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Introdução/Objetivos: Relato de caso de linfoma raro, que foi tratado com protocolo nunca utilizado anteriormente para este tipo de neoplasia. Com o sucesso do tratamento, nosso objetivo é colaborar com a comunidade médica, enriquecer a literatura e trazer novas alternativas terapêuticas para os pacientes. Material e métodos: Coleta dos dados clínicos na Unidade de Hematologia do Hospital Meridional e levantamento em prontuário das provas laboratoriais, exames especializados e revisão do tema na literatura. Resultados: Paciente hoje com 73 anos, em maio/2012 teve o diagnóstico de linfoma difuso de grandes células B (LDGCB) IIsB IPI = 2. Recebeu 8 ciclos de R-CHOP + radioterapia, finalizando o tratamento em 21/03/13 com remissão completa da doença. No fim de 2021 suspeitou-se de recidiva do LDGCB. Foi realizada nova biopsia de linfonodo abdominal, porém em 07/02/22 definiu-se o diagnóstico como linfoma de Hodgkin não clássico, subtipo predominância linfocítica nodular (LHPLN), estádio IV. Discussão: Como o LHPLN é o subtipo histológico mais raro do linfoma de Hodgkin (LH), não existe consenso sobre a melhor terapia nos estadios avançados. O protocolo ABVD é comumente aplicado como extrapolação da literatura do LH clássico, contudo, há relatos de que a recidiva com o ABVD é alta, com maior eficácia observada em regimes que contenham agentes alquilantes. A escolha da nova terapia foi um desafio, pois a paciente já havia recebido a dose máxima de antraciclina no tratamento anterior. Além disso também já havia usado agente alquilante e doses adicionais poderiam predispor à mielodisplasia e leucemia mieloide aguda. Por ser idosa e frágil, também não era candidata a transplante de medula óssea. Optamos pelo protocolo R-GemOx (rituximab, gencitabina e oxaliplatina) que, pela nossa revisão da literatura, nunca havia sido utilizado no tratamento de LHPLN, porém tem eficácia comprovada contra linfomas não Hodgkin de células B, com perfil de toxicidade bastante aceitável. Nesse tipo de linfoma, em casos refratários ou recidivados, a taxa de resposta global variou entre 61 a 83% e taxa de resposta completa foi de 44 a 50%, com taxa de sobrevida livre de eventos em 2 anos de 43% e sobrevida global de 66%, respectivamente, sobrevida livre de progressão em 42 meses de 28%, com sobrevida global de 37%. Também demonstrou boa ação no controle do linfoma de Hodgkin clássico com taxa de resposta global de 71% e completa de 38%. Dessa forma, a paciente recebeu 8 ciclos de R-GemOx entre 18/03/22 a 12/08/22 e obteve resposta completa que se mantém até a presente data. Conclusão: A paciente foi tratada com sucesso com protocolo de imunoquimioterapia nunca relatado anteriormente para esse tipo de neoplasia, com resultado animador. Assim, acreditamos que nossa contribuição possa ajudar comunidade médica e outros profissionais ao se depararem com casos semelhantes e servir como hipótese para realização de estudos prospectivos mais robustos que possam definir o melhor tratamento do LHPLN.

An 81-year-old male with a history of coronary artery disease, hypertension, paroxysmal atrial fibrillation and chronic kidney disease presents with asymptomatic bradycardia. Examination was notable for an early diastolic heart sound. 12-lead electrocardiogram revealed sinus bradycardia with a markedly prolonged PR interval and second-degree atrioventricular block, type I Mobitz. We review the differential diagnosis of early diastolic heart sounds and present a case of Wenckebach associated with a variable early diastolic sound on physical exam.

