The death penalty was long practised in South Africa as one of the sentence options for capital crimes such as murder, rape, treason, terrorism, and robbery with aggravating circumstances. Its practice has a matching effort for its abolishment or restricted application. Reflecting on some specific historical periods of the practice of the death penalty in South Africa, the author sought to contextualise the article, namely to understand the socio-political experience and perception of the death penalty in order to gauge its current relevance. The goal of the study on which this article reports was to determine whether the death penalty had a deterrent effect on capital crimes in South Africa during the pre-1996 constitutional period. In order to achieve the goal of the deterrence of serious crimes by the death sentence in South Africa, the author discusses legislation, case law, execution patterns and deterrence literature in its context.

RESUMO O foco deste trabalho foi a qualidade da educação oferecida nas 94 creches conveniadas de Fortaleza (Ceará). A primeira etapa levantou dados gerais sobre as condições de funcionamento (estrutura física, brinquedos, formação dos profissionais etc.) de 54 creches e a segunda incluiu 16 delas, buscando um maior conhecimento, especialmente, sobre as práticas pedagógicas desenvolvidas como as experiências e linguagens em contextos lúdicos; tempos, espaços e materiais; envolvimento das crianças e empenho dos professores. Foram realizadas visitas às creches, usando roteiros específicos para as observações e entrevistas. Tanto em relação às condições de funcionamento (como a estrutura física e materiais) quanto às práticas pedagógicas (a exemplo da falta de escuta e parcas interações entre professoras e os meninos e meninas), os dados indicam grandes desafios a serem enfrentados. Levando em conta a legislação vigente, os avanços da área da Educação Infantil e o grande impacto das experiências educacionais nas vidas dos bebês e crianças bem pequenas e mesmo o risco de adoecerem a que eles estão expostos ao frequentarem estas creches, a avaliação realizada indica a supressão do estabelecimento de convênios como estratégia para o atendimento da demanda por creches. Emergencialmente, enquanto este tipo de prática persistir, é urgente o maior investimento público em variados elementos do trabalho desenvolvido nesses equipamentos a fim de garantir o direito desses sujeitos à educação de qualidade.

ABSTRACT This paper focuses on the quality of the education offered by the 94 state-aided private childcare centers in Fortaleza, Ceará, Brazil. During the initial stage of this research, general data has been gathered concerning the operating conditions (physical infrastructure, toys, professional training, etc.) of 54 facilities. Subsequently, the scope has been narrowed to only 16 of them, seeking specific knowledge on the pedagogical practices adopted, such as: languages and experiences in playful contexts; time periods, space, and materials; children's engagement and teachers' commitment. Visits to childcare centers were conducted, and specific scripts for interviews and classroom observations were closely followed. The data analysis regarding both operating conditions (physical infrastructure and materials) and pedagogical practices (for example, the lack of communication and poor interaction between teachers and boys and girls) indicates great challenges to be faced. Taking into account the current legislation, the advances in the field of Early Childhood Education, the great impact of educational experiences on the lives of infants and toddlers and even the risk of becoming ill to which they are exposed, the assessment carried out implies the abolishment of such public-private partnership agreements as a strategy to meet the demand for nursery services. On an emergency basis, as long as this sort of practice persists, there is an urgent need for greater public investment in order to guarantee these citizens’ right to quality education.

Resumo: A gênese e desenvolvimento da literatura de esquerda no Brasil está intimamente ligada aos obstáculos e dilemas encontrados durante a evolução do país, e também é inseparável de movimentos políticos internacionais e correntes intelectuais. Da abolição da escravatura e colapso do império, no século XIX ao estabelecimento e retorno da ditadura, nos anos 30 e 60 do século XX, em cada momento de crise, a literatura brasileira de esquerda teve um papel seminal. Ao criticar injustiças sociais, ela também revigora o desenvolvimento da moderna literatura brasileira, incorporando diferentes formas de linguagem, pensamentos e arte. É seguro dizer que a literatura de esquerda forma um tipo de tradição literária no Brasil, porque não somente representa uma posição moral e estética, mas também inova a forma e a estética.

Abstract: The rise and development of Left-wing literature in Brazil is closely connected to the obstacles and dilemmas encountered during the evolution of its nation, and it is also inseparable from international political movements and intellectual trends. From the abolishment of slavery and collapse of empire in the nineteenth century, to the establishment and return of dictatorship in the 30s and 60s of the twentieth century, at every moment of crisis, Brazilian left-wing literature always played a seminal role. While criticizing social injustices, it also invigorates the development of modern Brazilian literature by incorporating different forms of language, thoughts and art. It is safe to say that left-wing literature forms a kind of literary tradition in Brazil, as it not only represents a moral and ethical stand, but also innovates the form and aesthetics.

Abstract During the last government of the conservative hegemony (1926-1930), there were increasingly more strikes and worker mobilizations and the Revolutionary Socialist Party. According to the Executive, all of this was part of the Bolshevik Revolution expansion and, to face it, they launched legal offensive and repressive actions against the workers' movement and any "socialist" political organization. One of the tools aimed at such purpose was Act 69, of 1928, or Social Defense Act, which was approved with the opposition of the Liberal minority in the Congress, who were afraid that the Act would also be used to repress them. The so-called Ley Heroica established a strong press censorship, and decreed that public protests as well as “causing or encouraging the abolishment or the lack of knowledge, by way of subversive actions, of the property and family right” were crimes. This article reconstructs the pathway of the act from its sources to its partial amendment in 1931, under the new Liberal government; it places it within its political context and also examines one of the most important institutional designs: press and public order judges.

Resumen Al final de la hegemonía conservadora (1926-1930) se agudizaron las huelgas y movilizaciones obreras. El gobierno, temeroso de la expansión de la Revolución Bolchevique, lanzó acciones represivas y una ofensiva jurídica contra esas manifestaciones y toda organización política “socialista”. Una de las herramientas para tal propósito fue la ley 69 de 1928 de Defensa Social o “ley heroica”, que establecía una férrea censura de prensa, convertía en delitos tanto a las manifestaciones públicas de protesta como “el provocar o fomentar la abolición o el desconocimiento, por medios subversivos, del derecho de propiedad y la familia”. El artículo reconstruye la trayectoria de la ley heroica hasta su modificación parcial en 1931, bajo el nuevo gobierno Liberal; la sitúa en su contexto político y además examina uno de sus más importantes diseños institucionales: los jueces de prensa y orden público.

Abstract General anesthetics are crucial drugs for surgical interventions, which are indicated to induce analgesia, diminish pain, and reduce anxiety in order to facilitate invasive procedures. In pediatric patients, benefits of general anesthetics also include abolishment of motility. Besides their probed benefits on surgery, the recent warning of the Food and Drug Administration (FDA) on the use of general anesthetics in children yielded a controversy on their potential neurotoxic effects. In this review, the main facts of the cerebral development are studied, and the available evidence concerning the use of general anesthesia on the neuropsychological development of children is analyzed. Most of the studies found were uncontrolled retrospective cohorts for which conclusions are difficult to obtain. However, a few group of controlled studies, including the Mayo Anesthesia Safety in Kids study (MASK), have partially supported the FDA warning. Cumulated evidence appears to support the safety use of general anesthetics, but no conclusive data supporting that it may induce massive effects on the cognitive development of exposed children has been reported. Important evidence suggests that specific cognitive functions may result altered under long-term expositions. Such data must be considered for those involved in anesthetic procedures.

Resumen La anestesia general es una herramienta imprescindible para el proceso quirúrgico, ya que disminuye el dolor, reduce la ansiedad y genera inconsciencia. Sin ella, las cirugías serían dolorosas, riesgosas y emocionalmente traumáticas. La reciente emisión de una alerta sobre el uso de fármacos anestésicos en niños menores de 3 años por parte de la Food and Drug Administration (FDA) de los Estados Unidos generó controversia en torno a sus posibles efectos negativos. En este artículo se abordan los principales hitos del desarrollo neurobiológico del niño y se revisan las posibles consecuencias neuropsicológicas del uso de anestesia general en esta población. La mayoría de los reportes que abordan este tema son de tipo retrospectivo y arrojan resultados controversiales por sus inherentes dificultades metodológicas. Sin embargo, el estudio prospectivo sobre seguridad del uso de anestesia general en niños de la Clínica Mayo (MASK, Mayo Anesthesia Safety in Kids), junto con otros estudios a gran escala, han confirmado algunos datos obtenidos en los estudios experimentales que dieron sustento a la alerta emitida por la FDA. Así, las evidencias hasta ahora publicadas sugieren que el uso de anestesia general es seguro para el desarrollo cognitivo general del niño, aunque evidencian también alteraciones focalizadas en procesos cognitivos específicos que deben ser consideradas por el médico y la familia ante un procedimiento quirúrgico-anestésico.

