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Introduction. Splenunculus has been described with an overall incidence of 10 to 30%. It can be an entity of congenital or acquired origin, it is frequently associated with abdominal trauma or a history of splenectomy for various reasons. Clinical case. Middle-aged woman, with a history of abdominal trauma and splenectomy due to traumatic rupture, who 30 years later presents with abdominal pain. Imaging studies identified a solid intrapancreatic mass. Results. She was taken to OR for distal pancreatectomy. The histological and immunohistochemical findings confirmed that the pancreatic mass corresponded to an acquired intrapancreatic splenunculus, associated with the previous traumatic event. Conclusion. Splenuncles usually constitute an "incidentaloma". Imaging studies are limited, since computed tomography, magnetic resonance imaging, and ultrasonography present similar imaging characteristics with hypervascularized pancreatic tumors, so histopathological study must be included during their evaluation. This entity should be included in the differential diagnoses, with greater emphasis on those patients with a history of abdominal trauma and associated splenectomy, a scenario in which this lesion can simulate a solid neoplasm of the pancreas, with malignant characteristics. [ABSTRACT FROM AUTHOR]

Introduction. Solid pseudopapillary neoplasia of the pancreas, also known as Frantz tumor, is a rare pathology, comprising less than 3% of pancreatic tumors, and the highest incidence is observed in young women between the second and third decades of life. Its etiology is unknown. The treatment of choice is surgical resection without lymphadenectomy when it is well located. Even when there is evidence of metastasis or local invasion, surgical management remains the treatment of choice. Clinical case. A 24-year-old woman presented with a palpable, painful abdominal mass of three weeks' duration. The computed tomography mentioned a tumor of pancreatic origin as a presumptive diagnosis. At laparotomy, a mass dependent on the body of the pancreas was found. Radical distal pancreatectomy with splenectomy and en bloc partial omentectomy was performed. Results. During the surgery there were no complications and until the sixth month of follow-up, the evolution was adequate and without tumor recurrence. Conclusions. In the presence of an abdominal mass, with pancreatic involvement documented by computed tomography, the diagnosis of solid pseudopapillary neoplasia of the pancreas, or Frantz tumor, should be considered, which must be treated surgically. Frantz tumor is a rare entity that is generally diagnosed incidentally or due to nonspecific symptoms in advanced stages. The diagnosis and management of this neoplasia represents a challenge and surgical resection continues to be the indicated treatment. [ABSTRACT FROM AUTHOR]

Introduction. Organ transposition due to situs inversus (SI) is a rare condition that makes the diagnosis of acute appendicitis difficult. This condition entails that the patient' symptoms and physical examination findings may be atypical, which requires the use of images for diagnostic confirmation in most cases. Clinical cases. Three cases of appendicitis in patients diagnosed with situs inversus are described. Two of them had a known medical history, while the third case was diagnosed intraoperatively. Results. In two patients it was decided to undergo laparoscopic surgery without additional diagnostic images. The patients progressed satisfactorily. Conclusion. Appendicitis should always be considered in the differential diagnoses in patients with pain in the left iliac fossa. It is essential to diagnose and treat appendicitis effectively to minimize associated complications. The importance of the anamnesis and the examiner's clinical suspicion are vital in these cases, which can be confirmed with diagnostic images. There may be cases where the patient's clinical condition does not allow diagnostic imaging studies to be performed, increasingly supports the use of the laparoscopic approach. It is recommended to consider the laparoscopic approach in the first instance, since it allows us to confirm the diagnosis of situs inversus totalis in case the history is unknown and facilitates timely management of the emergency. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

Background The diagnosis of Hansen disease (HD) can be difficult when acid-fast bacilli are not detected in the patient's skin sample.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana 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.)

Introduction. Kidney cancer is the eleventh most common malignancy in the United States of Mexico. Carcinoma renal cell (CRC) is considered the most frequent type and represents 2-3% of all cancers worldwide. In the setting of metastatic disease, a primary renal tumor is usually identified, and metastases are located in the lung, bone, liver, brain, and rarely in soft tissue. Patients with soft tissue metastases do not have symptoms in the initial stages and are generally found only when the lesions increase in size or during the study of the surgical resection piece. Clinical case. In this case, we report a female patient in the seventh decade of life with a soft tissue metastasis located in the sacral region, 10 years after a nephrectomy secondary to CRC. Results. Clinical and radiological findings of a well-defined tumor. Surgical resection of the lesion is performed under regional anesthesia with complete excision. Conclusions. It is recommended that patients with a resectable and solitary metastatic site be candidates for surgical resection with free margins, as was the case with our patient due to its easy access and single lesion. In CRC, in addition to its initial surgical treatment, close surveillance with physical examination and cross-sectional images is essential to monitor the presence of metastases and thus avoid late treatments. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia 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.)

