Enterocolite Induzida por Proteínas Alimentares: Uma Etiologia Rara

Introdução: A enterocolite induzida por proteínas alimentares (EIPA) é uma forma de hipersensibilidade gastrointestinal alimentar não mediada por imunoglobulina E, sendo provavelmente mediada por células. A fisiopatologia permanece incerta. O leite de vaca e os cereais estão entre as causas mais comuns. O diagnóstico baseia-se na história clínica. Descrição do caso: Descreve-se um caso raro de enterocolite à batata numa criança com antecedentes pessoais e familiares irrelevantes. O doente recusou várias vezes a introdução da primeira sopa (cenoura e batata) e sempre que a ingeria apresentava quadro de vómitos incoercíveis com desidratação, mas sem necessidade de internamento. Os testes cutâneos por picada com extrato de batata foram negativos e a prova de provocação oral foi positiva. Comentários: Neste contexto salienta-se a importância de reconhecer o quadro clínico de EIPA e estar alerta para a possibilidade de envolvimento de proteínas alimentares menos frequentes com o objetivo de fazer um diagnóstico precoce e evitar terapêuticas desadequadasinfo:eu-repo/semantics/publishedVersio

Monitoring the production of AAV vectors in insect cells by fluorescence spectroscopy

Adeno-associated viruses (AAV) are among the most promising viral vectors for gene therapy, since they can transduce non-dividing cells from several tissues while maintaining a long-term gene expression. Besides, AAVs possess low immunogenicity compared to other viral vectors, and are physically resistant, which makes them resilient to industrial manufacturing conditions, long-term storage, and in vivo administration. One of the systems available for large scale production of AAVs is the insect cell-baculovirus expression vector system (IC-BEVS). Insect cells grow in suspension to high cell densities with modest growth requirements and without the need of serum supplementation. Consequently, scaling up the production in order to achieve the large number of AAV needed for clinical trials is more straight‑forward than with transfection-based systems. However, methods for online monitoring of AAV production are still lacking. Such methods would allow determination of the best time of harvest in real-time, thus allowing recovery of AAV as soon as its concentration medium was higher. Here we apply Fluorescence Spectroscopy to baculovirus-infected insect cell cultures producing adeno‑associated virus vectors, correlating the spectra to critical process parameters like cell concentration, viability and AAV concentration. Sf9 cells were co-infected with two baculovirus (expressing AAV rep and cap and a CMV-GFP transgene) at low or high multiplicities of infection (MOI), and the culture was followed by Fluorescence Spectroscopy in situ through a bioreactor probe. After an exploratory calibration using data from only one bioreactor, we attested the aptitude of this technique to capture overall data trend: using a 3 component PLS model, we have obtained a calibration NRMSE of 2.9% for total AAV particles per cell, 5.9% for viable cell density and 0.9% for viability). Additional bioreactor productions using different infection parameters (CCI, MOI, time of infection) allowed testing the robustness of fluorescence monitoring to process variability. With this dataset, we tested several pre-treatment methods for the raw spectra, as well as different regression algorithms in order to establish a good predictive model. Ultimately, fluorescence spectroscopy provides a simple tool for online monitoring of key process variables in baculovirus-infected insect cell cultures. Acknowledgments: Funding from Fundação para a Ciência e a Tecnologia, projects EXPL/BBBBIO/1129/2013 and Daniel Pais’ PhD research grant PD/BD/105873/2014

Pancreatite Aguda Necrosante — Caso Clínico

Os autores apresentam um caso clínico de Pancreatite Aguda Hemorrágica, de provável etiologia idiopática, numa criança de 10 meses, que se manifestou inicialmente por vómitos, e alteração do estado de consciência e posteriormente por abdómen agudo. O diagnóstico foi feito durante a laparotomia. Houve boa evolução clínica. Como complicações, refere-se o aparecimento de dois pseudoquistos pancreáticos que regrediram progressiva e espontaneamente

How the 'plates' of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil's Sao Paulo and Maranhao states

Background: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. Methods: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. Results: We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible–if insecure–working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. Conclusions: The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded