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1.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(1): 60-66, maio 05,2022. fig
Article in Portuguese | LILACS | ID: biblio-1370675

ABSTRACT

Introdução: a hanseníase é uma doença de fácil diagnóstico, possuindo tratamento e cura. Quando diagnosticada tardiamente, pode trazer graves consequências para os portadores e seus familiares. Uma vez que o tratamento da hanseníase está inserido no componente estratégico da assistência farmacêutica, são exigidos cuidados e orientação. Há necessidade de intervenção clínica farmacêutica, com objetivo de acompanhar prescrições medicamentosas, analisando a adesão dos pacientes ao tratamento com a promoção de ações de educação em saúde, além de minimizar a ocorrência de eventos adversos relacionados aos fármacos do tratamento com possível redução de custos associados aos agravos. Objetivo: realizar o monitoramento para identificar e tratar as possíveis intercorrências que estão comumente presentes no tratamento de hanseníase. Metodologia: a realização do estudo deu-se com o acompanhamento dos pacientes atendidos no serviço de referência a partir da aplicação de questionários em consultas periódic as, vis to que a adesão ao tratamento, reduç ão dos eventos adver sos e controle dos comunic antes são de suma impor tância para o controle epidemiológico. Resultados: os principais sintomas dos indivíduos acometidos foram dormência e eritema nodoso hansênico. A maioria utilizava como tratamento o esquema multibacilar e talidomida. O acometimento relatado dos pacientes foi em nível moderado. Os pacientes possuíam comorbidades como hipertensão, artrose e diabetes. O acompanhamento clínico foi relatado como positivo pela maioria dos entrevistados. Conclusão: o desfecho do estudo mostra que a adesão do paciente é crucial para o êxito do tratamento e o acompanhamento do farmacêutico clínico constitui um pilar positivo, contribuindo para a prevenção de agravos e conscientização da comunidade.


Introduction: Hansen's disease is an easily diagnosed disease, with treatment and cure available. When diagnosed late, it can bring serious consequences for patients and their families. Since the treatment of Hansen's disease is part of the strategic component of pharmaceutical assistance, care and guidance are required. There is a need for clinical pharmaceutical intervention, aiming to monitor drug prescriptions, analyze patients' adherence to treatment while promoting health education actions, in addition to minimizing the occurrence of adverse events related to treatment drugs with possible reduction in costs associated to grievances. Objective:thus, the present study aimed to monitor, identify, and treat possible complications commonly present in the treatment of Hansen's disease. Methodology: The study was carried out with the follow-up of patients seen at the reference service, through the application of questionnaires in periodic appointments, since adherence to treatment, reduction of adverse events and control of communicants are of short importance for epidemiological control. Results:The main symptoms of Hansen's disease patients were numbness and leprosy nodosum erythema. Most used the multibacillary scheme and thalidomide as treatment. The reported involvement of patients was at a moderate level. Patients had other comorbidities such as hypertension, arthrosis and diabetes. The clinical assistance was reported as positive by most interviewees. Conclusion: The outcome of the study shows that patient's compliance is crucial for the success of treatment and the clinical pharmacist's accompaniment is a positive pillar, contributing to the prevention of complications and community awareness.


Subject(s)
Humans , Male , Female , Pharmaceutical Services , Thalidomide/therapeutic use , Leprosy/drug therapy , Health Centers , Cross-Sectional Studies
2.
Gac. méd. espirit ; 24(1): [18], abr. 2022.
Article in Spanish | LILACS | ID: biblio-1404892

