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2.
Chest ; 165(4): 959-966, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38599752

RESUMO

Technical and clinical developments have raised challenging questions about the concept and practice of brain death, culminating in recent calls for revision of the Uniform Determination of Death Act (UDDA), which established a whole brain standard for neurologic death. Proposed changes range from abandoning the concept of brain death altogether to suggesting that current clinical practice simply should be codified as the legal standard for determining death by neurologic criteria (even while acknowledging that significant functions of the whole brain might persist). We propose a middle ground, clarifying why whole brain death is a conceptually sound standard for declaring death, and offering procedural suggestions for increasing certainty that this standard has been met. Our approach recognizes that whole brain death is a functional, not merely anatomic, determination, and incorporates an understanding of the difficulties inherent in making empirical judgments in medicine. We conclude that whole brain death is the most defensible standard for determining neurologic death-philosophically, biologically, and socially-and ought to be maintained.


Assuntos
Morte Encefálica , Encéfalo , Humanos , Morte Encefálica/diagnóstico
4.
J Obstet Gynaecol Res ; 49(8): 1991-1999, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37194373

RESUMO

AIM: The objectives of this review are to identify and characterize attempts to transfer ectopic embryos to the uterus, and to understand arguments for and against the feasibility of such an intervention. METHODS: An electronic literature search involved all English language articles published in MEDLINE (1948-), Web of Science (1899-), and Scopus (1960-) before July 1, 2022. Articles were included that identify or describe attempts to transfer the embryo from its ectopic location to the uterine cavity, or discuss the feasibility of such an intervention; there were no exclusion criteria (PROSPERO registration number CRD42022364913). RESULTS: The initial search yielded 3060 articles; 8 articles were included. Of these, two articles were case reports that described the successful transfer of the embryo from its ectopic location to the uterus, followed by term births; both cases involved laparotomy with salpingostomy, followed by transfer of the embryonic sac into the uterine cavity through an opening made in the uterine wall. The other six articles varied in type, and provided a number of arguments for and against the feasibility of such a procedure. CONCLUSIONS: The evidence and arguments identified in this review may help manage expectations for those interested in transferring an ectopically implanted embryo in the hope of continuing the pregnancy, but who are uncertain about the extent to which such a procedure has been attempted or may be possible. Isolated case reports, with no evidence of replication, should be interpreted with the utmost caution and do not constitute a procedure for clinical use.


Assuntos
Útero , Gravidez , Feminino , Humanos , Útero/cirurgia
5.
J Appl Physiol (1985) ; 133(6): 1341-1348, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36356255

RESUMO

Bronchial thermoplasty (BT) is a treatment for moderate-to-severe asthma in which the airway smooth muscle layer is targeted directly using thermal ablation. Although it has been shown to be safe and effective in long-term follow-up, questions remain about its mechanism of action, patient selection, and optimization of protocol based on structural phenotype. Using a cohort of 20 subjects who underwent thermoplasty and assessment by computed tomography (CT), we demonstrate that response to BT can be feasibly predicted based on pretreatment airway dimensions that inform a subject-specific computational model. Analysis revealed the need for CT assessment at total lung capacity, rather than functional residual capacity, which was less sensitive to the effects of BT. Final model predictions compared favorably with observed outcomes in terms of airway caliber and asthma control, suggesting that this approach could form the basis of improved clinical practice.NEW & NOTEWORTHY Bronchial thermoplasty is a treatment for asthma that targets the airway smooth muscle directly. We demonstrate the feasibility and constraints of predicting patient-specific response to thermoplasty using a computational model informed by pretreatment CT scans at different lung volumes. Predictions are compared with functional outcomes and posttreatment CT scans. This has the potential to form the basis for improved clinical practice.


Assuntos
Asma , Termoplastia Brônquica , Humanos , Termoplastia Brônquica/métodos , Seleção de Pacientes , Estudos de Viabilidade , Brônquios/cirurgia
6.
Cutis ; 110(2 Suppl): 8-14, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36219602

RESUMO

Topical medications have high utility in the treatment of psoriasis because of their localized effect and ability to be used as both monotherapy and adjunctive therapy. The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) published guidelines in 2020 regarding the management of psoriasis with topical therapies. These guidelines are a framework that assist clinicians treating psoriasis patients with topical agents including steroids, calcineurin inhibitors (CNIs), vitamin D analogues, retinoids (tazarotene), emollients, keratolytics (salicylic acid), anthracenes (anthralin), and keratoplastics (coal tar). This review presents these evidence-based recommendations in a form that dermatologists can readily apply to their clinical practice. The selection of an appropriate topical therapy, effective combination therapies, duration of use, and adverse events are addressed.


