Upper Extremity Deep Vein Thrombosis as the Tip of the Iceberg: Case Report and Review of Literature.

Unprovoked venous thromboembolism (VTE) may be the earliest manifestation of cancer. According to recent studies, approximately 5% of patients with unprovoked VTE will be diagnosed with cancer within the first year of follow-up. Although screening extensively at the time of VTE diagnosis is attractive for clinicians, current clinical guidance documents suggest only a limited cancer screening strategy. The authors describe a rare case of Krukenberg tumor of the ovary arising from a primary gastric adenocarcinoma whose first sign was an unprovoked venous thrombosis of the upper extremity.

Pleural Mesothelioma: A Rapid Evolution of an Indolent Disease.

Mesothelioma is a rare and insidious neoplasm and is characterized by its highly malignant and aggressive nature. The most common etiology is asbestos exposure, but there are some reports without known asbestos exposure and other factors leading to malignant pleural mesothelioma (MPM). Here, we present the case of a 58-year-old woman with pleuritic chest pain, dyspnea, and fever on presentation to the emergency department (ED), which caused several admissions to the ED in 20 days. The patient was then admitted to the internal medicine department with a diagnosis of community-acquired pneumonia with parapneumonic effusion. During hospitalization, a positron emission tomography (PET) scan, thoracic computed tomography (CT), and pleural biopsy were performed and a final diagnosis of malignant epithelioid pleural mesothelioma was made. Six weeks after the onset of symptoms, the patient presented with an exponential disease progression, dying two months after the diagnosis, despite the initiation of chemotherapy. MPM remains a diagnostic and therapeutic challenge with a very poor prognosis. However, studies show that mesothelioma patients who undergo treatment live at least twice as long as patients who do not receive treatment. This case report is particularly significant because, although it was epithelioid mesothelioma, multiple solid masses were noted on CT and the patient exhibited rapid disease progression, dying a few weeks after starting treatment.

Portuguese Cross-Cultural Adaptations of the Pediatric International Knee Documentation Committee Score.

INTRODUCTION: The aim of this study was to translate the Pediatric International Knee Documentation Committee Score (Pedi-IKDC) into European Portuguese language. The Pedi-IKDC was originally developed in the English language and its main construct is functional assessment of knee disorders in children and adolescents. MATERIAL AND METHODS: The original English version of the questionnaire was translated to European Portuguese using the forwardbackwards method. Patients aged eight to 17 with knee disorders were considered eligible for the study. An online platform was implemented to collect patient responses, including general patient information, the questionnaires Pedi-IKDC, EuroQol-5 Dimension Youth and Childhood Health Assessment Questionnaire. Three surveys were sent: at the moment of first evaluation (T0), after two (T1) and ten (T2) weeks. These surveys followed the Consensus-based Standards for the Selection of Health Measurement Instruments - COSMIN Checklist recommendations. The internal consistency, reliability, error of measurement, structural and construct validity (by means of correlation with previously validated scales), responsiveness and interpretability (floor/ceiling effects, MIC and ROC curve) were evaluated. RESULTS: Forty-seven patients completed T0, 42 patients completed T1 and 40 patients completed T2. The factorial analysis confirmed that the scale has one dimension. Cronbach alpha (α) was 0.94; interclass correlation coefficient was 0.92; smallest detectable change was 19.04 for individuals and 3.31 for groups; standard error of measurement was 6.87; minimum important change was 18.48; floor and ceiling effects were absent. More than 75% of the hypotheses tested for construct validity were confirmed, showing its adequacy. The variation of scores between T0 and T2 correlated with the clinical evolution of the participants (r = 0.421, p < 0.05). CONCLUSION: The Portuguese version of Pedi-IKDC demonstrated good psychometric properties, being a valuable tool for clinical assessment of pediatric patients with knee disorder.

Systemic Bacillus Calmette-Guérin (BCG) Infection With Renal Involvement: A Rare Complication of BCG Immunotherapy.

