Seasonal allergic rhinoconjunctivitis (SAR) affects millions of people worldwide, particularly in childhood and adolescence. Pollen food allergy syndrome (PFAS) is a common adverse reaction occurring few minutes after the consumption of vegetable foods in patients with pollen-induced SAR. PFAS has rarely been investigated in the pediatric population, as it has been mainly examined as an adult disease. Recent studies suggested that PFAS might be more frequent in childhood than previously recognized. The present review aims to give an overview of the epidemiology, pathophysiology, diagnosis, management and prognosis of PFAS in children with SAR-induced by pollens.

/pdf/pollen-food-allergy-syndrome-a-not-so-rare-disease-in-1z81mrg6mq.pdf

Pollen-Food Allergy Syndrome: A not so Rare Disease in Childhood.

Objective: to understand the experience of care of people with venous ulcers using an Unna's boot. Method: a qualitative study, based on the social phenomenology by Alfred Schutz, was carried out with 12 adults interviewed in 2015. The statements were analyzed and organized in thematic categories. Results: the following categories emerged: "Unna's boot annoyance versus wound improvement", "Difficulties for accessing care with the Unna's boot", "Care for healing and preventing recurrence", and "Receiving more attention from the healthcare professional". Conclusion: the experience of care of people using an Unna's boot revealed the annoyance caused by this device, which was overcome due to the wound improvement. However, access to care was compromised by the lack of structure at the service, frustrating the patients' expectations regarding wound healing. The issues of these people's intersubjective universe should be considered in the management of care of venous ulcers.

/pdf/bota-de-unna-vivencia-do-cuidado-por-pessoas-com-ulcera-3ptm16zpp2.pdf

Bota de Unna: vivência do cuidado por pessoas com úlcera varicosa

The aim of the study was to determine microhardness of high- and low-viscosity bulk-fill composite resins and compare it with conventional composite materials. Four materials of high-viscosity were tested, including three bulk-fills: QuiXfi l (QF), x-tra fi l (XTF) and Tetric EvoCeram Bulk Fill (TEBCF), while nanohybrid composite GrandioSO (GSO) served as control. The other four were low-viscosity composites, three bulk-fill materials: Smart Dentin Replacement (SDR), Venus Bulk Fill (VBF) and x-tra base (XB), and conventional control material X-Flow (XF). Composite samples (n=5) were polymerized for 20 s with Bluephase G2 curing unit. Vickers hardness was used to determine microhardness of each material at the surface, and at 2-mm and 4-mm depth. GSO on average recorded significantly higher microhardness values than bulk-fill materials (p<0.001). The low-viscosity composite XF revealed similar microhardness values as SDR, but significantly lower than XB (p<0.001) and significantly higher than VBF (p<0.001). Microhardness of high-viscosity bulk-fill materials was lower than microhardness of the conventional composite material (GSO). Surface microhardness of low-viscosity materials was generally even lower. The microhardness of all tested materials at 4 mm was not different from their surface values. However, additional capping layer was a necessity for low-viscosity bulk-fill materials due to their low microhardness.

/pdf/microhardness-of-bulk-fill-composite-materials-fyqdsqduaf.pdf

Microhardness of Bulk-Fill Composite Materials

The aim of the study was to evaluate the efficacy and safety of the new method of platelet-rich plasma activation in the form of platelet gel, used in the treatment of non-healing chronic lower leg ulcers. The study was prospectively randomized, double blind and placebo controlled. We treated 60 patients (42 males and 18 females, mean age 69.43 years, SD 14.74) with chronic lower leg ulcers of different etiologies. Thirty patients were treated with allogeneic platelet gel and 30 with hydrogel. Both groups were comparable for duration of ulcer and its size. Treatment was repeated once a week for three consecutive weeks and then the last examination was scheduled at 6 months of the first platelet gel application. The t-test was used to analyze independent samples. Healing of chronic wounds with platelet gel was statistically significantly more effective compared to the treatment with hydrogel (p<0.05). At 6 months of platelet gel application, the mean wound area in the experimental group decreased to 35.01% (SD 53.69) of the initial wound size. In the control group, the wound area decreased to 89.95% (SD 71.82) of the initial wound size (p=0.001). The circumference of the wounds diminished to 54.62% (SD 39.85) of the initial value in the experimental group, compared to 91.28% (SD 29.32) in the control group (p<0.001). Allogeneic platelet gel prepared by the new method used in this study was found to be a good treatment option for non-healing chronic wounds when other methods are ineffective.

/pdf/regeneration-of-chronic-wounds-with-allogeneic-platelet-gel-1ij1sl7k4o.pdf

Regeneration of chronic wounds with allogeneic platelet gel versus hydrogel treatment: a prospective study.

The latest findings regarding AD pathogenesis point to an impaired function of the epidermal barrier, changed immune response, colonization of the skin by microorganisms, and certain psychological factors among other causes/triggers. The inflammatory response of AD patients is mainly associated with the activation of T cells (Th2 cells predominate), dendritic cells, macrophages, keratinocytes, mast cells, and eosinophils. Therapy usually involves medical evaluations and adequate management including treatment of concomitant diseases (e.g., allergies and infections), patient education and nursing care, psychological support, and nutritional consultations, which are organized through specific programs and structured educational groups. Systemic AD therapy includes conventional systemic treatment (cyclosporine, methotrexate, azathioprine) and new, specific drugs, interleukin inhibitors (e.g., dupilumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib, etc.). Since many AD patients are affected by various psychological factors and comorbidities, they should be assessed and managed through a multidisciplinary approach, involving different professions (psychologists, ear–nose–throat specialists, pulmonologists, allergologists, immunologists, nutritionists, pediatricians, gastroenterologists, psychiatrists (when necessary), and others). A multidisciplinary approach provides better coping strategies and improves control over the disease, patient adherence to therapy, and quality of life. It also has a positive influence on family quality of life while at the same time making more efficient use of dermatology healthcare resources, reducing the economic burden on both patients and society.

