Recurrent neck swelling after iodinated contrast media administration

A 74-year-old male with an abdominal aortic aneurism reported 2 episodes of neck swelling 16 hours after an abdominal CT with iodinated contrast media that reappeared in a subsequent CT, although the use of pre-medication. The tests used to exclude the hypersensitivity hypothesis where negative and once a new CT where needed we decided to do it with close monitoring. We performed a facial picture and cervical ultrasound exam before and 24 hours after the exam. The neck swelling and the ultrasound findings 24 hours after the CT made the diagnosis of contrast induced sialoadenitis possible. Contrast induced sialadentis is an uncommon adverse reaction to iodinated contrast media. As it presents with neck swelling it is important to exclude a hypersensitivity reaction because it's further limitations and make a differential diagnosis.info:eu-repo/semantics/publishedVersio

Curso: Coordenação de Políticas Públicas

Programa do curso contendo objetivo, ementa, metodologia de ensino e avaliação. Plano de aula, referências bibliográficas e currículo do professor. Slides referentes às aulas de 1 a 5.1. Programa do curso: Documento em PDF, 4 páginas, contendo as informações sobre o curso.2. Apresentação: Documento em PDF, 35 páginas, contendo a apresentação da Aula I.3. Apresentação: Documento em PDF, 18 páginas, contendo a apresentação da Aula II.4. Apresentação: Documento em PDF, 18 páginas, contendo a apresentação da Aula III.5. Apresentação: Documento em PDF, 34 páginas, contendo a apresentação da Aula IV.6. Apresentação: Documento em PDF, 29 páginas, contendo a apresentação da Aula V.GovernançaPolíticas PúblicasPolíticas Sociai

Dental workers in front-line of COVID-19: an in silico evaluation targeting their prevention

SARS-CoV-2 has high human-human transmission rate. The aerosols and saliva droplets are the main contamination source. Thus, it is crucial to point out that dental practitioners become a high-risk group of contagion by SARS-CoV-2. Based on this, protocols have been recommended to avoid cross-contamination during dental care; however, appropriate evidence has not yet been established. Objective: Our study sought to make a screening, by in silico analysis, of the potential of mouth rinses used in dental practices to prevent the dental workers' contamination by SARS-CoV-2. Methodology: Multiple sequence comparisons and construction of the phylogenetic tree were conducted using the FASTA code. Therefore, molecular docking investigation between SARS-CoV-2 proteins (Main Protease, Spike Glycoprotein, Non-structure Protein, and Papain-like Protease) and molecules used in dental practices (chlorhexidine digluconate, hydrogen peroxide, cetylpyridinium chloride, povidone-iodine, gallic acid, β-cyclodextrin, catechin, and quercetin) was performed using AutoDock Vina. Moreover, 2D interactions of the complex protein-ligand structure were analyzed by Ligplot+.  Results: The obtained results showed a remarkable affinity between SARS-CoV-2 proteins and all tested compounds. The chlorhexidine digluconate, catechin, and quercetin presented a higher affinity with SARS-CoV-2. Conclusions: The overall results allowed us to suggest that chlorhexidine is the most suitable active compound in reducing the SARS-CoV-2 salivary load due to its better binding energy. However, in vivo studies should be conducted to confirm their clinical use

CARACTERIZAÇÃO NUTRICIONAL DE CRIANÇAS COM ALERGIA À PROTEÍNA DO LEITE DE VACA: UMA REVISÃO DE LITERATURA

Allergy to cow's milk protein is the most frequent allergy, manifesting symptoms with a higher incidence in children under the age of three years. This article aims to characterize the main diagnoses, symptoms, nutritional deficiencies and treatment present in cow's milk protein allergy in children. The main diagnosis used is the oral provocation test, carried out in a hospital environment. Symptoms are divided into three categories: IgE-mediated, non-IgE-mediated, and mixed. The main deficiencies that can occur are calcium and vitamin D, triggering some later diseases. The most used form of treatment is the exclusion of cow's milk and its derivatives, with the use of specific formulas or diets to remedy any deficiencies. Therefore, monitoring with a multidisciplinary team is necessary in order to provide guidance to those responsible for children with cow's milk protein allergy, respecting the individuality of each one, avoiding complications or worsening of the condition.La alergia a la proteína de la leche de vaca es la alergia más frecuente, manifestándose síntomas con mayor incidencia en niños menores de tres años. Este artículo tiene como objetivo caracterizar los principales diagnósticos, síntomas, deficiencias nutricionales y tratamientos presentes en la alergia a la proteína de la leche de vaca en niños. El principal diagnóstico utilizado es la prueba de provocación oral, realizada en un entorno hospitalario. Los síntomas se dividen en tres categorías: mediados por IgE, no mediados por IgE y mixtos. Las principales deficiencias que pueden presentarse son el calcio y la vitamina D, desencadenando algunas enfermedades posteriores. La forma de tratamiento más utilizada es la exclusión de la leche de vaca y sus derivados, con el uso de fórmulas o dietas específicas para remediar las deficiencias. Por tanto, el seguimiento con un equipo multidisciplinar es necesario para orientar a los responsables de los niños con alergia a la proteína de la leche de vaca, respetando la individualidad de cada uno, evitando complicaciones o agravamiento de la patología.A alergia à proteína do leite de vaca é a alergia que se apresenta com mais frequência, manifestando sintomas com maior incidência em crianças com idade inferior a três anos. O presente artigo tem como objetivo caracterizar os principais diagnósticos, sintomas, deficiências nutricionais e tratamento presentes na alergia à proteína do leite de vaca em crianças. O principal diagnóstico utilizado é o teste de provocação oral, realizado em ambiente hospitalar. Os sintomas são divididos em três categorias: mediadas por IgE, não mediadas por IgE e mistas. As principais deficiências que podem ocorrer são de cálcio e vitamina D, desencadeando algumas doenças posteriores. A forma de tratamento mais utilizada é a exclusão do leite de vaca e seus derivados, com a utilização de fórmulas ou dietas específicas para sanar quaisquer deficiências. Portanto, é necessário um acompanhamento com equipe multiprofissional a fim de prestar orientações aos responsáveis pela criança com alergia à proteína do leite de vaca, respeitando a individualidade de cada uma, evitando complicações ou piora do quadro

