Pediatric conjunctival melanoma: A comprehensive case report and literature review.

Purpose: This case report aims to present a rare instance of conjunctival melanoma in a 5-year-old patient and contribute to the limited body of knowledge on pediatric conjunctival melanoma. The purpose is to understand the characteristics, diagnosis, and management of this uncommon malignancy in young individuals. Observations: The case describes a 5-year-old female with a progressively growing pigmented conjunctival lesion. The lesion was observed to be located on the temporal conjunctiva of the right eye and displayed distinctive features, including feeder vessels. Imaging revealed specific dimensions of the lesion and ruled out deeper invasions. Histopathological examination revealed architectural and cytologic atypia, positive immunohistochemical staining for HMB-45, and a Ki67 proliferation index of 20 %, confirming the diagnosis of conjunctival melanoma. Conclusions: Conjunctival melanoma, an uncommon malignancy even more so in pediatric patients, typically presents with pigmented growths and feeder vessels. This case underscores the need for thorough diagnosis and early intervention, as conjunctival melanoma can lead to devastating outcomes. The rarity of such cases limits our understanding of their etiology and progression. This case contributes to the literature on pediatric conjunctival melanoma and reinforces the importance of vigilance in detecting and managing ocular pigmented lesions in children.

Informal sale of antibiotics in Guatemalan convenience stores before and after implementation of federal antibiotic dispensing legislation.

BACKGROUND: Convenience stores in Guatemala provide essential consumer goods in communities, but many dispense antibiotics illegally. Federal legislation, passed in August of 2019, requires prescriptions for antibiotic purchase at pharmacies but it is unclear if this legislation is enforced or if it has any impact on unlawful sales of antibiotics. METHODS: To determine if antibiotic availability changed in convenience stores, we carried out a repeated measures study collecting antibiotic availability data before and after implementation of the dispensing regulation. RESULTS: There was no statistical difference in the proportion of convenience stores that sold antibiotics before and after antibiotic regulations [66.6% (295/443) and 66.7% (323/484), respectively, P>0.96], nor in the number of stores selling amoxicillin [55.5% (246/443) and 52.3% (253/484), respectively, P>0.96], but fewer stores (20%) sold tetracycline capsules after regulation was passed (P<0.05). For stores visited both before and after passage of legislation (n=157), 15% stopped selling antibiotics while 25% started selling antibiotics. Antibiotics from convenience stores were reportedly sold for use in people and animals. CONCLUSIONS: Antibiotics remain widely available in convenience stores consistent with no significant change in the informal sector after implementation of prescription requirements for pharmacies. Importantly, effects from regulatory change could have been masked by potential changes in antibiotic use during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic.

Systemic DL-kynurenine and probenecid pretreatment attenuates quinolinic acid-induced neurotoxicity in rats.

Kynurenine (KYN) is the precursor of kynurenic acid (KYNA), an endogenous antagonist of the glycine site of the NMDA (N-methyl-D-aspartate) receptor. Probenecid (PROB), blocks the excretion of KYNA from the extracellular fluid. KYNA antagonizes the toxic action of quinolinic acid (QUIN), an endogenous NMDA receptor agonist. In this study, we tested the effect of the systemic administration of KYN and PROB, either alone or in combination, on QUIN-induced circling behavior and gamma-aminobutyric acid (GABA) depletion in rats. Circling behavior and GABA depletion induced by QUIN were both partially prevented by PROB (200 and 300 mg/kg) and KYN (300 and 450 mg/kg) treatments. Lower doses of drugs administered separately were nonprotective. However, when administered in combination, doses of 150 or 300 mg/kg KYN plus 100 mg/kg PROB significantly protected animals against QUIN neurotoxicity. These findings suggest a role of KYN and PROB as promoters of KYNA-mediated NMDA receptor antagonism, via an increase of kynurenate in brain extracellular spaces.

Low- vs high-dose aspirin. Effects on platelet function in hyperlipoproteinemic and normal subjects.

Low-dose aspirin may be inadequate for inhibition of platelet function in hyperlipoproteinemics due to increased platelet reactivity. Platelet function was studied in 18 type II hyperlipoproteinemic and 12 normal subjects after at least ten days of treatment with placebo and with low-dose (0.45 mg/kg/day) and high-dose (900 mg/day) aspirin. In the normal and hyperlipoproteinemic subjects, low-dose aspirin produced near maximal (90%) inhibition of platelet thromboxane generation, significant prolongation of the bleeding time, and significant inhibition of platelet aggregation, similar in degree to the inhibition produced by high-dose aspirin. There was no significant difference between hyperlipoproteinemic and normal subjects in any of the platelet function measures before and after aspirin treatment. Thus, a daily 0.45-mg/kg aspirin dose (20 to 45 mg) effectively inhibited platelet function in type II hyperlipoproteinemics, who do not appear to have an increased dose requirement for aspirin.

