Breast myiasis in an elderly male patient: a case report.

Fly larvae cause myiasis. The most common of these are Cordylobia anthropophaga and Dermatobia hominis. Clinically, myiasis manifests as an erythematous papule that may become ulcerated and form furuncular lesions. In patients who have been in endemic areas, these larvae are to be suspected. Below, we present a 75-year-old male with a clinical picture of a palpable mass in the areola associated with the outflow of serohematic fluid through a central orifice. A breast intraductal lesion was suspected, so a breast ultrasound and biopsy were performed, which showed a structure compatible with myiasis. The diagnostic challenge was the high number of different diagnoses and the little knowledge of health professionals about tropical diseases.

Perceived gender and political persuasion: a social media field experiment during the 2020 US Democratic presidential primary election.

Women have less influence than men in a variety of settings. Does this result from stereotypes that depict women as less capable, or biased interpretations of gender differences in behavior? We present a field experiment that-unbeknownst to the participants-randomized the gender of avatars assigned to Democrats using a social media platform we created to facilitate discussion about the 2020 Primary Election. We find that misrepresenting a man as a woman undermines his influence, but misrepresenting a woman as a man does not increase hers. We demonstrate that men's higher resistance to being influenced-and gendered word use patterns-both contribute to this outcome. These findings challenge prevailing wisdom that women simply need to behave more like men to overcome gender discrimination and suggest that narrowing the gap will require simultaneous attention to the behavior of people who identify as women and as men.

Pathways from peers to mental health: Adolescent networks, role attainment, and adult depressive symptoms.

Both adolescent peer networks and adult role attainment affect mental health in adulthood. However, whether adult roles mediate associations between adolescent networks and adult mental health is unclear. Using path analysis with survey data from the National Longitudinal Study of Adolescent to Adult Health (N = 8543) in the United States, we examine the direct impact of adolescent (grades 7-12) popularity (received ties) and sociality (sent ties) among school peers on adult (ages 33-43) depressive symptoms, and we assess mediation pathways through four key adult roles: marriage, employment, education, and residential independence. We then examine whether pathways differ across men and women. Results indicate that adolescent popularity, or how others view an adolescent's position in the peer network, benefits adult mental health through the attainment of marriage, employment, and education. Residential independence is a significant mediator for popularity in models for men. Sociality, or how an adolescent views their own position in the peer network, relates to adult depressive symptoms through the attainment of a college degree for women and marriage for men. Sociality also directly predicts lower depressive levels, independent of adult role attainment, in models for women. Overall, results indicate gendered pathways for how adolescent networks relate to mental health decades later through adult roles.

Visualizing COVID Restrictions: Activity Patterns Before, During, and After COVID-19 Lockdowns in Uttar Pradesh, India.

Globally, restrictions implemented to limit the spread of COVID-19 have highlighted deeply rooted social divisions, raising concerns about differential impacts on members of different groups. Inequalities among households of different castes are ubiquitous in certain regions of India. Drawing on a novel data set of 8,564 households in Uttar Pradesh, the authors use radar plots to examine differences between castes in rates of activity for several typical behaviors before, during, and upon lifting strict lockdown restrictions. The visualization reveals that members of all castes experienced comparable reductions in activity rates during lockdown and recovery rates following it. Nonetheless, members of less privileged castes procure water outside the household more often than their more privileged peers, highlighting an avenue of improvement for future public health efforts.

Breast carcinoma or sweat gland carcinoma? A report of two cases and a comparison with the literature / ¿Carcinoma de mama o carcinoma de glándula sudorípara? Presentación de dos casos y análisis de la literatura.

Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established. We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.

