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ABSTRACT This study aimed to determine the prevalence of Eimeria spp., including the recently described Eimeria species Eimeria lata, Eimeria nagambie, and Eimeria zaria, on commercial broiler chicken farms (CBCFs) in the western region of the state of Santa Catarina, and to correlate their prevalence with the anticoccidial programs. Ninety-six fecal samples corresponding to 96 commercial broiler farms were examined by microscopic screening and genus-specific PCR (ITS-1 gene). All positive samples were subjected to genus-specific nested PCR (18S rRNA gene), followed by next-generation sequencing to identify the Eimeria species, and new Eimeria operational taxonomic units. Eimeria spp. were identified in 80.2% (77/96) of the samples. Next-generation sequencing revealed the following order of prevalence: Eimeria acervulina (70/77; 90.9%), Eimeria maxima (65/77; 84.4%), Eimeria mitis/mivati (17/77; 22.1%), and Eimeria praecox (37/77; 48.1%). Eimeria spp. were identified on 100% (62/62) and 44% (15/34) of the CBCFs employing treatment with salinomycin and nicarbazin, respectively. In conclusion, we observed a greater prevalence of Eimeria acervulina and Eimeria maxima; a lower prevalence of Eimeria mitis and Eimeria praecox; and the absence of Eimeria brunetti, Eimeria lata, Eimeria nagambie, Eimeria necatrix/tenella, and Eimeria zaria. There was lower positivity for Eimeria spp. on CBCFs employing treatment with nicarbazin.

Introdução: O número de pacientes elegíveis para transplante de células-tronco hematopoéticas tem aumentado devido aos avanços na seleção de doadores. A incompatibilidade ABO não é contraindicada, entretanto os pacientes recebem transfusão no período pós transplante, sendo necessário um protocolo de transfusão. Objetivo: Analisar o histórico imuno-hematológico e transfusional de paciente pós TMO com incompatibilidade ABO/RhD afim determinar a necessidade de revisão do Protocolo de Atendimento Transfusional a Pacientes Transplantados com Incompatibilidade ABO/RhD. Relato de caso: Paciente masculino, 51 anos, diagnóstico SMD, Grupo Sanguíneo O+, Pesquisa de Anticorpo Irregular negativo e Teste de Antiglobulina Direto positivo, candidato à transplante alogênico com incompatibilidade maior (DMO GS A RhD Negativo). Titulação de anti-A do paciente igual a 1024. Após a primeira plasmaférese título 512 e 128 pós a segunda. Apresentou PAI positivo (anti-K) antes da infusão do TMO. Em D+68 apresentou GS O+, anti-A 512 e em D+103 título de 64. Em D+166 foi observada discrepância entre as provas direta e reversa, título de anti-A igual a 1, PAI, AC e TAD negativos. Metodologia: Determinação de GS, PAI, TAD e IAI pré e pós transplante pela metodologia de gel centrifugação. Busca do histórico Imuno-hematológico e transfusional do paciente em sistema informatizado do Serviço de Hemoterapia. Resultado: Histórico de Estudo Imuno-hematológico: GS O+ do dia D0 até o dia D+103. Título de anti-A igual a 512 em D+68 e título 64 em D+103. Discrepância ABO e Rh em D+166. Histórico Transfusional: Transfundidos 04 Concentrados de hemácias e 25 Plasmas frescos antes do TMO. Do dia D+1 até o dia D+166 foram transfundidos 35 CH, 39 Concentrados de plaquetas por aférese e 27 Pool de concentrados de plaquetas. Todos os componentes transfundidos na fase pré transplante respeitaram o GS do receptor (O+). Dos componentes transfundidos na fase pós, 89% de CH, 51% de CPAF e 82% de PCP também eram GS ABO pré TMO. Discussão: A incompatibilidade ABO e/ou RhD pode causar hemólise das células vermelhas do DMO ao serem infundidas, pode ocorrer falha ou atraso no enxerto de eritrócitos, hemólise de células vermelhas do paciente a partir de infusão de plasma do doador, hemólise de hemácias do paciente devido aos linfócitos passageiros derivados de aglutininas, hemólise devido à formação de anticorpo. O manual técnico da AABB descreve as fases pré e pós transplante para auxiliar o suporte transfusional de pacientes com transplante ABO incompatível. Na Fase I o paciente é preparado para o transplante, a Fase II é o início da terapia mieloablativa até o paciente apresentar TAD negativo, isoaglutininas anti-doador indetectáveis na prova reversa da tipagem ABO, e o GS do paciente estar consistente com o GS do doador. A Fase III consiste na tipagem direta e reversa igual ao GS doador. As fases indicadas constam no Protocolo de Atendimento Transfusional a Pacientes Transplantados com Incompatibilidade ABO/RhD do Serviço de Hemoterapia do INCA. Conclusão: Os componentes eritrocitários e plasmáticos foram em sua maioria adequados à tipagem realizada no momento da solicitação transfusional, evidenciando a necessidade de avaliação da fase atual do transplante. O estudo demonstra a necessidade de reformulação do Protocolo de Atendimento Transfusional a Pacientes Transplantados com Incompatibilidade ABO/RhD do Serviço de Hemoterapia do INCA com informações mais criteriosas das fases do transplante e constante avaliação da incompatibilidade ABO do dia D0 até a determinação completa do GS ABO/Rh, a fim de que sejam oferecidos hemocomponentes compatíveis com a fase pós transplante.

