Majocchi’s Granuloma by Trichophytum rubrum in a kidney transplant patient - A case report

Introduction: Trichophytum rubrum is a filamentous fungus, with worldwide distribution, that usually causes superficial infections of skin and nails, namely tinea pedis, tinea corporis, tinea cruris and onychomycosis. Rarely, severe dermatophytosis can occur, presenting as deep dermatophytosis, Majocchi’s Granuloma or extensive dermatophytosis. Objectives and Methods: Case report of Majocchi’s Granuloma in a kidney transplant patient. Results: A case of a 55-year-old woman who underwent a kidney transplant 7 months before, under immunosuppressive therapy with tacrolimus and mycophenolate mofetil. She attended a Dermatology consultation to clarify skin lesions that appeared 6 months earlier. The skin exam revealed hard and painful plaque lesions on both legs, with an ulcer on the left leg lesion, violaceous papular lesions on the dorsum of the left foot and toes and a hard consistency nodule on the left leg. Some of the toe nails presented dystrophy or onycholysis. The patient denied any previous trauma or contact with plants or soil. Biopsies of lesions of the left leg and foot dorsum where sent for histology and mycological culture and toe nails for mycological culture. The histological examinations showed, in the reticular dermis and reaching the hypodermis, suppurative granulomas with multinucleated giant cells and areas of necrosis. PAS (Periodic Acid- Schiff) and GMS (Grocott’s Methenamine Silver) staining revealed multiple spores and septate hypha within the granulomas but not in the stratum corneum. No remnants of hair follicles where found. Culture of skin biopsies were positive for Tricophytum rubrum but nails´ culture was negative. Identification was further confirmed by sequencing of ITS region of ribosomal DNA (GenBank accession number MK967277). Oral Itraconazole 100mg bid and topic Sertoconazole where initiated. The patient was observed one month after and reported general malaise, tiredness, exertional dyspnea, whitish stools and increased abdominal volume. The physician chose to discontinue itraconazole and initiate oral terbinafine 250mg id. After two months on oral terbinafine, there was regression of the legs´ and left foot lesions with ulcer healing and disappearance of the left leg nodule. Conclusion: Diagnosis of deeper dermatophytosis is difficult, in part because there is no specific clinical presentation and, in many cases, it is even polymorphic. However, especially in patients with immunodeficiency, this hypothesis should be weighed. Confirmation is achieved by finding hyphae compatible with dermatophytes in the dermis and a positive culture for a dermatophyte. Treatment should include systemic antifungal agents, to which topical medication may be associated. Multiple therapeutic regimens have been proposed, but randomized trials or large case series are lacking. Antifungal therapy should be continued until the lesions are completely resolved. Surgical treatment has been reported as an option for highly localized lesions.info:eu-repo/semantics/publishedVersio

Effect of inhomogeneities on the expansion rate of the Universe

While the expansion rate of a homogeneous isotropic Universe is simply proportional to the square-root of the energy density, the expansion rate of an inhomogeneous Universe also depends on the nature of the density inhomogeneities. In this paper we calculate to second order in perturbation variables the expansion rate of an inhomogeneous Universe and demonstrate corrections to the evolution of the expansion rate. While we find that the mean correction is small, the variance of the correction on the scale of the Hubble radius is sensitive to the physical significance of the unknown spectrum of density perturbations beyond the Hubble radius.Comment: 19 pages, 2 figures Version 2 includes some changes in numerical factors and corrected typos. It is the version accepted for publication in Physical review

Assessment of fungal contamination in a Portuguese maternity unit

A descriptive study was developed to monitor air fungal contamination in one Portuguese maternity. Sixty air samples were collected through impaction method. Air sampling was performed in food storage facilities, kitchen, food plating, canteen, pharmacy, sterilization areas, genecology wards, intensive care unit, operating rooms, urgency and also, outside premises, since this was the place regarded as reference. Besides air samples, forty three samples were collected by swabbing the surfaces using a 10 by 10 cm square stencil. Simultaneously, temperature, relative humidity and particles counting (PM10) were registered. Twenty three species of fungi were identified in air, being the two most commonly isolated the genera Penicillium (41,5%) and Cladosporium (28,4%). Regarding yeasts, only Rhodotorula sp. (45,2%), Trichosporon mucoides (51,6%) and Cryptococcus neoformans (3,2%) were found. Thirteen species of fungi were identified in surfaces, being the most frequent the Penicillium genus (91,6%). Concerning yeasts found in surfaces, four species were identified being Rhodotorula sp. (29,1%) the most frequent. There was no coincidence between prevailing genera indoors and outside premises. Moreover, some places presented fungal species different from the ones isolated outside. In the inside environment, Aspergillus species were isolated in air and surfaces. There was no significant relationship (p>0,05) between fungal contamination and the studied environmental variables. Keywords: air, surfaces, fungal contamination, environmental variables, maternity

