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1.
J. bras. nefrol ; 41(3): 427-432, July-Sept. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1040255

RESUMEN

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.


Resumo Apesar de sua toxicidade, o metotrexato é um medicamento eficaz no controle de várias doenças. A mielossupressão, um de seus principais efeitos adversos, aumenta em gravidade e frequência nos pacientes com insuficiência renal. Apresentamos o caso de um homem de 68 anos de idade com doença renal terminal relacionada à vasculite associada ao ANCA em diálise peritoneal, que recebeu a medicação em dose baixa em função da atividade da doença e que teve como complicação pancitopenia grave com mucosite, tratada com medidas de suporte e diálise peritoneal com múltiplas trocas. Revisamos 20 casos publicados até o presente momento sobre pancitopenia associada a metotrexato em pacientes em diálise. Foi identificada alta morbidade e mortalidade, razão pela qual seu uso nesse tipo de paciente não é recomendado. No entanto, quando esta complicação ocorre, uma opção terapêutica pode ser o uso de diálise peritoneal com múltiplas trocas, além da terapia de suporte para toxicidade medicamentosa. Maiores estudos são necessários para demonstrar o papel da diálise peritoneal com múltiplas trocas na remoção desse medicamento.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Vasculitis/tratamiento farmacológico , Metotrexato/efectos adversos , Metotrexato/uso terapéutico , Diálisis Peritoneal/métodos , Antagonistas del Ácido Fólico/efectos adversos , Antagonistas del Ácido Fólico/uso terapéutico , Fallo Renal Crónico/terapia , Pancitopenia/etiología , Pancitopenia/terapia , Choque Séptico/etiología , Choque Séptico/tratamiento farmacológico , Metotrexato/sangre , Resultado del Tratamiento , Mucositis/etiología , Mucositis/tratamiento farmacológico , Antagonistas del Ácido Fólico/sangre , Antibacterianos/uso terapéutico
2.
An. bras. dermatol ; 89(6): 865-877, Nov-Dec/2014. tab, graf
Artículo en Inglés | LILACS | ID: lil-727645

RESUMEN

Researches on DH have shown that it is not just a bullous skin disease, but a cutaneous-intestinal disorder caused by hypersensitivity to gluten. Exposure to gluten is the starting point of an inflammatory cascade capable of forming autoantibodies that are brought to the skin, where they are deposited, culminating in the formation of skin lesions. These lesions are vesico-bullous, pruritic, and localized especially on elbows, knees and buttocks, although atypical presentations can occur. Immunofluorescence of perilesional area is considered the gold standard for diagnosis, but serological tests help in cases where it is negative. Patients who follow glutenfree diets have better control of symptoms on the skin and intestine, as well as lower risks of progression to lymphoma. Dapsone remains the main drug for treatment, but it requires monitoring of possible side effects, some potentially lethal.


Asunto(s)
Femenino , Humanos , Masculino , Dermatitis Herpetiforme/patología , Dermatitis Herpetiforme/terapia , Enfermedad Celíaca/etiología , Enfermedad Celíaca/patología , Enfermedad Celíaca/terapia , Dieta Sin Gluten , Dapsona/uso terapéutico , Dermatitis Herpetiforme/etiología , Técnica del Anticuerpo Fluorescente Directa , Antagonistas del Ácido Fólico/uso terapéutico , Piel/patología
3.
Mem. Inst. Oswaldo Cruz ; 100(4): 451-455, July 2005. tab, graf
Artículo en Inglés | LILACS | ID: lil-406004

RESUMEN

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS - but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrolment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.


Asunto(s)
Humanos , Animales , Masculino , Femenino , Recién Nacido , Preescolar , Niño , Antimaláricos/uso terapéutico , Antagonistas del Ácido Fólico/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Plasmodium falciparum/efectos de los fármacos , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Enfermedad Aguda , Quimioterapia Combinada , Razón de Masculinidad , Resultado del Tratamiento
4.
Arch. argent. pediatr ; 69(4): 159-161, 1971 Jun. tab
Artículo en Español | BINACIS, LILACS | ID: biblio-1159924

RESUMEN

Se realizó un ensayo con una nueva asociación trimetoprima/sulfametoxazol a la dosis de 4 a 8 mg de trimetoprima/Kg/día y 20 a 40 mg/sulfametoxazol/Kg/día, según gravedad del proceso en curso, por vía oral, en 154 pacientes con afecciones respiratorias, otorrinolangológicas, cutáneas y urinarias. Se obtuvieron resultados muy buenos en 73,21 % y buenos en 21,42 % de los casos. Solo en 3 se manifestó la presencia de efectos secundarios leves.


Asunto(s)
Humanos , Lactante , Preescolar , Niño , Pirimidinas/uso terapéutico , Sulfametoxazol/uso terapéutico , Sinergismo Farmacológico , Antagonistas del Ácido Fólico/uso terapéutico , Antiinfecciosos/uso terapéutico , Enfermedades Otorrinolaringológicas/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Trimetoprim/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico
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