Introdução: A técnica de monocamada de monócitos (Monocyte Monolayer Assay – MMA) é um ensaio celular funcional in vitro, capaz de prever a sobrevivência in vivo das hemácias transfundidas. É um teste utilizado para diferenciação entre anticorpos clinicamente significantes e não significantes, principalmente em pacientes complexos, para os quais não são encontrados hemocomponentes com provas de compatibilidade negativas. Objetivos: Analisar a relação entre os resultados dos testes de MMA, títulos e subclasses dos anticorpos envolvidos e o desfecho transfusional em pacientes complexos atendidos no Laboratório de Imuno-hematologia de Pacientes da Fundação Hemocentro de Brasília (LIHP-FHB). Materiais e métodos: As amostras dos pacientes foram coletadas nas agências transfusionais do DF e encaminhadas para os testes no LIHP-FHB. A monocamada dos monócitos foi obtida a partir de doadores saudáveis do sexo masculino (O RhD positivo), seguindo as etapas de isolamento (buffy-coat), separação (Ficoll) e cultivo (meio RPMI). A preparação das lâminas incluiu as fases de: aderência monocítica, adsorção do soro do paciente com as hemácias dos doadores, incubações, lavagens e coloração com Leishman. Os controles positivos (Control Cell, Immucor) e negativos (hemácias do doador) foram realizados nas mesmas condições. O Índice Monocitário (MI) foi calculado a partir da análise por microscopia óptica das hemácias fagocitadas ou aderidas, sendo considerados os resultados de MI ≤5%, 5,1%–20% e >20%, como baixo, moderado e alto risco de hemólise pós-transfusional, respectivamente. Foram realizados testes sorológicos em cartão gel-teste (Bio-Rad) para determinação da classe (IgG, IgM, IgA), subclasse (IgG1 e IgG3) e título dos anticorpos. Resultados: Foram avaliados 6 pacientes (13 a 51 anos), sendo 3 (50%) com múltiplos aloanticorpos e autoanticorpos, 2 (33,3%) com autoanticorpos e 1 (16,7%) com múltiplos aloanticorpos, autoanticorpos e anticorpos raros (anti-Hr, -hrs). Desses, 5 (83,3%) apresentavam anemia falciforme e 1 (16,7%) apresentava IRC e infecção por COVID-19. Metade dos pacientes apresentavam anticorpos IgG1 ou IgG3 com baixo risco hemolítico e a outra metade IgG1 ou IgG3 com alto risco. Foram testados 33 concentrados de hemácias (CHs) por meio do teste de MMA, sendo 8 (24,2%) com MI ≤5%, 20 (60,7%) com MI entre 5,1%–20% e 5 (15,1%) com MI >20%. Quatro pacientes receberam transfusões de CHs fenótipo-compatíveis para os sistemas Rh, Kell, Kidd, Duffy e MNS (MIs: 0%, 2%, 6% e 8%). Apenas o CH com MI de 8% resultou em redução dos índices de Hb (8,3 para 7,7 g/dL) e Ht (25 para 23,9%), após 1 hora da transfusão. Os demais CHs transfundidos promoveram incremento nos níveis de Hb e Ht, tanto após 1 hora (0,73 a 2,0 g/dL e 2,4 a 5,8%, respectivamente), quanto após 14 dias (0,8 a 1,2 g/dL e 2,9 a 4,2%, respectivamente). Discussão e conclusão: Nossos resultados revelaram que mais de 75% dos CHs testados apresentaram moderado ou alto risco de hemólise pós-transfusional. Das quatro unidades de CHs transfundidos, três (MIs: 0%, 2%, 6%) promoverem incremento e uma (MI: 8%) declínio, nos níveis de hemoglobina e hematócrito, indicando uma possível associação entre os índices de fagocitose e o risco de hemólise. Não foi evidenciado associação entre os resultados do MMA e as subclasses e títulos dos anticorpos. Apesar do pequeno número de amostras, nossos resultados revelam que o MMA pode ser uma importante ferramenta nas decisões transfusionais em pacientes complexos.

