Dermoscopy of melanoma according to different body sites: Head and neck, trunk, limbs, nail, mucosal and acral

Effective cancer screening detects early-stage tumours, leading to a lower incidence of late-stage disease over time. Dermoscopy is the gold standard for skin cancer diagnosis as diagnostic accuracy is improved compared to naked eye examinations. As melanoma dermoscopic features are often body site specific, awareness of common features according to their location is imperative for improved melanoma diagnostic accuracy. Several criteria have been identified according to the anatomical location of the melanoma. This review provides a comprehensive and contemporary review of dermoscopic melanoma criteria according to specific body sites, including frequently observed melanoma of the head/neck, trunk and limbs and special site melanomas, located on the nail, mucosal and acral region

Determinants of SARS-CoV-2 Contagiousness in Household Contacts of Symptomatic Adult Index Cases

BACKGROUND: Identifying determinants of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in settings of contagion is fundamental to inform containment strategies. We assessed SARS-CoV-2 cycle threshold value (Ct) from the first diagnostic nasal–pharyngeal swab of symptomatic index cases and which demographic or clinical characteristics among cases and contacts are associated with transmission risk within households. METHODS: This is a retrospective prevalence study on secondary SARS-CoV-2 cases (SC) among the household contacts of symptomatic adult index cases randomly sampled from all the SARS-CoV-2-positive diagnostic nasopharyngeal swabs analyzed at our regional referral hospital (Amedeo di Savoia Hospital, Turin, Italy) in March, 2020. Index cases underwent a telephone survey to collect their demographic and clinical data and all their household contacts. The Ct value of RdRp gene from the first diagnostic swab of index cases was recorded and index cases were grouped according to Ct tertiles (A < first tertile, first ≤ B ≤ second tertile, C ≥ second tertile). Post hoc analysis was performed in SC as well as contacts that did not undergo SARS-CoV-2 testing but developed compatible signs and symptoms. Non-parametric tests and generalized linear models were run. RESULTS: Index (n = 72) and contact (n = 164) median age was 54 (48–63) and 32 (20–56) years, respectively. A total of 60, 50, and 54 subjects were contacts of group A, B, and C index cases, respectively; 35.9% of contacts were SC. Twenty-four further subjects (14.6%) met the criteria for symptom-based likely positive SC. The secondary attack rate was 36.0% (28.6–43.4), assuming a mean incubation period of 5 days and a maximum infectious period of 20 days. SC prevalence differed between Ct groups (53.3% A, 32.0% B, 20.4% C; p < 0.001). No difference in SC was found according to sex, presence of signs/symptoms, and COVID-19 severity of index cases, or according to contacts’ sex and number per household. The age of both index cases [aOR 4.52 (1.2–17.0) for 60 vs. ≤45 years old] and contacts [aOR 3.66 (1.3–10.6) for 60 vs. ≤45years old] and the Ct of the index [aOR 0.17 (0.07–0.4) for Ct ≥ 31.8 vs. Ct < 24.4] independently associated with SC risk. Sensitivity analysis including symptoms-based likely positive SC supported all the previous results. CONCLUSION: In confined transmission settings such as households, PCR Ct values may inform on the contagiousness of infected subjects and age may modulate transmission/contagion risk

Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients

To date, there is no severe acute respiratory syndrome coronavirus 2-(SARS-CoV-2)-specific prognostic biomarker available. We assessed whether SARS-CoV-2 cycle threshold (Ct) value at diagnosis could predict novel CoronaVirus Disease 2019 (COVID-19) severity, clinical manifestations, and six-month sequelae. Hospitalized and outpatient cases were randomly sampled from the diagnoses of March 2020 and data collected at 6 months by interview and from the regional database for COVID-19 emergency. Patients were stratified according to their RNA-dependent-RNA-polymerase Ct in the nasopharyngeal swab at diagnosis as follows: Group A ≤ 20.0, 20.0 &lt; group B ≤ 28.0, and Group C &gt; 28.0. Disease severity was classified according to a composite scale evaluating hospital admission, worst oxygen support required, and survival. Two hundred patients were included, 27.5% in Groups A and B both, 45.0% in Group C; 90% of patients were symptomatic and 63.7% were hospitalized. The median time from COVID-19 onset to swab collection was five days. Lethality, disease severity, type, and number of signs and symptoms, as well as six-month sequelae distributed inversely among the groups with respect to SARS-CoV-2 Ct. After controlling for confounding, SARS-CoV-2 Ct at diagnosis was still associated with COVID-19-related death (p = 0.023), disease severity (p = 0.023), number of signs and symptoms (p &lt; 0.01), and presence of six-month sequelae (p &lt; 0.01). Early quantification of SARS-CoV-2 may be a useful predictive marker to inform differential strategies of clinical management and resource allocation

