RESUMEN
OBJECTIVE: Catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. Various studies have evaluated the efficacy of different interventions in postoperative CRBD. The present review was performed to assess the efficacy of these interventions. METHODS: PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were systematically searched to identify randomized controlled trials (RCTs) investigating the efficacy of different drugs for the prevention of postoperative CRBD. This review evaluated the incidence and severity of CRBD after different interventions at 0, 1, 2, and 6 h postoperatively. RESULTS: Forty-five studies including 31 different drugs were analyzed. Eleven drugs were investigated in more than two RCTs, of which dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and pudendal nerve block (PNB) generally showed significantly higher efficacy than controls postoperatively. Solifenacin only showed significant efficacy compared with the control at 0 h, and intravenous lidocaine only showed significant efficacy compared with the control at 6 h. There were insufficient trials to draw conclusions regarding atropine, butylscopolamine, chlorpheniramine, clonidine, darifenacin, diphenhydramine, glycopyrrolate, intravesical bupivacaine, ketamine-haloperidol, pethidine-haloperidol, ketorolac, lidocaine-prilocaine cream, magnesium, hyoscine n-butyl bromide, oxycodone, paracetamol, parecoxib, trospium, resiniferatoxin, or amikacin. However, all but pethidine-haloperidol and chlorpheniramine showed some efficacy at various time points compared with controls. CONCLUSION: This review suggests that dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and PNB are effective in preventing postoperative CRBD. Considering the efficacy and adverse effects of all drugs, dexmedetomidine and gabapentin were ranked best.
Asunto(s)
Dexmedetomidina , Ketamina , Nefopam , Tramadol , Clorfeniramina/farmacología , Clorfeniramina/uso terapéutico , Dexmedetomidina/uso terapéutico , Gabapentina/farmacología , Gabapentina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Lidocaína , Meperidina/farmacología , Meperidina/uso terapéutico , Nefopam/farmacología , Nefopam/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Pregabalina/farmacología , Tartrato de Tolterodina/farmacología , Tartrato de Tolterodina/uso terapéutico , Tramadol/uso terapéutico , Vejiga Urinaria/cirugía , Catéteres Urinarios/efectos adversosRESUMEN
Se describe los casos de tres pacientes a quien se les realiza diagnóstico de colestasis intrahepática del embarazo (CIE) de aparición temprana. En dos de ellos el diagnóstico se relacionó con infección por el virus de la hepatitis C (VHC). Reconocer que esta enfermedad puede presentarse de manera temprana en el embarazo y su relación con la infección por el VHC es fundamental para hacer un diagnóstico oportuno de ambas enfermedades y tomar las conductas terapéuticas adecuadas, mejorando así el pronóstico materno y fetal.
It is of great importance to acknowledge that this disease can occur early in pregnancy and that its relationship with HCV infection is a key point for a prompt diagnosis, allowing taking timely appropriate therapeutic decisions, aimed at improving the fetal prognosis.
Descrevemos os casos de três pacientes com diagnóstico de colestase intra-hepática da gravidez de início precoce. Em dois deles o diagnóstico estava relacionado à infecção pelo vírus da hepatite C (VHC). Reconhecer que esta doença pode se manifestar precocemente na gravidez e sua relação com a infecção pelo VHC é fundamental para fazer um diagnóstico oportuno de ambas as doenças e assumir condutas terapêuticas adequadas, melhorando assim o prognóstico materno e fetal.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Complicaciones Infecciosas del Embarazo/diagnóstico , Prurito , Colestasis Intrahepática/diagnóstico , Colestasis Intrahepática/etiología , Hepatitis C/complicaciones , Segundo Trimestre del Embarazo , Primer Trimestre del Embarazo , Ácido Ursodesoxicólico/uso terapéutico , Clorfeniramina/uso terapéutico , Colestasis Intrahepática/tratamiento farmacológico , Hepatitis C/diagnóstico , Diagnóstico PrecozRESUMEN
In French Guiana, a French overseas region partly located in the Amazon, "Africanized" bees, a hybrid species of Brazilian bees known as "killer bees," have been observed since 1975. Since then, several cases requiring long hospitalization times have been described, allowing for a better understanding of the physiopathological mechanisms of this particular envenomation. Here, we report on a series of 10 cases of patients simultaneously attacked by hundreds of killer bees and immediately treated by a prehospital medical team already on site. Between 75 and 650 stingers were removed per victim. The reference treatment for anaphylaxis using intramuscular injection of epinephrine, vascular filling, and oxygen therapy was administered to all patients without delay. A clinical description was provided, and biological tests were performed immediately after the envenomation. We therefore observe the existence of a two-phase, medically well-controlled systemic toxic reaction. Thus, all our patients left the hospital after 44 hours of monitoring with no complications or sequelae, despite levels of intoxication described as potentially fatal elsewhere in the literature.
