Markers for sepsis diagnosis in the forensic setting: state of the art.

Reliable diagnoses of sepsis remain challenging in forensic pathology routine despite improved methods of sample collection and extensive biochemical and immunohistochemical investigations. Macroscopic findings may be elusive and have an infectious or non-infectious origin. Blood culture results can be difficult to interpret due to postmortem contamination or bacterial translocation. Lastly, peripheral and cardiac blood may be unavailable during autopsy. Procalcitonin, C-reactive protein, and interleukin-6 can be measured in biological fluids collected during autopsy and may be used as in clinical practice for diagnostic purposes. However, concentrations of these parameters may be increased due to etiologies other than bacterial infections, indicating that a combination of biomarkers could more effectively discriminate non-infectious from infectious inflammations. In this article, we propose a review of the literature pertaining to the diagnostic performance of classical and novel biomarkers of inflammation and bacterial infection in the forensic setting.

Spinal epidural hematoma: not always an obvious diagnosis.

Spinal epidural hematoma (SEH) is a rare neurosurgical emergency. SEH is characterized by an archetypal clinical presentation including abrupt spinal pain followed more or less rapidly by various degrees of neurological deficit. The diagnosis of SEH, often based on a clinical presumption, represents a clinical challenge. Several reports have outlined missed or delayed diagnosis due to unusual and confusing onsets or unawareness of this diagnosis by physicians. Therefore, physicians should keep in mind the possibility of SEH in their differential diagnosis when confronted with patients complaining of sudden onset of acute spinal pain with or without neurological sign, because the impact of a delayed diagnosis can be disabling catastrophic neurological sequelae. We suggest that SEH is a dynamic disease, which occurs in patients with an abnormal vasculature structural degenerative change. The bleeding is probably of multifactorial origin incriminating veins as well as arteries. Therefore, we proposed a classification of SEH, according to the most probable etiology whatever the associated factors, in six groups: spontaneous, secondary, iatrogenic, traumatic, recurrent, and idiopathic SEH.

Immunoproteomics for Serological Diagnosis of Hypersensitivity Pneumonitis Caused by Environmental Microorganisms.

Diagnosis of immunoallergenic pathologies due to microorganisms such as hypersensitivity pneumonitis includes detection of circulating specific antibodies. Detection of precipitins has classically been performed using immunoprecipitation techniques with crude antigenic extracts from microorganisms implicated as etiologic agents. However, these techniques lack standardization because of the different composition of fungal antigenic extracts from one batch to another. Therefore, there is high interest in developing standardized serological diagnostic methods using recombinant antigens. Immunoproteomics have proved to be useful for identifying the immunogenic proteins in several microorganisms linked to hypersensitivity pneumonitis. With this approach, the causative microorganisms are first isolated from the environment of patients. Then the proteins are separated by two-dimensional electrophoresis and revealed by Western blotting with sera of different patients suffering from the disease compared to sera of asymptomatic exposed controls. Immunoreactive proteins are identified by mass spectrometry. Identified immunoreactive proteins found to be specific markers for the disease could be subsequently produced as recombinant antigens using various expression systems to develop ELISA tests. Using recombinant antigens, standardized ELISA techniques can be developed, with sensitivity and specificity reaching 80% and 90%, respectively, and more if using a combination of several antigens. Immunoproteomics can be applied to any environmental microorganisms, with the aim of proposing panels of recombinant antigens able to improve the sensitivity and standardization of serologic diagnosis of hypersensitivity pneumonitis, but also other mold-induced allergic diseases such as allergic broncho pulmonary aspergillosis or asthma.

Equações para a estimativa do índice de área foliar do cafeeiro

Com o objetivo de estudar a variação temporal do índice de área foliar (IAF) da cultura de café, utilizando um método simples e não-destrutivo, foi instalado um experimento no Departamento de Produção Vegetal, da Escola Superior de Agricultura Luiz de Queiroz, da Universidade de São Paulo. Utilizou-se a cultivar Mundo Novo IAC 388-17, enxertada sobre a cultivar Apoatã IAC 2258 (de 15 até 35 meses de idade), no espaçamento de 2,5 x 1,0 m. Foram coletadas todas as folhas de duas plantas de café, em intervalos de 60 a 150 dias, para a mensuração da área foliar com o equipamento LI-COR (modelo 3100). Para obter a relação funcional entre IAF e diferentes variáveis de crescimento (altura da planta, número e massa total de folhas e área foliar) e arquitetura da copa (área da seção inferior, média e superior do dossel, área lateral do dossel, diâmetro inferior, médio e superior do dossel, volume do dossel da planta e altura do primeiro par de ramos), assumiu-se que a parte aérea do cafeeiro tem a forma cônica. O diâmetro da seção inferior do dossel (primeiro par de ramos) e a altura da planta podem ser utilizadas para estimar o índice de área foliar do cafeeiro.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Diagnostic et traitement des tumeurs intra-oculaires chez l'enfant [Diagnosis and treatment of intraocular tumors in the child]

