Clinically amyopathic dermatomyositis associated with cutaneous ulcerations: a case-based review.

Introduction and importance: Dermatomyositis (DM) is an autoimmune myopathy primarily affecting both muscles and skin. When muscle weakness is not clinically apparent, but characteristic skin lesions are present, the condition is referred to as clinically amyopathic dermatomyositis (CADM). Case presentation: The authors present the case of a 52-year-old female with a typical DM rash, interstitial pneumonia, and multiple skin ulcers. The skin biopsy was consistent with DM, and there were no signs of muscle involvement. Myositis-related and myositis-specific autoantibodies were also negative. Significant improvement was not observed until the patient received successive monthly pulses of methylprednisolone and the introduction of methotrexate. This treatment regimen allowed for the complete tapering of prednisone and resulted in sustained disease control. Clinical discussion: In addition to the case presentation, a narrative literature review was conducted using the MEDLINE database, and an evidence-based treatment flowchart is proposed. CADM is a subtype of DM, related to higher incidences of interstitial lung disease, skin vasculopathy and malignancy. When ulcers or interstitial pneumonia are present, treatment should be early and aggressive. Active screening for neoplasms is recommended, particularly within the first 5 years. Conclusion: The authors presented a case of seronegative CADM featuring skin vasculopathy, successfully treated with consecutive methylprednisolone pulses. Our literature review emphasized the importance of focused CADM management trials, highlighting the need for further research.

High-Level Multidrug-Resistant Escherichia coli Isolates from Wild Birds in a Large Urban Environment.

Intensive clinical use of antibiotics together with inadequate sanitation in an urban environment may contribute to the dissemination of multidrug-resistant (MDR) bacteria in the community. Wild birds living in these areas may become colonized with such organisms and further disseminate these resistant bacteria. In this study, we examined Escherichia coli isolates from the intestine of wild birds in Rio de Janeiro, Brazil, for those expressing extended-spectrum beta-lactamase (ESBL), carbapenemase, and other drug resistances. We obtained 353 E. coli isolates from 112 birds admitted to three wildlife centers in Rio de Janeiro state, from July 2010 to December 2013. MDR isolates were found in 43 (38%) birds, including 14 carrying E. coli isolates that expressed ESBL. All ESBL-encoding genes were blaCTX-M type, and no carbapenemase-producing isolates were found. MDR isolates belonged to a variety of lineages. Multilocus sequence type clonal complexes 648 and 155 accounted for carriage in 9 (21%) of 43 birds with MDR isolates. The study birds were nonmigratory, and the bacteria obtained from them likely mirrored urban circulating genotypes. Altogether, these findings indicate a high level of environmental contamination with clinically relevant drug resistance genes in Rio de Janeiro. A large proportion of the MDR strains belonged to clonal lineages.

Age and input effects in the acquisition of mood in Heritage Portuguese.

The present study analyzes the effect of age and amount of input in the acquisition of European Portuguese as a heritage language. An elicited production task centred on mood choice in complement clauses was applied to a group of fifty bilingual children (six- to sixteen-year-olds) who are acquiring Portuguese as a minority language in a German dominant environment. The results show a significant effect of the age at testing and the amount of input in the acquisition of the subjunctive. In general, acquisition is delayed with respect to monolinguals, even though higher convergence with the monolingual grammar is observed after twelve years of age. Results also reveal that children with more exposure to the heritage language at home show faster acquisition than children from mixed households: the eight- to nine-year-old age boundary seems relevant for those speakers with more exposure, and the twelve- to thirteen-year-old age boundary for those with less exposure.

Haemophilus influenzae serotype b and a capsule-deficient type mutant (b-) invasive disease in a partially vaccinated child in Brazil.

We report a rare case of infection by two different types of Haemophilus influenzae strains in a child who received only one dose of the H. influenzae serotype b (Hib) conjugate vaccine (DTwP+Hib). The strains were recovered from blood and cerebrospinal fluid (CSF) and were phenotypically identified as Hib and non-typable H. influenzae, respectively, after serological tests. The two strains were characterized by PCR capsular typing, multilocus sequence typing and PFGE. Our results suggest that the infection was caused by the bloodstream invasion by a single Hib strain, followed by the diffusion of the bacteria across the blood-brain barrier and into the CSF. The strain recovered from the CSF, however, was identified as a capsule-deficient type mutant (b(-)) strain. Despite the high efficacy of the Hib conjugate vaccine, the increase in the numbers of strains able to escape the immune system of the vaccinated population advocates continued surveillance.