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1.
Rev. med. Risaralda ; 27(1): 96-100, ene.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1280499

ABSTRACT

Resumen El síndrome de DRESS (Reacción a drogas con eosinofilia y síntomas sistémicos) es una patología poco frecuente en Pediatría, descrita por primera vez en 1996, por Bocquet. Puede presentarse en un tiempo variable luego de exposición a algunos medicamentos, se caracteriza por fiebre, compromiso cutáneo y de órganos internos. En este caso, se presenta a un paciente de 13 años, con antecedente de uso de Trimetroprim sulfa desde hace 2 meses, con cuadro de 3 días consistente en fiebre y rash cutáneo, sin compromiso de mucosas, con respuesta no favorable al manejo con esteroide, requiriendo Inmunoglobulina IV. Semanas después del inicio de los síntomas y evolución estable presenta insuficiencia renal aguda que requirió terapia de reemplazo renal. Se descartaron otras patologías subyacentes de índole autoinmune. Hubo recuperación de azoados y normalización de los demás paraclínicos el día 40 de la enfermedad. El paciente continúa asintomático, 4 meses después, con tratamiento con esteroide oral, en descenso lento y gradual. Se debe considerar la evaluación permanente de las pruebas de función renal en los pacientes que presenten Síndrome de DRESS, por su asociación con Nefritis intersticial aguda y complicaciones relacionadas.


Abstract DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare pathology in Pediatrics, first described in 1996 by Bocquet. It can appear in a variable period of time after exposure to some medications, it is characterized by fever, skin involvement and internal organs. A 13-year-old patient is presented, with a history of use of Trimethoprim sulfa for two months, with a disease of three days of evolution, consisting of fever and skin rash, without mucosal involvement, with an unfavorable response to steroid management, requiring Intravenous inmunoglobulin. Weeks after the onset of symptoms and stable evolution, he presented acute renal failure that required renal replacement therapy. Other underlying autoimmune pathologies were ruled out. There was recovery of renal function test and normalization of the other paraclinical on day 40 of the disease. Patient remains asymptomatic four months later, with oral steroid treatment, in slow and gradual decline. Permanent evaluation of renal function tests should be considered in patients with DRESS syndrome, due to its association with acute tubulointerstitial nephritis and related complications.


Subject(s)
Humans , Male , Adolescent , Eosinophilia , Renal Insufficiency , Drug Hypersensitivity Syndrome , Kidney Function Tests , Nephritis, Interstitial , Steroids , Trimethoprim , Immunoglobulins , Pharmaceutical Preparations , Renal Replacement Therapy , Exanthema , Fever
2.
Medisur ; 19(3): 508-517, 2021. graf
Article in Spanish | LILACS | ID: biblio-1287332

ABSTRACT

RESUMEN El pseudotumor orbitario es la tercera causa de oftalmoplejía dolorosa; constituye un desafío diagnóstico pues obliga a descartar enfermedades de etiología muy diversa que lo provocan. Se presenta el caso de una paciente femenina, de color de piel blanca, de procedencia urbana, ama de casa, fumadora, que no practica ejercicios ni lleva dieta, con antecedentes de hipertensión arterial y artritis reumatoidea, que acudió al Servicio de Oftalmología por presentar síntomas inflamatorios anexiales: edema palpebral, quemosis conjuntival, vasos conjuntivales dilatados, que se acompañaban de proptosis, oftalmoplejía dolorosa con diplopía y de una masa tumoral palpable a nivel de la porción supero-externa de la órbita. Se ingresó y se le realizaron estudios imagenológicos e histológicos, que solo aportaron signos inflamatorios y una pansinusitis. Se concluyó como un pseudotumor orbitario en su forma aguda de aparición, asociada a la artritis reumatoidea, cuyo diagnóstico se realizó por exclusión sobre la base de los resultados negativos de los estudios imagenológicos y de la biopsia. Llevó tratamiento con antibióticos parenterales y altas dosis de esteroides orales con regresión del cuadro y mejoría clínica. Se decidió la presentación del caso porque en la provincia no existen reportes sobre esta entidad, y por el énfasis en cómo llegar al diagnóstico y su correcto manejo, evitando con ello secuelas en el órgano visual.


