A Rare Case of Paratesticular Leiomyosarcoma.

Paratesticular leiomyosarcoma is a rare urologic cancer that arises from undifferentiated smooth muscles of the spermatic cord or epididymis. Few accounts of this cancer have been reported but previous reports have identified radiation and anabolic steroids as possible risk factors. We report a case of an 83-year-old man with a previous history of radiation therapy for prostate cancer, who presented with a painless left scrotal mass. Given the nonspecific presentation, a histopathological classification was warranted for a definitive diagnosis. The tumor was resected via simple orchiectomy and was diagnosed as a paratesticular grade III leiomyosarcoma without any further treatment. Patient had a follow-up CT scan of the abdomen and pelvis that was normal without metastasis. The patient's history of previous external beam radiation and now development of a secondary tumor sums to the few cases that have been previously reported with this association.

Associations between Teacher Wellbeing and Social Support for Physical Activity in Two Urban School Districts during the early stages of the SARS-CoV-2 Pandemic.

Given physical activity's protective effects on mental health and the potential for school districts to support teachers in this area, we explore teacher wellbeing protective factors including social support for exercise. Specifically, we measured the association between social support for exercise and teacher wellbeing in racially and ethnically diverse urban school districts. Based on a prior partnership with 19 schools across 5 districts, we obtained approval from two districts to outreach to teachers (n=206) and invite them to complete the Teacher Subjective Wellbeing Questionnaire and the Social Support and Exercise Survey during the 2020-2021 academic year. We applied linear regression models for continuous variables with teacher wellbeing as the dependent variable and social support as the independent variable adjusting for teacher- and school-level factors. Teachers (n=121) across eight K-8th grade schools completed the survey. The majority of teachers identified as female (77%) and non-White (84%). In the adjusted analysis (n = 104), there was a positive association between family social support for exercise and teacher wellbeing (ß = 0.31; P Value < 0.05). Thus, for every unit increase in family social support for exercise, a small 0.31 unit increase in teacher wellbeing was predicted. Additional research is needed to better understand this relationship in marginalized school districts as it may yield insights to be applied through multiple channels. District representatives have an opportunity to positively influence teacher wellbeing, an important component to supporting student success, building educational equity, and closing the achievement gap.

Müllerianosis of the Urinary Bladder: A Rare Condition Which Mimics Neoplasia.

Müllerianosis of the urinary bladder is an extremely rare, benign condition defined by the presence of at least two of the three müllerian-derived components (endosalpinx, endometrium, and endocervix) in the lamina propria and muscularis propria of the urinary bladder. It frequently mimics neoplastic condition, either malignant or benign. Here, we present a case of cystic müllerianosis of urinary bladder, which was clinically thought to be a urinary bladder neoplasm.

Primer niño logrado por fertilización in vitro en la Amazonía del Perú / First baby achieved by in vitro fertilization in the Peruvian Amazon / First baby achieved by in vitro fertilization in the Peruvian Amazon

RESUMEN En el Perú, la mayoría de centros de fertilidad se encuentran en Lima, ciudad capital, y en algunas pocas ciudades principales de la costa y sierra del país. Por ello, muchas parejas de la región amazónica con la finalidad de iniciar su tratamiento de reproducción asistida se ven obligadas a trasladarse fuera de su ciudad de domicilio, a pesar de las enormes dificultades que esto les representa. En el presente reporte, describimos el primer nacimiento por fertilización in vitro (FIV) en la Región Amazónica del Perú, donde todos los procedimientos médicos y de laboratorio de reproducción asistida fueron realizados in situ.

ABSTRACT In Peru, most fertility centers are located in Lima, the capital city of Perú, and in a few main cities on the country's coast and the Andes. For this reason, many couples in the Amazon are forced to relocate outside their city of residence to start their assisted reproduction treatment, despite the enormous difficulties that this represents for them. In this report, we describe the first baby born by in vitro fertilization (IVF) in the Amazon Region of Peru, where all medical and laboratory assisted reproduction procedures were performed in situ.

Invasive Micropapillary Carcinoma: A Rare Case of Male Breast Cancer.

Invasive micropapillary carcinoma (IMPC) is a rare form of breast cancer, accounting for 3.8-5.9% of all breast cancer types. Less than 1% of all breast cancer occurs in men and there have been only nine other cases of IMPC specifically in male patients reported in the literature. This case presents a 77-year-old Caucasian man who was found to have IMPC of the left breast after presenting for a painless mass in the left lower subareolar region. After a left modified radical mastectomy, the patient was found to have only one metastatic lymph node with his variant of IMPC being less aggressive requiring no further treatment other than annual surveillance with mammography.

