Vascular complications caused by hyaluronic acid injection: a clinical analysis / 中华医学美学美容杂志

Objective:To analyze the epidemiological characteristics of vascular complications induced by hyaluronic acid facial injection.Methods:Patients with vascular complication induced by facial hyaluronic acid facial injection were collected in the Fourth Medical Center of the General Hospital of the Chinese People's Liberation Army from January 1, 2016 to October 1, 2021, including 5 males and 37 females. The age ranged from 16 to 70 (34±10) years. The clinical data, injection site, clinical symptoms and previous facial surgery history of the patients were analyzed and investigated.Results:Vascular complications occurred in 12 cases (28.6%). Nasolabial fold in 8 (19.0%) cases; Glabella in 6 (14.3%) cases; frontal part in 6 (14.3%) cases. There were 27 patients (64.3%) with a history of facial surgery. Furthermore, history of facial surgery had no effect on the clinical manifestations of vascular complications ( P>0.05). Among the 18 patients with visual impairment, 12 patients reported that the symptoms of ptosis, bulbar conjunctival congestion, and eye movement dysfunction had diminished after thrombolytic treatment, while 4 patients showed recovery to some extent in visual acuity. Likewise, 24 patients with blood circulation disorders were healed after treatment, with residual pigmentation and a slight scar left. Conclusions:Women aged 30 to 39 years old are the main target population of cosmetic surgery, as well as the most common population of vascular complications. Particular care should be taken in the nose, nasolabial fold, glabella and forehead areas of the operation. Patients with previous surgical history should be adequately informed before surgery, and postoperative observation time should be appropriately prolonged.

Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial

BACKGROUND: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.

Reações adversas a medicamentos na cavidade bucal de idosos / Adverse reactions caused by drugs in the oral cavity of the elderly / Reacciones adversas a medicamentos en la cavidad bucal de ancianos

Os indivíduos com idade avançada consomem maior número de medicações e, como consequência, surgem reações adversas frequentes a essas drogas, inclusive na cavidade bucal. O objetivo é verificar as reações adversas na cavidade oral relacionadas aos medicamentos, a fim de que sejam diagnosticadas corretamente e se executem ações que as reduzam ou eliminem. Como metodologia, nesta revisão, foram buscados artigos originais relatando estas reações em idosos, em inglês, português e espanhol, publicados de 2000 a 2018, usando-se termos relevantes ao tema, publicados on-line nas bases de dados dos periódicos da CAPES. Os artigos foram selecionados após leitura dos seus títulos e resumos efetuando-se, a seguir, leitura completa dos mesmos. Os Resultados mostram que, entre os 12 artigos selecionados, tivemos: 6 (50%) sobre xerostomia; 2 (17%) com ulcerações orais consequentes ao nicorandil; 2 (17%) com osteonecrose da mandíbula (bifosfonato e bevacizumab, um em cada); e 1 (8,3%) com ageusia (associada a romidepsin); e 1 (8,3%) com candidíase (associada a corticoide inalatório). Concluiu-se que o idoso requer atenção redobrada durante as consultas médicas e procedimentos odontológicos, em razão da associação de diferentes doenças crônicas e o uso contínuo de diversas medicações. Há necessidade de maior número de publicações focando este tema neste grupo etário, principalmente naqueles indivíduos mais longevos.

Introduction: The individuals with advanced age are the ones who consume the greatest number of medications and, as consequence, adverse reactions to these drugs often occur, including in the oral cavity. Objective: These drug-related manifestations deserve attention of health professionals so that they are properly diagnosed and actions are taken to reduce or eliminate them. Material and methods: In this article, we reviewed original articles, published from 2000 to 2018, reporting these reactions in elderly patients. Articles in English, Portuguese and Spanish were searched, using terms relevant to the topic, published online in the CAPES journals databases. The articles were selected after reading their titles and summaries and, then, the complete articles. Results: Among the 12 articles showing adverse drug reactions in the oral cavity of the elderly, we had: 6 (50%) with xerostomia and its consequences; 2 (17%) with oral ulcerations consequent to the use of nicorandil; 2 (17%) with osteonecrosis of the mandible (bisphosphonate and bevacizumab, one in each); and 1 (8.3%) with ageusia (associated with romidepsin) and 1 (8.3%) with oral candidiasis (associated with inhaled corticosteroids). Conclusion: The elderly require increased attention during medical consultations and dental procedures, due to the association of different chronic diseases and the continuous use of several medications. There is a need for a greater number of publications focusing on this theme in this age group, especially in those longevous senior individuals.

Los individuos con edad avanzada consumen mayor número de medicamentos y, como consecuencia, surgen reacciones adversas frecuentes a estos fármacos, incluso en la cavidad bucal. El objetivo es verificar las reacciones adversas en la cavidad oral relacionadas con los medicamentos, a fin de que sean diagnosticadas correctamente y se ejecuten acciones que las reduzcan o eliminen. La metodología de esta revisión se buscaron artículos originales que informaron estas reacciones en las personas mayores, en inglés, portugués y español, publicados desde 2000 hasta 2018, si el uso de términos relacionados con el tema, publicados en línea en las bases de datos CAPES periódicas. Los artículos fueron seleccionados después de leer sus títulos y resúmenes efectuando, a continuación, lectura completa de los mismos. Los resultados muestran que, entre los 12 artículos seleccionados, tuvimos: 6 (50%) sobre xerostomía; 2 (17%) con ulceraciones orales consecuentes al nicorandil; 2 (17%) con osteonecrosis de la mandíbula (bifosfonato y bevacizumab, uno en cada uno); y 1 (8,3%) con ageusia (asociada a romidepsin); y 1 (8,3%) con candidiasis (asociada a corticoides inhalados). Se concluyó que el anciano requiere atención redoblada durante las consultas médicas y procedimientos odontológicos, en razón de la asociación de diferentes enfermedades crónicas y el uso continuo de diversas medicaciones. Hay necesidad de mayor número de publicaciones enfocando este tema en este grupo de edad, principalmente en aquellos individuos más longevos.