El carcinoma apocrino primario de glándula sudorípara es una neoplasia con una muy baja incidencia, que puede representar un reto diagnóstico, clínico e histológico, y un reto terapéutico local, adyuvante y de la enfermedad avanzada. La edad media de los pacientes es de alrededor de 67 años, y no se ha observado preferencia según el sexo. Se presenta con mayor frecuencia en las axilas y en el cuero cabelludo. Se caracteriza clínicamente por un lento crecimiento, aunque puede progresar agresivamente, con compromiso local, ganglionar y metastásico, principalmente, pulmonar, hepático y óseo. El tratamiento recomendado -una vez establecida la histología- consiste en una resección local amplia con un margen claro de 1 a 2 cm y linfadenectomía regional si se detectan ganglios clínicamente positivos. El tratamiento adyuvante (radioterapia o quimioterapia) y de la enfermedad avanzada no está claramente establecido. Se presentan dos pacientes de sexo femenino con sospecha inicial de cáncer de mama, en quienes se diagnosticó finalmente un carcinoma apocrino de glándula sudorípara.

¿Carcinoma de mama o carcinoma de glándula sudorípara? Presentación de dos casos y análisis de la literatura / Breast carcinoma or sweat gland carcinoma? A report of two cases and a comparison with the literature

Resumen El carcinoma apocrino primario de glándula sudorípara es una neoplasia con una muy baja incidencia, que puede representar un reto diagnóstico, clínico e histológico, y un reto terapéutico local, adyuvante y de la enfermedad avanzada. La edad media de los pacientes es de alrededor de 67 años, y no se ha observado preferencia según el sexo. Se presenta con mayor frecuencia en las axilas y en el cuero cabelludo. Se caracteriza clínicamente por un lento crecimiento, aunque puede progresar agresivamente, con compromiso local, ganglionar y metastásico, principalmente, pulmonar, hepático y óseo. El tratamiento recomendado -una vez establecida la histología- consiste en una resección local amplia con un margen claro de 1 a 2 cm y linfadenectomía regional si se detectan ganglios clínicamente positivos. El tratamiento adyuvante (radioterapia o quimioterapia) y de la enfermedad avanzada no está claramente establecido. Se presentan dos pacientes de sexo femenino con sospecha inicial de cáncer de mama, en quienes se diagnosticó finalmente un carcinoma apocrino de glándula sudorípara.

Abstract Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established. We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.

Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report / Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso

Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso / Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report

Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Utilidad de las secuencias funcionales por resonancia magnética en el estudio de los tumores óseos y de partes blandas. Revisión imaginológica / Difusion and Functional Sequences: Utility in the Study of Bone and Soft Tissue Tumors. Pictorial Review

La resonancia magnética es la técnica de imagen de elección para diagnosticar, caracterizar, estadificar, realizar el seguimiento y valorar la respuesta al tratamiento de los tumores musculoesqueléticos. Para estos fines se utilizan las secuencias convencionales. Desde hace algunos años se han comenzado a implementar nuevas técnicas avanzadas, como la secuencia en fase y fase opuesta, difusión, perfusión y espectroscopia, que en conjunto se denominan técnicas funcionales, las cuales proporcionan información más específica del comportamiento, fisiología, metabolismo y biología molecular del tumor. Estas secuencias son no invasivas, aportan información adicional cualitativa, cuantitativa, metabólica y vascular por lo que deberían utilizarse de manera rutinaria en el momento de realizar el diagnóstico y, especialmente, en el seguimiento de los tumores óseos y de partes blandas. En este artículo se revisa la técnica de dichas secuencias, particularmente la secuencia de difusión, mediante casos ilustrativos de nuestros hospitales: Hospital Pablo Tobón Uribe y Hospital Universitario Quirón Salud de Madrid. También se revisarán las aplicaciones e importancia de un análisis combinado de estas nuevas herramientas, que aportarán información adicional para adecuada caracterización, enfoque diagnóstico y respuesta al tratamiento de las lesiones tumorales en el sistema musculoesquelético