A Rare Case of Angioleiomyoma of the Hand.

Angioleiomyoma is a benign tumor of the vascular system that is often not considered in the differential diagnosis of a painless subcutaneous nodule of the body. In this report, we present a rare case of angioleiomyoma of the phalanx in the left hand in a middle aged man. He underwent surgical excision of the mass with no complications. Given the nonspecific and indolent presentation, our case had a broad differential diagnosis including ganglion cyst and histopathological examination was warranted for definite diagnosis. At 9-month follow-up, the patient was asymptomatic with no signs of recurrence.

Eosinophilic angiocentric fibrosis : a sino-orbital masquerader.

A 58-year-old Caucasian male presented with left periorbital oedema extending to the nasal area for 1 year along with nasal discharge for 1 month. Lab work was significant for positive cytoplasmic antineutrophil cytoplasmic antibodies. CT scan showed solid mass along the nasal soft tissue with bony nasal destruction. A CT scan of the thorax was performed to rule out granulomatosis with polyangiitis and showed multiple pulmonary nodules. Biopsies of the nasal mass and lung nodule were performed which showed fragments of fibrosis with spindle cell proliferation consistent with eosinophilic angiocentric fibrosis (EAF). EAF is a very rare disease, recently described as a subtype of immunoglobulin G4-related disease. A few rare cases of EAF involving the structures of the orbit have been reported in the literature.

Hypertriglyceridemia and adverse outcomes during pregnancy / Hipertrigliceridemia y consecuencias adversas en el embarazo

Abstract Introduction: During pregnancy, levels of maternal serum triglycerides increase as a physiological adaptation mechanism to meet the needs of the developing fetus. However, although an excessive increase has been associated with preeclampsia, macrosomia and preterm delivery, the levels from which measurements should be taken in each trimester to prevent complications have not been established conclusively. Objective: To review the physiopathology, effects on mother and child, expected values in each trimester and therapeutic interventions in maternal hypertriglyceridemia. Materials and methods: A review was made based on a search of articles in the ScienceDirect, Pubmed, Scopus, LILACS, Cochrane and SciELO databases, with the terms: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications in English and its equivalents in Spanish. Results: 59 articles met the search criteria and responded to the objectives. Conclusions: The limited amount and the great variability of the data indicate the need to carry out further research to establish the normal triglycerides ranges during the three trimesters of pregnancy and to determine risks and effective interventions before pregnancy in order to reduce maternal and child morbidity and mortality.

Resumen Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones. Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional. Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español. Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos. Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.

Serum 25-hydroxyvitamin D levels throughout pregnancy: a longitudinal study in healthy and preeclamptic pregnant women.

BACKGROUND: Worldwide there is a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency and has been associated with adverse outcomes during pregnancy. OBJECTIVE: This is a nested, case-control study in a longitudinal cohort to compare the serum 25OHD levels and other biomarkers throughout pregnancy in a group of 20 preeclamptic women and 61 healthy pregnant women. An additional group of 29 healthy non-pregnant women were also studied during the two phases of the menstrual cycle. RESULTS: Mean 25OHD levels in non-pregnant women were 31.9 ng/mL and 34.9 ng/mL during follicular and luteal phase, respectively (P < 0.01). Mean serum 25OHD levels in healthy pregnant women were 26.5, 30.1 and 31.9 ng/mL, at first, second and third trimester, respectively (P < 0.001). The first trimester levels of 25OHD were lower than those of healthy non-pregnant women (P < 0.001), showing a significant recovery at third trimester. In the group of healthy pregnant women, the 25OHD levels were 25.7 ng/mL and 27.2 ng/mL at 3 and 6 months postpartum, respectively; both values were lower than those observed in the non-pregnant women (P < 0.001). In preeclamptic women, 25OHD serum levels were similar to those of healthy pregnant women; nevertheless, they remained almost unchanged throughout pregnancy. CONCLUSION: There were no significant differences between healthy and preeclamptic pregnant women in terms of 25OHD levels throughout the pregnancy. Serum 25OHD levels in non-pregnant women were higher during luteal phase compared with follicular phase. The 25OHD levels of non-pregnant women tended to be higher than those of pregnant women.

Looks Can Be Deceiving: A Case Report on Multicentric Reticulohistiocytosis Successfully Treated with Rituximab.

