Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018). Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006). Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019). Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024). Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013). When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015), whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054). Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

Measuring social impact: A guideline to implement a tableau de bord

Many impact-seeking organisations cannot measure and demonstrate their social impact because they either lack technical expertise or requisite financial and human resources. This report clarifies the process of social impact measurement to help these organisations engage in social impact measurement practices. It presents a simple guideline to create a measurement approach based on the Tableau de Board. The guideline has been developed through a theoretical revision of best practices in social impact measurement, academic research and the author's individual thoughts and ideas. While a first testing of the approach revealed positive feedback, only future broad-scale testing will demonstrate the approach’s validity and feasibility.

Assessing performance drivers in cross-border M&A

This research is an investigation on the deal-specific factors impacting long-term performance of cross-border M&A and on the nature of such relations. The analysis is conducted on a sample of 187 cross-border deals completed within the pharmaceutical and biotech industries by Western European bidders between 2000 and 2009. Findings suggest that post-deal variation in gross profit improves when bidders diversify in other businesses, when assets are purchased instead of equity, and when stock is used as deal currency. Furthermore, the method of payment is found to moderate the effects geographical distance has on deal outcomes.

Streptococcal acute pharyngitis

Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci) is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.

Triatominae (Hemiptera, Reduviidae) in the Pantanal region: association with Trypanosoma cruzi, different habitats and vertebrate hosts

ABSTRACTINTRODUCTION: The transmission cycle of Trypanosoma cruzi in the Brazilian Pantanal region has been studied during the last decade. Although considerable knowledge is available regarding the mammalian hosts infected by T. cruzi in this wetland, no studies have investigated its vectors in this region. This study aimed to investigate the presence of sylvatic triatomine species in different habitats of the Brazilian Pantanal region and to correlate their presence with the occurrences of vertebrate hosts and T. cruzi infection.METHODS: The fieldwork involved passive search by using light traps and Noireau traps and active search by visual inspection. The light traps were placed at five selected points along forested areas for seven nights during each of the nine excursions. At each point where a light trap was set, eight Noireau traps were placed in palm trees and bromeliads.RESULTS: In all, 88 triatomine bugs were collected: two and one individuals from light traps and Noireau traps, respectively; three from peridomestic areas; 23 in coati nests; and 59 in thornbird nests. In this study, active search in microhabitats showed higher efficiency than passive search, since 95% of the triatomine bugs were caught in nests. Further, triatomine bugs were only found to be infected by T. cruzi in coati nests.CONCLUSIONS: Coati nests might act as a point of convergence and dispersion for triatomine bugs and mammal hosts infected by T. cruzi, thereby playing an important role in the sylvatic cycle of T. cruziin the Pantanal region.

Frequency of histopathological changes in Howler monkeys ( Alouatta sp.) naturally infected with yellow fever virus in Brazil

Abstract: INTRODUCTION: Due to the importance that Howler monkeys have on the yellow fever (YF) epidemiological sylvatic cycle in Brazil, more accurate morphological diagnostic criteria needs to be established, especially considering the differences that may exist between the genera of Brazilian non-human primates (NHPs) involved in yellow fever virus (YFV) epizootics. METHODS: Records of YF epizootics in NHPs in Brazil between 2007 and 2009 were obtained from the Brazilian Ministry of Health database to select YF positive (n=98) Howler monkeys (Alouatta sp.) for this study. The changes described in the histopathological reports were categorized by organ and their frequencies calculated. RESULTS: The most frequent lesions observed in the animals with YF were hepatocyte apoptosis (Councilman body formation), midzonal hepatocyte necrosis, steatosis, liver hemorrhage, inflammatory mononuclear cell infiltration of the liver, renal acute tubular necrosis and interstitial nephritis. Midzonal hepatocyte necrosis, steatosis and hemorrhage presented positive correlations with apoptosis of hepatocytes, suggesting strong YFV pathogenic effect association; they were also the main histopathological changes in the Alouatta sp. A pronounced negative correlation between apoptosis of hepatocytes and hepatic mononuclear cell infiltration pointed to significant histopathological differences between YFV infection in Howler monkeys and humans. CONCLUSIONS: The results warn that NHPs may exhibit different response patterns following YFV infection and require a more careful diagnosis. Presumptive diagnosis based on primate histopathological lesions may contribute to public health service control.

