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1.
Arch. argent. pediatr ; 119(3): e247-e251, Junio 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1248216

ABSTRACT

La reacción a drogas con eosinofilia y síntomas sistémicos es una reacción adversa cutánea rara, potencialmente grave. Puede presentar fiebre, erupción cutánea polimorfa, edema facial y/o linfoadenopatías. La reactivación del virus herpes humano tipo 6 se asocia a un curso más grave y/o prolongado.Un lactante de 22 meses en tratamiento con fenobarbital presentó lesiones eritematopapulares, fiebre, leucocitosis, proteína C reactiva elevada y alteración de pruebas hepáticas. Se realizó biopsia de piel compatible con reacción adversa a drogas. Se trató con corticoides sistémicos e inmunoglobulina intravenosa sin respuesta. La reacción en cadena de la polimerasa para virus herpes humano tipo 6 resultó positiva. Se inició ciclosporina más prednisona, con buena respuesta. Existe poca evidencia del uso de ciclosporina en adultos, cuando los corticoides sistémicos son inefectivos. Este es el primer reporte pediátrico Podría ser una alternativa efectiva o un complemento de los corticosteroides sistémicos cuando no responde a tratamientos convencionales.


Drug reaction with eosinophilia and systemic symptoms is a rare and potentially serious skin adverse reaction, with fever, polymorphous skin rash, facial edema, and/or lymphadenopathy. Reactivation of human herpes virus type 6 has been associated with a more severe and/or prolonged course. A 22-month-old infant under phenobarbital treatment developed erythematous-papular lesions, fever, leukocytosis, elevated C-reactive protein, and abnormal liver tests. The skin biopsy was compatible with an adverse drug reaction. Treatment with systemic corticosteroids and intravenous immunoglobulin had no response. Polymerase chain reaction for human herpesvirus type 6 was positive, and cyclosporine plus prednisone was started with a good response. There is little evidence for the use of cyclosporine in adults when systemic corticosteroids are ineffective. This is the first report of pediatric drug reaction with eosinophilia and systemic symptoms treated with cyclosporine, which could be an effective alternative or an adjunct to systemic corticosteroid therapy unresponsive to conventional treatments.


Subject(s)
Humans , Male , Infant , Herpesvirus 6, Human , Drug Hypersensitivity Syndrome/diagnosis , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Drug-Related Side Effects and Adverse Reactions , Eosinophilia , Drug Hypersensitivity Syndrome/complications , Drug Hypersensitivity Syndrome/therapy
2.
Article in English | ID: biblio-1347991

ABSTRACT

Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of entire layers of the bladder wall. The condition has been described in adults, children, and dogs. However, there are no consensus guidelines for the treatment of eosinophilic cystitis. Although human and veterinary literature reviews show some effectiveness in management with corticosteroids, antihistamines, and antibiotics, a variety of serious and frequent side effects are associated with steroid therapy. As a result, steroids are relatively contraindicated for patients with diabetes mellitus and Cushing's syndrome. A five-year-old neutered male chow-chow with controlled diabetes was referred with an 18-month history of malodorous urine, gross haematuria, and dysuria that were nonresponsive to antibiotics. The findings on general examination were unremarkable except for abdominal suprapubic discomfort. The complete blood count and biochemical profile (such as urea and creatinine) were normal except for mild peripheral eosinophilia. Although ultrasonography, bladder contrast radiography, and urine cytology findings indicated malignancy, with the presence of atypical urothelial cells, histopathology confirmed eosinophilic cystitis. Management with cyclosporine was adequate with complete remission of haematuria. This case report presents the first reported successful use of cyclosporine for the treatment of eosinophilic cystitis in a dog with diabetes.(AU)


A cistite eosinofílica é uma doença inflamatória rara caracterizada por infiltração eosinofílica de todas as camadas da parede da bexiga. Essa enfermidade já foi descrita em adultos, crianças e cães. No entanto, não há um consenso de diretrizes sobre o seu tratamento. Mesmo que as literaturas humana e veterinária mostrem alguma eficácia no manejo com corticosteroides, anti-histamínicos e antibióticos, uma variedade de efeitos colaterais graves e frequentes está associada à terapia com esteroides. Dessa forma, o uso de esteroides é relativamente contraindicado para pacientes com diabetes mellitus e síndrome de Cushing, por exemplo. Um chow-chow, macho, castrado, de cinco anos e diabético estável foi encaminhado para atendimento com histórico de urina fétida, hematúria macroscópica e disúria não responsiva a antibióticos há 18 meses. A avaliação dos parâmetros físicos estava dentro dos padrões, exceto por desconforto abdominal suprapúbico à palpação. O hemograma e o perfil bioquímico (como a ureia e a creatinina) estavam dentro da normalidade para a espécie, exceto por eosinofilia periférica leve. Embora a ultrassonografia, a radiografia contrastada da bexiga e os achados da urinálise indicassem malignidade, com a presença de células uroteliais atípicas, a histopatologia confirmou o diagnóstico definitivo de cistite eosinofílica. O manejo com ciclosporina foi satisfatório, com ausência completa da hematúria. Este relato de caso apresenta o primeiro uso documentado de ciclosporina para o tratamento de cistite eosinofílica com sucesso em um cão com diabetes.(AU)


Subject(s)
Animals , Dogs , Cyclosporine , Cystitis , Dogs , Hematuria , Enterobacter , Eosinophilia , Klebsiella pneumoniae
3.
Brasília; s.n; 15 jun. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1100400

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 15 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Renin-Angiotensin System , Technology Assessment, Biomedical , Ceftriaxone/therapeutic use , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Cyclosporine/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Lopinavir/therapeutic use , Natalizumab/therapeutic use , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use
4.
s.l; s.n; 3 jun. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1099470

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos.


Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Ribavirin/therapeutic use , Technology Assessment, Biomedical , Immunoglobulins/therapeutic use , Chloroquine/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Interferons/therapeutic use , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Dexmedetomidine/therapeutic use , Lopinavir/therapeutic use , Rituximab/therapeutic use , Leflunomide/therapeutic use , Hydroxychloroquine/therapeutic use
5.
Diagn. tratamento ; 25(2): 01-04, abr.-jun. 2020.
Article in Portuguese | LILACS | ID: biblio-1116011

ABSTRACT

Contexto: O infliximabe é um anticorpo monoclonal quimérico que atua neutralizando a atividade biológica do fator de necrose tumoral alfa e impedindo a ligação da molécula aos receptores da célula-alvo. A melhora da psoríase ocorre logo nas primeiras semanas do seu uso, e está indicado, especialmente, em quadros graves, tanto cutâneos quanto articulares, nos quais necessitam pronta ação terapêutica. Descrição do caso: Relata-se caso de uma paciente com psoríase grave refratária a terapias sistêmicas prévias, incluindo metotrexate, ustequinumabe, secuquinumabe, acitretina e ciclosporina, com melhora de 70% em relação a avaliação inicial no índice de gravidade da psoríase por área, após início de fase de indução com infliximabe. Discussão: A paciente apresentou resposta satisfatória à terapia combinada de infliximabe com ciclosporina e acitretina, sem qualquer manifestação de eventos adversos, mas com melhoria das lesões e dos escores de avaliação. Poucos relatos de caso e estudos randomizados estão presentes na literatura sobre a associação de ciclosporina e imunobiológicos, devido ao risco de imunossupressão grave, porém no caso relatado não houve aumento desse risco. Entretanto, reconhecemos que é impossível avaliar adequadamente a efetividade e a segurança de qualquer tratamento com anticorpo monoclonal para doenças crônicas com apenas 14 dias de seguimento. Conclusão: O antifator de necrose tumoral alfa associado a ciclosporina mostrou ser uma combinação efetiva durante a fase de indução e e de grande valia neste caso, em que a paciente apresentava psoríase refratária a outras terapêuticas e necessidade de rápida resposta clínica.


Subject(s)
Humans , Female , Middle Aged , Psoriasis , Tumor Necrosis Factor-alpha , Cyclosporine , Combined Modality Therapy , Infliximab
6.
Con-ciencia (La Paz) ; 8(1): 53-65, 20200400. ilus.
Article in Spanish | LILACS | ID: biblio-1178439

ABSTRACT

INTRODUCCIÓN: los límites de decisión o valores de corte son alertas para el diagnóstico médico. Son obtenidos por estudios cuidadosamente diseñados para poder establecer un valor que permita una decisión médica para seguir un tratamiento. OBJETIVO: determinar los límites de decisión clínica de Ciclosporina A en sangre total de pacientes con trasplante renal. Método: para el tratamiento de datos y cálculo de límites de decisión se utilizó una metodología informática y bioestadística con software SPSS de IBM, realizando pruebas de normalidad, pruebas gráficas como Q-Q plots, test de Kolmogorov ­ Smirnov, test de Lillefors y prueba de Shapiro-Wilks. RESULTADOS: el grupo de estudio conformado por pacientes con trasplante renal atendidos durante 2016 a 2019, clasificados por el tiempo de trasplante. Los criterios de aceptación fueron: uso de control de calidad interno, con resultados satisfactorios utilizando cartas control y la detección de datos atípicos mediante la prueba de Grubbs. Obteniendo niveles basales de 0-3 meses 181-241 ng/ml; 3-12 meses 120-147 ng/ml y mayor a 12 meses de 81-119 ng/ml, y para concentración máxima de 1 mes 1193-2025 ng/ml; 2 meses 1379-1765 ng/ml; 3 meses 1060-1556 ng/ml; 4-6 meses 880-1293 ng/ml; 7-12 meses 735-1039 ng/ml y mayor a 12 meses 643-960 ng/ml. CONCLUSIÓN: los límites de decisión clínica obtenidos se ajustan perfectamente a los de la bibliografía con la ventaja de que ahora se tienen límites definidos para nuestra población, constituyéndose en alertas para el diagnóstico médico.


