Assuntos
Melanoma/mortalidade , Nevo Pigmentado/patologia , Neoplasias Cutâneas/mortalidade , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Melanoma/etiologia , Melanoma/patologia , Pessoa de Meia-Idade , Nevo Pigmentado/complicações , Nevo Pigmentado/mortalidade , Prognóstico , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Análise de SobrevidaAssuntos
Antineoplásicos Imunológicos/efeitos adversos , Ipilimumab/efeitos adversos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Síndrome de Sweet/induzido quimicamente , Idoso , Betametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Melanoma/patologia , Melanoma/secundário , Metástase Neoplásica , Prednisolona/uso terapêutico , Neoplasias Cutâneas/patologia , Síndrome de Sweet/tratamento farmacológico , Síndrome de Sweet/patologiaAssuntos
Melanoma/mortalidade , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Cutâneas/mortalidade , Humanos , Melanoma/genética , Melanoma/patologia , Proteínas de Neoplasias/genética , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/patologia , Polimorfismo de Nucleotídeo Único/genética , Prognóstico , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Análise de SobrevidaAssuntos
Neoplasias Primárias Múltiplas/patologia , Nevo de Células Epitelioides e Fusiformes/patologia , Neoplasias Cutâneas/patologia , Adulto , Idade de Início , Antebraço/patologia , Antebraço/cirurgia , Humanos , Masculino , Neoplasias Primárias Múltiplas/cirurgia , Nevo de Células Epitelioides e Fusiformes/cirurgia , Neoplasias Cutâneas/cirurgia , Coxa da Perna/patologia , Coxa da Perna/cirurgiaRESUMO
Severe cutaneous adverse reactions (SCARs) encompass a heterogeneous group of delayed hypersensitivity reactions, which are most frequently caused by drugs. Our understanding of several aspects of SCAR syndromes has evolved considerably over the last decade. This review explores evolving knowledge of the immunopathogenic mechanisms, pharmacogenomic associations, in vivo and ex vivo diagnostics for causality assessment, and medication cross-reactivity data related to SCAR syndromes. Given the rarity and severity of these diseases, multidisciplinary collaboration through large international, national and/or multicentre networks to collect prospective data on patients with SCAR syndromes should be prioritized. This will further enhance a systematized framework for translating epidemiological, clinical and immunopathogenetic advances into preventive efforts and improved outcomes for patients.
Assuntos
Toxidermias/etiologia , Alopurinol/efeitos adversos , Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Cefalosporinas/efeitos adversos , Didesoxinucleosídeos/efeitos adversos , Toxidermias/diagnóstico , Toxidermias/imunologia , Interações Medicamentosas , Infecções por Herpesviridae/induzido quimicamente , Humanos , Leucócitos Mononucleares/imunologia , Farmacogenética/tendências , Estudos Prospectivos , Testes Cutâneos/métodos , Linfócitos T/imunologia , Ativação Viral/efeitos dos fármacos , Latência Viral/efeitos dos fármacos , beta-Lactamas/efeitos adversosRESUMO
Linear IgA bullous dermatosis (LABD) is a subepidermal autoimmune bullous disease characterized by linear IgA deposition at the basement membrane zone, which is visualized by direct immunofluorescence. Patients with LABD typically present with widespread vesicles and bullae; however, this is not necessarily the case, as the clinical presentation of this disease is heterogeneous. LABD clinically presenting as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is an infrequent, yet well-described phenomenon. Most cases of LABD are idiopathic, but some cases are drug-induced. Multiple drugs have been implicated in the development of LABD. We report a case of piperacillin-tazobactam-induced LABD presenting clinically as SJS/TEN overlap. This is the first reported case of a strong causal association between piperacillin-tazobactam and the development of LABD.
Assuntos
Antibacterianos/efeitos adversos , Dermatose Linear Bolhosa por IgA/induzido quimicamente , Ácido Penicilânico/análogos & derivados , Síndrome de Stevens-Johnson/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Penicilânico/efeitos adversos , Piperacilina/efeitos adversos , Combinação Piperacilina e TazobactamAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias Vasculares/diagnóstico , Idoso , Biomarcadores Tumorais/análise , Transtornos Cognitivos/etiologia , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Febre de Causa Desconhecida/etiologia , Humanos , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/patologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/patologia , Masculino , Rituximab/administração & dosagem , Resultado do Tratamento , Neoplasias Vasculares/tratamento farmacológico , Neoplasias Vasculares/patologia , Redução de PesoRESUMO
BACKGROUND: Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for healthcare. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the healthcare system. AIM: The aim of this study is to assess quantitatively the first 2 years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic. METHODS: Data were extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly 1-month periods were recorded over 2 years. Patients were categorised according to the path through which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of 'did-not-attend' occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times. RESULTS: There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified, including effective triage of patients and organisation of appropriate investigations from the initial nurse assessment.
Assuntos
Gastroenterologia/organização & administração , Hepatite B/terapia , Hepatite C/terapia , Enfermeiros Clínicos/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Avaliação em Enfermagem/organização & administração , Ambulatório Hospitalar/organização & administração , Padrões de Prática em Enfermagem/organização & administração , Agendamento de Consultas , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Ambulatório Hospitalar/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Médicos , Padrões de Prática em Enfermagem/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Tempo , Triagem , Vitória/epidemiologiaRESUMO
Diphtheria is an acute, highly infectious, vaccine-preventable and previously endemic disease whose etiologic agent is Corynebacterium diphtheriae. Diphtheria may manifest as an upper respiratory tract infection, a cutaneous infection or as an asymptomatic carrier state. The most common sites of infection are the pharynx and the tonsils, with common clinical manifestations that include sore throat, malaise, cervical lymphadenopathy and low-grade fever. Absorption and dissemination of C. diphtheriae from the respiratory tract can cause disseminated infection and may lead to cardiac or neurological toxicity. The cornerstone of treatment for diphtheria is diphtheria antitoxin. Early treatment is critical as the degree of protection is inversely proportional to the duration of the illness before its administration. Routine childhood vaccination virtually eliminated diphtheria in most industrialised countries. However, in the pre-vaccination era, diphtheria was the most common infectious cause of death in Australia. A case of diphtheria in Brisbane in April 2011 and two recent positive cultures in regional Victoria underscore the need for heightened awareness of C. diphtheriae as an important pathogen. In order to prevent the re-emergence of diphtheria in Australia, public health measures are required to increase immunity in early school leavers and the adult population, and to ensure that travellers to endemic regions are fully immunised. Health policy-makers and clinicians alike should not underestimate the importance of primary vaccination and booster vaccination against diphtheria among healthy adults and travellers.