An unusual manifestation of Langerhans cell histiocytosis in the gastrointestinal tract.

Langerhans cell histiocytosis (LCH) is a monoclonal proliferative disease that can affect multiple organs. It is a rare disorder, and children are the most commonly affected. Its classification depends on whether the disease is localized (usually bone or skin) or systemic. We present the case of a 49-year-old woman with a previous diagnosis of LCH in 2018 with only cutaneous involvement, managed with topical corticosteroids. After developing hypertransaminasemia, a PET-CT scan was performed, showing dissemination of the disease with bone, hepatosplenic and gynecological involvement. In addition, hypermetabolic lesions were described in the cecum with ileocecal adenopathies. A colonoscopy was performed showing in the cecum and ascending colon multiple sessile polyps of 5-10mm with central fibrin-coated erosions, from which biopsies were obtained. Histology revealed typical features of LCH with positive staining for CD1A, S100 and Langerin.

A Tunable Soft Silicone Bioadhesive for Secure Anchoring of Diverse Medical Devices to Wet Biological Tissue.

Silicone is utilized widely in medical devices for its compatibility with tissues and bodily fluids, making it a versatile material for implants and wearables. To effectively bond silicone devices to biological tissues, a reliable adhesive is required to create a long-lasting interface. BioAdheSil, a silicone-based bioadhesive designed to provide robust adhesion on both sides of the interface is introduced here, facilitating bonding between dissimilar substrates, namely silicone devices and tissues. The adhesive's design focuses on two key aspects: wet tissue adhesion capability and tissue-infiltration-based long-term integration. BioAdheSil is formulated by mixing soft silicone oligomers with siloxane coupling agents and absorbents for bonding the hydrophobic silicone device to hydrophilic tissues. Incorporation of biodegradable absorbents eliminates surface water and controls porosity, while silane crosslinkers provide interfacial strength. Over time, BioAdheSil transitions from nonpermeable to permeable through enzyme degradation, creating a porous structure that facilitates cell migration and tissue integration, potentially enabling long-lasting adhesion. Experimental results demonstrate that BioAdheSil outperforms commercial adhesives and elicits no adverse response in rats. BioAdheSil offers practical utility for adhering silicone devices to wet tissues, including long-term implants and transcutaneous devices. Here, its functionality is demonstrated through applications such as tracheal stents and left ventricular assist device lines.

Plantar Vein Thrombosis in a Patient with COVID-19: Case Report.

Plantar thrombophlebitis is a rare abnormality with few cases reported in the literature. Coexistence with severe acute respiratory syndrome coronavirus 2 infection increases its relevance. The disease is generally classified as idiopathic, and it is suggested that it is attributed to conditions that lead to hypercoagulability. We present the case of a 68-year-old female patient with thrombosis of the lateral plantar veins and a diagnosis of coronavirus disease of 2019. The plantar vein thrombosis diagnosis was made by means of Doppler ultrasonography and magnetic resonance imaging. Severe acute respiratory syndrome coronavirus 2 infection was suspected per clinical information and confirmed with reverse-transcriptase polymerase chain reaction technique. Treatment was successful using rivaroxaban and nonsteroidal antiinflammatory drugs.

Crop succession and its reflections on soybean performance

The fluctuations in yield and consequently in production occurred due to climatic adversities in the main producing states of Brazil. Farming has changed over time, and past scenarios have shown high exploitation of natural resources focusing on soil tillage and conventional seeding methods. This study aimed to determine the yield performance of soybean grown under 10 consolidated crop succession systems. The experiment was conducted during the 2018/2019 crop season, before the research project entitled "Sustainable production systems with better use of biological and natural resources, with treatments arranged in a randomized block design and four replications". The treatments consisted of the following predecessor crops: Avena sativa, Avena strigosa, Triticum aestivum, Secale cereale, Brassica napus, Raphanus sativus, Avena strigosa + Raphanus sativus + Vicia sativa, Fallow, Avena strigosa + Lolium multiflorum, and Triticum aestivum ­ Fodder. Soybean was subsequently sown across winter crops. The succession that showed superior yield was Avena strigosa + Lolium multiflorum. This attribute was established by associating taller plants with the maximization of the number of grains per pod, hundred-grain mass, grain mass, and plant dry mass; in contrast, there was a lower emphasis on plant residue. The determining attributes for soybean yield were plant stand, plant height, the number of pods per plant, and total grain mass, with contrasts among groups composed of the succession of Avena sativa, Avena strigosa, Triticum aestivum, Secale cereale, and Brassica napus, distanced from Raphanus sativus, Avena strigosa + Raphanus sativus + Vicia sativa, Fallow, Avena strigosa + Lolium multiflorum, and Triticum aestivum - Fodder.

