Scedosporium prolificans Septic Arthritis

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did not show sustained response to antibiotics or a radiocarpal joint steroid injection given by other providers. On initial examination, she was afebrile with dorsal wrist swelling. There was no erythema, but wrist mobility was limited. She had tenderness throughout the wrist, but no fluctuance or drainage. All initial laboratory work was normal. Right wrist X-ray showed severe osteopenia with some mild evidence of cortical erosion. Despite the normal laboratory values, her presenting findings of swelling, radiographic erosions, and immunocompromised state prompted concern for atypical septic arthritis. The patient subsequently underwent wrist exploration for tissue and culture harvest. In addition to extensive wrist synovectomy, the proximal pole of the scaphoid, lunate, triquetrum, capitate, hamate, and metacarpal bases all showed evidence of necrosis that required debridement. One week later, her fluid aspirate and bone cultures unexpectedly grew an unidentified fungal species, and she was taken back to the operating room for further debridement and placement of a voriconazole-impregnated cement spacer. The culture grew pan-resistant Scedosporium prolificans, and based on recommendations from Rheumatology and Infectious Disease, the patient was started on a 6-week course of intravenous micafungin, and immunosuppressive medications were stopped. She returned to the operating room for debridement and serial treatments with polyhexamethylene biguanide (PHMB) irrigation until intraoperative tissue cultures showed no growth. PHMB is an antiseptic medication that has been described as a local adjunct to the treatment of resistant fungal infections.2–4 After successful eradication of her infection, she underwent wrist reconstruction and fusion with a double-barrel free fibula osteocutaneous flap. She is now 18 months out from her reconstruction, has healed uneventfully, and has a functional, painless upper extremity

RACE-OC Project: Rotation and variability in the epsilon Chamaeleontis, Octans, and Argus stellar associations

We aim at determining the rotational and magnetic-related activity properties of stars at different stages of evolution. We focus our attention primarily on members of young stellar associations of known ages. Specifically, we extend our previous analysis in Paper I (Messina et al. 2010, A&A 520, A15) to 3 additional young stellar associations beyond 100 pc and with ages in the range 6-40 Myr: epsilon Chamaeleontis (~6 Myr), Octans (~20 Myr), and Argus (~40 Myr). Additional rotational data of eta Chamaeleontis and IC2391 clusters are also considered. Rotational periods were determined from photometric time-series data obtained by the All Sky Automated Survey (ASAS) and the Wide Angle Search for Planets (SuperWASP) archives. With the present study we have completed the analysis of the rotational properties of the late-type members of all known young loose associations in the solar neighborhood. Considering also the results of Paper I, we have derived the rotation periods of 241 targets: 171 confirmed, 44 likely, 26 uncertain. The period of the remaining 50 stars known to be part of loose associations still remains unknown. This rotation period catalogue, and specifically the new information presented in this paper at ~6, 20, and 40 Myr, contributes significantly to a better observational description of the angular momentum evolution of young stars.Comment: Accepted by Astronomy & Astrophysics. Onlines figures will be available at CD

Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump

The increasing use of the intra aortic balloon pump is attributed to the relatively easy percutaneous insertion and the low threshold of use over the past few years, especially in elderly patients with multi-vessel diseases and an affected ejection fraction

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Comparison of the exhaust emissions of the vehicles with gasoline and LPG engines in the actual driving conditions

Benzin motorlu taşıtların egzozundan çıkan kirleticilerin hava kirliliğini önemli ölçüde artırdığı bilinmektedir. Kirletici emisyonları azaltmak amacıyla, motorlarda LPG, doğal gaz, etanol, metanol ve hidrojen gibi petrole dayalı ya da yenilenebilir alternatif yakıtlar kullanılmaktadır. Bu çalışmada hem LPG hem de benzinle çalışan iki taşıt gerçek yol şartlarında sürülerek emisyon seviyeleri karşılaştırılmıştır. Taşıtlar rölanti, sabit hızda gitme, yokuş tırmanma ve inme durumları için test edilmiştir. Testler sonucunda LPG’li çalışmada CO ve HC emisyonlarının benzinli çalışmaya göre genel olarak daha düşük çıktığı tespit edilmiştir. Benzinli çalışmada rölanti rejimindeki HC emisyonu LPG’li çalışmaya göre daha düşüktür. Ayrıca her iki yakıtlı çalışmada da rölanti çalışmasına göre; sabit hız, yokuş tırmanma ve inme rejimlerinde emisyon değerlerinin önemli ölçüde değiştiği belirlenmiştir.It is well known that the vehicles with gasoline engine which have the pollutant emissions increase the more the air pollution. For purpose exhaust emissions decreasing, it is used oil-based or renewable alternative fuels such as LPG, natural gas, ethanol, methanol and hydrogen in the gasoline engines. In this study, two vehicles which are used both LPG and gasoline, driving in the actual road conditions, have been compared to their emissions. The vehicles were tested for idling, cruising, going downhill and uphill conditions. In the result of the tests, it was seen that CO and HC emissions became generally the more less in the work with LPG relative to the work with gasoline. HC emission in the work with gasoline became the more less in the idling condition. Moreover, according to the test results it was seen that comparing to the idling condition, emission values were changed substantially during cruising, going downhill and uphill

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit