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O alopurinol, de uso contínuo oral, é o tratamento de escolha para os distúrbios hereditários do glicogênio. Apesar de não ser comum, a reação de hipersensibilidade ao alopurinol se torna um problema quando esta é a única medicação disponível para o controle da doença de base. Nestes casos, a dessensibilização é uma alternativa viável. No presente relato, descrevemos o caso de um paciente com diagnóstico de doença de depósito de glicogênio tipo I, com exantema pruriginoso generalizado ao alopurinol, tratado com um protocolo de dessensibilização oral acelerado. Este tratamento permitiu o uso contínuo deste medicamento sem novas reações em longo prazo.
Continuous oral allopurinol use is the first-line treatment for hereditary glycogen disorders. While hypersensitivity reactions to allopurinol are uncommon, they can pose challenges when this medication is the only available option for the long-term treatment of the underlying disorder. In such cases, desensitization emerges as a viable alternative. We report the case of a patient with glycogen storage disease type I who developed a generalized pruritic rash due to allopurinol. Drug intolerance was successfully managed using a rapid oral desensitization protocol, which allowed an uneventful long-term use of allopurinol.
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Humanos , Masculino , AdultoRESUMO
Abstract Objective Despite an increase in the rate of successful live donor renal transplantation done annually, the number of potential recipients with acceptable donors is relegated to the ever-expanding cadaver-donor waiting list due to sensitization to human leukocyte antigen (HLA) antibodies. If not sufficiently suppressed, these preformed HLA antibodies can trigger antimicrobial resistance (AMR) and early graft loss. To ameliorate this situation, various desensitization treatments are administered to provide a survival benefit to highly sensitized patients. Method One hundred and six patients in the time frame of January 2017 to March 2019 were included in the study group. The desensitization protocol included therapeutic plasma exchange and administration of low-dose intravenous immunoglobulin (100 mg/kg per therapeutic plasma exchange (TPE) session) to highly sensitized patients (treatment group) who subsequently underwent renal transplantation after negative pre-transplant Centers for Disease Control and Prevention Luminex crossmatch (CDC/LumXM). We compared graft survival rates between the group undergoing desensitization (treatment group) and matched control group of patients that underwent HLA-compatible transplantation. Results In the treatment group, Kaplan-Meier analysis estimates an average rate of patient graft survival of 95.2% at 3 years post-transplant, as compared with the rate of 86.9% in the same time frame for the control-matched group (p < 0.05 for both comparisons). Conclusion Desensitization treatment with TPE before live donor renal transplantation in the case of patients with HLA sensitization provides better survival benefits along with monitoring for donor-specific antibodies (DSAs) and other infections, rather than waiting for a compatible organ donor. The data lays out evidence that desensitization treatments can assist overcome HLA incompatibility barriers in live donor renal transplantation.
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HistocompatibilidadeRESUMO
Objective To investigate the effects of anti-HLA donor-specific antibodies(DSA)and desensitization for DSA+patients on engraftment of haploidentical hematopoietic stem cell transplantation(haplo-HSCT).Methods The patients who underwent haplo-HSCT and examinations for HLA antibodies and DSA in our department from March 2017 to July 2023 were recruited in this study.The effects of desensitization measure on engraftment in the DSA+patients after haplo-HSCT were analyzed.Results Among the 70 patients who underwent haplo-HSCT and test for HLA antibodies,15(21.4%)patients were DSA positive,including 7(46.7%)cases of strong positive,3(20.0%)cases of moderate positive,and 5(33.3%)cases of weak positive.The median duration for neutrophil implantation was significantly extended in the DSA+patients than the negative patients(P=0.027).For the 6 patients developed graft failure(GF),4 were DSA+which was statistically higher than the DSA-patients(P=0.025).Multivariate regression analysis showed that DSA was an independent factor affecting GF(HR=9.273,95%CI:1.505~57.124,P=0.016).Among the 10 patients(7 strong positive and 3 moderate positive DSA)received desensitization therapy,4 patients received combination desensitization,with a 100%rate of successful transplantation,and 6 received single desensitization,with 4(66.7%)experiencing GF,so the GF rate was obviously lower in the combination than the single desensitization(P=0.008).Conclusion In haplo-HSCT patients,DSA is an important factor leading to implantation delay and GF.While,single desensitization treatment has limited efficacy.In combined DSA desensitization therapy,the decrease of antibody titer should be dynamically monitored to ensure the successful implantation of stem cells and reduce GF rate.
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Abstract Objective Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). Methods Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. Results 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p =0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p =0,025). Thirty patients underwent the YFV desensitization protocol. Conclusion There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary.
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Introduction: Hypersensitivity to chemotherapeutic and biological agents has increased in recent years due to their frequent use. Avoidance has been the first line of defense, leading to decreased treatment efficacy and increased adverse events. Objective: To characterize the sociodemographic and clinical aspects of patients with hypersensitivity reactions to chemotherapeutic agents who underwent desensitization and biological procedures in a Colombian city. Methods: This observational, descriptive, retrospective, multicenter study was conducted in patients with hypersensitivity reactions to chemotherapeutic and biological agents who underwent desensitization. Results: In the 14 included patients with a history of hypersensitivity reactions to chemotherapeutic and biological agents (57.1% women; median age 42.5 years), 45 desensitization procedures were performed. The most commonly prescribed drug was rituximab (57%). The skin was the most frequent reaction site (78.6%), and systemic corticosteroids were the most common treatment (78.6%). Breakthrough reactions occurred in 31.1% of the patients and only premedication with corticosteroids was associated with less severe reactions. All cases of desensitization were successful. Conclusions: Desensitization to chemotherapeutic and biological agents proved to be a useful and safe tool in a Colombian population.
Introdução: A hipersensibilidade aos agentes quimioterápicos e biológicos aumentou nos últimos anos devido ao seu uso frequente. Evitar tem sido a primeira linha de ação, levando à diminuição da eficácia do tratamento e ao aumento de eventos adversos. Objetivos: Caracterizar os aspectos sociodemográficos e clínicos de pacientes com reações de hipersensibilidade a agentes quimioterápicos submetidos a dessensibilização e procedimentos biológicos em uma cidade colombiana. Métodos: Foi realizado um estudo observacional, descritivo, retrospectivo e multicêntrico em pacientes com reações de hipersensibilidade a agentes quimioterápicos e biológicos submetidos à dessensibilização. Resultados: Foram incluídos 45 procedimentos de dessensibilização em 14 pacientes com histórico de reações de hipersensibilidade a agentes quimioterápicos e biológicos (57,1% mulheres, com mediana de idade de 42,5 anos). O medicamento mais relatado foi o rituximabe (57%). O envolvimento cutâneo foi o mais frequente (78,6%) e os corticosteroides sistêmicos foram o tratamento mais utilizado (78,6%). As reações ocorreram em 31,1% e apenas a pré-medicação com corticosteroides foi associada a uma menor gravidade destas. Todos os casos de dessensibilização foram bem-sucedidos. Conclusões: A dessensibilização a agentes quimioterápicos e biológicos provou ser uma ferramenta útil e segura em uma população colombiana.
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HumanosRESUMO
A pitiríase versicolor (PV) consiste em uma infecção fúngica ocasionada por leveduras de Malassezia spp., que apesar de manejo simples, é uma doença com elevadas chances de recidiva e cronificação, além da pouca variedade de terapias efetivas para tratar cepas resistentes. Existem relatos na literatura sobre utilização de dessensibilização para Malassezia spp., mas para o tratamento de dermatite atópica e não PV, conferindo caráter inovador ao relato em questão. O caso apresentado consiste em um paciente de 28 anos, do sexo masculino, com manifestações típicas de PV em região de face, cervical, dorsal e axilar, há 4 anos, com resistência aos esquemas terapêuticos tópicos e sistêmicos. Uma vez identificada a ineficácia das terapias tradicionais, foi iniciado o tratamento com dessensiblização para Malassezia spp., em aplicações semanais, com aumento progressivo da dosagem e posterior aumento no intervalo das aplicações. Após onze meses de realização do novo tratamento, o paciente evoluiu com melhora completa das lesões. Conclui-se que a utilização de técnicas imunoterápicas para o tratamento de PV foi considerado eficaz no caso relatado, apesar de ainda não haver evidências que amparem sua utilização em maior escala.
Pityriasis versicolor is a infection caused by Malassezia yeast species, which, despite simple management, involves a high risk of recurrence and chronicity, and there are few effective therapies for resistant strains. Desensitization for Malassezia spp. has been reported in the literature, but for atopic dermatitis, rather than pityriasis versicolor, making this an innovative report. The case presented herein is of a 28-year-old man who had typical manifestations of pityriasis versicolor in the face, cervical, dorsal, and axillary region for 4 years that were resistant to topical and systemic therapies. Once the ineffectiveness of traditional therapies had been determined, weekly Malassezia desensitization sessions were begun, progressively increasing first in dosage and then in frequency. After 11 months, the lesions had improved completely. In this case, immunotherapeutic techniques effectively treated pityriasis versicolor, although the evidence is as yet insufficient to support large-scale use.
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Humanos , Masculino , AdultoRESUMO
Objective:Currently,patients with pre-exsiting donor-specific antibody(DSA)are prone to antibody-mediated rejection(AMR)after surgery and are at a relatively high risk of postoperative complications and graft failure.The risk of postoperative complications and graft failure is relatively high.This study aims to discuss the clinical outcome of DSA-positive kidney transplantation and analyze the role and safety of preoperative pretreatment in DSA-positive kidney transplantation,providing single-center treatment experience for DSA-positive kidney transplantation. Methods:We retrospectively analyzed the clinical data of 15 DSA-positive kidney transplants in the Department of Renal Transplantation of First Affiliated Hospital of Zhengzhou University from August 2017 to July 2022.Eight cases were organ donation after citizen's death(DCD)kidney transplant recipients,of which 3 cases in the early stage were not treated with preoperative desensitisation therapy(DCD untreated group,n=3),and 5 recipients were treated with preoperative rituximab desensitisation(DCD preprocessing group,n=5).The remaining 7 cases were living related donors recipients(LRD)who received preoperative desensitisation treatment with rituximab and plasma exchange(LRD preprocessing group,n=7).We observed and recorded the incidence of complications with changes in renal function and DSA levels in the recipients and the survival of the recipients and transplanted kidneys at 1,3 and 5 years,and to compare the differences in recovery and postoperative complications between 3 groups. Results:All 15 recipients were positive for preoperative panel reactive antibody(PRA)and DSA and were treated with methylprednisolone+rabbit anti-human thymocyte immunoglobulin induction before kidney transplantation.DCD untreated group all suffered from DSA level rebound,delayed renal graft function(DGF)and rejection reaction after surgery.After the combined treatment,DSA level was reduced and the graft renal function returned to normal.The DCD preprocessing group were all without antibody rebound,1 recipient developed DGF and the renal function returned to normal after plasmapheresis,and the remaining 4 recipients recovered their renal function to normal within 2 weeks after the operation.In the LRD preprocessing group,2 cases had antibody rebound and 1 case had rejection,but all of them recovered to normal after treatment,and DSA was maintained at a low level or even disappeared.The incidence of DGF and rejection in the DCD untreated group were significantly higher than that in the DCD preprocessing group and the LRD preprocessing group;and there were no significant difference in the incidence of postoperative haematuria,proteinuria,bacterial and fungal infections,and BK virus infection between the 3 groups(all P>0.05).A total of 11 of the 15 recipients were followed up for more than 1 year,6 for more than 3 years,and 1 for more than 5 years,and the survival rates of both the recipients and the transplanted kidneys were 100%. Conclusion:Effective preoperative pretreatment with desensitization therapy can effectively prevent antibody rebound in DSA-positive kidney transplantation and reduce perioperative complications.
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Desensitization therapy for iodinated contrast media (ICM) aims to induce drug tolerance in patients with a history of severe allergic reactions to ICM in a short time. Currently, there is no widely accepted consensus on inducing desensitization to avoid severe allergic responses to ICM. The clinically successful cases have shown that prophylactic use of antihistamines and glucocorticoids can increase the desensitization effect; repeatedly desensitizing and gradually increasing the dose can be conducive to establishing better tolerance to ICM. Most desensitization effects, including stress resistance, can endure 24-48 h. The mechanisms of desensitization therapy remain unclear, the initial dose, administration interval and dose gradient are largely based on clinical experiences and the reaction of patients. This article reviews the current research progress on ICM-related allergies, desensitization methods and related mechanisms, as well as the benefits and hazards of desensitization, to provide a reference for desensitization treatment of hypersensitivity to ICM .
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Humanos , Meios de Contraste/efeitos adversos , Consenso , Glucocorticoides , HipersensibilidadeRESUMO
Introdução: A vacina contra a febre amarela é cultivada em ovos embrionados de galinha e por isso pode estar contraindicada em indivíduos alérgicos ao ovo. Quando indicada, deve ser aplicada com cautela, após atendimento especializado para avaliação de testes e necessidade de dessensibilização. Sua segurança nos alérgicos ao ovo ainda é pouco estudada. Objetivo: Descrever uma população pediátrica encaminhada por alergia ao ovo, com ou sem diagnóstico comprovado, e os casos de eventos adversos do tipo imediata à vacina contra a febre amarela em um centro de referência para imunobiológicos especiais (CRIE). Material e métodos: Estudo transversal realizado com coleta de dados retrospectivos de crianças entre 9 meses e 12 anos de idade, vacinadas contra a febre amarela com história de alergia ao ovo, no período de 2018 a 2019. Resultados: Dentre as 829 crianças, com diagnóstico presumido de alergia ao ovo, foi identificada uma maior prevalência de sintomáticos após exposição ao ovo, com IgE específica detectável para ovo, clara de ovo e/ou ovoalbumina. Testes para vacina febre amarela foram realizados em 25 crianças com suspeita de alergia grave ou anafilaxia ao ovo, sendo 15 (60%) positivos com a vacina aplicada após dessensibilização. Foram evidenciados apenas 11 (1,3%) casos de evento adverso imediato à vacina, todos classificados como evento adverso não grave e com acometimento especial da pele (reação local e exantema ou urticária). A maioria dos eventos ocorreu em menores de 2 anos, nos sintomáticos após ingesta de ovo e naqueles com altos valores de IgE específica para clara de ovo. Conclusão: Este estudo evidencia que a vacina contra a febre amarela pode ser aplicada em crianças alérgicas ao ovo, de forma segura, inclusive naquelas com história de anafilaxia, desde que em ambiente adequado e com profissionais especializados.
Introduction: The yellow fever vaccine is grown in embryonated chicken eggs and may be contraindicated for egg-allergic individuals. When indicated, it should be applied with caution, after testing and desensitization. Its safety in egg-allergic patients is still poorly studied. Objective: To describe a pediatric population referred for egg allergy, with or without a confirmed diagnosis, and cases of immediate-type adverse events to the yellow fever vaccine at a reference center for special immunobiologicals. Material and methods: This cross-sectional study collected retrospective data from children between 9 months and 12 years of age who were vaccinated for yellow fever between 2018 and 2019 and had a history of egg allergy. Results: In the 829 children diagnosed with presumed egg allergy, a higher prevalence of symptoms was identified after egg exposure, with detectable specific IgE for egg, egg white, and/ or egg albumin. Yellow fever vaccine tests were performed in 25 children suspected of severe allergy or anaphylaxis to eggs, and 15 (60%) tested positive to the vaccine after desensitization. Only 11 (1.3%) cases of immediate adverse events to the vaccine occurred, all classified as non-serious events that especially involved the skin (local reaction and rash or urticaria). Most events occurred in children under 2 years of age, those symptomatic after egg ingestion, and those with high levels of specific IgE to egg white. Conclusion: This study demonstrated that the yellow fever vaccine can be safely administered to egg-allergic children, including those with a history of anaphylaxis, in an appropriate environment and with specialized professionals.