Introduction: decision limits or cut-off values are red flags for medical diagnosis. They are obtained by carefully designed studies to be able to establish a value that allows a medical decision to follow a treatment. OBJECTIVE: to determine the clinical decision limits of Cyclosporin A in whole blood of kidney transplant patients. METHODS: for data treatment and calculation of decision limits, a computer and biostatistical methodology was used with IBM SPSS software, performing normality tests, graphic tests such as QQ plots, Kolmogorov-Smirnov test, lillefors test and Shapiro Test -Wilks. RESULTS: the study group made up of kidney transplant patients treated during 2016 to 2019, classified by transplant time. The acceptance criteria were: use of internal quality control, with satisfactory results using control charts and the detection of outliers using the Grubbs test. Obtaining basal levels of 0-3 months 181-241 ng / ml; 3-12 months 120-147 ng / ml and over 12 months of 81-119 ng / ml, and for a maximum concentration of 1 month 1193-2025 ng / ml; 2 months 1379-1765 ng / ml; 3 months 1060-1556 ng / ml; 4-6 months 880-1293 ng / ml; 7-12 mon-ths 735-1039 ng / ml and more than 12 months 643-960 ng / ml. CONCLUSION: the clinical decision limits obtained are perfectly in line with those of the bibliography with the advantage that now there are defined limits for our population, becoming alerts for medical diagnosis.


Subject(s)
Humans , Patients , Biostatistics , Kidney Transplantation , Cyclosporine , Quality Control , Software
7.
Con-ciencia (La Paz) ; 8(1): 121-131, 20200400. ilus.
Article in Spanish | LILACS | ID: biblio-1178619

ABSTRACT

INTRODUCCIÓN: el proceso de trazabilidad metrológica de un estándar secundario a uno primario es una propiedad del resultado de una medición o del valor de un estándar, por la cual se puede relacionar a referencias establecidas, usualmente nacionales o internacionales, a través de una cadena ininterrumpida de comparaciones, todas las cuales tienen incertidumbres determinadas. OBJETIVO: realizar la trazabilidad de un estándar secundario a uno primario de ciclosporina y de esta manera asegurar la calidad y pureza del mismo. MÉTODOS: se utilizaron los siguientes métodos: descripción organoléptica, solubilidad, identificación y cuantificación por Cromatografía Líquida de alta resolución (HPLC) en fase reversa. RESULTADOS: el estándar secundario de ciclosporina, cumplió con todas las especificaciones referidas a descripción organoléptica, solubilidad, identificación y se obtuvo una pureza de 97,5% utilizando un estándar primario cuyo título es de 98,5 %. CONCLUSIÓN: se realizó la trazabilidad metrológica de un estándar secundario a un estándar primario para poder utilizarlo como estándar de trabajo, garantizando el título del mismo. Esta propiedad es uno de los pilares para que los resultados de medida sean comparables entre sí, independientemente del lugar y tiempo en el que se hayan realizado, facilitando su aceptación universal y reduciendo las potenciales barreras técnicas al comercio.


INTRODUCTION: the metrological traceability process from a secondary standard to a primary one is a property of the result of a measurement or the value of a standard, by which it can be related to established references, usually national or international, through an uninterrupted chain of comparisons, all of which have certain uncertainties. OBJECTIVE: to carry out the traceability of a secondary standard to a primary one of cyclosporine and in this way to ensure its quality and purity. METHODS: the following methods were used: organoleptic description, solubility, identification and quantification by reversed phase High Performance Liquid Chromatogra- phy (HPLC). RESULTS: the secondary cyclosporine standard met all the specifications referred to organoleptic description, solubility, identification and a purity of 97.5% was obtained using a primary standard whose titer is 98.5%. CONCLUSION: the metrological traceability of a secondary standard to a primary standard was carried out in order to be able to use it as a working standard, guaranteeing its title. This property is one of the pillars for the measurement results to be comparable with each other, regardless of the place and time in which they have been carried out, facilitating their universal acceptance and reducing potential technical barriers to trade.


Subject(s)
Solubility , Weights and Measures , Cyclosporine , Methods
8.
Korean Circulation Journal ; : 112-119, 2020.
Article in English | WPRIM | ID: wpr-786228

ABSTRACT

Kawasaki disease is a form of vasculitis, mainly in small and medium arteries of unknown origin, occurring frequently in childhood. It is the leading form of childhood-onset acquired heart disease in developed countries and leads to complications of coronary artery aneurysms in approximately 25% of cases if left untreated. Although more than half a century has passed since Professor Tomisaku Kawasaki's first report in 1957, the cause is not yet clear. Currently, intravenous immunoglobulin therapy has been established as the standard treatment for Kawasaki disease. Various treatment strategies are still being studied under the slogan, “Ending powerful inflammation in the acute phase as early as possible and minimizing the incidence of coronary artery lesions,” as the goal of acute phase treatments for Kawasaki disease. Currently, in addition to immunoglobulin therapy, steroid therapy, therapy using infliximab, biological products, suppression of elastase secretion inside and outside the neutrophils, inactivated ulinastatin therapy and cyclosporine therapy, plasma exchange, etc. are performed. This chapter outlines the history and transition of the acute phase treatment for Kawasaki disease.


