Persistent Fever after COVID-19 Vaccination in a Patient with Ulcerative Colitis: A Call for Attention.

The development of vaccinations has been game-changing in the ongoing effort to combat the COVID-19 pandemic. Until now, adverse effects are being reported at low frequency, including thrombocytopenia and myocarditis. Careful monitoring for any suspicious symptoms and signs following vaccination is necessary. We report a case of hemophagocytic lymphohistiocytosis (HLH) after mRNA COVID-19 vaccine in a 23-year-old female with ulcerative colitis. Diagnosis was made according to HLH-2004 criteria and the patient was treated with dexamethasone with response. Our report aimed to draw attention to the potential relation between COVID-19 vaccines and HLH and the necessity of continued surveillance, especially in at-risk populations such as those with underlying immune dysregulation.

O desenvolvimento de vacinas foi um ponto de viragem no combate contra a pandemia da COVID-19. Até ao momento, os efeitos adversos como a trombocitopenia e miocardite têm sido reportados com baixa frequência. A monitorização cuidadosa de qualquer sinal ou sintoma suspeitos é essencial. Reportamos um caso de linfohistiocitose hemofagocítica após vacinação contra a COVID-19 com uma vacina de mRNA, numa jovem de 23 anos com colite ulcerosa. O diagnóstico obedeceu os critérios HLH-2004 e a paciente foi tratada com dexametasona, com resposta. Pretendemos chamar à atenção para a potencial relação entre a vacinação para a COVID-19 e a HLH e a necessária contínua vigilância, especialmente em populações de maior risco, como as portadoras de doenças imuno-mediadas.

Undifferentiated Carcinoma With Osteoclast-Like Giant Cells: A Rare Cause of Upper Gastrointestinal Bleeding.

Undifferentiated osteoclast-like giant cell carcinomas (UOLGCCs) of the digestive tract are very rare, with only a few cases reported in the literature. An 82-year-old man was referred to the emergency department for melena. Endoscopic examination revealed a hemicircumferential ulcerovegetative lesion, involving the bulbar apex and extending to the second portion of the duodenum; biopsies revealed an UOLGCC. The patient underwent transfusion support therapy, and he was proposed for best supportive care. Duodenal UOLGCC is an extremely rare cause of upper gastrointestinal bleeding. Clinical findings and therapeutic approach represent a challenge in this pathology.

Diagnosis of Bowel Endometriosis Using Endoscopic Ultrasound-guided Fine Needle Aspiration.

Endometriosis is a relatively common gynecological condition in women of reproductive age. The rectosigmoid region is the most commonly affected segment when the gastrointestinal tract is involved. A differential diagnosis of colorectal neoplasia is difficult because of the similar clinical, endoscopic, and radiology findings. A 42-year-old female presented with abdominal distention and was subsequently diagnosed with a large bowel obstruction in the rectum. A temporary colostomy was performed, and endoscopy revealed a rectal mass obstructing the rectum. The biopsy showed normal mucosa, and it was difficult to exclude rectal malignancies even after the imaging workup. Endoscopic ultrasound demonstrated a hypoechoic lesion below the rectal mucosa, and fine needle aspiration confirmed the diagnosis of bowel endometriosis. Bowel endometriosis is a challenging diagnosis. Endoscopic ultrasound- guided fine-needle aspiration is useful for acquiring adequate samples for histological confirmation and a definitive diagnosis of bowel endometriosis.

Inflammatory bowel disease and thromboembolic events: a c'lot to learn.

Background: Inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations including arterial and venous thromboembolism. Research evidences that IBD patients have about a 2- to 3-fold increase in the risk of venous thromboembolism when compared with the general population. Objectives: We intended to evaluate the coagulation parameters and the prevalence of thromboembolic events (TE) in IBD patients. It was also our aim to investigate the correlation between coagulation parameters and disease phenotype and activity in this population. Methods: This single center prospective observational study was performed between November 2016 and April 2020. The cohort included patients with 18 years of age or older, diagnosed with IBD and followed at a gastroenterology consultation, during a follow-up period of 36 months. Patients were evaluated in terms of IBD type, extent and disease behavior, clinical scores of IBD activity, medication, smoking history, family and personal history of TE, coagulation parameters, fecal calprotectin levels, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hospitalization due to TE, IBD-related hospitalization or surgery, pregnancy, or diagnosis of malignancy. Results: The study included 149 IBD patients (67 males and 82 females). Coagulation parameters were similar in CD and UC patients and only plasminogen was increased in CD patients [97.4 (17.0) versus 91.6 (13.3), p = 0.035], when comparing with UC patients. The determined values were in the range of the reference values described in literature for the standard population. During the follow-up period, none of the patients experienced a TE that demanded hospitalization. Conclusion: In our study, acquired and inherited risk factors for TE and changes in coagulation parameters did not show to influence prothrombotic predisposition in IBD patients. As such, the clinical relevance of measuring coagulation parameters in this population is questionable. Trial Registry: NCT05162339 (ClinicalTrials.gov ID).