Asunto(s)
Abejas/clasificación , Mordeduras y Picaduras de Insectos/epidemiología , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Animales , Antiinfecciosos Locales/administración & dosificación , Antiinfecciosos Locales/uso terapéutico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Clorfeniramina/administración & dosificación , Clorfeniramina/uso terapéutico , Epinefrina/uso terapéutico , Guyana Francesa/epidemiología , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Mordeduras y Picaduras de Insectos/tratamiento farmacológico , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Oxígeno/uso terapéutico , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Solución Salina , Simpatomiméticos/administración & dosificación , Simpatomiméticos/uso terapéutico , Adulto JovenRESUMEN
A hybrid species of Brazilian bee has proliferated on the South American continent since 1956. We describe a "killer bee" swarm attack on a 2-year-old girl in French Guiana. The patient weighed 10 kg, and approximately hundreds of bees' stingers were removed, that is, 10 stings/kg. Our patient survived without long-term sequelae. The management of her condition required admission into intensive care for renal failure due to acute tubular necrosis and severe rhabdomyolysis. We emphasize the importance of early medical intervention, clinical surveillance, and biological monitoring at the hospital to prevent a toxic chain reaction that could prove fatal within 72 hours.
Asunto(s)
Lesión Renal Aguda/etiología , Venenos de Abeja/toxicidad , Abejas , Mordeduras y Picaduras de Insectos , Acetaminofén/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Animales , Preescolar , Clorfeniramina/administración & dosificación , Clorfeniramina/uso terapéutico , Femenino , Guyana Francesa , Furosemida/uso terapéutico , Glucocorticoides/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Mordeduras y Picaduras de Insectos/complicaciones , Prednisolona/uso terapéuticoRESUMEN
INTRODUCTION: Platinum compounds are frequently used for the treatment of colorectal cancer as initial chemotherapy. Oxaliplatin is a third-generation platinum used for the treatment of stage III colorectal cancer and is associated with hypersensitivity reactions. The incidence of hypersensitivity reaction is approximately 12%, with 1-2% of patients developing moderate to severe reactions. CASE REPORT: A 54-year-old male patient with stage III B colon cancer was diagnosed and chemotherapy with oxaliplatin was indicated by the oncology service. Within 20 min of the first cycle of oxaliplatin, he developed dyspnea, laryngeal spam, foreign body sensation in the throat, nausea, and diarrhea; therefore, the infusion of oxaliplatin was suspended, and intramuscular epinephrine was administered and intravenous hydrocortisone along with chlorpheniramine with adequate resolution of symptoms.Management and outcome: Intradermal skin test performed at the concentration of 5 mg/ml (dilution 1:100) was positive. Due to the symptoms presented we decided to perform desensitization to oxaliplatin (total dose: 250 mg) with three bags-12 steps protocol with an initial concentration dose of 1/100 of the total dose in a course of 5.56 h with no hypersensitivity reactions. DISCUSSION: Approximately 50% of patients who are exposed to oxaliplatin may have hypersensitivity despite premedication. Desensitization protocol induces tolerance to a drug temporarily and is dependent on continuous exposure.