PURPOSE: To remind of the absolute necessity for early diagnosis in the presence of ocular signs in children giving rise to possible intraocular tumours. METHOD: Based on our own experience of intraocular tumours in children, together with findings from the literature, diagnostic criteria and methods of treatment are presented. RESULTS: Retinoblastoma is the predominant cause of intraocular tumours in children, representing over 80% of cases under the age of 15 years. Other diseases may give rise to the same initial signs, usually leukocoria, sometimes strabismus, more rarely other atypical signs. Elements taken into account for diagnosis include age, sex, laterality, heredity, size of the globe, clinical aspect of the tumours, presence of calcifications and vitreous seeding. Full fundus examination under general anaesthetic is usually necessary. Biological examination, ultrasonography, computerized tomography and MRI enable an accurate diagnosis to be made in the majority of doubtful cases. The management of retinoblastoma is adapted for each individual case from the wide range of treatments available. Enucleation, radioactive applicators (...), brachytherapy (...), cryo- and photocoagulation represent classical measures. Primary chemotherapy, combined with other treatments such as thermotherapy, has become the treatment of choice in those cases where external beam radiotherapy has been used up to now, or in some instances before enucleation. Enucleation is usually carried out for medullo-epitheliomas, but brachytherapy may offer an alternative. CONCLUSION: Any unexplained ocular sign in children should be considered as a possible retinoblastoma, making an accurate and certain diagnosis imperative. Early treatment may save not only the life but also the vision of patients carrying this highly malignant lesion.

Apport du CT-3D dans le diagnostic et le traitement des fractures des plateaux tibiaux [Value of 3D CT in diagnosis and treatment of fractures of the tibial plateau]

A precise classification and an optimal understanding of tibial plateau fractures are the basis of a conservative treatment or adequate surgery. The aim of this prospective study is to determine the contribution of 3D CT to the classification of fractures (comparison with standard X-rays) and as an aid to the surgeon in preoperative planning and surgical reconstruction. Between November 1994 and July 1996, 20 patients presenting 22 tibial plateau fractures were considered in this study. They all underwent surgical treatment. The fractures were classified according to the Müller AO classification. They were all investigated by means of standard X-rays (AP, profile, oblique) and the 3D CT. Analysis of the results has shown the superiority of 3D CT in the planning (easier and more acute), in the classification (more precise), and in the exact assessment of the lesions (quantity of fragments); thereby proving to be of undeniable value of the surgeon.

DRIS norms validation for sugarcane crop

The objectives of this study were to evaluate the relationship between the diagnosis and recommendation integrated system (DRIS) indices and foliar nutrient concentrations, to establish optimum foliar nutrient concentrations with DRIS and to validate the DRIS norms for sugarcane crop. Foliar nutrient concentrations from 126 sugarcane commercial fields were analyzed during the 1996/97 season, to calculate DRIS indices. Regression analysis was used to fit a model relating DRIS indices to nutrient concentrations. Experiments were carried out during the 1997/98 season, whose treatments consisted of the addition of the most limiting nutrients according to DRIS. A new diagnosis was performed. At the end of 1997/98 season, the yields of each plot were collected. Analysis of variance and Duncan test (5%) were used for the evaluation of the collected data. There was a positive and significant relationship between sugarcane foliar nutrient concentrations and DRIS indices. The optimum foliar nutrient concentrations for sugarcane are: 13.4 g ha-1 for N, 1.91 g ha-1 for P, 12.2 g ha-1 for K, 2.99 g ha-1 for Ca, 2.15 g ha-1 for Mg, 1.61 g ha-1 for S, 4.48 mg ha-1 for Cu, 67.8 mg ha-1 for Mnand 11.7 mg ha-1 for Zn. DRIS norms evaluated are useful to correct nutritional imbalances and to increase sugarcane yield.

Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice.

ABSTRACT: While diagnosis has traditionally been viewed as an essential concept in medicine, particularly when selecting treatments, we suggest that the use of diagnosis alone may be limited, particularly within mental health. The concept of clinical case formulation advocates for collaboratively working with patients to identify idiosyncratic aspects of their presentation and select interventions on this basis. Identifying individualized contributing factors, and how these could influence the person's presentation, in addition to attending to personal strengths, may allow the clinician a deeper understanding of a patient, result in a more personalized treatment approach, and potentially provide a better clinical outcome.

Fertilização com boro e zinco no solo em complementação à aplicação via foliar em laranjeira Pêra