Abstract The processes of recording the past in education commonly forget their pedagogic power, thus paradoxically contributing to nostalgic, fossilized accounts. However, the matrix junction of narrative research and critical pedagogies fosters the composition of stories that invigorate and inhabit a more sensitive past —one which is more polite towards life. We hereby aim at disturbing the classical perspectives of History of Education with the partial, fluent and provisional intention of intervening in coloniality and the normalization of the legitimacy of “the” educational narrative. Specifically the objective is a (re) of a past —the past of Argentinian high schools— from a methodology of narrative research —which weighs both the data of the field and the reflections on what is done with them—; by the abolishment of its forms and the inversion of its enunciation as a means to fostering gestures leading to what we call a (de) composition of pedagogy. Preoccupation that becomes paramount to stop interpreting it as a social science that studies education, because in this way it is usually relegated to its systemic, technical and disciplinary use. The stories collected from the Argentinian high schools, dislocate it from its classical notion to try to understand it as a narrative in which human relations of education are verbalized in an extended and vital sense. In short, they activate a discursive power as a condition to restore other ways of knowing, being and knowing.

Resumen El registro del pasado en la educación suele olvidar su potencia pedagógica, construyendo paradójicamente relatos fosilizados y nostálgicos. Sin embargo el cruce matricial de la investigación narrativa y la pedagogía crítica convoca a componer historias que vigorizan y habitan un pasado más sensible y amable con la vida. En este texto se propone perturbar las perspectivas clásicas de la Historia de la Educación con la intención —siempre parcial, fluida, y provisoria— de intervenir en la colonialidad y la normalización de la legitimidad de ‘el’ relato educativo. Particularmente el objetivo aquí es (re)inventar un pasado —el del bachillerato argentino—, a partir de una metodología de investigación narrativa —que pondera tanto los datos del campo como las reflexiones sobre qué se realiza con ellos—; trasgrediendo sus formas e invirtiendo su enunciación como un modo de propiciar gestos que se encaminen a lo que aquí se denomina (des)composición de la pedagogía. Preocupación que deviene en primordial para dejar de interpretarla apenas como ciencia social que estudia la educación, pues de ese modo suele quedar relegada a su uso sistémico, técnico y disciplinar. Las historias recogidas del bachillerato argentino, además, la dislocan de su noción clásica para intentar comprenderla como una narrativa en la que se verbalizan relaciones humanas de educación en un sentido extendido y vital. En síntesis activan un poder discursivo como condición para restaurar otros modos de conocer, ser y saber.

ORIENTATION: Regardless of the implementation of the Employment Equity Act (EEA), No. 55 of 1998 and the abolishment of apartheid in 1994, African and mixed-race females are under-represented in managerial positions in the public sector of the Western Cape (WC) in South Africa and nationally in the private health sector. RESEARCH PURPOSE: The purpose was to explore the views of nurses about promotion to managerial positions in view of the Employment Equity Act (EEA) and the possible influence of race, class and gender. MOTIVATION FOR THE STUDY: South Africa has a history of racial hierarchies and gender inequities. It was therefore important to explore the influence of the EEA and race, class and gender on the promotion of nurses in the post-apartheid context. Research approach/design and method: A cross-sectional descriptive survey design was completed. Six hundred and eighty-eight (n = 688) nurses consented to participate and 573 (83%) questionnaires were returned. MAIN FINDINGS: Race as a social construct surfaced in the superior viewing of white and the inferior viewing of African nurses. Mixed-race and white nurses seemed disgruntled with the EEA because of the benefits it holds for African nurses. African nurses seemed angered by their under-representation in managerial positions in the private and public sectors in the WC. White nurses seemed convinced that African, mixed-race and Indian nurses experience upward mobility. Mixed-race nurses (public sector WC) showed concerns about the career successes of males in a female-dominated profession. PRACTICAL/MANAGERIAL IMPLICATIONS: Managerial structures should be required to invest in diversity training, create awareness of the noble intentions of the EEA and communicate the relevance of employment equity plans. CONTRIBUTION/VALUE-ADD: The findings provided evidence that reflected a need for diversity training and the creation of awareness about the longstanding influence of racial and gender hierarchies.