Multicentric reticulohistiocytosis (MRH) is an idiopathic multisystemic inflammatory disease characterized by symmetric erosive polyarthritis and typical papulonodular skin lesions. MRH can be associated with autoimmune diseases, malignancy, mycobacterial infections, and hyperlipidemia, and it is important to consider appropriate screening in this population. There is no specific diagnostic laboratory test for MRH. The gold standard for diagnosis is skin or synovial biopsy, which shows characteristic multinucleated non-Langerhans giant cells and ground glass eosinophilic cytoplasm. Although the disease spontaneously remits in approximately 10 years, MRH can rapidly progress to arthritis mutilans in the majority of cases. The diagnosis and treatment are challenging due to its low prevalence and lack of robust guidelines from major rheumatological societies. Corticosteroids and methotrexate are generally first-line treatment options. However, more recently, biologic agents have been increasingly used in refractory cases with some success. Early diagnosis is crucial in preventing disease progression. We report a case of MRH in a patient whose clinical presentation mimicked rheumatoid arthritis and was subsequently treated successfully with rituximab.

A Rare Location of a Neuroendocrine Tumor.

Neuroendocrine tumors (NETs) arising in the duodenum are rare neoplasms that are often classified as indolent and have a low potential to metastasize. Although rare, multiple reports cite an increasing incidence of duodenal NETs. Symptoms are usually nonspecific and the diagnosis is made via endoscopy. Endoscopic resection is the mainstay of therapy. The prognosis is usually favorable. We describe a case of a duodenal NET that presented with vague symptoms in order to increase the awareness of this rare but increasing in frequency entity.

Community structure of aquatic insects in the Esparza River, Costa Rica.

This study focused on the structure of the aquatic insect community in spatial and temporal scales in the Esparza River. The river was sampled for one full year throughout 2007. During the dry season low flow months, five sampling points were selected in two different habitats (currents and pools), with five replicates per sample site. During the wet season with peak rain, only the data in the "current habitat" were sampled at each site. Specimens present in the different substrates were collected and preserved in situ. A nested ANOVA was then applied to the data to determine richness and density as the response variables. The variations in temporal and spatial scales were analyzed using width, depth and discharge of the river, and then analyzed using a nested ANOVA. Only a correlation of 51% similarity in richness was found, while in spatial scale, richness showed significant variation between sampling sites, but not between habitats. However, the temporal scale showed significant differences between habitats. Density showed differences between sites and habitats during the dry season in the spatial scale, while in the temporal scale significant variation was found between sampling sites. Width varied between habitats during the dry season, but not between sampling points. Depth showed differences between sampling sites and season. This work studies the importance of community structure of aquatic insects in rivers, and its relevance for the quality of water in rivers and streams.

Community structure of aquatic insects in the Esparza River, Costa Rica

Community structure of aquatic insects in the Esparza River, Costa Rica. This study focused on the structure of the aquatic insect community in spatial and temporal scales in the Esparza River. The river was sampled for one full year throughout 2007. During the dry season low flow months, five sampling points were selected in two different habitats (currents and pools), with five replicates per sample site. During the wet season with peak rain, only the data in the "current habitat" were sampled at each site. Specimens present in the different substrates were collected and preserved in situ. A nested ANOVA was then applied to the data to determine richness and density as the response variables. The variations in temporal and spatial scales were analyzed using width, depth and discharge of the river, and then analyzed using a nested ANOVA. Only a correlation of 51% similarity in richness was found, while in spatial scale, richness showed significant variation between sampling sites, but not between habitats. However, the temporal scale showed significant differences between habitats. Density showed differences between sites and habitats during the dry season in the spatial scale, while in the temporal scale significant variation was found between sampling sites. Width varied between habitats during the dry season, but not between sampling points. Depth showed differences between sampling sites and season. This work studies the importance of community structure of aquatic insects in rivers, and its relevance for the quality of water in rivers and streams. Rev. Biol. Trop. 57 (1-2): 133-139. Epub 2009 June 30.

