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2.
Rev. bras. ter. intensiva ; 32(3): 354-362, jul.-set. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138502

ABSTRACT

RESUMO Objetivo: A infecção causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) disseminou-se por todo o mundo e foi categorizada como pandemia. As manifestações mais comuns da infecção pelo SARS-CoV-2 (doença pelo coronavírus 2019 - COVID-19) se referem a uma pneumonia viral com graus variáveis de comprometimento respiratório e até 40% dos pacientes hospitalizados, que podem desenvolver uma síndrome do desconforto respiratório agudo. Diferentes ensaios clínicos avaliaram o papel dos corticosteroides na síndrome do desconforto respiratório agudo não relacionada com COVID-19, obtendo resultados conflitantes. Delineamos o presente estudo para avaliar a eficácia da administração endovenosa precoce de dexametasona no número de dias vivo e sem ventilação mecânica nos 28 dias após a randomização, em pacientes adultos com quadro moderado ou grave de síndrome do desconforto respiratório agudo causada por COVID-19 provável ou confirmada. Métodos: Este é um ensaio pragmático, prospectivo, randomizado, estratificado, multicêntrico, aberto e controlado que incluirá 350 pacientes com quadro inicial (menos de 48 horas antes da randomização) de síndrome do desconforto respiratório agudo moderada ou grave, definida segundo os critérios de Berlim, causada por COVID-19. Os pacientes elegíveis serão alocados de forma aleatória para tratamento padrão mais dexametasona (Grupo Intervenção) ou tratamento padrão sem dexametasona (Grupo Controle). Os pacientes no Grupo Intervenção receberão dexametasona 20mg por via endovenosa uma vez ao dia, por 5 dias, e, a seguir, dexametasona por via endovenosa 10mg ao dia por mais 5 dias, ou até receber alta da unidade de terapia intensiva, o que ocorrer antes. O desfecho primário será o número de dias livres de ventilação mecânica nos 28 dias após a randomização, definido como o número de dias vivo e livres de ventilação mecânica invasiva. Os desfechos secundários serão a taxa de mortalidade por todas as causas no dia 28, a condição clínica no dia 15 avaliada com utilização de uma escala ordinal de seis níveis, a duração da ventilação mecânica desde a randomização até o dia 28, a avaliação com o Sequential Organ Failure Assessment Score após 48 horas, 72 horas e 7 dias, e o número de dias fora da unidade de terapia intensiva nos 28 dias após a randomização.


Abstract Objective: The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads worldwide and is considered a pandemic. The most common manifestation of SARS-CoV-2 infection (coronavirus disease 2019 - COVID-19) is viral pneumonia with varying degrees of respiratory compromise and up to 40% of hospitalized patients might develop acute respiratory distress syndrome. Several clinical trials evaluated the role of corticosteroids in non-COVID-19 acute respiratory distress syndrome with conflicting results. We designed a trial to evaluate the effectiveness of early intravenous dexamethasone administration on the number of days alive and free of mechanical ventilation within 28 days after randomization in adult patients with moderate or severe acute respiratory distress syndrome due to confirmed or probable COVID-19. Methods: This is a pragmatic, prospective, randomized, stratified, multicenter, open-label, controlled trial including 350 patients with early-onset (less than 48 hours before randomization) moderate or severe acute respiratory distress syndrome, defined by the Berlin criteria, due to COVID-19. Eligible patients will be randomly allocated to either standard treatment plus dexamethasone (Intervention Group) or standard treatment without dexamethasone (Control Group). Patients in the intervention group will receive dexamethasone 20mg intravenous once daily for 5 days, followed by dexamethasone 10mg IV once daily for additional 5 days or until intensive care unit discharge, whichever occurs first. The primary outcome is ventilator-free days within 28 days after randomization, defined as days alive and free from invasive mechanical ventilation. Secondary outcomes are all-cause mortality rates at day 28, evaluation of the clinical status at day 15 assessed with a 6-level ordinal scale, mechanical ventilation duration from randomization to day 28, Sequential Organ Failure Assessment Score evaluation at 48 hours, 72 hours and 7 days and intensive care unit -free days within 28.


Subject(s)
Humans , Adult , Pneumonia, Viral/drug therapy , Respiratory Distress Syndrome, Newborn/drug therapy , Dexamethasone/administration & dosage , Coronavirus Infections/drug therapy , Glucocorticoids/administration & dosage , Pneumonia, Viral/physiopathology , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/virology , Time Factors , Prospective Studies , Coronavirus Infections/physiopathology , Pandemics , Organ Dysfunction Scores , COVID-19 , Intensive Care Units
3.
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 95-104, sept. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1128985

ABSTRACT

La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)


The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)


