Sclerosing Polycystic Adenosis of the Parotid Gland: A Systematic Review and Report of 2 New Cases.

PURPOSE: We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases. MATERIALS AND METHODS: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases. RESULTS: Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%). CONCLUSIONS: We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.

Effectiveness of cognitive reappraisal and distraction for induced acute pain: A laboratory study.

OBJECTIVE: Cognitive reappraisal and distraction modulate pain; however, little is known about their effectiveness at different levels of pain intensity. Thus, the aim of this study has been to analyze the differential efficacy of both strategies to reduce perceived pain intensity and pain unpleasantness in low and moderate pain levels. METHOD: 3 (emotion regulation strategy: cognitive reappraisal, distraction, and control) × 2 (intensity of the painful stimuli: low and moderate intensity) × 2 (time: pretest and posttest) mixed factorial design. Ninety healthy adults were randomly assigned to one of six experimental conditions. Pain-heat stimuli were administered with an advanced thermal stimulator. All participants completed the experimental pretest and posttest phases; in each phase, 12 pain stimuli were administered. Participants received brief training on how to apply cognitive reappraisal, distraction, and the control condition for the posttest phase. Data were collected from May 2022 to November 2022. RESULTS: Analyses of repeated-measure analysis of variance showed that at posttest cognitive reappraisal and distraction were equally effective in reducing perceived pain intensity in low pain levels, while distraction was more effective than cognitive reappraisal in decreasing perceived pain intensity in moderate pain levels. Both distraction and cognitive reappraisal were effective in decreasing pain unpleasantness regardless of the intensity of the painful stimuli. CONCLUSION: These findings highlighted the beneficial use of both strategies in the short term for pain relief, distraction being more effective in moderate pain levels. Applying both strategies to everyday situations that may cause short-term acute pain could be of great clinical relevance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of Dimethyl Fumarate in Real-World Clinical Practice and Strategy to Minimize Adverse Effects and Use of Healthcare Resources.

BACKGROUND: Dimethyl fumarate (DMF) has shown efficacy in reducing relapse rates in patients with multiple sclerosis (MS). However, associated adverse effects (AE) such as gastrointestinal (GI) AE, flushing and lymphopenia are the main cause of treatment discontinuation. The aim of this study was to evaluate the effectiveness of DMF, and to assess strategies to reduce treatment discontinuation rates in routine clinical practice. PATIENTS AND METHODS: Ninety patients started DMF treatment between August 2015 and February 2020. Prior to DMF therapy, patients received written information regarding treatment and the management of AE, along with medical prescriptions. Clinical and analytical data were collected at clinical visits performed at least 6-monthly, and disease progression was evaluated by brain magnetic resonance imaging (MRI). RESULTS: Prior to DMF, 78.7% of patients had an annualized relapse rate (ARR) of 1.07 (range: 1-3) and median Expanded Disability Status Scale (EDSS) score of 1.0 (range: 0-2). At final follow-up, ARR and median EDSS scores were significantly reduced to 0.09 (range: 0-2; p< 0.001) and 0 (range: 0-1.625; p< 0.001), respectively. Just over one quarter of patients with brain MRI (26.8% of 71 patients) showed improvement in disease activity based on MRI evaluation. Lymphopenia was associated with previous treatment lines (p=0.042) and longer disease duration (p=0.032). A total of twelve patients abandoned DMF treatment, mainly due to lymphopenia (7.9%), but none did it because of GI AE or flushing. CONCLUSION: In our series, DMF showed high clinical and radiological efficacy. Providing patients with complete information prior to treatment on the management of associated AE helps them to better understand what to expect, improves tolerance and reduces clinical and telephone consultations, which may help to reduce the use and cost of healthcare resources.

Early interruption of breastfeeding. A qualitative study. / Interrupción temprana de la lactancia materna. Un estudio cualitativo.

