on productivity of bean cowpea, with the depth of 426.21 mm estimated for obtaining the maximum productivity of 2820.03 kg ha-1.

Quality of performance of the operation of sugarcane mechanized planting in day and night shifts

The sugarcane mechanized planting is becoming increasingly widespread in Brazil due to a higher operability and better working conditions offered to workers compared to other types of planting. Studies related to this topic are insufficient or scarce in Brazil. In this context, the aim of this study was to evaluate the operation quality of sugarcane mechanized planting in two operation shifts, by means of statistical process control. The mechanized planting was held on March 2012 and statistical design was completely randomized with two treatments, totaling 40 replications for the day shift and 40 replications for the night shift. The variables evaluated were: speed, engine rotation, engine oil pressure, water temperature of the engine, effective field capacity and the time consumption hourly and effective fuel. The use of statistical control charts showed that random intrinsic do not cause this process. The tractor alignment error showed outliers in the day and night shifts operations, indicating a possible delay in receiving the signal. The water temperature of the engine and the effective fuel consumption showed lower variability in nighttime operation with average values of 81°C and 22.66 L ha-1, respectively. The hourly fuel consumption had greater variability and consequently lower quality during the night of the operation, with an average consumption of 25.46 L h-1 while the day shift showed 26.86 L h-1.

Horizontal ridge augmentation of the atrophic anterior maxilla using rhBMP-2/ACS or autogenous bone grafts: A proof-of-concept randomized clinical trial

Aim To compare the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge carrier (ACS) with autogenous bone graft for augmentation of the edentulous atrophic anterior maxilla. Methods Twenty-four subjects were enrolled in a randomized, controlled, parallel-group, open-label clinical trial. Subjects either received rhBMP-2/ACS (1.5 mg/ml) or particulated autogenous bone harvested from the mandibular retromolar region. A titanium-mesh was used to provide space and wound stability. A guide was used to standardize clinical recordings using an analogue caliper. Alveolar ridge width was also assessed using cone-beam computed tomography. Results rhBMP-2/ACS yielded significantly greater radiographic horizontal bone gain compared with autogenous bone graft at immediate subcrestal levels (1.5 ± 0.7 versus 0.5 ± 0.9 mm; p = 0.01); non-significant differences were observed at mid- (2.9 ± 0.8 versus 2.9 ± 0.9 mm; p = 0.98) and apical (1.7 ± 0.9 versus 1.8 ± 1.1 mm; p = 0.85) crestal levels. No significant differences in clinical horizontal bone gain were observed at 6 months between rhBMP-2/ACS and autogenous bone graft (3.2 ± 0.9 mm versus 3.7 ± 1.4 mm; p = 0.31). Sixty-two implants were placed after 6 month of healing with no significant differences between groups for number of implants, implant size, primary stability and survival. Conclusions rhBMP-2/ACS appears a realistic alternative for augmentation of the edentulous atrophic anterior maxilla. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.