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1.
Int Immunopharmacol ; 99: 108031, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34358857

RESUMO

OBJECTIVE: Immunotherapies targeting immune checkpoints have achieved encouraging survival benefits in patients with various solid cancers. Corticosteroids are frequently administrated for cancer/non-cancer related indications and immune-related adverse events (irAEs). This study aimed to clarify the prognostic significance of corticosteroid administration in solid cancer patients receiving immune checkpoint inhibitor (ICI) treatment. METHOD: First, a meta-analysis was performed using the literatures searched from PubMed, Cochrane Library, Web of Science, Embase, and Clinicaltrials.gov before January 2021. The Hazard ratios (HRs) coupled with 95% confidence intervals (CIs) were used to evaluate the correlation of corticosteroid administration with overall survival (OS) and progression-free survival (PFS). Then, a retrospective analysis enrolling 118 ICI-treated cancer patients was performed for validation, among which 26 patients received corticosteroids for cancer-related indications. RESULT: In the meta-analysis, corticosteroid administration for cancer-related indications was significantly correlated with worse PFS (HR = 1.735(1.381-2.180)) and OS (HR = 1.936(1.587-2.361)) of the ICI-treated patients. However, corticosteroid administration for non-cancer-related indications and irAEs was unrelated with PFS (non-cancer-related indications: HR = 0.830(0.645-1.067); irAEs: HR = 1.302(0.628-2.696)) and OS (non-cancer-related indications: HR = 0.786(0.512-1.206); irAEs: HR = 1.107(0.832-1.474)) of the ICI-treated patients. The following retrospective analysis identified corticosteroid administration for cancer-related indications was an independent unfavorable predictor for PFS (P = 0.006) and OS (P = 0.044) of the ICI-treated patients. The subgroup analysis based on non-small cell lung cancer (NSCLC) demonstrated the similar results (P = 0.002 for PFS and P = 0.047 for OS). CONCLUSION: Our study demonstrated corticosteroid administration for cancer-related indications is an unfavorable prognostic factor in solid cancer patients receiving ICI treatment. Therefore, careful selection of corticosteroid-treated patients for ICI therapy is quite necessary in individualized clinical management.


Assuntos
Glucocorticoides/uso terapêutico , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias/mortalidade , Idoso , Fadiga/tratamento farmacológico , Fadiga/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Náusea/imunologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Seleção de Pacientes , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Vômito/tratamento farmacológico , Vômito/imunologia
2.
Eur J Haematol ; 107(3): 364-369, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34114691

RESUMO

OBJECTIVE: To investigate the incidence and severity of adverse drug reactions of cyclosporine using AUC-targeted therapeutic drug monitoring (TDM) compared to trough level (Ctrough )-targeted TDM in adult allogeneic stem cell recipients. METHODS: Blind, monocenter, intervention study. Subjects were 1:1 randomized into either an AUC group or a Ctrough group. Adverse drug reactions were accessed two and four weeks after start of treatment. RESULTS: Forty patients were included, resulting in 15 evaluable subjects (AUC group) and 13 evaluable subjects (Ctrough group). Grade two/three toxicity was observed in 46% (Ctrough group) versus 60% of subjects (AUC group) (P = .463). There was no significant difference between two and four weeks after start of cyclosporine for nausea (P = .142 resp. P = .122), renal dysfunction (P = .464 resp. P = 1.000), and hypomagnesemia (P = 1.000 resp. P = .411). Subjects in the AUC group reached the therapeutic goal earlier (72,7% versus 43,0% at third sampling point, P = .332) and were within the target range more consistently. CONCLUSION: This study showed no reduction in incidence and severity of cyclosporine-induced toxicity with AUC- versus trough level-targeted TDM. Although modeled dosing based on AUC led to faster optimal target attainment, this did not result in less toxicity in the early days after transplantation.


Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Leucemia Mieloide Aguda/terapia , Linfoma/terapia , Mieloma Múltiplo/terapia , Náusea/induzido quimicamente , Erros Inatos do Transporte Tubular Renal/induzido quimicamente , Adulto , Área Sob a Curva , Ciclosporina/farmacocinética , Monitoramento de Medicamentos/métodos , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/fisiologia , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunossupressores/farmacocinética , Leucemia Mieloide Aguda/imunologia , Leucemia Mieloide Aguda/patologia , Linfoma/imunologia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/patologia , Náusea/imunologia , Náusea/patologia , Curva ROC , Distribuição Aleatória , Erros Inatos do Transporte Tubular Renal/imunologia , Erros Inatos do Transporte Tubular Renal/patologia , Transplante Homólogo
3.
Gynecol Oncol ; 159(3): 794-798, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32951892

RESUMO

OBJECTIVES: Current grading systems for platinum hypersensitivities (pHSR) rely on subjective features rather than objective clinical signs leading to inconsistencies in grading. To standardize classification of pHSR, a clinical grading system was developed at our institution. We report the clinical outcomes our classification system and evaluate its correlation with the classification systems currently published and used in practice. METHODS: This was a retrospective review of patients with pHSR from 2011 to 2017. Demographics, chemotherapeutic histories (CT), and details of their initial HSR were collected. Mild reactions were defined as local skin manifestations only. Moderate-low reactions included widespread skin, respiratory or GI findings. Moderate-standard reactions were defined as transient cardiovascular compromise (CVC), hypoxia or neurologic changes whereas sustained changes (>10 min) were used to define severe reaction. Fischer Exact Tests (p < .05) and binary logistic regression analyses were performed. Spearman correlation were used to assess relationships between our grading system and the NCCN and CTCAEv4.0 criteria. RESULTS: 87 patients were identified with most having ovarian cancer (n = 55, 63.2%), receiving carboplatin (n = 62, 71.3%), and on second-line CT (n = 34, 42.5%). Chest pain was associated with transient CVC (OR 10.0, 95% CI 1.148-87.133) while nausea/vomiting (OR 8.420, 95% CI 1.263-55.275) was associated with transient hypoxia albeit less closely than transient hypotension (OR 17.010, 95% CI 2.026-142.825). Only presyncope/syncope remained associated with sustained CVC (OR 38.0, 95% CI 2.815-512.912) on logistic regression. The classification system was most strongly correlated with the NCCN grading system (ρ 0.761, p < .001). CONCLUSIONS: This classification system offers an objective means of grading pHSR severity and correlates with currently-used grading systems.


Assuntos
Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Carboplatina/efeitos adversos , Dor no Peito/epidemiologia , Dor no Peito/imunologia , Cisplatino/efeitos adversos , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Hipotensão/epidemiologia , Hipotensão/imunologia , Hipóxia/epidemiologia , Hipóxia/imunologia , Pessoa de Meia-Idade , Náusea/epidemiologia , Náusea/imunologia , Estudos Retrospectivos , Fatores de Risco , Síncope/epidemiologia , Síncope/imunologia , Vômito/epidemiologia , Vômito/imunologia
4.
Dig Dis Sci ; 65(7): 1932-1939, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32447742

RESUMO

The month of December 2019 became a critical part of the time of humanity when the first case of coronavirus disease 2019 (COVID-19) was reported in the Wuhan, Hubei Province in China. As of April 13th, 2020, there have been approximately 1.9 million cases and 199,000 deaths across the world, which were associated with COVID-19. The COVID-19 is the seventh coronavirus to be identified to infect humans. In the past, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome were the two coronaviruses that infected humans with a high fatality, particularly among the elderly. Fatalities due to COVID-19 are higher in patients older than 50 years of age or those with multimorbid conditions. The COVID-19 is mainly transmitted through respiratory droplets, with the most common symptoms being high fever, cough, myalgia, atypical symptoms included sputum production, headache, hemoptysis and diarrhea. However, the incubation period can range from 2 to 14 days without any symptoms. It is particularly true with gastrointestinal (GI) symptoms in which patients can still shed the virus even after pulmonary symptoms have resolved. Given the high percentage of COVID-19 patients that present with GI symptoms (e.g., nausea and diarrhea), screening patients for GI symptoms remain essential. Recently, cases of fecal-oral transmission of COVID-19 have been confirmed in the USA and China, indicating that the virus can replicate in both the respiratory and digestive tract. Moreover, the epidemiology, clinical characteristics, diagnostic procedures, treatments and prevention of the gastrointestinal manifestations of COVID-19 remain to be elucidated.


