Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)

Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.

O olhar como experiência: a pintura

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The Power of Tragedy: An Eighteenth-Century Debate on Theater and its Relevance to Literature Pedagogy Today

This article brings to light a debate on tragic fiction in eighteenth-century France, and more specifically, on whether or not tragedy has the power to transform individuals intellectually and emotionally. Through analysis of abbé Dubos’s Reflexions critiques sur la poésie et sur la peinture and Jean-Jacques Rousseau’s Lettre à d’Alembert sur les spectacles, I contend that Dubos’s overwhelmingly positive conception of fiction—and especially his contention that we learn through the emotions when we engage with tragic fiction—can serve as an admirable pedagogical model for today’s fiction-focused foreign language classrooms.

Principes de grammaire hébrai͏̈que et chaldai͏̈que

par J.B. Glaire

Vista del arco de triunfo y de la ciudad de Cabanes [Material gráfico] =Vue de l'arc de triomphe et de la ville de Cabanes=View of the triumphal Arch and the city of Cabanes

Estampado en la misma hoja con: "Detalles geometrales del Arco de Cabanes"

Joannis-Emmanuel Gilibert, olim in Collegio ... Exercitia phytologica quibus omnes plantae europaeae [sic], quas vivas invenit in variis herbationibus, seu in Lithuania, Gallia ... : [Texto impreso] volumen primum : plantae lithuanicae cum lugdunensibus comparatae

Tit. en antep.: "Supplementum systematis plantarum Europae"

Joannis-Emmanuel Gilibert, olim in Collegio ... Exercitia phytologica quibus omnes plantae europeae, quas vivas invenit in variis herbationibus, seu in Lithuania, Gallia ... : [Texto impreso] volumen secundum : caeterae plantae lithuanicae cum lugdunensibus comparatae

Tit. en antep.: "Supplementum systematis plantarum Europae"

Vista general del Teatro de Sagunto [Material gráfico] = Vue generale du Theatre de Sagonte = General view of the Theatre of Sagonta

Resumen: Descripción: vista general del Teatro de Sagunto desde el exterior, se observan las gradas

Vista de la puerta de entrada de la fortaleza de Xativa [ [Material gráfico]= Vue de la porte d'entrèe de la forteresse de Xativa, et d'une partie de la ville de St. Philippe = View of the great gate of the fortress of Xativa, and of a part of the town of St. Philip

Datos de publicación tomados de la obra a la que pertenece

Charlotte Corday and certain men of the revolutionary torment,

Mode of access: Internet.

Catalogue des livres de la bibliothèque de feu M. Millin ... dont la vent se fera le lundi 24 mai 1819, et jours suivans, à six heures très-précises de relevée ...

Mode of access: Internet.

Relation des funérailles de l'amiral de Villars, faites à Rouen le 5 septembre 1595,

Edition of 89 copies.

Grotte, labyrinthe, fontaines et bassins de Versailles.

This volume has been designated "sixième volume" in the Catalogue, for a collection known under the title of the repository, Cabinet du roi. The engravings were prepared between 1672 and 1689 by various engravers: Le Pautre, Le Clerc, Chauveau, Edelinck, Picart, Baudet, Silvestre, Simonneau and Chatillon. They were issued individually at the outset, collected, and in this instance issued in uniform format. The plates of the Labyrinthe, 15 x 8.5 cm., have been printed on 4 leaves of 9 and 1 leaf of 5.