Introduction: low-grade endometrial stromal sarcoma is a tumor that represents less than one percent of all uterine malignancies. It is mostly diagnosed between 40 and 55 years of age, it has slow growth, with extrauterine dissemination in 40 and up to 50% of cases at the time of diagnosis. Patient information: 72-year-old woman, with a history of high blood pressure, type 2 diabetes mellitus and surgery for fibroid, along with necrobiosis, who had to undergo total abdominal hysterectomy with double adnexectomy. As a result of the biopsy, submucosal and subserosal intramural leiomyomas with areas of necrosis and hemorrhages were detected. Subsequently, in August 2022, she presented scant bleeding, so she was sent to the Neck Pathology Consultation. She underwent video colposcopy with an exophytic lesion in the vaginal vault. The patient returned to the center due to a tumor measuring ±6 to 8 cm, violaceous, protruding through the vulvar introitus, coming from the vaginal vault and accompanied by bleeding, and friable. The biopsy result determined a low-grade sarcoma-type malignant mesenchymal tumor with two foci of necrosis. Conclusions: uterine cancer is the most common gynecological malignancy. On the other hand, low-grade endometrial stromal sarcoma is a very unusual tumor that ranks second among uterine mesenchymal tumors. [ABSTRACT FROM AUTHOR]

Objective: The clinical evaluation of palpable neck masses usually underestimates or overestimates their extension. A neck mass is defined as any increase in volume that forms in the cervical region, of congenital or acquired origin and that is visible, palpable, or identified by means of an imaging study. Method: An extensive bibliographic review was carried out in the PubMed database, where recent bibliographic information was inquired using the following keywords: cervical mass in adults, neck mass in adults, cervical lymphadenopathy in adults, as well as on evaluation methods such as ultrasound (US) and computed tomography, including original studies, and bibliographic reviews. Results: The manuscript indicates the CRISPS mnemonic, the CLN-RADS (Cervical Lymph Node Imaging Reporting and Data System for ultrasound of Cervical Lymphadenopathy) as well as the proposal of the UNN-RADS (Ultrasound Neck Node Reporting and Data System) classification, and how US examination of the neck should be performed with a systematic approach, organized to evaluate, and report cervical lymph nodes and do not omit any ganglionic chain. In current medical practice, there is often no defined clinical picture when a neck mass appears in adults and reflects a severe abnormality. Conclusion: A new persistent neck mass in an adult patient should be considered malignant until proven otherwise. Any neck mass, particularly unilateral, asymptomatic, in cervical lymph node group topography, should be considered a metastatic lesion, until proven otherwise. [ABSTRACT FROM AUTHOR]

Copyright of Casos & Revisiones de Salud is the property of Victor Manuel Mendoza Nunez, Universidad Nacional Autonoma de Mexico 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.)

Introducción. La transposición de los órganos debido al situs inversus (SI) es una rara afección que dificulta el diagnóstico de la apendicitis aguda. Esta condición hace que la sintomatología del paciente y los hallazgos al examen físico puedan ser atípicos, lo que demanda el uso de imágenes para la confirmación diagnóstica en la mayoría de los casos. Métodos. Se describieron tres casos de apendicitis en pacientes con diagnóstico de situs inversus. Dos de ellos tenían el antecedente conocido, mientras el tercer caso fue diagnosticado de forma intraoperatoria. Resultados. En dos pacientes se decidió llevar a cirugía vía laparoscópica sin imágenes diagnósticas adicionales. Los pacientes evolucionaron de manera satisfactoria. Conclusión. Siempre se debe considerar la apendicitis dentro de los diagnósticos diferenciales en los pacientes con dolor en fosa ilíaca izquierda. Es fundamental diagnosticar y tratar la apendicitis de manera efectiva para minimizar las complicaciones asociadas. La importancia de la anamnesis y la sospecha clínica del examinador son vitales en estos casos, que se pueden confirmar con las imágenes diagnósticas. Pueden existir casos en donde la condición clínica del paciente no permita la realización de estudios diagnósticos por imágenes; esto apoya cada vez más el uso del abordaje laparoscópico. Se recomienda considerar el abordaje laparoscópico en primera instancia, ya que nos permite la confirmación diagnóstica de situs inversus totalis en caso de que el antecedente sea desconocido y facilita el manejo oportuno de la urgencia

Tuberculosis (TB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis, with extrapulmonary manifestations occurring in approximately 1% of cases. Among these, central nervous system involvement, including intracranial tuberculomas, is rare. We present the case of a 13-year-old female from Borama, Somalia, admitted with abnormal lip movements and a complex medical history, including weight loss, recurrent urinary tract infections, and a familial predisposition to TB. Neurological examination revealed left-sided facial deviation and hyperreflexia, prompting investigations that confirmed left temporal epilepsy and a right-sided tuberculoma. Treatment with levetiracetam and anti-TB medication led to significant improvement. This case underscores the importance of considering tuberculomas in the differential diagnosis of neurological presentations, even in non-HIV patients, especially in resource-limited settings like Africa. Resumen: La tuberculosis (TB) es una enfermedad granulomatosa crónica causada por Mycobacterium tuberculosis, con manifestaciones extrapulmonares en aproximadamente el 1% de los casos. Entre éstas, la afectación del sistema nervioso central (SNC), incluidos los tuberculomas intracraneales, es poco frecuente. Presentamos el caso de una niña de 13 años de Borama, Somalia, que ingresó con movimientos labiales anormales y una historia clínica compleja, que incluía pérdida de peso, infecciones urinarias recurrentes y una predisposición familiar a la tuberculosis. La exploración neurológica reveló desviación facial izquierda e hiperreflexia, por lo que se realizaron pruebas que confirmaron epilepsia temporal izquierda y un tuberculoma derecho. El tratamiento con levetiracetam y medicación antituberculosa condujo a una mejoría significativa. Este caso subraya la importancia de considerar los tuberculomas en el diagnóstico diferencial de las presentaciones neurológicas, incluso en pacientes sin VIH, especialmente en entornos con recursos limitados como África.