Conhecimentos dos profissionais da comunidade educativa sobre a diabetes mellitus tipo 1 na criança / Knowledge of professionals in the educational community about type 1 diabetes mellitus in children

Enquadramento: A falta de capacitação que existe em muitas comunidades escolares para lidar com a criança com diabetes mellitus, enquanto esta se encontra sob a sua responsabilidade no ambiente escolar, gera dificuldades e insegurança. São necessários instrumentos válidos que permitam obter informação sobre os conhecimentos dos educadores sobre a criança com diabetes mellitus tipo 1 na escola, no sentido de planear intervenções educativas mais dirigidas. Objetivos: Avaliar os conhecimentos da comunidade educativa sobre a diabetes mellitus tipo 1 na criança e validar um questionário de avaliação de conhecimentos da comunidade educativa sobre a diabetes mellitus tipo 1. Métodos: O estudo delineado insere-se no tipo de investigação não experimental e descritiva, desenvolvido numa amostra não probabilística por conveniência, constituída por 382 indivíduos, com uma média de idades de 43,05 anos (± 8,675), pertencentes a uma comunidade educativa de Escolas Básicas e Secundárias da região centro do país. Foi aplicada a Escala de Conhecimentos Sobre Diabetes Mellitus Tipo 1 na Criança (Francisco, Silva, Bernardo & Martins, 2007), a qual foi ainda sujeita a um estudo psicométrico, que englobou dois a consistência interna e a análise fatorial. Resultados: dos participantes, maioritariamente travavam-se de professores e os restantes técnicos operacionais; a maioria (29,6%) possui entre 37 a 43 anos; 69,7% eram casados/união de facto; 82,3% dos inquiridos viviam na zona urbana, onde destes, a sua maioria era do sexo masculino (83,6%); 78,5% dos participantes possuíam o Ensino Superior. No global, 39,5% tinham conhecimentos sobre a diabetes, salientando-se pela análise inferencial que o sexo feminino, os residentes em zona urbana, os assistentes operacionais apresentaram de forma significativa melhores conhecimentos sobre a diabetes, enquanto a idade, o estado civil e as habilitações literárias não influenciaram os conhecimentos nessa área. A Escala Conhecimentos Sobre a Diabetes na Criança apresenta boa fiabilidade consistência interna. Tendo em conta o estudo psicométrico da escala, constatou-se que, para cada item constituinte da mesma, resultaram valores de Alpha de Cronbach considerados com consistência muito boa. Os fatores apresentaram valores de alfa considerados adequados: o Fator 1 apresentou um alfa de 0,921; o Fator 2 obteve um alfa de 0,865 e o Fator 3 apresentou um alfa de 0,762, o que significa que se está perante valores considerados muito bons para a aplicação futura da escala.

Background: The lack of capacity that exists in many school communities to deal with children with diabetes mellitus, while it is under its responsibility in the school environment, generates difficulties and insecurity. Valid instruments are needed to enable information about the knowledge of educators about children with type 1 diabetes mellitus in school in order to plan more targeted educational interventions are . Aims: Assess knowledge of the educational community about type 1 diabetes mellitus in children and validate a questionnaire for assessing knowledge of the educational community on diabetes mellitus type 1. Methods: The designed study falls within the type of non-experimental and descriptive research, developed a non-probabilistic convenience sample consisting of 382 individuals, with a mean age of 43.05 years (± 8.675), belonging to an educational community of Schools basic and Secondary from the central region of the country. Scale of Knowledge About Diabetes Mellitus Type 1 was applied to the Child (Francisco, Silva, Bernardo & Martins, 2007), which was further subjected to a psychometric study, which included two internal consistency and factor analysis. Results: participants , mostly up - waged teachers remaining technical and operational ; the majority ( 29.6 %) had between 37 and 43 years ; 69.7 % were married / unmarried ; 82.3 % of respondents lived in urban areas , where these , the majority were male ( 83.6 % ) ; 78.5 % of participants had higher education. Overall, 39.5 % had knowledge about diabetes, emphasizing the inferential analysis that female residents in urban areas, operating assistants had significantly better knowledge about diabetes, while age, marital status and educational attainment did not influence the knowledge in this area. The Scale Knowledge About Diabetes in Children has good internal consistency reliability. Having regard to the psychometric study of the scale, it was found that for each constituent of the same item, resulted values of Cronbach Alpha voted with very good consistency. Factors had alpha values considered appropriate: Factor 1 had an alpha of 0.921; Factor 2 obtained an alpha of 0.865 and Factor 3 showed an alpha of 0.762, which means that it is before values considered very good for the future application of the scale.

