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RESUMEN Hoy en día, un problema latente en el proceso de aprendizaje de una lengua extranjera es la comprensión lectora. Ante este panorama, es menester identificar estrategias o medios que permitan abatirlo. Los círculos literarios mejoran ampliamente las experiencias y conocimientos de lectura de los estudiantes, dado que permiten enriquecer su bagaje léxico con uso correcto de estructuras gramaticales. El objetivo del presente estudio fue identificar la influencia de los círculos literarios en el desarrollo de la lectura en extenso (LE) en ambientes virtuales, con la intención de contribuir al mejoramiento de la comprensión lectora del inglés de manera autónoma y fuera de las aulas ordinarias. Para analizar este fenómeno se realizó un estudio cuantitativo longitudinal con alcance correlacional que permitió a los investigadores identificar tres elementos principales en el proceso de aprendizaje con círculos literarios para la lectura extensiva: pedagógico, social, y técnico, así como cuatro formas de aproximación a la lectura: gráfica, oral, asociativa y analítica, donde subyacen recorridos cognitivos mediados por tecnología y procesos de internalización en un aprendizaje ubicuo que detona leer en grandes cantidades con placer, precisión, velocidad, motivación y confianza. Los hallazgos confirman la influencia de los círculos literarios en la LE aportando un modelo tecno-pedagógico para su implementación y una forma innovadora de desarrollar la LE en modalidades virtuales que contribuye a mejorar los niveles de proficiencia en la comprensión lectora.
ABSTRACT Today, a latent problem in foreign language learning is reading comprehension. Given this scenario, it is necessary to identify strategies or means to bring it down. Literary circles improve students' reading experiences and knowledge since they allow them to enrich their lexical baggage with the correct use of grammatical structures. The objective of the present study was to identify the influence of literary circles to foster extensive reading (ER) in virtual environments to improve English reading comprehension autonomously and outside ordinary classrooms. For analyzing this phenomenon, a quantitative longitudinal study with a correlational design was carried out, which helped researchers to identify three essential elements during the learning process with literary circles for extensive reading: pedagogical, social, and technical. Additionally, four ways of approaching reading were identified: graphic, oral, associative, and analytical, where technoloy-mediated cognitive pathways and internalization processes underlie ubiquitous learning that triggers reading in large quantities with pleasure, accuracy, speed, motivation, and confidence. The findings confirm the influence of literary circles in ER, providing a techno-pedagogical model for its implementation and an innovative way of developing it in virtual modalities that contributes to improving proficiency levels in reading comprehension.
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Buccal tablets
Diclofenac sodium
Drug release
Mucoadhesion
Mucoadhesive tablets
Release kinetics
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OBJECTIVE To evaluate the economics of serplulimab combined with chemotherapy regimens for the first-line treatment of extensive-stage small cell lung cancer （ES-SCLC） from the perspective of health system in China. METHODS A partitioned survival model was constructed based on the ASTRUM-005 clinical trial and related literature data， with a model simulation time frame of 10 years and a 3-week cycle， and both cost and utility values were discounted using a 5% discount rate. The quality-adjusted life year （QALY） was used as a model output indicator and the incremental cost-effectiveness ratio （ICER） was calculated to evaluate the economics of serplulimab combined with chemotherapy regimens （serplulimab group） versus chemotherapy alone regimens （chemotherapy alone group） for the first-line treatment of ES-SCLC. One-way sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the results of the base-case analysis and to conduct a scenario analysis for the serplulimab patient assistance program. RESULTS The results of the base-case analysis showed that compared with chemotherapy alone group， ICER of serplulimab group was 758 690.27 yuan/QALY， which was higher than 3 times China’s per capita gross domestic product （GDP） in 2022 as the willingness-to-pay （WTP） threshold. The results of the scenario analysis showed that compared with chemotherapy alone group， the ICER of serplulimab group was 172 275.74 yuan/QALY， which was below above WTP threshold. The one-way sensitivity analysis showed that the progress-free survival utility value， serplulimab price and so on had a significant impact on the model results. The results of the probabilistic sensitivity analysis showed that the probability of the serplulimab group being economic was 0 when the serplulimab patient assistance program was not considered， but 100% when the patient assistance program was considered. CONCLUSIONS At a WTP threshold of 3 times China’s per capita GDP in 2022， the serplulimab group is no cost-effectiveness compared to the chemotherapy alone group； however， this result is reversed when the patient assistance program is taken into account.
