ABSTRACT
Self-reported penicillin allergy is highly prevalent. Different studies estimate that 10% of the population is labeled as such. This label, confirmed or suspected, forces us to take precautions and replace the antibiotic treatment of choice (frequently beta-lactams) with other 2nd or 3rd choice alternatives with worse overall results: side effects, resistance, costs, etc. The penicillin allergy label, once placed, remains in the medical record. It is only confirmed in less than 5% of patients, either because it has been placed inappropriately or because over time the sensitivity decreases and may disappear. Penicillin Allergy Decision Rule -PEN-FAST- is a validated and simple clinical prediction rule that estimates the risk of presenting an allergic reaction. Its use, together with algorithms that involve primary care in the study and delabeling of low-risk patients, can change our clinical practice.
ABSTRACT
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
Subject(s)
Central Nervous System Neoplasms , Hematopoietic Stem Cell Transplantation , Lymphoma , Humans , Aged , Central Nervous System Neoplasms/therapy , Central Nervous System Neoplasms/drug therapy , Transplantation, Autologous , Combined Modality Therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma/therapy , Lymphoma/drug therapyABSTRACT
Alzheimer's disease (AD) is the most common neurodegenerative dementia. It manifests as early-onset or late-onset AD. Early-onset AD represents about 5.5% of the total cases and occurs in patients under age 65. The EOAD progresses more aggressively and has a shorter life expectancy due to a greater pathogenic load. We present two asymptomatic siblings, a 30-year-old male and a 34- year-old female, who are heterozygous carriers of a pathogenic variant c.428T>C (Ile143Thr) in the presenilin 1 (PSEN1) gene. During genetic counseling, assisted reproduction techniques (ART) coupled with embryo biopsy and a preimplantation genetic test for monogenic disorders (PGT-M) were recommended to provide reproductive care for the patients and their partners. ART and preimplantation genetic testing (PGT) have made it possible to have chromosomally normal and genetically unaffected offspring, allowing patients with genetic diseases to become parents.
Subject(s)
Alzheimer Disease , Presenilin-1 , Adult , Female , Humans , Male , Alzheimer Disease/genetics , Alzheimer Disease/pathology , Amyloid beta-Protein Precursor , Mutation , Presenilin-1/geneticsABSTRACT
La evolución del tratamiento de oxigenación por membrana extracorpórea (ECMO) y en particular del transporte de los pacientes sometidos a él, ha cambiado de forma significativa en la última década y lo ha hecho de manera desigual en diferentes regiones. Se ha demostrado que la creación de centros de referencia especializados mejora los resultados. Por todo ello ha sido necesario crear redes de equipos especializados y el número de transportes secundarios de pacientes con este tratamiento está en aumento. Con el fin de mejorar la calidad del tratamiento y ofrecer una guía para los servicios que intervienen en estos transportes, los grupos de trabajo de transporte crítico de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) han realizado un trabajo conjunto de elaboración de estas recomendaciones, enfocadas a los siguientes aspectos: indicaciones, sistemas de centros de referencia, medios de transporte, características y equipamiento, equipos humanos, formación y seguridad clínica (AU)
The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety (AU)
Subject(s)
Humans , Extracorporeal Membrane Oxygenation , Critical Care , Transportation of Patients/methods , Societies, Medical , Consensus , SpainABSTRACT
The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety.
Subject(s)
Extracorporeal Membrane Oxygenation , Child , Consensus , Critical Care , Extracorporeal Membrane Oxygenation/adverse effects , HumansABSTRACT
Under pathological conditions, nitric oxide can become a mediator of oxidative cellular damage, generating an unbalance between oxidant and antioxidant systems. The participation of neuronal nitric oxide synthase (nNOS) in the neurodegeneration mechanism has been reported; the activation of N-methyl-D-aspartate (NMDA) receptors by agonist quinolinic acid (QUIN) triggers an increase in nNOS function and promotes oxidative stress. The aim of the present work was to elucidate the participation of nNOS in QUIN-induced oxidative stress in knock-out mice (nNOS-/-). To do so, we microinjected saline solution or QUIN in the striatum of wild-type (nNOS +/+), heterozygote (nNOS+/-), and knock-out (nNOS-/-) mice, and measured circling behavior, GABA content levels, oxidative stress, and NOS expression and activity. We found that the absence of nNOS provides a protection against striatal oxidative damage induced by QUIN, resulting in decreased circling behavior, oxidative stress, and a partial protection reflected in GABA depletion. We have shown that nNOS-derived NO is involved in neurological damage induced by oxidative stress in a QUIN-excitotoxic model.