La paracoccidioidomicosis es una micosis sistémica endémica en Latinoamérica. La presentación más frecuente compromete crónicamente los pulmones, la piel y las mucosas. Al inicio, este paciente presentó, por varios años, una lesión única en la mucosa oral que, en ausencia de otros síntomas, se relacionó con una neoplasia maligna, específicamente con un carcinoma escamocelular. La diferenciación entre los dos diagnósticos se hace mediante un examen directo, un estudio histopatológico y cultivos iniciales y subsecuentes. Sin embargo, tales estudios no fueron concluyentes. Después de varias consultas y pruebas, con los resultados del examen directo, la inmunodifusión y la PCR en tiempo real se confirmó el diagnóstico de paracoccidioidomicosis crónica multifocal. Este caso alerta sobre la ausencia de sospecha clínica de micosis endémicas, dada la presencia de lesiones mucocutáneas que pueden ser producidas por hongos como Paracoccidioides spp, y la importancia de considerarlas entre los diagnósticos diferenciales.

Introducción. El cáncer de riñón es la undécima neoplasia maligna más común en los Estados Unidos Mexicanos. El carcinoma de células claras de riñón (CCR) es considerado la estirpe más frecuente y representa el 2-3 % de todos los cánceres a nivel mundial. En el contexto de la enfermedad metastásica, por lo general se identifica un tumor renal primario y las metástasis se localizan en pulmón, hueso, hígado, cerebro y, raramente, en tejidos blandos. Los pacientes con metástasis a tejidos blandos no tienen síntomas en las etapas iniciales y generalmente se identifican sólo cuando las lesiones aumentan de tamaño o durante el estudio de la pieza de resección quirúrgica. Caso clínico. Se presenta el caso de una paciente en la séptima década de la vida, con una metástasis en tejidos blandos de la región sacra, de 10 años de evolución posterior a una nefrectomía secundario a CCR. Resultados. Hallazgos clínicos e imagenológicos de un tumor bien delimitado. Se realizó resección quirúrgica de la lesión, bajo anestesia regional, con extirpación completa. Conclusión. Se recomienda que los pacientes con un sitio metastásico resecable y solitario sean llevados a resección quirúrgica con márgenes libres, como fue el caso de nuestra paciente, por su fácil acceso y ser una lesión única. En el CCR, además de su tratamiento quirúrgico inicial, es indispensable una estrecha vigilancia con examen físico e imágenes transversales, para detectar la presencia de metástasis y con ello evitar tratamientos tardíos.

Introducción. El esplenúnculo se ha descrito con una incidencia global del 10 al 30 %. Puede ser una entidad de origen congénito o adquirida, frecuentemente está asociada a trauma abdominal o antecedente de esplenectomía por diversas causas. Caso clínico. Mujer en edad media, con antecedente de trauma abdominal y esplenectomía por ruptura traumática, quien 30 años después presenta un cuadro de dolor abdominal. Los estudios imagenológicos identificaron una masa sólida intrapancreática. Resultados. Fue llevada a pancreatectomía distal. Los hallazgos histológicos e inmunohistoquímicos confirmaron que la masa pancreática correspondía a un esplenúnculo intrapancreático adquirido, asociado al evento traumático previo. Conclusión. Los esplenúnculos suelen constituir un “incidentaloma”. Los estudios imagenológicos se encuentran limitados, pues la tomografía computarizada, la resonancia nuclear magnética y la ultrasonografía presentan características imagenológicas similares con los tumores pancreáticos hipervascularizados, por lo que se debe practicar el estudio histopatológico durante su valoración. Esta entidad se debe incluir dentro de los diagnósticos diferenciales, con mayor énfasis en aquellos pacientes con historia de trauma abdominal y esplenectomía asociada, un escenario en el que esta lesión puede simular una neoplasia sólida del páncreas, con características malignas.

Es importante establecer el diagnóstico diferencial de alergia alimentaria con otras alteraciones, por ejemplo: reacciones tóxicas que ocurren en cualquier persona expuesta a una cantidad suficiente de algún alérgeno, y reacciones no tóxicas que dependen de la susceptibilidad individual (alergia o intolerancia alimentarias). El diagnóstico diferencial es decisivo para establecer el tratamiento adecuado. La intolerancia alimentaria implica reacciones adversas a alimentos sin ninguna respuesta inmunológica implicada, y comúnmente se manifiesta con síntomas gastrointestinales (malestar, dolor abdominal o diarrea). La alergia alimentaria es una reacción exagerada del sistema inmunológico, a menudo mediada por IgE, que puede desencadenar síntomas graves (urticaria, inflamación, dificultad respiratoria, incluso anafilaxia). Lo complejo es porque los síntomas a veces se superponen. Para establecer el diagnóstico certero se requiere la evaluación clínica exhaustiva, pruebas de laboratorio y, en algunos casos, pruebas de provocación controladas. Es importante comprender estas distinciones, porque el tratamiento y la gestión varían significativamente. La intolerancia alimentaria implica la eliminación o reducción del alimento desencadenante de la reacción alérgica y requiere medidas rigurosas (evitar por completo el alérgeno y disponibilidad de epinefrina en casos de reacciones graves).