Asunto(s)
Antineoplásicos/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/terapia , Oxaliplatino/efectos adversos , Antiinflamatorios/uso terapéutico , Antineoplásicos/uso terapéutico , Clorfeniramina/uso terapéutico , Epinefrina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Hidrocortisona/uso terapéutico , Tolerancia Inmunológica , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/tratamiento farmacológico , Oxaliplatino/uso terapéuticoRESUMEN
The unprecedented coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems in different ways. In the United Kingdom, various subspecialties are deployed to the wards to help medical workforce in the frontlines, with dermatologists helping with general medical wards and on-calls. We present a case of COVID-19-related urticaria manifesting in a palliative setting and responding well to systemic antihistamine. This pandemic has highlighted a new subspecialty that should be explored and researched-palliative dermatology-bridging elements of dermatology with the concepts of palliative medicine. As dermatologists, we should be in the position to help with the last stages of a patient's journey.
Asunto(s)
COVID-19/complicaciones , Cuidados Paliativos , Urticaria/tratamiento farmacológico , Urticaria/virología , Anciano , Clorfeniramina/uso terapéutico , Resultado Fatal , Femenino , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , SARS-CoV-2RESUMEN
BACKGROUND: Mosquitoes are vectors of several pathogens of considerable importance to humans and companion animals, including nematode helminths such as Dirofilaria immitis and Dirofilaria repens that cause heartworm disease and subcutaneous dirofilariosis, respectively. In addition to mosquito-borne pathogen transmission, mosquito bites can cause discomfort and irritation in pets, and even lead to severe hypersensitivity reactions. In the present study, we report an acute local hypersensitivity reaction in a dog following experimental exposure to Aedes (Stegomyia) aegypti. CASE PRESENTATION: A healthy six-year-old male beagle was included in an efficacy study in which dogs (n = 28) were exposed to Ae. aegypti mosquitoes. On Day - 6, the dog was allocated to one of the study groups, consisting of seven dogs to be treated on Day 0 with an imidacloprid/flumethrin collar. After sedation, animals were exposed to approximately 50 females of Ae. aegypti for 60 (± 5) minutes on Days - 6, 1, 7, 14, 21, 28, 55, and 83. On Day - 6, no allergic reaction to the mosquito bites was observed. However, on Day 1, corresponding to the second challenge, the dog demonstrated an acute allergic reaction characterized by swelling of the face (especially in the base of the muzzle and around the eyes), redness of the eyes, and conjunctival edema of the right eye was also observed. The dog was immediately treated with an intramuscular injection of a commercially available antihistamine treatment, Pen-Hista-Strep® containing a suspension of benzylpenicillin, chlorphenamine, dexamethasone, dihydrostreptomycin, and procaine at a dosage of 1 mL per 10 kg. A few hours after treatment, the dog showed noticeable improvement. CONCLUSIONS: This case provides the first evidence of canine acute local hypersensitivity reaction to mosquito bites under laboratory conditions. This observation suggests that invasive mosquito species such as Aedes spp. may affect the health and comfort of our companion animals, especially for pets with outdoor access without individual protective measures against insect bites.
Asunto(s)
Aedes/inmunología , Hipersensibilidad/veterinaria , Mordeduras y Picaduras de Insectos/veterinaria , Animales , Clorfeniramina/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/inmunología , Perros , Combinación de Medicamentos , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad/inmunología , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/inmunología , MasculinoRESUMEN
INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.
