Origin and diversification of Xanthomonas citri subsp. citri pathotypes revealed by inclusive phylogenomic, dating, and biogeographic analyses.

BACKGROUND: Xanthomonas citri subsp. citri pathotypes cause bacterial citrus canker, being responsible for severe agricultural losses worldwide. The A pathotype has a broad host spectrum, while A* and Aw are more restricted both in hosts and in geography. Two previous phylogenomic studies led to contrasting well-supported clades for sequenced genomes of these pathotypes. No extensive biogeographical or divergence dating analytic approaches have been so far applied to available genomes. RESULTS: Based on a larger sampling of genomes than in previous studies (including six new genomes sequenced by our group, adding to a total of 95 genomes), phylogenomic analyses resulted in different resolutions, though overall indicating that A + AW is the most likely true clade. Our results suggest the high degree of recombination at some branches and the fast diversification of lineages are probable causes for this phylogenetic blurring effect. One of the genomes analyzed, X. campestris pv. durantae, was shown to be an A* strain; this strain has been reported to infect a plant of the family Verbenaceae, though there are no reports of any X. citri subsp. citri pathotypes infecting any plant outside the Citrus genus. Host reconstruction indicated the pathotype ancestor likely had plant hosts in the family Fabaceae, implying an ancient jump to the current Rutaceae hosts. Extensive dating analyses indicated that the origin of X. citri subsp. citri occurred more recently than the main phylogenetic splits of Citrus plants, suggesting dispersion rather than host-directed vicariance as the main driver of geographic expansion. An analysis of 120 pathogenic-related genes revealed pathotype-associated patterns of presence/absence. CONCLUSIONS: Our results provide novel insights into the evolutionary history of X. citri subsp. citri as well as a sound phylogenetic foundation for future evolutionary and genomic studies of its pathotypes.

Monolithic Approach for Next-Generation Aircraft Design Considering Airline Operations and Economics.

Traditional approaches to design and optimization of a new system often use a system-centric objective that does not consider how the operator will use this new system alongside other existing systems. When the new system design is incorporated into the broader group of systems, the performance of the operator-level objective can be sub-optimal due to the unmodeled interaction between the new system and the other systems. Among the few available references that describe attempts to address this disconnect, most follow an MDO-motivated sequential decomposition approach of first designing an optimal system and then providing this system to the operator who decides the best way to use this new system along with the existing systems. This paper addresses this issue by including aircraft design, airline operations, and revenue management "subspaces"; and presents an approach that could simultaneously solve these subspaces posed as a monolithic optimization problem. The monolithic approach makes the problem an expensive MINLP problem and is extremely difficult to solve. We use a recently developed optimization framework that simultaneously solves the subspaces to capture the "synergy" in the problem. The results demonstrate that simultaneously optimizing the subspaces leads to significant improvement in the fleet-level objective of the airline when compared to the previously developed sequential subspace decomposition approach. The results also showcase that maximizing revenue and minimizing operating cost independently need not lead to a maximized profit solution for the airline.

The Role of Policy and Institutions on Health Spending.

This paper investigates the impact of policies and institutions on health expenditures for a large panel of Organisation for Economic Co-operation and Development countries for the period of 2000-2010. A set of 20 policy and institutional indicators developed by the Organisation for Economic Co-operation and Development are integrated into a theoretically motivated econometric framework, alongside control variables related to demographic (dependency ratio) and non-demographic (income, prices and technology) drivers of health expenditures per capita. Although a large share of cross-country differences in public health expenditures can be explained by demographic and economic factors (around 71%), cross-country variations in policies and institutions also have a significant influence, explaining most of the remaining difference in public health spending (23%). Copyright © 2016 John Wiley & Sons, Ltd.

A Guide to Phylogenomic Inference.