Prognostic factors influencing morbidity and mortality in esophageal carcinoma

PURPOSE: In 1980, operative mortality for esophageal resection was 29%. Over the last 15 years, technical and critical care improvements contributed to the reduction of postoperative mortality rate to 8%. The aim of this study is to analyze retrospectively the role of different factors (surgical procedure, stage of the disease, and anesthetic risk) on the postoperative mortality of 63 patients that underwent esophagectomy with gastric interposition for cancer. METHODS: Seventy-two patients underwent esophagectomy. The stomach was the esophageal substitute in 63 cases. Surgical procedures included transthoracic esophagectomy in 49 patients and transhiatal esophagectomy in 14 cases. Among the 49 transthoracic esophagectomy patients, there were 18 patients with a high anesthetic risk (ASA III). Among the patients that underwent transhiatal esophagectomy, there were 10 patients with a high anesthetic risk (ASA III). RESULTS: The operative mortality rate was 14% (2/14) in transhiatal esophagectomy group and 22% (11/49) in transthoracic esophagectomy group (P = ns). The postoperative mortality of patients with a high anesthetic risk (ASA III) was 47% (8/17) after transthoracic esophagectomy and 10% (1/10) after transhiatal esophagectomy (P <0.05). DISCUSSION: In our experience, the operative mortality was nearly 18% (16.6% after transhiatal esophagectomy and 20.8% after transthoracic esophagectomy). Among the patients with a high anesthetic risk (ASA III) that underwent surgery, the postoperative mortality was significantly lower after transhiatal esophagectomy (10%) compared to transthoracic esophagectomy (47%) (P <0.05).

Notas sobre Ugni Turcz. (Myrtaceae) na Amazônia Brasileira

O objetivo deste trabalho é registrar a ocorrência de Ugni Turcz., um gênero raro e mal conhecido na Amazônia Brasileira. Ugni é composto por quatro espécies, sendo que apenas Ugni myricoides (Kunth) O. Berg ocorre no Brasil, habitando principalmente regiões de altitude nos Estados de Roraima e Amazonas (Serra da Neblina), sendo conhecido nos Herbários regionais somente de uma coleta. Ugni têm sido considerado por muitos botânicos como sinônimo de Myrtus Linnaeus, devido ambos apresentarem caracteres morfológicos muito semelhantes entre si. Porém, Ugni é caracterizado por apresentar hábito arbóreo ou arbustivo, folhas pequenas, freqüentemente com 2 cm de comprimento ou menos, coriáceas, margens revolutas, venação secundária inconspícua, inflorescências unifloras, corola (4) 5-mera, pétalas brancas, com mancha avermelhada no centro, estames 25-30, anteras sagitadas, ovário (2-) 3-locular, 4-23 óvulos por lóculo, sementes 15-20 e embrião em forma de C.

Sinopse das espécies de Marlierea Cambess. (Myrtaceae) na Amazônia brasileira

O estudo de Marlierea Cambess. na Amazônia Brasileira tem como principal objetivo atualizar os dados sobre a morfologia e taxonomia das espécies da região, bem como fornecer subsídios para esclarecer a separação de Marlierea de Myrcia DC. ex Guill., conforme sugerem alguns autores. Na Amazônia Brasileira, Marlierea está representada por 11 espécies (Marlierea bipennis (O. Berg) McVaugh, M. caudata McVaugh, M. ensiformis McVaugh, M. ferruginea (Poir.) McVaugh, M. mcvaughii B. Holst, M. scytophylla Diels, M. spruceana O. Berg, M. subulata McVaugh, M. summa McVaugh, M. umbraticola (Kunth) O. Berg e M. velutina McVaugh) e uma mal conhecida (M. obumbrans (O. Berg) Nied.), habitando principalmente áreas de formações florestais. O gênero se caracteriza pelo hábito arbóreo ou arbustivo; folhas opostas (exceto em M. velutina que pode apresentar folhas opostas e/ou alternas); as inflorescências em panículas (de fascículos), racemos, cimeiras ou dicásios; botões florais geralmente fechados, abertura irregular do cálice, em 4-5 lobos, pétalas freqüentemente ausentes. Os Estados do Amazonas e Pará representam os dois principais centros de distribuição dessas espécies, sendo M. spruceana e M. umbraticola as espécies mais comuns. Marlierea obumbrans será melhor estudada posteriormente, devido apresentar sua delimitação taxonômica confusa entre Myrcia e Marlierea.

Caracteristicas anatômicas da casca e produção de látex em plantas de seringueira não enxertadas

As estruturas envolvidas na produção de látex na seringueira são os laticíferos articulados. O objetivo deste estudo foi descrever aspectos anatômicos da casca em seringueiras não enxertadas com quatro, seis e oito anos, visando à seleção de materiais promissores. O material analisado foi obtido através do corte da casca à altura aproximada de 1,50 m do solo, chegando até o xilema da planta. Os cortes transversais foram preparados de acordo com as técnicas usuais de microtécnica vegetal. Os resultados permitem concluir, que a utilização de caracteres anatômicos (diâmetro das células), da espessura da casca e do diâmetro do caule, visando à seleção dos materiais de pés-francos com idades diferentes, apresentaram uma correlação significativa com a produção de látex.

