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Hereditary angioedema (HAE) poses a high burden of disease, being its epidemiological and clinical data heterogeneous among countries, with no recent published studies concerning Portuguese patients. Therefore, we aimed to raise awareness of HAE and to contribute to clinical knowledge. An observational, descriptive, retrospective, and cross-sectional study was performed, that included a cohort of 126 patients followed in a single Portuguese Center. We observed a high prevalence of HAE-C1-INH type II (45.2% of patients). Most HAE patients (67.4%) presented the initial manifestations of the disease before adulthood, at a mean age of 12.6 ± 8.4 years. However, we found a long delay in HAE diagnosis, especially in those without family history (mean 20.7 ± 17.3 years). Stress was the most common trigger, followed by trauma and infection. Symptoms involving different systems were increasingly reported with increased disease duration. Cutaneous symptoms (95.0%) were more frequent, followed by gastrointestinal (80.7%), and respiratory symptoms (50.4%). HAE symptoms led to abdominal surgery in 22 (17.5%) patients and induced laryngeal edema requiring intubation/tracheostomy in 8 (6.3%) patients. Most patients were under long-term prophylaxis, mainly with attenuated androgens (62.7% of patients).The correct distinction between HAE and other common causes of angioedema is critical, allowing reduction of diagnostic delay, improvement of adequate management, and ultimately improving outcomes and quality of life of HAE patients.

Background: Allergic disease, allergic rhinoconjunctivitis/bronchial asthma, are very prevalent worldwide, and the poten-tially modifying therapy is immunotherapy with aeroallergens. In December 2019 a new coronavirus (SARS-CoV-2) was iden-tified in China, causing a pandemic with devastating effects. For this reason, the State of Emergency (SE) was declared in Portugal for the first time in this pandemic, between 18 March and 2 May 2020, and all non-urgent activity was suspended in our hospital, including the administration of subcutaneous immunotherapy with aeroallergens (SCITA). Objective: Cha-racterize the dose adjustments according to the delay in SCITA administration, verify the safety of the dose administered when resuming SCITA and evaluate the worsening of symptoms of the allergic disease, in patients under SCITA program that inter-rupted it during the SE. Material and methods: An analysis of the SCITA clinical records of the 195 patients who interrupt-ed the maintenance dose during EE was performed. According to the symptoms and the delay interval, the dose was reduced or a new initiation protocol was performed, according to our Allergen Immunotherapy Functional Unit protocol, adapted from international guidelines for this specific time. Results: 7.7% of patients had worsening of allergic symptoms during the interruption period and 6.2% resorted to rescue therapy. 96.4% decreased the dose in SCITA resumption, with a decrease that was mostly greater than predicted, according to our protocol. Immediate local reactions were recorded in 9.2%, with no ana-phylactic reactions. After recovery, 9.7% worsened symptoms and 5.1% resorted to rescue therapy. Conclusions: The pandemic made it very difficult to monitor patients’ chronic pathologies, including allergic diseases. The majority of patients did not report worsening of symptoms and few had adverse reactions in the resumption of SCITA, demonstrating the safety of the dose adjustment protocol. © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clinica. Published by Publicacoes Ciencia & Vida.

Resumen Introduccion La urticaria por frio (UF) es un tipo de urticaria cronica inducible (CIndU) donde aparecen ronchas pruriginosas recurrentes y/o angioedema tras la exposicion a estimulos frios. Aunque normalmente solo afecta a areas expuestas, pueden producirse reacciones sistemicas. Nuestro objetivo es caracterizar los casos de UF de nuestro hospital. Material y metodos Estudio retrospectivo de casos de UF seguidos en nuestra consulta de urticaria en Portugal hasta octubre de 2020. Resultados Se incluyeron 52 pacientes, de ellos 40 mujeres. La edad media fue de 35 anos. En 19 pacientes, los sintomas comenzaron antes de los 18 anos de edad. La UF se clasifico como adquirida en todos los pacientes. Las pruebas de provocacion por frio fueron negativas en 9 pacientes, clasificados como UF atipica. No se encontraron diferencias con respecto al inicio en edad pediatrica o adulta. Mas de la mitad de los pacientes (52%) tenian una UF localizada. A pesar de no ser estadisticamente significativa, la temperatura umbral evaluada con TempTest® 4.0 fue mas alta y el tiempo de estimulacion mas corto en los pacientes con sintomas mas graves. Todos los pacientes fueron tratados con antihistaminicos y uno con omalizumab. Los pacientes controlados con dosis estandar de antihistaminicos tenian temperatura umbral mas baja que los que necesitaban dosis mas altas (p Conclusion La UF es una enfermedad heterogenea que, en algunos casos, puede poner en peligro la vida del paciente. Las pruebas de provocacion con frio pueden ser utiles en el manejo e identificacion de grupos de gravedad.