Objetivos: Identificar as principais limitações encontradas no tratamento com CAR T- cells em doenças hemato-oncológicas. Material e métodos: Trata-se de uma análise sistemática, com busca na plataforma PubMed, onde foram utilizados os descritores (car t cell OR car-t cell) AND hematology, com restrição de 5 anos. Foram encontrados 1.190 artigos, dos quais, a partir de restrições para melhor adaptação ao tema, foram selecionados 145. Resultados: A maioria dos estudos considera a síndrome de liberação de citocinas (CRS) como a toxicidade mais presente no tratamento. O quadro clínico se inicia nos primeiros dias após a infusão e os sintomas vão desde gripe leve até febre alta, hipóxia e hipotensão chegando a eventos neurológicos. Outras pesquisas defendem a neurotoxicidade como o acometimento mais visto na prática de pesquisa, porém menos compreendido. Além disso, outros efeitos adversos foram levantados, como aplasia de células B em curto ou longo prazo, a síndrome de lise tumoral e, de forma mais rara, a doença do enxerto contra hospedeiro (GVHD). Discussão: A CRS advém da múltipla sinalização intracelular, correlacionada com a atividade antitumoral, o que acaba induzindo a liberação excessiva de citocinas, como IL-1, IL-2 L-6 e TNF-α. A análise pode ser feita em tempo real pelo uso da PCR e funciona como um marcador laboratorial do início e intensidade da CRS. Foi percebido que sua gravidade é diretamente relacionada à carga da doença no momento da infusão, pois pacientes que apresentam uma alta carga tumoral experimentam uma versão mais violenta da síndrome. Apesar de a fisiopatologia causadora dos efeitos neurotóxicos ser desconhecida, é provável que níveis elevados de citocinas possam ser responsáveis pelas sequelas neurológicas. Dessa forma, esse efeito seria uma consequência da CRS e não, propriamente, um efeito adverso separado. Por outro lado, a toxicidade direta pelo tratamento com CAR-T no sistema nervoso central também é possível, levando em consideração que a barreira hematoencefálica é permeável às células utilizadas na terapia. Até o momento, a neurotoxicidade tem sido reversível na maioria dos casos. A aplasia de células B é outro efeito adverso frequentemente relatado no tratamento com CAR-T cell. A principal diferença entre a de curto e a de longo prazo é que a primeira pode não necessitar de tratamento, enquanto a de longo prazo pode mitigar reposição mensal de imunoglobulinas, além de se fazer necessário o acompanhamento estendido para posterior avaliação dos efeitos, especialmente quando a terapia celular é aplicada em crianças. A hipogamaglobinemia é o principal achado dessa toxicidade, porém os níveis tendem a se recuperar conforme decresce o número de células CAR-T, o que faz com que essa aplasia sirva como um biomarcador da função contínua da terapia celular. A destruição maciça de células tumorais e consequente liberação do seu conteúdo no espaço extracelular caracteriza a síndrome de lise tumoral. Uma vez circulantes, os metabólitos provenientes da lise podem interferir nos mecanismos homeostáticos. Estas alterações provocam a ocorrência de diversas manifestações clínicas, incluindo lesão renal aguda, convulsões, podendo levar até a morte súbita. Conclusão: As toxicidades apresentadas demonstram que apesar de promissor, o tratamento com car-t cell necessita melhorias. Compreender as principais dificuldades no sucesso da terapia é o primeiro passo para torná-la cada vez mais real dentro da prática clínica.

