Nodular hidradenoma is an uncommon cutaneous adnexal tumor arising from sweat glands. In the skin, it usually presents as a solitary dermal nodule; excision is curative in most cases. In rare instances, it may present as a breast mass and can mimic breast carcinoma clinically and radiologically, causing diagnostic dilemmas for the treating physician and pathologist. Herein, we discuss a case of nodular hidradenoma in a 20-year-old Hispanic woman as a rapidly growing mass in the breast that mimicked breast carcinoma. We discuss the rare presentation of this uncommon tumor and the differential diagnosis of this entity, as well as the results of our literature review on the topic.

The management of primary immune thrombocytopenia (ITP) is becoming a subject of interest as there appears to be treatment failure and resistance to modern conventional treatment, necessitating a more universal and goal-directed approach to management. Our patient is a 74-year-old male who was diagnosed with ITP six years ago and recently presented to the emergency department (ED) with complaints of melena stools and severe fatigue lasting for two days. Prior to the ED presentation, he had received multiple lines of treatment including splenectomy. On admission, the pathology after splenectomy showed a benign enlarged spleen with a focal area of intraparenchymal hemorrhage/rupture and changes compatible with ITP. He was managed with multiple platelet transfusions, IV methyl prednisone succinate, rituximab, and romiplostim. His platelet counts improved to 47,000, and he was discharged home on oral steroids with outpatient hematology follow-up. However, in a few weeks, his condition deteriorated, and he presented with an increased platelet count and further multiple complaints. Romiplostim was discontinued, and he was continued on prednisone 20 mg daily, after which he improved, and his platelet count reduced to 273,000 on 20 mg prednisone. This case calls attention to the need to review the role of combination therapy in treating refractory ITP and the prevention of complications of thrombocytosis secondary to advanced therapy. Treatment needs to be more streamlined, focused, and goal-directed. Escalation and de-escalation of treatment should be synchronized to prevent adverse complications from overtreating or undertreating.

Bulletin the National academy of sciences of the Republic of Kazakhstan 2 NAS RK is pleased to announce that Bulletin of NAS RK scientific journal has been accepted for indexing in the Emerging Sources Citation Index, a new edition of Web of Science. Content in this index is under consideration by Clarivate Analytics to be accepted in the Science Citation Index Expanded, the Social Sciences Citation Index, and the Arts & Humanities Citation Index. The quality and depth of content Web of Science offers to researchers, authors, publishers, and institutions sets it apart from other research databases. The inclusion of Bulletin of NAS RK in the Emerging Sources Citation Index demonstrates our dedication to providing the most relevant and influential multidiscipline content to our community. Қазақстан Республикасы Ұлттық ғылым академиясы "ҚР ҰҒА Хабаршысы" ғылыми журналының Web of Science-тің жаңаланған нұсқасы Emerging Sources Citation Index-те индекстелуге қабылданғанын хабарлайды. Бұл индекстелу барысында Clarivate Analytics компаниясы журналды одан əрі the Science Citation Index Expanded, the Social Sciences Citation Index жəне the Arts & Humanities Citation Index-ке қабылдау мəселесін қарастыруда. Web of Science зерттеушілер, авторлар, баспашылар мен мекемелерге контент тереңдігі мен сапасын ұсынады. ҚР ҰҒА Хабаршысының Emerging Sources Citation Index-ке енуі біздің қоғамдастық үшін ең өзекті жəне беделді мультидисциплинарлы контентке адалдығымызды білдіреді. НАН РК сообщает, что научный журнал «Вестник НАН РК» был принят для индексирования в Emerging Sources CitationIndex, обновленной версии Web of Science. Содержание в этом индексировании находится в стадии рассмотрения компанией Clarivate Analytics для дальнейшего принятия журнала в the Science Citation Index Expanded, the Social Sciences Citation Index и the Arts & Humanities Citation Index. Web of Science предлагает качество и глубину контента для исследователей, авторов, издателей и учреждений. Включение Вестника НАН РК в Emerging Sources Citation Index демонстрирует нашу приверженность к наиболее актуальному и влиятельному мультидисциплинарному контенту для нашего сообщества.

