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1.
Medicina (B.Aires) ; 81(2): 208-213, June 2021. graf
Article in Spanish | LILACS | ID: biblio-1287272

ABSTRACT

Resumen El manejo de las reacciones adversas inducidas por los inhibidores del punto de control inmunitario (IPCI) en cáncer, demanda un trabajo multidisciplinario. Revisamos las causas y el curso clínico de las consultas e internaciones debidas a reacciones adversas de los IPCI entre septiembre de 2015 y julio de 2019 en el Instituto Alexander Fleming. Se registraron los datos demográficos, diagnóstico oncológico, reacción adversa y su grado, requerimiento de internación, tratamiento, mortalidad y evaluación de la reexposición. Se registraron 124 reacciones adversas por IPCI en 89 pacientes. Sesenta y ocho recibían monoterapia y 21 terapia combinada. Las manifestaciones cutáneas fueron las más frecuentes, seguidas de las generales, endocrinas (con mayor frecuencia hipotiroidismo), colitis, neumonitis, neurológicas y hepatitis. Fueron graves (grado ≥ 3), 26 toxicidades en 25 pacientes. Se internaron 15, y 6 de ellos requirieron terapia intensiva. Un caso fue fatal. Recibieron glucocorticoides 34 (12 de ellos por vía intravenosa). Un paciente recibió micofenolato y uno inmuno globulina endovenosa. En 20 se discontinuó el tratamiento. Ocho se reexpusieron y uno de ellos debió suspender definitivamente. Se presenta en esta serie de casos nuestra experiencia con el diagnóstico y tratamiento de las reacciones adversas de una familia de drogas cuya utilización ha crecido en los últimos años.


Abstract The management of patients with immune-related adverse events (irAEs) frequently demands a multidisciplinary approach. We reviewed the causes and clinical course of medical visits and admissions at the Instituto Alexander Fleming due to irAEs between September 2015 and July 2019. Demographic data, diagnosis, toxicity and its severity, requirement of admission, treatment, mortality, and evaluation of the re-administration of immunotherapy were collected. We found 124 irAEs in 89 patients. Sixty-eight of them received monotherapy (76.4%) and 21 (23.6%) combination of drugs. Cutaneous manifestations were the most frequent cause of irAEs, followed by general manifestations, endocrine dysfunctions (hypothyroidism the most frequent), colitis, pneumonitis, neurologic dis orders, and hepatitis. In 26 adverse events (in 25 patients), severity grade was ≥ 3. Fifteen were admitted and 6 required ICU admission. One patient died. Thirty-four received glucocorticoids, 12 of them by intravenous route. One patient received mycophenolate and one IVIG. In 20, the treatment was discontinued; 8 were re-exposed, with definitive discontinuation in one patient. In this case series we report our experience in the diagnosis and management of adverse reactions related to a family of drugs whose use has grown in recent years.


Subject(s)
Humans , Drug-Related Side Effects and Adverse Reactions , Neoplasms/drug therapy , Nervous System Diseases , Immune Checkpoint Inhibitors , Immunologic Factors/therapeutic use , Immunotherapy
2.
Rev. cuba. pediatr ; 93(1): e758, ene.-mar. 2021. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251754

ABSTRACT

Introducción: El síndrome de hiperIgE es una inmunodeficiencia primaria poco frecuente de etiología desconocida, con afectación multisistémica; causada por mutaciones dominantes del gen que codifica la proteína transductora de señal y activadora de la transcripción, STAT-3, por lo que condiciona un déficit en la generación de las células Th17 a partir de las células T CD4+ y explica la susceptibilidad de estos pacientes a las infecciones por Stafilococus aureus y Cándida albicans. Objetivo: Contribuir al conocimiento de esta inmunodeficiencia para su detección precoz y tratamiento oportuno. Presentación del caso: Se trata de una lactante, con puente nasal amplio, hiperlaxitud, erupción eccematosa desde el período neonatal, infecciones cutáneas, óticas, pulmonares con presencia de neumatoceles y candidiasis mucocutánea. Se detectaron concentraciones elevadas de IgE sérica y eosinofília. Se trató con inmunomoduladores, antihistamínicos, antimicrobianos y vitaminoterapia. Se logró mejoría clínica. Conclusiones: El síndrome de hiperIgE-AD es una inmunodeficiencia primaria poco frecuente caracterizada por altas concentraciones de IgE, eosinofilia, abscesos cutáneos, eccemas, candidiasis mucocutánea crónica e infecciones pulmonares recidivantes, neumatoceles y bronquiectasias; también se presentan alteraciones del tejido conectivo, esquelético y vascular. Se requiere de alto grado de sospecha clínica y es importante la atención precoz de las infecciones, que en general presentan una respuesta tórpida sistémica. Las alternativas terapéuticas están dirigidas a prevenir la sepsis y al control de los síntomas(AU)


