RESUMO
BACKGROUND: Linezolid is a broad-spectrum antimicrobial with limited use due to toxicity. This study aimed to evaluate linezolid toxicity in a large multicentre cohort. Secondary objectives were to identify factors contributing to toxicity, including the impact of therapeutic drug monitoring (TDM). METHODS: Patients administered linezolid between January 2017 and December 2019 were retrospectively reviewed. Data were collected on patient characteristics, linezolid therapy and outcomes. Descriptive statistics were performed on all patients, and statistical comparisons were undertaken between those who did and did not experience linezolid toxicity. A multivariable logistic regression model was constructed to identify any covariates that correlated with toxicity. RESULTS: Linezolid was administered to 1050 patients; of these, 381 did not meet the inclusion criteria and 47 were excluded as therapy ceased for non-toxicity reasons. There were 105 of 622 (16.9%) patients assessed to have linezolid toxicity. Patients who experienced toxicity displayed a higher baseline creatinine (96.5 µmol/L vs. 79 µmol/L; P = 0.025), lower baseline platelet count (225 × 109/L vs. 278.5 × 109/L; P = 0.002) and received a longer course (median 21 vs. 14 days; P < 0.001) than those who did not. Linezolid TDM was performed in 144 patients (23%). Multivariable logistic regression demonstrated that TDM-guided appropriate dose adjustment significantly reduced the odds of linezolid toxicity (aOR = 0.45; 95% CI 0.21-0.96; P = 0.038) and a treatment duration > 28 days was no longer significantly associated with toxicity. CONCLUSIONS: This study confirmed that linezolid treatment-limiting toxicity remains a problem and suggests that TDM-guided dose optimisation may reduce the risk of toxicity and facilitate prolonged courses beyond 28 days.
Assuntos
Antibacterianos , Trombocitopenia , Humanos , Linezolida/toxicidade , Estudos Retrospectivos , Antibacterianos/efeitos adversos , Monitoramento de Medicamentos , Trombocitopenia/induzido quimicamenteRESUMO
A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/etiologia , Pneumonia Viral/complicações , Doença Aguda , COVID-19 , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Pandemias , SARS-CoV-2 , Coluna Vertebral/diagnóstico por imagemRESUMO
BACKGROUND: Atopic eczema (AE) is a common chronic inflammatory skin disorder in children, with emollients and topical corticosteroids (TCSs) commonly prescribed as treatment. There is no published guidance on the correct order of application of emollient and TCS in children with AE. OBJECTIVE: The objective of this study was to determine whether the order of application of emollient and TCS makes a difference in the severity of AE in children. METHODS: Forty-six patients ages 4 months to 5 years with moderate to severe AE were randomized to two groups: group A applied emollient followed by TCS 15 minutes later twice daily, and group B applied TCS followed by emollient 15 minutes later twice daily for 2 weeks. RESULTS: There was no statistically significant difference in the Eczema Area and Severity Index (EASI) score, percentage of body surface area (BSA) affected, or itch score between groups A and B (p > 0.05). Group A had statistically significant improvement in the EASI score, percentage BSA affected, and itch score from baseline to weeks 1 and 2; group B demonstrated statistically significant improvement only in the EASI score from baseline to week 1 and in itch score from baseline to week 2. There was no difference in adverse events between the groups. CONCLUSION: This study suggests that the order of application of emollient and TCS does not matter in the treatment of AE in children and that parents can apply topical medications in whichever order they prefer.
Assuntos
Corticosteroides/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Emolientes/administração & dosagem , Administração Tópica , Corticosteroides/efeitos adversos , Pré-Escolar , Emolientes/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Distribuição AleatóriaRESUMO
Multiple dermatofibromas is a rare entity consisting of more than fifteen lesions. Multiple clustered dermatofibroma is a distinct variant of multiple dermatofibromas and is defined as a well-demarcated plaque composed of individual dermatofibromas. We report a 16-year-old boy with multiple clustered dermatofibroma in a segmental distribution, which has previously not been reported in the literature.
Assuntos
Histiocitoma Fibroso Benigno/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Adolescente , Histiocitoma Fibroso Benigno/diagnóstico , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
A 3-month-old female patient with a giant ulcerated nodule over the back since birth was diagnosed as congenital giant juvenile xanthogranuloma (JXG) based on clinical and histopathological examination. Congenital giant JXG with ulceration at birth is a rare presentation of JXG and commonly misdiagnosed. This case emphasizes the importance of being aware of the myriad presentations of JXG in order to make a correct diagnosis and avoid unnecessary investigations or treatment.
RESUMO
Lipoatrophic panniculitis is a rare condition affecting mainly children, often associated with connective tissue disease. We report a healthy 12-month-old girl with no clinical or laboratory features of connective tissue disease who presented with the progressive appearance of annular atrophic plaques beginning at the left arm. A histopathological analysis revealed lobular panniculitis, with fat necrosis and an associated inflammatory infiltrate supporting the diagnosis of lipoatrophic panniculitis. Lipoatrophic panniculitis should be considered in infants and young children with clinical features of panniculitis and fat atrophy even without clinical or serologic evidence of connective tissue disease.
Assuntos
Paniculite/diagnóstico , Paniculite/patologia , Gordura Subcutânea/patologia , Atrofia , Feminino , Humanos , Lactente , NecroseRESUMO
A 5-month-old boy had erythematous nodules over the left side of his trunk with a segmental arrangement since birth. Histopathologic examination revealed sheets of foamy histiocytes infiltrating the dermis and subcutaneous fat, admixed with multinucleated giant cells and lymphocytes, making this an unusual case of juvenile xanthogranuloma appearing in a segmental distribution.
Assuntos
Xantogranuloma Juvenil/diagnóstico , Biópsia , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Xantogranuloma Juvenil/patologiaRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Prevention of cardiovascular disease by modifying its major risk factors, including serum cholesterol levels, is an important strategy. Hibiscus sabdariffa L. has been promoted for reducing cholesterol levels, but its reported impact on cholesterol levels has been inconsistent. The study aimed to assess systematically the evidence and quality of current research on the effect of Hibiscus sabdariffa L. on blood lipids and its adverse effects. MATERIALS AND METHODS: Electronic databases were searched up to June 2013 for relevant randomised controlled trials (RCTs). Journals and conference proceedings were also searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The efficacy results of similar studies were pooled if they used the same comparator. Outcomes examined were levels of total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglycerides. RESULTS: Six studies involving 474 subjects met our inclusion criteria. These studies varied in terms of the types of interventions, comparators used, and duration of trials. Overall, Hibiscus sabdariffa L. did not produce any significant effect on any of the outcomes examined, when compared with placebo, black tea or diet. With short-term use it is well tolerated. CONCLUSIONS: The available evidence from RCTs does not support the efficacy of Hibiscus sabdariffa L. in lowering serum lipids. Further rigorously designed trials with larger sample sizes are warranted to confirm the effects of HS on serum lipids.
Assuntos
Hibiscus , Lipídeos/sangue , Preparações de Plantas/farmacologia , Animais , Humanos , Hiperlipidemias/tratamento farmacológico , Fitoterapia , Preparações de Plantas/uso terapêuticoRESUMO
A 47-year-old man presented to our hospital with collapse secondary to a subarachnoid hemorrhage. A careful history taking revealed symptoms of anaphylaxis before his collapse. This case illustrates an unusual cause of subarachnoid hemorrhage.