Donor-centered education offers students the opportunity to not only acquire visual and tactile experiences for applying anatomical knowledge but also a chance for students to reflect upon fundamental humanistic principles. The exploration of differences in students' viewpoints on body donation and the utilization of body donors in their education remains unexplored across various healthcare professional programs, which has an impact on student learning and experience. This study aimed to qualitatively examine the similarities and differences in student perspectives regarding body donation across three healthcare professional programs. One-page reflections from nursing (n = 37), physical and occupational therapy (n = 49), and medical students (n = 66) regarding their experiences in the anatomy laboratory at McGill University were collected and analyzed using a deductive approach based on themes and sub-themes outlined by Stephens et al. in 2019. Despite differences in their curricula, there were few discrepancies across the programs' reflections suggesting that donor-based learning had similar effects on each user group. Most students across the healthcare professional programs mentioned that their positive laboratory experiences motivated them to donate their bodies, extending the privilege they had to future generations. Nursing students did not reflect upon the notion that working with body donors provided unique learning experiences in the anatomy laboratory. Likewise, physical and occupational therapy (PT/OT) students did not address the importance of maintaining the privacy of body donors by covering certain body parts during lab. These findings show that prosection- and dissection-based exercises encourage reflective practices associated with these of medical ethics, highlighting an important advantage to including donor-based learning in anatomical education.

Case presentationA 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (Spo2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the Spo2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with Spo2 readings in the low 90% range, but pulmonary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjögren's syndrome, and fibromyalgia.

Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

Objective: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment. Methods: The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls. Results: Patients with missing molars failed significantly more often in MAS therapy than the controls (p = 0.020). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (p = 0.050). Conclusion: The study could not identify a single reason for MAS failure. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Obstructive sleep apnea (OSA) is prevalent in individuals with Osteogenesis imperfecta (OI). To date, no study has investigated treatment of OSA in adult individuals with OI using positive airway pressure (PAP). This observational pilot study examined the adherence of adults with OI to treatment of OSA with PAP therapy, and the evolution of self-experienced sleepiness and depression symptoms before and after treatment. Methods We included 20 patients, with a mean age of 51 years, who represented varying severity of OI and displayed an apnea and hypopnea index ≥ 5 /sleeping hour as recorded by an overnight polysomnography. PAP therapy was proposed to all patients. Epworth Sleepiness Scale (ESS) questionnaire to evaluate daytime sleepiness, and a validated self-rating depression questionnaire to identify possible depression, were completed prior to PAP therapy and repeated after a minimum of one year. The datasets supporting the conclusions of this article are included within the article. Results From the 20 patients, 15 initiated PAP therapy, and two patients later interrupted it. The mean PAP follow-up period was 1230 days. At baseline, an abnormally high ESS score was reported by 29% of the respondents, and an abnormally high number of symptoms suggesting depression by 29%. Follow-up questionnaires were completed by 60% of the patients, of whom 83% were adherent to PAP treatment. ESS score and depression symptoms did not decrease significantly with PAP therapy. Conclusions Patients with OI accepted well PAP therapy and remained compliant. Sleepiness and depression persisted unaltered despite good PAP adherence. These unexpectedly poor improvements in symptoms by PAP therapy may be due to subjective depression symptoms and the complexity of factors underlying persisting sleepiness in OI. Further research is needed to confirm this novel finding.

Summary: Background: In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods: National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings: The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200). Interpretation: The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding: The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.

