Are we bound to our scores? a 74-year-old patient with an abbreviated burn severity index of 14.

We report a case of a 74-year-old female patient who was involved in a car accident. The patient suffered deep dermal and full thickness burns and the probability of survival calculated with the Abbreviated Burn Severity Index (ABSI) was extremely low. The patient showed sufficient cardiorespiratory and renal function for the entire treatment period. An epifascial necrosectomy of all four limbs was performed on day three after admission. Wound coverage was performed using the MEEK technique and split skin grafts. The patient was bedded in a FluidAir bed, which enabled the burn wounds on the back to dry and heal in large part. After four surgical procedures and four months of treatment at the burn ICU, the patient was sufficiently mobilized for transfer to a hospital in her home region. The aim of the following case report is to demonstrate that burn patients with very low chances of survival can be treated successfully.

Nous rapportons le cas d'une patiente de 74 ans victime d'un accident de voiture. Elle souffrait de brûlures intermédiaires et profondes et ses chances de survie, selon le score ABSI, étaient extrêmement faibles. Elle a présenté des signes d'insuffisance cardiaque et rénale durant toute son hospitalisation. Une avulsion au niveau des 4 membres a été réalisée à J3. La couverture cutanée a été réalisée par greffes expansées et technique de Meek. Elle a été installée sur un lit fluidisé, ce qui a permis la guérison d'une bonne partie des brûlures postérieures. Elle a pu sortir de l'unité spécialisée de soins intensifs au bout de 4 mois, ayant subi 4 interventions chirurgicale. Elle a alors été transférée dans l'hôpital de sa région. Ce cas clinique a pour but de montrer que même des patients au pronostic très sombre peuvent survivre.

Sepsis caused by multidrug-resistant klebsiella pneumoniae infection in a 23-year-old burn patient: case report and literature review.

Septic complications are a major problem in burn care. Infections caused by multidrug-resistant (MDR) Klebsiella pneumoniae strains represent a growing threat. In particular, Romania has seen rapidly increasing rates of MDR Klebsiella pneumoniae isolates in recent years. The PubMed database was searched with the terms 'Klebsiella pneumoniae', 'multiple drug resistant', 'enterobacteria', 'infection', 'sepsis or septicaemia or blood stream infection', 'surveillance', 'diagnose', 'burn', 'intensive care unit' and 'Romania or Europe'. In addition, the case of a burn patient who suffered from sepsis caused by MDR Klebsiella pneumoniae and who was treated at our burn intensive care unit (ICU) was reviewed. The 23-year-old male was initially treated in Romania, but after 48 hours he was transferred to our burn ICU. Initially, the treatment course was appropriate and sufficient wound healing was achieved by day 27. However, the patient's condition deteriorated rapidly on day 28 and blood culture analysis showed growth of MDR Klebsiella pneumoniae. Despite intensive medical therapy, the patient died as a result of multiple organ failure (MOF) on day 44. Sepsis caused by MDR Klebsiella pneumoniae represents an enormous therapeutic challenge. Burn patients who are transferred from Southeast Europe would likely benefit from an intensified screening for MDR pathogens.

Les accidents septiques sont une préoccupation majeure en brûlologie. Celles dues à Klebsiella pneumoniæ multirésistante (KP-BMR) sont en augmentation, particulièrement rapide ces dernières années en Roumanie. Nous avons effectué une recherche PubMed avec les critères « Klebsiella pneumoniæ ¼, « multirésistant ¼, « entérobactérie ¼, infection ¼, « sepsis ¼, septicémie ¼, « surveillance ¼, « diagnostic ¼, « brûlure ¼, « unité de soins intensifs ¼, « Roumanie ¼, « Europe ¼, à la suite du cas d'un patient de 23 ans, transféré dans notre service en provenance de Roumanie, à sa 48ème heure d'hospitalisation. La couverture cutanée était terminée à J27. Á J28, son état s'est rapidement dégradé et les hémocultures sont revenues positives à KP-BMR. Le patient est décédé à J44, dans un tableau de défaillance multiviscérale. Les infections à KP-BMR représentent un formidable défi. Les patients en provenance d'Europe du Sud-Est devraient bénéficier d'un screening bactériologique à la recherche de BMR.

