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Background. With treatment for breast cancer, women treated may present significant sensory abnormalities in the upper extremity. However, there are no conclusive studies that have evaluated pressure pain thresholds (PPT) in the shoulder of postoperated women for breast cancer. The aim of this study was to compare PPT in the shoulder, stress, anxiety, depression symptoms, and quality of sleep among postoperated women for breast cancer (PO group) and asymptomatic women of shoulder pain (control group). Methods. 40 women participated ( n = 20 , PO group, age: average ± standard deviation , 49.2 ± 8.3 years; body mass index (BMI): 27.5 ± 3.0 kg/cm2; surgery time: 22.2 ± 34.4 months; n = 20 , control group, 46.9 ± 8.1 years; BMI: 26.8 ± 3.5 kg/cm2). The PPT was evaluated with a digital algometer at 32 points in the shoulder region and one control point in the tibialis anterior. Stress, anxiety, and depression were evaluated with the Depression, Anxiety and Stress Scale 21 (DASS-21) and the quality of sleep by the Pittsburgh Sleep Quality Index. Results. Significant differences were observed over 1.5 kgf/cm2 in 33 points evaluated ( p < 0.01 ) with a small to high effect size (Cliff’s delta range = 0.16 ; 0.92) and higher levels of anxiety and stress in the PO group (anxiety: median [first; third quartile], 5[3; 12.5]; stress: 9.7 ± 4.7 (7.8; 11.8)) in comparison with the control group (anxiety: 2.5[1; 4.8]; stress: 6.7 ± 3.31 (5.2; 8.3), ( p < 0.05 )). No significant differences were found between the groups in depression and sleep quality ( p > 0.05 ). Conclusion. Postoperated women for breast cancer present hyperalgesia in the shoulder anterior and posterior region, low PPT in the tibialis anterior, and higher levels of stress and anxiety compared to the control group.

Background During the severe acute respiratory syndrome Coronavirus 2 pandemic, there has been an increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome during the severe acute respiratory syndrome Coronavirus 2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain, and Pakistan with multi‐system inflammatory syndrome in children and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings, and initial therapies. A total of 55 patients presented with multi‐system inflammatory syndrome in children. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion, and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required intensive care unit admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), D‐dimer, and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular block, transient atrioventricular block, and ventricular tachycardia. Conclusions To our knowledge, we describe the first international cohort of pediatric patients with multi‐system inflammatory syndrome in children during the severe acute respiratory syndrome Coronavirus 2 pandemic with a range of cardiac manifestations. This article brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

The majority of patients with coronavirus disease 2019 (COVID-19) display pulmonary disease; however, a significant portion of patients have cardiac injury as well, with a high incidence of myocarditis documented in the adult population. Pediatric disease from COVID-19 has been relatively rare, and no cases of virus-related cardiac disease have been published. We present a case of an adolescent girl with fulminant myocarditis with complete heart block, elevated troponin I levels, and severely depressed systolic function in the setting of COVID-19 infection.

Background Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases. Objective We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios. Methods Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6). Results Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups. Conclusions Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.

We discuss an unsupervised technique for determining morpheme structure of words in an inflective language, with Spanish as a case study. For this, we use a global optimization (implemented with a genetic algorithm), while most of the previous works are based on heuristics calculated using conditional probabilities of word parts. Thus, we deal with complete space of solutions and do not reduce it with the risk to eliminate some correct solutions beforehand. Also, we are working at the derivative level as contrasted with the more traditional grammatical level interested only in flexions. The algorithm works as follows. The input data is a wordlist built on the base of a large dictionary or corpus in the given language and the output data is the same wordlist with each word divided into morphemes. First, we build a redundant list of all strings that might possibly be prefixes, suffixes, and stems of the words in the wordlist. Then, we detect possible paradigms in this set and filter out all items from the lists of possible prefixes and suffixes (though not stems) that do not participate in such paradigms. Finally, a subset of those lists of possible prefixes, stems, and suffixes is chosen using the genetic algorithm. The fitness function is based on the ideas of minimum length description, i.e. we choose the minimum number of elements that are necessary for covering all the words. The obtained subset is used for dividing the words from the wordlist. Algorithm parameters are presented. Preliminary evaluation of the experimental results for a dictionary of Spanish is given.