Sexuality, Sexual Behavior, and Relationships of Asexual Individuals: Differences Between Aromantic and Romantic Orientation.

Asexuality is a complex construct with a considerable lack of research until recently. Building upon available findings, we examined the extent to which romantic orientation shapes individual and relationship experiences, and expectations of asexual individuals. Specifically, our research focused on the distinction between romantic asexual individuals, who experience romantic attraction, and aromantic asexual individuals, who do not experience romantic attraction. A cross-sectional study with members of different asexual online communities (N = 447, 55.02% women; Mage = 24.77 years, SD = 7.21) aimed at examining how both groups differ in their identification with the asexuality construct as measured by the Asexuality Identification Scale (Yule et al., 2017), individual perspectives on sexuality, sexual behavior and relationships, concerns about commitment and sexual performance in a relationship, and attachment style. Results showed that aromantic asexual individuals identified more with asexuality, reported a more avoidant attachment style, and were more concerned with relationship commitment. In contrast, romantic asexual individuals reported less sex aversion, more sexual experiences (both past and current), and more sexual partners in the past. These individuals also engaged in romantic relationships more frequently in the past, had a stronger desire to engage in a romantic relationship in future (either with or without sexual intimacy), and were more concerned with sexual performance. Overall, our findings contribute to the literature by highlighting the need to consider romantic orientation when examining asexuality and its interpersonal outcomes.

Emborrhoid technique performed on a patient with portal hypertension and chronic hemorrhoidal bleeding as a salvage therapy.

BACKGROUND: Hemorrhoidal disease most commonly manifests itself with chronic rectal bleeding and, in its most severe and refractory forms, may lead to chronic anaemia with the need for recurrent blood transfusions. The main pathogenetic mechanism involved seems to be arterial hyperflux in the terminal branches that supply the hemorrhoidal plexus. It is based on this principle, that embolization of the superior rectal artery (emborrhoid technique) has recently re-emerged, with very promising results that support its feasibility, treatment efficacy, and safety. CASE PRESENTATION: We report a case of a patient with both recurrent hemorrhoidal bleeding and portal hypertension with rectal varices, who underwent SRA embolization as a salvage therapy, with significant clinical improvement and no immediate or short-term complications. CONCLUSIONS: We believe that the positive results from our case raise the possibility that the emborrhoid technique could be effective and safe even in patients with portal hypertension, and that it would be clinically relevant to investigate this hypothesis on larger samples with a longer follow-up.

Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus.

AIM: To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. METHODOLOGY: A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto-Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. RESULTS: The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p < .001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p < .001) and triglycerides levels (p < .05) and area under the curve (AUC) during the insulin tolerance test at t21 (p < .001). AP area was significantly greater in GK rats (p < .05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21 days after AP induction (p < .08; p < .07). GK rats had intrinsically lower levels of VEGF than control rats (p < .05), which did not change after AP. CONCLUSION: Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.

[Hypokalemic Paresis in Adolescent: A Case Report]. / Parésia Hipocaliemica em Adolescente: Um Caso Clínico.

Familial hypokalaemic periodic paralysis is a rare autosomal dominant neuromuscular disease characterized by episodic attacks of flaccid paralysis with concomitant hypokalaemia. We present a case of a 15-year-old male adolescent observed in the pediatric emergency department by flaccid paresis of the 4 limbs of sudden onset and progressive worsening. In the anamnesis, corticosteroid and antihistamine intake were observed on the previous day for urticaria and family history of transient episodes of flaccid paralysis in adolescence, asymptomatic after the fourth decade of life, without an established diagnosis. Diagnostic tests revealed hypokalaemia (K + < 2.4 mEq/L), without hypokaluria and without other changes. Symptomatology resolution after supplementation with potassium was verified until normalization of kaliemia. Flaccid paralysis is a rare form of presentation of hypokalaemia. Several etiologies may be involved in the child or adolescent presenting with acute flaccid paralysis. The description of this case draws attention to the importance of the knowledge of this entity, because if recognized and treated properly, patients usually recover without sequelae.