Introduction: Hyper IgE syndrome is a rare primary immunodeficiency of unknown etiology, with multi systemic impact; it is caused by dominant mutations of the gene that codifies the protein transducer of signal and activator of transcription (STAT-3), therefore it determines a deficit in the generation of Th17 cells from T CD4+ cells, and explains the sensitivity of these patients to the infections caused by Stafilococus aureus and Candida albicans. Objective: Contribute to the knowledge of this immunodeficiency for its early detection and timely treatment. Case presentation: Newborn with wide nasal bridge, hypermovility, eczematose rash since the neonatal period; cutaneous, ear, and pulmonary infections with presence of neumotoceles and mucocutaneous candidiasis. There were detected high concentrations of seric IgE and eosinophilia. The patient was treated with immunomodulators, antihestamines, antimicrobial drugs and vitaminotherapy. It was achieved a clinical improvement. Conclusions: Hyper IgE syndrome-AD is a rare primary immunodeficiency characterized by high concentrations of IgE, eosinophilia, cutaneous abscesses, eczemas, chronical mucocutaneous candidiasis and recurrent pulmonary infections, neumatoceles and bronchiectasis; it also presents alterations in the connective, skeletal and vascular tissue. It is required a high level of clinical suspicion and it is important the early care of the infections, which generally present a systemic torpid response. The therapeutic alternatives are directed to prevent a sepsis and to control the symptoms(AU)


Subject(s)
Humans , Female , Infant , Candidiasis, Chronic Mucocutaneous , Immunoglobulin E , Knowledge , Hypergammaglobulinemia , Immunologic Factors , Anti-Infective Agents
3.
Vitae (Medellín) ; 28(1): 1-8, 2021-01-28. Ilustraciones
Article in English | LILACS, COLNAL | ID: biblio-1362129

ABSTRACT

Background: Oxidative stress, genetic expression changes, and decomposition of the blood-brain barrier have been shown to be caused by exposure to radiofrequency radiation (RFR); therefore, the search for drugs or food products that offer some protection from these effects has attracted interest. Lepidium meyenii (maca) is a native Andean plant known for its effects on the female reproductive system as well as its immunomodulating, energizing, antioxidant, and nutritive properties due to its high concentration of alkaloids, amino acids, glucosinolates, fatty acids, and macamides. Objectives: We aim to determine the effect of dietary maca supplementation on spatial memory and cerebral oxidative damage in rats with induced menopause and/or with exposure to mobile phone radiation. Method:Female rats divided into 6 groups (six rats in each group): control or not ovariectomized (O-), ovariectomized (O+), ovariectomized + estrogen (O+E+), ovariectomized + estrogen + irradiated (O+E+I+), ovariectomized + maca (O+M+), and ovariectomized + maca + irradiated (O+M+I). Rat spatial memory was tested using the Morris water navigation task. Rats were sacrificed, and cerebral malondialdehyde was measured. Results: After exposure to mobile phone radiation, the group supplemented with maca showed improved spatial memory and lower levels of malondialdehyde than the estrogenized group. Conclusions: Our results suggest that consumption of maca has a positive effect on the maintenance of memory and decreases oxidative stress caused by mobile phone radiation. However, it is necessary to extend this work using a larger sample size


