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ABSTRACT Objective To compare the epidemiological profiles of patients who experienced extubation failure with those who achieved success and to evaluate the impact of extubation failure on total mechanical ventilation duration. Methods An observational study with both retrospective and prospective components was conducted on patients admitted to the Pediatric Intensive Care Unit of a private hospital. This study included patients who underwent mechanical ventilation and were extubated between January 2017 and December 2022. Patients were classified into extubation Success or Failure Groups, with failure defined as requiring a return to invasive mechanical ventilation within 48hs post-extubation. Epidemiological factors, including age, pre-existing illnesses, and time on invasive mechanical ventilation, were analyzed. Results A total of 173 patients were included, of which 9 (5.2%) required reintubation within 48hs. The total duration of mechanical ventilation differed significantly between the Success Group (3 days [1.8; 6.6]) and the Failure Group (6.5 days [5.6; 9.3]), p=0.004. Upper airway obstruction was identified as the primary cause of extubation failure. Conclusion This study demonstrated that extubation failure doubled the total duration of mechanical ventilation compared to successful extubation. These findings highlight the importance of daily patient assessment with clearly defined clinical criteria to ensure mechanical ventilation is discontinued precisely when the patient is ready-neither prematurely nor excessively delayed.

Abstract in English:

ABSTRACT Objective Chemotherapy-induced nausea and vomiting are highly prevalent adverse events that can lead to poor treatment adherence and a decreased quality of life. To the best of our knowledge, the complete omission of dexamethasone from any regimen for preventing nausea and vomiting has not yet been evaluated. This study aimed to evaluate the efficacy of a three-drug protocol without corticosteroids for preventing nausea and vomiting. Methods This prospective, single-arm, phase II study was designed to evaluate the efficacy of olanzapine, netupitant, and palonosetron in controlling nausea and vomiting induced by emetogenic chemotherapy. Patients were assigned to receive olanzapine on days 1-5 and netupitant and palonosetron on day 1. No corticosteroids were administered. The primary endpoint was complete nausea control during the first 5 days after chemotherapy. Secondary endpoints included complete emesis control (no emesis and no use of rescue medication) and overall complete control (no emesis, no rescue medication, and no nausea). Results The complete nausea control rate was 46% (95% confidence interval [95%CI] 0.32-0.59). The emesis control rate was 68% (95%CI= 0.55-0.80), and the overall control rate was 46% (95%CI= 0.32-0.59). Conclusion These findings suggest that omitting dexamethasone in highly emetogenic chemotherapy is feasible and results in nausea and vomiting control rates similar to those of the standard four-drug protocol. However, randomized controlled trials are required to confirm this hypothesis.

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ABSTRACT Objective This study aimed to evaluate the clinical manifestations of SARS-CoV-2 in children and adolescents with cystic fibrosis. Methods This was a case-control analysis of clinical variables and pulmonary function test results in 43 children with cystic fibrosis, 17 (39.5%) of whom tested positive for SARS-CoV-2. Results The infected children exhibited a higher frequency of dyspnea and cough and a greater need for hospitalization. One infected child died. Pulmonary exacerbations were more frequent among the infected children. Additional data indicated a subsequent reduction in pulmonary function in the infected children, although this was not significantly different from that in the uninfected children. Conclusion Children with cystic fibrosis who contracted SARS-CoV-2 experienced mild to moderate symptoms and required hospitalization but generally had high recovery rates.

