Risk factors for early onset prosthetic valve endocarditis: a case-control study.

BACKGROUND: Early onset prosthetic valve endocarditis (EO-PVE) is an infrequent complication of cardiac valve surgery. It is considered a healthcare-associated infection due to contamination of the prosthesis during the implant or in the early postoperative period. AIM: To evaluate which factors may be related to the acquisition of EO-PVE. METHODS: A nested case-control study was conducted from 2006 to 2016. Cases were patients who had definite prosthetic endocarditis by the modified Duke criteria up to 12 months of heart valve replacement. Cases and controls were matched by age, gender, date and type of surgery. FINDINGS: There were 26 cases and 78 controls, in 2496 valve surgeries. The median incidence of EO-PVE was 1.1%. Risk factors identified during surgery were: use of ≥2 cryoprecipitate units (odds ratio (OR): 5.95; 95% confidence interval (CI): 1.31-27.0) and ≥2 plasma units (OR: 2.73; 95% CI: 1.0-7.5). In the postoperative period, associated factors were bloodstream infection (OR: 14.00; CI: 1.49-131.77), pneumonia (4.38; 1.21-15.84), any infection (4.46; 1.63-12.21), central line for ≥2 weeks (5.33; 2.06-13.78), presence of dialysis catheter (3.22; 1.15-9.03), and new open chest surgery (3.89; 1.28-11.78). Mortality at 12 months was 34.6% in cases and 6.4% in controls (OR: 7.73; CI: 2.3-26.06). CONCLUSION: Cases had more infections, invasive procedures and surgical re-interventions in the early postoperative period, which favoured contamination of the newly implanted prosthesis. A preventive approach, with reinforcement of infection control practices, may curb the incidence of this condition.

Production-related traits of layers reared in different sized flocks: the concept of problematic intermediate group sizes.

Laying hens were reared from 1 d of age in four replicates each of four different group sizes: 15, 30, 60, and 120 birds. To maintain stocking density at a constant 5 birds/m2, they were housed in litter floor pens of 3, 6, 12, and 24 m2, respectively. The allocation of feeder space, drinker nipples, and perch space was also constant per bird, irrespective of group size, as was the arrangement of resources in the pens. Birds were individually weighed at 3, 7, 12, 15, and 18 wk of age, and comb length and height were measured with calipers. At 24 and 39 wk, a sample of 30 eggs from each pen was weighed to determine mean egg weight. Results show a significant effect of group size on BW, with birds in the groups of 30 and 120 being lighter than birds in groups of 15 and 60. Eggs from birds in groups of 30 were significantly smaller than those from birds in the other group sizes. Comb size was unaffected by group size. We propose that these results support the theory that the hierarchical social structure based on individual recognition in small groups breaks down in large groups as birds become less aggressive and more tolerant. The results suggest that this transition occurs at a group size of around 30 birds, and that this 'intermediate' group size presents social problems for birds which, in turn, has consequences for production. The practical implication of this research is to avoid keeping birds in flocks of this size.

Palatal lymphangioma: a case report.

Lymphangioma is a rare, congenital benign tumor involving vascular malformation, with a great potential for recurrence. It appears during the early years of life and therefore is highly common among children. We report here a five-year-old patient with a simple lymphngioma. The mother of the child reported she had noted the lesion in the palate after an injury in the area with a pen. The recommended treatment was surgical excision since this was a small and well-delimited lesion. Periodic clinical controls for 18 months showed that mucosa presented normal characteristics, with no signs of recurrence.

[The transjugular intrahepatic portosystemic shunt]. / Shunt porto-sistémico intra-hepático transjugular.

The case of a 66-year-old woman with several episodes of hemorrhage by esophageal varices and ascites due to portal hypertension is presented. Despite 4 sessions of endoscopic sclerotherapy bleeding recurred. A transjugular intrahepatic portosystemic shunt was performed. In the 10 months following the intervention, there was no further hemorrhage, the ascites disappeared and the shunt is open.

[Laser therapy of inflammatory lesions of the soft parts of the locomotor system]. / Tratamento com laser das lesões inflamatórias das partes moles do aparelho locomotor.

Soft Laser has been suggested as a useful tool in the management of a large number of pathologies. The aim of this study has been to test the utility of this radiation in the treatment of some Locomotor Apparatus Soft Tissues Inflammatory Conditions. One hundred and fourteen patients with clinical data suggesting tendinitis, bursitis or enthesitis entered this study; 97 patients (Group I) were treated with Infra-Red or/and Helion-Neon Laser using a pontual and/or a scanning technique. The remaining 17 patients were considered as a comparison group (Group II). For evaluation purposes, a semi-quantitative data file was used and the pain, mobility, edema and muscular status were observed. The observation of these items was done prior, two weeks and one month after the Laser treatment. Results were classified as positive when complete or significant remission of symptoms and signs were observed, and negative when there was no improvement or a very slight regression of the complaints observed. A significant difference (p. 001) between Group I and II was found; the acute cases registered better results than the chronic ones (86.8% positive results versus 69.4%). The shoulder patients showed the worst results with only 62% positive cases. Significant differences among the different kinds of Laser applications weren't found. This study seems to confirm the Soft Laser utility in the treatment of the Locomotor Apparatus Soft Tissues Inflammatory lesions.

Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms.

The control of the massive and often fatal hemorrhage from pelvic neoplasms is a major therapeutic problem. Transcatheter embolization of the internal iliac arteries was performed in 108 patients with uncontrollable hemorrhage due to pelvic neoplasms (urinary bladder in 50, uterus in 39, ovary in 16, and prostate in three). Complete control of the hemorrhage was achieved in 74 patients, partial control in 23, and no control in 11. Seventy patients experienced postembolization syndrome (nausea, vomiting, gluteal pain, and fever due to tissue necrosis), and three had transient acute tubular necrosis caused by the contrast medium. It is important for success that the embolization be bilateral and that the embolic agent used be a permanent one.