Asunto(s)
Antituberculosos/uso terapéutico , Vasculitis por IgA/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Cuidados Posteriores , Ácido Ascórbico/uso terapéutico , Clorfeniramina/uso terapéutico , Diagnóstico Diferencial , Fiebre/diagnóstico , Fiebre/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Vasculitis por IgA/tratamiento farmacológico , Ensayos de Liberación de Interferón gamma/métodos , Masculino , Resultado del Tratamiento , Tuberculina , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/diagnóstico por imagen , Vitaminas/uso terapéutico , Adulto JovenRESUMEN
INTRODUCTION: Exercise induced asthma (EIB) is an acute, reversible, usually selflimiting airways obstruction which sets in after exercise in patients with asthma. One popular mechanism of EIA is the increase in histamine and its metabolites in circulation after exercise, which leads to bronchoconstriction via histamine receptors in bronchi. Chlorpheniramine Maleate is potent, less sedative antihistaminic drug, which acts by inhibiting histamine release from mast cells. It is also said to have anticholinergic properties. The aerosol route of administration of a drug has the advantages of a faster onset of action, fewer side effects, and greater protection against EIB with respect to small airways function. This study was conducted to evaluate the effect of Chlorpheniramine Maleate aerosol inhalation on flow volumes and gas exchange. MATERIALS AND METHODS: 25 established patients of stabilized bronchial asthma (18 to 44 years) with history of EIA attending Allergy OPD, Medical OPD or Chest clinic were included in the present study. Patients were studied for 3 days in a week at the same time of day. Baseline spirometry was done to know test parameters, i.e. FEV1, PEFR and FEF50%. Gas exchange study during rest including minute ventilation (VE), oxygen consumption (VO2), Carbon dioxide produced per minute (VCO2), Respiratory quotient (R) was carried out. Patient was asked to perform exercise on bicycle ergometer. During exercise VE, VO2, VCO2 and R were recorded every 30 seconds. FEV1, PEFR and FEF50% were recorded immediately after and 5 min after completion of exercise. On day 2, same procedure was repeated with saline nebulisation before the exercise. On day 3, aerosolized Chlorpheniramine Maleate was used instead of saline for nebulisation. Values obtained were tabulated and analysed. OBSERVATIONS AND RESULTS: After exercise FEV1, PEFR, FEF50% decreased on all three days, but the fall in these parameters was less on Day III (prior nebulisation with Chlorpheniramine maleate) compared to previous days. There was significant increase in FEV1, PEFR and FEF50% (P<0.01, 0.05 and 0.05 respectively) which was seen 30 mins after inhalation of Chlorpheniramine maleate aerosol compared to placebo. Resting and exercise values of Minute Ventilation (VE), oxygen uptake (VO2) carbon dioxide expired, on all the three days were comparable and statistically not significant by the end of exercise. On day 2 and 3, 'R' as compared to that of day1 was slightly significant during rest and initial minutes of exercise but became insignificant after that till the end of exercise. CONCLUSION: This study shows that Chlorpheniramine causes bronchodilation during resting period by acting on the circulating or tissue histamine in asthmatics which contributes to an increase in resting bronchomotor tone. As there is incomplete inhibition of EIA by Chlorpheniramine, there may be some other associated mediator release for pathogenesis of EIA.
Asunto(s)
Asma Inducida por Ejercicio/tratamiento farmacológico , Asma , Clorfeniramina/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Prueba de Esfuerzo , Humanos , Pruebas de Función RespiratoriaAsunto(s)
Dermatitis/etiología , Hipersensibilidad Tardía/etiología , Hipersensibilidad al Cacahuete/complicaciones , Corticoesteroides/uso terapéutico , Arachis/inmunología , Preescolar , Clorfeniramina/uso terapéutico , Dermatitis/diagnóstico , Dermatitis/tratamiento farmacológico , Dermatitis/inmunología , Proteína Catiónica del Eosinófilo/sangre , Femenino , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/tratamiento farmacológico , Hipersensibilidad Tardía/inmunologíaRESUMEN
Iron deficiency is the main cause of anemia in both sexes, with women being more commonly affected. Iron therapy is currently considered an effective and safe remedy to replenish the iron storages. Iron can be administrated both orally and intravenously. In particular, intravenous (IV) iron therapy is widely used when oral iron preparations are either not tolerated or ineffective. Indeed, IV iron improves iron stores more rapidly. Two main immunological responses have been described for iron hypersensitivity reactions (HSRs): IgE-mediated allergy and complement activation-related pseudo-allergy. Here, we report 3 cases of adult patients with iron allergy, who were successfully treated with two different desensitization procedures, respectively. Analysis of these cases demonstrates that, in the presence of HSRs to iron products, desensitization is an effective and safe procedure that prevents treatment discontinuation and hence allows therapeutic target achievement.