O sofrimento no doente crónico

Cada vez mais a doença crónica é uma realidade revelando uma importância acrescida em termos de saúde pública pois, devido à sua irreversibilidade, tem repercussões na vida da pessoa: pessoais, socioeconómicas, psicológicas e espirituais, o que implica sem dúvida grande sofrimento. Valores humanistas altruístas devem ser a base dos profissionais que cuidam. Ajudar os profissionais de saúde à reflexão sobre o sofrimento do doente crónico, nomeadamente: ilustrar as fontes e as formas de sofrimento na doença crónica; e esclarecer quais as principais intervenções junto à pessoa em sofrimento. Revisão da literatura, tendo por finalidade identificar o estado da arte sobre a temática. Foi realizada uma pesquisa bibliográfica existente desde 2010, online, baseada em livros, Dissertações de Licenciatura, de Mestrado, de Doutoramento e artigos disponíveis, tendo utilizado as palavras-chave: doença crónica, cuidados continuados e paliativos, sofrimento na doença. Resultados: Seleção de 11 referências bibliográficas que contextualizam diretamente a temática a estudar. Segundo os vários autores, doença crónica “é uma doença de duração prolongada e progressão lenta e descreve quadros crónicos como sendo problemas de saúde que exigem tratamento continuado ao longo de um período de anos ou décadas”. Sofrimento é um “estado de desconforto severo associado a uma ameaça à integridade da sua pessoa como ser biopsicossocial, envolvendo a construção de significados profundamente pessoais, acompanhados de uma forte carga afetiva e que são passíveis de modificar esse sofrimento”. Dor e sofrimento não são a mesma coisa, podendo existir sofrimento sem dor e vice-versa. Gera reações variadas dependendo do significado atribuído à “ameaça” e do contexto em que a pessoa se encontra inserida. As Fontes de Sofrimento encontradas foram: Perda da autonomia e dependência de terceiros; Sintomas mal controlados; Alterações da imagem corporal; Perda de sentido da vida; Perda da dignidade; Perda de papéis sociais e de estatuto; Perda de regalias económicas; Alterações nas relações interpessoais; Modificação de expectativas e planos futuros e Abandono. As Formas de Sofrimento foram: Sofrimento Espiritual; Sofrimento Psicológico (Emocional ou Mental); Sofrimento Relacional (Social ou Familiar); Sofrimento Físico. As Intervenções Junto à Pessoa em Sofrimento devem incidir sobre os seguintes aspetos: Controlo dos sintomas- devendo recorrer-se tanto a medidas farmacológicas como não farmacológicas; Comunicação adequada- Escutar sem julgar e avaliar a linguagem não-verbal bem como as reações emocionais; Apoio à família- Avaliar as suas necessidades, realizando conferências familiares. É importante a sua validação dos cuidados prestados. Importa não esquecer eventuais conflitos passados e não resolvidos, não julgando estas relações; Trabalho em equipa- Intervir na dignidade e no sentido da vida

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery. a systematic review and meta-analysis

Background: Previous studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan. Methods: We performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) = 35% and/or low cardiac output syndrome (LCOS). The primary outcomes were mortality at longest follow-up and need for postoperative renal replacement therapy (RRT). Secondary postoperative outcomes investigated included myocardial injury, supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension during drug infusion. Results: Six RCTs were included in the meta-analysis, five of which investigated only patients with LVEF = 35% and one of which included predominantly patients with LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005). Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42, 0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p = 0.04). Among secondary outcomes, we found lower postoperative LCOS in patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p = 0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend toward lower mechanical support, both overall (p = 0.07) and in patients with LVEF < 35% (p= 0.05). Conclusions: Levosimendan reduces mortality in patients with preoperative severely reduced LVEF but does not affect overall mortality. Levosimendan reduces the need for RRT after high-risk cardiac surger

