ABSTRACT Purpose: Although the orthokeratology effects on corneal biomechanics have been proven with clinical trials, reports of stiffness parameter change are scarce. This study investigated the short-term orthokeratology effects in pediatric myopia and compared stiffness parameter changes to those published in recent clinical investigations. This prospective study aimed to investigate corneal biomechanics changes induced by short-term overnight orthokeratology treatment, focusing on stiffness parameter at A1 and stress-strain index Methods: Twenty-six children aged 8 to 18 were included in this study using orthokeratology lenses for two different durations: 1 day and 1 week. Corneal biomechanics were assessed using corneal visualization (Corvis) Scheimpflug technology. Measurements were taken at baseline and after each wearing session. Changes in corneal stiffness parameters and corneal curvature were analyzed. Results: All parameters changed significantly after 1 week of lens wear (p<0.05), except for velocity of corneal apex at the first and second applanation times highest concavity time, radius, stiffness parameter at A1 and stress-strain index. After 1 day, central corneal thickness, first applanation time, second applanation time, deformation amplitude ratio (2 mm), and Corvis biomechanical index (CBI) remained stable (p>0.05). After 1 week, central corneal thickness and first applanation time decreased, whereas second applanation time, deformation amplitude ratio, and Corvis Biomechanical Index significantly increased. With intraocular pressure and central corneal thickness as control variables, no significant correlation was found between stress-strain index and curvature changes (p>0.05). With age as the control variable, no significant correlation was found between stress-strain index and curvature changes (p>0.05). Conclusions: Short-term orthokeratology treatment induced notable changes in several corneal biomechanical parameters. Stiffness parameter at A1 and stress-strain index are unaffected by increasing lens wear duration and do not influence the orthokeratology effect.

Resumen Durante la valoración preanestésica de la paciente obstétrica, es fundamental evaluar la condición cardiovascular basal de la paciente, identificar riesgos potenciales y facilitar modificaciones conductuales para desarrollar una estrategia de manejo individualizada, dirigida a minimizar las complicaciones. La ecografía cardíaca a la cabecera del paciente (POCUS) es un instrumento valioso para evaluar la morfología y la función del corazón antes de un procedimiento quirúrgico. El POCUS cardiaco no está diseñado para sustituir a la ecocardiografía transtorácica formal, que corresponde al área de anestesiología cardiovascular y a la cardiología. Sin embargo, cuando se usa en conjunto con la anamnesis, el examen físico, el electrocardiograma y los resultados de exámenes de laboratorio previos, el POCUS cardiaco es un complemento valioso dentro del arsenal diagnóstico de los anestesiólogos. Permite la visualización directa del corazón y de los grandes vasos, con beneficios adicionales de velocidad, disponibilidad y bajo riesgo para la paciente. El objetivo del presente manuscrito es explorar y describir las ventajas del POCUS cardiaco durante el periodo preanestésico en pacientes obstétricas y su valor potencial para los anestesiólogos, a través de la identificación de condiciones eventualmente peligrosas que pudieran requerir un manejo preoperatorio individualizado.

Abstract During the preanesthetic assessment of the obstetric patient, it is critical to assess the patient's cardiovascular baseline condition, identify any potential risks, and facilitate behavioral modification to develop an individualized management strategy aimed at minimizing complications. Cardiac point-of-care ultrasound (POCUS) is a valuable instrument for assessing the morphology and function of the heart prior to surgery. Cardiac POCUS is not designed to replace comprehensive transthoracic echocardiography, which is the realm of cardiovascular anesthesiology and cardiology. However, when used in conjunction with anamnesis, physical examination, electrocardiogram, and previous laboratory results, cardiac POCUS is a valuable adjunct in the diagnostic toolbox of anesthesiologists. It allows for direct visualization of the heart and great vessels, with added benefits of speed, availability, and low risk for the patient. The purpose of this manuscript is to explore and describe the advantages of cardiac POCUS in the preanesthetic period of obstetric patients and its potential value for anesthesiologists through the identification of potentially hazardous conditions that may require individualized preoperative management.

Abstract In this article, I review proposed guidelines for the touristic management of micro-territories, to establish the foundation for new neighborhood-oriented planning methodologies (micro-territories). I proposed an exploratory methodology upon which I built the baseline for organizing micro-territories considering three main axes. The first axis is a diagnosis, subdivided into components: tourism, social, and environmental, each with its indicators and evaluations. The information for its construction was gathered through direct observation and information compilation. The second axis corresponds to satellite localization and categorization of micro spaces. These were constructed on Google Earth, based on diagnostic information, and are integral parts of a micro-territory; The third axis consists of strategies for strengthening the micro-territory; in this section, I provide ideas to assist decision-makers in the studied neighborhood. The micro-territory of San Juan, located in Quito’s Oldtown was selected for this study. The results indicate that San Juan’s neighborhood has the potential to develop tourism activities, along with an important social base and good natural diversity. These aspects were reflected in four micro-spaces and the development of various strategies, ranging from public lighting to tree planting in the area. In conclusion, it is reaffirmed that the proposal is feasible; however, aspects such as its scope need to be adjusted, certain evaluation indicators need to be changed, or additional micro-spaces need to be included.