Magnetic resonance imaging (MR) is the preferred technique for the diagnosis, characterization, staging, follow-up and assessment of response to treatment of musculoskeletal tumors. Conventional sequences help to classify these lesions. Recently new evolving functional MR sequences with advanced techniques have been implemented, such as phase sequence, opposite phase, diffusion, perfusion and spectroscopy, which provide specific information about the behavior, physiology, metabolism and molecular biology of the tumor. These sequences are non-invasive and provide additional qualitative, quantitative, metabolic and vascular information, making them important for the diagnosis and monitoring of bone and soft tissue tumors. This article reviews the technique of these sequences, particualrly the diffusion technique, using illustrative cases from the Hospital Pablo Tobon Uribe (Medellin ­ Colombia) and the University Hospital Quirón Salud (Madrid ­ Spain). We aim to review the utility and importance of a combined analysis of these new tools, which will provide additional information for adequate characterization, diagnosis and response to treatment of tumor lesions in the musculoskeletal system.

Rastreamento, diagnóstico e estadiamento do adenocarcinoma de cólon / Screening, diagnosis and staging of the colon adenocarcinoma

Introdução: O Câncer de Cólon (CC) é uma doença extremamente prevalente e letal quando não diagnosticada em tempo hábil para tratamento, o que justifica a necessidade de programas de rastreio na população. Métodos: Foram selecionados dezessete artigos das bases de dados Pubmed, Medline, Lilacs e Embase para compor uma revisão de literatura. Resultados: O objetivo do rastreamento do CC é detectar lesões precursoras (pólipos adenomatosos) ou câncer em estágio inicial, enquanto ainda são passíveis de tratamento. Pode-se utilizar diversos métodos para realizar este rastreamento, sendo a colonoscopia o exame padrão-ouro devido a capacidade de estabelecer diagnóstico histopatológico da doença e fornecer oportunidade de tratamento no mesmo procedimento em casos de lesão precursoras. O estadiamento é clínico e envolve exame físico, radiografia torácica e tomografia computadorizada (TC) de abdome e pelve. Conclusão: O CC é uma das neoplasias mais frequentes em adultos no mundo inteiro e é possivelmente curável se diagnosticado precocemente. O método padrão-ouro para rastreamento e diagnóstico é a colonoscopia, uma vez que ela permite biópsia para análise histopatológica na presença de lesão. O estadiamento deve ser feito para avaliar a extensão local e sistêmica da doença por meio do exame físico e exames complementares.

Introduction: The colorectal cancer (CC) is an extremely common disease that is lethal if not diagnosed in early stages, which justifies the need for screening in the general population. Methods: Seventeen publications from Pubmed, Medline, Embase and Lilacs databases were selected to compose a literature review. Results: The goal of screening for CC is to detect precursor lesions (polyps) or early stage cancer. There is a variety of methods available in order to perform this screening, being colonoscopy the gold standard due to the possibility of establishing both histopathological diagnosis of the disease and offering treatment in case of precursor lesions. The staging is clinical and includes physical examination, chest imaging and abdominal and pelvic CT scans. Conclusion: The CC is one of the most common cancers in adults and possibly treatable if early diagnosed. The gold standard method for screening is colonoscopy, since it allows biopsy for histopathological analysis. The staging needs to be done to assess the local and systemic extent of the disease through physical examination and complementary tests.

Synovial tuberculosis of the hand: An ancient disease in an unusual localisation.

BACKGROUND: Tuberculosis is the most prevalent infectious disease in the world. It is mainly caused by Mycobacterium tuberculosis. Osteoarticular tuberculosis represents 1%-3%. Tenosynovitis is the most common form of the disease in the hand. AIMS: The aim of this study is to present an update of synovial tuberculosis. MATERIALS AND METHODS: The authors present a literature review, the clinical and surgical management and case reports. RESULTS: The outcomes were satisfactory and were not report complications. CONCLUSIONS: Early diagnosis, surgical transection of the transverse carpal ligament, debridement and complete excision of the infected synovium may be required, along with antituberculosis drugs. Knowledge of this disease in the hand can provide a better diagnosis and outcome.

