Hokkaido birth cohort study on environment and children's health: cohort profile 2021

BACKGROUND@#The Hokkaido Study on Environment and Children's Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort and the Hokkaido cohort. Our primary objectives are to (1) examine the effects that low-level environmental chemical exposures have on birth outcomes, including birth defects and growth retardation; (2) follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders, as well as perform a longitudinal observation of child development; (3) identify high-risk groups based on genetic susceptibility to environmental chemicals; and (4) identify the additive effects of various chemicals, including tobacco.@*METHODS@#The purpose of this report is to provide an update on the progress of the Hokkaido Study, summarize recent results, and suggest future directions. In particular, this report provides the latest details from questionnaire surveys, face-to-face examinations, and a collection of biological specimens from children and measurements of their chemical exposures.@*RESULTS@#The latest findings indicate different risk factors of parental characteristics on birth outcomes and the mediating effect between socioeconomic status and children that are small for the gestational age. Maternal serum folate was not associated with birth defects. Prenatal chemical exposure and smoking were associated with birth size and growth, as well as cord blood biomarkers, such as adiponectin, leptin, thyroid, and reproductive hormones. We also found significant associations between the chemical levels and neuro development, asthma, and allergies.@*CONCLUSIONS@#Chemical exposure to children can occur both before and after birth. Longer follow-up for children is crucial in birth cohort studies to reinforce the Developmental Origins of Health and Disease hypothesis. In contrast, considering shifts in the exposure levels due to regulation is also essential, which may also change the association to health outcomes. This study found that individual susceptibility to adverse health effects depends on the genotype. Epigenome modification of DNA methylation was also discovered, indicating the necessity of examining molecular biology perspectives. International collaborations can add a new dimension to the current knowledge and provide novel discoveries in the future.

Research progress on adverse reactions and pseudo-allergic reactions of traditional Chinese medicine injections / 中国中药杂志

Since the safety re-evaluation of traditional Chinese medicine(TCM) injections began in 2009, some TCM injection companies and research institutes have done a lot of work. And with the increase of drug development and drug production technology levels in China, the safety of some TCM injections has been greatly improved. There are safety risks in TCM injections, which are mainly reflected in unclear basis of medicinal materials, simple production process, poor controllability of quality standards, nonstan-dard drug instructions and irrational medication in the use process. This paper describes the research progress of the above-mentioned aspects of TCM injections. In addition, the author team found that adverse reactions of TCM injections are mainly pseudo-allergic reactions. Therefore, a lot of work has been done in detection of pseudo-allergic reactions, mechanism research and risk control. This part of the work is also described in this article.

Alergia a los metales / Metal allergy

La presencia de metales en contacto con piel o mucosas puede ocasionar en personas sensibles, reacciones de distintos tipo que, muchas veces, no es posible determinar su origen. Ante la sospecha se puede recurrir a un estudio hematológico de laboratorio (Test Melisa) (AU)

The metal exposure in sensitive people could produce, local or general, different reactions of hypersensitive. The Melisa Test is a blood work that could make a diagnosis of those types of allergies (AU)

Avances de la crioanalgesia en la facoemulsificación / Advances of the cryonalgesia in phacoemulsification

Objetivo: Describir los resultados de la aplicación de la crioanalgesia en la cirugía de catarata por facoemulsificación bilateral simultánea en pacientes portadores de catarata, con historia de reacciones alérgicas a los anestésicos farmacológicos. Métodos: Se realizó un estudio descriptivo de serie de casos en un grupo de 10 pacientes con historias de reacciones alérgicas a los anestésicos farmacológicos empleados para la cirugía de catarata. En todos los casos se les efectuó facoemulsificación bilateral simultánea por la técnica de prechop en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, por vía córnea clara temporal, con irrigación de solución salina balanceada y viscoelásticos a 4 °C. Resultados: No se encontraron diferencias en el sexo; la edad media fue de 62,3 años; la dureza del cristalino, según LOCS III, se encontraba en su mayoría entre opacidades nucleares de II a IV; el tiempo efectivo del ultrasonido no fue superior a medio minuto; todos recuperaron su mejor agudeza visual corregida y no se reportaron complicaciones. El conteo celular endotelial reportó una pérdida de 3,5 % en relación con el conteo inicial preoperatorio. Conclusiones: La crioanalgesia en la facoemulsificación, con una técnica quirúrgica depurada en cirujanos con experiencia, es segura y efectiva con resultados visuales similares a los obtenidos en pacientes operados de catarata por la técnica de facoemulsificación con anestesia farmacológica(AU)