Resumen En el presente artículo se realizó una revisión a la propuesta de lineamientos para el ordenamiento turístico de microterritorios, misma que tenía como fin establecer las bases para una nueva metodología de planificación orientada a los barrios (microterritorios). Para ello se propuso una metodología exploratoria, en la cual se fueron construyendo las bases para el ordenamiento de microterritorios a través de tres ejes principales. Un diagnóstico subdividido en componentes: turístico, social y ambiental, cada uno con sus propios indicadores y evaluaciones. La información para su construcción se recopiló a través de observación directa y compilación de información. El segundo eje es la localización satelital y categorización de microespacios. Los microespacios se obtienen en base a la información del diagnóstico y son partes integrales de un microterritorio, para su construcción se usó Google Earth. El tercer eje son estrategias para el fortalecimiento del microterritorio; en este apartado se brindan ideas que sirvan a los tomadores de decisiones del barrio estudiado. El microterritorio San Juan, ubicado en el Centro Histórico de Quito, fue seleccionado para el desarrollo de la propuesta. Los resultados obtenidos señalan que el barrio San Juan cuenta con potencial para desarrollar la actividad turística, una base social importante y una buena diversidad natural. Estos aspectos fueron traducidos en la creación de cuatro microespacios y la elaboración de estrategias variadas que van desde alumbrado público hasta arborización de la zona. En conclusión, se reafirma que la propuesta es factible; sin embargo, se deben corregir aspectos como la extensión de la misma, cambiar ciertos indicadores de evaluación o aumentar otros microespacios.

ABSTRACT Obstructive sleep apnea (OSA) and cardiovascular (CV) risk co-existence is frequent. However, the implications of novel metrics used in the diagnosis of OSA in patients with CV risk are scarce in the Hispanic/Latino population. Aim: To determine the association between the respiratory disturbance index (RDI) and the Time under 90% of SpO2 (CT90%) with CV risk using the predictive model of Framingham 2008. In addition, we analyzed the diagnostic performance of the baseline CV risk model, adjusted for RDI, CT90%, and their combination to predict CV mortality. in patients with clinical suspicion of AOS. Methods: Single-center prospective cohort study, including 1560 subjects. All patients underwent a clinical evaluation for OSA, blood pressure, and anthropometric variables. To determine the association of the indices of interest with CV risk, a linear multivariate regression was performed between the RDI or CT90% score. All analyses were performed using R software (R-project), and a p-value < 0.05 was considered statistically significant. Results: RDI and CT90% showed significant differences for CV (p-value= <0.001). In addition, a percentage increase was demonstrated in each quartile of the RDI and CT90% (p-value= <0.001). Conclusions: The RDI and CT90% showed a significant and incremental association with the CV risk of the cohort. However, predictive analyses of CV mortality using the RDI and CT90% were not significant.

RESUMEN La coexistencia de apnea obstructiva del sueño (AOS) y el riesgo cardiovascular (CV) han sido descrito asiduamente. Sin embargo, las implicancias de métricas novedosas usadas en el diagnóstico de la AOS en pacientes con riesgo CV son escasa en población hispano/ latino. Objetivo: Determinar la asociación entre el índice de eventos respiratorios (IER) y el tiempo de desaturación bajo 90% de SpO2 (CT90%) con riesgo CV mediante el modelo predictivo de Framingham 2008. Además, analizamos el rendimiento diagnóstico del modelo de riesgo CV basal, ajustado por IER, CT90% y su combinación para predecir mortalidad CV en pacientes con sospecha clínica de AOS. Método: Estudio monocéntrico de cohorte, prospectivo. 1560 pacientes fueron evaluados para el presente estudio, todos los pacientes fueron sometidos a una evaluación clínica sugerente de AOS, presión arterial y variables antropométricas. Para determinar la asociación de los índices de interés con el riesgo CV, se realizó una regresión multi- variada linear entre el porcentaje de riesgo CV y el puntaje de IER o CT90%. Todos los análisis se realizaron en el software R (R-project) y se estableció un valor p < 0.05 como estadísticamente significativo. Resultados: IER y CT90% mostraron diferencias significativas para el CV (p-valor= <0.001). Además, se observó un incremento porcentual en cada cuartil del IER y CT90% (p-valor= <0.001). Conclusiones: El IER y CT90% mostraron una asociación significativa e incremental con el riesgo CV de la cohorte. Sin embargo, los análisis predictivos de mortalidad CV usando el IER y CT90% no fueron significativos.

