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1.
Rev. colomb. cir ; 36(4): 657-665, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1291220

ABSTRACT

Introducción. Los pacientes con inmunosupresión llevados a cirugía abdominal convencional tienen un mayor riesgo de desarrollar hernias incisionales en el posoperatorio, y cuando ellas ocurren, es necesario individualizar el procedimiento quirúrgico de elección, según las características anatómicas, fisiológicas y clínicas de cada paciente. Este estudio describe las características demográficas y clínicas de los pacientes con inmunosupresión, llevados a reconstrucción de la pared abdominal, y sus desenlaces después de 30 días del procedimiento quirúrgico. Métodos. Serie de casos de pacientes con inmunosupresión llevados a reconstrucción de la pared abdominal, en un centro especializado de cuarto nivel de complejidad. Se incluyeron pacientes mayores de 18 años, operados en el período de enero de 2016 a diciembre de 2019. Resultados. Se presenta una serie de 18 pacientes, cinco (27,7 %) con algún tipo de inmunosupresión primaria y 13 (72,2 %) con algún tipo de inmunosupresión secundaria. La edad promedio fue de 56 años, 11 (61 %) fueron mujeres, el peso promedio de los participantes fue de 73,3 kg. Se encontraron complicaciones en ocho pacientes (44,4 %). Dos pacientes requirieron manejo en la Unidad de Cuidados Intensivos, por un máximo de tres días. Ninguno de los pacientes presentó recidiva de la hernia ni mortalidad. Discusión. La reconstrucción de la pared abdominal en pacientes inmunosuprimidos representa un reto para cualquier equipo quirúrgico debido a las condiciones especiales de los pacientes y a las variables asociadas al procedimiento. Las tasas de recidiva y de complicaciones de este estudio, se asemejan a las descritas en la literatura


Introduction. Immunosuppressed patients undergoing conventional abdominal surgery have a higher risk of developing incisional hernias postoperatively, and when they do occur, it is necessary to individualize the surgical procedure of choice, according to the anatomical, physiological and clinical characteristics of each patient. This study describes the demographic and clinical characteristics of immunosuppressed patients, who underwent abdominal wall reconstruction and their outcomes 30 days after the surgical procedure.Methods. Series of cases of patients with immunosuppression underwent abdominal wall reconstruction in a specialized center of fourth level of complexity. Patients older than 18 years, operated on from January 2016 to December 2019, were included. Results. A series of 18 patients is analyzed, five (27.7%) with some type of primary immunosuppression and 13 (72.2%) with some type of secondary immunosuppression. The average age was 56 years, 11 (61%) were women, the average weight of the participants was 73.3 kg. Complications were found in eight patients (44.4%). Two patients required management in the ICU, for a maximum of three days. None of the patients had hernia recurrence or mortality. Discussion. Reconstruction of the abdominal wall in immunosuppressed patients represents a challenge for any surgical team due to the special conditions of the patients and the variables associated with the procedure. The recurrence and complication rates in this study are similar to those described in the literature.


Subject(s)
Humans , General Surgery , Abdominal Wall , Immunosuppression , Methods
2.
Rev. Asoc. Odontol. Argent ; 109(1): 59-63, ene.-abr. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1281778

ABSTRACT

Objetivo: Describir el diagnóstico y el tratamiento interdisciplinario de un caso clínico de histoplasmosis. Caso clínico: Un paciente masculino de 39 años, con antecedentes de consumo de drogas, alcohol, tabaquismo crónico y VIH+ sin adherencia al tratamiento, acudió al Servicio de Odontología por una interconsulta del Servicio de Clínica Médica para la evaluación de lesiones erosivas en paladar duro y blando, reborde alveolar anterior, dorso lingual y lesión tumoral en encía anterosuperior. El diagnóstico definitivo se obtuvo por medio del análisis de muestras de biopsia transbronquial, lavado broncoalveolar y biopsia de lesión en piel. El paciente recibió tratamiento sistémico con antimicóticos (anfotericina B e itraconazol según esquema) y tratamiento local con colutorio de clorhexidina al 0,12% y 100.000 UI de nistatina en suspensión. Al momento del alta, presentaba una considerable mejoría de su estado general y de las lesiones orales, con disminución de sintomatología dolorosa. Se indicó turno para control a los 7 días de forma ambulatoria, al cual el paciente no asistió. El abordaje interdisciplinario y el análisis de los diferentes aspectos socioeconómicos, culturales, ambientales y sistémicos del paciente facilitaron el diagnóstico temprano de la enfermedad (AU)


Aim: To describe the diagnosis and interdisciplinary treatment of a clinical case of histoplasmosis. Clinical case: 39-year-old male patient with a history of drug abuse, alcohol, and chronic smoking, HIV+ without treatment compliance, attends the dental department referred by the medical department for the diagnosis of erosive lesions in the hard and soft palate, anterior alveolar ridge, lingual dorsum and tumor lesion in the anterosuperior gingiva. The definitive diagnosis was obtained by the analysis of transbronchial biopsy, bronchoalveolar lavage and skin lesion biopsy. The patient received systemic treatment with antifungals (amphotericin b, itraconazole according to protocol), and local treatment with 0.12% chlorhexidine mouthwash and 100,000 IU nystatin suspension. At the time of medical discharge, the patient presented a considerable improvement in his general condition and of the oral lesions with a reduced pain. A 7 days recall was prescribed, however the patient failed to attend. The interdisciplinary approach to the patient and the analysis of the different socio-economic, cultural, environmental and systemic aspects of the patient facilitates the early diagnosis of the disease (AU)