This contribution critically examines the lawfulness of the use of race quotas in the selection of South African (professional) sports teams. These quotas purportedly function as affirmative action measures, and their legitimacy in this light is considered with reference to relevant case law on affirmative action and, more specifically, on the use of quotas in the application of affirmative action (as this has featured in other contexts in the case law to date). In the process, the author evaluates the constitutionality of such quotas (with specific reference to their apparent irrationality in the specific context of (professional) sport and its nature and characteristics). The piece further considers the legitimacy of these quotas at the domestic level in light of the application of the applicable labour legislation (specifically the Employment Equity Act, 1998), and at the international level in light of the applicable rules of international sports governing bodies in the relevant sporting codes. The author concludes that these race quotas are unconstitutional and have no legitimate place in South African sport and in the continuing process of sports transformation, and calls for their abolishment as a matter of urgency.

BACKGROUND: Medical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods AIM: This study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels SETTING: The study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province METHODS: An explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model RESULTS: Four main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These incluided: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices CONCLUSION: Male circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods

Two articles appeared recently in Lexikos that propose the abolishment of homonymy and polysemy in lexicography, particularly in dictionaries with a text reception function only. This contribution identifies two main theoretical premises of the proposal in these articles and challenges them. They are: (i) a theory of the lemma as linguistic sign; and (ii) the results of dictionary criticism. Under examination, it is found that both premises fail to support the proposal with regard to polysemy. With regard to homonymy, the first premise is proven invalid, and the second is found to be valid. This implies that the theoretical basis for the proposal should either be reviewed (for which the lexicographical communication theory is offered), or the proposal should rely on the sole practical and unproven argument of data accessibility. The contribution simultaneously develops a potential broad framework for the lexicographical communication theory. The framework constitutes a lexicographical text grammar, which is presented as a parallel communication code to elements of the lexicographic text theory and linguistic grammars. It is argued that dictionary articles constitute texts in which these two grammars overlap to varying degrees, representing a hybrid form of textual communication

Twee artikels het onlangs in Lexikos verskyn wat voorstel dat weggedoen word met homonimie en polisemie in die leksikografie, spesifiek in woordeboeke met slegs 'n teksresepsiefunksie. Hierdie bydrae identifiseer twee teoretiese hoofpremisse vir die voor-stel en bevraagteken hulle. Die premisse is: (i) 'n teorie van die lemma as taalteken; en (ii) die resultate van woordeboekkritiek. By nadere ondersoek word bevind dat beide die premisse faal met betrekking tot polisemie. Met betrekking tot homonimie word die eerste premis as ongeldig bewys, en die tweede een word geldig bevind. Die bevindinge hou in dat die teoretiese basis vir die voor-stel óf hersien moet word (waarvoor die teorie van leksikografiese kommunikasie aangebied word), óf op die enkele praktiese en onbewese argument van datatoeganklikheid moet steun. Terselfdertyd ontwikkel die bydrae 'n potensiële breë raamwerk vir die teorie van leksikografiese kommunikasie. Die raamwerk verteenwoordig 'n leksikografiese teksgrammatika, wat as 'n kommunikasiekode parallel tot elemente van die teorie van leksikografiese tekste en taalkundige grammatikas aange-bied word. Daar word aangevoer dat woordeboekartikels uit tekste bestaan waarin hierdie twee grammatikas in wisselende mates oorvleuel en as sodanig 'n hibridiese vorm van tekstuele kom-munikasie verteenwoordig.