Objective: To describe the results of the application of cryoanalgesia in the cataract surgery using simultaneous bilateral phacoemulsification in patients with a history of allergic reactions to pharmacological anesthesics. Methods: A descriptive case series study was performed in 10 patients with histories of allergic reactions to pharmacological anesthetics that are used in the cataract surgery. All these patients underwent Prechop technique-based simultaneous bilateral phacoemulsification through temporal clear cornea, with irrigation of balanced saline solution and viscoelastic substances at 4 °C in the Center of Ocular Microsurgery of Ramon Pando Ferrer Cuban Institute of Ophthalmology. Results: No differences were found between sexes; the average age was 62.3 years; the crystalline lens hardness, according to LOCS III mostly presented with nuclear opacities ranging II to IV; the effective ultrasound time did not exceed half a minute. All these patients recovered their best corrected visual acuity and no complications were reported. The endothelial cell count showed a loss of 3.5 % when compared with the preoperative initial count. Conclusions: Cryoanalgesia in phacoemulsification, with the use of refined surgical technique by experienced surgeons, is safe and effective with visual results similar to those achieved in patients operated on of cataract through phacoemulsification with pharmacological anesthetic(AU)

Factors associated with asthma expression in adolescents / Fatores associados à expressão da asma em adolescentes

ABSTRACT Objective: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. Methods: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. Results: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). Conclusions: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

RESUMO Objetivo: Avaliar os fatores de risco associados aos sintomas relacionados à asma em adolescentes de 13 e 14 anos. Métodos: Estudo transversal realizado com alunos matriculados em escolas públicas de Belo Horizonte (MG), selecionadas aleatoriamente, com a utilização dos questionários International Study of Asthma and Allergies in Childhood e de seu módulo complementar para a avaliação dos potenciais fatores de risco. O primeiro questionário foi respondido pelos alunos, e o segundo foi respondido pelos pais e/ou responsáveis. Após a análise univariada, todas as variáveis cujo valor de p foi igual ou inferior a 0,25 foram submetidas à análise multivariada. A seleção das variáveis foi realizada pelo método passo a passo com eliminação retrógrada de variáveis. Resultados: Foram avaliados 375 adolescentes, dos quais 124 (33,1%) apresentavam sintomas de asma. O modelo final da análise multivariada revelou que sintomas de asma estiveram associados a peso ao nascimento < 2.500 g (p < 0,001), frequência a creches ou berçários (p < 0,002), história materna de asma (p < 0,001), contato com animais durante o primeiro ano de vida (p < 0,027), contato atual com animais fora da residência (cão, gato ou outros animais em fazenda; p < 0,005) e consumo de mais que 20 cigarros por dia por residentes no mesmo domicílio que o adolescente (p < 0,02). Conclusões: As exposições intra e extradomiciliar a animais domésticos e ao tabaco estiveram associadas à presença de sintomas de asma. Esses resultados devem ser considerados tanto pelos familiares como pelos profissionais e gestores dos serviços de saúde na prevenção da asma e na redução do seu impacto na morbidade.

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Anafilaxias y reacciones alérgicas durante cirugías y procedimientos médicos / Anaphylaxis and allergic reactions during surgery and medical procedures