La hiperglucemia intrahospitalaria se define como un valor de glucosa >140 mg/dL. Si bien esto puede suceder en primer lugar en individuos con diabetes ya conocidos, en segundo lugar, en pacientes sin diagnóstico previo, pero que al momento del ingreso presenta síntomas asociados al diagnóstico de diabetes como pérdida de peso, hiperglicemia, deshidratación, cetosis, y en tercer lugar en aquellos pacientes que presentan hiperglicemia durante la hospitalización secundaria a fenómenos de estrés. La Asociación americana de Diabetes (ADA), Asociación Americana de Educadores en Diabetes (AADE) y la Sociedad Europea de Endocrinólogos Clínicos, recomienda mantener las glicemias en hospitalización en rango entre 140 mg/dL, y 180 mg/dL. Para este estudio se planteó determinar el efecto de la Hiperglicemia intrahospitalaria sobre la morbimortalidad en pacientes sometidos a cirugía cardiovascular en el Centro Médico Docente la Trinidad, en periodo de enero 2018 hasta agosto 2020. Para el logro de esto se realizó un estudio observacional analítico retrospectivo, donde se recolectaron los datos de 59 pacientes con diagnósticos de hiperglicemia intrahospitalaria sometidos a cirugía cardiovascular con una muestra total de 37 pacientes. Se observó que existieron mayores complicaciones médicas que quirúrgicas, de estas las más frecuentes fueron injuria renal aguda, fibrilación auricular, y trastorno acido base, así mismo. Las variables más relacionadas con complicaciones médicas fueron: pacientes con glicemias al ingreso > 180 mg/dl, excursiones glicemias amplias, glicemia al egreso ≥140mg/dl, así mismo se observó que la variabilidad glicémica fue el principal factor de riesgo a considerar para determinar riesgo de morbimortalidad.

Objectives: Hip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting. Methods: Patients aged ≥50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures. Results: There were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P 0.05). Conclusions: When comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity.

Abstract Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

This paper introduce a new way to simulate the effect of changing the length and the band gap of the nanotube on the current of carbon nanotube field effect transistors (CNTFET( by using simulation tools: FETToy, CNTFET lab, CNT bands 2.0, since this simulation were done in different parameters of ZigZag nanotube. We use three simulations tools because each tool provides simulation of parameters that differ from the parameters of other tools, so we can study more parameters that we change which this article is studied. In this paper we studied the effect of changing of ZigZag nanotube length which has a chirality (n,0) on the current of the CNTFET. We have found that the relationship between nanotube length and the current of the CNTFET is an inverse proportional, as the nanotube length increase, the current of CNTFET decrease, and the relation between the band gap of the ZigZag nanotube and current of the CNTFET has been studied too. We have found that this relationship is an inverse proportional, as the band gap increase, the current of CNTFET decrease. Also, we studied the relation between the band gap of the ZigZag nanotube and the average velocity of charges in CNTFET, we found that relationship is an inverse proportional, as the band gap increase, the average velocity of charges of CNTFET decrease.

A growing number of studies suggest that climate may impact the spread of COVID-19. This hypothesis is supported by data from similar viral contagions, such as SARS and the 1918 Flu Pandemic, and corroborated by US influenza data. However, the extent to which climate may affect COVID-19 transmission rates and help modeling COVID-19 risk is still not well understood. This study demonstrates that such an understanding is attainable through the development of regression models that verify how climate contributes to modeling COVID-19 transmission, and the use of feature importance techniques that assess the relative weight of meteorological variables compared to epidemiological, socioeconomic, environmental, and global health factors. The ensuing results show that meteorological factors play a key role in regression models of COVID-19 risk, with ultraviolet radiation (UV) as the main driver. These results are corroborated by statistical correlation analyses and a panel data fixed-effect model confirming that UV radiation coefficients are significantly negatively correlated with COVID-19 transmission rates.

Background Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.Methods OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.Results We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).Conclusion Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management. Case presentation We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms. Conclusions Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.