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ABSTRACT Objective To evaluate the quality indicators proposed by the American Academy of Neurology and Neuro-oncology Society in patients with primary intracranial central nervous system tumors. Methods This study is a retrospective level I analysis that used electronic medical records from the CERNER system and GDOC-SAME at the tertiary hospital. It was approved by the Research Ethics Committee and followed the Declaration of Helsinki. Data was collected and analyzed confidentially via REDCap. The research focused on patients 18 or older with primary central nervous system tumors who had surgery from August 2015 to August 2021. It excluded surgeries performed elsewhere, reoperations, secondary (metastatic) tumors, and primary central nervous system tumors outside the cranium. Results The results showed that 48% of the patients had gliomas, whereas 30 and 21.6% had meningiomas and other types of tumors. Quality measures showed that 35% of the patients with grade 2-4 tumors had multidisciplinary care plan discussions. All patients with gliomas underwent molecular testing and those eligible who underwent chemotherapy were educated and provided informed consent. Postoperative magnetic resonance imaging within 72h was performed in 87% of gliomas. The length of hospital stay, postoperative complications, Eastern Cooperative Oncology Group status at discharge, and 30-day status were also potential quality measures. However, for meningioma cases, readmissions were associated with patients in the American Society of Anesthesiologists II (58.33%) and American Society of Anesthesiologists III-IV (41.67%). Conclusion The study conclusions revealed that adherence to quality indicators was good; however, improvements are needed in multidisciplinary care plans and postoperative imaging. Quality measures can be enhanced by controlling factors such as American Society of Anesthesiologists and Eastern Cooperative Oncology Group scales at admission, epileptic seizure occurrence, neurological deficits, and tumor size in meningiomas. The study’s findings highlighted the importance of quality improvement programs for optimal medical care.

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ABSTRACT Objective To evaluate the effectiveness of Multiple Mini Interviews as a selection method for medical school admissions at the Faculdade Israelita de Ciências da Saúde Albert Einstein by evaluating the relationship between the Big Five personality traits and the performance of candidates in the Multiple Mini Interviews. Methods All candidates who had completed the NEO PI-R personality test and the socio-demographic questionnaire were the participants of the study. The personality profiles of candidates who participated in the Multiple Mini Interviews process of this cross-sectional descriptive study were analyzed by crossing data to identify significant correlations. Results Of the 225 candidates, 63% were female and the mean age of the sample was 21 years. Only the domain of Conscientiousness showed significant correlations with higher Multiple Mini Interviews scores (p=0.004). Specifically, traits of Conscientiousness such as Competence (p=0.046), Dutifulness (p=0.043), Achievement-Oriented (p=0.050) and Self-Discipline (p=0.028) were associated with better Multiple Mini Interviews performance. Other domains, like Neuroticism, Extraversion, Openness, and Agreeableness, showed no significant correlation. Additionally, socio-demographic factors had no significant impact on performance. Conclusion The findings validate the Multiple Mini Interviews as an effective method for medical school selection, as they correlate with high-value personality traits such as Conscientiousness, while not favoring irrelevant individualities. These results orient the enhancement of selection methods, ensuring a diverse and competent student body and, overall, improving medical education. The findings thus support the use of structured interviews in admission processes, highlighting their role in identifying candidates with essential qualities for success in medical education and practice, and offer valuable insights for similar educational institutions aiming to refine their selection methods.

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ABSTRACT Objective Ambulance transport time is an important metric in prehospital care. Limited studies have explored strategies to decrease on-scene time. We examined the effect of collecting telemedicine-based medical data during ambulance dispatch on the on-scene evaluation time of the prehospital team. Methods This randomized, single-center, open-label study included individuals aged >18 years who independently sought hospital emergency services and requested on-site emergency care. Individuals with primary trauma emergencies occurring outside the home, cardiac arrest cases, and situations in which video communication was unfeasible were excluded. Results Twenty patients were randomized to receive telemedicine assessment during ambulance dispatch or standard care with physician phone support. Both groups were comparable in age (53.2 ± 26.1 versus 63.4 ± 24.2 years, p=0.380), sex (50% versus 70% female, p=0.360), initial vital signs, and medical history. The main reasons for patients calls were falls from standing height (30%), followed by cardiovascular symptoms (20%), and acute neurological events (15%). Teleconsultation via a mobile application was successfully conducted in all cases. Furthermore, in situ interventions, including venous access, oxygen therapy, orthopedic immobilization, hypotension stabilization, and symptomatic treatment, were similar between the groups. The Telemedicine Group demonstrated a significantly shorter on-scene evaluation time (20.45 ± 6 min) than the Standard Group (36.80 ± 20.4 min, p = 0.019). Conclusion Conducting checklist-based anamnesis teleconsultation during ambulance dispatch considerably decreased the on-scene evaluation time of the emergency team. Further research with larger cohorts and different settings is required to better examine telemedicine’s potential in this context.

