COVID-19: analysis of the risks of operating during the pandemic. What are the real perioperative complications in asymptomatic patients and how to optimize early diagnosis?

Introduction: Controlling dissemination as well as treating patients infected with the new coronavirus are global challenges. Despite the protocols and guidelines generated by the WHO and the leading medical societies that seek to control the pandemic, there are still few reports in the literature that show complications in the perioperative period of patients, initially asymptomatic, infected by COVID-19. This study aims to offer data to plastic surgeons beyond the scope of aesthetic and reconstructive surgeries. Methods: A review article was performed after selecting sixteen articles from PubMed. These were analyzed for their type, statistical relevance, number of participants, complications, and reported outcomes. Results: The mortality rate of patients with COVID-19 undergoing surgical procedures was higher than that estimated in infected patients who did not undergo these procedures. There were also increases in the patient's admission rate to intensive care units and the pulmonary complications rate. The main predictors of mortality were defined, besides the role of chest tomography for the diagnosis of COVID-19 in the perioperative period. Conclusion: It is essential to understand the risk of operating patients during the pandemic, even if asymptomatic. The increased risk of complications and mortality in elective and emergency surgeries requires disseminating adequate information to both doctors and patients. The objective, therefore, is not to define the medical conduct of surgeons, but to allow analysis in the decision-making process

Post-COVID-19 syndrome and plastic surgery: case report of a patient with return of respiratory symptoms in the postoperative period of reduction mammaplasty

Introduction: As the concept of post-COVID-19 syndrome emerges, the negative result of an RT-PCR test is no longer enough to represent a patient’s complete clinical recovery. In this context, a question arises: what are the risks of performing surgery on a patient whom COVID-19 has already infected? Case Report: Female patient, 36 years, infected by COVID-19 in December 2020, showing mild symptoms. Once asymptomatic and with a negative RT-PCR test, she was submitted to a breast reduction surgery, in January 2021, through the inferior pedicle technique by Liacyr Ribeiro and Nipple-Areolar Complex (NAC) ascension by Letterman maneuver. On the first postoperative day, the patient developed respiratory symptoms, which continued throughout the postoperative period. Despite the unsatisfactory treatment of partial necrosis of the right NAC, the patient maintained respiratory and systemic symptoms suggestive of the return of COVID-19 in the late postoperative period. Discussion: Post-COVID-19 syndrome is defined as the persistence of symptoms of COVID-19, for at least 6 months, after the acute phase of infection. The syndrome’s pathophysiology is not completely elucidated; however, a relationship with the Mast Cell Activation Syndrome is proposed. In the report, we emphasize the chronological proximity between SARS-CoV-2 infection and the return of respiratory and systemic symptoms suggestive of post-COVID-19 syndrome and the need to know the possible symptoms and complications of this syndrome, especially in the context of postoperative. Conclusion: The need for a thorough preoperative analysis in patients with a clinical history of COVID-19 infection is evident since there is a greater risk of postoperative complications

Anti-inflammatory effect of diclofenac diethylammonium gel on acute phase of ligature induced periodontitis in rats

This study aimed to evaluate the effect of a diclofenac diethylammonium gel 10 mg/g (DD) on acute phase of ligature induced periodontitis model in rats. Experimental Periodontitis Disease (EPD) was induced in 30 Wistar rats subjected to ligature placement on left molars. Animals were treated with (DD), immediately after (EPD) induction. Saline-based gel (SG) was utilized as negative control and DD gel 10 mg/g was the tested substance. Animals were randomly assigned into the groups. The periodontium and the surrounding gingiva were examined at histopathology, as well as the neutrophil influx into the gingiva was assayed using myeloperoxidase activity levels by ELISA method. DD treatment reduced tissue lesion at histopathology coupled to decreased myeloperoxidase activity production in gingival tissue when compared to the saline gel control group (p < 0.05). The DD gel was able to provide a significant myeloperoxidase decreasing in gingiva tissue confirming to be effective in reducing gingival inflammation in this model.Colegio de Farmacéuticos de la Provincia de Buenos Aire

The Practice of Letter Writing: Skills, Models, and Early Modern Dutch Manuals

Article / Letter to editorLeiden Univ Centre for LinguisticsLeiden Univ Centre for Linguistic

Soft boundaries for statically enforceable protection domains

As safe languages, such as Java, find themselves leveraged to run larger, multi-task applications, many of the security concerns historically solved by hardware enforced protection domains are again sneaking their way into code. Previous schemes to enforce protection domains within the Java language have accepted run-time overhead and severe limitations on sharing semantics as a reasonable cost to achieve security. This thesis proposes soft boundaries to attain the benefits of separation without additional run-time overhead and without compromising the Java semantics. Soft boundaries use static analysis to assist the programmer in isolating components, protecting both a program's data and its control flow. Soft boundaries can be deployed either independently or in conjunction with previous separation schemes to further bolster separation

THE GOVERMENT OFTHE UNITED STATES

795 hlm;14 x 22 c

A First-Class Approach to Genericity

This paper describes how to add first-class generic types--- including mixins---to strongly-typed OO languages with nominal subtyping such as Java and C#. A generic type system is &quot;first-class&quot; if generic types can appear in any context where conventional types can appear. In this context, a mixin is simply a generic class that extends one of its type parameters, e.g., a class C&lt;T&gt; that extends T. Although mixins of this form are widely used in C++ (via templates), they are clumsy and error-prone because C++ treats mixins as macros, forcing each mixin instantiation to be separately compiled and type-checked. The abstraction embodied in a mixin is never separately analyzed