Assuntos
Infecções por Coronavirus/fisiopatologia , Diarreia/fisiopatologia , Náusea/fisiopatologia , Pneumonia Viral/fisiopatologia , Vômito/fisiopatologia , Betacoronavirus/fisiologia , COVID-19 , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Síndrome da Liberação de Citocina/imunologia , Citocinas/imunologia , Diarreia/imunologia , Endoscopia do Sistema Digestório , Fezes/virologia , Humanos , Náusea/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , SARS-CoV-2 , Tropismo Viral , Eliminação de Partículas Virais , Vômito/imunologia
5.
United European Gastroenterol J ; 8(4): 403-409, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32213025

RESUMO

Acute pancreatitis is a heterogeneous illness. Most patients experience a mild course of disease, but one third will develop local complications and/or organ failure associated with increased morbidity and risk of mortality. Diagnosis of acute pancreatitis is based on typical epigastric pain, elevation of serum lipase or amylase levels, and/or characteristic findings on imaging. Personalised management is needed in patients with acute pancreatitis. Currently, analgesia, Ringer's lactate solution-based goal-directed fluid resuscitation and early oral refeeding providing enteral nutrition if not tolerated are the cornerstones for early management. Prophylactic antibiotics or endoscopic retrograde cholangiopancreatography in the absence of cholangitis are considered to be futile. Future clinical trials should address optimal fluid resuscitation, the early administration of anti-inflammatory drugs and the exact role of nutritional support in severe acute pancreatitis. Here, we present a patient case and review the diagnosis, treatment and prognosis of acute pancreatitis.


Assuntos
Medicina Baseada em Evidências/métodos , Gastroenterologia/métodos , Pancreatite/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/imunologia , Dor Abdominal/terapia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Colangiopancreatografia Retrógrada Endoscópica , Nutrição Enteral/métodos , Medicina Baseada em Evidências/tendências , Hidratação/métodos , Gastroenterologia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/imunologia , Náusea/terapia , Pâncreas/diagnóstico por imagem , Pâncreas/imunologia , Pâncreas/cirurgia , Pancreatite/complicações , Pancreatite/diagnóstico , Pancreatite/imunologia , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Vômito/diagnóstico , Vômito/imunologia , Vômito/terapia
6.
Mult Scler ; 26(2): 253-255, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30663514

RESUMO

Anti-Glial fibrillary acidic protein (GFAP) encephalomyelitis is a recently described entity and while the spectrum of this disease has been explored, further research is needed to fully describe its phenotype. Area postrema syndrome (APS) is usually associated with neuromyelitis optica spectrum disorders (NMOSDs), whereas no case of APS has been previously reported with anti-GFAP encephalomyelitis. In this article, we report a case of APS in a 41-year-old woman in the context of anti-GFAP encephalomyelitis. This case was not associated with additional anti-AQP4 IgG and therefore extends the clinico-radiological spectrum of anti-GFAP encephalomyelitis.


Assuntos
Área Postrema , Autoanticorpos/imunologia , Encefalomielite/imunologia , Proteína Glial Fibrilar Ácida/imunologia , Adulto , Autoantígenos/imunologia , Encefalomielite/complicações , Encefalomielite/patologia , Feminino , Humanos , Náusea/imunologia , Síndrome , Vômito/imunologia
8.
BMC Res Notes ; 12(1): 326, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182146

RESUMO

OBJECTIVE: Increase in the evidence of global occurrence of Zika viral infection suggests that in Africa the circulation of the virus which causes 80% of asymptomatic infection could be undetected and/or overlooked. We sought to serologically detect Zika virus infection in febrile patients at Greater Accra Regional Hospital, Ghana. RESULTS: Of the 160 patient serum samples analyzed, 33 were found to have antibodies against Zika virus infection. Among the sero-positives 30 (91%) of the cases were anti-Zika virus IgM with the 21-30-year age group recording the highest number of 8 (26%) and 2 (7%) cases being the least for the 61 years and above age group. All sero-positive febrile patients developed at least one symptom consistent with Zika virus infection: 33 (100%) fever, 25 (76%) muscle pain, 24 (73%) joint pain, and conjunctivitis 2 (6%). Digestive symptoms recorded include 16 (49%) nausea, 12 (36%) vomiting and diarrhea 18 (55%). In addition, 28 (85%) loss of appetite, 14 (75%) rapid respiration and chest pain 15 (42%) were reported by seropositive febrile patients. Our data indicates exposure to Zika virus which suggests the possible circulation of the virus among febrile patients in Ghana with a sero-prevalence rate of 20.6%.