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Abstract The aim was to assess whether there is a correlation between the body condition score (BCS) and the pregnancy rate of cows submitted to fixed-time artificial insemination (FTAI) on Ilha do Marajó, Pará, in the Eastern Amazon. 159 female bovines were analyzed, submitted to FTAI, selected through clinical and gynecological evaluation, being considered clinically healthy and cyclic cows, of the Bos taurus indicus breed, from an extensive system property, in the municipality of Cachoeira do Arari, on Ilha do Marajó, Pará. The qualitative research method was used, with the objective of analyzing the correlation between the pregnancy rate and the BCS of this lot. Of the 159 women submitted to FTAI, 86 had a positive pregnancy diagnosis, obtaining a pregnancy rate of 54.08% and the number of pregnant animals was 73, or 45.92%. There was a positive and significant correlation (r=0.167) between BCS and pregnancy rate (p<0.05). Thus, the study has enabled us to conclude that there was a positive interdependence between BCS and the gestational diagnosis. Thus, the effect of body condition on pregnancy rate in cows raised in the Eastern Amazon is confirmed.
Resumo Objetivou-se avaliar se existe correlação entre o escore de condição corporal (ECC) e a taxa de prenhez de vacas submetidas a inseminação artificial em tempo fixo (IATF) na Ilha do Marajó, Pará, na Amazônia Oriental. Foram analisadas 159 fêmeas bovinas, submetidas à IATF, selecionadas mediante avaliação clínica e ginecológica, sendo consideradas vacas clinicamente saudáveis e cíclicas, da raça Bos taurus indicus, de uma propriedade de sistema extensivo, no município de Cachoeira do Arari, na Ilha do Marajó, Pará. Foi utilizado o método de pesquisa qualitativo, com objetivo de analisar a correlação entra a taxa de prenhez e o ECC, deste lote. Das 159 fêmeas submetidas a IATF, 86 apresentaram diagnóstico de gestação positivo, obtendo-se taxa de prenhez de 54,08% e o número de fêmeas vazias foi de 73, ou seja, 45,92%. Houve correlação positiva (r = 0,167) e significativa entre a ECC e a taxa de prenhez (p<0,05). Desta forma, o estudo permitiu concluir que houve uma interdependência positiva entre a ECC e o diagnóstico gestacional. De modo que constata o efeito da condição corporal sobre a taxa de prenhez em vacas criadas na Amazônia Oriental.
Resumen Objetivo evaluar si existe correlación entre el índice de condición corporal (BCS) y la tasa de preñez de vacas sometidas a inseminación artificial a tiempo fijo (IATF) en Ilha do Marajó, Pará, en la Amazonía Oriental. Fueron analizadas 159 hembras bovinas, sometidas al FTAI, seleccionadas mediante evaluación clínica y ginecológica, siendo consideradas vacas clínicamente sanas y cíclicas, de la raza Bos taurus indicus, de una propiedad de sistema extensivo, en el municipio de Cachoeira do Arari, en Ilha do Marajo, Pará. Se utilizó el método de investigación cualitativo, con el objetivo de analizar la correlación entre los taxones preñados y el CEC, de este lote. De las 159 mujeres sometidas a IATF, 86 tuvieron diagnóstico de embarazo positivo, obteniendo una tasa de embarazo de 54,08% y el número de gestantes fue de 73, o 45,92%. Hubo una correlación positiva y significativa (r=0,167) entre ECC y taxones de preñez (p<0,05). Así, el estudio permitió concluir que hubo una interdependencia positiva entre la CEC y el diagnóstico gestacional. Así, se confirma el efecto de la condición corporal sobre los taxones de gestación en vacas criadas en la Amazonía Oriental.