OBJECTIVE: The aim of this study was to discover the personal experience and feelings of primiparous women who had to abandon breastfeeding (BF) before the expected time, as well as the causes of abandonment and the role of health professionals. METHOD: A qualitative study through semi-structured interview was carried out. A purposive sampling by key informants was conducted, until saturation of the information was reached. Qualitative content analysis was carried out to generate codes and assign categories. RESULTS: We interviewed 15 women aged 33.1 (SD 5.4) years. Ambivalent feelings were found, while BF was considered a satisfying experience, it was also sacrificial and painful. They refer to a lack of knowledge, and insecurity about nourishing their infant and physical pain seem to be the most important reasons for giving up. There is also a duality of feelings between the peace of mind afforded by artificial feeding, knowing that their child is well nourished, and the feeling of guilt for not having maintained BF. They believe that professionals do not adequately perform their work to promote BF, referring to numerous occasions when health professionals themselves have performed practices contrary to its establishment and maintenance. CONCLUSIONS: In the mothers' account, emotional training and emotional support needs are insufficiently covered. Nursing professionals involved in the care of these women should systematically explore these needs.

Linfoma B de localización facial / Facial located B-cell lymphoma

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Interrupción temprana de la lactancia materna. Un estudio cualitativo / Early interruption of breastfeeding. A qualitative study

Objetivo: Conocer la experiencia personal y sentimientos de las mujeres primíparas que se vieron obligadas a abandonar la lactancia materna (LM) antes del tiempo previsto inicialmente por cada mujer, así como las causas del abandono y el papel de los profesionales sanitarios. Método: Estudio cualitativo fenomenológico mediante entrevista semiestructurada. Se realizó un muestreo opinático mediante informadores clave, hasta alcanzar la saturación de la información. Se realizó análisis de contenido cualitativo para generar códigos y asignar categorías. Resultados: Se entrevistaron 15 mujeres de 33,1 (DE 5,4) años. Se constató ambivalencia de sentimientos, considerando que la LM es una experiencia satisfactoria a la par que sacrificada y dolorosa. Las mujeres referían escasez de conocimientos. La inseguridad sobre la alimentación y el dolor físico fueron las causas más importantes para el abandono. Se evidenció además una dualidad de sentimientos entre la tranquilidad que supone la alimentación artificial, al saber que el niño está bien alimentado, y la sensación de culpabilidad por no haber mantenido la LM. Consideraron que los profesionales no realizan adecuadamente su labor de promoción de la LM, refiriendo numerosas ocasiones en las que los propios profesionales sanitarios efectuaron prácticas contrarias a su instauración y mantenimiento. Conclusiones: En el relato de las madres se constatan necesidades formativas y de soporte emocional insuficientemente cubiertas. Las enfermeras implicadas en la atención de estas mujeres deberían explorar sistemáticamente dichas necesidades

Objective: The aim of this study was to discover the personal experience and feelings of primiparous women who had to abandon breastfeeding (BF) before the expected time, as well as the causes of abandonment and the role of health professionals. Method: A qualitative study through semi-structured interview was carried out. A purposive sampling by key informants was conducted, until saturation of the information was reached. Qualitative content analysis was carried out to generate codes and assign categories. Results: We interviewed 15 women aged 33.1 (SD 5.4) years. Ambivalent feelings were found, while BF was considered a satisfying experience, it was also sacrificial and painful. They refer to a lack of knowledge, and insecurity about nourishing their infant and physical pain seem to be the most important reasons for giving up. There is also a duality of feelings between the peace of mind afforded by artificial feeding, knowing that their child is well nourished, and the feeling of guilt for not having maintained BF. They believe that professionals do not adequately perform their work to promote BF, referring to numerous occasions when health professionals themselves have performed practices contrary to its establishment and maintenance. Conclusions: In the mothers' account, emotional training and emotional support needs are insufficiently covered. Nursing professionals involved in the care of these women should systematically explore these needs

Fibrilación auricular paroxística en el contexto de cefalea en racimos / Paroxysmal atrial fibrillation within the context of cluster headaches

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