RESUMO
La isotretinoína es el medicamento más efectivo en el tratamiento del acné noduloquístico recalcitrante grave. Sin embargo, el tratamiento con este fármaco se encuentra asociado con efectos adversos, y el más grave es la teratogénesis. Se ha estimado que 40% de los embarazos expuestos a isotretinoína presenta un aborto espontáneo y 35% desarrolla embriopatía. Se presenta el caso de un recién nacido con antecedente de exposición prenatal a isotretinoína, una entidad clínica que puede evitarse, con graves defectos congénitos en el sistema nervioso central e importantes dismorfias faciales, con evolución clínica desfavorable.
Isotretinoin is the most effective drug in the treatment of severe recalcitrant nodulocystic acne. However, treatment with this drug is associated with adverse effects, the most severe being teratogenesis. It has been estimated that 40% of pregnancies exposed to isotretinoin present spontaneous abortion and 35% develop embryopathy. We present the case of a newborn with a history of prenatal exposure to isotretinoin, a clinical entity that can be avoided, with severe congenital defects in the central nervous system and important facial dysmorphisms, with unfavorable clinical course.
Assuntos
Humanos , Masculino , Recém-Nascido , Anormalidades Induzidas por Medicamentos/diagnóstico , Anormalidades Induzidas por Medicamentos/terapia , Isotretinoína/efeitos adversos , Evolução FatalRESUMO
Hemimelia (Greek Hemi + melos i.e Half limb) is a developmental anomaly characterized by the absence or gross shortening of lower portion of one ormore of the limbs. The condition may involve either or both bones of distal arm or leg. It is designated according to which bone is absent or defective as fibular, radial, tibial or ulnar hemimelia. In this study, I have analysed the details of a series of case reports, comprising of tibial (rarest form) and fibular (commonest form) hemimelia. The cases have been managed by physical medicine experts. The subjects aremanaging their ADL (Activities of daily living) bymeans of orthoprosthesis provided to them. Though the exact etiology is unknown, probable causes are- disruptions during the critical period of embryonic limb development (i.e 4th to 7th week of IUL), vascular dysgenesis, viral infections ,trauma and environmental influences ( like smoking) and thalidomide embryopathy etc. For optimum functional result in hemimelia patients our target is – “Reconstructive surgery and prosthesis adapted to growth together with regular post operative follow up and rehabilitation.”
RESUMO
Introducción: en modelos experimentales se han obtenido resultados prometedores con el empleo de suplementos antioxidantes en la prevención de la embriopatía diabética. Sin embargo, no siempre el beneficio es claro y queda por aclarar el mecanismo que subyace en esos resultados. Objetivo: evaluar el efecto de la suplementación nutricional con Vitamina E durante la gestación en la descendencia de ratas diabéticas. Materiales y Métodos: se emplearon ratas con diabetes inducida por estreptozotocina y ratas sanas como controles. Durante la gestación, un grupo de ratas diabéticas y uno de controles recibieron 150 mg/kg/día de vitamina E y los otros grupos el vehículo, hasta el día 11,5 en el que se practicó eutanasia. Se realizó el análisis morfológico de la descendencia y la determinación del contenido de ADN, proteínas y marcadores de estrés oxidativo en embriones. Para el análisis estadístico se emplearon pruebas no paramétricas y las diferencias se consideraron significativas con p < 0,05. Resultados: en las ratas diabéticas tratadas con Vitamina E se observó menor número de reabsorciones y los embriones tuvieron mayor talla, así como, menor retraso del desarrollo, severidad de las malformaciones y contenido de marcadores de daño oxidativo a proteínas y lípidos. Conclusiones: la suplementación nutricional con Vitamina E durante la gestación en ratas diabéticas disminuyó las pérdidas del producto de la concepción y favoreció el crecimiento y desarrollo de los embriones con menor daño oxidativo a biomoléculas que pudieran sugerir un efecto antioxidante beneficioso de esta vitamina.
Introduction: experimental models have obtained good results with the supplementation of antioxidants in the prevention of the diabetic embryopathy. However, not always the effect is beneficial and the mechanism of these results is unclear. T Objective: was to evaluate the effect of nutritional supplementation with vitamin E during gestation on offspring of diabetic rats. Materials and Methods: we used wistar rats with diabetes induced by streptozotocin and health rats like controls. During gestation, one group of diabetic rats and one group of controls received vitamin E 150mg/kg/day, and the others group the vehicle. Euthanasia was practiced at 11,5 day of pregnancy and we study the morphology of the products, DNA, proteins and oxidative stress markers in embryos. The statistic analyze was performed with non parametric tests and the significant differences were considered with p< 0, 05. Results: in diabetic rats with vitamin E the embryos were higher and decreased the number of resorptions, the developmental impairment and the content of oxidative damage markers to lipids and proteins in the embryos. Conclusions: nutritional supplementation with vitamin E during gestation in diabetic rats decreased the loss of the conception products, increased the growth and development of the embryos with decreased oxidative damage to biomolecules that will be suggest a beneficial antioxidant effect of the vitamin.
RESUMO
Thalidomide embryopathy resulted in babies born with deformities such as phocomelia after their mothers took only a few tablets of thalidomide drug during 36 to 56 days after their last menstrual periods. There are two thalidomide embryopathy groups depending upon whether their hypoplasia is in the limbs or the auditory organs. In the limb group, deformities range from amelia to hypoplasia of the thumb. In the auditory group, the severity can be determined by the degree of deafness. This group is often associated with aplasia of the abducens and facial nucleus. Fifty years after the thalidomide scandal, the drug is still in use. It helps treat leprosy, multiple myeloma, AIDS and cachexia. As of June 2012, there are two hundred and ninetyfive victims still living in Japan. Disabilities include inadequate pinch and grasp, besides short reach. In the last two decades, the condition of these patients has worsened with chronic intractable pain due to overuse of hypoplastic skeletal muscles. They are now suffering from snapping fingers, stenosing tenosynovitis (trigger finger) and carpal tunnel syndrome. As their concomitant deformities or impairments include dislocation of the shoulder, droopy shoulders, hip dislocation, cervical block vertebrae, thoracic kyphosis, scoliosis, occult spina bifida, and L 6 lumbarization, these have become secondary etiologies for chronic pain, resulting in a dependent ADL condition. For these patients, physical exercise or recreation activities have become a viscous circle of ever increasing pain, weakness and fatigue. Furthermore, the resulting inactivity and weight gain has made ADL even more problematic. They also suffer from internal organ anomalies. Thus, a variety of problems including weakness and chronic intractable pain, which may be called post-thalidomide syndrome, has created an additional barrier for the surviving thalidomide embryopathy patients in social participation, as their aging is progressing.
RESUMO
Warfarin is an oral anticoagulant which is known to cross the placenta causing birth defects, known as warfarin embryopathy; fetal effects of early gestational exposure to warfarin is known to cause marked nasal hypoplasia, rhizomelia, and stippled epiphyses. The period of greatest sensitivity is 6 to 9 weeks of gestational age. Clinical studies have suggested that discontinuing warfarin before 6 weeks of gestational age could avoid the teratogenic effect. We experienced a women who had been taking warfarin for 15 years because of SLE (Systemic Lupus Erythematosus) and CRF (Chronic renal failure), who was found to be pregnant at 9 weeks of gestation. She discontinued warfarin and started heparin treatment, however the ultrasound examination showed shortened long bone, scalp edema, and cardiac anomaly (Ventricular septal defect), and termination of pregnancy was performed at 17 weeks of gestation. We report a case of warfarin embryopathy resulting from warfarin exposure until 9 weeks of gestation with a brief review of literature.