Assuntos
Anticorpos Antivirais/sangue , Artralgia/imunologia , Febre/imunologia , Mialgia/imunologia , Infecção por Zika virus/imunologia , Zika virus/imunologia , Adolescente , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/epidemiologia , Artralgia/fisiopatologia , Criança , Pré-Escolar , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Conjuntivite Viral/imunologia , Conjuntivite Viral/fisiopatologia , Estudos Transversais , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/imunologia , Diarreia/fisiopatologia , Feminino , Febre/diagnóstico , Febre/epidemiologia , Febre/fisiopatologia , Gana/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Mialgia/diagnóstico , Mialgia/epidemiologia , Mialgia/fisiopatologia , Náusea/diagnóstico , Náusea/epidemiologia , Náusea/imunologia , Náusea/fisiopatologia , Estudos Soroepidemiológicos , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/imunologia , Vômito/fisiopatologia , Zika virus/crescimento & desenvolvimento , Zika virus/patogenicidade , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/fisiopatologia
9.
Neurogastroenterol Motil ; 31(10): e13611, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31016817

RESUMO

BACKGROUND: The identification of autoantibodies directed against neuronal antigens has led to the recognition of a wide spectrum of neurological autoimmune disorders (NAD). With timely recognition and treatment, many patients with NAD see rapid improvement. Symptoms associated with NAD can be diverse and are determined by the regions of the nervous system affected. In addition to neurological symptoms, a number of these disorders present with prominent gastrointestinal (GI) manifestations such as nausea, diarrhea, weight loss, and gastroparesis prompting an initial evaluation by gastroenterologists. PURPOSE: This review provides a general overview of autoantibodies within the nervous system, focusing on three scenarios in which nervous system autoimmunity may initially present with gut symptoms. A general approach to evaluation and treatment, including antibody testing, will be reviewed.


Assuntos
Doenças Autoimunes do Sistema Nervoso/fisiopatologia , Gastroenteropatias/fisiopatologia , Adulto , Idoso , Anticorpos Antinucleares/imunologia , Anticorpos Antineoplásicos , Aquaporina 4/imunologia , Área Postrema/fisiopatologia , Autoanticorpos/imunologia , Doenças Autoimunes do Sistema Nervoso/complicações , Doenças Autoimunes do Sistema Nervoso/tratamento farmacológico , Doenças Autoimunes do Sistema Nervoso/imunologia , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Doenças do Sistema Nervoso Autônomo/imunologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Encéfalo/diagnóstico por imagem , Diarreia/etiologia , Diarreia/imunologia , Diarreia/fisiopatologia , Dipeptidil Peptidases e Tripeptidil Peptidases/imunologia , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/imunologia , Gastroparesia/etiologia , Gastroparesia/imunologia , Gastroparesia/fisiopatologia , Humanos , Imunossupressores/uso terapêutico , Pseudo-Obstrução Intestinal/complicações , Pseudo-Obstrução Intestinal/tratamento farmacológico , Pseudo-Obstrução Intestinal/imunologia , Pseudo-Obstrução Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/imunologia , Náusea/fisiopatologia , Proteínas do Tecido Nervoso/imunologia , Neuromielite Óptica/complicações , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/imunologia , Neuromielite Óptica/fisiopatologia , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/tratamento farmacológico , Síndromes Paraneoplásicas do Sistema Nervoso/imunologia , Síndromes Paraneoplásicas do Sistema Nervoso/fisiopatologia , Canais de Potássio/imunologia , Redução de Peso
10.
Curr Drug Saf ; 14(1): 3-13, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30332974

RESUMO

BACKGROUND: Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article. DISCUSSION AND CONCLUSION: Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.


