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A 66-year-old patient, diagnosed κ light chains MM with t(11;14), presented before second cycle with bendamustine-dexamethasone. A complete remission was initially obtained with bortezomib-cyclophosphamide-dexamethasone and autologous HSCT. After relapse, he was successively treated with bortezomib-dexamethasone, carfilzomib-dexamethasone, daratumumab-dexamethasone and benda-mustine-dexamethasone.

Background: Worldwide, obesity in adolescents is an epidemiological concern. Overweight and obesity are associated with comorbidities in adult life, such as increased risk of hypertension and other non-communicable diseases. This study investigated possible differences between traditional lipid markers and Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) subfractions in a population-wide representative sample of Brazilian adolescents. Methods: The individuals included in the study comprise a subsample of the 2015 Health Survey of São Paulo (ISA-Capital 2015). LDL and HDL particle sizes were determined by the Lipoprint® System (Quantimetrix Corporation). Results: 272 Brazilian adolescents with a mean age of 15.2 ± 2.2 years, of which 47.8% (n = 130) are boys. Analysis of LDL subfractions showed an increase in LDL 2 content in girls (5.7% vs. 5.1%; p = 0.047). This result was associated with a higher content of large LDL in girls (17.8% vs. 13.5%; p < 0.001) and a significant, lower content of small LDL (1.7% vs. 3.4%; p = 0.002). When obesity was considered, we observed that regardless of being overweight, girls had higher large and small LDL than boys. However, when a large to small LDL ratio was calculated, girls with no excess weight had higher values than boys with no excess weight (10.6 vs. 9.3; p = 0.038), and these had lower LDL ratio than overweight boys (9.3 vs. 13.5; p = 0.016). On the other hand, boys had higher HDL 2 content than girls (8.9% vs. 8.0%; p = 0.017), which was associated with increased large HDL values in boys (1.9% vs. 1.7%; p = 0.047). Regression analysis was performed according to gender, the sum of very low-density lipoprotein (VLDL) + intermediate density lipoprotein (IDL) C + IDL B subfractions was adjusted for age and body mass index (BMI), showing that girls had lower atherogenic lipid profile (β = 0.987; CI = 0.977-0.998; p = 0.017) than boys. When the regression analysis was performed according to BMI, large LDL in adolescents with no excess weight presented a lower atherogenic lipid profile (β = 1.040; CI = 1.000-1.082; p = 0.049), adjusted for age and sex, than overweight adolescents.Conclusion: Regardless of excess weight, girls showed a cardioprotective profile more associated with a favorable distribution of LDL subfractions than boys, reinforcing the relevance of evaluating qualitative aspects of lipoproteins in addition to the traditional cholesterol content.

From my desk I could be watching the wind blow or the horses running. Practicing Medicine in a rural setting has these advantages: from time to time you can take the time to admire the beauty that surrounds you in the form of an obligatory pause within a marathon working day, and rest helps refresh your mind of prejudices to continue with the inescapable task that awaits us after a few minutes, the only ones allowed to order our thoughts.

The gold standard for advanced-stage ovarian cancer surgery entails exploration via a midline vertical laparotomy. Studies have shown that minimally invasive surgery (MIS) can be a safe and effective method for the surgical management of early ovarian cancer. In some cases, MIS can also be selectively used for cytoreductive surgery in cases with advanced-stage ovarian cancer. The robotic platform has the potential to provide similar outcomes to the laparotomy-based standard of care in advanced complex surgery while accelerating recovery, minimizing morbidity, and reducing perioperative complications. The primary objective of this study was to evaluate surgical and perioperative outcomes in patients with advanced ovarian carcinoma who underwent robotic-assisted cytoreduction. A chart review of a nonselected consecutive series of all patients undergoing surgical management of advanced ovarian cancer between 7/1/2017 and 12/31/2021 was conducted. All patients that were diagnosed with Stage III to IV ovarian cancer between the timeframe underwent robotic-assisted cytoreductive surgery at two urban community teaching hospitals in Los Angeles. Twenty-five patients were identified and included in this study. All surgeries were performed by a single surgeon. Optimal or complete CRS was achieved in 96% of the patients (24 of 25 cases). Seven (28%) underwent primary cytoreduction (PCRS) and 18 (72%) underwent interval cytoreduction (ICRS). The estimated median blood loss was 100 mL (25-500 mL), the median operative time was 5.9 hours (3.1-10.5 hours), and the conversion rate to open laparotomy was 0%. There were no intraoperative complications and the readmission rate within 30 days was 4% (1 patient) for ileus, which was managed conservatively. Currently, 64% of the patients in the case series remain alive. The median survival has not been reached. The median follow-up is 4.08 years. Results presented from this nonselected, consecutive case series illustrate how a minimally invasive robotic approach can be safely used in place of the standard exploratory laparotomy for ovarian cytoreduction.