Antecedentes: El estrés oxidativo, los cambios en la expresión genética y la descomposición de la barrera hematoencefálica son causados por la exposición a la radiación de radiofrecuencia (RFR); por tanto, ha despertado interés la búsqueda de fármacos o productos alimenticios que ofrezcan alguna protección frente a estos efectos. Lepidium meyenii (maca) es una planta andina nativa conocida por sus efectos sobre el sistema reproductor femenino así como por sus propiedades inmunomoduladoras, energizantes, antioxidantes y nutritivas debido a su alta concentración de alcaloides, aminoácidos, glucosinolatos, ácidos grasos y macamidas. Objetivos: Determinar el efecto de la suplementación dietética con maca sobre la memoria espacial y el daño oxidativo cerebral en ratas con menopausia inducida y / o con exposición a la radiación de teléfonos móviles. Método: Ratas hembras divididas en 6 grupos (seis ratas en cada grupo): control o no ovariectomizadas (O-), ovariectomizadas (O +), ovariectomizadas + estrógeno (O + E +), ovariectomizadas + estrógeno + irradiadas (O + E + I +), ovariectomizado + maca (O + M +), y ovariectomizado + maca + irradiado (O + M + I). La memoria espacial de las ratas se probó utilizando la tarea de navegación acuática de Morris. Se sacrificaron ratas y se midió el malondialdehído cerebral. Resultados: Después de la exposición a la radiación del teléfono móvil, el grupo suplementado con maca mostró una memoria espacial mejorada y niveles más bajos de malondialdehído que el grupo estrogenizado. Conclusiones: Nuestros resultados sugieren que el consumo de maca tiene un efecto positivo en el mantenimiento de la memoria y disminuye el estrés oxidativo causado por la radiación del teléfono móvil. Sin embargo, es necesario ampliar este trabajo utilizando un tamaño de muestra más grande


Subject(s)
Humans , Oxidative Stress , Immunologic Factors
5.
Journal of Integrative Medicine ; (12): 555-560, 2021.
Article in English | WPRIM | ID: wpr-922529

ABSTRACT

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare adverse cutaneous reaction with a low incidence and high mortality. Despite posing a serious threat to patients' health and lives, there is no high-quality evidence for a standard treatment regimen. Here we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/TEN. After consensus-based regular treatments at a local hospital, his symptoms became worse. Thus, he consented to receive Chinese herbal medicine (CHM) therapy. The affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a day. After 7 days of treatment, the dead skin began peeling away from the former lesions that had covered his hands, feet, and lips, indicating that skin had regenerated. After 12 days of treatment, the patient's skin was completely recovered. In this case, SJS/TEN was successfully treated with Pi-Yan-Ning, suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug treatments. Further basic investigations and clinical trials to explore the mechanism and efficacy are needed.


Subject(s)
Drugs, Chinese Herbal/therapeutic use , Humans , Immunologic Factors , Incidence , Male , Middle Aged , Skin , Stevens-Johnson Syndrome/etiology
6.
Chinese Journal of Lung Cancer ; (12): 777-783, 2021.
Article in Chinese | WPRIM | ID: wpr-922146

ABSTRACT

Lung cancer is a malignant tumor with the highest mortality in the world. The most common pathological type of lung cancer is non-small cell lung cancer (NSCLC). In recent years, immunotherapy has brought about epoch-making changes in the treatment of NSCLC. In particular, immune checkpoint inhibitors (ICIs) targeting programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) have been approved for first-line and second-line treatment in patients with metastatic NSCLC. However, only 15% to 30% of patients with advanced NSCLC can achieve sustained remission and long-term survival from immunotherapy. Therefore, biomarker for predicting the efficacy of immunotherapy is particularly important. This article reviews the relevant literatures on predictive biomarkers for immunotherapy of NSCLC and provides direction for future research.
.


Subject(s)
B7-H1 Antigen , Biomarkers , Biomarkers, Tumor , Carcinoma, Non-Small-Cell Lung/therapy , Humans , Immunologic Factors , Immunotherapy , Lung Neoplasms/therapy , Programmed Cell Death 1 Receptor
7.
Article in English | WPRIM | ID: wpr-921072

ABSTRACT

INTRODUCTION@#The use of drugs that modulate the immune system during paediatric severe sepsis and septic shock may alter the course of disease and is poorly studied. This study aims to characterise these children who received immunomodulators and describe their clinical outcomes.@*METHODS@#This is a retrospective chart review of patients with severe sepsis and septic shock admitted into the paediatric intensive care unit (PICU). Clinical, haematological and outcome characteristics of patients with or without exposure to immune-modulating drugs were compared. Primary outcome was PICU mortality; secondary outcomes were 28-day ventilator-free days (VFD) and intensive care unit-free days (IFD). Univariate and multivariable analyses were performed for these outcomes.@*RESULTS@#A total of 109 patients with paediatric severe sepsis or septic shock were identified. Of this number, 47 (43.1%), 16 (14.7%) and 3 (2.8%) patients received systemic corticosteroids, intravenous immunoglobulins and granulocyte colony stimulating factor, respectively. Patients who received immune-modulating drugs were more likely to require invasive ventilation (38/54 [70.4%] versus 26/55 [47.3%], @*CONCLUSION@#Immune-modulating drugs were frequently used in paediatric severe sepsis and septic shock. Patients who received these drugs seemed to require more PICU support. Further studies are required to examine this association thoroughly.


