Systemic Phaeohyphomycosis in a Dog Caused by Cladophialophora bantiana

Background: Cladophialophora bantiana is a dematiaceous fungus that causes phaeohyphomycosis, a generic term used to describe a variety of unusual mycoses caused by fungi that have melanin in their cell wall. C. bantiana targets the central nervous system, commonly causing localized brain infections that may result in disseminated infections. In Brazil, minimal phaeohyphomycosis data are available, and information about C. bantiana infections in animals, especially canines, is scarce. Thus, the aim of this study was to describe the clinical and pathological aspects of systemic phaeohyphomycosis caused by C. bantiana in a dog.Case: A 1-year-old female Pit Bull presented with weight loss, reduced appetite, and a history of cutaneous lesions on the right thoracic limb; however, clinical evolution was not reported. The dog had reportedly given birth recently. Physical examination revealed thinness, pale ocular and oral mucosa, submandibular lymph nodes, and enlarged popliteal lymph nodes. The animal died after convulsive crises during hospitalization. At necropsy, white-yellowish multifocal nodules were observed in the liver and right kidney. The brain featured left cerebral hemisphere asymmetry with blood vessel congestion in the leptomeninges and an irregular brownish focal area on the surface of the right occipital cortex. Cross-sections of the formalin-fixed brain exhibited compression of the left lateral ventricle and the presence of grayish and friable multifocal areas in the gray matter of the left parietal and right occipital cortices. Fragments of the lesions were collected for histopathological and microbiological examination. Histologically, the lesions were similar, characterized by hepatitis, nephritis, and granulomatous and necrotizing meningoencephalitis, multifocal to coalescing, accentuated, chronic, and associated with numerous pigmented fungi. Fontana-Masson–stained fungi exhibited a strong black color. In cleared and unstained histological slides, brownish pigmentation was observed in the cytoplasm and walls of the fungi. C. bantiana was identified via microbiological cultivation.Discussion: A diagnosis of phaeohyphomycosis caused by C. bantiana was made based on the characteristic morphology of the microscopic lesions and confirmed via isolation in microbiological culture. As numerous species cause phaeohyphomycosis, specific confirmation of the etiologic agent using several diagnostic techniques is necessary. In histopathological examinations, pigmented fungal organisms are easily seen among lesions. However, in some cases, the pigment is not apparent in the tissues. FM staining is necessary to demonstrate the presence of the melanin in fungi. As in most phaeohyphomycosis cases, it was not possible to determine the primary portal of entry. However, the lesion on the right thoracic limb probably favored the penetration of the agent. In addition to cerebral lesions, severe lesions in the hepatic and renal parenchyma were observed, which are characteristic of systemic mycosis. Infection and clinical diseases are usually associated with immunocompromised; here, the gestation period may have had an immunosuppressive effect, favoring the proliferation and dissemination of the agent. It was concluded that phaeohyphomycosis caused by C. bantiana produced severe systemic lesions in the brain and organs of the abdominal cavity. Although uncommon, phaeohyphomycosis caused by Cladophialophora bantiana should be included as a differential diagnosis for other canine diseases that present with similar clinical symptoms.Keywords: canine, fungal diseases, dematiaceous fungi, Cladosporium trichoides, Xylohypha bantiana, melanin, Fontana-Masso

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Non-flat audiograms in sensorineural hearing loss and speech perception

OBJECTIVE: The audibility thresholds for the sound frequency of 137 upward- and downward-sloping audiograms showing sensorineural hearing loss were selected and analyzed in conjunction with speech recognition thresholds obtained from individuals seen at a public otolaryngology clinic to determine which frequencies in slope audiograms best represent speech recognition thresholds. METHOD: The linear regression model and mean square error were used to determine the associations between the threshold values. RESULT: The mean square error identified larger errors when using thresholds of 500, 1000, and 2000 Hz than when using audibility thresholds of 500, 1000, 2000, and 4000 Hz. The linear regression model showed a higher correlation (91%) between the audiogram thresholds for frequencies of 500, 1000, 2000, and 4000 Hz than for the frequencies of 500, 1000, and 2000 Hz (88%). CONCLUSION: Frequencies of 500, 1000, 2000, and 4000 Hz were the most significant in predicting the speech recognition threshold

Uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais

The maxillofacial prosthetic rehabilitation aims of individuals with craniofacial deformities resulting from trauma, congenital malformations or tumors. Many researches have been done to improve the stability and retention of dentures in patients. With the advent of osseointegration, the maxillofacial prosthesis suffered a major advance making possible the realization of prosthetic works with stability, aesthetic quality and predictable results. This paper reviews the literature regarding the use of zygomatic implants in the fixation of maxillofacial prostheses.A prótese bucomaxilofacial tem como objetivo a reabilitação de indivíduos com deformidades craniofaciais, decorrentes de traumatismos, más formações congênitas ou tumores. Muitas pesquisas foram realizadas para melhorar a estabilidade e retenção das próteses em pacientes mutilados. Com o advento da osseointegração, a prótese bucomaxilofacial sofreu um grande avanço tornando possível a realização de trabalhos protéticos com estabilidade, qualidade estética e resultados previsíveis. Esse trabalho faz uma revisão de literatura a respeito do uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais

Systemic Phaeohyphomycosis in a Dog Caused by Cladophialophora bantiana

Background: Cladophialophora bantiana is a dematiaceous fungus that causes phaeohyphomycosis, a generic term used to describe a variety of unusual mycoses caused by fungi that have melanin in their cell wall. C. bantiana targets the central nervous system, commonly causing localized brain infections that may result in disseminated infections. In Brazil, minimal phaeohyphomycosis data are available, and information about C. bantiana infections in animals, especially canines, is scarce. Thus, the aim of this study was to describe the clinical and pathological aspects of systemic phaeohyphomycosis caused by C. bantiana in a dog.Case: A 1-year-old female Pit Bull presented with weight loss, reduced appetite, and a history of cutaneous lesions on the right thoracic limb; however, clinical evolution was not reported. The dog had reportedly given birth recently. Physical examination revealed thinness, pale ocular and oral mucosa, submandibular lymph nodes, and enlarged popliteal lymph nodes. The animal died after convulsive crises during hospitalization. At necropsy, white-yellowish multifocal nodules were observed in the liver and right kidney. The brain featured left cerebral hemisphere asymmetry with blood vessel congestion in the leptomeninges and an irregular brownish focal area on the surface of the right occipital cortex. Cross-sections of the formalin-fixed brain exhibited compression of the left lateral ventricle and the presence of grayish and friable multifocal areas in the gray matter of the left parietal and right occipital cortices. Fragments of the lesions were collected for histopathological and microbiological examination. Histologically, the lesions were similar, characterized by hepatitis, nephritis, and granulomatous and necrotizing meningoencephalitis, multifocal to coalescing, accentuated, chronic, and associated with numerous pigmented fungi. Fontana-Masson–stained fungi exhibited a strong black color. In cleared and unstained histological slides, brownish pigmentation was observed in the cytoplasm and walls of the fungi. C. bantiana was identified via microbiological cultivation.Discussion: A diagnosis of phaeohyphomycosis caused by C. bantiana was made based on the characteristic morphology of the microscopic lesions and confirmed via isolation in microbiological culture. As numerous species cause phaeohyphomycosis, specific confirmation of the etiologic agent using several diagnostic techniques is necessary. In histopathological examinations, pigmented fungal organisms are easily seen among lesions. However, in some cases, the pigment is not apparent in the tissues. FM staining is necessary to demonstrate the presence of the melanin in fungi. As in most phaeohyphomycosis cases, it was not possible to determine the primary portal of entry. However, the lesion on the right thoracic limb probably favored the penetration of the agent. In addition to cerebral lesions, severe lesions in the hepatic and renal parenchyma were observed, which are characteristic of systemic mycosis. Infection and clinical diseases are usually associated with immunocompromised; here, the gestation period may have had an immunosuppressive effect, favoring the proliferation and dissemination of the agent. It was concluded that phaeohyphomycosis caused by C. bantiana produced severe systemic lesions in the brain and organs of the abdominal cavity. Although uncommon, phaeohyphomycosis caused by Cladophialophora bantiana should be included as a differential diagnosis for other canine diseases that present with similar clinical symptoms.Keywords: canine, fungal diseases, dematiaceous fungi, Cladosporium trichoides, Xylohypha bantiana, melanin, Fontana-Masso

Ano VII, número 14

Espaço e Economia: Revista Brasileira de Geografia Econômica dedica sua 14ª Edição à publicização da primeira parte dos artigos apresentados no III Colóquio Espaço e Economia: Transformações no capitalismo mundial e a produção social do espaço: novos arranjos territoriais e a economia política do desenvolvimento, realizado na Universidade do Estado do Rio de Janeiro, entre os dias 10 e 12 de junho de 2019