Subject(s)
Aneurysm , Arteries , Biological Products , Coronary Vessels , Cyclosporine , Developed Countries , Heart Diseases , Immunization, Passive , Incidence , Inflammation , Infliximab , Mucocutaneous Lymph Node Syndrome , Neutrophils , Pancreatic Elastase , Plasma Exchange , Prednisolone , Vasculitis
9.
Chinese Journal of Biotechnology ; (12): 605-611, 2020.
Article in Chinese | WPRIM | ID: wpr-827008

ABSTRACT

Cyclophilin A (CypA) is a widely distributed and highly conserved protein in organisms. It has peptidyl-prolyl cis/trans isomerase activity and is a receptor for cyclosporin A (CsA). Coronaviruses are enveloped, single-stranded, positive-sense RNA viruses. Seven types of coronaviruses are currently known to infect humans, among which SARS-CoV, MERS-CoV, and SARS-CoV-2 are fatal for humans. It is well established that CypA is essential for the replication of various coronaviruses such as SARS-CoV, CoV-229E, CoV-NL63, and FCoV. Additionally, CsA and its derivatives (ALV, NIM811, etc.) have obvious inhibitory effects on a variety of coronaviruses. These results suggest that CypA is a potential antiviral target and the existing drug CsA might be used as an anti-coronavirus drug. At the end of 2019, SARS-CoV-2 raged in China, which seriously theatern human health and causes huge economic lases. In view of this, we describe the effects of CypA on the replication of coronaviruses and the antiviral activities of its inhibitors, which will provide the scientific basis and ideas for the development of antiviral drugs for SARS-CoV-2.


Subject(s)
Antiviral Agents , Pharmacology , Therapeutic Uses , Betacoronavirus , Coronavirus , Coronavirus Infections , Drug Therapy , Epidemiology , Virology , Cyclophilin A , Cyclosporine , Chemistry , Pharmacology , Therapeutic Uses , Humans , Pandemics , Pneumonia, Viral , Drug Therapy , Epidemiology , Virology , SARS Virus , Virus Replication
10.
Braz. oral res. (Online) ; 34: e007, 2020. graf
Article in English | LILACS | ID: biblio-1055531

ABSTRACT

Abstract The aim of this study was to assess the influence of cyclosporine administration on the repair of critical-sized calvaria defects (CSDs) in rat calvaria filled with diverse biomaterials. Sixty animals were divided into two groups: the control (CTR) group (saline solution) and the cyclosporine (CCP) group (cyclosporine, 10 mg/kg/day). These medications were administered daily by gavage, beginning 15 days before the surgical procedure and lasting until the day the animals were euthanized. A CSD (5 mm Ø) was made in the calvaria of each animal, which was allocated to one of 3 subgroups, according to the biomaterial used to fill the defect: coagulum (COA), deproteinized bovine bone (DBB), or biphasic calcium phosphate ceramics of hydroxyapatite and β-phosphate tricalcium (HA/TCP). Euthanasia of the animals was performed 15 and 60 days after the surgical procedure (n = 5 animals/period/subgroup). Bone repair (formation) assessment was performed through microtomography and histometry, while the analyses of the expression of the BMP2, Osteocalcin, and TGFβ1 proteins were performed using immunohistochemistry. The CSDs not filled with biomaterials demonstrated lower bone formation in the CCP group. At 15 days, less bone formation was observed in the CSDs filled with DBB, a smaller volume of mineralized tissue was observed in the CSDs filled with HA/TCP, and the expression levels of BMP2 and osteocalcin were lower in the CCP group compared to the CTR group. The use of cyclosporine impaired bone repair in CSD, and this effect can be partially explained by the suppression of BMP2 and osteocalcin expression.


Subject(s)
Animals , Male , Rats , Osteogenesis/drug effects , Bone Regeneration/drug effects , Cyclosporine/pharmacology , Bone Substitutes/pharmacology , Calcineurin Inhibitors/pharmacology , Skull/drug effects , Skull/pathology , Time Factors , Immunohistochemistry , Random Allocation , Osteocalcin/analysis , Reproducibility of Results , Transforming Growth Factor beta1/analysis , Bone Morphogenetic Protein 2/analysis , X-Ray Microtomography
11.
Braz. oral res. (Online) ; 34: e007, 2020. graf
Article in English | LILACS | ID: biblio-1089397

ABSTRACT

Abstract The aim of this study was to assess the influence of cyclosporine administration on the repair of critical-sized calvaria defects (CSDs) in rat calvaria filled with diverse biomaterials. Sixty animals were divided into two groups: the control (CTR) group (saline solution) and the cyclosporine (CCP) group (cyclosporine, 10 mg/kg/day). These medications were administered daily by gavage, beginning 15 days before the surgical procedure and lasting until the day the animals were euthanized. A CSD (5 mm Ø) was made in the calvaria of each animal, which was allocated to one of 3 subgroups, according to the biomaterial used to fill the defect: coagulum (COA), deproteinized bovine bone (DBB), or biphasic calcium phosphate ceramics of hydroxyapatite and β-phosphate tricalcium (HA/TCP). Euthanasia of the animals was performed 15 and 60 days after the surgical procedure (n = 5 animals/period/subgroup). Bone repair (formation) assessment was performed through microtomography and histometry, while the analyses of the expression of the BMP2, Osteocalcin, and TGFβ1 proteins were performed using immunohistochemistry. The CSDs not filled with biomaterials demonstrated lower bone formation in the CCP group. At 15 days, less bone formation was observed in the CSDs filled with DBB, a smaller volume of mineralized tissue was observed in the CSDs filled with HA/TCP, and the expression levels of BMP2 and osteocalcin were lower in the CCP group compared to the CTR group. The use of cyclosporine impaired bone repair in CSD, and this effect can be partially explained by the suppression of BMP2 and osteocalcin expression.