ABSTRACT

RESUMEN Fundamento: Aunque la estomatitis aftosa recurrente no tiene una etiología bien definida porque es una enfermedad multicausal, se ha reconocido que las interacciones o el debilitamiento del sistema inmunitario, contribuyen principalmente a la magnitud del proceso patológico. Las propuestas de tratamiento en pacientes inmunocomprometidos son diversas y por lo general se centran en alteraciones inmunológicas específicas. Objetivo: Evaluar el efecto clínico de los tratamientos propuestos para la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Metodología: La búsqueda se realizó en las bases de datos PubMed/Medline y Cochrane. Se incluyeron ensayos clínicos que tuviesen entre sus variables de respuesta principales: Cicatrización de la úlcera aftosa, tiempo de cicatrización, de recurrencia e intensidad del dolor y entre las variables secundarias: Los efectos adversos y los síntomas. La extracción de datos se realizó de manera independiente por los autores. Se aplicó la metodología por la colaboración Cochrane para evaluar el riesgo de sesgo en cada uno de los estudios. Resultados: Se incluyeron 11 ensayos clínicos (8 controlados) publicados entre 1995 y 2020 y que aportan resultados de la eficacia de varias intervenciones terapéuticas: talidomida (4), irsogladine (2), rebamipida (1), láser de diodo (1), cápsulas de Omega-3 (1), vitamina B 12 (1), Complejo B (1). Seis de estos estudios incluyeron pacientes con la forma menor de estomatitis aftosa recurrente. El periodo de seguimiento estuvo entre los 14 y 360 días. Conclusiones: La talidomida puede ser eficaz en el alivio de los síntomas, la cicatrización y remisión de las lesiones, el diodo de láser y vitamina B12 en la disminución de la intensidad del dolor.


ABSTRACT Background: Although recurrent aphthous stomatitis does not have a well-defined etiology due to it is a multicausal disease, it has been recognized that the interactions or the weakening of the immune system, contribute mainly to the magnitude of the process pathological. Treatment proposals in immune compromised patients are diverse and they usually focus on specific immunological alterations. Objective: To evaluate the clinical effect of the proposed treatments for recurrent aphthous stomatitis in immunocompromised patients. Methodology: The search was performed in the PubMed/Medline and Cochrane databases. Clinical trials were included that could have among their main response variables: Aphthous ulcer healing, healing time, recurrence and pain intensity and among the secondary variables: Adverse effects and symptoms. data extraction was done independently by the authors. The methodology was applied by Cochrane collaboration to assess the risk of bias in each of the studies. Results: 11 clinical trials (8 controlled) published between 1995 and 2020 and that provided the results of the efficacy of various therapeutic interventions: thalidomide (4), irsogladine (2), rebamipide (1), diode laser (1), Omega-3 capsules (1), vitamin B 12 (1), Complex B (1). Six of these studies included patients with the minor form of stomatitis recurrent aphthous. The follow-up period was between 14 and 360 days. Conclusions: Thalidomide may be effective in relieving symptoms, healing and remission of the lesions, the laser diode and vitamin B12 in the decrease of the intensity of the pain.


Subject(s)
Stomatitis, Aphthous/therapy , Thalidomide/therapeutic use , Vitamin B 12/therapeutic use , Lasers, Semiconductor/therapeutic use , Systematic Review
3.
Goiânia; SES-GO; jan. 2022. 1-15 p. graf.
Non-conventional in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1396204

ABSTRACT

A Talidomida é um medicamento de uso controlado, cuja utilização exige uma série de medidas relacionadas à produção, prescrição e dispensação pelos seus efeitos teratogênicos comprovados ­ Resolução n° 11 de 22 de março de 2011


Thalidomide is a drug for controlled use, whose use requires a series of measures related to production, prescription and dispensing for their teratogenic effects proven - Resolution No. 11 of March 22, 2011


Subject(s)
Humans , Pregnancy , Thalidomide/adverse effects , Thalidomide/administration & dosage , Thalidomide/therapeutic use
4.
Journal of Experimental Hematology ; (6): 1967-1971, 2021.
Article in Chinese | WPRIM | ID: wpr-922233

ABSTRACT

Thalidomide and its derivatives have been used in the treatment of myelodysplastic syndrome (MDS) because of their anti-angiogenic and immunomodulatory effects. In recent years, some studies have found that thalidomide and its derivatives not only showed significant efficacy in lower-risk MDS patients with del (5q), but also showed advantages in non-del (5q) MDS patients. In addition, the discovery of its molecular targets and new substrates makes it possible to develop a new generation of immunomodulatory drugs (IMiDs) and to design IMiDs-based proteolysis-targeting chimeras. In this review, the new progress in mechanism and clinical application of thalidomide and its derivatives were summarized briefly, so as to provide a more scientific, reasonable and effective scheme to the treatment of MDS.


