Clinical Epidemiology of Buruli ulcer from Benin (2005-2013): effect of time-delay to diagnosis on clinical forms and severe phenotypes

Buruli Ulcer (BU) is a neglected infectious disease caused by Mycobacterium ulcerans that is responsible for severe necrotizing cutaneous lesions that may be associated with bone involvement. Clinical presentations of BU lesions are classically classified as papules, nodules, plaques and edematous infiltration, ulcer or osteomyelitis. Within these different clinical forms, lesions can be further classified as severe forms based on focality (multiple lesions), lesions' size (>15 cm diameter) or WHO Category (WHO Category 3 lesions). There are studies reporting an association between delay in seeking medical care and the development of ulcerative forms of BU or osteomyelitis, but the effect of time-delay on the emergence of lesions classified as severe has not been addressed. To address both issues, and in a cohort of laboratory-confirmed BU cases, 476 patients from a medical center in Allada, Benin, were studied. In this laboratory-confirmed cohort, we validated previous observations, demonstrating that time-delay is statistically related to the clinical form of BU. Indeed, for non-ulcerated forms (nodule, edema, and plaque) the median time-delay was 32.5 days (IQR 30.0-67.5), while for ulcerated forms it was 60 days (IQR 20.0-120.0) (p = 0.009), and for bone lesions, 365 days (IQR 228.0-548.0). On the other hand, we show here that time-delay is not associated with the more severe phenotypes of BU, such as multi-focal lesions (median 90 days; IQR 56-217.5; p = 0.09), larger lesions (diameter >15 cm) (median 60 days; IQR 30-120; p = 0.92) or category 3 WHO classification (median 60 days; IQR 30-150; p = 0.20), when compared with unifocal (median 60 days; IQR 30-90), small lesions (diameter =15 cm) (median 60 days; IQR 30-90), or WHO category 1+2 lesions (median 60 days; IQR 30-90), respectively. Our results demonstrate that after an initial period of progression towards ulceration or bone involvement, BU lesions become stable regarding size and focal/multi-focal progression. Therefore, in future studies on BU epidemiology, severe clinical forms should be systematically considered as distinct phenotypes of the same disease and thus subjected to specific risk factor investigation.

The music of language: an ERP investigation of the effects of musical training on emotional prosody processing

Recent studies have demonstrated the positive effects of musical training on the perception of vocally expressed emotion. This study investigated the effects of musical training on event-related potential (ERP) correlates of emotional prosody processing. Fourteen musicians and fourteen control subjects listened to 228 sentences with neutral semantic content, differing in prosody (one third with neutral, one third with happy and one third with angry intonation), with intelligible semantic content (semantic content condition--SCC) and unintelligible semantic content (pure prosody condition--PPC). Reduced P50 amplitude was found in musicians. A difference between SCC and PPC conditions was found in P50 and N100 amplitude in non-musicians only, and in P200 amplitude in musicians only. Furthermore, musicians were more accurate in recognizing angry prosody in PPC sentences. These findings suggest that auditory expertise characterizing extensive musical training may impact different stages of vocal emotional processing.

Caracteres culturais das bactérias dos nódulos de algumas leguminosas tropicais

23 isolates from root nodules of 13 leguminous species were tested in laboratory for cultural and physiological characteristics. The following conclusions can be drawn: 1 - The cultural and physiological characters were not enough to identify the different isolates. 2 - The data from cultural and physiological tests help the identification of the bacteria, when checked with data from cross-inoculation tests reported elsewhere (GALLI, 1958). The bacteria studied herein may be grouped as the following: a) nodule bacteria from Vigna sinensis, Calopogonium muconoides, Centrosema pubescens, Desmodium adscendens, D. discolor, Indigofera mucronata, I. subulata, I. sumatrana, Stylosanthes guyanensisA Tephrosia cândida and Teramnus uncinatus: bacteria with scanty growth; alcaline reaction in milk-brom cresol purple; no acid production in medium with any of the carbohydrates used. b) nodule bacteria from pea and from Vicia obscura: bacteria with moderate growth; alcaline reaction, with serum zone, in milk-brom cresol purple; acid production in medium with all the carbohydrates used. c) nodule bacteria from Leucaena glauca: bacteria with moderate growth; alcaline reaction, with serum zone, in milk-brom cresol purple; acid production from rafinose and manitol. d) nodule bacteria from Cratylia floribunda: bacteria with scanty growth; alcaline reaction in milk-brom cresol purple; acid production from mannose and ramnose.

