ABSTRACT
Introducción: El tratamiento del asma grave es un reto a nivel mundial, por su impacto en la calidad de vida y el riesgo de desenlaces graves como hospitalizaciones y muerte. El objetivo del presente estudio es caracterizar a los pacientes de un centro de atención especializada en manejo del asma grave en Colombia. Métodos: Estudio observacional, retrospectivo, en pacientes atendidos entre 2019 y 2022. Se realizó un análisis univariado con medidas de tendencia central y dispersión para variables cuantitativas; frecuencias absolutas y relativas para variables cualitativas; y análisis bivariado con pruebas chi cuadrado y t-student tomando como variable dependiente el estado de control del asma. Resultados: Se analizaron 377 pacientes, 78,5% mujeres, edad media de 57 años; 79,0% con 1 - 5 crisis el año previo al ingreso al programa, y 19,6% con al menos un in- greso a unidad de cuidados intensivos por crisis a lo largo de su vida. La terapia más frecuente fue biológico-corticoide inhalado/agonista ß2 de acción prolongada-antagonista muscarínico de acción prolongada-antagonistas de los receptores de leucotrienos (14,3%). Se observó un tratamiento inadecuado en el 9,6%, solo con agonistas ß2 de acción corta a necesidad, LTRA en monoterapia o una combinación de LAMA/LTRA. El estado de control del asma al ingreso presentó asociación estadística con encontrar- se en terapia biológica. Conclusiones: Se caracterizó la población y se resalta la importancia del manejo adecuado de pacientes con asma grave por centros especializados buscando la mejor terapia posible, al menor costo y mayor impacto en el control de la enfermedad.
Introduction: The management of severe asthma is a worldwide challenge, due to its impact on quality of life and the risk of serious outcomes such as hospitalisations and death. This study aims to characterise patients in a centre specialising in managing severe asthma in Colombia.Methods: Observational, retrospective study in patients seen between 2019 and 2022. Univariate analysis was performed with measures of central tendency and dispersion for quantitative variables; absolute and relative frequencies for qualitative variables; and bivariate analysis with chi-square and t-student tests taking as dependent variable the asthma control status.Results: 377 patients were analysed, 78.5% female, mean age 57 years; 79.0% with 1-5 crises in the year before programme entry, and 19.6% with at least one-lifetime admission to the intensive care unit for crises. The most frequent therapy was biologic-in-haled corticosteroid/long-acting ß2-agonist-long-acting muscarinic antagonist-leukot-riene receptor antagonists (14.3%). Inadequate treatment was observed in 9.6%, with short-acting ß2-agonist alone on an as-needed basis, LTRA monotherapy or a combi-nation of LAMA/LTRA. Asthma control status at admission showed statistical associa-tion with being on biological therapy.Conclusions: The population was characterised and the importance of adequate man-agement of patients with severe asthma by specialised centres seeking the best possi-ble therapy, at the lowest cost and with the greatest impact on disease control is high-lighted.
Subject(s)
Humans , Male , Female , Middle Aged , Asthma/prevention & control , Status Asthmaticus/drug therapy , Adrenal Cortex Hormones/therapeutic use , Muscarinic Antagonists/therapeutic use , Leukotriene Antagonists , Primary Health Care , Biological Therapy , Chi-Square Distribution , Comorbidity , Colombia , Medical Care , Observational Study , Symptom Flare Up , HospitalizationABSTRACT
Introducción: El asma es una enfermedad heterogénea, caracterizada por la inflamación crónica de las vías respiratorias. El uso de los corticoides sistémicos como tratamiento de las crisis de asma constituye una práctica frecuente en los últimos 60 años y en pacientes refractarios a terapia estándar con corticoides inhalados a dosis altas asociado a beta dos agonistas de acción prolongada; sin embargo, el uso de esta terapia está asociado a efectos adversos, principalmente al uso de dosis excesivas, entendidas estas como dos o más ciclos de corticoides al año. Métodos: El objetivo de este estudio es describir los patrones y frecuencia de uso de los corticoides orales (CO) en pacientes con diagnóstico de asma a partir del uso de regis- tros administrativos de prestaciones de salud. Se desarrolló un estudio descriptivo, lon- gitudinal, retrospectivo para el periodo 2016 a 2020. Resultados: Se identificó un patrón de sobreuso de CO, posiblemente relacionado a la falta de claridad frente a los criterios de prescripción y tiempo de uso. Adicionalmente, se documentó la presencia de posibles efectos adversos asociados al uso de CO. Conclusiones: Lo anterior evidencia la necesidad de definir de manera precisa las indi- caciones y las restricciones frente al uso de esta terapia, incentivar el uso de manejos controladores óptimos para evitar crisis asmáticas y realizar un seguimiento clínico es- tricto a los pacientes que requieran el uso de CO.
Introduction: Asthma, characterized by chronic airway inflammation, is primarily treated with inhaled corticosteroids and other medications based on disease severity. For the past 60 years, systemic corticosteroids have been used to treat asthma attacks in patients who do not respond to standard therapy. However, this approach is associated with adverse effects. Methods: This study, based on medical records, aimed to describe the frequency of oral corticosteroid (OC) use in asthma patients. Results: A pattern of OC overuse was identified, possibly related to the lack of clarity regarding prescription criteria and time of use. In addition, the presence of possible adverse effects associated with the use of OC was documented. Conclusion: This shows the need to precisely define the indications for and restrictions to applying this therapy, to encourage optimal control management to avoid asthmatic crisis, and carry out a strict clinical follow-up of patients requiring the use of OC.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Adult , Middle Aged , Asthma/drug therapy , Status Asthmaticus/prevention & control , Database Management Systems , Health Systems , Medical Records/statistics & numerical data , Morbidity , Adrenal Cortex Hormones/administration & dosage , Colombia , DiagnosisABSTRACT
RESUMEN La sarcoidosis es una enfermedad inflamatoria crónica caracterizada por la prevalencia de granulomas no caseosos que puede afectar múltiples órganos. Presentamos el caso de un varón de 35 años de edad, sin patologías conocidas previamente, albañil, procedente de zona urbana. Presenta un cuadro de 4 meses de evolución que inicia con disnea y tos seca, además de sensación febril y pérdida de peso. En la tomografía de tórax simple se visual condensaciones parahiliares y múltiples lesiones nodulares y micronodulares sólidas con claro predominio en lóbulos superiores. La histopatología informa granulomas no caseosos en la muestra de tejido pulmonar. Se instaura tratamiento con corticoides sistémicos con notable mejoría de los síntomas respiratorios.
ABSTRACT Sarcoidosis is a chronic inflammatory disease characterized by the prevalence of noncaseating granulomas that can affect multiple organs. We present the case of a 35-year-old male, with no previously known pathologies, a bricklayer, from an urban area. The patient presents a 4-month history that begins with dyspnea and dry cough, as well as a feverish feeling and weight loss. The simple chest tomography showed parahilar condensations and multiple solid nodular and micronodular lesions with a clear predominance in the upper lobes. Histopathology reports non-caseating granulomas in the lung tissue sample. Treatment with systemic corticosteroids was instituted with notable improvement in respiratory symptoms.
Subject(s)
Humans , Male , Adult , Adrenal Cortex Hormones/therapeutic use , Sarcoidosis, Pulmonary , Granuloma, Respiratory TractABSTRACT
Introducción: Los objetivos del control del asma son prevenir la aparición de síntomas y reducir el riesgo de exacerbaciones y mortalidad mediante educación médica, técnica inhalatoria, adherencia a medicación controladora e indicación de planes de acción (PA); pero los pacientes enfrentan exacerbaciones de diversa gravedad. Objetivos: El objetivo principal del estudio SABINA EMERGENCIAS fue describir la forma en que los pacientes concurren al servicio de emergencias (SE), considerando la frecuencia y uso de medicación de rescate. Objetivos secundarios: consultas al SE; uso de corticoides sistémicos (CS), agonistas beta-2 de acción corta (SABA) y tratamiento controlador; disponibilidad de PA. Material y Métodos: Estudio transversal, observacional, descriptivo, en cuatro hospitales del área metropolitana de Buenos Aires en adultos con asma. Resultados: n=323 (edad: 43,7±16,8 años; mujeres: 66,6%): 61,3% no eran seguidos por especialistas; 90,1% utilizaron SABA como rescate (mediana:10 inhalaciones; rango 0-100) la semana previa; 75,9% tuvieron ≥1 consulta al SE el año previo (mediana:2 [0-100]); 29,4% habían sido hospitalizados; 59,1% recibieron ≥1 ciclo de CS; mediana de consumo de SABA: 3 envases/año (0-23); 51,7% habían utilizado ≥3 envases; 30% no empleaban tratamiento de mantenimiento (23% usaba SABA); 75,9% no efectuaban terapia regular de mantenimiento; 77,1% no contaban con PA. Conclusión: Una reducida proporción de pacientes asmáticos que concurren al SE son seguidos por médicos especialistas, con alto consumo y elevada frecuencia de aplicación de SABA como rescate y baja adherencia al tratamiento de mantenimiento. Se remarca la necesidad de optimizar el manejo, con énfasis en la derivación al especialista, adherencia al tratamiento y prescripción de PA.
Introduction: The objectives of asthma control are to prevent the onset of symptoms and reduce the risk of exacerbations and mortality through medical education, inhaler technique, adherence to controller medication and indication of action plans (AP); but patients experience exacerbations of varying severity. Objective: The main objective of the SABINA EMERGENCIAS study was to describe how patients attend the emergency department (ED), considering the frequency and use of rescue medication. Secondary objectives: ED visits; use of systemic corticosteroids (SC), short-acting beta-2 agonists (SABA) and controller therapy; availability of AP. Methods: Cross-sectional, observational, descriptive study in 4 hospitals in the metropolitan area of Buenos Aires in adults with asthma. Results: n=323 (age:43.7±16.8 years; women:66.6%): 61.3% were not followed by specialists; 90.1% used SABA as rescue medication (median:10 puffs; range 0-100) the previous week; 75.9% had ≥1 visit to the ES the previous year (median: 2 [0-100]); 29.4% had been hospitalized; 59.1% received ≥1 cycle of CS; median SABA consumption: 3 cannisters/year (0-23); 51.7% had used ≥3 cannisters; 30% did not use maintenance therapy (23% used SABA); 75.9% did not perform regular maintenance therapy; 77.1% did not have an AP. Conclusion: A small proportion of asthmatic patients attending the ES are followed by specialist physicians, with high consumption and high frequency of SABA application as rescue medication and low adherence to maintenance treatment. The need to optimize management is highlighted, with emphasis on referral to specialists, adherence to treatment and prescription of APs.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Asthma/diagnosis , Emergency Service, Hospital , Symptom Flare Up , Argentina , Quality of Life , Bronchodilator Agents , Surveys and Questionnaires , Adrenal Cortex Hormones , Dyspnea , Education, Medical , Treatment Adherence and ComplianceSubject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adrenal Cortex Hormones , Premature Birth , Prenatal Care , Infant, Premature , Gestational AgeABSTRACT
A urticária é uma condição caracterizada pela presença de urticas, angioedema, ou ambos, que pode ser classificada de acordo com o tempo de duração em aguda, quando persiste por menos de 6 semanas, ou crônica, quando por mais de 6 semanas e afeta significativamente a qualidade de vida. A atualização das recomendações quanto ao seu diagnóstico e tratamento é elaborada por especialistas de todo o mundo, que se reúnem a cada quatro anos em Berlim para revisar todas as novas evidências que justifiquem modificações na diretriz internacional. Este artigo discute as principais recomendações propostas na versão atual da diretriz internacional.
Urticaria is a condition characterized by the presence of hives, angioedema, or both. It can be classified according to its duration as acute, when it persists for less than 6 weeks, or chronic, when it persists for more than 6 weeks and greatly affects quality of life. Updated recommendations on diagnosis and management are developed by experts from all over the world who meet every 4 years in Berlin and review all new evidence that supports changes to the international guideline. This paper discusses the main recommendations proposed in the current version of the international guideline.
Subject(s)
Humans , Therapeutics , Urticaria , Angioedema , Quality of Life , Epidemiology , Cyclosporine , Adrenal Cortex Hormones , Histamine H1 Antagonists, Non-Sedating , Diagnosis, Differential , Allergy and Immunology , OmalizumabABSTRACT
A maioria das crianças e adolescentes com asma grave apresenta fenótipo de inflamação eosinofílica, com risco de exacerbações, uso de corticosteroides sistêmicos e redução na qualidade de vida. Crianças com inflamação tipo 2 respondem bem aos tratamentos convencionais, no entanto, há um grupo pequeno que falha na resposta terapêutica habitual e necessita medicamentos adicionais, como imunobiológicos, para o controle da doença. O conhecimento da fisiopatologia da inflamação brônquica e a avaliação de seus biomarcadores é fundamental para escolha adequada do imunobiológico. Relatamos o caso de um paciente de 13 anos, com asma grave do tipo 2 alérgico, sem indicação de omalizumabe, e que em uso de mepolizumabe não apresentou controle da doença depois de 12 meses de tratamento. A avaliação do endótipo com citologia de escarro identificou fenótipo inflamatório misto, direcionando a substituição por outro imunobiológico, o tezepelumabe, atingindo o controle das exacerbações, por provável redução da hiper-responsividade brônquica. A avaliação do endótipo da asma com os biomaracadores disponíveis permitiu um tratamento preciso e individualizado para o paciente.