ABSTRACT Orbital pseudotumor is the third cause of painful ophthalmoplegia; it constitutes a diagnostic challenge as it forces us to rule out diseases of very diverse etiology that cause it. A female patient, of white skin color, of urban origin, housewife, smoker, who does not practice exercises or is not on a diet, with a history of high blood pressure and rheumatoid arthritis, who attended the Ophthalmology service for presenting Adnexal inflammatory symptoms: eyelid edema, conjunctival chemosis, dilated conjunctival vessels, which were accompanied by proptosis, painful ophthalmoplegia with diplopia and a palpable tumor mass at the level of the superior-external portion of the orbit was presented. She was admitted and imaging and histological studies were performed, which only revealed inflammatory signs and pansinusitis. It was concluded as an orbital pseudotumor in its acute onset form, associated with rheumatoid arthritis, the diagnosis of which was made by exclusion on the basis of the negative results of imaging studies and biopsy. She was treated with parenteral antibiotics and high doses of oral steroids with regression of the symptoms and clinical improvement. The presentation of the case was decided because in the province there are no reports on this entity, and because of the emphasis on how to reach the diagnosis and its correct management, thereby avoiding effects in the visual organ.


Subject(s)
Humans , Female , Steroids/therapeutic use , Orbital Pseudotumor/therapy , Orbital Pseudotumor/diagnostic imaging , Antibiotics, Antineoplastic/therapeutic use
3.
Ciudad Autónoma de Buenos Aires; Comisión Nacional de Evaluación de Tecnologías de Salud; 28 de Abril 2021. 21 p. (Informe de Evaluación de Tecnologías Sanitarias COVID N°03, 3).
Monography in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1254781

ABSTRACT

La enfermedad por el Coronavirus 2019 (COVID-19 - Coronavirus Disease 2019) es una patología respiratoria de humanos producida por la infección por un nuevo coronavirus identificado como el Síndrome Respiratorio Agudo Severo por Coronavirus 2 (SARS-CoV-2). 1 El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaro al COVID-19 como una pandemia, y desde ese momento hasta el 28 abril del 2021 se ha reportado aproximadamente para Argentina con más de 2.900.000 casos confirmados y 62.599 muertes. 1,2 Al no existir un tratamiento farmacológico específico contra el virus hasta el momento la comunidad científica ha actuado globalmente orientada al descubrimiento y desarrollo intervenciones antivirales y en resignificar diferentes tipos de fármacos que se utilizan en otras indicaciones. En este contexto, existirían evidencias sobre efectos de fármacos como la dexametasona en la reducción de la mortalidad en pacientes hospitalizados por COVID-19 con complicaciones respiratorias graves y que las heparinas son efectivas en la prevención de la trombosis venosa profunda también en casos graves. El presente informe pretende evaluar si el empleo de los esteroides es eficaz, seguro y resulta conveniente para el tratamiento de pacientes con COVID-19 en Argentina


Subject(s)
Steroids , Therapeutics , COVID-19
5.
Rev. cuba. cir ; 60(1): e985, ene.-mar. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289379

ABSTRACT

Introducción: La retinopatía de Purtscher o ceguera por pancreatitis es una complicación poco frecuente de la pancreatitis aguda. Objetivo: Presentar a una paciente que en el curso de una pancreatitis aguda desarrolla una retinopatía de Purtscher como complicación infrecuente. Caso clínico: Paciente de piel blanca, de sexo femenino de 52 años de edad, con antecedentes de salud, que ingresa en el servicio de cirugía con el diagnóstico de pancreatitis aguda litiásica, con elementos clínicos, humorales e imaginológicos de esta entidad. Durante su ingreso presenta pérdida brusca de la visión y es diagnosticada durante su exploración oftalmológica de una retinopatía Purtscher, con resolución del cuadro a los 3 meses, previo tratamiento con esteroides por vía oral. Conclusiones: La retinopatía de Purtscher es una complicación oftalmológica poco frecuente de la pancreatitis, por lo que en todo paciente con diagnóstico de pancreatitis y alteraciones visuales hay que sospechar esta entidad(AU)