Assuntos
Síndrome de Guillain-Barré/tratamento farmacológico , Imunização Passiva/efeitos adversos , Imunoglobulinas Intravenosas/efeitos adversos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/imunologia , Febre/induzido quimicamente , Febre/diagnóstico , Febre/imunologia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/imunologia , Cefaleia/induzido quimicamente , Cefaleia/diagnóstico , Cefaleia/imunologia , Humanos , Imunização Passiva/métodos , Imunoglobulinas Intravenosas/administração & dosagem , Náusea/induzido quimicamente , Náusea/diagnóstico , Náusea/imunologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/imunologia , Resultado do Tratamento
11.
J Int Med Res ; 46(8): 3411-3416, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29806512

RESUMO

Autoantibodies targeting aquaporin 4 (AQP4) water channels are a sensitive and specific biomarker for neuromyelitis optica spectrum disorder (NMOSD). Presence of AQP4 antibodies distinguishes NMOSD from multiple sclerosis. We present our experience with an anti-AQP4 antibody-positive patient diagnosed with NMOSD who complained of intractable nausea and vomiting, not restricted to optic neuritis or acute myelitis during the first attack. Her symptoms partially resolved after appropriate therapy with intravenous methylprednisolone and oral prednisolone. Through this case, we hope to draw attention to an unusual neurological presentation of NMOSD which should be included in the differential diagnosis of intractable nausea and vomiting.


Assuntos
Aquaporina 4/imunologia , Autoanticorpos/imunologia , Náusea/etiologia , Neuromielite Óptica/diagnóstico , Vômito/etiologia , Administração Intravenosa , Administração Oral , Adulto , Autoanticorpos/sangue , Feminino , Glucocorticoides/administração & dosagem , Humanos , Metilprednisolona/administração & dosagem , Mielite Transversa/diagnóstico , Mielite Transversa/tratamento farmacológico , Náusea/tratamento farmacológico , Náusea/imunologia , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/imunologia , Prednisolona/administração & dosagem , Vômito/tratamento farmacológico , Vômito/imunologia
12.
Ann Allergy Asthma Immunol ; 120(6): 626-630, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29567357

RESUMO

BACKGROUND: Mycoprotein, which is produced by a mold and is the basis of Quorn-brand meat substitutes, is a novel cause of allergic and gastrointestinal reactions, but little information has been available on its associated symptomatology. OBJECTIVE: To describe the nature and frequency of adverse reactions to mycoprotein. METHODS: Self-reports of adverse reactions to mycoprotein were collected via a Web-based questionnaire (www.quorncomplaints.org) and then analyzed. RESULTS: Analysis of 1,752 adverse reactions found that Quorn products caused allergic and gastrointestinal symptoms, with some people experiencing both. Allergic reactions, including urticaria and anaphylaxis, occurred within 4 hours of consumption in 312 people. Of those reactions, 45.8%, 1 fatal, began within 1 hour of exposure. Of those 312 individuals, 188 (60.3%) reported repeated reactions after repeated consumption of Quorn, and 2 people experienced 8 reactions (13 people did not say whether they experienced more than 1 reaction). Quorn foods caused gastrointestinal symptoms, including emesis and diarrhea, within 8 hours of consumption in 1,692 people. Of the gastrointestinal symptoms, 66.6% occurred 46 to 180 minutes after consumption of the products. Symptoms ranged from mild nausea to emesis severe enough to warrant medical attention. CONCLUSION: Mycoprotein may be causing numerous and sometimes life-threatening allergic and gastrointestinal reactions. The acceptance in the food supply of this nonessential ingredient deserves reconsideration.


Assuntos
Anafilaxia/diagnóstico , Exposição Dietética/efeitos adversos , Hipersensibilidade Alimentar/diagnóstico , Proteínas Fúngicas/efeitos adversos , Urticária/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anafilaxia/induzido quimicamente , Anafilaxia/imunologia , Anafilaxia/fisiopatologia , Criança , Pré-Escolar , Diarreia/induzido quimicamente , Diarreia/diagnóstico , Diarreia/imunologia , Diarreia/fisiopatologia , Feminino , Alimentos/toxicidade , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/fisiopatologia , Fusarium/química , Fusarium/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/diagnóstico , Náusea/imunologia , Náusea/fisiopatologia , Autorrelato , Inquéritos e Questionários , Urticária/induzido quimicamente , Urticária/imunologia , Urticária/fisiopatologia , Vômito/induzido quimicamente , Vômito/diagnóstico , Vômito/imunologia , Vômito/fisiopatologia
13.
Immunotherapy ; 7(12): 1235-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26427747

RESUMO

Sublingual route, a noninjective way of allergen administration appears to be associated with a lower incidence of severe systemic reactions compared with the subcutaneous route. Local adverse reactions are reported which resolve spontaneously within a few days without need for discontinuation of treatment. Hereby, we report two pediatric cases, one with persistent asthma and the other one with persistent allergic rhinitis. Both were treated by house dust mite sublingual immunotherapy, one of whom developed severe wheezing (grade 2 systemic reaction based on World Allergy Organization subcutaneous systemic reaction grading system) and the other intractable vomiting (grade 3 local reaction based on World Allergy Organization sublingual immunotherapy local adverse events grading system) at the end of the build-up phase which repeated on re-administration of the same dose. Both of those two cases completed their 3-year immunotherapy successfully by patient-based adjustment of the highest tolerated dose of the maintenance.