Im siebzehnten Jahrhundert erlebte das naturmagische Denken in der Medizin eine Blütezeit. In der medizinischen Praxis verbreiteten sich Rezepte, die durch Sympathie und Antipathie zwischen Makro- und Mikrokosmos begründet wurden, wie etwa die Waffensalbe und das Sympathetische Pulver. In der zweiten Hälfte des siebzehnten Jahrhunderts fand die Iatrochemie durch Übersetzungen aus dem Lateinischen ins Arabische den Weg in das Osmanische Reich, wie es bei der Basilica Chymicavon Oswaldus Crollius (gest.1609) der Fall war. Das Werk enthält eine Vorschrift für die Waffensalbe « Unguentum sympatheticum seu stellatum Paracelsi », die ins Arabische übersetzt wurde. Diese Studie analysiert Textstellen im Zusammenhang mit der Transmission der Waffensalbe und des Sympathetischen Pulvers im arabischen und osmanischen Schrifttum des siebzehnten und achtzehnten Jahrhunderts und rekonstruiert die Übertragungsmodalitäten magischer Konzepte, welche der Verwendung der Waffensalbe zugrunde lagen. Die Studie zeigt, dass die lateinischen Texte einem Transformationsprozess auf textueller Ebene, aber auch hinsichtlich der astrologisch-magischen Konzepte unterlagen. Außerdem zeigt der Beitrag, dass ein europäischer Arzt das Sympathetische Pulver im Istanbul des siebzehnten Jahrhunderts therapeutisch einsetzte. The seventeenth century saw the spread of natural magic in medicine. Several remedies based on concepts of sympathy and analogy between microcosm and macrocosm were introduced into therapy, such as weapon salve and powder of sympathy. In the second half of the seventeenth century, European iatrochemical knowledge was introduced into the Ottoman Empire through translations from Latin into Arabic, such as the translation of the Basilica Chymica by Oswaldus Crollius (d. 1609). The book contains a recipe for weapon salve with the title « Unguentum sympatheticum seu stellatum Paracelsi » that was translated into Arabic. This study addresses the transition of weapon salve and powder of sympathy to the Ottoman Empire by examining Arabic and Ottoman texts from the seventeenth and eighteenth centuries. It also addresses the modalities of translation and transfer of magical concepts underlying the usage of sympathetic remedies. This paper reveals that the Latin texts underwent a transformation process on a textual as well as on a conceptual level, especially regarding astrological and magical concepts. The study shows that a European physician was probably using powder of sympathy in Istanbul in the late seventeenth century.

Abstract Background Patients with Osteogenesis imperfecta (OI) suffer from increased bone fracture tendency generally caused by a mutation in genes coding for type I collagen. OI is also characterized by numerous co-morbidities, and recent data from questionnaire studies suggest that these may include increased risk for sleep apnea, a finding that lacks clinical evidence from cohort studies. In this cross-sectional study, 25 adults with OI underwent clinical otorhinolaryngology examination as well as overnight polysomnography to address the question. The participants were aged between 19 and 77 years, and ten of them had mild clinical OI phenotype, seven had a moderately severe phenotype, and eight had a severe phenotype. Results We found obstructive sleep apnea (apnea hypopnea index ≥5/h) in as many as 52% of the OI patients in the cohort. Unexpectedly, however, no correlation was present between sleep apnea and daytime sleepiness, experienced bodily pain, severity of OI, Mallampati score, or neck circumference. Conclusions Seeing that the usual predictors showed no association with occurrence of sleep apnea, we conclude that obstructive sleep apnea may easily be left as an undetected disorder in individuals with OI. Recurrent nocturnal hypoxia due to episodes of apneas can even affect bone metabolism, thereby further aggravating bone fragility in patients with OI.

Acquired isolated oculomotor nerve palsy (ONP) is a commonly encountered clinical entity in ophthalmology. While most cases are due to microvascular ischemia, the diagnosis of ONP requires careful evaluation for alternate life-threatening etiologies. We present a case of isolated complete pupil-involving ONP in a healthy 47-year-old man in whom aneurysmal compression was initially suspected. Investigations later revealed a diagnosis of neurosyphilis. Neurosyphilis is an extremely rare cause of isolated ONP and seldom reported in the literature. Timely recognition of this disease by ophthalmologists can help orient patients to the appropriate neurology and infectious disease services they need.

Introduction The prevalence of obesity is continually increasing worldwide, which increases the incidence of obesity hypoventilation syndrome (OHS) and its consequent mortality. Methods We reviewed the therapy mode, comorbidity and mortality of all OHS patients treated at our hospital between 2005 and 2016. The control group consisted of randomly selected patients with obstructive sleep apnoea (OSA) treated during the same period. Results We studied 206 OHS patients and 236 OSA patients. The OHS patients were older (56.3 versus 52.3 years, p