Abstract in English:

ABSTRACT Schizophrenia diagnostics have evolved to adapt to clinical needs and scientific advances, and the current denominations emerged at the beginning of the twentieth century. Most problems arise while integrating clinical experiences, based on historical psychopathological descriptions, with emerging translational neuroscience research. This study aimed to evaluate the state-of-the-art critics of the current schizophrenia concept and their recommendations for new concepts. We performed a narrative review of the literature and searched for studies published in English in PubMed in the last 2 years which discussed the diagnosis of schizophrenia. Two authors independently selected the studies after analyzing the abstracts. Subsequently, studies were selected for this review by consensus. Twenty-six studies were selected, and all authors, except two, had restrictions on the current categorical model for the diagnosis of schizophrenia owing to the heterogeneity of symptomatology and high frequency of comorbidity. Eight studies proposed changes to the concept of schizophrenia. The central proposition was to adopt psychotic syndrome as a core feature instead of the current concept of schizophrenia. We synthesize these proposals using psychosis as a spectrum that includes schizophrenia as a more severe case at the end of the spectrum.

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ABSTRACT Introduction Traumatic brain injury is a leading cause of death and disability. Tranexamic acid, an antifibrinolytic agent, holds the potential for managing intracranial hemorrhages secondary to traumatic brain injury. However, its efficacy and safety remain subjects of ongoing debate. Objective To better clarify the efficacy and safety of tranexamic acid in that context and to evaluate the need for further studies. Methods We conducted a comprehensive search of seven electronic databases, eight study repositories, and tertiary sources between January 2021 and 2022 for randomized controlled trials involving victims of traumatic brain injury aged 15 or older who received tranexamic acid versus placebo or standard care. The primary outcomes were all-cause mortality and hemorrhagic complications during treatment. This review incorporated elements of PRISMA guidelines, Cochrane’s Risk of Bias assessment, and GRADE to assess evidence quality. Sensitivity analyses were also conducted. Results Out of 6,958 references retrieved, 14 of the 17 randomized controlled trials were analyzed, encompassing a total of 15,017 patients. Analyses for all-cause mortality did not reach statistical significance (RR= 0.95, 95%CI= 0.88-1.02 | trial sequential analysis RR= 0.95, 95%CI= 0.87-1.03). However, the analysis of hemorrhagic complications during treatment showed statistical significance for progressive intracranial hemorrhage (RR= 0.82, 95%CI= 0.68-0.99 | trial sequential analysis RR= 0.82, 95%CI= 0.38-1.78). Analyses of secondary outcomes, namely unfavorable neurological outcome and other adverse effects, did not demonstrate statistical significance. Conclusion Tranexamic acid use did not demonstrate efficacy based on all-cause mortality but showed a favorable safety profile. Additional clinical trials may shed light on remaining clinical uncertainties. Prospero database registration: CRD42021221949.

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ABSTRACT Diabetes mellitus is a highly prevalent human endocrine disorder. Skin lesions are reported in approximately one-third of all diabetes mellitus patients. The clinical presentation and frequency vary according to the subtype of diabetes mellitus, metabolic control, and clinical course, with certain skin diseases occurring before diagnosing hyperglycemia. In this regard, the correct definition of cutaneous manifestations associated with diabetes mellitus can help define the etiology of hyperglycemia as well as the need to optimize glycemic control. In this narrative review, the most common cutaneous diseases observed in diabetes mellitus are discussed, including pruritus, acanthosis nigricans, necrobiosis lipoidica, bullosis diabeticorum, scleroderma diabeticorum, granuloma annulare, diabetic dermopathy, skin reactions due to device use, diabetic foot ulcers, recurrent cutaneous infections in diabetes mellitus and other dermatoses associated with hyperglycemia. The epidemiology, pathophysiology, differential diagnosis, and treatment of this disease are discussed. Therefore, knowledge and recognition of the most common dermatological lesions in patients with diabetes mellitus are essential for both endocrinologists and primary care physicians.