ABSTRACT Introduction: In prolonged physical activities, water replacement and muscle glycogen content are limiting factors in marathon runners. Carbohydrate-loading (CHO) in the days prior to endurance competition is a commonly employed method to optimise muscle glycogen stores and optimise exercise performance. Since each gram of muscle glycogen binds ∼2.7-4 grams of water, water retention may occur during carbohydrate-loading diets. Objective: To evaluate differences between CHO loading strategies (Bergström and Sherman) on intracellular (ICW) and extracellular (ECW) water content. Methods: Twenty-three runners were randomly allocated to two interventions (Bergström and Sherman) in a crossover design. Participants underwent a baseline evaluation before 3 days of glycogen depletion followed by 3 days of carbohydrate loading with a washout of 30 days consisting of normal diet and training. Multifrequency bioimpedance (BIS) was used to assess ICW and ECW at Baseline, Post-depletion and Post-CHO to determine any differences between Bergström and Sherman protocols. Blood samples were also obtained to assess potassium levels. Associations between ICW and ECW and muscle glycogen were determined. Results: There were no differences in ICW or ECW content between the two interventions at any moment. There was an effect of time for ICW, with an increase from Post-depletion to Post-CHO without any difference between interventions. Plasma potassium decreased from Baseline to Post-depletion in both conditions. There was no difference in muscle glycogen content between interventions or moments. Conclusion: There were no differences in ICW and ECW content between the Bergström and Sherman interventions at any moment. Level of Evidence I; Tests of Previously Developed Diagnostic Criteria.

RESUMO Introdução: Em atividades físicas prolongadas a reposição hídrica e o conteúdo de glicogênio muscular são fatores limitantes em corredores de maratonas. O carregamento de carboidrato (CHO) nos dias anteriores à competição de resistência é um método comumente empregado para otimizar os estoques de glicogênio muscular e o desempenho no exercício. Uma vez que cada grama de glicogênio muscular liga-se a ≈2,7 a 4 gramas de água, a retenção hídrica pode ocorrer durante dietas de carregamento de carboidrato. Objetivo: Avaliar diferenças entre as estratégias de carregamento de carboidratos (Bergström e Sherman) no teor de água intracelular (AIC) ou água extracelular (AEC). Métodos: Vinte e três corredores foram alocados aleatoriamente para duas intervenções (Bergström e Sherman) num delineamento em “crossover”. Os participantes foram submetidos a uma avaliação inicial antes dos 3 dias de depleção de glicogênio, seguidos por 3 dias de carga de carboidratos com tempo de “washout” de 30 dias consistindo em dieta e treinamento normais. Utilizou-se a bioimpedância multifrequencial (BIS) para avaliar AIC e AEC na Etapa Inicial, Pós-depleção e Pós-CHO para determinar quaisquer diferenças entre os protocolos de Bersgstrom e Sherman. Também foram obtidas coletas de sangue para avaliar o potássio. Foram determinadas associações entre AIC, AEC e glicogênio muscular. Resultados: Não houve diferenças no conteúdo de AIC ou AEC entre as duas intervenções em qualquer momento. Houve um efeito do tempo para AIC, com aumento da etapa Pós-depleção para Pós-CHO sem qualquer diferença entre as intervenções. O potássio plasmático diminuiu entre a Linha de base e Pós-depleção em ambas condições. Não houve diferença no conteúdo de glicogênio muscular entre intervenções ou momentos. Conclusão: Não houve diferenças no conteúdo de AIC e AEC entre as intervenções de Bergström e Sherman em qualquer momento. Nível de Evidência I; Testes de Critérios Diagnósticos Desenvolvidos Anteriormente.