Assuntos
Alcatrão , Fármacos Dermatológicos , Psoríase , Administração Tópica , Antralina/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Alcatrão/efeitos adversos , Emolientes/uso terapêutico , Humanos , Psoríase/induzido quimicamente , Psoríase/tratamento farmacológico , Retinoides/uso terapêutico , Ácido Salicílico , Esteroides/uso terapêutico , Vitamina D
7.
J Dermatolog Treat ; 33(2): 622-625, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32459567

RESUMO

BACKGROUND: In late 2019 a viral pneumonia began to spread across the world. The viral disease, COVID-19, is now officially a pandemic, causing concern for the potential risk of systemic therapies for patients with psoriasis. OBJECTIVE: The purpose of this review is to analyze what is currently known about COVID-19 in regard to the safety of systemic treatment, and to provide guidelines for use in psoriasis during this pandemic. METHODS: Review of guidelines from various dermatologic regulatory bodies regarding the use of systemic medications during the COVID-19 pandemic was performed and summarized. RESULTS: The AAD, NPF and IPC are in agreement regarding their recommendation that patients with active COVID-19 infection should discontinue any biologic therapy. CONCLUSION: Patients with active COVID-19 infections should discontinue systemic treatment for psoriasis. Patients with risk factors should discuss continuing treatment on a case by case basis.


Assuntos
COVID-19 , Pneumonia Viral , Psoríase , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Psoríase/complicações , Psoríase/tratamento farmacológico , Psoríase/epidemiologia
8.
J Dermatolog Treat ; 33(2): 626-636, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32507066

RESUMO

Biologic medications are recent advances that have clinical significance in the treatment of moderate-to-severe AD. A systemic literature review was performed to examine the efficacy and safety of biologic therapies currently in phase II and phase III of clinical trials for moderate-to-severe AD. Our team searched the databases, PubMed, Google Scholar, and ClinicalTrials.gov, on September 2019 for studies pertaining to the use of biologic drugs in AD. Key words included each drug (lebrikizumab, tralokinumab, fezakinumab, etokimab, nemolizumab, tezepelumab, and GBR 830) or 'biologic drugs' or 'immunotherapies' combined with 'atopic dermatitis.' References within retrieved articles were also reviewed to identify potentially missed studies. A total of 19 articles were included in this review. Lebrikizumab, tralokinumab, fezakinumab, nemolizumab, and GBR 830 lead to statistically significant improvements in disease severity and multiple endpoint outcome scores. Tezepelumab and etokimab, however, did not demonstrate statistically significant changes in primary outcome endpoints. Further assessment of tezepelumab and etokimab are needed to assess their safety and efficacy in patients with moderate-to-severe AD. Tralokinumab, lebrikizumab, fezakinumab, nemolizumab, and GBR 830 are effective treatment options for adults with moderate-to-severe AD, but further large-scale studies are needed to confirm their efficacy as monotherapy in children with moderate-to-severe AD.


Assuntos
Dermatite Atópica , Eczema , Adulto , Terapia Biológica , Criança , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Dermatite Atópica/tratamento farmacológico , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento
9.
J Dermatolog Treat ; 33(2): 1166-1167, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32568009

RESUMO

Psoriasis is a systemic immune-mediated inflammatory disease that requires consistent treatment and follow-up. Given that COVID-19 will persist in the coming years, dermatologists need to adjust their practices accordingly to care for their patients, particularly psoriasis patients managed with systemic therapies. We provide guidelines for optimizing care for psoriasis patients, including considerations for medication management, lifestyle adjustments, and utilization of telemedicine.