Subject(s)
Humans , Endocrine System Diseases/chemically induced , Immunotherapy/adverse effects , Thyroid Diseases/diagnosis , Thyroid Diseases/chemically induced , Thyroid Diseases/pathology , Thyroid Diseases/therapy , Thyroxine/administration & dosage , Triiodothyronine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/chemically induced , Adrenal Insufficiency/pathology , Adrenal Insufficiency/therapy , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/chemically induced , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Endocrine System Diseases/diagnosis , Endocrine System Diseases/physiopathology , Endocrine System Diseases/therapy , Hypophysitis/diagnosis , Hypophysitis/chemically induced , Hypophysitis/pathology , Hypophysitis/therapy , Glucocorticoids/administration & dosage , Insulin/therapeutic use , Methimazole/therapeutic use , Mineralocorticoids/therapeutic use , Antibodies, Monoclonal/therapeutic use , Neoplasms/immunology
4.
Rev. bras. anestesiol ; 70(1): 15-21, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137141

ABSTRACT

Abstract Introduction: Painful shoulder syndrome is a frequent condition among the elderly and an important cause of functional disability. As the conservative treatment is not always effective, ultrasound guided suprascapular nerve blockade presents as an important alternative treatment. Objective: To evaluate the efficacy and safety of the use of 0.25% levobupivacaine and 40 mg of triamcinolone in the suprascapular nerve blockade in patients with chronic pain in the shoulder. Methods: A retrospective, descriptive and analytical study of 71 patients submitted to suprascapular nerve infiltration between August 2014 and March 2017. Surveys were carried out to patients before the technique was performed, after 72 hours and at 1, 3 and 6 months. Pain intensity was assessed using a numeric pain scale (NPS). Results: Out of the 71 patients who underwent a blockade of the suprascapular nerve, 81.2% reported a decrease in pain at 72 hours. In the first, third and sixth month, respectively, 89.8%, 76.1% and 61.8% of the patients presented pain relief. A statistically significant difference (p < 0.001) was verified between NPS and the 4 moments assessed after the technique. 43.7% had total pain remission (NPS = 0) at six months. Global effectiveness of suprascapular nerve blockade was 60.6% and for the subgroup of patients with rotators' cuff patology was 62.2%. No complications were reported regarding the suprascapular nerve block. Conclusion: The results show that ultrasound-guided blockade of the suprascapular nerve using 0.25% levobupivacaine and 40 mg of triamcinolone is a safe and effective treatment in patients with chronic shoulder pain.


Resumo Introdução: A síndrome do ombro doloroso é uma condição frequente entre os idosos e uma causa importante de incapacidade funcional na população em geral. O tratamento conservador nem sempre é eficaz, pelo que o bloqueio do nervo supraescapular guiado por ecografia apresenta-se como uma opção de tratamento válida. Objetivo: Avaliação da eficácia e segurança do uso de levobupivacaína a 0,25% e 40 mg de triancinolona no bloqueio do nervo supraescapular ecoguiado em doentes com dor crônica no ombro. Métodos: Realizou-se um estudo retrospectivo observacional, descritivo e analítico com 71 doentes submetidos à infiltração do nervo supraescapular entre agosto de 2014 e março de 2017. Foram aplicados questionários antes da realização da técnica, após 72 horas; 1, 2 e 6 meses. A intensidade da dor foi avaliada usando a Escala de Avaliação Numérica (EAN). Resultados: Dos 71 doentes submetidos ao bloqueio do nervo supraescapular; 81,2% referiram diminuição da dor às 72 horas. Aos primeiro, terceiro e sexto mês, respectivamente 89,8%; 76,1% e 61,8% apresentaram melhoria da dor. Verificou-se uma diferença estatisticamente significativa (p < 0,001), entre a EAN inicial e os 4 momentos após a realização da técnica. 43,7% dos doentes tiveram remissão total da dor (EAN = 0) aos seis meses. A eficácia global do bloqueio do nervo supraescapular foi de 60,6% e, para o subgrupo com patologia da coifa dos rotadores, de 62,2%. Nenhuma complicação do bloqueio do NSE foi registrada. Conclusão: Este estudo mostra que o bloqueio eco-guiado do NSE usando levobupivacaína a 0,25% e 40 mg de triancinolona é um procedimento seguro e eficaz em doentes com dor crônica no ombro.


Subject(s)
Humans , Male , Female , Triamcinolone/administration & dosage , Ultrasonography, Interventional , Shoulder Pain/therapy , Chronic Pain/therapy , Levobupivacaine/administration & dosage , Glucocorticoids/administration & dosage , Nerve Block/methods , Shoulder/innervation , Retrospective Studies , Treatment Outcome , Anesthetics, Local , Middle Aged
5.
Arq. bras. oftalmol ; 83(1): 73-75, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1088954

ABSTRACT

ABSTRACT We describe three patients who had previous heart diseases and nonproliferative diabetic retinopathy with clinically significant diabetic macular edema. They underwent unilateral dexamethasone intravitreal implantation. Without ophthalmological treatment in the fellow eye, patients showed marked bilateral improvement in best-corrected visual acuity, optical coherence images, and macular thickness values. These findings provide evidence of the bilateral effect of dexamethasone intravitreal implantation, which may be clinically useful in patients for whom the systemic effects of the drug may affect their general health.