RESUMEN Introducción: En actividades físicas prolongadas, la reposición de agua y el glucógeno muscular son factores limitantes en los corredores de maratón. La carga de carbohidratos (CHO) en los días previos a la competencia de resistencia es un método empleado para optimizar las reservas de glucógeno muscular y el rendimiento del ejercicio. Cómo cada gramo de glucógeno muscular se une a ≈ 2,7 a 4 gramos de agua, puede producirse retención de agua durante las dietas ricas en carbohidratos. Objetivo: Evaluar las diferencias entre las estrategias de carga de carbohidratos (Bergström y Sherman) en el contenido de agua intracelular (AIC) o extracelular (AEC). Métodos: Veintitrés corredores fueron asignados aleatoriamente a dos intervenciones (Bergström y Sherman) en un diseño cruzado. Los participantes se sometieron a una evaluación inicial antes de los 3 días de agotamiento del glucógeno, seguido de 3 días de carga de carbohidratos con un tiempo de “washout” de 30 días que consistía en una dieta y entrenamiento normales. Se utilizó bioimpedancia multifrecuencia (BIS) para evaluar AIC y AEC al inicio, después del agotamiento y después de CHO para determinar cualquier diferencia entre las dos intervenciones. También se obtuvieron muestras de sangre para evaluar el potasio. Se determinaron asociaciones entre AIC, AEC y glucógeno muscular. Resultados: No hubo diferencias en el contenido de AIC o AEC entre las dos intervenciones en ningún momento. Hubo un efecto de tiempo para AIC, con un aumento desde Post-agotamiento hasta Post-CHO sin ninguna diferencia entre las intervenciones. El potasio plasmático disminuyó entre el inicio y el post-agotamiento en ambas condiciones. No hubo diferencia en el contenido de glucógeno muscular entre las intervenciones o momentos. Conclusión: No hubo diferencias en el contenido de AIC y AEC entre las dos intervenciones en ningún momento. Nivel de Evidencia I; Pruebas de Criterios Diagnóstico Desarrollados Previamente.

BACKGROUND: In CT, the volumetric CT dose index (CTDIvol), dose-length product (DLP) and patient's size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics. OBJECTIVES: To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDIvol, DLP and SSDE, and to determine the image quality achieved. METHOD: In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants' body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution. RESULTS: The local DRL values given in terms of median CTDIvol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory. CONCLUSION: No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations. CONTRIBUTION: The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

BACKGROUND: Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient's health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression. AIM: This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool SETTING: South African acute psychiatric facility. METHODS: This was a retrospective observational study of all patients admitted to Netcare Akeso acute psychiatric facilities from 01 January 2018 to 31 October 2022. Patients were included if they were ≥ 18 years of age, admitted with a primary International Classification of Disease (ICD)-10 code for depression (i.e. F32-F33) and fully completed both an admission and discharge PHQ-9 questionnaire. We excluded facilities focusing only on the treatment of patients with specialised conditions such as addiction or eating disorders. RESULTS: This analysis included 13 308 patients admitted for depression at 10 different facilities. The median PHQ-9 score on admission was 19 (interquartile range [IQR] 14-23) and 5 (IQR 2-11) on discharge, with a median change of -12 (IQR -5 to -18). A minimal clinically important difference was seen in 87.6% patients (n = 10 091/11 515); a treatment effect was seen in 74.5% of patients and a clinically significant improvement was seen in 72.1% of patients. CONCLUSION: With the average patient reporting a four-fold reduction in the severity of their depression scores, PROMs provide a critical patient-centred window into the benefit that an inpatient admission has on those suffering with depression. CONTRIBUTION: These changes are consistent with those seen internationally and provide a baseline for understanding the treatment efficacy of an inpatient admission for the treatment of depression.

ABSTRACT Objective: To assess children's self-reported distress during dental procedures and investigate risk factors. Material and Methods: A total of 163 children (3–10 years old) were included from a clinical trial on diagnostic strategies for evaluating restorations in primary teeth. Treatment plans were elaborated based on the clinical examination performed at the baseline of the study. Dentists performed 742 dental procedures, and an external evaluator collected children's self-reported distress through the Wong Backer Facial Scale (WBFS) and dentists' opinions about children's behavior during the treatment. Kruskal-Wallis Test was performed to compare the distress and the dentists' perception of the different dental procedures, and multilevel ordered logistic regression analysis was conducted to the evaluate association between explanatory variables and the outcomes. Results: More complex procedures caused more distress in children (p=0.017), with a 5.5 times higher risk than simple operative treatments. Similarly, dentists reported children's worse behavior (p<0.001). Older children (older than 7 years) reported less distress than younger children (OR 0.52; CI 0.30-0.87; p=0.014). Patients reported greater distress in the first consultations, reducing the chance of higher scores by 16% in the next interventions. Conclusion: Children experience higher levels of distress during their first treatment appointments. More complex operative procedures and the child's age below 7 years were risk factors associated with greater distress during dental treatment. Objective childrens s selfreported self Methods 16 3–10 310 3 10 (3–1 old teeth study 74 WBFS (WBFS KruskalWallis Kruskal Wallis outcomes Results p=0.017, p0017 p p=0.017 , 0 017 (p=0.017) 55 5 5. treatments Similarly p<0.001. p0001 p<0.001 . 001 (p<0.001) older OR 0.52 052 52 0.300.87 030087 0.30 0.87 30 87 0.30-0.87 p=0.014. p0014 p=0.014 014 p=0.014) consultations interventions Conclusion appointments childs child 1 3–1 31 (3– p001 p=0.01 01 (p=0.017 p000 p<0.00 00 (p<0.001 0.5 05 300 0.300.8 03008 030 0.3 087 0.8 8 0.30-0.8 3– (3 p00 p=0.0 (p=0.01 p<0.0 (p<0.00 0. 0.300. 0300 03 08 0.30-0. ( p0 p=0. (p=0.0 p<0. (p<0.0 0.300 0.30-0 p=0 (p=0. p<0 (p<0. 0.30- p= (p=0 p< (p<0 (p= (p< (p