Most children and adolescents with severe asthma have an eosinophilic inflammatory phenotype and are at risk of exacerbations, systemic corticosteroid use, and reduced quality of life. Children with type 2 inflammation respond well to conventional treatment; however, there is a small group that is unresponsive to conventional therapy and requires additional medication for disease control, such as immunobiologic agents. Knowledge of the pathophysiology of bronchial inflammation and biomarker assessment are essential for the appropriate choice of an immunobiologic agent. We report the case of a 13-year-old patient with severe type 2 allergic asthma, with no indication for omalizumab, who did not respond to mepolizumab after 12 months of treatment. The sputum cytology identified a mixed inflammatory endotype that led to replacement with another immunobiologic agent, tezepelumab, achieving control of exacerbations by probable reduction in bronchial hyperresponsiveness. Assessment of asthma endotype with the available biomarkers allowed precise and personalized treatment for this patient.
Subject(s)
Humans , Male , Adolescent , Phenotype , Asthma , Omalizumab , Antibodies, Monoclonal , Therapeutics , Pharmaceutical Preparations , Biomarkers , Adrenal Cortex HormonesABSTRACT
Introducción. El benralizumab es un anticuerpo monoclonal efectivo en el tratamiento de pacientes con asma grave eosinofílica no controlada a pesar de una adecuada adherencia, técnica de uso del inhalador y la administración de corticoides inhalados en dosis plenas junto con agonistas ß de acción prolongada. Estas terapias innovadoras a menudo enfrentan retos en los sistemas de salud, la mayoría en términos de acceso efectivo y oportuno de los pacientes, lo que hace que los programas de soporte al paciente (PSP) puedan disminuir estas barreras de acceso, permitiendo mejoría en tiempos e identificando hitos sobre los cuales los diferentes actores del sistema pueden enfocar esfuerzos para una mayor efectividad en el acceso. Objetivo. comparar los resultados de un programa de soporte al paciente con asma grave eosinofílica en tratamiento con benralizumab y el acceso a la terapia durante 2021 y 2022 en Colombia. Materiales y métodos. Análisis descriptivo observacional retrospectivo de un programa de soporte a pacientes con asma grave eosinofílica durante 2021-2022 en Colombia. Resultados. En ambos periodos predominó el género femenino (69.8 % y 76.2 % respectivamente), la media de edad fue de 50.8 años (DE ±11.4) (valor p: 0.395) en 2021 y de 50.7 años (DE ±11.7) en 2022. El tiempo promedio entre la prescripción y la entrega del medicamento se mantuvo en 32 días sin incremento entre los años. Al comparar los dos periodos, hubo una disminución de tres días en el tiempo promedio para la autorización del tratamiento desde la vinculación al programa, de dos días en el tiempo promedio para la entrega del medicamento desde la autorización y de cinco días en el tiempo promedio para la entrega del medicamento desde la vinculación. Las principales barreras de acceso al medicamento fueron la cita de aplicación programada (76 %) y la asignación pendiente de la cita de control <5 días (6 %) en los dos años. Conclusiones. los programas de soporte al paciente en asma grave eosinofílica impactan en los tiempos de la ruta del paciente, la inequidad entre regímenes y desigualdad social, reduciendo la variabilidad en el acceso entre los grupos poblacionales. El seguimiento del programa evidencia una mayor experiencia en los procesos de acceso a los tratamientos, garantizando una mayor reducción de las brechas.
Introduction. Benralizumab is an effective monoclonal antibody in the treatment of patients with uncontrolled severe eosinophilic asthma despite adequate adherence and inhaler technique and the administration of high-dose inhaled corticosteroids and long-acting ß-agonists. Innovative therapies frequently encounter obstacles within healthcare systems, particularly in terms of providing patients with timely and effective access. Patient Support Programs (PSP) can help to reduce these access barriers by improving timelines and identifying milestones that different actors in the system can focus on to achieve more effective access. Objective. To compare the outcomes of a patient support program for patients with severe eosinophilic asthma and access to therapy during 2021 and 2022 in Colombia. Materials and Methods Retrospective observational descriptive analysis of a support program for patients with severe eosinophilic asthma during 2021-2022 in Colombia. Results. Female gender predominated in both periods (69.8% and 76.2% respectively). the mean age was 52 years (SD±11,4) (p value 0,395) in 2021 and 52 years (SD±11,7) in 2022. The average time between prescription and drug delivery remained at 32 days without increase between the years. When comparing the two periods, there was a decrease of 3 days in the average time for treatment authorization since linking the program, of 2 days in the average time for drug delivery since authorization and of 5 days in the average time for drug delivery since linking the program. The main medication access barriers were scheduled application appointment (76%) and appointment scheduling <5 days (6%) over the two years. Conclusions. Patient support programs in severe eosinophilic asthma impact patient pathway times, inequity between assurance and social inequity, reducing variability in access between population groups. Follow-up of the program evidences a greater experience in the processes of access to the treatment of severe eosinophilic asthma.
