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Alpha heavy chain disease (αHCD) is a rare variant of the mucosa-associated lymphoid tissue lymphoma characterized by expression of a monotypic truncated immunoglobulin α heavy chain. αHCD frequently involves the gastrointestinal (GI) tract, and its pathogenesis has been linked to clonal B-cell expansion from chronic immune stimulation by infectious agents. We report a rare case of GI αHCD with 5 concomitant pathogens identified on a GI multiplex real-time polymerase chain reaction panel, featured by persistent Campylobacter jejuni colonization and refractory giardiasis.
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Anterior mediastinal masses, including thymomas, can present with thoracic symptoms or paraneoplastic syndromes, especially in adults over 40. Diagnosis involves imaging and biopsy, and treatment includes surgical resection and chemotherapy, depending on the stage. A 31-year-old male, with a history of alcohol use disorder and a former smoker, presented with increasing heartburn, shortness of breath, left shoulder pain, and chest pain. Imaging revealed an anterior mediastinal mass with pleural thickening and a small effusion. A biopsy confirmed a B2-type thymoma. Initial treatment included cyclophosphamide, doxorubicin, and cisplatin, resulting in significant tumor reduction and pleural effusion resolution. The patient underwent planned surgical resection following neoadjuvant chemotherapy. This case highlights the complexity of advanced thymoma treatment and the effectiveness of neoadjuvant chemotherapy in reducing tumor burden, the associated effusions, and improving outcomes. Continuous follow-up and further studies are essential to optimize treatment protocols for advanced thymoma.
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Zalunfiban is a novel glycoprotein IIb/IIIa inhibitor currently being tested for its use in the prehospital setting for antiplatelet effect in patients with ST-elevation myocardial infarction. It has shown to be safe and effective in both phase 1 and phase 2 trials and is under investigation in phase 3 trials. In this review, we discuss zalunfiban in detail, including its mechanism of action, adverse effects, current recommendations for use, and ongoing trials.
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In two experiments we investigated blindfolded, sighted participants' capacity to extract the number of raised dots from arrays of braille cells that they scanned once via active touch. The arrays could contain between one and 12 raised dots and estimates were based on scanning with one or more fingers on one or both hands (Experiment 1), or when the dots were as maximally or minimally spaced as the braille code permits (Experiment 2). We sought evidence of discontinuities in performance that reflect more than one mode of enumeration. We found that participants' estimates of numerosity increased in a linear fashion with actual numerosity, but were increasingly underestimated beyond numerosity of six, and confidence in the judgment declined linearly with increasing numerosity. Finger combinations made no difference to accuracy, errors, or confidence. Increasing dot density had the effect of diminishing perceptual accuracy, exaggerating underestimation and reducing confidence. While perceptual accuracy was generally high up to six raised dots, patterns of confusions and scaling analyses suggest that numerosities of four or less are perceptually unique. In this article, we discuss these data in terms of enumeration in touch and other modalities, and consider whether this discontinuity in enumeration signifies a subitize-to-count or a count-to-estimate transition.
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Percepción del Tacto , Dedos , Mano , Humanos , Juicio , TactoRESUMEN
INTRODUCTION: Burn Wound Infection (BWI) is primarily caused by aerobic bacteria followed by fungi, anaerobes and viruses. There has been a worldwide decrease in incidence of bacterial infections in burns due to better patient care and availability of effective antibiotics. Consequently, the fungal burn wound infection has shown an increasing trend. AIM: The aim of study was to assess the frequency of fungal infections in thermal burn wounds with respect to age of wounds, total body surface involved, depth of burns and to assess common fungal pathogens. MATERIALS AND METHODS: The study was conducted on 50 patients admitted with thermal burn wounds having 20-60% burns in the surgical unit. Pus swab and scrapings were taken under local anaesthesia from each burn patient. Scrapings were put in a sterile container and sent to Mycology section of Microbiology department and were examined by direct microscopy and culture studies on Sabouraud's Dextrose Agar medium in the Mycology section of Microbiology department. RESULTS: In our study, the incidence of fungal infection in burn wound patients came out to be 26%. The incidence of fungal infection increased with increase in Total Body Surface Area, (TBSA) increase in depth and age of burn. In our study, the maximum positive fungal cultures were seen in the third week of post-burn period. No positive culture was seen in the first week and 30.76% positive fugal cultures were seen in second post-burn week. Candida albicans was found to be the most common organism followed by Non-albicans Candida and Aspergillus. CONCLUSION: It was concluded from the study that incidence of fungal infections in thermal burns increased with increase in post-burn period and with increasing depth and TBSA of burns. Candida albicans was found to be the most common fungus.
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OBJECTIVE: Refine instrument for auditing hospital-based child abuse and neglect violence intervention programmes prior to field-testing. DESIGN: A modified Delphi study to identify and rate items and domains indicative of an effective and quality child abuse and neglect intervention programme. Experts participated in four Delphi rounds: two surveys, a one-day workshop and the opportunity to comment on the penultimate instrument. SETTING: New Zealand. PARTICIPANTS: Twenty-four experts in the field of care and protection of children. MAIN OUTCOME MEASURES: Items with panel agreement >or=85% and mean importance rating >or=4.0 (scale from 1 (not important) to 5 (very important)). RESULTS: There was high-level consensus on items across Rounds 1 and 2 (89% and 85%, respectively). In Round 3 an additional domain (safety and security) was agreed upon and cultural issues, alert systems for children at risk, and collaboration among primary care, community, non-government and government agencies were discussed. The final instrument included nine domains ('policies and procedures', 'safety and security', 'collaboration', 'cultural environment', 'training of providers', 'intervention services', 'documentation' 'evaluation' and 'physical environment') and 64 items. CONCLUSIONS: The refined instrument represents the hallmarks of an ideal child abuse and neglect programme given current knowledge and experience. The instrument enables rigorous evaluations of hospital-based child abuse and neglect intervention programmes for quality improvement and benchmarking with other programmes.