Subject(s)
Animals , Male , Rats , Osteogenesis/drug effects , Bone Regeneration/drug effects , Cyclosporine/pharmacology , Bone Substitutes/pharmacology , Calcineurin Inhibitors/pharmacology , Skull/drug effects , Skull/pathology , Time Factors , Immunohistochemistry , Random Allocation , Osteocalcin/analysis , Reproducibility of Results , Transforming Growth Factor beta1/analysis , Bone Morphogenetic Protein 2/analysis , X-Ray Microtomography
12.
An. bras. dermatol ; 94(6): 713-716, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054898

ABSTRACT

Abstract Hyperzincemia and hypercalprotectinemia is a rare inflammatory disease caused by a mutation in the PSTPIP1 gene, with a dysregulation of calprotectin metabolism. Calprotectin is a zinc-binding protein with antimicrobial properties and pro-inflammatory action. The authors report the case of a 20 year-old girl with cutaneous ulcers comparable with pyoderma gangrenosum, growth failure and chronic anemia, who was given the diagnosis of hyperzincemia and hypercalprotectinemia. Measurement of serum zinc and calprotectin concentrations are indicated in these cases.


Subject(s)
Humans , Female , Young Adult , Pyoderma Gangrenosum/pathology , Metal Metabolism, Inborn Errors/pathology , Zinc/blood , Prednisolone/therapeutic use , Treatment Outcome , Cyclosporine/therapeutic use , Leukocyte L1 Antigen Complex/blood , Dermatologic Agents/therapeutic use , Glucocorticoids/therapeutic use , Metal Metabolism, Inborn Errors/drug therapy
13.
Arq. bras. oftalmol ; 82(5): 372-376, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019436

ABSTRACT

ABSTRACT Purpose: We evaluated the role of the conjunctival flap rotation technique using 5-fluorouracil and adjuvant therapy with topical cyclosporine A at 0.05% during short pre- and postoperative periods for the prevention of primary pterygium recurrence. Methods: In this prospective study, 76 patients with primary pterygium (76 eyes) were categorized into two groups: the control group with 31 patients who did not receive cyclosporine treatment, and the cyclosporine group with 45 patients who received topical cyclosporine A (0.05%) twice a day, for 10 days before and 10 days after the pterygium excision operations. Patients were examined for disease recurrence, side effects, and complications at 10 and 21 days, and at 2 and 6 months after the operation. Data on demography, systemic diseases, and ophthalmologic histories were obtained from all patients, and these data were analyzed using descriptive statistics involving the absolute and relative percentages of frequency distribution. Goodman test was used for contrasts among multinomial populations to study the association between cyclosporine A and recurrence. Results: Most patients were between 30 and 60 years of age, and 67.1% were women. We confirmed a higher recurrence in patients with occupational sunlight exposure. The cyclosporine A used topically 10 days before and 10 days after the pterygium removal did not significantly reduce the recurrence of the pterygium. Conclusion: Topical 0.05% cyclosporine A when used for 10 days before and 10 days after the pterygium removal does not prevent or reduce the recurrence of primary pterygium.


RESUMO Objetivo: Avaliamos os resultados da técnica de rotação de retalho conjuntival com uso de 5-fluorouracil e terapia adjuvante com ciclosporina A tópica a 0,05%, usada no pré e pós-operatório por curto período, quanto à prevenção da recidiva do pterígio primário Métodos: Estudo prospectivo, com 76 pacientes portadores de pterígio primário (76 olhos), divididos em dois grupos: controle com 31 pacientes que não receberam tratamento com ciclosporina e grupo ciclosporina com 45 pacientes que receberam ciclosporina tópica A (0,05%) duas vezes ao dia, por 10 dias antes e 10 dias após a cirurgia de excisão do pterígio. Os pacientes foram avaliados quanto à recorrência, efeitos colaterais e complicações com 10, 21 dias, 2 e 6 meses de pós-operatório. Dados demográficos, doenças sistêmicas e histórico oftalmológico foram coletados de todos os pacientes e esses dados foram analisados por meio de estatística descritiva envolvendo o percentual absoluto e relativo de distribuição de frequência. O teste de Goodman para contrastes entre populações multinomiais foi utilizado para o estudo da associação entre a ciclosporina A e a recorrência Resultados: A maioria dos pacientes tinha entre 30 e 60 anos e 67,1% eram mulheres. Confirmamos uma maior recorrência em pacientes com exposição ocupacional ao sol. A ciclosporina A tópica utilizada 10 dias antes e 10 dias após a remoção do pterígio não reduziu significativamente a sua recorrência Conclusão: A ciclosporina A tópica a 0,05% quando utilizada por 10 dias no pré e 10 dias no pós-operatório, não previne ou reduz a recidiva do pterígio primário significativamente.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Pterygium/prevention & control , Cyclosporine/administration & dosage , Conjunctiva/abnormalities , Immunosuppressive Agents/administration & dosage , Ophthalmic Solutions/administration & dosage , Postoperative Care , Recurrence , Surgical Flaps , Preoperative Care , Pterygium/surgery , Pterygium/drug therapy , Prospective Studies , Combined Modality Therapy , Conjunctiva/surgery , Corneal Diseases/drug therapy , Fluorouracil/therapeutic use
14.
Arq. bras. oftalmol ; 82(4): 310-316, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019421