Erlotinib-related Severe Hair Loss with Severe Exanthematous Drug Eruption: A Case Report / 대한피부과학회지

Erlotinib inhibits the epidermal growth factor receptor and is used in patients with various cancers. However, it can affect the epidermis and hair because the receptor is expressed in normal skin cells. A 54-year-old woman with metastatic non-small-cell lung cancer presented with erythematous patches over her entire body and severe hair shedding 2 weeks after starting erlotinib. Histopathological examinations showed lymphocytic exocytosis; perivascular infiltration of lymphohistiocytes and eosinophils in the right arm; and marked infiltration of eosinophils, neutrophils, and lymphohistiocytes in the scalp. Erlotinib discontinuation improved hair loss and skin lesions. Hair loss has been reported in 5% of patients taking erlotinib. Our case was unusual in that there was complete baldness, and to our knowledge, no report of complete hair loss and exanthematous drug eruption after erlotinib treatment has been previously reported. Here, we report a case of severe hair loss with concurrent exanthematous drug eruption that may have been linked to erlotinib hypersensitivity.

Seguimento farmacoterapêutico de pacientes em tratamento com talidomida em um centro especializado em hanseníase / Pharmacotherapeutic follow-up of patients treated with thalidomide at a specialized leprosy center

OBJETIVOS: Avaliar a farmacoterapia de pacientes com reação hansênica tipo 2 em tratamento com talidomida em um centro filantrópico de atendimento especializado. MÉTODOS: O estudo foi realizado no Centro Maria Imaculada de reabilitação de pacientes com hanseníase na cidade de Teresina, Piauí. Foram incluídos na pesquisa pacientes de ambos os sexos atendidos entre setembro e novembro de 2016. O Seguimento Farmacoterapêutico foi fundamentado no Método Dáder, na base eletrônica Drugdex System ­ Thomson Micromedex® ­ Interactions para análise de interações medicamentosas; na classificação de reações adversas a medicamentos de Rawlins e Thompson; e no teste de Morisky-Green para avaliar o nível de adesão terapêutica. RESULTADOS: Foram acompanhados 11 pacientes, dos quais oito eram homens. Foram identificadas três interações medicamentosas, sendo duas classificadas em risco moderado e uma em menor risco. Foram identificados 23 resultados negativos associados ao medicamento, destacando-se insegurança não quantitativa e problemas de saúde não tratados. Além disso, 22 problemas relacionados com medicamentos foram identificados, sendo o mais frequente a ocorrência de reações adversas a medicamentos. Todas as reações adversas associadas a medicamentos foram classificadas como tipo A ou previsíveis. Quanto à adesão, seis entre os nove pacientes que responderam ao teste de Morisky-Green obtiveram alto grau de adesão. A educação em saúde correspondeu à intervenção farmacêutica preponderante, sendo aplicada a todos os pacientes. CONCLUSÕES: Foram evidenciadas interações medicamentosas relevantes, resultados negativos associados ao medicamento e problemas associados a medicamentos. O grau de adesão ao tratamento com talidomida foi considerado alto. Foram necessárias intervenções farmacêuticas, sobretudo voltadas para ações de educação em saúde, o que ratifica a necessidade de acompanhamento constante desse grupo de pacientes.

AIMS: Evaluate the pharmacotherapy of patients with type 2 leprosy reaction in treatment with thalidomide in a philanthropic center of specialized care at Teresina. METHODS: The study was conducted at the Centro Maria Imaculada, for rehabilitation of patients with leprosy, in the city of Teresina, Piauí, Brazil. Patients of both sexes attended between september and november 2016 were included in the study. Pharmacotherapeutic follow-up was based on the Dáder Method, in the electronic base Drugdex System ­ Thomson Micromedex® ­ Interactions for analysis of drug interactions; in the classification of adverse drug reactions of Rawlins and Thompson; and the Morisky-Green test to evaluate the level of therapeutic adherence. RESULTS: Eleven patients were followed, of whom eight were male. Three drug interactions were identified, two of which were classified as moderate risk and one in lower risk. There were 23 negative results associated with medicines, mainly quantitative insecurity and untreated health problems. In addition, 22 drug-related problems were identified, with adverse drug reactions being the most frequent occurrence. All adverse drug reactions were classified as type A or predictable. Regarding adhesion, six patients among nine who responded to the Morisky-Green test obtained a high degree of adhesion. Health education corresponded to the preponderant pharmaceutical intervention, being applied to all patients. CONCLUSIONS: Relevant drug interactions, negative results associated with medicines, and drug-related problems were identified. Degree of adherence to thalidomide treatment was considered high. Pharmaceutical interventions were necessary, mainly focused on health education actions, which ratifies the need for constant monitoring of this group of patients.