Aim: Identify in literature the graft versus host disease (GVHD) incidence after autologous hematopoietic stem cell transplantation (HSCT). Materials and methods: We searched the PubMed database using a broad search strategy to identify studies related to GVHD complication after autologous stem cell transplant. The primary search was conducted using the terms: “GVHD in autologous transplant”, and publication date less than 5 years. 91 free full articles were identified, but 7 were better related to the purpose of the study. Results: Two articles present cases of gastrointestinal tract (GIT) GVHD in recipients of autologous HSCT. Two patients with multiple myeloma had GVHD and the clinical and endoscopic presentations were distinct. Another patient developed severe acute GVHD 93 days post autologous HSCT for Hodgkin's lymphoma. PET and CT findings included characteristic patterns of bowel inflammation with bowel wall thickening, mural stratification, and enhancement with high FDG-uptake of the involved regions, as well as typical extra intestinal findings such as ascites, engorgement of the vasa recti and stranding of the mesenteric fat. A case report of membranous nephropathy succeeding autologous HSCT described that this is a rarely entity (3% post-autologous vs . 97% post-allogeneic HSCT). In autologous HSCT populations, there have been reports of associated glomerular disease, because of any type of immune dysregulation. Based on literature, 6% of all patients with glomerulonephritis after HCT had received Autologous transplants. And the last case report presents a 4-year-old girl with metastatic neuroblastoma who spontaneously developed AGVHD after autologous HSCT. One article said the risk of GVHD in an autologous transplant is zero and the last one related the skin cancer with the delayed immune recovery and persistent immunodeficiency in GVHD. Discussion: GVHD following stem cell transplantation (SCT) is a common complication in patients that have undergone allogenic SCT but rare in recipients of autologous SCT. With the emergence of autologous HSCT, GVHD and its complications were expected to be eliminated. However, autologous GVHD has been described in some patients, and your prophylaxis mainly consists of post-transplant administration of immunosuppressive drugs and may impair the post-transplant immunologic reconstitution. After the sixth month, immune recovery occurs progressively towards complete recovery, but GVHD may develop. In chronic case, patients with only liver and skin involvement have a better prognosis. Patients with extensive involvement of multiple organs the prognosis may be poor. Recent studies have indicated that two major factors are necessary for the induction of autologous GVHD: the first factor was a disruption of thymic-dependent immune reconstitution and the second one was a failure to reestablish peripheral self-tolerance. On another hand, autologous GVHD has been thought of as an autoimmune syndrome and a milder form of GVHD than its counterpart in allogeneic transplantation, the presence of autoantibodies in relation to the HSCT provides evidence for the involvement of the B cell. Conclusion: The difficulty of finding articles related to the study shows GVHD in autologous HSCT is an uncommon entity, but although this fact, these cases are important to further the understanding of the various presentation of this manifestation and be awake to the possibilities of differential diagnoses.

