SUMMARY: This study aimed to investigate the morphological and morphometric features, as well as the histological composition of the medial and lateral menisci of domestic cats. A total of 180 menisci were obtained from 45 skeletally mature cat cadavers, followed by measuring the peripheral extension, width and thickness, circumference of the body and the body with horns, articulating height, and superior articulating length. A histological assessment was conducted to determine the meniscal cellularity and histomorphology. Each meniscus was evaluated in three regions (cranial horn, body, and caudal horn) and three zones (outer, middle, and deep). The proteoglycan content and collagen distribution were also examined. Overall, 62.2% of the medial meniscus displayed a crescentic shape, whereas 86.7% of the lateral meniscus exhibited a C-shaped configuration. The morphometric analysis revealed that the lateral menisci significantly differed (P<0.05) in circumference, thickness, width, and articulating height from the medial menisci. Despite cell density was not significantly different across the regions, the cellularity decreased from the outer zone to the deep zone of the menisci. Proteoglycan content was not significantly different in the various regions but was increased significantly (P<0.05) in the middle meniscal zone. Types I, II, and III collagens were distributed throughout the meniscal regions and zones. Type I collagen was abundant within the meniscus. In contrast, type III collagen is primarily localized in the middle zone. In conclusion, feline menisci exhibit morphometric variations and distinctive histological features, offering crucial insights for veterinarians and researchers.

RESUMEN: Este estudio tuvo como objetivo investigar las características morfológicas y morfométricas, así como la composición histológica de los meniscos medial y lateral de gatos domésticos. Se obtuvieron un total de 180 meniscos de 45 cadáveres de gatos esqueléticamente maduros, y luego se midió la extensión periférica, el ancho y el grosor, la circunferencia del cuerpo y el cuerpo con cuernos, la altura de las articulaciones y la longitud de las articulaciones superiores. Se realizó una evaluación histológica para determinar la celularidad meniscal y la histomorfología. Cada menisco se evaluó en tres regiones (asta craneal, cuerpo y asta caudal) y tres zonas (externa, media y profunda). También se examinaron el contenido de proteoglicanos y la distribución de colágeno. En general, el 62,2 % del menisco medial mostró una configuración en forma de media luna, mientras que el 86,7 % del menisco lateral exhibió una configuración en forma de C. El análisis morfométrico reveló que los meniscos laterales diferían significativamente (P<0,05) en circunferencia, grosor, ancho y altura de los meniscos mediales. A pesar de que la densidad celular no fue significativamente diferente entre las regiones, la celularidad disminuyó desde la zona exterior a la zona profunda de los meniscos. El contenido de proteoglicanos no fue significativamente diferente en las distintas regiones, pero aumentó significativamente (P<0,05) en la zona media del menisco. Los colágenos de tipo I, II y III se distribuyeron en las regiones y zonas de los meniscos. El colágeno tipo I era abundante dentro del menisco. Por el contrario, el colágeno tipo III se localiza principalmente en la zona media. En conclusión, los meniscos felinos exhiben variaciones morfométricas y características histológicas distintivas, lo que ofrece información crucial para veterinarios e investigadores.

SUMMARY: In current study, we used Nissl staining to examine the histological structure of the juvenile Chinese alligator brain, and immunohistochemistry (IHC) staining to detail the serotonin (5-hydroxytryptamine, 5-HT) localization and morphology of neurons belonging to the serotonergic system. Nissl staining revealed that the Chinese alligator brain was divided into four regions (telencephalon, diencephalon, brainstem, and cerebellum) and a connected ventricular system (containing the pair of lateral ventricles, third ventricle, fourth ventricle and the aqueduct). According to the IHC results, 5-HT immunoreactive (5-HT-IR) neurons were primarily observed in the cerebral cortex, the hypothalamic paraventricular nucleus (PH), tectum and tegmentum of the optic lobes, the medial longitudinal fasciculus (Flm) of medulla oblongata and the cerebellar cortex. 5-HT-IR fibers were mostly located lateral to the hypothalamic paraventricular nucleus (PH), in the medial vestibular nucleus (MVe) of the medulla oblongata, and in the choroid plexus (CP) of the lateral ventricles. Additionally, our findings paralleled those results of other reptiles; nevertheless, some distinctions in terms of both histological architecture and function were identified. The layering of the cerebral cortex and tectum, as well as the arrangement of Purkinje cells, differed between reptile brains. The distribution of 5-HT-IR neurons varied in the layer of cerebral and cerebellar cortex when compared to other reptiles. Within the diencephalon, 5-HT-IR neurons formed distinct nuclei in the hypothalamic paraventricular nucleus (PH), but few in the infundibular recess.