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Humanos , Lactente , Pré-Escolar , CriançaRESUMO
Resumen El objetivo fue conocer la exposición y desensibilización a la violencia en jóvenes de cinco contextos en distintas instituciones educativas y de readaptación social de la ciudad de San Luis Potosí. Método: se realizó un estudio analítico transversal comparativo de 25 instituciones de educación media superior, ubicados en Zonas Rurales (ZR), en Polígonos de Violencia (PV), Cercanas a Polígonos de Violencia (CPV), en Zonas Alejadas de los Polígonos de Violencia (ZAPV), y en un Centro de Internamiento Juvenil (CIJ) con un total de 1720 participantes; 851 (49.5 %) hombres y 869 (50.5%) mujeres. Resultados: Se encontraron medias significativamente más altas en desensibilización a la violencia en participantes del CIJ, seguidos por participantes de las ZAPV, y al final el ZR. Referente a la exposición a la violencia fue mayor en aquellos provenientes de las ZAPV después en jóvenes del CIJ y finalmente los de ZR. Conclusiones: La desensibilización a la violencia se presenta como consecuencia a la exposición de la violencia y las conductas que atentan contra la seguridad social. Finalmente, se encontró que las actividades artísticas y los padres unidos funcionan como factores de protección contra la desensibilización a la violencia.
Abstract The aim of this research was to measure the exposure and desensitization to violence in young people from five contexts in different educational institutions and a Juvenile Detention Center in the city of San Luis Potosí and its surroundings in Mexico. Desensitization to violence is a phenomenon that is generated due to constant exposure to violence, resulting in a decrease in emotional responses, adverse judgments, and opposition to violent acts, it can lead to a normalization of violent acts and with it a minimization of their seriousness, which promotes positive emotions in the individual such as pleasure, fun or entertainment when exposed to said acts or events. Method: a comparative cross-sectional analytical study was carried out in 25 institutions of higher secondary education, located in rural areas and in polygons identified as violent, near to polygons and far from them, and in a Juvenile Detention Center with a total of 1720 male participants. Results: Significantly higher means were found in desensitization to violence in participants from the internment center, later from those of the areas that were initially identified as far from the polygons of violence, and finally the lowest in the rural context. Regarding exposure to violence, it was higher in those participants far from the polygons of violence, then in young people from the internment center, and finally those from the rural context. In addition, of the three areas analyzed, lower levels of schooling were found in people in a situation of internment. Conclusions: Desensitization to violence occurs as a consequence of exposure to violence and behaviors that threaten social security. Also, it was found that artistic activities and being part of a family, with father and mother together, worked as a protective factor against desensitization to violence. Some plausible explanations for these findings are suggested.
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Resumen La fisiopatología del tinnitus crónico no pulsátil es poco clara, pero se reconoce un componente psicológico relevante, por tanto, existen distintas aproximaciones psicoterapéuticas que han sido estudiadas. La terapia cognitivo conductual es la que cuenta con mayor evidencia. Ella contempla la reestructuración de las cogniciones disfuncionales que favorecen la presencia del tinnitus. Se ha verificado su eficacia en los niveles de distrés, calidad de vida, severidad, sintomatología depresiva e insomnio asociados. La desensibilización y reprocesamiento por movimientos oculares recoge algunos presupuestos de la terapia cognitivo conductual, pero considera técnicas como la estimulación bilateral. Sus resultados en patologías crónicas somáticas han sugerido la aplicación en tinnitus, corroborando su eficacia en calidad de vida, distrés y sintomatología depresiva. Dos psicoterapias basadas en mindfulness aplicadas en tinnitus son la reducción del estrés basado en el mindfulness y la terapia cognitiva basada en mindfulness. La primera ha demostrado eficacia en la calidad de vida y en la disminución y el refuerzo de cogniciones negativas y positivas, respectivamente. La segunda, es eficaz en la severidad, intensidad, distrés, ansiedad, depresión y discapacidad asociadas a tinnitus. Finalmente, la terapia de aceptación y compromiso promueve la aceptación como componente central del tratamiento de condiciones crónicas, considerando el control que ejerce el contexto sobre la vivencia de estas condiciones y el compromiso terapéutico. Esta terapia es eficaz en calidad de vida. Se promueve la investigación en aproximaciones psicoterapéuticas para el tinnitus, lo que posibilitará la aplicación de terapias más específicas y la clarificación de su fisiopatología.
