Lipoma-like hibernoma of the breast: A case report and literature review.

Hibernomas are uncommon and benign tumors made up of brown fat cells. These tumors are typically found in the thigh, axillae, shoulder, back, neck, thorax, arm, and retroperitoneum. There are 4 histological variants of hibernomas, including the typical pattern, myxoid, lipoma-like, and spindle cell variant. The lipoma-like variant is characterized by numerous univacuolated adipocytic cells with intermingled multivacuolated granular cells. It is worth noting that lipoma-like hibernoma in the breast is infrequent. In this case, we present a 72-year-old woman with a history of moderately differentiated cholangiocarcinoma, obesity, and no family history of breast cancer. She consulted for a mass sensation in her right breast that had been present for a year. The mass was not painful and showed no inflammation or nipple discharge. Upon physical examination, a palpable 14 cm mass was identified, occupying the 2 internal quadrants and causing deformation of the surface of the right breast. Imaging studies indicated a solid mass in the lower-inner quadrant of the right breast, which was oval-shaped, well-defined, and displayed internal vascularization. Initially, a diagnosis of low-grade liposarcoma was considered, leading to a core needle biopsy guided by ultrasound. However, the histopathology study revealed a lipoma-like hibernoma, an exceedingly rare benign lesion. Lipoma-like hibernoma can present as a palpable mass or may be incidentally discovered. It should be considered in the differential diagnosis of any lesion containing fatty content. Imaging methods may suggest its presence, but histopathology confirms the diagnosis and its accuracy prevents needless overtreatment.

COVID-19 and Tuberculosis Coinfection in a 51-Year-Old Taxi Driver in Mexico City.

BACKGROUND Coinfection with severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis (MBT) has been reported, albeit rarely, in various parts of the world and has received attention from health systems because up to one-third of the world's population has been infected with SARS-CoV-2. Mexico was not included in the first-ever report on a global cohort of patients with this coinfection. We report on a case of SARS-CoV-2/MBT coinfection in a 51-year-old taxi driver from Mexico City that underscores the importance of rapid and accurate laboratory testing, diagnosis, and treatment. CASE REPORT We present the case of a man in the sixth decade of life who was admitted to the National Institute of Respiratory Diseases (INER) with a diagnosis of COVID-19 pneumonia, which was confirmed by nasopharyngeal exudate using real-time polymerase chain reaction (RT-PCR) for the identification of SARS-CoV-2. Findings from imaging studies suggested that the patient might be coinfected with MBT. That suspicion was confirmed with light microscopy of a sputum sample after Ziehl-Neelsen staining and when a Cepheid Xpert MTB/RIF assay, an automated semi-quantitative RT-PCR assay, failed to detect rifampicin resistance. The patient was discharged from the hospital 10 days later. CONCLUSIONS The present report underscores the importance of using validated molecular diagnostic tests to identify coinfections in areas where there is a high prevalence of other causes of pneumonia, such as MBT, as a way to improve clinical outcomes in patients during the COVID-19 pandemic. While it is imperative to control the COVID-19 pandemic, the medical community must not forget about the other pandemics to which populations are still prey, and tuberculosis is one of them. We must remain alert to any clinical subtleties so as to ensure timely and accurate diagnosis and stay one step ahead of COVID-19.

A 65-Year-Old Woman with a History of Type 2 Diabetes Mellitus and Hypertension and a 15-Day History of Dry Cough and Fever Who Presented with Acute Renal Failure Due to Infection with SARS-Cov-2.

BACKGROUND Acute kidney injury is one of the most common complications in patients infected with SARS-CoV-2, occurring in up to 7% of cases and increasing to 23% in patients treated in the Intensive Care Unit (ICU). The objective of this report was to describe the clinical case of a patient infected by SARS-CoV-2 who developed acute renal injury, probably secondary to this infection. CASE REPORT On 1 April 2020, a 65-year-old woman presented to the emergency service of the National Institute of Respiratory Diseases, Mexico City, with a 15-day history of dry cough and subjective fever. Finally, the following diagnoses were integrated: Acute renal injury of etiology to be determined (acute chronic kidney disease secondary to T2DM vs. acute renal injury by SARS-CoV-2) and COVID-19. The patient had a typical presentation of severe COVID-19, evidencing all the risk and severity factors for this disease. However, after being admitted to the hospital, she showed evidence of acute renal injury. Although the renal injury may have been due to microangiopathic damage caused by chronic hypertension and diabetes, it is imperative to consider the possibility that such exacerbation contributes to SARS-CoV-2 infection or synergy of multiple factors. CONCLUSIONS Every aspect of this pandemic remains unclear. The formulation of hypotheses to explain the physiopathological mechanisms by which this new virus can cause mortality in infected patients may help reduce mortality rates and control the pandemic itself.

