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Adenoma of the nipple is a very uncommon benign neoplasm of lactiferous ducts. Its clinical presentation is variable and it can be easily misdiagnosed as a malignancy such as mammary Paget disease or breast intraductal carcinoma. Although dermoscopy and imaging tests such as ultrasonography or mammography can be of help, histological examination is mandatory to confirm the diagnosis. We describe the clinical, dermoscopic, and histopathological findings in a patient with nipple adenoma and discuss the clinical and histological differential diagnosis as well as the different treatment options.

Resumen: Las cicatrices por quemadura suponen una elevada morbilidad en forma de contracturas, desfiguración corporal y prurito, así como un elevado impacto emocional que disminuye la calidad de vida de estos pacientes. Los dispositivos láser se han mostrado eficaces para su tratamiento, por encima de los tratamientos tópicos y complementarios a la cirugía, sin generar tanta morbilidad. Sin embargo, su uso en los departamentos de dermatología hospitalarios todavía está poco extendido. El láser más utilizado es el láser CO2 para tratar el grosor de la cicatriz, alteraciones texturales, y la posible contractura asociada, restaurando la movilidad de estos pacientes cuando se encuentra alterada. El láser de colorante pulsado es especialmente útil ante las cicatrices de quemaduras recientes con componente eritematoso y para prevenir el desarrollo de cicatrices hipertróficas posteriores. La hiperpigmentación puede mejorar con láseres de pigmento en modalidades de pulso corto (nano- y picosegundos). Revisamos la evidencia de estos dispositivos para el tratamiento de las cicatrices por quemaduras y aportamos una propuesta de algoritmo terapéutico. Abstract: Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, and they also have a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser resurfacing is the most widely used modality for reducing scar thickness, improving textural abnormalities, and treating contractures. Treatments improve mobility for patients with constrictions. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm.

Muriel Spark’s The Driver’s Seat is a radical metafictional experiment, suggesting the inexorable connections between contingency and a predetermined plot which are so common to many Sparkian novels. Following Marina MacKay’s perception that Spark’s experimental narrative operates “in the conceptual space where the more abstract preoccupations of Roman Catholic theology overlap with the metafictional and fabulist concerns of postmodernism” (2008: 506), this essay will discuss how the notion of predestination reverberates in The Driver’s Seat, not only as a remnant of Spark’s Presbyterian education but also as a postmodern re-visitation of classical tragedy in a metafictional key. Spark’s preference for predetermined plots may echo a long philosophical and theological discussion spanning many centuries about free will and predestination, particularly intense in the times of the Protestant Reformation, but it also reflects the sense of predestination as a necessary ingredient of classical tragedy. In The Driver’s Seat Spark deliberately brought to the fore some conventions of Aristotelian tragedy, although she approached them through an experimental subversion ultimately resorting to comedy and ridicule, on Spark’s own admission her weapons for the only possible art form. Our contention is that the metafictional implications of The Driver’s Seat’s prolepses undermine a Calvinist-like certainty concerning predestined salvation or damnation. By using a partial narrator only capable of producing limited accounts, Spark may be playing with an experimental and essentially postmodern interpretive openness which is in tune with the ultimate uncertainty about each individual’s eternal salvation that is commonly accepted in Catholic thought.

Resumen: Antecedentes y objetivo: La psoriasis es una enfermedad con una gran implicación sistémica en la que se ha descrito una mayor prevalencia de alteraciones de la mucosa oral. El objetivo del estudio fue determinar la prevalencia de alteraciones orales en pacientes con psoriasis y su asociación con las características clínicas y epidemiológicas de la enfermedad. Material y métodos: Se realizó un estudio transversal, incluyendo pacientes con psoriasis y voluntarios sanos entre diciembre de 2019 y febrero de 2020. Se recogieron datos biométricos, comorbilidades asociadas y alteraciones orales detectadas en la exploración física. Además, en los pacientes con psoriasis se registraron las características clínicas de la enfermedad. Resultados: Se incluyeron 100 pacientes con psoriasis y 100 controles. Los pacientes con psoriasis presentaron una mayor prevalencia de alteraciones de la mucosa oral respecto al grupo control (74% frente a 46%, p