Las reacciones anafilácticas intraoperatorias son impredecibles, infrecuentes y pueden poner en riesgo al paciente. Tienen una incidencia de 1/10 000 a 1/20 000 produciéndose en la mayoría de los casos por bloqueantes musculares, látex y antibióticos. No hay estadística de las reacciones alérgicas sistémicas durante otros procedimientos médicos. El estudio diagnóstico posterior a una reacción es complejo debiendo incluir toda la medicación utilizada en el procedimiento. En este estudio retrospectivo describimos 15 pacientes, de los cuales 10 tuvieron reacciones anafilácticas en un procedimiento quirúrgico, 2 en endoscopías y 1 en una ecografía transvaginal. Los dos pacientes restantes presentaron una reacción alérgica sistémica durante una ecografía transvaginal y un procedimiento odontológico. Estudiamos los pacientes con toda la medicación utilizada, incluimos látex y, eventualmente, los detergentes y desinfectantes, de haber sido empleados. Tres de las 10 cirugías no pudieron realizarse por desarrollarse la reacción durante la inducción anestésica, en cinco casos debieron interrumpirse y solo en dos se terminaron. Las reacciones posteriores a endoscopías fueron severas, requiriendo internación en terapia intensiva; las reacciones en ecografías transvaginales y procedimientos odontológicos fueron asistidas en emergencias. Los agentes causales en las cirugías incluyeron bloqueantes musculares, látex, cefalosporina, azul patente y ranitidina; en endoscopías el agente causal fue el orto-ftalaldehído (OPA), en las ecografías transvaginales el látex y en el procedimiento odontológico la amoxicilina. El objetivo de este artículo es describir la etiología de las reacciones alérgicas sistémicas y anafilácticas intraoperatorias y en procedimientos médicos, recalcando su gravedad y la necesidad de su identificación.

Anaphylaxis during anesthesia is an unpredictable, severe, and rare reaction. It has an incidence of 1/10 000 to 1/20 000 surgeries. In most series, the responsible drugs include neuromuscular blocking agents, latex, or antibiotics. The frequency and etiology of systemic allergic reactions in other medical procedures are largely unknown. The identification of responsible drugs of anaphylaxis is a complex task, requiring testing of all medications and substances used during surgery. We describe our experience in a retrospective study of 15 patients. Ten subjects developed anaphylaxis during surgery, two in endoscopic studies and one in a trans-vaginal ultrasound. The remaining two subjects, one in a trans-vaginal ultrasound and another during a dental procedure had a systemic allergic reaction. We studied all patients with all medications administered during the procedures, including latex and detergents and disinfectants. Three surgeries had to be suspended at induction of anesthesia, five were stopped incomplete and two were completed. Both patients that presented a reaction during endoscopy required intensive care unit admission and the rest were observed in a Hospital. The responsible drugs during surgery anaphylaxis were neuromuscular blocking agents, latex, patent blue, and ranitidine. Ortho-phthalaldehyde (OPA) was identified during endoscopic studies; latex was responsible in transvaginal ultrasounds; and amoxicillin in the dental procedure. The aim of the present article is to review our experience studying allergic systemic reactions and anaphylaxis during general anesthesia and medical procedures, emphasizing the severity of these reactions and the need for causative drug identification.

Epigenética en enfermedades alérgicas y asma / Epigenetics in allergic diseases and asthma

Las enfermedades alérgicas y el asma son el resultado de complejas interacciones entre la predisposición genética y factores ambientales. El asma es una de las enfermedades crónicas más prevalentes en niños. En este artículo se revisan algunos factores ambientales como la exposición a alérgenos, tabaco, bacterias, componentes microbianos, dieta, obesidad y estrés, que intervienen durante la vida intrauterina y la infancia en la regulación epigenética de las enfermedades alérgicas y el asma. La revisión se realiza en tres tipos de modelos: in-vitro, animales y humanos.

Allergic diseases and asthma are the result of complex interactions between genetic predisposition and environmental factors. Asthma is one of the most prevalent chronic disease among children. In this article we review some environmental factors like: allergen exposition, tobacco, bacteria, microbial components, diet, obesity and stress, which influences during intrauterine and infancy life in the epigenetic regulation of asthma and allergic diseases. The review has been done in three models: in-vitro, animal and human.

Pet avoidance in allergy cases: Is it possible to implement it? / Evitación de mascotas en casos de alergia. ¿Es factible lograrla?

