RESUMO
To study the possible genetic associations with adverse drug reactions (ADR), the Singapore Health Sciences Authority (HSA) has piloted a program to collect DNA and phenotype data of ADR cases as part of its pharmacovigilance program. Between 2009 and 2012, HSA screened 158 cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To assess the association between HLA-B*1502 and carbamazepine (CBZ)-induced SJS/TEN, 13 cases and 26 drug-tolerant controls were analyzed. All 13 CBZ-SJS/TEN cases and 3/26 controls were HLA-B*1502 positive (odds ratio 181, 95% confidence interval: 8.7-3785, P=6.9 × 10(-8)). Discussions of the finding with the Ministry of Health and an expert panel led to the decision to make HLA-B*1502 testing the standard of care prior to first use of CBZ in Asians and to subsidize the genotyping test at public hospitals. This program illustrates the role of a regulatory authority in advancing the use of pharmacogenetics for drug safety.
Assuntos
Carbamazepina/efeitos adversos , Exantema/induzido quimicamente , Farmacogenética , Farmacovigilância , Adulto , Alelos , Estudos de Casos e Controles , Genótipo , Antígenos HLA-B/genética , Humanos , Pessoa de Meia-Idade , Farmacogenética/métodos , Projetos Piloto , Singapura , Síndrome de Stevens-Johnson/etiologiaRESUMO
INTRODUCTION: Pemphigus vulgaris is a rare cause of oral mucosal ulceration. CLINICAL PICTURE: A 47-year-old Chinese man presented with a 3-month history of oral ulceration. There were no lesions on the skin or other mucosal sites. Histology and immunostaining were consistent with pemphigus vulgaris. TREATMENT: Systemic and topical corticosteroids were instituted, together with topical antifungals. Conventional periodontal therapy was carried out to improve gingival/oral health. OUTCOME: Control of oral ulceration was achieved with re-establishment of normal oral function. No other sites to date have been involved. CONCLUSIONS: Chronic oral ulceration can be the sole manifestation of pemphigus vulgaris, at least initially. Early recognition of this lesion may prevent delayed diagnosis and inappropriate treatment of a potentially chronic dermatological condition.
Assuntos
Doenças da Boca/patologia , Pênfigo/patologia , Antifúngicos/administração & dosagem , Cimetidina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/tratamento farmacológico , Pênfigo/tratamento farmacológico , Prednisolona/administração & dosagemRESUMO
INTRODUCTION: Delusional parasitosis (DP) is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. PATIENTS AND METHODS: All patients with DP seen by the Division of Dermatology, Department of Medicine, National University Hospital were reviewed. The case histories of 8 Chinese patients are discussed. RESULTS: The patients with DP were predominantly women above 50 years of age, with medical co-morbidities and presented with a variety of symptoms and signs. The patients were prescribed various antipsychotics including the atypical antipsychotics. Response was variable, and the patients often defaulted follow-up. An approach to the management of DP is proposed together with a review of the literature.