Subject(s)
Humans , Immunomodulating Agents , Myelodysplastic Syndromes/drug therapy , Thalidomide/therapeutic use
5.
Rev. méd. Chile ; 148(9)sept. 2020.
Article in English | LILACS | ID: biblio-1389324

ABSTRACT

ABSTRACT Myelodysplastic syndrome with deletion of chromosome 5q (5q-syndrome) has a favorable prognosis and a low risk of transformation to acute myeloid leukemia, when treated with lenalidomide. Azacitidine leads to complete remission even as second-line therapy and in patients with clonal evolution. We report a 70 years old female without previous exposure to myelotoxic drugs, presenting with three weeks with fatigue and dyspnea. She had anemia with normal white blood cell and platelet count. Bone marrow biopsy showed 50% cellularity and the karyotype analysis revealed a (5) (q33q34) deletion in 22% of the metaphases. A diagnosis of 5q-syndrome with low risk calculated using the Revised International Prognostic Scoring System (IPSS-R), was made. Since lenalidomide was not affordable, thalidomide 100 mg/day was initiated, achieving transfusion independence for three years. Afterwards, she developed pancytopenia and a bone marrow biopsy showed erythroid and megakaryocyte dysplasia with a complex karyotype, which worsened prognosis (IPSS-R of five points). Therefore, azacitidine (by donation) was administered. She achieved complete remission with a normal karyotype and completed 12 cycles of treatment. Thereafter, she relapsed and received only supportive care for a year. She suffered an ischemic stroke and died two weeks later.


El síndrome mielodisplásico con deleción del cromosoma 5q (síndrome 5q) tiene un pronóstico favorable y riesgo bajo de transformación a leucemia aguda en pacientes que son tratados con lenalidomida (tratamiento estándar). El uso Azactidina tiene respuestas completas incluso como segunda línea de tratamiento en pacientes con evolución clonal. Presentamos una mujer de 71 años, sin exposición a mielotóxicos que debutó con un síndrome anémico. Se realizó biopsia de medula ósea que mostró celularidad del 50% y en el análisis citogenético se detectó una deleción del cromosoma 5 en 22% de las metafases analizadas, lo que llevó al diagnóstico de Síndrome 5q- de riesgo bajo de acuerdo con el puntaje IPSS-R (Revised International Prognostic Scoring System). Ya que no se pudo costear lenalidomida, se trató con talidomida (100 mg/día). Permaneció tres años sin requerir soporte transfusional. Posteriormente, presentó pancitopenia y en el nuevo aspirado de médula ósea se observó displasia de la serie roja y megacariocitos, con cariotipo complejo y peor pronóstico (IPSS-R 5 puntos). Se trató con 12 ciclos de azacitidina con lo que logró respuesta completa. Recayó 12 meses después y continuó manejo de soporte por un año. Finalmente falleció debido a un accidente vascular cerebral.


Subject(s)
Aged , Female , Humans , Thalidomide , Myelodysplastic Syndromes , Chromosome Deletion , Angiogenesis Inhibitors , Anemia, Macrocytic , Thalidomide/therapeutic use , Myelodysplastic Syndromes/genetics , Myelodysplastic Syndromes/drug therapy , Chromosomes, Human, Pair 5/genetics , Treatment Outcome , Angiogenesis Inhibitors/therapeutic use , Lenalidomide , Anemia, Macrocytic/genetics , Anemia, Macrocytic/drug therapy
6.
Brasília; s.n; 5 jun. 2020. 24 p.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1100288

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 11 artigos e 7 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Ascorbic Acid/therapeutic use , Ribavirin/therapeutic use , Technology Assessment, Biomedical , Thalidomide/therapeutic use , Ceftriaxone/therapeutic use , Methylprednisolone/therapeutic use , Chloroquine/therapeutic use , Interferons/therapeutic use , Enoxaparin/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Lopinavir/therapeutic use , Vasopeptidase Inhibitors/therapeutic use , Hydroxychloroquine/therapeutic use
7.
An. bras. dermatol ; An. bras. dermatol;94(3): 337-340, May-June 2019. graf
Article in English | LILACS | ID: biblio-1011104

ABSTRACT

Abstract: Necrobiotic xanthogranuloma is a rare chronic condition, belonging to the group C non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly hematologic malignancies. The case reported here was only diagnosed after nine years of evolution and was associated with plasma cell dyscrasia. After treatment with cyclophosphamide, dexamethasone, and thalidomide, there was a reduction of cutaneous lesions and serum levels of monoclonal protein.