Introduction: Among allergic patients, pet avoidance is commonly recommended. It is difficult for patients to accomplish this because of their emotional attachment to the pets, and its effectiveness is controversial. Objective: To explore the applicability and effectiveness of pet avoidance measures among sensitized patients. Materials and methods: We evaluated 288 patients with asthma, rhinitis, conjunctivitis and/or dermatitis using skin prick test to measure their sensitization to cats, dogs and other animals to which they were exposed. Exposure to animals was evaluated in each patient (pets at home, frequent indirect exposure or no exposure). In those patients sensitized to animals some avoidance measures, such as removing pets from home and preventing indirect exposure, were recommended. On the following two appointments, we evaluated patients' fulfillment of these recommendations. Results: Sensitization to cats, dogs and birds was high (9%, 48%, 14%, respectively), as well as direct and indirect exposure (30%, 46%, 24%, respectively). Most patients denied contact with other animals (horses, hamsters, rabbits or cows), and sensitization to them was low. During the follow-up of patients sensitized to their pets at home (n=50), most of them refused to remove them from their house due to emotional attachment, and only two followed this recommendation. Conclusions: High exposure to animals could explain the frequency of sensitization to pets in this population. However, emotional attachment and prevalent indirect exposure to animals among sensitized patients make avoidance recommendations impractical or impossible to achieve.

Introducción. Entre los pacientes alérgicos se recomienda comúnmente la evitación de mascotas; sin embargo, es difícil que los pacientes cumplan con esta recomendación debido al apego emocional y, además, su efecto clínico no es claro. Objetivo. Explorar la aplicabilidad de las medidas de evitación entre pacientes sensibilizados a mascotas . Materiales y métodos. En 284 pacientes con asma, rinitis, conjuntivitis y dermatitis, se evaluó la sensibilización a gatos, perros y otros animales mediante pruebas de punción epidérmica. Se evaluó, igualmente, el nivel de exposición a animales (mascotas en la casa y exposición indirecta frecuente). A aquellos pacientes sensibilizados a los animales, se les recomendaron medidas de evitación como retirar la mascota de la casa y evitar la exposición indirecta. En las dos citas médicas siguientes se evaluó el cumplimiento de estas recomendaciones. Resultados. La sensibilización a gatos, perros y aves fue alta (9, 48, y 14 %, respectivamente), al igual que la exposición directa o indirecta a estos animales (30, 46, 24 %, respectivamente). La mayoría de los pacientes negó el contacto frecuente con otros animales (caballos, hámsteres, conejos, vacas) y la sensibilización a estos fue baja. La mayoría de los pacientes sensibilizados a su propia mascota (n= 50) se rehusó a retirar la mascota de la casa y solo dos de ellos siguieron la recomendación de hacerlo. Conclusiones. La exposición frecuente a los animales podría explicar la gran frecuencia de sensibilización a las mascotas en esta población. Sin embargo, el apego emocional y la exposición indirecta frecuente, hacen que las recomendaciones de evitación sean imprácticas o casi imposibles de lograr.

Prevalencia y perfil de sensibilización a aeroalérgenos en 1.199 niños asmáticos: serie consecutiva de casos / Prevalence of atopy in 1,199 asthmatic children from southern Santiago, Chile

Background: The prevalence of atopy in asthmatic children is widely variable around the world as demonstrated by large multicentric international studies. Aim: To determine the prevalence of atopy, defined as a positive reaction to one or more allergens in the skin prick test (SPT), in children with persistent asthma. Material and Methods: We studied 1,199 children (54% male), aged between 4 and 16 years with confirmed diagnosis of asthma and followed at a Department of Pediatric Respiratory Medicine, between 2006 and 2011. SPT was performed according to international recommendations using standardized aeroallergens, in the forearm. A positive reaction was defined as a wheal ≥ 3 mm to one or more allergens. Results: The overall prevalence of atopy (positive SPT) was 49.4% (95% confidence interval (CI) 46.5-52.2) and there was a significant trend towards a higher prevalence with increasing age (p < 0.01). The main allergens with positive reactions were Dermatophagoides with 24.9% (95% CI 26.7-31.9), grass 24.0% (95% CI 21.6-26.5), weeds 19.0% (95% CI 16.9-21.4), cat 17.7% (95% CI 15.4-20.2), and Alternaria with 11.0% (95% CI 9.1-13.1). Sixty five percent of positive children reacted to one or more allergens. There were no adverse reactions. Conclusions: In the southern metropolitan area of Santiago de Chile, half of children with asthma are sensitized to common aeroallergens.