Subject(s)
Child , Humans , Immunologic Factors/therapeutic use , Intensive Care Units, Pediatric , Retrospective Studies , Sepsis/drug therapy , Shock, Septic/drug therapy
8.
Chinese Medical Journal ; (24): 1267-1275, 2021.
Article in English | WPRIM | ID: wpr-878175

ABSTRACT

Immunotherapy has opened a new era in cancer treatment. Drugs represented by immune checkpoint inhibitors have led to important breakthroughs in the treatment of various solid tumors, greatly improving the survival rate of cancer patients. Many types of immunotherapeutic drugs have become widely available; however, their efficacy is variable, and relatively few patients with advanced cancer experience life-altering durable survival, reflecting the complex and highly regulated nature of the immune system. The research field of cancer immunotherapy (CIT) still faces many challenges in pursuing the broader social goal of "curing cancer." Increasing attention has been paid to strengthening the understanding of the molecular or cellular drivers of resistance to immunotherapy, actively exploring more effective therapeutic targets, and developing combination therapy strategies. Here, we review the key challenges that have emerged in the era of CIT and the possible solutions or development directions to overcome these difficulties, providing relevant references for basic research and the development of modified clinical treatment regimens.


Subject(s)
Combined Modality Therapy , Humans , Immunologic Factors , Immunotherapy , Neoplasms/therapy
9.
Washington; PAHO; Dec. 18, 2020. 163 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1145577

ABSTRACT

This is the thirteenth edition of this summary of rapid systematic reviews, which includes the results of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 58 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, pregnant women, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/immunology
10.
Arq. bras. med. vet. zootec. (Online) ; 72(6): 2397-2401, Nov.-Dec. 2020. graf
Article in English | LILACS, VETINDEX | ID: biblio-1142296

ABSTRACT

O presente estudo avaliou o efeito da suplementação com OmniGen-AF® na proliferação de linfócitos e títulos de anticorpos após vacinação em bovinos leiteiros. Amostras de sangue periférico foram coletadas de 32 vacas leiteiras para quantificação dos títulos de anticorpos anti-Leptospira, e amostras de sangue periférico de 16 vacas leiteiras foram também coletadas para avaliação da proliferação de linfócitos. Observou-se que a suplementação com OmniGen-AF® aumentou a proliferação basal de linfócitos (sem estímulos) 21 dias após a vacinação (P=0,03), apesar de reduzir a proliferação de linfócitos B quando estimulada com Leptospira borgpetersenii serovar Hardjo inativada pelo calor (P=0,03). Ademais, nenhum efeito da suplementação sobre a proliferação de linfócitos no momento imediatamente anterior à vacinação e nos títulos de anticorpos anti-Leptospira foi encontrado. Além disso, a proliferação de linfócitos estimulada com lipopolissacarídeos foi maior em vacas multíparas que em primíparas 21 dias após a vacinação (P=0,03). Desse modo, o presente estudo demonstra que a suplementação com OmniGen-AF® não afetou de forma robusta a proliferação de linfócitos e os títulos de anticorpos anti-Leptospira após vacinação em vacas leiteiras sadias.(AU)


Subject(s)
Animals , Female , Cattle , Vaccines, Combined/analysis , Dietary Supplements/analysis , Immunologic Factors/administration & dosage , Lymphocytosis/veterinary , Lipopolysaccharides , Leptospira/immunology
11.
Washington; PAHO; Nov. 13, 2020. 128 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1140054

ABSTRACT

This is the twelfth edition of this summary of rapid systematic reviews, which includes the results of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 58 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/immunology
12.
Washington; PAHO; Nov. 30, 2020. 131 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1140053

ABSTRACT

This is the twelfth edition of this summary of rapid systematic reviews, which includes the results of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 58 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/immunology
13.
Pesqui. vet. bras ; 40(11): 898-902, Nov. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1155020