RESUMO Descrevemos três pacientes que tiveram doenças cardíacas prévias e retinopatia diabética não proliferativa com edema macular diabético clinicamente significativo. Eles foram submetidos a implante intravítreo de dexametasona unilateral. Sem tratamento oftalmológico no olho contralateral, os pacien tes apresentaram uma melhora bilateral significativa na melhor acuidade visual corrigida, nas imagens de coerência óptica e nos valores da espessura macular. Esses achados fornecem evidências sobre o efeito bilateral do implante intravítreo de dexametasona, que pode ser clinicamente útil em pacientes para os quais os efeitos sistêmicos da droga possam afetar a saúde geral do paciente.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Dexamethasone/administration & dosage , Macular Edema/drug therapy , Diabetic Retinopathy/drug therapy , Glucocorticoids/administration & dosage , Visual Acuity , Macular Edema/physiopathology , Tomography, Optical Coherence/methods , Diabetes Mellitus , Diabetic Retinopathy/physiopathology , Drug Implants , Intravitreal Injections
6.
Rev. chil. endocrinol. diabetes ; 13(3): 95-97, 2020.
Article in Spanish | LILACS | ID: biblio-1116916

ABSTRACT

La insuficiencia suprarrenal es un síndrome que se produce por la disminución de niveles séricos de glucocorticoides, la cual se clasifica en primaria o secundaria, según la etiología. El uso prolongado de corticoides exógenos a altas dosis puede producir una inhibición en el eje hipotálamo-hipofisiario-adrenal, y la supresión aguda de éstos produce insuficiencia suprarrenal secundaria. Los glucocorticoides inhalados, usados ampliamente como tratamiento del asma bronquial, pudiesen tener un impacto a nivel del eje adrenal, principalmente en la población pediátrica. Por el momento, si bien hay reportes de casos que evidencian insuficiencia suprarrenal secundaria al uso de corticoides tanto tópicos como inhalatorios, aún es materia de discusión esta interacción a nivel sistémico, con artículos que se contraponen en sus resultados. Se presenta un caso clínico de una paciente usuaria de glucocorticoides inhalatorios por el antecedente de asma bronquial, que desarrolla una clínica de insuficiencia suprarrenal en el periodo de lactancia.


Adrenal insufficiency is a syndrome that is produced by the decrease in serum glucocorticoid levels, which is classified as primary or secondary, according to the etiology. Prolonged use of exogenous corticosteroids at high doses may cause inhibition in the hypothalamic-pituitary-adrenal axis, and acute suppression of these results in secondary adrenal insufficiency. Inhaled glucocorticoids, widely used as a treatment for bronchial asthma, could have an impact at the level of the adrenal axis, mainly in the pediatric population. At the moment, although there are reports of cases that show adrenal insufficiency secondary to the use of both topical and inhalation corticosteroids, this interaction at systemic level is still a matter of discussion, with articles that contrast in their results. We present a clinical case of a patient using inhaled glucocorticoids due to a history of bronchial asthma, which develops a clinical of adrenal insufficiency in the period of breastfeeding.


Subject(s)
Humans , Female , Adult , Adrenal Insufficiency/chemically induced , Glucocorticoids/adverse effects , Asthma/drug therapy , Administration, Inhalation , Lactation , Glucocorticoids/administration & dosage
7.
Clinics ; 75: e2022, 2020. tab
Article in English | LILACS | ID: biblio-1133398

ABSTRACT

The coronavirus disease 2019 (COVID-19) is an emerging pandemic challenge. Acute respiratory distress syndrome (ARDS) in COVID-19 is characterized by a severe cytokine storm. Patients undergoing glucocorticoid (GC) replacement therapy for adrenal insufficiency (AI) represent a highly vulnerable group that could develop severe complications due to the SARS-CoV-2 infection. In this review, we highlight the strategies to avoid an adrenal crisis in patients with AI and COVID-19. Adrenal crisis is a medical emergency and an important cause of death. Once patients with AI present symptoms of COVID-19, the dose of GC replacement therapy should be immediately doubled. In the presence of any emergency warning signs or inability to administer oral GC doses, we recommend that patients should immediately seek Emergency services to evaluate COVID-19 symptoms and receive 100 mg hydrocortisone by intravenous injection, followed by 50 mg hydrocortisone intravenously every 6 h or 200 mg/day by continuous intravenous infusion.


Subject(s)
Humans , Hydrocortisone/administration & dosage , Adrenal Insufficiency/complications , Adrenal Insufficiency/drug therapy , Coronavirus Infections/prevention & control , Betacoronavirus , Glucocorticoids/administration & dosage , Pneumonia, Viral/prevention & control , Severity of Illness Index , Risk Factors , Pandemics/prevention & control , SARS-CoV-2 , COVID-19 , Injections, Intravenous
8.
Rev. Soc. Bras. Med. Trop ; 53: e20200227, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136858

ABSTRACT

Abstract The novel coronavirus pneumonia (NCP) outbreak occurred in Wuhan, China at the end of 2019. Here, we report the clinical characteristics and therapeutic procedure for a case of severe NCP. The patient was started on glucocorticoids and non-invasive ventilator treatment. After treatment, the patient's symptoms improved, and the status was confirmed as NCP negative. Our results may provide clues for the treatment of NCP.


