Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review / Diálise peritoneal com múltiplas trocas bem-sucedida em paciente com grave toxicidade hematológica por metotrexato: relato de caso e revisão de literatura

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.

Resumo Apesar de sua toxicidade, o metotrexato é um medicamento eficaz no controle de várias doenças. A mielossupressão, um de seus principais efeitos adversos, aumenta em gravidade e frequência nos pacientes com insuficiência renal. Apresentamos o caso de um homem de 68 anos de idade com doença renal terminal relacionada à vasculite associada ao ANCA em diálise peritoneal, que recebeu a medicação em dose baixa em função da atividade da doença e que teve como complicação pancitopenia grave com mucosite, tratada com medidas de suporte e diálise peritoneal com múltiplas trocas. Revisamos 20 casos publicados até o presente momento sobre pancitopenia associada a metotrexato em pacientes em diálise. Foi identificada alta morbidade e mortalidade, razão pela qual seu uso nesse tipo de paciente não é recomendado. No entanto, quando esta complicação ocorre, uma opção terapêutica pode ser o uso de diálise peritoneal com múltiplas trocas, além da terapia de suporte para toxicidade medicamentosa. Maiores estudos são necessários para demonstrar o papel da diálise peritoneal com múltiplas trocas na remoção desse medicamento.

The effect of hippophae rhamnoides extract on oral mucositis induced in rats with methotrexate

ABSTRACT Objective: To investigate the effect of HRE (Hippophae rhamnoides extract) on oral mucositis induced in rats with MTX. Material and Methods: Experimental animals were divided into groups as healthy (HG), HRE+MTX (HMTX), and control group, which received MTX (MTXC). HMTX group received 50 mg/kg HRE while MTXC and HG groups received equivolume distilled water with gavage once a day. After one hour of HRE and distilled water administration, HMTX and MTXC groups received a single dose of oral MTX 5 mg/ kg. This procedure was repeated for one month. Results: The levels of MDA, IL-1β, and TNF-α were found to be significantly higher in the cheek, lower lip, and tongue tissue of the animals receiving MTX, compared with HG and HMTX groups; however, these parameters were lower in the cheek and low lip tissue, and a milder damage ocurred in these tissues, compared with the tongue tissue in MTXC group. No histopathologic damage was observed in the cheek, lower lip, and tongue tissues of the rats treated with HRE. Conclusion: This findings indicate that HRE as a natural product is an important advantage compared with synthetic drugs for prophylaxis of oral mucositis developed due to MTX.

Ulcerations due to methotrexate toxicity in a psoriasis patient

Abstract: Methotrexate is one of the most used drugs in the treatment of psoriasis with indication of systemic therapy. Cutaneous and mucous side effects are described by pharmacological characteristics of the drug itself or due to overdose. We report the case of a patient with ulcerations in oral mucosa and psoriatic plaques after incorrect use of Methotrexate. Prescribed in a weekly dose, it was used continuously for 10 days and without simultaneous intake of folic acid. It is important to ensure correct comprehension of the prescription.

Dapsone in the treatment of pemphigus vulgaris: adverse effects and its importance as a corticosteroid sparing agent

Pemphigus vulgaris is an autoimmune disease characterized by suprabasal blisters with acantholysis, which has a fatal course in a large number of untreated patients. Systemic corticosteroid therapy is considered first-line therapy. Adjuvant treatment with the goal of sparing corticosteroids include, among others, dapsone. This drug is not without side effects and its use requires clinical and laboratory control. We present a patient with PV initially managed with suboptimal dose of prednisone, evolving into drug-induced hepatitis after introduction of dapsone.

Percepção de enfermeiros sobre o uso do computador no trabalho / Perception of nurses on the use of computer at the work / Resumen percepción de enfermeros sobre el uso de la computadora en el trabajo

Estudo que teve como objetivo apreender a percepção de enfermeiros sobre o uso do computador no ambiente de trabalho hospitalar. Participaram 14 enfermeiros de um hospital público. A coleta de dados realizou-se por meio de entrevista gravada e Diário de Campo. Os dados foram analisados de acordo com a técnica Análise de Conteúdo. Das entrevistas emergiram seis categorias temáticas abordando aspectos positivos tais como: rapidez, legibilidade e exatidão das informações; maior segurança do paciente e melhorias na qualidade do cuidado. Dentre os aspectos negativos se destacaram a conduta de copiar e colar as Prescrições Médicas e de Enfermagem; falta de computadores e distanciamento do enfermeiro do paciente. Apesar das fragilidades relatadas, os enfermeiros manifestaram-se favoráveis ao uso da tecnologia computacional no trabalho e indicaramna como recurso indispensável à qualidade do cuidado.

The objective of this study was to apprehend the perception nurses have on the use of computer in the hospital environment. Took part in the study 14 nurses of a public hospital. Collection of data took place through recorded interview and Field Diary. Data was analyzed according to Content Analysis technique. Six thematic categories emerged from the interviews such as the one that approached the positive aspects: speed, legibility and accuracy of the information; patients' safety and; improvements in the quality of care. Among the negative aspects copy and paste the Medical Prescriptions and Nursing; lack of computers and the nurse distancing to the patient were highlighted. In spite of the fragilities, they were all in favor of the use of computer technology at the work and they pointed it as indispensable resource to the quality of care.

Estudio que tuvo como objetivo aprehender la percepción de enfermeros sobre el uso de la computadora en el ambiente de trabajo hospitalario. Participaron 14 enfermeros de un hospital público. La recolección de datos fue realizado por medio de entrevista grabada y Diario de Campo. Los datos fueron analizados de acuerdo con la técnica Análisis de Contenido. De las entrevistas emergieron seis categorías temáticas como aquella que abarcó los aspectos positivos tales como: rapidez, legibilidad y exactitud de las informaciones; mayor seguridad del paciente y; mejorías en la calidad del cuidado. Entre los aspectos negativos se destacaron la conducta de copiar y pegar las Prescripciones Médicas y de Enfermería; falta de computadoras y alejamiento del enfermero con el paciente. A pesar de las fragilidades, todos se manifestaron favorables al uso de la tecnología computacional en el trabajo y la señalaron como recurso indispensable a la calidad del cuidado.