Abstract The pathophysiology of non-pulsatile chronic tinnitus is unclear, but it is recognized a relevant psychological component. In this sense, different psychotherapeutic approaches have been studied. Cognitive behavioral therapy is the psychotherapy with the most evidence. It considers the restructuring of dysfunctional cognitions that favor the presence of tinnitus. Its efficacy has been verified on distress, quality of life, severity, associated depressive symptoms and insomnia. Eye movement desensitization and reprocessing includes some conceptions of cognitive behavioral therapy and considers techniques such as bilateral stimulation. Its results in chronic somatic pathologies have suggested its application in tinnitus, corroborating its efficacy in quality of life, distress, and depressive symptoms. Two mindfulness-based psychotherapies applied in tinnitus are mindfulness-based stress reduction and mindfulness-based cognitive therapy. The first has shown efficacy on quality of life and reduction and reinforcement of negative and positive cognitions, respectively. The second is effective on severity, loudness, distress, anxiety, depression and disability associated with tinnitus. Finally, acceptance and commitment therapy promote acceptance as a central component of the treatment of chronic conditions, considering the control exerted by the context over the experience of these conditions and the therapeutic commitment. This therapy is effective on quality of life. We foster the research on psychotherapeutic approaches to tinnitus, which will make it possible the application of more specific interventions and, at the same time, elucidate its pathophysiology.
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Humanos , Zumbido/terapia , Terapia Cognitivo-Comportamental , Dessensibilização e Reprocessamento através dos Movimentos Oculares , Psicoterapia , Qualidade de Vida , Zumbido/fisiopatologia , Zumbido/psicologiaRESUMO
Introducción: La osteomielitis es una inflamación del tejido óseo, la cual puede ser causada por un agente infeccioso de tipo Gram positivo como Gram negativo, generalmente ocasionado por Staphylococcus aureus; esta infección usualmente es tratada con trimetoprim + sulfametoxazol, desafortunadamente durante el tratamiento pueden aparecer reacciones adversas a medicamentos de tipo alérgicas, lo que implicaría un cambio de antibiótico o someter al paciente a esquema de desensibilización. Objetivo: Reportar el caso de un paciente que fue sometido a dicho esquema, empleando la vía intravenosa. Resultados: Paciente masculino de 14 años de edad ingresó a la institución con osteomielits de tibia derecha en su posoperatorio de osteosintesis realizado dos meses antes. Se decidió iniciar tratamiento con TMP-SMX 300 mg intravenoso (IV) cada 12 horas. Se informó al paciente y ya que era menor de edad, a su familiar a cargo sobre la importancia del procedimiento, posibles riesgos y beneficios mediante consentimiento informado por escrito. El paciente presentó una erupción cutánea acompañada de prurito en el pecho y espalda, lo cual fue tratado y solucionado, por consiguiente se dispuso a someter al paciente al esquema para su desensibilización el cual fue realizado empleando el medicamento en solución inyectable (trimetoprim + sulfametoxazol 400 mg + 80 mg/5 mL) para dar continuidad a su tratamiento, además el paciente fue monitorizado y no se le administró tratamiento con antihistamínicos o corticoides para así evitar una respuesta errónea o resultados falsos/positivos durante el procedimiento. Conclusión: El paciente fue desensibilizado con éxito para continuar con su tratamiento farmacológico. Este caso reportado puede contribuir a modificar los esquemas de desensibilización actuales, el esquema de desensibilización es una herramienta muy útil para continuar el tratamiento farmacológico en pacientes con hipersensibilidad al TMP/SMX, sin necesidad de optar por otras alternativas terapéuticas que podrían ser menos eficaces para el control de la infección.
SUMMARY Introduction: Osteomyelitis is an inflammation of the bone tissue, which can be caused by a Gram-positive or Gram-negative infectious agent, generally caused by Staphylococcus aureus. This infection is usually treated with trimethoprim + sulfamethoxazole. Unfortunately, adverse drug reactions of the allergic type may appear during treatment, which would imply a change of antibiotic or subject the patient to a desensitization scheme. Objective: To report the case of a patient who underwent this scheme, using the intravenous route. Results: A 14-year-old male patient was admitted to the institution with osteomyelitis of the right tibia in his postoperative period of osteosynthesis performed two months earlier. It was decided to start treatment with TMP-SMX 300 mg intravenously (IV) every 12 hours. The patient and, since he was a minor, his dependent relative were informed about the importance of the procedure, possible risks and benefits through written informed consent. The patient presented a skin rash accompanied by itching on the chest and back. which was treated and resolved, therefore, the patient was submitted to the scheme for his desensitization, which was carried out using the medicine in injectable solution (trimethoprim + sulfamethoxazole 400 mg + 80 mg/5 mL) to continue his treatment, In addition, the patient was monitored and treatment with antihistamines or corticosteroids was not administered in order to avoid an erroneous response or false/positive results during the procedure. Conclusion: The patient was successfully desensitized to continue with his pharmacological treatment. This reported case can contribute to modify the current desensitization schemes; the desensitization scheme is a very useful tool to continue pharmacological treatment in patients with hypersensitivity to TMP/SMX, without the need to opt for other therapeutic alternatives that could be less effective for infection control.
