Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients

Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disease (PTLD) is one of the most serious complications associated with solid organ and hematopoietic stem cell transplantation. PTLD is most frequently seen with primary EBV infection post-transplant, a common scenario for pediatric solid organ recipients. Risk factors for infection or reactivation of EBV following solid organ transplant are stronger immunosuppressive therapy regimens, and being seronegative for receptor. For hematopoietic stem cell transplantation, the risk factors relate to the type of transplant, human leukocyte antigen disparity, the use of stronger immunosuppressants, T-cell depletion, and severe graft-versus-host disease. Mortality is high, and most frequent in patients who develop PTLD in the first six months post-transplant. The primary goal of this article is to provide an overview of the clinical manifestations, diagnosis, accepted therapies, and management of EBV infection in transplant recipients, and to suggest that the adoption of monitoring protocols could contribute to a reduction in related complications.

Nutrient loss in composting of agroindustrial residues

The management of composting may influence the characteristics of the produced compounds. The experiment used three frequencies of plowing, combined with the conditions: with and without coverage of the composting patio, with and without the use of commercial inoculant, resulting in 12 furrows, installed on the Experimental Center of Agricultural Engineering (NEEA), of the STATE UNIVERSITY OF WEST PARANÁ (UNIOESTE), Campus of Cascavel city - state of Paraná (PR), in Brazil. The waste and quantities used in kg were: corn cob (7.5); hatchery residue (5); floater sludge (31); ash (1); wheat cleaning residue (120); wheat pre-cleaning residue (120); corn peel (7.5); solid fraction of wash trucks used to transport chickens (2); solid fraction of pig manure (1) and coal (5), totaling 300kg of natural matter. The aim of this study was to evaluate the influence of plowings, patio coverage and inoculation in losses of N, P, K, Ca, Mg, Na, Cu, Zn, Mn, Fe. The furrows plowed three times a week in the first month showed significant higher losses of N (p<0.05). The coverage of the composting patio influenced significantly the losses of N, K, Mg and Na (p<0.05). The produced compounds had a high agronomic value in relation to macro and micronutrients. It is recommended the use of patio coverage and plowing twice a week in the first month and once a week in the subsequent months for a compound with higher concentrations of nutrients.

The use of the Family Management Style Framework to evaluate the family management of liver transplantation in adolescence

Objective: To understand the family management experience of liver transplantation during adolescence based on the Family Management Style Framework(FMSF). Method: This is a case study that used the FMSF as theoretical framework and the hybrid model of thematic analysis as methodological reference. The case presented is from an adolescent’s family that lives in Salvador, Bahia. The data were collected through interviews with the mother and the patient charts analysis. Results: The results shows that the family defines the transplantation as threatening and there are divergence between mother and daughter related to the teen’s capabilities perception. Facing those discrepancies, the family assumes a protective posture by believing that the teen cannot take care of herself alone. The perceived consequences reflect how much the uncertainty permeates the family environment. Conclusion: It is concluded that the use of a model to evaluate the management can help professionals to direct and plan specific interventions.



Chemical and physical properties of organic residues

Due to human activity, large amounts of organic residue are generated daily. Therefore, an adequate use in agricultural activities requires the characterization of the main properties. The chemical and physical characterization is important when planning the use and management of organic residue. In this study, chemical and physical properties of charcoal, coffee husk, pine-bark, cattle manure, chicken manure, coconut fiber, sewage sludge, peat, and vermiculite were determined. The following properties were analyzed: N-NH4+, N-N0(3)-, and total concentrations of N, P, S, K, Ca, Mg, Mn, Zn, Cu, and B, as well as pH, Electrical Conductivity (EC) and bulk density. Coffee husk, sewage sludge, chicken manure and cattle manure were generally richer in nutrients. The EC values of these residues were also the highest (0.08 - 40.6 dS m-1). Peat and sewage sludge had the highest bulky density. Sodium contents varied from 0 to 4.75 g kg-1, with the highest levels in chicken manure, cattle manure and sewage sludge. Great care must be taken when establishing proportions of organic residues in the production of substrates with coffee husk, cattle or chicken manure or sewage sludge in the calculation of the applied fertilizer quantity in crop fertilization programs.

Investigation of the occurrence of pesticide residues in rural wells and surface water following application to tobacco

In this work the exposure of wells and surface water to pesticides, commonly used for tobacco cropping, was assessed. Water consumption wells and surface water flows were sampled at different times. After a preconcentration step with solid phase extraction (SPE), the selected pesticides were determined by gas chromatography with electron capture detection (GC-ECD) or high performance liquid chromatography with diode array detection (HPLC-DAD). No pesticides were detected in the well water samples and surface water flow in the winter season. However, in the spring and summer higher concentrations of chlorpyrifos and imidacloprid were found in the water source samples. Atrazine, simazine and clomazone were also found. The occurrence of pesticides in collected water samples was related with the application to tobacco.