Reações transfusionais em crianças: fatores associados / Blood transfusion reactions in children: associated factors

OBJETIVO: Analisar o perfil das reações transfusionais em crianças e identificar os fatores intervenientes. MÉTODOS: Estudo transversal realizado em um hospital-escola pediátrico terciário da rede pública, envolvendo todas as crianças internadas de janeiro a julho de 2011 (5437), das quais 1.226 foram hemotransfundidas, constituindo, assim, a amostra. Realizado estudo documental dos relatórios do serviço de hemovigilância e das fichas de notificação de reações transfusionais. As variáveis investigadas foram: número e tipo de hemocomponente transfundido, local de transfusão, local da reação, idade, sexo, tipo de hemocomponente envolvido, tipo de incidente e história prévia de politransfusão. Realizada análise descritiva e inferencial, utilizando-se testes estatísticos para estabelecer associação entre as variáveis. RESULTADOS: Verificou-se 57 incidentes transfusionais envolvendo 47 crianças distintas e 72 hemocomponentes, constituindo uma prevalência de reações de 3,8%. Na análise inferencial, pelo teste do Qui-quadrado, as seguintes variáveis apresentaram associação estatisticamente significativa (p < 0,05) com o tipo de reação: faixa etária e tipo de hemocomponente envolvido. Analogamente, a doença de base do paciente associou-se com a história prévia de incidente transfusional e o tipo de hemocomponente. CONCLUSÕES: A prevalência de reações transfusionais em crianças é elevada, e os fatores intervenientes são o tipo de hemocomponente, a faixa etária, comorbidade do paciente e politransfusão, sendo que os dois primeiros associam-se, também, com tipo de reação ocorrida.

OBJECTIVE:To analyze the profile of blood transfusion reactions in children and to identify the involved factors. METHODS: This was a cross-sectional study in a tertiary pediatric teaching hospital from the public healthcare system, involving all children admitted from January to July of 2011 (5,437), of which 1,226 received blood transfusions, constituting the sample. A documental study was performed by analyzing files from the hemovigilance service and notification forms of transfusion reactions. The variables investigated were: number and type of blood components transfused, transfusion site, reaction site, age, gender, type of blood components involved, type of incident, and previous history of multiple transfusions. A descriptive and inferential analysis was performed, using statistical tests to establish the association between the variables. RESULTS: There were 57 transfusion incidents involving 47 children and 72 different blood products, thus constituting a prevalence of reactions of 3.8%. At the inferential analysis, the chi-squared test showed that the following variables were significantly associated (p < 0.05) with the type of reaction: age range and type of blood component. Similarly, the patient's underlying disease was associated with previous history of transfusion incident and type of blood component. CONCLUSIONS: The prevalence of transfusion reactions in children is high, and the intervening factors are: type of blood component, age, patient comorbidity, and multiple transfusions; type of blood component and age are also associated with type of reaction.

Nickel and chromium levels in the saliva of a Saudi sample treated with fixed orthodontic appliances

The aim of this study was to measure the amount of nickel [Ni] and chromium [Cr] released into the saliva of Saudi patients treated with fixed orthodontic appliances. Ninety salivary samples were collected in a cross-sectional manner. Forty samples were collected from patients [17 males, 23 females] with fixed orthodontic appliances after different periods of orthodontic treatment ranging from the first month and up to 32 months into treatment. The fixed orthodontic appliance consisted of 4 bands, 20 stainless steel brackets, and upper and lower nickel titanium or stainless-steel arch wires. The other 50 samples were collected from people without appliances [24 males, 26 females]. Samples were analyzed using Inductive Coupled Plasma/Mass Spectrometry and Inductively Coupled Plasma Optical Emission Spectroscopy to measure Ni and Cr levels, respectively. Student's t-test was used to compare Ni and Cr levels in the treated and untreated control groups. The mean Ni level was 4.197 microg/L in the experimental group and 2.3 ug/L in the control group [p < 0.05]. The mean Cr level was 2.9 microg/L in the experimental group and 3.3 microg/L in the control group [p < 0.05]. Fixed orthodontic appliances resulted in a non-toxic increase in salivary levels of Ni, but no change in Cr levels. Duration of orthodontic treatment did not affect Ni and Cr levels in the saliva

