ABSTRACT
BACKGROUND AND OBJECTIVE: Allergen immunotherapy clinics (AITCs) in Spain differ widely in terms of structure, organization, resources, and portfolio of services. Therefore, it is essential to unify treatment criteria and define quality standards for the most complex AITCs. Objective: To establish a series of recommendations that make it possible to guarantee quality and safety in the administration of immunotherapy and define quality standards for the most complex AITCs. METHODS: This project began with an online survey of 65 allergy departments/units throughout Spain in 2013. Next, a 2-phase consensus process was carried out. In the first phase, 10 experts defined and agreed on the standards using the RAND/UCLA Appropriateness method; in the second, the agreements were validated by means of a 2-round Delphi consultation with 84 experts. RESULTS: Consensus was reached on minimum safety and quality criteria in the administration of allergen immunotherapy, and 2 levels of highly complex AITCs were defined: accredited AITCs and accredited AITCs with excellence. Consensus was also reached on quality standards and accreditation criteria for both levels. CONCLUSIONS: This project is pioneering in terms of its purpose (the definition of quality standards for AITCs) and of the use of structured participation techniques (combination of the RAND/UCLA and Delphi methods). It enabled the design of minimum standards for quality and safety in administering AIT, as well as quality criteria for accreditation of AITCs supported by a broad panel of experts from the Spanish Society of Allergology and Clinical Immunology.
Subject(s)
Desensitization, Immunologic , Hypersensitivity/epidemiology , Hypersensitivity/therapy , Quality of Health Care , Consensus , Desensitization, Immunologic/methods , Desensitization, Immunologic/standards , Expert Testimony , Humans , Hypersensitivity/immunology , Internet , Public Health Surveillance , Quality Indicators, Health Care , Referral and Consultation , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Acute Coronary Syndrome/diagnosis , Electrocardiography/methods , Diagnosis, Differential , Myocardial RevascularizationSubject(s)
Acute Coronary Syndrome , Electrocardiography , Arrhythmias, Cardiac , Humans , Myocardial InfarctionSubject(s)
Atrial Fibrillation/complications , Epilepsy/complications , Wolff-Parkinson-White Syndrome/complications , Adult , Atrial Fibrillation/physiopathology , Electrocardiography/methods , Epilepsy/physiopathology , Female , Humans , Seizures/complications , Seizures/physiopathology , Video Recording/methods , Wolff-Parkinson-White Syndrome/physiopathologySubject(s)
Antineoplastic Agents, Alkylating/administration & dosage , Brain Neoplasms/drug therapy , Dacarbazine/analogs & derivatives , Desensitization, Immunologic/methods , Drug Hypersensitivity/therapy , Glioma/drug therapy , Hypersensitivity, Delayed/therapy , Adult , Aged , Antineoplastic Agents, Alkylating/adverse effects , Dacarbazine/administration & dosage , Dacarbazine/adverse effects , Drug Hypersensitivity/etiology , Exanthema/etiology , Exanthema/prevention & control , Female , Humans , Hypersensitivity, Delayed/etiology , Immune Tolerance , Skin Tests , TemozolomideABSTRACT
INTRODUCTION: Everolimus has been prescribed both for initial and maintenance therapy after cardiac transplantation. Herein, we present our initial experience with everolimus as maintenance therapy after cardiac transplantation. METHODS: We retrospectively included all of our patients in whom therapy was changed from calcineurin inhibitors to everolimus between September 2006 and October 2007. We analyzed their baseline clinical characteristics, indications for conversion to everolimus therapy, and beneficial vs adverse effects of the maneuver. RESULTS: In 16 heart transplant recipients, therapy was changed to everolimus because of allograft vasculopathy (n = 8), renal failure (n = 4), or sirolimus toxicity (n = 4). Treatment with everolimus was initiated at a mean (SD) of 79.8 (52.7) months (range, 10-163 mo) after transplantation. The initial dose was 1.4 (0.2) mg (range, 1.0-1.5 mg), and the maintenance dose was 1 (0.31) mg (range, 0.5-1.5 mg). Follow-up was 7.28 (3.22) months (range, 0.5-13 mo). Observed side effects included hypertriglyceridemia, hypertension, and edema. Only 1 of 4 patients included because of sirolimus intolerance did not tolerate everolimus; renal dysfunction did not worsen in any of these 4 patients. No allograft vasculopathy was observed. CONCLUSIONS: Renal function seem to stabilize after conversion to everolimus therapy in patients with previous progressive dysfunction. The safety profile was proved in all patients, although conclusions cannot be established about the evolution of allograft vasculopathy.