Phylogenomics aims at reconstructing the evolutionary histories of organisms taking into account whole genomes or large fractions of genomes. Phylogenomics has significant applications in fields such as evolutionary biology, systematics, comparative genomics, and conservation genetics, providing valuable insights into the origins and relationships of species and contributing to our understanding of biological diversity and evolution. This chapter surveys phylogenetic concepts and methods aimed at both gene tree and species tree reconstruction while also addressing common pitfalls, providing references to relevant computer programs. A practical phylogenomic analysis example including bacterial genomes is presented at the end of the chapter.

Recurrent Plunging Ranula Due to a Sublingual Ectopic Gland: A Rare Clinical Entity.

Ranula is a benign cystic lesion caused by the escape and collection of salivary mucus. Classically, it is divided into simple ranulas, a cystic mass in the floor of the mouth, and diving/plunging/cervical ranulas, a submandibular mass without apparent intraoral involvement. Although plunging ranula is a well-documented cause of neck swelling, its association with the presence of ectopic sublingual glands is extremely rare, with less than five cases reported. Other cervical cystic lesions may have the same clinical aspect; therefore, advanced diagnostic techniques like a CT scan or MRI play a critical role in early diagnosis. Different approaches have been used to treat ranulas, including non-invasive, minimally invasive, and surgical techniques. The purpose of this paper is to highlight a case report of a giant plunging ranula due to an anatomical aberration of the right sublingual gland, along with a significant literature review.

CFD-based design optimization of ducted hydrokinetic turbines.

Hydrokinetic turbines extract kinetic energy from moving water to generate renewable electricity, thus contributing to sustainable energy production and reducing reliance on fossil fuels. It has been hypothesized that a duct can accelerate and condition the fluid flow passing the turbine blades, improving the overall energy extraction efficiency. However, no substantial evidence has been provided so far for hydrokinetic turbines. To investigate this problem, we perform a CFD-based optimization study with a blade-resolved Reynolds-averaged Navier-Stokes (RANS) solver to explore the design of a ducted hydrokinetic turbine that maximizes the efficiency of energy extraction. A gradient-based optimization approach is utilized to effectively deal with the high-dimensional design space of the blade and duct geometry, with gradients being calculated through the adjoint method. The final design is re-evaluated through higher-fidelity unsteady RANS (URANS) simulations. Our optimized ducted turbine achieves an efficiency of about 54% over a range of operating conditions, higher than the typical 46% efficiency of unducted turbines.

New insights into plant natriuretic peptide evolution: From the lysogenic conversion in Xanthomonas to the lateral transfer to the whitefly Bemisia tabaci.

Plant natriuretic peptide-like (PNP) are signaling molecules related to adaptive responses to stress. The Arabidopsis thaliana PNP (AtPNP-A) is capable of modulating catalase 2 (CAT2) and rubisco activase (RCA) activity in some circumstances. Interestingly, many plant-pathogens co-opted PNP-like molecules to their benefit. For instance, the citrus pathogen Xanthomonas citri carries a PNP-like (XacPNP) that can mimic and regulate plant homeostasis, and many phytopathogenic fungi carry effectors (e.g., Ave1 and AvrLm6) that are indeed PNP-like homologs. This work investigates the PNP-like evolution across the tree of life, revealing many parallel gains and duplications in plant and fungi kingdoms. All PNP-like proteins in the final dataset are structurally similar, containing the AtPNP-A active domains modulating CAT2 activity and RCA interaction. Comparative genomics evinced that XacPNP is a lysogenic conversion factor associated with a Myoviridae-like prophage identified in many Xanthomonas species. Surprisingly, a PNP-like homolog was identified in Bemisia tabaci, an important agricultural pest, being to date the second example of lateral gene transfer (LGT) from plant to the whitefly. Moreover, the Bemisia PNP-like homolog can also be considered a potential new effector of this phloem-feeding insect. Noteworthy, the whiteflies infest many plants carrying PNP-like copies and interact with some of their bacterial and fungal pathogens, strongly suggesting complex recipient/donor traits of PNP by LGT and bringing new insights into the evolution of host-pathogen arms race across the tree of life.