Subject(s)
Humans , Male , Adult , Oral Manifestations , HIV , Dental Care for Chronically Ill , Histoplasmosis , Argentina , Biopsy , Amphotericin B , Nystatin , Immunosuppression/adverse effects , Itraconazole , Bronchoalveolar Lavage , Dental Service, Hospital , Early Diagnosis , Mouth Mucosa/injuries , Antifungal Agents
3.
Rev. cuba. pediatr ; 93(1): e845, ene.-mar. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1251751

ABSTRACT

Introducción: El cáncer pediátrico es un importante problema de salud pública y el más frecuente es la leucemia. En ocasiones, esta enfermedad puede generar depleción de las líneas celulares y es la transfusión de hemocomponentes un importante pilar de su tratamiento. Este procedimiento puede generar reacciones postransfusionales que pueden ser letales. Objetivo: Exponer las diferentes características clínicas y epidemiológicas de las reacciones postransfusionales en población pediátrica con leucemia. Métodos: Se realizó una búsqueda sistemática en las principales bases de datos de literatura médica. Se incluyeron 46 artículos. Resultados: La complicación más frecuente es la reacción febril no hemolítica. También es frecuente la sobrecarga de hierro. El factor de riesgo más importante para presentar esta sobrecarga es el número de transfusiones. Es necesario monitorizar la cantidad de hierro hepático. La reacción pulmonar aguda relacionada con la transfusión es una condición potencialmente mortal. Las infecciones pueden presentarse y pueden ser mortales dada la inmunosupresión de este grupo de pacientes. Otras reacciones inmunológicas pueden ser raras, pero deben ser tenidas en cuenta. Consideraciones finales: Las reacciones postransfusionales pueden ser más graves en los pacientes con leucemia. Se requiere realizar estudios con modelos epidemiológicos adecuados para identificar las reacciones postransfusionales más frecuentes en población pediátrica con esta enfermedad(AU)


Introduction: Pediatric cancer is a major public health problem and leukemia is the most common. Sometimes this disease can lead to depletion of cell lines and the transfusion of blood components is an important pillar of their treatment. This procedure can generate post-transfusion reactions that can be lethal. Objective: Show the different clinical and epidemiological characteristics of post-transfusion reactions in pediatric population with leukemia. Methods: A systematic search was carried out in the main databases of medical literature. 46 items were included. Results: The most common complication is the non-hemolytic febrile reaction. Iron overloading is also common. The most important risk factor for this overload is the number of transfusions. It is necessary to monitor the amount of iron in the liver. Acute transfusion-related pulmonary reaction is a life-threatening condition. Infections can occur and can be fatal given the immunosuppression of this group of patients. Other immune reactions may be rare, but they should be taken into account. Final considerations: Post-transfusion reactions may be more severe in patients with leukemia. Studies with appropriate epidemiological models are required to identify the most common post-transfusion reactions in the pediatric population with this disease(AU)


Subject(s)
Humans , Leukemia , Immunosuppression , Transfusion Reaction , Neoplasms
4.
Infectio ; 25(1): 71-74, ene.-mar. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1154407

ABSTRACT

Resumen La bacteremia por Streptococcus gordonii es infrecuente. Su aislamiento en hemocultivo traduce alta significancia clínica y debe dirigir el abordaje diagnóstico hacia la búsqueda de entidades subyacentes como neoplasias hematológicas, cardiopatías valvulares, neumonía, alteraciones estructurales de cabeza y cuello, inmunosupresión, y otras condiciones asociadas. No se han identificado reportes en pacientes con neoplasia de vías urinarias como posible condicionante de bacteremia por este agente. Se describe el caso de un paciente que, durante el estudio de bacteremia por este microorganismo, fue diagnosticado de carcinoma urotelial de alto grado.


Abstract Streptococcus gordonii bacteremia is rare. Its isolation in blood culture translates into high clinical significance and the diagnostic approach should be directed towards the search for underlying entities such as hematologic malignancies, valvular heart disease, pneumonia, structural changes of the head and neck, immunosuppression and other related conditions. No reports have been identified in patients with urinary tract neoplasia as a possible condition of bacteremia by this agent. The case of a patient who was diagnosed with high-grade urothelial carcinoma during the study of bacteremia by this microorganism is described.


Subject(s)
Humans , Male , Aged, 80 and over , Carcinoma , Bacteremia , Streptococcus gordonii , Urinary Tract , Immunosuppression , Sepsis , Hematologic Neoplasms , Neoplasms
5.
Infectio ; 25(1): 63-66, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1154405

ABSTRACT

Resumen La tuberculosis (TB) es una de las enfermedades infecciosas con mayor carga de morbimortalidad a nivel mundial,la presentación pulmonar es la forma más común, sin embargo, las manifestaciones extrapulmonares, especialmente las osteoarticulares, pueden ser difíciles de diagnosticar debido a sus síntomas inespecíficos sugestivos de otras entidades como neoplasias o enfermedades infiltrativas, lo que hace de su diagnóstico un reto clínico. Está enfermedad esta asociada a múltiples factores de riesgo como inmunosupresión, contacto cercano con pacientes con tuberculosis, hacinamiento, residir en zona endémica, entre otros. A continuación, se presentan dos casos de pacientes pediátricos sin compromiso inmune que cursaron con cuadros sugestivos de neoplasias musculoesqueleticas, con hallazgos imagenológicos congruentes, pero con estudios microbiológicos positivos para TB.