RESUMEN: Utilizamos la tinción de Nissl para examinar la estructura histológica del cerebro juvenil del caimán chino y la tinción inmunohistoquímica (IHC) para detallar la localización y morfología de la serotonina (5-hidroxitriptamina, 5-HT) de las neuronas que pertenecen al sistema serotoninérgico. La tinción de Nissl reveló que el cerebro del caimán chino estaba dividido en cuatro regiones (telencéfalo, diencéfalo, tronco encefálico y cerebelo) y un sistema ventricular conectado (que contiene el par de ventrículos laterales, el tercer ventrículo, el cuarto ventrículo y el acueducto). Según los resultados de IHC, las neuronas inmunorreactivas 5-HT (5-HT-IR) se observaron principalmente en la corteza cerebral, el núcleo paraventricular (PH) hipotalámico, el tectum y tegmento de los lóbulos ópticos, el fascículo longitudinal medial (Flm) de médula oblonga y la corteza cerebelosa. Las fibras 5-HT-IR se ubicaron principalmente lateral al núcleo paraventricular (PH) hipotalámico, en el núcleo vestibular medial (MVe) de la médula oblonga y en el plexo coroideo (CP) de los ventrículos laterales. Además, nuestros hallazgos fueron semejantes a los resultados obtenidos de otros reptiles; sin embargo, se identificaron algunas distinciones en términos tanto de arquitectura histológica como de función. Las capas de la corteza cerebral y el tectum, así como la disposición de las neuronas purkinjenses, diferían entre los cerebros de los reptiles. La distribución de las neuronas 5-HT-IR varió en la capa de la corteza cerebral y cerebelosa en comparación con otros reptiles. Dentro del diencéfalo, las neuronas 5-HT-IR formaron núcleos distintos en el núcleo paraventricular (PH) hipotalámico, pero pocos en el receso infundibular.

Abstract: Metastatic cardiac tumors are rare, and their diagnosis can be challenging, partly due to the absence of specific clinical signs and the difficulty imposed by their heterogeneous histology on characterization in non-invasive imaging studies. They are usually metastases from lung carcinoma, and breast cancer. Other malignant neoplasms, such as urothelial carcinoma, are rare entities. The case of a male patient with a history of squamous cell carcinoma of the bla dder, who underwent surgery and neoadjuvant chemotherapy is presented. Approximately 18 months later, he manifested with pulmonary embolism secondary to fragmentation of a partially thrombosed tumor mass located in the right heart chambers. The definitive biopsy following surgical excision reveals metastasis of urothelial carcinoma.

Resumen: Los tumores cardíacos metastásicos son poco frecuentes y su diagnóstico puede ser desafiante, en parte por la ausencia de signos clínicos específicos, como también por la dificultad que su histología heterogénea impone sobre su caracterización en los estudios de imágenes no invasivas. Suelen corresponder a linfomas, carcinoma de pulmón y mama. Otras neoplasias malignas, como el carcinoma urotelial, son entidades raras. Se presenta el caso de un paciente masculino con antecedente de Carcinoma Escamoso de Vejiga, sometido a cirugía y quimioterapia neoadyuvante, que aproximadamente 18 meses después debuta con cuadro de embolia pulmonar secundaria a fragmentación de masa tumoral parcialmente trombosada alojada en cavidades cardiacas derechas. La biopsia definitiva posterior a exéresis quirúrgica demuestra metástasis de carcinoma urotelial.

RESUMEN: La importancia y relevancia de los cursos e-learning en medicina y ciencias de la salud ha aumentado significativamente en la última década. A pesar de ello, existen pocas experiencias docentes publicadas de cursos de histología e-learning en la literatura a nivel mundial. El curso de histología que diseñamos se estructuró en la plataforma Moodle, y los contenidos se propusieron en formato síncrono (zoom) y asíncrono (grabaciones). También incluimos el uso de herramientas gratuitas de microscopía virtual. Este estudio tuvo como objetivo investigar el impacto de un curso de histología e-learning en la satisfacción y el rendimiento de los estudiantes de medicina, enfermería y obstetricia. La muestra incluyó 424 estudiantes chilenos de medicina, enfermería y obstetricia de dos cohortes. Se aplicó una encuesta tipo Likert al final del curso. Se realizó un análisis exploratorio y una regresión por mínimos cuadrados ordinarios. En este estudio, presentamos una experiencia positiva de un curso de e-learning de histología. El análisis factorial exploratorio reveló tres factores principales relacionados con la "satisfacción sobre el aprendizaje e-learning", "clases presenciales versus clases virtuales" y el "diseño del curso y la calidad de la enseñanza". También encontramos que existía una relación positiva y significativa entre las percepciones de los estudiantes sobre la adaptación del curso de histología tradicional (presencial) a un formato e-learning y su rendimiento académico. Nuestro estudio muestra que los cursos de histología e-learning que integran clases teóricas y sesiones prácticas pueden ser una valiosa herramienta de enseñanza. Los responsables de la elaboración de planes de estudios y los profesores de histología deben tener en cuenta las limitaciones y ventajas de este tipo de enseñanza y sugerimos incorporar estos tres factores al diseño y la evaluación de los cursos de histología en línea.