ABSTRACT

Bacillus toyonensis is a probiotic microorganism that for decades has been used in animal nutrition around the world. The objective of this work was to evaluate the immunomodulatory effect of oral B. toyonensis supplementation in dogs vaccinated against canine parvovirus. Puppies were randomly selected and divided in two groups, one received B. toyonensis at a concentration of 2x10 8 viable spores per day and another group without supplementation was left as control. The puppies were vaccinated against canine parvovirus type 2. B. toyonensis supplementation was efficient in stimulating specific IgG for parvovirus with titers of 2, 3, and 2.5-fold higher than controls at 7, 21, and 35 pos-vaccination days respectively. Peripheral blood mononuclear cells (PBMCs) from dogs were cultured and stimulated with B. toyonensis DNA, vegetative cell and spores. The mRNA transcription of cytokines IL-4, IL-17, and IFN-γ up modulated by the stimuli. Thus, we conclude in this study that B. toyonensis supplementation may amplify the vaccine immune response against canine parvovirus.(AU)


Bacillus toyonensis é um micro-organismo probiótico que há décadas é utilizado na nutrição animal em todo o mundo. O objetivo deste trabalho foi avaliar o efeito imunomodulador da suplementação oral de B. toyonensis em cães vacinados contra o parvovírus canino. Os filhotes foram selecionados aleatoriamente e divididos em dois grupos, um recebeu B. toyonensis na concentração de 2 × 10 8 esporos viáveis por dia e outro grupo sem suplementação como controle. Os filhotes foram vacinados contra o parvovírus canino tipo 2. A suplementação com B. toyonensis foi eficiente em estimular IgG específica para parvovírus com títulos de 2, 3 e 2,5 vezes maior que os controles aos 7, 21 e 35 dias pós-vacinação, respectivamente. Células mononucleares do sangue periférico (PBMCs) de cães foram cultivadas e estimuladas com DNA de B. toyonensis, células vegetativas e esporos. A transcrição do mRNA das citocinas IL-4, IL-17 e IFN-γ foi modulada pelos estímulos. Assim, concluímos neste estudo que a suplementação com B. toyonensis pode amplificar a resposta imune da vacina contra o parvovírus canino.(AU)


Subject(s)
Animals , Dogs , Bacillus , Vaccines , Parvovirus, Canine , Probiotics , Immunologic Factors
14.
Washington; PAHO; Oct. 09, 2020. 103 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1127989

ABSTRACT

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/therapeutic use
15.
Washington; PAHO; Oct. 30, 2020. 121 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1127985

ABSTRACT

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/therapeutic use
16.
Washington; PAHO; Sept. 22, 2020. 81 p.
Non-conventional in English | PIE, LILACS, PIE | ID: biblio-1127987

ABSTRACT

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/therapeutic use
17.
Arq. bras. oftalmol ; 83(5): 402-409, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131633

ABSTRACT

ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.


RESUMO Objetivo: Comparar os benefícios e efeitos co laterais da vitrectomia via pars plana com os da terapia imunomo duladora sistêmica em pacientes com uveíte intermediária complicada. Métodos: Estudo clínico prospectivo incluiu pacientes com uveíte intermediária recorrente que apresentaram melhora minima da acuidade visual, apesar das injeções perioculares de esteroides. Vinte pacientes foram randomizados para o grupo de vitrectomia via pars plana ou esteróide oral e ciclosporina A (10 olhos de 10 pacientes por grupo). O acompanhamento foi de 24 meses para estudar al te rações na acuidade visual, o escore da oftalmoscopia binocular indireta, a angiofluoresceinografia e achados na to mográfica de coerência óptica. Resultados: A acuidade visual (logaritmo do ângulo mínimo de resolução) melhorou significativamente de 0,71 para 0,42 (p=0,001) no grupo cirúrgico, enquanto melhorou de 0,68 para 0,43 (p=0,001) no grupo da terapia imunomoduladora. Sete pacientes (70%) no grupo cirúrgico ganharam ≥2 linhas e seis pacientes (60%) no grupo da terapia imunomoduladora ganharam ≥2 linhas (p=0,970). Os estudos de angiofluoresceinografia e tomografia de coerência óptica mostraram que seis dos sete pacientes da vitrectomia via pars plana que apresentaram edema macular cistóide melhoraram, enquanto dois pacientes com edema macular difuso não apresentaram melhora. No grupo da terapia imunomoduladora, três dos seis pacientes com edema macular cistoide não apresentaram melhora, enquanto dois pacientes com edema macular difuso melhoraram. Conclusões: A vitrectomia via pars plana e a terapia imunomoduladora resultaram em melhora significative da função visual dos pacientes com inflamação persistente secundária a uveíte intermediária crônica. Apesar desse sucesso, continua sendo necessário determinar as melhores indicações para o uso de cada modalidade. A terapia imunomoduladora foi bem sucedida no tratamento do edema macular difuso associado à uveíte intermediária crônica, enquanto a vitrectomia via pars plana não foi.