Another color morph of Sporophila Seedeater from the capuchinos group (Aves, Emberizidae)

The genus Sporophila (Cabanis, 1844) unites about 30 species of small seedeaters that predominantly inhabit open or semi-open areas in the Neotropical region. The taxonomy of this group is based on morphological studies from collected male specimens. The dynamic spatial and temporal variation in the male plumage and lack of knowledge of their vocalizations make it difficult to properly diagnose some species even today, so these two aspects account for the existing taxonomic dilemmas involving Sporophila. During a four-year field study, we investigated the natural history of a breeding population of Sporophila melanogaster (Pelzeln, 1870). This is an endemic species in Brazil, which reproduces in the high-altitude grasslands of the Atlantic Forest biome. We found four male specimens with clearly diagnosable plumage, distinct from the typical form of the species. Here we describe this previously unreported plumage form. Based on the evaluation of habitat use, vocalization, and reproductive behavior, we tested two hypotheses regarding its taxonomic status. We concluded that this is another case of an intra-specific color morph within the seedeaters of the "capuchinos" group.

Description of two new species of Plesiopelma (Araneae, Theraphosidae, Theraphosinae) from Argentina

Two new species of Plesiopelma Pocock, 1901 from northern Argentina are described and diagnosed based on males and habitat descriptions are presented. Males of Plesiopelma paganoi sp. nov. differ from most of species by the absence of spiniform setae on the retrolateral face of cymbium, aspect of the palpal bulb. Plesiopelma aspidosperma sp. nov. differs from most species of the genus by the presence of spiniform setae on the retrolateral face of cymbium and it can be distinguished from P. myodes Pocock, 1901, P. longisternale (Schiapelli & Gerschman, 1942) and P. rectimanum (Mello-Leitão, 1923) by the separated palpal bulb keels and basal nodule of metatarsus I very developed. It differs from P. minense (Mello-Leitão, 1943) by the shape of the palpal bulb and basal nodule on metatarsus I well developed. Specimens were captured in Salta province, Argentina, inhabiting high cloud forests of Yungas eco-region.

Mitsuda's reactions: induced by BCG in the normal Rhesus ("Macacca mulatta")

The reversals of Mitsuda's reactions induced by BCG have been objected to based on the possiblem interference of other determination causes of the phenomenon: tuberculous primo-infections, communicants of unsuspected leprosy, revearsals due to other causes, such as anti-diphteric and anti-tetanic vaccination, etc. In order to study the problem, we have used Rhesus monkeys (Macaca mulatta), which were reared in isolation, in an attempt to avoid the referred to interferences. Prior to the experiments, all animals were tested and found negative to radiograph, tuberculin and lepromin tests and were then submitted to the application of BCG vaccine (from 1 to 3 days old), in different doses and by different via. At different times, after the application of BCG, they were again submitted to the radiographic, tuberculin and lepromin tests. In the tables I to IV the experiences were summarised. From the experiments, the following conclusions were reached: 1 - From 12 Rhesus that received BCG 11 showed reversals of the Mitsuda reaction (91.7%). 2 - These reverseals took place both in tests effected shortly after BCG (from 6 days to 2 months), and tests effected much later (from 7 to 12 months after BCG). 3 - Some differences were found in the results, according to the dosis and the application via of the BCG. a) - The testicular and peritonela via (0,02g) were the only that determined strong positive Mitsuda's reactions (+++). b) - By oral via, animals that received high dosis (0.6g and 1.2 g), there resulted uniform and regular reversals, even though of low intensity (+); but from those who got small doses (0.2 g.) one showed no reversals in all tests, and the other presented reversals in the 2nd and 3rd tests only, also with low positivity (+). 4) In the 2nd and 3rd Mitsuda's reactions in the same animals, positivity was always precocious (generally within 48 hours), one getting the impression that there occurs a sensibilization of the animal body by the antigen with the repetition of the tests, even though the intensity of the reaction always remains the same. This precocious reaction (Fernandez type) occurs both shortly and long time after the application of the BCG. Its precocity depends not of the antigen only because the first Mitsuda's reaction after the BCG application occurs after some time and seems not influenced by the control lepromin test effected on the Rhesus before the BCG. 5) On the control group, the animals which received a.a.f. bacilli suspensions (Mycobacterium sp.; M. avium, and M. smegmatis), did not show reverseals of the Mitsuda's reaction. Two Rhesus, however, which received dead BCG (120ºC autoclave 1 hour), one intradermically (0.006 g) and the other orally (1.2 g), did both present reversals of the Mitsuda's reaction, with weak positivity (+). In all animals of the control-group, the allergic reactions were found negative. 6) Strong local inflammatory reactions were observed in the Rhesus that had received living BCG by intradermal via, and in the one submitted to multipunctures, there occurred the formation of a large caseous abcess. 7) The allergic tuberculinic and infratuberculinic reactions appeared dissociated from the Mitsuda's reactions: sometimes they are more precocious, occurring before of the lepromin test; on other occasions they disappear, when the Mitsuda's reactions still persist; and finally, they may be absent, when the latter occur, especially after the oral application of the BCG. 8) In Rhesus which received BCG by testicular and peritonela via, in the infratuberculinic test (0.1 ml of total BCG extract), besides the classic answer, which occurs between 48 and 96 hours, one could observe a delayed answer (15 to 20 days), represented by a non-erythematous nodule, which persists for 11-14 days.

