Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , COVID-19/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/microbiologia , Superinfecção/tratamento farmacológico , Superinfecção/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/virologia , SARS-CoV-2 , Tratamento Farmacológico da COVID-19RESUMO
OBJECTIVES: The persistent positivity of aPLs, either isolated or associated with thrombotic and/or obstetric events (APS), has been associated with the increase of intima-media thickness (IMT) and carotid plaques. Despite the fact that aPLs can promote both thrombotic and obstetric complications, some pathogenic differences have been documented between the two entities. This study aimed to evaluate whether the atherosclerotic risk differs between subjects with obstetric and thrombotic APS. METHODS: A total of 167 APS women (36 obstetric and 131 thrombotic) were compared with 250 aPLs negative controls. IMT of the common carotid artery (CCA) and of the bulb and the prevalence of carotid plaques were assessed. RESULTS: CCA- and bulb-IMT were significantly higher in women with thrombotic APS, while being similar between the obstetric APS and the controls [CCA-IMT: mean (s.d.) 0.97 (0.49), 0.78 (0.22) and 0.81 (0.12) mm for the thrombotic, obstetric and control groups, respectively, P < 0.001 between thrombotic and controls, P = 0.002 between thrombotic and obstetric; bulb-IMT: mean (s.d.) 1.38 (0.79), 0.96 (0.27) and 0.96 (0.51) mm for the thrombotic, obstetric and control groups, P < 0.001]. Women with thrombotic APS had significantly increased risk of presenting carotid plaques. This risk was significantly lower in obstetric APS. CONCLUSION: Unlike thrombotic APS, obstetric APS is not associated with an increase of markers of subclinical atherosclerosis. If confirmed on wider populations, these results could suggest different pathogenetic role of aPLs in promoting atherosclerosis in vascular and obstetric APS, and raise questions on the risk-benefit profile of thromboprophylaxis in obstetric APS outside pregnancy periods.
Assuntos
Síndrome Antifosfolipídica/complicações , Aterosclerose/etiologia , Complicações na Gravidez/etiologia , Trombose/etiologia , Adulto , Aterosclerose/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , GravidezRESUMO
OBJECTIVE: To evaluate the efficacy and safety of secukinumab in Behçet's patients with active mucocutaneous and articular manifestations refractory to previous treatments. METHODS: We retrospectively evaluated 5 patients treated with the IL17-inhibitor secukinumab and diagnosed with Behçet according to ISG/ICBD criteria. All patients had active mucocutaneous and articular manifestations refractory to colchicine, conventional DMARDs and at least one anti-TNFα agent. Four patients received secukinumab in the dose of 150 mg/monthly since also fulfilling the criteria for ankylosing spondylitis, while the fifth patient received secukinumab 300 mg/monthly because she met psoriatic arthritis criteria. Achievement of response was based on the number of oral ulcers, BASDAI and ASDAS for articular involvement, and BDCAF for Behçet activity. Complete response was defined as: i) decrease ≥50% in the number of oral ulcers; ii) BASDAI index <4; iii) ASDAS index <1.4; iv) decrease of 50% or more in BDCAF index. RESULTS: The patient starting secukinumab 300â¯mg/month successfully achieved complete response within 3 months. Complete response was maintained during all 9-months follow-up. Among the 4 subjects starting secukinumab 150â¯mg/month, two achieved complete response at month 6, but one relapsed. This patient and the two who not achieved complete response at month 6 were switched to secukinumab 300â¯mg/month. Within 3 months from the dosage increase, all three subjects successfully (re)achieved complete response. CONCLUSION: Our study suggested for the first time that secukinumab (either 150â¯mg and 300â¯mg/month) improved active mucocutaneous manifestations refractory to previous treatments, while secukinumab 300 mg/monthly resulted superior in inducing articular and complete response in Behçet's patients.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Interleucina-17/antagonistas & inibidores , Adulto , Anticorpos Monoclonais Humanizados/farmacologia , Antirreumáticos/farmacologia , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/etiologia , Síndrome de Behçet/metabolismo , Resistência a Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Fenótipo , Retratamento , Resultado do TratamentoRESUMO
BACKGROUND: Spondylodiscitis is an infection of the vertebral column, the incidence of which is increasing due to an increase in the susceptible population and improved ascertainment. This disease has been associated with a wide range of microorganisms. Fungal spondylodiscitis is uncommon (0.5-1.6%) and strongly associated with immunosuppression and diabetes (Gouliouris et al., 2010). A rare case of Candida glabrata spondylodiscitis in a non-neutropenic diabetic patient is reported herein, along with a review of the literature. CASE REPORT: A case of C. glabrata spondylodiscitis of L3-L4 metameres was diagnosed. The diagnosis was obtained through open biopsy of an abscess and culture examination. The patient was treated with anidulafungin and surgical debridement of the lesion. CONCLUSIONS: The diagnosis of spondylodiscitis is often delayed or missed. Physicians should consider this entity in the differential diagnosis of lumbar pain in order to initiate an appropriate therapy to prevent spinal cord lesions and disability. This is particularly relevant in the case of a fungal aetiology, as there is a recognized global shift towards invasive candidiasis due to non-albicans Candida species, in particular C. glabrata, which has variable susceptibility to antifungal drugs.