ABSTRACT

ABSTRACT Purpose: Chronic instillation of benzalkonium chloride, a preservative, has inflammatory effects on the ocular surface. However, addition of the anti-inflammatory agent cyclosporine to a therapeutic protocol may mitigate these effects. This study compared the toxic effects of a 0.1% benzalkonium chloride solution and the possible protective effect of 0.05% cyclosporine when applied topically to the rabbit conjunctiva. Methods: Fifteen age- and weight-matched, female New Zealand white rabbits were categorized into three groups and treated for 30 consecutive days. Group 1, 2, and 3 - benzalkonium chloride received 0.1% every 24 h, 0.05% cyclosporine every 6 h, and both treatments, respectively. In each rabbit, the left eye was subjected to treatment and the right eye was a control. The rabbits were euthanized at after the experiment. Goblet cells and blood vessels were then enumerated in conjunctival tissues stained with periodic acid-Schiff and hematoxylin-eosin, respectively. Differences between treated and untreated eyes and between groups were compared using the t-test and analysis of variance. Results: Benzalkonium chloride treatment, with and without cyclosporine, significantly reduced (p≤0.05) in the number of goblet cells in treatment eyes compared with that in respective control eyes. Alternatively, adding cyclosporine to benzalkonium chloride did not prevent the loss of conjunctival goblet cells, and a significant reduction in the number of goblet cells was noted. Benzalkonium chloride-induced significant increase in the number of new blood vessels was mitigated significantly by the addition of cyclosporine. Conclusion: This study demonstrated the magnitude of conjunctival injury caused by chronic instillation of benzalkonium chloride. Although cyclosporine did not mitigate the effects on goblet cells, its addition minimized inflammatory angiogenesis induced by benzalkonium chloride.


RESUMO Objetivo: A instilação crônica de cloreto de benzal­cônio, um conservante, tem efeitos inflamatórios na superfície ocular. No entanto, a adição do agente anti-inflamatório ciclosporina a um protocolo terapêutico pode atenuar esses efeitos. Este estudo comparou os efeitos tóxicos de uma solução de cloreto de benzalcônio a 0,1% e o possível efeito protetor de ciclosporina a 0,05% quando aplicado topicamente à conjuntiva de coelho. Métodos: Quinze coelhos fêmeas brancos da raça Nova Zelândia, pareados por idade e peso, foram categorizados em três grupos e tratados por 30 dias consecutivos. Os grupos 1, 2 e 3 - receberam cloreto de benzalcônio 0,1% a cada 24h, ciclosporina a 0,005% a cada 6h e ambos os tratamentos, respectivamente. Em cada coelho, o olho esquerdo foi submetido a tratamento e o olho direito foi controle. Os coelhos foram submetidos à eutanásia após o experimento. Células caliciformes e vasos sanguíneos foram então enumerados em tecidos conjuntivais corados com ácido periódico-Schiff e hematoxilina-eosina, respectivamente. As diferenças entre os olhos tratados e não tratados e entre os grupos foram comparadas usando o teste t e análise de variância. Resultados: O tratamento com cloreto de benzalcônio, com e sem ciclosporina, reduziu significativamente (p£0,05) o número de células caliciformes nos olhos tratados em comparação com os olhos controle correspondentes. Alternativamente, a adição de ciclosporina ao cloreto de benzalcônio não impediu a perda de células caliciformes conjuntivais, e foi observada uma redução significativa no número de células caliciformes. O aumento significativo induzido pelo cloreto de benzalcônio no número de novos vasos sanguíneos foi significativamente mitigado pela adição da ciclosporina. Conclusão: Este estudo demonstrou a magnitude da lesão conjuntival resultante da instilação crônica de cloreto de benzalcônio. Embora a ciclosporina não tenha atenuado os efeitos nas células caliciformes, sua adição minimizou a angiogênese inflamatória induzida pelo cloreto de benzalcônio.