Summary Introduction. Managing Acetylsalicylic Acid (ASA) hypersensitivity (HS) in patients with ischemic heart disease (IHD) is a challenge. Data on Rapid Desensitization (RD) to ASA is scarce. We aimed to report the outcomes of our 10-year experience with RD to ASA. Methods. Retrospective, observational, single-center study of patients with ASA HS and suspected IHD who underwent RD to ASA between March 2009 and February 2019. Results. Fifty patients were included. ASA HS presentation ranged from urticaria (56%) to anaphylaxis (32%). Regarding cardiologic diagnoses, 40 patients (80%) had acute coronary syndrome and 10 (20%) stable angina. The majority of patients (N = 36.72%) underwent percutaneous coronary intervention. RD to ASA was successful in all patients. Two patients presented a mild HS reaction during the RD, which was promptly treated, and subsequent daily doses of ASA 100 mg were tolerated. Conclusions. In our cohort, RD to ASA in patients with ASA HS and IHD was very effective and safe.

Biofilms are surface attached, matrix embedded micro-organisms. Biofilms are difficult to eradicate since Biofilm structure prevents the penetration of chemical agents and makes more resistant to antimicrobials. This research evaluate the efficacy routine chemical agents in removing bacterial biofilms. Agar well diffusion, MIC and MBC evaluate the efficacy against planktonic bacteria. Post-exposure biofilm biomass was quantified using CV assay. All disinfectants tested effectively eradicate biofilms and planktonic bacteria, whereas 2% chlorhexidine diclogunate and 2% sodium hypochlorite demonstrate highest efficacy.

A Endocardite Infecciosa (EI) e definida como o evento patologico, que ocorre em estruturas cardiacas lesadas, atraves das bacteremias transitorias. O abscesso apical agudo (AAA) e resultado do deslocamento de bacterias via forame apical para a superficie radicular externa do elemento dentario, caracterizando-se como a infeccao endodontica extrarradicular mais prevalente. O objetivo deste estudo foi: 1) investigar a presenca de microrganismos especificos nos AAA’s; 2) detectar especies mais relacionados com a EI, atraves da tecnica de Nested-PCR. Para isso, foram realizadas coletas microbiologicas em 10 pacientes que apresentavam AAA. Nested-PCR, com primers especificos, foi utilizado para detectar a presenca de microrganismos. As especies bacterianas mais frequentemente encontradas foram Enterococcus faecalis (10/10), Fusobacterium nucleatum (10/10-100%), seguido de Treponema denticola (8/10-80%) e Prevotella tannerae (5/10-50%), sendo E.faecalis e F.nucleatum as mais associadas com EI. Conclui-se que os AAA’s apresentaram microrganismos com significativa participacao no desenvolvimento de EI, denotando a grande importância do tratamento imediato dessa patologia.

This survey investigated the level of perceived stress among undergraduate dentistry students and concluded that the moderate level of stress was more prevalent than mild among students of both genders.

The forensic facial reconstruction process was carried out in the plaster replica of the skull of a leucoderma, melanoderma and fiaoderma woman. To perform the American technique were located and marked 21 craniometric points, at those points were fixed sticky stick wax blocks with measures of the thickness of the soft tissues of the face and connected with strips of plasticine. For the Russian technique were located and demarcated of the origin and insertion of the muscles and modeling of muscles, salivary glands and adipose tissue. For both techniques was put plastilina of cover representing the color of the skin of the ancestralities, were adhered the sensory organs and delimited for the tricologia forense. Were reconstructed six faces, three by the American technique and three by the Russian technique.

El objetivo del presente estudio fue valorar la prueba del azul brillante de cresilo (BCB) como método indirecto para seleccionar ovocitos competentes para la producción in vitro de embriones (PIV). Los complejos cúmulos-ovocitos (COC) fueron obtenidos de dos vaquillas criollas sometidas a dos tratamientos: T1 = COC recuperados por OPU (ovum pick-up) previa estimulación con FSH-LH; T2 = COC recuperados sin previa estimulación de la donante (testigo). Las dos vaquillas fueron alternadas en los dos tratamientos y se hicieron cinco repeticiones. Los COC recuperados fueron clasificados en tipos A, B, C y D. Luego se aplicó la prueba del BCB a cada uno de los tipos de COC para determinar si son BCB+ o BCB-. T1 permitió recuperar 5.2 más COC que T2 (p, The objective of the present study was to evaluate the bright blue cresyl (BCB) test as an indirect method to select competent oocytes for the in vitro production of embryos (IVP). The cumulus-oocyte complexes (COC) were obtained from two Creole heifers subjected to two treatments: T1 = COC recovered by OPU (ovum pick-up) previous stimulation with FSH-LH; T2 = COC recovered from non-stimulated animals (control). The two heifers were alternated in the two treatments and five repetitions were done. Recovered COCs were classified into types A, B, C and D. Then the BCB test was applied to each of the COC types to determine if they were BCB+ or BCB-. T1 allowed to recover 5.2 more COC than T2 (p