Conceito e implementação do cuidado centrado na pessoa na perspectiva do médico da estratégia saúde da família / Concept and implementation of the person centered care in medical perspective of family health strategy

Objetivo: O objetivo do estudo foi compreender a percepção de médicos da Estratégia Saúde da Família acerca do conceito de Cuidado Centrado na Pessoa, sua aplicabilidade e possíveis aspectos intervenientes na prática cotidiana. Métodos: Trata-se de uma pesquisa de natureza qualitativa, realizada junto a 10 médicos trabalhadores de cinco Unidades Básicas de Saúde de um município do sul do Brasil, no período julho a setembro de 2017. As entrevistas semiestruturadas foram gravadas, transcritas e submetidas à análise de conteúdo temática. Resultados: Por meio do estudo, foi possível apreender que os entrevistados embora conheçam e aprovem o método, compartilham de dificuldades em sua operacionalidade, além de se constatar entraves na abordagem da relação médico-paciente. Todavia, explicitam em suas falas que quando aplicado, o método centrado na pessoa auxilia no empoderamento do indivíduo e na harmonia interrelacional dos profissionais. Salienta-se ainda nas falas, a necessidade de se desenvolver uma formação médica focada para além da cura da doença, mas também ao entendimento holístico com uma visão mais ampliada do indivíduo. Conclusão: Apesar de reconhecidamente valoroso, o método centrado na pessoa ainda é pouco utilizado por impasses voltados à própria formação dos médicos, mas também a obstáculos estruturais e de aceitação por parte do próprio usuário. Espera-se, com esse resultado, colaborar com evidências para uma melhor abordagem dentro dos serviços de saúde

Engineering shape anisotropy of Fe3O4-¿-Fe2O3 hollow nanoparticles for magnetic hyperthermia

The use of microwave-assisted synthesis (in water) of a-Fe2O3 nanomaterials followed by their transformation onto iron oxide Fe3O4-¿-Fe2O3 hollow nanoparticles encoding well-defined sizes and shapes [nanorings (NRs) and nanotubes (NTs)] is henceforth described. The impact of experimental variables such as concentration of reactants, volume of solvent employed, and reaction times/temperatures during the shape-controlled synthesis revealed that the key factor that gated generation of morphologically diverse nanoparticles was associated to the initial concentration of phosphate anions employed in the reactant mixture. All the nanomaterials presented were fully characterized by powder X-ray diffraction, field emission scanning electron microscopy, Fourier transform infrared, Mössbauer spectroscopy, and superconducting quantum interference device (SQUID). The hollow nanoparticles that expressed the most promising magnetic responses, NTs and NRs, were further tested in terms of efficiencies in controlling the magnetic hyperthermia, in view of their possible use for biomedical applications, supported by their excellent viability as screened by in vitro cytotoxicity tests. These systems NTs and NRs expressed very good magneto-hyperthermia properties, results that were further validated by micromagnetic simulations. The observed specific absorption rate (SAR) and intrinsic loss power of the NRs and NTs peaked the values of 340 W/g and 2.45 nH m2 kg-1 (NRs) and 465 W/g and 3.3 nH m2 kg-1 (NTs), respectively, at the maximum clinical field 450 Oe and under a frequency of 107 kHz and are the highest values among those reported so far in the hollow iron-oxide family. The higher SAR in NTs accounts the importance of magnetic shape anisotropy, which is well-predicted by the modified dynamic hysteresis (ß-MDH) theoretical model