The effectiveness of army field manual interrogation approaches for educing information and building rapport.

In 2016, the U.S. Congress mandated that federal intelligence interrogators adhere to the methods of the U.S. Army Field Manual FM 2-22.3 (AFM) and that the manual be revised based upon empirically based evaluations of the interrogation methods' effectiveness with interviewees motivated to withhold information. In the present study, 120 participants took part in a testing situation in which half were induced to cheat. All participants were then accused of cheating and interrogated with either (a) a combination of AFM interrogation approaches that focused on the potential benefits of cooperation with the interviewer (cooperation-focused condition), or (b) a combination of AFM approaches that focused on the potential risks of withholding information (withholding-focused condition). Participants who cheated on the test were significantly more likely to admit their wrongdoing and to provide additional relevant information when interrogated with the withholding-focused approaches than when questioned with the cooperation-focused approaches. The "we know all" AFM approach was especially effective for eliciting truthful admission-related details. Participants reported high rapport with the interrogator in both the cooperation-focused and withholding-focused conditions. These findings indicate that the we-know-all approach can be effective for maintaining rapport and eliciting accurate information in brief interrogations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Frecuencia del virus de la hepatitis B (HBV) en estudiantes universitarios de la ciudad de Corrientes, Argentina / Frequency of hepatitis B virus (HBV) in university students in the city of Corrientes, Argentina

El virus de la hepatitis B (HBV) presenta amplia distribución en todo el mundo, con más de 500 millones de individuos infectados. Este microorganismo pertenece a la familia Hepadnaviridae. En el presente trabajo se analizó la presencia del antígeno de superficie del virus (HBsAg) y perfil enzimático (GOT, GPT y FAL) en 292 muestras de suero o plasma de estudiantes universitarios de ambos sexos. De las muestras analizadas una sola resultó "Reactiva" para el HBsAg, lo que representa el 0.34 %, confirmado por técnica de reacción en cadena de la polimerasa.

Summary The Hepatitis B virus (HBV) is widely distributed throughout the world, with more than 500 million infected individuals. Is a virus belonging to the Hepnaviridae family. In the present work was analyzed the presence of HBsAg and enzymatic profile (GOT, GPT, FAL) in 292 serum samples or plasm of university students of both sexes. From analyzed samples so far, only one of them was "reactive" for HBsAg, which represents 0,34%. In addition, the determination of total anti-core antibodies was realised to the latter sample resulting "reactive

Pandemic (H1N1) 2009 in breeding turkeys, Valparaiso, Chile.

Pandemic (H1N1) 2009 virus was detected in breeding turkeys on 2 farms in Valparaiso, Chile. Infection was associated with measurable declines in egg production and shell quality. Although the source of infection is not yet known, the outbreak was controlled, and the virus was eliminated from the birds.

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites.

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.

Insulin-secretion abnormalities and clinical deterioration related to impaired glucose tolerance in cystic fibrosis.

OBJECTIVE: To evaluate insulin-secretion kinetics and insulin sensitivity in cystic fibrosis (CF) patients with normal glucose tolerance (CF-NGT), impaired glucose tolerance (CF-IGT) or CF-related diabetes (CFRD), and the potential effects of moderate hyperglycemia on clinical and nutritional status. DESIGN AND METHODS: Cross-sectional study including 50 outpatients with CF. Patients underwent both oral (OGGT) and intravenous (IVGTT) glucose tolerance tests in order to assess insulin secretion and peripheral insulin sensitivity. Homeostasis assessment model and OGGT were used to investigate insulin sensitivity. Forced expiratory volume in the first second (FEV(1)) and forced vital capacity (FVC) were measured to evaluate pulmonary function. Body mass index (BMI) was determined to assess nutritional status. RESULTS: Insulin secretion was significantly decreased (and delayed at OGTT) in the CFRD group (n = 9) versus the CF-IGT group (n = 10) and the CF-IGT versus the CF-NGT group (n = 31). Insulin sensitivity was significantly different in the CF-IGT and CFRD groups versus the CF-NGT group. FEV(1), FVC and BMI presented a significant linear correlation with plasma glucose value at 120 min at OGTT and were significantly lower in both CF-IGT and CFRD versus the CF-NGT group, whereas no differences were found between the CF-IGT and CFRD groups. CONCLUSIONS: CF patients with IGT present diminished insulin secretion and increased peripheral insulin resistance, correlating with a worse clinical status, undernutrition and impaired pulmonary function. These findings open the question of whether early treatment of mild alterations of glucose metabolism with insulin secretagogues or short-action insulin may lead to improvement of clinical status in CF patients.