Subject(s)
Humans , Female , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Betacoronavirus , Glucocorticoids/administration & dosage , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Coronavirus Infections , Coronavirus Infections/drug therapy , Combined Modality Therapy , Pandemics , Noninvasive Ventilation , Middle Aged
9.
Braz. j. otorhinolaryngol. (Impr.) ; 85(6): 733-738, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055504

ABSTRACT

Abstract Introduction: Glucocorticoids are considered the first-line therapy for sudden sensorineural hearing loss. But there is currently no consensus on administering them as a single dose versus multiple divided daily doses. Objective: We aim to evaluate the treatment outcome of sudden sensorineural hearing loss between a single-dose and multiple divided daily doses of steroid treatment. Methods: A total of 94 patients who were diagnosed and treated for sudden sensorineural hearing loss and followed up for more than three months were reviewed retrospectively. Patients were divided into single-dose and multiple divided-dose groups, based on their medication regimens. Hearing thresholds were repeatedly measured: on the initial visit and 1 week, 1 month, and 3 months after the initial treatment. Treatment outcomes were analyzed by comparing hearing recovery rates and post-treatment audiometric changes. Results: The hearing threshold was significantly reduced at three months post-treatment in both groups. The hearing recovery rate of the single-dose group was significantly higher than that of the multiple divided-dose groups. Audiometric changes showed no statistical difference either in pure tone threshold or speech discrimination. Conclusion: When oral steroids are indicated for sudden sensorineural hearing loss, both a single dose and multiple divided doses can be effective for treatment and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen.


Resumo Introdução: Os glicocorticoides são considerados terapia de primeira linha para perda auditiva neurossensorial súbita. Contudo, atualmente não há consenso em como para administrá-los, se em dose única ou múltiplas doses diárias. Objetivo: Nosso objetivo é avaliar o resultado do tratamento da perda auditiva neurossensorial súbita com uma dose única ou várias doses diárias de tratamento com esteróides. Método: Um total de 94 pacientes que foram diagnosticados e tratados para perda auditiva neurossensorial súbita e acompanhados por mais de três meses pós-tratamento foram avalia-dos retrospectivamente. Os pacientes foram divididos em grupos de dose única diária e dose diária dividida em múltiplas tomadas, baseado em seu regime medicamentoso. Os limiares auditivos foram medidos repetidamente: na visita inicial e em 1 semana, 1 mês e 3 meses após o tratamento inicial. Os resultados do tratamento foram analisados comparando-se as taxas de recuperação da audição e as alterações audiométricas pós-tratamento. Resultados: O limiar auditivo foi significativamente reduzido aos três meses pós-tratamento em ambos os grupos. A taxa de recuperação auditiva no grupo de dose única foi significativamente maior do que no grupo de dose diária dividida em múltiplas tomadas. As alterações audiométricas não mostraram diferença estatística, tanto no limiar de tom puro quanto na discriminação da fala. Conclusão: Quando esteroides orais são indicados para perda auditiva neurossensorial súbita, tanto uma dose única quanto múltiplas doses podem ser eficazes para o tratamento e têm resultados comparáveis. No entanto, o regime de dose única diária parece ser mais eficaz do que o regime de dose diária dividida em múltiplas tomadas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Hearing Loss, Sudden/drug therapy , Glucocorticoids/administration & dosage , Hearing Loss, Sensorineural/drug therapy , Audiometry, Pure-Tone , Steroids/administration & dosage , Methylprednisolone/administration & dosage , Prednisolone/administration & dosage , Administration, Oral , Retrospective Studies , Treatment Outcome
10.
Rev. chil. pediatr ; 90(3): 316-320, jun. 2019. graf
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1013839

ABSTRACT

INTRODUCCIÓN: El hemangioendotelioma hepático (HEH) es un tumor benigno, raro en niños, que se presenta frecuentemente en el primer año de vida. La presentación clínica es variable y su diagnóstico se realiza en base a la sospecha clínica, estudios de laboratorio y de imagen. El objetivo fue describir un caso de hemangioendotelioma hepático multifocal. CASO CLÍNICO: Niña de 3 meses que presentó hepatomegalia sin elementos de falla hepática ni cardiaca. Se realizó ecografía y tomografía de ab domen que orientaron al diagnóstico de HEH que se confirmó con la angioresonancia de abdomen. Recibió glucocorticoides a altas dosis en forma prolongada. Al año y medio de iniciado el tratamiento se evidenció remisión del tumor. Presentó efectos secundarios por el tratamiento instaurado. CONCLUSIONES: La presencia de una hepatomegalia aislada en un lactante asintomático debe hacer pensar en una probable patología tumoral, orientándonos por la clínica e imagenología al diagnóstico nosológico de la misma. Siempre se debe sospesar las posibles complicaciones con los riesgos de los tratamientos a realizar. En este caso la extensión del tumor y sus probables complicaciones justificó el uso de corticoterapia prologada a altas dosis a pesar de sus efectos adversos.