SUMMARY: The importance and relevance of e-learning courses in medicine and health sciences has increased significantly in the last decade. Despite this, there are few published teaching experiences of e-learning histology courses in the literature worldwide. The histology course we designed was structured on the Moodle platform as a learning management system, and the content was proposed in a synchronous (zoom) and asynchronous (recordings) format. We also included the use of free virtual microscopy tools. This study aimed to investigate the impact of an e-learning histology course on the satisfaction and performance of medical, nursing and midwifery students. The sample included 424 Chilean medical, nursing, and midwifery students from two cohorts. A Likert-type survey was administered at the end of the course. We performed exploratory analysis and ordinary least squares regression. In this study, we present a positive experience of an e-learning histology course. Exploratory factor analysis revealed three main factors related to "e- learning satisfaction", "in-person class activities", and "course design and teaching quality". We also found that there was a positive and significant relationship between students' perceptions of the adaptation of the traditional (face-to-face) histology course into an e-learning format and their academic performance. Our study shows that e-learning histology courses that integrate lectures and practical sessions can be a valuable teaching method for learning histology. Curriculum developers and teachers need to consider the limitations and advantages of this type of teaching and incorporate these three factors into the design and assessment of e-learning histology courses.

Abstract Background Cutaneous squamous cell carcinoma (CSCC) is one of the most common types of skin cancer worldwide. Therefore, the identification of biomarkers associated with CSCC progression could aid in the early detection of high-risk squamous cell carcinoma and the development of novel therapeutic strategies. Objective This study aimed to investigate the expression patterns of silent mating type Information Regulation 2 homolog 6 (SIRT6) in CSCC and its clinical significance. Methods The protein expression level of SIRT6 in tissues was detected by immunohistochemistry, and the correlation between SIRT6 expression and clinicopathological parameters in CSCC patients was analyzed. The relative expression of SIRT6 in CSCC cell lineage and tissue specimens was determined by western blotting and PCR. The effect of SIRT6 silencing on cell proliferation was evaluated using cell counting kit 8. Wound healing, transwell method, and flow cytometry were used to investigate the migration, invasion, and cell cycle distribution/apoptosis of CSCC cells after SIRT6 silencing, respectively. Western blot was used to detect the expression of EMT (Epithelial-Mesenchymal Transition), cycle, apoptosis, and other related proteins. Results The high expression of SIRT6 was correlated with the location of cancer tissue and Broder staging in CSCC patients. Knockdown of SIRT6 inhibited the proliferation, migration, invasion and EMT of CSCC cells, and promoted their apoptosis, with cells blocked in G1 phase. Study limitations No animal experiments were conducted to further verify the results. Conclusion Decreased expression of SIRT6 can inhibit the occurrence and development of CSCC. (CSCC worldwide Therefore highrisk risk strategies SIRT (SIRT6 significance immunohistochemistry analyzed PCR 8 healing method migration distributionapoptosis distribution apoptosis respectively EpithelialMesenchymal Epithelial Mesenchymal Transition, Transition , Transition) proteins G phase results (SIRT

Abstract Primary anal cancer accounts for 1% to 3% of gastrointestinal cancers. The most common histology is squamous cell carcinoma, with an incidence of 0.5 to 2 per 100,000 people. The main risk factor is infection with the human papillomavirus, particularly subtypes 16 and 18, which represent 85% to 93% of cases. Treatment and prognosis depend on the stage of the tumor. Localized tumors can be treated with curative surgery, but locally advanced stages require a combination of chemotherapy and radiation. Advanced-stage tumors (IIIC and IV) have a poor prognosis even with chemotherapy. In recent years, immunotherapy and targeted therapies have shown promise in improving survival for patients with advanced, recurrent, or difficult-to-treat disease. We present the case of a 69-year-old woman with moderately differentiated squamous cell carcinoma (T2N1M0, stage IIIA) of the anal canal who, after treatment with chemoradiotherapy and checkpoint inhibitors and subsequent disease progression, received targeted therapy (cetuximab) and achieved complete remission with a sustained response for over 18 months. This case highlights the challenges of treating advanced anal cancer and the potential benefits of targeted therapy, particularly cetuximab, in achieving long-term responses. Further research and large-scale studies are needed to determine the role of targeted therapy and immunotherapy in the treatment of anal canal cancer.