Retrospective Analysis of Risk Factors and Predictors of Intraoperative Complications in Neuraxial Blocks at Faculdade de Medicina de Botucatu-UNESP

SummaryBackground and objectivesCardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital – HCFMB-UNESP.MethodsA retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis.Results32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27).ConclusionsIntraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks

Poor Immune Reconstitution in HIV-Infected Patients Associates with High Percentage of Regulatory CD4(+) T Cells

CD4(+) regulatory T cells (Tregs) are essential for the maintenance of the immune system's equilibrium, by dampening the activation of potential auto-reactive T cells and avoiding excessive immune activation. To correctly perform their function, Tregs must be maintained at the right proportion with respect to effector T cells. Since this equilibrium is frequently disrupted in individuals infected with the human immunodeficiency virus (HIV), we hypothesize that its deregulation could hamper immune reconstitution in patients with poor CD4(+) T cell recovery under highly active antiretroviral therapy (HAART). We analysed Tregs percentages amongst CD4(+) T cells in 53 HIV-infected patients under HAART, with suppression of viral replication and distinct levels of immune reconstitution. As controls, 51 healthy individuals were also analysed. We observed that amongst the patients with Nadir values (the lowest CD4(+) T cell counts achieved) = 10% of total CD4(+) T cells) had the worse CD4(+) T cell reconstitution. In accordance, the well-described direct correlation between the Nadir value and CD4(+) T cell reconstitution is clearly more evident in individuals with high Tregs proportions. Furthermore, we observed a strong negative correlation between Tregs percentages and CD4(+) T cell recovery among immunological non-responder HIV+ individuals. All together, this work shows that high Tregs frequency is an important factor associated with sub-optimal CD4(+) T cell recovery. This is particularly relevant for immunological non-responders with low Nadir values. Our results suggest that the Tregs proportion might be of clinical relevance to define cut-offs for HAART initiation

Size effects on antimicrobial efficiency of DBD plasma coated silver nanoparticles on textiles

This work studies the surface characteristics, the antimicrobial activity and the aging effect, of plasma pre-treated polyamide 6,6 fabrics (PA66) coated with silver nanoparticles (AgNPs), with the aim to identify the optimum size of nanosilver exhibiting antibacterial properties suitable for manufacturing of hospital textiles. The release of bactericidal Ag+ ions from the 10, 20, 40, 60 and 100 nm AgNPs-coated PA66 surface were function of the particles size, number and aging. Plasma pre-treatment promoted both ionic and covalent interactions between AgNPs and the formed oxygen species on the fibers (Figure 1), favoring the deposition of smaller in diameter AgNPs that consequently showed better immediate and durable antimicrobial effect against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus bacteria. Surprisingly, after 30 days of aging, a comparable bacterial growth inhibition was achieved for all the fibers treated with AgNPs of <100 nm in size. The Ag+ in the coatings also favored the electrostatic stabilization of the plasma-induced functional groups on the PA66 surface, thereby retarding the aging process (Figure 2). At the same time, the size-related ratio Ag+/Ag0 of the AgNPs between 40 and 60 nm allowed for controlled release of Ag+ rather than bulk silver. Overall, the results suggest that instead of reducing the AgNPs size, which is associated to higher toxicity, similar long-term effects can be achieved with larger NPs (40-60 nm), even in lower concentrations. Since the antimicrobial efficiency of AgNPs larger than 30 nm is mainly ruled by the release of Ag+ over time and not by the size and number of the AgNPs, this parameter is crucial for the development of efficient antimicrobial coatings on plasma-treated surfaces, and contribution to the safety and durability of clothing used in clinical settings