8 research outputs found
Maintaining and breaking symmetry in homomeric coiled-coil assemblies
Higher order coiled coils with five or more helices can form α-helical barrels. Here the authors show that placing β-branched aliphatic residues along the lumen yields stable and open α-helical barrels, which is of interest for the rational design of functional proteins; whereas, the absence of β-branched side chains leads to unusual low-symmetry α-helical bundles
World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections
Peer reviewe
FasciÃte necrosante: revisão com enfoque nos aspectos dermatológicos Necrotizing fasciitis: new insights with a focus on dermatological aspects
FasciÃte necrosante é infecção bacteriana destrutiva e rapidamente progressiva do tecido subcutâneo e fáscia superficial, associada a altos Ãndices de morbimortalidade, se não tiver tratamento precoce. Recentemente, inúmeros casos publicados têm demonstrado aumento na freqüência e gravidade dessa infecção, particularmente causada pelo Streptococcus do grupo A (GAS) e que acomete até mesmo pessoas jovens e saudáveis. Classifica-se em tipo I, quando causada por flora mista de anaeróbios e outras bactérias, e tipo II, quando causada pelo GAS isolado ou associado ao Staphylococcus aureus. Os fatores predisponentes incluem: doenças crônicas e malignas, abuso de álcool, uso de drogas endovenosas, lesões da pele como varicela, úlceras crônicas, psorÃase, cirurgia, traumas abertos e fechados, entre outros. Clinicamente destacam-se: a dor intensa, o edema grave, a rápida progressão e a resposta pobre à antibioticoterapia. É necessário um alto Ãndice de suspeição para o diagnóstico clÃnico, que é confirmado à intervenção cirúrgica, com a evidência de necrose da fáscia superficial. Os exames radiológicos são úteis, e o diagnóstico diferencial deve ser feito principalmente com celulite em seu estágio inicial. O tratamento, que deve ser precoce, é feito com antibióticos de amplo espectro, debridamento cirúrgico agressivo e medidas de suporte clÃnico e nutricional.<br>Necrotizing fasciitis is a destructive and quickly progressing bacterial infection of the subcutaneous layer and superficial fascia. It is associated with high levels of unhealthiness and mortality if not treated early. Recently, countless published cases demonstrated an increasing frequency and severity of these infections, especially those caused by Group A Streptococcus (GAS), which afflicts even young and healthy persons. It is classified as type I when caused by a mixed anaerobic flora and other bacteria, and type II when caused by GAS alone or in association with Staphylococcus aureus. Predisposing factors include: chronic and malignant diseases, alcohol abuse, intravenous drug use, skin lesions such as chicken pox, chronic ulcers, psoriasis, surgery, and opened or closed traumas, among others. Clinical features are intense pain, severe edema, fast progress and poor antibiotic therapy feedback. A high level of suspicion is necessary to achieve a clinical diagnosis for this disease. Moreover, it is confirmed primarily when surgery takes place and reveals the superficial fascia necrosis. Radiological examinations are useful and the differential diagnosis must be done mainly with cellulitis at its initial stage. Treatment must be done early and with broad spectrum antibiotics, aggressive surgical debridement and clinical and nutritional support measures