RESUMO
Extensive experience in the diagnosis and treatment of tuberculosis (TB) has led to treatment guidelines, which almost always result in progressive clinical improvement and cure in the compliant patient. Failure of a patient to respond as expected raises concerns of unexpected drug resistance, poor absorption, drug fever, or rarely an intense inflammatory reaction known as paradoxical reaction. Paradoxical reactions to anti-TB treatment are relatively rare in nonimmunocompromised individuals. Hepatic abscess is a very rare consequence of primary TB infection but has never been described as occurring as part of a paradoxical reaction. We present a case of a unique paradoxical reaction to initiation of TB treatment.
Assuntos
Antituberculosos/efeitos adversos , Abscesso Hepático/etiologia , Tuberculose/tratamento farmacológico , Adulto , Antituberculosos/uso terapêutico , Humanos , MasculinoRESUMO
Amiodarone is used extensively in clinical practice for the treatment of arrhythmias but is associated with a number of well-known side effects. We present 3 cases of extensive thrombosis occurring secondary to intravenous amiodarone. In cases like these, amiodarone must be stopped immediately and patients started on appropriate anticoagulation therapy. Providing education to nursing and pharmacy staff regarding the administration of IV amiodarone and the necessity of defining institutional guidelines are central to decreasing the risk of complications from using this widely available antiarrhythmic agent.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Trombose/induzido quimicamente , Idoso , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Anticoagulantes/uso terapêutico , Educação Continuada em Enfermagem/métodos , Educação Continuada em Farmácia/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Trombose/tratamento farmacológicoRESUMO
Erythropoietin refractory anemias represent a continuing and increasing burden on the healthcare system. The current practice of providing these patients with rHuEPO does not seem to be working. Fewer than 50% of patients respond in some studies. We demonstrate that androgens have multiple benefits in this population. They control anemia and stop transfusion dependence and improve nutritional parameters. In some patients, they also have a salutary effect on both white blood cell and platelet counts.