Assuntos
Produtos Biológicos , COVID-19 , Psoríase , Telemedicina , Produtos Biológicos/uso terapêutico , Humanos , Pandemias , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , SARS-CoV-2
10.
J Clin Aesthet Dermatol ; 14(6): 55-59, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34804357

RESUMO

BACKGROUND: Interleukin (IL)-17 inhibitors are a newer class of biologic used to treat patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. OBJECTIVE: We compared evidence-based clinical practice guidelines (CPGs) from leading dermatological organizations for the use of IL-17 inhibitors in psoriasis. METHODS: Guidelines from the Joint American Academy of Dermatology-National Psoriasis Foundation (AAD-NFP) Guidelines, British Association of Dermatologists guidelines (BAD), and European S3 group (ES3) were all reviewed and compared. RESULTS: This analysis revealed significant overlap in the recommendations made by experts from each CPG. However, our review highlights differences in routine laboratory recommendations and the relative and absolute contraindications to use with IL-17 inhibitors. CONCLUSION: IL-17 inhibitors are an effective treatment option for psoriasis. This analysis and review of guidelines for IL-17 inhibitor use highlights the consensus in treatment protocols and areas of disagreement between CPGs.

11.
Cutis ; 108(2S): 7-11, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34662273

RESUMO

In April 2019, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) released a set of guidelines regarding the management of psoriasis with a focus on its extracutaneous manifestations-comorbidities, mental health, psychosocial wellness, and quality of life (QOL). These guidelines provide the most up-to-date evidence on the screening and treatment recommendations for these disease comorbidities. The purpose of this review is to present the recommendations in a form that can be easily applied in clinical practice.


Assuntos
Psoríase , Qualidade de Vida , Comorbidade , Humanos , Psoríase/epidemiologia , Psoríase/terapia , Estados Unidos/epidemiologia
13.
Dermatol Ther ; 34(4): e14974, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33991048

RESUMO

The aim of this review is to compare and contrast evidence-based clinical practice guidelines from global dermatological organizations for the use of ustekinumab in psoriasis. Clinical practice guidelines from the American Academy of Dermatology, National Psoriasis Foundation, British Association of Dermatologists, and European S3 were reviewed and compared. Practice guidelines from the three dermatological organizations are similar with regards to treatment dosage and initiation but differ in their recommendations for baseline screening and interval laboratory monitoring, treatment in patients undergoing surgery or receiving live vaccines, and treatment contraindications. Ustekinumab is an effective and well-tolerated systemic treatment for patients with psoriasis and should be considered in the line of therapy that dermatologists discuss with their patients. Consideration should be given to evidence-based practice guidelines of global dermatology organizations to effectively guide treatment decisions in patients with psoriasis.


Assuntos
Psoríase , Ustekinumab , Europa (Continente) , Humanos , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Reino Unido , Estados Unidos
15.
Cutis ; 107(2): 99-103, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33891841

RESUMO

In 2020, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) released a set of guidelines for the management of psoriasis in adults with systemic nonbiologic therapies, including acitretin, apremilast, cyclosporine, fumaric acid esters, methotrexate, and tofacitinib. This review addresses dosing, efficacy, toxicity, drug-related interactions, and contraindications alongside evidence-based treatment recommendations for each systemic therapy. Important considerations for treatment such as drug selection, initiation of therapy, drug monitoring, and patient management also are discussed. Physicians are encouraged to use these recommendations to guide treatments based on individual patient needs and disease characteristics.


Assuntos
Psoríase , Acitretina , Adulto , Ciclosporina , Humanos , Metotrexato , Psoríase/tratamento farmacológico , Estados Unidos
19.
J Dermatolog Treat ; 32(5): 492-494, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31697211

RESUMO

BACKGROUND: Generalized pustular psoriasis (GPP) is an uncommon variant of psoriasis that is characterized clinically by sterile pustule formation superimposed over inflamed, erythematous skin. METHODS: In June 2019, we conducted a systematic search of the PubMed Medline database using the keywords 'pustular psoriasis' and 'treatment'. RESULTS: First-line treatment for the condition consists of established therapies, such as acitretin, cyclosporine, methotrexate, and infliximab. Several medications targeting IL-17 or IL-23 have also emerged recently with drugs such as ixekizumab, secukinumab, brodalumab, guselkumab, and ustekinumab having shown some efficacy. CONCLUSIONS: This review highlights the research in support of common treatments of GPP, including classically used medications and newer monoclonal antibodies, and addresses the continued need for high quality studies regarding treatments for this condition.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Psoríase/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Humanos , Interleucina-17/imunologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico
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