Surgical Treatment of an Exuberant Case of Penoscrotal Elephantiasis.

Lymphedema is a manifestation of lymphatic system disturbance and deranged lymph transport, with resultant swelling, a proliferation of parenchymal and stromal elements, and excess deposition of the extracellular matrix. It may occur in any part of the body, most frequently in the limbs. Staging ranges from inconspicuous lymphatic system derangement to lymphatic elephantiasis. Surgical treatment is the preferred modality. This case report is of a 36-year-old male patient with morbid obesity with a five-year-long history of penoscrotal volume increase without any apparent trigger. Patient observation revealed a frankly enlarged scrotum involving the penis, with distortion and an increase in urinary meatus diameter. The penis was palpable but hardly observable. Neither testicle was palpable. Scrotal tissue was hardened and sclerotic. We performed surgical excision of all swollen tissue while identifying and preserving the penis and both testicles. Local advancement flaps were used to create a neoscrotum. Resurfacing of the penis was accomplished with split-thickness skin grafting harvested from a small part of healthy skin included in the excised tissue and held in place during the first week with negative pressure therapy. There are no signs of local or distant relapse, and the patient mentions a dramatic improvement in urinary flow, quality of life in terms of ambulation, everyday tasks, and self-esteem. We present a very rare clinical case of exuberant penoscrotal lymphedema in a young patient with very few risk factors. Given the extent and time of presentation, microsurgery of the lymphatics was not indicated, and thus, a Charles procedure was undertaken. Even so, patient quality of life was significantly improved, and no recurrences have been reported so far.

Plasmodium falciparum Acetyl-CoA Synthetase Is Essential for Parasite Intraerythrocytic Development and Chromatin Modification.

The malaria parasite Plasmodium falciparum possesses a unique Acetyl-CoA Synthetase (PfACS), which provides acetyl moieties for different metabolic and regulatory cellular pathways. We characterized PfACS and studied its role focusing on epigenetic modifications using the var gene family as reporter genes. For this, mutant lines to modulate plasmodial ACS expression by degron-mediated protein degradation and ribozyme-induced transcript decay were created. Additionally, an inhibitor of the human Acetyl-CoA Synthetase 2 was tested for its effectiveness in interfering with PfACS. The knockdown of PfACS or its inhibition resulted in impaired parasite growth. Decreased levels of PfACS also led to differential histone acetylation patterns, altered variant gene expression, and concomitantly decreased cytoadherence of infected red blood cells containing knocked-down parasites. Further, ChIP analysis revealed the presence of PfACS in many loci in ring stage parasites, underscoring its involvement in the regulation of chromatin. Due to its central function in the plasmodial metabolism and significant differences to human ACS, PfACS is an interesting target for drug development.

Genomic Characterization of mcr-1.1-Producing Escherichia coli Recovered From Human Infections in São Paulo, Brazil.

Polymyxins are one of most important antibiotics available for multidrug-resistant Gram-negative infections. Diverse chromosomal resistance mechanisms have been described, but the polymyxin resistance phenotype is not yet completely understood. The objective of this study was to characterize colistin resistant mcr-1-producing strains isolated from human infections over one year in a hospital setting (Hospital das Clínicas, São Paulo, Brazil). We isolated 490 colistin-resistant Gram-negative rods, of which eight were mcr-1.1-positive Escherichia coli, the only species with this result, indicating a low incidence of the mcr-1 production mechanism among colistin-resistant isolates. All mcr-1.1 positive isolates showed similarly low MICs for colistin and were susceptible to most antibiotics tested. The isolates showed diversity of MLST classification. The eight mcr-1.1-positive E. coli genomes were sequenced. In seven of eight isolates the mcr-1.1 gene is located in a contig that is presumed to be a part of an IncX4 plasmid; in one isolate, it is located in a contig that is presumed to be part of an IncHI2A plasmid. Three different genomic contexts for mcr-1.1 were observed, including a genomic cassette mcr-1.1-pap2 disrupting a DUF2806 domain-containing gene in six isolates. In addition, an IS1-family transposase was found inserted next to the mcr-1.1 cassette in one isolate. An mcr-1.1-pap2 genomic cassette not disrupting any gene was identified in another isolate. Our results suggest that plasmid dissemination of hospital-resident strains took place during the study period and highlight the need for continued genomic surveillance.