Abstract Tuberculosis (TB) is one of the infectious diseases with the highest burden of morbidity and mortality worldwide. Pulmonary presentation is the most common, however, extrapulmonary manifestations, especially osteoarticular, can be difficult to diagnose due to their nonspecific symptoms suggestive of other entities such as neoplasms or infiltrative diseases. Tuberculosis is also associated with multiple risk factors, especially immunosuppression, and among others, household contact with patients with tuberculosis or residing in an endemic area. We present two pediatric patients without immunecompromise, with clinical history suggestive of musculoskeletal neoplasms, with congruent imaging findings, but with positive microbiological studies for TB.


Subject(s)
Humans , Male , Female , Child , Soft Tissue Neoplasms , Tuberculosis , Patients , Communicable Diseases , Risk Factors , Mortality , Immunosuppression , Diagnosis , Neoplasms
6.
Infectio ; 25(1): 49-54, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1154402

ABSTRACT

Resumen La linfocitopenia T CD4 idiopática (LCI) es un síndrome clínico inusual que se caracteriza por un déficit de células T CD4+ circulantes en ausencia de infección por VIH u otra condición de inmunosupresión. Los pacientes con dicha enfermedad pueden presentarse asintomáticos o con infecciones oportunistas, las más frecuentes son por criptococo, micobacterias o virales como herpes zoster. Presentamos el caso de un hombre de 32 años, sin antecedentes, en quien se descartó infección por retrovirus, con recuento de linfocitos T CD4+ menor a 300 células/m3; se diagnosticó LCI posterior al diagnóstico de criptococomas cerebrales mediante hallazgos imagenológicos los cuales fueron congruentes con estudios microbiológicos.


Summary Idiopathic CD4 T lymphocytopenia (ICL) is an unusual clinical syndrome characterized by a deficit of circulating CD4 + T cells in the absence of HIV infection or another immunosuppression condition. Patients with this disease may present asymptomatic or with opportunistic infections, the most frequent are cryptococcus, mycobacteria or viral such as herpes zoster. We present a case of a 32-year-old man with no prior disease, in whom retrovirus infection was discarded, with CD4 + T lymphocyte count less than 300 cells/m3; ICL was diagnosed after the diagnosis of brain cryptococomas by imaging findings which were consistent with microbiological studies.


Subject(s)
Humans , Male , Adult , Cryptococcosis , T-Lymphocytes , HIV Infections , HIV , Immunosuppression , Cryptococcus , Herpes Zoster , Lymphopenia
7.
Rev. colomb. gastroenterol ; 36(1): 109-114, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251530

ABSTRACT

Resumen Introducción: la tuberculosis es una enfermedad infecciosa que suele afectar a los pulmones y es causada por Mycobacterium tuberculosis. Se transmite de una persona a otra a través de gotículas generadas en el sistema respiratorio de pacientes con enfermedad pulmonar activa. La tuberculosis esofágica es una afección rara (representa solo el 2,8% de todos los casos de tuberculosis gastrointestinal). Por lo general, ocurre como resultado de la diseminación directa desde los ganglios mediastínicos (rara vez desde los pulmones o el torrente sanguíneo). Su diagnóstico definitivo requiere el aislamiento de los bacilos tuberculosos, lo que rara vez se logra en la práctica clínica; aun así, clínicamente los pacientes presentan síntomas de disfagia, odinofagia y adelgazamiento. Caso clínico: se presenta un paciente de 40 años de edad con cuadro clínico de 6 meses de evolución con disfagia progresiva exacerbada a disfagia para líquidos, astenia, adinamia, hiporexia, dolor pleurítico, epigastralgia y tos con expectoración blanquecina; se realizó una endoscopia de vías digestivas altas que mostró una mucosa gravemente inflamada con ulceraciones irregulares de hasta 2 cm de profundidad, lesiones que sugirieron tuberculosis esofágica, confirmada por el estudio histopatológico: esofagitis crónica granulomatosa; por tanto, se inició el tratamiento tetraconjugado: rifampicina, isoniazida, pirazinamida y etambutol. Conclusiones: La tuberculosis con afección del tubo digestivo es una entidad de baja frecuencia; adicionalmente, es importante recordar que la gravedad del cuadro clínico usualmente está relacionada con la coinfección por el virus de la inmunodeficiencia humana (VIH), y que la asociación de ambas patologías es frecuente.


Abstract Introduction: Tuberculosis is an infectious disease that usually affects the lungs and is caused by Mycobacterium tuberculosis. It is transmitted from one person to another through droplets generated in the respiratory system of patients with active lung disease. Esophageal tuberculosis is a rare condition (accounting for only 2.8% of all cases of gastrointestinal tuberculosis). It usually occurs as a result of the direct spread from the mediastinal nodes, but rarely from the lungs or bloodstream. Its definitive diagnosis requires the isolation of tuberculous bacilli, which is rarely achieved in clinical practice. However, clinically speaking, patients present with symptoms of dysphagia, odynophagia, and weight loss. Case study: This is the case of a 40-year-old patient with symptoms of 6 months of evolution with progressive dysphagia exacerbated to dysphagia for liquids, asthenia, adynamia, hyporexia, pleuritic pain, epigastric pain, and cough with whitish sputum. An endoscopy of the upper digestive tract was performed, showing severely inflamed mucosa with irregular ulcerations up to 2 cm deep, which suggested esophageal TB. The diagnosis was confirmed by histopathology, which reported chronic granulomatous esophagitis. Tetraconjugated treatment was initiated, including rifampicin, isoniazid, pyrazinamide, and ethambutol. Conclusions: Gastrointestinal tuberculosis is a rare entity. It should be noted that the severity of the symptoms is usually associated with HIV co-infection, and their association is a frequent occurrence.