Retalho tenar adipofascial reverso para cobertura do nervo mediano hipertrofiado em macrodactilia / The reverse adipofascial thenar flap for coverage of the hypertrophied median nerve in macrodactyly

A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.

Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.

Granuloma piógeno como diagnóstico diferencial de las masas del vestíbulo nasal / Pyogenic granuloma as differential diagnosis of nasal mass the hall: case report

Las masas del vestíbulo nasal son tumores poco frecuentes. Pueden dividirse en dos grupos; benignos como el papiloma invertido, angiofibroma juvenil y malignos como el carcinoma escamolacular. El granuloma piógeno corresponde a una hiperplasia inflamatoria con tejido de granulación de muy baja aparición. Se presenta el caso de una mujer de 34 años con masa nasal diagnosticada como carcinoma escamolacular del vestíbulo nasal, a quien se le realizo recesión amplia de la lesión...

The masses of the nasal vestibule are rare tumors. They can be divided into two groups: benign such as Inverted Papilloma and Juvenile Angiofibroma and malign as Escamolacular Carcinoma. Pyogenic granuloma corresponds to an inflammatory granulation tissue hyperplasia with very poor appearance. It is presented the case of a 34 year old woman diagnosed with nasal mass as Escamolacular Carcinoma of the nasal vestibule, a wide recession of the lesson was performed...

Consenso médico de biopsia por aspiración con aguja fina de tiroides. reporte de citología tiroidea basado en el sistema de bethesda / Medical consensus of fine-needle aspiration biopsy of the thyroid. bethesda system for reporting thyroid cytopathology

En este artículo se presenta un consenso médico basado en el sistema de Bethesda del Instituto Nacionalde Cáncer (Estados Unidos) para el uso de la biopsia por aspiración con aguja fina en el manejo de nódulos tiroideos, realizado en conjunto con patólogos, radiólogos, endocrinólogos y otras especialidades médicas de Colombia, España, Chile, Venezuela, Estados Unidos y Panamá. En este trabajo se describen las indicaciones de la biopsia por aspiración con aguja fina de tiroides, requisitos previos, entrenamiento, acreditación, técnicas, terminología diagnóstica, pruebas complementarias y opciones de tratamiento. El objetivo del actual artículo es presentar ante la comunidad médica la clasificación de los reportes citológicos, el reporte de ecografía que propone usar el sistema de datos y el reporte de imágenes tiroideas (TIRADS, del inglés The Thyroid Imaging Reporting and Data System), el uso de la medición de tiroglobulina en biopsia por aspiración con aguja fina y técnicas de citología líquida;...

This article presents a medical consensus based on the Bethesda system of the National Cancer Institute (USA) for the use of fine needle aspiration biopsy in the management of thyroid nodules. This consensus was performed in conjunction with pathologists, radiologists, endocrinologists, and other medical specialties of Colombia, Spain, Chile, Venezuela, United States, and Panama. In this work was described the indications for fine needle aspiration biopsy of thyroid, prerequisites, training, accreditation, techniques, diagnostic terminology, additional tests and treatment options. The aim of this article is present to the medical community the classification of cytological report, ultrasound report using the data system, and the thyroid imaging reporting and data system (TIRADS); as well as, the use of thyroglobulin measurement in fine needle aspiration biopsy, and liquid-based cytology techniques...

Colonic angiolipoma - a rare finding in the gastrointestinal tract. Case report and review of literature.

Angiolipomas are benign lesions that are frequently found in subcutaneous cellular tissue, but are rarely located in the gastrointestinal tract. Here we discuss a case of colonic angiolipoma that presented as a mass near the hepatic flexure, occupying approximately 90% of the colonic lumen. The diagnosis was made by endoscopy and computed tomography. The mass was resected successfully and diagnosis was confirmed by histological studies and immunohistochemical tests.