INTOXICAÇÃO POR CALCITRIOL APÓS TRATAMENTO DE HIPOPARATIREOIDISMO TRANSITÓRIO

RESUMOIntrodução: A toxicidade da vitamina D é extremamente rara e potencialmente grave. As características clínicas da hipervitaminose D são decorrentes, principalmente, da hipercalcemia. Objetivo: Relatar um caso de intoxicação por calcitriol. Relato de caso: MH, sexo feminino, 50 anos, em acompanhamento no serviço de endocrinologia e metabologia do HC-UFPR devido bócio multinodular (BMN) tóxico, sendo iniciado tratamento com tapazol. Encaminhada para tireoidectomia total pelo serviço de cirurgia de cabeça e pescoço do HC-UFPR, realizada em novembro de 2015. Anátomo-patológico com ausência de malignidade. Evoluiu, no pós operatório, com hipoparatireoidismo e hipocalcemia grave sintomática (PTH < 5,00ng/ml e cálcio total de 6,2 mg/dl), necessitando reposição de gluconato de cálcio endovenoso por vários dias. Recebeu alta hospitalar no 19º dia de pós operatório com cálcio total de 8,2mg/dl e prescrição de calcitriol 0,25mcg 6 comprimidos (cp) ao dia, carbonato de cálcio (CaCO3) 500mg 8 cp ao dia e vitamina D3 15.000U/semana e retorno ambulatorial em 2 semanas. Paciente retornou em consulta três meses após, com queixa de náuseas, vômitos, hiporexia e perda de 5,8kg em dois meses, apresentando sinais de desidratação ao exame físico e, em uso de calcitriol 0,25mcg 6 cp ao dia e CaCO3 500mg 2 cp ao dia. Cálcio total no retorno de 11,4mg/dl, PTH < 5,00pg/ml, fósforo (Pi) 3,5mg/dl, albumina (alb) 3,9g/dl, creatinina (Cr) 1,5mg/dl. Suspenso CaCO3 e vitamina D, reduzida dose de calcitriol para 2 cp ao dia e orientada hidratação via oral. Após 1 semana, relatou melhora dos sintomas, com cálcio total de 8,1mg/dl, Pi 3,9mg/dl, alb 3,8g/dl, PTH 10,70pg/ml, 25-OH-vitamina D 43ng/ml, Cr 1,1mg/dl. Mantida dose de calcitriol e reiniciado CaCO3 na dose de 1g/dia. Novo retorno em um mês, assintomática, com cálcio total de 8,3mg/dl, PTH 20pg/ml e 25-OH-vitamina D 41ng/ml, Cr 0,8mg/dl, compatível com hipoparatireoidismo transitório e intoxicação por calcitriol resolvida. Conclusão: Diante de um quadro de vômitos persistentes e hipercalcemia, na presença de hormônio da paratireódide normal ou baixo, o diagnóstico de intoxicação por vitamina D deve ser suspeitado e, a normalização de seus níveis alivia os sintomas e pode prevenir lesão renal aguda

UMA CAUSA INCOMUM DE ASCITE

RESUMOIntrodução: A ascite causada por hipotireoidismo é uma condição rara e sua causa ainda não está bem definida. Quando causas comuns de ascite forem excluídas, a possibilidade de ascite mixedematosa deve ser considerada e a função tireoidiana deve ser avaliada. Objetivo: relatar um caso de ascite mixedematosa. Relato de caso: Paciente feminina, 57 anos, encaminhada para abordagem cirúrgica de prolapso retal e uterino. No internamento, observada ascite volumosa e iniciada investigação etiológica. Constatado GASA de 2 e descartadas outras causas de ascite por exames complementares, foram solicitados exames laboratoriais para avaliação da função tireoidiana, cujos resultados foram compatíveis com hipotireoidismo (TSH >100 Ui/ml e T4L <0.4 ng/dl). Foi iniciado tratamento com levotiroxina e a paciente recebeu alta com normalização da função tireoidiana e evidente melhora da ascite. Conclusão: Em caso de ascite mixedematosa, haverá uma resposta importante após o tratamento do hipotireoidismo somente. A resposta ao uso de levotiroxina confirma a etiologia da ascite secundária ao hipotireoidismo

May-Hegglin Anomaly, Sebastian Syndrome, Fechtner Syndrome, and Epstein Syndrome Are not Distinct Entities but Represent a Variable Expression of a Single Illness