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The coronavirus pandemic brought with it a wide range of clinical presentations. Earlier, the respiratory symptoms comprised most of the clinical picture. However, as more and more people got infected, many atypical presentations came into the limelight, especially the neurological manifestations. Spinal cord complications are widely reported, with COVID-19 associated myelitis constituting a big part. Through this report, we bring you a series of cases of COVID-19 associated myelitis to add to the already available data. We report four patients, two of whom developed longitudinally extensive myelitis (three or more vertebral segments). The other two suffered from multisegmented short-segment myelitis (less than three vertebral segments). COVID-19 myelitis can be seen during COVID-19 illness and post COVID. We aim to familiarize the medical community with this entity so that there is a minimum delay between the onset of the symptoms in the patient and the management of this complication, as the treatment is often gratifying.
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Neuromyelitis optica spectrum disorders (NMOSD) is an immune mediated inflammatory demyelinating disease of the central nervous system. Optic neuritis and longitudinally extensive transverse myelitis are the main clinical signs, and the etiology is mainly related to aquaporin 4 (AQP4) antibody. AQP4 is the target antigen of immune attack. NMOSD is characterized by optic neuritis, longitudinally extended transverse myelitis, medulla area postrema syndrome, brainstem syndrome, diencephalic syndrome and cerebral syndrome. In recent years, the etiological mechanism, clinical diagnosis and monoclonal antibodies targeting new mechanisms of NMOSD have made great progress, which promoted the development of clinical neurology.
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Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.
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Although acupuncture has spanned thousands of years in the history of traditional medicine, still some basic questions are not clarified. Acupuncture is the theory based on long time medical practice of the ancient sage, combined with objectivesymptom and medical expertise from diseases, and being applied for the instruction in clinic. In this way, acupoint is discovered by doctors in the practice of disease treatment other than a natural occurrence in the healthy population. And acupoint specificity is attached to the target organ involved in pathological condition. In our opinion, acupoint originates from somatic referred area reactive to visceral disorders. And accordingly, referred hyperesthesia of the somatic area is phenomenon of acupoint sensitization. Acupoint is the situ having health code formed in the biological evolution. Corresponding acupoint of a given organ is the alarmer for the state of health, and also is the trigger for self-healing where acupuncture can work as a gating-button. Therefore, acupoint must be accompanied with diseases in that it is reinforced by, relayed on, responsive to and neutralize by the pathological course. In conclusion, acupoint cannot exist without the disease. In another word, acupoint will be unshown, or be functionally hidden, under physiological condition.
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Humans , Acupuncture , Acupuncture Points , Acupuncture Therapy , Medicine, Traditional , PhysiciansABSTRACT
Extensive stage small cell lung cancer (ES-SCLC) has a poor prognosis and short survival. Although platinum based combined with etoposide regimens and prophylactic craniocerebral irradiation have become the treatment regimens for ES-SCLC, it still faces the challenges of low local control rate and overall survival rate. As a local treatment, radiotherapy has a wide range of applications, which can not only be used for the radical treatment of local lesions, but also for the selective palliative treatment of advanced patients. Thoracic radiotherapy can improve the local control of ES-SCLC, among them, patients with residual intrathoracic lesions after chemotherapy benefit the most. There is still no unified standard for the appropriate population, optimal dose and segmentation of thoracic radiotherapy, and further research is needed.
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OBJECTIVE：To evaluate the economics of atezolizumab combined with stardard chemotherapy regimens versus chemotherapy regimens alone as first-line treatment for extensive-stage small-cell lung cancer （ES-SCLC）from the healthcare system perspective. METHODS ：A partitioned survival model was constructed using published phase Ⅲ clinical trial data （IMpower133）and literature data to evaluate the economics of atezolizumaba combined with standard chemotherapy regimens versus chemotherapy regimens alone as first-line treatment for ES-SCLC. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the stability of the results. RESULTS ：The results of cost-utility analysis showed that the cost of atezolizumab combined with chemotherapy group was 489 598.52 yuan，with utility of 0.70 QALYs；the cost of chemotherapy alone group was 126 276.80 yuan，with utility of 0.55 QALYs；the incremental cost-utility ratio （ICUR）between the two groups was 2 361 709.05 yuan/QALY，far exceeding the willingness-to-pay （WTP）in China （3 times of GDP per capita in 2019，212 676 yuan）. One-way sensitivity analysis showed that progression-free utility value of atezolizumab combined with chemotherapy had the greatest impact on the results of cost-utility analysis ；probabilistic sensitivity analysis suggested that the atezolizumab combined with chemotherapy regimen was not economical within the WTP range of 0-500 000 yuan/QALY. CONCLUSIONS ：Atezolizumab combined with chemotherapy regimen has no cost-utility advantage versus chemotherapy alone in the first-line treatment of ES-CLC under the current economic level of China.
