Observations and Projections of Heat Waves in South America.

Although Heat Waves (HWs) are expected to increase due to global warming, they are a regional phenomenon that demands for local analyses. In this paper, we assess four HW metrics (HW duration, HW frequency, HW amplitude, and number of HWs per season) as well as the share of extremely warm days (TX95, according to the 95th percentile) in South America (SA). Our analysis included observations as well as simulations from global and regional models. In particular, Regional Climate Models (RCMs) from the Coordinated Regional Climate Downscaling Experiment (CORDEX), and Global Climate Models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) were used to project both TX95 estimates and HW metrics according to two representative concentration pathways (RCP4.5 and RCP8.5). We found that in recent decades the share of extremely warm days has at least doubled over the period December-January-February (DJF) in northern SA; less significant increases have been observed in southern SA. We also found that by midcentury, under the RCP4.5 scenario, extremely warm DJF days (as well as the number of HWs per season) are expected to increase by 5-10 times at locations close to the Equator and in the Atacama Desert. Increases are expected to be less pronounced in southern SA. Projections under the RCP8.5 scenario are more striking, particularly in tropical areas where half or more of the days could be extremely warm by midcentury.

Multifocal pelvic osteomyelitis in a child associated with cat-scratch disease: a case report and review of the literature.

Bone infections in cat-scratch disease (CSD) are uncommon and the diagnosis can be missed. A 3-year-old boy with multifocal pelvic osteomyelitis caused by Bartonella henselae is reported. Serological tests were negative but DNA was detected by polymerase chain reaction assay of a lymph node. A swift recovery followed antibiotic treatment and there was completeresolution within a few months. The literature on 64 cases of osteomyelitis owing to CSD in children and adults since 1954 is reviewed.

Effects of soiling on photovoltaic (PV) modules in the Atacama Desert.

Soiling by dry deposition affects the power output of photovoltaic (PV) modules, especially under dry and arid conditions that favor natural atmospheric aerosols (wind-blown dust). In this paper, we report on measurements of the soiling effect on the energy yield of grid-connected crystalline silicon PV modules deployed in five cities across a north-south transect of approximately 1300 km in the Atacama Desert ranging from latitude 18°S to latitude 30°S. Energy losses were assessed by comparing side-by-side outputs of four co-planar PV modules. Two of the PV modules of the array were kept clean as a control, while we allowed the other two to naturally accumulate soiling for 12 months (from January 2017 to January 2018). We found that the combination of high deposition rates and infrequent rainfalls led to annual energy losses that peaked at 39% in the northern coastal part of the desert. In contrast, annual energy losses of 3% or less were measured at relatively high-altitude sites and also at locations in the southern part of the desert. For comparison, soiling-induced annual energy losses of about 7% were measured in Santiago, Chile (33°S), a major city with higher rainfall frequency but where urban pollution plays a significant role.

Macroglossia, the first manifestation of systemic amyloidosis associated with multiple myeloma: Case report.

Amyloidosis is a group of diseases characterized by an irreversible and extracellular deposition of fibrillar, amorphous protein known as amyloid in different organs and tissues. Amyloid deposits may occur locally in tissues or may involve various organs, resulting in a wide range of clinical manifestations. Amyloidosis of the head and neck is rarely seen and can reflect some plasma cell dyscrasia that affects B lymphocytes. Deposition of amyloid on the tongue is very rare and accounts for less than 9% of all types of amyloidosis. Amyloid involvement of the tongue is almost always secondary to systemic amyloidosis. We report a 73-year-old female who presented with weight loss and macroglossia. Firstly, she was diagnosed only with amyloidosis of the tongue. Her general health condition was evaluated, revealing renal dysfunction, anemia, hypercalcemia, and hyperphosphatemia. The final diagnosis was systemic amyloidosis with multiple myeloma. The patient was referred for emergency hemodialysis and chemotherapy. Her condition progressed to congestive heart failure and recurrent urinary and respiratory infections. After 100 days from diagnosis, the patient died by pulmonary infection as a consequence of her weakened state of health. It is important to highlight role of the dentist especially oral pathologist to the evaluation of local alterations that may reflect systemic deterioration of patients.

Ultraviolet radiation in the Atacama Desert.