Alergia al plasma seminal humano: ¿mito o realidad? / Human seminal plasma allergy

Antecedentes: la hipersensibilidad al plasma seminal humano abarca una amplia variedad de manifestaciones clínicas que comprenden desde prurito local y reacciones dérmicas localizadas, hasta situaciones que ponen en riesgo la vida, como la anafilaxia. Objetivo: caracterizar este fenómeno, para el estudio a profundidad del tema y enfatizar en un problema que no está siendo valorado debido al poco conocimiento del evento. Método: revisión de la literatura empleando los términos "semen allergy" y "human seminal plasma allergy" y sus equivalentes en español en diferentes bases de datos. Resultados: este desorden inmunológico es más frecuente entre los 23 y los 35 años de edad, en la mayoría de los casos los síntomas se inician dentro de la primera hora después de culminada la relación sexual o inmediatamente después de tener contacto con el semen. El método de prevención más eficaz es el condón, aunque no es una opción adecuada para las parejas que desean concebir. Conclusión: se requiere estudiar y caracterizar mejor este fenómeno para mejorar tanto su diagnóstico como su tratamiento.

Background: human seminal plasma hypersensitivity includes a wide variety of clinical manifestations comprising itching and localized dermal reactions to situations that threaten life as anaphylaxis. Aims: to characterize this phenomenon, for in-depth study of the subject and emphasize a problem that is not being assessed due to poor knowledge of the event. Method: review of the literature using the terms "semen allergy" and "human seminal plasma allergy" and their spanish equivalents in different databases. Results: this immune disorder is more common between 23 and 35 years of age, in most cases the symptoms begin within the first hour after culminating intercourse or immediately after contact with the semen and most effective prevention method is the condom, although not an adequate solution for couples who want to conceive. Conclusion: further studies are required to further characterize this phenomenon to improve both diagnosis as treatment.

Glucocorticoid hypersensitivity syndrome: a case report / Síndrome de la hipersensibilidad glucocorticoidea reporte de caso

Glucocorticoid hypersensitivity syndrome has been reported to date only in several patients. This article describes a unique case of this syndrome in a 24-year old female admitted to hospital because of arterial hypertension and obesity. Although her clinical picture suggested Cushing's syndrome, she had low adrenocorticotropic hormone (ACTH) and cortisol levels with a poor response to corticotrophin-releasing hormone and Synacthen. In turn, an overnight dexamethasone suppression test with 0.25 mg of dexamethasone led to a dramatic decrease in morning cortisol. A diagnosis of glucocorticoid hypersensitivity was made and the patient started treatment with ketoconazole and cabergoline, which resulted in some clinical improvement. This case illustrates the need for clinical awareness of glucocorticoid hypersensitivity in patients suspected of Cushing's syndrome.

El síndrome de la hipersensibilidad glucocorticoidea ha sido reportado hasta la fecha en varios pacientes. Este artículo describe un caso único de este síndrome en una mujer de 24 años, ingresada en el hospital debido a hipertensión arterial y obesidad. Aunque su cuadro clínico hizo pensar en el síndrome de Cushing, presentaba un bajo nivel tanto de hormona adrenocorticotropa (ACTH) como de cortisol, acompañado de una respuesta pobre a la hormona liberadora de corticotropina y al synacthen. A su vez, una prueba de supresión de la dexametasona realizada durante la noche con 0.25 mg de dexametasona, condujo a una disminución dramática del cortisol en la mañana. Se hizo un diagnóstico de hipersensibilidad glucocorticoide, y la paciente empezó el tratamiento con ketoconazol y cabergolina, lo cual trajo como consecuencia cierta mejoría clínica. Este caso ilustra la necesidad de una mayor conciencia clínica en torno a la hipersensibilidad glucocorticoidea en pacientes sospechosos de padecer el síndrome de Cushing.

Chlorhexidine allergy due to topical application.

Chlorhexidine is commonly used in dentistry in various forms. Allergic reactions to chlorhexidine of both immediate and delayed type have been reported. Although the incidence is low there may be severe manifestations in some patients. This report presents a case of allergy to chlorhexidine following topical application.