/pdf/atopic-dermatitis-disease-features-therapeutic-options-and-a-13s1jk2m.pdf

Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach

Oral allergy syndrome (OAS) is one of the most common types of food allergy. The syndrome includes itching and swelling of the lips, palate and tongue, usually after consuming fresh fruits and vegetables. The underlying pathogenic mechanism is cross-reactivity between IgE antibodies specific to pollen, and antigens in food, such as fresh fruits, vegetables and nuts that are structurally similar to pollen. Both pollen and food antigens can bind to IgE and trigger type I immune reaction. Diagnosis is primarily based on the patient's history, and confirmed by skin tests, in vitro tests, and oral provocation tests. Differential diagnoses include many diseases (such as burning mouth syndrome, angioedema, hay fever, various other oral diseases, etc.), and for this reason a multidisciplinary approach is necessary, as different specialists need to be involved in the diagnostic procedure. Therapy includes avoiding, or thermal processing of, fruit and vegetables known to trigger a reaction, and antihistamine medications. If a more severe anaphylactic reaction develops, more aggressive therapy is required. The goal of this article is to present OAS, its etiopathogenesis, clinical picture, and symptoms, diagnostic approach and therapy for OAS.

/pdf/oral-allergy-syndrome-the-need-of-a-multidisciplinary-66rz3vvxem.pdf

Oral allergy syndrome--the need of a multidisciplinary approach.

Chronic wounds on lower extremities most commonly result from chronic venous insufficiency. Chronic leg ulcer impacts the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation, etc. This study included 100 patients with chronic wounds/lower leg ulcer (59% of women and 41% of men, aged 31 to 89) treated locally with special wound dressings for moist wound healing. Study results showed no age and sex correlation with the quality of life, and all participants evaluated their quality of life and health satisfaction as neither good nor bad, but it was found that the disease mostly affected social relationships and to a lesser extent patient satisfaction with their physical and mental health, and the environment. Results on the disease perception showed that the participants considered their disease to have a significant effect on their life and would last for a relatively long time, but they also believed they had good control of their disease. Also, they considered the disease to have many symptoms affecting them; they were worried about their disease which they understood relatively well; they were aware that treatment could be very helpful; and that the disease had moderate effect on their emotional health. According to sex, the disease was found to have greater effect on women (especially on their emotional condition) and women had more faith in successful treatment, while correlation with age was nonsignificant. This study confirmed the importance of the patient psychological condition and the need of due care of their psychological reactions to and facing with the disease.

/pdf/quality-of-life-and-perception-of-disease-in-patients-with-37y825uz7i.pdf

Quality of life and perception of disease in patients with chronic leg ulcer.

Concomitant presence of hydatid cyst and hepatocellular carcinoma is a very rare clinical scenario especially in a previously non-diseased liver. Including our case here reported, there are 12 cases of synchronous HCC and hydatid cyst found in the scientific literature and 3 of them were found in a patient with non-diseased liver. We provide detailed review of all reported cases with additional highlights on etiology, pathogenesis, diagnosis, treatment and outcomes of both HCC and echinococcal disease. Although there is a small number of patients, possible relation between these 2 liver lesions should be investigated and standardized classification should be established. This will help us to understand the nature of HCC carcinogenesis, identify diagnostic features of liver lesions and choose the most appropriate type of treatment.

A Synchronous Occurrence of Hepatocellular Carcinoma and Echinoccocal Liver Cyst - Can Parasite Promote Carcinogenesis? Literature Review and Classification Proposal.

A 56-year-old woman presented with a 9-month history of intermittent fevers and pain in the right upper quadrant of the abdomen. For the last 2 months she noticed a painful swelling and skin redness in the upper abdomen. She had no respiratory symptoms. The physical examination revealed hepatomegaly and fistulizing skin changes in epigastrium with minimal purulent secretion. Laboratory tests showed elevated white-cell count (17,000 per microliter), CRP of 76mg/l and elevated liver markers (aspartate aminotransferase 122 U/L, alanine transaminase 140 U/L, total bilirubin 43 mg/dL) while prothrombin time was normal.

Isolated liver tuberculoma infiltrating anterior abdominal wall and skin.

Distant abscesses are uncommon during the episode of acute pancreatitis (AP). However, these are possible sequalae of necrotizing pancreatitis and should be treated appropriately to prevent serious septic complications. We demonstrate a case of a 56-year-old male patient who presented with severe necrotizing pancreatitis and distant retroperitoneal abscess that reached femoral region and was detected on diagnostic imaging scans. Combination of surgical and supportive therapy was employed, and the patient recovered well with no permanent consequences. Our article highlights the importance of quick and accurate diagnosis and timely intervention in this rare type of pancreatitis complication.

/pdf/rare-complication-of-necrotizing-pancreatitis-extension-of-rd7gmsw3c6.pdf

Rare Complication of Necrotizing Pancreatitis: Extension of Retroperitoneal Abscess into Femoral Region.

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