Subject(s)
Calcineurin Inhibitors , Heart Transplantation/immunology , Immunosuppressive Agents/therapeutic use , Sirolimus/analogs & derivatives , Adult , Aged , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Dose-Response Relationship, Drug , Everolimus , Female , Humans , Male , Middle Aged , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , Renal Insufficiency/chemically induced , Retrospective Studies , Sirolimus/therapeutic use , T-Lymphocytes/drug effects , T-Lymphocytes/immunologyABSTRACT
Aunque la etiología de la enfermedad de Crohn es desconocida, se han descrito factos de carácter genético, infecciosos, inmunológico, y ambiental que aumentan el riesgo de padecerla, entre otros, eventos estresantes que exacerban o agravan la enfermedad. Desde el año 200 6, este mal, englobado dentro del grupo de las enfermedades inflamatorias intestinales (E.II, I.B.D.) clasifica a los pacientes en función de la edad de comienzo, localización de la enfermedad y comportamiento de ésta. Como es bien conocido, actualmente no es curable, pero sí controlarle, y la mayoría de las personas pueden hacer una vida normal, bajo tratamiento y vigilancia. Paralelamente a los tratamientos de tipo farmacológico, dietético, sintomático o quirúrgico, el poder proporcionar técnicas de relajación a los pacientes con trastornos gastrointestinales, que puedan aplicar fácilmente en cualquier momento puede convertirse en una inestimable herramienta que les ayude al control de su propia salud. El estudio muestra los beneficios obtenidos al comparar una muestra de pacientes de Crohn que siguieron un entrenamiento en relajación y lo incorporaron a su vida cotidiana, comparado con otro grupo de pacientes de la misma enfermedad, sin tratamiento(AU)
Subject(s)
Humans , Male , Female , Crohn Disease/epidemiology , Crohn Disease/genetics , Crohn Disease/immunology , Relaxation/physiology , Relaxation/psychology , Relaxation Therapy/trends , Risk Factors , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/psychologySubject(s)
Catheter Ablation/adverse effects , Heart Diseases/etiology , Tachycardia, Ventricular/surgery , Thrombosis/etiology , Anticoagulants/therapeutic use , Echocardiography , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/etiology , Heart Ventricles , Humans , Myocardial Infarction/complications , Thrombosis/diagnostic imaging , Thrombosis/prevention & controlABSTRACT
BACKGROUND: Nocardial infections typically affect patients receiving immunosuppressants, occurring early after surgery in 3% to 40% of heart transplant (HTx) recipients. The emergence of antibiotic resistance and occurrence of disease recurrences in AIDS population has engendered controversy about the treatment for immunodepressed HTx patients. METHODS: We present a retrospective study of the diagnosis, treatment and outcome of 560 HTx recipients between 1984 and 2002. RESULTS: Among the five cases of Nocardia infection (0.9%), three cases developed late after HTx (between 3.1 and 11 years follow-up). All patients had pulmonary disease and one in addition had subcutaneous nodules. Microbiological diagnosis required open lung biopsy in one case. All patients were treated primarily with trimethoprim-sulphamethoxazole, but evidence of resistance to sulfonamides led us to change the antimicrobial combination in two cases. Four patients who received one year of antibiogram-guided therapy showed complete healing without recidivism. Three patients died, all due to non-related causes, at follow-ups between 1 and 5 years. In one case a cutaneous recurrence of disease was attributed to noncompliance. CONCLUSIONS: Nocardiosis in current HTx is less common than previously reported. Its incidence seems to be delayed in time with modern immunosuppressants. Given the high incidence of sulfamide resistance, treatment must be guided by antibiotic sensitivity. We believe that maintenance therapy for a whole year is the appropriate option in order to avoid recidivism in this population.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Heart Transplantation , Nocardia Infections/drug therapy , Respiratory Tract Infections/drug therapy , Humans , Male , Middle Aged , Nocardia Infections/diagnosis , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Respiratory Tract Infections/diagnosis , Retrospective Studies , Treatment OutcomeABSTRACT