Subject(s)
Asthma , Adrenal Cortex Hormones , Health Services Accessibility , Nebulizers and VaporizersABSTRACT
Introducción: en los pacientes que cursaron COVID-19 grave o crítico se ha descripto el uso de prednisona y rehabilitación musculoesquelética y respiratoria. No está claramente establecido el rol de estas intervenciones, ni el momento óptimo para su inicio. En este trabajo se muestran los resultados de la Unidad de Rehabilitación del Hospital del Banco de Seguros del Estado (URHBSE) que implementó un programa de rehabilitación integral y uso de corticoides en la etapa subaguda de pacientes pos-COVID-19 grave o crítico, con un enfoque sistematizado, trabajando desde la interdisciplina y centrado en la persona atendida. Se reportan hallazgos al ingreso, requerimiento de oxígeno, escala de Barthel, patrones tomográficos, uso de corticoides, su respuesta y complicaciones. Se describen los resultados de este enfoque sobre variables clínicas, respiratorias y funcionales. Material y método: estudio descriptivo, retrospectivo, de pacientes pos-COVID-19 que completaron la rehabilitación en la URHBSE, en el período comprendido entre abril y agosto de 2021. Datos obtenidos de revisión de historias clínicas. Análisis estadístico con PRISM (v8.2.1). Resultados: completaron el programa de rehabilitación 84 pacientes. Al ingreso a la URHBSE, 55% tenía dependencia total o grave en la escala de Barthel. No lograba marcha el 48%. Requería oxígeno el 89,2% de los pacientes con una media de saturación de 90,3 ± 4,8. El 25% ingresó requiriendo máscara con reservorio. Todos los pacientes que comenzaron el programa se encontraban en fase subaguda de la enfermedad (4 a 12 semanas), y recibieron un plan de rehabilitación integral e individualizado. El objetivo era alcanzar una situación funcional similar a la que presentaban previo al COVID-19. La duración de la internación en la URHBSE fue de 23,5 ± 13,8 días. A 76 pacientes (90,5%) se les realizó tomografía de alta resolución de tórax (TACAR), resultando patológica en 96,1%. Predominaba el vidrio deslustrado (49,3%), la consolidación en 8,23% y un patrón de tipo fibrosis like en 30,13%. Se detectaron alteraciones tomográficas "no típicas" de daño pos-COVID (derrame pleural, nódulos cavitados, cavidades apicales, etc.) en 11,8% de las tomografías. En dos pacientes (2,6%) se halló una aspergilosis pulmonar y en 6,6% tromboembolismo pulmonar. Recibieron prednisona 44 pacientes (52,3%). En 63,4% se suspendió el aporte de oxígeno en los primeros 15 días desde el inicio de prednisona. Encontramos asociación entre el patrón tomográfico con vidrio deslustrado y la suspensión precoz del aporte de oxígeno desde el inicio de prednisona (p = 0,047). A pesar del alto grado de colonización, incluso en aquellos casos en que utilizamos prednisona, no observamos infecciones por microorganismos colonizantes. Comparando ingreso y egreso se hallaron diferencias estadísticamente significativas en los siguientes parámetros: el grado de disnea, el requerimiento de oxígeno (un solo paciente fue dado de alta con oxígeno), la saturación, el grado de instrumentación (traqueostomía, sonda nasogástrica, etc.), y la escala de dependencia de Barthel. En cuanto a las variables respiratorias solo contamos con el dato de la presencia de disnea de los primeros 35 pacientes, de éstos, 83% presentaba disnea al ingreso, mientras que solo 17% la presentaba al egreso (p < 0,0001). Hubo, asimismo, diferencias significativas en el requerimiento de oxígeno entre el ingreso y el egreso (p < 0,0001) y en el grado de dependencia medido en la escala de Barthel, teniendo dependencia total o grave al ingreso 55% de los pacientes y solo 3,4% al alta. Conclusiones: las intervenciones realizadas en la etapa subaguda de la enfermedad se asociaron con mejoras significativas en variables de interés clínico. Faltan más estudios para definir el rol y el momento exacto del inicio de los corticoides y la rehabilitación en este grupo de pacientes. (AU)
Introduction: In patients with severe or critical COVID-19, the use of prednisone and musculoskeletal and respiratory rehabilitation has been described. The role of these interventions and the optimal time for their initiation are not clearly established. This study presents the results of the Rehabilitation Unit of the Banco de Seguro del Estado Hospital, which implemented a comprehensive rehabilitation program and the use of corticosteroids in the subacute stage of patients with severe or critical post-COVID-19, with a systematic approach, working interdisciplinary and centered on the person being treated. Findings at admission, oxygen requirement, Barthel scale, tomographic patterns, use of corticosteroids, their response, and complications are reported. The results of this approach on clinical, respiratory, and functional variables are described. Method: Descriptive, retrospective study of post-COVID-19 patients who completed rehabilitation at the Rehabilitation Unit of the Banco de Seguros del Estado Hospital (URHBSE) in the period April-August 2021. Data obtained from review of medical records, statistical analysis with PRISM (v8.2.1). Results: Eighty-four patients completed the rehabilitation program. Upon admission to the URHBSE, 55% had total or severe dependence on the Barthel scale. Forty-eight percent were unable to walk. Eighty-nine-point two percent required oxygen, with a mean saturation of 90.3 ± 4.8. Twenty-five percent of patients were admitted requiring a reservoir mask. All patients who entered the program were in the subacute phase of the disease (4 to 12 weeks) and received a comprehensive and individualized rehabilitation plan. The objective was to achieve a functional situation similar to what they had before COVID-19. The length of stay at the URHBSE was 23.5 ± 13.8 days. A total of 76 patients (90.5%) underwent high-resolution chest tomography (HRCT), which was pathological in 96.1% of cases. The predominant findings were ground-glass opacity in 49.3% of cases, consolidation in 8.23%, and a fibrosis-like pattern in 30.13%. "Non-typical" post-COVID damage tomographic alterations were detected (pleural effusion, cavitary nodules, apical cavities, etc.) in 11.8% of the tomographies. In 2 patients (2.6%), pulmonary aspergillosis was found, and in 6.6%, pulmonary thromboembolism. Forty-four patients (52.3%) received prednisone. In 63.4% of cases, oxygen supplementation was discontinued within the first 15 days from the start of prednisone. We found an association between the ground-glass opacity tomographic pattern and early discontinuation of oxygen supplementation from the start of prednisone (p = 0.047). Despite the high degree of colonization, we did not observe infections by colonizing microorganisms, even in those who used prednisone. Comparing admission and discharge, statistically significant differences were found in the following parameters: degree of dyspnea, oxygen requirement (only one patient was discharged with oxygen), saturation, degree of instrumentation (tracheostomy, nasogastric tube, etc.), and the Barthel dependency scale. Regarding respiratory variables, we only have data on the presence of dyspnea in the first 35 patients. Of these, 83% had dyspnea at admission, while only 17% had it at discharge (p < 0.0001). There were also significant differences in the oxygen requirement between admission and discharge (p < 0.0001) and in the degree of dependency measured on the Barthel scale. Fifty-five percent of patients had total or severe dependence at admission, compared to only 3.4% at discharge. Conclusions: The interventions carried out in the subacute stage of the disease were associated with significant improvements in clinical variables of interest. More studies are needed to define the role and the exact timing of the initiation of corticosteroids and rehabilitation in this group of patients.