BACKGROUND:We report a case of a premature newborn girl with a hospital course complicated by suspected respiratory syncytial virus pneumonitis for which she was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Despite phototherapy, her total bilirubin steadily increased to a peak of 50.4 mg/dL with concern for bilirubin-induced neurologic dysfunction, kernicterus. STUDY DESIGN AND METHODS: Therapeutic plasma exchange (TPE) was achieved via connection with the VA-ECMO circuit. Our institution's standard apheresis procedural parameters were adjusted to account for the small body weight and thus the low blood volume of the neonate while on ECMO. These included calculating the total blood volume to include the patient as well as the ECMO circuit, priming of the apheresis instrument with packed red blood cells to limit the extracorporeal volume, using a lower inlet flow rate, the connection setup of the inlet and return line, and monitoring of ionized calcium and anticoagulation throughout the procedure. RESULTS: A total of three TPE procedures were performed over three consecutive days. This resulted in improvement and stabilization of the patient's bilirubin. CONCLUSION: This case emphasizes that TPE is feasible on a neonate with a suboptimal body weight and thus a low blood volume due to the increased blood volume provided while on ECMO. In the absence of ECMO, whole blood manual exchange transfusion is recommended as TPE would be unsafe due to significant extracorporeal volume that would occur during TPE in a pediatric patient with low body weight.

AJCP / Meeting AbstrActs oxyhemoglobin to methemoglobin. We present a case of severe methemoglobinemia that resolved rapidly with red blood cell exchange (RBCX). The patient is a 57-year-old African-American woman with stage IV rectal adenocarcinoma, hepatitis C, arthritis, and bipolar disorder who was admitted to the hospital with a partial small bowel obstruction, for which she was treated conservatively. On hospital day five, the patient developed acute confusion and diaphoresis, and her oxygen saturation was noted to be 73%-75%. ABG was drawn, the blood was noted to be chocolate brown, and the methemoglobin level was too high to be quantitated (on three separate co-oximeters). The patient admitted to going through almost two bottles of HurriCaine spray (benzocaine) that morning for her sore throat. Methylene blue was considered for treatment, but the patient was on three different selective serotonin reuptake inhibitors at the time and there was concern for the precipitation of serotonin syndrome. Ascorbic acid was also considered, but the hospital did not have sufficient quantities on hand. The decision was made to proceed with RBCX. Using the Spectra Optia Apheresis system (Terumo BCT, Lakewood, CO), a 2.0 RBC volume RCBX was completed, using nine units of leukocyte-reduced type A positive packed red blood cells. Rinseback was not done. After the 108-minute uncomplicated procedure, the patient's methemoglobin level was 5.8%, and she subjectively felt much better and no longer had signs of cyanosis. Her O 2 saturation was 97% on 2L nasal cannula, and the methemoglobin level was 1.7% 11.5 hours after the RBCX. Fewer than 10 cases of RBCX for methemoglobinemia have been published. Objectives: A premature baby girl with a complicated hospital course developed RSV pneumonitis at 2 months of age for which she was placed on extracorporeal membrane oxygenation (ECMO). In spite of earlier phototherapy, bilirubin was steadily increasing and reached 50.4 mg/dL with concern for bilirubin induced neurologic dysfunction. Exchange transfusion was not recommended due to patient instability and risk of significant deterioration while on ECMO. Plasma exchange (PLEX), although not a recognized as a category treatment option for hyperbilirubinemia by the American Society for Apheresis (ASFA), was suggested as an alternative management option. We present a case of successful management of hyperbilirubinemia by PLEX in a premature baby while on ECMO. Methods: PLEX was done via connection with the ECMO circuit. Parameters were appropriately adjusted for the small body weight and ECMO circuit. For the procedure we used all fresh frozen plasma with plasma volume exchange between 1.0 and 1.3. We also primed the apheresis machine with packed red blood cells to minimize volume loss in tubing systems. Results: A total of three procedures were done daily and resulted in rapid improvement and stabilizing of bilirubin level. The procedure was very effective and well tolerated. Despite stabilizing the bilirubin level, the patient ultimate...