Coriandrum sativum grown under organic or chemical fertilizer effectively prevents DNA damage: Preliminary phytochemical screening, flavonoid content, ESI (-) FT-ICR MS, in vitro antioxidant and in vivo (mice bone marrow) antimutagenic activity against cyclophosphamide

Objective: To evaluate the influence of fertilization and phenological stages on secondary metabolites production and chemoprotective effects of Coriandrum sativum (C. sativum) L.Methods: The plants were grown under organic or chemical fertilizer, collected at vegetative and flowering development stages and their hydroalcoholic extracts were analyzed by phytochemicals methods, mass spectrometry, antioxidant and antimutagenic assays. Results:All extracts exhibited metabolites such as coumarins, flavonoids and steroids, and mass spectrometry showed similar molecular peaks among the extracts evaluated, suggesting the presence of palmitic and α-linolenic acids. Vegetative C. sativum extract grown under chemical fertilizer showed better antioxidant activity, according to the DPPH assay. Vegetative C. sativum extracts grown under organic and chemical fertilizer were able to effectively reduce micronucleous frequency in the simultaneous and pre-treatment protocols, especially reaching 55.90％ of damage reduction in the pre-treatment protocol. Conclusions: These findings suggest that chemical fertilization promotes an increase in the content of flavonoids in C.sativum and, consequently, leads to better antioxidant and antimutagenic activities, as well as reinforces the potential uses of this culinary plant in health promotion and disease prevention.

Comparison between primary sex ratio in spermatozoa of bulls and secondary sex ratio in the deriving offspring.

The objectives of the present work were to compare the primary sex ratio in sperm with the secondary sex ratio recorded in the offspring produced by artificial insemination (AI) with the same sperm and assess whether the primary sex ratio is influenced by sperm survival and motility after thawing. Calving data of 98 Holstein Friesian bulls used in AI were collected during 4 years, and commercial semen of the same bulls was analyzed immediately after thawing and after swim-up using a real-time polymerase chain reaction method developed and validated in our laboratory. Calving data relative to single bulls did not reveal any significant deviation between genders from the theoretical 1:1 for none of the bulls, being the mean values of male and female calves born 52.1 ± 2.80% and 47.9 ± 2.71%, respectively. Thereafter, calving events of bulls were classified and analyzed according to four classes of years: 2009 (n = 13,261), 2010 (n = 21,551), 2011 (n = 24,218), and 2012 (n = 41,726), and seasons categorized as winter, spring, summer, and fall. When data aggregated per years were analyzed, the difference between the two sexes was significant (P < 0.005) in favor of the male gender, whereas no influence of the season was evidenced. Real-time polymerase chain reaction did not evidence any difference between the mean values of frequency of Y chromosome-bearing sperm detected in three sperm batches of the same bulls analyzed immediately after thawing (51.1 ± 2.1), nor a difference with respect to the theoretical 1:1 ratio was reported after sperm analysis of one batch of sperm of the bulls analyzed after swim-up and immediately after thawing (50.1 ± 2.1 and 49.8 ± 1.8, respectively). The results are consistent with the observation of the farmers who often report a skewed sex ratio of the calves being born with AI in favor of the male gender. However, we have not evidenced differences in the primary sex ratio with respect to the theoretical 1:1 ratio both at thawing and after swim-up, thus demonstrating that the freezing procedure itself does not impact selectively on the survival of the X or Y chromosome-bearing sperm. Therefore, we hypothesize that the difference between genders observed after AI is more likely due to the events occurring after fertilization, which can comprise an impaired function of the X- or Y-bearing sperm with consequences on embryo development or a maternal influence.

Minimum number of spermatozoa per dose in Mediterranean Italian buffalo (Bubalus bubalis) using sexed frozen semen and conventional artificial insemination.

