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Introduction Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. Methods A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. Results More than the 36-month period, 41 patients were submitted to T2–T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). Conclusion Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. Level of evidence III.

The ideal approach to hemodynamically unstable patients requires the quick identification of the type of shock and its etiology. This can be a challenge in critically ill patients due to the limited information, the wide number of differential diagnosis and the need for fast intervention. Point-of-care ultrasound (POCUS) is a non-invasive, low-cost, real-time and reliable tool used to rapidly and accurately assess hemodynamically unstable patients at the bedside. It can support diagnosis, tailor therapy and guide further workup, especially in patients deemed too unstable to undergo other imaging studies. The authors describe the case of a patient in obstructive shock due to pulmonary embolism, in which McConnell sign was identified by bedside echocardiography, before lab tests and pulmonary computerized tomography angiogram results were obtained.

Burns are a common cause of pediatric injury and represent significant morbidity and mortality in this age group. In children, most burns are thermal, resulting from exposure to a hot surface, liquid, or fire. Cyanoacrylate is a liquid compound commonly found in households, mainly in “superglue” and nail glue. This compound solidifies through an exothermic reaction that is magnified when in contact with certain fibers that act as catalysts, such as cotton. In these circumstances, intense heat is produced in the contact area, potentially causing severe thermal burns. Despite its widespread availability, there is a paucity of safety information about cyanoacrylate and its role as a cause for burns. In the literature, only 18 cases of cyanoacrylate burns are reported in children. We present two cases of pediatric burns with cyanoacrylate and a review of the literature.

Non-islet cell tumor hypoglycemia is a rare paraneoplastic condition caused by an extra-pancreatic tumor. We report a rare case of hypoglycemia caused by a relapsing pelvic solitary fibrous tumor associated with Big-IGF-2 production. A 72-year-old woman was admitted to our hospital because of loss of consciousness and hypoglycemia. She had a history of ovarian solitary fibrous tumor, which has relapsed. From investigation, serum levels of insulin and C-peptide were suppressed; IGF-1 was slightly reduced and IGF-2 was within the normal range, but the IGF-2: IGF-1 ratio was elevated, indicating the presence of Big-IGF-2 secreting non-islet cell tumor. Contrast-enhanced computed tomography (CT) showed a large pelvic mass. She was then submitted to surgical resection of the mass, which histologically proved to be a solitary fibrous tumor. Three months later, she remains asymptomatic. Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycemia.

Background: Acupuncture is still a controversial topic, as methodologic problems associated to its research impair scientific progress. Besides effective allocation of acupoints and double blinding, quantification of its effects is still a problem that has to be addressed. In particular, the effects of acupuncture need to be quantified more clearly for relieving pain and reducing inflammatory effects associated to Rheumatoid Arthritis (RA). We aim to study the effects of acupuncture resorting to an algometry device specifically designed to assess the pressure tolerated by RA patients. Methods/Design: A quasi-experimental nature design was developed. Fourteen RA patients with a Traditional Chinese Medicine (TCM) (Heidelberg Model) diagnosis of a so called pivotal or turning point syndrome, and meeting the criteria of the American College of Rheumatology, received three acupuncture treatments in one week with a standardized treatment. A newly developed pressure algometry device, designed to assess the tolerance in hand pain in RA, was tested. We compared the outcome of clinical acupuncture, as measured by Pressure Algometry (PA) and Visual Analogue Scale (VAS). Results: The patients tolerated higher pressure on the hands (p=0.001) as well as improved VAS scores along with the treatment (p=0.005). All 14 patients displayed improvements in PA, while 11 improved their VAS scores. Out of the remaining, two patients had their VAS score unaltered and one (who also displayed the smallest improvement in PA) worsened slightly. Discussion: The findings of this study suggest that acupuncture effects in hand pain relief can be measured by the PA device. This opens the door to quantify the differences between the tolerated hand pressure before and after the acupuncture treatment to one specific TCM syndrome designed as turning point in a future double blinded acupuncture study on pain in RA patients. Trial Registration Number: NCT02553005.

Aphidius colemani Viereck and Eretmocerus mundus Mercet are two of the most representative parasitoids used as biological control agents (BCAs) primarily against aphids and whiteflies, respectively. The macrocyclic lactone emamectin benzoate (4”-deoxy-4”-methylamino-4”-epiavermectin B1 benzoate), an insecticide derived from the avermectin family of natural products, is being developed for controlling lepidopteran pests on a range of vegetable and other crops in Europe. The objective of this study was to determine the level of compatibility of the insecticide emamectin benzoate with A. colemani and Er. mundus, which are used in greenhouse vegetable production in southeastern Spain. Trials were conducted under commercial greenhouses to assess the effect of 1-, 3- and 7-day-old residues of emamectin benzoate at the highest recommended concentration (14.25 mg L-1) on the population dynamics of the parasitoids. A. colemani, although released at higher rates than those commercially used, only reached low densities (less than 1 adult per plant), without significant differences among control plots and those treated with the compound. On the contrary, a natural infestation by native Er. mundus occurred and this trial can be considered as a direct-spray trial. Neither adult population nor parasitism on emamectin benzoate treated plots differed significantly from the control. Therefore, emamectin benzoate residues did not diminish A. colemani population densities if applied 1 day before the introduction of the arthropod (exposure to 1-day old residues). Similarly, emamectin benzoate was compatible with Er. mundus if a direct spray application was used on developed populations. Aphidius colemani Viereck y Eretmocerus mundus Mercet son dos de los parasitoides más importantes que se utilizan como agentes de control biológico contra pulgones y moscas blancas, respectivamente. La lactona macrocíclica benzoato de emamectina (benzoato de 4”-deoxy-4”-(metilamino)-epiavermectina B1), insecticida derivado de la familia de las avermectinas, se está desarrollando para controlar plagas de lepidópteros en varios cultivos en toda Europa, incluyendo los hortícolas. En este estudio se determina la compatibilidad del insecticida con A. colemani y Er. mundus, utilizados en la producción hortícola del sureste español. Los ensayos se llevaron a cabo en invernaderos comerciales para estudiar los efectos de residuos de 1, 3 y 7 días de edad del insectida a la máxima concentración recomendada (14,25 mg L-1) en la dinámica poblacional de los parasitoides. A. colemani, aunque liberado a dosis mayores de las utilizadas comercialmente, apenas consiguió establecerse (menos de un adulto por planta), sin detectarse diferencias significativas entre el control y los residuos del compuesto. Por el contrario, se produjo una infestación natural de Er. mundus y, por tanto, el ensayo correspondiente se consideró como un ensayo de aplicación directa. Ni la población adulta del parasitoide ni el parasitismo fueron significativamente diferentes entre el control y los residuos del compuesto. En conclusión, el benzoato de emamectina no redujo las poblaciones de A. colemani, cuando se aplicó un día antes de la introducción del insecto (residuo de un día). Igualmente, el compuesto fue compatible con Er. mundus, incluso en pulverización directa sobre una población ya establecida del insecto.