Introduction: Acute epididymitis (AE) in children usually responds to conservative therapy. However, in rare cases (1% to 2%), it may progress to severe complications such as testicular infarction or necrosis due to vascular compromise. We report a case of progressive segmental testicular necrosis following presumed post-infectious AE after a recent viral respiratory illness. Methods: An 8-year-old boy presented with a 2-day history of left testicular pain, swelling, and erythema. Initial Doppler ultrasound revealed epididymal enlargement, hyperemia, and reactive hydrocele without signs of torsion. Urine culture was collected, and empirical ibuprofen and trimethoprim-sulfamethoxazole were prescribed. Results: Six days later, symptoms worsened with increased swelling and pain. Repeat Doppler ultrasound demonstrated hypoechoic avascular areas and reduced flow, consistent with necrosis. Urine, blood, and smegma cultures were negative. Surgical exploration revealed extensive testicular necrosis without torsion, leading to simple orchiectomy. Histopathology confirmed ischemic necrosis secondary to an inflammatory process. The observed evolution supports the concept of TCS, in which rising intratesticular pressure due to venous congestion and extraluminal compression within the noncompliant tunica albuginea leads to impaired microcirculatory perfusion and ischemic necrosis. Conclusions: Testicular necrosis is an exceedingly uncommon but serious complication of AOE in children. Persistent pain, increasing testicular size, or poor clinical response should prompt early Doppler reassessment and consideration of surgical exploration. Recognition of TCS as a possible pathophysiological mechanism may help guide timely diagnosis and intervention to prevent irreversible ischemic injury.
Introduction: congenital hypopituitarism (CH) is an uncommon cause of pituitary insufficiency that may present with deficiency of one or more pituitary hormones. Early diagnosis and timely treatment are essential to prevent severe sequelae in growth, pubertal development, and quality of life. Objective: to describe the clinical, biochemical, imaging, and therapeutic characteristics of patients with CH followed at the Pereira Rossell Hospital between 2012 and 2022. Methods: descriptive, retrospective study. Patients aged 0 to 21 years with a diagnosis of CH were included. Clinical, hormonal, and imaging variables were analyzed. Descriptive statistics and Fisher's exact test (p < 0.05) were used. Results: twelve patients were included, with equal sex distribution. Nine were diagnosed before six months of age, mainly due to hypoglycemia and jaundice. In school age, the most frequent presentation was short stature. Combined hormonal deficiency predominated (83.3%), with the thyrotropic and corticotropic axes being the most affected (83.3%), followed by the somatotropic axis (75%). Umbilical cord TSH was normal in 91.7% of patients. Among those evaluated by magnetic resonance imaging, 91% showed structural abnormalities, most commonly hypoplastic or absent pituitary gland and ectopic neurohypophysis. No genetic studies were performed. One death was documented. Conclusions: CH presented with nonspecific symptoms during the neonatal period, making early diagnosis challenging. Hypoglycemia was significantly associated with early age at diagnosis. Hormonal deficiency was predominantly combined. Imaging abnormalities were frequent. The need for more sensitive diagnostic strategies is emphasized, including expanded newborn screening and genetic studies.
Abstract Introduction People with hearing disorders are prone to stigmatization and reduced access to education in many parts of the globe. Public policies often claim to be inclusive, but frequently, people with disabilities when seeking education or healthcare struggle to obtain holistic treatment provided by qualified professionals. When it comes to the deaf population, in our country, they have been marginalized in many aspects of society; access to health and sexual education are no exception to this problem. We emphasize the relevance of this problem since there are few related papers and it is important to give visibility to this community. Objective The aim of the present work was to elucidate the access that deaf women have to information on sexual and reproductive education. Methods We conducted an observational, descriptive and transversal study approved by the medical setting authorities and Ethics Board of the University as a collective approval for students monograph research. The setting is a specific outpatient clinic in our country that is the reference center in public health for the deaf population. The study was conducted with two samples of similar characteristics, one of them was a sample of hearing women and the other one with deaf or hearing-impaired women. The measurement instrument used for data collection consisted of a self-administered form that sought to characterize the population to be studied and to evaluate some aspects of the patients’ knowledge of sexual and reproductive education. The form was applied to a group of hearing-impaired women with the help of sign language interpreters and then to a group of hearing women from the same clinic. To assist women with hearing impairment, we contacted a group of sign language interpreters. Results We recruited a total of 26 deaf or hearing impaired women and a control group of 24 hearing women. 19 of the 26 deaf women were deaf since they were born, 6 of them use hearing devices and only 1 has a cochlear implant. More deaf women had not completed elementary school compared to control group. Access to information about female cancer, birth control, STI were significantly lower in the deaf group (p < 0.005). Information about legal termination of pregnancy and pregnancy was not significantly different among groups. In terms of access to sexual education, deaf women struggled more to obtain information and most of it was via internet. Conclusions The results revealed greater misinformation in deaf women, with the areas of greatest lack of knowledge being contraceptive methods, cancer prevention, and sexually transmitted infections. Sign language in our country is not learned in schools, although there are many groups of deaf persons, the access to this courses is not part of the educational or medical training. This work attempted to be a first approach in addressing this issue in deaf women. From a future perspective, we believe that further research is necessary in this population, as well as developing specific tools, and this is only possible if more human and financial resources are allocated. Disclosure No