Introdução: A Doença de Gaucher (DG) resulta de uma mutação rara, de padrão autossômico recessivo, do gene que codifica a enzima beta-glicosidase ácida (GBA), levando a uma alteração funcional ou conformacional da mesma. A deficiência de GBA impede a correta degradação do glicolipídeo glicocerebrosídeo, que, em excesso, passa a se acumular no interior de macrófagos do sistema reticuloendotelial. Os macrófagos ricos em glicocerebrosídeo são denominados “células de Gaucher”. Sua deposição no fígado e no baço provoca hepatoesplenomegalia e dor abdominal. Quando concentrados na medula óssea, causam anemia ou pancitopenia, fraqueza, osteopenia e lesões ósseas, podendo levar a fraturas patológicas. O quadro clínico desempenha um importante papel na suspeição da DG, cuja confirmação se baseia na constatação de uma atividade diminuída de GBA (< 1.14 mcmol/L/h) e, em alguns casos, de um aumento de quitotriosidase (> 44 nmol/mL/h) em amostra de sangue periférico. Materiais e métodos: Trabalho realizado através da análise de prontuário do Hemocentro Unicamp. Relato de caso: YAR, 19 anos, masculino, é encaminhado ao Ambulatório de Hematologia - UNICAMP por queixa de fraqueza, dor óssea generalizada e anemia detectada em consulta externa. Refere que, há 4 anos, apresentou aumento do volume abdominal, seguido de emagrecimento de 4 quilos em um período de 2 meses. Em fevereiro de 2021, foi internado em outro serviço por queixa de dor abdominal e submetido à ultrassonografia de abdome, que evidenciou um aumento difuso do volume hepático (lobo direito: 190mm) e esplênico (228 × 99 × 140mm). Diante da história clínica do paciente e dos achados ao exame de imagem, a hipótese diagnóstica de DG foi aventada. No momento da consulta, o paciente encontrava-se em bom estado geral, lúcido, orientado em tempo e espaço e hipocorado (++/++++). Ao exame físico, constatou-se baço palpável a 9cm do rebordo costal. O hemograma trazido à consulta apresentava: hemoglobina 10.7 g/dL; hematócrito 34.2%; volume corpuscular médio 73fL; hemoglobina corpuscular média 24.7 pg; leucócitos 2,160/μL; linfócitos 840μL; neutrófilos 1,080 μL; e plaquetas 85,000/μL. Para a confirmação de DG, solicitou-se a dosagem da atividade de GBA e quitotriosidase em amostra de sangue periférico, que revelou os seguintes valores: GBA 0.13 mcmol/L/h e quitotriosidase 807 nmol/mL/h. Assim, foi estabelecido o diagnóstico de DG. Discussão e conclusões: O caso descrito retrata um quadro clínico típico e uma conduta médica adequada frente à investigação de DG. Além disso, evidencia como o processo de suspeição da doença é longo, visto que sua confirmação ocorreu 4 anos após o início do primeiro sintoma. O diagnóstico precoce é fundamental para evitar complicações relacionadas à doença não tratada, como atraso no crescimento e na puberdade, osteonecrose, fraturas ósseas e aumento do risco de desenvolvimento de neoplasias hematológicas. No entanto, a DG é uma patologia subdiagnosticada devido à sua baixa incidência (1:40,000), sua sintomatologia pouco específica e ao desconhecimento, por parte tanto da população geral como de profissionais da saúde, em relação à doença em questão. Por isso, é fundamental que os sintomas clássicos e os métodos diagnósticos da DG sejam amplamente divulgados, a fim de possibilitar o diagnóstico precoce de casos suspeitos e reduzir as complicações associadas à doença.

Background: Methicillin resistant Staphylococcus aureushas emerged as one of the most important nosocomial pathogens. It invokes a tremendous financial burden and enhanced morbidity and mortality due to difficult to treat systemic infections.Aim of this study was to determine antibiotic susceptibility pattern of Staphylococcus aureus and Methicillin resistant Staphylococcus aureus. Materials and Methods: Different clinical specimens were collected and processed for routine culture and antibiotic sensitivity test by standard microbiology techniques. Results: Out of 1173 samples received for microbiological examination, 100 were found to be S. aureus with 19% cases were Methicillin resistant Staphylococcus aureus (MRSA). Fourteen MRSA were found from inpatient and 5 were from outpatient. MRSA was found higher in female than male and maximum number (31.5%) was found in age group 0-10 years. Staphylococcus aureus was 100% sensitive to Vancomycin followed by Amikacin (90%), Gentamycin (83%), and tetracycline (81%). On urine isolates Nitrofurantoin(91.6%) was drug of choice. All the isolates were resistant to Penicillin G. In case of Methicillin resistant Staphylococcus aureus showed 100% sensitive to Vancomycin followed by Amikacin (84.2%), Tetracycline (63.1%), Ciprofloxacin (42%) and Gentamycin (36.8%). Among urine isolates Nitrofutantoin showed 87.5% sensitive followed by Norfloxacin (75%). Conclusion: Methicillin resistant Staphylococcus aureus was found 19% of Staphylococcus aureus isolates. It was most common in females, hospitalized patients and young age group. Vancomycin seems to be drug of choice followed by Amikacin. It would be helpful to formulating and monitoring the antibiotic policy and ensure proper empiric treatment. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10297 Journal of Pathology of Nepal (2014) Vol. 4, 548-551