Assuntos
Asma/terapia , Dermatophagoides farinae/imunologia , Dermatophagoides pteronyssinus/imunologia , Rinite Alérgica/terapia , Imunoterapia Sublingual/efeitos adversos , Animais , Asma/tratamento farmacológico , Criança , Pré-Escolar , Relação Dose-Resposta Imunológica , Fluticasona/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Dose Máxima Tolerável , Náusea/imunologia , Sons Respiratórios/imunologia , Rinite Alérgica/tratamento farmacológico , Vômito/imunologia
14.
Eur J Clin Nutr ; 69(7): 781-5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26014268

RESUMO

BACKGROUND/OBJECTIVES: It is unknown what causes uraemic symptoms in renal disease. Chronic kidney disease (CKD) patients are known to have increased levels of urea, sodium, potassium and phosphate in their saliva compared with those without renal disease. The present cross-sectional study investigated associations between known genetic traits of taste and self-reported upper gastrointestinal (GI) symptoms experienced in CKD patients with the changes in saliva composition found in renal failure. SUBJECTS/METHODS: Fifty-six CKD patients (35 males, 21 females, age 67±14 years), with stages 4 and 5 renal failure, selected from a tertiary hospital renal outpatient clinic participated in this study. Subjects answered a questionnaire to assess upper GI symptoms and tested for the genetic taste recognition thresholds of thiourea, phenylthiocarbamide and sodium benzoate. Saliva samples were collected to determine biochemical composition. Possible associations between genetic taste variations, saliva composition and upper GI symptoms were investigated. RESULTS: Of the 56 patients enroled, 29 (52%) reported major upper GI uraemic symptoms, whereas 27 (48%) had no symptoms or only minor complaints of dry mouth. There was a strong association between the symptomatic burden a patient experienced and the genetic ability to taste thiourea (P<0.0003). Uraemic symptoms of taste changes (P<0.004) and nausea (P<0.002) were found to be related to a patient's genetic ability to taste thiourea. CONCLUSIONS: This study provides evidence that the genetic ability to taste thiourea as bitter, in combination with the increase in active compounds found in CKD patient's saliva, impacts on the uraemic upper GI symptoms experienced.


Assuntos
Disgeusia/etiologia , Gastroenterite/etiologia , Falência Renal Crônica/fisiopatologia , Saliva/química , Uremia/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Disgeusia/genética , Disgeusia/imunologia , Feminino , Gastroenterite/genética , Gastroenterite/imunologia , Predisposição Genética para Doença , Humanos , Falência Renal Crônica/genética , Falência Renal Crônica/imunologia , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/genética , Náusea/imunologia , Feniltioureia/efeitos adversos , Autorrelato , Índice de Gravidade de Doença , Benzoato de Sódio/efeitos adversos , Limiar Gustativo , Tioureia/efeitos adversos , Uremia/genética , Uremia/imunologia , Uremia/fisiopatologia , Xerostomia/etiologia , Xerostomia/imunologia
15.
Brain Dev ; 37(1): 149-52, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24750850

RESUMO

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease with a poor prognosis that is characterized by inflammatory optic neuritis and myelitis. Although it is commonly misdiagnosed as multiple sclerosis (MS), distinguishing NMO from MS is important, as therapeutic approaches approved for MS are ineffective in patients with NMO. The aquaporin-4 (AQP4) antibody is a pathogenic and diagnostic biomarker for NMO. We report an AQP4 antibody-positive 9-year-old female with intractable hiccups and nausea (IHN). Brain imaging revealed lesions in the brainstem, thalami, and hypothalamus. Nevertheless, she had no clinical or radiological signs referable to the optic nerve or spinal cord. We propose that in patients with characteristic IHN associated lesions involving the brainstem or hypothalamus, measurement of AQP4 antibody should be considered for selectivity of treatment, even if the patient has no optic nerve or spinal cord lesions.