RESUMEN Un síndrome caracterizado por dolor cervical y un apófisis estiloides alargado fue descrito por primera vez por Watt Eagle en 1937. Aunque el síndrome de Eagle en su variante vascular es raro y no es reconocido como causa clara de disección carotídea, en los últimos años ha sido reportado un incremento del número de casos de disección carotídea causada por una apófisis estiloides alargada. Paciente de 56 años que acudió al servicio de urgencias por paresia facial izquierda aguda y habla confusa. Presentaba dolor cervical de dos días de evolución, relacionado con un ataque de tos. Se activó el código ictus y la tomografía computarizada (TC) mostró isquemia del lóbulo temporal derecho y disección bilateral de la arteria carótida interna. La angio-TC de los troncos supraaórticos con reconstrucción tridimensional, identificó una apófisis estiloides alargado en ambos lados. El paciente fue sometido a una angioplastía con colocación de dos stents. Debido al alto riesgo de padecer nuevo ictus, se decidió realizar tratamiento quirúrgico. Para el lado derecho se realizó un abordaje transoral y en el izquierdo un abordaje abierto. La apófisis estiloides alargado es una causa importante de disección carotídea y de las complicaciones cerebrovasculares relacionadas. ABSTRACT A syndrome characterized by cervical pain and an abnormally elongated styloid process was first described by Watt Eagle in 1937. Even though vascular Eagle syndrome is uncommon and is not well recognized as a cause for carotid artery dissection, in the last few years there have been an increasing number of case reports of carotid artery dissection caused by an elongated styloid process. A 56 years old man presented to the emergency department with acute left facial weakness and slurred speech. He complained of two days neck pain, related to a coughing fit. The code stroke protocol was activated and imaging showed a right temporal bone stroke and a bilateral internal carotid artery dissection. A scan angiography of the supra-aortic vessels with 3D reconstruction was performed showing a bilateral abnormally elongated styloid process. The patient underwent angioplasty with two stent placements. Due to the high risk of recurrent strokes, the patient was evaluated in the otolaryngology department for styloid process resection. Finally a transoral approach for the right side and an open approach for the left side were performed. We have to consider an elongated styloid process as an important cause of carotid artery dissection and subsequent cerebrovascular complications

The very long standing problem of sound waves propagation in fluids is reexamined. In particular, from the analysis of the wave damping in reacting gases following the work of Einsten \citep{Ein}, it is found that the damping due to the chemical reactions occurs nonetheless the second (bulk) viscosity introduced by Landau \& Lifshitz \citep{LL86} is zero. The simple but important case of a recombining Hydrogen plasma is examined., 23 pages, 5 figures

RESUMEN La piomiositis es una infección bacteriana del músculo estriado, siendo extremadamente rara la afectación de la musculatura cervical. Se ha asociado en nuestro medio a enfermedades crónicas como la diabetes y a la inmunodepresión. Presentamos a un paciente de 67 años que acude al servicio de urgencias por tumoración laterocervical de rápido crecimiento, negando antecedentes de interés a excepción de diabetes mellitus tipo II. Se le realizó estudio de imagen con tomografía computarizada con contraste, observándose aumento de volumen del músculo esternocleidomastoideo izquierdo y se empezó tratamiento empírico con antibióticos endovenosos. Dada la evolución tórpida finalmente se realizó drenaje quirúrgico bajo anestesia general con mejoría de los parámetros clínicos y analíticos. La piomiositis de los músculos cervicales es muy rara (0,4%-1% de todos los casos) siendo el esternocleidomastoideo el músculo del cuello más frecuentemente afectado. La tomografía computarizada representa la prueba de imagen de elección, permitiendo un rápido diagnóstico llegando a poder diferenciar este cuadro de otros similares. Considerando que muchos de estos pacientes presentan comorbilidades asociadas y/o inmunosupresión, es de extrema importancia diagnosticarlos precozmente y empezar un tratamiento adecuado que dependerá del grado y extensión de la infección. A pesar de ser una entidad poco frecuente, su incidencia está en aumento en nuestro medio asociada a la infección por VIH y otras condiciones de inmunodepresión. Hay que tenerla en mente en el diagnóstico diferencial de las tumoraciones laterocervicales porque solo con una alta sospecha clínica se podrá llevar al cabo un diagnóstico precoz y un tratamiento adecuado. ABSTRACT Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chronic diseases as diabetes and immunosuppression. We present a 67 years old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyositis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it's very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing associated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.