Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cutaneous mucormycosis is a rare entity related to kidney transplantation. It usually presents with ecthyma-like lesions and black necrotic cellulitis. We report an unusual case of primary cutaneous mucormycosis presenting as erythema-nodosum-like lesions in a woman who had received a renal transplant.</p> <p>Case presentation</p> <p>A 49-year-old woman with diabetes received a living-unrelated kidney transplant. Her clinical course was uneventful for the first six months after transplantation. She then developed multiple, painful, erythema-nodosum-like lesions on her right leg and thigh following an episode of minor trauma. Mucormycosis was diagnosed by skin biopsy. Microscopic examination also showed panniculitis. The patient was treated successfully with amphotericin B and surgical resection. To our knowledge, this is the first description of primary cutaneous mucormycosis with erythema-nodosum-like lesions and panniculitis after renal transplantation.</p> <p>Conclusion</p> <p>Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema-nodosum-like lesions with panniculitis.</p

Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

BACKGROUND: Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base. METHODS: Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS: Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available. CONCLUSIONS: The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0714-x) contains supplementary material, which is available to authorized users

Recommendations on basic requirements for intensive care units: structural and organizational aspects

OBJECTIVE: To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. METHODOLOGY: The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. RESULTS: The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. CONCLUSION: This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESIC

El campo de las ciencias y la educación superior entre el monopolio del inglés y el plurilingüismo: elementos para una política del lenguaje en América Latina

El campo de las ciencias y la educación superior constituye un espacio estratégico donde se reflejan con gran nitidez los problemas de la globalización del inglés como única lengua híper-central: De un modelo plurilingüe restringido de unas pocas lenguas, el alemán, francés e inglés que expresaban el campo científico hace un siglo, hemos transitado hacia un predominio casi absoluto del inglés. Hoy nos encontramos ante una disyuntiva crucial, con posibles consecuencias irreversibles: o transitamos de una hegemonía del inglés a un total monopolio que excluiría a todas las demás lenguas de las ciencias; o avanzamos, por el contrario, a través de un siglo XXI de renovado carácter plurilingüe que refuerce, en el campo estratégico de la ciencia y enseñanza superior, la diversidad de lenguas, estrategias discursivas y modelos culturales de hacer ciencia y educación. Desde una perspectiva latinoamericana, destacan tres razones de peso que nos deberían impulsar a oponernos al monolingüismo inglés y a reforzar el español, el portugués y otras lenguas en los espacios vitales de las ciencias: los riesgos teórico-epistemológicos de un monolingüismo para la creatividad en las ciencias; el problema de las asimetrías crecientes de poder y conocimientos entre comunidades lingüísticas de científicos con el "English only"; y las consecuencias negativas del monolingüismo anglófono para una cooperación internacional simétrica. En este texto se analizará el carácter sesgado de los estudios sobre la distribución de las lenguas en las publicaciones indexadas cuando éstas se toman como representativas del campo científico. Como alternativa propongo concebir el espacio de las ciencias y la educación superior en su conjunto, estructurado como campo sociológico y comunicacional (Bourdieu) que integra las esferas de la producción, circulación y formación, como unidad y objeto para analizar el uso real de las lenguas. Propondré finalmente elementos de un modelo plurilingüe para definir políticas integradas del lenguaje, las ciencias y la educación superior en América Latina

Bridging Virtual and Real Worlds: Enhancing Outlying Clustered Value Creations

International audienceVirtual worlds and virtual social networks provide real opportunities for companies to implement research in management dealing with immersive environment, interaction and co-creation of values (artefact, process, knowledge). New capabilities and new tools are emerging. The observations drawn from experiments allow categorizing them. We then propose an approach that could help companies to start activities inside these new environments of collaborative work. The cross fertilizing insights between the virtual and the real world are shown and introduced as the bridge. The 3D economy process is based on shorter cycles of decision making processes. The "bridge model' integrates the added value chain and goes beyond it with the creation of outlying clustered values. The bridge mechanism shows a spectrum from low potential to high potential areas - of fulfillments. A company strategy may explain a positioning on one or the other limits of the spectrum

Electrodes de platine modifiées : caractéristiques électrochimiques et comportement dans les boues activées

International audiencePolished platinum electrodes were coated with platinum black and/or with polymers (Nafion, polyurethane) to accelerate the electron transfer rate to the metal-solution interface and/or to constitute a protection barrier for the metal against neutral or anionic contaminants present in wastewater. The modified electrodes were electrochimically characterized (surface roughness and exchange current density) and their behaviour in activated sludge was studied. A platinum black deposit increases the roughness and the exchange current density. However, the response of these electrodes in an anoxic environment is very slow. A Nafion film provides a partial protection against contaminants thus increasing electrode response reproductibility. A polyurethane film has no apparent protective effect.Des électrodes de platine polies ont été recouvertes de noir de platine et/ou avec des polymères organiques (Nafion, polyuréthane) pour accélérer les vitesses de transfert d'électrons vers l'interface métal/solution et/ou pour constituer une protection pour le métal contre la présence des contaminants anioniques ou neutres dans l'eau résiduaire. On a caractérisé l'électrochimie des électrodes (rugosité de surface et densité des courants d'échange) et on a étudié leur comportement dans les boues activées. Un dépôt de noir de platine accroît la rugosité et la densité du courant d'échange ; cependant, la réponse de ces électrodes est très lente dans un environnement anoxique. Un film de Nafion procure une protection partielle contre les contaminants, augmentant ainsi la reproductibilité des réponses. Un film de polyuréthane n'a apparemment pas d'effet protecteur