Introdução: A osteomielite é uma inflamação do tecido ósseo, que pode ser causada por um agente infeccioso Gram-positivo ou Gram-negativo, geralmente causado por Staphylococcus aureus; essa infecção geralmente é tratada com trimetoprima + sulfametoxazol, mas infelizmente, durante o tratamento, podem surgir reações adversas medicamentosas do tipo alérgico, o que implicaria na troca de antibiótico ou submeter o paciente a um esquema de dessensibilização. Objetivo: Relatar o caso de um paciente submetido a esse esquema, pela via intravenosa. Resultados: Um paciente do sexo masculino de 14 anos foi admitido na instituição com osteomielite da tíbia direita em pós-operatório de osteossíntese realizada há dois meses. Optou-se por iniciar o tratamento com TMP-SMX 300 mg por via intravenosa (IV) a cada 12 horas. O paciente e, por ser menor de idade, seu familiar dependente foram informados sobre a importância do procedimento, possíveis riscos e benefícios por meio do termo de consentimento livre e esclarecido. O paciente apresentou erupção cutânea acompanhada de coceira no tórax e nas costas, que foi tratado e resolvido, portanto, o paciente foi submetido ao esquema para sua dessensibilização, que foi realizada utilizando o medicamento em solução injetável (trimetoprim + sulfa-metoxazol 400 mg + 80 mg/5 mL) para continuar seu tratamento. o paciente foi monitorado e não foi administrado tratamento com anti-histamínicos ou corticos-teróides para evitar resposta errônea ou resultados falsos/positivos durante o procedimento. Conclusão: O paciente foi dessensibilizado com sucesso para continuar com seu tratamento farmacológico. Este caso relatado pode contribuir para modificar os esquemas de dessensibilização atuais, o esquema de dessensibilização é uma ferramenta muito útil para continuar o tratamento farmacológico em pacientes com hipersensibilidade ao TMP/SMX, sem a necessidade de optar por outras alternativas terapêuticas que poderiam ser menos eficazes para o controle de infecção.
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Resumen Introducción: la desensibilización y reprocesamiento por movimientos oculares (EMDR) tiene abundante evidencia de eficacia en desórdenes del espectro traumático. Su eficacia en trastornos ansiosos (TA) y depresivos (TD) en niños, niñas y adolescentes ha sido escasamente estudiada. Método: se realizó una revisión narrativa para describir la evidencia disponible sobre eficacia de EMDR en TA y TD en población infantojuvenil. Se buscaron artículos disponibles en PubMed/Medline, SciELO, PsycINFO y Cochrane Library. Se incluyeron todos los artículos primarios y secundarios que evaluaron el efecto de EMDR en TA y TD en población infantojuvenil. Se revisaron sus referencias como segundo método de inclusión. Resultados: se identificaron nueve estudios (cinco en TA y cuatro en TD); tres fueron observacionales y seis experimentales. Todos tuvieron tamaños muestrales reducidos. En TA, los estudios corroboraron la eficacia de EMDR sobre el temor fóbico en fobia a las arañas, pero no sobre la conducta evitativa, donde sería superior la exposición in vivo. Dos series de casos expusieron la utilidad de EMDR en fagogobia y en TA asociados a epilepsia. En TD, EMDR fue eficaz en la reducción de sintomatología depresiva en el contexto del trastorno depresivo mayor, trastorno de estrés agudo y trastornos conductuales. EMDR fue comparable a terapia cognitivo-conductual. Conclusiones: la evidencia corrobora la eficacia de EMDR en TA y TD en niños, niñas y adolescentes. Sin embargo, es muy escasa y cuenta con limitaciones metodológicas. Es necesario realizar estudios experimentales con protocolos estandarizados y especializados de EMDR para TA y TD en población infantojuvenil.
Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of efficacy in traumatic spectrum disorders. Its efficacy in anxiety disorders (AD) and depressive disorders (DD) in children and adolescents has been scarcely studied. Methods: We conducted a narrative review to describe the available evidence on the efficacy of EMDR in AD and DD in children and adolescents. We searched for articles available in PubMed/Medline, SciELO, PsycInfo and the Cochrane Library. All primary and secondary studies evaluating the effect of EMDR on AD and DD in children and adolescents were included. Their references were reviewed as a second method of inclusion. Results: nine studies were identified (five in AD and four in DD); three were observational and six experimental. All had small sample sizes. In AD, studies corroborated the efficacy of EMDR on phobic fear in spider phobia, but not on avoidance behavior, where in vivo exposure would be superior. Two case series reported the efficacy of EMDR in choking phobia and AD associated with epilepsy. In DD, EMDR was effective in reducing depressive symptomatology in the context of major depressive disorder, acute stress disorder, and conduct disorders. EMDR was comparable to cognitive behavioral therapy. Conclusions: The evidence corroborates the efficacy of EMDR in AD and DD in children and adolescents. However, it is very scarce and has methodological limitations. It is necessary to carry out experimental studies with standardized and specialized EMDR protocols for AD and DD in the child and adolescent population.
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Humanos , Criança , Adolescente , Transtornos de Ansiedade/terapia , Transtorno Depressivo/terapia , Dessensibilização e Reprocessamento através dos Movimentos OcularesRESUMO
Objective:To investigate eye movement desensitization and reprocessing on ICU memory and post-traumatic stress disorder among patients with ventilator associated pneumonia.Methods:Totally, 66 cases of ICU patients with ventilator associated pneumonia enrolled at Guangzhou Red Cross Hospital from August 2017 to August 2020 were collected as research object, they were randomly divided into intervention group and control group, with 33 cases in each groups. The control group received routine nursing care and cognitive training, in the intervention group, patients implemented EMDR therapy for 8 times. Before and after intervention, the effect was assessed by ICU memory scale and PTSD Checklist-Civilian Version, respectively.Results:After intervention, the scores of factual memories, emotional memories, delusional memories dimension and total ICUMS were (19.48±5.14), (10.45±2.62), (7.06±2.62) and (37.00±6.12) in the intervention group, those scores in the control group were (24.58±7.38), (13.58±4.07), (9.48±3.57) and (47.64±9.99), the difference was statically significant (t values were 3.14-5.22, all P<0.05). The re-experiencing, avoidance, hyperarousal dimensions scores and total PCL-C scores were (8.09±2.13), (10.42±2.62), (7.24±2.69) and (25.76±4.25) in the intervention group, and in the control group those scores were (9.30±2.35), (12.73±2.11), (9.24±2.51) and (31.27±4.97), the difference was statically significant (t values were 2.20-4.85, all P<0.05). Conclusions:Eeye movement desensitization and reprocessing therapy can effectively alleviate ICU memory and improve PTSD symptoms of patients with ventilator associated pneumonia.