ABSTRACT Purpose: To describe cellular alterations detected by impression cytology of the ocular surface in patients with xeroderma pigmentosum. The secondary objective was to assess the reliability of impression cytology in diagnosing ocular surface squamous neoplasia. Methods: Patients with xeroderma pigmentosum underwent a single-day complete ophthalmological examination and impression cytology for ocular surface evaluation using 13 mm diameter mixed cellulose esters membrane filters and combined staining with Periodic Acid Schiff, Hematoxylin and Eosin, and Papanicolaou stains followed by microscopic analysis. The cytological findings were correlated with the clinical diagnosis. The impression cytology findings at baseline and one-year follow-up were correlated with the clinical course (no tumor, treated tumor, residual tumor recurrent tumor, new tumor). Results: Of the 42 patients examined, impression cytology was performed in 62 eyes of 34 participants (65% females). The mean age of patients was 29.6 ± 17 years (range 7-62). Fifteen eyes had a clinical diagnosis of ocular surface squamous neoplasia. Impression cytology showed goblet cells (47, 75%), inflammatory cells (12, 19%), keratinization (5, 8%), and squamous metaplasia (30, 48%). Impression cytology was positive for atypical cells in 18 patients (12 with and 6 without ocular surface squamous neoplasia). The sensitivity, specificity, positive predictive value, and negative predictive value of impression cytology (at baseline) for diagnosis of ocular surface squamous neoplasia were 80%, 87%, 67%, and 93%, respectively, using clinical diagnosis of ocular surface squamous neoplasia as the reference standard. Conclusion: Impression cytology has a moderate positive predictive value for the diagnosis of ocular surface squamous neoplasia in patients with xeroderma pigmentosum. However, the lack of detection of atypical cells on impression cytology has a high negative predictive value for ocular surface squamous neoplasia. Integration of impression cytology in the long-term management of high-risk patients, such as patients with xeroderma pigmentosum, can avoid unnecessary diagnostic biopsies. Purpose Methods singleday single day 1 Schiff Eosin analysis oneyear one year followup follow up no tumor. . tumor) Results 4 examined 3 65% 65 (65 females. females females) 296 29 29. range 762. 762 7 7-62) 47, 47 (47 75%, 75 75% , 75%) 12, 12 19%, 19 19% 19%) 5, 5 (5 8%, 8 8% 8%) 30, 30 (30 48%. 48 48% 48%) (1 neoplasia) sensitivity specificity 80 80% 87 87% 67 67% 93 93% respectively standard Conclusion However longterm long term highrisk risk biopsies (6 2 76 7-62 (4 ( (3 9 7-6 7-

ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents. (DTC cancer surgeons physicians pathologists radiologists approach large daytoday day generalists persistentrecurrent persistent/recurrent threetiered three tiered low intermediate basis evolution preference iodine agents

RESUMO Este estudo visa padronizar o exame clínico e complementar, mediante a utilização de eletromiografia (EMG) de superfície, para avaliar a função neuromuscular da cauda equina. Primeiramente, foram realizados exames clínicos das caudas e medições EMG em 10 animais saudáveis, sem qualquer interferência ou manipulação da cauda. Esse experimento inicial teve como objetivo estabelecer um padrão de exame clínico e dos resultados de EMG. Os animais sofreram bloqueio do plexo nervoso da cauda no segundo experimento com o uso de agente anestésico. O objetivo compara o exame clínico e os achados EMG entre as caudas anestesiadas e saudáveis. Por fim, dois animais foram utilizados no terceiro experimento, em que foi realizada infiltração periférica dos plexos nervosos da cauda com agente neurolítico. O estudo obteve com sucesso um padrão para o exame clínico de uma cauda equina saudável e estabeleceu um padrão para o exame clínico de uma cauda após infiltração com agentes anestésicos e neurolíticos. Diferenças significativas foram observadas no exame clínico, bem como nos valores EMG antes e após a infiltração local com anestésico (P=0,04) e agente neurolítico (P=0,03). O estudo apresenta um protocolo de exame clínico que utiliza a eletromiografia de superfície como ferramenta diagnóstica para o bloqueio da cauda equina. complementar (EMG Primeiramente 1 saudáveis fim neurolíticos P=0,04 P004 P 0 04 (P=0,04 P=0,03. P003 P=0,03 . 03 (P=0,03) P=0,0 P00 (P=0,0 (P=0,03 P=0, P0 (P=0, P=0 (P=0 P= (P= (P