Resumen El cáncer anal primario representa del 1% al 3% de los cánceres gastrointestinales. La histología más común es el carcinoma escamocelular, con una incidencia de 0,5 a 2 por cada 100.000 personas. El principal factor de riesgo es la infección por el virus del papiloma humano, especialmente los subtipos 16 y 18, que representan del 85% al 93% de los casos. El tratamiento y el pronóstico dependen del estadio del tumor. Los tumores localizados se pueden tratar con cirugía curativa, pero las etapas localmente avanzadas requieren una combinación de quimioterapia y radiación. Los tumores en estadio avanzado (IIIC y IV) tienen un mal pronóstico incluso con quimioterapia. En los últimos años, la inmunoterapia y las terapias dirigidas son prometedoras para mejorar la supervivencia de los pacientes con enfermedad avanzada, recurrente o difícil de tratar. Se presenta el caso de una mujer de 69 años con carcinoma escamocelular moderadamente diferenciado (T2N1M0, estadio IIIA) del canal anal que, después del tratamiento con quimiorradioterapia e inhibidores de punto de chequeo y luego de la progresión de la enfermedad, recibió tratamiento con terapia blanco (cetuximab) y logró la remisión completa de la enfermedad y una respuesta mantenida por más de 18 meses. Este caso destaca los desafíos del tratamiento del cáncer anal avanzado y los beneficios potenciales de la terapia dirigida, especialmente cetuximab, para lograr respuestas a largo plazo. Se necesitan más investigaciones y estudios a gran escala para determinar el papel de la terapia blanco y la inmunoterapia en el tratamiento del cáncer del canal anal.

Abstract Mucormycosis corresponds to a potentially fatal invasive fungal disease that has an increasing incidence, mainly in immunocompromised onco-hematological patients and stem-cell transplant recipients. Skin involvement being one of its clinical presentations. We report the case of a 21-year-old patient, diagnosed with acute lymphoblastic leukemia, who developed primary cutaneous mucormycosis caused by Rhizopus arrhizus, confirmed by molecular methods and histology, and who evolved favorably after a large surgical resection and antifungal therapy based on to liposomal amphotericin B and isavuconazole.

Resumen La mucormicosis corresponde a una enfermedad fúngica invasora potencialmente mortal y que presenta una incidencia en aumento, principalmente en pacientes inmunocomprometidos onco-hematológicos y receptores de trasplante de células progenitoras hematopoyéticas. La forma cutánea primaria es una de sus presentaciones clínicas. Comunicamos el caso de un paciente de 21 años, con diagnóstico de leucemia linfoblástica aguda, que desarrolló una mucormicosis cutánea primaria causada por Rhizopus arrhizus, confirmada por métodos moleculares e histología, y que evolucionó en forma favorable tras una resección quirúrgica amplia y terapia antifúngica con anfotericina B liposomal e isavuconazol.

ABSTRACT Integrative studies are important for a better understanding of the functional development of fish digestive systems and the consequent design of suitable feeding regimes and ad-hoc diets. To characterize the ontogeny of digestive function in larvae and juveniles of two atherinopsids from South America, Odontesthes bonariensis and O. hatcheri, morphologic, histologic, and intestinal enzyme biochemical analyses were performed. Both species showed a functional digestive system from one week after hatching (wah) with a sustained high-level activity of the cytosolic enzyme leucine alanine peptidase (leu-ala) until 9 and 13 wah in O. hatcheri and O. bonariensis, respectively. Maximum specific leu-ala activities in both species were higher compared to other agastric and most gastric fish. These results and the abundant pinocytic vacuoles in the posterior intestine suggest that cytosolic digestion is crucial for these species. It seems that their apparent anatomically simple digestive system is compensated by an uncommonly early development and function of the digestive tract and accessory organs accompanied by high intestinal cytosolic activity. The above findings contribute to the understanding of the Atherinopsidae digestive model and, for the first time, suggest that under farming conditions, these species could be weaned at an early developmental stage with an appropriate balanced diet.

Abstract Primary hepatic sarcomatoid carcinoma is a very ag gressive tumor, representing 0.4-0.7% of all primary he patic neoplasms. The disease is associated with liver dis ease due to hepatotropic viruses and is more prevalent in Asians. Histology shows sarcomatous and carcinoma components. It does not have pathognomonic clinical or imaging characteristics and its diagnosis is based on the pathological and immunohistochemistry findings. Surgery could prolong survival in localized stages. We report the case of a 72-year-old Korean patient with a history of chronic liver disease due to B virus, who was diagnosed with primary hepatic sarcomatoid carcinoma with bone and lymph node metastases.

