RESUMO
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions characterized by necrosis and detachment of the epidermis. Drugs and bacterial or viral infections are the most common causes of SJS/TEN. Although cases of SJS/TEN have been reported after hydroxychloroquine, vaccine (mRNA [Biontech], and inactivated vaccine [Sinovac]) administration and during the clinical course of active Coronavirus disease 2019 (COVID-19), limited data is indicating the COVID-19 disease as a triggering factor. Also, there are no pediatric cases of SJS/TEN associated with COVID-19 in the literature. Herein we reported two pediatric cases with a diagnosis of TEN related to COVID-19. Therapeutic plasma exchange therapy was applied to both of our patients. Although there are a few adult cases in the literature, our article is the first pediatric case report about patients diagnosed with TEN related to COVID-19 and successfully treated with plasma exchange.
Assuntos
COVID-19 , Troca Plasmática , Síndrome de Stevens-Johnson , Humanos , COVID-19/complicações , COVID-19/terapia , Hidroxicloroquina/efeitos adversos , RNA Mensageiro , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/terapia , Vacinas de Produtos Inativados/efeitos adversos , Criança , Vacinas contra COVID-19/efeitos adversosRESUMO
ABSTRACT: This study aimed to evaluate the economic efficiency of DD treatment on milk yield in lame cows suffering from DD. A total of 33 Holstein dairy cows with DD were included in the study. The milk yields were assessed as (1st); beginning milk production (BMP), (2nd); peak milk production before the diagnosis (PMPBD), (3rd); diagnosis day milk production (DMP), and (4th); post-treatment milk production (TMP). In the first stage of analyses, using the E-views equity test of means program, cows were classified into three groups for diagnosis time of DD according to the day in milk (DIM) (Group 1: 0 ≤ DIM ≤ 50, Group 2: 51 ≤ DIM ≤ 100, and Group 3: 101 ≤ DIM ≤ 150). Analysis of variance (ANOVA F-Test) and the Welch F-Test were conducted to compare the means of TMP to BMP, PMPBD, and DMP. Differences between TMP and DMP were statistically significant in all three groups. In the second stage of analyses, a cost-benefit analysis was conducted to determine the break-even point for each group to cover treatment costs for increasing milk yield. The DIM of DMP was considered as the gained milk yield per cow. Treatment cost and the mean break-even DIM for each group was then calculated. After treatment, the mean optimum break-even day for Groups 1, 2, and 3 was determined as 18.68, 26.43, and 27.14, respectively. Results suggested that treatment of DD may be considered as favorable and useful for a dairy economy.
RESUMO: Esse estudo tem o objetivo de avaliar a eficiência econômica no tratamento da DD na produção de leite em vacas tratadas com claudicao. Foram incluidas no total 33 vacas leiteiras Holstein com DD nesse estudo. A produção de leite foi avaliada (1°); início da produção de leite (BMP), 2°; pico na produção de leite antes do diagnostico (PMPBD), (3°); dia de diagnostico da produção de leite (DMP), e (4°); produção de leite pós-tratamento (TMP). Na primeira etapa das análises, utilizamos o programa E-views Equity Test of Mean, as vacas foram classificadas em três grupos para o tempo de diagnostico de DD Segundo o dia do leite (DMI) (Grupo 1: 0 ≤ DIM ≤ 50, Grupo 2 : 51 ≤ DIM ≤ 100 e Grupo 3: 101 ≤ DIM ≤ 150).A análise de variância (ANOVA F-Test) e o Welch F-Test foram conduzidos para comparar as medias de TMP a BMP, PMPBD e DMP. Diferenças entre TMP e DMP foram estatisticamente significativas nos três grupos. No segundo estágio das análises, uma análise de custo-benefício foi realizada para determinar o ponto de equilíbrio para cada grupo para cobrir os custos de tratamento e aumentar a produção de leite. O DIM de DMP foi considerado como a produção de leite adquirida por vaca. O custo do tratamento e o DIM médio de equilíbrio para cada grupo foram então calculados. Após o tratamento, o dia de equilíbrio ideal médio para os Grupos 1, 2 e 3 foi determinado como 18,68; 26,43 e 27,14, respectivamente. Os resultados sugerem que o tratamento de DD pode ser considerado favorável e útil para uma economia leiteira.