This case describes the use of percutaneous mechanical thrombectomy to remove caval tumor thrombus in a 55-year-old male with renal cell carcinoma, using the Inari CloTriever system. The procedure was fast, safe, and effective, with complete tumor thrombus removal and no complications. This case demonstrates the expanding indications for large-bore thrombectomy devices offering minimally invasive options in place of high-risk open interventions.

In Nepal, we started regular open-heart surgery since February 1997. Primary tumors of the heart are rare and the commonest is myxoma. Left atrium is the commonest site of occurrence. There is diagnostic difficulty in this most frequent benign tumor of the heart. We present 5 cases of left atrial myxomas who presented with different clinical features. Among them 4 cases were diagnosed preoperatively by transthoracic echocardiography. The youngest was 32 years whereas the oldest was 58 years (mean 49.8 years) and 4 of them were female. Among them, one presented with right unilobar pulmonary venous hypertension; another mimicking mitral stenosis with large left atrial clot; with embolization to brain with motor the third aphasia and the remaining two had only constitutional symptoms. All of them were discharged with successful removal of tumor and are surviving at present with no features of recurrence. There are no pathognomic features of atrial myxoma. All suspected cases must be subjected for echocardiography. With the advent of open-heart surgery, extirpation of tumors with good outcome has been a regular service in our hospital. Key Words: Atrial myxoma, Transthoracic Echocardiography, Embolization, Recurrence.

Giant cell arteritis (GCA) is a well-known cause of cranial vasculitis often presenting with headache and jaw claudication. Here we report the case of a woman suffering GCA who presented with critical lower limb ischemia. Despite best medical therapy, she developed progressive calf claudication and ulceration of the right foot. The findings on workup were highly suggestive of GCA involving the superficial femoral artery. The limb was successfully revascularized with angioplasty and placement of a drug-eluting stent. GCA is an important cause of lower limb ischemia and should be considered in patients without evidence of atherosclerosis. Endovascular intervention is a feasible treatment of critical limb ischemia due to GCA and has been shown to be safe in this case. Keywords: Endovascular procedures, Balloon angioplasty, Lower limb ischemia, Critical limb ischemia, Giant cell arteritis

Abstract Background Medical education can affect medical students’ physical and mental health as well as their quality of life. The aim of this study was to assess medical students’ perceptions of their quality of life and its relationship with medical education. Methods First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student’s lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students’ quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

A prática médica depende de um repertório de competências sociais que permitem ao médico desenvolver empatia, habilidades de comunicação, pensamento crítico, capacidade de liderança e tomada de decisões. Nosso objetivo foi analisar as habilidades sociais e a presença de sonolência diurna entre estudantes de Medicina nos quatro primeiros anos do curso. Os estudantes (n = 180) responderam ao Inventário de Habilidades Sociais de Del Prette & Del Prette e à Escala de Sonolência Diurna. Observou-se que não houve diferença dos escores de habilidades sociais nos diferentes anos do curso e que 47,3% dos estudantes apresentaram escores baixos, necessitando de aprimoramento. Estudantes do sexo feminino apresentaram maior autocontrole da agressividade. Entre os estudantes, 50% apresentaram sonolência diurna, cuja presença se associou a menores escores de habilidades sociais, principalmente do fator relativo à autoexposição a desconhecidos ou a situações novas.