Phylogenetic relationships in genus Arachis based on ITS and 5.8S rDNA sequences.

BACKGROUND: The genus Arachis comprises 80 species and it is subdivided into nine taxonomic sections (Arachis, Caulorrhizae, Erectoides, Extranervosae, Heteranthae, Procumbentes, Rhizomatosae, Trierectoides, and Triseminatae). This genus is naturally confined to South America and most of its species are native to Brazil. In order to provide a better understanding of the evolution of the genus, we reconstructed the phylogeny of 45 species using the variation observed on nucleotide sequences in internal transcribed spacer regions (ITS1 and ITS2) and 5.8 S of nuclear ribosomal DNA. RESULTS: Intraspecific variation was detected, but in general it was not enough to place accessions of the same species in different clades. Our data support the view that Arachis is a monophyletic group and suggested Heteranthae as the most primitive section of genus Arachis. The results confirmed the circumscriptions of some sections (Caulorrhizae, Extranervosae), but raised questions about others. Sections Erectoides, Trierectoides and Procumbentes were not well defined, while sections Arachis and Rhizomatosae seem to include species that could be moved to different sections. The division of section Arachis into A and B genome species was also observed in the phylogenetic tree and these two groups of species may not have a monophyletic origin. The 2n = 2x = 18 species of section Arachis (A. praecox, A. palustris and A. decora) were all placed in the same clade, indicating they are closely related to each other, and their genomes are more related to B genome than to the A genome. Data also allowed insights on the origin of tetraploid A. glabrata, suggesting rhizome appeared twice within the genus and raising questions about the placement of that species in section Rhizomatosae. CONCLUSION: The main clades established in this study in general agreed with many other studies that have used other types of evidences and sets of species, being some of them included in our study and some not. Thus, the relationships established can be a useful framework for future systematic reviews of genus Arachis and for the selection of species to pre-breeding programs.

Carcinoma of the gallbladder presenting as haemorrhagic cholecystitis.

Gallbladder carcinoma has several atypical presentations, but one of the rarest is intraluminal haemorrhage, which occurs in 1% of patients. We report a case of gallbladder cancer diagnosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst.

Analyses of Seven New Genomes of Xanthomonas citri pv. aurantifolii Strains, Causative Agents of Citrus Canker B and C, Show a Reduced Repertoire of Pathogenicity-Related Genes.

Xanthomonas citri pv. aurantifolii pathotype B (XauB) and pathotype C (XauC) are the causative agents respectively of citrus canker B and C, diseases of citrus plants related to the better-known citrus canker A, caused by Xanthomonas citri pv. citri. The study of the genomes of strains of these related bacterial species has the potential to bring new understanding to the molecular basis of citrus canker as well as their evolutionary history. Up to now only one genome sequence of XauB and only one genome sequence of XauC have been available, both in draft status. Here we present two new genome sequences of XauB (both complete) and five new genome sequences of XauC (two complete). A phylogenomic analysis of these seven genome sequences along with 24 other related Xanthomonas genomes showed that there are two distinct and well-supported major clades, the XauB and XauC clade and the Xanthomonas citri pv. citri clade. An analysis of 62 Type III Secretion System effector genes showed that there are 42 effectors with variable presence/absence or pseudogene status among the 31 genomes analyzed. A comparative analysis of secretion-system and surface-structure genes showed that the XauB and XauC genomes lack several key genes in pathogenicity-related subsystems. These subsystems, the Types I and IV Secretion Systems, and the Type IV pilus, therefore emerge as important ones in helping explain the aggressiveness of the A type of citrus canker and the apparent dominance in the field of the corresponding strain over the B and C strains.