Introduction: This paper presents the first application of forensic entomology in a murder investigation in Nigeria involving the remains of a 54-years victim, on January 9th, 2019 in a shaded wooded area in advanced decomposition, with no clear indication of the time of death. Objectives: To estimate the minimum post-mortem interval of a 54-year-old corpse recovered in the advanced decomposition stage using the blowfly Chrysomya megacephala and the Advance-Degree-day (ADD) method.Results: An autopsy report revealed multiple wounds to the forehead including a bullet hole. Dead embalmed dead maggots recovered from the body were identified as C. megacephala, and an accumulated degree-day model was used to estimate the minimum post-mortem interval. The findings revealed that the recovered larvae were still within the third-instar stage and had accumulated thermal energy between 58 hours (= 1.6 days, equivalent to 38.7 ADD) and 102 hours (= 2.8 days, equivalent to 68.0 ADD), suggesting that the body may have been exposed to insect activity between January 1st and 9th January 2019 after expanding the range to cater for some uncertainties. Conclusion: In this Nigerian murder case, forensic entomology used the calliphorid species C. megacephala to estimate the minPMI to be between 2 and 9 days before the body was discovered, which translates to 1st - 9th January 2019 after consideration of some uncertainties and limitations. This confirmed the crucial role that insects play in providing valuable evidence to complement forensic pathological findings in homicides when conventional methods failed. Notwithstanding difficulties with employing insect evidence in forensic investigations in Nigeria, the application of this modern forensic technique has the potential to aid in the resolution of many unsolved murder cases and expedite the delivery of justice. The ability of law enforcement agencies in Nigeria to use the potential of insects in criminal investigations can be improved through collaborations and training with professionals from diverse professions.

Objective: Foot and mouth disease (FMD) is a highly infectious and economically important disease affecting cloven-hoofed domestic and wild animals. Early diagnosis and serotyping of the agent are very important to effectively design and implement the control approach. This study was conducted on serum samples collected from Amhara, Tigray, Oromia and Addis Ababa between October 2018 to February 2020. The animals were kept under a semi-intensive to an extensive system of rearing. Serum samples with low OD values (positive) using competition NSP-ELISA were subjected to serotyping ELISA. Results: In the present study, three serotypes were identified from 186 NSP ELISA positive sera of which 156 serotype O, 40 serotypes A and 28 serotype SAT2. In this analysis, multiple serotype infection was observed which is why the number of serotypes was beyond the samples analyzed. Among 23 samples from Addis Ababa 10, 3 and 5 were O, A and SAT2 serotypes respectively, while in samples from the Oromia region 12 were O and 3 were SAT2 serotypes. From the Amhara region, 99 samples analyzed were found to be serotype O and SAT2 in 7 of the serum samples. From the Tigray region, 30 samples were seen to have Serotype O infection, whereas 13 of them were SAT2. The proportion of serotypes identified based on the production system practices was also found that semi-intensive production takes the largest share in all three serotypes followed by extensive production. Generally, early determination of the serotype from past infection helps to aware of the epidemiology as well as the infection immunity of the herd/individual animals.

This article addresses, in an integrated way, the main aspects of the by-products obtained from sugarcane processing summarizing their most important and economic characteristics, their composition, and most relevant uses as options for industrial diversification, all taken as a review.

Malignant pericardial effusion is a usual and crucial exacerbation in malignancies. In some cases, pericardial effusion may be the first manifestation of the disease. Neoplastic pericarditis is extremely rare in thyroid cancer. Hereby, we describe the case of a 54-year-old man submitted to the hospital for chest pain and dyspnea. Clinical and radiological examinations were suggestive of pericardial effusion and mediastinal lymphadenopathy. The patient underwent pericardial drainage and surgical biopsy of a paratracheal lymph node. Pericardial biopsies were also taken. Histology study was compatible with metastatic papillary thyroid carcinoma with “signet-ring” cell morphology. Extended study of thyroid gland and function was performed and he was referred to oncologists for further treatment. Clinical presentation and histology are discussed emphasizing the rare correlation between pericardial pathology and metastatic thyroid carcinomas as the first diagnosis. Histopathologic findings of “signet-ring” cell morphology are very challenging for a differential diagnosis between thyroid carcinoma and other metastatic adenocarcinomas.

The aspects that affect the well-being of patients after neurosurgery are diverse. While most contemporary research argues that well-being is multidimensional and related to how individuals, communities, and societies feel when they are successful, there is no single agreed-upon definition [1]. Well-being is defined in the Oxford Dictionary as the state of feeling healthy and happy (Cambridge Dictionary). Well-being is a term used synonymously with a wide range of concepts including self-esteem, self-efficacy, self-determination, resilience, quality of life, improved mood, positive mental health, life satisfaction, and value [2]. 

Background: Interleukin-6 (IL-6) promotes antibody production. The objective of this study was to investigate whether IL-6 C-572G single nucleotide polymorphisms (SNP) and clinical factors are associated with positive platelet antibody test. Materials and methods: Thirty platelet recipients with platelet antibodies (responders) and 20 platelet recipients without platelet antibodies (non-responders) were randomly selected. The -572 C>G (rs 1800796) SNPs in the promoter region of IL-6 gene were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. Solid phase red cell adherence assay (SPRCA) was used for platelet antibody detection. Results: Age, sex, percentage patients with benign diseases, and percentage of patients with homozygotes for the C allele at position -572 of the IL-6 gene were similar between responders and non-responders. Although the amounts of platelets pheresis transfused to patients with hematologic diseases were higher than those of non-hematologic diseases (47.2 ± 54.2 vs. 17.4 ± 13.8 units, p = 0.019), detection rate of platelet antibodies was lower in patients with hematologic diseases than that in patients with non-hematologic diseases (42.3% vs. 79.2%, p = 0.01). Conclusion: There was no association between IL-6 C-572G gene polymorphism and positive reactivity in solid phase platelet antibody detection method in platelet recipients.