La incidència de l’afinació en el reconeixement auditiu dels intervals harmònics: una experiència a l’inici dels estudis musicals especialitzats de grau mitjà.

L’article presenta una investigació sobre la incidència de l’afinació vocal en el reconeixement auditiu dels intervals harmònics. La recerca s’ha realitzat durant el curs acadèmic 2006-07 en el context del Conservatori Professional de Música de Girona, concretant-se la mostra d’estudi en els alumnes de primer curs de grau mitjà. S’hi exposen en primer lloc les línies bàsiques del concepte d’educació de l’oïda musical, que seguidament s’especifiquen en l’afinació i el reconeixement auditiu dels intervals musicals. Posteriorment es relata el procediment metodològic que s’ha dut a terme en aquest estudi de cas, detallant-se els resultats musicals obtinguts a través de la realització d’un test de nivell de reconeixement auditiu harmònic. Aquest test s’ha efectuat prèviament i posterior a un breu treball d’intervenció vocal. L’estratègia de recerca es completa mitjançant unes enquestes adreçades als alumnes i als seus corresponents professors especialitzats en Llenguatge Musical. Les conclusions de la investigació ens permeten confirmar que l’afinació vocal ha incidit positivament en el reconeixement auditiu dels intervals harmònics.

Evaluation de la douleur chez les personnes cérébrolésées non-communicantes aux soins intensifs