Assuntos
Aquaporina 4/imunologia , Autoanticorpos/imunologia , Encéfalo/patologia , Soluço/imunologia , Náusea/imunologia , Autoanticorpos/sangue , Autoantígenos/imunologia , Criança , Feminino , Humanos , Mielite/patologia , Nervo Óptico/patologia , Neurite Óptica/patologia , Medula Espinal/patologia
16.
Clin Gastroenterol Hepatol ; 11(3): 240-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23211959

RESUMO

BACKGROUND & AIMS: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. METHODS: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). RESULTS: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. CONCLUSIONS: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.


Assuntos
Aquaporina 4/imunologia , Autoanticorpos/imunologia , Encéfalo/efeitos dos fármacos , Náusea/induzido quimicamente , Vômito/induzido quimicamente , Adulto , Idoso , Encéfalo/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/imunologia , Vômito/imunologia
17.
Toxins (Basel) ; 4(11): 1120-38, 2012 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-23202308

RESUMO

Deoxynivalenol (DON), mainly produced by Fusarium fungi, and also commonly called vomitoxin, is a trichothecene mycotoxin. It is one of the most abundant trichothecenes which contaminate cereals consumed by farm animals and humans. The extent of cereal contamination is strongly associated with rainfall and moisture at the time of flowering and with grain storage conditions. DON consumption may result in intoxication, the severity of which is dose-dependent and may lead to different symptoms including anorexia, vomiting, reduced weight gain, neuroendocrine changes, immunological effects, diarrhea, leukocytosis, hemorrhage or circulatory shock. During the last two decades, many studies have described DON toxicity using diverse animal species as a model. While the action of the toxin on peripheral organs and tissues is well documented, data illustrating its effect on the brain are significantly less abundant. Yet, DON is known to affect the central nervous system. Recent studies have provided new evidence and detail regarding the action of the toxin on the brain. The purpose of the present review is to summarize critical studies illustrating this central action of the toxin and to suggest research perspectives in this field.


Assuntos
Encéfalo/efeitos dos fármacos , Fusarium/crescimento & desenvolvimento , Tricotecenos/toxicidade , Animais , Anorexia/induzido quimicamente , Anorexia/imunologia , Encéfalo/imunologia , Química Encefálica/efeitos dos fármacos , Citocinas/biossíntese , Citocinas/imunologia , Contaminação de Alimentos/análise , Fusarium/metabolismo , Humanos , Atividade Motora/efeitos dos fármacos , Náusea/induzido quimicamente , Náusea/imunologia
18.
Arch Neurol ; 68(4): 473-9, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21149806

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of mitoxantrone hydrochloride and determine how it exhibits a differential inhibitory effect on subsets of B cells in patients with highly relapsing neuromyelitis optica (NMO). DESIGN: Retrospective case series with prospective follow-up. SETTING: Three referral medical centers in the Republic of Korea. PATIENTS: Twenty patients with highly relapsing NMO or neuromyelitis optica spectrum disorder who had at least 2 relapses during the year preceding the start of mitoxantrone treatment, despite other immunotherapies. INTERVENTION: Infusions of mitoxantrone up to a maximum cumulative dose of 120 mg/m(2). MAIN OUTCOME MEASURES: Annualized relapse rate, disability according to the Expanded Disability Status Scale score, and fraction of CD27(+)CD19(+) memory B cells. RESULTS: During mitoxantrone treatment, the median annualized relapse rate was reduced by 75%, and 50% of patients became relapse free. Disability improved or stabilized in all patients. No patients had serious adverse effects during the mean follow-up period of 41 months after completing therapy. Flow cytometric analysis of cell surface markers revealed that mitoxantrone treatment preferentially affected CD27(+)CD19(+) memory B cells. CONCLUSIONS: Treatment with mitoxantrone in patients with highly relapsing NMO significantly reduces relapse rates, resulting in subsequent functional stabilization or improvement.