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Rationale: Salmonella (S.) typhi is a rare cause of osteomyelitis in immunocompetent adults. Extensive drug resistance (XDR) may lead to more complicated cases of S. typhi osteomyelitis. Patient concern: A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months. Her symptoms had been unresponsive to previous anti-microbial therapy. Diagnosis: Rib osteomyelitis caused by XDR S. typhi. Interventions: Surgical wound debridement, left 7th-9th rib resection and intravenous IV meropenem were done. Outcome: Fever resolved and left-sided swelling resected without recurrence. Lessons: The prevalence of XDR S. typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.
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Background: In extensive-disease-small cell lung cancer (ED-SCLC), the median survival is 8–10 months and 2-year survival is <5%. Primary tumor progression occurs in 90% of patients approximately within 1 year. The role of consolidative thoracic radiotherapy (C-TRT) for the postchemotherapy residue with the aim of improving local control (LC) and survival is currently of great interest. The objective of this study is to determine the effectiveness of C-TRT on LC, progression-free survival (PFS), and overall survival (OS) in ED-SCLC. Materials and Methods: Medical records of patients diagnosed as SCLC between January 2010 and December 2015 were evaluated retrospectively. Patients who received C-TRT were identified. Pre- and post-chemotherapy radiological evaluations, radiotherapy schedules, relapse patterns, toxicity incidence, LC, PFS, and OS were analyzed. Results: Among 552 SCLC patients, 26 ED-SCLC patients who underwent C-TRT were analyzed. Median follow-up was 7.5 months (range, 6.5–8.5 months). Nearly 50% of the patients had >4 metastatic lesions. Restaging was performed mostly by positron emission tomography/computed tomography and cranial magnetic resonance imaging. All patients had complete or near-complete response distantly. C-TRT was 10 × 300 cGy (n = 1), 23 × 200 cGy (n = 2), 25 × 200 cGy (n = 7), 30 × 200 cGy (n = 12), and 33 × 200 cGy (n = 4). There was no toxicity ≥ Grade 3. LC rate was 77%; there was no isolated local relapse. PFS was 3 months. Median survival was 13 months. The 1- and 2-year OS rates were 62% and 8%, respectively. Conclusion: In ED-SCLC patients, C-TRT may prevent isolated local recurrence and may improve 1-year survival. This survival improvement might be the reflection of high intrathoracic control achieved in 77% of patients
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Fournier's gangrene is rare necrotizing soft tissue infection affecting the perianal, perineal, and genital areas. The mean age of the reported cases was found to be at 55 y, predominantly in men. It occurs due to insufficient blood supply to the affected areas, along with the presence of an infection. Delay in the treatment is associated with a higher mortality rate, up to 90%, as the condition might progress to septic shock and other complications. Treatment requires urgent surgical debridement of all the necrotic tissue along with high doses of broad-spectrum antibiotics. Empirical broad-spectrum antibiotic therapy is to be initiated as soon as possible until the results of the culture cause modifications in the therapy.
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RESUMO A autora desenvolve uma reflexão sobre a extensão da clínica psicanalítica, mostrando como as ideias, os estudos, as discussões construídos durante muitos anos foram levando a Diretoria de Atendimento à Comunidade da Sociedade Brasileira de Psicanálise de São Paulo (2017-2020) a colocar o pensamento em ação e se deixar penetrar pelas questões da cidade e a se relacionar diretamente com territórios diversificados. Com as demandas surgidas no período de pandemia, a autora coloca em debate como os tempos de crise provocada pelo coronavírus têm nos colocado à prova, mostrado como o processo psicanalítico pode se dar em variadas formas de encontro de subjetividades, evidenciando tanto seus desafios como sua eficácia e potência.