La douleur est fréquente en milieu de soins intensifs et sa gestion est l'une des missions des infirmières. Son évaluation est une prémisse indispensable à son soulagement. Cependant lorsque le patient est incapable de signaler sa douleur, les infirmières doivent se baser sur des signes externes pour l'évaluer. Les guides de bonne pratique recommandent chez les personnes non communicantes l'usage d'un instrument validé pour la population donnée et basé sur l'observation des comportements. A l'heure actuelle, les instruments d'évaluation de la douleur disponibles ne sont que partiellement adaptés aux personnes cérébrolésées dans la mesure où ces personnes présentent des comportements qui leur sont spécifiques. C'est pourquoi, cette étude vise à identifier, décrire et valider des indicateurs, et des descripteurs, de la douleur chez les personnes cérébrolésées. Un devis d'étude mixte multiphase avec une dominante quantitative a été choisi pour cette étude. Une première phase consistait à identifier des indicateurs et des descripteurs de la douleur chez les personnes cérébrolésées non communicantes aux soins intensifs en combinant trois sources de données : une revue intégrative des écrits, une démarche consultative utilisant la technique du groupe nominal auprès de 18 cliniciens expérimentés (6 médecins et 12 infirmières) et les résultats d'une étude pilote observationnelle réalisée auprès de 10 traumatisés crâniens. Les résultats ont permis d'identifier 6 indicateurs et 47 descripteurs comportementaux, vocaux et physiologiques susceptibles d'être inclus dans un instrument d'évaluation de la douleur destiné aux personnes cérébrolésées non- communicantes aux soins intensifs. Une deuxième phase séquentielle vérifiait les propriétés psychométriques des indicateurs et des descripteurs préalablement identifiés. La validation de contenu a été testée auprès de 10 experts cliniques et 4 experts scientifiques à l'aide d'un questionnaire structuré qui cherchait à évaluer la pertinence et la clarté/compréhensibilité de chaque descripteur. Cette démarche a permis de sélectionner 33 des 47 descripteurs et valider 6 indicateurs. Dans un deuxième temps, les propriétés psychométriques de ces indicateurs et descripteurs ont été étudiés au repos, lors de stimulation non nociceptive et lors d'une stimulation nociceptive (la latéralisation du patient) auprès de 116 personnes cérébrolésées aux soins intensifs hospitalisées dans deux centres hospitaliers universitaires. Les résultats montrent d'importantes variations dans les descripteurs observés lors de stimulation nociceptive probablement dues à l'hétérogénéité des patients au niveau de leur état de conscience. Dix descripteurs ont été éliminés, car leur fréquence lors de la stimulation nociceptive était inférieure à 5% ou leur fiabilité insuffisante. Les descripteurs physiologiques ont tous été supprimés en raison de leur faible variabilité et d'une fiabilité inter juge problématique. Les résultats montrent que la validité concomitante, c'est-à-dire la corrélation entre l'auto- évaluation du patient et les mesures réalisées avec les descripteurs, est satisfaisante lors de stimulation nociceptive {rs=0,527, p=0,003, n=30). Par contre la validité convergente, qui vérifiait l'association entre l'évaluation de la douleur par l'infirmière en charge du patient et les mesures réalisés avec les descripteurs, ainsi que la validité divergente, qui vérifiait si les indicateurs discriminent entre la stimulation nociceptive et le repos, mettent en évidence des résultats variables en fonction de l'état de conscience des patients. Ces résultats soulignent la nécessité d'étudier les descripteurs de la douleur chez des patients cérébrolésés en fonction du niveau de conscience et de considérer l'hétérogénéité de cette population dans la conception d'un instrument d'évaluation de la douleur pour les personnes cérébrolésées non communicantes aux soins intensifs. - Pain is frequent in the intensive care unit (ICU) and its management is a major issue for nurses. The assessment of pain is a prerequisite for appropriate pain management. However, pain assessment is difficult when patients are unable to communicate about their experience and nurses have to base their evaluation on external signs. Clinical practice guidelines highlight the need to use behavioral scales that have been validated for nonverbal patients. Current behavioral pain tools for ICU patients unable to communicate may not be appropriate for nonverbal brain-injured ICU patients, as they demonstrate specific responses to pain. This study aimed to identify, describe and validate pain indicators and descriptors in brain-injured ICU patients. A mixed multiphase method design with a quantitative dominant was chosen for this study. The first phase aimed to identify indicators and descriptors of pain for nonverbal brain- injured ICU patients using data from three sources: an integrative literature review, a consultation using the nominal group technique with 18 experienced clinicians (12 nurses and 6 physicians) and the results of an observational pilot study with 10 traumatic brain injured patients. The results of this first phase identified 6 indicators and 47 behavioral, vocal and physiological descriptors of pain that could be included in a pain assessment tool for this population. The sequential phase two tested the psychometric properties of the list of previously identified indicators and descriptors. Content validity was tested with 10 clinical and 4 scientific experts for pertinence and comprehensibility using a structured questionnaire. This process resulted in 33 descriptors to be selected out of 47 previously identified, and six validated indicators. Then, the psychometric properties of the descriptors and indicators were tested at rest, during non nociceptive stimulation and nociceptive stimulation (turning) in a sample of 116 brain-injured ICLI patients who were hospitalized in two university centers. Results showed important variations in the descriptors observed during the nociceptive stimulation, probably due to the heterogeneity of patients' level of consciousness. Ten descriptors were excluded, as they were observed less than 5% of the time or their reliability was insufficient. All physiologic descriptors were deleted as they showed little variability and inter observer reliability was lacking. Concomitant validity, testing the association between patients' self report of pain and measures performed using the descriptors, was acceptable during nociceptive stimulation (rs=0,527, p=0,003, n=30). However, convergent validity ( testing for an association between the nurses' pain assessment and measures done with descriptors) and divergent validity (testing for the ability of the indicators to discriminate between rest and a nociceptive stimulation) varied according to the level of consciousness These results highlight the need to study pain descriptors in brain-injured patients with different level of consciousness and to take into account the heterogeneity of this population forthe conception of a pain assessment tool for nonverbal brain-injured ICU patients.