It is important to establish the differential diagnosis of food allergy with other disorders, for example: toxic reactions that occur in any person exposed to a sufficient amount of some allergen, and non-toxic reactions that depend on individual susceptibility (food allergy or intolerance). The differential diagnosis is decisive to establish the appropriate treatment. Food intolerance involves adverse reactions to foods without any immunological response involved, and commonly manifests with gastrointestinal symptoms (malaise, abdominal pain or diarrhea). Food allergy is an exaggerated reaction of the immune system, often mediated by IgE, that can trigger serious symptoms (hives, inflammation, respiratory distress, even anaphylaxis). The complex thing is because the symptoms sometimes overlap. To establish an accurate diagnosis, exhaustive clinical evaluation, laboratory tests and, in some cases, controlled provocation tests are required. It is important to understand these distinctions, because treatment and management vary significantly. Food intolerance involves the elimination or reduction of the food that triggers the allergic reaction and requires rigorous measures (complete avoidance of the allergen and availability of epinephrine in cases of severe reactions). [ABSTRACT FROM AUTHOR]

Scabies is a common infection that affects people all over the world and has various presentations and impacts depending on the clinical situation. It is caused by the mite Sarcoptes scabiei var. hominis, an obligate ectoparasite that resides in the epidermis of the human skin. In this article, we present a review of the differential diagnoses and complications of scabies and scabies variants. We also present a summary of the etiology and the current diagnostic methods of scabies. [ABSTRACT FROM AUTHOR]

Dengue is the most common arbovirus in tropical and subtropical regions. Dengue endemic areas faced a major public health and socioeconomic impact during the COVID-19 pandemic. COVID-19 is a serious respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Co-infection between diseases shows fundamental differences in terms of epidemiology and clinical evolution. Thus, the objective of this review was to discuss the differential diagnosis between Dengue and COVID-19. Noting that co-infection by COVID-19 and dengue was associated with serious and fatal diseases. The main clinical manifestations associated with co-infection were defined as fever, headache, dyspnea, cough, myalgia, retro-orbital pain and skin eruptions. The laboratory findings described were thrombocytopenia, lymphopenia and leukopenia. Differential diagnosis is essential to prevent clinical conditions and reduce unexpected outcomes. Correct diagnosis and treatment of co-infection poses a challenge due to clinical and laboratory overlap. Therefore, confirmatory tests are necessary for accurate diagnosis, correct monitoring and treatment of patients. [ABSTRACT FROM AUTHOR]

A literature review was conducted to facilitate the differential diagnosis of headaches in individuals over the age of 65. The review focused on primary and secondary headaches according to the International Headache Society Classification, highlighting the most common types among older individuals. The review described the acute or chronic nature, frequency, characteristics, and specific features of these headaches to aid in making a presumptive diagnosis and guide appropriate interventions. The most common primary headaches in older adults are tension-type headache and migraine. Among the secondary headaches, the most frequent ones include cervicogenic headache, medication-overuse headache, cranial pain, and various metabolic causes of headaches. The review also mentioned basic and paraclinical studies, criteria for neuroimaging, and warning signs for secondary headaches. [ABSTRACT FROM AUTHOR]

Introduction: leptospirosis is one of the most widely distributed zoonotic diseases in the world, however, its diagnosis can be difficult because the clinical manifestations are diverse. We present a school-age patient with leptospirosis, to promote early diagnosis in similar cases. Case presentation: 11-year-old male patient with fever, asthenia, adynamia, headache, edema in the lower limbs, choluria, myalgia in the gastrocnemius, as well as rash on the trunk and all four extremities. Different infections were ruled out, such as dengue, COVID-19, and syphilis. Given the persistence of symptoms for more than seven days, and due to the history of contact with domestic animals, leptospirosis was suspected. It was confirmed by elevation of specific IgM antibodies for Leptospira and a positive urine PCR result for Leptospira spp. 48 hours after starting antimicrobial treatment, the patient began to improve, reaching complete resolution. Conclusions: leptospirosis is a disease that has a variable clinical course, so it should always be considered as part of the differential diagnosis of patients with febrile syndrome. [ABSTRACT FROM AUTHOR]

Acute abdominal pain in the pediatric population is a common complaint in emergency services. The diagnosis of this clinical condition is often challenging, since it can be a clinical or surgical disease, localized, systemic or functional, with abdominal or extra-abdominal causes. Objective: Development of a protocol and flowchart for investigative and, consequently, therapeutic targeting of pediatric patients with acute abdominal pain. Methodology: Bibliographic research using review articles and book chapters, including the Pediatrics Treaty and recommendations of the São Paulo Pediatric Society. Results: The literature review was used to, based on evidence, provide updated recommendations for the assessment, investigation and treatment of acute abdominal pain in the pediatric population, improving the quality of care. Conclusions: This article is intended to help clinical practice with the formulation of a protocol and flowchart of conducts that aim to establish an investigative and, consequently, therapeutic direction, reducing hospitalization time, as well as early interventions. The protocol was approved by the Hospital Universitário Walter Cantídio (HUWC) quality management and is now available for consultation on the hospital’s intranet.

Introducción. La neoplasia sólida pseudopapilar de páncreas, también conocida como tumor de Frantz, es una patología poco frecuente, que comprende menos del 3 % de los tumores pancreáticos, y la mayor incidencia se observa en mujeres jóvenes entre la segunda y tercera década de la vida. Su etiología es desconocida. El tratamiento de elección es la resección quirúrgica sin linfadenectomía cuando se encuentra bien localizado. Inclusive aún cuando hay evidencia de metástasis o invasión local, el manejo quirúrgico sigue siendo el tratamiento de elección. Caso clínico. Mujer de 24 años de edad, con masa abdominal palpable, dolorosa, de tres semanas de evolución. La tomografía computarizada mencionó como presunción diagnóstica un tumor de origen pancreático. En la laparotomía se encontró una masa dependiente del cuerpo del páncreas. Se realizó pancreatectomía distal radical con esplenectomía y omentectomía parcial en bloque. Resultados. Durante la cirugía no se presentaron complicaciones y hasta el sexto mes de seguimiento, la evolución fue adecuada y sin recidiva tumoral. Conclusiones. Ante la presencia de masa abdominal, con compromiso pancreático documentado por tomografía computarizada, se debe considerar el diagnóstico de neoplasia sólida pseudopapilar de páncreas, o tumor de Frantz. El tumor de Frantz es una entidad poco frecuente que generalmente se diagnostica de forma incidental o por síntomas inespecíficos en estadios avanzados. El diagnóstico y manejo de esta neoplasia representa un reto y la resección quirúrgica continúa siendo el tratamiento indicado.