Resumen El carcinoma sarcomatoide primario hepático es un tumor agresivo que representa el 0.4-0.7% de todas las neoplasias primarias hepáticas. Se asocia a hepa topatía por virus hepatotropos, es más prevalente en la población asiática y en su histología se evidencian componentes de carcinoma y sarcoma. No posee carac terísticas clínicas ni imagenológicas patognomónicas y su diagnóstico se realiza en base a los hallazgos de la anatomía patológica e inmunohistoquímica. La cirugía en estadio localizado representa la única modalidad terapéutica con impacto en la sobrevida. Reportamos el caso de una paciente de 72 años, coreana, con an tecedentes de hepatopatía crónica por virus B, a quien se le diagnosticó un carcinoma sarcomatoide hepático primario con metástasis ósea y ganglionares.

Summary Background and aims: The false-root knot nematode (Nacobbus spp.) comprises polyphagous species, with pepper (Capsicum annuum) being one of the most affected crops. Due to the lack of resistant pepper genotypes, we compared the responses of different commercial cultivars to identify possible plant defence mechanisms against N. celatus. M&M: Nematodes from Río Cuarto (Córdoba Province) and Lisandro Olmos (Buenos Aires Province) were inoculated on pepper cultivars: California Wonder (control), Fyuco INTA, Yatasto, and Fenomeno RZ. Plants were grown under a greenhouse and galls were analysed by histopathological techniques. Results: The roots of the commercial cultivars showed the typical morpho-anatomical alterations induced by N. celatus: gall formation, hyperplasia reactions, development of syncytia in the central cylinder and disorganisation of vascular tissues. Syncytial cells in contact with females of nematodes from Lisandro Olmos showed a defence reaction by Fyuco INTA, whereas feeding sites in Fenomeno RZ did not denote high metabolic activity in nematodes of both origins. Conclusions: The different responses observed between populations and/or hosts demonstrate the importance of considering nematodes from different geographical origins when testing plant material for tolerance and/or resistance to N. celatus. Studies of this nature are necessary since they facilitate a more in-depth understanding of the parasite-plant interaction.

Resumen Introducción y objetivos: El falso nematodo de la agalla (Nacobbus spp.) comprende especies polífagas, siendo el pimiento (Capsicum annuum) uno de los cultivos más afectados. Debido a la falta de genotipos resistentes del pimiento, comparamos las respuestas de diferentes cultivares comerciales para identificar posibles mecanismos de defensa contra N. celatus. M&M: Nematodos provenientes de Río Cuarto (provincia de Córdoba) y Lisandro Olmos (provincia de Buenos Aires) se inocularon en cultivares de pimiento: California Wonder, Fyuco INTA, Yatasto y Fenomeno RZ. Las plantas se desarrollaron en invernadero y las agallas se analizaron mediante técnicas histopatológicas. Resultados: Las raíces de los cultivares analizados mostraron las alteraciones morfo-anatómicas típicas inducidas por N. celatus: formación de agallas, reacciones de hiperplasia, desarrollo de sincitios en el cilindro central y desorganización de los tejidos vasculares. Las células sincitiales en contacto con hembras de Lisandro Olmos mostraron una reacción de defensa por parte de Fyuco INTA, mientras que los sincitios en Fenomeno RZ denotaron baja actividad metabólica en nematodos de ambas procedencias. Conclusiones: Las diferencias observadas entre las poblaciones y/o hospedadores demuestran la importancia de considerar nematodos de diferentes orígenes geográficos al analizar material vegetal para determinar su tolerancia y/o resistencia a N. celatus. Estudios de esta naturaleza son necesarios ya que facilitan una comprensión más profunda de la interacción parásito-planta.

Abstract Primary intestinal lymphangiectasia (PIL) is a rare disease that was discovered in 1961 by Waldmann et al., who first described the concept of intestinal lymphangiectasia. PIL is manifested by large and dilated intestinal lymphatic vessels that lead to the loss of lymphatic fluid to the intestinal lumen, including severe hypoalbuminemia and, consequently, generalized edema. The etiology of PIL is unknown; however, several genes are involved in the development of the lymphatic system. The case of a two-month-old patient with a prenatal diagnosis of ascites on third-trimester ultrasound was presented. The patient was born with rapidly progressive ascites and showed an endoscopic study with evidence of snowflake images and histology compatible with intestinal lymphangiectasia. The patient remained on octreotide infusion at baseline and subsequently with refractory ascites the dose was increased. Several evacuatory paracentesis were performed and he remained on enteral nutrition based on an extensively hydrolyzed formula with a 54% contribution of medium chain triglycerides (MCTs) and parenteral nutrition (PN). Subsequently, the patient was switched to a subcutaneous infusion of octreotide, which allowed hospital discharge and adequate outpatient follow-up with a favorable evolution.