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@#Dental anxiety refers to the unique tension, worry and even fear of dental treatment, which may lead to patients refusing to receive treatment and missing the best time for treatment. With the development of bio-psycho-social medical models, psychotherapy has gradually become the optimal treatment for dental anxiety. This article reviewed the etiology, evaluation and psychotherapy of dental anxiety. Research has shown that uncomfortable dental treatment experience is the main cause of dental anxiety, which is commonly assessed using questionnaires in clinical practice. Psychotherapy for dental anxiety is a noninvasive, widely applicable treatment without side effects, mainly including improving the treatment environment and service attitude, behavior therapy, and cognitive therapy, which has been shown to effectively alleviate dental anxiety in patients. However, psychotherapy for dental anxiety is highly demanding for dentists, which hinders its promotion and application. At the same time, the psychotherapeutic mechanism of dental anxiety is not clear and remains to be further elucidated by large-scale and high-quality randomized controlled studies.
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Allergen immunotherapy (AIT), also known as allergen vaccine desensitization, is currently the only treatment that can change the natural course of allergic diseases. AIT for pregnant women is a protective factor for neonatal allergies. Existing findings suggest that AIT should not be started during pre-pregnancy, pregnancy, or lactation periods, but can be continued if has already been started before; unexpected pregnancy during AIT does not require termination; AIT shows no obvious adverse effects on fetuses, infants, and young children. The latest evidence on the effectiveness and safety of AIT during pre-pregnancy, pregnancy, and lactation periods were reviewed.
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By analyzing the theoretical basis of safeguarding citizens’ personal information right during the normalization period of epidemic prevention and control, this paper concluded that there are some problems in personal information, such as solidified collection and utilization mode, low degree of management systematization, imperfect processing technology and narrow application scope, low degree of data value development and high risk coefficient. Further combined with China’s current epidemic prevention mode and social governance characteristics, this paper put forward the idea of innovating data hierarchical management and implementing the sharing mode in the industry to reduce the number of information circulation, trace the source, strengthen data desensitization technology and broaden its application scope, make rational use of personal information and appropriately develop its commercial use to increase its utilization efficiency.
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La enfermedad de Pompe es un desorden neuromuscular autosómico recesivo de baja prevalencia, causado por la deficiencia total o parcial de la enzima alfa glucosidasa ácida (GAA), cuya única terapia de reemplazo enzimático disponible es la alglucosidasa alfa recombinante. Las reacciones adversas asociadas a la infusión se presentan con frecuencia. Se reportan dos casos de desensibilización exitosa con alglucosidasa alfa utilizando protocolos con dosis meta de 20 mg/kg, administrados quincenalmente; el primero de ellos, en una niña con historia de reacción adversa grave a los 15 meses de edad, en quien se utilizó un esquema con una dilución inicial de 1/10.000.000 de 28 pasos y una duración total de 13,1 horas. En el segundo caso, la paciente tuvo una reacción adversa grave a los 4 años de edad, se utilizó el protocolo de 22 pasos, concentración inicial de 1/1.000.000 y duración total de 7,2 horas. Se concluye que en pacientes con enfermedad de Pompe que presentan reacciones adversas durante la terapia de reemplazo enzimático, es posible realizar la desensibilización cada dos semanas con la dosis estándar de 20 mg/kg de forma exitosa, y progresivamente lograr la administración usual de la infusión
Pompe disease is a low prevalence autosomal recessive neuromuscular disorder, caused by total or partial deficiency of the acid alpha-glucosidase (GAA) enzyme, and its only available enzyme replacement therapy is the recombinant alglucosidase alfa. Infusion-associated adverse reactions occur frequently. Two cases of successful desensitization with alglucosidase alfa using protocols with a target dose of 20 mg/kg administered biweekly are reported; the first was a girl who had a history of serious adverse reaction at the age of 15 months, and undergone to a scheme with an initial dilution of 1/10,000,000 with 28 steps and a total duration of 13.1 hours. In the second case, the patient had a severe adverse reaction at the age of 4 years, a 22-step protocol was used with an initial concentration of 1/1,000,000 and a total duration of 7.2 hours. In conclusion, in patients with Pompe disease who presented adverse reactions during enzyme replacement therapy with alglucosidase alfa, it is possible to perform desensitization every two weeks with the standard dose of 20 mg/kg, and progressively achieve the usual administration of the infusion
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Doença de Depósito de Glicogênio Tipo II , Terapêutica , Dessensibilização Imunológica , Enzimas , alfa-Glucosidases , HipersensibilidadeRESUMO