Subject(s)
Corpus Striatum/drug effects , Nitric Oxide Synthase Type I/drug effects , Oxidative Stress/drug effects , Quinolinic Acid/pharmacology , Animals , Antioxidants/pharmacology , Corpus Striatum/metabolism , Lipid Peroxidation/drug effects , Male , Mice, Knockout , Nitric Oxide/metabolism , Nitric Oxide Synthase/drug effects , Nitric Oxide Synthase/metabolism , Nitric Oxide Synthase Type I/metabolism , Quinolinic Acid/metabolism , Receptors, N-Methyl-D-Aspartate/drug effects , Receptors, N-Methyl-D-Aspartate/metabolismABSTRACT
No disponible
Subject(s)
Humans , Female , Infant , Cushing Syndrome/drug therapy , Etomidate/pharmacokinetics , Hypertension/complications , Hypokalemia/complications , Treatment Outcome , Adrenocorticotropic Hormone/analysisABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/toxicity , Abdominal Pain/etiology , Dipyrone/administration & dosage , Acetaminophen/administration & dosage , Renal Insufficiency/complications , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/therapy , Anti-Inflammatory Agents, Non-Steroidal , Dipyrone/toxicity , Hypovolemia/chemically induced , Hyponatremia/chemically induced , Hypoalbuminemia/chemically inducedSubject(s)
Cushing Syndrome/drug therapy , Etomidate/therapeutic use , Hypertension/etiology , Hypokalemia/etiology , Adrenal Cortex/drug effects , Adrenal Cortex/metabolism , Adrenal Cortex/pathology , Cushing Syndrome/blood , Cushing Syndrome/complications , Cushing Syndrome/physiopathology , Disease Susceptibility , Escherichia coli Infections/complications , Etomidate/pharmacology , Fatal Outcome , Female , Humans , Hydrocortisone/blood , Hydrocortisone/metabolism , Hypertension/drug therapy , Hypertension/physiopathology , Immunocompromised Host , Infant , Labetalol/therapeutic use , Shock, Septic/complicationsABSTRACT
No disponible
Subject(s)
Humans , Apnea/diagnosis , Brain Death/diagnosis , Continuous Positive Airway Pressure , Oxygen Consumption/physiologySubject(s)
Apnea , Brain Death , Continuous Positive Airway Pressure , Humans , Positive-Pressure RespirationABSTRACT
No disponible
Subject(s)
Humans , Male , Child , Cardiac Tamponade/etiology , Cardiac Tamponade/prevention & control , Central Venous Catheters/adverse effectsABSTRACT
OBJECTIVE: To determine if a relationship exists between pregnancy rates obtained in patients undergoing in vitro fertilization (lVF) with donor eggs and levels of thyroid stimulating hormone greater than 2.5 mlU/L but still within a range considered normal. STUDY DESIGN: Retrospective comparative cohort study. With prior approval of the Ethics Committee, 233 patients undergoing IVF with donor eggs, in a two-year period, were included. Patients were grouped depending on the thyroid stimulating hormone (TSH) level. Pregnancy rates were compared. Statistical analysis was made with the Chi-square test. RESULTS: Pregnancy rates, depending on the TSH level, were 56.6% in patients with TSH levels below 2.49 mU/L vs. 21.6%, in patients with levels above 2.5 mU/L. This difference was statistically significant (p < 0.001). CONCLUSIONS: Mild abnormalities of thyroid function may adversely affect the pregnancy rates in patients un- dergoing in vitro fertilization with donor eggs. A possible alteration in endometrial function may be associated.
Subject(s)
Fertilization in Vitro/methods , Pregnancy Rate/trends , Thyrotropin/blood , Tissue and Organ Procurement/methods , Adult , Biomarkers/blood , Female , Follow-Up Studies , Gestational Age , Humans , Pregnancy , Retrospective Studies , Spain , Young AdultABSTRACT
No disponible
