Food allergens in oral care products.

Food allergies are a growing concern, especially in Western societies and can dramatically impact the quality of life of affected individuals. In recent years, various food allergens have been introduced into the oral care industry to improve product properties and provide the best possible treatment. Since small doses of food allergens may be sufficient to trigger allergic reactions, the non-discrimination of the sources of certain excipients in the product composition can compromise the patient's health. Therefore, knowledge and awareness of allergies and product composition among health professionals are critical on behalf of patients' and consumers' health. This study aimed to ascertain the presence of dairy products (e.g., cow's milk proteins and lactose), cereals (e.g., gluten, soy, and oats), fruits, nuts, spices, shellfish, and additives as excipients in oral care products for outpatients and products for professional use in the Dental Office. Among the 387 surveyed products, the highest prevalence of food allergens was found in toothpaste, fluoride varnishes, and alginates, mostly in spices and fresh fruits. As food allergies may occur because of erroneous information or a lack of labeling on the allergen list, manufacturers should be more rigorous in declaring allergens on product labeling regarding the safety of consumers.

Is Invasive Pressure Monitoring More Reliable Than Non-Invasive in Patients with Cardiovascular Pathology? - A Case Report.

INTRODUCTION: Patients undergoing carotid endarterectomy (CEA) require strict arterial blood pressure (BP) control to maintain adequate cerebral perfusion. Invasive blood pressure (IBP) is the gold standard, however artifacts may lead to erroneous readings. METHODS: We report a case of CEA using IBP monitoring. RESULTS: A 64-year-old man, American Society Anaesthesiology (ASA) physical status 3 (diffuse atheromathosis, dyslipidemia and non-medicated hypertension), was presented for an elective right CEA. ASA standard, neuromuscular block monitoring, anesthesia depth and cerebral oximetry were used as monitorization. On preanaesthetic assessment noninvasive BP (NIBP) had no significant difference between right and left arms (180/90 mmHg). IBP monitoring was placed in left radial artery after several attempts in both arms. Surgery was performed under balanced general anesthesia (GA). Intra-operatively the patient remained stable (140/86 mmHg) however the systolic carotid artery stump pressure (SP) was 210-220mmHg. This finding was confirmed by measuring NIBP in both legs. At this point NIBP was used to monitor and guide the BP target until the end of the procedure and during postoperative period (PO) in postanesthetic care unit (PACU). Surgery proceeded uneventfully. After discharge to the ward (48h stay at PACU), a hypertensive crisis lead to cervical neck haematoma which required emergent surgery under GA. Intraoperatively the BP was assessed with NIBP. After a new period of 48h at PACU the patient was discharged to the ward and subsequently from the hospital on the 8th postoperative day, without further complications. CONCLUSION: IBP allow beat-by-beat measures with optimization of BP in order to improve cerebral perfusion during CEA. IBP can be inaccurate in patients with diffuse atheromatosis. NIBP may be an alternative, however is not continuous and is expected to be less accurate than the IBP.1 The high IBP-NIBP difference (>40 mmHg) was clinically relevant and in this patient might be explained by diffuse atheromatosis. NIBP was compatible with carotid SP, indicating that, in this case was a reliable and accurate method of monitoring.

[Takotsubo cardiomiopathy in the context of a general anaesthesia - Case report]. / Miocardiopatia de Takotsubo no Contexto de uma Anestesia Geral - Caso Clínico.

Takotsubo cardiomiopathy was first described in 1900 by Sato et al and reported in the anaesthetic literature by Mizutani et al and Takigawa et al in 20061,4. Doron Gavish et al. were the first to publish a case report concerning a general anaesthesia. This rare syndrome results in an acute, reversible left ventricule dysfunction in the absence of an obstructive coronary disease1-3 and mimics an acute coronary syndrome. We report the clinical case of a 66 years old man, without relevant medical history, who underwent an elective inguinal hernia repair. During anesthetic emergence, the patient started with hemodynamic instability, followed by a cardiorespiratory arrest. Electrocardiographic changes were compatible with an acute myocardial infarction. The patient also revealed cardiac enzymes elevation, normal coronary angiography and severe left ventricule dysfunction and motility wall changes on ventriculogram, both typical of Takotsubo cardiomiopathy. With this case report we intend to divulge an event of this rare miocardiopathy in an anaesthetic-surgical context, probably related to physical and emotional distress.