Asunto(s)
Anemia Ferropénica/diagnóstico , Hipersensibilidad/diagnóstico , Hierro/efectos adversos , Adulto , Anemia Ferropénica/tratamiento farmacológico , Clorfeniramina/uso terapéutico , Dexametasona/uso terapéutico , Femenino , Compuestos Férricos/uso terapéutico , Hematínicos/uso terapéutico , Humanos , Hipersensibilidad/etiología , Hierro/uso terapéutico , Maltosa/análogos & derivados , Maltosa/uso terapéutico , Persona de Mediana Edad , Pruebas CutáneasRESUMEN
BACKGROUND: Anticonvulsant hypersensitivity syndrome is a rare adverse drug reaction associated with aromatic anticonvulsant drugs. This syndrome can range from mild cutaneous rash to drug reaction with eosinophilia and systemic symptoms that include fever, rash, lymphadenopathy, pancytopenia, and involvement of multiple internal organs. We aimed to report this case in the literature and make physicians aware of the uncommon symptoms of this syndrome when they prescribe antiepileptic medications in particular. CASE PRESENTATION: A 14-year-old Middle Eastern female patient from Iran with free past medical and allergic history was admitted to hospital because of fever, rash, lymphadenopathy, and pancytopenia after taking anticonvulsants due to new-onset seizure. High fever and cutaneous rash along with lymphadenopathy following administration of anticonvulsant medications that could not be explained by other causes alerted the physician to the possibility of this syndrome. Our investigation revealed no further diagnosis and 1 week after discontinuation of the drugs, her symptoms were resolved. Anticonvulsant hypersensitivity syndrome is a diagnosis of exclusion and immediate discontinuation of the suspicious drugs is necessary. Hence, early recognition can prevent permanent multiorgan damage. CONCLUSIONS: Chlorpheniramine as a simple treatment was provided for this syndrome.
Asunto(s)
Anticonvulsivantes/efectos adversos , Síndrome de Hipersensibilidad a Medicamentos/etiología , Adolescente , Clorfeniramina/uso terapéutico , Síndrome de Hipersensibilidad a Medicamentos/tratamiento farmacológico , Exantema/inducido químicamente , Femenino , Fiebre/inducido químicamente , Humanos , Irán/epidemiología , Linfadenopatía/inducido químicamente , Pancitopenia/inducido químicamenteAsunto(s)
Eritema Multiforme/diagnóstico , Síndrome Mucocutáneo Linfonodular/diagnóstico , Preescolar , Clorfeniramina/uso terapéutico , Eritema Multiforme/patología , Eritema Multiforme/terapia , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Síndrome Mucocutáneo Linfonodular/patología , Síndrome Mucocutáneo Linfonodular/terapia , Prednisolona/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: The deletion of the distal 7q region is a rare chromosomal syndrome characterized by wide phenotypic manifestations including growth and psychomotor delay, facial dysmorphisms, and genitourinary malformations. METHODS: We describe a 6-year-old child with a 12-Mb deletion of the region 7q35q36.3. RESULTS: Among the deleted genes, two genes have cardiac implications: PRKAG2 (OMIM #602743), associated with hypertrophic cardiomyopathy, cardiac conduction disease, and sudden death, and KCNH2 (OMIM #152427), coding for a cardiac potassium channel involved in long QT syndrome, unmasked by the chlorpheniramine treatment. At same time, the SHH gene (OMIM #600725), encoding sonic hedgehog, a secreted protein that is involved in the embryonic development, is deleted. CONCLUSION: Our report underlines potential cardiac complications linked to the common pharmacological treatment in this rare multiorgan and proteiform disease.
Asunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 7 , Canal de Potasio ERG1/genética , Síndrome de QT Prolongado/genética , Niño , Clorfeniramina/efectos adversos , Clorfeniramina/uso terapéutico , Variaciones en el Número de Copia de ADN , Prescripciones de Medicamentos , Electrocardiografía , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/tratamiento farmacológico , MasculinoAsunto(s)
Anafilaxia/diagnóstico , Hipersensibilidad/diagnóstico , Laxativos/administración & dosificación , Polietilenglicoles/administración & dosificación , Cuidados Preoperatorios/efectos adversos , Anciano , Anafilaxia/tratamiento farmacológico , Anafilaxia/etiología , Prueba de Desgranulación de los Basófilos , Clorfeniramina/uso terapéutico , Colonoscopía , Edema , Femenino , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad Inmediata , Hipotensión , Metilprednisolona/uso terapéutico , ParestesiaRESUMEN
A 72-year-old woman with primary biliary cholangitis was admitted to our hospital with heart failure with a preserved ejection fraction. An accidental right ventricular perforation that occurred during an endomyocardial biopsy precipitated cardiogenic shock. Despite successful surgical treatment, she demonstrated progressive hemodynamic deterioration, which was resistant to the administration of high-dose catecholamines. She was diagnosed with acute adrenal insufficiency, which was attributed to the discontinuation of Celestamine® (betamethasone/dextrochlorpheniramine combination) just after the perforation. Prompt intravenous administration of hydrocortisone (150 mg/day) led to hemodynamic stabilization. The serial noninvasive assessment of systemic vascular resistance using transthoracic echocardiography was instrumental in detecting acute adrenal insufficiency in this case.