INTRODUCTION: Hepatic hemangioendothelioma is a rare benign tumor in children, which frequently occurs in the first year of life. The clinical presentation is variable and the diagnosis is based on clinical suspicion, and laboratory and imaging studies. The objective was to describe a case of multifocal hepa tic hemangioendothelioma. CLINICAL REPORT: 3-month-old girl who presented hepatomegaly without elements of hepatic or heart failure. Abdominal ultrasound and CT scan were used to diagnose hepatic hemangioendothelioma, which was confirmed by CT abdominal angiography. The patient received glucocorticoid treatment at high doses for a prolonged period. A year and a half after treatment, there was evidence of tumor remission. She had side effects from the established treatment. CONCLUSIONS: In asymptomatic patients with isolated hepatomegaly, it should be considered a probable tumor patho logy, considering the clinic and imaging studies. Possible complications and treatments risks must always be assessed. In this case, the tumor extension and its probable complications justified the use of prolonged corticosteroid therapy at high doses despite its adverse effects.


Subject(s)
Humans , Female , Infant , Hemangioendothelioma/diagnostic imaging , Hepatomegaly/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Treatment Outcome , Computed Tomography Angiography , Glucocorticoids/administration & dosage , Hemangioendothelioma/drug therapy , Hepatomegaly/etiology , Hepatomegaly/drug therapy , Liver Neoplasms/drug therapy
11.
Arq. bras. oftalmol ; 82(3): 195-199, May-June 2019. tab
Article in English | LILACS | ID: biblio-1001305

ABSTRACT

ABSTRACT Purpose: To investigate changes in axial length after intravitreal dexamethasone implantation in patients with macular edema. Methods: We performed a prospective comparative study of 46 patients with unilateral macular edema, due to diabetic retinopathy, retinal vein occlusion, and non-infectious uveitis, who underwent dexamethasone implantation. The fellow eyes of the patients were considered the control group. The central macular thickness was measured by spectral-domain optical coherence tomography, and axial length was measured by IOLMaster 700 optical coherence biometry. We compared axial length and central macular thickness values within the groups. Results: In the study group, the baseline central macular thickness was 460.19 ± 128.64 mm, significantly decreasing to 324.00 ± 79.84 mm after dexamethasone implantation (p=0.000). No significant change in central macular thickness measurements was seen in the control group (p=0.244). In the study group, the baseline axial length was 23.16 ± 0.68 mm, significantly increasing to 23.22 ± 0.65 mm after dexamethasone implantation (p=0.039). However, the control group exhibited no significant change in axial length (p=0.123). Conclusions: In addition to significantly reducing central macular thickness measurements, intravitreal dexamethasone implantation also significantly changes optical biometry-based axial length measurements.


RESUMO Objetivo: Investigar alterações no comprimento axial após implante de dexametasona intravítrea em pacientes com edema macular. Métodos: Foi realizado um estudo prospectivo e comparativo de 46 pacientes com edema macular unilateral, devido à retinopatia diabética, oclusão da veia retiniana e uveíte não infecciosa, que foram submetidos ao implante de dexametasona. Os olhos contralateral de cada paciente foram considerados o grupo controle. A espessura macular central foi medida por tomografia de coerência óptica de domínio espectral, e o comprimento axial foi medido por meio de biometria de coerência óptica de domínio espectral e o comprimento axial foi medido pela biometria de coerência óptica com IOLMaster 700. Comparamos o comprimento axial e os valores da espessura macular central dentro dos grupos. Resultados: No grupo de estudo, a espessura macular basal foi de 460,19 ± 128,64 mm, diminuindo significativamente para 324,00 ± 79,84 mm após o implante de dexametasona (p=0,000). Nenhuma mudança significativa nas medidas da espessura macular central foi observada no grupo controle (p=0,244). No grupo de estudo, o comprimento axial basal foi de 23,16 ± 0,68 mm, aumentando significativamente para 23,22 ± 0,65 mm após o implante de dexametasona (p=0,039). No entanto, o grupo controle não apresentou alteração significativa no comprimento axial (p=0,123). Conclusões: Além de reduzir significativamente as medidas da espessura macular central, o implante de dexametasona intravítrea também altera significativamente as medidas de comprimento axial baseadas na biometria óptica.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Dexamethasone/administration & dosage , Macular Edema/drug therapy , Axial Length, Eye/drug effects , Intravitreal Injections/methods , Glucocorticoids/administration & dosage , Macula Lutea/drug effects , Visual Acuity , Macular Edema/pathology , Prospective Studies , Biometry/methods , Treatment Outcome , Statistics, Nonparametric , Tomography, Optical Coherence/methods , Diabetic Retinopathy/drug therapy , Axial Length, Eye/pathology , Macula Lutea/pathology
12.
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
13.
J. bras. nefrol ; 41(1): 152-156, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002430

ABSTRACT

ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.


RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.


