Eyelid trichoadenoma: surgical treatment associated with aesthetic lepharoplasty

Trichoadenoma is a benign cutaneous tumor that is asymptomatic, rare, and slow growing. There are few cases reported in the literature, and we could only identify one description of trichoadenoma occurring in the eyelid area. We describe the case of a patient with trichoadenoma in the outer corner of the lower eyelid that we treated with surgical excision associated with blepharoplasty.O tricoadenoma é um tumor cutâneo benigno, assintomático, raro e de crescimento lento. Existem poucos casos relatados na literatura e identificamos apenas um descrito na região palpebral. Apresentamos o caso de uma paciente portadora de tricoadenoma no canto externo da pálpebra inferior direita, tratada com excisão cirúrgica associada a blefaroplastia.Universidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)Universidade de UberabaUNIFESPSciEL

Social Inequalities In Health Behaviors Among Brazilian Adults: National Health Survey, 2013

Considering the high socioeconomic inequalities prevailing in Brazil and lifestyle as a strong determinant of morbidity and premature mortality, our purpose was to evaluate the degree of socioeconomic disparities in the prevalence of health behaviors among Brazilian adult population using data from the 2013 Brazilian National Health Survey. Method: Based on a sample of 49,025 individuals aged 20 to 59 years, we estimated the prevalence of several health behaviors and a score of unhealthy behaviors according to gender, education, race/color and possession of private health insurance. The prevalence ratios adjusted by age and gender were estimated by means of multiple Poisson regression and the analyses took into account the sampling design. Results: Significant social inequalities were identified in the Brazilian adults. Higher prevalence of current smoking, leisure-time physical inactivity, sedentary lifestyle, whole milk consumption and low ingestion of greens, vegetables, and fruits were observed among the less educated, in the non-white population, and among those without private health insurance. Higher prevalence of heavy episodic drinking was found in the non-white population, but no difference in the consumption of fatty meat was found according to skin color. Score of unhealthy behavior higher than 6 was more frequent in lower educational strata (PR = 3.74) in the non-white population (PR = 1.39) and among those without private health insurance (PR = 1.78). Compared to women, men had higher prevalence rates of smoking, hazardous alcohol consumption, and fatty meat consumption and lower consumption of greens, vegetables and fruits. Conclusion: The results of the study emphasize the importance of monitoring social inequalities in health as part of national health policies and the urgent need to prioritize actions to promote healthy behaviors, especially among the most socially vulnerable segments of society.15Ministry of Health of BrazilCAP

Cutaneous adverse reactions in B-RAF positive metastatic melanoma following sequential treatment with B-RAF/MEK inhibitors and immune checkpoint blockade or vice versa. A single-institutional case-series

Background With the advent of immune-checkpoint inhibitors and targeted treatments (TT), there have been unprecedented response rates and survival in advanced melanoma, but the optimal sequencing of these two treatments modalities is unknown. Combining or sequencing these agents could potentially result in unique toxicities. Cutaneous adverse events (CAE) after sequential exposure to these agents represents one toxicity that needs further description. Methods After retrospectively reviewing charts of patients from 2015 to 2018, we identified six patients who experienced CAEs after recent exposure to sequential immunotherapy and TT or vice versa for the treatment for metastatic melanoma at the University of North Carolina, Chapel Hill. Skin biopsies were available in five patients. Results Five patients received TT after immunotherapy, and one patient received immunotherapy after TT. TT consisted of vemurafenib/cobimetinib (V/C) in five patients with four patients starting V/C immediately before manifesting with a CAE. In patients receiving V/C after immunotherapy, the median time from beginning V/C to development of CAE was 14.5 days. The clinical presentation of diffuse morbilliform rash, fevers, hypotension, and end-organ damage raised concern for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Histopathological features of lympho-eosinophilic infiltrate were supportive of a drug eruption. Immunotherapy or TT were re-initiated in five patients within 1–8 weeks after resolution of the index CAE. This resulted in two patients re-experiencing the CAE. Both of these patients were off prednisone at the time of therapy re-initiation, whereas none of the patients who were restarted on targeted therapy with a steroid overlap had a rash recurrence. Conclusions Sequential treatment using immunotherapy and TT, especially the sequence of V/C after immunotherapy appears to be the most common trigger for CAE with a median time to onset of approximately 2 weeks. Although the clinical presentation of these CAEs can be dramatic, they respond well to prednisone therapy. This unique presentation suggests that it may be reasonably safe to re-challenge certain patients with a steroid overlap after rash resolution

New housing/new crime? Changes in safety, governance and everyday incivilities for residents relocated from informal to formal housing at Hammond's Farm, eThekwini