[Life-threatening hemoptysis in cystic fibrosis: clinical characteristics and management in 36 episodes]. / Hemoptisis amenazante en la fibrosis quística: descripción clínica y actitud terapéutica en 36 episodios.

BACKGROUND: Our goal was to evaluate the clinical characteristics and management of life-threatening hemoptysis in patients with cystic fibrosis (CF). PATIENTS AND METHOD: We included adult CF patients followed up at the Cystic Fibrosis Units of the Autonomous Community of Madrid who had life-threatening hemoptysis from June 1990 to December 1999. RESULTS: Twelve CF patients (4 females) developed 36 episodes of life-threatening hemoptysis (30 massive and 6 recurrent). Lung disease was moderate to severe. Sputum cultures revealed Pseudomonas aeruginosa in 10 patients. Thirteen episodes (36%) resolved upon antibiotic treatment and 3 (8%) after antibiotic therapy and bronchoscopy. Bronchial artery embolization (BAE) was performed in 20 of 36 events. Immediate technique success was achieved in 80% episodes (16 of 20) after one session, 85% (17/20) after two sessions, and 95% (19/20) after three sessions. No major complications associated with the procedure were seen. The overall recurrence rate per episode was 69% (24 of 35 episodes in 6 patients) with a mean time of recurrence of 13 months. There were no massive hemoptysis-associated deaths during the follow-up. CONCLUSIONS: Life-threatening hemoptysis is a frequent complication in CF patients who have moderate or severe lung disease. When conservative therapeutic measures (including antibiotics) fail to control it, BAE should be performed. When performed by expert professionals, BAE is effective and safe to immediate control of life-threatening hemoptysis in patients with CF.

Serologic IgE immune responses against Aspergillus fumigatus and Candida albicans in patients with cystic fibrosis.

OBJECTIVES: The objectives of this study were to determine the prevalence of Aspergillus fumigatus and Candida albicans in the sputa of patients with cystic fibrosis (CF), to assess serologic IgE responses of these patients to the presence of fungi in the sputum, to evaluate what effect this may have on clinical status, and to determine how the above-mentioned factors relate to allergic bronchopulmonary aspergillosis (ABPA). PATIENTS: Seventy-six CF patients (40 male and 36 female patients; age, 15.3 plus minus 8.7 years [mean plus minus SD]) were studied. MEASUREMENTS AND RESULTS: A total of 1,239 sputum samples from 66 patients were cultured for fungi. A fumigatus was grown in 256 sputum specimens (20.7%), and C albicans was grown in 588 sputum samples (47.5%). Forty patients (60.6%) had at least one positive culture finding for A fumigatus, and 58 patients (87.9%) had at least one positive culture finding for C albicans. Forty-nine patients (64.5%) were sensitized to A fumigatus, and 20 patients (26.7%) were sensitized to C albicans. No correlation was found between the finding of A fumigatus in sputum and IgE to A fumigatus. Only patients who had at least one positive culture finding for C albicans had IgE to C albicans develop. Lung function values and chest radiograph scores were not significantly lower in patients sensitized to either A fumigatus or C albicans as compared to nonsensitized patients. Of the 20 patients sensitized to C albicans, 10 patients had confirmed ABPA and 10 patients had some immunologic characteristics of ABPA. CONCLUSIONS: A high prevalence of colonization and sensitization to A fumigatus and C albicans in CF patients was observed. The sensitization to these fungi was not related to the clinical severity. IgE to C albicans may be an immunologic marker related to the development of ABPA in patients with CF.