Resumen Este artículo discute el concepto de autoficción como pacto ambiguo entre la escritura y la vida, entre la lectura y la sobrevivencia de residuos de identidades. Se trata de relatos híbridos, que ocupan un lugar móvil entre la novela y la autobiografía. Los restos de la experiencia y de la escritura de sí ejercen la función de barajar el aspecto referencial de la autobiografía y de la pretendida autonomía de la ficción. El análisis de relatos autoficcionales posibilita la caracterización de varias propuestas de la escritura y lectura, como compensación, como autoayuda, como ocupación de un lugar de vacío, como modo de abolir la distancia entre arte/vida, y reiteración de la paradoja entre salud y enfermedad, muerte y sobrevivencia.

Resumé Dans ce texte on va presenter le concept d'autofiction en tant que pacte ambigu d'une part entre l'écriture et la vie et, d'autre part, entre la lecture et la survie des résidus d'identités. Ce sont des récits hybrides qu'occupent un lieu mobile entre roman et autobiographie. Les restes de l'expérience et de l'écriture de soi ont la fonction de confondre l'aspect factuel de l'autobiographie et la prétendue autonomie de la iction. L'analyse des récits d'autoiction rend possible la caractérisation de plusieurs propositions d'écriture/lecture, comme la compensatrice, celle de développement personnel qui comble le vide, abolit la distance entre l'art et la vie et réitere le paradoxe entre santé/maladie, mort/survie.

Abstract This article discusses the concept of autofiction as an ambiguous pact between writing and life, between the reading and the survival of identity residues. It has to do with hybrid narratives that occupy a mobile place between novel and autobiography. These fragments of experience and self-writing have the role of scrambling the referential aspect of autobiography and the assumed autonomy of fiction. The analysis of autoictional narrative enables the characterization of reading and writing as compensation, self-help, occupation of an empty space, abolishment of the distance between art and life, and reiteration of the paradox between health and illness, death and survival.

Resumo Pretende-se, neste texto, discutir o conceito de autoficção como pacto ambíguo entre a escritura e a vida, entre a leitura e a sobrevivência de resíduos de identidades. Trata-se de relatos híbridos, ocupando um lugar móvel entre o romance e a autobiografia. Os restos da experiência e da escritura de si exerceriam a função de embaralhar o aspecto referencial da autobiografia e a suposta autonomia da ficção. A análise dos relatos autoficcionais possibilita a caracterização de várias propostas de escritura/leitura, como a compensatória, a autoajuda, a de ocupar o lugar do vazio, de abolir a distância entre arte/vida e de reiterar o paradoxo entre saúde/doença e morte/ sobrevivência.

The university campuses across South Africa have recently been challenged by significant student protests concerning issues such as the abolishment of study fees, aspects of decolonisation and language policies, to name but a few. This contribution will briefly reflect on these challenges by engaging with the narrative of decolonisation. An area of particular focus is whether reconciliation is still relevant within the current South African context, given the nature of the issues driving the university protests. This contribution will attempt to provide some recommendation for public theologians to engage with these challenges in a responsible way in their endeavour to be advocates for sustainable peace and reconciliation.

An earlier paper in this journal reported on the perception and experience of 77 allopathic health practitioners (AHPs) and health managers about working together with South African traditional health practitioners (THPs). The paper stated that the abolishment of the Witchcraft Suppression Act of 1957 and the introduction of the Traditional Health Practitioners Act No. 22 of 2007 is a milestone in the development of traditional health knowledge, and for the eventual incorporation thereof into modern health care practices. The authors also comment that a decolonisation of mindset and a change of attitude is required to change one's perception of traditional healer practices and to develop them parallel to allopathic health practice. This opinion paper is a response to the paper, to negate its claims about the Witchcraft Suppression Act of 1957 and to provide clarity on the Traditional Health Practitioners Act No. 22 of 2007 and related policies and regulations. Although this Act recognises THP, the Act and other regulations actually require THP to conform to practices analogous to those of AHP. It is rather a systematic and scientific 'mindset' that is required to develop THP parallel to AHP. The Traditional Health Practitioners Act of 2007 and the Draft Policy on African Traditional Medicine (TM) for South Africa dictate that a substantial THP sectoral transformation is required before there can be a parallel system. Legislation and regulations have excluded THP and African TM from operating (present and future) in the same space as AHP.

