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1.
Semin Dial ; 28(6): 661-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26147019

RESUMO

Allergic reactions to epoetin alfa, including anaphylaxis, have been described but desensitization in the setting of an IgE-mediated reaction has not been reported. We present a case of a hemodialysis patient who developed symptoms of an IgE-mediated allergic response to epoetin alfa that occurred after each administration. These reactions progressed to a single episode of anaphylaxis with generalized pruritus, urticaria, oropharyngeal edema, and hypotension that prompted its discontinuation. Intradermal skin testing confirmed an allergic response to this agent. The patient then underwent a desensitization procedure to epoetin alpha after which she was able to tolerate it without further problems.


Assuntos
Anafilaxia , Dessensibilização Imunológica/métodos , Imunidade Inata , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Anafilaxia/imunologia , Feminino , Humanos , Testes Cutâneos
2.
Chest ; 142(5): 1193-1199, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22677348

RESUMO

OBJECTIVE: The purpose of our study was to examine in patients hospitalized with community acquired pneumonia (CAP) the association between abnormal Pa CO 2 and ICU admission and 30-day mortality. METHODS: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. RESULTS: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal PaCO2 (35-45 mm Hg), 194 patients (42%) had aPa CO 2 , 35 mm Hg (hypocapnic), and 70 patients (15%) had a Pa CO 2 . 45 mm Hg (hypercapnic).In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR= 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR= 2.88;95% CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR= 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission(OR =5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis,the differences persisted between groups. CONCLUSION: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Mortalidade Hospitalar , Hipercapnia/mortalidade , Hipocapnia/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia/diagnóstico , Pneumonia/mortalidade , Gasometria , Comorbidade , Demografia , Feminino , Hospitais de Ensino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Texas/epidemiologia
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