ABSTRACT This study aims to standardize the clinical and complementary examination using surface electromyography (EMG) to assess the neuromuscular function of the equine tail. Firstly, clinical examinations of the tails and EMG measurements were performed on ten healthy animals without any tail interference or manipulation. This initial experiment aimed to establish a baseline for clinical examination and EMG results. The animals underwent tail nerve plexus blockade in the second experiment using an anesthetic agent. The objective compares the clinical examination and EMG findings between the anesthetized and non-manipulated tails. Finally, two animals were used in the third experiment, where peripheral infiltration of the tail nerve plexuses was performed using a neurolytic agent. The study successfully obtained a pattern for the clinical examination of a healthy equine tail and established a pattern for the clinical examination of a tail after infiltration with anesthetic and neurolytic agents. Significant differences were observed in the clinical examination before and after the application of local anesthesia, as well as in the EMG values before and after local infiltration with anesthetic (P=0.04) and neurolytic agent (P=0.03). The presented study introduces a clinical examination protocol that utilizes surface electromyography as a diagnostic tool for cauda equina block. (EMG Firstly manipulation results nonmanipulated non manipulated Finally agents anesthesia P=0.04 P004 P 0 04 (P=0.04 P=0.03. P003 P=0.03 . 03 (P=0.03) block P=0.0 P00 (P=0.0 (P=0.03 P=0. P0 (P=0. P=0 (P=0 P= (P= (P

RESUMO Objetivo: Descrever os achados clínicos, tratamentos, e desfechos em uma série de pacientes com me tástases vítreas de melanoma cutâneo. Métodos: Série retrospectiva de casos de único centro com intervenção. Pacientes incluídos tiveram seu diagnóstico de MVMC confirmado por biópsia entre 1997 e 2020. Vitrectomia via pars plana com 23 ou 25 gauge foram realizadas para obter espécimens. Esclerotomias foram tratadas com crioterapia em duplo ou triplo congelamento. Injeção intravítrea perioperatória de melfalano (32 ug/0,075 mL) foi administrada quando necessário. Foram relatados acuidade visual, pressão intraocular, resposta terapêutica sistêmica e ocular. Resultados: Cinco olhos de 5 pacientes com metástases vítreas de melanoma cutâneo unilateral foram identificados. Idade média de diagnóstico foi 84 anos (variando de 37-88). Seguimento médio após diagnóstico oftalmológico foi 28 (8,5-36) meses; 1 paciente não teve acompanhamento. Acuidade visual inicial variou de 20/30 a movimentos de mão. Achados clínicos iniciais incluíram infiltração de células pigmentadas e não-pigmentadas no vítreo (5/5), segmento anterior (4/5), e retina (3/5). Quatro pacientes tiveram glaucoma secundário. Tratamento sistêmico incluiu imunoterapia com inibidores da via de sinalização (3 - todos com resposta parcial/completa), quimioterapia sistêmica (2), ressecção cirúrgica (3), e irradiação (2). Intervalo médio entre diagnóstico primário e metástases vítreas foi 2 (2-15) anos. Um paciente teve doença sistêmica ativa simultânea as metástases vítreas. Acuidade visual final variou entre 20/40 e SPL. Tratamento oftalmológico incluiu vitrectomia nos 5 pacientes, melfalano intravítreo em 3 e metotrexato intravítreo em 1. Um paciente precisou de enucleação. A histopatologia revelou invasão celular extensa de melanoma. Conclusões: Metástases vítreas de melanoma cutâneo pode se manifestar como uma infiltração difusa de células pigmentadas e não-pigmentadas no vítreo e erroneamente diagnosticada como uveites. Vitrectomia diagnóstica e quimioterapia intravítrea periódica podem estar indicadas. Objetivo tratamentos Métodos intervenção 199 2020 espécimens congelamento 32 ug0075 ug 0 075 ug/0,07 mL necessário intraocular ocular Resultados identificados 8 variando 3788. 3788 37 88 . 37-88) 8,536 8536 8,5 36 (8,5-36 meses acompanhamento 2030 20 30 20/3 mão nãopigmentadas 5/5, 55 5/5 , (5/5) 4/5, 45 4/5 4 (4/5) 3/5. 35 3/5 (3/5) secundário ( parcial/completa, parcialcompleta parcial/completa parcial completa parcial/completa) 2, (2) 3, (3) 2. 215 15 (2-15 2040 40 20/4 SPL enucleação Conclusões uveites indicadas 19 202 ug007 07 ug/0,0 378 37-88 536 8,53 853 85 8, (8,5-3 203 20/ 5/ (5/5 4/ (4/5 3/ (3/5 (2 21 (2-1 204 ug00 ug/0, 37-8 53 (8,5- (5/ (4/ (3/ (2- ug0 ug/0 37- (8,5 (5 (4 ug/ (8, (8