Assuntos
Mitoxantrona/administração & dosagem , Mitoxantrona/efeitos adversos , Neuromielite Óptica/tratamento farmacológico , Adulto , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Leucopenia/induzido quimicamente , Leucopenia/imunologia , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/imunologia , Neuromielite Óptica/imunologia , Neuromielite Óptica/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Prevenção Secundária , Resultado do Tratamento , Adulto Jovem
19.
Neurosci Lett ; 450(3): 301-5, 2009 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-19059465

RESUMO

The effects of systemic treatment with lipopolysaccharide (LPS) on conditioned gaping in a rodent model of anticipatory nausea were examined. Stimulation of the immune system has been found to enhance, impair, or have no effect on various learning and memory tasks. The development of anticipatory nausea is formed through a classically conditioned response to a context that has been paired previously with toxin-induced nausea and/or vomiting. Rats display a distinctive conditioned gaping response when injected with a nausea-inducing drug such as LiCl. In the present study, male Long-Evans rats were injected intraperitoneally with LPS (200microg/kg) or saline (NaCl) followed 90min later by an injection of the toxin LiCl or saline before being placed in a distinctive context on four conditioning days (72h apart). On the condition test day, rats (n=6/group) were placed in the distinctive context in a drug-free state and behavioral responses were videotaped. Rats given LPS followed by LiCl were found to have significantly fewer gaping responses when compared to rats given NaCl followed by LiCl. All groups were also found to have similar levels of spontaneous ingestive behaviors suggesting that the decrease in gaping was not due to motor impairment. The present results suggest that activation of the immune system with LPS administration significantly impairs the acquisition of anticipatory nausea.


Assuntos
Aprendizagem por Associação/fisiologia , Condicionamento Psicológico/fisiologia , Fenômenos do Sistema Imunitário/fisiologia , Náusea/imunologia , Vômito Precoce/imunologia , Animais , Aprendizagem por Associação/efeitos dos fármacos , Condicionamento Psicológico/efeitos dos fármacos , Modelos Animais de Doenças , Fenômenos do Sistema Imunitário/efeitos dos fármacos , Lipopolissacarídeos/farmacologia , Cloreto de Lítio/antagonistas & inibidores , Masculino , Memória/efeitos dos fármacos , Memória/fisiologia , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/imunologia , Náusea/induzido quimicamente , Ponte/anatomia & histologia , Ponte/efeitos dos fármacos , Ponte/imunologia , Ratos , Ratos Long-Evans , Vômito Precoce/induzido quimicamente
20.
Psychoneuroendocrinology ; 31(2): 226-36, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16143452

RESUMO

It has been shown that stress changes stimulated pro-inflammatory cytokine production and the sensitivity of stimulated cytokine production to glucocorticoid suppression. While glucocorticoid secretion habituates in response repeated stimulation, it is not known whether stimulation and suppression of cytokine production are also subject to adaptation. Eight healthy young subjects were exposed to repeated nauseogenic body rotation on four consecutive days. On each day subjects were rotated around the vertical axis up to five times for a period of 1 min or until subjects chose to stop due to nausea. Blood and saliva samples were obtained before and after rotation for assessment of cortisol, ACTH, plasma vasopressin (ADH), in vitro TNF-alpha and IL-6 production and glucocorticoid sensitivity of TNF-alpha and IL-6 production. Rotation induced increases of ACTH, cortisol, and ADH in the first session. All endocrine responses habituated over time, except for the free cortisol response in men. Pro-inflammatory cytokine production showed a sex-specific response pattern with increases in men and decreases in women in the first session vs. increases in men and women in the last session. Response patterns of GC sensitivity also changed over time: in the first session, sensitivity increased only in men, but in the last session, GC sensitivity decreased in all subjects. In conclusion, in response to repeated nausea induction, habituation occurs only in the endocrine system and predominantly in women. In the immune system, response patterns change in the favor of inflammatory conditions, with increases in stimulated IL-6 and TNF-alpha and decreases in the effectiveness of glucocorticoid suppression of these cytokines. These presumably unfavorable changes in the inflammatory system are more pronounced men.


Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Citocinas/metabolismo , Hidrocortisona/metabolismo , Enjoo devido ao Movimento/metabolismo , Náusea/metabolismo , Rotação , Adaptação Fisiológica/imunologia , Adaptação Fisiológica/fisiologia , Adulto , Feminino , Humanos , Interleucina-6/metabolismo , Masculino , Enjoo devido ao Movimento/etiologia , Enjoo devido ao Movimento/imunologia , Náusea/etiologia , Náusea/imunologia , Valores de Referência , Rotação/efeitos adversos , Saliva/metabolismo , Fatores Sexuais , Fator de Necrose Tumoral alfa/metabolismo , Vasopressinas/sangue
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