Background: Infantile capillary hemangiomas (IHs) are common, benign, self-limited tumors with a well-defined natural history, occurring most often on the head and neck. IHs are the most common soft-tissue tumors in infancy and occur in 5–10% of children. The main risk factors identified for IH include female sex and low birth weight. For many hemangioma patients, treatment is not required; however, there are many treatment options for IH, each with their own limitations and side effects. Aims and Objectives: The study aimed to study the role, efficacy, and side effects of propranolol in infantile hemangioma. Materials and Methods: Patients with infantile hemangioma at SN Medical College, Agra, in the Department of General Surgery and Pediatric Surgery with the required eligibility criteria are considered in this study from December 2021 to December 2023, in total 60 patients, prospectively randomized into three groups: Group A: Infants given propranolol only. Group B: Infants given steroids only Group C: Infants given a steroid plus propranolol. Results: In our study, Group A taking propranolol alone 14 out of 20 (70%) responded well, Group B taking steroid alone 7 out of 20 (35%) responded well and Group C taking steroid and propranolol 16 out of 20 (80%) responded well, which shows that propranolol in a low dose (0.5–3 mg/kg/day) is an effective drug for infantile hemangioma. Conclusion: In our study, we can conclude that propranolol is a safe, efficacious, and better drug than corticosteroid for infantile hemangioma when used in low doses, and the effects are better if started in the early phase.

Background: Cholecystectomy is one of the most common, clean, and contaminated surgery operations performed by surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Aims and Objectives: The aims and objectives are to study antimicrobial prophylaxis on elective laparoscopic cholecystectomy and to compare surgical site infections (SSI) between the two groups after laparoscopic cholecystectomy with respect to (a) duration of surgery, (b) post-operative pain, (c) complications encountered, and (d) post-operative hospital stay. Materials and Methods: Patients were randomly divided into the study group (Group A) and the control group (Group B). Antibiotic dose of ceftriaxone + sulbactam 1.5 g will be administered intravenously 2 h before induction of anesthesia for the patients in the study Group A (n=30), and no antibiotic will be administered prophylactically to the control Group B (n=30). Results: In the study group, one patient developed fever, and in the control Group, 4 patients developed fever. In this study, SSIs were considered. In the study group, two patients (6.67%) developed pus discharge from the port site which was considered superficial infection, and in the control group, five patients (16.67%) developed pus discharge. Conclusion: Based on our study, in elective cholecystectomy, a single dose of intravenous ceftriaxone + salbactam 1.5 g given before the operative procedure does not lead to a higher SSI rate as compared to the conventionally given antibiotics which are continued postoperatively for a variable length of time.

Summary:. We report the case of a 35-year-old female patient who presented with stabbing pain on inspiration and expiration, fever, and dyspnea. The patient had undergone breast augmentation with mastopexy and upper quadrant liposuction 5 days earlier. Seven days after hospitalization, a fistula ruptured in the left breast at the suture, and copious outflow of thick whitish fluid was observed. The breast implants were then removed. During surgery, a small amount of fluid was found, and bacterial culture revealed a Cutibacterium acnes infection, for which antibiotics were prescribed. Fifteen days after implant removal, the patient complained of uncomfortable tingling sensations, similar to breastfeeding. A dressing was applied, which resulted in the copious discharge of whitish, viscous fluid through the wound and nipple. The prolactin level was four times higher than the normal range. The patient was diagnosed with hyperprolactinemia and prescribed bromocriptine treatment, which restored her prolactin levels to normal within 4 days. After 4 weeks of hospitalization, the patient was discharged in good condition. This is the first case in the world to show that, in addition to infection, galactorrhea can be an extremely rare complication, which in our case was detected at a late stage at a similar clinic.