ABSTRACT Purpose: To report the clinical findings, treatments, and outcomes in a series of patients with vitreous metastasis from cutaneous melanoma. Methods: This single-center, retrospective, interventional case series included patients with biopsy-confirmed vitreous metastasis from cutaneous melanoma diagnosed between 1997 and 2020. Standard 23- or 25-gauge pars plana vitrectomy was performed for diagnostic sampling. Sclerotomies were treated with double or triple freeze-thaw cryotherapy. Perioperative intravitreal injections of melphalan (32 µg/0.075 mL) were administered, when indicated. Visual acuity, intraocular pressure, and systemic and ocular treatment responses were reported. Results: Five eyes of five patients with unilateral vitreous metastasis from cutaneous melanoma were identified. The median age at diagnosis was 84 (range, 37-88) years. The median follow-up after ophthalmic diagnosis was 28 (8.5-36) months; one patient did not have a follow-up. The initial visual acuity ranged from 20/30 to hand motions. Baseline clinical findings included pigmented or non-pigmented cellular infiltration of the vitreous (5/5), anterior segment (4/5), and retina (3/5). Four patients had secondary glaucoma. Systemic therapy included checkpoint inhibitor immunotherapy (n=3, all with partial/complete response), systemic chemotherapy (n=2), surgical resection (n=3), and radiation (n=2). The median time from primary diagnosis to vitreous metastasis was 2 (2-15) years. One patient had an active systemic disease at the time of vitreous metastasis. The final visual acuity ranged from 20/40 to no light perception. Ophthalmic treatment included vitrectomy in all five patients, intravitreal administration of melphalan in three, and intravitreal administration of methotrexate in one. One patient required enucleation, and histopathology revealed extensive invasion by melanoma cells. Conclusions: Vitreous metastasis from cutaneous melanoma can present as a diffuse infiltration of pigmented or non-pigmented cells into the vitreous and may be misdiagnosed as uveitis. Diagnostic pars plana vitrectomy and periodic intravitreal chemotherapy may be indicated. Purpose treatments Methods singlecenter, singlecenter single center, center single-center retrospective biopsyconfirmed biopsy confirmed 199 2020 23 25gauge gauge 25 sampling freezethaw freeze thaw cryotherapy 32 (3 µg0075 µg 0 075 µg/0.07 mL administered indicated pressure reported Results identified 8 range, range (range 3788 37 88 37-88 years followup follow up 8.536 8536 8.5 36 5 (8.5-36 months followup. up. 2030 20 30 20/3 motions nonpigmented non 5/5, 55 5/5 , (5/5) 4/5, 45 4/5 4 (4/5) 3/5. 35 3/5 . 3 (3/5) glaucoma n=3, n3 n (n=3 partialcomplete partial complete response, response response) n=2, n2 n=2 (n=2) n=3 (n=3) n=2. 215 15 (2-15 2040 40 20/4 perception three enucleation Conclusions uveitis 19 202 ( µg007 07 µg/0.0 378 37-8 536 8.53 853 85 8. (8.5-3 203 20/ 5/ (5/5 4/ (4/5 3/ (3/5 (n= n= (n=2 21 1 (2-1 204 µg00 µg/0. 37- 53 (8.5- (5/ (4/ (3/ (n (2- µg0 µg/0 (8.5 (5 (4 (2 µg/ (8. (8