Subject(s)
Humans , Middle Aged , Complement C3/metabolism , Leprosy, Multibacillary/diagnosis , Acute Kidney Injury/diagnosis , Glomerulonephritis, IGA/diagnosis , Rifampin/therapeutic use , Biopsy , Blood Urea Nitrogen , Fluorescent Antibody Technique , Clofazimine/therapeutic use , Creatinine/blood , Dapsone/therapeutic use , Diagnosis, Differential , Acute Kidney Injury/drug therapy , Glomerulonephritis, IGA/drug therapy , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use
14.
Rev. chil. obstet. ginecol. (En línea) ; 84(1): 41-48, feb. 2019. tab
Article in Spanish | LILACS | ID: biblio-1003721

ABSTRACT

RESUMEN Introducción: El estándar para inducción de madurez pulmonar en fetos con riesgo de nacer prematuramente es la administración de 12 mg de betametasona acetato/fosfato por dos veces espaciada cada 24 horas. El uso establecido en algunos hospitales públicos en Chile es con dos dosis de 12 mg betametasona fosfato aunque no existen estudios publicados sólo con betametasona fosfato sobre la incidencia de Síndrome de Distress Respiratorio (SDR). Objetivo: Evaluar efecto de betametasona en su forma fosfato como tratamiento antenatal para inducción de madurez fetal pulmonar en la incidencia SDR debido a membrana hialina en prematuros menores de 34 semanas de edad gestacional. Comparar el efecto de betametasona fosfato con el efecto publicado de betametasona acetato/fosfato. Material y método: Análisis de incidencia de SDR en prematuros nacidos en Hospital Padre Hurtado entre 24+0 y 34+0 semanas que recibieron betametasona fosfato para madurez pulmonar y aquellos que no la recibieron. Resultados: De 1.265 neonatos estudiados, 722 completaron dos dosis (57,5%); 436 sólo una dosis (34,5%) y 107 (8,5%) no recibieron corticoides antenatales. La incidencia de SDR debido a membrana hialina en el grupo con dos dosis fue 8,7%, una dosis 25,3% y 32,7% en los no tratados (p<0,001). Para SDR severo las incidencias fueron 6,7%, 12,6% y 16,8% respectivamente (p<0,001). Conclusiones: Inducción de madurez fetal pulmonar con betametasona fosfato en dos dosis de 12 mg IM separadas por 24 horas otorga una reducción significativa de incidencia de SDR semejante a la publicada con betametasona acetato/fosfato en iguales dosis.


ABSTRACT The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Respiratory Distress Syndrome, Newborn/prevention & control , Betamethasone/analogs & derivatives , Premature Birth , Glucocorticoids/administration & dosage , Prenatal Care/methods , Respiratory Distress Syndrome, Newborn/epidemiology , Betamethasone/administration & dosage , Incidence , Retrospective Studies , Hospitals, Public , Hyaline Membrane Disease/prevention & control , Lung/drug effects
15.
J. pediatr. (Rio J.) ; 95(1): 87-93, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-984651

ABSTRACT

Abstract Objective: The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. Methods: A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. Results: Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p < 0.05). Based on the parental reports, only the physical and total scores were significantly lower in autoimmune hepatitis patients versus controls (p < 0.05). Further analysis in autoimmune hepatitis patients with abdominal pain in the last month revealed significantly lower physical, social, and total median scores (p < 0.05). No differences were observed based on disease remission state or disease severity (p > 0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16 mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16 mg/kg/day (87.5 [50-100] vs. 75 [15.63-100], p = 0.006). Conclusions: Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis.


Resumo Objetivo: Avaliar a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune (HAI). Métodos: Foi concluída uma avaliação transversal com o Inventário Pediátrico de Qualidade de Vida 4.0 (PedsQL 4.0) para 80 pacientes com hepatite autoimune e 45 controles saudáveis. Os dados demográficos, a dose de prednisona, o estado de remissão da doença, a gravidade da doença e dor abdominal também foram avaliados. Resultados: Com base nos autorrelatos das crianças, os escores físico, emocional, escolar e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Com base nos relatos dos pais, apenas os escores físico e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Uma análise adicional em pacientes com hepatite autoimune com dor abdominal no mês passado revelou escores médios físico, social e total significativamente menores (p < 0,05). Nenhuma diferença foi observada com base no estado de remissão da doença ou na gravidade da doença (p > 0,05). Os pacientes com hepatite autoimune que receberam uma dose de prednisona abaixo de 0,16 mg/kg/dia no momento da entrevista mostraram escores físicos significativamente maiores que os que receberam uma dose semelhante ou acima de 0,16 mg/kg/dia [87,5 (50-100) em comparação com 75 (15,63-100), p = 0,006]. Conclusões: Escores reduzidos nos domínios físico, emocional e escolar foram observados em pacientes pediátricos com hepatite autoimune em comparação com pacientes do grupo de controle. Dor abdominal e dose de corticosteroide influenciaram negativamente a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Quality of Life/psychology , Prednisone/administration & dosage , Hepatitis, Autoimmune/psychology , Glucocorticoids/administration & dosage , Severity of Illness Index , Remission Induction , Case-Control Studies , Cross-Sectional Studies , Surveys and Questionnaires , Hepatitis, Autoimmune/drug therapy
16.
Medwave ; 19(11): e7740, 2019.
Article in English, Spanish | LILACS | ID: biblio-1049157