Phylogenomics.

Phylogenomics aims at reconstructing the evolutionary histories of organisms taking into account whole genomes or large fractions of genomes. The abundance of genomic data for an enormous variety of organisms has enabled phylogenomic inference of many groups, and this has motivated the development of many computer programs implementing the associated methods. This chapter surveys phylogenetic concepts and methods aimed at both gene tree and species tree reconstruction while also addressing common pitfalls, providing references to relevant computer programs. A practical phylogenomic analysis example including bacterial genomes is presented at the end of the chapter.

The Candidatus Liberibacter-Host Interface: Insights into Pathogenesis Mechanisms and Disease Control.

"Candidatus Liberibacter" species are associated with economically devastating diseases of citrus, potato, and many other crops. The importance of these diseases as well as the proliferation of new diseases on a wider host range is likely to increase as the insects vectoring the "Ca. Liberibacter" species expand their territories worldwide. Here, we review the progress on understanding pathogenesis mechanisms of "Ca. Liberibacter" species and the control approaches for diseases they cause. We discuss the Liberibacter virulence traits, including secretion systems, putative effectors, and lipopolysaccharides (LPSs), as well as other important traits likely to contribute to disease development, e.g., flagella, prophages, and salicylic acid hydroxylase. The pathogenesis mechanisms of Liberibacters are discussed. Liberibacters secrete Sec-dependent effectors (SDEs) or other virulence factors into the phloem elements or companion cells to interfere with host targets (e.g., proteins or genes), which cause cell death, necrosis, or other phenotypes of phloem elements or companion cells, leading to localized cell responses and systemic malfunction of phloem. Receptors on the remaining organelles in the phloem, such as plastid, vacuole, mitochondrion, or endoplasmic reticulum, interact with secreted SDEs and/or other virulence factors secreted or located on the Liberibacter outer membrane to trigger cell responses. Some of the host genes or proteins targeted by SDEs or other virulence factors of Liberibacters serve as susceptibility genes that facilitate compatibility (e.g., promoting pathogen growth or suppressing immune responses) or disease development. In addition, Liberibacters trigger plant immunity response via pathogen-associated molecular patterns (PAMPs, such as lipopolysaccharides), which leads to premature cell death, callose deposition, or phloem protein accumulation, causing a localized response and/or systemic effect on phloem transportation. Physical presence of Liberibacters and their metabolic activities may disturb the function of phloem, via disrupting osmotic gradients, or the integrity of phloem conductivity. We also review disease management strategies, including promising new technologies. Citrus production in the presence of Huanglongbing is possible if the most promising management approaches are integrated. HLB management is discussed in the context of local, area-wide, and regional Huanglongbing/Asian Citrus Psyllid epidemiological zones. For zebra chip disease control, aggressive psyllid management enables potato production, although insecticide resistance is becoming an issue. Meanwhile, new technologies such as clustered regularly interspaced short palindromic repeat (CRISPR)-derived genome editing provide an unprecedented opportunity to provide long-term solutions.

O Uso de Tecnologias de Comunicação e Informação no Processo de Ensino Aprendizagem: uma Inovação diante da Pandemia / Use of communication and information technologies in the teaching and learning process: na innovation facing the pandemic / Uso de las tecnologías de la comunicación y de la información en el proceso de enseñanza y aprendizaje: una innovación ante la pandemia