BackgroundDespite being a new entity, there is a large amount of information on the characteristics of SARS-CoV-2 infection and the symptoms of the acute phase; however, there are still many unknowns about the clinical features and pathophysiology of post-COVID syndrome. Refractory chronic cough is one of the most prevalent symptoms and carries both a medical problem and a social stigma. Many recent studies have highlighted the role of SARS-CoV-2 neurotropism, but no studies have demonstrated vagus nerve neuropathy as a cause of persistent chronic cough or other COVID-19 long-term effects.ObjectiveThe main objective was to assess the involvement of the vagus nerve neuropathy as a cause of chronic cough and other post-COVID syndrome symptoms.Material and methodsThis was a single-center observational study with prospective clinical data collected from 38 patients with chronic cough and post-COVID-19 syndrome. Clinical characteristics and laryngeal electromyographic findings were analyzed.ResultsClinical data from 38 patients with chronic cough after 12 weeks of the acute phase of COVID-19 infection were analyzed. Of these patients, 81.6% suffered from other post-COVID conditions and, 73.6% reported fluctuating evolution of symptoms. Laryngeal electromyography (LEMG) of the thyroarytenoid (TA) muscles and cricothyroid (CT) muscles was pathological in 76.3% of the patients. Of the patients with abnormal LEMG, chronic denervation was the most frequent finding (82.8%), 10.3% presented acute denervation signs, and 6.9% presented myopathic pattern in LEMG.ConclusionsLEMG studies suggest the existence of postviral vagus nerve neuropathy after SARS-CoV-2 infection that could explain chronic cough in post-COVID syndrome.

Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, as well as a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser is the most widely used device for reducing scar thickness, improving textural abnormalities, and treating associated contractures, which may restore the mobility of these patients when it is altered. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm. Resumen: Las cicatrices por quemadura suponen una elevada morbilidad en forma de contracturas, desfiguración corporal y prurito, así como un elevado impacto emocional que disminuye la calidad de vida de estos pacientes. Los dispositivos láser se han mostrado eficaces para su tratamiento, por encima de los tratamientos tópicos y complementarios a la cirugía, sin generar tanta morbilidad. Sin embargo, su uso en los departamentos de dermatología hospitalarios todavía está poco extendido. El láser más utilizado es el láser CO2 para tratar el grosor de la cicatriz, alteraciones texturales, y la posible contractura asociada, restaurando la movilidad de estos pacientes cuando se encuentra alterada. El láser de colorante pulsado es especialmente útil ante las cicatrices de quemaduras recientes con componente eritematoso y para prevenir el desarrollo de cicatrices hipertróficas posteriores. La hiperpigmentación puede mejorar con láseres de pigmento en modalidades de pulso corto (nano- y picosegundos). Revisamos la evidencia de estos dispositivos para el tratamiento de las cicatrices por quemaduras y aportamos una propuesta de algoritmo terapéutico.

Efficient Microorganisms (EM) are commonly used in organic crops; however, there are no studies on their effects on the production of citrus seedlings. The work aimed to evaluate the impact of applying the inoculants Native Efficient Microorganisms (NEM) and the commercial product EM1® in forming the seedling of the rootstock Poncirus trifoliata (L.) Raf and in the development of young plants of Sweet Orange “Valência” (Citrus sinensis (L.) Osbeck) and Murcott tangor (Citrus sinensis x Citrus reticulata Blanco). The inoculant based on efficient microorganisms from the homemade technology of capture and multiplication, native efficient microorganisms (NEM), showed greater microbial diversity when compared to the commercial product EM1®. The results obtained from the dry mass analysis of the Valência orange and Murcott tangor plants indicate that positive effects resulting from the use of EM1® and NEM inoculums can be obtained by cultivating the respective crops in a system with oat straw cover. It was observed that the use of efficient microorganisms, as microbial natural bioactive formulation, has potential use in citrus and that farmers with fewer resources will be able to produce the microorganisms on their properties.

Background and objective: Psoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics. Material and methods: We conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis. Results: We studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P

Abstract Pretreatment of keratinous residues using an ultrasonic reaction system provides greater enzymatic production in less time. This is a promising technology for measuring enzyme activity and microwave processes. In the present work, an ultrasonic probe reaction system was used to evaluate the potential of swine hair pretreatment. The pretreated material was submerged with non-pretreated residues for 9 days to obtain the enzyme. Enzyme activity was measured in the extracts obtained using the ultrasonic probe, ultrasonic bath, and microwave. We also used the enzymatic concentration technique with NaCl and acetone. Homemade enzymatic extracts were evaluated for their ability to degrade swine hair and chicken feathers by comparing them with the activities commercial enzymes. Macrobeads gave greater energy dissipation in less time, providing greater enzyme activity (50.8 U/mL over 3 days). In terms of waste degradation, non-pretreated swine hair was more promising. The ultrasonic probe reaction system had the potential to evaluate increased enzyme activity (38.4% relative activity) and the enzyme concentration increased activity by 53.5%. The homemade enzymatic extract showed promise for degradation of keratinous residues.

Abstract This study aimed to analyze an intervention on Strengths Based Character Education for the Elderly (Educafi) and its effects on the variables character strengths, psychological well-being, life satisfaction and depressive symptoms. Forty-one elderly people participated in the research, divided into three groups: experimental, active control and control. Participants answered the same questionnaires in three moments: pretest, post-test and follow up. Statistically significant results were obtained for depressive symptoms, but not for the positive constructs assessed. Elderly people who participated in Educafi decreased the levels of these symptoms from the pretest to the post-test. However, in the follow up they returned to the initial levels. The results are discussed and suggestions for Educafi and other positive interventions for the elderly are presented.