ABSTRACT The author develops a reflection on the extension of the psychoanalytic clinic and presents how the ideas, the studies, the discussions built over many years, led to putting into action the board of directors that intervenes with the SBPSP community (2017-2020) and allowing himself to be penetrated by the issues of the city and relating directly to a universe of different territories. With the demands arising from the pandemic, the author discusses how the times of crisis caused by the coronavirus have put to the test and shown that the psychoanalytic process can occur in a varied way reaching subjectivity, highlighting both its challenges and its efficiency and power.
RESUMEN La autora desarrolla una reflexión sobre la extensión de la clínica psicoanalítica y presenta cómo las ideas, los estudios y las discusiones construidas durante muchos años llevaron a colocar en acción a la dirección, que interviene junto a la comunidad de la SBPSP (2017-2020) y se dejar penetrar por las cuestiones de la ciudad y que también no deja de relacionarse directamente con un universo de diversos calados. Con las demandas surgidas a partir de la pandemia, la autora coloca en debate cómo los tiempos de crisis provocados por el coronavirus han puesto a prueba y mostrado que el proceso psicoanalítico puede darse de varias formas de encuentro de subjetividad, evidenciando tanto sus desafíos como su eficacia y potencia.
RÉSUMÉ L'autrice développe une réflexion concernant l'étendue de la clinique psychanalytique, en démontrant comment les idées, les études, les discussions construites pendant plusieurs années ont mené petit à petit l'équipe de la direction d'accueil à la communauté de la SBPSP (2017-2020), à mettre en œuvre la pensée, à permettre que les questions de la ville s'y infiltrent et créer des rapports avec des territoires diversifiés. Étant donné les demandes surgies dans cette période de pandémie, l'autrice met en question comment ces temps de crise entraînés par le coronavirus nous ont mis à l'épreuve, démontre comment le processus psychanalytique peut avoir lieu dans des formes diverses de rencontre de subjectivités, tout en rendant évident aussi bien ses défis que son efficace et puissance.
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As fraturas panfaciais acometem concomitantemente os terços superior, médio e inferior da face, decorrentes de acidentes automobilísticos, arma de fogo, atropelamento, agressão física, entre outros. Essas fraturas geralmente envolvem osso frontal, zigomático, maxila, mandíbula e ossos nasais, necessitando assim, fixação interna rígida através do uso de miniplacas e parafusos com o propósito de estabilizar as estruturas fraturadas, dar suporte aos tecidos moles e evitar deformidades estéticas da face. O objetivo deste trabalho é relatar o manejo cirúrgico de um caso clinico atendido em um hospital público de Salvador/BA, no qual a vítima apresenta ampla laceração na face e fratura exposta do terço médio da face. O tratamento executado sob anestesia geral foi redução dos cotos ósseos fraturados, fixação com miniplacas e parafusos, reconstrução imediata dos tecidos moles acometidos(AU)
Panfacial fractures affect concomitantly the upper, middle, lower third of the face, resulting from automobile accidents, firearms, hit-and-run, physical aggression, among others. These fractures usually involve frontal bone, zygomatic, maxilla, jaw and nasal bones, thus requiring rigid internal fixation through the use of miniplates and screws in order to stabilize fractured structures, support soft tissues avoiding aesthetic face deformities. The objective of this work is to report the surgical management of a clinical case attended in a public hospital in Salvador/BA, in which the victim has wide laceration of the face and exposed fracture of the middle third of the face. Treatment performed under general anesthesia was reduction of fractured bone stumps, fixation with miniplates and screws, immediate reconstruction of the affected soft tissues(AU)
Subject(s)
Humans , Male , Facial Bones/injuries , Facial Injuries , Plastic Surgery Procedures , Face/surgeryABSTRACT