Presentamos un estudio retrospectivo de 15 pacientes con pioderma gangrenoso cuyo diagnóstico se realizó basándose en la clínica, histopatología y exploraciones complementarias, excluyendo otras causas de úlceras cutáneas. Se han valorado los siguientes parámetros: sexo, edad, tipo clínico, enfermedades asociadas, número y localización de las lesiones, histopatología, tiempo de tratamiento, relación entre el tiempo de tratamiento con el número de lesiones y con las enfermedades asociadas, así como los efectos secundarios de la terapéutica utilizada. Se han obtenido resultados similares a otras series en la práctica totalidad de los parámetros evaluados, salvo la menor duración del tratamiento en pacientes que no recibieron ciclosporina A, en pacientes que presentaban asociada la enfermedad inflamatoria crónica intestinal y en aquellos con más de una lesión. Recomendamos la evaluación de estos resultados en series de casos más amplias (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Pyoderma Gangrenosum/pathology , Retrospective Studies , Prognosis , Cyclosporine/administration & dosage , Cyclosporine/adverse effects , Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effectsSubject(s)
Carcinoma, Bronchogenic/complications , Carcinoma, Bronchogenic/diagnostic imaging , Hypohidrosis/etiology , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging , Aged , Humans , Hyperhidrosis/diagnosis , Hyperhidrosis/etiology , Hypohidrosis/diagnosis , Male , Pain/etiology , Paresthesia/etiology , Shoulder , Tomography, X-Ray ComputedABSTRACT
El liquen escrofulosorum es una forma infrecuente de tubercúlides caracterizada por pequeñas pápulas liquenoides en tronco y extremidades que surgen fundamentalmente en niños y adultos jóvenes con tuberculosis ósea o ganglionar.Hemos estudiado un caso de liquen escrofulosorum que apareció dos años después de una tuberculosis osteomuscular multifocal. La tinción de Ziehl-Neelsen, el cultivo y la PCR para Mycobacterium tuberculosis en fresco fueron negativas, descartándose la pérdida de sensibilidad de la PCR relacionada con la inclusión en parafina. El cuadro respondió en pocas semanas al tratamiento antituberculoso, si bien, aconsejamos completar la pauta de la Sociedad Torácica Americana. (AU)
Subject(s)
Aged , Male , Humans , Lichenoid Eruptions/diagnosis , Tuberculosis/complications , Tuberculosis, Cutaneous/etiology , Lichenoid Eruptions/etiology , Lichenoid Eruptions/drug therapy , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Mycobacterium tuberculosis/pathogenicity , Tuberculosis, Cutaneous/diagnosis , Back , Extremities , Isoniazid/therapeutic use , Rifampin/therapeutic use , Polymerase Chain ReactionSubject(s)
Trichotillomania/pathology , Adult , Follow-Up Studies , Genitalia, Male , Humans , Male , RecurrenceABSTRACT
El granuloma inguinal o donovanosis es una infección granulomatosa crónica producida por calymmatobacterium granulomatis, considerada enfermedad venérea clásica, típica de zonas tropicales o subtropicales y excepcional en nuestro país. Es un proceso poco contagioso que evoluciona de forma crónica con elementos vegetantes en zona genital y/o perigenital, sin adenopatías regionales. El agente etiológico puede demostrarse en el estudio dermatopatológico, comprobándose los cuerpos de Donovan mediante las tinciones de Giemsa o Whartin-Starry.El caso de granuloma inguinal que justifica este trabajo apareció en varón caucásico que mantuvo contacto sexual con mujer procedente de las Antillas Holandesas. Se le realizaron múltiples tratamientos antibióticos hasta llegar a la curación aunque posteriormente requirió tratamiento quirúrgico para resolver la fibrosis y el linfoedema residual (AU)