Subject(s)
Animals , Female , Rats , Preservatives, Pharmaceutical/adverse effects , Benzalkonium Compounds/adverse effects , Cyclosporine/pharmacology , Conjunctiva/drug effects , Protective Agents/pharmacology , Anti-Inflammatory Agents/pharmacology , Time Factors , Random Allocation , Reproducibility of Results , Treatment Outcome , Conjunctiva/pathology , Goblet Cells/drug effects , Angiogenesis Inducing Agents/pharmacology
15.
Medicentro (Villa Clara) ; 23(2): 145-150, abr.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1002576

ABSTRACT

Resumen El agrandamiento gingival medicamentoso se describe como un aumento de volumen anormal, exagerado y deformante de las encías, provocado por la ingesta de algunos medicamentos. Entre los más comunes se encuentran: fármacos anticonvulsivantes, antihipertensivos, particularmente los antagonistas del calcio e inmunosupresores. Se presentó el caso de un paciente del sexo masculino, de 44 años de edad, con antecedentes de hipertensión arterial e insuficiencia renal crónica, durante 10 y tres años respectivamente. Después de 22 meses de haber recibido un trasplante renal y tratamiento con ciclosporina, acude a consulta por aumento del volumen de las encías en ambos maxilares, clínicamente compatible con agrandamiento gingival medicamentoso generalizado y grave.


ABSTRACT Drug-induced gingival enlargement is described as an abnormal, exaggerated, and deforming growth of the gingiva caused by the ingestion of some medications. Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are among the most common drugs. We present a 44-year-old male patient with a history of arterial hypertension and chronic renal failure, for 10 and three years, respectively. Twenty-two months after receiving a kidney transplant and treatment with cyclosporine, he visited the clinic due to an increase in the volume of the gums in both jaws, clinically compatible with a generalized and severe gingival enlargement.


Subject(s)
Cyclosporine/adverse effects , Gingival Overgrowth/chemically induced
16.
Arq. bras. oftalmol ; 82(3): 236-238, May-June 2019. graf
Article in English | LILACS | ID: biblio-1001314

ABSTRACT

ABSTRACT This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.


RESUMO Este relato é para descrever um caso de líquen plano conjuntival unilateral induzido por brimonidina. Como o exame oftalmológico indicava conjuntivite crônica ou pseudopenfigóide induzido por medicamento, o paciente foi submetido a exames oftalmológicos e sistémicos completos, além de biópsia conjuntival e estudos de imunofluorescência direta. Uma mulher de 71 anos de idade com achados unilaterais do olho esquerdo de conjuntivite crônica foi encaminhada ao nosso departamento de Oftalmologia. A paciente relatou que a conjuntivite crônica começou logo após o início do uso da brimonidina tópica. O exame oftalmológico revelou encurtamento do fórnice inferior e do symblepharon. A biópsia conjuntival revelou linfócitos submucosos e distribuição felpuda de fibrinogênio na imunofluorescência direta; isso era sugestivo de líquen plano ocular. Não foram encontradas outras lesões sistêmicas compatíveis com a apresentação do líquen plano. Uma boa resposta foi observada no tratamento tópico com ciclosporina. Pelo nosso conhecimento, este pode ser o primeiro relato de líquen plano ocular unilateral sem achados sistêmicos. A correlação com o início da brimonidina tópica sugere que este pode ser o primeiro caso de líquen plano ocular induzido por brimonidina confirmado por biópsia.


Subject(s)
Humans , Female , Aged , Conjunctival Diseases/chemically induced , Brimonidine Tartrate/adverse effects , Lichen Planus/chemically induced , Antihypertensive Agents/adverse effects , Biopsy , Cyclosporine/therapeutic use , Conjunctiva/pathology , Conjunctival Diseases/pathology , Conjunctival Diseases/drug therapy , Immunosuppressive Agents/therapeutic use , Lichen Planus/pathology , Lichen Planus/drug therapy
17.
An. bras. dermatol ; 94(2,supl.1): 76-107, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011088

ABSTRACT

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.


Subject(s)
Humans , Male , Female , Psoriasis/diagnosis , Psoriasis/therapy , Phototherapy/methods , Psoriasis/epidemiology , Societies, Medical , Time Factors , Vitamin D/analysis , Severity of Illness Index , Brazil , Comorbidity , Anthralin/therapeutic use , Methotrexate/therapeutic use , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Dermatology , Drug Combinations , Calcineurin Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use
18.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 252-256, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013282

ABSTRACT

ABSTRACT Objective: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. Case description: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. Comments: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.


RESUMO Objetivo: Destacar a importância do conhecimento sobre os novos critérios de classificação para síndrome de ativação macrofágica (SAM) na artrite idiopática juvenil sistêmica para reduzir a morbidade e mortalidade desse desfecho. Descrição do caso: Adolescente do sexo feminino de 12 anos de idade, em terapia imunossupressora por diagnóstico de artrite idiopática juvenil sistêmica há 2 anos, com quadro de tosse, dor precordial aguda, taquipneia, taquicardia e hipoxemia há 2 dias. A tomografia de tórax evidenciou efusão pleural laminar bilateral com consolidação bibasal. O eletrocardiograma foi compatível com pericardite aguda, e o ecocardiograma foi normal. Os exames laboratoriais revelaram anemia, leucocitose e aumento da velocidade de hemossedimentação, proteína C-reativa e marcadores séricos de lesão miocárdica. Infecção sistêmica e/ou doença sistêmica em atividade foram consideradas. A paciente foi tratada com antibióticos e glicocorticoide. Entretanto, dez dias depois, evoluiu com doença sistêmica em atividade (febre, exantema e miopericardite com insuficiência cardíaca) associada à SAM, de acordo com o 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis, e necessitou de cinco dias de pulsoterapia com glicocorticoide, imunoglobulina e ciclosporina A, com melhora de todos os parâmetros clínicos e laboratoriais. Comentários: A miopericardite com sinais de insuficiência cardíaca associada à SAM é uma apresentação clínica rara da artrite idiopática juvenil sistêmica, que ocorre principalmente em períodos de atividade sistêmica da doença e pode ser deflagrada por infecções. O conhecimento sobre essa síndrome é fundamental para reduzir morbidade e mortalidade desse grave desfecho.