Testing the Frozen-Flow Approximation

We investigate the accuracy of the frozen--flow approximation (FFA), recently proposed by Matarrese \etal (1992), for following the nonlinear evolution of cosmological density fluctuations under gravitational instability. We compare a number of statistics between results of the FFA and nbody simulations, including those used by Melott, Pellman \& Shandarin (1993) to test the Zel'dovich approximation. The FFA performs reasonably well in a statistical sense, e.g. in reproducing the counts--in--cell distribution, at small scales, but it does poorly in the crosscorrelation with nbody which means it is generally not moving mass to the right place, especially in models with high small--scale power.Comment: 13 pages in TEX (plus 8 Figures but only figs 5,6,7,8 are available--and here enclosed as postscript files, due to size problems), DAPD-93-25

Evaluation of Alcohol Preference and Drinking in msP Rats Bearing a Crhr1 Promoter Polymorphism

Alcoholism is a pervasive societal problem, yet available pharmacotherapies fail to treat most sufferers. The type 1 corticotropin-releasing factor (CRF1) receptor has received much attention for its putative role in the progression to alcohol dependence, although at present its success in clinical trials has been limited. Two single-nucleotide polymorphisms in the rat Crhr1 promoter have been identified in the Marchigian substrain of Sardinian alcohol-preferring (msP) rats. Unlike other Wistar-derived alcohol-preferring lines, nondependent msP rats reduce their alcohol self-administration in response to CRF1 antagonists and show increased brain CRF1 expression. The current study tested the hypotheses that the A alleles in the Crhr1 promoter polymorphisms are: (1) unique to msP (vs. CRF1 antagonist-insensitive) alcohol-preferring lines and (2) associate with greater alcohol preference or intake. Two related polymorphisms were observed in which both loci on a given chromosome were either mutant variant (A) or wild-type (G) alleles within the distal Crhr1 promoter of 17/25 msP rats (68%), as compared to 0/23 Indiana P rats, 0/20 Sardinian alcohol-preferring rats bred at Scripps (Scr:sP) and 0/21 outbred Wistar rats. Alcohol consumption in msP rats did not differ according to the presence of Crhr1 A alleles, but greater alcohol preference (98%) was observed in A allele homozygous msP rats (AA) compared to msP rats with wild-type (GG, 91%) or heterozygous (GA, 91%) genotypes. The greater alcohol preference reflected decreased water intake, accompanied by reduced total calories consumed by AA rats. The data show that msP rats differentially possess mutant A variant alleles in the polymorphic promoter region of the Crhr1 gene that may differentially regulate consumption

Banco de estacas para multiplicação de Gliricidia sepium: uma espécie de múltiplo uso.

Avaliação do desempenho de banco de estacas de gliricidia implantado em áreas degradadas e determinação da relação entre diâmetro e comprimento das estacas com a qualidade das hastes que elas produzem visando acelerar a produção de material multiplicativo dessa espécie

On the spatial distribution of dark matter halos

We study the spatial distribution of dark matter halos in the Universe in terms of their number density contrast, related to the underlying dark matter fluctuation via a non-local and non-linear bias random field. The description of the matter dynamics is simplified by adopting the `truncated' Zel'dovich approximation to obtain both analytical results and simulated maps. The halo number density field in our maps and its probability distribution reproduce with excellent accuracy those of halos in a high-resolution N-body simulation with the same initial conditions. Our non-linear and non-local bias prescription matches the N-body halo distribution better than any Eulerian linear and local bias.Comment: 4 pages, LaTeX (uses emulateapj; included psfig.tex), 3 figures, 1 table. Shortened version, matching the size requirements of ApJ Letters. Accepted for publicatio

How our hearts beat together: a study on physiological synchronization based on a self-paced joint motor task

Cardiac physiological synchrony is regarded as an important component of social interaction due to its putative role in prosocial behaviour. Yet, the processes underlying physiological synchrony remain unclear. We aim to investigate these processes. 20 dyads (19 men, 21 women, age range 18-35) engaged in a self-paced interpersonal tapping synchronization task under different levels of tapping synchrony due to blocking of sensory communication channels. Applying wavelet transform coherence analysis, significant increases in heart rate synchronization from baseline to task execution were found with no statistically significant difference across conditions. Furthermore, the control analysis, which assessed synchrony between randomly combined dyads of participants showed no difference from the original dyads' synchrony. We showed that interindividual cardiac physiological synchrony during self-paced synchronized finger tapping resulted from a task-related stimulus equally shared by all individuals. We hypothesize that by applying mental effort to the task, individuals changed into a similar mental state, altering their cardiac regulation. This so-called psychophysiological mode provoked more uniform, less variable fluctuation patterns across all individuals leading to similar heart rate coherence independent of subsequent pairings. With this study, we provide new insights into cardiac physiological synchrony and highlight the importance of appropriate study design and control analysis