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ABSTRACT Background Child immunization plays a critical role in preventing numerous diseases. However, the COVID-19) pandemic has profoundly disrupted healthcare systems globally, including routine child vaccination programs. Objective To provide an overview of the reduction in vaccine coverage among infants and children during the pandemic and analyze the potential impacts of decreased child immunization during this period. Methods A comprehensive search was conducted using the MeSH terms “Child,” “Vaccination”, and “COVID-19,” along with their synonyms. Systematic reviews published between March 11, 2020, and June 1, 2023, in Portuguese or English were included. Databases searched included PubMed, BVS (Biblioteca Virtual em Saúde), Embase, and Scopus. Two blinded independent reviewers performed the selection process, with conflicts resolved by a third reviewer. The AMSTAR-II tool was used to assess the methodological quality of the included studies. Results Of the 1,534 eligible articles, only 13 addressed the pandemic’s impact on children’s vaccination coverage. Most studies involved multiple countries and reported a significant decrease in children’s vaccination coverage due to the COVID-19 pandemic. Conclusion The findings were heterogeneous but consistently highlighted the substantial impact of the COVID-19 pandemic on routine vaccination coverage in most countries. Further research is needed to explore the epidemiological consequences of disruptions to vaccination schedules, potentially guiding public policies and raising awareness about the importance of adhering to health protection programs.

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ABSTRACT Objective: To compare the effectiveness and safety of phacoviscocanalostomy and phacotrabeculectomy in treating combined glaucoma and cataracts. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. The PubMed, Web of Science, Cochrane, and Embase databases were searched for randomized controlled trials or observational studies comparing phacotrabeculectomy to phacoviscocanalostomy in patients with glaucoma and cataracts. Statistical analysis was used to compare the efficacy (intraocular pressure reduction, mean deviation of the visual field, and failure rates) and safety (general complication rate and rates of hyphema, hypotony, perforation, and intraocular pressure spikes) between the two procedures. Results: The study included 331 eyes from one randomized controlled trial and two non-randomized controlled trials, with 154 undergoing phacoviscocanalostomy and 177 undergoing phacotrabeculectomy. The results indicated no significant differences in surgical failure rates, mean deviation of the visual field, and intraocular pressure at one, three, six, and twelve months between the phacoviscocanalostomy and phacotrabeculectomy groups. Furthermore, although the overall complication rate between the two procedures showed no difference, the rate of intraocular pressure spikes was higher in patients who underwent phacoviscocanalostomy. Conclusion: Phacotrabeculectomy and phacoviscocanalostomy are effective treatments for glaucoma and cataracts. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42024502391.

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ABSTRACT Objective To evaluate the prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. Methods This scoping review was conducted following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) tool to ensure methodological rigor. We systematically searched PubMed, Embase, Scopus, Lilacs, and Web of Science databases to identify relevant literature published between 2018 and 2023. Results Twenty-four studies were included, mostly single-center studies from six continents, with varying study designs: 16 cross-sectional, seven retrospective, and one prospective cohort. The most prevalent autoimmune diseases found among patients with type 1 diabetes mellitus enrolled in these studies were autoimmune thyroiditis (5.5-41.2%), celiac disease (0.45-24.8%), rheumatoid arthritis (0.4-5.1%), and primary adrenal insufficiency (0.6-2.6%). Conclusion Autoimmune thyroiditis and celiac disease were the most prevalent autoimmune diseases in patients with type 1 diabetes mellitus. As the complexity of managing type 1 diabetes mellitus increases in the presence of multiple autoimmune comorbidities, further studies are required to elucidate the relationship between type 1 diabetes mellitus and different autoimmune pathologies. A deeper understanding of these associations will guide the development of public health policies, screening strategies, and educational initiatives tailored to the specific needs of this population.

Abstract in English:

ABSTRACT Purpose of review Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery. Recent findings Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.