The world's highest levels of surface ultraviolet (UV) irradiance have been measured in the Atacama Desert. This area is characterized by its high altitude, prevalent cloudless conditions, and a relatively low total ozone column. In this paper, we provide estimates of the surface UV (monthly UV index at noon and annual doses of UV-B and UV-A) for all sky conditions in the Atacama Desert. We found that the UV index at noon during the austral summer is expected to be greater than 11 in the whole desert. The annual UV-B (UV-A) doses were found to range from about 3.5 kWh/m2 (130 kWh/m2) in coastal areas to 5 kWh/m2 (160 kWh/m2) on the Andean plateau. Our results confirm significant interhemispherical differences. Typical annual UV-B doses in the Atacama Desert are about 40% greater than typical annual UV-B doses in northern Africa. Mostly due to seasonal changes in the ozone, the differences between the Atacama Desert and northern Africa are expected to be about 60% in the case of peak UV-B levels (i.e. the UV-B irradiances at noon close to the summer solstice in each hemisphere). Interhemispherical differences in the UV-A are significantly lower since the effect of the ozone in this part of the spectrum is minor.

Genetic signatures of variation in population size in a native fungal pathogen after the recent massive plantation of its host tree.

Historical fluctuations in forests' distribution driven by past climate changes and anthropogenic activities can have large impacts on the demographic history of pathogens that have a long co-evolution history with these host trees. Using a population genetic approach, we investigated that hypothesis by reconstructing the demographic history of Armillaria ostoyae, one of the major pathogens of the maritime pine (Pinus pinaster), in the largest monospecific pine planted forest in Europe (south-western France). Genetic structure analyses and approximate Bayesian computation approaches revealed that a single pathogen population underwent a severe reduction in effective size (12 times lower) 1080-2080 generations ago, followed by an expansion (4 times higher) during the last 4 generations. These results are consistent with the history of the maritime pine forest in the region characterized by a strong recession during the last glaciation (~19 000 years ago) and massive plantations during the second half of the nineteenth century. Results suggest that recent and intensive plantations of a host tree population have offered the opportunity for a rapid spread and adaptation of their pathogens.

[Rotavirus-Salmonella coinfection due to turtles: Two cases with exotic pets]. / Co-infection rotavirus-Salmonella lié aux tortues : à propos de 2 cas de zoonoses domestiques.

Salmonellosis is a leading cause of bacterial gastroenteritis, responsible for invasive infections especially in young children. Reptiles are salmonella reservoirs, and the indirect contact via parents' hands may be responsible for contamination. We report on two cases of Salmonella-rotavirus coinfection secondary to the presence of turtles in the home.

A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy.

AIM: The aim of this study was to compare the efficacy between stapled hemorrhoidopexy (Longo technique) and transanal hemorrhoidal artery ligation with mucopexy (THDm) in the treatment of hemorrhoidal disease. PATIENTS AND METHODS: From June 2009 to January 2011, 81 patients having grade II or III hemorrhoidal disease underwent prospective evaluation followed by surgery at two centers (27 Longo and 54 THDm). Symptoms (bleeding, tenesmus, prolapse, fecal incontinence, pain) and the satisfaction score were compared on the first post-operative day and at 1, 6, 12, and 24 months thereafter. The follow-up was 24 months. RESULTS: There was no difference in mean length of stay. One complication (recto-vaginal fistula) was observed after Longo. The prolapse score was significantly lower after THDm than after Longo on the first post-operative day (P < 0.0015). Bleeding score after THDm was significantly lower on the first post-operative day (P = 0.04), but higher thereafter (P = 0.03 and P = 0.04). Tenesmus score after THDm was significantly lower for the first three months (P < 0.06 and 0.001). On the first post-operative day and at one month, the visual analog pain score was significantly lower after THDm than that after Longo (P < 0.0003 et P < 0.01). On the first post-operative day and at one month, the satisfaction score was higher after THDm than after Longo (P < 0.001). CONCLUSION: THDm was safe and effective. Short-term outcomes after THDm were better than after Longo but long-term results seemed to be similar.

[Isolation of Geosmithia argillacea in a cystic fibrosis patient]. / Isolement de Geosmithia argillacea chez un enfant atteint de mucoviscidose.

We report the case of an 11-year-old child with cystic fibrosis where Geosmithia argillacea has been isolated from sputum. This is a filamentous fungus (mold) recently described as emergent infectious agent in cystic fibrosis patients. In our case, the presence of G. argillacea was not associated with clinical disorder. However, recent evidence shows that it can be responsible for very serious invasive infection, especially in chronic granulomatous disease and may be, after lung transplantation.

Spectral UV radiance measured at a coastal site: a case study.

We have sampled the spatial distribution of the UV radiation (i.e. the UV radiance) at a station located on the southern pacific coastline (Valparaiso, Chile, 33.03°S-71.58°W). The site is characterized by the partial horizon obstruction (due to the surrounding topography). Our spectral measurements were carried out over the period January-March 2012 and were meant to weigh up the effects of the local cloudiness, the heterogeneous albedo, and the horizon obscuration. We found that a nearly translucent overcast sky affects the radiance distribution such that from its maximum (measured close to the solar zenith angle) the radiance is monotonically decreasing towards the horizon. Under cloudless conditions, the radiance distribution becomes less isotropic with the wavelength; we detected spatial variations in the distribution of radiation up to a factor of 5 at 320 nm, and up to a factor of 9 at 400 nm. We also observed that radiances measured at points over the sea are greater than those measured at the corresponding point over the land; we partially attributed this effect to the spatial variations in the albedo. Moreover, we found that the horizon obscuration leads to significant reductions in the radiance at points on the blocked horizon; these reductions range from 60% (at 400 nm) to 80% (at 300 nm). Methodological details are provided below.

[Percutaneous drainage of infected pancreatic necrosis: an alternative to surgery]. / Drainage percutané des nécroses pancréatiques infectées: alternative à la chirurgie.

AIM OF THE STUDY: To describe a technique of percutaneous CT guided catheter drainage of infected pancreatic necrosis and to report the results of this technique compared with those of the conventional surgical treatment and of other percutaneous drainage series. PATIENTS AND METHODS: Between 1992 and 1997, the series included 32 patients who had a severe acute necrotizing pancreatitis with a mean Ranson score of 4.6, scored into grade D (n = 10), and grade E (n = 22), according to the Balthazar radiological staging. Modified Van Sonnenberg 24 F double lumen catheters were used for continuous irrigation and aspiration. RESULTS: Forty-nine drains were inserted for 41 infected necroses and eight abscesses. Among the 32 patients, the proof of infected necrosis was obtained in 26 patients by fine needle aspiration and culture (enterococcus, staphylococcus, pseudomonas). The average delay of catheter insertion was 23 days after onset of pancreatitis; the mean duration of drainage was 43 days, and an average of three catheters per patient was required. Five patients (15%) died, and among the survivors, 16 (59%) presented 21 complications including 14 enterocutaneous or pancreatic fistulas. A subsequent surgical procedure including two necrosectomies was necessary in six patients. CONCLUSION: This study demonstrates that percutaneous drainage of infected pancreatic necrosis with a 15% mortality and 70% success rate, represents an interesting alternative to conventional surgery.

[Biliary colonic ileus: an unusual cause of colonic obstruction]. / L'iléus biliaire colique: une cause rare d'occlusion colique.

We report a rare case of colonic gallstone obstruction in a patient with cholecystocolic fistula. Diagnosis of this condition is usually difficult and only achieved at surgery. We review the radiological findings, particularly the CT findings, helpful for diagnosis: ectopic gallstone, biliary gas and fistula. Early preoperative diagnosis could reduce morbidity and mortality. Treatment is surgical with enterolithotomy. There is some controversy over the need to repair the fistula.

[Late morbidity after esophagectomy for cancer: is partial esophagectomy preferred?]. / Morbidité tardive après oesophagectomie pour cancer: faut-il préférer les oesophagectomies partielles?

