RESUMO
Dasatinib es un potente inhibidor de la tinosina kinasa utilizado como tratamiento de segunda línea en pacientes con leucemia mieloide crónica, especialmente cuando se desarrolla resistencia o algún tipo de intolerancia a imatinib. A pesar de la aparente selectividad, pueden producirse efectos secundarios significativos. Los derrames pericárdicos son complicaciones frecuentes, que usualmente necesitan reducir la dosis o discontinuar el tratamiento. Por otro lado, la hipertensión pulmonar es un efecto adverso poco frecuente que puede aparecer a los 8 meses del inicio de la terapia. A continuación se presenta el caso de un paciente de 82 años que desarrolla derrame pericárdico crónico e hipertensión pulmonar reversible tras reducción de la dosis de Dasatinib.
Dasatinib is a potent tyrosine kinase inhibitor used as second line treatment for patients with chronic myeloid leukemia, particularly when resistance or some type of intolerance to imatinib has built up. Despite its apparent selectivity it can have significant side effects. Pericardial effusions are frequent complications and usually require dose reduction or treatment discontinuation. On the other hand, pulmonary hypertension is an infrequent side effect which may appear 8 months after initiating treatment. In the following we present the case of an 82 year old who developed a chronic pericardial effusion and pulmonary hypertension which were reversed upon reducing the dasatinib dose.
RESUMO
Background: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. Aim: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. Patients and Methods: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. Results: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. Conclusions: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.