New state-subsidised ‘RDP’ housing in South Africa aims to provide former informally-housed residents with a better quality of life, stronger community and decreased levels of crime. Despite the state’s ambitions, this process is highly contradictory, increases in safety occurring alongside rising incivilities and tensions. This paper contributes to an emerging set of debates on the socio-political outcomes of state-led housing interventions in the global South, through an illustration of the limitations of efforts to produce ‘safe neighbourhoods’ in contexts of high unemployment alongside high levels of violence. The conceptual framing of ‘Southern Criminology’ (Carrington et al, 2015), centres the significance of histories of colonial and post-colonial violence, inequality, hybrid governance and justice practices, as well as informal living, and is employed to analyse recently housed residents’ experiences of crime and safety in South Africa, in a north eThekwini settlement, Hammond’s Farm. Recognising these ‘Southern’ factors, the paper argues that movement into new formal housing, is typified by significant material changes at the home and neighbourhood scale which foster privacy and safety, formalised governance practices and (partial) improvements in policing services. These occur in conjunction with access to new leisure activities including alcohol consumption and ‘township life’ which alongside ongoing poverty foster urban incivilities. A ‘Southern Criminology’ perspective frames concluding questions about the nature of crime in contexts of urban change, which are persistently shaped by inequality and wider historical and structural factors, challenging the state’s aspirations to achieve crime reduction through housing

Anatomical texture patterns identify cerebellar distinctions between essential tremor and Parkinson's disease

Voxel-based morphometry is an established technique to study focal structural brain differences in neurologic disease. More recently, texture-based analysis methods have enabled a pattern-based assessment of group differences, at the patch level rather than at the voxel level, allowing a more sensitive localization of structural differences between patient populations. In this study, we propose a texture-based approach to identify structural differences between the cerebellum of patients with Parkinson's disease (n =???280) and essential tremor (n =???109). We analyzed anatomical differences of the cerebellum among patients using two features: T1-weighted MRI intensity, and a texture-based similarity feature. Our results show anatomical differences between groups that are localized to the inferior part of the cerebellar cortex. Both the T1-weighted intensity and texture showed differences in lobules VIII and IX, vermis VIII and IX, and middle peduncle, but the texture analysis revealed additional differences in the dentate nucleus, lobules VI and VII, vermis VI and VII. This comparison emphasizes how T1-weighted intensity and texture-based methods can provide a complementary anatomical structure analysis. While texture-based similarity shows high sensitivity for gray matter differences, T1-weighted intensity shows sensitivity for the detection of white matter differences

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma

PURPOSE: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. METHODS: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. RESULTS: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. CONCLUSION: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736

The construction of viewpoint aspect: the imperfective revisited

This paper argues for a constructionist approach to viewpoint Aspect by exploring the idea that it does not exert any altering force on the situation-aspect properties of predicates. The proposal is developed by analyzing the syntax and semantics of the imperfective, which has been attributed a coercer role in the literature as a de-telicizer and de-stativizer in the progressive, and as a de-eventivizer in the so-called ability (or attitudinal) and habitual readings. This paper proposes a unified semantics for the imperfective, preserving the properties of eventualities throughout the derivation. The paper argues that the semantics of viewpoint aspect is encoded in a series of functional heads containing interval-ordering predicates and quantifiers. This richer structure allows us to account for a greater amount of phenomena, such as the perfective nature of the individual instantiations of the event within a habitual construction or the nonculminating reading of perfective accomplishments in Spanish. This paper hypothesizes that nonculminating accomplishments have an underlying structure corresponding to the perfective progressive. As a consequence, the progressive becomes disentangled from imperfectivity and is given a novel analysis. The proposed syntax is argued to have a corresponding explicit morphology in languages such as Spanish and a nondifferentiating one in languages such as English; however, the syntax-semantics underlying both of these languages is argued to be the same

Evaluation of the antiurolithiatic activity of the extract of Costus spiralis Roscoe in rats

The antiurolithiatic activity of the water extract of Costus spiralis Roscoe was tested on formation of calculi on implants of calcium oxalate crystals or zinc disc in the urinary bladder of rats. The plant is a species from the family Zingiberaceae used in Brazilian folk medicine in urinary affections and for expelling urinary stones. Implantation of the foreign body in the urinary bladder of adult rats induced formation of urinary stones and hypertrophy of the smooth musculature. Oral treatment with the extract of Costus spiralis Roscoe (0.25 and 0.5 g/kg per day) after 4 weeks surgery reduced the growth of calculi, but it did not prevent hypertrophy of the organ smooth musculature. The contractile responses of isolated urinary bladder preparations to the muscarinic agonist bethanecol, in the presence and absence of the extract (0.3-3 mg/ml) or atropine (0.3-3 nM) did not differ among the experimental groups. The results indicate that the extract of Costus spiralis Roscoe is endowed with antiurolithiatic activity confirming thus folk information. The effect, however, was unrelated to increased diuresis or to a change of the muscarinic receptor affinity of the bladder smooth musculature to cholinergic ligands, (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.Univ Fed Sao Paulo, Escola Paulista Med, Dept Pharmacol, Div Cellular Pharmacol, BR-04044020 Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pharmacol, Div Cellular Pharmacol, BR-04044020 Sao Paulo, BrazilWeb of Scienc