Se estudió la estructura de la comunidad de insectos acuáticos en el río Esparza, Costa Rica, en escalas espacial y temporal. Los muestreos se realizaron durante 2007 en 5 estaciones. En mayor sequía se recolectaron cinco réplicas en cada estación en dos tipos de hábitat: corriente y pozas. En mayor precipitación se utilizó este procedimiento únicamente en la corriente. Se recolectaron los especimenes en diferentes sustratos con un cernidor y se preservaron in situ. Se analizó la variabilidad en ambas escalas con un análisis de varianza anidado cuyas variables respuesta fueron riqueza y densidad de organismos. Se efectuaron mediciones de profundidad promedio, descarga, y ancho del cauce, y se les hizo análisis de varianza. Se encontró un 51% de similaridad en riqueza entre hábitats. La riqueza analizada en la escala espacial mostró variación significativa entre sitios de muestreo pero no entre hábitats, mientras que en la escala temporal presentó diferencia entre época seca y lluviosa. La densidad mostró diferencias debido al sitio y al hábitat durante la época seca en la escala espacial, pero solo se encontró variación significativa debida al sitio de muestreo entre estaciones. Se encontró variabilidad significativa en el ancho del río en diferentes hábitats durante la época seca pero no así entre estaciones de muestreo. La profundidad mostró variación significativa entre estaciones y entre sitios de muestreo. Se discute la importancia de estudiar la estructura de la comunidad y su posible relevancia en investigación orientada a calidad de aguas.

Panbiogeographical analysis of Costa Rican freshwater fishes.

Track analysis and Parsimony analysis of endemicity (PAE) were performed to analyze the distribution pattern of Costa Rican freshwater fishes. A basic matrix (presence/absence) was prepared using the distribution of 77 freshwater fish. The data were analyzed with CLIQUE software in order to find generalized tracks (cliques). Data also were analyzed with the software NONA and Winclada version 1.00.08 in order to perform the Parsimony Analysis of Endemicity (PAE). Fourteen equally probable cliques were found with 31 species in each and the intersection of the amount was selected as a generalized track dividing the country in two main zones: Atlantic slope from Matina to Lake Nicaragua and Pacific slope from the Coto River to the basin of the Tempisque River connected with some branches oriented to the central part of the country. PAE analysis found ten cladogram areas (72 steps, CI=0.45, RI=0.64), using the "strict consensus option" two grouping zones were identified: Atlantic slope and Pacific slope. Both PAE and Track Analysis show the division of the two slopes and the orientation of the generalized track suggests new biogeographical evidence on the influence of both old and new southern elements to explain the migrations of freshwater fish into Central America during two different geological events.

Panbiogeographical analysis of Costa Rican freshwater fishes

Track analysis and Parsimony analysis of endemicity (PAE) were performed to analyze the distribution pattern of Costa Rican freshwater fishes. A basic matrix (presence/absence) was prepared using the distribution of 77 freshwater fish. The data were analyzed with CLIQUE software in order to find generalized tracks (cliques). Data also were analyzed with the software NONA and Winclada version 1.00.08 in order to perform the Parsimony Analysis of Endemicity (PAE). Fourteen equally probable cliques were found with 31 species in each and the intersection of the amount was selected as a generalized track dividing the country in two main zones: Atlantic slope from Matina to Lake Nicaragua and Pacific slope from the Coto River to the basin of the Tempisque River connected with some branches oriented to the central part of the country. PAE analysis found ten cladogram areas (72 steps, CI=0.45, RI=0.64), using the "strict consensus option" two grouping zones were identified: Atlantic slope and Pacific slope. Both PAE and Track Analysis show the division of the two slopes and the orientation of the generalized track suggests new biogeographical evidence on the influence of both old and new southern elements to explain the migrations of freshwater fish into Central America during two different geological events.

Con el objetivo de analizar el patrón de distribución de peces de agua dulce de Costa Rica se aplicó un análisis de trazos y de parsimonía de endemismos (PAE). Se construyó una matriz básica utilizando la distribución de 77 especies. Se utilizó el programa CLIQUE con la intención de encontrar los trazos generalizados y NONA y Winclada, versión 1.00.08, con el fin de llevar a cabo el PAE. Se encontró un total de 14 cliques igualmente probables con 31 especies. De esta cantidad se construyó un trazo generalizado que constituye la intersección del total, dividiendo el país en dos zonas: Atlántico, desde Matina hasta el Lago de Nicaragua y Pacífico desde el río Coto hasta el río Tempisque conectado con la región central del país. El PAE encontró diez cladogramas de áreas (72 pasos, CI=0.45, RI=0.64), cuyo consenso estricto identificó dos zonas de agrupamiento: Atlántico y Pacífico. Ambos análisis muestran la división entre las dos vertientes y la orientación de los trazos generalizados sugiere nueva evidencia de la influencia biogeográfica de los denominados elementos de migración antiguo y nuevo del sur, los cuales se habían sugerido empíricamente en el pasado para explicar las migraciones hacia Centroamérica en dos periodos geológicos diferentes.