Subject(s)
Humans , Male , Adult , Tuberculosis , HIV , Immunosuppression , Mycobacterium tuberculosis
8.
Rev. Soc. Bras. Med. Trop ; 54: e20200143, 2021. graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1143881

ABSTRACT

Abstract Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi. Reactivation of CD occurs via drug-induced immunosuppression before and during transplantation. Here, we report the case of a 62-year-old man diagnosed with classic Hodgkin lymphoma who received highly aggressive conditioning chemotherapy before undergoing stem cell transplantation (SCT). The patient tested positive for CD in pre-transplantation evaluation. The patient exhibited persistent fever and elevated C-reactive protein levels before and after SCT, and was treated with antibiotics. Micro-Strout test showed evidence of trypomastigotes and he was treated with benznidazole until tested negative. Post-transplantation seropositive patients should be screened for possible reactivation.


Subject(s)
Humans , Animals , Male , Trypanosoma cruzi , Chagas Disease , Hematopoietic Stem Cell Transplantation/adverse effects , Zoonoses , Immunosuppression , Middle Aged
9.
São Paulo; s.n; HSPM; 2021.
Thesis in Portuguese | LILACS, ColecionaSUS, SMS-SP, HSPM-Producao, SMS-SP | ID: biblio-1348412

ABSTRACT

RESUMO A Leishmaniose Visceral (LV), também conhecida como Calazar (Kala-azar, febre negra em Híndi) é uma doença tropical de grande importância para a saúde pública, causada por protozoários intracelulares obrigatórios do gênero Leishmania, que podem também causar a doença base em sua forma muco-cutânea. A doença visceral multissistêmica é causada principalmente pelas espécies Leishmania donovani e Leishmania infantum (Leishmania Chagasi). Cerca de 200.000 casos de Leishmaniose Visceral foram reportados pela Organização Mundial da Saúde (OMS) em 2015 e este é um dado provavelmente subestimado, principalmente na África, podendo se estimar cerca de 500.000 casos novos por ano no mundo. Segundo a OMS, em 2019 o Brasil foi responsável por cerca de 97% dos casos confirmados de LV na região das Américas. Neste mesmo ano, segundo o Ministério da Saúde (MS), foram confirmados 2529 casos de LV no Brasil, sendo a região do Nordeste a maior responsável pelo registro destes casos (49,1%). O estado com o maior número de casos foi o Maranhão, com 390 casos. A Bahia, estado de procedência da paciente deste relato de caso, apresentou 152 casos, 6% do total registrado no país. São Paulo teve registro de 80 casos em 2019. A LV acomete principalmente adultos jovens na faixa de 20 a 49 anos de idade, principalmente no sexo masculino (65,4%). A taxa de letalidade por LV neste ano foi de 9%, com elevado número percentual nos menores de um ano de idade (10,3%), porém a maior parte ainda é de adultos acima de 50 anos de idade (19,2%). Este estudo apresenta um relato de caso de Leishmaniose Visceral de paciente de 53 anos, procedente do estado da Bahia, com passado de infecções oportunistas, internada no Hospital do Servidor Público Municipal de São Paulo em novembro de 2020, onde foi diagnosticada e tratada, para expor a importância do diagnóstico, avaliação epidemiológica e tratamento precoce para esta enfermidade grave, que figura em segundo no ranking de mortalidade entre as doenças tropicais e sétimo nas doenças que diminuem o indicador DALY (disability-adjusted life years), segundo a OMS. Foi caracterizado o caso de recidiva de LV apresentado pela paciente em abril de 2021, tentando relacionar suas comorbidades com fatores preditores de recidiva publicados em literatura. Palavras-chave: Leishmaniose Visceral. Recidiva. Imunossupressão.


Subject(s)
Humans , Male , Female , Immunosuppression , Leishmaniasis, Visceral
10.
Ciencia Tecnología y Salud ; 8(2): 220-231, 2021. il 27 c
Article in Spanish | LILACS-Express | LILACS, LIGCSA, DIGIUSAC | ID: biblio-1353228

ABSTRACT

El uso de inhibidores de calcineurina, en particular de tacrolimus como terapia inmunosupresora se ha generalizado a nivel mundial, permitiendo mejorar la tasa de sobrevida del injerto y la calidad de vida del paciente trasplantado. Con el acceso a los estudios de farmacogenética, los grupos de trasplante a nivel mundial se han visto motivados a realizar estudios genéticos que permitan interpretar la influencia de polimorfismos de genes como mTOR, PPP3CA, FK BP1A, FKBP2, y FOXP3, sin embargo, los más estudiados en la población trasplantada para optimizar la dosis de tacrolimus y ciclosporina son los polimorfismos del citocromo p450, CYP3A4 y CYP3A5.El objetivo de la presente revisión narrativa es examinar publicaciones recientes que estudien la relación entre el polimorfismo de CYP3A4/5 y el metabolismo de tacrolimus en pacientes trasplantados renales.Se revisó literatura reciente extraída de los sitios NCBI PubMed y PharmGKB.org en la que se hubiera investigado la influencia de los polimorfismos de CYP3A4/5 en el metabolismo de tacrolimus en trasplantados renales. Se identificó variaciones genéticas de CYP3A4/5 en pacientes trasplantados tratados con tacrolimus que permitirán a los médicos trasplantólogos dosificar de manera precisa el inmunosupresor. El uso de análisis farmacogenéticos permite determinar las variables genéticas del CYP3A4/5, y por lo tanto la toma de decisiones personalizadas en la dosis de inicio y de mantenimiento del inmunosupresor tacrolimus para alcanzar los niveles óptimos y con ello disminuir el riesgo de rechazo, de infecciones asociadas a inmunosupresión, y de toxicidad por el medicamento.