PTX3-based genetic testing for risk of aspergillosis after lung transplant

PTX3-based genetic testing for risk of aspergillosis after lung transplant

Mineralogia e reserva de K de Cambissolos submetidos a diferentes manejos após derrubada e queima da floresta na Amazônia Meridional

As altas temperaturas ocorrentes durante a queima na floresta Amazônica podem induzir transformações mineralógicas da fração argila. Este trabalho objetivou avaliar as alterações mineralógicas nas frações areia, silte e argila e na reserva mineral de solos submetidos a diferentes manejos (11 anos de mata secundária, pastagem e café) após a derrubada e queima de floresta nativa situada na Amazônia Meridional, município de Cacoal (RO). Uma área de floresta nativa ombrófila densa, com mesma feição pedológica, foi dividida em quatro partes, sendo três áreas submetidas ao corte e à queima e posteriormente cultivadas. Em cada manejo, os perfis de solos foram descritos e amostras dos horizontes A, AB, B1, 2B2 e 2BC foram coletadas para as análises mineralógicas das frações argila, silte e areia (difratometria de raios X) e químicas da fração argila (extração de Fe com ditionito-citrato-bicarbonato - DCB e com oxalato de amônio - OA). Os teores de K não trocáveis foram determinados nas amostras de solo após extração com HNO3 1 mol L-1 fervente. Verificou-se o predomínio da caulinita na fração argila e alta reserva mineral de K nos solos, associada à ocorrência de mica nas frações argila, silte e areia. Os diferentes manejos não afetaram os teores de Fe2O3DCB e Fe2O3OA; por outro lado, o maior valor estimado para a relação entre os teores de goethita e hematita [Gt/(Gt+Hm)] na fração argila no horizonte A da floresta indica uma possível transformação parcial de Gt em Hm durante a queima da floresta para a implantação dos manejos mata secundária, pastagem e café.

Risk of multiple myeloma is associated with polymorphisms within telomerase genes and telomere length

Compelling biological and epidemiological evidences point to a key role of genetic variants of the TERT and TERC genes in cancer development. We analyzed the genetic variability of these two gene regions using samples of 2,267 multiple myeloma (MM) cases and 2,796 healthy controls. We found that a TERT variant, rs2242652, is associated with reduced MM susceptibility (OR?=?0.81; 95% CI: 0.72-0.92; p?=?0.001). In addition we measured the leukocyte telomere length (LTL) in a subgroup of 140 cases who were chemotherapy-free at the time of blood donation and 468 controls, and found that MM patients had longer telomeres compared to controls (OR?=?1.19; 95% CI: 0.63-2.24; ptrend ?=?0.01 comparing the quartile with the longest LTL versus the shortest LTL). Our data suggest the hypothesis of decreased disease risk by genetic variants that reduce the efficiency of the telomerase complex. This reduced efficiency leads to shorter telomere ends, which in turn may also be a marker of decreased MM risk.

Challenges and confusion in media regulation: a four-country comparison

[Excerto] ln this chapter we discuss recent developments and challenges in European media and communication policy, focusing on the period following the 2008 global financial crisis. We are especially interested in the implications of the financial crisis and its political repercussions nationally (austerity measures and cuts to public services, growing anti-politics sentiments and widespread dissatisfaction with free-market capitalism and representative democracy) for media and communication policy, understood here in a broad sense, so as to include ali electronic communications, such as the Internet, mobile communications, social media etc. Our overarching concern is with the implications of developments in media and communication policy for the democratic functions of the media in Europe (...).

Melastomataceae em formações costeiras de restingas no Pará, Brasil

Restingas são ambientes constituídos de um complexo de comunidades de plantas ocorrendo sobre planícies arenosas costeiras quaternárias de influência marinha. A Amazônia brasileira é o segundo bioma de maior riqueza de Melastomataceae no país, o qual está representado por 47 gêneros e 487 espécies. O presente trabalho objetivou conhecer a diversidade de Melastomataceae nas diferentes formações vegetacionais que compõem a paisagem das restingas no Pará. Foi realizado levantamento de coleções herborizadas nos herbários IAN (Herbário da Empresa Brasileira de Pesquisas Agropecuárias) e MG (Herbário do Museu Paraense Emílio Goeldi), e coletas nos municípios de Bragança, Maracanã e Marapanim. Apresenta-se o tratamento taxonômico com descrições, ilustrações, dados de distribuição geográfica, chave de identificação para as espécies e comentários sobre particularidades morfológicas. A família está representada por 10 espécies nas restingas do Pará, a conhecer: Acisanthera bivalvis, A. crassipes, Comolia villosa, Miconia alata, Mouriri brachyantera, M. guianensis, Nepsera aquatica, Pterolepis trichotoma, Rhynchanthera serrulata e Tibouchina aspera. Tais espécies ocorrem pricipalmente em Brejos Herbáceos, Campos entre Dunas, Dunas, Campos Arbustivos Abertos e Matas de Restinga. Miconia alata representa um novo registro para o ambiente de restinga no Pará. As restingas dos municípios de Maracanã e Marapanim concentram 80% das espécies estudadas. Através deste trabalho foi possível reconhecer que nenhuma delas pode ser caracterizada como exclusiva, pois todas são encontradas em outros ecossistemas ou formações vegetacionais do país.