High prevalence of ST121 in community-associated methicillin-susceptible Staphylococcus aureus lineages responsible for skin and soft tissue infections in Portuguese children

In order to evaluate the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal, we analyzed a collection of 38 S. aureus isolates recovered from 30 children attending the pediatric emergency department of a central hospital in Lisbon due to skin and soft tissue infections. Molecular characterization identified seven clonal lineages among the 35 methicillin-susceptible S. aureus (MSSA) isolates, of which the major lineage PFGE A/t159/ST121 included 63% of the isolates. The three MRSA isolates belonged to the Pediatric clone PFGE D/t535/ST5-IV (n = 2) and to the European CA-MRSA clone PFGE G/t044/ST80-IVc (n = 1). All isolates harbored several virulence factors, namely, leukocidins. Panton–Valentine leukocidin (PVL) was produced by isolates from five MSSA lineages and by the ST80 MRSA. Of interest, this is the first reported isolation of CA-MRSA ST80 in Portugal.     

Effect of ceruletide on rest pain in patients with arterial insufficiency of the lower extremity

Summary The effect of ceruletide^? (CRL), a synthetic decapeptide analogue of cholecystokinin, on rest pain and arterial blood flow was evaluated in 8 patients with advanced, occlusive atherosclerosis of the lower extremities. CRL 1, 2, or 4 ng kg⁻¹ or placebo were infused intravenously in random order, and in a double-blind fashion. Pain relief, assessed by a scoring system, was significantly better (p<0.01) following the 2 and 4 ng kg⁻¹ doses of CRL (2.71 and 2.66, respectively) than following placebo (0.75). Arterial blood flow was not affected by either CRL in any dose or by placebo. Pretreatment with naloxone, a pure opioid antagonist, abolished the analgesic effect of CRL. Following the 2 ng dose of CRL, β-endorphin levels were significantly elevated from a basal value of 125±15 pg/ml to 191±35 pg/ml 5 h after CRL administration (p<0.05). Circulating levels of ACTH, prolactin and GH were not affected by CRL. It is concluded that CRL was effective in relieving ischaemic rest pain, and that the mechanism was related to the release of endogenous opioids.     

“Roman Sandal” modified method for securing the chest drain to the skin

Chest drain insertion is a simple procedure with very low morbidity and mortality. The correct procedure provides for a good fixation of the drainage to the skin. An alternative “Roman Sandal technique” for securing the chest drain to the skin is proposed compared to the classical methods. The main feature of the method is the fact that a single suture acts as “tube fixing” and “wound closure” by creating an alpha-cross-wires into and around the wound. The new method is presented as more elegant, effective, quicker application and removal of the drainage and excellent cosmetic results.     

Lobectomy for destroyed lung in quadriplegic patients

BACKGROUND: Sixty-seven percent of quadriplegic patients after spinal cord injury (SCI) develop respiratory complications, which leads to death in one third. Preventive measures may fail to avoid parenchymal destruction and possible septic complications. METHODS: Three quadriplegic patients (C3-C6 level), with destroyed lower lobes and incontrollable septic symptoms, were subjected to lobectomy. RESULTS: Neither operative morbidity nor mortality was observed. All patients were discharged home without ventilatory assistance, and were symptom-free. CONCLUSIONS: When the endobronchial chronic infection calls for repeated fiberoptic bronchoscopies to clear the bronchial tree, the parenchymal destruction is limited to one lobe of the lung, and there is evidence of impending septic complications, lobectomy may be indicated in quadriplegics to eradicate the source of infection.     

Review of future insights of Dragon's Blood in dermatology

To assess the possible clinical implication of Dragon's Blood in dermatology, a PubMed search was conducted using the keyword “Dragon's Blood,” “Croton lechleri,” and more. Dragon's Blood from C. lechleri is an Amazonian medicinal plant with a characteristic red sap. Its array of phytochemical action in preclinical studies include anti‐inflammatory, antioxidant, antimicrobial, antifungal, and antineoplastic properties. Clinical studies reflect wound healing and antiviral properties. Although its popularity is rising in western medicine, C. lechleri offers limited use in dermatology and further investigation is necessary to gain further insight into its potential clinical implication.     

Lobar hypoplasia.

Lung tissue developmental abnormalities are seldom reported. According to the classification of Schneider (1900), which was amended by Boyden (1955), they include pulmonary agenesis, aplasia and hypoplasia. Due to the early onset of symptoms, lung agenesis and aplasia are usually detected soon after birth. Conversely, lung or lobar hypoplasia may remain clinically silent for a long time. A single case of left lower lobe hypoplasia is reported. A recurring and unrelenting septic fever was the presenting symptom, whilst the radiological picture showed a left lower lobe consolidation. On the surgical specimen gross pathology revealed a lobar hypoplasia. At a short-term follow-up (nine months) the patient shows good overall condition, being free from further complications.