O objetivo foi identificar as estratégias tecnológicas utilizadas no processo de ensino e aprendizagem pela enfermagem durante a pandemia. Esta revisão de escopo seguiu as recomendações propostas pelo Preferred Reporting Itens for Systematic Reviews and MEta-Analyses extension for Scoping Reviews (PRISMA-ScR), Como estratégia de busca para seleção dos artigos, realizou-se a varredura online nas bases de dados Biblioteca Virtual em Saúde (BVS), Health Information from the National Library of Medicine (PUBMED). Os estudos apontam a necessidade de adaptar-se às novas contingências, assim como um desafio à educação no mundo. A preocupação com a continuidade dos processos educacionais de pesquisa e extensão também se configurou como um desafio a ser trabalhado e o aprendizado virtual passou então a ser entendido como uma inovação enquanto estratégia para minimizar os danos da aprendizagem, assim como a incorporação das tecnologias de comunicação e informação. Contudo, não podemos deixar a necessidade da presença do professor que incentiva e proporciona a reflexão do aluno capaz de leva-lo ao desenvolvimento das habilidades competências e atitudes necessárias a formação do enfermeiro. (AU)

Objective: Identify the technological strategies used in the teaching and learning process by nursing during the pandemic. Methods: This scope review followed the recommendations proposed by Preferred Reporting Items for Systematic Reviews and MEta-Analyses extension for Scoping Reviews (PRISMA-ScR). in Health (BVS), Health Information from the National Library of Medicine (PUBMED). Results: Studies point to the need to adapt to new contingencies, as well as a challenge to education in the world. The concern with the continuity of educational research and extension processes was also a challenge to be worked on and virtual learning then came to be understood as an innovation as a strategy to minimize the damage of learning, as well as the incorporation of communication technologies and information. Conclusion: There is need for the presence of the teacher who encourages and provides the student's reflection capable of taking him/her to the development of skills, competences and attitudes necessary for nursing education. (AU)

Objetivo: Identificar las estrategias tecnológicas utilizadas en el proceso de enseñanza y aprendizaje por parte de la enfermería durante la pandemia. Métodos: Esta revisión del alcance siguió las recomendaciones propuestas por la extensión Preferred Reporting Items for Systematic Reviews y MEta-Analyzes para Scoping Reviews (PRISMA-ScR). In Health (BVS), Health Information de la National Library of Medicine (PUBMED). Resultados: Los estudios apuntan a la necesidad de adaptarse a nuevas contingencias, así como a un desafío para la educación en el mundo. La preocupación por la continuidad de los procesos de investigación y extensión educativa fue también un desafío a trabajar y entonces el aprendizaje virtual pasó a entenderse como una innovación como estrategia para minimizar el daño del aprendizaje, así como la incorporación de las tecnologías de la comunicación y la información. Conclusión: Es necesaria la presencia del profesor que aliente y brinde la reflexión del alumno capaz de llevarlo al desarrollo de habilidades, competencias y actitudes necesarias para la formación en enfermería. (AU)

Phylogenomics of Xanthomonas field strains infecting pepper and tomato reveals diversity in effector repertoires and identifies determinants of host specificity.

Bacterial spot disease of pepper and tomato is caused by four distinct Xanthomonas species and is a severely limiting factor on fruit yield in these crops. The genetic diversity and the type III effector repertoires of a large sampling of field strains for this disease have yet to be explored on a genomic scale, limiting our understanding of pathogen evolution in an agricultural setting. Genomes of 67 Xanthomonas euvesicatoria (Xe), Xanthomonas perforans (Xp), and Xanthomonas gardneri (Xg) strains isolated from diseased pepper and tomato fields in the southeastern and midwestern United States were sequenced in order to determine the genetic diversity in field strains. Type III effector repertoires were computationally predicted for each strain, and multiple methods of constructing phylogenies were employed to understand better the genetic relationship of strains in the collection. A division in the Xp population was detected based on core genome phylogeny, supporting a model whereby the host-range expansion of Xp field strains on pepper is due, in part, to a loss of the effector AvrBsT. Xp-host compatibility was further studied with the observation that a double deletion of AvrBsT and XopQ allows a host range expansion for Nicotiana benthamiana. Extensive sampling of field strains and an improved understanding of effector content will aid in efforts to design disease resistance strategies targeted against highly conserved core effectors.