Las reacciones a medicamentos han aumentado con el tiempo, estas implican ahora una carga importante de enfermedad, principalmente en los servicios de hospitalización. Los agentes quimioterapéuticos y biológicos son fármacos utilizados con frecuencia en enfermedades reumatológicas y neoplasias de diferente orden. Las reacciones de hipersensibilidad a quimioterapéuticos y monoclonales impactan en la calidad de vida, el pronóstico y la mortalidad de los pacientes con enfermedades autoinmunes y cáncer, es por eso que deben ser reconocidas y manejadas por un equipo de trabajo multidisciplinar. La desensibilización es una herramienta terapéutica que ofrece grandes beneficios a los pacientes con reacciones de hipersensibilidad, permitiéndoles la utilización de medicamentos de primera línea de manera segura y costoefectiva, con un impacto importante en la morbilidad y mortalidad de estos pacientes. El objetivo de este artículo fue revisar la información y evidencia más reciente sobre las reacciones de hipersensibilidad a quimioterapéuticos y biológicos, y los datos sobre las opciones de desensibilización con estos medicamentos y su desenlace
Drug reactions have increased over time, they now imply a significant burden of disease mainly in hospital services. Chemotherapeutic and biological agents are drugs frequently used in different rheumatological diseases and neoplasms. Hypersensitivity reactions to chemotherapeutic and monoclonal drugs impact the quality of life, prognosis and mortality of patients with autoimmune diseases and cancer, that is why they must be recognized and managed by a multidisciplinary team. Desensitization is a therapeutic tool that offers great benefits to patients with hypersensitivity reactions, allowing them to use first-line drugs in a safe and cost-effective manner, with a significant impact on patient morbidity and mortality. The objective of this article was to review the most recent information and evidence on hypersensitivity reactions to chemotherapeutics and biologics, and data on desensitization options with these drugs and their outcome
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Humanos , Hipersensibilidade a Drogas , Terapia Biológica , Dessensibilização Imunológica , Hipersensibilidade , AntineoplásicosRESUMO
Introducción: La desensibilización rápida a medicamentos induce una tolerancia temporal a los quimioterapéuticos que provocan reacciones de hipersensibilidad. Objetivo: Evaluar el protocolo de desensibilización rápida en escenario ambulatorio en pacientes que presentaron reacciones de hipersensibilidad a fármacos citotóxicos. Métodos: Se realizó un estudio observacional, y retrospectivo, de 30 pacientes con cáncer que desarrollaron reacciones de hipersensibilidad entre los años 2016 y 2018, tratados en el Hospital de Día del Servicio de Oncología del Clínico Quirúrgico Hermanos Ameijeiras. Se clasificaron según su intensidad, y se analizaron variables demográficas, características clínicas, y síntomas presentados. Se utilizó un protocolo en doce etapas basado en tres diluciones del fármaco. Se administró premedicación en todos los casos. Se realizó estadística descriptiva, y para la asociación entre variables, se utilizó la prueba estadística Chi-cuadrado. Resultados: La mediana de edad fue 54 años (23;77). Predominaron las mujeres; los menores de 60 años; tumor primario de colon; antecedentes de alergia; el oxaliplatino como fármaco más implicado; las RHS durante la infusión; e intensidad moderada. Fueron más frecuentes los síntomas cutáneos y gastrointestinales. Con la aplicación del protocolo se completó la quimioterapia planificada a los 30 pacientes (145 ciclos adicionales). Solo se presentaron ocho desensibilizaciones con reacciones leves de tipo cutáneas. El 94,5 por ciento de las desensibilizaciones no presentaron reacción alguna. Conclusiones: Constituye el primer reporte nacional de la utilización exitosa de un protocolo de desensibilización rápida a citostáticos que demostró ser eficaz y seguro en el escenario ambulatorio, con un manejo multidisciplinario(AU)
Introduction: Rapid desensitization to drugs induces a temporary tolerance to chemotherapeutics causing hypersensitivity reactions. Objective: To evaluate the rapid desensitization protocol in an outpatient setting in patients who had hypersensitivity reactions to cytotoxic drugs. Methods: An observational and retrospective study was carried out in 30 cancer patients, who developed hypersensitivity reactions, from 2016 to 2018. They were treated in the outpatient Oncology service at Hermanos Ameijeiras Surgical Clinical Hospital. These subjects were classified according to intensity; demographic variables, clinical characteristics, and symptoms were analyzed. A twelve-step protocol based on three dilutions of the drug was used. Premedication was administered in all cases. Descriptive statistics and for the association between variables were performed. Chi-square statistical test was used. Results: The median age was 54 years (23; 77). Predominance was observed in women, those under 60 years of age, primary colon tumor, history of allergy, oxaliplatin as the drug most implicated, HRH during infusion, and moderate intensity. Skin and gastrointestinal symptoms were more frequent. The planned chemotherapy was completed with the application of the protocol, in all 30 patients (145 additional cycles). There were only eight desensitization with mild skin-type reactions. 94.5 percent of desensitizations did not show any reaction. Conclusions: It constitutes the first national report of successful use of a rapid desensitization protocol to cytostatics that proved to be effective and safe in the outpatient setting with multidisciplinary management(AU)