As deficiências de boro (B) e zinco (Zn) são as mais freqüentes na citricultura brasileira e há escassez de conhecimento sobre critérios de diagnóstico e manejo desses nutrientes nessa cultura. A aplicação foliar tem sido a forma tradicional de fornecimento desses nutrientes, a despeito da baixa redistribuição na planta cítrica. O objetivo deste trabalho foi avaliar a eficiência da aplicação complementar de B e Zn no solo em comparação com a aplicação via foliar e estabelecer curvas de calibração de análises de solo e de folhas com a produtividade da laranjeira Pêra. Os tratamentos foram arranjados em delineamento fatorial 4², com três repetições. Foram aplicadas no solo as doses anuais de 0, 2, 4 e 6 kg ha-1 de B (ácido bórico) e Zn (sulfato de zinco), em complemento à adubação foliar. A produção de frutos aumentou significativamente com a aplicação de B no solo até a dose de 4 kg ha-1, enquanto a aplicação de Zn no solo mostrou-se pouco eficiente. As doses de B afetaram a qualidade dos frutos. A produtividade máxima foi obtida com teor de B no solo de 1,0 mg dm-3, e na folha de cerca de 300 mg kg-1. A aplicação foliar de B, apesar de evitar os sintomas típicos de deficiência, não otimizou a produtividade e a qualidade dos frutos, enquanto a aplicação foliar de Zn mostrou-se eficiente. Curvas de calibração de análises de solo e de folhas mostraram a necessidade de rever as classes de interpretação desses micronutrientes na citricultura.

Morfogênese e acúmulo de biomassa foliar em pastagem de capim-elefante avaliada em diferentes épocas do ano

O objetivo deste trabalho foi avaliar o efeito da época do ano nas características morfogênicas e estruturais e no acúmulo de biomassa foliar de uma pastagem de capim-elefante (Pennisetum purpureum Schum.). Vacas mestiças Holandês x Zebu foram manejadas segundo o método de pastejo com lotação rotacionada com três dias de ocupação e 30 dias de descanso. Foi usado delineamento em blocos casualizados com seis repetições. As avaliações foram realizadas em fevereiro/março, abril/maio, julho/agosto e outubro de 2001. As maiores taxas de alongamento e aparecimento de folhas ocorreram durante fevereiro/março. Os perfilhos aéreos superaram os basilares em quantidade, mas apresentaram menores taxas de alongamento (5,1 versus 9,8 cm/dia/perfilho), aparecimento (0,13 versus 0,16 folhas/dia/perfilho) e senescência (0,9 versus 1,3 cm/dia/perfilho) foliares. As produções e taxas de acúmulo de biomassa foliar foram maiores durante fevereiro/março e apresentaram estreita relação com as variáveis morfogênicas. Os perfilhos aéreos contribuíram, em média, com 63% da biomassa foliar do capim-elefante.

Organogênese de explante foliar de clones de Eucalyptus grandis x E. urophylla

O objetivo deste trabalho foi avaliar os efeitos dos reguladores de crescimento TDZ [1-fenil-3-(1,2,3-tia-diazol-5-il)uréia], BAP (6-benzilaminopurina) e ANA (ácido naftalenoacético) no desempenho da propagação in vitro por organogênese de explante foliar de três clones híbridos de Eucalyptus grandis x Eucalyptus urophylla. Houve resposta diferenciada dos clones quanto a intensidade, textura e coloração dos calos, em razão dos tratamentos com os reguladores de crescimento. Os melhores resultados de calejamento dos três genótipos foram observados nos tratamentos com a combinação dos reguladores de crescimento TDZ (0,5 mg L-1) e ANA (0,1 mg L-1), obtendo-se 100% de calejamento no explante foliar. Os piores resultados de calejamento foram observados nos tratamentos com a combinação dos reguladores de crescimento BAP (0,1 mg L-1) e ANA (0,1 mg L-1). Em relação à regeneração, a melhor resposta foi obtida com 1,0 mg L-1 BAP em que 8% dos calos formados a partir de explantes foliares regeneraram gemas, com número médio destas formadas por calo igual a 4,2.

Produção estacional, índice de área foliar e interceptação luminosa de cultivares de alfafa sob pastejo

A alfafa (Medicago sativa L.) pastejada pode promover redução de custos de alimentação de ruminantes, mas o desempenho agronômico de cultivares sob pastejo no Brasil ainda é pouco conhecido. O objetivo deste trabalho foi avaliar o efeito do método de pastejo sobre o acúmulo de forragem (AF), índice de área foliar (IAF) e interceptação luminosa (IL) de cinco cultivares de alfafa, durante 295 dias de pastejo em Piracicaba, SP. O experimento seguiu um delineamento de blocos completos casualizados, com parcelas subdivididas (método na parcela e cultivar na subparcela). A cultivar ABT-805 foi a mais produtiva sob lotação contínua (26.600 kg ha-1 ano-1) e rotacionada (18.000 kg ha-1 ano-1), com maior IAF médio (2,1) e o máximo valor médio de IL (53%) sob lotação rotacionada. Alfagraze, apesar de ser uma das menos produtivas sob lotação rotacionada (13.300 kg ha-1 ano-1), foi semelhante em produtividade a ABT-805, sob lotação contínua (26.300 kg ha-1 ano-1), apresentando IL média de 47% e IAF médio de 1,1 e 1,8 para a lotação contínua e rotacionada, respectivamente. Pioneer 5432 foi intermediária, com IL média de 49%, AF de 24.300 e 15.300 kg ha-1 ano-1, valores médios de IAF de 0,98 e 1,76 e sobrevivência de 7,3% e 24,9% para lotação contínua e rotacionada, respectivamente. Crioula e CUF-101 são as mais estacionais sob ambos os métodos. ABT-805 tem a maior produtividade sob pastejo nas condições edafoclimáticas da região.