Subject(s)
Humans , Female , Middle Aged , Necrobiotic Xanthogranuloma/drug therapy , Smoldering Multiple Myeloma/drug therapy , Thalidomide/therapeutic use , Dexamethasone/therapeutic use , Treatment Outcome , Cyclophosphamide/therapeutic use , Necrobiotic Xanthogranuloma/complications , Necrobiotic Xanthogranuloma/pathology , Smoldering Multiple Myeloma/complications , Smoldering Multiple Myeloma/pathology , Immunosuppressive Agents/therapeutic use
8.
Chinese Journal of Hematology ; (12): 24-28, 2019.
Article in Chinese | WPRIM | ID: wpr-1011921

ABSTRACT

Objective: To evaluate the efficacy and tolerability of ruxolitinib combined with prednisone, thalidomide and danazol for treatment of in myelofibrosis (MF). Methods: Patients of MF according to the WHO 2016 criteria, received ruxolitinib (RUX) combined with prednisone, thalidomide and danazol (PTD). The response, changes of blood counts and adverse events were evaluated. Results: Six PMF and one post-ET MF patients were enrolled. Four patients presented JAK2V617F mutation, one CALR mutation, one MPL mutation, one triple-negative. Responses per IWG-MRT criteria were clinical improvement in 5 patients, stable disease in 2 ones, spleen response in 6 ones. All of 7 patients were symptomatic responses, four patients achieved at least 50% improvement from baseline on MPN-SAF TSS. Three patients initially treated with RUX alone, all of 3 patients experienced treatment-associated anemia and thrombocytopenia. Then these 3 patients received RUX combined with PTD, both hemoglobin and platelet increased significantly. Four patients initially treated with RUX combined with PTD. Increased levels of hemoglobin and platelet were seen in all of 7 patients received RUX combined with PTD with maximum increased hemoglobin of 30(18-54) g/L and maximum increased platelets of 116(13-369)×10(9)/L, respectively from baseline. The treatment dose of RUX increased due to improved platelet count in 3 patients. The frequent non-hematologic adverse events grade 1-2 were constipation, abdominal distension, crura edema and increased ALT. Conclusions: RUX combined with PTD for treatment of MF may modulate initial hematologic toxicity observed when RUX alone, and may increase response due to improved levels of hemoglobin or platelet.


Subject(s)
Humans , Danazol , Drug Combinations , Nitriles , Pilot Projects , Prednisone , Primary Myelofibrosis/drug therapy , Pyrazoles/therapeutic use , Pyrimidines , Thalidomide/therapeutic use , Treatment Outcome
9.
Rev. Soc. Bras. Med. Trop ; Rev. Soc. Bras. Med. Trop;52: e20180385, 2019. tab
Article in English | LILACS | ID: biblio-1041594

ABSTRACT

Abstract INTRODUCTION: Thalidomide, used to treat erythema nodosum leprosum (ENL), is associated with severe adverse events (AEs) and is highly teratogenic. METHODS: A cross-sectional study was conducted on thalidomide-treated patients with ENL. AEs and selected variables were investigated through interviews and assessment of medical records. Odds ratios with 95% confidence intervals were estimated via logistic regression. RESULTS: Peripheral neuropathy symptoms and deep vein thrombosis (DVT) were the most common AEs reported. Although women of reproductive age used contraceptives, <50% of patients reported using condoms. Polypharmacy was associated with all endpoints, except DVT. CONCLUSIONS: Pharmacovigilance is crucial to prevent harmful thalidomide-associated AEs.


Subject(s)
Humans , Male , Female , Thalidomide/adverse effects , Leprostatic Agents/adverse effects , Leprosy/drug therapy , Thalidomide/therapeutic use , Cross-Sectional Studies , Educational Status , Leprostatic Agents/therapeutic use , Middle Aged
10.
An. bras. dermatol ; An. bras. dermatol;93(6): 881-883, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-973645

ABSTRACT

Abstract: Zoon's plasma cell balanitis is a chronic genital inflammatory dermatosis that affects uncircumcised men, especially the elderly. It's characterized by painless erythematous plaques of orange hue, located on the glans penis and foreskin. Circumcision is the most effective treatment; however, it can be hard for patients to accept. As an alternative, topical calcineurin inhibitors are used, with good response. This article reports the case of a 32-year-old patient, HIV carrier, diagnosed with Zoon's plasma cell balanitis. Treatment with topical tacrolimus was administered, without improvement. A 6-week course of thalidomide resulted in complete remission of the lesions, without recurrence after eight months of follow-up.