Conjunctival MALT lymphoma: utility of FDG PET/CT for diagnosis, staging, and evaluation of treatment response.

A 67-year-old woman was referred for staging of a mucosa-associated lymphoid tumor lymphoma involving the left conjunctiva. CT scan had shown paravertebral and pelvic masses, and a breast nodule. FDG PET/CT demonstrated moderately increased uptake in the left ocular conjunctiva and confirmed the paravertebral and pelvic masses and the breast nodule. Moreover, abnormal FDG uptake was shown in 2 breast nodules, the flank, the gluteus maximus, and the gastric cardia. The patient received 6 cycles of rituximab-bendamustine chemotherapy with a complete clinical and metabolic response at the 6-month follow-up PET/CT and remained relapse-free without visual acuity problem after a 36-month follow-up.

La reactivitat davant l’estrès i els problemes de veu en docents i futurs docents

L’objectiu d’aquest treball de recerca és indagar sobre l’existència d’una possible relació entre la reactivitat a l’estrès i els problemes de veu en el col•lectiu docent. S’ha utilitzat una mostra de 447 persones, entre estudiants de magisteri i docents, donat que són una població que presenten un elevat índex de patologia vocal, així com d’estrès. Per recollir la informació necessària s’utilitza el qüestionari VHI-10 (Voice Handicap Index) i el test IRE-32 (Índice de Reactividad al Estrés). En els resultats obtinguts es troben indicis que ens permeten afirmar que les persones amb problemes de veu tenen una major reactivitat a l’estrès, i dins d’aquesta reactivitat, s’observen també respostes que són més representatives del grup de persones disfòniques, la majoria de les quals estan vinculades, directa o indirectament, a aspectes relacionats amb la emissió vocal.

Toux sèche, douleurs thoraciques et dyspnée chez un patient atteint d'une polyarthrite rhumatoïde [Dry cough, chest pain and difficult breathing in a patient with rheumatoid arthritis]

Pulmonary involvement is the most frequent extra-articular manifestation of rheumatoid arthritis. The occurrence of a chronic hydro-pneumo-thorax associated with pulmonary nodules is rare. Cavitation of the most superficial nodules and their rupture into the pleural cavity are most likely involved in this complication. The presence of broncho-pleural fistulae may be responsible for the persistence of the phenomenon in our patient.

Traduccions cantables per a corals infantils catalanes: el repertori anglès-català del SCIC