Synthesis, characterization and thermal behaviour of solid 2-methoxycinnamylidenepyruvate of some bivalent metal ions in CO2 and N2 atmospheres

Solid State M-2-MeO-CP compounds, where M stands for bivalent metals (Mn, Fe, Co, Ni, Cu and Zn) and 2-MeO-CP is 2-methoxycinnamylidenepyruvate, were synthesized. Simultaneous thermogravimetry and differential thermal analysis (TG-DTA), differential scanning calorimetry (DSC), elemental analysis and complexometry were used to establish the stoichiometry and to study the thermal behaviour of these compounds in CO2 and N2 atmospheres. The results were consistent with the general formula: M(L)2∙H2O. In both atmospheres (CO2, N2) the thermal decomposition occurs in consecutive steps which are characteristic of each compound. For CO2 atmosphere the final residues were: Mn3O4, Fe3O4, Co3O4, NiO, Cu2O and ZnO, while under N2 atmosphere the thermal decomposition is still observed at 1000 º C.

Effect of crop residues applied isolated or in combination on the germination and seedling growth of horse purslane (Trianthema portulacastrum)

Soil incorporation of crop residues can lead to weed suppression by posing allelopathic and physical effects. Allelopathic potential of the crops sorghum, sunflower, brassica applied as sole or in combination for horse purslane (Trianthema portulacastrum) suppression was evaluated in a pot investigation. Chopped crop residues alone and in combination were incorporated at 6 g kg-1 soil (12 t ha-1), and a weedy check was maintained. Germination traits time to start germination; time to 50% emergence, mean emergence time, emergence index and final germination percentage were negatively influenced by residue incorporation. Crop residues also exerted a pronounced negative influence on the shoot and root length of horse purslane. Significant suppression in leaf and root score and leaf area per plant was also observed. A combination of sorghum and sunflower residues accounted for maximum (71%) seedling mortality. Soil incorporation of allelopathic crop residues can be employed for horse purslane management.

Integrated Management of Childhood Illness: efficiency of primary health in Northeast Brazil

OBJECTIVE: The Integrated Management of Childhood Illness is a strategy designed to address major causes of child mortality. The aim of this study was to assess the impact of the strategy on the quality of child health care provided at primary facilities. METHODS: Child health quality of care and costs were compared in four states in Northeastern Brazil, in 2001. There were studied 48 health facilities considered to have had stable strategy implementation at least two years before the start of study, with 48 matched comparison facilities in the same states. A single measure of correct management of sick children was used to assess care provided to all sick children. Costs included all resources at the national, state, local and facility levels associated with child health care. RESULTS: Facilities providing strategy-based care had significantly better management of sick children at no additional cost to municipalities relative to the comparison municipalities. At strategy facilities 72% of children were correctly managed compared with 56% in comparison facilities (p=0.001). The cost per child managed correctly was US$13.20 versus US$21.05 in the strategy and comparison municipalities, respectively, after standardization for population size. CONCLUSIONS: The strategy improves the efficiency of primary facilities in Northeastern Brazil. It leads to better health outcomes at no extra cost.

A municipal level approach to the management of schistosomiasis control in Peri-Peri, MG, Brazil

A schistosomiasis control program was implemented between 1974/87 in Peri-Peri,. MG (622 inhabitants). Molluscicide (niclosamide) was applied at three monthly intervals in water sources with Biomphalaria glabrata, and individuals eliminating Schistosoma mansoni eggs in the feces were treated annually with oxamniquine. From 1974 to 1983 the control measures were undertaken by staff of the "René Rachou" Research Center FIOCRUZ (CPqRR), and from 1984 to 1987 these measures were included in the Capim Branco basic health network activities. During both periods, the prevalence, incidence, intensity of infection and hepatosplenic form as well as the number of infected snails decreased significantly. The prevalence decreased from 43.5 to 4.4%, the incidence from 19.0 to 2.9%, the overall intensity of S. mansoni from 281 to 87 and of the hepatosplenic form from 5.9 to 0.0%. The results obtained suggest that the municipal management of control measures was as effective as the vertical program conducted by CPqRR staff.

Clinical guideline for diagnosis and management of melioidosis

Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.

Challenge in the management of infective endocarditis with multiple valvular involvement

We describe the case of a 41-year-old man with congenital heart disease and infective endocarditis (IE), who presented multiple vegetations attached to the pulmonary, mitral, and aortic valves. Three valve replacements were performed, but the patient developed an abscess at the mitral-aortic intervalvular fibrosa and died due to sepsis. We briefly discuss the indications for surgery in IE, emphasizing its role in the treatment of uncontrolled infection.