Hemoptisis amenazante en la fibrosis quística: descripción clínica y actitud terapéutica en 36 episodios / Life-threatening hemoptysis in cystic fibrosis: clinical characteristics and management in 36 episodes

FUNDAMENTO: El objetivo del trabajo es valorar la eficacia de la reacción en cadena de la polimerasa (PCR) anidada para el diagnóstico de laboratorio de la infección toxoplásmica activa en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). PACIENTES Y MÉTODO: Se realizó un estudio en 157 pacientes con infección por el VIH en quienes se investigó la presencia de anticuerpos anti Toxoplasma gondii IgG, IgM e IgA, así como de ADN de T. gondii mediante PCR anidada en muestras de sangre periférica. RESULTADOS: El estudio demostró la presencia de ADN del parásito en 11 pacientes, anticuerpos IgG anti-T. gondii en 56, del tipo IgM en uno y del tipo IgA en 5. CONCLUSIONES: La técnica de PCR anidada es una herramienta rápida, sensible y eficaz en el diagnóstico temprano de toxoplasmosis en pacientes con infección por el VIH, además de ser útil para la indicación del tratamiento en individuos asintomáticos FUNDAMENTO: Estudiar la presentación clínica y actitud terapéutica ante la hemoptisis amenazante en los pacientes con fibrosis quística (FQ).PACIENTES Y MÉTODO: Pacientes con FQ mayores de 18 años atendidos en la Comunidad Autónoma de Madrid que presentaron hemoptisis amenazante entre enero de 1990 y diciembre de 1999.RESULTADOS: Doce pacientes (4 mujeres y 8 varones) con FQ presentaron 36 episodios de hemoptisis amenazante. En 30 casos fue masiva y en 6 recurrente. La afección pulmonar era moderada-grave. Diez pacientes tenían colonización pulmonar por Pseudomonas aeruginosa. De los 36 episodios de hemoptisis, 13 (36 por ciento) se solucionaron con tratamiento antibiótico y tres (8 por ciento) con tratamiento antibiótico y fibrobroncoscopia. En los 20 episodios restantes se realizó embolización de las arterias bronquiales. La eficacia de la embolización para el control de la hemoptisis fue de un 80 por ciento (16 de 20 episodios) con una sesión de embolización, de un 85 por ciento (17/20) con dos sesiones y de un 95 por ciento (19/20) con tres sesiones. No hubo ninguna complicación mayor por la embolización. La tasa de recurrencia por episodio fue de un 69 por ciento (24/35 episodios, en 6 pacientes), con un tiempo medio de recurrencia de 13 meses. Durante el seguimiento no se produjeron muertes secundarias a la hemoptisis. CONCLUSIONES: La hemoptisis amenazante es frecuente en los pacientes con FQ y afección pulmonar moderada-grave. Si la hemorragia no cesa con tratamiento conservador (incluyendo antibióticos), debe realizarse embolización de las arterias bronquiales. Esta técnica es efectiva y segura cuando la lleva a cabo personal experto (AU)

Experiencia endoscópica en una Unidad de Gastroenterología Pediátrica

Se analizan los resultados de las exploraciones endoscópicas realizadas en un período de 7 años en la Unidad de Gastroenterología del servicio de Pediatría del Hospital Ramón Cajal, Madrid-España. Hernia hiatal, esofagitis péptica

Paracoccidioidomicosis genital femenina: informe de un caso / Female genital paracoccidioidomycosis: report of a case

Se presenta el caso de una mujer de 47 anos de edad quien fue remitida a la Unidad de Ginecologia del Hospital General Universitario Santa Sofia para estudio colposcopico por citologia anormal. Imagen fue sugestiva de Neoplasia Intraepitelial Cervical pero en estudio histologico de biopsias tomadas de zonas acetoblancas, con mosaico y punteado revelaron la presencia de reaccion granulomatosa con estructuras de hongos de doble pared y morfologia del Paracoccidioides Braziliensis. Estudio sistemico de la paciente habia revelado compromiso pulmonar con cambios de laboratorio de infeccion paracoccidioidal que fue tratado un ano antes en forma inconstante con sulfas. Este informe presenta un caso observado recientemente, con compromiso sistemico y presentacion clinica prominente en genitales femeninos (cervis-uretra-vagina) siendo su manifestacion clinica y colposcopicocitologica, sugestiva de Neoplasia

Fistula del munon bronquial post neumonectomia / Bronchial stumps fistulae post pneumonectomy

La fistula del munon bronquial post neumonectomia es una de las mas graves complicaciones que se pueden presentar en la cirugia del torax. Los tratamientos propuestos hasta el momento han tenido resultados muy desalentadores. El presente trabajo es un informe preliminar donde se describen casos de tratamiento local de la fistula a traves de broncoscopia, con Hidroxido de Sodio (NaOH). En tres casos se logro el cierre de la fistula. Se describe lo sencillo del procedimiento y se sugiere como una alternativa en el tratamiento de este tipo de complicacion