In buffaloes, AI with sexed semen is not fully optimized, and the procedure has only been performed using the approach currently in use for cattle. The objective of the present work was to compare the pregnancy rates in Mediterranean Italian buffalo cows inseminated with sexed frozen-thawed semen at 2, 4, 6, and 8 million sperm per dose, using the Ovsynch protocol and conventional AI at a fixed time. Fresh ejaculates from three buffalo bulls were processed according to Beltsville sperm sorting technology, and packaged in 0.25-mL straws with two total concentrations of 2 and 4 million live sorted sperm per straw. After thawing, semen was evaluated for total motility, forward motility, average path velocity, membrane and DNA integrity, and membrane fluidity. Sorting efficiency was estimated using a real time polymerase chain reaction method developed and validated in our laboratory. The artificial inseminations were conducted during the breeding season on 849 Italian Mediterranean buffalo heifers and cows distributed in 13 farms in northern and central Italy. No significant difference in quality parameters was reported between nonsexed and sexed straws produced with 2 and 4 million sperm. Lower pregnancy rate (P < 0.001) was reported when inseminating doses of sexed semen at 2 million were used (53/170; 31.2%), with respect to conventional nonsexed (78/142; 54.9%), and sexed doses at 4, 6, and 8 million spermatozoa (102/205, 49.8%; 84/175, 48.0%; and 74/157, 47.1%, respectively). No differences were evident using conventional doses and sexed semen with sperm numbers equal or higher than 4 million per dose. Pregnancies were not affected by the sire; 39/82 (47.6%), 120/270 (44.4%), and 151/355 (42.5%), respectively, for the three bulls. Variability in pregnancy rates observed in different herds was not significant. Furthermore, no significant difference was reported between pregnancies obtained with sexed semen in heifers and multiparous, respectively, 179/407 (44.0%) and 131/300 (43.7%). The results of the present work indicate that in Mediterranean Italian buffalo the dose of 4 million represents an optimal compromise when using sexed semen with conventional technologies of insemination, together with estrus synchronization, and the minimum number of spermatozoa per dose. In addition, the real time polymerase chain reaction method was optimized and is now available for estimating sorting efficiency in buffalo.

Comparação entre a citologia em base líquida e a citologia esfoliativa convencional no diagnóstico de carcinomas da região de cabeça e pescoço / Comparison between liquid-based cytology and conventional exfoliative cytology in the diagnosis of head and neck carcinomas

Objetivo: Comparar a citologia esfoliativa em base líquida em relação à citologia convencional no diagnóstico de carcinomas da região de cabeça e pescoço. Método: Cento e duas lâminas obtidas de 19 indivíduos portadores de neoplasias malignas foram examinadas. As amostras foram divididas em três grupos: grupo 1 - esfregaços de carcinomas da região de cabeça e pescoço obtidos pela citologia em base líquida; grupo 2 (controle) - amostras de citologia em base líquida provenientes de tecido sadio (região anatômica oposta) e grupo 3 - esfregaços de carcinomas da região de cabeça e pescoço obtidos pela citologia esfoliativa convencional. Os esfregaços foram processados em laboratório e avaliados por meio da microscopia de luz. Os dados foram submetidos aos testes do Qui-quadrado (X2), Análise de Variância (ANOVA) e Teste de Tukey-Kramer (P<0,05). Resultados: Houve uma diferença significativa entre os grupos em relação às alterações celulares sugestivas de malignidade (p<0,05). As lâminas preparadas por meio da citologia em base líquida evidenciaram melhores as células neoplásicas. As células epiteliais encontraram-se mais dissociadas e a amostra foi mais representativa. Houve uma redução de 54,6% no número de amostras insatisfatórias e um ganho de sensibilidade de 53% ao se utilizar a citologia em base líquida. Esta técnica permitiu a obtenção de esfregaços mais homogêneos e lâminas de melhor qualidade proporcionando uma redução no número de amostras insatisfatórias e um aumento de sensibilidade do exame. Conclusão: A citologia esfoliativa em base líquida pode ser indicada como um recurso auxiliar no diagnóstico de lesões bucais, principalmente nos casos de neoplasias malignas de natureza epitelial.

Objective: To compare the liquid-based cytology and conventional exfoliative cytology in the diagnosis of head and neck carcinomas. Methods: One hundred and two slides obtained from 19 individual with malignant neoplasias were examined. The samples were divided into 3 groups: group 1 - head and neck carcinoma smears obtained by liquid-based cytology; group 2 (control) - liquid-based cytology samples obtained from healthy tissue (opposed anatomic region), and group 3 - head and neck carcinoma smears obtained by conventional exfoliative cytology. The smears were processed in laboratory and evaluated by light microscopy. Data were subjected to the chi-square (X2), ANOVA and Tukey-Kramer test (p<0.05). Results: There was statistically significant difference (p<0.05) among the groups for the cellular alterations suggestive of malignancy. The slides prepared by liquid-based cytology permitted better visualization of the neoplastic cells. The epithelial cells were more dissociated and the sample was more representative. The number of unsatisfactory samples decreased by 54.6% and the sensitivity increased by 53% when liquid-based cytology was used. This technique permitted obtaining more homogeneous smears and slides with better quality, reducing the number of unsatisfactory samples and increasing the sensitivity of the exam. Conclusion: Liquid-based cytology can be indicated as an auxiliary resource in the diagnosis of oral lesions, especially in the cases of malignant neoplasias of epithelial origin.