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ABSTRACT Food allergies are the leading cause of anaphylaxis in children. Cofactors, such as exercise and non-steroidal anti-inflammatory drugs, may influence the occurrence and severity of allergic reactions to food. However, despite their relevance, the underlying mechanisms of cofactor-enhanced food allergies remain poorly understood. We report the case of a 12-year-old girl with mitochondrial DNA depletion syndrome who was referred to an allergy appointment due to suspected ibuprofen hypersensitivity. Detailed anamnesis, laboratory assessment, and negative drug challenge results excluded this diagnosis; however, continued follow-up revealed a crucial pattern on patient reactions that led to the diagnosis of a cofactor-enhanced food allergy with the presumed involvement of soy storage proteins and non-steroidal anti-inflammatory drugs. Our purpose was to highlight the non-negligible role of cofactors in food allergies and the importance of early identification. Moreover, to underscore the relevance of maintaining patient follow-up, as new information may arise and redirect the diagnosis.

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ABSTRACT Kabuki syndrome is a rare congenital malformation with typical facial features, skeletal anomalies, delayed neuropsychomotor development and growth, and cardiac, genitourinary, gastrointestinal, endocrine, and dental anomalies. One of the main differential diagnoses is CHARGE syndrome, standing for and characterized by Coloboma of the eye, Heart defects, Atresia of the nasal choanae, Restricted intellectual development, Genitourinary malformations, and Ear anomalies. Because these syndromes have similar characteristics, distinguishing them may be challenging. A 24-year-old male patient admitted with reduced renal function had a previous phenotype-based diagnosis of CHARGE syndrome based on many characteristic clinical features. The unveiling of a hypocalcemic crisis diagnosed as primary hypoparathyroidism at the age of 15 years, which did not fit into that diagnosis, led the nephrologist to request a genetic test, which evidenced a missense variant of uncertain significance in exon 38 of the KMT2D gene. This phenotype further suggested Kabuki syndrome, ruling out CHARGE. The present report highlights the importance of genetic testing and discusses phenotype-genotype correlations, which ultimately showed that specific variants in exon 38 rendered a form of Kabuki syndrome distinct from the typical one.

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ABSTRACT Dengue, a vector-borne acute febrile illness caused by members of the Flavivirus genus, has dramatically increased its occurrence worldwide. Neurological complications of dengue range from 2.63 to 40%, and subarachnoid hemorrhage is a rare, but significant manifestation. Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome, sometimes secondary to infections such as dengue. This report presents a rare case of severe dengue with subarachnoid hemorrhage and hemophagocytic lymphohistiocytosis. A 19-year-old male presented with a 7-day history of fever and myalgia, followed by severe headache and vomiting. Initial examination revealed high fever, hepatosplenomegaly, and pancytopenia. Lumbar puncture confirmed via computed tomography showed a Fisher Grade 2 subarachnoid hemorrhage with a small aneurysm at the junction of the left anterior coronary and anterior communicating arteries. Secondary hemophagocytic lymphohistiocytosis was diagnosed based on the criteria from 2004, with elevated inflammatory markers, hypertriglyceridemia, and hyperferritinemia. The patient was treated conservatively with intravenous fluids, osmotic diuretics, antiepileptics, steroids, and nimodipine. The patient showed clinical improvement and was discharged on the 11th day. Isolated subarachnoid hemorrhage is rare in dengue. The hyperinflammatory state in hemophagocytic lymphohistiocytosis, which is often overlooked due to nonspecific symptoms, can lead to aneurysm formation and rupture. Persistent fever, cytopenia, and hyperferritinemia should raise suspicion of hemophagocytic lymphohistiocytosis in cases of severe dengue with neurological complications. In patients with severe dengue and intracranial hemorrhage, clinicians should remain cautious for hemophagocytic lymphohistiocytosis to reduce the associated morbidity and mortality.

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ABSTRACT Azacitidine is a hypomethylating agent recommended for the treatment of patients with high-risk myelodysplastic syndromes. Here, we report the case of a patient with myelodysplastic syndrome who was not eligible for allogeneic stem cell transplantation (allo-SCT) and presented with a rare and previously unreported cutaneous side effect after the use of subcutaneous azacitidine. We propose that changing the route of azacitidine administration from subcutaneous to intravenous could potentially decrease the occurrence of bullous pemphigoid-like localized toxic reactions in some patients.