Introduction: Purtscher's retinopathy or blindness due to pancreatitis is a rare complication of acute pancreatitis. Objective: To present the case of a patient who develops Purtscher's retinopathy as a rare complication during acute pancreatitis. Clinical case: 52-year-old female white-skinned patient without a previous history of medical conditions, admitted to the surgery service with a diagnosis of acute lithiasic pancreatitis, showing clinical, humoral and imaging elements characteristic of this entity. During her admission, she presented sudden vision loss. During her ophthalmological examination, she was diagnosed with Purtscher's retinopathy. The condition disappeared at three months, after treatment with oral steroids. Conclusions: Purtscher's retinopathy is a rare ophthalmological complication of pancreatitis, a reason why this entity should be suspected in all patients diagnosed with pancreatitis and visual disturbances(AU)


Subject(s)
Humans , Female , Middle Aged , Pancreatitis/diagnosis , Steroids/therapeutic use , Blindness/complications , Pancreatitis/diagnostic imaging
6.
Article in Chinese | WPRIM | ID: wpr-879064

ABSTRACT

To analyze quality standards of cattle bile and sheep bile, and to discuss the related problems in the standards. The results showed that physical forms of the related medicinal materials of cattle bile and sheep bile were chaotic, and the technical methods adopted in the quality standards were generally backward. In addition, there were still problems that some medicinal material standards lacked necessary test items, which were especially obvious in the relevant medicinal material standards of sheep bile and brought difficulties to quality evaluation and control. We suggest that physical forms of cattle bile and sheep bile in quality standards should be determined, and inspection items should be completed. Based on mainstream analytical technology, some technical methods of these standards should be improved.


Subject(s)
Animals , Bile , Cattle , Reference Standards , Sheep , Steroids
7.
Med. lab ; 25(3): 569-580, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1343146

ABSTRACT

La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad


Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options


Subject(s)
Glomerulonephritis , Purpura , Purpura, Schoenlein-Henoch , Steroids , Biopsy , ISCOMs , Glomerulonephritis, IGA , Kidney Failure, Chronic
8.
Brasília; S.N; 23 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117682

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 21 artigos e 8 protocolos.


Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Steroids/therapeutic use , Technology Assessment, Biomedical , BCG Vaccine/therapeutic use , Heparin/therapeutic use , Almitrine/therapeutic use , Cohort Studies , Adrenal Cortex Hormones/therapeutic use , Enoxaparin/therapeutic use , Azithromycin/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Darunavir/therapeutic use , Betacoronavirus/drug effects , Ipilimumab/therapeutic use , Fondaparinux/therapeutic use , Nivolumab/therapeutic use , Histamine Antagonists/therapeutic use , Hydroxychloroquine/therapeutic use , Anticoagulants/therapeutic use
9.
Brasília; s.n; 10 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117640

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 20 artigos e 16 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Steroids/toxicity , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Ivermectin/therapeutic use , Immunoglobulins/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Vaccines/therapeutic use , Chloroquine/therapeutic use , Fingolimod Hydrochloride/therapeutic use , Rituximab/therapeutic use , Infliximab/therapeutic use , Hydroxychloroquine/therapeutic use , Lithium/therapeutic use
10.
Brasília; s.n; 7 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117630

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 17 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Steroids/therapeutic use , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Warfarin/therapeutic use , Ivermectin/therapeutic use , Ceftriaxone/therapeutic use , Chloroquine/therapeutic use , Methotrexate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lopinavir/therapeutic use , Infliximab/therapeutic use , Leflunomide/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use , Mycophenolic Acid/therapeutic use
11.
Brasília; s.n; 13 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097393

ABSTRACT

Essa é uma produção do Departamento de Ciência e Tecnologia (Decit) da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE) do Ministério da Saúde (Decit/SCTIE/MS), que tem como missão promover a ciência e tecnologia e o uso de evidências científicas para a tomada de decisão do SUS, tendo como principal atribuição o incentivo ao desenvolvimento de pesquisas em saúde no Brasil, de modo a direcionar os investimentos realizados em pesquisa pelo Governo Federal às necessidades de saúde pública. Informar sobre as principais evidências científicas descritas na literatura internacional sobre tratamento farmacológico para a COVID-19. Além de resumir cada estudo identificado, o informe apresenta também uma avaliação da qualidade metodológica e a quantidade de artigos publicados, de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, entre outros). Foram encontrados 15 artigos e 10 protocolos.


Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Renin-Angiotensin System , Ribavirin/therapeutic use , Steroids/therapeutic use , Technology Assessment, Biomedical , Methylprednisolone/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Sulbactam/therapeutic use , Cefoperazone/therapeutic use , Chloroquine/therapeutic use , Plasmapheresis/instrumentation , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Disease Progression , Ritonavir/therapeutic use , Lopinavir/therapeutic use , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use , Anticoagulants/therapeutic use , Antimalarials/therapeutic use
12.
Brasília; s.n; 19 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097389

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 19 artigos e 17 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Steroids/therapeutic use , Methylprednisolone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Ritonavir/therapeutic use , Leukotriene Antagonists/therapeutic use , Drug Combinations , Lopinavir/therapeutic use , Histamine Antagonists/therapeutic use , Hydroxychloroquine/therapeutic use , Anticoagulants/therapeutic use
13.
Article in English | WPRIM | ID: wpr-762179

ABSTRACT

PURPOSE: We evaluated the severity of olfactory disturbance (OD) in the murine model of allergic rhinitis (AR) and local allergic rhinitis (LAR) in mice. We also investigated the therapeutic effect of an intranasal steroid on OD. METHODS: Forty BALB/c mice were divided into 5 groups (n = 8 for each). The control group was sensitized intraperitoneally (i.p.) and challenged intranasally (i.n.) with saline. Mice in the AR group got i.p. and i.n. ovalbumin (OVA) administration for AR induction. The LAR group was challenged i.n. with 1% OVA for inducing local nasal allergic inflammation, without inducing the systemic allergy. The OD group got an i.p. methimazole administration (75 mg/kg) to induce total destruction of olfactory mucosa. Mice in the intranasal budesonide group received i.n. budesonide (12.8 μg per time, 30 minutes after the i.n. OVA challenge) while using OVA to cause systemic allergies. We conducted a buried-food pellet test to functionally assess the degree of OD in each group by measuring the time taken until finding hidden food. We evaluated the damage to olfactory epithelium using histopathologic evaluation and compared the degree of olfactory marker protein (OMP) expression in olfactory epithelium using immunofluorescent staining. RESULTS: Mice of the AR (81.3 ± 19.8 seconds) and LAR groups (66.2 ± 12.7 seconds) spent significantly more time to detect the pellets than the control group (35.6 ± 12.2 seconds, P < 0.01). After treatment, the intranasal budesonide group exhibited significantly better results (35.8 ± 11.9 seconds) compared with the AR and LAR groups (P < 0.01). The AR and LAR groups showed considerable olfactory epithelial damage and suppression of OMP expression compared with the control group. In the intranasal budesonide group, the olfactory lesions and OMP expression had improved substantially. CONCLUSIONS: OD may be caused by olfactory epithelial damage and suppression of OMP expression in nasal allergic inflammation and could be reversed using an intranasal steroid.


Subject(s)
Animals , Budesonide , Hypersensitivity , Inflammation , Methimazole , Mice , Olfaction Disorders , Olfactory Marker Protein , Olfactory Mucosa , Ovalbumin , Ovum , Quality of Life , Rhinitis, Allergic , Steroids
14.
Article in Korean | WPRIM | ID: wpr-785348

ABSTRACT

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. Although viral reactivation is associated with DRESS syndrome, its role in TEN remains unclear. An 80-year-old woman visited our hospital because of fever and skin eruption. DRESS syndrome was diagnosed and was thought to caused by the use of the drug allopurinol. She was treated by discontinuation of the drug and administration of systemic steroids. She recovered from DRESS syndrome and was discharged from the hospital with tapering doses of steroids prescribed. One week after discharge, she visited our hospital again as the skin rash recurred and oral pain as well as oral and ocular mucosal lesions developed. In addition to the skin rash, blisters and Nikolsky's sign that were different from the skin lesions present in the previous DRESS syndrome were observed. Unlike those in DRESS syndrome, the viral serological test results were positive for anti-cytomegalovirus (CMV) IgM and CMV polymerase chain reaction. Therefore, it was thought that TEN was due to reactivation of CMV and she was treated this with ganciclovir and intravenous immunoglobulin. Here, we report a case of TEN caused by viral reactivation after DRESS syndrome developed after use of allopurinol which recovered after steroid treatment.


