Secondary breast lymphoma: A case report

Lymphoma is the most frequent hematologic malignancy that involves the breast. It represents less than 1% of all breast cancer. The most common subtype is the secondary B-cell lymphoma. Clinically, lymphomas are divided into primary and secondary breast lymphoma. We presented a case of 49-year-old female, who has diagnosed of Non-Hodgkin's Lymphoma, finalizing the treatment 2 months ago. Currently, she came for a check-up due to a palpable lump in the right breast. Mammography shows a dense, oval, and circumscribed mass. Ultrasound revealed a 3.6 cm oval, hypoechoic, lobulated mass with internal vascularity at color Doppler. Axillary nodes show cortical thickening of 7 mm, cortical blood flood, and absence of fatty hilum. The histopathology report corresponds to infiltration of the right breast and bilateral axillary nodes by Non-Hodgkin Lymphoma. This case corresponds with lymphoma recurrence manifested in breast. The diagnosis of lymphoma is an imaging challenge that simulates benign and malignant pathologies

Physician practices and attitudes towards atopic dermatitis in Latin America: A cross-sectional study

Background: The prevalence of atopic dermatitis (AD) is increasing in developing countries. Different worldwide guidelines have been proposed, but their applicability for AD specialists in Latin American (LA) countries is unknown. Objective: The objective of this study was to explore the medical approach to treating AD in LA countries. Methods: The study population comprised AD specialists (allergists and dermatologists). They completed an electronic survey containing questions about the health system, diagnostic criteria, and pharmacotherapy approach to treating AD. The survey was constructed and validated by the Atopic Dermatitis Committee of the Latin American Society of Allergy Asthma and Immunology (SLAAI) in Spanish and Portuguese. Each member was responsible for distributing the questionnaire through different networks in their respective countries. Results: A total of 284 AD specialists from 13 LA countries completed the questionnaire; among them, 67% were allergists and 33% were dermatologists. Less than 50% of the AD specialists strictly followed guideline recommendations. Among the AD specialists, the European and North American guidelines were more frequently used, and only 16% followed LA guidelines. Dermatologists used the local guidelines less frequently than allergists. Most physicians did not routinely use AD assessment tools (55%). The frequency of the diagnostic tests depends on symptom severity. The availability of some systemic treatments, such as biologics and Janus Kinase (JAK) inhibitors, is not universal in all LA countries. Conclusion: There were marked differences between the specialists, and these differences seemed to be affected by their specialty and each country's healthcare system. New AD education strategies that consider the particularities of the region could allow patients to be more accurately managed. AD assessment tools may provide a way to enhance AD treatment and allow for shared decision-making, patient empowerment, and standardized care

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients

Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703–0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217–0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623–0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822–0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829–0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity