Report of a recurrent tongue malignant melanoma and review of literature

Primary oral mucosal melanoma is a rare disease. Etiopathogenesis of oral mucosal melanoma (OMM) is inadequately understood. The prognosis of OMM is very poor . Due to its low incidence and late recognition, the optimal treatment modality is not well established. Surgery with free margins is the mainstay of treatment.

Obesity-Hypoventilation Syndrome - A Neglected Problem?

Obesity-hypoventilation syndrome (OHS) is the most severe complication of obesity, being burdened by numerous cardiovascular complications and an increase in the mortality rate. Late recognition of this syndrome is common. Approaching the patient with suspicion or confirmed with OHS requires a multidisciplinary team. Positive pressure treatment remains the first line therapy, with the highest efficiency. Weight loss should be recommended in all patients. Apparently, bariatric surgery is superior to lifestyle changes. Early detection and prompt treatment are of paramount importance to minimize adverse effects, which has necessitated consideration of this article.

Could routine pregnancy self-testing facilitate earlier recognition of unintended pregnancy? A feasibility study among South African women

IntroductionWe explored whether routine pregnancy self-testing is feasible and acceptable to women at risk of late recognition of pregnancy as a strategy to facilitate early entry into either antenatal or abortion care.MethodsA feasibility study among South African sexually active women not desiring pregnancy within 1 year, and not using long-acting or injectable contraceptives. At recruitment, we provided five free urine pregnancy tests for self-testing on the first day of each of the next 3 months. We sent monthly text reminders to use the tests with requests for no-cost text replies. Our main outcome was the proportion of participants self-testing within 5 days of the text reminder over three consecutive months. Other outcomes were ease of use of tests, preference for self-testing versus clinic testing, acceptability of routine self-testing (all binary responses followed by open response options) and response to text messages (four-point Likert scale).ResultsWe followed up 71/76 (93%) participants. Two confirmed new pregnancies at the first scheduled test and completed exit interviews, and 64/69 (93%) self-reported completing all three monthly tests. Self-testing was easy to do (66/71, 93%); advantages were convenience (21/71, 30%) and privacy (18/71, 25%), while the main disadvantage was no nurse present to advise (17/71, 24%). Most would recommend monthly testing (70/71, 99%). Text reminders were generally not bothersome (57/71, 80%); 35/69 (51%) participants replied with test results over all three months.ConclusionProviding free pregnancy tests to women at risk of late recognition of pregnancy is feasible to strengthen early confirmation of pregnancy status.

Open Fora

Just half a century ago, Malevich’s name was familiar to very few people. On a wave of international interest to the avant-garde, he became a world-famous artist. Kazimir Malevich (1879–1935) was born into a Polish family in Kyiv and created the Black Square (1915) in Moscow. These are the most important facts that todayallow three countries (Poland, Ukraine, and Russia) to consider him as their “own” artist. Art historians and curators actively research Malevich’s work, usually arguing that he belongs to the culture they themselves represent.This paper gives a brief overview of the discovery of Malevich in the West and of his late recognition in the USSR. It also deals with the growth of his popularity since the early 1980s, and provides examples of the current use of his name and work in cultural-political narratives. Malevich’s legacy has gone far beyond art history tobecome iconic in each of the three countries. Today the abstract visual language unseats realistic images due to its universal nature; pure abstract forms become incorporated with their three-dimensional configurations into urban spaces. Million-dollar prices at auctions encourage counterfeits, resulting in some huge scandals. Suprematist language is employed in a very broad range: from the tragic to the entertaining. Malevich becomes a “trump card” in national “decks.” It is precisely the international meaning of Malevich’s ideas that has caused national “competition” for this author.

Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

Our descriptive study examines the clinical profile of referred neonates who underwent exchange blood transfusion (EBT) and identifies possible interventions at peripheral hospitals to decrease their severe hyperbilirubinemia. Among the 38 neonates enrolled, the following were identified as potential clinical gaps in management: early discharge within 24 h of birth (57%); non-availability of ABORh blood grouping (43%); lack of anti-D immunoprophylaxis (75%); pathological weight loss because of inadequate breastfeeding (42%); and low usage of phototherapy. Because of late recognition, the mean age at admission was 5.4 ± 3.3 days, levels of total serum bilirubin (TSB) were 516.4 ± 123.1 µmol/L, and acute bilirubin encephalopathy (ABE) was seen in 45% of neonates. Rh iso-immunisation (39.5%), ABO iso-immunisation (21%) and sepsis (8%) were major risk factors for severe hyperbilirubinaemia. Quality prenatal screening identifying at-risk newborns, preventing early discharge after birth, a bilirubin nomogram risk assignment before discharge and assuring early recognition of hyperbiliubinaemia by parents may well minimise the incidence of EBT.

P0575TIME TO NEPHROLOGY CONSULTATION AND MORTALITY RISK IN COMMMUNITY ACQUIRED AKI

Background and Aims Acute Kidney Injury (AKI) is the most frequent cause of Nephrology consultation. Although time to nephrology consultation (TNC) has been object of study, few works focus on its influence on in-hospital mortality in patients with community acquired AKI (CA-AKI). Method We picked cases of CA-AKI, and divided individuals in dead in-hospital and survivors. We analyzed clinical and epidemiological variables, and categorized AKI with the KDIGO-2012 stages. We compared clinical outcomes and influence of TNC in mortality. Results We included 420 patients, 92 (22%) in the mortality group. These individuals were older, had higher Charlson’s Index, were hospitalized in critical care units, and were classified in KDIGO-2012 Stage 3 more frequently (Table 1). TNC was higher in the dead patients and was significantly associated with mortality HR 1.28 (CI 95% 1.03-1.55, P=0,009). In KDIGO Stages 1 and 2 TNC was shorter in the survivors group, and in Stage 3 we found no differences. In general wards (medical and surgical), TNC was higher in the mortality group, with no differences in the consults from critical units (Table 1). In the survival curves we observe a decline in survival in patients with TNC ≥2 days since admission (Figure 1). Conclusion We found that a longer TNC was associated with a poorer survival. This finding would indicate that earlier nephrology attention could impact in-hospital mortality. We interpret the longer TNC in less severe AKI stages as a warning of the unawareness and late recognition of AKI in other specialties. More well designed and larger studies are needed to prove that electronic alerts offer a survival benefit.