Asunto(s)
Insuficiencia Suprarrenal/tratamiento farmacológico , Betametasona/uso terapéutico , Clorfeniramina/uso terapéutico , Insuficiencia Cardíaca/fisiopatología , Hidrocortisona/uso terapéutico , Cumplimiento de la Medicación , Resistencia Vascular/efectos de los fármacos , Insuficiencia Suprarrenal/diagnóstico , Anciano , Ecocardiografía , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Alérgenos/inmunología , Antígenos de Plantas/inmunología , Hipersensibilidad a los Alimentos/diagnóstico , Algas Marinas/inmunología , Adulto , Angioedema , Clorfeniramina/uso terapéutico , Hipersensibilidad a los Alimentos/tratamiento farmacológico , Humanos , Masculino , Porphyra/inmunología , Pruebas Cutáneas , UrticariaRESUMEN
Infection with Strongyloides stercoralis is a common parasitic infection in tropical and subtropical regions, including the Peruvian Amazon. The clinical manifestations are varied in patients with immunocompromised disease, and the systemic spread of the disease is frequent, compromising different organs and systems. Cutaneous manifestations are infrequent, being described in patients with some degree of immunosuppression. We present the case of an immunocompetent patient who developed a reactive purpura due to chronic Strongyloides stercoralis infection. Thus, skin involvement is possible in immunocompetent patients with systemic exacerbation due to this parasite.
Asunto(s)
Púrpura/etiología , Púrpura/inmunología , Estrongiloidiasis/complicaciones , Estrongiloidiasis/inmunología , Adulto , Animales , Antiparasitarios/clasificación , Antiparasitarios/uso terapéutico , Antipruriginosos/uso terapéutico , Clorfeniramina/uso terapéutico , Humanos , Huésped Inmunocomprometido , Ivermectina/uso terapéutico , Masculino , Púrpura/tratamiento farmacológico , Strongyloides stercoralis/aislamiento & purificación , Adulto JovenRESUMEN
This paper aims to analyze the specific effect of chlorpheniramine on upper airway cough syndrome is related to its treatment of chronic rhinitis and sinusitis. A total of 218 patients admitted to hospital between March 2014 and June 2016 were treated with chlorpheniramine. The patients were divided into two groups based on treatment effect in follow-up visits (all were effective): effective group (114 cases, 52.29%) and ineffective group (104 cases, 47.71%). The proportion of complicated rhinitis or sinusitis of the two groups were compared, and improvement effect on clinical symptoms of chronic rhinitis and sinusitis after treatment was compared. The probability of rhinitis / sinusitis was 65.79% (75/114) in the effective group and 69.23% (72/104) in the ineffective group. There was no statistical difference between the two groups (P>0.05). In both effective and ineffective group, the symptoms such as chest tightness and shortness of breath and pharyngeal discomfort were improved to a certain extent, and the effective group had better improvement effect, but there was no statistical difference between the two groups (P>0.05). In addition, there was no correlation between improvement of cough and improvement of symptoms in the effective group, 21 cases of cough disappeared completely, while complete disappearance rate of other symptoms was only 57.15% (12/21). Chlorpheniramine is effective to some extent in treatment of upper airway cough syndrome, but chlorpheniramine in treatment of upper airway cough syndrome is not associated with rhinitis/sinusitis treatment.