Subject(s)
Humans , Female , Child , Cyclosporine/administration & dosage , Glucocorticoids/administration & dosage , Arthritis, Juvenile/complications , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/physiopathology , Arthritis, Juvenile/immunology , Chest Pain/diagnosis , Chest Pain/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome , Immunoglobulins, Intravenous/administration & dosage , Pulse Therapy, Drug/methods , Electrocardiography/methods , Macrophage Activation Syndrome/etiology , Macrophage Activation Syndrome/physiopathology , Macrophage Activation Syndrome/blood , Macrophage Activation Syndrome/therapy , Immunosuppressive Agents/administration & dosage , Leukocytosis/diagnosis , Leukocytosis/etiology
19.
Con-ciencia (La Paz) ; 7(1): 67-77, abr. 2019.
Article in Spanish | LILACS | ID: biblio-1178663

ABSTRACT

El presente estudio describe la validación del método para la cuantificación de Ciclosporina A en sangre total por Cromatografía Líquida de Alta Resolución (HPLC) en Fase Reversa con Detector de Arreglo de Diodos. La Ciclosporina A es un fármaco inmunosupresor con un estrecho margen terapéutico además de su amplia variabilidad en los procesos farmacocinéticos, justifican su monitorización de dosis a pacientes con trasplantes de órganos para evitar los efectos secundarios y el posible rechazo del órgano trasplantado. La separación de la Ciclosporina A de una matriz compleja como la sangre fue llevada a cabo de manera exitosa utilizando como fase estacionaria una columna C8 5um (250 mm x 4,6mm) o equivalente a L7 según la USP 37, la fase móvil fue una mezcla de acetonitrilo y agua en gradiente, flujo 1.4 ml/min, temperatura de la columna 75ºC y detección con Arreglo de Diodos a 210nm. El método fue validado con los siguientes parámetros: especificidad, linealidad, precisión, exactitud, límite de detección y límite de cuantificación. También se realizó la prueba de aptitud del sistema. El método fue específico para la Ciclosporina A, la respuesta fue lineal en el rango de 100 a 1000 ng/mL de concentración del analito. El valor del coeficiente de variación o desviación estándar relativa (C.V. o DSR) para la precisión fue óptimo. La recuperación media fue de 103,06%. Y el límite de detección y cuantificación resultaron óptimos para la cuantificación de Ciclosporina en sangre total en el rango definido. Finalmente el método cromatográfico nos permitió separar y cuantificar a la Ciclosporina A presente en las muestras de sangre de pacientes con transplante renal.


This study describe the validation method for the quantification of Cyclosporin A in Whole Blood by Liquid Chromatography High Efficiency (HPLC) in reverse phase. Cyclosporine A is immunosuppressant United Nations UN the narrow scam therapeutic margin: In addition to its extensive ¿variability in pharmacokinetic processes justify their monitoring dose Patients with organ transplants paragraph Avoid Side Effects and poaible organ rejection transplanted. Separation of Cyclosporine A of a matrix complex as the blood was carried out successfully using as the stationary phase C8 column, the mobile phase is a mixture of acetonitrile and water gradient, flow 1.4 ml / min, Temperature column was 75 ° C detection 210 nm in one. The method was validated with the following parameters: specificity, linearity, precision, accuracy, limit of detection and limit of quantification. Aptitude Test System was also performed. Was Method Specific for Cyclosporin A, the response was linear in the range 100 a 1000 ng/mL concentration of the analyte. The coefficient of variation or relative standard deviation (RSD or CV) for the precision was optimal. Recovery media WAS 103,06%. And the limit of detection and quantification were optimal for the quantification of total Cyclosporine in blood in the range defined. Finally Chromatographic Method allowed us to separate and quantify Cyclosporin A in samples of patients with renal transplantation.


Subject(s)
Cyclosporine , Dosage , Limit of Detection , Sensitivity and Specificity , Kidney Transplantation , Reference Parameters
20.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 530-534, Apr. 2019.
Article in English | LILACS | ID: biblio-1003055

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Psoriasis/drug therapy , Dermatologic Agents/administration & dosage , Immunosuppressive Agents/administration & dosage , Antibodies, Monoclonal/administration & dosage , Psoriasis/pathology , Time Factors , Severity of Illness Index , Brazil , Methotrexate/administration & dosage , Methotrexate/adverse effects , Treatment Outcome , Cyclosporine/administration & dosage , Cyclosporine/adverse effects , Acitretin/administration & dosage , Acitretin/adverse effects , Dermatologic Agents/adverse effects , Clinical Decision-Making , Immunosuppressive Agents/adverse effects , Antibodies, Monoclonal/adverse effects
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