Fístula oroantral en contexto de osteonecrosis maxilar y mandibular por bifosfonatos. Caso clínico / Oroantral fistula in maxillary and jaw osteonecrosis by bisphosphonates. Case report / Fístulao roantral em contexto de osteonecrose maxilar e mandibular por bifosfonatos. Caso clínico

La fístula oroantral es una comunicación patológica entre la cavidad oral y el seno maxilar. Están descritas varia causas, entre ellas la osteonecrosis maxilar y mandibular por bifosfonatos, descrita por primera vez en 2003. Este medicamento ha sido ampliamente utilizado y con gran eficacia en el tratamiento de diversas neoplasias con metástatización ósea, especialmente en el cáncer de mama, en el que la supervivencia ha aumentado considerablemente. Presentamos el caso paradigmático de una mujer de 58 años con historia de neoplasia maligna de mama y metátasis óseas, tratada con quimioterapia endovenosa asociada a bifosfonatos, que desarrolló osteonecrosis maxilar y mandibular en el contexto de una extracción dentaria y que desarrolló una fístula oroantral. Esto nos recuerda este importante factor de riesgo, considerando que dada la supervivencia actual entre la población con cáncer de mama, la prevalencia de la fístula oroantral irá en aumento

Oroantral fistula is a pathological communication between the oral cavity and the maxillary sinus. There are several causes, being the maxillary and jaw osteonecrosis by intravenous bisphosponates an important cause which was reportedby the first time in 2003. The bisphosphonates have been used with good results in treatment of several cancers and in bone metastases, especially in breast cancer, where the survival rate has increased in the recent years. We report a representative case of a 58-year-old female with previous history of breast cancer and bone metastases. She had been treated with chemotherapy and intravenous bisphosphonates and had developed maxillary and jaw osteonecrosis. After that, she underwent surgery with extraction of first molar and acquired an oroantral fistula. The present case reminds us of an important risk factor for oroantral fistula in patients treated with intravenous bisphosphonates. Thus, due to the increasing survival rate in breast cancer patients, the oroantral fistula prevalence is going to increase exponentially

A fístula oroantral é uma comunicação patológica A entre a cavidade oral e o seio maxilar. Estão descritas várias causas, sendo que a osteonecrose maxilar e mandibular por bifosfonatos foi descrita pela primeira vez em 2003. Esta terapêutica tem sido largamente utilizada e com grande eficácia no tratamento de várias neoplasias com metastização óssea, em especial no cancro da mama, onde a sobrevida tem aumentado consideravelmente. Os autores reportam um caso paradigmático de uma mulher de 58 anos de idade com história de neoplasia maligna da mama e metastização óssea, tendo efectuado quimioterapia associada a bifosfonatos por via endovenosa. A doente desenvolveu posteriormente osteonecrose maxilar e mandibular e, em contexto de extracção dentária, condicionou fístula oroantral. O caso apresentado relembra um importante factor de risco para o desenvolvimento de fístula oroantral nos doentes em quimioterapia associada a bifosfonatos. Devido ao aumento da sobrevida da população com cancro da mama, a prevalência de fístula oroantral irá aunmentar exponencialmente

Bathing waters: new directive, new standards, new quality approach.

Bathing water quality is an important public health issue, mainly because of fecal contamination. In 2006, the European Commission (EC) adopted a new directive with respect to recreational bathing waters that calls for stricter standards and reduces the number of laboratory tests done in routine beach monitoring from nineteen to two bacterial indicators, namely, Escherichia coli and intestinal enterococci, replacing policies of the EC Bathing Water Directive that have existed since 1976. Our practice in Portugal is in line with this international development, and this study demonstrates the equivalency of the new bacteriological parameters with the old. The water quality of 25 coastal beaches was surveyed using both new and old microbiological indicators of fecal contamination. Statistical analysis demonstrated equivalency of the results obtained for fecal coliforms with Escherichia coli and for fecal streptococci with intestinal enterococci.