Objetivo: Relatar um caso incomum de Pseudolinfoma Cutâneo na adolescência, não diagnosticado por aproximadamente oito anos. Método: As informações foram obtidas pela revisão do prontuário, entrevista com o paciente, registro fotográfico das lesões e dos métodos diagnósticos e revisão de literatura. O trabalho foi submetido e aprovado pelo Comitê de Ética em Pesquisa (CEP), número de aprovação 4.952.193, com autorização do paciente e seus responsáveis legais. Considerações Finais: o caso relatado evidencia a importância de um diagnóstico fidedigno e dos diagnósticos diferenciais, uma vez que a paciente apresentou a lesão por aproximadamente oito anos, sem receber nenhum diagnóstico e/ou tratamento. Além disso, não só a faixa etária é incomum, mas também a localização da lesão e por esta razão, as informações são fundamentais para auxiliar outros profissionais, com benefício deste estudo para o Sistema de Saúde.

Arbovírus são transmitidos por mosquitos e carrapatos, causando doenças graves em humanos, como dengue, Zika, Chikungunya e febre amarela. Este estudo buscou padronizar a técnica de RT-qPCR para detecção desses vírus em amostras de tecidos parafinados. Foram utilizadas 45 amostras parafinadas, incluindo arbovírus em estudo e amostras de controle negativo, provenientes de diferentes períodos e tecidos, catalogadas pelo Instituto Evandro Chagas. A padronização da técnica de RT-qPCR é essencial para a vigilância epidemiológica de arbovírus na região amazônica e no Brasil. Os resultados demonstraram eficiência na detecção e quantificação do genoma viral dos diferentes arbovírus. A técnica de RT-qPCR se mostrou uma ferramenta importante para o diagnóstico diferencial em amostras de tecidos parafinados. Essa padronização é relevante para o monitoramento e controle efetivo das doenças transmitidas por arbovírus, contribuindo para a saúde pública e a prevenção de surtos. Este estudo ressalta a importância da padronização da técnica de RT-qPCR para detecção de arbovírus em amostras de tecidos parafinados. A região amazônica e o Brasil são áreas propensas a surtos dessas doenças, tornando esses avanços ainda mais significativos. A detecção precoce e precisa dos arbovírus permite a implementação de medidas de controle e prevenção mais eficazes, além de contribuir para a compreensão da epidemiologia dessas doenças.

Introdução: O Sinal do Halo Invertido (SHI) é um indício tomográfico pulmonar definido por uma área focal circular de opacidade em vidro fosco, circundada por um anel de consolidação e pode ser visto em um amplo espectro de doenças pulmonares. Já o sinal da bandeira se caracteriza por áreas de despigmentação de fâneros, como cabelos e sobrancelhas, e tem como causa a baixa ingestão proteica. Descrição do caso: J.V.A.A, sexo masculino, 18 anos, residente em Ourilândia-PA, sem contato com a zona rural e sem animais domésticos, iniciou em maio/2022 quadro de clareamento de pelos das sobrancelhas e cabelos na fronte, seguido por mal-estar, perda de 12 kg, febre vespertina havia 20 dias de até 40°C com sudorese noturna, linfonodomegalias inguinais, diarreia, episódios de vômitos, mialgias e artralgias. Negou contactantes tuberculosos. Consulta prévia com dermatologista, que solicitou revisão laboratorial extensa sem alterações (sorologias ‒ inclusive teste rápido de leishmaniose visceral ‒ provas reumatológicas, hemograma, bioquímica completa - incluindo dosagem de albumina sérica), radiografia de tórax e ultrassom de abdome também sem achados de importância clínica. Encaminhado para a Infectologia em outubro/2022, realizou Tomografia Computadorizada (TC) do tórax, que evidenciou “imagem nodular com opacidade com halo invertido localizada no lobo lingular esquerdo medindo cerca de 1,3 cm; imagem nodular de contornos regulares e limites bem definidos localizada no segmento posterior do lobo médio direito medindo cerca de 0,8 cm, sugestiva de processo inflamatório infeccioso agudo”. TC do abdome inespecífica, prova tuberculínica não reatora e anatomopatológico de linfonodo inguinal com “hiperplasia folicular reacional”. Optado pelo início terapia de prova com Itraconazol 200 mg/dia devido alta prevalência de paracoccidioidomicose na região. Paciente iniciou curva de melhora clínica nos meses seguintes (ganho ponderal, achatamento de curva térmica, redução das náuseas, desaparecimento de linfonodomegalias inguinais, retorno da coloração habitual de pelos e cabelos). Em fevereiro/2023 (3° mês de terapia), nova TC de tórax mostrou melhora em relação ao 1° exame com apenas um “nódulo arredondado, medindo cerca de 0,6 cm no seu maior eixo”. Conclusão: Trata-se de um caso de febre de origem indeterminada com SHI como possível achado tomográfico da Paracoccidioidomicose associado a sinal de bandeira, a despeito de albumina sérica normal.

