RESUMO
In the era of a pandemic, the utilization of telemedicine is growing at a rapid speed. This new and necessary adaption in medicine is a threat to the basics of medicine which include the physical exam. A 72-year-old woman presents for a 1-week history of cervical neck discomfort. The patient was found to be febrile with initial physical exam nonrevealing due to patient preference of not taking off hospital gown. After blood cultures grew group A beta-hemolytic streptococcus and a computed tomography scan of the abdomen and pelvis with contrast demonstrated subtle bilateral renal hypodensities suggesting possible septic emboli, a more thorough physical exam was sought out which revealed a large rodent ulcer which the patient had been hiding from her family for 2 years. Transthoracic echocardiography was done which demonstrated a vegetation on the mitral valve confirming the diagnosis of endocarditis. The source of infection was the ulcer which was biopsied and found to be basal cell carcinoma. We present a unique case of endocarditis that was reliant on the physical exam to reveal the source of infection which was a rodent basal cell carcinoma ulcer. This case reminds physicians that at the forefront of telemedicine, the physical exam should not be forgotten.
RESUMO
PREMISE: The importance of chloroplast movement for plant growth in constant, controlled light and of nonphotochemical quenching (NPQ) in variable, natural light are known. Here we concurrently investigated growth and reproduction of several Arabidopsis thaliana mutants to assess the relative importance of photoprotection via chloroplast movement and NPQ. METHODS: Plants were grown outdoors (natural conditions) or in a growth chamber with variable light and chilling temperatures (controlled conditions). Phenotypic growth and reproductive variables were determined at set times before maturity in wild-type (WT) and phot1, phot2, phot1phot2 (e.g., impaired chloroplast movement, stomatal conductance, leaf flattening), chup1 (impaired chloroplast movement), and npq1 (reduced NPQ) plants. RESULTS: Mutants were most adversely affected in natural conditions, with phot1phot2 and chup1 most severely impacted. These mutants bolted later and produced fewer leaves and siliques, less leaf biomass, and fewer secondary inflorescences than WT. In controlled conditions, leaf traits of these mutants were unaffected, but phot1phot2 bolted later and produced fewer secondary inflorescences and siliques than WT. For most variables, there were significant interactions between growth conditions and plant genotype. Many variables were correlated, but those relationships changed with growth conditions and genotype. CONCLUSIONS: Phenotypic variables at the time of the harvest were strongly affected by growth conditions and genotype. In natural conditions, phot1phot2 and chup1 mutants were most adversely affected, demonstrating the importance of chloroplast movement. In controlled conditions, only phot1phot2 was consistently affected, also emphasizing the important, pleiotropic effects of phototropins. In both conditions, NPQ was less important.