Subject(s)
Humans , Vitrectomy , Uveitis, Intermediate , Macular Edema , Immunologic Factors , Visual Acuity , Uveitis, Intermediate/therapy , Prospective Studies , Retrospective Studies , Immunologic Factors/therapeutic use
18.
Washington; PAHO; Aug. 11, 2020. 91 p.
Monography in English | PIE, LILACS, PIE | ID: biblio-1094870

ABSTRACT

More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review we examined 30 therapeutic options. Findings from the RECOVERY Trial showed that low doses of dexamethasone (6 mg of oral or intravenous preparation once daily for 10 days) significantly reduced mortality by one-third in ventilated patients and by one fifth in patients receiving oxygen only. The anticipated RECOVERY. Trial findings and WHO's SOLIDARITY Trial findings both show no benefit via use of hydroxychloroquine and lopinavir/ritonavir in terms of reducing 28-day mortality or reduced time to clinical improvement or reduced adverse events. Currently, there is no evidence of benefit in critical outcomes (i.e. reduction in mortality) from any therapeutic option (though remdesivir is revealing promise as one option based on 2 randomized controlled trials) and that conclusively allows for safe and effective use to mitigate or eliminate the causative agent of COVID-19. Currently, as to ivermectin, we found 1 in vitro study and 4 observational studies that were largely confounded (nonrandomized), and lacked the methodological rigor to allow much confidence in the results. They were pre-print and non-peer reviewed and were judged to be of high risk of bias and very low quality of evidence. The researchers concluded in large part that the findings could be considered hypothesis testing and urged the conduct of large sample sized RCTs to assess any clinical benefit. Currently, as to favipiravir, we found 1 RCT and 2 observational studies. The results were inconclusive for benefits of favipiravir, and sample sizes were small and results came via largely preprints and non-peer reviewed publications. The 2 nonrandomized observational designs revealed sub-optimal methods with no optimal adjustments, masking, or stratification. A recent release by Glenmark announced promising results from a Phase 3 Clinical Trial of favipiravir in patients with mild to moderate COVID-19. A Phase 3 RCT demonstrates statistically significant faster time to clinical improvement with favipiravir treatment compared to control (n=150 patients).


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Pandemics/prevention & control , Betacoronavirus/drug effects , Antiviral Agents/therapeutic use , Clinical Trials as Topic , Immunologic Factors/therapeutic use
19.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1441-1448, July-Aug. 2020. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1131488

ABSTRACT

A mastite bovina, uma das principais doenças do rebanho leiteiro, caracteriza-se por um processo inflamatório no úbere. A inviabilidade econômica, o impacto ambiental negativo e os resíduos antimicrobianos têm estimulado a pesquisa de outros tratamentos alternativos para a prevenção e o tratamento de doenças na bovinocultura leiteira. O betaglucano é um agente imunomodulador com potencial ação preventiva para doenças infecciosas, inclusive a mastite. Este estudo teve como objetivo avaliar a eficácia do uso do betaglucano, por meio de administração oral, em animais em lactação. Foram utilizadas 20 vacas lactantes, distribuídas em dois grupos, um controle e um tratamento, com 10 animais em cada grupo. O grupo tratamento recebeu 5g/dia, durante 60 dias, de 1,3-1,6 betaglucano isolado da parede celular de Saccharomyces cerevisiae diluído em ração após a ordenha, enquanto o grupo controle recebia somente a ração. Foram realizados os testes de California Mastitis Test (CMT), contagem de células somáticas (CCS), produção de leite e percentual de gordura e proteína no leite. Não houve diferença estatisticamente significativa entre os grupos quanto à CCS, ao CMT, à composição do leite ou produção. Não se observou, portanto, eficácia do uso do betaglucano purificado, administrado por via oral, no controle e na prevenção da mastite em vacas leiteiras, quando comparadas com o grupo controle. Atribuem-se esses resultados, principalmente, à degradação ruminal do produto testado. Sugerem-se, portanto, mais pesquisas utilizando o 1,3-1,6 betaglucano purificado de parede de S. cerevisiae por outras vias de administração, tais como intramamária e subcutânea.(AU)