ABSTRACT

El granuloma facial es una dermatosis benigna poco frecuente de etiología desconocida, generalmente asintomática, caracterizada por inflamación crónica y localizada habitualmente en zonas fotoexpuestas de la cara, con un patrón histológico característico. Si bien la respuesta al tratamiento es variable, existen múltiples opciones terapéuticas que han reportado ser efectivas en algunos pacientes. Entre estas alternativas se incluyen tratamientos sistémicos con corticoides y dapsona o tratamientos intralesionales con corticoides, crioterapia e inhibidores de calcineurina tópicos. Describimos el caso de un paciente adulto con una placa eritemato violácea asintomática en mejilla derecha, de crecimiento lentamente progresivo de dos años de evolución, clínica e histopatológicamente compatible con granuloma facial y respuesta favorable a corticoides intralesionales.


Granuloma faciale is an uncommon benign dermatosis, with unknown etiology, usually asymptomatic, characterized by chronic inflammation localized in sun-exposed areas of the face with a characteristic histological pattern. Although response to treatment is variable, there are multiple therapeutic alternatives that have been reported to be effective in some patients, including systemic treatments with steroids and dapsone or also topical treatments like intralesional corticosteroid, cryotherapy and calcineurin inhibitors, such as tacrolimus. We present the case of an adult patient with an asymptomatic erythematous-violet plaque on the right cheek, with progressive slow growth over two years, clinically and histologically and pathologically compatible with a facial granuloma. The patient responded well to intralesional corticosteroids.


Subject(s)
Humans , Male , Middle Aged , Skin Diseases, Vascular/diagnosis , Facial Dermatoses/diagnosis , Granuloma/diagnosis , Skin Diseases, Vascular/pathology , Skin Diseases, Vascular/drug therapy , Facial Dermatoses/pathology , Facial Dermatoses/drug therapy , Glucocorticoids/administration & dosage , Granuloma/pathology , Granuloma/drug therapy
17.
Braz. j. med. biol. res ; 52(7): e8222, 2019. graf
Article in English | LILACS | ID: biblio-1011591

ABSTRACT

Monoclonal gammopathy of renal significance (MGRS) can present with different morphologic features and lead to kidney failure. The Henoch-Schönlein purpura nephritis (HSPN) that cannot be relieved by treatment with glucocorticoid and immunosuppressive agents suggests the presence of monoclonal gammopathy in adult patients. The present study reports on a single case of HSPN associated with IgA-κMGRS. The patient who suffered from recurrent skin purpura for 6 months and nephrotic syndrome for 2 months was admitted to our hospital. Bone marrow biopsy showed monoclonal gammopathy of undetermined significance. Kidney biopsy indicated a Henoch-Schönlein purpura nephritis (HSPN, ISKDC classified as type III) with positive staining with κ-light chain in the glomeruli and renal tubular epithelial cells. Furthermore, skin biopsy showed leukocytoclastic vasculitis and negative staining for Congo red and light chain. Given both the renal and cutaneous involvement, the patient was considered to have HSPN associated with IgA-κMGRS. The patient experienced an exacerbation in his purpura-like lesions and clinical status after treatment with glucocorticoid and immunosuppressive agents. Consequently, the patient was put on a regimen that included dexamethasone (20 mg on the 1st, 4th, 8th, and 11th days of each month, iv) and bortezomib (2.4 mg on the 1st, 4th, 8th, and 11th days of each month, iv). Eight weeks after treatment, he had complete resolution of his cutaneous purpura and his biochemical parameters improved. The latent presence of MGRS in cases of HSPN should be considered in adult patients. Increased cognizance and correct treatment options could improve patient outcomes.


Subject(s)
Humans , Male , Middle Aged , Paraproteinemias/etiology , Purpura, Schoenlein-Henoch/complications , Nephritis/complications , Paraproteinemias/pathology , Paraproteinemias/drug therapy , Purpura, Schoenlein-Henoch/pathology , Purpura, Schoenlein-Henoch/drug therapy , Glucocorticoids/administration & dosage , Immunosuppressive Agents/administration & dosage , Nephritis/pathology , Nephritis/drug therapy
18.
Arch. argent. pediatr ; 116(6): 749-752, dic. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-973690

ABSTRACT

La miocardiopatía hipertrófica en el recién nacido es una entidad poco frecuente y de etiología heterogénea. Se han descrito formas transitorias en hijos de madres con diabetes gestacional y en recién nacidos pretérminos expuestos a corticoides tanto prenatal como posnatalmente. Se presenta un caso de un recién nacido pretérmino, hijo de madre trasplantada renal al que se le detectó una miocardiopatía hipertrófica y que había estado expuesto prenatalmente a corticoides y tacrolimus que recibía la madre como tratamiento inmunosupresor. Ambos fármacos cruzan la barrera placentaria y, al llegar al feto, podrían haber favorecido su desarrollo. La miocardiopatía hipertrófica puede ser un efecto secundario poco común del tratamiento con tacrolimus en adultos y niños, y es reversible al retirarlo. En nuestro conocimiento, es el primer caso publicado de miocardiopatía hipertrófica transitoria tras la exposición fetal tanto a corticoides como a tacrolimus en un hijo de madre trasplantada renal.


