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Sexual activity during healthy pregnancy is safe. There are little data on how coital activity affects outcome of the high-risk pregnancies. Hereby we report a case demonstrating that orgasmic coitus triggered placental abruption resulting in preterm stillbirth. A 38-year-old 8-para, 12-gravida woman lived unmarriedly with a constant partner in low socioeconomic conditions. Her previous pregnancies included 7 deliveries without complication, two early miscarriages and two pregnancy terminations. Her present pregnancy was complicated with gestational hypertension successfully treated with nifedipine. She had coitus 2 to 4 times a month, mostly without orgasm. The last coitus which happened in side-by-side position was accompanied by orgasm which continued in uterine hypertonicity and massive vaginal bleeding at 29 weeks gestation. Two hours subsequently, on admission to hospital, placental abruption and fetal demise were diagnosed. At the emergency cesarean section, a dead female infant weighing 1,510 g was born. Fetal pathology was not discovered. Placental histopathology showed retroplacental hematoma, intervillous and decidual hemorrhages, focal distal villous hypoplasia and avascular villuses. Patient’s recovery rapidly occurred after intensive care. Placental abruption complicates 0.4% - 1.0% of deliveries. It is known that most cases of abruption cannot be predicted and prevented. Our report suggests that orgasmic coitus may be a trigger for placental abruption in those women who have gestational hypertension and multiple risks for placental abruption. We infer from the above case that sexual intercourse is advised to avoid during pregnancy of such women in order to prevent placental abruption.

Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration. Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF ≤ 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias. Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p < 0,05). Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.

Zoon’s vulvitis or plasma cell vulvitis (PCV) is a rare, benign inflammatory condition of the vulvar mucosa [1]. PCV can present with an asymptomatic lesion, or can cause discomfort, dyspareunia and pruritus [2]. In this way, PCV can mimic other lesions of the vulval mucosa, such as lichen planus.

The Anterolateral Ligament (ALL) [1,2] is a ligamentous structure of the knee whose definition as a ligament has been disputed in the past, however in the last decade more and more anatomical studies have concluded that its definition as a separate ligament is the most accurate. In this case report we present our findings from the dissection of a formalinized cadaver which we find are consistent with the anatomical characteristics of the anterolateral ligament and with that we aim to further its morphological definition.

Toxic epidermal necrolysis -the most serious variant of Steven Johnson Syndrome -arises as the result of cell-mediated cytotoxic reaction against keratinocytes. Most common inciting factors include drugs, and infections. On the other hand, Hemophagocytic lymphohistiocytosis (HLH), is a syndrome characterized by enormous immune response in the absence of down-regulation of activated immune cells resulting in cytokine storm causing severe tissue damage. Up to date, several cases of concomitance of Toxic Epidermal Necrolysis (TEN) and Hemophagocytic Lympohystiocytosis (HLH) in pediatric patients have been reported. Both situations can be fatal and pediatricians should be aware that these two clinical entities are not mutually exclusive, to the contrary they may coexist. We herein describe a case of Toxic Epidermal Necrolysis, complicated with Hemophagocytic Lymphohistiocytosis with Central Nervous System involvement due to EBV infection.

A 25-year-old man presented with fever and rash which progressed to extensive vesicular eruptions all over the body by the 4th day (Figure 1A).

