RESUMO
Directed immunotherapy at the programmed cell death-1 receptor has demonstrated efficacy in non-small-cell lung cancer, metastatic melanoma, and various other malignancies. Immune checkpoint inhibitors are innovative therapies producing some impressive clinical responses with a more manageable adverse effect profile when compared to traditional chemotherapy. The more common adverse effects associated with these agents include fatigue, rash, myalgia, pyrexia, and cough, but less common yet serious adverse effects have included immune-mediated colitis, pneumonitis, hepatitis, type 1 diabetes, and encephalitis. Here we present a case of a female patient with glioblastoma multiforme, who was treated with the programmed cell death-1 receptor inhibitor nivolumab and subsequently developed aplastic anemia.
Assuntos
Anemia Aplástica/induzido quimicamente , Anemia Aplástica/diagnóstico , Antineoplásicos Imunológicos/efeitos adversos , Nivolumabe/efeitos adversos , Anemia Aplástica/imunologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/imunologia , Feminino , Glioblastoma/tratamento farmacológico , Glioblastoma/imunologia , Humanos , Imunoterapia/efeitos adversos , Pessoa de Meia-Idade , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologiaRESUMO
INTRODUCTION: Urinary tract infections represent one of the most frequent reasons for hospitalization. As a result of their prevalence from community-based origins as well as those which develop in hospital setting, this constellation of infections represents a tremendous burden to the global healthcare system. Areas covered: Over the last several decades the management of these infections has become more complicated due to the underlying comorbid conditions of the patients as well as escalating antimicrobial resistance to many of the most frequently used oral and parenteral agents. One such example is the emergence of extend spectrum ß-lactamase-producing (ESBL) bacteria that render many of the most frequently utilized oral and parenteral penicillin and cephalosporin based regimens of little clinical utility. As such new treatment strategies are required to effectively manage the growing population of patients with multi-drug resistant bacteria. Expert commentary: Herein, we review some of the current literature which reveals the challenges associated with the contemporary management of UTIs, while presenting strategies such as the implementation of clinical pathways that have the potential to enhance the quality and efficiency of care while reducing the overall cost of care.