Subject(s)
Humans , Male , Adult , Plasma Cells/pathology , Thalidomide/therapeutic use , Balanitis/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Balanitis/pathology , Treatment Outcome , AIDS-Related Opportunistic Infections/pathology
11.
An. bras. dermatol ; An. bras. dermatol;93(1): 104-107, Jan.-Feb. 2018.
Article in English | LILACS | ID: biblio-887163

ABSTRACT

Abstract: Atopic dermatitis is a common inflammatory skin disease. New understanding in disease pathogenesis has led to a considerable number of promising new drugs in development. New topical agents can be especially helpful for children, providing an alternative to the need for chronic topical corticosteroid use. While many patients with mild or moderate disease can be managed with topical treatments, there are unmet needs for recalcitrant and severe cases. New and developing therapies hold promise for real advances in management of this complex disease.


Subject(s)
Humans , Dermatitis, Atopic/drug therapy , Dermatologic Agents/therapeutic use , Thalidomide/analogs & derivatives , Thalidomide/therapeutic use , Administration, Cutaneous , Adrenal Cortex Hormones/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/therapeutic use
12.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;51(3): e6650, 2018. graf
Article in English | LILACS | ID: biblio-889040

ABSTRACT

In the present study, we successfully developed a docetaxel (DTX) and thalidomide (TDD) co-delivery system based on low density lipoprotein (LDL) modified silica nanoparticles (LDL/SLN/DTX/TDD). By employing the tumor homing property of LDL and the drug-loading capability of silica nanoparticles, the prepared LDL/SLN/DTX/TDD was expected to locate and specifically deliver the loaded drugs (DTX and TDD) to achieve effective chemotherapy of liver cancer. In vitro analysis revealed that nano-sized LDL/SLN/DTX/TDD with decent drug loading capabilities was able to increase the delivery efficiency by targeting the low density lipoprotein receptors, which were overexpressed on HepG2 human hepatocellular liver carcinoma cell line, which exerted better cytotoxicity than unmodified silica nanoparticles and free drugs. In vivo imaging and anti-cancer assays also confirmed the preferable tumor-homing and synergetic anti-cancer effects of LDL/SLN/DTX/TDD.


Subject(s)
Humans , Animals , Male , Mice , Thalidomide/administration & dosage , Silicon Dioxide/administration & dosage , Taxoids/administration & dosage , Lipoproteins, LDL/blood , Liver Neoplasms, Experimental/drug therapy , Antineoplastic Agents/administration & dosage , Thalidomide/therapeutic use , Time Factors , Taxoids/therapeutic use , Drug Synergism , Nanoparticles , Hep G2 Cells , Liver Neoplasms, Experimental/blood , Antineoplastic Agents/therapeutic use
13.
Rev. Hosp. Ital. B. Aires (2004) ; 37(4): 157-159, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1096381

ABSTRACT

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)


The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)


Subject(s)
Humans , Female , Adult , Photosensitivity Disorders/diagnosis , Sunlight/adverse effects , Erythema/diagnosis , Phototherapy , Photosensitivity Disorders/immunology , Photosensitivity Disorders/pathology , Quality of Life , Seasons , Sunscreening Agents/therapeutic use , Azathioprine/therapeutic use , Thalidomide/therapeutic use , Ultraviolet Rays/adverse effects , Ultraviolet Therapy , Adrenal Cortex Hormones/therapeutic use , Cholecalciferol/therapeutic use , Erythema/etiology , Erythema/immunology , Erythema/pathology , Histamine Antagonists/therapeutic use , Antimalarials/therapeutic use
14.
An. bras. dermatol ; An. bras. dermatol;92(4): 575-577, July-Aug. 2017. graf
Article in English | LILACS | ID: biblio-1038255

ABSTRACT

Abstract: One of the biggest challenges in treating leprosy is the control of reaction events. Patients with lepromatous leprosy may present reaction type II, or erythema nodosum leprosum, during treatment, and this reaction can remain in a recurrent form after being released from the hospital, requiring the use of thalidomide and/or prednisone for long periods of time, in turn increasing the risk of side effects. Two reports of the use of antiTNF to treat erythema nodosum leprosum were found in the literature. A good response was found after an assay with infliximab and etanercept. This study reports on a patient with lepromatous leprosy and recurrent reaction, controlled by using etanercept and a 10-month follow-up, with the interruption of thalidomide and the maintenance of prednisone at 10 mg/day.