Introduction: In the latest WHO classification of central nervous system tumors, Mitotic Index (MI) counted on Phosphohistone-H3 stained slides (pHH3-MI) has been suggested as a valid proliferative marker in various tumors including in the evaluation of meningioma grading.We aim to report our own experience in assessing the efficiency of the anti-pHH3 antibody as a grading tool for meningiomas.Methods: A retrospective study was conducted on a series of 40 meningiomas diagnosed from March 2020 to April 2021 at the Pathology Department of the Military Hospital of Tunis. We attempted immunohistochemistry and compared MI assessed on both pHH3 and HE-stained slides.Results: According to the HE-MI and pHH3-MI, the 40 cases of meningiomas were respectively divided into 35 versus 29 grade 1 cases, four versus eight grade 2 cases, and one versus three grade 3 cases. A highly significant correlation was found between pHH3-MI and HE-MI (p < 0.001). A significantly higher sensitivity in the pHH3 counting method was reported in our study. Discussion: we found, in accordance with the literature, that pHH3-MI is more reliable and accurate in mitotic counting, therefore exhibiting a high sensitivity in tumor grading, reported by an upgrade within 22,5% of the cases.Conclusion: PHH3-MI count facilitated a rapid reliable grading of meningiomas. However, molecular characteristics that could have a potentially significant impact on tumor progression should be the subject of further research.

The introduction of a new class of drugs known as direct acting antiviral (DAA) agents represents a revolution in the treatment of hepatitis C virus (HCV) in the general population, as these regimens are associated with higher sustained virological response (SVR) rates and fewer side effects. However, for patients with advanced chronic kidney disease suffering from HVC infection, treatment options including DAA remain limited. The aim of this study is to report our experience on Sofosbuvir (SOF) based regimen in the treatment of HCV in hemodialysis patients.In this observational study, we included all patients with chronic HCV infection on hemodialysis who were treated with SOF in our Hospital between April 2016 and March 2018. All patients were treated with a combination of 400 mg of SOF three times a week after hemodialysis and of 60 mg of Daclatasvir daily for a total of 12 to 24 weeks.A total of 20 hemodialysis patients were included in this study. 12 were females and the mean age was 52.1 ± 15.5 years. 11 patients were infected with HCV genotypes 1b. All patients achieved SVR. Clinical and biological tolerance was very good for all patients and none of them had to discontinue treatment because of side effects or developed hepatobiliary and cardiac toxicity. Two patients reported fatigue and another patient reported headaches. However, these symptoms were spontaneously resolved after the end of the treatment.In Morocco, despite the absence of new DAA combination treatment regimens which are not renally eliminated, our study concludes that SOF based treatment without Ribavirin or Peginterferon was effective and safe with minimal side effects. However, larger studies are still needed in order to validate these results.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan, China, and caused coronavirus disease-19 (COVID-19), which is still a global pandemic. Dermatologic manifestations have increasingly been identified as significant extrapulmonary manifestations of COVID-19. The dermatologic manifestations associated with COVID-19 infection reported to date include maculopapular rash, vesicular lesions, urticaria-like lesions, and chilblain-like lesions. Knowledge of dermatologic manifestations of COVID-19 may be essential for early diagnosis and a better prognosis in COVID-19 patients. This review summarizes the current understanding of common COVID-19-associated dermatologic manifestations.

There is still limited information regarding patients’ perception of the dental approach changes in the pandemic circumstance. Therefore, the aims of this study were, firstly, to evaluate patient perception regarding the COVID-19 infection risk in the orthodontic office in Brazil, and to assess the influence of age in infection risk perception. Orthodontic patients from five states answered an online questionnaire, anonymously, about quarantine behavior, perception of the infection risk in the orthodontic office, as well as the apparent need for the new biosafety approach. Descriptive analyses were performed for each question. Correlations between age and concern of getting infected were calculated with Spearman correlation tests. There were 406 responses. Most patients respected the quarantine, and 93.10% of those who were scheduled for appointments realized that their appointment would be safe enough. From the total, 83.99%, 84.98%, 89.90%, and 95.81% of patients judged, respectively, health status checks by phone, temperature checking, disposable coat, and face shield, as necessary. Only 6.40% reported an increase in the concern of returning to appointments. The younger the patient, the greater the concern of getting infected in future appointments (p = 0.042). Most patients were confident in the professional care before the appointment. The new biosafety approach was well accepted by the majority, with less agreement with temperature checking and the use of disposable coats. The younger the patient, the greater the concern of getting infected in future appointments. The rate of patients with risk factors for COVID-19 was 14.77%.