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ABSTRACT A 49-year-old woman presented with a 16-year history of burning pain, warmth, redness, and edema in both toes, feet, legs and calves. Despite extensive medical testing, including genetic analysis, no specific cause was identified. Initial treatments failed to improve symptoms, leading to impaired quality of life and mental health. Eventually, a six-month course of intravenous immunoglobulin therapy provided complete relief, allowing the patient to resume normal activities. Erythromelalgia is a rare neurovascular condition characterized by pain, warmth, and erythema in the extremities. It can manifest as primary, inherited or sporadic, or secondary to underlying conditions, such as hematological neoplasms. Although genetic studies suggest a pivotal role of a gain-of-function mutation in the Nav1.7 voltage-gated sodium channel in familial cases, the pathogenesis underlying sporadic adult-onset cases remains uncertain. The frequent coexistence of autoimmune connective tissue diseases and the expanding evidence supporting immunotherapies in idiopathic small-fiber neuropathies underscores the possible involvement of adaptive immunity in such conditions. Given the potential complications in untreated patients, risks associated with long-term opioid therapy, and the absence of disease-modifying strategies, intravenous immunoglobulins may offer a more effective approach to pain control than conventional pain relievers, representing a promising direction for understanding the pathogenesis of erythromelalgia.

Abstract in English:

ABSTRACT The etiologies of vulvar nodules range from infectious to neoplastic. Owing to the wide spectrum of vulvar diseases, clinical differentiation of the lesions is crucial for adequate diagnosis and management. A 46-year-old patient presented with a nodular lesion in the vulvar region that had been growing slowly for 10 years. Gynecological examination revealed the presence of a solid nodular lesion measuring approximately 3 cm in the middle third of the right labia majora without phlogistic signs or secretion discharge. The lesion was excised and an anatomopathological study revealed a nodular hidradenoma. Nodular hidradenoma is a rare benign neoplasm of the apocrine glands that mainly affects women between 30 and 60 years of age. Although generally asymptomatic, some symptoms have been described, such as itching, pain, ulceration, or secretory discharge. The diagnosis was made by an anatomopathological study, and treatment consisted of total excision of the lesion without the need to enlarge the margin. During the investigation, malignant lesions such as liposarcoma of the vulvar region and non-melanoma skin cancers were excluded. Differential diagnosis is important because it requires a more invasive approach and surgical margins. This report aimed to expand the knowledge of the diagnosis of vulvar hidradenoma to exclude the possibility of malignant neoplasia while caring for vulvar nodules, thereby allowing proper management of the case.

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ABSTRACT Moebius Syndrome is a genetic condition that results in inability for facial mimicry due to palsy of cranial nerves VI and VII. Syringomyelia is characterized by a dilation of the central canal in the spinal cord, and is generally asymptomatic. Both disorders are diagnosed using imaging tests. A newborn with no facial movements upon physical examination was admitted to the delivery room of our hospital. A specialist confirmed the condition to be Moebius Syndrome. Further investigation using magnetic resonance imaging indicated that syringomyelia was associated with Moebius Syndrome. Given that syringomyelia is a silent myelopathy with a possible impact on the future health of the patient, careful analysis is recommended when diagnosing Moebius Syndrome. Few similar cases have been reported to date. Further studies are warranted to determine the actual association between these two conditions. Since syringomyelia diagnoses are often made when testing for other conditions, as in this study, neurological examinations of the brain should be expanded to include the spinal cord, in order to verify the presence of coexisting disorders.

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ABSTRACT Fungal infections have become a public health problem owingdute to their progressive increase in recent decades and high morbidity rates. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. Trichosporon spp. are yeast-like basidiomycetes, with Trichosporon asahii being the most common pathogenic species. This article describes a rare case of tenosynovitis caused by Trichosporon asahii in an immunocompetent patient. Treatment with voriconazole resulted in an excellent clinical response.

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ABSTRACT Chryseobacterium indologenes is a Gram-negative aerobic bacillus commonly found in nosocomial environments, particularly in patients with prolonged hospital stays or those requiring long-term invasive devices. It primarily affects elderly and immunocompromised individuals. This microorganism is associated with multidrug resistance, which is a crucial factor in treatment decisions. Here, we report a case of C. indologenes infection in an infant following the ingestion of milk formula diluted with untreated water.