ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.

Abstract The archaeological signal of occupation of the canyons in the northern bank of the Santa Cruz River is more abundant during the Late Holocene. The similarities in rock art motifs and techniques with sites located to the northwest of this region, together with the presence of black obsidian artifacts, whose potential sources are to the North and the synchrony in the dates have led different researchers to propose the complementary use of these spaces. On the other hand, the archaeological record of the canyons on the northern bank of the Santa Cruz River shows that there are variations in rock art motifs and techniques between the easternmost and westernmost canyons.The purpose of this paper is to explore the possible routes of circulation that the hunter-gatherer groups who inhabited these canyons could have used. To do this, seasonal accessibility models are generated between sites located in these canyons and between them and sites located towards the northwest, with which they share chronologies, engraved footprint motifs and black obsidian artifacts. Geographic Information Systems (GIS) were used to model winter and summer least cost paths. The results suggest that some sectors of the middle course of the Chalía River would have been relevant for circulation and that the archaeological record of the Santa Cruz River was not, for the most part, linked to the circulation between these spaces.

Resumen La señal arqueológica de ocupación de los cañadones de la margen norte del río Santa Cruz es más abundante durante el Holoceno tardío. Las similitudes en motivos y técnicas rupestres con sitios ubicados al noroeste de esta región, junto con la presencia de artefactos en obsidiana negra cuyas fuentes potenciales de aprovisionamiento se encuentran al norte y la sincronía en los fechados han llevado a distintos investigadores a plantear la utilización complementaria de estos espacios. Por otra parte, el registro arqueológico de los cañadones de la margen norte del río Santa Cruz muestra que existen variaciones en motivos y técnicas rupestres entre los más orientales y los más occidentales. El propósito de este trabajo es explorar las potenciales vías de circulación que podrían haber utilizado grupos cazadores-recolectores que habitaron estos cañadones. Para ello, se generan modelos estacionales de accesibilidad entre sitios localizados en cañadones y entre ellos y aquéllos ubicados hacia el noroeste, con los que comparten cronologías, motivos grabados de pisadas y artefactos de obsidiana negra. Se utilizaron Sistemas de Información Geográfica (SIG) para modelar caminos óptimos de invierno y verano. Los resultados obtenidos sugieren que sectores de la cuenca media del río Chalía habrían sido relevantes para la circulación y que el registro arqueológico del río Santa Cruz no parece, en su mayoría, estar vinculado con la circulación entre estos espacios.

More than 18 million people in 188 countries have been diagnosed as having coronavirus disease (COVID-19), and COVID-19 has been responsible for more than 600,000 deaths worldwide. Brazil is now the second most affected country globally. Faced with this scenario, various public health measures and changes in the daily routines of hospitals were implemented to stop the pandemic. Patients with hepatocellular carcinoma (HCC) are at an increased risk for severe COVID-19 as they present with two major diseases: cancer and concomitant chronic liver disease. The COVID-19 pandemic can significantly impact the management of HCC patients from diagnosis to treatment strategies. These patients need special attention and assistance at this time, especially since treatment for tumors cannot be delayed in most cases. The aim of this guideline was to standardize the management of HCC patients during the COVID-19 pandemic. This document was developed, on the basis of the best evidence available, by a multidisciplinary team from Instituto do Câncer do Estado de São Paulo (ICESP), and Instituto Central of the Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP), which are members of the São Paulo Clínicas Liver Cancer Group.