2019 WACEM - Academic College of Emergency Experts Consensus Recommendations on Admission Criteria to Pediatric Intensive Care Unit from the Emergency Departments in India.

There is a global variation in policies that define clear indications for pediatric intensive care unit (PICU) admissions. In resource-limited countries where PICU service availability is limited, the admission criteria to PICU are urgently needed to optimize the utilization of available intensive care services and to maximize patient benefit. The objective of these consensus recommendations on PICU admission criteria is to provide a framework and reference for future policy development by professional societies and governments. DESIGN: The consensus recommendations were developed by a multidisciplinary consensus task force comprised of international experts in pediatric critical care, emergency medicine, trauma, critical care, and health policy stakeholders during the 2016 annual INDUSEM WORLD CONGRESS in Bengaluru, India. MEASUREMENTS AND MAIN RESULTS: A task force steering committee completed a global literature search about PICU admission criteria development, reviewed PICU admission guidelines published by a variety of professional organizations worldwide, and performed a literature review of relevant publications. The objectives of this task force is to provide a framework for validated approach to determine appropriateness of intensive care unit (ICU) admission in India (resource-limited setting) based on (a) prioritization modeling; (b) general clinical criteria; (c) clinical and objective parameters; and (d) other criteria. The expert consensus panel then discussed and ranked proposed criteria according to scientific evidence, the current standard of care, and expert opinion in the context of the Indian health system. The general subject was addressed in sections: admission criteria and benefits of different levels of care. Following the appraisal of the literature, discussion, and consensus, recommendations were written. CONCLUSION: Although these are consensus recommendations, the subjects addressed encompass complex ethical and medicolegal aspects of patient care that affect daily clinical practice. The scarcity of high-quality evidence made it difficult to answer all the questions asked related to ICU admission. Despite these limitations, the members of the task force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission process. This publication is designed to assist in future development of health policies to ensure effective resource allocation, maximize healthcare benefits, and improve access to quality care for children.

Tumor anficrino de antro gástrico-comunicación de un caso / Amphicrine tumor of gastric antrum—A case rport

Los tumores anficrinos malignos son un grupo de tumores en los que las células tumorales muestran evidencia de diferenciación tanto epitelial como neuroendocrina. Los tumores anficrinos malignos de estómago aunque han sido reportados no son muy comunes. El examen histopatológico de los tumores muestra características de adenocarcinoma o tumor neuroendocrino grado 1 a 2. Mediante inmunohistoquímica, estos tumores son positivos para ambos, marcadores neuroendocrinos así como marcadores epiteliales, indicando su naturaleza anficrina. Los tumores anficrinos malignos se clasifican ahora como un nuevo subgrupo en clasificación de la OMS. La rareza de este tumor en el antro gástrico nos motivó a publicarlo(AU)

Malignant amphicrine tumors are a group of tumors in which tumor cells show evidence of both epithelial as well as neuroendocrine differentiation. Malignant amphicrine tumors of gastric region though have been reported are not very common. Histopathological examination of these tumors show features of adenocarcinoma or grade 1 to 2 neuroendocrine tumor. Immunohistochemically, these tumors are positive for both neuroendocrine as well as epithelial markers indicating their amphicrine nature. Malignant amphicrine tumors are now classified as a new subgroup based on WHO classification. The rarity of this tumor in gastric antrum made us to report the case(AU)

Carcinoma adenoide quístico de la glándula de Bartolino. Una entidad poco común sujeta a diagnósticos erróneos / Adenoid cystic carcinoma of Bartholin's gland—A rare entity likely to be misdiagnosed

Los carcinomas primarios de la glandula de Bartolino son muy infrecuentes. El carcinoma adenoide quístico, una variante de adenocarcinoma, es todavía más raro que otros tipos histológicos en este órgano. Este tumor maligno es localmente agresivo, ocurre en mujeres postmenopáusica y muy raramente se encuentra en mujeres menores de 40 años. Una mujer de 35 años consultó por dispareunia en el departamento ginecológico del ambulatorio de nuestro Instituto. La lesión había sido diagnosticada previamente como un proceso inflamatorio. El diagnosticó de carcinoma adenoide quístico fue realizado mediante punción aspiración con aguja fina y confirmado histopatológicamente. Comunicamos los rasgos citohistológicos de este raro tumor, diagnosticado en una paciente joven. Realizamos una revisión de la literatura pertinente(AU)

Primary carcinomas of Bartholin's gland are very rare. Adenoid cystic carcinoma, a variant of adenocarcinoma is even rarer than the other histological types at this site. This locally aggressive malignant neoplasm is usually found in postmenopausal females and occurs only very occasionally in women under forty years of age. A 35-year-old patient presenting with dyspareunia was admitted at our gynaecology outpatients department. The lesion had been previously misdiagnosed as an inflammatory lesion. The diagnosis of adenoid cystic carcinoma was made on fine needle aspiration cytology which was confirmed on histopathological examination. We report the cyto- and histopathological features of this rare tumour occurring in a young patient together with a review of the relevant literature(AU)

Pilomyxoid astrocytoma.

Pilomyxoid astrocytoma (PMA) is a recently described brain tumor. PMA shares similar features with pilocytic astrocytoma (PA), the most common central nervous system (CNS) tumor in the pediatric population, yet displays subtle histologic differences. We describe a case of PMA in a six-year-old male involving sellar and suprasellar region presenting with failure to thrive and delayed developmental milestones. The histological findings revealed a tumor composed of a monotonous population of loosely arranged cells with delicate piloid like processes, within a prominent myxoid background. The tumor lacked biphasic appearance, Rosenthal fibers, eosinophilic granular bodies and calcification that are commonly observed in classical PA. Previous studies have shown PMA to behave more aggressively than PA, with shorter progression-free survival as well as a higher rate of recurrence and CNS dissemination. Thus, recognition of PMA and its distinction from classical PA is very important.