Introdução e objetivos: A Síndrome Oculoglandular de Parinaud manifesta-se como uma conjuntivite granulomatosa não supurativa, unilateral associada à linfadenopatia pré-auricular e submandibular. Classicamente é ocasionada pela bactéria Bartonella hanselae, que por sua vez apresenta a pulga do gato como principal vetor, todavia, Sporothrix spp. têm se destacado como agente etiológico. Assim, o objetivo do estudo foi descrever a ocorrência de Síndrome Oculoglandular de Parinaud causada por Sporothrix spp. em área endêmica para a esporotricose. Métodos: A pesquisa recebeu aprovação do Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de Pernambuco e está sob protocolo CAAE: 52143021.5.3001.8807. Tratou-se de uma pesquisa descritiva que teve como público-alvo os pacientes atendidos no Laboratório Multiusuário de Pesquisa e Diagnóstico em Doenças Tropicais do Serviço de Dermatologia de um hospital terciário do Recife, Pernambuco, no período de 2020 a 2022. Os registros internos foram avaliados e variáveis clínico-epidemiológicas foram descritas. Resultados: Foram atendidos no local do estudo 889 pacientes, destes, 34,2% (n=304) possuíam suspeita clínica de esporotricose, com diagnóstico laboratorial confirmado para 46,1% (n=140). Dentre os pacientes com esporotricose confirmada, 15,7% (n=22) foram diagnosticados com Síndrome Oculoglandular de Parinaud, por meio de exame clínico e avaliação laboratorial das características macromorfológicas e micromorfológicas de Sporothrix spp. cultivados em Ágar mycosel. Houve maior acometimento do público feminino (63,6%; n=14/22), com uma idade média de 31,4 anos para ambos os gêneros. Quanto as ocupações declaradas pelos pacientes, 31,8% (n=7/22) eram estudantes. A Região Metropolitana do Recife abrigou o maior número de pacientes (68,0%; n=15/22). Com relação a fonte de infecção, 54,5% (n=12/22) dos pacientes referiram contato com gatos doentes, onde o espirro do felino, bem como, arranhadura e/ou mordedura são as principais formas de transmissão. Quanto ao tratamento, 54,5% (n=12/22) fizeram uso de itraconazol previamente a coleta. Conclusão: Neste contexto, a avaliação clínico-epidemiológica e laboratorial dos casos de conjuntivite granulomatosa são mandatórios para esclarecer a etiologia da infecção e proporcionar um tratamento confiável aos pacientes.

Apresentação do quadro sinótico, elaborado pelo Dr. Jorge de Marsillac, com diretrizes para o diagnóstico do câncer.

Introducción: la enfermedad de Crohn (EC) es inusual en Colombia. La tuberculosis (TB) se presenta con mayor frecuencia, pero el compromiso intestinal es raro. Diferenciar estas dos entidades y el tratamiento de los casos en los que coexisten es un reto. Caso clínico: hombre de 28 años con 3 meses de síntomas constitucionales, respiratorios y gastrointestinales al que en un inicio se le confirmó el diagnóstico de tuberculosis pulmonar y se le atribuyó a esta entidad todas las manifestaciones clínicas. Ante la ausencia de mejoría con el tratamiento y la suma de hallazgos radiológicos, endoscópicos y patológicos, se confirmó EC. El tratamiento fue difícil debido a la coexistencia de las dos entidades, aunque finalmente presentó remisión con el uso de biológicos. Discusión: diagnosticar la EC requiere de la sumatoria de hallazgos clínicos y paraclínicos. Para diferenciarla de TB intestinal puede llegar a ser necesaria una prueba terapéutica. El tratamiento de EC en un paciente con TB tiene algunas limitaciones, los esteroides no se contraindican de manera absoluta y el inicio de biológicos debe hacerse con precaución. Conclusiones: diferenciar la EC de la TB intestinal es un reto diagnóstico. El enfoque terapéutico cuando coexisten estas dos entidades requiere un abordaje interdisciplinario.

O autor apresenta inicialmente a sintomatologia geral, assim como os recursos usuais para o diagnóstico das lesões bucais, acentuando a necessidade do exame direto, minucioso e sistemático, tendo em vista a finalidade, principalmente profilática a que o mesmo se presta.

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia 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.)

Arboviruses are transmitted by mosquitoes and ticks, causing severe diseases in humans such as dengue, Zika, Chikungunya, and yellow fever. This study aimed to standardize the RT-qPCR technique for detecting these viruses in paraffin-embedded tissue samples. A total of 45 paraffin-embedded samples were used, including arboviruses under study and negative control samples from different periods and tissues, cataloged by the Evandro Chagas Institute. Standardization of the RT-qPCR technique is essential for arbovirus surveillance in the Amazon region and Brazil. The results demonstrated efficiency in detecting and quantifying the viral genome of different arboviruses. The RT-qPCR technique proved to be an important tool for the differential diagnosis in paraffin-embedded tissue samples. This standardization is relevant for monitoring and effectively controlling arbovirus-transmitted diseases, contributing to public health and outbreak prevention. This study highlights the importance of standardizing the RT-qPCR technique for detecting arboviruses in paraffin-embedded tissue samples. The Amazon region and Brazil are prone to outbreaks of these diseases, making these advancements even more significant. Early and accurate detection of arboviruses enables the implementation of more effective control and prevention measures, as well as contributing to the understanding of the epidemiology of these diseases. [ABSTRACT FROM AUTHOR]