Resumen La linfangiectasia intestinal primaria (LIP) es una enfermedad rara que se descubrió en 1961 por Waldmann y colaboradores, quienes describieron por primera vez el concepto de linfangiectasia intestinal. La LIP se manifiesta por vasos linfáticos intestinales grandes y dilatados que conllevan la pérdida de líquido linfático hacia la luz intestinal, siendo responsable de una hipoalbuminemia grave y, en consecuencia; de un edema generalizado. La etiología de la LIP es desconocida, sin embargo, varios genes están implicados en el desarrollo del sistema linfático. Se presenta el caso de una paciente de dos meses de edad con diagnóstico prenatal de ascitis en ecografía de tercer trimestre. Nació con ascitis rápidamente progresiva y presentó un estudio endoscópico con evidencia de imágenes en copos de nieve e histología compatible con linfangiectasia intestinal. Se mantuvo en tratamiento con infusión de octreotida al inicio y posteriormente con ascitis refractaria se aumentó la dosis. Se realizaron varias paracentesis evacuatorias y permaneció con nutrición enteral a base de una fórmula extensamente hidrolizada con aporte del 54% de triglicéridos de cadena media (TCM) y nutrición parenteral (NPT). Más tarde, se cambió a infusión de octreotida por vía subcutánea, lo que permitió el alta hospitalaria y un seguimiento adecuado por consulta externa con una evolución favorable.

Abstract Objective: To describe the experience of the insertion of the duodenal stent in patients with malignant obstruction of the gastric outflow tract in a third-level reference center in Cundinamarca. Materials and methods: Observational study, case series. Patients with Malignant gastric outlet obstruction (MGOO) diagnosed between December 2019 and February 2022 underwent the insertion of a self-expanding duodenal metal stent in the Gastroenterology unit of Hospital Universitario de la Samaritana. Results: 17 patients were enrolled, 76% of whom were male, with a mean age of 69 years (standard deviation [SD]: 11 years). Histology confirmed gastric adenocarcinoma was found in 82% of the patients, and 41% reported peritoneal carcinomatosis. We achieved total technical success (100%) and clinical success (88%) (15 patients). Regarding the size of the stent used, 35% (6 patients) were 12 cm, 53% (9 patients) were 9 cm, and 12% (2 patients) were 6 cm. Fluoroscopic and endoscopic guidance was used in 88% of cases. Patient survival at follow-up was an average of 84 days (2.8 months; range: 0-414 days) and currently, 1 patient continues in post-insertion surveillance for stent at the time described in the study. Conclusion: Duodenal stent is an effective and safe palliative management alternative in patients with MGOO that improves symptoms, particularly, oral tolerance and early hospital discharge in this group of patients (with advanced terminal neoplastic disease in the palliative management phase), reducing the need for surgical management.

Resumen Objetivo: Describir la experiencia de la inserción del stent duodenal en pacientes con obstrucción maligna del tracto de salida gástrico en un centro de referencia de tercer nivel de Cundinamarca. Materiales y métodos: Estudio observacional, serie de casos. Pacientes con obstrucción maligna del tracto de salida gástrico (OTSG) diagnosticados entre diciembre de 2019 y febrero de 2022 llevados a inserción de stent metálico autoexpandible duodenal en la unidad de Gastroenterología del Hospital Universitario de la Samaritana. Resultados: 17 pacientes fueron incluidos, de los cuales el 76 % eran hombres, con una edad promedio de 69 años (desviación estándar [DE]: 11 años). Se encontró adenocarcinoma gástrico confirmado por histología en el 82 % de los pacientes, y el 41 % tenía carcinomatosis peritoneal. El éxito técnico fue del 100 % y el éxito clínico fue del 88 % (15 pacientes). En cuanto al tamaño del stent utilizado, el 35 % (6 pacientes) fue de 12 cm, el 53 % (9 pacientes) de 9 cm y el 12 % (2 pacientes) de 6 cm. Se utilizó guía fluoroscópica y endoscópica en el 88 % de los casos. La sobrevida de los pacientes en el seguimiento fue en promedio de 84 días (2,8 meses; rango: 0-414 días) y actualmente 1 paciente continúa en vigilancia posterior a la inserción de stent en el tiempo descrito del estudio. Conclusión: El stent duodenal es una alternativa de manejo paliativo efectiva y segura en los pacientes con OTSG que permite mejorar los síntomas y, en especial, la tolerancia a la vía oral y el egreso hospitalario temprano en este grupo de pacientes con una enfermedad neoplásica avanzada terminal en fase de manejo paliativo, lo que disminuye la necesidad de manejo quirúrgico.