Subject(s)
Aged, 80 and over , Allopurinol , Blister , Cytomegalovirus Infections , Cytomegalovirus , Drug Hypersensitivity Syndrome , Eosinophilia , Exanthema , Female , Fever , Ganciclovir , Humans , Immunoglobulin M , Immunoglobulins , Polymerase Chain Reaction , Serologic Tests , Skin , Steroids , Stevens-Johnson Syndrome
15.
Immune Network ; : 9-2020.
Article in English | WPRIM | ID: wpr-811173

ABSTRACT

Immune checkpoint inhibitors (ICIs) have been changing the paradigm of cancer treatment. However, immune-related adverse effects (irAEs) have also increased with the exponential increase in the use of ICIs. ICIs can break up the immunologic homeostasis and reduce T-cell tolerance. Therefore, inhibition of immune checkpoint can lead to the activation of autoreactive T-cells, resulting in various irAEs similar to autoimmune diseases. Gastrointestinal toxicity, endocrine toxicity, and dermatologic toxicity are common side effects. Neurotoxicity, cardiotoxicity, and pulmonary toxicity are relatively rare but can be fatal. ICI-related gastrointestinal toxicity, dermatologic toxicity, and hypophysitis are more common with anti- CTLA-4 agents. ICI-related pulmonary toxicity, thyroid dysfunction, and myasthenia gravis are more common with PD-1/PD-L1 inhibitors. Treatment with systemic steroids is the principal strategy against irAEs. The use of immune-modulatory agents should be considered in case of no response to the steroid therapy. Treatment under the supervision of multidisciplinary specialists is also essential, because the symptoms and treatments of irAEs could involve many organs. Thus, this review focuses on the mechanism, clinical presentation, incidence, and treatment of various irAEs.


Subject(s)
Autoimmune Diseases , Cardiotoxicity , Homeostasis , Incidence , Myasthenia Gravis , Organization and Administration , Specialization , Steroids , T-Lymphocytes , Thyroid Gland
16.
Article in Chinese | WPRIM | ID: wpr-878799

ABSTRACT

Genus Veratrum plants contain a diversity of steroidal alkaloids, so far at least 184 steroidal alkaloids attributed to cevanine type(A-1~A-69), veratramine type(B-1~B-21), jervanine type(C-1~C-31), solanidine type(D-1~D-10) and verazine type(E-1~E-53), respectively, have been isolated and identified in the genus Veratrum. Their pharmacological activities mainly focused on decreasing blood pressure, anti-platelet aggregation and anti-thrombosis, anti-inflammatory and analgesic, and antitumor effect. This paper classified and summarized the 184 kind of steroidal alkaloids from the Veratrum plants and their major pharmalogical activities in order to provide the scientific basis for the further development and utilization of active alkaloids.


Subject(s)
Alkaloids/pharmacology , Analgesics , Platelet Aggregation , Steroids/pharmacology , Veratrum
17.
J. Phys. Educ. (Maringá) ; 31: e3166, 2020.
Article in Portuguese | LILACS | ID: biblio-1134718

ABSTRACT

RESUMO Este artigo trata do dilema enfrentado por estudantes-fisiculturistas de Educação Física que se dedicam a aprender, por conta própria, sobre o uso de anabolizantes para fins não terapêuticos em um curso de graduação vinculado à área da saúde. A noção de dilema ético-sanitário é desenvolvida a partir da articulação entre os conceitos de expertise, de Nikolas Rose, e o de risco em saúde, de Deborah Lupton. Entrevistas episódicas com seis alunos da graduação dos cursos de licenciatura e bacharelado em Educação Física de uma universidade brasileira foi a opção metodológica adotada. Como resultado, identificamos dois perfis de estudantes praticantes de fisiculturismo: um composto pelos que ingressaram no curso com o objetivo de aprender a usar anabolizantes; e outro que julgava já saber sobre e tinha por objetivo buscar uma certificação profissional universitária. Concluímos que o dilema ético-sanitário observado em ambos os perfis deveria ser tratado em aula nos cursos de graduação em Educação Física, pois o "silêncio curricular" sobre o processo de hipertrofia muscular pela via medicamentosa, associado à atmosfera de clandestinidade, pode favorecer a circulação de mais desinformação e ainda mais riscos ao público alvo deste estudo.