En primer lloc els objectius que s’estableixen en aquest estudi són: Valorar la importància de la melodia, dels accents i la musicalitat del text en les cançons traduïdes analitzades. Plantejar la necessitat de la traducció de cançons infantils. Analitzar les traduccions existents de l’anglès al català del repertori de cançons infantils que es canten a les corals infantils. Relacionar poesia infantil i cançó. Visualitzar l’ús de la cançó infantil per a l’ensenyament dels infants, tant pel que fa a la transmissió de valors com per a l’ensenyament de llengües. La metodologia utilitzada fa referència a dos aspectes. El mètode qualitatiu amb la lectura d’articles i la bibliografia seleccionada i el mètode quantitatiu amb l’anàlisi de tres entrevistes i vint-i-una enquestes a responsables de corals infantils. En aquest estudi ofereixo l’estat de la qüestió sobre la traducció de cançons, amb especial atenció a la traducció de cançons per ser cantades. Després s’aborda la traducció de cançons infantils per ser cantades, per acabar especificant el tema d’aquest treball d’investigació en concret: la traducció de cançons infantils per ser cantades, amb l’estudi de traduccions de l’anglès al català de cançons cantades per corals infantils de Catalunya, i se n’ubica el context: el moviment coral infantil a Catalunya. Per a la confecció d’aquest estudi s’ha fet un recull de vint-i-set cançons traduïdes (anglès-català) que canten les corals infantils de Catalunya aplegades en el Secretariat de Corals Infantils de Catalunya (SCIC). Se n’ha seleccionat les cançons traduïdes de l’anglès al català, incloent-hi la partitura, la lletra original i la traducció. Aquest recull permet establir un lligam entre la traducció, la música i la pedagogia musical a Catalunya, els tres eixos principals d’aquest treball. D’aquestes cançons se n’han analitzat tres seguint els criteris establerts per autors com Peter Low, per la seva àmplia experiència en la traducció de música vocal. Els criteris són referents al ritme, rima, cantabilitat, naturalitat i sentit. Per tal de fer aquest estudi es van portar a terme tres entrevistes a traductors de cançons infantils: Enriqueta Anglada, Maria Martorell i Josep Vigo. Per valorar l’ús de cançons traduïdes dins del moviment coral infantil en l’actualitat i de manera més global, el treball inclou una enquesta, adreçada a directors de cors infantils, resposta per 21 cors. Aquestes enquestes palesen els canvis produïts amb el temps respecte a la necessitat de traduir cançons, ja que actualment la traducció no és tant important tot i que es continua valorant la seva importància, sobretot per afavorir la comprensió del que es canta. Però alhora es referma el desig de cantar en l’idioma original (especialment en el cas de l’anglès), quan aquest idioma l’entén qui dirigeix o interpreta la cançó, quan aquest fet es veu com a repte, o quan es prioritza la relació original entre música i text.

Bihippocampal damage with emotional dysfunction: impaired auditory recognition of fear.

A right-handed man developed a sudden transient, amnestic syndrome associated with bilateral hemorrhage of the hippocampi, probably due to Urbach-Wiethe disease. In the 3rd month, despite significant hippocampal structural damage on imaging, only a milder degree of retrograde and anterograde amnesia persisted on detailed neuropsychological examination. On systematic testing of recognition of facial and vocal expression of emotion, we found an impairment of the vocal perception of fear, but not that of other emotions, such as joy, sadness and anger. Such selective impairment of fear perception was not present in the recognition of facial expression of emotion. Thus emotional perception varies according to the different aspects of emotions and the different modality of presentation (faces versus voices). This is consistent with the idea that there may be multiple emotion systems. The study of emotional perception in this unique case of bilateral involvement of hippocampus suggests that this structure may play a critical role in the recognition of fear in vocal expression, possibly dissociated from that of other emotions and from that of fear in facial expression. In regard of recent data suggesting that the amygdala is playing a role in the recognition of fear in the auditory as well as in the visual modality this could suggest that the hippocampus may be part of the auditory pathway of fear recognition.

Effects of azadirachtin on Rhodnius prolixus: immunity and trypanosoma interaction

The effects of azadirachtin, a tetranortriterpenoid from the neem tree Aradirachta indica J. on both immunity and Trypanosoma cruzi interaction within Rhodniusprolixus and other triatomines, were presented Given through a blood meal, azadirachtin affected the immune reactivity as shown by a significant reduction in numbers of hemocytes and consequently nodule formation follwing challenge with Enterobacter cloacae ß12, reduction in ability to produce antibacterial activities in the hemolymph when injected with bacteria, and decreased ability to destroy the infection caused by inoculation of E. cloacae cells. A single dose of azadirachtin was able to block the development of T. cruzi in R. prolixus if given through the meal at different intervals, together with, before or after parasite infection. Similary, these results were observed with different triatomine species and different strains of T. cruzi. Azadirachtin induced a permanent resistance of the vector against reinfection with T. cruzi. The significance of these data is discussed in relation to the general mode of azadirachtin action in insects.