الملخص: أهداف البحث: تهدف هذه الدراسة لتقييم الآثار النفسية للشفة والحنك المشقوق على الأطفال وأولياء أمورهم وتحديد أي علاقة بين الدعم الاجتماعي، ووقت الإصلاحات الجراحية لهذه العيوب. طرق البحث: مراجعة منهجية باستخدام طريقة المشكلة، والتدخل، والمقارنة، والنتيجة والإعداد. وشارك في الدراسة أطفال لديهم شفة وحنك مشقوق، والتدخلات هي التصحيحات الجراحية، و/أو الدعم الاجتماعي، وكانت المقارنات مع الأطفال الذين ليس لديهم تصحيحات جراحية ولا دعم اجتماعي، وكانت النتائج هي الآثار النفسية، وكان تصميم الدراسة هو مراجعة منهجية. تم البحث في أربع قواعد بيانات إلكترونية: إبسكو، وبروكويست، وسسينس دايريكت، وسيك انفو على مدى عشر سنوات (يناير ٢٠٠٧ إلى يناير ٢٠١٧). واستخدمت القواعد الإرشادية لعناصر التقارير المفضلة للمراجعة المنهجية وتحليل – ميتا (بريزما) ٢٠٠٩ بشأن الإبلاغ عن المراجعات المنهجية في هذه الدراسة. النتائج: كشف البحث في أربع قواعد للبيانات ٥٣٣٤٦ مقالة; ولكن، استوفت ٢٦ مقالة فقط معايير الاشتمال وتم إدراجها. كان هناك عدد قليل من المقالات التي تعنى بالأطفال. الاستنتاجات: الشفة والحنك المشقوق لا ترتبط فقط بالآثار النفسية التي كانت تزعج تقدير الذات لدى الأطفال ووظائفهم النفسية، بل تمتد أيضا إلى آبائهم، وخاصة الأمهات. ومع ذلك، بدا أن الدعم الأبوي والاجتماعي له نتائج إيجابية على الحد من هذه الآثار النفسية. Abstract: Objectives: This study aimed to evaluate the psychological effects of cleft lip and palate (CLP) on children and their parents and to determine any relationship between social support and timing of surgical repairs for these defects. Methods: A systematic review that followed the problem, intervention, comparison, outcome and setting (PICOS) method was used. The participants were children with CLP, interventions were surgical corrections and/or social support, comparison occurred with children with neither surgical corrections nor social support, outcomes were psychological effects and the study design was a systematic review. Four electronic databases, EBSCO, ProQuest, Science Direct, and PsycInfo were used to search for studies over the period of ten years (January 2007 until January 2017). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2009 guidelines on systematic review reporting were used for this study. Results: Searching through four databases revealed 53,346 articles; however, only 26 articles that met the inclusion criteria were included. There were few articles about children. Conclusions: CLP is not only connected to psychological effects which distress children's self-esteem and psychological functions, it also extends to their parents, particularly their mothers. However, parental and social support seem to have positive influences by reducing these psychological effects. الكلمات المفتاحية: نفسي, الأطفال, الشق, الشفة, الحنك, Keywords: Children, Cleft, Lip, Palate, Psychological

Hair growing inside the skin and burrowing in the uppermost dermis, previously termed as “ingrowing hair,” is a rarely reported cutaneous disorder. Up to July 31, 2018, only five cases have been reported, all were male. The authors report two Chinese Han men, 26-year-old and 31-year-old respectively, presenting with progressive extending black lines inside the skin on the right mandibular angle and the neck respectively. The black lines were finally demonstrated as growing beard hairs. The 26-year-old man was cured after the hair was pulled out, whereas the 31-year-old patient had re-occurrence after the initial hair was extracted and was cured finally by destroying the individual beard follicle. The authors would prefer the term of “intradermal growing hair” to “ingrowing hair” when describing the condition of hair growing inside the skin and extending in the uppermost dermis. Pulling out the growing hair, and sometimes destroying the beard follicle, may be of choice for its treatment.

Abstract Background Empathy is a central characteristic of medical professionalism and has recently gained attention in medical education research. The Jefferson Scale of Empathy is the most commonly used measure of empathy worldwide, and to date it has been translated in 39 languages. This study aimed to adapt the Jefferson Scale of Empathy to the Brazilian culture and to test its reliability and validity among Brazilian medical students. Methods The Portuguese version of the Jefferson Scale of Empathy was adapted to Brazil using back-translation techniques. This version was pretested among 39 fifth-year medical students in September 2010. During the final fifth- and sixth-year Objective Structured Clinical Examination (October 2011), 319 students were invited to respond to the scale anonymously. Cronbach’s alpha, exploratory factor analysis, item-total correlation, and gender comparisons were performed to check the reliability and validity of the scale. Results The student response rate was 93.7% (299 students). Cronbach’s coefficient for the scale was 0.84. A principal component analysis confirmed the construct validity of the scale for three main factors: Compassionate Care (first factor), Ability to Stand in the Patient’s Shoes (second factor), and Perspective Taking (third factor). Gender comparisons did not reveal differences in the scores between female and male students. Conclusions The adapted Brazilian version of the Jefferson Scale of Empathy proved to be a valid, reliable instrument for use in national and cross-cultural studies in medical education.