Hypertrophic cardiomyopathy in the newborn is a rare entity with heterogeneous etiology. Transient forms have been described in children of mothers with gestational diabetes and in preterm infants exposed both to prenatal and postnatal corticosteroids. We report a case of a preterm infant son of a mother who received renal transplant in whom hypertrophic cardiomyopathy was detected. He had been prenatally exposed to corticosteroids and tacrolimus that received the mother as immunosuppressive therapy. Both drugs cross the placental barrier and, on reaching the fetus, could have favored its development. Hypertrophic cardiomyopathy may be an uncommon side effect of treatment with tacrolimus in adults and children and it is reversible upon withdrawal. To our knowledge, it is the first published case of transient hypertrophic cardiomyopathy after fetal exposure to both corticosteroids and tacrolimus in the son of a renal transplanted mother.


Subject(s)
Humans , Male , Infant, Newborn , Cardiomyopathy, Hypertrophic/chemically induced , Tacrolimus/adverse effects , Glucocorticoids/adverse effects , Immunosuppressive Agents/adverse effects , Placenta/metabolism , Infant, Premature , Pregnancy , Kidney Transplantation/methods , Tacrolimus/administration & dosage , Tacrolimus/pharmacokinetics , Glucocorticoids/administration & dosage , Glucocorticoids/pharmacokinetics , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/pharmacokinetics , Mothers
19.
An. bras. dermatol ; 93(6): 878-880, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-973628

ABSTRACT

Abstract: Granuloma annulare is a relatively common, idiopathic, benign inflammatory dermatosis, with a varied clinical presentation that often makes diagnosis difficult. It mainly affects the extremities, such as the dorsa of the hands and feet, forearms and legs. Palmar and plantar regions are generally spared. It occurs mainly in young female patients. The presentation of the palmar variant in an elderly patient is a rarity.


Subject(s)
Humans , Female , Middle Aged , Granuloma Annulare/pathology , Hand Dermatoses/pathology , Clobetasol/administration & dosage , Granuloma Annulare/drug therapy , Glucocorticoids/administration & dosage , Hand Dermatoses/drug therapy
20.
Arch. argent. pediatr ; 116(3): 468-470, jun. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-950029

ABSTRACT

En los neonatos, la parálisis facial es muy infrecuente y, por lo general, diagnosticada al nacer. Se presenta el primer caso de parálisis facial neonatal con identificación del virus del herpes simple 1 en el líquido cefalorraquídeo. Un varón de 35 días de vida acudió a Urgencias por la desviación de la comisura bucal hacia la izquierda y la ausencia de cierre del ojo derecho, sin sintomatología infecciosa ni antecedentes relevantes. La exploración física fue compatible con parálisis facial periférica. Las exploraciones complementarias de urgencia (hemograma, bioquímica, coagulación y citoquímica de líquido cefalorraquídeo) fueron normales. Fue ingresado con prednisolona oral y aciclovir intravenoso. La resonancia magnética craneal fue normal. A las 48 horas, se recibió el resultado positivo de la reacción en cadena de la polimerasa para el virus del herpes simple 1 en el líquido cefalorraquídeo. Con evolución favorable, completó 7 días de prednisolona oral y fue dado de alta tras 21 días de aciclovir intravenoso, con exploración neurológica previa normal.


Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal fluid. A 35-day-old male was presented at the Emergency Department with mouth deviation to the left and impossibility of full closure of the right eye. There were no symptoms of infection or relevant medical history. Physical examination was compatible with peripheral facial palsy. Studies performed at admission were normal (blood count, biochemical analysis and coagulation blood tests and cerebrospinal fluid analysis). The patient was admitted on oral prednisolone and intravenous aciclovir. Cranial magnetic resonance was normal. Polymerase chain reaction test for herpes simplex virus 1 in cerebrospinal fluid was reported positive after 48 hours of admission. Patient followed good evolution and received prednisolone for 7 days and acyclovir for 21 days. At discharge, neurological examination was normal.


Subject(s)
Humans , Male , Infant , Herpesvirus 1, Human/isolation & purification , Facial Paralysis/diagnosis , Herpes Simplex/diagnosis , Antiviral Agents/administration & dosage , Acyclovir/administration & dosage , Prednisolone/administration & dosage , Cerebrospinal Fluid/virology , Treatment Outcome , Facial Paralysis/drug therapy , Facial Paralysis/virology , Glucocorticoids/administration & dosage , Herpes Simplex/drug therapy
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