The use of the calcineurin inhibitor tacrolimus as immunosuppressive therapy, has become widespread world-wide, improving the graft's survival rate and the quality of life of the transplanted patient. With access to pharmacogenetic studies, transplant groups worldwide have been motivated to conduct genetic studies to inter-pret the influence of polymorphisms of genes such asmTOR, PPP3CA, FK BP1A, FKBP2, and FOXP3, however the most studied in the transplanted population to optimize the dose of tacrolimus and cyclosporine are those of cytochrome p450,CYP3A4 and CYP3A5. The objective of this narrative review is to examine recent publications studying the relationship betweenCYP3A4/5polymorphism, and tacrolimus metabolism in renal transplant patients. Literature extracted from the NCBI PubMed site and PharmGKB.org, from the past five years, which investigated the influence ofCYP3A4/5polymorphism on tacrolimus metabolism in renal transplants had been reviewed. Genetic variations ofCYP3A4/5 were identified in transplant patients treated with tacrolimus that will allow transplant physicians to dose the immunosuppressant accurately. The use of pharmacogenetic analyses makes it possible to determine the genetic polymorphisms ofCYP3A4/5, and therefore the decision-making cus-tomized at the starting and maintenance dose of the tacrolimus immunosuppressant to achieve optimal levels and thereby reduce the risk of rejection, immunosuppression-associated infections, and drug toxicity.


Subject(s)
Humans , Pharmacogenetics , Polymorphism, Genetic/genetics , Kidney Transplantation , Tacrolimus , Cytochrome P-450 CYP3A/drug effects , Immunosuppression/adverse effects , Cytochrome P-450 Enzyme System/genetics , Drug-Related Side Effects and Adverse Reactions , Prescription Drugs/toxicity , Calcineurin Inhibitors
11.
Clinics ; 76: e2597, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153997

ABSTRACT

A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.


Subject(s)
Humans , Kidney Transplantation , Liver Transplantation , Randomized Controlled Trials as Topic , Immunosuppression , Tacrolimus/adverse effects , Drug Therapy, Combination , Graft Rejection/prevention & control , Immunosuppressive Agents/adverse effects , Mycophenolic Acid/adverse effects
12.
Article in Chinese | WPRIM | ID: wpr-880055

ABSTRACT

OBJECTIVE@#To explore the relationship between the change of lymphocyte subsets before and after immunosuppressive therapy (IST) with disease severity of severe aplastic anemia (SAA) and hematologic response to IST.@*METHODS@#The clinical data of 94 patients with SAA/VSAA treated by r-ATG and CsA in our hospital from December 2009 to October 2011 was analyzed retrospectively. Among them, 26 patients who had sequential data of lymphocyte subsets and cytokines before and after treatment were enrolled. The relationship between lymphocyte subsets, cytokine level before IST and disease severity, as well as the relationship between changes if lymphocyte subsets, changes of cytokine and the HR after IST for 6 months was analyzed.@*RESULTS@#There were no statistical differences in the ratio and absolute count of lymphocyte, the ratio and absolute count of each lymphocyte subsets, including CD3@*CONCLUSION@#The hematopoietic recovery and early hematologic remission may be affected by the intensity of immune suppression reflected from the changes of lymphocyte subsets and the immune reconstruction reflected from the recovery of lymphocyte subsets. The immune reconstruction is most significant within 3 months after IST.


Subject(s)
Anemia, Aplastic , Humans , Immunosuppression , Immunosuppressive Agents/therapeutic use , Lymphocyte Subsets , Retrospective Studies
13.
Rev. colomb. gastroenterol ; 35(4): 545-550, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156339

ABSTRACT

Resumen La enfermedad inflamatoria intestinal comprende la enfermedad de Crohn (EC) y la colitis ulcerativa (CU). Esta última es una patología crónica caracterizada por una inflamación difusa de la mucosa colónica, que afecta el recto y se extiende de forma proximal. Su curso clínico es intermitente, con exacerbaciones y remisiones. Su tratamiento, por lo general, es farmacológico, con corticoides, inmunomoduladores e inhibidor del factor de necrosis tumoral (anti tumor necrosis factor, TNF), los cuales causan un estado de inmunosupresión en el paciente, que puede asociarse en algunos casos a infecciones oportunistas. En la literatura se describe la aparición de la criptococosis pulmonar en pacientes con infección por el virus de inmunodeficiencia humana (VIH). En otros casos se asocia al tratamiento farmacológico de pacientes con EC, así como con otras infecciones oportunistas, tales como la tuberculosis y el herpes. Presentamos uno de los primeros casos de criptococosis pulmonar en un paciente con diagnóstico de colitis ulcerativa, quien recibió tratamiento escalonado con salicilatos, inmunomoduladores y terapia biológica. La infección fue documentada clínica, radiológica e histológicamente. El paciente recibió el tratamiento adecuado y presentó una evolución satisfactoria.


Abstract Inflammatory bowel disease comprises Crohn's disease (CD) and ulcerative colitis (UC), the latter being a chronic disease characterized by diffuse inflammation of the colonic mucosa that affects the rectum and extends proximally. Its clinical course is intermittent with exacerbations and remissions and its treatment is generally pharmacological, with steroids, immunomodulators, and anti-tumor necrosis factor inhibitors (TNF), which cause the patient to be in a state of immunosuppression associated, in some cases, with opportunistic infections. The literature describes the occurrence of pulmonary cryptococcosis in patients with human immunodeficiency virus (HIV) infection, in cases associated with drug treatment of patients with CD, as well as with other opportunistic infections such as tuberculosis and herpes. This is one of the first cases of pulmonary cryptococcosis reported in a patient diagnosed with ulcerative colitis, who received step therapy with salicylates, immunomodulators, and biological therapy. The infection was documented clinically, radiologically, and histologically. The patient received the appropriate treatment and had a satisfactory evolution.