Introdução: O uso de prednisona e reabilitação musculoesquelética e respiratória foi descrito no tratamento de pacientes com COVID-19 grave ou crítico. O papel destas intervenções e o momento ideal para o seu início não estão claramente estabelecidos. Este trabalho mostra os resultados da Unidade de Reabilitação Hospitalar do Banco de Seguro del Estado que implementou um programa abrangente de reabilitação e uso de corticosteroides na fase subaguda de pacientes graves ou críticos pós-COVID-19, com uma abordagem sistematizada, trabalhando de forma interdisciplinar e centrada no paciente. São relatados os achados na admissão, a necessidade de oxigênio, a escala de Barthel, os padrões tomográficos, o uso de corticosteroides, a resposta ao tratamento e as complicações. Os resultados desta abordagem sobre variáveis clínicas, respiratórias e funcionais são descritos. Material e métodos: Estudo descritivo e retrospectivo de pacientes pós-COVID-19 que completaram reabilitação na Unidade de Reabilitação do Hospital Banco de Seguros del Estado (URHBSE) no período de abril a agosto de 2021. Os dados foram obtidos dos prontuários de pacientes com posterior análise estatísticas usando PRISM (v8.2.1). Resultados: 84 pacientes completaram o programa de reabilitação. No momento da admissão na URHBSE, 55% apresentavam dependência total ou grave da escala de Barthel. 48% não conseguiam se mover. 89,2% necessitaram oxigênio com saturação média de 90,3 ± 4,8. 25% dos pacientes foram internados necessitando máscara com reservatório. Todos os pacientes que ingressaram no programa estavam na fase subaguda da doença (4 a 12 semanas) e receberam um plano de reabilitação abrangente e individualizado. O objetivo era alcançar uma situação funcional semelhante à que apresentavam antes da COVID-19. O tempo de permanência na URHBSE foi de 23,5±13,8 dias. A tomografia de tórax de alta resolução (TCAR) foi realizada em 76 pacientes (90,5%); os resultados foram patológicos em 96,1%. O vidro fosco predominou em 49,3% deles, a consolidação em 8,23% e o padrão fibroso em 30,13%. Alterações tomográficas "atípicas" de danos pós-COVID (derrame pleural, nódulos cavitados, cavidades apicais, etc.) foram detectadas em 11,8% dos exames tomográficos. Aspergilose pulmonar foi encontrada em 2,6% dos pacientes e tromboembolismo pulmonar em 6,6%. 44 pacientes (52,3%) receberam prednisona. Em 63,4% a oferta de oxigênio foi suspensa nos primeiros 15 dias após o início da mesma. Encontramos associação entre o padrão tomográfico em vidro fosco e a suspensão precoce da oferta de oxigênio desde o início da administração da prednisona (p = 0,047). Apesar do alto grau de colonização, mesmo naqueles que usaram prednisona, não observamos infecções. Em relação às variáveis respiratórias, só temos dados sobre a presença de dispneia nos primeiros 35 pacientes; destes, 83% apresentavam dispneia na admissão, enquanto apenas 17% a apresentavam na alta (p< 0,0001). Observou-se também diferenças significativas na necessidade de O2 entre a admissão e a alta (p< 0,0001) e no grau de dependência medido pela escala de Barthel, com 55% dos pacientes apresentando dependência total ou grave na admissão e apenas 3,4% na alta. Conclusões: As intervenções realizadas na fase subaguda da doença foram associadas a melhorias significativas nas variáveis de interesse clínico. São necessários mais estudos para definir o papel e o momento exato do início dos corticosteroides e da reabilitação neste grupo de pacientes.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Post-Acute COVID-19 Syndrome/rehabilitation , Post-Acute COVID-19 Syndrome/therapy , Retrospective StudiesABSTRACT
Introducción: La fiebre es un marcador de enfermedades infecciosas e inflamatorias que se da por una respuesta inmune innata y por diferentes mediaciones entre marcadores moleculares. En el paciente inmunodeprimido, uno o varios mecanismos inmunológicos pueden estar alterados, debido a que la respuesta inmune puede estar deprimida y la fiebre puede denotar un estado patológico grave subyacente. Se realizó una búsqueda exploratoria en las bases de datos PubMed/Medline, Scopus y Scielo entre septiembre y octubre de 2022. Se incluyeron los términos fiebre, pacientes inmunodeprimidos, tratamiento y sistema inmune. Se seleccionaron 41 artículos científicos con diferentes diseños epidemiológicos. Objetivo: Describir aspectos relacionados con la fisiopatología de la fiebre, el tratamiento de la presencia de fiebre en pacientes con virus de inmunodeficiencia humana y síndrome de inmunodeficiencia adquirida, así como también en pacientes receptores de trasplantes de órgano sólido y de trasplantes hematopoyéticos, pacientes neutropénicos y pacientes tratados con corticosteroides y terapia biológica. Desarrollo: El tratamiento del paciente inmunodeprimido con fiebre incluye aspectos fundamentales como una adecuada anamnesis y examen físico, además de pruebas diagnósticas orientadas para establecer la causa de la fiebre. En estos pacientes, las infecciones juegan un papel protagónico y su intervención temprana es fundamental para impactar en la morbimortalidad. Conclusiones: El paciente inmunodeprimido con presencia de fiebre presenta un panorama desafiante para su manejo médico integral. Entre otros aspectos es relevante considerar el tipo y tiempo de inmunosupresión, así como los factores de riesgo, con el fin de orientar los diagnósticos y tratamientos(AU)
Introduction: Fever is a marker of infectious and inflammatory diseases that is caused by an innate immune response and by different mediations between molecular markers. In the immunocompromised patient, one or more immunological mechanisms may be altered because the immune response may be compromised, and fever may denote a serious underlying disease state. An exploratory search was conducted in the PubMed/Medline, Scopus, and Scielo databases between September and October 2022. The terms fever immunocompromised patients, treatment, and immune system. A total of 41 scientific articles with different epidemiological designs were selected. Objective: To describe aspects related to the pathophysiology of fever, management of the presence of fever in patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, as well as in patients who have received solid organ transplants and hematopoietic transplants, neutropenic patients and patients treated with corticosteroids and biological therapy. Developing: The approach to the immunocompromised patient with fever includes fundamental aspects such as an adequate history and physical examination, as well as diagnostic tests aimed at establishing the cause of the fever. In these patients, infections play a leading role and early intervention is essential to impact morbidity and mortality. Conclusions: The immunocompromised patient with the presence of fever presents a challenging panorama for his/her comprehensive medical approach. Among other aspects, it is relevant to consider the type and duration of immunosuppression, as well as the risk factors, to guide diagnoses and treatments(AU)