Suspeição de depressão segundo escala geriátrica em umaequipe da estratégia saúde da família / Geriatric Scale-Defined Depression Suspicion in the Family Health Strategy Setting

Objetivo: determinar a frequência da suspeição de depressãoem idosos de uma Equipe de Saúde da Família de umacidade do Sul de Minas baseado em Escala Geriátrica com30 questões. Métodos: Pesquisa de campo, do tipo quantitativo,com estudo de perfil populacional, com 289 idososde ambos os sexos, maiores de 60 anos e com autonomia deresposta. O desfecho analisado foi a suspeita de depressãoidentificada por Escala de Depressão Geriátrica (EDG-30).Os dados foram coletados e foram calculadas as proporçõesde acordo com os fatores determinantes como: sexo, faixaetária, comorbidades (presença e tipo), estado civil, cor dapele e internações hospitalares no último ano. Resultados:Neste estudo, foi verificado o predomínio de suspeiçãode depressão entre pacientes do sexo feminino e entreaqueles que tiveram comorbidades associadas. Observou-setambém prevalência de viúvos entre os pacientes suspeitosde depressão. A cor branca foi predominante tanto parasuspeitos como não suspeitos de depressão. Quanto àsmedicações em uso, houve apenas significância entre osusuários de anti-hipertensivos. Conclusão: Os dados conferemimportância em se diagnosticar e tratar precocementea depressão a fim de promover qualidade de vida aos indivíduosafetados, sem prejuízo de suas atividades cotidianas.

Endovascular treatment of aortic arch aneurysms / Tratamento endovascular dos aneurismas de arco aórtico

BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6 percent: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7 percent. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7 percent: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0 percent. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2 percent: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5 percent. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.

CONTEXTO: O tratamento endovascular dos aneurismas do arco aórtico é uma solução interessante para pacientes selecionados. OBJETIVO: Comparar os sucessos técnico e clínico registrados nas diferentes regiões anatômicas do arco aórtico após a colocação de endoprótese. MÉTODOS: Entre junho de 1999 e outubro de 2006, 178 pacientes foram tratados na nossa instituição devido a doenças da aorta torácica com a colocação de endoprótese, sendo que o arco aórtico estava envolvido em 64 casos. De acordo com a classificação proposta por Ishimaru, a zona aórtica 0 estava envolvida em 14 casos, zona 1 em 12 casos e zona 2 em 38 casos. Procedimentos de debranching do arco aórtico e revascularização extra-anatômica dos troncos supra-aórticos foram realizados em 37 casos para obter um adequado colo aórtico proximal. RESULTADOS: Zona 0. Comprimento do colo proximal: 44±6 mm. Sucesso clínico inicial de 78,6 por cento: dois óbitos (acidente vascular cerebral), um vazamento do tipo Ia. Seguimento médio de 16,4±11 meses com sucesso clínico a médio prazo de 85,7 por cento. Zona 1. Comprimento do colo proximal: 28±5 mm. Sucesso clínico inicial de 66,7 por cento: 0 óbitos, quatro vazamentos do tipo Ia. Seguimento médio de 16,9±17,2 meses com sucesso clínico a médio prazo de 75 por cento. Zona 2. Comprimento do colo proximal: 30±5 mm. Sucesso clínico inicial de 84,2 por cento: dois óbitos (um infarto cardíaco e uma embolização de múltiplos órgãos), três vazamentos do tipo Ia, um caso de conversão para operação aberta. Dois casos de paraparesia/paraplegia transitória tardia foram observados. Seguimento médio de 28,0±17,2 meses com sucesso clínico a médio prazo de 89,5 por cento. CONCLUSÃO: Este estudo e a análise da literatura demonstram que o procedimento híbrido para moléstia do arco aórtico é factível em pacientes selecionados com alto risco para a operação convencional. Nossa experiência ainda é limitada pelo tamanho relativamente pequeno da amostra. Sugerimos...