Subject(s)
Humans , Male , Middle Aged , Azathioprine , Therapeutics , Prednisolone , Colitis, Ulcerative , Cryptococcosis , Opportunistic Infections , Inflammatory Bowel Diseases , Crohn Disease , HIV , Immunosuppression
14.
Rev. colomb. nefrol. (En línea) ; 7(2): 123-128, jul.-dic. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1251573

ABSTRACT

Resumen La enfermedad por SARS-CoV-2 (COVID-19) ha aumentado drásticamente desde marzo 2020 y en la actualidad no existen datos suficientes para establecer el riesgo de contagio de este virus en receptores de trasplante renal en comparación con la población general. El objetivo de este reporte de caso fue presentar las características del curso clínico y terapéutico de una paciente trasplantada renal en terapia de mantenimiento que presentó neumonía por COVID-19 y fue atendida en un hospital no trasplantador. La paciente era una mujer de 47 años con antecedente de insuficiencia renal no filiada que recibió trasplante renal de donante por muerte encefálica en el año 2006. Las características clínicas (síntomas, exámenes de laboratorio e imágenes radiológicas) de la mujer fueron similares a las de otros pacientes con COVID-19 de la población general, por lo que fue tratada con hidroxicloroquina, lopinavir/ritonavir, antibioticoterapia profiláctica y dosis única de tocilizumab. La triple terapia inmunosupresora de mantenimiento que recibía se discontinuó al no poder monitorizar los niveles sanguíneos de algunos fármacos inmunosupresores; asimismo se indicaron dosis bajas de metilprednisolona y 5 dosis de flebogama. La neumonía por COVID-19 en esta paciente inmunodeprimida evolucionó favorablemente sin necesidad de respiración mecánica asistida, y la función renal mejoró a sus valores basales, mantenien- do moderada proteinuria. Al alta se reinició la dosis previa de su medicación inmunosupresora habitual. La experiencia descrita en el presente caso puede ser útil para en tratamiento de pacientes trasplantados y con COVID-19 en hospitales no trasplantadores y que no disponen de la capacidad de verificar los niveles de medicación inmunosupresora.


Abstract SARS-CoV-2 disease (COVID-19) has dramatically increased since March 2020. There is insufficient data to establish the risk of acquiring the infection in kidney transplant recipients in comparison with the general population. The objective of this case is to report here the clinical features and therapeutic course of the renal transplant recipient with confirmed COVID-19 pneumonia in a non-transplant hospital. This is a 47-year-old woman with end stage renal disease (ESRD) of unknown cause who received kidney transplantation 14 years ago. Her clinical characteristics (symptoms, laboratory test results, and chest x-ray images) were similar to those of non-transplanted COVID-19 patients. She was treated with hydroxychloroquine, lopinavir/ritonavir, prophylactic antibiotic therapy, and a single dose of tocilizumab for COVID-19. The triple maintenance immunosuppressive therapy she was receiving was temporarily suspended due to the inability to monitor immunosuppressive drugs levels in our hospital, and low dose methylprednisolone plus five doses of flebogamma were administered instead. The COVID-19 pneumonia in this long-term immunosuppressed patient was successfully recovered without the need to assisted mechanical respiration. The renal function improved to its baseline values, maintaining moderate proteinuria. At discharge, the previous dose of his usual immunosuppressive medication was restarted. We conclude that the experience described with our case may be useful for non-transplant hospitals, which do not have the capacity to perform immunosuppressive medication titration.


Subject(s)
Humans , Female , Middle Aged , Kidney Transplantation , COVID-19 , Patients , Spain , Therapeutics , Immunosuppression
15.
Appl. cancer res ; 40: 1-9, Oct. 19, 2020. ilus
Article in English | LILACS, Inca | ID: biblio-1281364

ABSTRACT

A large number of cancer patients relapse after chemotherapeutic treatment. The immune system is capable of identifying and destroying cancer cells, so recent studies have highlighted the growing importance of using combinatorial chemotherapy and immunotherapy. However, many patients have innate or acquired resistance to immunotherapies. Long-term follow-up in a pooled meta-analysis exhibited long-term survival in approximately 20% of patients treated with immune checkpoint inhibitors or the adoptive transfer of chimeric T cells. It has been reported that high levels of immunoregulatory cells in cancer patients contribute to immunotherapy resistance via immunosuppression. Among the most important regulatory cell subtypes are the CD4+ T-regulatory cells (Tregs), identified by their expression of the well-characterized, lineage-specific transcription factor FOXP3. In addition to CD4+ Tregs, other regulatory cells present in the tumor microenvironment, namely CD8+ Tregs and IL10-producing B-regulatory cells (Bregs) that also modulate the immune response in solid and lymphoid tumors. These cells together have detrimental effects on tumor immune surveillance and anti-tumor immunity. Therefore, targeting these regulatory lymphocytes will be crucial in improving treatment outcomes for immunotherapy.