Subject(s)
Humans , Risk Factors , Acquired Immunodeficiency Syndrome , Immunocompromised Host , Fever/etiology , Fever/physiopathology , Fever/therapy , Transplant Recipients , Immunity , Immunity, Innate , Patients , Biological Therapy/methods , Organ Transplantation , Adrenal Cortex Hormones/therapeutic use , Febrile Neutropenia/complicationsABSTRACT
Objective: To analyze the clinical features,treatment and prognosis of drug induced hypersensitivity syndrome related hemophagocytic lymphohistiocytosis (DIHS-HLH). Methods: This was a retrospective case study. Clinical characteristics, laboratory results, treatment and prognosis of 9 patients diagnosed with DIHS-HLH in Beijing Children's hospital between January 2020 and December 2022 were summarized. Kaplan-Meier survival analysis was used to calculate the overall survival rate. Results: Among all 9 cases, there were 6 males and 3 females, with the age ranged from 0.8 to 3.1 years. All patients had fever, rash, hepatomegaly and multiple lymph node enlargement. Other manifestations included splenomegaly (4 cases), pulmonary imaging abnormalities (6 cases), central nervous system symptoms (3 cases), and watery diarrhea (3 cases). Most patients showed high levels of soluble-CD25 (8 cases), hepatic dysfunction (7 cases) and hyperferritinemia (7 cases). Other laboratory abnormalities included hemophagocytosis in bone marrow (5 cases), hypofibrinogenemia (3 cases) and hypertriglyceridemia (2 cases). Ascending levels of interleukin (IL) 5, IL-8 and interferon-γ (IFN-γ) were detected in more than 6 patients. All patients received high dose intravenous immunoglobulin, corticosteroid and ruxolitinib, among which 4 patients were also treated with high dose methylprednisolone, 2 patients with etoposide and 2 patients with cyclosporin A. After following up for 0.2-38.6 months, 7 patients survived, and the 1-year overall survival rate was (78±14)%. Two patients who had no response to high dose immunoglobulin, methylprednisolone 2 mg/(kg·d) and ruxolitinib died. Watery diarrhea, increased levels of IL-5 and IL-8 and decreased IgM were more frequently in patients who did not survive. Conclusions: For children with fever, rash and a suspicious medication history, when complicated with hepatomegaly, impaired liver function and high levels of IL-5 and IL-8, DIHS-HLH should be considered. Once diagnosed with DIHS-HLH, suspicious drugs should be stopped immediately, and high dose intravenous immunoglobulin, corticosteroid and ruxolitinib could be used to control disease.
Subject(s)
Child , Male , Female , Humans , Infant , Child, Preschool , Lymphohistiocytosis, Hemophagocytic/complications , Retrospective Studies , Interleukin-5 , Hepatomegaly/complications , Immunoglobulins, Intravenous/adverse effects , Interleukin-8 , Methylprednisolone , Adrenal Cortex Hormones , Diarrhea/complications , Exanthema/complicationsABSTRACT
O objetivo deste estudo era realizar análise de custo-efetividade dos medicamentos ciclosporina, dupilumabe e upadacitinibe comparados à terapia tópica padrão no tratamento de dermatite atópica grave refratária. Foi feito um estudo de custo-efetividade com modelo de ciclos de Markov, na perspectiva do Sistema Único de Saúde (SUS) como pagador. Os parâmetros do modelo foram obtidos da literatura. Análises de sensibilidade foram realizadas para avaliar as incertezas do modelo. Os resultados indicam que todos os medicamentos promoviam aumento de custos e ganho de benefícios, comparados à terapia tópica padrão. As razões de custo efetividade incremental eram: ciclosporina, R$ 28.941,54/QALY; monoterapia de upadacitinibe de 15 mg, R$ 253.665,86/QALY; monoterapia de dupilumabe monoterapia, R$ 484.417,73/QALY; terapia combinada de dupilumabe, R$ 419.295,44/QALY; terapia combinada de upadacitinibe 30mg, R$456.742,51/QALY; monoterapia de upadacitinibe de 30 mg, R$ 484.006,31/QALY. Quando comparado à terapia tópica padrão, o tratamento com ciclosporina era custo-efetivo. Já a monoterapia de dupilumabe, a terapia combinada de dupilumabe, a monoterapia de upadacitinibe de 15 mg, a monoterapia de upadacitinibe de 30 mg e a terapia combinada de upadacitinibe de 30 mg eram pouco custo-efetivas, pois a razão de custo-efetividade estava acima do limite de disposição a pagar do SUS
The aim of this study was to perform a cost-effectiveness analysis of cyclosporine, dupilumab and upadacitinib compared to standard topical therapy in the treatment of severe refractory atopic dermatitis. We made a cost-effectiveness study with Markov cycle model, from the perspective of the Brazilian Public Health System (BPHS) as payer. The model parameters were obtained from the literature. Sensitivity analyzes were performed to assess model uncertainties. The results shows that all medicines increased costs and gained benefits, compared to standard topical therapy. The incremental cost-effectiveness ratios were: cyclosporine, BRL 28,941.54/QALY; 15 mg upadacitinib monotherapy, BRL 253,665.86/QALY; dupilumab monotherapy, BRL 484,417.73/QALY; dupilumab combination therapy, BRL 419,295.44/QALY; combination therapy of upadacitinib 30mg, R$456,742.51/QALY; 30 mg upadacitinib monotherapy, BRL 484,006.31/QALY. When compared to standard topical therapy, treatment with cyclosporine was costeffective. Dupilumab monotherapy, dupilumab combination therapy, upadacitinib 15 mg monotherapy, upadacitinib 30 mg monotherapy, and upadacitinib 30 mg combination therapy were not very costeffective, as the cost-effectiveness ratio was above the BPHS willingness-to-pay limit
Subject(s)
Humans , Cyclosporine/economics , Dermatitis, Atopic/drug therapy , Cost-Effectiveness Analysis , Biological Therapy/economics , Adrenal Cortex Hormones , Calcineurin Inhibitors/economicsABSTRACT
La estenosis laríngea es una de las causas más habituales de obstrucción de la vía aérea superior en pediatría. La estenosis laríngea congénita es la tercera anormalidad congénita laríngea más frecuente, luego de la laringomalacia y la parálisis cordal. El diagnóstico se sustenta en la clínica del paciente, la evaluación radiológica, la laringoscopía flexible y la endoscopía rígida de la vía aérea bajo anestesia general. Describimos un caso de estenosis laríngea congénita de presentación atípica con un pólipo en línea media, predominando la disfonía en lugar de la obstrucción respiratoria.