Background:Teeth are among the most important parts of our body which help in mastication, phonetic and esthetic. Now a daystooth extraction can be avoided due to availabilities of most advanced treatment. Mostly, extraction is the treatment of choice for extensive caries and severe periodontitis because of late reporting to dentist due to lack of knowledge. Knowledge about post extraction complications and their management can prevent the occurrence of untoward sequalae following extraction. Previous studies have shown that preoperative patient education can help in decreasing postoperative anxiety, pain and complications Methodology:This is a questionnaire based cross-sectional descriptive study. The study was conducted during the period of January to March 2018. Total of 250 patients (138 males and 112 females) were included in the study by the convenient method of sampling that visited the dental clinics of college of Dentistry, TaibahUniversity.Validated questionnaire was asked about post extraction preventive knowledge.Categories of answer was good, average and poor according to number of correct answers.The statistical analysis was performed by the Statistical Package for Social Science version 21 (SPSS Inc Chicago, IL, USA). The significant value was obtained by using Chi Square test and p< 0.05 was set to be significant. Results:Females and 31-45 years age group had betterpost extraction preventive knowledge and there was significant relation. Nationality and education level had no significant relation with level of post extraction preventive knowledge. The patients who had better knowledge followed the instructions precisely. Conclusion:It was concluded that female, patients above middle age group and more qualified patients had more post extraction preventive knowledge and they also followed the instructions very strictly. The importance of study came out that dentist or dental assistant should explain and convince them to follow proper post-operative instruction to avoid complications
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Background: Extensive intraductal component positive carcinoma (EICPC) of breast is defined by Schnitt et al as-A. 25% or more of Ductal carcinoma in situ (DCIS) is present along the invasive lesion and DCIS is also present outside the area of invasive carcinoma. B. EICPC also include carcinomas in which DCIS is associated with a “small” (approximately 10 mm or less) invasive carcinoma or carcinomas. In Extensive Intraductal Carcinoma (EIDC) most of the cases were associated with recurrence when surgical margin status is not evaluated or focally involved. Our objective was to study the prevalence of EIDC and expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor (HER2NEU)/Ki67(antigen identified by monoclonal antibody KI67) in those cases.Methods: It was a retrospective cross sectional study conducted over a period of 2017 to August 2019.All the histologically confirmed cases of EIDC was retrieved from the institute.Results: Out of 65 cases of invasive carcinoma 17 (26.1%) cases were positive for EICPC. Age of patients ranged from 27 to 73years with mean age of 43 years and 5 patients (29.4%) were postmenopausal. Most of the cases i.e. 6(35.2%) had a ER+/PR+/HER2NEU- status with most of the cases having high 6(47%)Ki-67 index. According to the BLOOM RICHARDSON GRADING 14 cases were grade II (82.3%) and 3 cases were grade I (17.7%) and in pT and pN staging majority were stage pT1 - 7 (41.1%). Most of the cases were mastectomy cases 11 (64.4%) with a base free status except in one lumpectomy case where margin was involved.Conclusions: In this study majority of the cases were ER+//PR+/HER2NEU- with most of the cases having high Ki67 index. Evaluation of EIDC, along with the negative margin status is important to prevent recurrence.
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Las enfermedades del espectro neuromielitis óptica son trastornos inflamatorios del sistema nervioso central caracterizados por una grave desmielinización y daño axonal inmunomediado que afecta principalmente a los nervios ópticos y médula espinal. Suelen presentars e en edades tempranas, aunque existen algunas comunicaciones en la literatura de pacientes con presentaciones tardías. Presentamos el caso de una mujer de 78 años que consultó por un cuadro de paraparesia grave, trastornos sensitivos y retención urinaria. Se realizó una resonancia magnética de columna cervicodorsal que evidenció una lesión medular longitudinal extensa. Se descartaron otras causas secundarias, basadas en la clínica y en resultados de laboratorio. El dosaje de anticuerpos anti-acuaporina 4 resultó positivo. Se indicó tratamiento con glucocorticoides a altas dosis y plasmaféresis, y mantenimiento con rituximab, obteniendo escasa respuesta clínica. En pacientes con lesiones medulares extensas se deben contemplar múltiples diagnósticos diferenciales según la presentación clínica, hallazgos mediante estudios por imágenes y epidemiología. Asimismo, debe incluir la búsqueda de anticuerpos anti-acuaporina 4 y contra la glicoproteína de la mielina del oligodendrocito, ya que el pronóstico funcional de estos pacientes suele ser desfavorable debido al gran componente destructivo de las lesiones. En consecuencia, el tratamiento temprano es fundamental a fin de limitar el daño agudo y prevenir futuras recaídas, lo cual es especialmente importante en presentaciones tardías de esta entidad debido a la escasa reserva funcional y baja capacidad de remielinización.