Subject(s)
T-Lymphocytes, Regulatory , Immunotherapy , Neoplasms , Immunosuppression
16.
Rev. Méd. Clín. Condes ; 31(3/4): 304-316, mayo.-ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223757

ABSTRACT

Los pacientes inmunosuprimidos presentan un riesgo mayor de infecciones, debido a sus disfunciones inmunes, producto de la actividad de su enfermedad y la terapia inmunosupresora. El uso de vacunas disminuye este riesgo, otorgando protección directa e indirecta, a través de la vacunación del paciente y sus contactos. Las vacunas inactivadas han demostrado un perfil de seguridad adecuado en estos pacientes, por lo que no están contraindicadas, aunque su respuesta inmune puede ser inadecuada. Las vacunas vivas atenuadas, formalmente contraindicadas, poseen una información creciente que permite evaluar su riesgo/beneficio de manera individual. Por este motivo es necesario procurar mantener el calendario de vacunas actualizado y complementado, evitando el retraso en esquemas de vacunación y poniéndolo al día lo antes posible, con estrategias basadas en el individuo. Para llevar a cabo esto, se debe conocer y considerar los intervalos entre las vacunas, los esquemas acelerados, la solicitud de vacunas especiales, las aprobaciones vigentes y, finalmente, sus contraindicaciones.


Immunecompromised patients are at higher risk of infections due to their immune dysfunction caused by ongoing disease processes and immunosuppressive therapy. Patient vaccination or vaccination of the people in contact with patients diminishes their risk of infection. Although the immune response of immunocompromised patients might be impaired, the use of inactivated vaccines is safe and it is not contraindicated in these patients. Formerly, live attenuated vaccines were contraindicated in immunecompromised patients, but recently more data supports their use when evaluating case by case the risks and benefits of their application. Thus, it is important to keep and up-to-date, taylor-based and enhanced vaccination schedule in these cases. For this, specialists need to be informed about the availability of regular and special vaccines, their current approvals, vaccine administration protocols under specific situations and vaccine contraindications.


Subject(s)
Humans , Vaccines/administration & dosage , Communicable Disease Control/methods , Immunosuppression , Immunocompromised Host , Vaccines, Attenuated/administration & dosage , Vaccines, Inactivated/administration & dosage , Immunization Schedule , Vaccines, Live, Unattenuated/administration & dosage
17.
Rev. Méd. Clín. Condes ; 31(3/4): 317-329, mayo.-ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223762

ABSTRACT

Los sujetos con infección por Virus de inmunodeficiencia humana (VIH) tienen mayor susceptibilidad de adquirir infecciones por su deterioro inmunológico. Según el deterioro inmunológico y el uso de terapia antiretroviral (TARV) en niños y adultos VIH (+), la intensidad de la respuesta inmune a las vacunas es menor que la población general. Por este motivo es preferible administrar vacunas una vez que la TARV haya permitido la inmunoreconstitución, y se recomiendan dosis de refuerzo. Por otra parte, las vacunas vivas atenuadas deben ser usadas con precaución, y están contraindicadas en inmunosupresión severa.


Patients with Human Immunodeficiency Virus (HIV) are more susceptible to acquiring infections due to their immune deterioration. The intensity of the immune response to vaccines is lower than general population, depending on immune status and the use of antiretroviral therapy (ARV). For this reason, it is preferable to administer vaccines once ART has allowed immune reconstitution, and booster doses are recommended. On the other hand, live vaccines should be used with caution, and are contraindicated in severe immunosuppression.


Subject(s)
Humans , Infant, Newborn , Child , Adult , Vaccines/administration & dosage , Communicable Disease Control/methods , Acquired Immunodeficiency Syndrome/complications , Vaccination , Vaccines/immunology , HIV Infections/complications , Acquired Immunodeficiency Syndrome/immunology , Immunosuppression , Immunization/methods , AIDS-Related Opportunistic Infections/prevention & control , Antiretroviral Therapy, Highly Active
18.
Infectio ; 24(2): 112-125, abr.-jun. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1114851

ABSTRACT

Abstract Intestinal coccidia have been classified as protozoa of the Apicomplex phylum, with the presence of an intracellular behavior and adaptation to the habit of the intestinal mucosa, related to several parasites that can cause enteric infections in humans, generating especially complications in immunocompetent patients and opportunistic infections in immunosuppressed patients. Alterations such as HIV/AIDS, cancer and immunosuppression. Cryptosporidium spp., Cyclospora cayetanensis and Cystoisospora belli are frequently found in the species. Multiple cases have been reported in which their parasitic organisms are associated with varying degrees of infections in the host, generally characterized by gastrointestinal clinical manifestations that can be observed with diarrhea, vomiting, abdominal cramps, malaise and severe dehydration. Therefore, in this review a specific study of epidemiology has been conducted in relation to its distribution throughout the world and in Colombia, especially, global and national reports about the association of coccidia informed with HIV/AIDS. Proposed revision considering the needs of a consolidated study in parasitology, establishing clarifications from the transmission mechanisms, global and national epidemiological situation, impact at a clinical level related to immunocompetent and immunocompromised individuals, as well as a focus on public health in institutional government policies and scientific information based on the characterization of coccidia in the tropical region and Colombia.


Resumen Los coccidios intestinales se han clasificado como protozoos del Apicomplexa phylum, con presencia de un comportamiento intracelular y adaptación al hábito de la mucosa intestinal, relacionado con varios parásitos que pueden causar infecciones entéricas en los humanos, generando especialmente complicaciones en pacientes inmunocompetentes e infecciones oportunistas en pacientes inmunodeprimidos. Alteraciones como el VIH/SIDA, cáncer e inmunosupresión con tratamientos farmacológicos. En las especies que se encuentran frecuentemente se encuentran Cryptosporidium spp., Cyclospora cayetanensis y Cystoisospora belli. Se han reportado múltiples casos en los que sus organismos parásitos se asocian a diversos grados de infecciones en el huésped, generalmente caracterizadas por manifestaciones clínicas gastrointestinales que pueden observarse con diarrea, vómitos, calambres abdominales, malestar general y deshidratación severa. Por lo tanto, en esta revisión se ha realizado un estudio específico de epidemiología con relación a su distribución en todo el mundo y en Colombia, especialmente, reportes a nivel global y nacional a cerca de la asociación de coccidios informados con el VIH/SIDA. Revisión propuesta con el objetivo de considerar las necesidades de un estudio consolidado a nivel del campo de la parasitología, evidenciando literatura actualizada, estableciendo información de los mecanismos de transmisión, situación epidemiológica global y nacional, impacto a nivel clínico relacionadas con individuos inmunocompetentes e inmunocomprometidos, así como un enfoque en salud pública en políticas gubernamentales institucionales y la información científica basada en la caracterización de coccidias en la región tropical y principalmente en Colombia.