Abstract Objective To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand. RichéCannieu Riché Cannieu (RCA (KCL 2 recentlydeceased recently deceased head hand limbs lines

Resumo Objetivo Identificar a localização da anastomose de Riché-Cannieu (ARC) em relação à linha cardinal de Kaplan (LCK) e à linha Y. Métodos Ao todo, 20 mãos de 10 cadáveres adultos do sexo masculino com idades entre 27 e 66 anos, recentemente falecidos, foram dissecadas para a investigação da relação do ponto mais distal da ARC com a LCK e a linha Y traçada a partir do eixo da cabeça do terceiro metacarpo seguindo o eixo longitudinal da mão. Resultados Nos 20 membros, o ponto mais distal da comunicação nervosa era distal à LCK. A linha Y estava no lado radial em relação ao ponto mais distal da ARC em 14 membros, e no lado ulnar em relação à linha Y em 6 membros. O cruzamento entre a LCK e a linha Y foi proximal à ARC em 18 membros; em 1 mão, era distal à intersecção entre essas linhas e, em outra mão, a LCK estava exatamente na ARC. Conclusão O conhecimento dessas relações anatômicas pode prevenir danos aos ramos nervosos e, assim, também prevenir a paralisia dos músculos intrínsecos em procedimentos cirúrgicos na palma da mão. RichéCannieu Riché Cannieu (ARC (LCK todo 2 anos falecidos mão membros assim

Abstract Introduction: Autoimmune hepatitis (AIH) has a spectrum of symptoms ranging from asymptomatic disease to acute severe hepatitis, chronic hepatitis, and decompensated cirrhosis. The acute presentation is not rare and could represent genuine acute AIH (GAAIH) or acute exacerbation of chronic autoimmune hepatitis. We aimed to identify the prevalence, clinical features, and prognostic factors associated with GAAIH and compare these cases with acute exacerbation of chronic AIH. Methods: This cross-sectional observational study evaluated patients with acute AIH presentation, defined as total bilirubin >5 times the upper limit of normality (xULN) and/or alanine aminotransferase >10 xULN, and no prior history of liver disease. Histology findings of acute disease defined GAAIH. Bivariate analyses were performed to identify factors associated with the GAAIH, when compared with acute exacerbation of chronic AIH. Results: Seventy-two patients with acute presentation of AIH were included and six (8.3%) of them presented GAAIH. Comparative analysis between patients with GAAIH and patients with acute exacerbation of chronic AIH revealed that prothrombin activity (96% [74-100] vs. 61% [10-100]; p = 0.003) and albumin levels (3.9 ± 0.2 g/dL vs. 3.4 ± 0.5 g/dL; p < 0.001) were higher in patients with GAAIH. The International Autoimmune Hepatitis Group score was higher in patients with acute exacerbation of chronic AIH (18.5 [8-23] vs. 16.5 [15-17]; p = 0.010). Compared to 15.2% of acute exacerbation of chronic AIH, complete therapeutic response to treatment was achieved in 67.7% of cases with GAAIH (p = 0.018). Conclusions: GAAIH was rare (8.3%), and patients with this presentation exhibited more preserved liver function tests, suggesting that most cases presenting with loss of function are acute exacerbation of chronic AIH. Additionally, patients with GAAIH had a better complete therapeutic response, suggesting a more preserved liver function at presentation, and early diagnosis has a positive therapeutic implication.

Resumo Introdução: A hepatite autoimune (HAI) apresenta um espectro de sintomas que varia de doença assintomática a hepatite aguda grave, hepatite crónica e cirrose descompensada. A apresentação aguda não é rara e pode representar hepatite autoimune aguda genuína (HAIAG) ou exacerbação aguda de hepatite autoimune crónica (EAHAIC). O nosso objetivo foi identificar a prevalência, caraterísticas clínicas e fatores prognósticos associados à HAIAG, e comparar esses casos com EAHAIC. Métodos: Estudo observacional, transversal, incluindo doentes com apresentação aguda de HAI, definida como bilirrubina total > 5 vezes o limite superior da normalidade (xLSN) e/ou ALT > 10 xLSN, e sem história prévia de doença hepática. HAIAG foi definida pela presença de achados histológicos de doença aguda. Análises bivariadas foram realizadas para identificar fatores associados à HAIAG, quando comparado com o EAHAIC. Resultados: Foram incluídos setenta e dois doentes com apresentação agu-da de HAI, dos quais seis (8.3%) com HAIAG. A análise comparativa entre doentes com HAIAG e doentes com EAHAIC mostrou que a atividade de protrombina (96%(74-100) versus 61% (10-100; p=0.003) e os níveis de albumina (3,9 ± 0,2 g/dL vs. 3,4 ± 0,5 g/dL; p < 0,001) foram significativamente mais elevados em pacientes com HAIAG. O score do Grupo Internacional de Hepatite Autoimune foi mais elevado em doentes com EAHAIC (18.5 (8-23) versus 16.5 (15-17); p=0.010). A resposta terapêutica completa ao tratamento foi alcançada em 66.7% dos casos de HAIAG (vs. 15,2% na EAHAIC, p=0,018). Conclusões: A HAIAG é rara (8.3%), e os doentes com esta apresentação mostraram testes de função hepática mais preservados, sugerindo que a maioria dos casos com perda de função são EAHAIC. Além disso, os doentes com HAIAG tiveram maior taxa de resposta terapêutica completa, sugerindo que uma função hepática mais preservada na apresentação e o diagnóstico precoce tem uma implicação terapêutica positiva.