[Postplacental application of 5 different types of intrauterine devices]. / Aplicación postplacenta de cinco tipos diferentes de dispositivos intrauterinos.

PIP: 5 different types of IUDs were used in 1020 women after placental expulsion: T Cu220 in 101 cases; Lippes Loop in 407 cases; T Cu200 in 180; Progestasert in 196; and the Multiload 250 in 136. IUD insertion was accomplished by 3 different techniques: manual, with Forester's forceps, and with an experimental applicator. There were more expulsions and more pregnancies when the applicator was used. Expulsion and pregnancy rates were higher with the Progestasert. The T Cu220C showed the lowest number of expulsions and pregnancies and the highest continuation rate. Removals for medical reasons were similar among all IUD types. (author's modified)^ieng

Aplicacion postplacenta de cinco tipos diferentes de dispositivos intrauterinos. / Post-placental insertion of five different types of intrauterine devices

Se analizan los resultados obtenidos en 1020 casos de aplicacion, inmediatamente despues del nacimiento de la placenta, de cinco tipos diferentes de dispositivos intrauterinos. En 101 casos se utilizo T Cu 220 C, en 407 Asa de Lippes, en 180 T Cu 200, en 196 Progestasert y en 136 Multiload 250. La aplicacion se hizo mediante tres tecnicas: a) manual, b) con pinza de Forester y c) con un aplicador en experimentacion. Cuando se utilizo el aplicador se observo mayor tasa de expulsiones y por tanto de embarazos. Las tasas de expulsiones y embarazos fueron mayores con el Progestasert. Con la Teu 220 C se observo el menor numero de expulsiones y de embarazos, asi como la mayor continuidad de uso.Los retiros por causas medicas fueron semejantes para todos los dispositivos intrauterinos

Post-placental insertion of IUDs.

PIP: A study was conducted into the efficacy of high fundal insertion of IUDs immediately postplacental delivery. 1008 women who were delivered at 5 large hospitals in Mexico during 1978 accepted this method of contraception. 5 different types of IUD were inserted by approximately 75 persons (ranging from medical students through interns and residents to certified gynecologists) by 3 different insertion techniques. Age and parity of the acceptors are tabulated. Life table follow-up analysis is used to cover cumulative pregnancy, expulsion, removal and continuation events at 3, 6, 9, and 12 months postinsertion. The continuation rate at the end of a year was 61.8 and this rate may rise as the study is completed. There were no differences as to any of these events or in the extent of postinsertion bleeding among the groups using the 5 different devices or with the 3 different techniques. High fundus placement seems to have improved the retention of IUDs inserted immediately after delivery. Rates for accidental pregnancy and medical removal were the same as those obtained with interval IUD insertion. Infection rates did not increase with this timing of insertion. Patient acceptance of this method was high.^ieng

Use and acceptance of the "Paper Pill" among an urban clinic population.

A randomized, crossover study comparing the acceptability of two presentations of the same oral contraceptive, a paper formulation and the conventional tablet, was carried out among two-hundred-and-seventy women attending two urban family planning clinics in Mexico City. During the first three cycles of use, the percentage of women discontinuing the medication for side effects was almost identical in the two groups. Although the paper formulation failed to demonstrate any major advantage in terms of continuation or acceptability, it was preferred by a majority of the women who began oral contraception with its use.

Electrocardiographic changes induced by insertion of an intrauterine device and other uterine manipulations.

A prospective study was carried out in normal women in order to investigate the effects of the following procedures on the electrocardiogram and blood pressure: (1) insertion of an intrauterine device (IUD)--the Lippes loop, Tcu-200, uterine progesterone system or Cu-7; (2) endometrial biopsy; and (3) uterine flushing. In groups in which a large IUD like the Lippes loop and/or a stiff IUD like the Cu-7 was inserted, the frequency of bradycardia was significantly higher than in any other groups. The severity of the bradycardia was similar in all of the groups and the frequency of this alteration was also similar among the nulliparous women or in those who complained of pain during the instrumentation, irrespective of the type of IUD inserted or the procedure carried out. No alarming modifications of blood pressure were observed and maintaining the patients in the recumbent position was sufficient to alleviate symptoms. In severe cases use of the Trendelenburg position should be enough to correct any alterations.

PIP: The effects of the insertion of an intrauterine device (IUD), endometrial biopsy, and uterine flushing on electrocardiograph patterns were evaluated in a prospective study of 260 women. The frequency of bradycardia was significantly higher during insertion of a Lippes loop IUD (p less than .001) or Cu-7 IUD (p less than .02) than with other procedures. The frequency of tachycardia was greater than that of bradycardia during the insertion of an uterine progesteronr system and TCu-200 IUD. However, the severity of bradycardia was similar in all groups. The frequency of bradycardia was similar among nulliparous women, and was correlated with reports of pain during any of the procedures. Changes in blood pressure were not severe, and symptoms were relieved by maintaining patients in a recumbent position. The Trendelenburg position is recommended in severe cases.