SUMMARYHyperamylasemia has been reported in more than 65% of patients with severe leptospirosis, and the true diagnosis of acute pancreatitis is complicated by the fact that renal failure can increase serum amylase levels. Based on these data we retrospectively analyzed the clinical and histopathological features of pancreas involvement in 13 cases of fatal human leptospirosis. The most common signs and symptoms presented at admission were fever, chills, vomiting, myalgia, dehydratation, abdominal pain and diarrhea. Trombocytopenia was evident in 11 patients. Mild increased of AST and ALT levels was seen in 9 patients. Hyperamylasemia was recorded in every patient in whom it was measured, with values above 180 IU/L (3 cases). All patients presented acute renal failure and five have been submitted to dialytic treatment. The main cause of death was acute respiratory failure due to pulmonary hemorrhage. Pancreas fragments were collected for histological study and fat necrosis was the criterion used to classify acute pancreatitis. Histological pancreatic findings were edema, mild inflammatory infiltrate of lymphocytes, hemorrhage, congestion, fat necrosis and calcification. All the patients infected with severe form of leptospirosis who develop abdominal pain should raise the suspect of pancreatic involvement.

Endometriosis can have several different presentations, including overt ascites and peritonitis; increased awareness can improve diagnostic accuracy and patient outcomes. We aim to provide a systematic review and report a case of endometriosis with this unusual clinical presentation. The PubMed/MEDLINE database was systematically reviewed until October 2016. Women with histologically-proven endometriosis presenting with clinically significant ascites and/or frozen abdomen and/or encapsulating peritonitis were included; those with potentially confounding conditions were excluded. Our search yielded 37 articles describing 42 women, all of reproductive age. Ascites was mostly hemorrhagic, recurrent and not predicted by cancer antigen 125 (CA-125) levels. In turn, dysmenorrhea, dyspareunia and infertility were not consistently reported. The treatment choices and outcomes were different across the studies, and are described in detail. Endometriosis should be a differential diagnosis of massive hemorrhagic ascites in women of reproductive age.

Background and Objectives: Transfusion is one of the most performed medical procedures. Wrong indications are common and are probably related to the scarcity of transfusion teaching during medical education. The development of a new way to improve transfusion education is paramount. Social media has the potential to reach larger audiences for rapid communication of medical content. The use of social media for transfusion education in Brazil has not been published. The aim of this article is to describe a new tool to improve transfusion learning. Materials and Methods: Evidence-based cards were created. Initially, these cards were sent by WhatsApp. Later, Instagram and Facebook pages were created.EducaSangue, as this e-learning project was called, is a tool for the spreading of transfusion knowledge that permits the exchange of experiences.Results: By April 2021, Facebook and Instagram pages had 8300 and 5100 followers, respectively. Cards about single red blood cell (RBC) unit, alternatives to transfusion, transfusion reactions and pre-transfusion tests were published. Doctors and other health professionals follow EducaSangue. RBC transfusions reduced in Ceara and single-unit RBC increased by 28%, although not statistically significant. In Brazil, the minority of medical schools have transfusion as a discipline. The scarcity of transfusion education is related to the poorer care of the patient. Technological innovation has been used for educational changes and is an alternative to formal education. Conclusion:Social media is an interesting tool to provide quality to medical services, since they can reach a broader public, especially where personal contact is difficult.patient blood management, transfusion medicine, transfusion therapy Highlights• This is the first article that evaluates the use of social media in transfusion medicine education in Brazil.• Social media is a powerful tool to improve transfusion safety and patient blood management.

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