Optic neuromyelitis spectrum diseases are inflammatory disorders of the central nervous system characterized by severe demyelination and immunomediated axonal damage that mainly affects the optic nerves and spinal cord. They usually appear at an early age, although there are some reports in the literature of patients with late presentations. We present the case of a 78-year-old woman who consulted for severe paraparesis, sensory disorders, and urinary retention. An MRI of the cervicodorsal spine was performed, showing extensive longitudinal spinal injury. Secondary causes based on clinical observations and laboratory studies were ruled out. The dosage of anti-aquaporin 4 antibodies was positive. Acute treatment with high-dose glucocorticoids and plasmapheresis was indicated, and maintenance with rituximab, obtaining little clinical response. In patients with extensive spinal injuries, multiple differential diagnoses should be considered according to the clinical presentation, findings through imaging studies and epidemiology. Likewise, it should include the search for anti-aquaporin 4 antibodies and against the oligodendrocyte myelin glycoprotein, since the functional prognosis of these patients is usually unfavourable due to the large destructive component of the lesions. Consequently, early treatment is essential in order to limit acute damage and prevent future relapses, which is especially important in late presentations of this entity due to the low functional reserve and low remyelination capacity.
Subject(s)
Humans , Female , Aged , Neuromyelitis Optica/diagnosis , Magnetic Resonance Spectroscopy/methods , Neuromyelitis Optica/immunology , Neuromyelitis Optica/cerebrospinal fluid , Aquaporin 4/immunology , Antibodies/analysisABSTRACT
Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.
ABSTRACT
ABSTRACT If essential care is thorough, teeth with extensive orthodontically induced dental resorption can have the same endurance as normal teeth. These teeth are subjected to the same disturbances as normal ones, such as dental trauma, dental caries and periodontal disease, all of which are independent of severe dental resorption. Orthodontic retreatments of teeth presenting with extensive orthodontically induced dental resorption must take into consideration that these roots are shorter in length, therefore, they are more prone to root resorption. Conventional movements are not viable in severe resorption, but Orthodontics offer some alternatives, such as; 1) movement of multiple teeth, providing better distribution of force; 2) use of lesser forces along with bodily movements, as opposed to rotation; 3) anchorage using miniplates, which provide more diffuse and equally distributed force and movements upon teeth and bone. Extensive orthodontically induced dental resorption are not an indication for endodontic treatment. These teeth also should not be replaced by osseointegrated dental implants, but they must receive special care, as they must remain in the dental arch indefinitely.
RESUMO Se os cuidados essenciais forem seguidos detalhadamente, os dentes com reabsorções radiculares extensas induzidas ortodonticamente permanecem na boca o mesmo tempo que os dentes normais. Esses dentes podem ter as mesmas alterações que os normais, como traumatismos dentários, cárie dentária e doença periodontal, que independem das reabsorções severas. Os retratamentos ortodônticos envolvendo dentes com reabsorções radiculares extensas induzidas ortodonticamente devem considerar que as raízes são curtas e representam um forte fator preditivo para as reabsorções radiculares. A movimentação convencional fica inviabilizada nas reabsorções radiculares severas, mas a Ortodontia oferece alternativas, como: 1) movimentação de dentes em grupos, distribuindo melhor as forças; 2) uso de forças bem leves e com movimento de corpo, e não de inclinação; e 3) planejamentos com ancoragem tipo miniplacas, cujas forças e movimentos sobre os dentes e ossos são mais difusos e igualmente distribuídos. As reabsorções radiculares extensas induzidas ortodonticamente não são indicações para se fazer tratamentos endodônticos. Esses dentes também não devem ser substituídos por implantes dentários osseointegráveis. Eles devem receber cuidados especiais, para que possam permanecer em função na arcada dentária, indefinidamente.