SUMMARY Denosumab is a potent antiresorptive medication, commonly used in the treatment of osteoporosis, as well as in a variety of other diseases. Potential adverse rebound effects after its cessation include a loss in bone mineral density and an increased risk of osteoporotic fractures. Hypercalcemia is a less frequently reported rebound phenomenon after denosumab discontinuation, that may pose a diagnostic challenge to physicians as a rare non-parathyroid hormone (PTH) dependent cause of hypercalcemia. In our case, a 47-year-old male presented with rebound hypercalcemia after denosumab cessation during follow-up after surgical treatment for parathyroid carcinoma. This non-PTH-dependent hypercalcemia resolved after re-initiation of denosumab. We performed a systematic literature review on rebound hypercalcemia after denosumab cessation and identified 52 individual patient cases. Children appear to be more prone to developing rebound hypercalcemia, which could be attributed to their higher baseline bone turnover, underlying conditions, or denosumab dosage regimens. In most cases, patients initially presented with acute and often severe symptoms of hypercalcemia that occur from 1.75 to 9 months after denosumab cessation (4 to 9 months in adults). Most effective treatment approaches to sufficiently decrease serum calcium levels were bisphosphonates or re-administration of denosumab. A watch and wait strategy may be sufficient in asymptomatic cases, which are less common and probably underdiagnosed. Subsequent antiresorptive treatment after denosumab cessation, which is a common practice in osteoporosis treatment, may reduce the risk of rebound hypercalcemia. As denosumab is a frequently used drug in patients with advanced malignant diseases and rebound hypercalcemia with low PTH levels may raise the suspicion for skeletal metastases, awareness of this rebound effect may be for particular relevance in such settings. medication fractures discontinuation nonparathyroid non (PTH case 47yearold yearold 47 year old followup follow up carcinoma nonPTHdependent reinitiation re initiation 5 cases turnover conditions regimens 175 1 75 1.7 4 ( adults. adults . adults) readministration administration underdiagnosed metastases settings 17 7 1.

Abstract Synovial sarcoma is a rare malignity of mesenchymal origin; the diagnostic approach usually begins by documenting a soft tissue tumor; however, it results in a challenging diagnosis when it is more profound, of small size, or primary from the bone. The present report describes a patient who presented insidious onset hip pain attributed to rheumatoid arthritis, with a fatal outcome due to baseline disease and surgery complications. The underestimation of hip pain, mainly when there is no palpable mass, may delay the diagnosis. origin tumor however profound size bone arthritis complications mass

Resumo Sarcoma sinovial é uma rara malignidade de origem mesenquimal; a abordagem diagnóstica geralmente começa documentando um tumor de tecido mole; no entanto, resulta em um diagnóstico desafiador quando é mais profundo, de pequeno porte ou primário do osso. O presente relato descreve um paciente que apresentou dor insidiosa no quadril atribuída a artrite reumatoide, com desfecho fatal devido a doenças de base e complicações cirúrgicas. A subestimação da dor no quadril, principalmente quando não há massa palpável, pode atrasar o diagnóstico. mesenquimal mole entanto profundo osso reumatoide cirúrgicas palpável

ABSTRACT Introduction: Acute leukemias (ALs) are aggressive diseases that lead to death without medical attention. We evaluated the association between delays in diagnosis and poor outcomes in AL by evaluating the symptom onset to treatment intervals in adults with newly diagnosed AL and their effect on an early death (ED). Methods: We assessed adults diagnosed with AL between 2015 and 2020 and evaluated baseline characteristics, the patient interval (PI), diagnostic interval (DI), treatment interval (TI) and the total time interval (TTI) to determine ED-associated factors. Main results: We assessed 102 patients with acute lymphoblastic leukemia (ALL), 57 with acute myeloblastic leukemia (AML) and 29 with acute promyelocytic leukemia (APL). Median interval days were PI 14, DI 10, TI 4 and TTI 31.5. The TI and TTI intervals were lower in APL than in ALL and AML; TI 1 vs. 4 and 3 (p = 0.001) and TTI 21 vs. 31 and 35 (p = 0.016). The 30-day and 60-day EDs were 13.8% and 20.7%, mainly infections. ECOG > 2 (OR = 15.0) and PI < 7 days (OR = 4.06) were associated with 30-day ED; AML (OR = 2.69), high-risk (OR = 3.34), albumin < 3.5 g/dl (OR = 5) and platelets < 20 × 103/uL (OR = 2.71) with a 60-day ED. Conclusion: None of the interval-delays were associated with an ED. Intervals seemed to be longer in patients without an ED, except for the TI, probably because of “the waiting time paradox.” Aggressive manifestations of disease may lead to shorter diagnostic intervals, but increased mortality. Introduction ALs (ALs attention ED . (ED) Methods 201 202 characteristics PI, , (PI) DI, (DI) (TI (TTI EDassociated factors results 10 ALL, (ALL) 5 (AML APL. (APL) 14 315 31.5 vs p 0.001 0001 0 001 0.016. 0016 0.016 016 0.016) 30day day 30 60day 60 138 13 8 13.8 207 20.7% infections OR 15.0 150 15 4.06 406 06 2.69, 269 2.69 69 2.69) highrisk high risk 3.34, 334 3.34 34 3.34) 3. gdl g dl 103uL uL 103 2.71 271 71 Conclusion intervaldelays paradox. paradox mortality (ED (PI (DI (ALL (APL 31. 0.00 000 00 0.01 01 6 13. 20.7 15. 4.0 40 26 2.6 33 3.3 2.7 27 0.0 20. 4. 2. 0.