Abstract Free-floating thrombus of the internal carotid artery is infrequent (< 1% of strokes), although its diagnosis is straightforward, its treatment represents a challenge. Based mostly on case reports, standard treatment consists of therapeutic anticoagulation, while waiting for carotid endarterectomy. Both unfractioned heparin and Vitamin K antagonists have been reported as efficaceous; nevertheless, due to its rarity, clinical trials with novel oral anticoagulants are lacking. We report a patient with cardioembolic stroke and a free-floating carotid thrombus successfully treated with apixaban.

Resumen Los trombos libres flotantes de la arteria carótida interna son infrecuentes (menos del 1% de los ictus), y representan un desafío terapéutico. El tratamiento actual, basado en series de casos, consiste en anticoagulación terapéutica en espera de endarterectomía. Tanto la heparina no fraccionada, como los antagonistas de vitamina K, han sido reportados como eficaces. Sin embargo, dada la escasez de casos, no se dispone de ensayos clínicos con nuevos anticoagulantes orales. Reportamos el caso de un paciente con ictus cardioembólico y un trombo libre flotante de la carótida, tratado exitosamente con apixaban.

ABSTRACT The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. Objective: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. Methods: Historical narrative review. Results: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. Conclusions: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated.

RESUMO El síndrome de Ofelia describe la asociación entre pérdida de memoria y enfermedad de Hodgkin, en memoria del personaje de La Tragedia de Hamlet, Príncipe de Dinamarca, de William Shakespeare. Sin embargo, existen diferencias entre ambos. Objetivo: Revisar los orígenes y usos del epónimo a través del artículo original, su relación con el personaje y los autoanticuerpos relacionados. Métodos: Revisión narrativa histórica. Resultados: Además de una descripción elocuente, el artículo original prefigura los autoanticuerpos, cuando no se buscaban de rutina. Desde entonces, cinco distintos (mGluR5, Hu, NMDAR, SOX, PCA2) han sido asociados. Cabe destacar, que el desenlace del personaje y del paciente fueron diametralmente opuestos, el primero falleció y el segundo se recuperó, llevando una vida normal. Conclusiones: A pesar de la poca relación entre el personaje y el síndrome, ambos implican el desencadenamiento no intencional de daño auto-inflingido (suicidio en un caso, autoinmunidad en el otro), manteniendo así la adecuacía.

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, “books and the night”. Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest “phantom chromatopsia”, a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

Se obtuvieron huevos de siete especies de nóctuidos chilenos: Eriopyga perfusca Hampson, Scriptania americana (Blanchard), Scriptania leucofasciata Rodríguez, Magnagrotis oorti (Koehler), Pseudoleucania brossi (Koehler) y Scania simillima (Koehler) de La Mina, VII Región, 925 m, (35º 21’ S, 71º 41’ W) y Paso Internacional Pehuenche, 2560 m, (35º 57’ S, 70º23’ W). Se fotografiaron entre cuatro y nueve huevos de cada especie con Microscopia Electrónica de Barrido para analizar las variaciones entre las celdas primarias y secundarias. Los resultados morfológicos fueron utilizados para actualizar la clave taxonómica de las especies de nóctuidos chilenos

Egg morphology of seven noctuid species (Lepidoptera:Noctuidae) from Chilean and updated key to their identification. Eggs from seven Noctuid moth species, Eriopyga perfusca (Hampson), Magnagrotis oorti (Koehler), Pseudoleucania brosii (Koehler), Scania simillima (Koehler), Scriptania americana (Blanchard), Scriptania leucofasciata Rodríguez, were collected at La Mina, 925 msnm, (35º 21’ S; 71º 41’ W) and Paso Internacional Pehuenche (35º 57’ S; 70º 23’ W), 2560 msnm, Chile. The Scanning Electron Microscope showed that egg morphology allows identification to species level. This is particularly useful in agricultural pest control, and morphological differences are used in this report to present an updated taxonomic key to the Chilean Noctuidae. Rev. Biol. Trop. 53(1-2):153-163. Epub 2005 Jun 24

Considerando que a aquisição precoce dos estreptococos do grupo mutans é um fator de risco para o desenvolvimento de lesões cariosas nas crianças e que a transmissão desses microrganismos é dependente do nível de colonização apresentado pelas mães, procurou-se analisar a situação bucal de gestantes residentes na cidade de Bauru-SP-Brasil. Foram amostradas 50 gestantes na faixa etária de 16 a 37 (média de 22,8 ± 5,5 anos) de baixo nível sócio-econômico que faziam acompanhamento pré-natal no Núcleo de Assistência às Gestantes (NAG-7). A condição bucal foi avaliada pelo índice CPO-S, realizado com o auxílio de sonda exploradora e espelho, sem o uso de tomadas radiográficas. Amostras de saliva estimulada foram obtidas e manipuladas de acordo com as especificações do fabricante do Caritest-SM (HERPO), para pesquisa do grupo mutans. Entre as 50 gestantes examinadas, o índice CPO-S variou de 5 a 114 (média de 37,1), sendo que 8 (16%) possuíam todos os dentes; 39 (78%) haviam perdido de 1 a 10 dentes e 4 (8%), de 13 a 22 dentes. O grupo mutans foi detectado em 48 (96%) amostras de saliva, das quais 4 (8%) apresentavam nível de infecção de 1 x 104 UFC/ml; 10 (20%), 5 x 104 UFC/ml e 4 (8%), 1 x 105 UFC/ml. Níveis de infecção mais favoráveis para a transmissão mãe-filho foram encontrados em 30 (60%) gestantes, das quais 10 (20%) mostraram 2,5 x 105 UFC/ml; 12 (24%), 5 x 105 UFC/ml e 8 (16%), 1 x 106 UFC/ml. Esses resultados demonstram que as gestantes albergam elevados níveis salivares de estreptococos do grupo mutans e que um programa preventivo direcionado ao grupo urge ser desenvolvido, a fim de reduzir ou protelar a transmissão intrafamilial desses microrganismos.

The CFU number of mutans streptococci in saliva has been used to indicate dental caries risk, as well as to assess the effectiveness or the need for preventive measures. Considering that the acquisition in early childhood of mutans streptococci is a risk factor for developing dental caries in children, and that the transmission of these bacteria is dependent of the mothers salivary levels, the oral status of 50 pregnant women aged between 16 to 37 years (mean of 22.8 years) and of low socio-economic class, that attended a public medical center in Bauru-SP- Brazil for prenatal check up was studied. The dental examination was analysed through the DMF-T and DMF-S indexes using a mirror and an explorer, without radiographs. Paraffin-stimulated saliva was collected and handled according to the instructions of the Caritest-SM manufacturer (HERPO) for researching mutans groups. Of the 50 examined women, 8 (16%) had all teeth present, 39 (78%) had lost from 1 to 10 teeth and 4 (8%) had lost from 13 to 22 teeth. The DMF-S index registered a range from 5 to 114 (mean 37.1). Mutans streptococci were detected in 48 (96%) saliva samples, 4 (8%) of which had an infection level of 1x104 CFU/mL saliva; 10 (20%), 5x104 CFU/mL; and 4 (8%), 1x105 CFU/mL. Levels of infection considered more favorable to transmission were exhibited by 30 (60%) pregnant women 10 (20%) of which showed 2,5x105 CFU/mL, 12 (24%) 5x105 CFU/mL and 8 (16%) 1x106 CFU/mL. The results indicated that there are many pregnant women harbouring high levels of mutans streptococci, prompting the need of a preventive program directed to them in order to reduce or delay the intrafamilial transmission of these microorganisms.