Subject(s)
Humans , Male , Adult , Leprosy, Lepromatous/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Erythema Nodosum/drug therapy , Etanercept/therapeutic use , Thalidomide/therapeutic use , Prednisone/therapeutic use , Immunosuppressive Agents/therapeutic use
15.
Rev. méd. Chile ; 145(6): 812-815, June 2017. graf
Article in Spanish | LILACS | ID: biblio-902550

ABSTRACT

Solitary extramedullary plasmacytomas represent 3% of plasma cell neoplasms. Their most common locations are the upper gastrointestinal and respiratory tract. We report a 70-year-old male presenting with progressive dyspnea and cough. A chest radiography showed widened mediastinum. Chest computed tomography showed a mediastinal mass. A bronchoscopy showed an extrinsic compression and complete occlusion of the primary bronchus. A self-expandable prosthesis was installed in left bronchus. A population of plasmacytoid cells was evidenced in the mass biopsy. Immunohistochemistry revealed CD20+ and CD138+. These tumor cells stained positively for lambda light chains, but negatively for kappa chains. Therefore an extramedullary plasmacytoma was diagnosed. A multiple myeloma was discarded with a normal blood count, serum calcium and creatinine levels. Serum protein electrophoresis had a monoclonal spike, serum IgG was 1963 mg/dl. Bone marrow aspiration had 1% of plasma cells. Bone x-rays were normal. Computed tomographies of the neck, thorax, abdomen and pelvis ruled out other plasmacytomas. Eight cycles of chemotherapy with thalidomide, melphalan and prednisone were indicated, obtaining complete remission of the tumor. The review of the literature shows that mediastinal extramedullary plasmacytomas are extremely rare. They generally appear in men aged between 50 and 60 years. The treatment of choice is radiotherapy, but given the location in the present case, chemotherapy was considered the best option. Recurrence is approximately 10 to 30% and 10% of patients progress to myeloma, thus requiring close monitoring.


Subject(s)
Humans , Male , Aged , Plasmacytoma/drug therapy , Plasmacytoma/diagnostic imaging , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Mediastinal Neoplasms/drug therapy , Mediastinal Neoplasms/diagnostic imaging , Thalidomide/therapeutic use , Prednisone/therapeutic use , Tomography , Treatment Outcome , Mediastinoscopy , Melphalan/therapeutic use
16.
An. bras. dermatol ; An. bras. dermatol;91(3): 345-349, tab, graf
Article in English | LILACS | ID: lil-787306

ABSTRACT

Abstract Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.


Subject(s)
Humans , Female , Adult , Sweet Syndrome/diagnosis , Leprosy, Multibacillary/diagnosis , Thalidomide/therapeutic use , Prednisone/therapeutic use , Sweet Syndrome/etiology , Sweet Syndrome/pathology , Sweet Syndrome/drug therapy , Erythema/diagnosis , Leprosy, Multibacillary/complications , Leprosy, Multibacillary/pathology , Leprosy, Multibacillary/drug therapy , Histiocytes/pathology , Leprostatic Agents/therapeutic use , Neutrophils/pathology
17.
Bogotá; IETS; mayo 2016. 40 p. tab, graf.
Monography in Spanish | BRISA, LILACS | ID: biblio-846469