Intravesical instillation of bacillus Calmette-Guérin (BCG) is the adjuvant therapy for superficial urothelial carcinoma of the bladder with the lowest recurrence rates and is well tolerated with minor and self-limiting adverse effects. Serious complications, such as systemic BCG infection, are uncommon as the diagnosis is difficult and, in the majority of cases, Mycobacterium bovis cannot be isolated. We describe a case of a man who presented with prolonged fever associated with polyuria, dysuria, anorexia, and significant weight loss, refractory to several courses of appropriate antibiotic therapy. After an exhaustive investigation, the underlying diagnosis of systemic BCG infection with renal involvement was considered. Antituberculosis treatment resulted in a marked clinical and radiological recovery, supporting this diagnosis.

Adesão nos grupos educativos em contracepção em uma área programática do Rio de Janeiro / Adherencia en los grupos educativos en anticoncepción en un área programática de Rio de Janeiro / Adhesion in educative groups on contraception in a programmatical area of Rio de Janeiro

Os objetivos do presente estudo sãoanalisar as causas da baixa adesão nos grupos educativos de contracepção sob o pontode vista dos profissionais coordenadores dos grupos; identificar a abordagem pedagógica utilizada no desenvolvimento dosgrupos educativos de contracepção, a partir de relatos dos profissionais que coordenam os grupos; discutir a adesão dosusuários e a abordagem pedagógica adotada pelos profissionais coordenadores dos grupos, na perspectivados direitossexuais e reprodutivos. Trata-se de um estudo descritivo, do tipo estudo de caso com sete profissionais de saúde quecoordenam os grupos educativos de contracepção. Utilizou-se entrevista gravada para coleta de dados que foi submetida àanálise de conteúdo. De acordo com as concepções dos entrevistados,os resultados apontaram como causas da baixaadesão fatores internos e externos da própria clientela, como as dificuldades de vida diária. A abordagem pedagógicautilizada pelos coordenadores, de acordo com os recursos disponíveis, atende às orientações do Ministério da Saúde no quetange as práticas educativas em saúde...

The objectives analysing the causes of low adhesionin educative groups on contraception from the point of view ofprofessionals who coordinate the groups; identifingthe pedagogical approach used in the development of educativegroups on contraception, from reports of the professionals who coordinate the groups; discussing the adhesion of the usersand the pedagogical approach adopted by the professionals who coordinate the groups, from the perspective of sexual andreproductive rights.Descriptive study - case studywith seven professionals of health who were coordinating the educativegroups on contraception. Interview recorded collection tools were submitted to content analysis. According to theinterviewees, the results pointed as causes of lowadhesion internal and external factors of the customers themselves, likethe difficulties survived by life daily income. Thepedagogical approach used by the coordinators paysattention to thedirections of the Ministry of Health about...

Los objetivos de este estudio son analizar las causas de la falta de adhesión en los grupos educativosde la anticoncepcióndesde el punto de vista de los coordinadores de losgrupos; identificar el enfoque pedagógico utilizado en el desarrollo delos grupos de educación de la anticoncepción, con base en los informes de los profesionales de la coordinación de losgrupos; discutir la adherencia de los usuarios y elenfoque pedagógico de los coordinadores de los grupos, desde laperspectiva de los derechos sexuales y reproductivos. Se realizó un estudio descriptivo, un estudio decaso con sieteprofesionales de la salud que coordinan los gruposeducativos de anticonceptivos. Se utilizó una entrevista grabada pararecoger datos que fue sometida a análisis del contenido. De acuerdo con las opiniones de los encuestados, los resultadosindicaron como causas de la baja aceptación factores internos y externos de sus propios clientes, comolas dificultades dela vida cotidiana. El enfoque pedagógico utilizadopor los coordinadores, de acuerdo con los recursosdisponibles, cumplecon las directrices del Ministerio de Salud en materia de educación para...