Bovine mastitis, one of the main diseases of dairy herds, is characterized by an inflammatory process in the udder. The economic and environmental impacts, as well as the residues of antimicrobial drugs have stimulated the research of novel alternative treatments for the prevention and treatment of diseases in dairy production cows. The beta-glucan is an immunomodulator agent, with potential preventive action for infectious diseases, including mastitis. This study aimed to assess the effectiveness of orally administered beta-glucan in lactating cows. 20 lactating cows were used, distributed into two groups, one control and one treatment, with 10 cows in each group. The treatment group received 5g of 1.3-1.6 betaglucan daily for 60 days, isolated from the cell-wall of Saccharomyces cerevisiae diluted into a grain meal, whereas the animals in the control group received only the ration. The California Mastitis Test (CMT), Somatic Cells Counting (SCC), daily production and assessments of fat and protein content in milk were done. There was no statistically significant difference between the groups concerning subclinical mastitis detected by CMT, SCC, milk production and composition regarding protein and fat content. It was not observed, therefore, the effectiveness of the use of purified beta-glucan orally administered on the control or prevention of mastitis in dairy cows. The results are attributed to the ruminal degradation of the product tested. It is, therefore, suggested that more research should be conducted using the 1.3-1.6 beta-glucan purified from the cell wall of S. cerevisiae by other administration means and ruminal protection technologies for the isolated beta-glucan.(AU)


Subject(s)
Animals , Cattle , Saccharomyces cerevisiae , beta-Glucans/administration & dosage , Mastitis, Bovine/prevention & control , Dietary Supplements/analysis , Prebiotics/administration & dosage , Immunologic Factors/administration & dosage
20.
Arq. neuropsiquiatr ; 78(7): 430-439, July 2020. tab
Article in English | LILACS | ID: biblio-1131732

ABSTRACT

ABSTRACT Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism's normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.


RESUMO Introdução: A mais recente pandemia causada pelo coronavírus SARS-CoV-2 (COVID-19, do inglês coronavirus disease 2019) representa uma ameaça potencial para pacientes com doenças autoimunes, incluindo esclerose múltipla (EM) e transtorno do espectro de neuromielite óptica (NMOSD, do inglês neuromyelitis optica spectrum disorders). Esses pacientes são geralmente tratados com medicamentos imunomoduladores ou imunossupressores que podem alterar a resposta normal do organismo a infecções. Até o momento, não há consenso sobre como o manejo dos pacientes com EM e NMOSD deve ser realizado durante a pandemia. Objetivo: Discutir estratégias para manejar esses pacientes. Métodos: Focamos em como 1) reduzir o risco de infecção por COVID-19, como distanciamento social, telemedicina e exames laboratoriais e de imagem em intervalos mais amplos; 2) manejo de surtos, incluindo evitar tratamento de surto leve e uso de corticoide oral; 3) gerenciar terapias modificadoras de doença, como a preferência por medicamentos associados a menor risco de infecção (interferons, glatirâmer, teriflunomida e natalizumabe) e infusão em intervalo estendido de natalizumabe, quando seguro; 4) individualizar a escolha da terapia de indução para EM (anticorpos monoclonais anti-CD20, alentuzumabe e cladribina); 5) manejar terapias preventivas de NMOSD, incluindo seleção inicial de terapia e manutenção do tratamento atual; 6) manejar pacientes com EM/NMOSD que foram infectados por COVID-19. Conclusão: No futuro, séries de casos de pacientes com MS/NMOSD infectados com COVID-19 nos ajudará a definir as melhores estratégias de manejo. Por enquanto, contamos com a experiência e orientação especializadas.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Neuromyelitis Optica/drug therapy , Coronavirus Infections/prevention & control , Coronavirus , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Pneumonia, Viral/epidemiology , China/epidemiology , Risk , Neuromyelitis Optica/diagnosis , Telemedicine , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections , Coronavirus Infections/epidemiology , Disease Susceptibility , Pandemics , Betacoronavirus , Immunologic Factors/therapeutic use , Multiple Sclerosis/diagnosis
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