Laryngeal stenosis is one of the most frequent causes of airway obstruction in pediatrics. Congenital laryngeal stenosis is the third most common laryngeal congenital abnormality, after laryngomalacia and cord paralysis. The diagnosis is based on the patient's symptoms, radiological evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. We describe a case of congenital laryngeal stenosis with atypical presentation with a midline polyp, predominating dysphonia instead of respiratory obstruction.
A estenose laríngea é uma das causas mais comuns de obstrução das vias aéreas superiores em pediatria. A estenose laríngea congênita é a terceira anomalia laríngea congênita mais comum, depois da laringomalácia e da paralisia cordal. O diagnóstico é baseado nos sintomas clínicos do paciente, avaliação radiológica, laringoscopia flexível e endoscopia rígida das vias aéreas sob anestesia geral. Descrevemos um caso de estenose laríngea congênita de apresentação atípica com pólipo mediano, predominando disfonia e não obstrução respiratória.
Subject(s)
Humans , Infant, Newborn , Laryngostenosis/diagnostic imaging , Laryngostenosis/complications , Laryngostenosis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Dysphonia/etiology , Dysphonia/drug therapy , AnalgesiaSubject(s)
Humans , Sciatica/therapy , Diskectomy/statistics & numerical data , Intervertebral Disc Displacement/surgery , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Adrenal Cortex Hormones/therapeutic use , Systematic Reviews as Topic , Intervertebral Disc Displacement/complicationsABSTRACT
La neumonía por Pneumocystis jirovecii es una enfermedad fúngica oportunista descrita principalmente en pacientes con VIH, sin embargo, tras la introducción de la TARV, ha incrementado su incidencia en pacientes con inmunosupresión no asociada a VIH, como neoplasias hematológicas y trasplantes de órganos sólidos. Presentamos el caso de un varón de 17 años, receptor de un trasplante renal, con inmunosupresión prolongada con corticoesteroides, con cuadro clínico de tos, disnea y fiebre. La TC mostró micronódulos pulmonares centrolobulillares y vidrio esmerilado. El LBA fue compatible con hemorragia alveolar difusa (HAD), con RPC positiva para P. jirovecii. Se descartaron otras infecciones y enfermedades autoinmunes. Recibió tratamiento con cotrimoxazol con buena evolución clínica y mejoría radiológica. Si bien las causas más frecuentes de HAD son etiologías autoinmunes como enfermedades reumatológicas o vasculitis, es prioritario descartar causas infecciosas, incluyendo P. jirovecii, ya que el tratamiento dirigido puede tener un impacto significativo en la mortalidad en este grupo de pacientes.
Pneumocystis jirovecii pneumonia is an opportunistic fungal infection, described mainly in HIV patients, however, after the introduction of ART, its presentation has increased in patients with non-HIV immunosuppression, such as hematological cancers, solid or hematopoietic stem cell transplantation. We report the case of a 17-year-old male, kidney transplant patient, with prolonged immunosuppression with corticoesteroids, with history of cough, dyspnea, and fever. Chest CT evidences centrilobular pulmonary micronodules with ground glass. BAL was performed compatible with diffuse alveolar hemorrhage, with positive PCR for P. jirovecii. Other infections and autoimmune disease were ruled out. He received treatment with cotrimoxazole with clinical improvement of the patient, and follow up chest CT at the end of treatment showed decrease of pulmonary infiltrates. Although the most frequent causes of DAH are autoimmune etiologies such as rheumatic diseases or vasculitis, it is a priority to rule out infectious causes, including P. jirovecii, since targeted treatment could have a significant impact on mortality outcomes in this group of patients.
Subject(s)
Humans , Male , Adolescent , Pneumonia, Pneumocystis/complications , Hemorrhage/complications , Pneumonia, Pneumocystis/drug therapy , Pneumonia, Pneumocystis/diagnostic imaging , Pulmonary Alveoli , Tomography, X-Ray Computed , Kidney Transplantation , Immunocompromised Host , Adrenal Cortex Hormones/administration & dosage , Pneumocystis carinii , Immunosuppressive Agents/administration & dosage , Anti-Bacterial Agents/therapeutic useABSTRACT
Introduction: Monitoring changes in the levels of immune markers is of great significance in evaluating the effectiveness of treatment in patients with allergic rhinitis. Objectives: Determine the change in the concentration of immune markers after treatment in patients with allergic rhinitis caused by cotton dust. Methods: A descriptive, single-group, comparative before and after intervention study on 52 patients with allergic rhinitis caused by cotton dust. Comparison of immunological markers results before and after 36 months of treatment. Results: Total IgE concentration after treatment decreased, the median decreased from 1227.756 U/mL to 676.805 UI/mL. Serum levels of IgG, IgG4, and IgG1 in patients after treatment increased compared to before (p< 0.001). The cytokines also changed in the direction of no longer responding toward allergy. Median IL-17 decreased from 1.752 mg/dL to 0.417 mg/dL. Conclusion: In patients with allergic rhinitis after specific sublingual desensitization treatment, IgE levels and cytokines such as IL-6 and IL-17 are significantly reduced and IgG, IgG4 and IgG1 levels are increased after treatment(AU)
Introducción: El monitoreo de los cambios en los niveles de marcadores inmunes es de gran importancia para evaluar la efectividad del tratamiento en pacientes con rinitis alérgica. Objetivos: Determinar el cambio en la concentración de marcadores inmunes después del tratamiento, en pacientes con rinitis alérgica causada por polvo de algodón. Métodos: Estudio descriptivo, monogrupo, comparativo antes y después de la intervención, en 52 pacientes con rinitis alérgica por polvo de algodón. Se compararon resultados de marcadores inmunológicos antes y después de 36 meses de tratamiento. Resultados: La concentración de IgE total después del tratamiento disminuyó, la mediana disminuyó de 1227,756 U/mL a 676,805 UI/mL. Los niveles séricos de IgG, IgG4 e IgG1 en pacientes, después del tratamiento, aumentaron (p< 0,001). Las citocinas también cambiaron en dirección a ausencia de respuesta a la alergia. La mediana de IL-17 disminuyó de 1,752 mg/dL a 0,417 mg/dL. Conclusión: En pacientes con rinitis alérgica, después del tratamiento específico de desensibilización sublingual, los niveles de IgE y citocinas como IL-6 e IL-17 se reducen significativamente y los niveles de IgG, IgG4 e IgG1 aumentan(AU)
Subject(s)