PURPOSE: The aim of this study is to report late postoperative complications occurring after oesophagectomy for cancer over a 12-month period and to compare the incidence of these complications according to the level of the anastomosis. PATIENTS AND METHOD: This study included 106 consecutive patients 51% with subtotal oesophagectomy (thoracic anastomosis), and 49% with total oesophagectomy (cervical anastomosis). The two groups were comparable for age, mean weight loss before surgery, life expectancy, number of positive margins, TNM grading, size and tumour differentiation. RESULTS: Late morbidity concerned 67.9% of the 106 patients. Predominant complications were dysphagia (32.1% of the 106), gastro-esophageal reflux (25.5% of the 106), and diarrhoea (18.8% of the 106). Among all the factors causing dysphagia, evaluated by logistic regression, the level of anastomosis was only found significant with a 20.4% occurrence for thoracic anastomosis and 44.2% for cervical anastomosis (P = 0.012). All the other complications were similar in the two groups. CONCLUSION: Functional results of oesophagectomy for cancer are poor. As partial oesophagectomy morbidity is lower, total oesophagectomy should not be proposed in all cases of oesophageal cancer.

[Monozygotic triplet pregnancy after transfer of frozen embryos]. / Grossesse triple monochoriale après transfert d'embryons congelés.

We report a case of monozygotic triplet pregnancy after transfer of 3 frozen thawed embryos. The pregnancy ended by the birth of 3 healthy normal boys and all the analysis showed that it was really a monochorionic triamniotic triplet pregnancy, that as far as we know is the first reported one induced by frozen thawed technics. We shall discuss: the etiology of monozygotic pregnancies after IVF; the sonographic diagnosis of placentation; the obstetrical care which allowed the birth of 3 healthy normal boys.

Monozygotic triplet pregnancy following transfer of frozen-thawed embryos.

We report a case of monozygotic triplet pregnancy after the transfer of three frozen-thawed embryos. The outcome of the pregnancy was the birth of three healthy normal boys. The pregnancy was a monochorionic triamniotic triplet pregnancy. This is the first such case of triplets, although it seems that zygote splitting is significantly more common than normal in patients undergoing in-vitro fertilization.

Prenatal diagnosis of a fetus with partial monosomy 7(q34-->qter) and partial trisomy 18(q21-->qter).

Ultrasound examination of a 31-year-old woman at 27 weeks' gestation revealed fetal growth retardation, a bilateral cleft lip and palate, and the absence of median cerebral structures. Chromosome analysis after cordocentesis showed an abnormal karyotype with a structural abnormality of the long arm of chromosome 7: 46,XX,-7,+der(7),t(7;18) (q34;q21.3)mat. The pregnancy was terminated at week 29. The ultrasound findings were confirmed by post-mortem examination, which also revealed a semilobar holoprosencephaly.

The arterial blood supply of the human fetal diaphragm.

To gain a better understanding of the development of the human diaphragm, a study of the arterial supply was made in 20 fetuses. The Micropaque injection was injected either by an ascending route in the thoracic aorta or by a descending route in the left internal carotid below the ductus arteriosus. Two studies using diaphanization have displayed the diaphragmatic anastomoses. The phrenic and the intercostal a. seemed the most important to explain the diaphragm organogenesis.

Value of systematic post mortem radiographic examinations of fetuses--400 cases.

A retrospective study of 400 cases of fetal deaths has been carried out to assess the value of systematic post mortem radiological examination. Apart from general diagnosis purpose, special attention was given to the assessment of bone age and mineralization. The results were correlated with the clinical, U.S., chromosomal and pathological data. Computerized analysis of our information show the following results: (1) The radiological examination was valuable for the final diagnosis in 13.5% of cases. (2) It brings additional information in 34.5% of cases. (3) It had no diagnostic value in 52%. Furthermore, several points deserve attention such as apparition of teeth (21 weeks), calcaneum (24 weeks). Major osteoporosis was always associated with a constitutional bone disease or an infectious process. An excessive length of the upper limbs (12) was seen in 11 cases of anencephaly. We suggest that a radiological examination should not be routinely performed, when the diagnosis is otherwise obvious, but should be considered in the presence of dwarfism, or other limb abnormalities and when the gestational age is uncertain. The films provide essential information especially for further genetic counselling. Systematic post mortem radiographic examinations are performed in all naturally aborted fetuses over 11 weeks of gestation in our institution. A retrospective study of the last 400 cases was designed in order to assess the value of this examination, with regard to overall diagnosis and assessment of bone maturation and mineralisation.