IntroductionWe analyzed the department and surgeon learning curves during implementation of the percutaneous internal ring suturing (PIRS) technique in our department.MethodsChildren proposed for inguinal hernia or communicating hydrocele repair were included (n = 607). After mentorship, all surgeons were free to propose open or PIRS repair. From gathered data, we assessed department and surgeon learning curves through cumulative experience focusing in perioperative complications, conversion, ipsilateral recurrence, postoperative complications, and metachronous hernia, with benchmarks defined by open repair.ResultsDepartment-centered analysis revealed that perioperative complications, conversion, and ipsilateral recurrence rates were higher in the beginning, reaching the benchmarks when each surgeon performed, at least, 35 laparoscopic repairs. Postoperative complications and metachronous hernia rates were independent from learning curves, with the metachronous hernia rate being significantly lower in PIRS patients. During the program, the percentage of males in those operated by PIRS progressively increased reaching the percentage of males, in our sample, when department operated over 230 cases.ConclusionThirty-five laparoscopic cases per surgeon are required for perioperative complications, conversion, and ipsilateral recurrence reach the benchmark. The gap between the percentage of males, in those operated by PIRS and in those proposed for surgery, monitors the confidence of the team in the program.

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for approximately 6.8 million deaths worldwide, threatening more than 753 million individuals. People with severe coronavirus disease-2019 (COVID-19) infection often exhibit an immunosuppression condition, resulting in greater chances of developing co-infections with bacteria and fungi, including opportunistic yeasts belonging to the Saccharomyces and Candida genera. In the present work, we have reported the case of a 75-year-old woman admitted at a Brazilian university hospital with an arterial ulcer in the left foot, which was being prepared for surgical amputation. The patient presented other underlying diseases and presented positive tests for COVID-19 prior to hospitalization. She received antimicrobial treatment, but her general condition worsened quickly, leading to death by septic shock after 4 days of hospitalization. Blood samples collected on the day she died were positive for yeast-like organisms, which were later identified as Saccharomyces cerevisiae by both biochemical and molecular methods. The fungal strain exhibited low minimal inhibitory concentration values for the antifungal agents tested (amphotericin B, 5-flucytosine, caspofungin, fluconazole and voriconazole), and it was able to produce important virulence factors, such as extracellular bioactive molecules (e.g., aspartic peptidase, phospholipase, esterase, phytase, catalase, hemolysin and siderophore) and biofilm. Despite the activity against planktonic cells, the antifungals were not able to impact the mature biofilm parameters (biomass and viability). Additionally, the S. cerevisiae strain caused the death of Tenebrio molitor larvae, depending on the fungal inoculum, and larvae immunosuppression with corticosteroids increased the larvae mortality rate. In conclusion, the present study highlighted the emergence of S. cerevisiae as an opportunistic fungal pathogen in immunosuppressed patients presenting several severe comorbidities, including COVID-19 infection.

Introdução: Em dezembro de 2019, surgiu na China o primeiro grupo de pessoas infectadas com o novo coronavírus, SARS-CoV-2, e em 2020 a doença atingiu proporções globais sendo classificada como uma pandemia. As manifestações dermatológicas da infecção por COVID-19 acontecem com uma frequência de 20% em doentes hospitalizados sem história de exposição a medicamentos nas duas semanas anteriores. Objetivo: Relatar manifestações urticariformes em paciente com COVID-19, sugerindo que tais lesões podem ser expressão do polimorfismo clínico dermatológico, apresentado durante a infecção pelo novo coronavírus. Relato de caso: Paciente de 27 anos apresenta quadro clínico inicial com coriza, tosse e fadiga. Evoluiu com anosmia, disgeusia e piora da tosse. No décimo dia de doença, o paciente apresentou lesões ponfosas de distribuição folicular e interfolicular que coalesciam e formavam placas eritematosas, pruriginosas, com duração de aproximadamente 30 minutos e resolução espontânea, localizadas no tronco e membros superiores e inferiores. O diagnóstico foi de urticária aguda relacionada à infecção pelo SARS-CoV2. Conclusão: A Covid-19 apresenta quadro clínico variável, com um amplo espectro de sintomatologia que abrange desde quadros assintomáticos até doença sistêmica grave. As lesões apresentadas pelo paciente já foram relatadas na literatura como sinais relacionados à infecção pelo SARS-CoV-2. É de suma importância a identificação de manifestações dermatológicas, sendo mais um dado relevante para suspeição de infecção, permitindo manejo sintomático e isolamento precoce para interromper a cadeia de transmissão da doença.

Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men.Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia 1 with uncertain etiopathogenesis and possible genetic influence that may be triggered by environmental factors. 2 It predominantly affects the vertex and occipital regions of Afro-descendent men. 1,2 Female DC is uncommon, and little is known about this condition in childhood. 3 Clinical findings vary according to