Rapidly lethal dermatomyositis associated with cutaneous lymphangitis carcinomatosa

A 70-year-old woman with a recent diagnosis of dermatomyositis (DM) presented to the dermatology department for study of a probably paraneoplastic syndrome. On examination, we observed discrete, indurated, reddish, painful plaques and nodules on her abdomen and both thighs. A cutaneous biopsy from an abdominal nodule, performed as part of the paraneoplastic workup, was suggestive of cutaneous lymphangitis carcinomatosa, secondary to unknown malignancy. An extensive investigation to locate the site of the primary tumour revealed no specific findings. A course of palliative chemotherapy with cisplatin and 5-fluorouracil was then given, but the patient's condition deteriorated and 6 months after her initial observation the patient died. We describe this case because, to our knowledge, the association between DM and cutaneous lymphangitis carcinomatosa has not been described yet in the literature and to highlight that, DM can be a rapidly lethal disease

Kikuchi´s disease of the xanthomathous type with cutaneous manifestation

Kikuchi's disease is a benign, self-limiting disease, whose pathogenesis remains unknown. Patients most often present with cervical lymphadenopathy, sometimes associated with fever and leukopenia. It has been reported that up to 40% of patients with Kikuchi's disease have also cutaneous eruptions, but no specific skin changes have been described. Kikuchi's disease can be subclassified into three histologic subtypes: a proliferative type, a necrotizing type and a xantomathous type. Most patients with Kikuchi's disease require no specific treatment, because the disease regresses spontaneously, within a few weeks to months. We report a case of a 31-year-old woman with xanthomatous type of Kikuchi's disease, whose first manifestation was the onset of erythematous papules with central suppuration on her face and on her left hand

Election turnout statistics in many countries: similarities, differences, and a diffusive field model for decision-making

We study in details the turnout rate statistics for 77 elections in 11 different countries. We show that the empirical results established in a previous paper for French elections appear to hold much more generally. We find in particular that the spatial correlation of turnout rates decay logarithmically with distance in all cases. This result is quantitatively reproduced by a decision model that assumes that each voter makes his mind as a result of three influence terms: one totally idiosyncratic component, one city-specific term with short-ranged fluctuations in space, and one long-ranged correlated field which propagates diffusively in space. A detailed analysis reveals several interesting features: for example, different countries have different degrees of local heterogeneities and seem to be characterized by a different propensity for individuals to conform to the cultural norm. We furthermore find clear signs of herding (i.e. strongly correlated decisions at the individual level) in some countries, but not in others.Comment: 15 pages, 9 figures, 7 table

Intravenous immunoglobulin in dermatology – clinical experience in Hospital de Braga

Introdução: Nos últimos anos tem aumentado a experiência clínica com o uso de Imunoglobulinas Endovenosas (IgEv) em Dermatologia. Apesar da informação limitada na literatura, a utilização off-label das IgEv tem demonstrado eficácia na terapêutica de várias dermatoses refratárias aos tratamentos convencionais. Material e métodos: Efetuou-se um estudo retrospetivo dos doentes com patologia dermatológica tratados com IgEv entre Janeiro de 2004 e Outubro de 2011 no Serviço de Dermatologia do Hospital de Braga. Foram analisadas as características demográficas e clínicas, as terapêuticas efetuadas, a resposta clínica e o perfil de segurança. Resultados: Foram tratados 21 doentes com IgEv em 10 diferentes patologias dermatológicas: quatro doentes com Pênfigo Vulgar [2 com resposta completa (RC), um com resposta parcial (RP) e outro que interrompeu o tratamento por efeito lateral grave]; dois doentes com Penfigóide Bolhoso (um com RC e outro com RP); três doentes com Necrólise Epidérmica Tóxica (NET) com RC; dois doentes com Dermatomiosite (ambos com RP); quatro doentes com Urticária Crónica (um com RC, um com RP, um que não respondeu e outro que suspendeu o tratamento por efeito lateral); dois doentes com Vasculopatia Livedóide com RP; um doente com Síndrome CREST que não melhorou; um doente com Escleromixedema com RP; um doente com Pioderma Gangrenoso com RC e uma doente com Dermite Atópica que interrompeu o tratamento na sequência de gravidez. Com excepção dos 3 doentes com NET, em todos os outros a doença havia sido refratária aos tratamentos sistémicos convencionais. Conclusões: Apesar de a nossa experiência ser limitada, o tratamento com IgEv pode ser benéfico em determinadas patologias que não melhoram com o tratamento clássico. Atendendo ao seu custo elevado e efeito terapêutico variável, o seu uso deve ser criterioso até que mais estudos definam a relação risco-benefício

Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil.

Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications

Characterization and Evaluation of Layered Bi2WO6 Nanosheets as a New Antibacterial Agent

Background: Pathogenic microorganisms are causing increasing cases of mortality and morbidity, along with alarming rates of ineffectiveness as a result of acquired antimicrobial resistance. Bi2WO6 showed good potential to be used as an antibacterial substance when exposed to visible light. This study demonstrates for the first time the dimension-dependent antibacterial activity of layered Bi2WO6 nanosheets. Materials and methods: The synthesized layered Bi2WO6 nanosheets were prepared by the hydrothermal method and characterized by powder X-ray diffraction (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), and Raman and Fourier transform infrared spectroscopy (FTIR). Antibacterial and antibiotic-modulation activities were performed in triplicate by the microdilution method associated with visible light irradiation (LEDs). Results: Bi2WO6 nanosheets were effective against all types of bacteria tested, with MIC values of 256 µg/mL against Escherichia coli standard and resistant strains, and 256 µg/mL and 32 µg/mL against Staphylococcus aureus standard and resistant strains, respectively. Two-dimensional (2D) Bi2WO6 nanosheets showed antibacterial efficiency against both strains studied without the presence of light. Conclusions: Layered Bi2WO6 nanosheets revealed dimension-dependent antibacterial activity of the Bi2WO6 system.The authors thank Conselho Nacional de Desenvolvimento Científico e Tecnológico— CNPq, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES, and Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico—FUNCAP (Proc. BP4-00172-00232.01.00/20 and Proc. PR2-0101-00006.01.00/15) for the financial support. The authors would also like to thank the educational institutions UFCA, URCA, and UNILEÃO for their support during the experiments

Outbreak of acute gastroenteritis in an air force base in Western Greece

BACKGROUND: On the 20(th )September 2005, soldiers and staff at the Air Force base in Western Greece experienced an outbreak of acute gastroenteritis. The purpose of this study was to identify the agent and the source of the outbreak in order to develop control measures and to avoid similar outbreaks in the future. METHODS: A case-control analytical approach was employed with 100 randomly selected cases and 66 controls. Patients completed standardized questionnaires, odds ratios were calculated and statistical significance was determined using χ(2 )test. In addition, to identify the source of the infection, we performed bacteriological examination of food samples (included raw beef, cooked minced meat, grated cheese and grated cheese in sealed package) collected from the cuisine of the military unit. RESULTS: More than 600 out of the 1,050 individuals who ate lunch that day, became ill. The overall attack rate, as the military doctor of the unit estimated it, was at least 60%. The overall odds ratio of gastroenteritis among those who had lunch was 370 (95% CI: 48–7700) as compared to those who didn't eat lunch. Among the symptoms the most prominent were watery diarrhoea (96%) and abdominal pain (73%). The mean incubation period was 9 h and the median duration of the symptoms was 21 h. In the bacteriological examination, Staphylococcus aureus was detected in a sample of raw beef (2,000 cfu per g) and in two samples of grated cheese; leftover cheese from lunch (7,800 cfu per g) and an unopened package purchased from the market (3,000 cfu per g). CONCLUSION: The findings of this study suggest that the aetiological agent of this outbreak was S. aureus. The food vehicle was the grated cheese, which was mixed with the beef and served for lunch in the military unit. This outbreak highlights the capacity of enterotoxin-producing bacteria to cause short term, moderately-severe illness in a young and healthy population. It underscores the need for proper food handling practices and reinforces the public health importance of timely notification of such outbreaks

Impacts of climate change on plant diseases – opinions and trends

There has been a remarkable scientific output on the topic of how climate change is likely to affect plant diseases in the coming decades. This review addresses the need for review of this burgeoning literature by summarizing opinions of previous reviews and trends in recent studies on the impacts of climate change on plant health. Sudden Oak Death is used as an introductory case study: Californian forests could become even more susceptible to this emerging plant disease, if spring precipitations will be accompanied by warmer temperatures, although climate shifts may also affect the current synchronicity between host cambium activity and pathogen colonization rate. A summary of observed and predicted climate changes, as well as of direct effects of climate change on pathosystems, is provided. Prediction and management of climate change effects on plant health are complicated by indirect effects and the interactions with global change drivers. Uncertainty in models of plant disease development under climate change calls for a diversity of management strategies, from more participatory approaches to interdisciplinary science. Involvement of stakeholders and scientists from outside plant pathology shows the importance of trade-offs, for example in the land-sharing vs. sparing debate. Further research is needed on climate change and plant health in mountain, boreal, Mediterranean and tropical regions, with multiple climate change factors and scenarios (including our responses to it, e.g. the assisted migration of plants), in relation to endophytes, viruses and mycorrhiza, using long-term and large-scale datasets and considering various plant disease control methods