Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation : pharmaceutical care contribution

Background: Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration. Objective: This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT. Methods: The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range. Results: Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004). Conclusion: The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant

Producción imaginativo-reflexiva infantil en talleres clínico-narrativos

El trabajo se centra en la variable subjetiva del aprendizaje: busca identificar las transformaciones psíquicas de seis niños en su tránsito por un dispositivo clínico mediado por cuentos (taller narrativo). El trabajo de campo se desarrolló en una escuela pública, con niños de 6 y 7 años, con pronóstico pedagógico desfavorable. Una herramienta informática organiza el análisis cualitativo y cuantitativo de la producción discursiva infantil. Los resultados ponen de manifiesto un incremento de dicha producción a medida que se fueron desarrollando los talleres y un menor requerimiento de participación del equipo coordinador. Sin embargo, se observa una tendencia decreciente de la producción imaginativo-reflexiva que motiva a focalizar el presente texto en esa dimensión y a dar cuenta de sus posibles causas

Arthrogryposis in Murrah buffaloes in southern Brazil

Congenital arthrogryposis is described in a Murrah buffalo herd. The disease was characterized by curvature and multiple articular rigidity of the hindlimbs or of all limbs without associated defects except for one case of brachygnatia. Histologically there was reduction of motor neurons from the ventral horns of the spinal cord and hypoplasia of the limb muscles. Analysis of the herd breeding records suggests that the disease is genetically transmitted by an autosomal recessive trait.Facultad de Ciencias Veterinaria

Potent Inhibition of Arterial Intimal Hyperplasia by TIMP1 Gene Transfer using AAV vectors

Seminal to the process of arterial restenosis after balloon angioplasty is extracellular matrix degradation by metalloproteinases (MMPs); activity of these proteins is strongly inhibited by the tissue inhibitors of MMPs (TIMPs). Here we exploit gene transfer using an adeno-associated virus (AAV) for TIMP1 gene delivery in a rat model of intimal hyperplasia. High-titer AAV-Timp1 efficiently transduced human coronary artery smooth muscle cells (SMCs) in vitro and inhibited the capacity of these cells to migrate through a Matrigel barrier. In injured rat carotid arteries, AAV vectors were found to transduce SMCs efficiently and to maintain transgene expression for several weeks in vivo. In AAV-Timp1-transduced animals, the intima:media ratio of injured carotids was significantly reduced by 70.5% after 2 weeks, by 58.5% after 1 month, and by 52.4% after 2 months from treatment. The decrease in intimal hyperplasia was paralleled by a significant inhibition of collagen accumulation and by increased elastin deposition in the neointima, two findings that relate to the inhibition of MMP activity. These results indicate that AAV vectors are efficient tools for delivering genes to the arterial wall and emphasize the importance of MMPs for the generation of intimal hyperplasia. Local TIMP1 gene transfer might thus represent an efficient strategy to prevent restenosis

Persistent SARS-CoV-2 infection in patients seemingly recovered from COVID-19

SARS-CoV-2 infection is clinically heterogeneous, ranging from asymptomatic to deadly. A few patients with COVID-19 appear to recover from acute viral infection but nevertheless progress in their disease and eventually die, despite persistent negativity at molecular tests for SARS-CoV-2 RNA. Here, we performed post-mortem analyses in 27 consecutive patients who had apparently recovered from COVID-19 but had progressively worsened in their clinical conditions despite repeated viral negativity in nasopharyngeal swabs or bronchioalveolar lavage for 11-300 consecutive days (average: 105.5 days). Three of these patients remained PCR-negative for over 9 months. Post-mortem analysis revealed evidence of diffuse or focal interstitial pneumonia in 23/27 (81%) patients, accompanied by extensive fibrotic substitution in 13 cases (47%). Despite apparent virological remission, lung pathology was similar to that observed in acute COVID-19 individuals, including micro- and macro-vascular thrombosis (67% of cases), vasculitis (24%), squamous metaplasia of the respiratory epithelium (30%), frequent cytological abnormalities and syncytia (67%), and the presence of dysmorphic features in the bronchial cartilage (44%). Consistent with molecular test negativity, SARS-CoV-2 antigens were not detected in the respiratory epithelium. In contrast, antibodies against both spike and nucleocapsid revealed the frequent (70%) infection of bronchial cartilage chondrocytes and para-bronchial gland epithelial cells. In a few patients (19%), we also detected positivity in vascular pericytes and endothelial cells. Quantitative RT-PCR amplification in tissue lysates confirmed the presence of viral RNA. Together, these findings indicate that SARS-CoV-2 infection can persist significantly longer than suggested by standard PCR-negative tests, with specific infection of specific cell types in the lung. Whether these persistently infected cells also play a pathogenic role in long COVID remains to be addressed. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland

Aplicación móvil para el cálculo de factores meteorológicos y ayudas a la navegación

En este trabajo de fin de grado se estudia el tema de la meteorología relacionada directamente con la navegación de una forma real y no tan física. Por ello, se ha fabricado un programa que otorgue la posibilidad de realizar múltiples cálculos como, por ejemplo, el rumbo a seguir entre dos destinos, la distancia total recorrida, datos de vientos, oleajes, sus respectivos ángulos de incidencia con respecto al buque y cómo respondería este ante dichas variables. Como pilar fundamental, el TFG se centra en el trazado de derrotas óptimas de una forma muy sencilla, evitando el empleo de fórmulas excesivamente complejas. A su vez, el programa desarrollado contiene otros bloques, como es el cálculo de altura de olas o la pendiente frontal, aspectos a tener en cuenta a la hora de navegar ya que pueden influir en nuestro comportamiento; para tener un mejor control de ellas se ha creado esta aplicación

Open challenge for the diagnosis of cow's milk protein allergy

OBJECTIVES: To report the results of open challenge tests performed in children fed with cow's milk-free diet. DESCRIPTIONS: Cross-sectional study evaluating cow's milk open challenge performed under supervision in a hospital setting during 2.5 hours and ambulatory follow-up for 30 days when no immediate reaction occurred. One hundred and twenty-one patients were included, with ages between 4 and 95 months. Cow's milk open challenge tests were positive in 28 patients (23.1%). A clinical manifestation of cow's milk allergy different from the one presented at diagnosis occurred in 12 (24.9%) patients with positive challenge. Positive challenge was more frequent (p = 0.042) in patients fed with extensively hydrolyzed formulae or amino acid-based formulae (30.3%) when compared to those fed with other exclusion diets (14.5%). CONCLUSION: Open challenge allowed the interruption of exclusion diet in a significant proportion of the patients.OBJETIVO: Relatar os resultados de testes de desencadeamento aplicados em crianças alimentadas com dieta de exclusão das proteínas do leite de vaca. DESCRIÇÃO: Estudo transversal que avaliou testes de desencadeamento oral aberto, com leite de vaca, realizados sob supervisão em ambiente hospitalar por 2,5 horas e ambulatoriamente por 30 dias quando não ocorreu reação imediata. Foram incluídos 121 pacientes, com idades entre 4 e 95 meses. O teste de desencadeamento com leite de vaca foi positivo em 28 (23,1%) pacientes. Manifestação clínica de alergia ao leite de vaca diferente da apresentada por ocasião da suspeita diagnóstica ocorreu em 12 (42,9%) pacientes com desencadeamento positivo. O desencadeamento positivo foi mais frequente (p = 0,042) nos pacientes alimentados com fórmulas extensamente hidrolisadas ou de aminoácidos (30,3%) quando comparados com os alimentados com outras dietas de exclusão (14,5%). CONCLUSÃO: O teste de desencadeamento permitiu que fosse suspensa a dieta de exclusão de grande parte dos pacientes.Universidade Federal de São Paulo (UNIFESP) Disciplina de Gastroenterologia PediátricaHospital Pequeno Príncipe Centro de Gastroenterologia PediátricaUNIFESP Curso de NutriçãoUNIFESP Disciplina de Gastroenterologia PediátricaUNIFESP, Disciplina de Gastroenterologia PediátricaUNIFESP, Curso de NutriçãoUNIFESP, Disciplina de Gastroenterologia PediátricaSciEL

Study of the chemical interaction between a high-viscosity glass ionomer cement and dentin

Objective: To investigate the chemical interactions between a high-viscosity glass ionomer cement (GIC) (KetacTM Molar Easymix, 3M ESPE, Seefeld, Bavaria, Germany) and human dentin. It was also analyzed the dynamics of GIC setting mechanism based on the time intervals required for the GIC and the GIC mixed with dentin to achieve stability. Material and Methods: Each constituent of GIC – powder (P) and liquid (L) – and powdered dentin (D), as well as the associations P+L, D+L, and P+L+D in the concentrations of 29%, 50%, 65%, 78%, 82%, and 92% of GIC were analyzed with Fourier transform infrared (FTIR) and Raman spectroscopy. Results: New optical absorption bands and/or Raman bands, which were not present in P, L, or D, were observed in the associations. The concentrations of 29% and 50% of GIC showed higher interaction, revealing that the amount of dentin influences the formation of new optical absorption or scattering bands. FTIR bands showed that the setting time to achieve bond stability was longer for the high-viscosity GIC (38±7 min) than for the sample with 29% of GIC (28±4 min). Conclusions: The analysis revealed the formation of new compounds or molecular rearrangements resulting from the chemical interactions between GIC and dentin. Moreover, this study provides an effective method to evaluate the dynamics of the setting mechanism of GICs