ABSTRACT This article deals with the dilemma faced by physical education student-bodybuilders who are dedicated to learning on their own about the uses of anabolic steroids for non-therapeutic purposes. The concept of the ethical-sanitary dilemma is developed from the articulation between Nikolas Rose's concept of expertise and Deborah Lupton's concept of risk. Episodic interviews with six undergraduate students of Physical Education from a Brazilian university were applied in this study as the principal method. As a result, we identified two profiles of student-bodybuilders: one composed of those who joined the program in order to learn how to use anabolic steroids, and another one composed of those who presumed to know about the uses and whose purpose was to earn an undergraduate diploma. We conclude that the ethical-sanitary dilemma observed in both profiles should be addressed in the Physical Education undergraduate courses since the "curricular silence" on the process of muscular hypertrophy via steroid anabolics, associated with the clandestine atmosphere, may add more misinformation and even more risks to the target audience of this study.


Subject(s)
Humans , Male , Female , Physical Education and Training , Students , Anabolic Agents , Professional Competence , Sports/physiology , Steroids , Therapeutics , Fitness Centers , Scientific Domains , Resistance Training , Hormones , Hypertrophy , Learning
18.
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
19.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 408-414, Out.-Dez. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1024235

ABSTRACT

Introduction: Acute acoustic trauma, which is a kind of sensorineural hearing loss, is caused by acoustic overstimulation. Hyperbaric oxygen therapy (HBOT) is reported to be effective against acute acoustic trauma. Objective: We aimed to evaluate the efficacy of HBOT against acoustic hearing loss based on our 20 years of experience with such cases. Methods: Patients who were treated with HBOT for acute acoustic trauma between April 1997 and August 2017 were evaluated in this study. Thirty-five patients with a mean age of 25.7 ± 9.2 (range: 16­48) years were included. Thirty-nine out of 70 ears (35 patients) were damaged. We investigated the initial level of hearing loss; the extent to which hearing recovered; subjective symptoms, such as tinnitus and aural fullness; and the treatment administered. Results: The planned HBOT was completed in 37 of 39 ears. Twenty-six of the 37 ears (70.2%) displayed improved hearing, and 31 of the 37 ears (83.9%) exhibited symptom improvement. Twenty-three (76.7%) and 26 (86.7%) of the 30 ears treated with steroids demonstrated improvements in hearing and subjective symptoms, respectively. Conclusion: A combination of HBOT and steroids should be considered as a treatment for acute acoustic trauma in cases involving symptoms such as tinnitus and aural fullness (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Hearing Loss, Noise-Induced/therapy , Hyperbaric Oxygenation , Steroids/therapeutic use , Tinnitus/therapy , Treatment Outcome , Hearing Loss, Sensorineural/therapy , Hearing Tests , Hospitals, Military , Japan
20.
Medicina (B.Aires) ; 79(supl.3): 71-76, set. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1040554

ABSTRACT

La miastenia gravis juvenil es una enfermedad autoimmune poco frecuente, por lo que ha sido difícil recopilar datos de estudios controlados aleatorizados prospectivos para evaluar la eficacia y los resultados de distintos tratamientos. Si bien hay diferencias entre la miastenia gravis juvenil y la del adulto, se han utilizado los datos aportados por algunas investigaciones en adultos en el tratamiento de la miastenia gravis juvenil. Se evaluarán las distintas opciones terapéuticas, con las distintas evidencias que lo sostienen y se elaborará un algoritmo de tratamiento teniendo siempre presente que cada paciente nos ofrece distintos desafíos.


Juvenile myasthenia gravis is a rare autoimmune disease, which has made it difficult to collect data from prospective randomized controlled trials to evaluate the efficacy and results of different treatments. Although there are differences between the juvenile myasthenia gravis and that of the adult, the data provided by some researches in adults in the treatment of juvenile myasthenia gravis have been used. The different therapeutic options will be evaluated, with the different evidences that sustain it and a treatment algorithm will be elaborated keeping always in mind that each patient offers us different challenges.


Subject(s)
Humans , Child , Myasthenia Gravis/therapy , Steroids/therapeutic use , Thymectomy , Cholinesterase Inhibitors/therapeutic use , Immunosuppressive Agents/classification , Immunosuppressive Agents/therapeutic use , Myasthenia Gravis/surgery
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