Humans , Immunoglobulin E , Immunoglobulin G , Biomarkers , Treatment Outcome , Dust , Antigens, Plant , Rhinitis, Allergic/therapy , Administration, Sublingual , Cytokines/immunology , Clothing , Adrenal Cortex Hormones/therapeutic use , Gossypium , Drug Evaluation/methods , Histamine Antagonists/therapeutic use , Occupational GroupsSubject(s)
Humans , Male , Infant , Glycogen Storage Disease/complications , Glycogen Storage Disease/diagnosis , Glycogen Storage Disease/drug therapy , Adrenal Cortex Hormones/therapeutic use , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/drug therapy , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosisABSTRACT
Introdução: As Disfunções temporomandibulares (DTM) incluem desordens dos músculos da mastigação, das articulações temporomandibulares e da inervação local, frequentemente associadas a dor orofacial e que resultam em mioartropatias do Sistema Mastigatório. A tendência atual tende a começar com tratamento conservador e progredir a procedimentos mais invasivos na falha dos tratamentos iniciais. Relato de caso: O presente relato visa mostrar o resultado de uma técnica invasiva para o tratamento de uma DTM grave, com a aplicação do ácido hialurônico e de corticoide através de uma punção guiado por ultrassonografia. A paciente apresentava dor crônica e perda importante de peso devido a limitação da abertura da boca. A RM demonstrou disfunção das ATMs, com sinais de deslocamento parcial do disco direito anteromedialmente. Foi realizada a aplicação bilateral intra-articular de ácido hialurônico e de corticoide através de uma punção guiado por ultrassonografia. Considerações Finais: A associação destas classes na punção de ATMs ainda não está bem estabelecida havendo necessidade de estudos complementares para avaliar eficácia, como este relato de caso, que se mostrou favorável com grande melhora clínica da paciente... (AU)
Introduction: Temporomandibular dysfunctions (TMD) include disorders of the masticatory muscles, temporomandibular joints, and local innervation, often associated with orofacial pain and resulting in myoarthropathies of the masticatory system. The current trend tends to begin with conservative treatment and progress to more invasive procedures if the initial treatments fail. Case Report: The present report aims to show the result of an invasive technique for the treatment of a severe TMD, with the application of hyaluronic acid and corticoid through an ultrasound-guided puncture. The patient presented with chronic pain and significant weight loss due to limited mouth opening. MRI demonstrated TMJ dysfunction, with signs of partial anteromedial dislocation of the right disc. Bilateral intra-articular application of hyaluronic acid and corticoid was performed through an ultrasound guided puncture. Final considerations: The association of these classes in TMJ puncture is still not well established, and further studies are needed to evaluate efficacy, as in this case report, which proved favorable, with great clinical improvement for the patient... (AU)
Introducción: Los trastornos temporomandibulares (TTM) incluyen trastornos de los músculos masticatorios, de las articulaciones temporomandibulares y de la inervación local, a menudo asociados a dolor orofacial y que dan lugar a mioartropatías del sistema masticatorio. La tendencia actual es comenzar con un tratamiento conservador y progresar hacia procedimientos más invasivos al fracasar los tratamientos iniciales. Informe de un caso: El presente informe pretende mostrar el resultado de una técnica invasiva para el tratamiento de un TTM severo, con la aplicación de ácido hialurónico y corticoide a través de una punción guiada por ecografía. El paciente presentaba dolor crónico y una importante pérdida de peso debido a la limitación de la apertura bucal. La RMN demostró una disfunción de la ATM, con signos de dislocación parcial del disco derecho anteromedialmente. Se realizó la aplicación intraarticular bilateral de ácido hialurónico y corticoide mediante una punción guiada por ecografía. Consideraciones finales: La asociación de estas clases en la punción de la ATM aún no está bien establecida y se necesitan más estudios para evaluar la eficacia, como en el reporte de este caso, que resultó favorable con gran mejoría clínica del paciente... (AU)
Subject(s)
Humans , Female , Adult , Temporomandibular Joint Dysfunction Syndrome , Adrenal Cortex Hormones/therapeutic use , Conservative Treatment , Hyaluronic Acid/pharmacologyABSTRACT
En el siguiente trabajo se desarrollan, luego de una extensa búsqueda bibliográfica, los hallazgos clíni- cos y radiográficos existentes en lesiones de la ATM en pacientes con artritis reumatoidea, para luego proponer una metodología de abordaje odontoló- gico que logre un buen tratamiento para devolverle al paciente un mejor funcionamiento de la ATM, aliviando el dolor y la inflamación, pero sobre todo mejorando su calidad de vida. Ello, siempre desde los estadios tempranos de la enfermedad, ya que facilita el tratamiento y previene secuelas. De ser necesario, se realiza una rehabilitación protética y evalúan los riesgos de procedimientos odontológicos conside- rando la medicación habitual de estos pacientes, como los aines y corticoides (AU)
In the following work, after an extensive bibliographical search, the existing clinical and radiographic findings in Temporo Mandibular Joint (TMJ) lesions in patients with rheumatoid arthritis are developed in order to later propose a dental approach methodology achieving a good treatment to restore better TMJ function to that patient relieving pain and inflammation but above all improving the quatity of life , always from the early stages of the disease to facilitate treatment and prevent sequelae, perform prosthetic rehabilitation if necessary and assess the risks of dental procedures considering the usual medication of these patients such as NSAIDs and corticosteroids (AU)
Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/diagnostic imaging , Temporomandibular Joint Disorders/therapy , Dental Care for Chronically Ill/methods , Clinical Diagnosis , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Minimally Invasive Surgical ProceduresABSTRACT
Se presenta el caso de un paciente con diagnóstico de adenocarcinoma de pulmón metastásico que, luego de realizar cinco meses de tratamiento con pembrolizumab, presentó neumonitis grado 2, interpretada como toxicidad por pembrolizumab con buena respuesta y resolución de los infiltrados con la suspensión del inmunomodulador y la administración de corticoides(AU)
We present the case of a patient diagnosed with metastatic lung adenocarcinoma who, after five months of treatment with pembrolizumab, presented grade 2 pneumonitis, interpreted as pembrolizumab toxicity, with a good response and resolution of the infiltrates with the suspension of the immunomodulator and the administration of corticosteroids(AU)