Problem: Practice of reporting cases of women with induced abortion to the police is rela tively common and add legal and police problems to these patients. Objective: To determine perception, opinion, knowledge, attitudes and practices of gynecologists regarding information given to the police on patients with induced abortion. Design: Qualitative participatory, and quantitative observational cross-sectional prospective study. Setting: Three hospitals of the Ministry of Health (MINSA), Lima, Peru. Participants: Gynecologists and obstetricians. Methodology: Thirty-three obstetricians and gynecologists from three hospitals were systematically selected for in depth interview. Other 69 doctors completed a standardized self-administered questionnaire. Participation was voluntary and the studywas reviewed and approved bythe ethics committee of each ofthe three hospitals. Main outcome measures: Information to the police on cases of induced abortion. Results: 78.3% of participants knew there is a law requiring the report of cases of induced abortion to the police, 43.5% disagreed with this rule, and 58% agreed with the right of professional secrecy. However, 43.5% of par ticipants reported to the police the last induced abortion attended. The main reason was to comply with the law as well as fear to be identified as an accomplice and the criminal consequences. Conclusions: The practice of reporting women with induced abortion confronts confidentiality of the medical act. Recommendations: Modification or abolishment of Article 30 of the Peruvian Health General Law is proposed. Instead a coordinated and coherent national program of responsible parenthood, contraception and family planning should be implemented.

Problema: La práctica de informar a la policía los casos de mujeres con aborto inducido es relativamente frecuente y agrega complicaciones policiales y judiciales a estas pacientes. Objetivo: Conocer la percepción, opinión, conocimiento, actitudes y prácticas de los médicos ginecoobstetras con respecto a informar a la policía los casos de mujeres con aborto inducido. Diseño: Estudio cualitativo participativo y cuantitativo observacional transversal prospectivo. Institución: Tres hospitales del Ministerio de Salud (MINSA), Lima, Perú. Participantes: Médicos ginecoobstetras. Metodología: En tres hospitales de Lima se seleccionó sistemáticamente 33 médicos ginecoobstetras y se les aplicó una entrevista en profundidad. Otros 69 médicos ginecoobstetras llenaron un cuestionario estandarizado y autoadministrado. La participación fue voluntaria y el estudio revisado y aprobado por el comité de ética de los tres hospitales. Principales medidas de resultados: Información a la policía de los casos de aborto inducido. Resultados: El 78,3% de los participantes sabía que existe una ley que obliga a informar a la policía los casos de aborto inducido. Sin embargo, 43,5% no estaba de acuerdo con esta norma y 58% estaba de acuerdo con el derecho al secreto profesional. Sin embargo, 43,5% de los médicos reportó a la policía el último caso de aborto inducido atendido y la principal razón fue el cumplimiento de la ley y el temor a ser identificado como encubridor y las consecuencias penales posibles. Conclusiones: La práctica de informar un caso de aborto inducido a la policía atentaría contra la confidencialidad del acto médico. Recomendaciones: Se propone la modificación o derogación del artículo 30 de la ley general de salud del Perú y, en su lugar, implementar un programa articulado y coherente de paternidad responsable a nivel nacional.

Un adulto con un gran ductus arterioso permeable puede presentar fatiga, disnea y palpitaciones y menos frecuentemente presentar endocarditis. El caso muestra el papel de la vegetación de la endocarditis en la anemia hemolítica con el conducto arterioso patente (CAP) en adultos. A pesar del tratamiento de la endocarditis con la terapia antibiótica completa, la normalidad en la proteína C-reactiva, la tasa de sedimentación globular y leucocitaria, y un estado de bienestar general del paciente, la ecocardiografía trans torácica reveló gran vegetación en el lumen de CAP y el cierre completo quirúrgico de PDA, sin hemólisis y la desaparición de glóbulos rojos fragmentados en frotis de sangre periférica. Los 3 meses de seguimiento revelaron oclusión completa de CAP y la desaparición de la anemia hemolítica confirmada por examen clínico y laboratorio.

An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.