A paralisia periódica hipocaliémica familiar é uma doença neuromuscular autossómica dominante, rara, caracterizada por crises episódicas de paralisia flácida acompanhadas de hipocaliemia. Apresenta-se o caso de um adolescente do sexo masculino, com 15 anos de idade, observado no Serviço de Urgência de Pediatria por parésia flácida dos quatro membros de início subito e agravamento progressivo. Na anamnese verificou-se a ingestão de corticoesteroide e antihistaminico no dia anterior por urticária e história familiar de episódios transitórios de paralisia flácida na adolescência, assintomáticos após a 4ª década de vida, sem diagnóstico estabelecido. Os exames auxiliares de diagnóstico revelaram hipocaliemia (K+ < 2,4 mEq/L), sem hipocaliúria e sem outras alterações. Verificou-seresolução da sintomatologia após suplementação com potássio até normalização da caliemia. A paralisia flácida é uma forma rara de apresentação da hipocaliemia. Diversas etiologias podem estar envolvidas na criança ou adolescente que se apresenta com com paralisia flácida de início agudo. Com a descrição deste caso alerta-se para a importância do conhecimento desta entidade, porque se reconhecidos e tratados apropriadamente, os doentes geralmente recuperam sem sequelas.

Doença inflamatória intestinal com eritema nodoso como manifestação inicial ­ dois casos clínicos / Inflammatory bowel disease with erythema nodosum as the initial manifestation ­ two clinical cases

OBJETIVOS: Descrever dois casos de doença inflamatória intestinal cujo diagnóstico foi precedido pelo surgimento de eritema nodoso e alertar para essa manifestação extraintestinal como forma de apresentação inicial da doença. DESCRIÇÃO DOS CASOS: Dois adolescentes de 12 e 15 anos recorreram ao serviço de urgência de Pediatria por eritema nodoso acompanhado de anorexia e perda de peso. Os exames auxiliares de diagnóstico disponíveis foram sugestivos de doença crônica inflamatória e a ecografia abdominal sugestiva de doença inflamatória intestinal. O diagnóstico de doença de Crohn foi confirmado após realização de endoscopia digestiva alta e colonoscopia total com biópsias. CONCLUSÕES: O eritema nodoso pode ser a forma de apresentação de doenças potencialmente graves com terapêuticas bem estabelecidas e implicações prognósticas. Na criança ou adolescente com eritema nodoso o índice de suspeição de doença inflamatória intestinal deve ser elevado, embora devam ser considerados outros diagnósticos diferenciais. A importância do diagnóstico precoce na doença inflamatória intestinal em idade pediátrica consiste na oportunidade terapêutica e nas complicações específicas dessa faixa etária, como déficit de crescimento, que ocorre mais frequentemente na doença de Crohn.

AIMS: To describe two cases of inflammatory bowel disease whose diagnosis was preceded by the appearance of erythema nodosum and to alert to this extra-intestinal manifestation as the initial presentation of the disease. CASES DESCRIPTION: Two adolescents of 12 and 15 years of age were referred to the pediatrics emergency department because of erythema nodosum accompanied by anorexia and weight loss. The available diagnostic tests were suggestive of chronic inflammatory disease and the abdominal ultrasound was suggestive of inflammatory bowel disease. The diagnosis of Crohn's disease was confirmed after completion of upper digestive endoscopy and total colonoscopy with biopsies. CONCLUSIONS: Erythema nodosum may be the form of presentation of potentially serious diseases with well established therapies and prognostic implications. In children or adolescents with erythema nodosum, the index of suspicion of inflammatory bowel disease should be high, although other differential diagnoses should be considered. The importance of early diagnosis of inflammatory bowel disease in pediatric age refers to the therapeutic opportunity and specific complications in this age group, as growth disturbance, which occurs more frequently in Crohn's disease.