May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome, and Epstein syndrome are autosomal dominant macrothrombocytopenias distinguished by different combinations of clinical and laboratory signs, such as sensorineural hearing loss, cataract, nephritis, and polymorphonuclear Döhle-like bodies. Mutations in the MYH9 gene encoding for the nonmuscle myosin heavy chain IIA (NMMHC-IIA) have been identified in all these syndromes. To understand the role of the MYH9 mutations, we report the molecular defects in 12 new cases, which together with our previous works represent a cohort of 19 families. Since no genotype-phenotype correlation was established, we performed an accurate clinical and biochemical re-evaluation of patients. In addition to macrothrombocytopenia, an abnormal distribution of NMMHC-IIA within leukocytes was observed in all individuals, including those without Döhle-like bodies. Selective, high-tone hearing deficiency and cataract was diagnosed in 83% and 23%, respectively, of patients initially referred as having May-Hegglin anomaly or Sebastian syndrome. Kidney abnormalities, such as hematuria and proteinuria, affected not only patients referred as Fechtner syndrome and Epstein syndrome but also those referred as May-Hegglin anomaly and Sebastian syndrome. These findings allowed us to conclude that May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome, and Epstein syndrome are not distinct entities but rather a single disorder with a continuous clinical spectrum varying from mild macrothrombocytopenia with leukocyte inclusions to a severe form complicated by hearing loss, cataracts, and renal failure. For this new nosologic entity, we propose the term "MHY9-related disease," which better interprets the recent knowledge in this field and identifies all patients at risk of developing renal, hearing, or visual defects

THYROID ANAPLASTIC CARCINOMA – CASE REPORT

Introduction: Thyroid anaplastic carcinoma, or undifferentiated thyroid carcinoma (UTC), is the most aggressive form of thyroid neoplasm, with a high mortality rate and a survival rate of 6 months. Case report: female patient, 64 years old, was hospitalized with symptoms that started 3 weeks earlier. She presented with progressive dysphagia, cervical pain, dysphonia, asthenia, poor general state, dyspnea and weight loss, with worsening of symptoms in the last week. Thyroid function was normal. Fine needle aspiration biopsy of the thyroid showed a positive result for malignity of left lobe nodule, compatible with undifferentiated malignant neoplasm, suggestive of thyroid anaplastic cancer. The cervical computed tomography showed a cervical mass with extension from mediastinum to the aortic arc, involving the supra aortic vessels, and compressing the trachea, which had 4mm in its lowest diameter. The patient did not have surgical indication for resection and had no conditions to establish a definite airway, due to the extension of tumor and infraglotic tracheal compression. The patient was treated with palliative care and, after 7 days of admission, the patient passed away. Conclusion: due to severity and fast progression of UTC, early diagnostic is fundamental for the evaluation of the tumor staging and therapeutic plan, when it is possible. The best plan is the association of an aggressive surgical treatment with new chemotherapeutic drugs and external radiotherapy.Introdução: O carcinoma anaplásico de tireóide, ou carcinoma indiferenciado de tireóide (CIT), corresponde a forma mais agressiva das neoplasias tireoidianas, com alto índice de mortalidade e sobrevida média de 6 meses após o diagnóstico. Relato de caso: Paciente feminina, 64 anos, internou com quadro clínico com início há 3 semanas de disfagia progressiva, dor em região cervical, disfonia, astenia, queda do estado geral, dispnéia e perda de peso, com piora dos sintomas há 1 semana. A função tireoidiana era normal. Punção com agulha fina de tireóide, realizada no início do quadro, mostrou resultado positivo para malignidade em nódulo de lobo esquerdo, compatível com neoplasia maligna pouco diferenciada, epitelióide e sugestiva de câncer anaplásico de tireóide. No internamento, realizada Tomografia Computadorizada de região cervical que evidenciou massa cervical com extensão para mediastino até topografia de arco aórtico, com envolvimento dos vasos supra aórticos, além de desvio e compressão importantes da traqueia, cujo menor calibre era de 4mm. Paciente sem indicação de ressecção cirúrgica e sem condições de estabelecimento de via aérea definitiva devido à extensão do tumor e compressão traqueal infra glótica. Foi optado por cuidados paliativos com medidas de conforto e, após 7 dias de internamento, a paciente evoluiu para óbito. Conclusão: Pela gravidade e rápida progressão do CIT, é fundamental o diagnóstico precoce para avaliação do estadiamento do tumor e do plano terapêutico, quando possível. Atualmente, a melhor conduta baseia-se na associação de um tratamento cirúrgico agressivo da neoplasia com a combinação de novos agentes quimioterápicos e radioterapia externa