ABSTRACT

Problema de investigación: Estimar para el caso colombiano, la RICE de lenalidomida más terapia de soporte comparada con terapia de soporte sin lenalidomida para pacientes adultos con SMD y Del 5q en Colombia.Tipo de evaluación económica: Análisis de costo-efectividad (ACE). Población objetivo: Pacientes adultos con SMD y Del 5q en Colombia. Intervención y comparadores: Intervención: lenalidomida (10 mg/día) más terapia de soporte.\r\nHorizonte temporal: Un (1) año. Perspectiva: La perspectiva de análisis es la del Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: No se aplicó tasa de descuento para costos ni para desenlaces en salud debido a que el horizonte temporal es de un año. Estructura del modelo: Para capturar las principales características del SMD y Del 5q se desarrolló un modelo de Markov con probabilidades de transición basadas en el estado de transfusión del paciente, la progresión a LMA y la muerte. La duración del cada ciclo (28 días) se basa en el intervalo de dosificación para lenalidomida. Fuentes de datos de efectividad y seguridad: Los datos de efectividad y seguridad para la elaboración del modelo se obtuvieron del ensayo clínico Fase III MDS-004, el único identificado de este tipo que compara el uso de lenalidomida contra placebo en pacientes con SMD y Del 5q dependientes de transfusión. Desenlaces y valoración: Como unidad natural de desenlace se tomó la proporción de pacientes que alcanzan independencia de transfusión de sangre por un mínimo de 8 semanas consecutivas. Costos incluidos: Se consideran eventos generadores de costos todos los recursos directos asociados al uso de las tecnologías evaluadas. Fuentes de datos de costos: SISMED 2015, Manual de Tarifas ISS 2001 + 30%, Circular No. 02 de 2015 de la Comisión Nacional de Precios de Medicamentos y Dispositivos Médicos, 4 laboratorios clínicos y 2 hemocentros del país. Resultados del caso base: La alternativa de lenalidomida más terapia de soporte es una opción costo-efectiva comparada con la terapia de soporte sin lenalidomida para el tratamiento de SMD y Del 5q en Colombia. \r\nAnálisis de sensibilidad: El análisis de sensibilidad determinístico muestra que los resultados del caso base no son sensibles a variaciones en los costos, aunque cambios en las efectividades pueden alterar esta conclusión. El análisis de sensibilidad probabilístico muestra que, con una probabilidad del 98%, la alternativa de lenalidomida más terapia de soporte sería costo-efectiva para todos los umbrales superiores a $6.345.981,2. Conclusiones y discusión: Es razonable incorporar en el POS la alternativa de lenalidomida más terapia de soporte para el tratamiento de SMD y Del 5q. Esta recomendación obedece a que la tecnología evaluada es costo-efectiva, pero sobre todo a que los pacientes a quienes se les administre esta opción de tratamiento pueden experimentar una mejoría significativa en su calidad de vida.(AU)


Subject(s)
Humans , Thalidomide/analogs & derivatives , Thalidomide/therapeutic use , Myelodysplastic Syndromes/therapy , Chromosome Deletion , Health Evaluation/economics , Cost-Benefit Analysis/economics , Colombia , Biomedical Technology
18.
Bogotá; IETS; mayo 2016. 32 p.
Monography in Spanish | BRISA, LILACS | ID: biblio-846828

ABSTRACT

Tecnologías evaluadas: Análisis de impacto presupuestal de lenalidomida (10 mg/día) más terapia de soporte comparada con terapia de soporte sin lenalidomida para el tratamiento de pacientes con síndrome \r\nmielodisplásico y deleción 5q. Población: Pacientes adultos con SMD y Del 5q en Colombia. Perspectiva: La perspectiva de análisis es la del tercer pagador, que en el caso colombiano corresponde al Sistema General de Seguridad Social en Salud. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Se consideran eventos generadores de costos todos los recursos directos (medicamentos y procedimientos) asociados al uso de las tecnologías evaluadas. Fuente de costos: SISMED 2015, Manual de Tarifas ISS 2001 + 30%, Circular No. 02 de 2015 de la Comisión Nacional de Precios de Medicamentos y Dispositivos Médicos, 4 laboratorios clínicos y 2 hemocentros del país. Escenarios: Se realizó un análisis por escenarios que contempló que la tasa de inserción de la nueva tecnología sea del 100% y uno donde se introduce de forma progresiva la nueva tecnología. Resultados: En el escenario 1 donde la incorporación de la nueva tecnología es progresiva, el impacto presupuestal es de $7.002.403.319,77 para el primer año. En el segundo escenario donde la inserción de la nueva tecnología es del 100% en el año 1, el impacto presupuestal es de $8.634.282.761,73. (AU)


Subject(s)
Humans , Adult , Thalidomide/analogs & derivatives , Myelodysplastic Syndromes/drug therapy , Chromosome Deletion , Thalidomide/therapeutic use , Reproducibility of Results , Colombia , Costs and Cost Analysis/methods , Biomedical Technology , Medication Adherence
19.
An. bras. dermatol ; An. bras. dermatol;91(1): 23-26, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-776422

ABSTRACT

Abstract BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.


Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Immunoglobulin E/blood , Photosensitivity Disorders/blood , Photosensitivity Disorders/physiopathology , Skin Diseases, Genetic/blood , Skin Diseases, Genetic/physiopathology , Case-Control Studies , Immunoassay , Immunosuppressive Agents/therapeutic use , Photosensitivity Disorders/pathology , Reference Values , Severity of Illness Index , Skin Diseases, Genetic/pathology , Thalidomide/therapeutic use
20.
Rev. Nac. (Itauguá) ; 8(2): 04-18, dic 2016.
Article in Spanish | LILACS, BDNPAR | ID: biblio-884748

ABSTRACT

Introducción la lepra, llamada también enfermedad de Hansen, es una afección de la piel y de los nervios periféricos, infectocontagiosa, causada por Mycobacterium leprae. Las reacciones lepromatosas se presentan aún con tratamiento y son expresiones de respuesta inmunitaria. Conocerlas es importante a fin de facilitar el abordaje. Objetivo determinar la frecuencia y tipo de reacciones lepromatosas en pacientes con diagnóstico de lepra que acuden al centro de referencia de Enfermedad de Hansen en el Hospital Distrital de San Lorenzo, de enero 2013 a diciembre 2015. Metodología observacional, descriptivo, retrospectivo de corte transverso. Resultados se incluyeron 217 pacientes, 72% presentaban lepra MB y 63% era de sexo masculino. La prevalencia de reacción lepromatosa fue 44%, siendo más frecuentes las de tipo 2 (65%). Se presentó reacción lepromatosa como debut de la enfermedad en 27 %. Treinta y tres pacientes presentaron de tres a doce episodios de reacción lepromatosa. El tratamiento fue talidomida y corticoides. Conclusiones la prevalencia de leprorreacciones fue cercana al 50%, predominando las de tipo 2. El tratamiento utilizado fue talidomida y/o corticoides dependiendo del tipo de reacción lepromatosa.


Introduction leprosy, wich is cause by Mycobacterium leprae, also known as Hansen's Disease, affects skin and peripheral nerves. Lepromatous reactions (LRs) are expressions of an immune reaction and remain as a major persistent problem. LRs are present even with appropriated treatment. Emphasis must be made in early diagnosis and prevention of the catastrophic consequences of LRs. Objective to determine the frequency and type of lepromatous reactions in leprosy patients with leprosy attending to reference center of Hansen´s Disease in the District Center Hospital in San Lorenzo, from January 2013 to December 2015. Methodology observational, retrospective cross sectional study. Results 217 patients were included, 72% with multibacillary leprosy. 63% were male. Lepromatous reactions were found in 44%, been more frequent Type II reaction, in 65% of cases. LRs as oset disease occurred in 27%. 33 patients presented from 3 to 12 episodes of lepromatous reaction. The number of LRs episodes per patient were 3 to 12. Thalidomide was used as treatment in Erithema Nodosum Leprosum (ENL) and corticosteroids for the other types de LRs. Conclusions prevalence of PRs were 50%, been more frecuent the type II. Reaction the treatment used was Thalidomide and/or corticosteroids depending on the type of lepromatosus reaction.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Leprosy, Multibacillary/physiopathology , Leprosy, Multibacillary/epidemiology , Leprosy, Paucibacillary/physiopathology , Leprosy, Paucibacillary/epidemiology , Paraguay/epidemiology , Thalidomide/therapeutic use , Prevalence , Cross-Sectional Studies , Retrospective Studies , Erythema Multiforme/drug therapy , Erythema Multiforme/epidemiology , Adrenal Cortex Hormones/therapeutic use , Erythema Nodosum/drug therapy , Erythema Nodosum/epidemiology , Leprosy, Multibacillary/drug therapy , Leprosy, Paucibacillary/drug therapy
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