Introduction: Crohn's disease (CD) is unusual in Colombia. Tuberculosis (TB) occurs more frequently, but intestinal involvement is rare. Differentiating these two entities and treating the cases in which they coexist is a challenge. Clinical case: A 28-year-old man with three months of constitutional, respiratory, and GI symptoms was initially diagnosed with pulmonary tuberculosis, and all the clinical manifestations were attributed to this entity. Given the absence of improvement with treatment and the sum of radiological, endoscopic, and pathological findings, CD was confirmed. Treatment was complex due to the coexistence of the two entities, although he finally went into remission with the use of biologicals. Discussion: Diagnosing CD requires the sum of clinical and paraclinical findings. A therapeutic test may be necessary to differentiate it from intestinal TB. The treatment of CD in a patient with TB has some limitations; steroids are not contraindicated, and biologicals must be initiated cautiously. Conclusions: Differentiating CD from intestinal TB is a diagnostic challenge. Therapeutic management when these two entities coexist requires an interdisciplinary approach. [ABSTRACT FROM AUTHOR]

This article aims to examine the differences between a manicdepressive psychosis and a schizophrenic psychosis based on a crisis report experienced by a patient. The case report approach presented is based on three distinct and complementary analyses, the report in the first, second and third person. Through this, the importance of the report for contemporary psychiatry is discussed. Furthermore, we phenomenologically describe a psychopathological differentiation between a manic-depressive psychotic crisis and a schizophrenic psychotic break, considering the experiential expressions of affectivity and integrity of the self. Based on these considerations, the concepts of endogeneity by H. Tellenbach and comprehensibility and incomprehensibility by K. Jaspers are debated illuminating the importance of these concepts for the current psychiatry in their relationship with the one of psychosis. [ABSTRACT FROM AUTHOR]

La Organización Mundial de la Salud (OMS) informa que ocurren 1.1 millones de casos de tuberculosis (TBC) en niños

El escorpionismo, como se denomina al cuadro clínico producido por la picadura de escorpiones tóxicos en humanos, es un problema de salud pública en áreas urbanas y rurales de la América Tropical, incluyendo Paraguay, asociado a pobreza y a la falta de acceso a antivenenos específicos. Aunque su prevalencia en Paraguay no ha sido aún evaluada, la presencia de especies de reconocida toxicidad que son propias del país junto a otras especies compartidas con los países limítrofes y el registro de envenenamientos severos en niños en el Departamento Central, demandan la revisión de esta patología para su conocimiento por los profesionales de salud y de investigación sobre el tema. En esta revisión, se describen el conocimiento actual sobre esta patología en Paraguay, las alteraciones fisiopatológicas ocasionadas por los componentes tóxicos presentes en el veneno escorpiónico en los principales sistemas fisiológicos que sirven de blanco farmacológico de las toxinas, además de aportar a su diagnóstico diferencial, con el fin de contribuir con el adecuado tratamiento de las víctimas de estos envenenamientos y a la comprensión holística de esta emergente enfermedad desatendida en el país.

This report was performed after the advisor monitored a patient in a private network. The patient did not present common symptoms upon examination, and her age was already above the age range for the pathology, which made it difficult to suspect this rarity at first. Transvaginal ultrasound was requested to validate the diagnosis due to abnormal bleeding. The examination revealed calcification, which could be the cause of the metaplasia. As a result, the case was discussed with the patient, and options were presented. Hysterectomy surgery with preservation of the ovaries was selected. Currently, the patient is well and has no complaints. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca 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.)

Copyright of Revista Sociedad Colombiana de Oftalmología is the property of Sociedad Colombiana de Oftalmologia 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.)

O presente artigo busca discutir a diferenciação entre uma psicose maníaco-depressiva e uma psicose esquizofrênica a partir de um relato de caso de uma crise sofrida por uma paciente por nós atendida. A abordagem do relato de caso apresentado aqui é realizada a partir de três análises distintas e complementares, o relato em primeira, segunda e terceira pessoa. Com isso, se discute a importância do relato para a psiquiatria atual, além de se descrever fenomenologicamente uma diferenciação psicopatológica de um surto psicótico maníaco-depressivo e um surto psicótico esquizofrênico tendo em conta as expressões vivenciais da afetividade e da integridade do "eu". A partir dessas considerações, debate-se sobre os conceitos de endogeneidade de H. Tellenbach e compreensibilidade e incompreensibilidade de K. Jaspers ilumina a importância desses conceitos para a atualidade em sua relação com o de psicose.

Os autores relatam um caso de antracossilicose que simulava neoplasia pulmonar. Discutem aspectos da associação de patologias, pontos do diagnóstico e esquema de tratamento da tuberculose quando relacionada a silicose.

Os autores realizaram um estudo de 272 bócios nodulares solitários da tireóide, diagnosticados e tratados com confirmação histopatológica. Serviço de Cirurgia de Cabeça e Pescoço do instituto Nacional do Câncer-RJ. A experiência, contudo, demonstrou ser baixa a ocorrência de carcinomas nestes módulos (13,2%), rotineiramente ressecados em muitos Serviços, mostrando que há necessidade de melhor seleção dos pacientes na indicação cirúrgica. Acreditam que não existem dúvidas sobre a eficácia da associação de dados clínicos, cintilografia, ultra-sonografia, terapia de supressão e citologia da biópsia de aspiração na seleção cirúrgica dos pacientes com nódulos solitários da tireóide.

Da análise de 115 casos de mamografias com calcificações mamárias, (exames realizados no Instituto Nacional de Câncer, RJ). Os autores mostram os principais aspectos e as características radiológicas dentro das patologias benignas e malignas.