Lesões oculares por Processionária (Thaumetopoea pityocampa Schiff): relatos de casos / Processionary (Thaumetopoea pityocampa Schiff) induced ocular lesions: case reports

A Processionária (Thaumetopoea pityocampa Schiff), vulgarmente conhecida como "lagarta do pinheiro" é um inseto dos pinheiros e cedros, endêmico em meios rurais mas também em meios urbanos. A toxicidade ocular, rara nas últimas décadas pelo desenvolvimento de métodos de erradicação eficazes, é provocada pelos seus pelos e prevê-se mais frequente com o recrudescimento deste inseto. Revemos a epidemiologia da Processionária e as suas lesões oculares a partir de 3 casos clínicos. Caso 1: Doente de 64 anos recorre ao Serviço de Urgência (SU) com olho direito vermelho e sensação de corpo estranho após prática de jardinagem. A observação revela AVODc: 0,5, erosão epitelial, presença de um filamento no estroma corneano profundo, flare (++) e Tyndall (+++). Caso 2: Doente de 28 anos, recorre ao SU por dor intensa no olho direito acompanhada de hiperemia após contato com lagarta. Apresenta AVODc: 0,6 e Tyndall (+++) com presença de múltiplos filamentos (mais de 20) a diferentes profundidades da córnea. Caso 3: Doente de 26 anos, recorre ao SU por sensação de corpo estranho e lacrimejamento constante no olho direito, após realizar exercícios militares num parque urbano. Apresenta AVODc: 0,3, múltiplas erosões epiteliais puntiformes na metade nasal da córnea que recobriam filamentos de cor laranja e Tyndall (+). Foi instituída terapêutica com corticoide tó­pico e vigilância sintomática a cada um dos casos. A patologia ocular por Processionária decorre da toxicidade dos seus pelos, cuja migração ocorre preponderantemente no sentido intraocular. Inclui por isso lesões precoces (conjuntivite, queratite e uveíte) e tardias (catarata, pars planite, vitreíte e retinite). Os casos apresentados possuíam lesões iniciais, tendo recuperado totalmente do quadro inflamatório após seis meses mas mantendo os pelos inativos no estroma corneano. A gravidade destes casos prende-se à possibilidade de migração intraocular, que pode ocorrer anos após o episódio inicial, obrigando a uma vigilância ao longo da vida. CONCLUSÃO: O recrudescimento da Processionária, tanto em meios rurais como urbanos, justifica o conhecimento das lesões oculares que pode causar e o seu tratamento.

The Processionary (Thaumetopoea pityocampa Schiff), is an endemic insect of pine and cedar trees, existing both in rural and urban areas. Ocular toxicity, once rare due to the efficacy of eradication methods, is caused by the insects' hair and is expected to be more frequent with its recrudescence. We report two clinical cases and review the epidemiology of Processionary and its eye injuries. Case 1: a 64 year-old patient complained of red eye and foreign body sensation after being gardening. She had a BCVA of 0.5 and biomicroscopy revealed an epithelial erosion, flare (++), Tyndall (+++) and the presence of a setae in the deep corneal stroma. Case 2: a 28 year-old patient complained of severe pain in the right eye and hyperemia after having had contact with a caterpillar. He presented with a BCVA of 0.6, Tyndall (+++) and multiple filaments (over 20) at different depths in the cornea. Case 3: a 23 year-old patient refers to the ER with foreign body sensation and constant lacrimation in the right eye after having been completing military exercises in an urban park. He presented a BCVA of 0.3, multiple epithelial erosions in the nasal half of the cornea that cove­red multiple orange strands and an anterior chamber reaction (Tyndall +). Therapy was initiated with topical steroids and symptomatic surveillance. Ocular toxicity due to Processionary hairs, whose movement occurs preferentially towards the posterior pole, includes early signs (conjunctivitis, keratitis, and uveitis) and late signs (cataract, pars planitis, vitritis, and retinitis). The 3 cases presented had early lesions, having fully recovered from the inflammatory condition after 6 months. However, inactive setae were still visible in the corneal stroma. Intraocular migration, which can occur years after the initial episode, is possible and might be severe, thus requiring a life-long surveillance. CONCLUSION: Processionary recrudescence has been observed, both in rural and urban areas. It is therefore imperative to be familiar with eye injuries caused by the insect and its treatment.