Subject(s)
Humans , Coccidia , Parasites , Public Health , Epidemiology , HIV , Immunosuppression , Colombia , Cryptosporidium , Cyclospora
19.
Rev. fac. cienc. méd. (Impr.) ; 17(1): 43-46, ene.-jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1223833

ABSTRACT

Chikungunya es una enfermedad emergente en Honduras y en la región Centro y Suramericana, estudios anteriores indican que 0.3% pueden ser formas atípicas o severas. Objetivo: analizar como la inmunosupresión provocada por el virus de chikungunya predispuso al paciente para que el Staphylococcus aureusentrara al torrente sanguíneo y produjera complicaciones Presentación del caso clínico:paciente de 8 meses de edad, inicia cuadro clínico febril y rash generalizado. Diez días después presenta dificultad respiratoria y dolor torácico, acompañado de absceso en maléolo interno de pierna derecha; se realiza ecografía torácica y se diagnostica pericarditis, se ordena serología por inmunoglobulina M para chikungunya, considerando la epidemia del momento (2015), que resultó positiva. Posteriormente paciente evoluciona con las siguientes complicaciones: taponamiento cardiaco, shock séptico y cardiogénico, conjuntivitis bacteriana, insuficiencia renal aguda, endocarditis y osteomielitis bacteriana. El paciente mejoró progresivamente hasta su recuperación completa. Conclusión:la infección con el virus del chikungunya provocó inmunosupresión, se complicó por infección de Staphylococcus aureus, presente en el absceso de la pierna derecha, pasó al torrente sanguíneo, afectando a múltiples órganos, necesitando manejo en la Unidad de Cuidados Intensivos Pediátricosdel Instituto Hondureño de Seguridad Social, poniendoen riesgo la vida del paciente...(AU)


Subject(s)
Humans , Male , Infant , Staphylococcal Infections/complications , Chikungunya Fever/complications , Viruses , Immunosuppression
20.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 353-358, Mar. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136204

ABSTRACT

SUMMARY Melatonin has anti-inflammatory and antioxidant properties that can influence tissue growth and apoptosis. This aspect may influence the success of organ transplantation. OBJECTIVE To evaluate the relationship between melatonin and organ transplantation. METHODS A systematic review was performed in PubMed databases using the search terms: "melatonin physiology" or "melatonin therapy" and "transplant pharmacology" or "transplant physiology" or "transplant therapy" or "Transplant therapy". Experiments on the organs of the reproductive system were not included. After analysis, five articles were selected after reading the title and abstract of 50 manuscripts. The works were divided into two aspects: a) analysis of the influence of the organ transplantation procedure on melatonin production; b) action of melatonin on organ transplantation. RESULTS The cardiac transplantation surgical procedure, immunosuppression, and graft did not influence melatonin secretion in rodents, but there was a significant reduction of melatonin in the renal transplantation procedure in patients with renal insufficiency. Melatonin administration in experimental models decreased rejection and improved transplant success. CONCLUSION Studies show that melatonin can reduce organ and species dependence, and the use of melatonin decreases graft rejection.


RESUMO A melatonina tem propriedades anti-inflamatórias e antioxidantes que podem influenciar o crescimento e a apoptose dos tecidos. Esse aspecto pode influenciar o sucesso do transplante de órgãos. OBJETIVO Avaliar a relação entre a melatonina e o transplante de órgãos. MÉTODO A revisão sistemática foi realizada nas bases de dados do PubMed, usando os termos de pesquisa: "fisiologia da melatonina" ou "terapêutica da melatonina" e "farmacologia do transplante" ou "fisiologia do transplante" ou "terapêutica do transplante" ou "terapia do transplante". Não foram incluídos os experimentos sobre os órgãos do sistema reprodutivo. Após análise, cinco artigos foram selecionados após a leitura do título e do resumo de 50 manuscritos. Os trabalhos foram divididos em duas vertentes: a) análise da influência do procedimento de transplante de órgão na produção de melatonina; b) ação da melatonina sobre o transplante de órgãos. RESULTADOS O procedimento cirúrgico do transplante cardíaco, a imunossupressão e o enxerto não influenciaram a secreção de melatonina em roedores, mas houve redução significante da melatonina nos casos do procedimento de transplante renal em pacientes com insuficiência renal. A ministração de melatonina em modelos experimentais diminuiu a rejeição e melhorou o sucesso de transplante. CONCLUSÃO Os estudos mostram que a melatonina pode reduzir a dependência da espécie e do órgão e que o emprego da melatonina diminui a rejeição do órgão.


Subject(s)
Humans , Animals , Rats , Organ Transplantation , Graft Rejection/prevention & control , Melatonin/administration & dosage , Antioxidants/administration & dosage , Heart Transplantation , Immunosuppression , Kidney Transplantation , Graft Survival/drug effects , Melatonin/physiology
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