Abstract Introduction: The association of hepatitis delta virus (HDV) infection with positive autoantibodies and autoimmune features has been known for decades. However, to date, very few cases of clinical autoimmune hepatitis (AIH) have been reported in association with HDV infection, most of them being in the context of treatment with peginterferon. Case Report: This case refers to a 46-year-old woman born in Guinea-Bissau who moved to Portugal in 2018 to investigate complaints of diffuse abdominal discomfort and nausea. Her initial work-up, including laboratory and liver histology, was consistent with type 1 AIH. She had HBe antigen-negative chronic hepatitis B virus infection with negative DNA and also a positive total anti-HDV antibody, with negative IgM and undetectable RNA. Therefore, after initiating prophylactic tenofovir difumarate, she was started on prednisolone followed by azathioprine, which was later stopped due to presumed hepatotoxicity. Repeated histology showed signs of viral superinfection, and she was treated with acyclovir due to a positive herpes simplex IgM, with HDV RNA remaining negative. A third flare in transaminases prompted the introduction of mycophenolate mofetil (MMF) after a thorough exclusion of additional causes of liver disease. About 6 months later, during another bout of hepatitis, HDV RNA was finally positive and classified as genotype 5. MMF was stopped, and, considering a contraindication to interferon, the patient was offered therapy with bulevirtide, which she refused for personal reasons as she is currently living in her home country. Discussion: This is a challenging case of autoimmune or “autoimmune-like” hepatitis, probably induced by chronic HDV infection. High suspicion of HDV was essential because, had the case been interpreted as refractory AIH, with escalation of immunosuppression, a more severe course of the viral infection might have ensued. Recently, HDV suppression with bulevirtide was shown to reverse autoimmune liver disease. We hypothesize that the same could have happened to our patient, had she accepted this treatment.

Resumo Introdução: A associação da infeção pelo vírus da hepatite delta (VHD) com a presença de autoanticorpos e outros aspetos de autoimunidade é conhecida desde há várias décadas. Contudo, até à data, muito poucos casos de hepatite autoimune (HAI) clínica foram reportados em relação com a infeção VHD, sendo a maioria destes no contexto de terapêutica com interferão peguilado. Caso clínico: O caso refere-se a uma mulher de 46 anos natural da Guiné-Bissau, que se mudou para Portugal em 2018 para investigação de queixas de desconforto abdominal difuso e náuseas. A avaliação laboratorial inicial e a histologia hepática foram compatíveis com HAI tipo 1. A doente apresentava também infeção crónica a VHB (vírus da hepatite B) antigénio HBe negativa, com DNA negativo, e anti-VHD (vírus da hepatite delta) total positivo, com IgM negativo e RNA indetetável. Assim, após início de tenofovir difumarato profilático, foi iniciada terapêutica com prednisolona seguida de azatioprina, que posteriormente se interrompeu por presumível hepatotoxicidade. Uma segunda biópsia mostrou aspetos de superinfeção viral e como tal a doente foi tratada com aciclovir, tendo em conta IgM positivo para Herpes Simplex, mantendo-se o RNA VHD negativo. Um terceiro flare de transaminases motivou o início de micofenolato de mofetil, após extensa investigação e exclusão de outras causas de doença hepática. Cerca de 6 meses mais tarde, durante novo episódio de hepatite, o RNA VHD revelou-se finalmente positivo e este foi classificado como genotipo 5. O MMF foi suspenso e, considerando a contra-indicação para interferão, foi proposto à doente tratamento com bulevirtide, que esta recusou, alegando motivos pessoais, visto estar atualmente a residir no seu país de origem. Discussão: Este é um caso desafiante de hepatite autoimune, ou autoimune-like, provavelmente induzida pela infeção crónica pelo VHD. Um elevado índice de suspeição para VHD foi essencial porque, se o caso tivesse sido interpretado como HAI refratária, com incremento de imunossupressão, poderia ter-se verificado um agravamento da hepatite viral. Recentemente, foi reportado que a supressão do VHD pelo bulevirtide pode reverter a doença hepática autoimune. Questionamo-nos se o mesmo poderia ter sucedido com a nossa doente, caso esta tivesse aceite este tratamento.