RESUMO Objetivo Apresentar a tradução e adaptação transcultural do Apraxia of Speech Rating Scale (ASRS) versão 3.5 para o português brasileiro. Método Estudo de validação restrito à tradução e adaptação transcultural. Foram realizadas as seguintes etapas: tradução e síntese das traduções; verificação da aplicabilidade da síntese da escala por juízes, recrutados para tal finalidade; análise da relevância e da viabilidade da escala, calculadas pelo Índice de Validade de Conteúdo (IVC) individual (IVC-I) e total (IVC-T). Foram selecionados 18 fonoaudiólogos, cujas respostas foram utilizadas para a análise de concordância (coeficientes de correlação intraclasse - CCI) e o cálculo do Índice de Validade de Conteúdo (IVC). Por fim, a síntese da tradução foi equiparada quanto à equivalência semântica, idiomática, experiencial, conceitual, sintática, gramatical e operacional. Resultados O CCI variou entre 0,83 e 0,94. Seis itens obtiveram valores superiores a 0,9. Os demais itens apresentaram valores entre 0,8 e 0,9. O IVC-I e IVC-T apresentaram excelentes valores (IVC ≥ 0,78) para a relevância e viabilidade. Conclusão A versão brasileira do ASRS 3.5 apresenta equivalência semântica, idiomática, experiencial, conceitual e sintática/gramatical em relação ao original, dessa forma, está apta para as próximas etapas de validação.

Resumo O infarto do miocárdio com artérias coronárias não obstrutivas (MINOCA) é um fenômeno clínico intrigante e de prognóstico incerto, caracterizado pela evidência de infarto do miocárdio (IM) com artérias coronárias normais ou quase normais na angiografia1. Atualmente, não há diretrizes para o manejo e muitos pacientes recebem alta sem uma etiologia determinada, significando muitas vezes que o tratamento ideal é adiado.Relatamos três estudos de caso MINOCA com as principais causas fisiopatológicas cardíacas, particularmente epicárdicas, microvasculares e não isquêmicas, levando ao tratamento diferencial. Os pacientes apresentavam dor torácica aguda, aumento da troponina e nenhuma doença coronariana angiograficamente significativa.Neste estudo, analisamos a etiologia, diagnóstico clínico e tratamento da MINOCA em relação à literatura relevante.MINOCA é considerado um diagnóstico de trabalho dinâmico, incluindo distúrbios coronários, miocárdicos e não coronários. Estudos prospectivos e registros são necessários para melhorar o atendimento e o resultado do paciente.

Introduction: Abdominal pain is one of the most frequent reasons for consultation in the emergency services, its adequate diagnostic approach determines the treatment to be chosen by the doctor in charge of the case; This in turn can opt for medical or surgical management, all this if the underlying cause of the symptoms presented by the patient is considered. Clinical case: This article presents the case of a male patient in the fifth decade of life, with a surgical history of appendectomy, which he consults due to a clinical picture of intense abdominal pain located in the right iliac fossa. In the physical examination, the presence of signs of peritoneal irritation was striking, for which serological studies were requested, which were found to be within normal parameters, in addition to a computed tomography of the abdomen that revealed trabeculation of pericecal fat. The patient persisted with symptoms, so he was taken for open abdominal cavity exploration, with an intraoperative finding of acute appendagitis. Conclusion: Despite being an infrequent cause of acute surgical abdomen, acute appendagitis should always be a diagnosis to be considered by emergency physicians and surgeons. The availability of imaging studies that allow an adequate characterization of the clinical picture is going to be essential for the management of patients, especially if the whole variety of entities that occur in the abdominal cavity are taken into account. [ABSTRACT FROM AUTHOR]

ß-thalassemia is a genetic disease characterized by the decrease or absence of the production of ß hemoglobin chains, which can be heterozygous, presenting asymptomatically or with mild microcytic and hypochromic anemia; or homozygous, with severe hemolytic anemia, leading to musculoskeletal and developmental disorders. The aim of the present study was to analyze the Mentzer Index as an adjuvant in the diagnosis of the thalassemia trait of beta-thalassemia, given that, in its homozygous form, beta thalassemia has a clinical setting that is distinct from iron deficiency anemia or even from the beta-thalassemia trait, culminating in a hemolytic anemia with symptoms of excessive hemolysis leading to splenomegaly, anemia with significant hemoglobin deficiency, bone marrow hyperplasia and, in some cases, imminent need for blood transfusion. This is an integrative review of the Mentzer index. A bibliographic review was carried out in the electronic databases PUBMED, SciELO and Periódicos CAPES between 2016 and 2021. 12 manuscripts to be reviewed were incorporated in the present study, which needed to relate the Mentzer index to the differentiation of beta-thalassemia trait from anemia ferropenic. After reading and analyzing the articles related to this study, it was shown that the Mentzer index can be recommended for differentiating between the two pathologies with good sensitivity and specificity for the trait related to beta-thalassemia, however, in case of doubts between anemia iron deficiency and beta-thalassemia, a study with hemoglobin electrophoresis should be performed. Therefore, it is concluded that in the absence of the possibility of carrying out hemoglobin electrophoresis or hemoglobin analysis by HPLC, the Mentzer index can be used to differentiate between iron deficiency anemia and the respective beta-thalassemia trait and start treatment, however, it is necessary to point out that in the absence of response to therapy, hemoglobin electrophoresis or hemoglobin analysis by HPLC becomes an indispensable test. [ABSTRACT FROM AUTHOR]

The characteristic optical coherence tomography finding in solar maculopathy is a well-defined outer retinal hyporeflective space primarily involving the photoreceptor inner and outer segment layers. This typical optical coherence tomography image may be present in a few other pathologies, which currently constitute their main differential diagnoses. Our study shows the report of 12 eyes of 6 patients treated at the Hospital de Olhos do Paraná, presenting their clinical history and diagnostic images, with the purpose of comparing the findings of the first 3 patients (diagnosed with solar maculopathy) with the last 3 patients, which are also cases of external macular holes. [ABSTRACT FROM AUTHOR]